BACKGROUND: In clinical guidelines regarding atrial fibrillation, oral anticoagulation is recommended for patients over the age of 65 or with additional risk factors. The aim of the present study was to investigate how these recommendations are followed in clinical practice. MATERIAL AND METHODS: A retrospective study was conducted among patients hospitalized for atrial fibrillation at Tromsø University Hospital from 1995 to 1998. Data were obtained from hospital files. RESULTS: 362 patients with atrial fibrillation (57% men), mean age 68.4 years (range 24-96), were included. 23.5% had their first atrial fibrillation event. 224 (62%) patients experienced successful cardioversion during hospitalization(s), while 138 (38%) were discharged from hospital with chronic atrial fibrillation. 97 (70%) of these patients were given warfarin at discharge. Previous stroke and atrial fibrillation were significant predictors for warfarin prescription. Prescription did not increase with age. 28 (20%) of patients with chronic atrial fibrillation received acetylsalicylic acid, while 16 (12%) were not given antithrombotic treatment. INTERPRETATION: This study indicates a high degree of implementation of guidelines for antithrombotic treatment of patients with chronic atrial fibrillation in hospital practice.
Coronary heart disease (CHD) mortality was registered in an inland and a coastal community in Northern Norway. Subgroups of healthy males from the communities were investigated further. The daily consumption of fish in the coastal and inland areas was 132.4 g and 55.1 g respectively, and the intake of eicosapentaenoic acid was 0.9 g and 0.25 g. The content of n-3 polyunsaturated fatty acids in platelet phospholipids and primary bleeding time were similar in the two groups. Linoleic acid was lower and saturated fatty acids were higher in phospholipids in men from the coastal area. Collagen-induced platelet aggregation was increased and serum triglyceride concentration was higher in men from the coastal area. CHD mortality during a 10-year period was higher in the coastal area for both sexes. This may be associated with differences in serum triglyceride levels and platelet fatty acid composition. This study indicates that a high consumption of lean fish is not sufficient to induce changes in blood lipids and platelet function associated with low CHD mortality and it does not seem to prevent high CHD mortality.
This paper describes the outline and first results of an international study to investigate the effect of a reasonable amount of dietary fish on some aspects of cardiovascular risk. In Maastricht and Zeist, The Netherlands, and Tromsø, Norway, healthy male volunteers were given a dietary supplement consisting of 100 g/d of mackerel or meat for a 6-wk period. Compliance was monitored on the basis of the urinary excretion of lithium, which was added to the supplements. Average compliance was approximately 80% and this decreased slightly in time. Systolic blood pressure decreased in both groups to a comparable degree; consequently no specific effect of the fish supplement was observed. The fish supplement significantly prolonged bleeding times. Hematology was hardly affected but platelet counts decreased significantly. No indications were obtained for adverse effects of the fish supplement.
We examined the cross-sectional relationships between the frequency of habitual fish consumption, plasma phospholipid fatty acids, and serum lipids and lipoproteins in 152 men and women. There was a significant association between fish consumption starting from 1 dish/wk and plasma n-3, n-6, and n-9 fatty acids. Plasma eicosapentaenoic acid (EPA; 20: 5n-3) reflected fish consumption to a greater extent than did docosahexaenoic acid (DHA;22:6n-3). Triglycerides decreased (P less than 0.05) with fish consumption. In multivariate analysis in which anthropometric and lifestyle factors were controlled for, EPA correlated inversely with triglycerides (P less than 0.05) and positively with high-density-lipoprotein (HDL) cholesterol and apolipoprotein A-I (both P less than 0.001). In contrast, DHA did not correlate with triglycerides and showed negative associations to HDL cholesterol and apolipoprotein A-I (both P less than 0.001). Platelet phospholipid EPA, but not DHA, was associated with lower triglyceride and higher HDL-cholesterol concentrations (both P less than 0.05). This study suggests that long-term intake of small amounts of fish has biological effects, and that EPA and DHA have divergent relations with lipoprotein metabolism.
OBJECTIVE: To assess the oxidative burden of a highly concentrated compound of n-3 PUFAs as compared to corn oil by measuring thiobarbituric acid-malondialdehyde complex (TBA-MDA) by HPLC. We also studied the influence on TBA-MDA of statins combined with n-3 PUFAs or corn oil. DESIGN: A prospective, randomised, double-blind, controlled study. SETTING: One hospital centre in Stavanger, Norway. SUBJECTS: A total of 300 subjects with an acute myocardial infarction (MI). INTERVENTIONS: Gelatine capsules, containing 850-882 mg EPA and DHA as concentrated ethylesters, or 1 g of corn oil, were ingested in a dose of two capsules twice a day for at least 1 y. Alpha-tocopherol (4 mg) was added to all capsules to protect the PUFAs against oxidation. RESULTS: After 1 y TBA-MDA increased modestly in the n-3 PUFA group (n=125), as compared to the corn oil group (n=130), P=0.027. Multiple linear regression analyses of fatty acids in serum total phospholipids (n=56) on TBA-MDA measured after 12 months intervention, showed no dependency. Performing best subsets regression, serum phospholipid concentration of arachidonic acid (20:4 n-6 PUFA) was identified as a predictor of TBA-MDA at 12 months follow-up, P=0.004.We found no impact of statins on TBA-MDA. CONCLUSION: TBA-MDA increased modestly after long-term intervention with n-3 PUFAs compared to corn oil post-MI, suggesting biological changes induced by n-3 PUFAs, rather than simply reflecting their concentration differences. The peroxidative potential of n-3 PUFAs was not modified by statin treatment. SPONSORSHIP:: Pharmacia A/S and Pronova A/S, Norway.
In an inland and a coastal community, mortality from coronary heart disease (CHD) was registered over a 10-year period. Healthy males representing these two communities were investigated. A dietary registration showed a high saturated fat intake and a daily consumption of fish of 132.4 and 55.1 g and 0.9 and 0.2 g of eicosapentaenoic acid (EPA), in the two groups respectively. The contents of n-3 fatty acids in platelet phospholipids and primary bleeding times were similar, but collagen-induced platelet aggregation was higher in the coastal area. Higher serum triglyceride levels, higher content of saturated fatty acids and lower content of linoleic acid in platelet phospholipids were observed in males from the coastal area. CHD mortality was higher in the coastal area for both sexes. Daily dietary supplement of cod liver oil prolonged the bleeding time, reduced n-6 and increased n-3 fatty acids of platelet phospholipids. This studies indicate that a high content of lean fish and diet rich in saturated fat is not sufficient to prevent CHD.
The 4S study was followed by guidelines for statin treatment of patients with manifest coronary heart disease recommending statins for patients with serum cholesterol above 5.5 mmol/l, age below 70 years, and more than three years life expectancy. The purpose of the present study was to investigate how these guidelines were implemented in clinical practice. A retrospective registration was conducted on two cohorts of patients; patients with myocardial infarction in 1994 (before 4S) (n = 101) and 1996 (n = 100). Risk factors for coronary diseases and the use of statins were registered from the patients records. No significant differences in risk factors between the two cohorts were observed. The proportion of patients given statins increased from 4% in 1994 to 40% in 1996, whereas 50% of patients with serum cholesterol above 5.5 mmol/l were given statins in 1996. Statin treatment was usually instituted during hospitalization. Awareness of actual prescription and handling of statin treatment, and adaption of knowledge from clinical studies to clinical practice is probably needed for further improvement of statin treatment.
BACKGROUND: The objective of this study was to register the frequency of statin prescription during the initial hospitalization for acute myocardial infarction and therapeutic intensity at follow-up. MATERIAL AND METHODS: A retrospective study among patients aged below 70 of both sexes with acute myocardial infarction, who survived the initial hospitalization at the University Hospital of Tromsø during 1995-1998. RESULTS: 473 patients with acute myocardial infarction, 76% men, mean age 57.4 (range 33-70 yrs) were included. Statin treatment was started in 55% of the patients within discharge from the hospital. Total cholesterol (odds ratio 0.51, 0.41-0.64; 95% CI) and decreasing age (1.60, 1.21-2.10) were significant predictors for statin prescription. Statin treatment started during hospitalization increased gradually from 42% in 1995 to 91% in 1998 (p
