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Silent myocardial infarction in women with impaired glucose tolerance: The Northern Sweden MONICA study
Dan Lundblad, Mats Eliasson
Cardiovascular Diabetology , 2003, DOI: 10.1186/1475-2840-2-9
Abstract: Within the Northern Sweden MONICA project a population survey was performed in 1986. Electrocardiograms (ECG's) were recorded for half of the survey (n = 790) and oral glucose test was carried out in 78 % of those. The association between subjects with ECG's indicating previously unknown myocardial infarction (ukMI), IGT and conventional risk factors were analyzed by logistic regression for men and women separately, adjusting for age, smoking, hypercholesterolemia and hypertension.Impaired glucose tolerance was significantly more common among women with ukMI, but not in men, compared to the group with normal ECG. In men, no variable was significantly associated with ukMI although the odds ratio (OR) for hypercholesterolemia was of borderline significance, 3.2 (95% confidence interval (CI) 0.9 to 11). The OR of having ukMI was 4.1 (CI 1.1 to 15) in women with IGT compared to women with normal glucose tolerance after multiple adjustment. The OR for hypertension was of borderline significance; 3.3 (CI 0.97 to 11).We found that IGT was associated with ECG findings indicating silent myocardial infarction in women in a middle-aged general population in northern Sweden. The results persisted even after adjusting for known risk factors.Diabetes contributes strongly to the risk of CVD with a risk that is increased four to six times, both for stroke and myocardial infarction [1]. The increase in risk for myocardial infarction seem to be more pronounced in women than in men [2].The prevalence of IGT in the general population is 2–3 times higher than that of previously unknown diabetes, which, in turn, is as common as known diabetes [3]. Patients with impaired glucose tolerance have an increased risk of CVD that is independent of traditional risk factors such as hypertension, smoking and hypercholesterolemia [4] and it has been suggested that slightly elevated glucose levels, even in the non-diabetic range, might be associated with increased macrovascular disease. Thus, the ris
Increased free androgen index is associated with hypertension in premenopausal women  [PDF]
Liselott Andersson, Mats Eliasson, Inger Sundstr?m Poromaa
Open Journal of Obstetrics and Gynecology (OJOG) , 2011, DOI: 10.4236/ojog.2011.14045
Abstract: Objective: Increased testosterone and decreased sex hormone-binding globulin (SHBG) are associated with a number of adverse cardiovascular risk factors in postmenopausal women. The aim of this population-based study of women aged 25 to 50 was to assess the relationship between free androgen index (FAI) and cardiovascular risk factors in premenopausal women. Methods: A population-based survey of 396 premenopausal women with no hormonal treatment was undertaken as part of the Northern MONICA study. The study involved questionnaires, anthropometry and assays of testosterone and SHBG. Results: Increased FAI was associated with a number of cardiovascular risk factors in premenopausal women but this relationship was strongly affected by body mass index (BMI). After adjustment for age and BMI, FAI was significantly associated with increased systolic and diastolic blood pressures. Conclusion: Hyperandrogenism is associated with increased blood pressure and these findings emphasize the need to assess cardiovascular risk factors in women with hyperandrogenism of all ages.
Improved survival in both men and women with diabetes between 1980 and 2004 – a cohort study in Sweden
Mats Eliasson, Mats Talb?ck, M?ns Rosén
Cardiovascular Diabetology , 2008, DOI: 10.1186/1475-2840-7-32
Abstract: The annual Swedish Living Conditions Survey from 1980 to 2004 has been record-linked to the Cause of Death Register in order to study trends in mortality risk for those reporting diabetes as a chronic illness. Survival and the relative mortality risk within 5 years of follow-up have been calculated for a random sample of men and women aged 40–84 years with (n = 3,589) and without diabetes (n = 85,685) for the period 1980 to 2004. Poisson regression models were used.The age-adjusted mortality risk relative to non-diabetics within 5 years of follow-up for men was doubled during all periods. The relative risk for women was initially about 2.5, with a substantial drop in mortality in 1995–1999 to 1.45 although it increased to 1.90 in the last period. Using models that took into consideration the presence of heart disease, hypertension, daily smoking, and socio-economic status at the initial interview did not change the relative mortality risk. The age-adjusted 10-year observed survival rate for men with diabetes increased from 41.4% 1980–1984 to 51.5% in 1995–1999. The observed survival for women increased from 43.7% to 61.0%.Survival rates have improved in subjects with diabetes since the early 1980s, more so in women than in men, thereby decreasing the gap to non-diabetic women.Patients with diabetes have a markedly increased mortality which arises mainly from cardiovascular disease and end-stage renal disease [1-3]. The classical risk factors for cardiovascular disease, smoking, hypertension, and hypercholesterolemia, contribute strongly to the mortality [4]. Treatment methods for diabetes focus on improved glucose control and cardiovascular prevention. These methods have undergone several changes during the last decades, and international guidelines have been established.There is a consensus among researchers that diabetes prevalence is increasing. The debate is rather whether this is due to an increasing age-specific prevalence due to an increase in incidence or to
Aetiology of Tick-Borne Infections in an Adult Swedish Population—Are Co-Infections with Multiple Agents Common?  [PDF]
Marika Nordberg, Pia Forsberg, Johan Berglund, Anneli Bj?ersdorff, Jan Ernerudh, Ulf Garpmo, Mats Haglund, Kenneth Nilsson, Ingvar Eliasson
Open Journal of Clinical Diagnostics (OJCD) , 2014, DOI: 10.4236/ojcd.2014.41007
Abstract: In Scandinavia, tick-borne infections affecting humans include Lyme borreliosis (LB), tick-borne encephalitis (TBE) and human granulocytic anaplasmosis (HGA). Each of these infections can present with unspecific symptoms. In this prospective clinical study, we recruited patients based on two independent inclusion criteria; 1) patients with unspecific symptoms, i.e. fever (≥38.0℃) or a history of feverishness and/or any combination of headache, myalgia or arthralgia and 2) patients with erythema migrans (EM), following an observed tick bite or tick exposure within one month prior to onset of symptoms. A total of 206 patients fulfilled the study. Among these, we could identify 186 cases of LB (174 with EM), 18 confirmed and two probable cases of HGA and two cases of TBE. Thirteen of the HGA cases presented without fever. Furthermore, 22 of the EM patients had a sub-clinical co-infection with Anaplasma phagocytophilum, based on serology. Both TBE cases had co-infections, one with Borrelia burgdorferi and one with Anaplasma phagocytophilum. We conclude that it is important to consider several causative agents and possible co-infections in the clinical management of infectious diseases where ticks may be suspected as vectors.
A 3-Year Randomized Trial of Lifestyle Intervention for Cardiovascular Risk Reduction in the Primary Care Setting: The Swedish Bj?rkn?s Study
Margareta K. Eriksson, Paul W. Franks, Mats Eliasson
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0005195
Abstract: Background Successfully transferring the findings of expensive and tightly controlled programmes of intensive lifestyle modification to the primary care setting is necessary if such knowledge is to be of clinical utility. The objective of this study was to test whether intensive lifestyle modification, shown previously in tightly-controlled clinical trials to be efficacious for diabetes risk-reduction among high-risk individuals, can reduce cardiovascular risk factor levels in the primary care setting. Methodology / Principal Findings The Swedish Bj?rkn?s study was a randomized controlled trial conducted from 2003 to 2006 with follow-up on cardiovascular risk factors at 3, 12, 24 and 36 months. A total of 151 middle-aged men and women at moderate- to high-risk of cardiovascular disease from northern Sweden were randomly assigned to either an intensive lifestyle intervention (n = 75) or control (n = 76) group. The intervention was based broadly on the protocol of the Diabetes Prevention Program. The three-month intervention period was administered in the primary care setting and consisted of supervised exercise sessions and diet counselling, followed by regular group meetings during three years. The control group was given general advice about diet and exercise and received standard clinical care. Outcomes were changes in anthropometrics, aerobic fitness, self-reported physical activity, blood pressure, and metabolic traits. At 36 months post-randomisation, intensive lifestyle modification reduced waist circumference (?2.2 cm: p = 0.001), waist-hip ratio (?0.02: p<0.0001), systolic blood pressure (?4.9 mmHg: p = 0.036), and diastolic blood pressure (?1.6 mmHg: p = 0.005), and improved aerobic fitness (5%; p = 0.038). Changes in lipid or glucose values did not differ statistically between groups. At 36 months, self-reported time spent exercising and total physical activity had increased more in the intervention group than in the control group (p<0.001). Conclusion / Significance A program of intensive lifestyle modification undertaken in the primary health care setting can favourably influence cardiovascular risk-factor profiles in high-risk individuals. Trial Registration ClinicalTrials.gov NCT00486941
Hydrological Science and Its Connection to Religion in Ancient Egypt under the Pharaohs  [PDF]
Jonas Eliasson
Advances in Historical Studies (AHS) , 2013, DOI: 10.4236/ahs.2013.23019
Abstract: The history of water management in the Fertile Crescentis closely related to the religion. This is most clear in ancientEgyptin pharaonic time. The class of priests serving under the pharaoh had also many other administrative duties, they had good skill in science, collected hydrological and astronomical data and used it to levy taxes and predict the floods that irrigated the arable land. The special hydrological features of the riverNilemake it rather predictable in behavior compared to other major rivers of the region. In this social position the priests had great influence and could use it to stop the pharaoh Ikhnaton in his attempt to establish a monotheistic religion by ousting Amon-Ra and replacing him with Aton. Social life was very colorful at pharaohs’ court and the various arts and festivals flourished. The most remarkable of these was the Opet festival where pharaoh himself was the leading figure together with the statues of the gods. The festival was to last 10 days and during that time the riverNilewas to change color from grayish to reddish and thereby mark the beginning of the life-giving flood and bear witness to the good relations between the king and the divine powers. This kind of event, an annual prayer by the king to the gods for good harvest was well known in many societies, but it shows the remarkable skills of the Amon-Ra priest that they were ready to predict the onset of theNileflood within ten days and get away with it.
The impact of diabetes on coronary heart disease differs from that on ischaemic stroke with regard to the gender
Marjukka Hyv?rinen, Jaakko Tuomilehto, Tiina Laatikainen, Stefan S?derberg, Mats Eliasson, Peter Nilsson, Qing Qiao
Cardiovascular Diabetology , 2009, DOI: 10.1186/1475-2840-8-17
Abstract: Hazards ratios (HRs) (95%CI) for acute CHD and ischaemic stroke events were estimated based on data of Finnish and Swedish cohorts of 5111 women and 4167 men.182 (3.6%) women and 348 (8.4%) men had CHD and 129 (2.5%) women and 137 (3.3%) men ischaemic stroke events. The multivariate adjusted HRs for acute CHD at age groups of 40–49, 50–59 and 60–69 years were 1.00 (1.94), 1.78 (4.23), 3.75 (8.40) in women (men) without diabetes and 4.35 (5.40), 5.49 (9.54) and 8.84 (13.76) in women (men) with diabetes. The corresponding HRs for ischaemic stroke were 1.00 (1.26), 2.48 (2.83) and 5.17 (5.11) in women (men) without diabetes and 4.14 (4.91), 3.32 (6.75) and 13.91 (18.06) in women (men) with diabetes, respectively.CHD risk was higher in men than in women but difference reduced in diabetic population. Diabetes, however, increased stroke risk more in men than in women.Coronary heart disease (CHD) and stroke are common causes of disability and death [1]. Diabetes mellitus has been found to increase the risk of CHD and stroke events both in women and in men [2-8]. A more markedly increased relative risk for CHD [2,4,5] and stroke [6-8] has been found in diabetic women compared with diabetic men, however the reported magnitudes vary greatly between studies [2,7,8].CHD and stroke are generally discussed as two diseases with similar etiology caused by atherosclerotic vascular disease. While CHD and stroke have been shown to share some known cardiovascular disease (CVD) risk factors [1], some common CHD risk factors, such as serum total cholesterol [9,10] levels have not been indicated to have an association with increased risk of stroke [10,11]. Also, MONICA study reported CHD rates to decrease and stroke rates to increase in some populations while in other populations the opposite was observed [12]. This may imply different underlying mechanisms and etiology for the two diseases. To what extent diabetes, gender and age affect the development of CHD and stroke is not fully eluc
High levels of tissue plasminogen activator (tPA) antigen precede the development of type 2 diabetes in a longitudinal population study. The Northern Sweden MONICA Study
Mats CE Eliasson, Jan-H?kan Jansson, Bernt Lindahl, Birgitta Stegmayr
Cardiovascular Diabetology , 2003, DOI: 10.1186/1475-2840-2-19
Abstract: We studied the activities of tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) and the levels of tPA antigen (a marker of endothelial dysfunction) in 551 subjects with normal glucose tolerance in 1990 in relation to incident diabetes during nine years of follow-up.Subjects with diabetes at follow-up (n = 15) had significantly lower baseline tPA activity and higher PAI-1 activity and tPA antigen than non-converters. The risk of diabetes increased linearly across quartiles of PAI-activity (p = 0.007) and tPA antigen (p < 0.001) and decreased across quartiles of tPA activity (p = 0.026). The risk of diabetes with low tPA activity or high PAI-1 activity persisted after adjustment for age and sex but diminished to a non-significant level after further adjustments. The odds ratio of diabetes for high tPA antigen was 10.4 (95% confidence interval 2.7–40) adjusted for age and sex. After further adjustment for diastolic blood pressure, waist circumference, insulin, triglycerides, fasting and post load glucose the odds ratio was 6.5 (1.3–33, p = 0.024).Impaired fibrinolysis and endothelial dysfunction are evident in subjects with normal glucose tolerance who later develop diabetes. High tPA antigen is predictive of future diabetes independent from the metabolic syndrome.The risk of stroke and myocardial infarction is considerably increased in subjects with diabetes [1]. Already at the time of diagnosis of type 2 diabetes, many patients have manifest cardiovascular disease (CVD) [2]. This could be due to a long presymtomatic period with increased glucose level as evident by the increased CVD risk already present with impaired glucose tolerance (IGT) [3,4]. Thus, interest has focused on factors, not only glucose levels, in the prediabetic state that would increase the atherothrombotic process [5]. A common, possibly genetic, antecedent of both type 2 diabetes and CVD has been proposed as the "common soil" hypotheses [6,7].Recently, markers of infl
Gender differences in trends of acute myocardial infarction events: The Northern Sweden MONICA study 1985 – 2004
Dan Lundblad, Lars Holmgren, Jan-H?kan Jansson, Ulf N?slund, Mats Eliasson
BMC Cardiovascular Disorders , 2008, DOI: 10.1186/1471-2261-8-17
Abstract: Diagnosed MI events in subjects aged 25–64 years in the Counties of Norrbotten and V?sterbotten were validated according to the MONICA protocol. The total number of events registered up to January 1, 2005 was 11,763: 9,387 in men and 2,376 in women.The proportion of male/female events has decreased from 5.5:1 to 3:1. For males the reductions were 30% and 70% for first and recurrent MI, respectively, and for women 0% and 40% in the 55–64 year group. For both sexes a 50% reduction in 28-day case fatality was seen in the 25–64 year-group. Mortality was reduced by 69% and 45% in men and women, respectively.First and recurrent events of myocardial infarction was markedly reduced in men over the 20-year observation period, but for women the reduction was seen only for recurrent infarctions. Case fatality, on the other hand, was markedly reduced for both sexes. As a result of the positive effects on incidence and case fatality a substantial reduction was seen in total mortality, most pronounced for men.Coronary heart disease (CHD) is the leading cause of death in Sweden as well as in most Western European countries and in the United States. Incidence and mortality rates in CHD have decreased substantially during the last decades, and this trend seems to continue [1-4].At the start of the MONICA project in 1985 the incidence of, and mortality due to, myocardial infarction (MI) in the two northernmost counties in Sweden were the highest in the country. However, they have gradually approached the national average indicating a faster reduction in Northern Sweden than in the rest of the country [5]. Generally, in the Western world, the decreased mortality in CHD is due to a combination of declining incidence and improved survival. Better primary prevention and improvements in acute coronary care, including secondary prevention, may explain these impressing achievements [1].Gender differences in both events and case-fatality, and thereby also in mortality due to CHD, have been s
Reported food intake and distribution of body fat: a repeated cross-sectional study
Benno Krachler, Mats Eliasson, Hans Stenlund, Ingegerd Johansson, G?ran Hallmans, Bernt Lindahl
Nutrition Journal , 2006, DOI: 10.1186/1475-2891-5-34
Abstract: This study investigates the relative importance of individual food items for time trends in waist circumference (WC) and hip circumference (HC) on a population level.Independent cross-sectional surveys conducted in 1986, 1990, 1994 and 1999 in the two northernmost counties of Sweden with a common population of 250000. Randomly selected age stratified samples, altogether 2982 men and 3087 women aged 25–64 years. Questionnaires were completed and anthropometric measurements taken. For each food item, associations between frequency of consumption and waist and hip circumferences were estimated. Partial regression coefficients for every level of reported intake were multiplied with differences in proportion of the population reporting the corresponding levels of intake in 1986 and 1999. The sum of these product terms for every food item was the respective estimated impact on mean circumference.Time trends in reported food consumption associated with the more favourable gynoid distribution of adipose tissue were increased use of vegetable oil, pasta and 1.5% fat milk. Trends associated with abdominal obesity were increased consumption of beer in men and higher intake of hamburgers and French fried potatoes in women.Food trends as markers of time trends in body fat distribution have been identified. The method is a complement to conventional approaches to establish associations between food intake and disease risk on a population level.The global trend of increasing obesity in the developed world and, even more pronounced in the countries of transition, is associated with an increase in prevalence of all components of the metabolic syndrome. Based on these observations, predictions of a world-wide epidemic of diabetes have been made. Accumulating evidence for effective preventive intervention [1-3] highlights the importance of early indicators for identifying high-risk individuals. Recent studies have shown that the distribution of body-fat, independent of body mass index
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