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Richter, Arina
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Publications (10 of 28) Show all publications
Starkhammar Johansson, C., Ravald, N., Pagonis, C. & Richter, A. (2014). Periodontitis in Patients With Coronary Artery Disease: An 8-Year Follow-Up. Journal of Periodontology, 85(3), 417-425
Open this publication in new window or tab >>Periodontitis in Patients With Coronary Artery Disease: An 8-Year Follow-Up
2014 (English)In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 85, no 3, p. 417-425Article in journal (Refereed) Published
Abstract [en]

Background: This study examines whether preceding assessment of periodontal status in patients with established coronary artery disease (CAD) can predict future CAD endpoints (myocardial infarction, new revascularization procedure, or CAD-related death) during 8-year follow-up and whether the changes in periodontal status over time differ in patients with CAD compared with healthy controls. Methods: In 2003, periodontal status was examined in 161 patients with CAD who underwent percutaneous coronary intervention or coronary artery bypass graft due to significant stenosis in the coronary arteries and 162 controls without CAD. Eight years later, 126 patients with CAD (102 males and 24 females, mean age: 68 -8.9 years) and 121 controls (101 males and 20 females, mean age: 69 -9.0 years) were reexamined periodontally. A standard classification of periodontal disease in three groups (mild, moderate, and severe) was used. CAD endpoints during follow-up were obtained by review of medical records. CAD as cause of death was confirmed from the Swedish Cause of Death Register. Results: No significant differences were found among patients with CAD, with or without CAD-related endpoints at 8-year follow-up, and severity of periodontitis at baseline (P = 0.7). CAD did not influence the incidence or severity of periodontitis. Significant differences were found at the final examination in periodontitis prevalence and severity (P = 0.001), number of teeth (P = 0.006), probing depth 4 to 6 mm (P = 0.016), bleeding on probing (P = 0.001), and radiographic bone level (P = 0.042) between CAD patients and controls, all in favor of controls. Conclusions: The study results did not show a significant association during 8 years among CAD endpoints and periodontal status at baseline. The progression of periodontitis was low in both groups, although the higher proportion of individuals with severe periodontitis among patients with CAD compared with controls remained unchanged over the 8-year follow-up. Further long-term prospective studies are needed to show whether periodontitis can be considered a risk or prognostic factor for CAD, in terms of endpoints including myocardial infarction, new revascularization procedure, and CAD-related death.

Place, publisher, year, edition, pages
American Academy of Periodontology, 2014
Keywords
Atherosclerosis; cardiovascular diseases; coronary artery bypass grafting; percutaneous coronary intervention; periodontal disease; periodontitis
National Category
Cardiac and Cardiovascular Systems Dentistry
Identifiers
urn:nbn:se:liu:diva-106031 (URN)10.1902/jop.2013.120730 (DOI)000332532500013 ()
Available from: 2014-04-17 Created: 2014-04-17 Last updated: 2017-12-05
Richter, A., Cederholm, I., Fredrikson, M., Mucchiano, C., Träff, S. & Janerot Sjöberg, B. (2012). Effect of Long-Term Thoracic Epidural Analgesia on Refractory Angina Pectoris: A 10-Year Experience. Journal of Cardiothoracic and Vascular Anesthesia, 26(5), 822-828
Open this publication in new window or tab >>Effect of Long-Term Thoracic Epidural Analgesia on Refractory Angina Pectoris: A 10-Year Experience
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2012 (English)In: Journal of Cardiothoracic and Vascular Anesthesia, ISSN 1053-0770, E-ISSN 1532-8422, Vol. 26, no 5, p. 822-828Article in journal (Refereed) Published
Abstract [en]

Objectives

In patients with refractory angina, the adjuvant effects of long-term home self-treatment with thoracic epidural analgesia on angina, quality of life, and safety were evaluated.

Design

A prospective, consecutive study.

Setting

A university hospital.

Participants and Intervention

Between January 1998 and August 2007, 152 consecutive patients with refractory angina began treatment with thoracic epidural analgesia by intermittent injections of bupivacaine (139 home treatment and 13 palliative). Data were collected until August 2008; therefore, the follow-up for each patient was between 1 and 9 years.

Measurements and Main Results

All but 7 of the patients improved symptomatically, and the improvement was maintained throughout the period of treatment (median = 19 months; range, 1 month-8.9 years). After 1 to 2 weeks, the median (interquartile range [IQR]) Canadian Cardiovascular Society angina class decreased from 4.0 (3.0-4.0) to 2.0 (1.0-2.0), the mean ± standard deviation frequency of anginal attacks decreased from 36 ± 19 to 4.4 ± 6.8 a week, the nitroglycerin intake decreased from 27.7 ± 15.7 to 2.7 ± 4.9 a week, and the median (IQR) overall self-rated quality of life assessed by the visual analog scale increased from 25 (20-30) to 70 (50-75) (all p < 0.001). About one-third of the patients had a dislodgement of the epidural catheter. Apart from 1 epidural hematoma that appeared in 1 patient with a previously undiagnosed bleeding defect, no other serious catheter-related complications occurred.

Conclusions

Long-term self-administered home treatment with thoracic epidural analgesia is a safe, widely available adjuvant treatment for patients with severe refractory angina. It produces symptomatic relief of angina and improves quality of life. The technical development of the method to protect the catheter against dislodgement is needed.

Place, publisher, year, edition, pages
Saunders Elsevier, 2012
Keywords
coronary artery disease, refractory angina pectoris, horacic epidural analgesia, quality of life
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84740 (URN)10.1053/j.jvca.2012.01.047 (DOI)000309020900012 ()
Note

Funding Agencies|Research Board of the County Council of Ostergotland, Ostergotland, Sweden||

Available from: 2012-10-19 Created: 2012-10-19 Last updated: 2017-12-07
Lönn, J., Starkhammar Johansson, C., Kälvegren, H., Brudin, L., Skoglund, C., Garvin, P., . . . Nayeri, F. (2012). Hepatocyte growth factor in patients with coronary artery disease and its relation to periodontal condition. Results in Immunology, 2, 7-12
Open this publication in new window or tab >>Hepatocyte growth factor in patients with coronary artery disease and its relation to periodontal condition
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2012 (English)In: Results in Immunology, ISSN 2211-2839, Vol. 2, p. 7-12Article in journal (Refereed) Published
Abstract [en]

Hepatocyte growth factor (HGF) is an angiogenic, cardioprotective factor important for tissue and vascular repair. High levels of HGF are associated with chronic inflammatory diseases, such as coronary artery disease (CAD) and periodontitis, and are suggested as a marker of the ongoing atherosclerotic event in patients with CAD. Periodontal disease is more prevalent among patients with CAD than among healthy people. Recent studies indicate a reduced biological activity of HGF in different chronic inflammatory conditions. Biologically active HGF has high affinity to heparan sulfate proteoglycan (HSPG) on cell-membrane and extracellular matrix. The aim of the study was to investigate the serum concentration and the biological activity of HGF with ELISA and surface plasmon resonance (SPR), respectively, before and at various time points after percutaneous coronary intervention (PCI) in patients with CAD, and to examine the relationship with periodontal condition. The periodontal status of the CAD patients was examined, and the presence of P. gingivalis in periodontal pockets was analyzed with PCR. The HGF concentration was significantly higher, at all time-points, in patients with CAD compared to the age-matched controls (P< 0.001), but was independent of periodontal status. The HGF concentration and the affinity to HSPG adversely fluctuated over time, and the biological activity increased one month after intervention in patients without periodontitis. We conclude that elevated concentration of HGF but with reduced biological activity might indicate a chronic inflammatory profile in patients with CAD and periodontitis.

Place, publisher, year, edition, pages
Elsevier, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86207 (URN)10.1016/j.rinim.2011.12.002 (DOI)
Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2014-09-10
Starkhammar Johansson, C., Ravald, N., Richter, A. & Pagonis, C. (2012). Periodontal conditions in patients with coronary heart disease: A case-control study.
Open this publication in new window or tab >>Periodontal conditions in patients with coronary heart disease: A case-control study
2012 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Aim: To study if CAD-related morbidity and mortality (endpoints; myocardial infarction, coronary artery revascularization or CAD-related death) during 8-years follow was related to baseline periodontal status.

Material and methods: In 2003, periodontal status was examined in 161 CAD patients who underwent percutaneous coronary intervention or coronary artery by-pass graft due to significant stenosis in the coronary arteries, and in 162 control subjects without CAD history. Eight years later, 126 CAD patients and 121 controls were periodontally re-examined. The groups were classified into five categories as per periodontal disease experience (Hugoson & Jordan 1982). Cause of death due to CAD was obtained from Sweden’s death register. Myocardial infarction and coronary artery revascularization procedures were confirmed by review of medical records.

Results: No significant differences were found among CAD patients with / without CAD related endpoints and periodontal disease experience group (p=0.7). Significant differences were found at the final examination in periodontitis prevalence and severity (p=0.001), number of teeth (p=0.006), pockets 4-6 mm (p=0.016), bleeding on probing (p=0.001) and radiographic bone level between (p=0.042) between CAD-patients and controls.

Conclusion: The study results did not show a significant association between CAD outcomes after 8 years and periodontal status at baseline. Further long-term prospective studies are needed to show whether periodontitis can be considered a risk or prognostic factor for CAD.

Keywords
coronary artery, periodontitis, alveolar bone level
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86205 (URN)
Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2012-12-11Bibliographically approved
Järemo, P., Milovanovic, M., Lindahl, T. & Richter, A. (2009). Letter: Elevated platelet density and enhanced platelet reactivity in stable angina pectoris complicated by diabetes mellitus type II [Letter to the editor]. Thrombosis Research, 124(3), 373-374
Open this publication in new window or tab >>Letter: Elevated platelet density and enhanced platelet reactivity in stable angina pectoris complicated by diabetes mellitus type II
2009 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 124, no 3, p. 373-374Article in journal, Letter (Other academic) Published
Abstract [en]

The prognosis of coronary heart disease (CHD) has changed for the better. Type II diabetes mellitus (T2DM) complicates CHD and is associated with less favorable prospects and higher rates of coronary recurrence.

149 individuals below 75 years of age subject to elective coronary angiography to evaluate chest pain were consented. Patients were eligible if they did not have a history of rheumatic disease. 51 individuals treated medically for T2DM were compared with the remaining subjects (n = 98). Blood samples were obtained before elective coronary angiography.A special designed optical apparatus was used to analyze peak platelet density. Platelet bound fibrinogen after provocation reflecting the activation of the GPIIb-IIIa receptor i.e. platelet reactivity was determined with the use of a flow cytometer.

T2DM is associated with augmented platelet density (p < 0.001).Diabetic platelets displayed enhanced reactivity when stimulating with higher concentrations ADP (8.5 μmol/l) (p < 0.01) and TRAP-6 (74 μmol/l) (p < 0.001).

DTII patients with stable angina pectoris showed enhanced platelet density, augmented platelet reactivity and increased MPV. Platelets are more reactive in DTII. More aggressive platelets may offer a explanation as to why DTII has an impact upon the prognosis of CHD.

 

Place, publisher, year, edition, pages
Elsevier Ltd, 2009
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-59613 (URN)10.1016/j.thromres.2008.12.042 (DOI)19230957 (PubMedID)
Available from: 2010-09-21 Created: 2010-09-21 Last updated: 2017-12-12Bibliographically approved
Kälvegren, H., Fridfeldt (Berggren), J., Garvin, P., Wind, L., Leanderson, P., Kristenson, M., . . . Richter, A. (2008). Correlation between rises in Chlamydia pneumoniae-specific antibodies, platelet activation and lipid peroxidation after percutaneous coronary intervention.. European Journal of Clinical Microbiology and Infectious Diseases, 27(7), 503-511
Open this publication in new window or tab >>Correlation between rises in Chlamydia pneumoniae-specific antibodies, platelet activation and lipid peroxidation after percutaneous coronary intervention.
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2008 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 27, no 7, p. 503-511Article in journal (Refereed) Published
Abstract [en]

We recently showed that Chlamydia pneumoniae activates platelets in vitro, with an associated oxidation of low-density lipoproteins. The aim of this study was to investigate whether C. pneumoniae is released during percutaneous coronary intervention (PCI) and, thereby, causes platelet activation and lipid peroxidation. Seventy-three patients undergoing coronary angiography and following PCI or coronary artery bypass graft (CABG) and 57 controls were included in the study. C. pneumoniae antibodies, serotonin and lipid peroxidation were measured before and 24 h, 1 month and 6 months after angiography. The results show that serum C. pneumoniae IgA concentrations were significantly higher in patients than in the controls. Furthermore, in 38% of the C. pneumoniae IgG positive patients, the C. pneumoniae IgG concentration increased 1 month after PCI. The levels of C. pneumoniae IgG antibodies 1 month after PCI correlated with plasma-lipid peroxidation (r = 0.91, P < 0.0001) and platelet-derived serotonin (r = 0.62, P = 0.02). There was no elevation in the total serum IgG 1 month after PCI. In conclusion, the present results suggest that PCI treatment of coronary stenosis releases C. pneumoniae from the atherosclerotic lesions, which leads to platelet activation and lipid peroxidation.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14388 (URN)10.1007/s10096-008-0465-y (DOI)
Available from: 2007-04-20 Created: 2007-04-20 Last updated: 2017-12-13Bibliographically approved
Järemo, P., Milovanovic, M., Lindahl, T. & Richter, A. (2008). Elevated platelet reactivity in stable angina pectoris without significant coronary flow obstruction. Journal of Cardiovascular Medicine, 9(2), 129-130
Open this publication in new window or tab >>Elevated platelet reactivity in stable angina pectoris without significant coronary flow obstruction
2008 (English)In: Journal of Cardiovascular Medicine, ISSN 1558-2027, Vol. 9, no 2, p. 129-130Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

There are many different causes of angina pectoris without significant coronary flow obstruction in major coronary arteries. Examples include Prinzmetal angina and small vessel atherosclerotic disease.

METHODS:

We investigated individuals with stable angina pectoris subject to elective coronary angiography. To keep the study group as homogeneous as possible, patients with diabetes mellitus were excluded. Subjects with normal coronary angiograms (n = 13) or insignificant (< 50%) coronary flow obstruction(s) (n = 4) were grouped together. The remaining cohort (n = 96) with at least one significant (> or = 50%) flow obstruction in at least one major coronary artery served as controls.

RESULTS:

Before angiography, platelet activity in vitro on stimulation with a thrombin-receptor activating peptide (TRAP-6) (57 micromol/l and 74 micromol/l) and ADP (1.7 micromol/l and 8.5 micromol/l) was determined. Angina pectoris individuals without significant flow obstruction in major coronary arteries had enhanced platelet reactivity both when stimulated with TRAP-6 and ADP (P < 0.01 for both TRAP-6 concentrations and P < 0.05 for both ADP concentrations, respectively.

CONCLUSIONS:

It is concluded that angina pectoris without significant flow impediment in major epicardial arteries is associated with augmented platelet reactivity.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2008
Keywords
angina pectoris; flow cytometry; platelets; platelet reactivity
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-44108 (URN)10.2459/JCM.0b013e3280c56d46 (DOI)18192803 (PubMedID)75552 (Local ID)75552 (Archive number)75552 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2014-01-07Bibliographically approved
Johansson, C., Richter, A., Lundstrom, A., Thorstensson, H. & Ravald, N. (2008). Periodontal conditions in patients with coronary heart disease: A case-control study. Journal of Clinical Periodontology, 35(3), 199-205
Open this publication in new window or tab >>Periodontal conditions in patients with coronary heart disease: A case-control study
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2008 (English)In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 35, no 3, p. 199-205Article in journal (Refereed) Published
Abstract [en]

Aim: This study examined periodontal conditions in patients with coronary heart disease (CHD) and subjects with no history of CHD. Material and Methods: Participants were 161 patients (40-75) with severe angina pectoris (diagnosed as CHD by coronary angiography) who subsequently underwent percutaneous coronary intervention and 162 control subjects with no history of CHD. Periodontal status was recorded. Bone loss was determined on radiographs. Periodontal disease experience was classified into five groups according to Hugoson & Jordan. Results: Periodontal disease experience groups 4 and 5 were more common in the CHD group (25%) compared with the control group (8%). The mean bone level (the distance from the CEJ to the most coronal level of the alveolar bone) was 3.0±1.0 mm in CHD subjects and 2.6±0.8 mm in controls. CHD patients had significantly lower numbers of natural teeth, higher numbers of periodontal pockets 4-6-mm and higher bleeding on probing (%). In a stepwise regression analysis, the factor periodontal disease experience groups 4+5 gave an odds ratio of 5.74 (2.07-15.90) for having CHD after controlling for smoking and age. Conclusion: Severe periodontal disease expressed by several clinical and radiographic parameters was more prevalent among subjects with CHD than among controls. Analysis, the factor periodontal disease experience groups 4+5 gave an odds ratio of 5.74 (2.07-15.90) for having CHD after controlling for smoking and age. © 2008 Blackwell Munksgaard.

Keywords
Alveolar bone level, Coronary heart disease, Number of teeth, Periodontal disease
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47655 (URN)10.1111/j.1600-051X.2007.01185.x (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
Järemo, P., Starkhammar, C., Lundström, Å., Lindahl, T. & Richter, A. (2007). Inverse relationship between the severity of gingivitis and platelet reactivity in stable angina pectoris [6]. Journal of Thrombosis and Haemostasis, 5(2), 422-423
Open this publication in new window or tab >>Inverse relationship between the severity of gingivitis and platelet reactivity in stable angina pectoris [6]
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2007 (English)In: Journal of Thrombosis and Haemostasis, ISSN 1538-7933, E-ISSN 1538-7836, Vol. 5, no 2, p. 422-423Article in journal (Other academic) Published
Abstract [en]

[No abstract available]

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-39827 (URN)10.1111/j.1538-7836.2007.02323.x (DOI)51416 (Local ID)51416 (Archive number)51416 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Kälvegren, H., Bylin, H., Leanderson, P., Richter, A., Grenegård, M. & Bengtsson, T. (2005). Chlamydia pneumoniae induces nitric oxide synthase and lipoxygenase-dependent production of reactive oxygen species in platelets — effects on oxidation of low-density lipoproteins.. Thrombosis and Haemostasis, 94(2), 327-335
Open this publication in new window or tab >>Chlamydia pneumoniae induces nitric oxide synthase and lipoxygenase-dependent production of reactive oxygen species in platelets — effects on oxidation of low-density lipoproteins.
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2005 (English)In: Thrombosis and Haemostasis, ISSN 0340-6245, Vol. 94, no 2, p. 327-335Article in journal (Refereed) Published
Abstract [en]

There is increasing evidence that Chlamydia pneumoniae is linked to atherosclerosis and thrombosis. In this regard, we have recently shown that C. pneumoniae stimulates platelet aggregation and secretion, which may play an important role in the progress of atherosclerosis and in thrombotic vascular occlusion. The aims of the present study were to investigate the effects of C. pneumoniae on platelet-mediated formation of reactive oxygen species (ROS) and oxidation of low-density lipoprotein (LDL) in vitro. ROS production was registered as changes in 2´,7`-dichlorofluorescin- fluorescence in platelets with flow cytometry. LDL-oxidation was determined by measuring thiobarbituric acid reactive substances (TBARs). We found that C. pneumoniae stimulated platelet production of ROS.Polymyxin B treatment of C. pneumoniae, but not elevated temperature, abolished the stimulatory effects on platelet ROS- production, which suggests that chlamydial lipopolysaccharide has an important role. In hibition of nitric oxide synthase with nitro-L-arginine, lipoxygenase with 5,8,11-eicosatriynoic acid and protein kinase C with GF 109203X significantly lowered the production of radicals. In contrast, inhibition of NADPH-oxidase with di-phenyleneiodonium (DPI) did not affect the C. pneumoniae induced ROS-production. These findings suggest that the activities of nitric oxide synthase and lipoxygenase are the sources for ROS and that the generation is dependent of the activity of protein kinase C.The C. pneumoniae-induced ROS-production in platelets was associated with an extensive oxidation of LDL, which was significantly higher compared to the effect obtained by separate exposure of LDL to C. pneumoniae or platelets. In conclusion, C. pneumoniae interaction with platelets leading to aggregation, ROS-production and oxidative damage on LDL, may play a crucial role in the development of atherosclerotic cardiovascular disease.

Keywords
Atherosclerosis, bacteria-cell interaction, oxygen radical, LPS, thrombosis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14387 (URN)10.1160/TH04-06-0360 (DOI)
Available from: 2007-04-20 Created: 2007-04-20
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