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Östgren, Carl Johan
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Publications (10 of 96) Show all publications
Nowak, C., Carlsson, A. C., Östgren, C. J., Nyström, F., Alam, M., Feldreich, T., . . . Arnlov, J. (2018). Multiplex proteomics for prediction of major cardiovascular events in type 2 diabetes. Diabetologia, 61(8), 1748-1757
Open this publication in new window or tab >>Multiplex proteomics for prediction of major cardiovascular events in type 2 diabetes
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2018 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, no 8, p. 1748-1757Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis Multiplex proteomics could improve understanding and risk prediction of major adverse cardiovascular events (MACE) in type 2 diabetes. This study assessed 80 cardiovascular and inflammatory proteins for biomarker discovery and prediction of MACE in type 2 diabetes. Methods We combined data from six prospective epidemiological studies of 30-77-year-old individuals with type 2 diabetes in whom 80 circulating proteins were measured by proximity extension assay. Multivariable-adjusted Cox regression was used in a discovery/replication design to identify biomarkers for incident MACE. We used gradient-boosted machine learning and lasso regularised Cox regression in a random 75% training subsample to assess whether adding proteins to risk factors included in the Swedish National Diabetes Register risk model would improve the prediction of MACE in the separate 25% test subsample. Results Of 1211 adults with type 2 diabetes (32% women), 211 experienced a MACE over a mean (+/- SD) of 6.4 +/- 2.3 years. We replicated associations (amp;lt; 5% false discovery rate) between risk of MACE and eight proteins: matrix metalloproteinase (MMP)-12, IL-27 subunit alpha (IL-27a), kidney injury molecule (KIM)-1, fibroblast growth factor (FGF)-23, protein S100-A12, TNF receptor (TNFR)-1, TNFR-2 and TNF-related apoptosis-inducing ligand receptor (TRAIL-R)2. Addition of the 80-protein assay to established risk factors improved discrimination in the separate test sample from 0.686 (95% CI 0.682, 0.689) to 0.748 (95% CI 0.746, 0.751). A sparse model of 20 added proteins achieved a C statistic of 0.747 (95% CI 0.653, 0.842) in the test sample. Conclusions/interpretation We identified eight protein biomarkers, four of which are novel, for risk of MACE in community residents with type 2 diabetes, and found improved risk prediction by combining multiplex proteomics with an established risk model. Multiprotein arrays could be useful in identifying individuals with type 2 diabetes who are at highest risk of a cardiovascular event.

Place, publisher, year, edition, pages
SPRINGER, 2018
Keywords
Biomarkers; Major adverse cardiovascular event; Proteomics; Risk; Type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-149837 (URN)10.1007/s00125-018-4641-z (DOI)000437432200006 ()29796748 (PubMedID)
Note

Funding Agencies|European Union Horizon 2020 project [634869]; Swedish Research Council [2012-2215, 2015-03477]; Landstinget Dalarna (Falun, Sweden); Dalarna University (Falun, Sweden); Sparbanksstiftelsen Nya [552, 693, 932, 2297]; Region Vastmanland (Vasteras, Sweden); Swedish Medical Association; Swedish Heart-Lung Foundation [20150429]

Available from: 2018-08-02 Created: 2018-08-02 Last updated: 2018-08-20
Samefors, M., Scragg, R., Länne, T., Nyström, F. H. & Östgren, C. J. (2017). Association between serum 25(OH)D-3 and cardiovascular morbidity and mortality in people with Type 2 diabetes: a community-based cohort study. Diabetic Medicine, 34(3), 372-379
Open this publication in new window or tab >>Association between serum 25(OH)D-3 and cardiovascular morbidity and mortality in people with Type 2 diabetes: a community-based cohort study
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2017 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 3, p. 372-379Article in journal (Refereed) Published
Abstract [en]

Aim We aimed to explore the association between vitamin D and cardiovascular morbidity and mortality in people with Type 2 diabetes recruited from a community-based study because there is limited and inconsistent research of this group. Methods A prospective community-based cohort study among people aged 55-66 years with Type 2 diabetes as part of The Cardiovascular Risk in Type 2 Diabetes -A Prospective Study in Primary Care (CARDIPP). We analysed serum 25-hydroxyvitamin D-3 [25(OH)D-3] at baseline. Cox regression analyses were used to calculate hazard ratios (HR) for the first myocardial infarction, stroke or cardiovascular mortality according to 25(OH)D-3. Results We examined 698 people with a mean follow-up of 7.3 years. Serum 25(OH)D-3 was inversely associated with the risk of cardiovascular morbidity and mortality: HR 0.98 [95% confidence interval (CI) 0.96 to 0.99, P = 0.001]. Compared with the fourth quartile (Q4) [25(OH)D-3 amp;gt; 61.8 nmol/l], HR (with 95% CI) was 3.46 (1.60 to 7.47) in Q1 [25(OH)D-3 amp;lt; 35.5 nmol/l] (P = 0.002); 2.26 (1.01 to 5.06) in Q2 [25(OH)D-3 35.5-47.5 nmol/l] (P = 0.047); and 1.62 (0.70 to 3.76) in Q3 [25(OH)D-3 47.5-61.8 nmol/l] (P = 0.26) when adjusting for age, sex and season. The results remained significant after adjusting also for cardiovascular risk factors, physiological variables including parathyroid hormone and previous cardiovascular disease (P = 0.027). Conclusions Low 25(OH)D-3 is associated with an increased risk of cardiovascular morbidity and mortality in people with Type 2 diabetes independent of parathyroid hormone. Vitamin D could be considered as a prognostic factor. Future studies are needed to explore whether vitamin D deficiency is a modifiable risk factor in Type 2 diabetes.

Place, publisher, year, edition, pages
WILEY, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-136630 (URN)10.1111/dme.13290 (DOI)000397404200009 ()27862247 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Futurum; King Gustaf V and Queen Victoria Freemason Foundation; Department of Medical and Health Sciences at Linkoping University; County Council of Ostergotland; Swedish Society of Medicine; National Research School in General Practice

Available from: 2017-04-21 Created: 2017-04-21 Last updated: 2018-05-03
Kalkan, A., Bodegård, J., Sundstrom, J., Svennblad, B., Östgren, C. J., Nilsson Nilsson, P., . . . Ekman, M. (2017). Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice. Primary Care Diabetes, 11(2), 184-192
Open this publication in new window or tab >>Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice
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2017 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 11, no 2, p. 184-192Article in journal (Refereed) Published
Abstract [en]

Aims: To compare long-term changes in healthcare utilization and costs for type 2 diabetes patients before and after insulin initiation, as well as healthcare costs after insulin versus non-insulin anti-diabetic (NIAD) initiation. Methods: Patients newly initiated on insulin (n = 2823) were identified in primary health care records from 84 Swedish primary care centers, between 1999 to 2009. First, healthcare costs per patient were evaluated for primary care, hospitalizations and secondary outpatient care, before and up to seven years after insulin initiation. Second, patients prescribed insulin in second line were matched to patients prescribed NIAD in second line, and the healthcare costs of the matched groups were compared. Results: The total mean annual healthcare cost increased from 1656 per patient 2 years before insulin initiation to 3814 seven years after insulin initiation. The total cumulative mean healthcare cost per patient at year 5 after second-line treatment was 13,823 in the insulin group compared to 9989 in the NIAD group. Conclusions: Initiation of insulin in type 2 diabetes patients was followed by increased healthcare costs. The increases in costs were larger than those seen in a matched patient population initiated on NIAD treatment in second-line. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe. This is an open access article under the CC BY-NC-ND license.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2017
Keywords
Type 2 diabetes mellitus; Healthcare utilization; Healthcare costs; Observational study
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-136887 (URN)10.1016/j.pcd.2016.11.002 (DOI)000396955300012 ()27894781 (PubMedID)
Note

Funding Agencies|AstraZeneca

Available from: 2017-04-29 Created: 2017-04-29 Last updated: 2018-05-03
Borgström Bolmsjö, B., Molstad, S., Gallagher, M., Chalmers, J., Östgren, C. J. & Midlov, P. (2017). Risk factors and consequences of decreased kidney function in nursing home residents: A longitudinal study. Geriatrics & Gerontology International, 17(5), 791-797
Open this publication in new window or tab >>Risk factors and consequences of decreased kidney function in nursing home residents: A longitudinal study
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2017 (English)In: Geriatrics & Gerontology International, ISSN 1444-1586, E-ISSN 1447-0594, Vol. 17, no 5, p. 791-797Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of the present study was to study the renal function and the relationship of deterioration in renal function with major outcomes in elderly nursing home residents. A second aim was to compare the internationally recommended formulae for estimated glomerular filtration rate (eGFR) consisting of both creatinine and cystatin C in a nursing home population. Methods: A total of 429 patients from 11 nursing homes were included during 2008-2011. GFR was estimated, from formulae based on both creatinine and cystatin C, at baseline and after 1 and 2 years. The patients were divided into groups based on chronic kidney disease level, and comparisons were made for mortality, morbidity, the use of medications and between the different formulae for eGFR. Results: Survival was lower in the groups with lower renal function. Over 60% of the residents had impaired renal function. Those with impaired renal function were older, had a higher number of medications and a higher prevalence of heart failure. Higher number of medications was associated with a greater risk of rapid decline in renal function with an odds ratio of 1.2 (95% confidence interval 1.06-1.36, P = 0.003). The compared eGFR formulae based on both cystatin C and creatinine were in excellent concordance with each other. Conclusions: Decreased renal function was associated with increased mortality. A majority of nursing home residents had declining renal function, which should be considered when prescribing medications. The more medications, the higher the risk for rapidly declining renal function.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
clinical medicine; geriatric medicine; kidney; urinary tract
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-139298 (URN)10.1111/ggi.12789 (DOI)000403931900016 ()27151162 (PubMedID)
Note

Funding Agencies|Servier

Available from: 2017-07-07 Created: 2017-07-07 Last updated: 2018-05-03
Jonasson, H., Bergstrand, S., Nyström, F. H., Länne, T., Östgren, C. J., Bjarnegård, N., . . . Strömberg, T. (2017). Skin microvascular endothelial dysfunction is associated with type 2 diabetes independently of microalbuminuria and arterial stiffness. Diabetes & Vascular Disease Research, 14(4), 363-371, Article ID UNSP 1479164117707706.
Open this publication in new window or tab >>Skin microvascular endothelial dysfunction is associated with type 2 diabetes independently of microalbuminuria and arterial stiffness
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2017 (English)In: Diabetes & Vascular Disease Research, ISSN 1479-1641, E-ISSN 1752-8984, Vol. 14, no 4, p. 363-371, article id UNSP 1479164117707706Article in journal (Refereed) Published
Abstract [en]

Skin and kidney microvascular functions may be affected independently in diabetes mellitus. We investigated skin microcirculatory function in 79 subjects with diabetes type 2, where 41 had microalbuminuria and 38 not, and in 41 age-matched controls. The oxygen saturation, fraction of red blood cells and speed-resolved microcirculatory perfusion (% red blood cells x mm/s) divided into three speed regions: 0-1, 1-10 and above 10 mm/s, were assessed during baseline and after local heating of the foot with a new device integrating diffuse reflectance spectroscopy and laser Doppler flowmetry. Arterial stiffness was assessed as carotid-femoral pulse wave velocity. Subjects with diabetes and microalbuminuria had significantly higher carotid-femoral pulse wave velocity compared to subjects without microalbuminuria and to controls. The perfusion for speeds 0-1 mm/s and red blood cell tissue fraction were reduced in subjects with diabetes at baseline and after heating, independent of microalbuminuria. These parameters were correlated to HbA1c. In conclusion, the reduced nutritive perfusion and red blood cell tissue fraction in type 2 diabetes were related to long-term glucose control but independent of microvascular changes in the kidneys and large-vessel stiffness. This may be due to different pathogenic pathways in the development of nephropathy, large-vessel stiffness and cutaneous microvascular impairment.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2017
Keywords
Skin blood flow; microalbuminuria; microcirculation; endothelial dysfunction; type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-139273 (URN)10.1177/1479164117707706 (DOI)000403606900012 ()28482676 (PubMedID)
Note

Funding Agencies|VINNOVA (Swedens innovation agency); Perimed AB through the SamBIO [2008-00149, 2011-03074]; NovaMedTech - European Union Regional Development Fund [68737, 160382]

Available from: 2017-07-07 Created: 2017-07-07 Last updated: 2018-05-03
Rådholm, K., Tengblad, A., Dahlén, E., Länne, T., Engvall, J., Nyström, F. H. & Östgren, C. J. (2017). The impact of using sagittal abdominal diameter to predict major cardiovascular events in European patients with type 2 diabetes. NMCD. Nutrition Metabolism and Cardiovascular Diseases, 27(5), 418-422
Open this publication in new window or tab >>The impact of using sagittal abdominal diameter to predict major cardiovascular events in European patients with type 2 diabetes
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2017 (English)In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 27, no 5, p. 418-422Article in journal (Refereed) Published
Abstract [en]

Background and aims: Obesity is associated with diabetes type 2 and one of the most important risk factors for cardiovascular disease. We explored if sagittal abdominal diameter (SAD) is a better predictor of major cardiovascular events than waist circumference (WC) and body mass index (BMI) in type 2 diabetes. Methods and results: The CARDIPP study consists of a cohort of patients with type 2 diabetes. In this study we used data from 635 participants with no previous myocardial infarction or stroke, with a mean follow-up time of 7.1 years. SAD, WC and BMI were measured at baseline and the end-point was first cardiovascular event, measured as a composite of ICD-10 codes for acute myocardial infarction, stroke or cardiovascular mortality. SAD was significantly higher in the major cardiovascular event group compared to participants that did not suffer a major cardiovascular event during follow-up (p amp;lt; 0.001). SAD amp;gt; 25 cm was the only anthropometric measurement that remained associated with major cardiovascular events when adjusted for modifiable and non-modifiable factors (hazard ratio 2.81, 95% confidence interval 1.37-5.76, p = 0.005). Conclusion: SAD with the cut off level of amp;gt; 25 cm, if confirmed in larger studies, may be used as a more independent risk-assessment tool compared with WC in clinical practice, to identify persons with type 2 diabetes at high cardiovascular risk. (C) 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2017
Keywords
Diabetes; Obesity; Anthropometric measurements; Cardiovascular risk
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-139300 (URN)10.1016/j.numecd.2017.02.001 (DOI)000403554000006 ()28390663 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden; Center for Medical Image Science and Visualization (CMIV)), Linkoping University; Futurum; King Gustaf V and Queen Victoria Freemason Foundation; GE Healthcare

Available from: 2017-07-07 Created: 2017-07-07 Last updated: 2018-05-03
Carlsson, A. C., Östgren, C. J., Nyström, F. H., Länne, T., Jennersjö, P., Larsson, A. & Arnlov, J. (2016). Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes. Cardiovascular Diabetology, 15(1), 40
Open this publication in new window or tab >>Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes
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2016 (English)In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 15, no 1, p. 40-Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis: Soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) contribute to experimental diabetic kidney disease, a condition with substantially increased cardiovascular risk when present in patients. Therefore, we aimed to explore the levels of sTNFRs, and their association with prevalent kidney disease, incident cardiovascular disease, and risk of mortality independently of baseline kidney function and microalbuminuria in a cohort of patients with type 2 diabetes. In pre-defined secondary analyses we also investigated whether the sTNFRs predict adverse outcome in the absence of diabetic kidney disease. Methods: The CARDIPP study, a cohort study of 607 diabetes patients [mean age 61 years, 44 % women, 45 cardiovascular events (fatal/non-fatal myocardial infarction or stroke) and 44 deaths during follow-up (mean 7.6 years)] was used. Results: Higher sTNFR1 and sTNFR2 were associated with higher odds of prevalent kidney disease [odd ratio (OR) per standard deviation (SD) increase 1.60, 95 % confidence interval (CI) 1.32-1.93, p < 0.001 and OR 1.54, 95 % CI 1.21-1.97, p = 0.001, respectively]. In Cox regression models adjusting for age, sex, glomerular filtration rate and urinary albumin/creatinine ratio, higher sTNFR1 and sTNFR2 predicted incident cardiovascular events [hazard ratio (HR) per SD increase, 1.66, 95 % CI 1.29-2.174, p < 0.001 and HR 1.47, 95 % CI 1.13-1.91, p = 0.004, respectively]. Results were similar in separate models with adjustments for inflammatory markers, HbA1c, or established cardiovascular risk factors, or when participants with diabetic kidney disease at baseline were excluded (p < 0.01 for all). Both sTNFRs were associated with mortality. Conclusions/Interpretations: Higher circulating sTNFR1 and sTNFR2 are associated with diabetic kidney disease, and predicts incident cardiovascular disease and mortality independently of microalbuminuria and kidney function, even in those without kidney disease. Our findings support the clinical utility of sTNFRs as prognostic markers in type 2 diabetes.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2016
Keywords
Type 2 diabetes; TNF; Laplace regression; Incident cardiovascular disease; Mortality; Inflammation
National Category
Cardiac and Cardiovascular Systems General Practice
Identifiers
urn:nbn:se:liu:diva-126836 (URN)10.1186/s12933-016-0359-8 (DOI)000371581000001 ()26928194 (PubMedID)
Note

Funding Agencies|Swedish Research Council; Swedish Heart-Lung foundation; Thureus foundation; Marianne and Marcus Wallenberg Foundation; Dalarna University; Uppsala University

Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2018-01-10
Rådholm, K., Festin, K., Falk, M., Midlöv, P., Mölstad, S. & Östgren, C. J. (2016). Blood pressure and all-cause mortality: a prospective study of nursing home residents. Age and Ageing, 45(6), 826-832
Open this publication in new window or tab >>Blood pressure and all-cause mortality: a prospective study of nursing home residents
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2016 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 45, no 6, p. 826-832Article in journal (Refereed) Published
Abstract [en]

Aim: To explore the natural course of blood pressure development and its relation to mortality in a nursing home cohort.

Methods: A cohort of 406 nursing home residents in south east Sweden was followed prospectively for 30 months. Participants were divided into four groups based on systolic blood pressure (SBP) at baseline. Data were analysed using a Cox regression model with all-cause mortality as the outcome measurement; paired Student t-tests were used to evaluate blood pressure development over time.

Results: During follow-up, 174 (43%) people died. Participants with SBP <120 mmHg had a hazard ratio for mortality of 1.56 (95% confidence interval, 1.08–2.27) compared with those with SBP 120–139 mmHg, adjusted for age and sex. Risk of malnutrition or present malnutrition was most common in participants with SBP <120 mmHg; risk of malnutrition or present malnutrition estimated using the Mini Nutritional Assessment was found in 78 (71%). The levels of SBP decreased over time independent of changes in anti-hypertensive medication.

Conclusions: In this cohort of nursing home residents, low SBP was associated with increased all-cause mortality. SBP decreased over time; this was not associated with altered anti-hypertensive treatment. The clinical implication from this study is that there is a need for systematic drug reviews in elderly persons in nursing homes, paying special attention to those with low SBP.

Place, publisher, year, edition, pages
Oxford University Press, 2016
Keywords
older people, prospective study, nursing home, hypertension, hypotension, all-cause mortality
National Category
General Practice Other Health Sciences
Identifiers
urn:nbn:se:liu:diva-121283 (URN)10.1093/ageing/afw122 (DOI)000392702200018 ()
Note

Funding agencies| Health Research Council in south east Sweden (FORSS-8888, FORSS-11636 and FORSS-31811); the County of Östergötland (LIO-11877, LIO-31321 and LIO-79951); the Family Janne Elgqvist Foundation; King Gustaf V and Queen Victoria Freemason Foundation.

At the time for thesis presentation publication was in status: Manuscript

Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2018-01-11Bibliographically approved
Wijkman, M., Länne, T., Östgren, C. J. & Nyström, F. H. (2016). Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study. Cardiovascular Diabetology, 15(83), 1-10
Open this publication in new window or tab >>Diastolic orthostatic hypertension and cardiovascular prognosis in type 2 diabetes: a prospective cohort study
2016 (English)In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 15, no 83, p. 1-10Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In patients with type 2 diabetes, the prognostic impact of an orthostatic rise in blood pressure is not known. Therefore, the aim of this study was to determine the prognostic implications of the diastolic orthostatic blood pressure response in a cohort of patients with type 2 diabetes. We also evaluated associations between different orthostatic blood pressure responses and markers of subclinical cardiovascular organ damage.

METHODS: Office blood pressures were measured in the sitting and in the standing position in 749 patients with type 2 diabetes who participated in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes-a Prospective study in Primary care). Diastolic orthostatic hypertension was defined as a rise of diastolic blood pressure ≥10 mmHg and diastolic orthostatic hypotension was defined as a drop of diastolic blood pressure ≥10 mmHg. Recruitment took place between the years 2005-2008, and patients were followed until any of the primary outcome events (cardiovascular death or hospitalization for either myocardial infarction or stroke) occurred or until December 31st, 2014. Measurements of aortic pulse wave velocity and of carotid intima-media thickness were performed at base-line.

RESULTS: Diastolic orthostatic hypertension was found in 140 patients (18.7 %) and was associated with significantly lower risk of cardiovascular events (crude hazard ratio compared with patients with normal systolic and diastolic orthostatic blood pressure response: 0.450, 95 % C.I. 0.206-0.987, P = 0.046). Diastolic orthostatic hypotension was found in 31 patients (4.1 %) and was associated with higher values for aortic pulse wave velocity and carotid intima-media thickness, compared with patients with normal systolic and diastolic orthostatic blood pressure response.

CONCLUSIONS: Diastolic orthostatic hypertension is common in patients with type 2 diabetes, and may be a novel marker for decreased cardiovascular risk in these patients.

Place, publisher, year, edition, pages
BioMed Central, 2016
Keywords
Arterial stiffness, Blood pressure, Cardiovascular risk, Carotid intima-media thickness, Events, Orthostatic hypotension, Type 2 diabetes mellitus
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-129959 (URN)10.1186/s12933-016-0399-0 (DOI)000377852600001 ()27255168 (PubMedID)
Note

Funding agencies: FORSS; Research Council of Southeastern Sweden; King GustafV and Queen Victoria Freemason Foundation, Sweden

Available from: 2016-07-02 Created: 2016-07-02 Last updated: 2017-11-28Bibliographically approved
Lannering, C., Ernsth Bravell, M., Midlov, P., Östgren, C. J. & Molstad, S. (2016). Factors related to falls, weight-loss and pressure ulcers - more insight in risk assessment among nursing home residents. Journal of Clinical Nursing, 25(7-8), 940-950
Open this publication in new window or tab >>Factors related to falls, weight-loss and pressure ulcers - more insight in risk assessment among nursing home residents
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2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 7-8, p. 940-950Article in journal (Refereed) Published
Abstract [en]

Aims and objectivesTo describe how the included items in three different scales, Downton Fall Risk Index, the short form of Mini Nutritional Assessment and the Modified Norton Scale are associated to severe outcomes as falls, weight loss and pressure ulcers. BackgroundFalls, malnutrition and pressure ulcers are common adverse events among nursing home residents and risk scoring are common preventive activities, mainly focusing on single risks. In Sweden the three scales are routinely used together with the purpose to improve the quality of prevention. DesignLongitudinal quantitative study. MethodsDescriptive analyses and Cox regression analyses. ResultsOnly 4% scored no risk for any of these serious events. Longitudinal risk scoring showed significant impaired mean scores indicating increased risks. This confirms the complexity of this populations status of general condition. There were no statistical significant differences between residents categorised at risk or not regarding events. Physical activity increased falls, but decreased pressure ulcers. For weight loss, cognitive decline and the status of general health were most important. ConclusionsRisk tendencies for falls, malnutrition and pressure ulcers are high in nursing homes, and when measure them at the same time the majority will have several of these risks. Items assessing mobility or items affecting mobility were of most importance. Care processes can always be improved and this study can add to the topic. Relevance to clinical practiceA more comprehensive view is needed and prevention can not only be based on total scores. Mobility is an important factor for falls and pressure ulcers, both as a risk factor and a protective factor. This involves a challenge for care - to keep the inmates physical active and at the same time prevent falls.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2016
Keywords
falls; frail older; malnutrition; nursing homes; pressure ulcers; risk assessment
National Category
Geriatrics Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-127422 (URN)10.1111/jocn.13154 (DOI)000372928900006 ()26813994 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden (FORSS); Janne Elgqvist Foundation

Available from: 2016-05-01 Created: 2016-04-26 Last updated: 2018-01-10Bibliographically approved
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