We here study antibodies against phosphorylcholine (anti-PC) which we reported to be inversely associated with atherosclerosis, cardiovascular disease (CVD), and autoimmune conditions. In previous studies, we determined that this inverse association is more pronounced at low levels with high risk and at high levels, with decreased risk. We compare individuals from Kitava, New Guinea (with low risk of these conditions), with Swedish controls.
We studied a group of 178 individuals from Kitava (age 20-86), and compared those above age 40 (n = 108) with a group of age- and sex-matched individuals from a population based cohort in Sweden (n = 108). Traditional risk factors for CVD and fatty acids were determined. IgM, IgG, and IgA anti-PC were tested by enzyme-linked immunosorbent assay (ELISA).
All anti-PC measures were significantly lower among Swedish controls as compared to Kitavans (p
PURPOSE: To describe and compare the pattern of antihypertensive drug prescriptions during different time periods. METHODS: Antihypertensive prescriptions were registered in all patients who underwent an annual follow-up during 1998 (n = 984), 1992-1993 (n = 924), and 1981 (n = 689), at the hypertension outpatient clinic in primary health care, Skara, Sweden. RESULTS: From 1981 to 1998 the total prescriptions of thiazides declined from 61 to 10% (p
AIMS: To investigate associations between CVD risk factors and socio-economic status (SES) in middle-age men during a period of economic changes. METHODS: Crossectional surveys at age 37, 40 and 43 in a birth cohort of men in Helsingborg, Sweden. All male residents born 1953-4 (n = 1460) were invited; participation rates were 68% (n = 991) at baseline. Of these enrolled, 78% (n = 770) were re-examined after three years and 71% (n = 702) again after six years follow-up. Main outcome measures were body mass index (BMI), S-cholesterol, HDL-cholesterol, systolic and diastolic blood pressure (SBP, DBP), smoking and leisure time physical activity (LTPA), education, employment, ethnicity. RESULTS: Baseline unemployment rate was low, n = 23 (2.4%), but three and six years later it had increased to 61 (8.2%) and 51 (7.5%) respectively. At baseline, BMI and S-cholesterol were significantly higher in unemployed than in employed men (deltaBMI 1.6 kg/m2, CI: 0.2; 2.9, delta S-cholesterol 0.6 mmol/L, CI: 0.1; 1.0), and in men with short versus long education (delta BMI 0.9 kg/m2, CI: 0.4; 1.4, delta S-cholesterol 0.2 mmol/L, CI: 0.03: 0.4), independent of other SES factors. Over the study period crossectional associations with employment status disappeared for BMI, but remained between short education and BMI. Short education was also associated with a significant increase in BMI (delta = 0.4 kg/m2, CI: 0.1; 0.7) during 6-year follow-up. CONCLUSIONS: This study shows that associations between unemployment and CVD risk factors were lost when unemployment rates increased. When the attributable risk of unemployment associated with CVD risk factors is estimated, it is vital to consider the general unemployment rates in society.
AIM: To investigate the development of blood pressure (BP) determinants over a period of 6 years in a birth cohort of middle-aged Swedish men. METHODS: Men born 1953 and 1954 living in Helsingborg, Southern Sweden, were surveyed at 37, 40 and 43 years of age. Baseline participation rate was 68% (n = 991). S-Cholesterol, HDL-Cholesterol, systolic and diastolic blood pressure (SBP and DBP) and anthropomorphic measurements were collected and a questionnaire covering ethnicity, smoking, leisure time physical activity (LTPA) and alcohol consumption was completed. RESULTS: At these surveys, SBP means were: 131, 132, 135 mm Hg and DBP were 83, 83 and 85 mm Hg respectively. Body mass index (BMI), waist hip ratio (WHR), S-Cholesterol and alcohol consumption consistently showed cross-sectional positive associations with SBP and DBP. One mmol/L higher S-Cholesterol at baseline predicted an increase in SBP by 1.16 mm Hg (confidence interval, CI: 0.25; 2.07) over 6 years. At age 40, there was a 4.4 mm Hg (p
BACKGROUND: Patients' health beliefs influence their willingness to comply with medical advice. In an earlier study, it was found that men with a previous history of information on risk factors for ischaemic heart disease expressed more feelings of threat to their health than did men without this experience. As anxiety may have adverse effects, such as making patients avoid the desired action, this could complicate adequate patient treatment. AIMS: To investigate the impact on health beliefs caused by participation in a screening programme for risk factors for ischaemic heart disease, including individualized information to patients with hypercholesterolaemia. METHODS: A random sample of middle-aged, urban men participating in a health screening completed a questionnaire on socioeconomic factors, medical history, lifestyle, and health beliefs. Blood pressures and plasma cholesterol values were measured. Four months after the initial screening, hypercholesterolaemic men and controls completed the questionnaire again. RESULTS: In a univariate analysis, no differences in health belief indices were found between cases and controls at the baseline screening. Controls achieved lower values of the indices "perceived control over illness" and "medical motivation" at follow-up. In a matched case-control design, the differences in "medical motivation" increased between cases and controls because controls reported lower values. "Perceived threat to health" did not change, and it is suggested that this is due to the supportive information to the patients. CONCLUSION: Individualized and supportive patient information on risk factors for cardiovascular disease does not increase patients' perceptions of threat.
The vasoconstricting peptide endothelin-1 has been proposed to be a marker of cardiovascular disease. Our aim was to investigate whether circulating endothelin-1 levels predict coronary heart disease (CHD) in Sweden.
In 2002-2005, 2816 adult participants (30-74 years) were randomly selected from two municipalities in south-western Sweden. Cardiovascular risk factors and endothelin-1 levels were assessed at baseline, and incident CHD was followed-up in all participants through 2011. After exclusion of 50 participants due to known CHD at baseline and 21 participants because of unsuccessful analysis of endothelin-1, 2745 participants were included in the study. In total, 72 CHD events (52 in men and 20 in women) were registered during the follow-up time.
We showed that baseline circulating endothelin-1 levels were higher in women with incident CHD than in women without CHD (3.2?pg/ml, SE: 0.36 vs 2.4?pg/ml, SE: 0.03, p?=?0.003) whereas this difference was not observed in men (2.3?pg/ml, SE: 0.16 vs 2.3?pg/ml, SE: 0.04, p?=?0.828). An age-adjusted Cox proportional regression analysis showed an enhanced risk of CHD with increasing baseline endothelin-1 levels in women (hazard ratio (HR)?=?1.51, 95?% CI?=?1.1-2.1, p?=?0.015) but not in men (HR?=?0.98, 95?% CI?=?0.8-1.2, p?=?0.854). Furthermore, the predictive value of endothelin-1 for incident CHD in women was still significant after adjustments for age, HOMA-IR, apolipoprotein (apo)B/apoA1 and smoking (HR?=?1.53, CI?=?1.1-1.2, p?=?0.024).
Circulating endothelin-1 levels may predict CHD in women.
Lund University, Department of Clinical Sciences, Malmö, Social Medicine and Global Health, Skåne University Hospital, Jan Waldenströms gata 35, 205 02 Malmö, Sweden; University of Gothenburg, The Sahlgrenska Academy, Department of Public Health and Community Medicine/Primary Health Care, Box 454, 405 30 Göteborg, Sweden. Electronic address: firstname.lastname@example.org.
Risk factors for acute myocardial infarction (AMI) are known to cluster and to be differently distributed in men and women. The aim of this study was to sex-specifically explore clusters of acknowledged AMI risk factors by factor analysis, and to study whether such clusters are associated with left ventricular hypertrophy (LVH), used as a subclinical measure of CHD.
In 2001-2005, 2328 subjects (30-74 years) were randomly selected from two municipalities in Sweden (participation-rate 76%) and were assessed with regard to cardiovascular risk factors; 852 participants also had an echocardiographic examination performed.
Factor analysis identified three identical factors in men and women. WHR, HOMA-ir, systolic blood pressure, and ApoB/ApoA1 loaded significantly on the principal "metabolic factor", leisure-time physical activity and self-rated health loaded significantly on the "vitality factor", and smoking and alcohol consumption loaded significantly on the "addiction factor". The metabolic factor was associated with LVH in both men (P
The authors investigated a possible contextual effect of neighborhood on individual use of hormone replacement therapy (HRT) and antihypertensive medication (AHM) and the impact of neighborhood social participation on individual use of these medications. They attempted to disentangle contextual from individual influences. Multilevel logistic regression modeling was used to analyze data on 15,456 women aged 45-73 years (first level) residing in 95 neighborhoods (second level) of the city of Malmö, Sweden (250,000 inhabitants) who participated in the Malmö Diet and Cancer Study (1991-1996). AHM use was studied among 7,558 participants with defined hypertension. Of the total variability in medication use in this population, only 1.7% (HRT) and 0.5% (AHM) was between neighborhoods. After adjustment for age, individual socioeconomic factors, individual low levels of social participation, and health and behavioral variables, no neighborhood effect on AHM use was found. However, women living in neighborhoods with low social participation were much less likely to use HRT (odds ratio = 0.36, 95% confidence interval: 0.21, 0.63), especially if they themselves experienced low social participation (synergy index, 1.53) or were immigrants (synergy index, 1.68). The Malmö neighborhoods were homogeneous with regard to HRT and especially AHM use. However, differences in neighborhood social participation affected HRT use independently of individual characteristics.
It is a known fact that the 1990s brought a decrease in mortality after myocardial infarction in Sweden but that differences in mortality rates following myocardial infarction still remain between the Swedish counties. Unresolved, however, are questions as to what these inter-county differences mean for the individual patient and what role hospital care plays in this context. We analysed all patients aged 64-85 years who were hospitalised following diagnosis of myocardial infarction in Sweden during the period 1993-1996. To gain an understanding of the relevance of geographical differences in mortality after myocardial infarction for the individual patient we applied multi-level regression analysis and calculated county and hospital median odds ratios (MORs) in relation to 28-day mortality. For hospitalised patients with myocardial infarction, being cared for in another hospital with higher mortality would increase the risk of dying by 9% (MOR = l.09) in men and 12% in women. If these patients moved to another county with higher mortality the risk would increase by 7% and 3%, respectively. The small geographical differences in 28-day mortality after myocardial infarction found in Sweden suggest a high degree of equality across the country; however, further improvement could be achieved in hospital care, especially for women--an issue that deserves further analysis.
Comment In: Lakartidningen. 2005 Jan 3-16;102(1-2):9-1015707101
Multiple medicine use among elderly persons is likely to be the result of treatment regimens developed over a long period of time. By learning more about how multiple medication use develops, the quality of prescribing may be improved across the adult lifespan.
To describe patterns of multiple medicine use in the general Swedish population and its association with sociodemographic, lifestyle, and health status factors.
Data from a cross-sectional population health survey collected during 2001-2005 from 2816 randomly selected Swedish residents (age 30-75 y; response rate 76%) were analyzed. Multiple medicine use was restricted to prescription drugs and defined as the 75th percentile; that is, the 25% of the study group using the highest number of drugs per individual.
Seventy-one percent of the respondents used some kind of drug, 51.5% used one or more prescription drug, 38.4% used one or more over-the-counter (OTC) medication, and 8.3% used one or more herbal preparation. The cutoff amounts defining multiple medicine use were: 2 or more medications for 30- to 49-year-olds, 3 or more for 50- to 64-year-olds, and 5 or more for 65- to 75-year-olds. No association between use of multiple medicines and use of OTC drugs or herbal preparations was found. When drugs were classified into therapeutic subgroups, 76.3% of those aged 30-49 years, 97.9% of those aged 50-64 years, and 100% of those aged 65-75 years were taking a unique combination of drugs. Multivariate analyses showed that diabetes and poor self-rated health were associated with multiple medicine use in all age cohorts. Female sex and hypertension were associated with multiple medicine use among those aged 30-49 and 50-64 years, current smoking among those aged 50-64 years, and obesity among those aged 65-75 years.
Multiple medicine use was associated with morbidity and poor self-rated health across all age groups. The vast majority of users of multiple drugs are taking a unique combination of medications.