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Bergström, G., Rosengren, A., Bacsovics Brolin, E., Brandberg, J., Cederlund, K., Engström, G., . . . Lind, L. (2023). Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS. Atherosclerosis, 373, 46-54
Open this publication in new window or tab >>Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS
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2023 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 373, p. 46-54Article in journal (Refereed) Published
Abstract [en]

Background and aims: Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change.Methods: We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomog-raphy angiography (CCTA) and expressed as segment involvement score (SIS).Results: The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p < 0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women.Conclusions: Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2023
Keywords
Weight; Weight gain; Midlife; Coronary artery calcium score; Sex
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-192724 (URN)10.1016/j.atherosclerosis.2023.01.024 (DOI)001010662800001 ()36813601 (PubMedID)
Note

Funding: Swedish CArdioPulmonary bioImage Study (SCAPIS); Knut and Alice Wallenberg Foundation; Swedish Research Council and VINNOVA (Swedens Innovation agency) ,; University of Gothenburg and Sahlgrenska University Hospital; Karolinska Institutet; Karolinska University Hospital; Linkoping University; University Hospital; Lund University; Skkne University Hospital; Umek University and University Hospital, Uppsala University; Swedish Heart and Lung Foundation [20180324]; Swedish Research Council [2019-01140, 160334]; LUA/ALF [2018-02527]; AFA Insurance [ALFGBG-718851]

Available from: 2023-03-27 Created: 2023-03-27 Last updated: 2023-08-31
Hammaréus, F., Nilsson, L., Ong, K.-L., Kristenson, M., Festin, K., Lundberg, A. K., . . . Jonasson, L. (2023). Plasma type I collagen α1 chain in relation to coronary artery disease: findings from a prospective population-based cohort and an acute myocardial infarction prospective cohort in Sweden.. BMJ Open, 13(9), Article ID e073561.
Open this publication in new window or tab >>Plasma type I collagen α1 chain in relation to coronary artery disease: findings from a prospective population-based cohort and an acute myocardial infarction prospective cohort in Sweden.
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 9, article id e073561Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate the association between type I collagen α1 chain (COL1α1) levels and coronary artery disease (CAD) by using absolute quantification in plasma. Also, to investigate the correlates of COL1α1 to clinical characteristics and circulating markers of collagen metabolism.

DESIGN: Life conditions, Stress and Health (LSH) study: prospective cohort study, here with a nested case-control design.Assessing Platelet Activity in Coronary Heart Disease (APACHE) study: prospective cohort study.

SETTING: LSH: primary care setting, southeast Sweden.APACHE: cardiology department, university hospital, southeast Sweden.

PARTICIPANTS: LSH: 1007 randomly recruited individuals aged 45-69 (50% women). Exclusion criteria was serious disease. After 13 years of follow-up, 86 cases with primary endpoint were identified and sex-matched/age-matched to 184 controls.

APACHE: 125 patients with myocardial infarction (MI), 73 with ST-elevation MI and 52 with non-ST-elevation MI.

EXCLUSION CRITERIA: Intervention study participation, warfarin treatment and short life expectancy.

PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was the association between baseline COL1α1 and first-time major event of CAD, defined as fatal/non-fatal MI or coronary revascularisation after 13 years. Secondary outcomes were the association between the collagen biomarkers PRO-C1 (N-terminal pro-peptide of type I collagen)/C1M (matrix metalloproteinase-mediated degradation of type I collagen) and CAD; temporal change of COL1α1 after acute MI up to 6 months and lastly, correlates between COL1α1 and patient characteristics along with circulating markers of collagen metabolism.

RESULTS: COL1α1 levels were associated with CAD, both unadjusted (HR=0.69, 95% CI=0.56 to 0.87) and adjusted (HR=0.55, 95% CI=0.41 to 0.75). PRO-C1 was associated with CAD, unadjusted (HR=0.62, 95% CI=0.47 to 0.82) and adjusted (HR=0.61, 95% CI=0.43 to 0.86), while C1M was not. In patients with MI, COL1α1 remained unchanged up to 6 months. COL1α1 was correlated to PRO-C1, but not to C1M.

CONCLUSIONS: Plasma COL1α1 was independently and inversely associated with CAD. Furthermore, COL1α1 appeared to reflect collagen synthesis but not degradation. Future studies are needed to confirm whether COL1α1 is a clinically useful biomarker of CAD.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
coronary heart disease, ischaemic heart disease, vascular medicine
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-198543 (URN)10.1136/bmjopen-2023-073561 (DOI)001127161700042 ()37714678 (PubMedID)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, SwedenSwedish Heart Lung Foundation
Note

Funding: Swedish Research Council [2004-1881]; Swedish Heart and Lung Foundation [2004053]; ALF Region Ostergotland [LIO 131 471]; County Council of Ostergotland [ROE-910951]; Academy of Health Care, County Council of Jonkoping; Danish Research Foundation; Linkoping University; Innovation Fund Denmark

Available from: 2023-10-16 Created: 2023-10-16 Last updated: 2024-03-18Bibliographically approved
Ekblom-Bak, E., Börjesson, M., Bergman, F., Bergström, G., Dahlin-Almevall, A., Drake, I., . . . Ekblom, Ö. (2022). Accelerometer derived physical activity patterns in 27.890 middle-aged adults: The SCAPIS cohort study. Scandinavian Journal of Medicine and Science in Sports, 32(5), 866-880
Open this publication in new window or tab >>Accelerometer derived physical activity patterns in 27.890 middle-aged adults: The SCAPIS cohort study
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2022 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 32, no 5, p. 866-880Article in journal (Refereed) Published
Abstract [en]

The present study aims to describe accelerometer-assessed physical activity (PA) patterns and fulfillment of PA recommendations in a large sample of middle-aged men and women, and to study differences between subgroups of socio-demographic, socio-economic, and lifestyle-related variables. A total of 27 890 (92.5% of total participants, 52% women, aged 50-64 years) middle-aged men and women with at least four days of valid hip-worn accelerometer data (Actigraph GT3X+, wGT3X+ and wGT3X-BT) from the Swedish CArdioPulmonary bioImage Study, SCAPIS, were included. In total, 54.5% of daily wear time was spent sedentary, 39.1% in low, 5.4% in moderate, and only 0.1% in vigorous PA. Male sex, higher education, low financial strain, born in Sweden, and sedentary/light working situation were related to higher sedentary time, but also higher levels of vigorous PA. High BMI and having multiple chronic diseases associated strongly with higher sedentary time and less time in all three PA intensities. All-year physically active commuters had an overall more active PA pattern. The proportion fulfilling current PA recommendations varied substantially (1.4% to 92.2%) depending on data handling procedures and definition used. Twenty-eight percent was defined as having an "at-risk" behavior, which included both high sedentary time and low vigorous PA. In this large population-based sample, a majority of time was spent sedentary and only a fraction in vigorous PA, with clinically important variations between subgroups. This study provides important reference material and emphasizes the importance of a comprehensive assessment of all aspects of the individual PA pattern in future research and clinical practice.

Place, publisher, year, edition, pages
Wiley, 2022
Keywords
accelerometery; pattern; physical Activity; population-based; SCAPIS Study; sedentary
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-183047 (URN)10.1111/sms.14131 (DOI)000752081700001 ()35080270 (PubMedID)2-s2.0-85124561197 (Scopus ID)
Available from: 2022-02-22 Created: 2022-02-22 Last updated: 2023-05-04Bibliographically approved
Edin, C., Ekstedt, M., Scheffel, T., Karlsson, M., Swahn, E., Östgren, C. J., . . . Carlhäll, C.-J. (2022). Ectopic fat is associated with cardiac remodeling - A comprehensive assessment of regional fat depots in type 2 diabetes using multi-parametric MRI.. Frontiers in Cardiovascular Medicine, 9, Article ID 813427.
Open this publication in new window or tab >>Ectopic fat is associated with cardiac remodeling - A comprehensive assessment of regional fat depots in type 2 diabetes using multi-parametric MRI.
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2022 (English)In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 9, article id 813427Article in journal (Refereed) Published
Abstract [en]

Background: Different regional depots of fat have distinct metabolic properties and may relate differently to adverse cardiac remodeling. We sought to quantify regional depots of body fat and to investigate their relationship to cardiac structure and function in Type 2 Diabetes (T2D) and controls.

Methods: From the SCAPIS cohort in Linköping, Sweden, we recruited 92 subjects (35% female, mean age 59.5 ± 4.6 years): 46 with T2D and 46 matched controls. In addition to the core SCAPIS data collection, participants underwent a comprehensive magnetic resonance imaging examination at 1.5 T for assessment of left ventricular (LV) structure and function (end-diastolic volume, mass, concentricity, ejection fraction), as well as regional body composition (liver proton density fat fraction, visceral adipose tissue, abdominal subcutaneous adipose tissue, thigh muscle fat infiltration, fat tissue-free thigh muscle volume and epicardial adipose tissue).

Results: Compared to the control group, the T2D group had increased: visceral adipose tissue volume index (P < 0.001), liver fat percentage (P < 0.001), thigh muscle fat infiltration percentage (P = 0.02), LV concentricity (P < 0.001) and LV E/e'-ratio (P < 0.001). In a multiple linear regression analysis, a negative association between liver fat percentage and LV mass (St Beta -0.23, P < 0.05) as well as LV end-diastolic volume (St Beta -0.27, P < 0.05) was found. Epicardial adipose tissue volume and abdominal subcutaneous adipose tissue volume index were the only parameters of fat associated with LV diastolic dysfunction (E/e'-ratio) (St Beta 0.24, P < 0.05; St Beta 0.34, P < 0.01, respectively). In a multivariate logistic regression analysis, only visceral adipose tissue volume index was significantly associated with T2D, with an odds ratio for T2D of 3.01 (95% CI 1.28-7.05, P < 0.05) per L/m2 increase in visceral adipose tissue volume.

Conclusions: Ectopic fat is predominantly associated with cardiac remodeling, independently of type 2 diabetes. Intriguingly, liver fat appears to be related to LV structure independently of VAT, while epicardial fat is linked to impaired LV diastolic function. Visceral fat is associated with T2D independently of liver fat and abdominal subcutaneous adipose tissue.

Place, publisher, year, edition, pages
Frontiers Media SA, 2022
Keywords
cardiac remodeling, ectopic fat, left ventricular diastolic function, left ventricular structure, magnetic resonance imaging, type 2 diabetes, visceral fat
National Category
Endocrinology and Diabetes Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-190027 (URN)10.3389/fcvm.2022.813427 (DOI)000890713700001 ()35966535 (PubMedID)
Note

This work was funded by the Swedish Research Council, theSwedish Heart and Lung Foundation, and through ALF GrantsRegion Östergötland.

Available from: 2022-11-17 Created: 2022-11-17 Last updated: 2023-05-04
Sederholm Lawesson, S., Swahn, E. & Alfredsson, J. (2021). Adherence to Study Drugs A Matter of Sex?. Circulation, 143(7), 696-698
Open this publication in new window or tab >>Adherence to Study Drugs A Matter of Sex?
2021 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 143, no 7, p. 696-698Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2021
Keywords
Editorials; cardiovascular agents; cardiovascular diseases; medication adherence; randomized controlled trial; sex factors
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-175425 (URN)10.1161/CIRCULATIONAHA.121.053493 (DOI)000639305800013 ()33587664 (PubMedID)
Available from: 2021-05-03 Created: 2021-05-03 Last updated: 2021-05-11Bibliographically approved
Holm, A., Swahn, E., Sederholm Lawesson, S., Gustafsson, K., Janzon, M., Jonasson, L., . . . Alfredsson, J. (2021). Sex differences in platelet reactivity in patients with myocardial infarction treated with triple antiplatelet therapy-results from assessing platelet activity in coronary heart disease (APACHE). Platelets, 32(1), 524-532
Open this publication in new window or tab >>Sex differences in platelet reactivity in patients with myocardial infarction treated with triple antiplatelet therapy-results from assessing platelet activity in coronary heart disease (APACHE)
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2021 (English)In: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 32, no 1, p. 524-532Article in journal (Refereed) Published
Abstract [en]

)Several earlier studies have reported increased risk of bleeding in women with myocardial infarction, (MI) compared to men. The reasons for the observed difference are incompletely understood, but one suggested explanation has been excess dosing of antithrombotic drugs in women. The aim of this prospective observational study was to assess sex differences in platelet activity in patients treated with three different platelet inhibitors. We recruited 125 patients (37 women and 88 men) with MI, scheduled for coronary angiography. All patients received clopidogrel and aspirin. A subgroup of patients received glycoprotein (GP) IIb/IIIa-inhibitor. Platelet aggregation in whole blood was assessed at several time points, using impedance aggregometry. SolubleP-selectin was measured 3 days after admission. There were no significant differences between women and men in baseline features or comorbidities except higher frequency of diabetes, lower hemoglobin value, and lower estimated glomerular filtration rate, in women on admission. We observed significantly more in-hospital bleeding events in women compared to men (18.9% vs. 6.8%,p= .04). There were no differences in platelet aggregation using three different agonists, reflecting treatment effect of GPIIb/IIIa-inhibitors, clopidogrel, and aspirin, 6-8 hours, 3 days, 7-9 days, or 6 months after loading dose. Moreover, there was no significant difference in solubleP-selectin. The main finding of this study was a consistent lack of difference between the sexes in platelet aggregation, using three different agonists at several time-points. Our results do not support excess dosing of anti-platelet drugs as a major explanation for increased bleeding risk in women.

Place, publisher, year, edition, pages
Taylor & Francis, 2021
Keywords
Gender; myocardial infarction; platelet aggregation; sex
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-167751 (URN)10.1080/09537104.2020.1771550 (DOI)000543070400001 ()32493086 (PubMedID)2-s2.0-85088856352 (Scopus ID)
Note

Funding Agencies|Linkoping University; County Council of Ostergotland

Available from: 2020-07-21 Created: 2020-07-21 Last updated: 2022-05-25Bibliographically approved
Östgren, C. J., Soderberg, S., Festin, K., Angeras, O., Bergstrom, G., Blomberg, A., . . . Jernberg, T. (2021). Systematic Coronary Risk Evaluation estimated risk and prevalent subclinical atherosclerosis in coronary and carotid arteries: A population-based cohort analysis from the Swedish Cardiopulmonary Bioimage Study. European Journal of Preventive Cardiology, 28(3), 250-259
Open this publication in new window or tab >>Systematic Coronary Risk Evaluation estimated risk and prevalent subclinical atherosclerosis in coronary and carotid arteries: A population-based cohort analysis from the Swedish Cardiopulmonary Bioimage Study
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2021 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 28, no 3, p. 250-259Article in journal (Refereed) Published
Abstract [en]

Background It is not clear if the European Systematic Coronary Risk Evaluation algorithm is useful for identifying prevalent subclinical atherosclerosis in a population of apparently healthy individuals. Our aim was to explore the association between the risk estimates from Systematic Coronary Risk Evaluation and prevalent subclinical atherosclerosis. Design The design of this study was as a cross-sectional analysis from a population-based study cohort. Methods From the general population, the Swedish Cardiopulmonary Bioimage Study randomly invited individuals aged 50-64 years and enrolled 13,411 participants mean age 57 (standard deviation 4.3) years; 46% males between November 2013-December 2016. Associations between Systematic Coronary Risk Evaluation risk estimates and coronary artery calcification and plaques in the carotid arteries by using imaging data from a computed tomography of the heart and ultrasonography of the carotid arteries were examined. Results Coronary calcification was present in 39.5% and carotid plaque in 56.0%. In men, coronary artery calcium score amp;gt;0 ranged from 40.7-65.9% and presence of carotid plaques from 54.5% to 72.8% in the age group 50-54 and 60-65 years, respectively. In women, the corresponding difference was from 17.1-38.9% and from 41.0-58.4%. A doubling of Systematic Coronary Risk Evaluation was associated with an increased probability to have coronary artery calcium score amp;gt;0 (odds ratio: 2.18 (95% confidence interval 2.07-2.30)) and to have amp;gt;1 carotid plaques (1.67 (1.61-1.74)). Conclusion Systematic Coronary Risk Evaluation estimated risk is associated with prevalent subclinical atherosclerosis in two major vascular beds in a general population sample without established cardiovascular disease or diabetes mellitus. Thus, the Systematic Coronary Risk Evaluation risk chart may be of use for estimating the risk of subclinical atherosclerosis.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2021
Keywords
Systematic Coronary Risk Evaluation; estimated risk; subclinical; atherosclerosis; population
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-164871 (URN)10.1177/2047487320909300 (DOI)000517878800001 ()32126830 (PubMedID)
Note

Funding Agencies|Swedish Heart-Lung FoundationSwedish Heart-Lung Foundation [2019-0012]; Knut and Alice Wallenberg FoundationKnut & Alice Wallenberg Foundation [2014-0047]; Swedish Research CouncilSwedish Research Council [822-2013-2000]; VINNOVA (Swedens Innovation agency)Vinnova [2012-04476]; University of Gothenburg; Sahlgrenska University Hospital; Karolinska InstitutetKarolinska Institutet; Karolinska University HospitalKarolinska Institutet; Linkoping University; University Hospital; Lund University; Skane University Hospital; Swedish Heart Lung FoundationSwedish Heart-Lung Foundation; Swedish government [ALFGBG-718851, ALF-VLL-548791, ALF-LIO-700841]; county councils, the ALF-agreement [ALFGBG-718851, ALF-VLL-548791, ALF-LIO-700841]; AFA Insurance [160334]

Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2022-05-24
Beygui, F., Castren, M., Brunetti, N. D., Rosell-Ortiz, F., Christ, M., Zeymer, U., . . . Goldstein, P. (2020). Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.. European Heart Journal: Acute Cardiovascular Care, 9(1_SUPPL), 59-81
Open this publication in new window or tab >>Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.
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2020 (English)In: European Heart Journal: Acute Cardiovascular Care, ISSN 2048-8726, E-ISSN 2048-8734, Vol. 9, no 1_SUPPL, p. 59-81Article in journal (Refereed) Published
Abstract [en]

Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts opinions, for all emergency medical services health providers involved in the pre-hospital management of acute cardiovascular care.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2020
Keywords
Pre-hospital; chest pain; dyspnoea
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-164659 (URN)10.1177/2048872615604119 (DOI)000516634700007 ()26315695 (PubMedID)
Available from: 2020-03-29 Created: 2020-03-29 Last updated: 2023-08-28
Sundstrom, J., Lind, L., Lampa, E., Angeras, O., Bachus, E., Bergstrom, G., . . . Rosengren, A. (2020). Weight gain and blood pressure. Journal of Hypertension, 38(3), 387-394
Open this publication in new window or tab >>Weight gain and blood pressure
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2020 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 38, no 3, p. 387-394Article in journal (Refereed) Published
Abstract [en]

Objective: Although the causality of the obesity--hypertension association is established, the potential for prevention is not. We hypothesized that weight gain between early adulthood and mid-life is associated with higher mid-life blood pressure. Methods: We investigated the hypothesis using a large contemporaneous population-based mid-life cohort of men and women aged 50-64 years. Recalled body weight at age 20 years was self-reported, and mid-life body weight and office blood pressures were measured in accordance with a detailed protocol. Results: On average, men had gained 14.9 (95% CI 14.6-15.2) kg of weight, and women 14.6 (95% CI 14.4-14.9) kg, between age 20 years and the mid-life examination, corresponding to 0.40 (95% CI 0.39-0.41) kg/year for men and women. Both weight at age 20 years and weight at the mid-life examination were associated with mid-life blood pressures. On average, a 10 kg weight increase between age 20 years and mid-life was associated with 2.2 (95% CI 0.9-3.5) mmHg higher systolic and 1.7 (95% CI 0.9-2.5) mmHg higher diastolic mid-life blood pressure in men, and 3.2 (2.5-4.0) mmHg higher systolic and 2.4 (1.9-2.9) mmHg higher diastolic mid-life blood pressure in women. Mid-life weight was more closely associated than weight at age 20 years with mid-life blood pressure. For a given mid-life weight, blood pressure was higher in persons with higher weight gain from age 20 years. Conclusion: In sum, weight gain between early adulthood and mid-life was associated with higher mid-life blood pressure. The magnitude of the association indicates a potentially great public health impact of strategies to prevent weight gain throughout adulthood.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2020
Keywords
cohort; epidemiology; obesity; public health; weight gain; SCAPIS; Swedish CArdioPulmonary bioImage Study
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-165349 (URN)10.1097/HJH.0000000000002298 (DOI)000524568900002 ()31764589 (PubMedID)
Note

Funding Agencies|Swedish Heart-Lung FoundationSwedish Heart-Lung Foundation [2019-0012]; Knut and Alice Wallenberg FoundationKnut & Alice Wallenberg Foundation [2014-0047]; Swedish Research CouncilSwedish Research Council [822-2013-2000]; VINNOVA (Swedens Innovation agency)Vinnova [2012-04476]; University of Gothenburg; Sahlgrenska University Hospital; Karolinska Institutet and Karolinska University Hospital; Linkoping University and University Hospital; Lund University; Ska ne University Hospital; Umea University and University Hospital; Uppsala University and University Hospital; AFA Insurance [160334]; Swedish government [ALF-GBG-718851, ALF-VLL-548791, ALFLIO-700841]

Available from: 2020-04-27 Created: 2020-04-27 Last updated: 2021-12-28
Ängerud, K. H., Sederholm Lawesson, S., Isaksson, R.-M., Thylén, I. & Swahn, E. (2019). Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction. European Heart Journal: Acute Cardiovascular Care, 8(3), 201-207
Open this publication in new window or tab >>Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction
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2019 (English)In: European Heart Journal: Acute Cardiovascular Care, ISSN 2048-8726, E-ISSN 2048-8734, Vol. 8, no 3, p. 201-207Article in journal (Refereed) Published
Abstract [en]

AIM: In ST-elevation myocardial infarction, time to reperfusion is crucial for the prognosis. Symptom presentation in myocardial infarction influences pre-hospital delay times but studies about differences in symptoms between patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction are sparse and inconclusive. The aim was to compare symptoms, first medical contact and pre-hospital delay times in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction.

METHODS AND RESULTS: This multicentre, observational study included 694 myocardial infarction patients from five hospitals. The patients filled in a questionnaire about their pre-hospital experiences within 24 h of hospital admittance. Chest pain was the most common symptom in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction (88.7 vs 87.0%, p=0.56). Patients with cold sweat (odds ratio 3.61, 95% confidence interval 2.29-5.70), jaw pain (odds ratio 2.41, 95% confidence interval 1.04-5.58), and nausea (odds ratio 1.70, 95% confidence interval 1.01-2.87) were more likely to present with ST-elevation myocardial infarction, whereas the opposite was true for symptoms that come and go (odds ratio 0.58, 95% confidence interval 0.38-0.90) or anxiety (odds ratio 0.52, 95% confidence interval 0.29-0.92). Use of emergency medical services was higher among patients admitted with ST-elevation myocardial infarction. The pre-hospital delay time from symptom onset to first medical contact was significantly longer in non-ST-elevation myocardial infarction (2:05 h vs 1:10 h, p=0.001).

CONCLUSION: Patients with ST-elevation myocardial infarction differed from those with non-ST-elevation myocardial infarction regarding symptom presentation, ambulance utilisation and pre-hospital delay times. This knowledge is important to be aware of for all healthcare personnel and the general public especially in order to recognise symptoms suggestive of ST-elevation myocardial infarction and when to decide if there is a need for an ambulance.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Myocardial infarction, ST-elevation myocardial infarction, care seeking, first medical contact, non-ST-elevation myocardial infarction, prehospital delay, symptoms
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-144358 (URN)10.1177/2048872617741734 (DOI)000464034100002 ()29111768 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden (FORSS) [161061]; Faculty of Medicine, Umea University, Sweden; Swedish Heart and Lung Foundation; Swedish Diabetes Foundation; County Councils of Vasterbotten, Sweden; Heart Foundation of Northern Sweden

Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2023-08-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2608-2062

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