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  • 1. Hedberg, Pär
    et al.
    Lönnberg, Ingemar
    Jonason, Tommy
    Nilsson, Göran
    Pehrsson, Kenneth
    Ringqvist, Ivar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Electrocardiogram and B-type natriuretic peptide as screening tools for left ventricular systolic dysfunction in a population-based sample of 75-year-old men and women2004Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 148, nr 3, s. 524-529Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Plasma concentration of B-type natriuretic peptide (BNP) has been suggested as a powerful screening tool for left ventricular systolic dysfunction. However, there are reports indicating that the 12-lead electrocardiogram (ECG) could be just as powerful. We aimed to evaluate the 12-lead ECG and BNP as screening tools for left ventricular systolic dysfunction in an elderly, unselected population.

    Methods: In a randomly selected population-based sample of 75-year-old men and women (n = 407), diagnostic characteristics were evaluated for the ECG and plasma concentration of BNP to detect left ventricular systolic dysfunction.

    Results: Sensitivity, specificity, and negative and positive predictive values for the ECG to detect left ventricular systolic dysfunction were 96%, 79%, 100%, and 26%, respectively. The corresponding values for the BNP (cut-off value 28 pg/mL) were 93%, 55%, 99%, and 13%. In participants without major abnormalities in the ECG, left ventricular systolic dysfunction was found in <1% (1/302), irrespective of BNP concentrations. In participants with abnormal ECGs, systolic dysfunction was more prevalent in persons with abnormal BNP concentrations than in those with normal concentrations (35% vs 3%, difference 32%, 95%CI for the difference 16%–44%)

    Conclusions: In 75-year-old subjects both the ECG and the plasma concentration of BNP are highly efficient in excluding left ventricular systolic dysfunction. However, compared with the BNP, the ECG yields a lower number of false positive cases. In screening for left ventricular systolic dysfunction, the BNP has a diagnostic value in addition to the ECG, but only in individuals with abnormal ECGs.

  • 2. Hedberg, Pär
    et al.
    Lönnberg, Ingemar
    Jonason, Tommy
    Nilsson, Göran
    Pehrsson, Kenneth
    Ringqvist, Ivar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Left ventricular systolic dysfunction in 75-year-old men and women: A population-based study2001Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 22, nr 8, s. 676-683Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims To determine the prevalence of left ventricular systolic dysfunction in 75-year-old men and women.

    Methods and Results In a population-based random sample of 75-year-old subjects (n = 433; response rate 70.1%) the left ventricular systolic function was determined using two echocardiographic methods: (1) wall motion in nine left ventricular segments was visually scored and wall motion index was calculated as the mean value of the nine segments and (2) ejection fraction as measured by the disc summation method. Presence of heart failure was determined by a cardiologist's clinical evaluation. Wall motion index was achievable in 95% of the participants while ejection fraction was measurable in 65%. Normal values were obtained from a healthy subgroup (n = 108) and left ventricular systolic dysfunction was defined as the 0.5th percentile of the wall motion index (i.e. <1.7). In participants in whom both ejection fraction and wall motion index were achievable, wall motion index <1.7 predicted ejection fraction <43% with a sensitivity and specificity of 84.0% and 99.6%, respectively. The prevalence of left ventricular systolic dysfunction was 6.8% (95% CI, 5.6-8.0%) and was greater in men than in women (10.2% vs 3.4%, P = 0.006). Clinical evidence of heart failure was absent in 46% of the participants with left ventricular systolic dysfunction.

    Conclusions Left ventricular systolic dysfunction is common among 75-year-olds with a prevalence of 6.8% in our estimate. The condition is more likely to affect men than women. In nearly half of 75-year-olds with left ventricular systolic dysfunction there is no clinical evidence of heart failure.

  • 3. Hellden, Anders
    et al.
    Odar-Cederlof, Ingegerd
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Sjoviker, Susanne
    Söderström, Anders
    von Euler, Mia
    Ohlen, Gunnar
    Bergman, Ulf
    Renal function estimations and dose recommendations for dabigatran, gabapentin and valaciclovir: a data simulation study focused on the elderly2013Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 4, s. e002686-Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 4. Lönnblad, Jens
    et al.
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Folke, Mia
    Hök, Bertil
    Lindén, Maria
    Bäcklund, Ylva
    Artefacts in continuous ECG recordings: provoking and preventing manoeuvres2005Inngår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 39, nr 3, s. 167-171Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives. A systematic estimation of the effects of some clinically important artefact provoking and artefact-preventing manoeuvres.

    Design. A test protocol for the evaluation of technical modifications of continuous ECG recordings was tested in 17 patients. The programme comprised ECG recordings during five artefact-provoking manoeuvres (slight shaking of the ECG cables, rotating shoulders, slight electrode touching, washing, teeth-brushing) and two simple artefact-preventing manoeuvres (taping ECG cables and covering electrodes with paper cups).

    Results. The artefact-provoking manoeuvres induced a substantial increase in artefactual ECG. The artefact-preventing manoeuvres only incompletely prevented this increase.

    Conclusion. There is a great need of technical improvements to reduce the distortion of ECG by artefacts. The test protocol developed by us exposes a broad spectrum of different categories of ECG qualities and is therefore suitable for evaluating technical improvements concerning artefactual ECG.

  • 5.
    Nilsson, G
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hedberg, P
    Jonason, T
    Lönnberg, I
    Tenerz, A
    Öhrvik, J.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniskt forskningscentrum (UCR).
    White blood cell counts associate more strongly to the metabolic syndrome in 75-year-old women than in men: a population based study.2007Inngår i: Metabolic Syndrome and Related Disorders, ISSN 1540-4196, E-ISSN 1557-8518, Vol. 5, nr 4, s. 359-364Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A positive relation between the metabolic syndrome (MetS) and inflammatoryactivity has been reported. The purpose of this investigation was to study the relationshipsbetween 1) white blood cell (WBC) count and MetS, 2) WBC count and the individual com-ponents of MetS and 3) WBC count and insulin sensitivity in 75-year-old women and menfrom the general population.   Methods: The study included 200 women and 196 men comprising 64% of the 75-year oldpeople from the city of Västerås in Sweden. MetS was defined according to the National Cho-lesterol Education Program (NCEP).   Results: WBC count (109/L; median and interquartile range) was 5.7 (4.9–6.8) for women and6.3 (5.4–7.2) for men, P Ͻ .001 for gender difference. For women with and without MetS, WBCcount was 6.3 (5.3–7.3) and 5.4(4.7–6.3), respectively. For men the corresponding figures were6.7 (5.9–7.6) and 6.1 (5.4–7.1).The difference in WBC count between individuals with and with-out MetS was significant (P Ͻ .001 for women; P ϭ .014 for men). All individual componentsof MetS (with exception of blood pressure) were more strongly associated with WBC countfor women than for men. Insulin sensitivity, measured as HOMA-IR (HOmeostasis ModelAssessment-Insulin Resistance) index, was significantly associated with WBC count in wo-men but not in men.   Conclusions: In this elderly population, individuals with MetS had a higher WBC countthan those without. Women had a lower WBC count and stronger relationship between WBCcount and insulin sensitivity than did men.

  • 6.
    Nilsson, Göran
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Västerås.
    [A good doctor can hardly be measured for quality]2005Inngår i: Lakartidningen, ISSN 0023-7205, Vol. 102, nr 8, s. 537-Artikkel i tidsskrift (Annet vitenskapelig)
  • 7.
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Defibrillatorn - en chockartad historia: [Defibrillator--a shock story]2007Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, nr 37, s. 2619-2621Artikkel i tidsskrift (Annet vitenskapelig)
  • 8.
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hjärtinfarktdiagnos på ny bas: Troponin skall ha avgörande roll, enligt internationella rekommendationer2007Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, nr 20, s. 1573-1574Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [sv]

    Plasmakoncentration av troponin har genom internationella rekommendationer fått en avgörande roll i diagnostiken av akut hjärtinfarkt.

    Det diagnostiska gränsvärdet för troponin avgör i flertalet fall om diagnosen vid akuta anginösa symtom blir instabil angina pectoris eller akut hjärtinfarkt.

    Val av gränsvärde har stora patientpsykologiska, organisatoriska och försäkringsmässiga konsekvenser. Gränssättningen påverkar registrerad dödlighet i hjärtinfarkt och möjligheten att utnyttja denna för kvalitetsbedömning. Definitionen av hjärtinfarkt i Sverige bör bli mer enhetlig.

  • 9.
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Läkarägda specialsjukhus invasiv kranskärlsbehandling2007Inngår i: Läkartidningen, ISSN 0023-7205, Vol. 104, nr 20, s. 1579-Artikkel i tidsskrift (Fagfellevurdert)
  • 10.
    Nilsson, Göran
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Västerås.
    [The stethoscope--an epoch-making discovery]2006Inngår i: Lakartidningen, ISSN 0023-7205, Vol. 103, nr 30-31, s. 2248-9Artikkel i tidsskrift (Annet vitenskapelig)
  • 11.
    Nilsson, Göran
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Västerås.
    [Too many methods are used for measurement of health-related quality of life]2003Inngår i: Lakartidningen, ISSN 0023-7205, Vol. 100, nr 4, s. 230-2Artikkel i tidsskrift (Annet vitenskapelig)
  • 12.
    Nilsson, Göran
    et al.
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Västerås.
    Hedberg, P
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Västerås.
    Jonasson, T
    Lönnnberg, I
    Öhrvik, J
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Västerås.
    QTc interval and survival in 75-year-old men and women from the general population.2006Inngår i: Europace, ISSN 1099-5129, Vol. 8, nr 4, s. 233-40Artikkel i tidsskrift (Fagfellevurdert)
  • 13.
    Nilsson, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hedberg, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Jonason, Tommy
    Lönnberg, Ingemar
    Öhrvik, John
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Heart rate recovery is more strongly associated with the metabolic syndrome, waist circumference, and insulin sensitivity in women than in men among the elderly in the general population2007Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 154, nr 3, s. 460.e1-460.e7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Low heart rate recovery (HRR) at exercise test and the metabolic syndrome (MetS) are both predictors of cardiovascular morbidity and mortality. We studied in 75-year-old women and men, representative of the general population, the relationship between (1) HRR and the MetS, (2) HRR and the individual components of the MetS, and (3) HRR and insulin sensitivity. Methods: A cross-sectional study of randomly selected 75-year-olds from a general population was performed (191 women and 194 men). The MetS was defined according to the National Cholesterol Education Program criteria. Heart rate was measured as beats per minute immediately after exercise and at 4 minutes into recovery. Results: Heart rate recovery (median and interquartile range, beat/min) was 48 (37-58) for women and 49 (38-58) for men. Thirty-seven percent of the women and 25% of the men had the MetS. Heart rate recovery was 52 (42-61) for women with the MetS and 42 (31-49) for those without. The corresponding values for men was 50 (39-61) and 47 (35-54); the difference between individuals with and without the MetS was significant for women (P < .001) but not for men (P = .084). The following significant correlation coefficients between HRR and MetS components were found: for women, waist circumference (-0.43, P < .001), high-density lipoprotein cholesterol (0.37, P < .001), insulin sensitivity (-0.37, P < .001), fasting plasma glucose (-0.30, P < .001), and triglycerides (-0.24, P = .001); for men, triglycerides (-0.20, P = .005). The sex disparity in the strength of correlation reached statistical significance for insulin sensitivity (P < .001) and waist circumference (P = .042). Conclusion: Among 75-year-olds, the MetS and related components are more strongly correlated to HRR in women than in men.

  • 14.
    Nilsson, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hedberg, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Hosp Vastmanland, Dept Clin Physiol, Vasteras, Sweden.
    Leppert, Jerzy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Öhrvik, John
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Basic Anthropometric Measures in Acute Myocardial Infarction Patients and Individually Sex- and Age-Matched Controls from the General Population2018Inngår i: Journal of Obesity, ISSN 2090-0708, E-ISSN 2090-0716, artikkel-id 3839482Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 15.
    Nilsson, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hedberg, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Ohrvik, John
    Inflammation and the Metabolic Syndrome: Clustering and Impact on Survival in a Swedish Community-Based Cohort of 75 Year Olds2013Inngår i: Metabolic Syndrome and Related Disorders, ISSN 1540-4196, E-ISSN 1557-8518, Vol. 11, nr 2, s. 92-101Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 16.
    Nilsson, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hedberg, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Öhrvik, John
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Survival of the fattest: unexpected findings about hyperglycaemia and obesity in a population based study of 75-year-olds2011Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 1, nr 1, artikkel-id e000012Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 17.
    Nilsson, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Leppert, Jerzy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hedberg, P. O.
    Cent Hosp Vasteras, Dept Clin Physiol, Vasteras, Sweden..
    Rosenblad, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Ohrvik, C. J. O.
    Karolinska Inst, Stockholm, Sweden..
    Heavy torso and narrow hip means high risk of myocardial infarction in elderly men: findings from a population based case-control study on anthropometric measures2015Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, nr Suppl. 1, s. 119-120Artikkel i tidsskrift (Annet vitenskapelig)
  • 18.
    Nilsson, Göran
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Rosenblad, Andreas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Hedberg, P. O.
    Leppert, Jerzy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    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 study2013Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, nr S1, s. 148-148Artikkel i tidsskrift (Annet vitenskapelig)
  • 19.
    Rosenblad, Andreas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Leppert, Jerzy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Maternal age at childbirth is associated with changes in smoking status between late adolescence and early middle age: results from 22 years of follow-up2012Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, nr Suppl 1, s. 615-615Artikkel i tidsskrift (Annet vitenskapelig)
  • 20.
    Rosenblad, Andreas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Leppert, Jerzy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Intelligence level in late adolescence is inversely associated with BMI change during 22 years of follow-up: results from the WICTORY study2012Inngår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 27, nr 8, s. 647-655Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 21. Selmeryd, Jonas
    et al.
    Sundstedt, Milena
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Henriksen, Egil
    Hedberg, Pär
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Impact of left ventricular geometry on long-term survival in elderly men and women2014Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 34, nr 6, s. 442-448Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 22.
    Tenerz, Ake
    et al.
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Västerås.
    Norhammar, Anna
    Silveira, Angela
    Hamsten, Anders
    Nilsson, Göran
    Uppsala universitet, Fakultetsövergripande enheter, Centrum för klinisk forskning, Västerås.
    Rydén, Lars
    Malmberg, Klas
    Diabetes, insulin resistance, and the metabolic syndrome in patients with acute myocardial infarction without previously known diabetes.2003Inngår i: Diabetes Care, ISSN 0149-5992, Vol. 26, nr 10, s. 2770-6Artikkel i tidsskrift (Fagfellevurdert)
  • 23.
    Tenerz, Åke
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Forberg, Rosanne
    Öhrvik, John
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Malmberg, Klas
    Berne, Christian
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Leppert, Jerzy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Basal glucometabolic status has an impact on long-term prognosis following an acute myocardial infarction in non-diabetic patients2003Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 254, nr 5, s. 494-503Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Patients with diabetes are known to have a worse prognosis after an acute myocardial infarction (AMI) compared with non-diabetic patients. The primary aim of this study was to investigate the effect of glucometabolic status on long-term prognosis in non-diabetic patients with an AMI. The second aim was to evaluate the extent to which blood glucose levels at admission depended on acute stress, assessed as serum cortisol, previous glucometabolic status, measured as haemoglobin A1c (HbA1c), or both.

    DESIGN: In a prospective study of patients with an AMI, blood glucose, HbA1c and cortisol were measured at admission. Fasting blood glucose was determined before discharge and also afterwards, if necessary, for classification. Patients were followed-up for 5.5 years.

    SUBJECTS: Of the 305 consecutive patients 24% were diagnosed as diabetic and 76% as non-diabetic.

    MAIN OUTCOME MEASURES: Death or non-fatal myocardial re-infarction.

    RESULTS: In non-diabetic patients, a Cox regression model was used. With death or re-infarction as endpoint, the following prognostic factors had an impact on event-free survival: age (P<0.001), HbA1c (P=0.002), cortisol (P<0.001) and thrombolytic treatment (P=0.001). There was a correlation between cortisol and blood glucose at admission (r=0.44, P<0.001). Fasting blood glucose day 5 showed no association with event-free survival.

    CONCLUSIONS: In non-diabetic patients with AMI, admission HbA1c and cortisol were predictors for 5.5-year survival without recurrent non-fatal myocardial infarction. The glucometabolic status of importance for prognosis was detected by HbA1c but not by fasting blood glucose or admission blood glucose, of which the latter was influenced by cortisol.

  • 24. Venskutonyte, Laura
    et al.
    Ryden, Lars
    Nilsson, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Ohrvik, John
    Mortality prediction in the elderly by an easily measured metabolic index2012Inngår i: Diabetes & Vascular Disease Research, ISSN 1479-1641, Vol. 9, nr 3, s. 226-233Artikkel i tidsskrift (Fagfellevurdert)
    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.

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