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Alehagen, Urban
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Broström, A., Wahlin, A., Alehagen, U., Ulander, M. & Johansson, P. (2018). Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.. Journal of Cardiovascular Nursing, 33(5), 422-428
Open this publication in new window or tab >>Sex-Specific Associations Between Self-reported Sleep Duration, Cardiovascular Disease, Hypertension, and Mortality in an Elderly Population.
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2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 5, p. 422-428Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Both short and long sleep durations have been associated to increased mortality. Knowledge about sex-specific differences among elderly regarding associations between sleep duration, cardiovascular health, and mortality is sparse.

OBJECTIVE: The aims of this study are to examine the association between self-reported sleep duration and mortality and to investigate whether this association is sex specific and/or moderated by cardiovascular morbidity, and also to explore potential mediators of sleep duration effects on mortality.

METHODS: A population-based, observational, cross-sectional design with 6-year follow-up with mortality as primary outcome was conducted. Self-rated sleep duration, clinical examinations, echocardiography, and blood samples (N-terminal fragment of proBNP) were collected. A total of 675 persons (50% women; mean age, 78 years) were divided into short sleepers (≤6 hours; n = 231), normal sleepers (7-8 hours; n = 338), and long sleepers (≥9 hours; n = 61). Data were subjected to principal component analyses. Cardiovascular disease (CVD) and hypertension factors were extracted and used as moderators and as mediators in the regression analyses.

RESULTS: During follow-up, 55 short sleepers (24%), 68 normal sleepers (20%), and 21 long sleepers (34%) died. Mediator analyses showed that long sleep was associated with mortality in men (hazard ratio [HR], 1.8; P = .049), independently of CVD and hypertension. In men with short sleep, CVD acted as a moderator of the association with mortality (HR, 4.1; P = .025). However, when using N-terminal fragment of proBNP, this effect became nonsignificant (HR, 3.1; P = .06). In woman, a trend to moderation involving the hypertension factor and short sleep was found (HR, 4.6; P = .09).

CONCLUSION: Short and long sleep duration may be seen as risk markers, particularly among older men with cardiovascular morbidity.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-154038 (URN)10.1097/JCN.0000000000000393 (DOI)000457865500009 ()28060086 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-05-02
Szummer, K., Evans, M., Carrero, J. J., Alehagen, U., Dahlström, U., Benson, L. & Lund, L. H. (2017). Comparison of the Chronic Kidney Disease Epidemiology Collaboration, the Modification of Diet in Renal Disease study and the Cockcroft-Gault equation in patients with heart failure. Open heart, 4(2), Article ID e000568.
Open this publication in new window or tab >>Comparison of the Chronic Kidney Disease Epidemiology Collaboration, the Modification of Diet in Renal Disease study and the Cockcroft-Gault equation in patients with heart failure
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2017 (English)In: Open heart, E-ISSN 2053-3624, Vol. 4, no 2, article id e000568Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It is unknown how the creatinine-based renal function estimations differ for dose adjustment cut-offs and risk prediction in patients with heart failure.

METHOD AND RESULTS: The renal function was similar with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) (median 59 mL/min/1.73 m2, IQR 42 to 77) and Modification of Diet in Renal Disease Study (MDRD) (59 mL/min/1.73 m2, IQR 43 to 75) and slightly lower with the Cockcroft-Gault (CG) equation (57 mL/min, IQR 39 to 82). Across the commonly used renal function stages, the CKD-EPI and the MDRD classified patients into the same stage in 87.2% (kappa coefficient 0.83, p<0.001); the CKD-EPI and the CG equation agreed in 52.3% (kappa coefficient 0.39, p<0.001). Hence, a differing number of patients will receive dose adjustment depending on which formula is used as cut-off. The CG equation predicted worse prognosis better (c-statistics 0.740, 95% CI 0.734 to 0.746) than CKD-EPI (0.697, 95% CI 0.690 to 0.703, p<0.001) and MDRD (0.680, 95% CI 0.734 to 0.746). Using net reclassification improvement (NRI), the CG identified 12.8% more patients at higher risk of death as compared with the CKD-EPI equation. Patients registered in the Swedish Heart Failure Registry (n= 40 736) with standardised creatinine values between 2000 and 2012 had their renal function estimated with the CKD-EPI, the MDRD and the CG. Agreement between the formulas was compared for categories. Prediction of death was assessed with c-statistics and with NRI.

CONCLUSION: The choice of renal function estimation formula has clinical implications and differing results at various cut-off levels. For prognosis, the CG predicts mortality better than the CKD-EPI and MDRD.

Place, publisher, year, edition, pages
Gateshead, United Kingdom: Open House International Association, 2017
Keywords
application, creatinine, heart failure, prognosis, register, renal function estimation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-144357 (URN)10.1136/openhrt-2016-000568 (DOI)28761677 (PubMedID)2-s2.0-85020645932 (Scopus ID)
Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2018-09-26Bibliographically approved
Fredriksson, A. G., Svalbring, E., Eriksson, J., Dyverfeldt, P., Alehagen, U., Engvall, J., . . . Carlhäll, C.-J. (2016). 4D flow MRI can detect subtle right ventricular dysfunction in primary left ventricular disease.. Journal of Magnetic Resonance Imaging, 43(3), 558-565
Open this publication in new window or tab >>4D flow MRI can detect subtle right ventricular dysfunction in primary left ventricular disease.
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2016 (English)In: Journal of Magnetic Resonance Imaging, ISSN 1053-1807, E-ISSN 1522-2586, Vol. 43, no 3, p. 558-565Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate whether 4D flow magnetic resonance imaging (MRI) can detect subtle right ventricular (RV) dysfunction in primary left ventricular (LV) disease.

MATERIALS AND METHODS: 4D flow and morphological 3T MRI data were acquired in 22 patients with mild ischemic heart disease who were stratified into two groups based on LV end-diastolic volume index (EDVI): lower-LVEDVI and higher-LVEDVI, as well as in 11 healthy controls. The RV volume was segmented at end-diastole (ED) and end-systole (ES). Pathlines were emitted from the ED volume and traced forwards and backwards in time to ES. The blood volume was separated into flow components. The Direct Flow (DF) component was defined as RV inflow passing directly to outflow. The kinetic energy (KE) of the DF component was calculated. Echocardiographic conventional RV indices were also assessed.

RESULTS: The higher-LVEDVI group had larger LVEDVI and lower LV ejection fraction (98 ± 32 ml/m(2) ; 48 ± 13%) compared to the healthy (67 ± 12, P = 0.002; 64 ± 7, P < 0.001) and lower-LVEDI groups (62 ± 10; 68 ± 7, both P < 0.001). The RV 4D flow-specific measures "DF/EDV volume-ratio" and "DF/EDV KE-ratio at ED" were lower in the higher-LVEDVI group (38 ± 5%; 52 ± 6%) compared to the healthy (44 ± 6; 65 ± 7, P = 0.018 and P < 0.001) and lower-LVEDVI groups (44 ± 6; 64 ± 7, P = 0.011 and P < 0.001). There was no difference in any of the conventional MRI and echocardiographic RV indices between the three groups.

CONCLUSION: We found that in primary LV disease mild impairment of RV function can be detected by 4D flow-specific measures, but not by the conventional MRI and echocardiographic indices. J. Magn. Reson. Imaging 2015.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
4D flow MRI; interventricular interaction; left ventricular disease; right ventricular function
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124293 (URN)10.1002/jmri.25015 (DOI)000373000300003 ()26213253 (PubMedID)
Note

Funding agencies: Swedish Heart and Lung Foundation; Swedish Research Council; European Union [223615]; Medical Research Council of Southeast Sweden (FORSS); County Council of Ostergotland/Heart and Medicine Center

Available from: 2016-01-25 Created: 2016-01-25 Last updated: 2017-05-03
Karlström, P., Johansson, P., Dahlström, U., Boman, K. & Alehagen, U. (2016). Can BNP-guided therapy improve health-related quality of life, and do responders to BNP-guided heart failure treatment have improved health-related quality of life? Results from the UPSTEP study.. BMC Cardiovascular Disorders, 16
Open this publication in new window or tab >>Can BNP-guided therapy improve health-related quality of life, and do responders to BNP-guided heart failure treatment have improved health-related quality of life? Results from the UPSTEP study.
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2016 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16Article in journal (Refereed) Published
Abstract [en]

Background: To investigate whether B-type natriuretic peptide (NP)-guided treatment of heart failure (HF) patients improved their health related quality of life (Hr-QoL) compared to routine HF treatment, and whether changes in Hr-QoL differed depending on whether the patient was a responder to NP-guided therapy or not.

Methods: A secondary analysis of the UPSTEP-study, a Scandinavian multicentre study using a prospective, randomized, open, blinded evaluation design on patients with HF with New York Heart Association (NYHA) class II-IV. NP-guiding was aimed to reduce BNP <150 ng/L if<75 years or BNP<300 ng/L if>75 years. A responder was defined as a patient with a BNP<300 ng/L and/or a decrease in BNP of at least 40 % in week 16 compared to study start. Short form-36 (SF-36) was used to measure Hr-QoL. At the study start, 258 patients presented evaluable SF-36 questionnaires, 131 in the BNP group and 127 in the control group. At the study end 100 patients in the NP-guided group and 98 in the control group, presenting data from both the study start and the study end.

Results: There were no significant differences in Hr-QoL between NP-guided HF treatment and control group; however significant improvements could be seen in four of the eight domains in the NP-guided group, whereas in the control group improvements could be seen in six of the domains.

Among the responders improvements could be noted in four domains whereas in the non-responders improvements could be seen in only one domain evaluating within group changes.

Conclusions: Improved Hr-QoL could be demonstrated in several of the domains in both the NP-guided and the control group. In the responder group within group analyses showed more increased Hr-QoL compared to the non-responder group. However, all groups demonstrated increase in Hr-QoL.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Heart failure, treatment guided by natriuretic peptides, Health related quality of life, responders, BNP, SF-36
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124558 (URN)10.1186/s12872-016-0221-7 (DOI)000370472800001 ()
Note

Vid tiden för disputationen förelåg publikationen endast som manuskript

Funding agencies:  Swedish Heart-lung foundation [20060596]; Regional Research Foundation in south-eastern Sweden [FORSS-3963]; Regional Research Foundation in northern Sweden; Biosite international; Infiniti Medical AB

Available from: 2016-02-03 Created: 2016-02-03 Last updated: 2017-11-30Bibliographically approved
Goetze, J. P., Rehfeld, J. F. & Alehagen, U. (2016). Cholecystokinin in plasma predicts cardiovascular mortality in elderly females. International Journal of Cardiology, 209, 37-41
Open this publication in new window or tab >>Cholecystokinin in plasma predicts cardiovascular mortality in elderly females
2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 209, p. 37-41Article in journal (Refereed) Published
Abstract [en]

Background: Cholecystokinin (CCK) and gastrin are related gastrointestinal hormones with documented cardiovascular effects of exogenous administration. It is unknown whether measurement of endogenous CCK or gastrin in plasma contains information regarding cardiovascular mortality. Methods: Mortality risk was evaluated using Cox proportional hazard regression and Kaplan-Meier analyses. Elderly patients in a primary care setting with symptoms of cardiac disease, i.e. shortness of breath, peripheral edema, and/or fatigue, were evaluated (n = 470). Primary care patients were followed for 13 years (from 1999); the 5-year all-cause and cardiovascular mortality was used as end point. Results: In univariate analysis, patients in the 4th CCK quartile had an increased risk of 5-year cardiovascular mortality (hazard ratio 3.9, 95% confidence interval: 2.1-7.0, p &lt; 0.0001). In multivariate analysis including established factors associated with cardiovascular mortality, CCK concentrations in the 4th quartile were still associated with increased 5-year cardiovascular mortality risk (HR 3.1, 95% C.I.: 1.7-5.7, p = 0.0004), even when including 4th quartile NT-proBNP concentrations in the same model. We observed a marked difference between the genders, where CCK concentrations in the 4th quartile were associated with a higher 5-year cardiovascular mortality in female patients (HR 8.99, 95% C.I.: 3.49-102.82, p = 0.0007) compared to men (1.47, 95% C.I.: 0.7-3.3, p = 0.35). In contrast, no significant information was obtained from 4th quartile gastrin concentrations on 5-year cardiovascular mortality risk. Conclusions: CCK in plasma is an independent marker of cardiovascular mortality in elderly female patients. The study thus introduces measurement of plasma CCK in gender-specific cardiovascular risk assessment. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2016
Keywords
ANP; Atrial natriuretic peptide; Cholecystokinin; BNP; B-type natriuretic peptide; Heart failure; Prognosis
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-127412 (URN)10.1016/j.ijcard.2016.02.038 (DOI)000372530700013 ()26878472 (PubMedID)
Note

Funding Agencies|Novo Nordisk Foundation; Danish Center for Cellular Communication

Available from: 2016-05-02 Created: 2016-04-26 Last updated: 2017-05-02
Alehagen, U., Johansson, P., Björnstedt, M., Rosén, A., Post, C. & Aaseth, J. (2016). Relatively high mortality risk in elderly Swedish subjects with low selenium status. European Journal of Clinical Nutrition, 70(1), 91-96
Open this publication in new window or tab >>Relatively high mortality risk in elderly Swedish subjects with low selenium status
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2016 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 70, no 1, p. 91-96Article in journal (Refereed) Published
Abstract [en]

Background/Objectives: 

The daily dietary intake of selenium (Se), an essential trace element, is still low in Sweden in spite of decades of nutritional information campaigns and the effect of this on the public health is presently not well known. The objective of this study was to determine the serum Se levels in an elderly Swedish population and to analyze whether a low Se status had any influence on mortality.

Subjects/Methods: 

Six-hundred sixty-eight (n=668) elderly participants were invited from a municipality and evaluated in an observational study. Individuals were followed for 6.8 years and Se levels were re-evaluated in 98 individuals after 48 months. Clinical examination of all individuals included functional classification, echocardiography, electrocardiogram and serum Se measurement. All mortality was registered and endpoints of mortality were assessed by Kaplan–Meier plots, and Cox proportional hazard ratios adjusted for potential confounding factors were calculated.

Results: 

The mean serum Se level of the study population (n=668) was 67.1 μg/l, corresponding to relatively low Se intake. After adjustment for male gender, smoking, ischemic heart disease, diabetes, chronic obstructive pulmonary disease and impaired heart function, persons with serum Se in the lowest quartile had 43% (95% confidence interval (CI): 1.02–2.00) and 56% (95% CI: 1.03–2.36) increased risk for all-cause and cardiovascular mortality, respectively. The result was not driven by inflammatory effects on Se concentration in serum.

Conclusion: 

The mean serum Se concentration in an elderly Swedish population was 67.1 μg/l, which is below the physiological saturation level for several selenoprotein enzymes. This result may suggest the value of modest Se supplementation in order to improve the health of the Swedish population.

Place, publisher, year, edition, pages
Nature Publishing Group, 2016
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-120772 (URN)10.1038/ejcn.2015.92 (DOI)000369434800015 ()26105108 (PubMedID)
Note

Funding agencies: County Council of Ostergotland; University of Linkoping; Cancer-och Allergifonden

Available from: 2015-08-24 Created: 2015-08-24 Last updated: 2017-09-22Bibliographically approved
Alehagen, U., Alexander, J. & Aaseth, J. (2016). Supplementation with Selenium and Coenzyme Q10 Reduces Cardiovascular Mortality in Elderly with Low Selenium Status. A Secondary Analysis of a Randomised Clinical Trial. PLoS ONE, 11(7), Article ID e0157541.
Open this publication in new window or tab >>Supplementation with Selenium and Coenzyme Q10 Reduces Cardiovascular Mortality in Elderly with Low Selenium Status. A Secondary Analysis of a Randomised Clinical Trial
2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 7, article id e0157541Article in journal (Refereed) Published
Abstract [en]

Background Selenium is needed by all living cells in order to ensure the optimal function of several enzyme systems. However, the selenium content in the soil in Europe is generally low. Previous reports indicate that a dietary supplement of selenium could reduce cardiovascular disease but mainly in populations in low selenium areas. The objective of this secondary analysis of a previous randomised double-blind placebo-controlled trial from our group was to determine whether the effects on cardiovascular mortality of supplementation with a fixed dose of selenium and coenzyme Q10 combined during a four-year intervention were dependent on the basal level of selenium. Methods In 668 healthy elderly individuals from a municipality in Sweden, serum selenium concentration was measured. Of these, 219 individuals received daily supplementation with selenium (200 mu g Se as selenized yeast) and coenzyme Q10 (200 mg) combined for four years. The remaining participants (n = 449) received either placebo (n = 222) or no treatment (n = 227). All cardiovascular mortality was registered. No participant was lost during a median follow-up of 5.2 years. Based on death certificates and autopsy results, all mortality was registered. Findings The mean serum selenium concentration among participants at baseline was low, 67.1 mu g/L. Based on the distribution of selenium concentration at baseline, the supplemented group was divided into three groups; amp;lt;65 mu g/L, 65-85 mu g/L, and amp;gt;85 mu g/L (45 and 90 percentiles) and the remaining participants were distributed accordingly. Among the non-treated participants, lower cardiovascular mortality was found in the high selenium group as compared with the low selenium group (13.0% vs. 24.1%; P = 0.04). In the group with the lowest selenium basal concentration, those receiving placebo or no supplementation had a mortality of 24.1%, while mortality was 12.1% in the group receiving the active substance, which was an absolute risk reduction of 12%. In the middle selenium concentration group a mortality of 14.0% in the non-treated group, and 6.0% in the actively treated group could be demonstrated; thus, there was an absolute risk reduction of 8.0%. In the group with a serum concentration of amp;gt;85 mu g/L, a cardiovascular mortality of 17.5% in the non-treated group, and 13.0% in the actively treated group was observed. No significant risk reduction by supplementation could thus be found in this group. Conclusions In this evaluation of healthy elderly Swedish municipality members, two important results could be reported. Firstly, a low mean serum selenium concentration, 67 mu g/L, was found among the participants, and the cardiovascular mortality was higher in the subgroup with the lower selenium concentrations amp;lt; 65 mu g/L in comparison with those having a selenium concentration amp;gt; 85 mu g/L. Secondly, supplementation was cardio-protective in those with a low selenium concentration, amp;lt;= 85 at inclusion. In those with serum seleniumamp;gt; 85 mu g/L and no apparent deficiency, there was no effect of supplementation. This is a small study, but it presents interesting data, and more research on the impact of lower selenium intake than recommended is therefore warranted.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2016
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-130422 (URN)10.1371/journal.pone.0157541 (DOI)000378914900010 ()27367855 (PubMedID)
Note

Funding Agencies|Pharma Nord Aps, Denmark; County Council of Ostergotland; Linkoping University

Available from: 2016-08-07 Created: 2016-08-05 Last updated: 2017-11-28
Karlström, P., Johansson, P., Dahlström, U., Boman, K. & Alehagen, U. (2016). Time since heart failure diagnosis influences outcomes more than age when handling heart failure patients: Results from the UPSTEP study.
Open this publication in new window or tab >>Time since heart failure diagnosis influences outcomes more than age when handling heart failure patients: Results from the UPSTEP study
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2016 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Heart failure (HF) is a life-threatening condition and optimal handling is necessary to reduce risk of therapy failure.

Objectives: The aims of this study were (I) to evaluate the impact of patient age on clinical outcomes, (II) to evaluate the impact of duration of the HF disease on outcomes, and (III) to evaluate the impact of age and HF duration on B-type Natriuretic Peptide (BNP) concentration.

Methods and Results: With data from the UPSTEP (Use of PeptideS in Tailoring hEart failure Project) study we retrospectively evaluated how age and HF duration affected HF outcome. HF duration was divided into <1 year (group 1), 1-5 years (group 2) and >5 years (group 3). The multivariate Cox proportional hazard regression analysis showed that HF duration influenced outcome more than age, even when adjusted for comorbidities(<1 year versus >5 years: HR 1.65; 95 % CI 1.28-2.14; p <0.0002) on HF mortality and hospitalizations. The influence of age on BNP showed increased BNP as age increased. However, there was a significant effect on BNP concentration comparing HF duration of < one year to HF duration >five years even when adjusted for age.

Conclusions: Patients with longer HF duration had significantly worse outcome compared to those with short duration, even when adjusted for patient age and comorbidities. Age itself did not influence outcome in this evaluation. Age had impact on BNP concentration; however BNP concentration increased as HF duration increased even when adjusted for age.

Keywords
Heart failure, B-type natriuretic peptides, age, heart failure duration
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124559 (URN)
Available from: 2016-02-03 Created: 2016-02-03 Last updated: 2016-02-03Bibliographically approved
Johansson, P., Alehagen, U., van der Wal, M. H. L., Svensson, E. & Jaarsma, T. (2016). Vitamin D levels and depressive symptoms in patients with chronic heart failure. International Journal of Cardiology, 207, 185-189
Open this publication in new window or tab >>Vitamin D levels and depressive symptoms in patients with chronic heart failure
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2016 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 207, p. 185-189Article in journal (Refereed) Published
Abstract [en]

Background: Vitamin D (Vit D) is suggested to play a role in the regulation of physical function as well as in depression. Since, Vit D deficiency is common in patients with heart failure (HF), this study aims to explore if Vit D levels are associated with depressive symptoms and if this association is mediated by the patients physical function. Method: 506 HF patients (mean age 71, 38% women) were investigated. Depressive symptoms and physical function were measured with the Centre for Epidemiological Studies Depression Scale and the physical function scale from the RAND-36. Vit D was measured in blood samples Results: At baseline there was no relationship between depressive symptoms and Vit D levels. However, at 18 months follow-up 29% of patients with Vit D &lt; 50 nmol/l at baseline had depressive symptoms compared 19% of those with Vit D levels &gt;50 nmol/l (p &lt; 0.05). Only in patients with Vit D &lt; 50 nmol/l, Vit D correlated significantly to physical function and depressive symptoms (r = .29, p &lt; 0.001 and r = .20, p &lt; 0.01). In structural equation modelling an indirect association between Vit D and depressive symptoms was found, mediated by physical function (B = 0.20). This association was only found in patients with Vit D levels &lt;50 nmol/l. Conclusion: In HF patients with Vit D &lt; 50 nmol/l, Vit D is associated to depressive symptoms during follow-up and this association is mediated by physical function. This relationship is not found in patients with Vitamin D level &gt;50 nmol/l. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2016
Keywords
Heart failure; Vitamin D; Depression; Physical exercise
National Category
Sociology
Identifiers
urn:nbn:se:liu:diva-126804 (URN)10.1016/j.ijcard.2016.01.173 (DOI)000371271400062 ()26803239 (PubMedID)
Note

Funding Agencies|Netherlands Heart Foundation [2000Z003]

Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2019-06-27
Alehagen, U., Benson, L., Edner, M., Dahlström, U. & Lund, L. H. (2015). Association Between Use of Statins and Mortality in Patients With Heart Failure and Ejection Fraction of greater than= 50%. Circulation Heart Failure, 8(5), 862-870
Open this publication in new window or tab >>Association Between Use of Statins and Mortality in Patients With Heart Failure and Ejection Fraction of greater than= 50%
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2015 (English)In: Circulation Heart Failure, ISSN 1941-3289, E-ISSN 1941-3297, Vol. 8, no 5, p. 862-870Article in journal (Refereed) Published
Abstract [en]

Background The pathophysiology of heart failure with preserved ejection fraction is poorly understood, but may involve a systemic proinflammatory state. Therefore, statins might improve outcomes in patients with heart failure with preserved ejection fraction defined as 50%. Methods and Results Of 46 959 unique patients in the prospective Swedish Heart Failure Registry, 9140 patients had heart failure and ejection fraction 50% (age 7711 years, 54.0% women), and of these, 3427 (37.5%) were treated with statins. Propensity scores for statin treatment were derived from 40 baseline variables. The association between statin use and primary (all-cause mortality) and secondary (separately, cardiovascular mortality, and combined all-cause mortality or cardiovascular hospitalization) end points was assessed with Cox regressions in a population matched 1:1 based on age and propensity score. In the matched population, 1-year survival was 85.1% for statin-treated versus 80.9% for untreated patients (hazard ratio, 0.80; 95% confidence interval, 0.72-0.89; Pless than0.001). Statins were also associated with reduced cardiovascular death (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P=0.026) and composite all-cause mortality or cardiovascular hospitalization (hazard ratio, 0.89; 95% confidence interval, 0.82-0.96; P=0.003). Conclusions In heart failure with ejection fraction 50%, the use of statins was associated with improved outcomes. The mechanisms should be evaluated and the effects tested in a randomized trial.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS and WILKINS, 2015
Keywords
heart failure; heart failure with preserved ejection fraction; mortality; propensity score; statin intervention
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121899 (URN)10.1161/CIRCHEARTFAILURE.115.002143 (DOI)000361186000005 ()26243795 (PubMedID)
Note

Funding Agencies|County Council of Ostergotland; Swedish Heart and Lung Foundation; University of Linkoping; County Council of Stockholm; Swedish Research Council; Swedish Heart Failure Research Foundation

Available from: 2015-10-13 Created: 2015-10-12 Last updated: 2017-12-01
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