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Clinical Manifestations of Coronary Heart Disease and the Metabolic Syndrome: A Population-based Study in Middle-aged Men in Uppsala
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During the past decades the knowledge concerning risk factors and pathophysiology of coronary heart disease (CHD) has substantially increased. However, despite identification of important risk factors CHD remains the leading cause of death in the western world.

The metabolic syndrome is a cluster of metabolic disorders such as hypertension, hypertriglyceridemia, low HDL-cholesterol, and glucose intolerance associated with an increased risk of cardiovascular morbidity and mortality.

The studies in this thesis are epidemiological in their character, and examine the relationships between different aspects of CHD and the metabolic syndrome in a population-based study of middle-aged men (ULSAM).

The findings indicated that serum lipids were important risk factors for the development of both angina pectoris demanding revascularisation and acute myocardial infarction (MI). Proinsulin and blood pressure were independent predictors of MI only, suggesting these factors to be involved in thrombosis and plaque rupture.

It was also found that antihypertensive treatment with beta-blockers and thiazide diuretics resulted in increased fasting blood glucose concentrations in subjects with an insulin resistant state with elevated proinsulin concentrations. Both proinsulin concentrations and increase in fasting blood glucose were associated with increased risk of developing future MI.

The finding of a new Q/QS-pattern on the resting ECG, regardless of history of MI, was associated with impaired insulin secretion and was an independent predictor of total and cardiovascular mortality.

A risk prediction score for MI including proinsulin and the ratio between apolipoprotein B and apolipoprotein A1 was developed in middle-aged men. This score was predictive for future fatal and nonfatal MI, and proved to be at least as good as the Framingham and the PROCAM scores, being based on traditional risk factors.

In summary these studies provide further knowledge about the associations between CHD and the metabolic syndrome and the possible importance of new markers of cardiovascular risk such as proinsulin and the apolipoproteins.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2004. , p. 73
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1354
Keyword [en]
Medicine, coronary heart disease, metabolic syndrome, insulin resistance, antihypertensive treatment, risk score
Keyword [sv]
Medicin
National Category
Dermatology and Venereal Diseases
Identifiers
URN: urn:nbn:se:uu:diva-4280ISBN: 91-554-5980-3 (print)OAI: oai:DiVA.org:uu-4280DiVA, id: diva2:164683
Public defence
2004-06-04, Robergsalen, UAS, ingång 40 4 tr, Uppsala, 13:15
Opponent
Supervisors
Available from: 2004-05-12 Created: 2004-05-12Bibliographically approved
List of papers
1. Increase in blood glucose concentration during antihypertensive treatment as a predictor of myocardial infarction: population based cohort study
Open this publication in new window or tab >>Increase in blood glucose concentration during antihypertensive treatment as a predictor of myocardial infarction: population based cohort study
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2003 In: BMJ, Vol. 326, no 7391, p. 681-3Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-91823 (URN)
Available from: 2004-05-12 Created: 2004-05-12Bibliographically approved
2. Cardiovascular risk factors for stable angina pectoris versus unheralded myocardial infarction
Open this publication in new window or tab >>Cardiovascular risk factors for stable angina pectoris versus unheralded myocardial infarction
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2004 In: Am Heart J., Vol. 147, no 3, p. 502-8Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-91824 (URN)
Available from: 2004-05-12 Created: 2004-05-12Bibliographically approved
3. A new Q/QS pattern on the resting electrocardiogram is associated with impaired insulin secretion and a poor prognosis in elderly men independently of history of myocardial infarction
Open this publication in new window or tab >>A new Q/QS pattern on the resting electrocardiogram is associated with impaired insulin secretion and a poor prognosis in elderly men independently of history of myocardial infarction
2004 In: J Intern Med, Vol. 255, no 2, p. 221-8Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-91825 (URN)
Available from: 2004-05-12 Created: 2004-05-12Bibliographically approved
4. Evaluation of a scoring scheme, including proinsulin and the apolipoprotein B/apolipoprotein A1 ratio, for the risk of acute coronary events in middle-aged men: Uppsala Longitudinal Study of Adult Men (ULSAM)
Open this publication in new window or tab >>Evaluation of a scoring scheme, including proinsulin and the apolipoprotein B/apolipoprotein A1 ratio, for the risk of acute coronary events in middle-aged men: Uppsala Longitudinal Study of Adult Men (ULSAM)
Show others...
2004 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 148, no 4, p. 596-601Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In recent years, the importance of circulating levels of proinsulin and apolipoproteins as risk factors for myocardial infarction (MI) has been highlighted. The aims of the current study were to investigate whether introduction of these new markers of coronary risk could improve the performance of a risk prediction score and to compare this new score with traditional scoring schemes, such as the Framingham Study and the Prospective Cardiovascular Munster (PROCAM) Study schemes.

METHODS: From 1970 to 1973 all 50-year-old men in Uppsala, Sweden, were invited to participate in a health survey aimed at identifying risk factors for cardiovascular disease (the Uppsala Longitudinal Study of Adult Men [ULSAM] cohort). The current study investigated metabolic characteristics at baseline and the incidence of fatal and nonfatal MI (n = 251) during 28.7 years of follow-up in 1108 men who were free of coronary heart disease at baseline.

RESULTS: The risk prediction score was derived from one half of the population sample from the ULSAM cohort and included systolic blood pressure, smoking, family history of MI, serum proinsulin, and the ratio between apolipoprotein B and apolipoprotein A1. The score was highly predictive for future MI (hazard ratio, 1.77 for a 1 SD increase; 95% CI, 1.49 to 2.10, P <.0001) in the other half of the population that was not used for generating the score. The ULSAM score performed slightly better than the Framingham and PROCAM scores (evaluated as areas under the receiver operating curves; Framingham, 61%; PROCAM, 63%; ULSAM, 66%; P =.08).

CONCLUSIONS: A risk prediction score for MI including proinsulin and the ratio between apolipoprotein B and apolipoprotein A1 was developed in middle-aged men. This score was highly predictive for future fatal and nonfatal MI and proved to be at least as good as the Framingham and the PROCAM scores, being based on traditional risk factors.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-91826 (URN)10.1016/j.ahj.2004.03.021 (DOI)15459588 (PubMedID)
Available from: 2004-05-12 Created: 2004-05-12 Last updated: 2017-12-14Bibliographically approved

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