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  • 1.
    Chow, Clara K.
    et al.
    Univ Sydney, Australia; Westmead Hosp, Australia; Univ New South Wales, Australia.
    Thiagalingam, Aravinda
    Univ Sydney, Australia; Westmead Hosp, Australia; Univ New South Wales, Australia.
    Santo, Karla
    Univ Sydney, Australia.
    Kok, Cindy
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Thakkar, Jay
    Univ Sydney, Australia; Westmead Hosp, Australia; Univ New South Wales, Australia.
    Stepien, Sandrine
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Billot, Laurent
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Jan, Stephen
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Joshi, Rohina
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Hillis, Graham S.
    Univ Western Australia, Australia.
    Brieger, David
    Univ Sydney, Australia; Concord Repatriat Gen Hosp, Australia.
    Chew, Derek P.
    Flinders Univ S Australia, Australia.
    Rådholm, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ödeshög.
    Atherton, John J.
    Royal Brisbane and Womens Hosp, Australia; Univ Queensland, Australia.
    Bhindi, Ravinay
    Royal North Shore Hosp, Australia.
    Collins, Nicholas
    John Hunter Hosp, Australia.
    Coverdale, Steven
    Sunshine Coast Univ Hosp, Australia.
    Hamilton-Craig, Christian
    Prince Charles Hosp, Australia; Univ Queensland, Australia.
    Kangaharan, Nadarajah
    Royal Darwin Hosp, Australia; Alice Springs Hosp, Australia.
    Maiorana, Andrew
    Curtin Univ, Australia; Fiona Stanley Hosp, Australia.
    McGrady, Michelle
    Royal Prince Alfred Hosp, Australia.
    Shetty, Pratap
    Wollongong Hosp, Australia.
    Thompson, Peter
    Sir Charles Gairdner Hosp, Australia.
    Rogers, Anthony
    Univ Sydney, Australia; Univ New South Wales, Australia.
    Redfern, Julie
    Univ Sydney, Australia; Westmead Hosp, Australia; Univ New South Wales, Australia.
    TEXT messages to improve MEDication adherence and Secondary prevention (TEXTMEDS) after acute coronary syndrome: a randomised clinical trial protocol2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 1, artikel-id e019463Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Identifying simple, low-cost and scalable means of supporting lifestyle change and medication adherence for patients following a cardiovascular (CV) event is important. Objective The TEXTMEDS (TEXT messages to improve MEDiGation adherence and Secondary prevention) study aims to investigate whether a cardiac education and support programme sent via mobile phone text message improves medication adherence and risk factor levels in patients following an acute coronary syndrome (ACS). Study design A single-blind, multicentre, randomised clinical trial of 1400 patients after an ACS with 12 months follow-up. The intervention group will receive multiple weekly text messages that provide information, motivation, support to adhere to medications, quit smoking (if relevant) and recommendations for healthy diet and exercise. The primary endpoint is the percentage of patients who are adherent to cardioprotective medications and the key secondary outcomes are mean systolic blood pressure (BP) and low density lipoprotein cholesterol. Secondary outcomes will also include total cholesterol, mean diastolic BP, the percentage of participants who are adherent to each cardioprotective medication class, the percentage of participants who achieve target levels of CV risk factors, major vascular events, hospital readmissions and all-cause mortality. The study will be augmented by formal economic and proGess evaluations to assess acceptability, utility and Gost-effectiveness. Summary The study will provide multicentre randomised trial evidence of the effects of a text message-based programme on cardioprotective medication adherence and levels of CV risk factors. Ethics and dissemination Primary ethics approval was received from Western Sydney Local Health District Human Research EthiGs Committee (HREC2012/12/4.1 (3648) AU RED HREC/13ANMEAD/15). Results will be disseminated via peer-reviewed publications and presentations at international conferences.

  • 2.
    Pikkemaat, Miriam
    et al.
    Husensjo Hlth Care Ctr, Sweden; Lund Univ, Sweden.
    Andersson, Tobias
    Narhalsan Norrmalm Hlth Ctr, Sweden; Univ Gothenburg, Sweden.
    Melander, Olle
    Lund Univ, Sweden.
    Chalmers, John
    UNSW Sydney, Australia.
    Rådholm, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ödeshög. UNSW Sydney, Australia.
    Bostrom, Kristina Bengtsson
    Univ Gothenburg, Sweden; RandD Ctr Skaraborg Primary Care, Sweden.
    C-peptide predicts all-cause and cardiovascular death in a cohort of individuals with newly diagnosed type 2 diabetes. The Skaraborg diabetes register2019Ingår i: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 150, s. 174-183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims

    To study the association between baseline level of C-peptide and all-cause death, cardiovascular death and cardiovascular complications among persons with newly diagnosed type 2 diabetes.

    Methods

    The Skaraborg Diabetes Register contains data on baseline C-peptide concentrations among 398 persons <65 years with newly diagnosed type 2 diabetes 1996–1998. National registries were used to determine all-cause death, cardiovascular death and incidence of myocardial infarction and ischemic stroke until 31 December 2014. The association between baseline C-peptide and outcomes were evaluated with adjustment for multiple confounders by Cox regression analysis. Missing data were handled by multiple imputation.

    Results

    In the imputed and fully adjusted model there was a significant association between 1 nmol/l increase in C-peptide concentration and all-cause death (HR 2.20, 95% CI 1.49–3.25, p < 0.001, number of events = 104), underlying cardiovascular death (HR 2.69, 1.49–4.85, p = 0.001, n = 35) and the composite outcome of underlying cardiovascular death, myocardial infarction or ischemic stroke (HR 1.61, 1.06–2.45, p = 0.027, n = 90).

    Conclusions

    Elevated C-peptide levels at baseline in persons with newly diagnosed type 2 diabetes are associated with increased risk of all-cause and cardiovascular mortality. C-peptide might be used to identify persons at high risk of cardiovascular complications and premature death.

  • 3.
    Rådholm, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Cardiovascular risk factors in elderly: With special emphasis on atrial fibrillation, hypertension and diabetes2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background

    The part of the population that belongs to the oldest-old (ages 80 years or older) increases rapidly, worldwide. Cardiovascular disease (CVD) is the leading cause of death and disease burden globally. Multimorbidity is common in old age and stroke, diabetes mellitus (DM) and atrial fibrillation (AF) are strongly associated with age. Cardiovascular risk factors are well studied and documented in younger and middle ages, but not as well in old and frail individuals. Therefore, preventive treatment choices are mostly based on evidence for younger patients. The aim of this thesis was to explore age and other aspects of cardiovascular risk factors; AF, hypertension and DM, in relation to comorbidity, cardiovascular outcome and mortality.

    Methods

    This thesis was based on four different studies:

    • The ELSA85 study of 85 years old in Linköping, Sweden
    • The international, multicentre, randomised controlled INTERACT2 trial of spontaneous intracranial haemorrhage (ICH), mean age 64 years.
    • The prospective SHADES study of nursing home residents, mean age 85 years.
    • The prospective, national SWE-diadep study of dispensed antidiabetics, antidepressantsand prevalent myocardial infarction (MI) in 45-84 years old.

    Data was obtained from questionnaires (ELSA85, INTERACT2), medical records and medical examination (ELSA85, INTERACT2, SHADES), and national registers (SWE-Diadep).

    Results

    The ELSA85 study showed that 16% (n=53) had an ECG showing AF. There was an increased hazard ratio (HR) for all-cause mortality in participants with AF at baseline, at 90 years of age (HR 1.59, 95% [Confidence Interval] CI 1.04-2.44) adjusted for sex. This increase in HR did not persist when adjusted for congestive heart failure (CHF). In the INTERACT2 study, increasing age was associated with increasing frequency of death or dependency (odds ratio [OR] 4.36, 95% [CI] 3.12-6.08 for >75 years vs <52 years, p value for trend <0.001). The SHADES study showed that participants with Systolic blood pressure (SBP) <120 mmHg had an increased HR for mortality (1.56, 95% CI, 1.08–2.27; p=0.019) but there were no differences between SBP groups 140–159 mmHg and ≥160 mmHg compared with the reference group SBP 120–139 mmHg. SBP decreased during the prospective study period. In the SWE-diadep study, individuals with antidiabetics and antidepressants combined had a greater HR for MI compared to the reference of no antidiabetics or antidepressants, mostly so in women aged 45-64 years (HR 7.4, 95% CI: 6.3-8.6).

    Conclusion

    Risk factors for CVDs in elderly differ from cardiovascular risk factors in middle aged individuals an

    Delarbeten
    1. Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects.
    Öppna denna publikation i ny flik eller fönster >>Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects.
    Visa övriga...
    2011 (Engelska)Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 52, nr 3, s. e170-e175Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The occurrence of AF increases sharply with age. The aim of this study was to explore and compare prevalent co-morbidity and self-estimated health-related quality of life (HRQoL) in subjects with AF versus subjects with sinus rhythm or pacemaker in 85 years old subjects. We analyzed data from a population of 336 eighty-five years old subjects participating in the Elderly in Linköping Screening Assessment (ELSA-85) study. Medical history was obtained from postal questionnaire, medical records and during medical examination that included a physical examination, cognitive tests, non-fasting venous blood samples and electrocardiographic (ECG) examination. 19% had an ECG showing AF. There were very few significant differences regarding medical history, self-estimated quality of life (QoL), laboratory- and examination findings and use of public health care between the AF group and the non-AF group. The study showed that the population of 85 years old subjects with AF was surprisingly healthy in terms of prevalent co-existing medical conditions, healthcare contacts and overall HRQoL. We conclude that elderly patients with AF do not in general have increased co-morbidity than subjects without AF.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2011
    Nyckelord
    Atrial fibrillation; Co-morbidities of elderly; CHADS2 score; Oral anticoagulation; Health-related quality of life
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-67143 (URN)10.1016/j.archger.2010.10.024 (DOI)000288989400015 ()
    Anmärkning

    Original Publication: Karin Rådholm, Carl Johan Östgren, Urban Alehagen, Magnus Falk, Eva Wressle, Jan Marcusson and Katarina Nägga, Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects., 2011, Archives of gerontology and geriatrics (Print), (52), 3, e170-e175. http://dx.doi.org/10.1016/j.archger.2010.10.024 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/

    Tillgänglig från: 2011-03-31 Skapad: 2011-03-31 Senast uppdaterad: 2019-06-27
    2. Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study
    Öppna denna publikation i ny flik eller fönster >>Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study
    Visa övriga...
    2015 (Engelska)Ingår i: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, nr 3, s. 422-427Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND AND PURPOSE:: Global ageing contributes greatly to the burden of stroke. We investigated the influence of age on the baseline profile and on outcomes in acute intracerebral haemorrhage (ICH) among participants of the INTERACT2 study.

    METHODS:: INTERACT2 was an international, randomised controlled trial in 2839 patients with spontaneous ICH within 6 h of onset and elevated systolic blood pressure (SBP; 150-220 mmHg) who were allocated to receive intensive (target SBP <140 mmHg within 1 h) or guideline-recommended (target SBP <180 mmHg) blood pressure lowering treatment. Stroke severity was assessed with the National Institutes of Health Stroke Scale. Poor outcome was defined as death or major disability ('dependency', modified Rankin Scale scores 3-6) at 90 days. Health-related quality of life (HRQoL) was assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. Associations between age and outcomes were analysed in multivariable logistic regression models.

    RESULTS:: Stroke severity increased in categories of older age (P-trend 0.002). Stroke patients over 75 years old were four times more likely to die or be disabled at 90 days than those <52 years when other confounders were accounted for (odds ratio 4.36, 95% confidence interval 3.12-6.08). Older age was also associated with decreasing HRQoL, across mobility, self-care, usual activities and depression (all P-trend <0.001), and pain or discomfort (P-trend 0.022).

    CONCLUSION:: In the INTERACT2 cohort, older people had more severe ICH and worse outcomes (death, major disability and HRQoL). These data will help guide clinicians manage older people with haemorrhagic stroke. Clinical Trial Registration: http://www.clinicaltrials.gov (NCT00716079).

    Ort, förlag, år, upplaga, sidor
    Oxford University Press, 2015
    Nationell ämneskategori
    Allmänmedicin
    Identifikatorer
    urn:nbn:se:liu:diva-115371 (URN)10.1093/ageing/afu198 (DOI)000355623100014 ()25497513 (PubMedID)
    Tillgänglig från: 2015-03-13 Skapad: 2015-03-13 Senast uppdaterad: 2018-01-11
    3. Blood pressure and all-cause mortality: a prospective study of nursing home residents
    Öppna denna publikation i ny flik eller fönster >>Blood pressure and all-cause mortality: a prospective study of nursing home residents
    Visa övriga...
    2016 (Engelska)Ingår i: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 45, nr 6, s. 826-832Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Oxford University Press, 2016
    Nyckelord
    older people, prospective study, nursing home, hypertension, hypotension, all-cause mortality
    Nationell ämneskategori
    Allmänmedicin Annan hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-121283 (URN)10.1093/ageing/afw122 (DOI)000392702200018 ()
    Anmärkning

    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

    Tillgänglig från: 2015-09-11 Skapad: 2015-09-11 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
    4. Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study
    Öppna denna publikation i ny flik eller fönster >>Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study
    2016 (Engelska)Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, nr 2, s. 218-223Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aims

    To explore the gender- and age-specific risk of developing a first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared with people with no pharmaceutical treatment for diabetes or depression.

    Methods

    A cohort of all Swedish residents aged 45–84 years (n = 4 083 719) was followed for a period of 3 years. Data were derived from three nationwide registers. The prescription and dispensing of antidiabetic and antidepressant drugs were used as markers of disease. All study subjects were reallocated according to treatment and the treatment categories were updated every year. Data were analysed using a Cox regression model with a time-dependent variable. The outcome of interest was first fatal or non-fatal myocardial infarction.

    Results

    During follow-up, 42 840 people had a first myocardial infarction, 3511 of which were fatal. Women aged 45–64 years, receiving both antidiabetic and antidepressant drugs had a hazard ratio for myocardial infarction of 7.4 (95% CI 6.3–8.6) compared with women receiving neither. The corresponding hazard ratio for men was 3.1 (95% CI 2.8–3.6).

    Conclusions

    The combined use of antidiabetic and antidepressant drugs was associated with a higher risk of myocardial infarction compared with use of either group of drugs alone. The increase in relative risk was greater in middle-aged women than in middle-aged men.

    Ort, förlag, år, upplaga, sidor
    Wiley-Blackwell, 2016
    Nationell ämneskategori
    Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Annan hälsovetenskap Allmänmedicin
    Identifikatorer
    urn:nbn:se:liu:diva-121285 (URN)10.1111/dme.12822 (DOI)000370161800011 ()26036276 (PubMedID)
    Anmärkning

    Funding agencies: King Gustaf V and Queen Victoria Freemason Foundation

    Tillgänglig från: 2015-09-11 Skapad: 2015-09-11 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
  • 4.
    Rådholm, Karin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland.
    Arima, Hisatomi
    The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, NSW, Australia.
    Lindley, Richard I
    The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, NSW, Australia.
    Wang, Jiguang
    The Shanghai Institute of Hypertension, Rui Jin Hospital, Shanghai Jiaotong University, Shanghai, China.
    Tzourio, Christophe
    INSERM U897, Bordeaux, France and University of Bordeaux, Bordeaux, France.
    Robinson, Thompson
    The Department of Cardiovascular Sciences and NIHR Biomedical Research Unit in Cardiovascular Disease, University of Leicester, Leicester, UK.
    Heeley, Emma
    The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, NSW, Australia.
    Anderson, Craig S
    The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, NSW, Australia.
    Chalmers, John
    The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, NSW, Australia.
    Older age is a strong predictor for poor outcome in intracerebral haemorrhage: the INTERACT2 study2015Ingår i: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, nr 3, s. 422-427Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND PURPOSE:: Global ageing contributes greatly to the burden of stroke. We investigated the influence of age on the baseline profile and on outcomes in acute intracerebral haemorrhage (ICH) among participants of the INTERACT2 study.

    METHODS:: INTERACT2 was an international, randomised controlled trial in 2839 patients with spontaneous ICH within 6 h of onset and elevated systolic blood pressure (SBP; 150-220 mmHg) who were allocated to receive intensive (target SBP <140 mmHg within 1 h) or guideline-recommended (target SBP <180 mmHg) blood pressure lowering treatment. Stroke severity was assessed with the National Institutes of Health Stroke Scale. Poor outcome was defined as death or major disability ('dependency', modified Rankin Scale scores 3-6) at 90 days. Health-related quality of life (HRQoL) was assessed with the European Quality of Life-5 Dimensions (EQ-5D) questionnaire. Associations between age and outcomes were analysed in multivariable logistic regression models.

    RESULTS:: Stroke severity increased in categories of older age (P-trend 0.002). Stroke patients over 75 years old were four times more likely to die or be disabled at 90 days than those <52 years when other confounders were accounted for (odds ratio 4.36, 95% confidence interval 3.12-6.08). Older age was also associated with decreasing HRQoL, across mobility, self-care, usual activities and depression (all P-trend <0.001), and pain or discomfort (P-trend 0.022).

    CONCLUSION:: In the INTERACT2 cohort, older people had more severe ICH and worse outcomes (death, major disability and HRQoL). These data will help guide clinicians manage older people with haemorrhagic stroke. Clinical Trial Registration: http://www.clinicaltrials.gov (NCT00716079).

  • 5.
    Rådholm, Karin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Festin, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Falk, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Midlöv, Patrik
    Department of Clinical Sciences in Malmö, Center for Primary Health Care Research Lund University, Malmö, Sweden.
    Mölstad, Sigvard
    Department of Clinical Sciences in Malmö, Center for Primary Health Care Research Lund University, Malmö, Sweden.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Primärvården i västra länsdelen.
    Blood pressure and all-cause mortality: a prospective study of nursing home residents2016Ingår i: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 45, nr 6, s. 826-832Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Rådholm, Karin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ödeshög. Univ New South Wales, Australia.
    Figtree, Gemma
    Royal North Shore Hosp, Sydney, NSW, Australia.
    Perkovic, Vlado
    Univ New South Wales, Australia; Univ Sydney, Australia.
    Solomon, Scott D.
    Harvard Med Sch, MA USA; Brigham and Womens Hosp, MA 02115 USA.
    Mahaffey, Kenneth W.
    Stanford Univ, CA 94305 USA.
    de Zeeuw, Dick
    Univ Groningen, Netherlands.
    Fulcher, Greg
    Royal North Shore Hosp, Sydney, NSW, Australia.
    Barrett, Terrance D.
    Janssen Res and Dev LLC, NJ USA.
    Shaw, Wayne
    Janssen Res and Dev LLC, NJ USA.
    Desai, Mehul
    Janssen Res and Dev LLC, NJ USA.
    Matthews, David R.
    Univ Oxford, England; Univ Oxford, England.
    Neal, Bruce
    Univ New South Wales, Australia; Univ New South Wales, Australia; Univ Sydney, Australia; Imperial Coll London, England.
    Canagliflozin and Heart Failure in Type 2 Diabetes Mellitus: Results From the CANVAS Program2018Ingår i: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 138, nr 5, s. 458-468Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Canagliflozin is a sodium glucose cotransporter 2 inhibitor that reduces the risk of cardiovascular events. We report the effects on heart failure (HF) and cardiovascular death overall, in those with and without a baseline history of HF, and in other participant subgroups. Methods: The CANVAS Program (Canagliflozin Cardiovascular Assessment Study) enrolled 10142 participants with type 2 diabetes mellitus and high cardiovascular risk. Participants were randomly assigned to canagliflozin or placebo and followed for a mean of 188 weeks. The primary end point for these analyses was adjudicated cardiovascular death or hospitalized HF. Results: Participants with a history of HF at baseline (14.4%) were more frequently women, white, and hypertensive and had a history of prior cardiovascular disease (all Pamp;lt;0.001). Greater proportions of these patients were using therapies such as blockers of the renin angiotensin aldosterone system, diuretics, and -blockers at baseline (all Pamp;lt;0.001). Overall, cardiovascular death or hospitalized HF was reduced in those treated with canagliflozin compared with placebo (16.3 versus 20.8 per 1000 patient-years; hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.67-0.91), as was fatal or hospitalized HF (HR, 0.70; 95% CI, 0.55-0.89) and hospitalized HF alone (HR, 0.67; 95% CI, 0.52-0.87). The benefit on cardiovascular death or hospitalized HF may be greater in patients with a prior history of HF (HR, 0.61; 95% CI, 0.46-0.80) compared with those without HF at baseline (HR, 0.87; 95% CI, 0.72-1.06; P interaction =0.021). The effects of canagliflozin compared with placebo on other cardiovascular outcomes and key safety outcomes were similar in participants with and without HF at baseline (all interaction P values amp;gt;0.130), except for a possibly reduced absolute rate of events attributable to osmotic diuresis among those with a prior history of HF (P=0.03). Conclusions: In patients with type 2 diabetes mellitus and an elevated risk of cardiovascular disease, canagliflozin reduced the risk of cardiovascular death or hospitalized HF across a broad range of different patient subgroups. Benefits may be greater in those with a history of HF at baseline. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01032629 and NCT01989754.

  • 7.
    Rådholm, Karin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Wiréhn, Ann-Britt
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys.
    Chalmers, J.
    The George Institute for Global Health, University of Sydney, NSW, Australia.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Primärvården i västra länsdelen.
    Use of antidiabetic and antidepressant drugs is associated with increased risk of myocardial infarction: a nationwide register study2016Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, nr 2, s. 218-223Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims

    To explore the gender- and age-specific risk of developing a first myocardial infarction in people treated with antidiabetic and/or antidepressant drugs compared with people with no pharmaceutical treatment for diabetes or depression.

    Methods

    A cohort of all Swedish residents aged 45–84 years (n = 4 083 719) was followed for a period of 3 years. Data were derived from three nationwide registers. The prescription and dispensing of antidiabetic and antidepressant drugs were used as markers of disease. All study subjects were reallocated according to treatment and the treatment categories were updated every year. Data were analysed using a Cox regression model with a time-dependent variable. The outcome of interest was first fatal or non-fatal myocardial infarction.

    Results

    During follow-up, 42 840 people had a first myocardial infarction, 3511 of which were fatal. Women aged 45–64 years, receiving both antidiabetic and antidepressant drugs had a hazard ratio for myocardial infarction of 7.4 (95% CI 6.3–8.6) compared with women receiving neither. The corresponding hazard ratio for men was 3.1 (95% CI 2.8–3.6).

    Conclusions

    The combined use of antidiabetic and antidepressant drugs was associated with a higher risk of myocardial infarction compared with use of either group of drugs alone. The increase in relative risk was greater in middle-aged women than in middle-aged men.

  • 8.
    Rådholm, Karin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Falk, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Marcusson, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neurovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Primärvården i västra länsdelen.
    Myocardial infarction in subjects using anti-diabetic and/or anti-depressant agents compared tonon-users: a nationwide register study in Sweden2013Konferensbidrag (Refereegranskat)
  • 9.
    Rådholm, Karin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ödeshög. UNSW Sydney, Australia.
    Wu, Jason H. Y.
    UNSW Sydney, Australia.
    Wong, Muh Geot
    UNSW Sydney, Australia; Royal North Shore Hosp, Australia.
    Foote, Celine
    UNSW Sydney, Australia; Concord Repatriat Gen Hosp, Australia.
    Fulcher, Gregory
    Royal North Shore Hosp, Australia; Univ Sydney, Australia.
    Mahaffey, Kenneth W.
    Stanford Univ, CA 94305 USA.
    Perkovic, Vlado
    UNSW Sydney, Australia.
    Neal, Bruce
    UNSW Sydney, Australia; Univ Sydney, Australia; Imperial Coll London, England.
    Effects of sodium-glucose cotransporter-2 inhibitors on cardiovascular disease, death and safety outcomes in type 2 diabetes - A systematic review2018Ingår i: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 140, s. 118-128Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Aim: Sodium glucose co-transporter 2 (SGLT2) inhibitors appear to protect against increased risks of cardiovascular and kidney disease in patients with type 2 diabetes but also cause some harms. Whether effects are comparable across drug class or specific to individual compounds is unclear. This meta-analysis assessed the class and individual compound effects of SGLT2 inhibition versus control on cardiovascular events, death, kidney disease and safety outcomes in patients with type 2 diabetes. Methods: MEDLINE, EMBASE, the Cochrane Library and regulatory databases were systematically searched for data from randomized clinical trials that included reporting of cardiovascular events, deaths or safety outcomes. We used fixed effects models and inverse variance weighting to calculate relative risks with the 95% confidence intervals. Results: The analyses included data from 82 trials, four overviews and six regulatory reports and there were 1,968 major cardiovascular events identified for analysis. Patients randomly assigned to SGLT2 had lower risks of major cardiovascular events (RR 0.85, 95% CI 0.77-0.93), heart failure (RR 0.67, 95% CI 0.55-0.80), all-cause death (RR 0.79, 95% CI 0.70-0.88) and serious decline in kidney function (RR 0.59, 0.49-0.71). Significant adverse effects were observed for genital infections (RR 3.06, 95% CI 2.73-4.43), volume depletion events (RR 1.24, 95% CI 1.07-1.43) and amputation (RR 1.44 95% CI 1.13-1.83). There was a high likelihood of differences in the associations of the individual compounds with cardiovascular death, hypoglycaemia and amputation (all I-2 amp;gt; 80%) and a moderate likelihood of differences in the associations with non-fatal stroke, all-cause death, urinary tract infection and fracture (all I-2 amp;gt; 30%). Conclusion: There are strong overall associations of SGLT2 inhibition with protection against major cardiovascular events, heart failure, serious decline in kidney function and all-cause death. SGLT2 inhibitors were also associated with infections, volume depletion effects and amputation. Some associations appear to differ between compounds. (C) 2018 Elsevier B.V. All rights reserved.

  • 10.
    Rådholm, Karin
    et al.
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvården i centrala länsdelen. Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Primärvården i västra länsdelen.
    Alehagen, Urban
    Linköpings universitet, Institutionen för medicin och hälsa, Kardiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Falk, Magnus
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvården i centrala länsdelen. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Wressle, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Marcusson, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Nägga, Katarina
    Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet.
    Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects.2011Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 52, nr 3, s. e170-e175Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The occurrence of AF increases sharply with age. The aim of this study was to explore and compare prevalent co-morbidity and self-estimated health-related quality of life (HRQoL) in subjects with AF versus subjects with sinus rhythm or pacemaker in 85 years old subjects. We analyzed data from a population of 336 eighty-five years old subjects participating in the Elderly in Linköping Screening Assessment (ELSA-85) study. Medical history was obtained from postal questionnaire, medical records and during medical examination that included a physical examination, cognitive tests, non-fasting venous blood samples and electrocardiographic (ECG) examination. 19% had an ECG showing AF. There were very few significant differences regarding medical history, self-estimated quality of life (QoL), laboratory- and examination findings and use of public health care between the AF group and the non-AF group. The study showed that the population of 85 years old subjects with AF was surprisingly healthy in terms of prevalent co-existing medical conditions, healthcare contacts and overall HRQoL. We conclude that elderly patients with AF do not in general have increased co-morbidity than subjects without AF.

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