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  • 3501.
    Wanhainen, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Svensjö, Sverker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Holst, Jan
    Lund Univ, Dept Vasc Dis, Skane Univ Hosp, Malmo, Sweden.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Gottsäter, Anders
    Lund Univ, Dept Vasc Dis, Skane Univ Hosp, Malmo, Sweden.
    Screening for abdominal aortic aneurysm2019In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10166, p. 27-28Article in journal (Other academic)
  • 3502.
    Ward, Liam
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Sex differences in atherosclerosis and exercise effects2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Cardiovascular disease (CVD) is the leading cause of death globally, with atherosclerosis being the main cause of cardiovascular diseases. Atherosclerosis is an inflammatory disease of the blood vessel wall, which over time will cause thickening and hardening of the vessel wall. Atherosclerosis can result in catastrophic vascular events, such as myocardial infarction and stroke. There are distinct sex differences in CVD mortality at different ages, before menopause women have a lower mortality of CVD in comparison to men, which equalises after menopause. In addition to sex differences in the incidence of CVD, there are also distinct sex differences in the phenotype of atherosclerotic plaques, with men generally developing more severe and vulnerable plaques that are at risk of rupture.

    This thesis aimed to investigate the sex differences in atherosclerosis, in particular how the proteome and pathophysiology differs. In addition, we sought to investigate the potential benefit of an exercise programme, in reducing CVD risks, using a randomised controlled trial including postmenopausal women.

    Sex differences in atherosclerosis were first investigated via proteomic analysis of human carotid endarterectomy samples. Initially, five intraplaque biopsies were taken from distinct atheroma regions, including; internal control, fatty streak, plaque shoulder, plaque centre, and fibrous cap. Protein extracts from these biopsies were subjected to analysis by mass spectrometry. The novel sampling method was successful in reducing the effect of plaque heterogeneity, a limitation in previous proteomic studies of atherosclerosis, and a number of previously unreported proteins were identified in human carotid atheroma. In addition to this, with the inclusion of multivariate statistical modelling, it was found that 43 proteins significantly discriminated the carotid atheroma between men and women. These proteins were grouped by function, and it was found that atheroma from men was associated with the increased abundance of inflammatory response proteins, including phospholipase-A2 membrane associated and lysozyme C, and atheroma from women was associated with increased abundance of blood coagulation, complement activation, and transport proteins, notably including; antithrombin-III, coagulation factor XII, and afamin. In addition, differences were also ii observed in the abundance of iron metabolism related proteins. These sex differences were further expanded upon from a pathophysiological perspective. Immunohistochemistry stainings of ferritin and transferrin receptor 1 were found significantly increased in the atheroma from men. Moreover, the levels of plasma haemoglobin were also significantly increased in men and were associated with the development of more vulnerable and severe plaque types. The more vulnerable and severe plaque types were also associated with significantly greater macrophage infiltration. In summary, these results are indicative of men developing atheroma with greater inflammation that are more vulnerable, due to increased iron and inflammatory proteins and macrophage infiltration, whereas atheroma from women develop with less inflammation and a more stable phenotype.

    The randomised controlled clinical trial aimed at investigating the effects of resistance training (RT), over a 15-week period, in postmenopausal women. Plasma samples were obtained at week-0 and week-15 of the study period, and analyses were performed primarily using a series of immunoassays. Results showed that women participating in RT, with good compliance, were associated with significant decreases in plasma levels of ferritin, lipids, and inflammatory adipokines. These results suggest that the use of regular RT may be a beneficial intervention in reducing the levels of body iron, lipids, and inflammation, all of which are risk factors for the development of CVD. However, validation studies are required in a larger cohort of postmenopausal women, in addition to the inclusion or complementary studies in middle-aged men.

    In summary, the works included in this thesis further expand on the current knowledge of sex differences in atherosclerosis, and also provides information on the potential of an exercise intervention to beneficially reduces the effects of known risk factors of CVD.

  • 3503.
    Ward-Caviness, Cavin K.
    et al.
    Helmholtz Zentrum Munchen, Inst Epidemiol 2, Neuherberg, Germany..
    Xu, Tao
    Helmholtz Zentrum Munchen, Inst Epidemiol 2, Neuherberg, Germany.;Helmholtz Zentrum Munchen, Res Unit Mol Epidemiol, Neuherberg, Germany..
    Aspelund, Thor
    Iceland Heart Assoc, Kopavogur, Iceland.;Univ Iceland, Ctr Publ Hlth, Reykjavik, Iceland..
    Thorand, Barbara
    Helmholtz Zentrum Munchen, Inst Epidemiol 2, Neuherberg, Germany..
    Montrone, Corinna
    Helmholtz Zentrum Munchen, Inst Bioinformat & Syst Biol, Neuherberg, Germany..
    Meisinger, Christa
    Helmholtz Zentrum Munchen, Inst Epidemiol 2, Neuherberg, Germany..
    Dunger-Kaltenbach, Irmtraud
    Helmholtz Zentrum Munchen, Inst Bioinformat & Syst Biol, Neuherberg, Germany..
    Zierer, Astrid
    Helmholtz Zentrum Munchen, Inst Epidemiol 2, Neuherberg, Germany..
    Yu, Zhonghao
    Helmholtz Zentrum Munchen, Inst Epidemiol 2, Neuherberg, Germany.;Helmholtz Zentrum Munchen, Res Unit Mol Epidemiol, Neuherberg, Germany..
    Helgadottir, Inga R.
    Iceland Heart Assoc, Kopavogur, Iceland..
    Harris, Tamara B.
    NIA, Bethesda, MD 20892 USA..
    Launer, Lenore J.
    NIA, Bethesda, MD 20892 USA..
    Ganna, Andrea
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Eiriksdottir, Gudny
    Iceland Heart Assoc, Kopavogur, Iceland..
    Waldenberger, Melanie
    Helmholtz Zentrum Munchen, Inst Epidemiol 2, Neuherberg, Germany.;Helmholtz Zentrum Munchen, Res Unit Mol Epidemiol, Neuherberg, Germany..
    Prehn, Cornelia
    Helmholtz Zentrum Munchen, Inst Expt Genet, Genome Anal Ctr, Neuherberg, Germany..
    Suhre, Karsten
    Helmholtz Zentrum Munchen, Inst Bioinformat & Syst Biol, Neuherberg, Germany..
    Illig, Thomas
    Hannover Med Sch, Hannover Unified Biobank, Hannover, Germany..
    Adamski, Jerzy
    Helmholtz Zentrum Munchen, Inst Expt Genet, Genome Anal Ctr, Neuherberg, Germany.;Tech Univ Munich, Chair Expt Genet, Munich, Germany..
    Ruepp, Andreas
    Helmholtz Zentrum Munchen, Inst Bioinformat & Syst Biol, Neuherberg, Germany.;Tech Univ Munich, Chair Expt Genet, Munich, Germany..
    Koenig, Wolfgang
    Univ Ulm, Med Ctr, Dept Internal Med 2, Ulm, Germany.;Tech Univ Munich, Deutsches Herzzentrum, Munich, Germany.;DZHK German Ctr Cardiovasc Res, Partner Site Munich Heart Alliance, Munich, Germany..
    Gudnason, Vilmundur
    Iceland Heart Assoc, Kopavogur, Iceland.;Univ Iceland, Fac Med, Reykjavik, Iceland..
    Emilsson, Valur
    Iceland Heart Assoc, Kopavogur, Iceland.;Univ Iceland, Fac Pharmaceut Sci, Reykjavik, Iceland..
    Wang-Sattler, Rui
    Helmholtz Zentrum Munchen, Inst Epidemiol 2, Neuherberg, Germany.;Helmholtz Zentrum Munchen, Res Unit Mol Epidemiol, Neuherberg, Germany..
    Peters, Annette
    Helmholtz Zentrum Munchen, Inst Epidemiol 2, Neuherberg, Germany.;DZHK German Ctr Cardiovasc Res, Partner Site Munich Heart Alliance, Munich, Germany.;Harvard Sch Publ Hlth, Dept Environm Hlth, Boston, MA USA..
    Improvement of myocardial infarction risk prediction via inflammation-associated metabolite biomarkers2017In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 103, no 16, p. 1278-1285Article in journal (Refereed)
    Abstract [en]

    Objective The comprehensive assaying of low-molecular-weight compounds, for example, metabolomics, provides a unique tool to uncover novel biomarkers and understand pathways underlying myocardial infarction (MI). We used a targeted metabolomics approach to identify biomarkers for MI and evaluate their involvement in the pathogenesis of MI.

    Methods and results Using three independent, prospective cohorts (KORA S4, KORA S2 and AGES-REFINE), totalling 2257 participants without a history of MI at baseline, we identified metabolites associated with incident MI (266 cases). We also investigated the association between the metabolites and high-sensitivity C reactive protein (hsCRP) to understand the relation between these metabolites and systemic inflammation. Out of 140 metabolites, 16 were nominally associated (p<0.05) with incident MI in KORA S4. Three metabolites, arginine and two lysophosphatidylcholines (LPC 17: 0 and LPC 18:2), were selected as biomarkers via a backward stepwise selection procedure in the KORA S4 and were significant (p<0.0003) in a meta-analysis comprising all three studies including KORA S2 and AGES-REFINE. Furthermore, these three metabolites increased the predictive value of the Framingham risk score, increasing the area under the receiver operating characteristic score in KORA S4 (from 0.70 to 0.78, p=0.001) and AGES-REFINE study (from 0.70 to 0.76, p=0.02), but was not observed in KORA S2. The metabolite biomarkers attenuated the association between hsCRP and MI, indicating a potential link to systemic inflammatory processes.

    Conclusions We identified three metabolite biomarkers, which in combination increase the predictive value of the Framingham risk score. The attenuation of the hsCRP-MI association by these three metabolites indicates a potential link to systemic inflammation.

  • 3504.
    Warensjö, Eva
    et al.
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Risérus, Ulf
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Gustafsson, Inga-Britt
    Örebro University, School of Hospitality, Culinary Arts & Meal Science.
    Mohsen, Rawya
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Cederholm, Tommy
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Vessby, Bengt
    Clinical Nutrition and Metabolism, Department of Public health and Caring sciences, Uppsala University, Sweden.
    Effects of saturated and unsaturated fatty acids on estimated desaturase activities during a controlled dietary intervention2008In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 18, no 10, p. 683-690Article in journal (Refereed)
    Abstract [en]

    Background and aims

    Direct measurement of desaturase activities are difficult to obtain in humans. Consequently, surrogate measures of desaturase activity (estimated desaturase activities) have been frequently used in observational studies, and estimated Δ9- (or stearoyl-CoA-desaturase (SCD)), Δ6- and Δ5-desaturase activities have been associated with cardiometabolic disease. Data on how the markers of desaturase activities are modified by changes in dietary fat quality are lacking and therefore warrant examination.

    Methods and results

    In a two-period (three weeks) strictly controlled cross-over study, 20 subjects (six women and 14 men) consumed a diet high in saturated fat (SAT-diet) and a rapeseed oil diet (RO-diet), rich in oleic acid (OA), linoleic acid (LA) and α-linolenic acid (ALA). Estimated desaturase activities were calculated as precursor to product FA ratios in serum cholesteryl esters and phospholipids. The estimated SCD [16:1 n-7/16:0] and Δ6-desaturase [20:3 n-6/18:2 n-6] was significantly higher while Δ5-desaturase [20:4 n-6/20:3 n-6] was significantly lower in the SAT-diet (P < 0.001 for all), compared to the RO-diet. The serum proportions of palmitic, stearic, palmitoleic and dihomo-γ-linolenic acids were significantly higher in the SAT-diet while the proportions of LA and ALA were significantly higher in the RO-diet.

    Conclusion

    This is the first study to demonstrate that surrogate measures of desaturase activities change as a consequence of an alteration in dietary fat quality. Both the [16:1/16:0]-ratio and 16:1 seem to reflect changes in saturated fat intake and may be useful markers of saturated fat intake in Western countries.

  • 3505.
    Warme, Anna
    et al.
    Univ Gothenburg, Sweden; Skaraborg Hosp, Sweden.
    Hadimeri, Ursula
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Skaraborg Hosp, Sweden.
    Hadimeri, Henrik
    Univ Gothenburg, Sweden; Skaraborg Hosp, Sweden.
    Nasic, Salmir
    Skaraborg Hosp, Sweden.
    Stegmayr, Bernd
    Umea Univ, Sweden.
    High doses of erythropoietin stimulating agents may be a risk factor for AV-fistula stenosis2019In: Clinical hemorheology and microcirculation, ISSN 1386-0291, E-ISSN 1875-8622, Vol. 71, no 1, p. 53-57Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A native AV-fistula (AVF) for access in hemodialysis (HD) is preferable. Stenosis, a major hurdle, is associated with older age and diabetes mellitus. PURPOSE: This case-control study aimed to clarify if any medical and/or laboratory factors, that can be altered, could be associated to AVF stenosis. METHODS: 33 patients with a patent AVF without need of intervention during a two year period (Controls) were matched by diagnosis and age with 33 patients (Cases), that had at least one radiological invasive examination/intervention due to suspected AVF malfunction (case-control mode 2:1). RESULTS: Cases had higher weekly doses of Erythropoietin-Stimulating Agent (ESA) than Controls both before intervention (mean 8312 +/- 7119 U/w versus 4348 +/- 3790, p = 0.005) and after the intervention (7656 +/- 6795, versus 4477 +/- 3895, p = 0.018). Before intervention serum phosphate was higher in Cases while there was no significant difference in blood hemoglobin, weekly standard Kt/V, parathyroid hormone, calcium, albumin, C-reactive protein, smoking habits, BMI or other medication. CONCLUSION: Higher doses of ESA were administered in patients with AVF stenosis. Since ESA may cause local hypertrophic effects on the vascular endothelium, we should prescribe lower doses of ESA in patients at risk. Further studies should clarify such connection.

  • 3506.
    Washam, Jeffrey B.
    et al.
    Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA.
    Hohnloser, Stefan H.
    Goethe Univ Frankfurt, Frankfurt, Germany.
    Lopes, Renato D.
    Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA.
    Wojdyla, Daniel M.
    Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA.
    Vinereanu, Dragos
    Univ & Emergency Hosp Bucharest, Bucharest, Romania.
    Alexander, John H.
    Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA.
    Gersh, Bernard J.
    Mayo Clin, Coll Med, Rochester, MN USA.
    Hanna, Michael
    Bristol Myers Squibb Co, Princeton, NJ USA.
    Horowitz, John
    Univ Adelaide, Basil Hetzel Inst, Queen Elizabeth Hosp, Adelaide, SA, Australia.
    Hylek, Elaine M.
    Boston Univ, Sch Med, Boston, MA 02118 USA.
    Xavier, Denis
    St Johns Res Inst, Bengaluru, India.
    Verheugt, Freek W. A.
    Univ Med Ctr Nijmegen, Nijmegen, Netherlands.
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Granger, Christopher B.
    Duke Univ, Sch Med, Duke Clin Res Inst, Duke Heart Ctr, Box 3943 DUMC, Durham, NC 27710 USA.
    Interacting medication use and the treatment effects of apixaban versus warfarin: results from the ARISTOTLE Trial2019In: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 47, no 3, p. 345-352Article in journal (Refereed)
    Abstract [en]

    Warfarin is dependent on multiple hepatic enzymes for metabolism while apixaban is a substrate for P-glycoprotein (P-gp) transport and hepatic CYP3A4 metabolism. The aim of this analysis was to assess the impact of interacting medication use on the treatment effects of apixaban versus warfarin. Outcomes were compared between apixaban and warfarin using Cox proportional hazards modeling according to the use of interacting medications at randomization in ARISTOTLE (n=18,201). Interacting medications for apixaban were identified as combined P-gp and 3A4 inhibitors or inducers while interacting medications for warfarin were defined as those highly probable for warfarin potentiation or inhibition. At randomization, 5547 (30.5%) patients were on an interacting medication, including 2722 on apixaban and 2825 on warfarin. Patients using an interacting medication were more likely to be female, taking aspirin, and have a history of prior bleeding and were less likely to have a prior stroke or transient ischemic attack. No significant differences were observed on the treatment effect of apixaban compared with warfarin in patients on and off interacting medications for outcomes including the primary efficacy outcome of stroke or systemic embolism (P for interaction=0.79) or the primary safety outcome of major bleeding (P for interaction=0.75). Use of interacting medications with anticoagulants occurs often in patients with atrial fibrillation. Despite the potential for altered exposure, interacting medication use was not associated with a significant change in the efficacy or safety of apixaban compared with warfarin in the ARISTOTLE trial.Trial registration ClinicalTrials.gov, NCT00412984

  • 3507. Watt, A.
    et al.
    Lindqvist, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Jashari, Haki
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Holmgren, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Henein, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Pre-operative right ventricular function predicts clinical outcome after prophylactic tricuspid ring implantation2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, p. 1107-1108Article in journal (Other academic)
  • 3508. Waziri, H.
    et al.
    Joergensen, E.
    Kelbaek, H.
    Stagmo, M.
    Pedersen, F.
    Lagerqvist, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Kober, L.
    Wachtell, K.
    Comparison of outcome in patients with ST-elevation myocardial infarction treated with PCI in Eastern Denmark with patients treated in Southern Sweden2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, p. 133-133Article in journal (Refereed)
  • 3509. Waziri, H.
    et al.
    Stagmo, M.
    Joergensen, E.
    Kelbaek, H.
    Pedersen, F.
    Lagerqvist, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Kober, L.
    Wachtell, K.
    Short- and long-term outcomes after PCI for young patients with ST-elevation myocardial infarction2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 35, p. 469-469Article in journal (Refereed)
  • 3510.
    Waziri, Homa
    et al.
    Univ Copenhagen, Rigshosp, Ctr Heart, Dept Cardiol, DK-1168 Copenhagen, Denmark..
    Jorgensen, Erik
    Univ Copenhagen, Rigshosp, Ctr Heart, Dept Cardiol, DK-1168 Copenhagen, Denmark..
    Kelbaek, Henning
    Univ Copenhagen, Rigshosp, Ctr Heart, Dept Cardiol, DK-1168 Copenhagen, Denmark..
    Stagmo, Martin
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Malmo, Sweden..
    Pedersen, Frants
    Univ Copenhagen, Rigshosp, Ctr Heart, Dept Cardiol, DK-1168 Copenhagen, Denmark..
    Lagerqvist, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Kober, Lars
    Univ Copenhagen, Rigshosp, Ctr Heart, Dept Cardiol, DK-1168 Copenhagen, Denmark..
    Wachtell, Kristian
    Univ Orebro, Fac Hlth, Dept Cardiol, SE-70182 Orebro, Sweden.;Glostrup Univ Hosp, Glostrup, Denmark..
    Short and long-term survival after primary percutaneous coronary intervention in young patients with ST-elevation myocardial infarction2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 203, p. 697-701Article in journal (Refereed)
    Abstract [en]

    The long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) aged 45 years or younger and differences according to gender have not been well characterized. Methods: We included 16,685 consecutive STEMI patients from 2003 to 2012 (67,992 patient-years follow-up) from the Eastern Danish Heart Registry and the Swedish Coronary Angiography and Angioplasty Registry who were treated with primary percutaneous coronary intervention (PCI). Results: We identified 1026 (6.2%) patients up to 45 years of age (mean age: 40.7 vs. 66.3 years, P < 0.001). Patients in the young group were predominantly men (79.7% vs. 71.9%) and smokers (71.2% vs. 44.2%, P < 0.001) but with a lower prevalence of hypertension (17.3% vs. 39.3%), hyperlipidemia (18.0% vs. 23.8%), diabetes (9.0% vs. 12.4%) and previous myocardial infarction (6.9% vs. 12.2%, all P < 0.001) compared with older patients. Young patients had a 0.8% annualmortality. During the follow-up period 6.3% of young patients died vs. 28.5% of older patients (P < 0.001). Both 30-day-mortality (adjusted hazard ratio [HR] = 0.26, 95% confidence interval [CI]: 0.12-0.54, P < 0.001) and mortality after 30 days and onwards (HR = 0.25, CI: 0.17-0.37, P < 0.001) were significantly lower in the young group. There was no difference in short-term (HR = 0.78, CI: 0.32-1.90, P = 0.59) or long-term (HR = 0.62, CI: 0.33-1.91, P = 0.59) mortality between women and men in the young group (HR = 0.79, CI: 0.21-1.80, P = 0.39). Conclusions: STEMI patients, aged 45 years or younger, have an excellent prognosis after treatment with primary PCI. Long-termannual survival is more than 99% in these patients. Young women with STEMI do not have a worse long-term prognosis than young men with STEMI.

  • 3511. Webb, Thomas R.
    et al.
    Erdmann, Jeanette
    Stirrups, Kathleen E.
    Stitziel, Nathan O.
    Masca, Nicholas G. D.
    Jansen, Henning
    Kanoni, Stavroula
    Nelson, Christopher P.
    Ferrario, Paola G.
    Koenig, Inke R.
    Eicher, John D.
    Johnson, Andrew D.
    Hamby, Stephen E.
    Betsholtz, Christer
    Ruusalepp, Arno
    Franzen, Oscar
    Schadt, Eric E.
    Bjoerkegren, Johan L. M.
    Weeke, Peter E.
    Auer, Paul L.
    Schick, Ursula M.
    Lu, Yingchang
    Zhang, He
    Dube, Marie-Pierre
    Goel, Anuj
    Farrall, Martin
    Peloso, Gina M.
    Won, Hong-Hee
    Do, Ron
    van Iperen, Erik
    Kruppa, Jochen
    Mahajan, Anubha
    Scott, Robert A.
    Willenborg, Christina
    Braund, Peter S.
    van Capelleveen, Julian C.
    Doney, Alex S. F.
    Donnelly, Louise A.
    Asselta, Rosanna
    Merlini, Pier A.
    Duga, Stefano
    Marziliano, Nicola
    Denny, Josh C.
    Shaffer, Christian
    El-Mokhtari, Nour Eddine
    Franke, Andre
    Heilmann, Stefanie
    Hengstenberg, Christian
    Hoffmann, Per
    Holmen, Oddgeir L.
    Hveem, Kristian
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Joeckel, Karl-Heinz
    Kessler, Thorsten
    Kriebel, Jennifer
    Laugwitz, Karl L.
    Marouli, Eirini
    Martinelli, Nicola
    McCarthy, Mark I.
    Van Zuydam, Natalie R.
    Meisinger, Christa
    Esko, Tonu
    Mihailov, Evelin
    Escher, Stefan A.
    Alver, Maris
    Moebus, Susanne
    Morris, Andrew D.
    Virtamo, Jarma
    Nikpay, Majid
    Olivieri, Oliviero
    Provost, Sylvie
    AlQarawi, Alaa
    Robertson, Neil R.
    Akinsansya, Karen O.
    Reilly, Dermot F.
    Vogt, Thomas F.
    Yin, Wu
    Asselbergs, Folkert W.
    Kooperberg, Charles
    Jackson, Rebecca D.
    Stahl, Eli
    Mueller-Nurasyid, Martina
    Strauch, Konstantin
    Varga, Tibor V.
    Waldenberger, Melanie
    Zeng, Lingyao
    Chowdhury, Rajiv
    Salomaa, Veikko
    Ford, Ian
    Jukema, J. Wouter
    Amouyel, Philippe
    Kontto, Jukka
    Nordestgaard, Borge G.
    Ferrieres, Jean
    Saleheen, Danish
    Sattar, Naveed
    Surendran, Praveen
    Wagner, Aline
    Young, Robin
    Howson, Joanna M. M.
    Butterworth, Adam S.
    Danesh, John
    Ardissino, Diego
    Bottinger, Erwin P.
    Erbel, Raimund
    Franks, Paul W.
    Girelli, Domenico
    Hall, Alistair S.
    Hovingh, G. Kees
    Kastrati, Adnan
    Lieb, Wolfgang
    Meitinger, Thomas
    Kraus, William E.
    Shah, Svati H.
    McPherson, Ruth
    Orho-Melander, Marju
    Melander, Olle
    Metspalu, Andres
    Palmer, Colin N. A.
    Peters, Annette
    Rader, Daniel J.
    Reilly, Muredach P.
    Loos, Ruth J. F.
    Reiner, Alex P.
    Roden, Dan M.
    Tardif, Jean-Claude
    Thompson, John R.
    Wareham, Nicholas J.
    Watkins, Hugh
    Willer, Cristen J.
    Samani, Nilesh J.
    Schunkert, Heribert
    Deloukas, Panos
    Kathiresan, Sekar
    Systematic Evaluation of Pleiotropy Identifies 6 Further Loci Associated With Coronary Artery Disease2017In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 69, no 7, p. 823-836Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Genome-wide association studies have so far identified 56 loci associated with risk of coronary artery disease (CAD). Many CAD loci show pleiotropy; that is, they are also associated with other diseases or traits. OBJECTIVES This study sought to systematically test if genetic variants identified for non-CAD diseases/traits also associate with CAD and to undertake a comprehensive analysis of the extent of pleiotropy of all CAD loci. METHODS In discovery analyses involving 42,335 CAD cases and 78,240 control subjects we tested the association of 29,383 common (minor allele frequency >5%) single nucleotide polymorphisms available on the exome array, which included a substantial proportion of known or suspected single nucleotide polymorphisms associated with common diseases or traits as of 2011. Suggestive association signals were replicated in an additional 30,533 cases and 42,530 control subjects. To evaluate pleiotropy, we tested CAD loci for association with cardiovascular risk factors (lipid traits, blood pressure phenotypes, body mass index, diabetes, and smoking behavior), as well as with other diseases/traits through interrogation of currently available genome-wide association study catalogs. RESULTS We identified 6 new loci associated with CAD at genome-wide significance: on 2q37 (KCNJ13-GIGYF2), 6p21 (C2), 11p15 (MRVI1-CTR9), 12q13 (LRP1), 12q24 (SCARB1), and 16q13 (CETP). Risk allele frequencies ranged from 0.15 to 0.86, and odds ratio per copy of the risk allele ranged from 1.04 to 1.09. Of 62 new and known CAD loci, 24 (38.7%) showed statistical association with a traditional cardiovascular risk factor, with some showing multiple associations, and 29 (47%) showed associations at p < 1 x 10(-4) with a range of other diseases/traits. CONCLUSIONS We identified 6 loci associated with CAD at genome-wide significance. Several CAD loci show substantial pleiotropy, which may help us understand the mechanisms by which these loci affect CAD risk. (C) 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

  • 3512.
    Weber, Christian
    et al.
    Univ Munich, Inst Cardiovasc Prevent, Munich, Germany.;Partner Site Munich Heart Alliance, German Ctr Cardiovasc Res, Munich, Germany..
    Shantsila, Eduard
    Univ Birmingham, Inst Cardiovasc Sci, City Hosp, Birmingham, W Midlands, England..
    Hristov, Michael
    Univ Munich, Inst Cardiovasc Prevent, Munich, Germany..
    Caligiuri, Giuseppina
    Hop Xavier Bichat, INSERM, Paris, France..
    Guzik, Tomasz
    Jagiellonian Univ, Krakow, Poland.;Univ Glasgow, Glasgow, Lanark, Scotland..
    Heine, Gunnar H.
    Univ Saarland, Med Ctr, Dept Internal Med 4, Homburg, Germany..
    Hoefer, Imo E.
    UMC Utrecht, Lab Expt Cardiol, Utrecht, Netherlands.;UMC Utrecht, Lab Clin Chem & Hematol, Utrecht, Netherlands..
    Monaco, Claudia
    Univ Oxford, Oxford, England..
    Peter, Karlheinz
    Baker IDI Heart & Diabet Inst, Atherothrombosis & Vasc Biol, Melbourne, Vic, Australia..
    Rainger, Ed
    Univ Birmingham, Inst Cardiovasc Sci, City Hosp, Birmingham, W Midlands, England..
    Siegbahn, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Steffens, Sabine
    Univ Munich, Inst Cardiovasc Prevent, Munich, Germany.;Partner Site Munich Heart Alliance, German Ctr Cardiovasc Res, Munich, Germany..
    Wojta, Johann
    Med Univ Vienna, Core Facil, Dept Internal Med 2, Vienna, Austria..
    Lip, Gregory Y. H.
    Univ Birmingham, Inst Cardiovasc Sci, City Hosp, Birmingham, W Midlands, England..
    Role and analysis of monocyte subsets in cardiovascular disease Joint consensus document of the European Society of Cardiology (ESC) Working Groups "Atherosclerosis & Vascular Biology" and "Thrombosis"2016In: Thrombosis and Haemostasis, ISSN 0340-6245, Vol. 116, no 4, p. 626-637Article in journal (Refereed)
    Abstract [en]

    Monocytes as cells of the innate immunity are prominently involved in the development of atherosclerotic lesions. The heterogeneity of blood monocytes has widely been acknowledged by accumulating experimental and clinical data suggesting a differential, subset-specific contribution of the corresponding subpopulations to the pathology of cardiovascular and other diseases. This document re-evaluates current nomenclature and summarises key findings on monocyte subset biology to propose a consensus statement about phenotype, separation and quantification of the individual subsets.

  • 3513. Weber, Michael A
    et al.
    Schiffrin, Ernesto L
    White, William B
    Mann, Samuel
    Lindholm, Lars H
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Kenerson, John G
    Flack, John M
    Carter, Barry L
    Materson, Barry J
    Ram, C Venkata S
    Cohen, Debbie L
    Cadet, Jean-Claude
    Jean-Charles, Roger R
    Taler, Sandra
    Kountz, David
    Townsend, Raymond R
    Chalmers, John
    Ramirez, Agustin J
    Bakris, George L
    Wang, Jiguang
    Schutte, Aletta E
    Bisognano, John D
    Touyz, Rhian M
    Sica, Dominic
    Harrap, Stephen B
    Clinical practice guidelines for the management of hypertension in the community a statement by the American society of hypertension and the International society of hypertension2014In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Vol. 16, no 1, p. 14-26Article in journal (Refereed)
  • 3514.
    Wei, Xiaodan
    et al.
    Binzhou Med Univ, Med & Pharmaceut Res Ctr, Yantai, Shandong, Peoples R China..
    Liu, Zhuang
    Binzhou Med Univ, Affiliated Hosp, Dept Clin Imaging, Binzhou, Shandong, Peoples R China..
    Li, Min
    Binzhou Med Univ, Med & Pharmaceut Res Ctr, Yantai, Shandong, Peoples R China..
    Yang, Chunhua
    Binzhou Med Univ, Med & Pharmaceut Res Ctr, Yantai, Shandong, Peoples R China..
    Wang, Wenming
    Binzhou Med Univ, Affiliated Hosp, Dept Clin Imaging, Binzhou, Shandong, Peoples R China..
    Li, Xianglin
    Binzhou Med Univ, Med & Pharmaceut Res Ctr, Yantai, Shandong, Peoples R China..
    Zhang, Shuping
    Binzhou Med Univ, Med & Pharmaceut Res Ctr, Yantai, Shandong, Peoples R China..
    Li, Xuri
    Binzhou Med Univ, Med & Pharmaceut Res Ctr, Yantai, Shandong, Peoples R China..
    Tian, Geng
    Binzhou Med Univ, Med & Pharmaceut Res Ctr, Yantai, Shandong, Peoples R China..
    Bergquist, Jonas
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Wang, Bin
    Binzhou Med Univ, Med & Pharmaceut Res Ctr, Yantai, Shandong, Peoples R China..
    Mi, Jia
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry. Uppsala University, Science for Life Laboratory, SciLifeLab. Binzhou Med Univ, Med & Pharmaceut Res Ctr, Yantai, Shandong, Peoples R China..
    The Number of Stenotic Intracranial Arteries Is Independently Associated with Ischemic Stroke Severity2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 9, article id e0163356Article in journal (Refereed)
    Abstract [en]

    Background The severity of ischemic stroke symptoms varies among patients and is a critical determinant of patient outcome. To date, the association between the number of stenotic intracranial arteries and stroke severity remains unclear. Aims We aimed to investigate the association between the number of stenotic major intracranial arteries (NSMIA) and ischemic stroke severity, as well as the degree of stenosis and common stroke risk factors. Methods We performed a retrospective analysis of patients with digital subtraction angiography (DSA)-confirmed ischemic stroke. Clinical stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). The number of stenotic vessels was counted from the internal carotid arteries and vertebral arteries, bilaterally. Results Eighty three patients were recruited from a single center and included in the study. NSMIA was significantly correlated with stroke severity (Pearson Correlation Coefficient = 0.485, P < 0.001), but not with the degree of stenosis (Pearson Correlation Coefficient = 0.01, P = 0.90). Multivariate regression analysis revealed that NSMIA was significantly associated with the NIHSS score after adjusting for stroke risk factors. The adjusted odds ratio (per lateral) was 2.092 (95% CI, 0.865 to 3.308, P = 0.001). The degree of stenosis was also significantly associated with the NIHSS score after adjusting for common risk factors. The odds ratio (per 10%) was 0.712 (95% CI, 0.202 to 1.223, P = 0.007). Conclusions The number of stenotic intracranial major arteries is associated with the severity of ischemic stroke independent of the degree of stenosis and other stroke risk factors. To the best of our knowledge, this has not been previosuly studied in great detail using DSA. Our data highlight the importance of examining all major arteries in stroke patients.

  • 3515.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Västerbottens satsning på storskalig hjärt–kärlprevention2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 36, p. 1552-4Article in journal (Refereed)
    Abstract [sv]

    Under lång tid har man i Sverige ifrågasatt hälso- och sjukvårdens roll i kardiovaskulär prevention på befolkningsnivå.

    Hittills har relativt få befolkningsinriktade program med fokus på kardiovaskulär hälsa genomförts i landet.

    Utvärderingar tyder på att program där primärvården utgör ett nav, har en betydande preventiv potential.

  • 3516.
    Weisz, Giora
    et al.
    Shaare Zedek Med Ctr, IL-91031 Jerusalem, Israel;Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA;Cardiovasc Res Fdn, New York, NY USA.
    Généreux, Philippe
    Cardiovasc Res Fdn, New York, NY USA; Univ Montreal, Hop Sacre Coeur Montreal, Montreal, PQ, Canada.
    Iñiguez, Andres
    Hosp Meixoeiro, Vigo, Spain.
    Zurakowski, Aleksander
    Amer Heart Poland SA, Katowice, Poland.
    Shechter, Michael
    Chaim Sheba Med Ctr, IL-52621 Tel Hashomer, Israel.
    Alexander, Karen P.
    Duke Clin Res Inst, Durham, NC USA; Duke Univ, Durham, NC USA.
    Dressler, Ovidiu
    Cardiovasc Res Fdn, New York, NY USA.
    Osmukhina, Anna
    Gilead Sci Inc, Foster City, CA 94404 USA.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Ohman, E. Magnus
    Duke Clin Res Inst, Durham, NC USA; Duke Univ, Durham, NC USA.
    Ben-Yehuda, Ori
    Cardiovasc Res Fdn, New York, NY USA.
    Farzaneh-Far, Ramin
    Gilead Sci Inc, Foster City, CA 94404 USA.
    Stone, Gregg W.
    Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA; Cardiovasc Res Fdn, New York, NY USA.
    Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): a multicentre, randomised, double-blind, placebo-controlled trial2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10014, p. 136-145Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Incomplete revascularisation is common after percutaneous coronary intervention and is associated with increased mortality and adverse cardiovascular events. We aimed to assess whether adjunctive anti-ischaemic pharmacotherapy with ranolazine would improve the prognosis of patients with incomplete revascularisation after percutaneous coronary intervention.

    METHODS: We performed this multicentre, randomised, parallel-group, double-blind, placebo-controlled, event-driven trial at 245 centres in 15 countries in Europe, Israel, Russia, and the USA. Patients (aged ≥18 years) with a history of chronic angina with incomplete revascularisation after percutaneous coronary intervention (defined as one or more lesions with ≥50% diameter stenosis in a coronary artery ≥2 mm diameter) were randomly assigned (1:1), via an interactive web-based block randomisation system (block sizes of ten), to receive either twice-daily oral ranolazine 1000 mg or matching placebo. Randomisation was stratified by diabetes history (presence vs absence) and acute coronary syndrome presentation (acute coronary syndrome vs non-acute coronary syndrome). Study investigators, including all research teams, and patients were masked to treatment allocation. The primary endpoint was time to first occurrence of ischaemia-driven revascularisation or ischaemia-driven hospitalisation without revascularisation. Analysis was by intention to treat. This study is registered at ClinicalTrials.gov, number NCT01442038.

    FINDINGS: Between Nov 3, 2011, and May 27, 2013, we randomly assigned 2651 patients to receive ranolazine (n=1332) or placebo (n=1319); 2604 (98%) patients comprised the full analysis set. After a median follow-up of 643 days (IQR 575-758), the composite primary endpoint occurred in 345 (26%) patients assigned to ranolazine and 364 (28%) patients assigned to placebo (hazard ratio 0·95, 95% CI 0·82-1·10; p=0·48). Incidence of ischaemia-driven revascularisation and ischaemia-driven hospitalisation did not differ significantly between groups. 189 (14%) patients in the ranolazine group and 137 (11%) patients in the placebo group discontinued study drug because of an adverse event (p=0·04).

    INTERPRETATION: Ranolazine did not reduce the composite rate of ischaemia-driven revascularisation or hospitalisation without revascularisation in patients with a history of chronic angina who had incomplete revascularisation after percutaneous coronary intervention. Further studies are warranted to establish whether other treatment could be effective in improving the prognosis of high-risk patients in this population.

    FUNDING: Gilead Sciences, Menarini.

  • 3517.
    Wennberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Strömberg, Ulf
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Kauhanen, Jussi
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Salonen, Jukka T
    Skerfving, Staffan
    Tuomainen, Tomi-Pekka
    Vessby, Bengt
    Virtanen, Jyrki K
    Myocardial infarction in relation to mercury and fatty acids from fish: a risk-benefit analysis based on pooled Finnish and Swedish data in men2012In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, no 4, p. 706-713Article in journal (Refereed)
    Abstract [en]

    Background: Exposure to methylmercury from fish has been associated with increased risk of myocardial infarction (MI) in some studies. At the same time, marine n-3 (omega-3) PUFAs are an inherent constituent of fish and are regarded as beneficial. To our knowledge, no risk-benefit model on the basis of data on methylmercury, PUFA, and MI risk has yet been presented.

    Objective: The objective of this study was to describe how exposure to both marine n-3 PUFAs and methylmercury relates to MI risk by using data from Finland and Sweden.

    Design: We used matched case-control sets from Sweden and Finland that were nested in population-based, prospective cohort studies. We included 361 men with MI from Sweden and 211 men with MI from Finland. MI risk was estimated in a logistic regression model with the amount of mercury in hair (hair-Hg) and concentrations of n-3 PUFAs (EPA and DHA) in serum (S-PUFA) as independent variables.

    Results: The median hair-Hg was 0.57 mu g/g in Swedish and 1.32 mu g/g in Finnish control subjects, whereas the percentage of S-PUFA was 4.21% and 3.83%, respectively. In combined analysis, hair-Hg was associated with higher (P = 0.005) and S-PUFA with lower (P = 0.011) MI risk. Our model indicated that even a small change in fish consumption (ie, by increasing S-PUFA by 1%) would prevent 7% of MIs, despite a small increase in mercury exposure. However, at a high hair-Hg, the modeled beneficial effect of PUFA on MI risk was counteracted by methylmercury.

    Conclusions: Exposure to methylmercury was associated with increased risk of MI, and higher S-PUFA concentrations were associated with decreased risk of MI. Thus, MI risk may be reduced by the consumption of fish high in PUFAs and low in methylmercury.

    Am J Clin Nutr 2012;96:706-13.

  • 3518.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wensley, Frances
    Di Angelantonio, Emanuele
    Johansson, Lars A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rumley, Ann
    Lowe, Gordon
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Danesh, John
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Haemostatic and inflammatory markers are independently associated with myocardial infarction in men and women2012In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 129, no 1, p. 68-73Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Previous studies have shown that plasma levels of haemostatic and inflammatory markers are associated with risk of coronary heart disease (CHD). As haemostatic markers are also acute-phase reactants, it is not clear if their association with CHD is independent of inflammatory markers and established cardiovascular risk factors.

    MATERIALS AND METHODS: We used a prospective incident case-control study design nested in two cohorts from Sweden. Baseline measurements of a panel of cardiovascular risk factors and eight established markers of haemostasis or inflammation were assessed in 469 first-ever myocardial infarction (MI) cases and 895 matched controls.

    RESULTS: After adjustment for baseline values of established risk factors, von Willebrand factor appeared to have the strongest association with MI among the haemostatic markers assayed, with an odds ratio of 2.52 (95% CI, 1.72-3.67) for a comparison of individuals in extreme thirds of baseline levels. For a similar comparison, after adjustment for established risk factors and haemostatic markers, odds ratios for IL-6 and CRP were 1.67 (95% CI, 1.08-2.60) and 1.58 (95% CI, 1.03-2.41), respectively. The relative predictive ability of the individual markers over and above established risk factors was modest according to comparisons of Area under the Receiver Operating Characteristic (AUROC) curves. However, when all eight markers were combined in a single model, the AUROC curve was significantly increased to 0.820 (95% CI, 0.795-0.846) compared to 0.762 (95% CI, 0.732-0.791) for established risk factors only.

    CONCLUSIONS: These findings suggest that haemostasis and inflammation have at least partially separate roles in risk of myocardial infarction.

  • 3519.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wensley, Frances
    Di Angeloantonio, Emanuele
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rumley, Ann
    Lowe, Gordon
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Danesh, John
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Haemostatic and inflammatory markers are independently associated with a first-ever myocardial infarction in men and women2012In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 129, no 1, p. 68-73Article in journal (Refereed)
    Abstract [en]

    Introduction: Previous studies have shown that plasma levels of haemostatic and inflammatory markers are associated with risk of coronary heart disease (CHD). As haemostatic markers are also acute-phase reactants, it is not clear if their association with CHD is independent of inflammatory markers and established cardiovascular risk factors.

    Materials and Methods: We used a prospective incident case-control study design nested in two cohorts from Sweden. Baseline measurements of a panel of cardiovascular risk factors and eight established markers of haemostasis or inflammation were assessed in 469 first-ever myocardial infarction (MI) cases and 895 matched controls.

    Results: After adjustment for baseline values of established risk factors, von Willebrand factor appeared to have the strongest association with MI among the haemostatic markers assayed, with an odds ratio of 2.52 (95% CI, 1.72-3.67) for a comparison of individuals in extreme thirds of baseline levels. For a similar comparison, after adjustment for established risk factors and haemostatic markers, odds ratios for IL-6 and CRP were 1.67 (95% CI, 1.08-2.60) and 1.58 (95% CI, 1.03-2.41), respectively. The relative predictive ability of the individual markers over and above established risk factors was modest according to comparisons of Area under the Receiver Operating Characteristic (AUROC) curves. However, when all eight markers were combined in a single model, the AUROC curve was significantly increased to 0.820 (95% CI, 0.795-0.846) compared to 0.762 (95% CI, 0.732-0.791) for established risk factors only.

    Conclusions: These findings suggest that haemostasis and inflammation have at least partially separate roles in risk of myocardial infarction.

  • 3520.
    Wennberg, Patrik
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wensley, Frances
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Di Angeloantonio, Emanuele
    Rumley, Ann
    Lowe, Gordon
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Reduced risk of myocardial infarction related to active commuting: inflammatory and haemostatic effects are potential major mediating mechanisms2010In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 17, no 1, p. 56-62Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Regular physical activity is inversely associated with risk of coronary heart disease, but the precise mechanisms remain unclear. Active commuting is an environmental friendly way to achieve the recommended 30 min of daily physical activity. The aim of this study was to explore the relative contribution of markers from different potential mediating pathways on the association between active commuting and risk of myocardial infarction (MI) in a general population. DESIGN: Prospective incident nested case-control study. METHODS: Commuting habits, traditional risk factors and biomarkers were assessed at baseline and compared in 204 MI cases and 327 matched controls. RESULTS: Car commuting was significantly associated with MI risk, even after adjusting for potential confounders (odds ratio: 1.77, 95% confidence interval: 1.05-2.99). When potential mediators were included in the model, the risk was substantially attenuated. Among the traditional risk factors, apolipoprotein B/apolipoprotein A-1 ratio seemed to be the largest mediator (26.0%), followed by body mass index (18.7%). The inflammatory and haemostatic markers similarly dampened the effect, with tissue plasminogen activator/plasminogen activator inhibitor-1 complex and IL-6 explaining 33.6 and 27.6% of MI risk, respectively. Combined, the potential mediators investigated seemed to explain 40.1% of MI risk related to car commuting. CONCLUSION: Overall, the traditional, inflammatory and haemostatic markers seemed to explain a substantial proportion of the reduction in MI risk related to active commuting in this study population. The predominant effect of the inflammatory and haemostatic markers supports the hypothesis that regular physical activity may work through additional biological mechanisms to reduce coronary risk beyond traditional risk factors. However, these findings need to be confirmed in larger studies.

  • 3521. Werling, M
    et al.
    Thorén, A-B
    Axelsson, C
    [external].
    Herlitz, Johan
    [external].
    Treatment and outcome in post-resuscitation care after out-of-hospital cardiac arrest when a modern therapeutic approach was introduced.2007In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 73, no 1, p. 40-45Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The outcome among patients who are hospitalised alive after out-of-hospital cardiac arrest is still relatively poor. At present, there are no clear guidelines specifying how they should be treated. The aim of this survey was to describe the outcome for initial survivors of out-of-hospital cardiac arrest when a more aggressive approach was applied. PATIENTS: All patients hospitalised alive after out-of-hospital cardiac arrest in the Municipality of Göteborg, Sweden, during a period of 20 months. RESULTS: Of all the patients in the municipality suffering an out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n=375), 85 patients (23%) were hospitalised alive and admitted to a hospital ward. Of them, 65% had a cardiac aetiology and 50% were found in ventricular fibrillation. In 32% of the patients, hypothermia was attempted, 28% underwent a coronary angiography and 21% had a mechanical revascularisation. In overall terms, 27 of the 85 patients who were brought alive to a hospital ward (32%) survived to 30 days after cardiac arrest. Survival was only moderately higher among patients treated with hypothermia versus not (37% versus 29%; NS), and it was markedly higher among those who had early coronary angiography versus not (67% versus 18%; p<0.0001). CONCLUSION: In an era in which a more aggressive attitude was applied in post-resuscitation care, we found that the survival (32%) was similar to that in previous surveys. However, early coronary angiography was associated with a marked increase in survival and might be of benefit to many of these patients. Larger registries are important to further confirm the value of hypothermia in representative patient populations

  • 3522. Westenbrink, B. D.
    et al.
    Alings, M.
    Connolly, S. J.
    Eikelboom, J.
    Ezekowitz, M. D.
    Oldgren, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Yang, S.
    Pongue, J.
    Yusuf, S.
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    van Gilst, W. H.
    Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation: insights from the RE-LY trial2015In: Journal of Thrombosis and Haemostasis, ISSN 1538-7933, E-ISSN 1538-7836, Vol. 13, no 5, p. 699-707Article in journal (Refereed)
    Abstract [en]

    BackgroundAnemia may predispose to thromboembolic events or bleeding in anticoagulated patients with atrial fibrillation (AF). ObjectivesTo investigate whether anemia is associated with thromboembolic events and bleeding in patients with AF. Patients and methodsWe retrospectively analyzed the RE-LY trial database, which randomized 18113 patients with AF and a risk of stroke to receive dabigatran or warfarin for a median follow-up of 2years. Cox regression analysis was used to determine whether anemia predicted cardiovascular events and bleeding complications in these patients. ResultsAnemia was present in 12% of the population at baseline, and the presence of anemia was associated with a higher risk of thromboembolic cardiovascular events, including the composite endpoint of all-cause mortality or myocardial infarction (adjusted hazard ratio [HR]1.50, 95% confidence interval [CI]1.32-1.71) and the primary RE-LY outcome of stroke or systemic embolism (adjusted HR1.41, 95%CI1.12-1.78). Anemia was also associated with a higher risk of major bleeding complications (adjusted HR2.14, 95%CI1.87-2.46) and discontinuation of anticoagulants (adjusted HR1.40, 95%CI1.28-1.79). The association between anemia and outcome was similar irrespective of cardiovascular comorbidities, randomized treatment allocation, or prior use of warfarin. The incidence of events was lower in patients with transient anemia than in patients in whom anemia was sustained (adjusted HR0.66, 95%CI0.49-0.91). ConclusionsAnemia is associated with an increased risk of thromboembolic events, bleeding complications and mortality in anticoagulated patients with AF. These findings suggest that patients with anemia should be monitored closely during all types of anticoagulant treatment.

  • 3523.
    Westenbrink, B. Daan
    et al.
    Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands..
    Alings, Marco
    Working Grp Cardiovasc Res, Utrecht, Netherlands..
    Granger, Christopher B.
    Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA..
    Alexander, John H.
    Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA..
    Lopes, Renato D.
    Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA..
    Hylek, Elaine M.
    Boston Univ, Sch Med, Boston, MA USA..
    Thomas, Laine
    Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA..
    Wojdyla, Daniel M.
    Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA..
    Hanna, Michael
    Bristol Myers Squibb, Princeton, NJ USA..
    Keltai, Matyas
    Hungarian Inst Cardiol, Budapest, Hungary..
    Steg, P. Gabriel
    Univ Paris Diderot, AP HP, Hop Bichat, INSERM,DHU FIRE, Paris, France..
    De Caterina, Raffaele
    Univ G dAnnunzio, Chieti, Italy.;Fdn Toscana G Monasterio, Chieti, Italy..
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    van Gilst, Wick H.
    Univ Groningen, Univ Med Ctr Groningen, Groningen, Netherlands..
    Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial2017In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 185, p. 140-149Article in journal (Refereed)
    Abstract [en]

    Background Patients with atrial fibrillation (AF) are prone to cardiovascular events and anticoagulation-related bleeding complications. We hypothesized that patients with anemia are at increased risk for these outcomes. Methods We performed a post hoc analysis of the ARISTOTLE trial, which included >18,000 patients with AF randomized to warfarin (target international normalized ratio, 2.0-3.0) or apixaban 5 mg twice daily. Multivariable Cox regression analysis was used to determine if anemia (defined as hemoglobin <13.0 in men and <12.0 g/dL in women) was associated with future stroke, major bleeding, or mortality. Results Anemia was present at baseline in 12.6% of the ARISTOTLE population. Patients with anemia were older, had higher mean CHADS2 and HAS-BLED scores, and were more likely to have experienced previous bleeding events. Anemia was associated with major bleeding (adjusted hazard ratio [HR], 1.92; 95% CI, 1.62-2.28; P < .0001) and all-cause mortality (adjusted HR, 1.68; 95% CI, 1.46-1.93; P <. 0001) but not stroke or systemic embolism (adjusted HR, 0.92; 95% CI, 0.70-1.21). The benefits of apixaban compared with warfarin on the rates of stroke, mortality, and bleeding events were consistent in patients with and without anemia. Conclusions Chronic anemia is associated with a higher incidence of bleeding complications and mortality, but not of stroke, in anticoagulated patients with AF. Apixaban is an attractive anticoagulant for stroke prevention in patients with AF with or without anemia.

  • 3524.
    Wester, Axel
    et al.
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden.
    Mohammad, Moman A.
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden.
    Andell, Pontus
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden.
    Rylance, Rebecca
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden.
    Dankiewicz, Josef
    Lund Univ, Skane Univ Hosp, Dept Intens & Perioperat Care, Clin Sci, Lund, Sweden.
    Friberg, Hans
    Lund Univ, Skane Univ Hosp, Dept Intens & Perioperat Care, Clin Sci, Lund, Sweden.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Omerovic, Elmir
    Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden.
    Erlinge, David
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden.
    Koul, Sasha
    Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden.
    Coronary angiographic findings and outcomes in patients with sudden cardiac arrest without ST-elevation myocardial infarction: A SWEDEHEART study2018In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 126, p. 172-178Article in journal (Refereed)
    Abstract [en]

    Background/aim: Sudden cardiac arrest (SCA) has a substantial mortality rate and the acute coronary syndrome constitutes the major cause. Post-resuscitation electrocardiogram ST-elevation SCA (STE-SCA) is a strong indication for emergency coronary angiography, but the role of early angiography and PCI in patients without STelevation (NSTE-SCA) remains to be established. This paper aimed to describe this patient group and evaluate the prognostic effect of early PCI in a large nationwide cohort of NSTE-SCA patients undergoing coronary angiography. Methods: Data from SCAAR (Swedish Coronary Angiography and Angioplasty Registry) and RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) on 4308 SCA patients in Sweden between 2005 and 2016 were descriptively analyzed and related to mortality within 30-days in both unadjusted and adjusted analyses using Cox proportional hazard models. Results: NSTE-SCA patients had more often serious comorbidities than STE-SCA patients. Among NSTE-SCA patients, 36.4% had no significant coronary artery stenosis while severe coronary stenosis (>= 90%) was present in 43.9% (1271/2896). In NSTE-SCA patients with significant stenosis (>= 90%), PCI was performed in 59.2% (753/1271) with an increased unadjusted 30-day mortality (40.9% vs. 32.7%; p =. 011). However, after adjustments for confounders, no difference in mortality was observed (hazard ratio 1.07; 95% CI 0.84-1.36; p =. 57). Conclusion: In resuscitated SCA patients without ST-elevation who underwent coronary angiography, this large retrospective study found severe coronary artery stenosis in 43.9% but found no clear benefit of early PCI. Prospective randomized controlled trials are needed to accurately define the role of coronary angiography and PCI in post-resuscitation care.

  • 3525.
    Westerdahl, Elisabeth
    et al.
    Univ Orebro, Sch Hlth Sci, Fac Med & Hlth, Orebro, Sweden..
    Jonsson, Marcus
    Univ Orebro, Sch Med Sci, Fac Med & Hlth, Orebro, Sweden..
    Emtner, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery2016In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 11, article id 99Article in journal (Refereed)
    Abstract [en]

    Background: Pulmonary function is severely reduced in the early period after cardiac surgery, and impairments have been described up to 4-6 months after surgery. Evaluation of pulmonary function in a longer perspective is lacking. In this prospective study pulmonary function and health-related quality of life were investigated 1 year after cardiac surgery.

    Methods: Pulmonary function measurements, health-related quality of life (SF-36), dyspnoea, subjective breathing and coughing ability and pain were evaluated before and 1 year after surgery in 150 patients undergoing coronary artery bypass grafting, valve surgery or combined surgery.

    Results: One year after surgery the forced vital capacity and forced expiratory volume in 1 s were significantly decreased (by 4-5 %) compared to preoperative values (p < 0.05). Saturation of peripheral oxygen was unchanged 1 year postoperatively compared to baseline. A significantly improved health-related quality of life was found 1 year after surgery, with improvements in all eight aspects of SF-36 (p < 0.001). Sternotomy-related pain was low 1 year postoperatively at rest (median 0 [min-max; 0-7]), while taking a deep breath (0 [0-4]) and while coughing (0 [0-8]). A more pronounced decrease in pulmonary function was associated with dyspnoea limitations and impaired subjective breathing and coughing ability.

    Conclusions: One year after cardiac surgery static and dynamic lung function measurements were slightly decreased, while health-related quality of life was improved in comparison to preoperative values. Measured levels of pain were low and saturation of peripheral oxygen was same as preoperatively.

  • 3526.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health Sciences.
    Jonsson, Marcus
    Örebro University, School of Medical Sciences.
    Emtner, Margareta
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery2016In: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 11, no 1, article id 99Article in journal (Refereed)
    Abstract [en]

    Background: Pulmonary function is severely reduced in the early period after cardiac surgery, and impairments have been described up to 4-6 months after surgery. Evaluation of pulmonary function in a longer perspective is lacking. In this prospective study pulmonary function and health-related quality of life were investigated 1 year after cardiac surgery.

    Methods: Pulmonary function measurements, health-related quality of life (SF-36), dyspnoea, subjective breathing and coughing ability and pain were evaluated before and 1 year after surgery in 150 patients undergoing coronary artery bypass grafting, valve surgery or combined surgery.

    Results: One year after surgery the forced vital capacity and forced expiratory volume in 1 s were significantly decreased (by 4-5 %) compared to preoperative values (p < 0.05). Saturation of peripheral oxygen was unchanged 1 year postoperatively compared to baseline. A significantly improved health-related quality of life was found 1 year after surgery, with improvements in all eight aspects of SF-36 (p < 0.001). Sternotomy-related pain was low 1 year postoperatively at rest (median 0 [min-max; 0-7]), while taking a deep breath (0 [0-4]) and while coughing (0 [0-8]). A more pronounced decrease in pulmonary function was associated with dyspnoea limitations and impaired subjective breathing and coughing ability.

    Conclusions: One year after cardiac surgery static and dynamic lung function measurements were slightly decreased, while health-related quality of life was improved in comparison to preoperative values. Measured levels of pain were low and saturation of peripheral oxygen was same as preoperatively.

  • 3527.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala; Department of Physiotherapy and Thoracic Surgery, Örebro University Hospital, Örebro.
    Lindmark, B
    Department of Neuroscience, Section of Physiotherapy, University Hospital, Uppsala, Sweden .
    Bryngelsson, I
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro,Sweden.
    Tenling, A
    Department of Thoracic Anaesthesia, Huddinge Hospital, Huddinge, Sweden.
    Pulmonary function 4 months after coronary artery bypass graft surgery2003In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 97, no 4, p. 317-322Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to describe the pulmonary function and pain 4 months after coronary artery bypass graft surgery. Twenty-five male patients performed pulmonary function tests before surgery, on the 4th postoperative day and 4 months after surgery. A severe reduction in pulmonary function was present after surgery. Four months postoperatively, the patients still showed a significant decrease (6-13% of preoperative values) in vital capacity (P<0.001), inspiratory capacity (P<0.001), forced expiratory volume in 1 s (P<0.001) peak expiratory flow rate (P<0.001), functional residual capacity (P=0.05) total lung capacity (P<0.001) and single-breath carbon monoxide diffusing capacity (P<0.01). Residual volume and single-breath carbon monoxide diffusing capacity per litre of alveolar volume had returned to the preoperative level. Four months postoperatively, the median values for sternotomy pain while taking a deep breath was 0.2 and while coughing 0.3 on a 10 cm visual analogue pain scale. In conclusion, a significant restrictive pulmonary impairment persisting up to 4 months into the postoperative period was found after CABG. Measured levels of pain were low and could not explain the impairment.

  • 3528.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala; Departments of Physiotherapy and Thoracic Surgery, Örebro University Hospital, Örebro,.
    Lindmark, Birgitta
    Department of Neuroscience, Section of Physiotherapy, University Hospital, Uppsala.
    Eriksson, Tomas
    Department of Radiology, Örebro University Hospital, Örebro.
    Hedenstierna, Göran
    Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala.
    Tenling, Arne
    Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala; Department of Thoracic Anaesthesia, Huddinge University Hospital, Huddinge, Sweden.
    The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery2003In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 37, no 6, p. 363-367Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the effects of deep breathing performed on the second postoperative day after coronary artery bypass graft surgery.

    Design: The immediate effects of 30 deep breaths performed without a mechanical device (n = 21), with a blow bottle device (n = 20) and with an inspiratory resistance-positive expiratory pressure mask (n = 20) were studied. Spiral computed tomography and arterial blood gas analyses were performed immediately before and after the intervention.

    Results: Deep breathing caused a significant decrease in atelectatic area from 12.3 +/- 7.3% to 10.2 +/- 6.7% (p < 0.0001) of total lung area 1 cm above the diaphragm and from 3.9 +/- 3.5% to 3.3 +/- 3.1% (p < 0.05) 5 cm above the diaphragm. No difference between the breathing techniques was found. The aerated lung area increased by 5% (p < 0.001). The PaO (2) increased by 0.2 kPa (p < 0.05), while PaCO (2) was unchanged in the three groups.

    Conclusion: A significant decrease of atelectatic area, increase in aerated lung area and a small increase in PaO (2) were found after performance of 30 deep breaths. No difference between the three breathing techniques was found.

  • 3529.
    Westerdahl, Elisabeth
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University Hospital, Centre for Health Care Sciences, Örebro, Sweden .
    Urell, Charlotte
    Physiotherapy, Department of Neuroscience, Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Jonsson, Marcus
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic Surgery, Örebro University Hospital, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden .
    Hedenström, Hans
    Department of Clinical Physiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Emtner, Margareta
    Physiotherapy, Department of Neuroscience, Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Respiratory Medicine and Allergology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden .
    Deep breathing exercises performed 2 months following cardiac surgery: a randomized controlled trial2014In: Journal of cardiopulmonary rehabilitation and prevention, ISSN 1932-7501, Vol. 34, no 1, p. 34-42Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Postoperative breathing exercises are recommended to cardiac surgery patients. Instructions concerning how long patients should continue exercises after discharge vary, and the significance of treatment needs to be determined. Our aim was to assess the effects of home-based deep breathing exercises performed with a positive expiratory pressure device for 2 months following cardiac surgery.

    METHODS: The study design was a prospective, single-blinded, parallel-group, randomized trial. Patients performing breathing exercises 2 months after cardiac surgery (n = 159) were compared with a control group (n = 154) performing no breathing exercises after discharge. The intervention consisted of 30 slow deep breaths performed with a positive expiratory pressure device (10-15 cm H2O), 5 times a day, during the first 2 months after surgery. The outcomes were lung function measurements, oxygen saturation, thoracic excursion mobility, subjective perception of breathing and pain, patient-perceived quality of recovery (40-Item Quality of Recovery score), health-related quality of life (36-Item Short Form Health Survey), and self-reported respiratory tract infection/pneumonia and antibiotic treatment.

    RESULTS: Two months postoperatively, the patients had significantly reduced lung function, with a mean decrease in forced expiratory volume in 1 second to 93 ± 12% (P< .001) of preoperative values. Oxygenation had returned to preoperative values, and 5 of 8 aspects in the 36-Item Short Form Health Survey were improved compared with preoperative values (P< .01). There were no significant differences between the groups in any of the measured outcomes.

    CONCLUSION: No significant differences in lung function, subjective perceptions, or quality of life were found between patients performing home-based deep breathing exercises and control patients 2 months after cardiac surgery.

  • 3530. Westholm, Carl
    et al.
    Johnson, Jonas
    KTH, School of Technology and Health (STH), Medical Engineering, Medical Imaging.
    Jernberg, Tomas
    Winter, Reidar
    KTH, School of Technology and Health (STH), Medical Engineering.
    The prognostic value of mechanical left ventricular dyssynchrony in patients with acute coronary syndrome2013In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 11, no 1, p. 35-Article in journal (Refereed)
    Abstract [en]

    Background: Echocardiography is a well-established tool for risk stratification in patients with acute coronary syndrome (ACS). ACS has significant impact on LV dyssynchrony, and detrimental effects on systolic function and long term outcome. The aims of this study were to determine whether LV dyssynchrony carries any predictive information in an unselected ACS population and to evaluate if it has any incremental value to the information given from conventional echocardiographic measurements. Methods: The study included 227 consecutive ACS patients. Primary endpoint was the composite of death, new MI, or rehospitalisation due to heart failure. Dyssynchrony was measured as intersegmental variation of time to peak strain, the post systolic index (PSI) and myocardial performance index (MPI) with the standard deviation and difference between lowest and highest value (delta) expressing the amount of dyssynchrony. Septal-lateral delay was also tested. All dyssynchrony parameters were compared with Ejection fraction (EF). Results: The median follow up time was 53 months. 85 patients reached the combined endpoint. Patients with and without a subsequent combined endpoint differed significantly regarding calculated SD: s and delta-value for PSI, time to peak 2D-strain and MPI but not regarding septal-lateral delay. In ROC-analysis none of the dyssynchrony parameters had larger AUC than EF. When adjusting for traditional risk factors none of the dyssynchrony parameters remained associated with outcome, whereas EF still did. Conclusion: LV dyssynchrony seem to have significant prognostic information in patient with acute coronary syndrome but in comparison to conventional parameters such as EF there is no incremental value of this information.

  • 3531. White, Harvey D.
    et al.
    Held, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Stewart, Ralph
    Tarka, Elizabeth
    Brown, Rebekkah
    Davies, Richard Y.
    Budaj, Andrzej
    Harrington, Robert A.
    Steg, P. Gabriel
    Ardis-Sino, Diego
    Armstrong, Paul W.
    Avezum, Alvaro
    Aylward, Philip E.
    Bryce, Alfonso
    Chen, Hong
    Chen, Ming-Fong
    Corbalan, Ramon
    Dalby, Anthony J.
    Danchin, Nicolas
    De Winter, Robbert J.
    Denchev, Stefan
    Diaz, Rafael
    Elisaf, Moses
    Flather, Marcus D.
    Goudev, Assen R.
    Granger, Christopher B.
    Grinfeld, Liliana
    Hochman, Judith S.
    Husted, Steen
    Kim, Hyo-Soo
    Koenig, Wolfgang
    Linhart, Ales
    Lonn, Eva
    Lopez-Sendon, Jose
    Manolis, Athanasios J.
    Mohler, Emile R., III
    Nicolau, Jose C.
    Pais, Prem
    Parkhomenko, Alexander
    Pedersen, Terje R.
    Pella, Daniel
    Ramos-Corrales, Marco A.
    Ruda, Mikhail
    Sereg, Mtys
    Siddique, Saulat
    Sinnaeve, Peter
    Smith, Peter
    Sritara, Piyamitr
    Swart, Henk P.
    Sy, Rody G.
    Teramoto, Tamio
    Tse, Hung-Fat
    Watson, David
    Weaver, W. Douglas
    Weiss, Robert
    Viigimaa, Margus
    Vinereanu, Dragos
    Zhu, Junren
    Cannon, Christopher P.
    Wallentin, Lars
    Survival with Cardiac-Resynchronization Therapy in Mild Heart Failure2014In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 370, no 18, p. 1702-1711Article in journal (Refereed)
    Abstract [en]

    Background: Elevated lipoprotein-associated phospholipase A(2) activity promotes the development of vulnerable atherosclerotic plaques, and elevated plasma levels of this enzyme are associated with an increased risk of coronary events. Darapladib is a selective oral inhibitor of lipoprotein-associated phospholipase A(2). Methods: In a double-blind trial, we randomly assigned 15,828 patients with stable coronary heart disease to receive either once-daily darapladib (at a dose of 160 mg) or placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included the components of the primary end point as well as major coronary events (death from coronary heart disease, myocardial infarction, or urgent coronary revascularization for myocardial ischemia) and total coronary events (death from coronary heart disease, myocardial infarction, hospitalization for unstable angina, or any coronary revascularization). Results: During a median follow-up period of 3.7 years, the primary end point occurred in 769 of 7924 patients (9.7%) in the darapladib group and 819 of 7904 patients (10.4%) in the placebo group (hazard ratio in the darapladib group, 0.94; 95% confidence interval [CI], 0.85 to 1.03; P=0.20). There were also no significant between-group differences in the rates of the individual components of the primary end point or in all-cause mortality. Darapladib, as compared with placebo, reduced the rate of major coronary events (9.3% vs. 10.3%; hazard ratio, 0.90; 95% CI, 0.82 to 1.00; P=0.045) and total coronary events (14.6% vs. 16.1%; hazard ratio, 0.91; 95% CI, 0.84 to 0.98; P=0.02). ConclusionsIn patients with stable coronary heart disease, darapladib did not significantly reduce the risk of the primary composite end point of cardiovascular death, myocardial infarction, or stroke. (Funded by GlaxoSmithKline; STABILITY ClinicalTrials.gov number, NCT00799903.)

  • 3532. White, Harvey D.
    et al.
    Huang, Zhen
    Tricoci, Pierluigi
    Van de Werf, Frans
    Wallentin, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Lokhnygina, Yuliya
    Moliterno, David J.
    Aylward, Philip E.
    Mahaffey, Kenneth W.
    Armstrong, Paul W.
    Reduction in Overall Occurrences of Ischemic Events With Vorapaxar: Results From TRACER2014In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 3, no 4, p. e001032-Article in journal (Refereed)
    Abstract [en]

    Background-Clinical trials traditionally use time-to-first-event analysis embedded within the composite endpoint of cardiovascular death (CVD), myocardial infarction (MI), or stroke. However, many patients have >1 event, and this approach may not reflect overall experience. We addressed this by analyzing all cardiovascular events in TRACER. Methods and Results-TRACER randomized 12 944 patients with non-ST-segment elevation acute coronary syndromes to placebo or to protease-activated receptor 1 antagonist vorapaxar with a median follow-up of 502 days (interquartile range, 349 to 667). Analysis of vorapaxar's effect on recurrent CVD, MI, or stroke was prespecified using the Wei, Lin, and Weissfeld approach. Vorapaxar did not reduce the first occurrence of the primary endpoint of CVD, MI, stroke, revascularization, or rehospitalization for recurrent ischemia, but reduced the secondary composite endpoint of CVD, MI, or stroke (14.7% vorapaxar vs. 16.4% placebo; hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.81 to 0.98; P=0.02; number needed to treat [NNT], 81). Recurrent secondary events occurred in 2.7% of patients. Vorapaxar reduced overall occurrences of ischemic events, first and subsequent (HR, 0.88; 95% CI, 0.80 to 0.98; P=0.02; NNT, 51). Also, there was a trend indicating that vorapaxar reduced the expanded endpoint, including revascularization and rehospitalization for recurrent ischemia (HR, 0.92; 95% CI, 0.84 to 1.01; P=0.09). Vorapaxar increased overall occurrences of moderate and severe Global Use of Strategies to Open Occluded Coronary Arteries bleeding (HR, 1.42; 95% CI, 1.21 to 1.66; P<0.001) and Thrombolysis in Myocardial Infarction clinically significant bleeding (HR, 1.550; 95% CI, 1.403 to 1.713; P<0.001). Conclusions-Vorapaxar reduced overall occurrences of ischemic events, but increased bleeding. These exploratory findings broaden our understanding of vorapaxar's potential and expand our understanding of the value of capturing recurrent events.

  • 3533.
    Wibring, Kristoffer
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Department of Ambulance and Prehospital Care, Region Halland, Sweden.
    Herlitz, Johan
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Christensson, Lennart
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Lingman, Markus
    Department of Medicine, Region Halland, Sweden.
    Bång, Angela
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 219, p. 373-379Article in journal (Refereed)
    Abstract [en]

    Background: Chest pain is a common symptom among patients contacting the emergency medical services (EMS). Risk stratification of these patients is warranted before arrival in hospital, regarding likelihood of an acute life-threatening condition (LTC).

    Aim: To identify factors associated with an increased risk of acute LTC among patients who call the EMS due to non-traumatic chest pain.

    Methods: Several databases were searched for relevant articles. Identified articles were quality-assessed using the Scottish Intercollegiate Guidelines Network checklists. Extracted data was analysed using a semi-quantitative synthesis evaluating the level of evidence of each identified factor.

    Results: In total, 10 of 1245 identified studies were included. These studies provided strong evidence for an increased risk of an acute LTC with increasing age, male gender, elevated heart rate, low systolic blood pressure and ST elevation or ST depression on a 12-lead ECG. The level of evidence regarding the history of myocardial infarction, angina pectoris or presence of a Q wave or a Left Bundle Branch Block on the ECG was moderate. The evidence was inconclusive regarding dyspnoea, cold sweat/paleness, nausea/vomiting, history of chronic heart failure, smoking, Right Bundle Branch Block or T-inversions on the ECG.

    Conclusions: Factors reflecting age, gender, myocardial ischemia and a compromised cardiovascular system predicted an increased risk of an acute life-threatening condition in the prehospital setting in cases of acute chest pain. These factors may form the basis for prehospital risk stratification in acute chest pain.

  • 3534.
    Widen, Cecilia
    et al.
    Kristianstad Univ, Sch Hlth & Soc, SE-29188 Kristianstad, Sweden..
    Holmer, Helene
    Kristianstad Cent Hosp, Kristianstad, Sweden..
    Coleman, Michael
    Aston Univ, Birmingham, W Midlands, England..
    Tudor, Marian
    Kristianstad Cent Hosp, Kristianstad, Sweden..
    Ohlsson, Ola
    Kristianstad Univ, Sch Hlth & Soc, SE-29188 Kristianstad, Sweden.;Kristianstad Cent Hosp, Kristianstad, Sweden..
    Sattlin, Susanna
    Kristianstad Univ, Sch Hlth & Soc, SE-29188 Kristianstad, Sweden..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Persson, Gösta Rutger
    Kristianstad Univ, Sch Hlth & Soc, SE-29188 Kristianstad, Sweden.;Univ Washington, Seattle, WA 98195 USA..
    Systemic inflammatory impact of periodontitis on acute coronary syndrome2016In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 9, p. 713-719Article in journal (Refereed)
    Abstract [en]

    AimA causative relationship between acute coronary syndrome (ACS) and periodontitis has yet to be defined. The aim of this study was to assess differences in levels of serum cytokines between individuals with or without ACS or periodontal comorbidity. Material and MethodsIn a case-control study, individuals with ACS (78 individuals, 10.3% females) and matching healthy controls (78 individuals, 28.2% females) were included. Medical and dental examinations were performed to diagnose ACS and periodontitis. Serum levels of cytokines were assessed, using Luminex technology. ResultsA diagnosis of periodontitis in the ACS and control group was diagnosed in 52.6% and 12.8% of the individuals, respectively. The unadjusted odds-ratio that individuals with ACS also had periodontitis was 7.5 (95% CI: 3.4, 16.8, p<0.001). Independent of periodontal conditions, individuals with ACS had significantly higher serum levels of IL8 (mean: 44.3 and 40.0pg/ml) and vascular endothelial growth factor (VEGF) (mean: 82.3 and 55.3pg/ml) than control individuals. A diagnosis of periodontitis made no difference in serum cytokine expressions. ConclusionElevated serum levels of VEGF were associated with ACS. Serum cytokine expression in individuals with ACS is unrelated to periodontal conditions.

  • 3535. Wiedmann, Silke
    et al.
    Norrving, Bo
    Nowe, Tim
    Abilleira, Sonia
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Dennis, Martin
    Hermanek, Peter
    Rudd, Anthony
    Thijs, Vincent
    Wolfe, Charles D. A.
    Heuschmann, Peter U.
    Variations in Quality Indicators of Acute Stroke Care in 6 European Countries The European Implementation Score (EIS) Collaboration2012In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 43, no 2, p. 458-463Article in journal (Refereed)
    Abstract [en]

    Background and Purpose-Quality indicators serve as standards of care by which performance of individual hospitals is measured. Although several audits for monitoring quality of stroke care have been established in Europe, there is currently no consensus on quality indicators for acute stroke care or for methodology for collecting information on these measures. Methods-An up-to-date inventory on European stroke audits in place in 2006 was performed in the course of a project funded by the European Union (European Implementation Score Collaboration [EIS]). Two regional (Flanders, Belgium; Catalonia, Spain) and 4 national (Germany, Scotland, Sweden, England/Wales/Northern Ireland) stroke audits took part. Between November 2009 and July 2010, 2 standardized surveys and a series of interviews were performed to determine characteristics, methods, and content of these quality initiatives. For quality purposes, all summarized information was validated by representatives of the respective audits. Results-Overall, 123 quality indicators (91 process, 24 outcome, and 8 structural indicators) were identified. Anticoagulants in patients with atrial fibrillation and brain imaging were the only quality indicators used in all, whereas another 13 indicators were used in at least 2 of the quality initiatives. Substantial variations were found across the audits in terms of the development process of quality indicators, inclusion criteria, participation, population coverage, data documentation, follow-ups, benchmarking, and feedback of results to participants. Conclusions-There is a huge variety in measuring performance of acute stroke care in Europe, hampering valid comparisons of acute stroke care. Common standards for defining quality indicators and collecting information required for these measures should be defined in Europe. (Stroke. 2012;43:458-463.)

  • 3536. Wieloch, Mattias
    et al.
    Själander, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Frykman, Viveka
    Rosenqvist, Marten
    Eriksson, Niclas
    Svensson, Peter J.
    Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thrombo-embolic complications from the national quality registry AuriculA2011In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 32, no 18, p. 2282-2289Article in journal (Refereed)
    Abstract [en]

    Aims: In anticoagulation treatment with warfarin, the risk of thrombo-embolic events must be weighed against the risk of bleeding. Time in therapeutic range (TTR) is an important tool to assess the quality of anticoagulation treatment, and has been shown to correlate with less bleeding and thrombo-embolic complications. AuriculA, the Swedish national quality registry for atrial fibrillation and anticoagulation, is used for follow-up and dosage control of warfarin. This is the first report of TTR in AuriculA and, in a subgroup of two centres, bleeding and thrombo-embolic complications during 2008.

    Methods and results: Prothrombin complex (International normalized ratio) values from 18 391 patients in 67 different centres were analysed. The mean (SD) age was 70 (12) years. The main indications for warfarin treatment were: atrial fibrillation (64%), venous thromboembolism (19%), and heart valve dysfunction (13%). Time in therapeutic range for all patients was 76.2%. The mean weekly dose of warfarin decreased with age and TTR increased with age. In 4273 patients from two centres in AuriculA, the frequency of major bleedings and venous/arterial thrombo-embolism were 2.6 and 1.7% and for atrial fibrillation, 2.6 and 1.4%, per treatment year, respectively. A correlation between age and the risk of major bleeding (P< 0.001), but not thrombo-embolic complications (P= 0.147), was seen.

    Conclusion: Compared with prospective randomized trials of warfarin treatment, TTR in the AuriculA population was higher. Complications were low, probably due to the organization of anticoagulation treatment in Sweden. Use of the AuriculA dosing programme could have contributed to the results by keeping dosing regimens consistent over all centres.

  • 3537. Wierup, Ia
    et al.
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Wandell, Per
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Ärnlov, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Borne, Yan
    Low anthropometric measures and mortality-results from the Malmo Diet and Cancer Study2015In: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 47, no 4, p. 325-331Article in journal (Refereed)
    Abstract [en]

    Aim. To study the association between anthropometric measures: body mass index (BMI), percent body fat, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-hip-to-height ratio (WHHR), and A Body Shape Index (ABSI); to see if individuals in the lowest 5 percentiles for these measures have an increased risk of mortality. Methods. A population-based prospective cohort study ( 10,304 men and 16,549 women), the Malmo Diet and Cancer study (MDC), aged 45-73 years. Results. During a mean follow-up of 14 +/- 3 years, 2,224 men and 1,983 women died. There was a significant increased mortality risk after adjustments for potential confounders in the group with the 5% lowest BMI ( referent 25%-75%); hazard ratios (HR) with 95% confidence intervals were 1.33 (1.10-1.61) for women and 1.27 (1.07-1.52) for men. A similar significant increased mortality risk was seen with the 5% lowest percent body fat, HR 1.31 (1.07-1.60) for women and 1.25 (1.04-1.50) for men. Women with an ABSI in the lowest 5 percentiles had a lower mortality risk HR 0.64 (0.48-0.85). Conclusion. These results imply that BMI or percent body fat could be used to identify lean individuals at increased mortality risk.

  • 3538.
    Wieslander, Inger
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Jönköping University, Jönköping, Sweden.
    Mårtensson, Jan
    Jönköping University, Jönköping, Sweden.
    Fridlund, Bengt
    Jönköping University, Jönköping, Sweden.
    Svedberg, Petra
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
    Women’s experiences of how their recovery process is promoted after a first myocardial infarction: Implications for cardiac rehabilitation care2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, article id 30633Article in journal (Refereed)
    Abstract [en]

    Background: A rapid improvement in the care of myocardial infarction (MI) in the emergency services has been witnessed in recent years. There is, however, a lack of understanding of the factors involved in a successful recovery process, after the initial stages of emergency care among patients, and in particular those who are women. Both preventive and promotive perspectives should be taken into consideration for facilitating the recovery process of women after a MI.

    Aim: To explore how women’s recovery processes are promoted after a first MI.

    Methods: A qualitative content analysis was used.

    Findings: The women’s recovery process is a multidirectional process with a desire to develop and approach a new perspective on life. The women’s possibility to approach new perspectives on life incorporates how they handle the three dimensions: behaviour, that is, women’s acting and engaging in various activities; social, that is, how women receive and give support in their social environment; and psychological, that is, their way of thinking, reflecting, and appreciating life.

    Conclusions: The personal recovery of women is a multidirectional process with a desire to develop and approach a new perspective on life. It is important for cardiac rehabilitation nurses to not only focus on lifestyle changes and social support but also on working actively with the women’s inner strength in order to promote the recovery of the women.

  • 3539. Wigren, M
    et al.
    Rattik, S
    Hultman, K
    Björkbacka, H
    Nordin-Fredrikson, G
    Bengtsson, E
    Hedblad, B
    Siegbahn, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Coagulation and inflammation science.
    Gonçalves, I
    Nilsson, J
    Decreased levels of stem cell factor in subjects with incident coronary events2016In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 279, no 2, p. 180-191Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: It has been proposed that vascular progenitor cells play an important role in vascular repair, but their possible clinical importance in cardiovascular disease has not been fully characterized. Vascular endothelial growth factor A, placental growth factor and stem cell factor (SCF) are three growth factors that are important in recruiting vascular progenitor cells. In this study, we investigated the association between the plasma levels of these growth factors and incident coronary events (CEs).

    METHODS: Levels of the three growth factors were measured using the proximity extension assay technique in baseline plasma samples from 384 subjects with a first CE (mean follow-up 14.0 ± 4.3 years) and 409 event-free control subjects matched by sex and age, as well as in homogenates from 201 endarterectomy specimens.

    RESULTS: After controlling for known cardiovascular disease risk factors in a Cox regression model, subjects in the lowest SCF tertile had a hazard ratio of 1.70 (95% confidence interval 1.14-2.54) compared with subjects in the highest SCF tertile. Lower SCF levels were also associated with more severe carotid disease, less fibrous atherosclerotic plaques and an increased incidence of heart failure. Expression of the SCF receptor c-kit was demonstrated in the subendothelial layer and fibrous cap of human atherosclerotic plaques. Smokers and subjects with diabetes had decreased levels of SCF compared with control subjects.

    CONCLUSION: To our knowledge, this is the first clinical study to provide evidence to support a key role for SCF and progenitor cells in vascular repair. We suggest that the SCF-c-kit pathway may be a promising biomarker and therapeutic target in cardiovascular disease.

  • 3540.
    Wijkman, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Sandberg, Klas
    Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping. Region Östergötland, Local Health Care Services in East Östergötland, Department of Rehabilitation in Norrköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy.
    Kleist, Marie
    Region Östergötland, Local Health Care Services in East Östergötland, Department of Rehabilitation in Norrköping. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Falk, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Dermatology and Venerology. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    The exaggerated blood pressure response to exercise in the sub-acute phase after stroke is not affected by aerobic exercise.2018In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Journal of Clinical Hypertension, Vol. 20, p. 56-64Article in journal (Refereed)
    Abstract [en]

    The prevalence of an exaggerated exercise blood pressure (BP) response is unknown in patients with subacute stroke, and it is not known whether an aerobic exercise program modulates this response. The authors randomized 53 patients (27 women) with subacute stroke to 12 weeks of twice-weekly aerobic exercise (n = 29) or to usual care without scheduled physical exercise (n = 24). At baseline, 66% of the patients exhibited an exaggerated exercise BP response (peak systolic BP ≥210 mm Hg in men and ≥190 mm Hg in women) during a symptom-limited ergometer exercise test. At follow-up, patients who had been randomized to the exercise program achieved higher peak work rate, but peak systolic BP remained unaltered. Among patients with a recent stroke, it was common to have an exaggerated systolic BP response during exercise. This response was not altered by participation in a 12-week program of aerobic exercise.

  • 3541.
    Wiklander, Kerstin
    et al.
    Chalmers, Sweden; University of Gothenburg, Sweden.
    Erichsen Andersson, Annette
    University of Gothenburg, Sweden.
    Källman, Ulrika
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. South Alvsborg Hospital, Sweden.
    An investigation of the ability to produce a defined "target pressure using the PressCise compression bandage2016In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 6, p. 1336-1343Article in journal (Refereed)
    Abstract [en]

    Compression therapy is the cornerstone in the prevention and treatment of leg ulcers related to chronic venous insufficiency. The application of optimal high pressure is essential for a successful outcome, but the literature has reported difficulty applying the intended pressure, even among highly skilled nurses. The PressCise bandage has a novel design, with both longitudinal and horizontal reference points for correct application. In the current experimental study, the results for the general linear model, where the data set is treated optimally, showed that all 95% confidence intervals of the expected values for pressure were, at most, 5 mmHg from the target value of 50 mmHg, independent of the position on the leg and the state of activity. Moreover, even nurses with limited experience were consistently able to reach the targeted pressure goal. Future studies are needed to determine how well the bandage works on legs of different shapes, the optimal way of using the bandage (day only or both day and night) and whether the bandage should be combined with an outer bandage layer. In addition, special attention should be paid to subjective patient experiences in relation to the treatment as pain, discomfort and bulk are factors that can compromise patients willingness to adhere to the treatment protocol and thereby prolong the healing process.

  • 3542. Wiklund, S
    et al.
    Norelius, M
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Check-up your hearthealth at the pharmacy2012In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 19, no 1, p. S82-Article in journal (Refereed)
  • 3543.
    Wiklund, Urban
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Kadkhodaee, Amir
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Andersson, Kennet
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Cardiorespiratory Coherence Analysis of Abnormal Heart Rate Responses during Deep Breathing2013In: 2013 COMPUTING IN CARDIOLOGY CONFERENCE (CINC), 2013, Vol. 40, p. 109-112Conference paper (Refereed)
    Abstract [en]

    Although the heart rate variability (HRV) normally is highly synchronised with respiration during deep breathing, in patients with transthyretin amyloidosis we occasionally observe abnormal heart rate responses due to subtle arrhythmias, This study evaluates the use of cardiorespiratory coherence analysis for automatic detection of these abnormal patterns.

  • 3544.
    Wiklund, Urban
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Kadkhodaee, Amir
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Andersson, Kennet
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Suhr, Ole B.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Hörnsten, Rolf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    Normal scores of deep breathing tests: beware of dysrhythmia in transthyretin amyloidosis2018In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 25, no 1, p. 54-61Article in journal (Refereed)
    Abstract [en]

    Background: The heart rate (HR) response to paced deep breathing (DB) is a common test of cardiac autonomic function, where high heart rate variability (HRV) is considered to reflect normal autonomic function. We evaluated the DB test in patients with hereditary transthyretin amyloid (ATTRm) amyloidosis, where autonomic dysregulation and atrial arrhythmias are common.Methods: Paced DB was performed during one minute (six breaths/min) in 165 recordings in adult ATTRm amyloidosis patients with the TTR Val30Met mutation, 42 hypertrophic cardiomyopathy (HCM) patients and 211 healthy subjects. HRV was scored by traditional DB indices and by a novel regularity index, estimating the fraction of the HRV that was coherent with the breathing pattern.Results: Twenty per cent of ATTRm amyloidosis patients presented with age-adjusted HRV scores within normal limits but poor regularity due to subtle atrial arrhythmias and cardiac conduction disturbances. Forty-seven per cent of ATTRm amyloidosis patients presented with HRV scores below normal limits, whereas HCM patients presented with higher HRV than ATTRm amyloidosis patients.Conclusions: Reduced HRV is common in ATTRm amyloidosis patients during DB, however, autonomic function cannot be evaluated in patients presenting with the combination of normal scores and low regularity, since their HR responses often reflects dysrhythmias.

  • 3545. Wikstrom, G.
    et al.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Olofsson, Mona
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindmark, Krister
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lahoz, R.
    Corda, S.
    Wintzell, V.
    Linder, R.
    Gondos, A.
    Stalhammar, J.
    Dosing of heart failure treatments in newly diagnosed unselected patients in sweden: compliance with european society of cardiology guidelines2016In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 18, p. 341-341Article in journal (Other academic)
  • 3546. Wikstrom, G.
    et al.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Olofsson, Mona
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lindmark, Krister
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lahoz, R.
    Corda, S.
    Wintzell, V.
    Linder, R.
    Gondos, A.
    Stalhammar, J.
    Exposure to heart failure treatments in newly diagnosed patients in Sweden2016In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 18, p. 48-48Article in journal (Other academic)
  • 3547.
    Wikström, Bernt Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Correspondence concerning the article: Is levosimendan better than dobutamine in acute heart failure in patients on beta blockade treatment? What is the evidence?2010In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 12, no 8, p. 893-893Article in journal (Refereed)
  • 3548.
    Wikström, Gerhard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Boman, K.
    Umea Univ, Skelleftea Cty Hosp, Dept Publ Hlth, Res Unit,Med & Geriatr, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Skelleftea Cty Hosp, Dept Publ Hlth, Res Unit,Med & Geriatr, Umea, Sweden..
    Lindmark, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Ctr Heart, Umea, Sweden..
    Lahoz, R.
    Novartis Pharma AG, Basel, Switzerland..
    Corda, S.
    Novartis Pharma AG, Basel, Switzerland..
    Wintzell, V.
    IMS Hlth Sweden, Stockholm, Sweden..
    Linder, R.
    IMS Hlth Sweden, Stockholm, Sweden..
    Gondos, A.
    IMS Hlth Germany, Berlin, Germany..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Dosing of heart failure treatments in newly diagnosed unselected patients in sweden: compliance with european society of cardiology guidelines2016In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 18, p. 341-341Article in journal (Other academic)
  • 3549.
    Wikström, Gerhard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala Univ, Inst Med Sci, Uppsala, Sweden..
    Boman, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Lindmark, K.
    Umea Univ, Ctr Heart, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Lahoz, R.
    Novartis Pharma AG, Basel, Switzerland..
    Corda, S.
    Novartis Pharma AG, Basel, Switzerland..
    Wintzell, V.
    IMS Hlth Sweden, Stockholm, Sweden..
    Linder, R.
    IMS Hlth Sweden, Stockholm, Sweden..
    Gondos, A.
    IMS Hlth Germany, Berlin, Germany..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Exposure to heart failure treatments in newly diagnosed patients in Sweden2016In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 18, p. 48-48Article in journal (Other academic)
  • 3550.
    Wikström, Gerhard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Boman, K.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Bergman, G. J.
    QuintilesIMS, Solna, Sweden..
    Tornblom, M.
    QuintilesIMS, Solna, Sweden..
    Wintzell, V.
    QuintilesIMS, Solna, Sweden..
    Balas, B.
    Novartis Pharma AG, Basel, Switzerland..
    Corda, S.
    Novartis Pharma AG, Basel, Switzerland..
    Lindmark, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Ctr Heart, Umea, Sweden..
    Suboptimal dosing of common heart failure treatments in newly diagnosed patients with heart failure: a retrospective population-based cohort study in Sweden2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 54-54Article in journal (Other academic)
68697071727374 3501 - 3550 of 3669
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