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  • 1.
    Ding, Mozhu
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Ljungdahl, Maria
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Atrial fibrillation and use of antithrombotic medications in older people: A population-based study2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 249, p. 173-178Article in journal (Refereed)
    Abstract [en]

    Background: Trends in the use of antithrombotic drugs in elderly patients with atrial fibrillation (AF) are largely unknown. We estimated the prevalence of AF in an older population, and examined whether use of anticoagulant and antiplatelet drugs in older AF patients has changed over time. Methods: Data from the population-based Swedish National study on Aging and Care in Kungsholmen (n = 3363, age = 60 years, 64.9% women) were used (2001-2004 and 2007-2010). AF cases were identified through 12-lead electrocardiogram, physician examinations, and patient register records (ICD-10 code I48). We used the CHADS(2) and CHA(2)DS(2)-VASc scores to estimate stroke risk, and an incomplete HAS-BLED score to estimate bleeding risk. Results: At baseline (2001-2004), 328 persons (9.8%) were ascertained to have AF. The prevalence of AF increased significantly with age from 2.8% in people aged 60-66 years to 21.2% in those = 90 years, and was more common in men than in women (11.2% vs. 9.0%). Among AF patients with CHADS2 score = 2 at baseline, 25% were taking anticoagulant drugs and 54% were taking antiplatelet drugs. High bleeding risk was significantly associated with not using anticoagulant drugs in AF patients (multi-adjusted OR = 2.50, p = 0.015). Between 2001-2004 and 2007-2010, use of anticoagulant drugs increased significantly, especially in AF patients with CHA2DS2-VASc score >= 2 (23% vs. 33%, p = 0.008) and in those with HAS-BLED score <3 (32% vs. 53%, p = 0.004). Conclusion: AF is common among old people. The use of anticoagulant drugs increased over time in AF patients, yet still two-thirds of those with high stroke risk remained untreated.

  • 2. Dludla, Phiwayinkosi V.
    et al.
    Nkambule, Bongani B.
    Tiano, Luca
    Louw, Johan
    Jastroch, Martin
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute. Helmholtz-Zentrum München, German Research Center for Environmental Health (GmbH), Germany; German Center for Diabetes Research (DZD), Germany.
    Mazibuko-Mbeje, Sithandiwe E.
    Uncoupling proteins as a therapeutic target to protect the diabetic heart2018In: Pharmacological Research, ISSN 1043-6618, E-ISSN 1096-1186, Vol. 137, p. 11-24Article, review/survey (Refereed)
    Abstract [en]

    Myocardial remodeling and dysfunction caused by accelerated oxidative damage is a widely reported phenomenon within a diabetic state. Altered myocardial substrate preference appears to be the major cause of enhanced oxidative stress-mediated cell injury within a diabetic heart. During this process, exacerbated free fatty acid flux causes an abnormal increase in mitochondrial membrane potential leading to the overproduction of free radical species and subsequent cell damage. Uncoupling proteins (UCPs) are expressed within the myocardium and can protect against free radical damage by modulating mitochondrial respiration, leading to reduced production of reactive oxygen species. Moreover, transgenic animals lacking UCPs have been shown to be more susceptible to oxidative damage and display reduced cardiac function when compared to wild type animals. This suggests that tight regulation of UCPs is necessary for normal cardiac function and in the prevention of diabetes-induced oxidative damage. This review aims to enhance our understanding of the pathophysiological mechanisms relating to the role of UCPs in a diabetic heart, and further discuss known pharmacological compounds and hormones that can protect a diabetic heart through the modulation of UCPs.

  • 3. Eisenberg, Tobias
    et al.
    Abdellatif, Mahmoud
    Schroeder, Sabrina
    Primessnig, Uwe
    Stekovic, Slaven
    Pendl, Tobias
    Harger, Alexandra
    Schipke, Julia
    Zimmermann, Andreas
    Schmidt, Albrecht
    Tong, Mingming
    Ruckenstuhl, Christoph
    Dammbrueck, Christopher
    Gross, Angelina S.
    Herbst, Viktoria
    Magnes, Christoph
    Trausinger, Gert
    Narath, Sophie
    Meinitzer, Andreas
    Hu, Zehan
    Kirsch, Alexander
    Eller, Kathrin
    Carmona-Gutierrez, Didac
    Büttner, Sabrina
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute. University of Graz, Austria.
    Pietrocola, Federico
    Knittelfelder, Oskar
    Schrepfer, Emilie
    Rockenfeller, Patrick
    Simonini, Corinna
    Rahn, Alexandros
    Horsch, Marion
    Moreth, Kristin
    Beckers, Johannes
    Fuchs, Helmut
    Gailus-Durner, Valerie
    Neff, Frauke
    Janik, Dirk
    Rathkolb, Birgit
    Rozman, Jan
    de Angelis, Martin Hrabe
    Moustafa, Tarek
    Haemmerle, Guenter
    Mayr, Manuel
    Willeit, Peter
    von Frieling-Salewsky, Marion
    Pieske, Burkert
    Scorrano, Luca
    Pieber, Thomas
    Pechlaner, Raimund
    Willeit, Johann
    Sigrist, Stephan J.
    Linke, Wolfgang A.
    Muehlfeld, Christian
    Sadoshima, Junichi
    Dengjel, Joern
    Kiechl, Stefan
    Kroemer, Guido
    Sedej, Simon
    Madeo, Frank
    Cardioprotection and lifespan extension by the natural polyamine spermidine2016In: Nature Medicine, ISSN 1078-8956, E-ISSN 1546-170X, Vol. 22, no 12, p. 1428-1438Article in journal (Refereed)
    Abstract [en]

    Aging is associated with an increased risk of cardiovascular disease and death. Here we show that oral supplementation of the natural polyamine spermidine extends the lifespan of mice and exerts cardioprotective effects, reducing cardiac hypertrophy and preserving diastolic function in old mice. Spermidine feeding enhanced cardiac autophagy, mitophagy and mitochondrial respiration, and it also improved the mechano-elastical properties of cardiomyocytes in vivo, coinciding with increased titin phosphorylation and suppressed subclinical inflammation. Spermidine feeding failed to provide cardioprotection in mice that lack the autophagy-related protein Atg5 in cardiomyocytes. In Dahl salt-sensitive rats that were fed a high-salt diet, a model for hypertension-induced congestive heart failure, spermidine feeding reduced systemic blood pressure, increased titin phosphorylation and prevented cardiac hypertrophy and a decline in diastolic function, thus delaying the progression to heart failure. In humans, high levels of dietary spermidine, as assessed from food questionnaires, correlated with reduced blood pressure and a lower incidence of cardiovascular disease. Our results suggest a new and feasible strategy for protection against cardiovascular disease.

  • 4. Ekelund, Ulf
    et al.
    Tarp, Jakob
    Steene-Johannessen, Jostein
    Hansen, Bjørge H.
    Jefferis, Barbara
    Fagerland, Morten W.
    Whincup, Peter
    Diaz, Keith M.
    Hooker, Steven P.
    Chernofsky, Ariel
    Larson, Martin G.
    Spartano, Nicole
    Vasan, Ramachandran S.
    Dohrn, Ing-Mari
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Hagströmer, Maria
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska University Hospital, Sweden.
    Edwardson, Charlotte
    Yates, Thomas
    Shiroma, Eric
    Anderssen, Sigmund A.
    Lee, I-Min
    Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis2019In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 366, article id l4570Article, review/survey (Refereed)
    Abstract [en]


    To examine the dose-response associations between accelerometer assessed total physical activity, different intensities of physical activity, and sedentary time and all cause mortality.


    Systematic review and harmonised meta-analysis.


    PubMed, PsycINFO, Embase, Web of Science, Sport Discus from inception to 31 July 2018.


    Prospective cohort studies assessing physical activity and sedentary time by accelerometry and associations with all cause mortality and reported effect estimates as hazard ratios, odds ratios, or relative risks with 95% confidence intervals.


    Guidelines for meta-analyses and systematic reviews for observational studies and PRISMA guidelines were followed. Two authors independently screened the titles and abstracts. One author performed a full text review and another extracted the data. Two authors independently assessed the risk of bias. Individual level participant data were harmonised and analysed at study level. Data on physical activity were categorised by quarters at study level, and study specific associations with all cause mortality were analysed using Cox proportional hazards regression analyses. Study specific results were summarised using random effects meta-analysis.


    All cause mortality.


    39 studies were retrieved for full text review; 10 were eligible for inclusion, three were excluded owing to harmonisation challenges (eg, wrist placement of the accelerometer), and one study did not participate. Two additional studies with unpublished mortality data were also included. Thus, individual level data from eight studies (n=36 383; mean age 62.6 years; 72.8% women), with median follow-up of 5.8 years (range 3.0-14.5 years) and 2149 (5.9%) deaths were analysed. Any physical activity, regardless of intensity, was associated with lower risk of mortality, with a non-linear dose-response. Hazards ratios for mortality were 1.00 (referent) in the first quarter (least active), 0.48 (95% confidence interval 0.43 to 0.54) in the second quarter, 0.34 (0.26 to 0.45) in the third quarter, and 0.27 (0.23 to 0.32) in the fourth quarter (most active). Corresponding hazards ratios for light physical activity were 1.00, 0.60 (0.54 to 0.68), 0.44 (0.38 to 0.51), and 0.38 (0.28 to 0.51), and for moderate-to-vigorous physical activity were 1.00, 0.64 (0.55 to 0.74), 0.55 (0.40 to 0.74), and 0.52 (0.43 to 0.61). For sedentary time, hazards ratios were 1.00 (referent; least sedentary), 1.28 (1.09 to 1.51), 1.71 (1.36 to 2.15), and 2.63 (1.94 to 3.56).


    Higher levels of total physical activity, at any intensity, and less time spent sedentary, are associated with substantially reduced risk for premature mortality, with evidence of a non-linear dose-response pattern in middle aged and older adults.

  • 5. Farioli, Andrea
    et al.
    Hemmingsson, Tomas
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Karolinska Institutet, Sweden.
    Kriebel, David
    Vascular risk factors and rhegmatogenous retinal detachment: a follow-up of a national cohort of Swedish men2016In: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 100, no 7, p. 907-913Article in journal (Refereed)
    Abstract [en]

    Background We aimed to investigate the role of vascular risk factors in the genesis of rhegmatogenous retinal detachment (RRD) using data from a large cohort of Swedish conscripts. Methods We used data from a nationwide cohort of 49 321 Swedish men born during 1949-1951, conscripted for compulsory military service in 19691970 with nearly complete follow-up to 2009. Information on surgically treated RRD between 1973 and 2009 was collected from the National Patient Register. We fitted Cox regression models stratified on myopia degree and including blood pressure levels, body mass index and cigarette smoking. Population attributable fractions of RRD were estimated through maximum likelihood methods. Results We observed 262 cases of RRD in 1 725 770 person-years. At multivariate analysis, the number of cigarettes per day showed a reverse association with the risk of RRD (p for trend 0.01). Conscripts with obesity presented a higher risk compared with normal subjects (adjusted HR 2.51, 95% CI 1.02 to 6.13). We found weak evidence of an association between blood pressure and RRD (HR for men with hypertension compared with normotension 1.41, 95% CI 0.93 to 2.13). All the observed associations were stronger when the analysis was restricted to non-myopic conscripts. In particular, the HR for hypertension was 2.33 (95% CI 1.30 to 4.19) compared with normotension. If this association is causal, we estimated that 42.0% of RRD cases (95% CI 11.5% to 62.0%) occurring among non-myopics are attributable to elevated blood pressure. Conclusions Vascular risk factors may be important determinants of RRD, particularly among non-myopics. Further investigations on the role of hypertension and obesity are needed.

  • 6.
    Fransson, Eleonor I.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Jönköping University, Sweden.
    Nyberg, Solja T.
    Heikkilä, Katriina
    Alfredsson, Lars
    Bjorner, Jakob B.
    Borritz, Marianne
    Burr, Hermann
    Dragano, Nico
    Geuskens, Goedele A.
    Goldberg, Marcel
    Hamer, Mark
    Hooftman, Wendela E.
    Houtman, Irene L
    Joensuu, Matti
    Jokela, Markus
    Knutsson, Anders
    Koskenvuo, Markku
    Koskinen, Aki
    Kumari, Meena
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lunau, Thorsten
    Madsen, Ida E. H.
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Nielsen, Martin L.
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Pejtersen, Jan H.
    Rugulies, Reiner
    Salo, Paula
    Shipley, Martin J.
    Steptoe, Andrew
    Suominen, Sakari B.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Toppinen-Tanner, Salla
    Vahtera, Jussi
    Virtanen, Marianna
    Väänänen, Ari
    Westerholm, Peter J. M.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Zins, Marie
    Britton, Annie
    Brunner, Eric J.
    Singh-Manoux, Archana
    Batty, G. David
    Kivimäki, Mika
    Job strain and the risk of stroke: an individual-participant data meta-analysis2015In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 46, no 2, p. 557-559Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Psychosocial stress at work has been proposed to be a risk factor for cardiovascular disease. However, its role as a risk factor for stroke is uncertain.

    METHODS: We conducted an individual-participant-data meta-analysis of 196 380 males and females from 14 European cohort studies to investigate the association between job strain, a measure of work-related stress, and incident stroke.

    RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job strain was 1.24 (95% confidence interval, 1.05;1.47) for ischemic stroke, 1.01 (95% confidence interval, 0.75;1.36) for hemorrhagic stroke, and 1.09 (95% confidence interval, 0.94;1.26) for overall stroke. The association with ischemic stroke was robust to further adjustment for socioeconomic status.

    CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies.

  • 7. Fuks, Kateryna B.
    et al.
    Weinmayr, Gudrun
    Basagana, Xavier
    Gruzieva, Olena
    Hampel, Regina
    Oftedal, Bente
    Sorensen, Mette
    Wolf, Kathrin
    Aamodt, Geir
    Aasvang, Gunn Marit
    Aguilera, Inmaculada
    Becker, Thomas
    Beelen, Rob
    Brunekreef, Bert
    Caracciolo, Barbara
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Cyrys, Josef
    Elosua, Roberto
    Eriksen, Kirsten Thorup
    Foraster, Maria
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Hilding, Agneta
    Houthuijs, Danny
    Korek, Michal
    Kunzli, Nino
    Marrugat, Jaume
    Nieuwenhuijsen, Mark
    Östenson, Claes-Göran
    Penell, Johanna
    Pershagen, Göran
    Raaschou-Nielsen, Ole
    Swart, Wim J. R.
    Peters, Annette
    Hoffmann, Barbara
    Long-term exposure to ambient air pollution and traffic noise and incident hypertension in seven cohorts of the European study of cohorts for air pollution effects (ESCAPE)2017In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 38, no 13, p. 983-990Article in journal (Refereed)
    Abstract [en]

    Aims We investigated whether traffic-related air pollution and noise are associated with incident hypertension in European cohorts. Methods and results We included seven cohorts of the European study of cohorts for air pollution effects (ESCAPE). We modelled concentrations of particulate matter with aerodynamic diameter <= 2.5 mu m (PM2.5), <= 10 mu m (PM10), >2.5, and <= 10 mu m (PMcoarse), soot (PM2.5 absorbance), and nitrogen oxides at the addresses of participants with land use regression. Residential exposure to traffic noise was modelled at the facade according to the EU Directive 2002/49/EC. We assessed hypertension as (i) self-reported and (ii) measured (systolic BP >= 140mmHg or diastolic BP >= 90mmHg or intake of BP lowering medication (BPLM). We used Poisson regression with robust variance estimation to analyse associations of traffic-related exposures with incidence of hypertension, controlling for relevant confounders, and combined the results from individual studies with random-effects meta-analysis. Among 41 072 participants free of self-reported hypertension at baseline, 6207 (15.1%) incident cases occurred within 5-9 years of follow-up. Incidence of self-reported hypertension was positively associated with PM2.5 (relative risk (RR) 1.22 [95%-confidence interval (CI): 1.08; 1.37] per 5 mu g/m(3)) and PM2.5 absorbance (RR 1.13 [95% CI: 1.02; 1.24] per 10(-5) m(-1)). These estimates decreased slightly upon adjustment for road traffic noise. Road traffic noise was weakly positively associated with the incidence of self-reported hypertension. Among 10 896 participants at risk, 3549 new cases of measured hypertension occurred. We found no clear associations with measured hypertension. Conclusion Long-term residential exposures to air pollution and noise are associated with increased incidence of self-reported hypertension.

  • 8.
    Goodman, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). London School of Hygiene and Tropical Medicine, UK.
    Kajantie, Eero
    Osmond, Clive
    Eriksson, Johan
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Thornburg, Kent
    Phillips, David IW
    The relationship between umbilical cord length and chronic rheumatic heart disease: a prospective cohort study2015In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 9, p. 1154-1160Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: One previous, preliminary study reported that the length of the umbilical cord at birth is related to the risk of developing chronic rheumatic heart disease in later life. We sought to replicate this finding.

    DESIGN: Prospective, population-based birth cohort.

    METHODS: We traced 11,580 individuals born between 1915 and 1929 in Uppsala, Sweden. We identified cases with a main or secondary diagnosis of chronic rheumatic heart disease in the Swedish national inpatient, outpatient or death registers. Archived obstetric records provided data on umbilical cord length, gestational age, birthweight and placental weight.

    RESULTS: There were 136 patients with chronic rheumatic heart disease (72 men and 64 women) with a mean age at first hospital admission of 68 years (range 36-92). There was evidence of a positive association between umbilical cord length and risk of subsequent chronic rheumatic heart disease. The overall hazard ratio in the Swedish study (1.13, 95% confidence interval 1.01 to 1.27) was similar to that of the previous study, with some suggestion of larger effect in men than in women. No other birth characteristics were predictive except for weak evidence of a protective effect of higher birthweight in men.

    CONCLUSIONS: People with longer umbilical cords at birth are more likely to develop chronic rheumatic heart disease in later life. As longer umbilical cords have more spiral arteries and a higher vascular resistance, we hypothesize that the increased pressure load on the heart leads to changes in endothelial biology and increased vulnerability to the autoimmune process initiated by infection with β-haemolytic streptococci.

  • 9. Hantikainen, Essi
    et al.
    Löf, Marie
    Grotta, Alessandra
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institutet, Sweden.
    Trolle Lagerros, Ylva
    Serafini, Mauro
    Bellocco, Rino
    Weiderpass, Elisabete
    Dietary non enzymatic antioxidant capacity and the risk of myocardial infarction in the Swedish women's lifestyle and health cohort2018In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 2, p. 213-221Article in journal (Refereed)
    Abstract [en]

    Foods rich in antioxidants have been associated with a reduced risk of myocardial infarction. However, findings from randomized clinical trials on the role of antioxidant supplementation remain controversial. It has been suggested that antioxidants interact with each other to promote cardiovascular health. We therefore investigated the association between dietary Non Enzymatic Antioxidant Capacity (NEAC), measuring the total antioxidant potential of the whole diet, and the risk of myocardial infarction. We followed 45,882 women aged 30-49 years and free from cardiovascular diseases through record linkages from 1991 until 2012. Dietary NEAC was assessed by a validated food frequency questionnaire collected at baseline. Total dietary NEAC was categorized into quintiles and multivariable Cox proportional hazard regression models were fitted to estimate hazard ratios (HR) with 95% confidence intervals (CI). During a mean follow-up time of 20.3 years we detected 657 incident cases of myocardial infarction. After adjusting for potential confounders, we found a significant 28% lower risk of myocardial infarction among women in the fourth (HR: 0.72; 95% CI 0.55-0.95) and a 40% lower risk among women in the fifth quintile (HR: 0.60, 95% CI 0.45-0.81) of dietary NEAC compared to women in the first quintile, with a significant trend (p-value < 0.001). Higher dietary NEAC is associated with a lower risk of myocardial infarction in young to middle-aged women. These findings support the hypothesis that dietary antioxidants protect from myocardial infarction and that this effect might be exerted through interactions between antioxidants.

  • 10. Hunter, Amanda L
    et al.
    Unosson, Jon
    Bosson, Jenny A
    Langrish, Jeremy P
    Pourazar, Jamshid
    Raftis, Jennifer B
    Miller, Mark R
    Lucking, Andrew J
    Boman, Christoffer
    Nyström, Robin
    Donaldson, Kenneth
    Flapan, Andrew D
    Shah, Anoop SV
    Pung, Louis
    Sadiktsis, Ioannis
    Stockholm University, Faculty of Science, Department of Analytical Chemistry.
    Masala, Silvia
    Stockholm University, Faculty of Science, Department of Analytical Chemistry.
    Westerholm, Roger
    Stockholm University, Faculty of Science, Department of Analytical Chemistry.
    Sandström, Thomas
    Blomberg, Anders
    Newby, David E
    Mills, Nicholas L
    Effect of wood smoke exposure on vascular function and thrombus formation in healthy fire fighters2014In: Particle and Fibre Toxicology, ISSN 1743-8977, E-ISSN 1743-8977, Vol. 11, no 62Article in journal (Refereed)
    Abstract [en]


    Myocardial infarction is the leading cause of death in fire fighters and has been linked with exposure to air pollution and fire suppression duties. We therefore investigated the effects of wood smoke exposure on vascular vasomotor and fibrinolytic function, and thrombus formation in healthy fire fighters.


    In a double-blind randomized cross-over study, 16 healthy male fire fighters were exposed to wood smoke (~1 mg/m3 particulate matter concentration) or filtered air for one hour during intermittent exercise. Arterial pressure and stiffness were measured before and immediately after exposure, and forearm blood flow was measured during intra-brachial infusion of endothelium-dependent and -independent vasodilators 4–6 hours after exposure. Thrombus formation was assessed using the ex vivo Badimon chamber at 2 hours, and platelet activation was measured using flow cytometry for up to 24 hours after the exposure.


    Compared to filtered air, exposure to wood smoke increased blood carboxyhaemoglobin concentrations (1.3% versus 0.8%; P < 0.001), but had no effect on arterial pressure,augmentation index or pulse wave velocity (P > 0.05 for all). Whilst there was a dose-dependent increase in forearm blood flow with each vasodilator (P < 0.01 for all), there were no differences in blood flow responses to acetylcholine, sodium nitroprusside or verapamil between exposures (P > 0.05 for all). Following exposure to wood smoke, vasodilatation tobradykinin increased (P = 0.003), but there was no effect on bradykinin-induced tissue-plasminogen activator release, thrombus area or markers of platelet activation (P > 0.05 for all).


    Wood smoke exposure does not impair vascular vasomotor or fibrinolytic function, or increase thrombus formation in fire fighters. Acute cardiovascular events following firesuppression may be precipitated by exposure to other air pollutants or through other mechanisms, such as strenuous physical exertion and dehydration.

  • 11.
    Kjellqvist, Sanela
    et al.
    Stockholm University, Faculty of Science, Department of Biochemistry and Biophysics. Stockholm University, Science for Life Laboratory (SciLifeLab).
    Klose, Christian
    Surma, Michal A.
    Hindy, George
    Mollet, Ines G.
    Johansson, Anna
    Stockholm University, Faculty of Science, Department of Biochemistry and Biophysics. Stockholm University, Science for Life Laboratory (SciLifeLab).
    Chavaux, Patrick
    Gottfries, Johan
    Simons, Kai
    Melander, Olle
    Fernandez, Celine
    Identification of Shared and Unique Serum Lipid Profiles in Diabetes Mellitus and Myocardial Infarction2016In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 5, no 12, article id e004503Article in journal (Refereed)
    Abstract [en]

    Background-Diabetes mellitus (DM) and cardiovascular disease are associated with dyslipidemia, but the detailed lipid molecular pattern in both diseases remains unknown. Methods and Results-We used shotgun mass spectrometry to determine serum levels of 255 molecular lipids in 316 controls, 171 DM, and 99 myocardial infarction (MI) events from a cohort derived from the Malmo Diet and Cancer study. Orthogonal projections to latent structures analyses were conducted between the lipids and clinical parameters describing DM or MI. Fatty acid desaturases (FADS) and elongation of very long chain fatty acid protein 5 (ELOVL5) activities were estimated by calculating product to precursor ratios of polyunsaturated fatty acids in complex lipids. FADS genotypes encoding these desaturases were then tested for association with lipid levels and ratios. Differences in the levels of lipids belonging to the phosphatidylcholine and triacylglyceride (TAG) classes contributed the most to separating DM from controls. TAGs also played a dominating role in discriminating MI from controls. Levels of C18:2 fatty acids in complex lipids were lower both in DM and MI versus controls (DM, P=0.004; MI, P=6.0E-06) at least due to an acceleration in the metabolic flux from C18: 2 to C20:4 (eg, increased estimated ELOVL5: DM, P=0.02; MI, P=0.04, and combined elongase-desaturase activities: DM, P=3.0E-06; MI, P=2.0E-06). Minor allele carriers of FADS genotypes were associated with increased levels of C18: 2 (P <= 0.007) and lower desaturase activity (P <= 0.002). Conclusions-We demonstrate a possible relationship between decreased levels of C18: 2 in complex lipids and DM or MI. We thereby highlight the importance of molecular lipids in the pathogenesis of both diseases.

  • 12. L'Angiocola, Paolo Diego
    et al.
    Vetrano, Davide Liborio
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lardieri, Gerardina
    From bicuspid to quadricuspid aortic valve: The clinical case of a 38-year-old woman with chest pain2019In: Journal of Cardiovascular Echography, ISSN 2211-4122, Vol. 29, no 3, p. 119-122Article in journal (Refereed)
    Abstract [en]

    We report a case of a 38-year-old woman with an alleged diagnosis of bicuspid aortic valve disease that was correctly identified as quadricuspid aortic valve (QAV) disease in our cardiology unit. In this case report, we focus on echocardiographic features of this rare congenital valve disease aiming to provide useful tips to achieve correct differential diagnosis according to the updated echocardiographic international guidelines and recommendations, briefly reviewing other QAV cases reported in the current literature as well. In conclusion, we strongly recommend adhering to practical echocardiographic guidelines to reduce interobserver variability, not to miss the diagnosis of rare congenital defects like the one we reported.

  • 13.
    Liang, Yajun
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide Liborio
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    The role of biological age in the management of hypertension in old age: Does SPRINT tell the whole story?2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 222, p. 699-700Article in journal (Refereed)
  • 14. Liperoti, Rosa
    et al.
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Università Cattolica del Sacro Cuore, Italy.
    Bernabei, Roberto
    Onder, Graziano
    Herbal Medications in Cardiovascular Medicine2017In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 69, no 9, p. 1188-1199Article in journal (Refereed)
    Abstract [en]

    Herbal medications are commonly used for clinical purposes, including the treatment of cardiovascular conditions. Compared with conventional medications, herbal medications do not require clinical studies before their marketing or formal approval from regulatory agencies, and for this reason their efficacy and safety are rarely proven. In this review, we summarize available evidence on herbal medications mostly used in cardiovascular medicine. We show that the use of these medications for the treatment of cardiovascular diseases is often not supported by scientific evidence. Despite most of these herbs showing an effect on biological mechanisms related to the cardiovascular system, data on their clinical effects are lacking. Potential relevant side effects, including increased risk of drug interactions, are described, and the possibility of contamination or substitution with other medications represents a concern. Physicians should always assess the use of herbal medications with patients and discuss the possible benefits and side effects with them.

  • 15. Ljung Faxen, Ulrika
    et al.
    Hage, Camilla
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Donal, Erwan
    Daubert, Jean-Claude
    Linde, Cecilia
    Brismar, Kerstin
    Lund, Lars H.
    HFpEF and HFrEF exhibit different phenotypes as assessed by leptin and adiponectin2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 228, p. 709-716Article in journal (Refereed)
    Abstract [en]

    Background: Heart failure with reduced ejection fraction (HFrEF) exhibits a reverse metabolic profile. Whether this profile exists in HF with preserved ejection fraction (HFpEF) is unknown. We tested the hypothesis that HFpEF and HFrEF are similar regarding concentrations of and prognostic impact of leptin and adiponectin.

    Methods: In patients with HFpEF(n = 79), HFrEF(n = 84), and controls(n = 71), we analyzed serum leptin and adiponectin concentrations, their correlations, and associations with outcome.

    Results: Leptin levels in HFpEF and HFrEF were increased (p < 0.05) compared to controls; with the highest levels in HFpEF, median (IQR), 23.1 (10.2-51.0), vs. HFrEF 15.0 (6.2-33.2), and vs. controls 10.8 (5.4-18.9) ng/mL. There was no difference between HFpEF and HFrEF p=0.125 (adjusted for gender, BMI and age). Leptin was inversely associated with NT-proBNP (r = -0.364 p = 0.001) and associated with better outcome in HFrEF (HR per ln increase of leptin 0.76, 95% CI 0.58-0.99, p = 0.044) but not in HFpEF.

    Crude levels of adiponectin were similar in HFpEF: 11.8 (7.9-20.1), HFrEF: 13.7 (7.0-21.1), and controls: 10.5 (7.4-15.1) mu g/L. In men, adjusted similarly as leptin, there was no difference between HFpEF and HFrEF, p = 0.310 but, compared to controls, higher levels in HFpEF (p - 0.044) and HFrEF (p - 0.001). Adiponectin correlated positively with NT-proBNP; r = 0.396 p < 0.001 and higher levels were associated with adverse outcome only in HFrEF (HR per ln increase 2.88 (95% CI 1.02-8.14, p = 0.045).

    Conclusion: HFpEF and HFrEF share elevated levels of leptin and adiponectin. However, the concept of reverse metabolic profile could not be confirmed in HFpEF, suggesting that HFpEF might have a conventional metabolic profile, rather than a distinct HF syndrome.

  • 16. Ljung Faxén, Ulrika
    et al.
    Hage, Camilla
    Benson, Lina
    Zabarovskaja, Stanislava
    Andreasson, Anna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska institutet, Sweden.
    Donal, Erwan
    Daubert, Jean-Claude
    Linde, Cecilia
    Brismar, Kerstin
    Lund, Lars H.
    HFpEF and HFrEF Display Different Phenotypes as Assessed by IGF-1 and IGFBP-12017In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 23, no 4, p. 293-303Article in journal (Refereed)
    Abstract [en]


    Anabolic drive is impaired in heart failure with reduced ejection fraction (HFrEF) but insufficiently studied in heart failure with preserved ejection fraction (HFpEF). Insulin-like growth factor 1 (IGF-1) mediates growth hormone effects and IGF binding protein 1 (IGFBP-1) regulates IGF-1 activity. We tested the hypothesis that HFpEF and HFrEF are similar with regard to IGF-1 and IGFBP-1.

    Methods and Results

    In patients with HFpEF (n = 79), HFrEF (n = 85), and controls (n = 136), we analyzed serum IGF-1 and IGFBP-1 concentrations, correlations, and associations with outcome. Age-standardized scores of IGF-1 were higher in HFpEF, median arbitrary units (interquartile range); 1.21 (0.57–1.96) vs HFrEF, 0.09 (-1.40–1.62), and controls, 0.22 (-0.47-0.96), P overall <.001. IGFBP-1 was increased in HFpEF, 48 (28–79), and HFrEF, 65 (29–101), vs controls, 27(14–35) µg/L, P overall <.001. These patterns persisted after adjusting for metabolic and HF severity confounders. IGF-1 was associated with outcomes in HFrEF, hazard ratio per natural logarithmic increase in IGF-1 SD score 0.51 (95% confidence interval 0.32–0.82, P = .005), but not significantly in HFpEF. IGFBP-1 was not associated with outcomes in either HFpEF nor HFrEF.


    HFpEF and HFrEF phenotypes were similar with regard to increased IGFBP-1 concentrations but differed regarding IGF-1 levels and prognostic role. HFrEF and HFpEF may display different impairment in anabolic drive.

  • 17. Malki, Ninoa
    et al.
    Hägg, Sara
    Tiikkaja, Sanna
    Koupil, Ilona
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS).
    Sparén, Pär
    Ploner, Alexander
    Short-term and long-term case-fatality rates for myocardial infarction and ischaemic stroke by socioeconomic position and sex: a population-based cohort study in Sweden, 1990-1994 and 2005-20092019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e026192Article in journal (Refereed)
    Abstract [en]

    Objective Case-fatality rates (CFRs) for myocardial infarction (MI) and ischaemic stroke (IS) have decreased over time due to better prevention, medication and hospital care. It is unclear whether these improvements have been equally distributed according to socioeconomic position (SEP) and sex. The aim of this study is to analyse differences in short-term and long-term CFR for MI and IS by SEP and sex between the periods 1990-1994 to 2005-2009 for the entire Swedish population.

    Design Population-based cohort study based on Swedish national registers.

    Methods We used logistic regression and flexible parametric models to estimate short-term CFR (death before reaching the hospital or on the disease event day) and long-term CFR (1 year case-fatality conditional on surviving short-term) across five distinct SEP groups, as well as CFR differences (CFRDs) between SEP groups for both MI and IS from 1990-1994 to 2005-2009.

    Results Overall short-term CFR for both MI and IS decreased between study periods. For MI, differences in short-term and long-term CFR between the least and most favourable SEP group were generally stable, except in long-term CFR among women; intermediate SEP groups mostly managed to catch up with the most favourable SEP group. For IS, short-term CFRD generally decreased compared with the most favourable group; but long-term CFRD were mostly stable, except for an increase for older subjects.

    Conclusion Despite a general decline in CFR for MI and IS across all SEP groups and both sexes as well as some reductions in CFRD, we found persistent and even increasing CFRD among the least advantaged SEP groups, older patients and women. We speculate that targeted prevention rather than treatment strategies have the potential to reduce these inequalities.

  • 18. Manousek, Jan
    et al.
    Andrsova, Irena
    Stejskal, Vera
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute. Masaryk Universit, Czech Republic.
    Vlasinova, Jitka
    Sepsi, Milan
    Kuta, Jan
    Klanova, Jana
    Mazik, Michal
    Jarkovsky, Jiri
    Snajdrova, Lenka
    Benesova, Klara
    Novotny, Tomas
    Zadakova, Andrea
    Spinar, Jindrich
    Hypersensitivity to material and environmental burden as a possible cause of late complications of cardiac implantable electronic devices2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no 9, p. e140-e147Article in journal (Refereed)
    Abstract [en]


    To evaluate whether patients with late complications of pacemakers or implantable cardioverter-defibrillators have hypersensitivity reactions to some of the materials used in generators or in electrodes, or to environmental metal burden.

    Methods and results

    The cohort consisted of 20 men and 4 women (mean age: 62.3 +/- 17.2 years) who had a history of late complications of implanted devices. The control group involved 25 men and 8 women (mean age: 64.6 +/- 14.0 years) who had comparable devices, but no history of late complications. Lymphocyte transformation test was used to evaluate hypersensitivity to eight metal pollutants (antimony, manganese, mercury, molybdenum, nickel, platinum, tin, and titanium) selected by results of questionnaires on environmental burden, and by material analysis of generators and electrode surfaces. Exposures to metal pollutants were approximately the same in patients and in controls. Titanium alloy used in generators contained at least 99.32% of titanium and trace levels of other metals; higher levels of tin and platinum were detected in electrode surfaces. Hypersensitivity reactions to mercury and tin were significantly more frequent in patients than in controls (patients and controls: mercury: 68.2 and 31.1%, respectively; P = 0.022; tin: 25.0 and 3.2%, respectively; P = 0.035). In contrast, hypersensitivity to manganese was significantly more frequent in controls than in patients (patients and controls: 13.6 and 50.0%, respectively; P = 0.008).


    Our findings suggest a possible relation between hypersensitivity to metals used in implantable devices or to environmental metal burden and the occurrence of their late complications.

  • 19. Manousek, Jan
    et al.
    Stejskal, Vera
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute. Masaryk University, Czech Republic .
    Kubena, Petr
    Jarkovsky, Jiri
    Nemec, Petr
    Lokaj, Petr
    Dostalova, Ludmila
    Zadakova, Andrea
    Pavlusova, Marie
    Benesova, Klara
    Kala, Petr
    Miklik, Roman
    Spinar, Jindrich
    Parenica, Jiri
    Delayed-Type Hypersensitivity to Metals of Environmental Burden in Patients with Takotsubo Syndrome - Is There a Clinical Relevance?2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 11, article id e0164786Article in journal (Refereed)
    Abstract [en]

    Objective Takotsubo syndrome (TS) is a heart condition characterised by a sudden transient left ventricular dysfunction; its pathophysiology is probably associated with elevated levels of catecholamines but the exact mechanism is not known as yet. Literature and clinical experience suggest that TS affects persons with various comorbidities. This pilot work aims to evaluate the frequency of comorbidities with potential pathological immune reactivity, and to evaluate the potential association between TS and hypersensitivity to metals assessed by LTT-MELISA (R). Methodology, Results A total of 24 patients (23 women, 1 man) with a history of TS attack and 27 healthy controls were evaluated. Hypersensitivity was evaluated by a lymphocyte transformation test (LTT-MELISA (R)); a questionnaire of environmental burden was used to select evaluated metals. A total of 19 patients (79%) had at least one condition that might potentially be associated with pathological immune reactivity (autoimmune thyroid disease, drug allergy, bronchial asthma, cancer, contact dermatitis, rheumatoid arthritis). Hypersensitivity to metals was identified significantly more frequently in TS patients than in healthy controls (positive reaction to at least one metal was identified in 95.8% of TS patients and in 59.3% of controls; p = 0.003); the difference was statistically significant for mercury (45.8% and 14.8%, respectively; p = 0.029). Conclusion Our work shows that conditions with pathological immune reactivity occur frequently in TS patients, and our data suggest a possible association between TS and hypersensitivity tometals (mercury in particular) evaluated by LTT-MELISA (R). We also suggest that apart from the triggering stress factor, potential existence of other serious conditions should be considered when taking medical history of TS patients.

  • 20. Meng, Linghui
    et al.
    Hou, Dongqing
    Zhao, Xiaoyuan
    Hu, Yuehua
    Liang, Yajun
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jining Medical University, China.
    Liu, Junting
    Yan, Yinkun
    Mi, Jie
    Cardiovascular target organ damage could have been detected in sustained pediatric hypertension2015In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 24, no 5, p. 284-292Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess sustained hypertension in children and its impact on cardiovascular target organ damage (TOD). Blood pressure (BP) was measured in children in Beijing in 2009. Primary hypertension was diagnosed based on three separate visits. Hypertensive children and normotensive children were followed up in 2011. According to these evaluations, three groups were defined: sustained hypertension, non-sustained hypertension and normotensive. Cardiovascular TOD and metabolic disorders were evaluated using pulse-wave velocity (PWV), carotid intima-media thickness (cIMT), and assessments of left ventricular structure and kidney function. A total of 3032 children aged 9-15 years participated in this survey, of whom 128 were diagnosed with hypertension after three separate BP measurements. Eighty out of 128 (62.5%) hypertensive and 158 normotensive children were available for follow-up in 2011. Forty-eight children were defined as having sustained hypertension, 38 as non-sustained hypertension and 152 as normotensive. Mean levels of brachial-ankle PWV (baPWV), left ventricular mass, left ventricular mass index (LVMI) and cIMT were significantly different between the three groups (p < 0.01). Compared to normotensives, the odds ratios and 95% confidence intervals for elevated LVM and cIMT were 5.27 (1.57-17.66) and 2.88 (1.03-8.09) in the non-sustained hypertensive group, and 3.28 (1.00-10.74) and 7.25 (2.69-19.58) in the sustained hypertensive group. The children with sustained hypertension have the highest risk of developing arterial stiffness, left ventricular hypertrophy and early blood vessel endothelium damage. The indices of cIMT, LVMI and PWV were useful to identify children at high risk of cardiovascular TOD.

  • 21. Papp, Marian E.
    et al.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Nygren-Bonnier, Malin
    Gullstrand, Lennart
    Wändell, Per E.
    Effects of high-intensity hatha yoga on cardiovascular fitness, adipocytokines, and apolipoproteins in healthy students: a randomized controlled study2016In: Journal of Alternative and Complementary Medicine, ISSN 1075-5535, E-ISSN 1557-7708, Vol. 22, no 1, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Background: Yoga exercises are often used as a form of body and mind exercise to increase performance. However, knowledge about the physiologic effects of performing high-intensity Hatha yoga exercises over a longer time period remains limited.

    Objective: To investigate the effects of high-intensity yoga (HIY) on cardiovascular fitness (maximal oxygen consumption, estimated from the Cooper running test), ratings of perceived exertion (RPE), heart rate (HR), heart rate recovery (HRR), blood pressure (BP), adipocytokines, apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), and glycosylated hemoglobin (HbA1c) in healthy students.

    Methods: The 44 participants (38 women and 6 men; median age, 25 years [range, 20–39 years]) were randomly assigned to an HIY or a control group. The HIY program was held for 6 weeks (60 minutes once a week). Cardiovascular fitness, RPE, HR, HRR, BP, adipocytokines, HbA1c, ApoA1, and ApoB were measured at baseline and after 6 weeks in both groups.

    Results: HIY had no significant effects on cardiovascular fitness (mean dose: 390 minutes [range, 210–800 minutes]), HR, HRR, BP, or any of the blood parameters. However, ApoA1 (1.47 ± 0.17 to 1.55 ± 0.16 g/L; p = 0.03) and adiponectin (8.32 ± 3.32 to 9.68 ± 3.83 mg/L; p = 0.003) levels increased significantly in the HIY group after 6 weeks.

    Conclusions: Six weeks of HIY did not significantly improve cardiovascular fitness. However, ApoA1 and adiponectin levels increased significantly in the HIY group. This finding suggests that HIY may have positive effects on blood lipids and an anti-inflammatory effect.

  • 22. Rehm, Jürgen
    et al.
    Anderson, Peter
    Prieto, Jose Angel Arbesu
    Armstrong, Iain
    Aubin, Henri-Jean
    Bachmann, Michael
    Bastus, Nuria Bastida
    Brotons, Carlos
    Burton, Robyn
    Cardoso, Manuel
    Colom, Joan
    Duprez, Daniel
    Gmel, Gerrit
    Gual, Antoni
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). IFT Institut für Therapieforschung, Germany.
    Kreutz, Reinhold
    Liira, Helena
    Manthey, Jakob
    Møller, Lars
    Okruhlica, L´ubomír
    Roerecke, Michael
    Scafato, Emanuele
    Schulte, Bernd
    Segura-Garcia, Lidia
    Shield, Kevin David
    Sierra, Cristina
    Vyshinskiy, Konstantin
    Wojnarand, Marcin
    Zarco, José
    Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union2017In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 15, article id 173Article in journal (Refereed)
    Abstract [en]


    Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.


    A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statisticalmodelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.


    Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.


    The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

  • 23. Rigattieri, Stefano
    et al.
    Sciahbasi, Alessandro
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Mussino, Eleonora
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Cera, Maria
    Di Russo, Cristian
    Fedele, Silvio
    Pugliese, Francesco Rocco
    Transradial Access and Radiation Exposure in Diagnostic and Interventional Coronary Procedures2014In: The Journal of invasive cardiology, ISSN 1042-3931, E-ISSN 1557-2501, Vol. 26, no 9, p. 469-474Article in journal (Refereed)
    Abstract [en]

    Background. Although transradial access (TRA) is being increasingly used in interventional cardiology, there are concerns about a possible increase in radiation exposure (RE) as compared to transfemoral access (TFA). Methods. In this retrospective study, we aimed to compare RE during coronary angiography and percutaneous coronary intervention (PCI) according to the vascular access route (TRA vs TFA). We included all procedures performed in our laboratory, in which RE data (dose area product, were available, from May 2009 to May 2013. Both multiple linear regression analysis and propensity score matching were performed in order to compare RE between TRA and TFA after adjusting for clinical and procedural confounders. Results. DAP values were available for 1396 procedures; TRA rate was 82.6%. TRA patients were younger, less frequently female, and had higher body mass index as compared to TFA patients; the rates of PCI, ad hoc PCI, bypass angiography, thrombus aspiration, and primary angioplasty, as well as the number of stents implanted, fluoroscopy time, and contrast dose were significantly higher in TFA. Median DAP value was significantly higher in TFA than in TRA (9670 vs 7635; P<.01). After adjusting for clinical and procedural confounders, vascular access was not found to be an independent predictor of RE at multiple regression analysis; this was also confirmed by stratified comparison of DAP values by quintiles of propensity score. Conclusion. After adjusting for clinical and procedural confounders, TRA was not found to be associated with increased RE as compared to TFA in an experienced TRA center.

  • 24. Song, Aiqin
    et al.
    Liang, Yajun
    Yan, Zhongrui
    Sun, Binglun
    Cai, Chuanzhu
    Jiang, Hui
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Highly prevalent and poorly controlled cardiovascular risk factors among Chinese elderly people living in the rural community2014In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 21, no 10, p. 1267-1274Article in journal (Refereed)
    Abstract [en]

    Background The epidemiological scenario of cardiovascular risk factors (CRFs) among elderly people in rural China is unclear. We seek to describe the distribution, burden and management of major CRFs among older Chinese people living in the rural community. Methods This cross-sectional study included 1538 participants in the Confucius Hometown Aging Project (2010-2011) of people 60 years of age (mean age 68.6 years; 59.1% women) who lived in a rural community nearby Qufu, Shandong, China. Data were collected through a face-to-face interview, a clinical examination and laboratory tests. We carried out descriptive analysis on the prevalence and management of major CRFs. Results The overall prevalence of current smoking, physical inactivity, hypertension, diabetes, high cholesterol and obesity were 13.8%, 83.7%, 76.0%, 26.6%, 42.4% and 13.1%, respectively: 82.8% and 50.4% of participants had 2 and 3, respectively, of the six CRFs. Prevalence of alcohol consumption was 18.7%. Men were more likely to smoke and consume alcohol than women, whereas women were more likely to be obese and physically inactive than men (p<0.001). Prevalence of physical inactivity and hypertension increased with age, prevalence of alcohol intake and obesity decreased with age, and prevalence of smoking and diabetes was stable. Hypertension, diabetes and high cholesterol were treated in 60.6%, 68.1% and 41.1% of those with the disease, respectively, but only 11.3%, 13.7% and 31.7% achieved good control. Conclusions CRFs are highly prevalent and poorly controlled among elderly people in rural China, where men and women have different CRF profiles. Intervention programs targeting major CRFs may improve the health of older people in China.

  • 25. Song, Huan
    et al.
    Fang, Fang
    Arnberg, Filip K.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Mataix-Cols, David
    de la Cruz, Lorena Fernandez
    Almqvist, Catarina
    Fall, Katja
    Lichtenstein, Paul
    Thorgeirsson, Gudmundur
    Valdimarsdottir, Unnur A.
    Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study2019In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 365, article id l1255Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To assess the association between stress related disorders and subsequent risk of cardiovascular disease.

    DESIGN Population based, sibling controlled cohort study. SETTING Population of Sweden.

    PARTICIPANTS 136 637 patients in the Swedish National Patient Register with stress related disorders, including post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions, from 1987 to 2013; 171 314 unaffected full siblings of these patients; and 1 366 370 matched unexposed people from the general population.

    MAIN OUTCOME MEASURES Primary diagnosis of incident cardiovascular disease-any or specific subtypes (ischaemic heart disease, cerebrovascular disease, emboli/thrombosis, hypertensive diseases, heart failure, arrhythmia/conduction disorder, and fatal cardiovascular disease)-and 16 individual diagnoses of cardiovascular disease. Hazard ratios for cardiovascular disease were derived from Cox models, after controlling for multiple confounders.

    RESULTS During up to 27 years of follow-up, the crude incidence rate of any cardiovascular disease was 10.5, 8.4, and 6.9 per 1000 person years among exposed patients, their unaffected full siblings, and the matched unexposed individuals, respectively. In sibling based comparisons, the hazard ratio for any cardiovascular disease was 1.64 (95% confidence interval 1.45 to 1.84), with the highest subtype specific hazard ratio observed for heart failure (6.95, 1.88 to 25.68), during the first year after the diagnosis of any stress related disorder. Beyond one year, the hazard ratios became lower (overall 1.29, 1.24 to 1.34), ranging from 1.12 (1.04 to 1.21) for arrhythmia to 2.02 (1.45 to 2.82) for artery thrombosis/embolus. Stress related disorders were more strongly associated with early onset cardiovascular diseases (hazard ratio 1.40 (1.32 to 1.49) for attained age < 50) than later onset ones (1.24 (1.18 to 1.30) for attained age >= 50; P for difference=0.002). Except for fatal cardiovascular diseases, these associations were not modified by the presence of psychiatric comorbidity. Analyses within the population matched cohort yielded similar results (hazard ratio 1.71 (1.59 to 1.83) for any cardiovascular disease during the first year of follow-up and 1.36 (1.33 to 1.39) thereafter).

    CONCLUSION Stress related disorders are robustly associated with multiple types of cardiovascular disease, independently of familial background, history of somatic/psychiatric diseases, and psychiatric comorbidity.

  • 26. Subic, Ana
    et al.
    Cermakova, Pavla
    Religa, Dorota
    Han, Shuang
    von Euler, Mia
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Univ, Stockholm, Sweden.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Bognandi, Liselia
    Winblad, Bengt
    Kramberger, Milica G.
    Eriksdotter, Maria
    Garcia-Ptacek, Sara
    Treatment of Atrial Fibrillation in Patients with Dementia: A Cohort Study from the Swedish Dementia Registry2018In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 61, no 3, p. 1119-1128Article in journal (Refereed)
    Abstract [en]

    Background: Patients with dementia might have higher risk for hemorrhagic complications with anticoagulant therapy prescribed for atrial fibrillation (AF).

    Objective: This study assesses the risks and benefits of warfarin, antiplatelets, and no treatment in patients with dementia and AF.

    Methods: Of 49,792 patients registered in the Swedish Dementia Registry 2007-2014, 8,096 (16%) had a previous diagnosis of AF. Cox proportional hazards models were used to calculate the risk for ischemic stroke (IS), nontraumatic intracranial hemorrhage, any-cause hemorrhage, and death.

    Results: Out of the 8,096 dementia patients with AF, 2,143 (26%) received warfarin treatment, 2,975 (37%) antiplatelet treatment, and 2,978 (37%) had no antithrombotic treatment at the time of dementia diagnosis. Patients on warfarin had fewer IS than those without treatment (5.2% versus 8.7%; p < 0.001) with no differences compared to antiplatelets. In adjusted analyses, warfarin was associated with a lower risk for IS (HR 0.76, CI 0.59-0.98), while antiplatelets were associated with increased risk (HR 1.25, CI 1.01-1.54) compared to no treatment. For any-cause hemorrhage, there was a higher risk with warfarin (HR 1.28, CI 1.03-1.59) compared to antiplatelets. Warfarin and antiplatelets were associated with a lower risk for death compared to no treatment.

    Conclusions: Warfarin treatment in Swedish patients with dementia is associated with lower risk of IS and mortality, and a small increase in any-cause hemorrhage. This study supports the use of warfarin in appropriate cases in patients with dementia. The low percentage of patients on warfarin treatment indicates that further gains in stroke prevention are possible.

  • 27.
    Vetrano, Davide L.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Pisciotta, Maria S.
    Brandi, Vincenzo
    Lo Monaco, Maria R.
    Laudisio, Alice
    Onder, Graziano
    Fusco, Domenico
    L'Angiocola, Paolo D.
    Bentivoglio, Anna R.
    Bernabei, Roberto
    Zuccalà, Giuseppe
    Impact of disease duration and cardiovascular dysautonomia on hypertension in Parkinson's disease2017In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Vol. 19, no 4, p. 418-423Article in journal (Refereed)
    Abstract [en]

    The authors evaluated the association of Parkinson's disease (PD) duration with hypertension, assessed by office measurements and 24-hour (ambulatory) monitoring, in 167 patients. Hypertension was evaluated through both office and ambulatory blood pressure (BP) measurements. Among participants (mean age 73.4 +/- 7.6years; 35% women), the prevalence of hypertension was 60% and 69% according to office and ambulatory BP measurements, respectively (Cohen's k=0.61; P<.001). PD duration was inversely associated with hypertension as diagnosed by office measurements (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.86-0.98) but not by ambulatory monitoring (OR, 0.94; 95% CI, 0.81-1.01). Ambulatory BP patterns showed higher nocturnal BP among patients with long-lasting disease. In conclusion, ambulatory BP monitoring improves the detection of hypertension by 15% in PD, compared with office evaluation. The likelihood of having hypertension does not decrease during the PD course; rather, BP pattern shifts towards nocturnal hypertension.

  • 28. Villani, Emanuele R.
    et al.
    Tummolo, Anita M.
    Palmer, Katie
    Manes Gravina, Ester
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of the Sacred Heart, Italy.
    Bernabei, Roberto
    Onder, Graziano
    Acampora, Nicola
    Frailty and atrial fibrillation: A systematic review2018In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 56, p. 33-38Article, review/survey (Refereed)
    Abstract [en]

    Atrial fibrillation (AF) is a common cardiac arrhythmia and its prevalence increases with age. There is a significant correlation between frailty, morbidity and mortality in elderly patients with cardiovascular disease, but the relation between AF and frailty is still under debate. The aim of this study is to systematically review evidence on the association between AF and frailty. A systematic review of articles published between 02/01/2002 and 09/28/2017 according to PRISMA recommendations was carried out. PubMed, Web of Science, and Embase were searched for relevant articles. 11 studies were included; one longitudinal, 10 cross-sectional. Only 4 studies assessed the association of frailty with AF, while 7 studies were performed in a sample of participants with AF and did not provide any measure of association between these two conditions. The prevalence of frailty in AF patients ranged from 4.4%-75.4% while AF prevalence in the frail population ranged from 48.2%-75.4%. Selected studies enrolled an overall sample of 9420 participants. Among them, 2803 participants were diagnosed with AF and of these 1517 (54%) were frail and 1286 (46%) were pre-frail or robust. The four studies assessing the association of AF and frailty provided conflicting results. Evidence suggests that frailty is common in persons with AF. More research is needed to better assess the association of these conditions and to identify the optimal therapeutic approach to AF in persons with frailty.

  • 29.
    Virtanen, Marianna
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Uppsala University, Sweden.
    Kivimäki, Mika
    Long Working Hours and Risk of Cardiovascular Disease2018In: Current Cardiology Reports, ISSN 1523-3782, E-ISSN 1534-3170, Vol. 20, no 11, article id 123Article, review/survey (Refereed)
    Abstract [en]

    To summarize the evidence on the relationship between long working hours and cardiovascular disease, such as coronary heart disease and stroke. Large-scale meta-analyses with published and individual participant observational data on more than 740,000 men and women free of cardiovascular disease report a link between long working hours (>= 55 h a week) and the onset of cardiovascular events. Our meta-analytic update of summary evidence suggests a 1.12-fold (95% CI 1.03-1.21) increased risk associated with coronary heart disease and a 1.21-fold (95% CI 1.01-1.45) increased risk of stroke, although the evidence is somewhat inconsistent and the possibility of residual confounding and bias cannot be ruled out. Few studies have examined the mechanisms which may be stress-related, behavioral, or biological. The recent pooled analyses suggest that increased cardiac electric instability and hypercoagulability might play a role. The evidence that long working hours are a risk factor for cardiovascular disease is accumulating and suggests a small risk. Studies on the effects of long working hours in high-risk populations and those with pre-existing cardiovascular disease, mechanistic research, and intervention studies are needed to advance this research field.

  • 30. Wain, Louise V.
    et al.
    Vaez, Ahmad
    Jansen, Rick
    Joehanes, Roby
    van der Most, Peter J.
    Erzurumluoglu, A. Mesut
    O'Reilly, Paul F.
    Cabrera, Claudia P.
    Warren, Helen R.
    Rose, Lynda M.
    Verwoert, Germaine C.
    Hottenga, Jouke-Jan
    Strawbridge, Rona J.
    Esko, Tonu
    Arking, Dan E.
    Hwang, Shih-Jen
    Guo, Xiuqing
    Kutalik, Zoltan
    Trompet, Stella
    Shrine, Nick
    Teumer, Alexander
    Ried, Janina S.
    Bis, Joshua C.
    Smith, Albert V.
    Amin, Najaf
    Nolte, Ilja M.
    Lyytikainen, Leo-Pekka
    Mahajan, Anubha
    Wareham, Nicholas J.
    Hofer, Edith
    Joshi, Peter K.
    Kristiansson, Kati
    Traglia, Michela
    Havulinna, Aki S.
    Goel, Anuj
    Nalls, Mike A.
    Sober, Siim
    Vuckovic, Dragana
    Luan, Jian'an
    Del Greco M, Fabiola
    Ayers, Kristin L.
    Marrugat, Jaume
    Ruggiero, Daniela
    Lopez, Lorna M.
    Niiranen, Teemu
    Enroth, Stefan
    Jackson, Anne U.
    Nelson, Christopher P.
    Huffman, Jennifer E.
    Zhang, Weihua
    Marten, Jonathan
    Gandin, Ilaria
    Harris, Sarah E.
    Zemunik, Tatijana
    Lu, Yingchang
    Evangelou, Evangelos
    Shah, Nabi
    de Borst, Martin H.
    Mangino, Massimo
    Prins, Bram P.
    Campbell, Archie
    Li-Gao, Ruifang
    Chauhan, Ganesh
    Oldmeadow, Christopher
    Abecasis, Goncalo
    Abedi, Maryam
    Barbieri, Caterina M.
    Barnes, Michael R.
    Batini, Chiara
    Beilby, John
    Blake, Tineka
    Boehnke, Michael
    Bottinger, Erwin P.
    Braund, Peter S.
    Brown, Morris
    Brumat, Marco
    Campbell, Harry
    Chambers, John C.
    Cocca, Massimiliano
    Collins, Francis
    Connell, John
    Cordell, Heather J.
    Damman, Jeffrey J.
    Davies, Gail
    de Geus, Eco J.
    de Mutsert, Renee
    Deelen, Joris
    Demirkale, Yusuf
    Doney, Alex S. F.
    Dorr, Marcus
    Farrall, Martin
    Ferreira, Teresa
    Frånberg, Mattias
    Stockholm University, Faculty of Science, Numerical Analysis and Computer Science (NADA). Karolinska Institutet, Sweden; Karolinska Universitetsjukhuset, Sweden.
    Gao, He
    Giedraitis, Vilmantas
    Gieger, Christian
    Giulianini, Franco
    Gow, Alan J.
    Hamsten, Anders
    Harris, Tamara B.
    Hofman, Albert
    Holliday, Elizabeth G.
    Hui, Jennie
    Jarvelin, Marjo-Riitta
    Johansson, Asa
    Johnson, Andrew D.
    Jousilahti, Pekka
    Jula, Antti
    Kahonen, Mika
    Kathiresan, Sekar
    Khaw, Kay-Tee
    Kolcic, Ivana
    Koskinen, Seppo
    Langenberg, Claudia
    Larson, Marty
    Launer, Lenore J.
    Lehne, Benjamin
    Liewald, David C. M.
    Lin, Li
    Lind, Lars
    Mach, Francois
    Mamasoula, Chrysovalanto
    Menni, Cristina
    Mifsud, Borbala
    Milaneschi, Yuri
    Morgan, Anna
    Morris, Andrew D.
    Morrison, Alanna C.
    Munson, Peter J.
    Nandakumar, Priyanka
    Quang, Tri
    Nutile, Teresa
    Oldehinkel, Albertine J.
    Oostra, Ben A.
    Org, Elin
    Padmanabhan, Sandosh
    Palotie, Aarno
    Pare, Guillaume
    Pattie, Alison
    Penninx, Brenda W. J. H.
    Poulter, Neil
    Pramstaller, Peter P.
    Raitakari, Olli T.
    Ren, Meixia
    Rice, Kenneth
    Ridker, Paul M.
    Riese, Harriette
    Ripatti, Samuli
    Robino, Antonietta
    Rotter, Jerome I.
    Rudan, Igor
    Saba, Yasaman
    Saint Pierre, Aude
    Sala, Cinzia F.
    Sarin, Antti-Pekka
    Schmidt, Reinhold
    Scott, Rodney
    Seelen, Marc A.
    Shields, Denis C.
    Siscovick, David
    Sorice, Rossella
    Stanton, Alice
    Stott, David J.
    Sundstrom, Johan
    Swertz, Morris
    Taylor, Kent D.
    Thom, Simon
    Tzoulaki, Ioanna
    Tzourio, Christophe
    Uitterlinden, Andre G.
    Volker, Uwe
    Vollenweider, Peter
    Wild, Sarah
    Willemsen, Gonneke
    Wright, Alan F.
    Yao, Jie
    Theriault, Sebastien
    Conen, David
    Attia, John
    Sever, Peter
    Debette, Stephanie
    Mook-Kanamori, Dennis O.
    Zeggini, Eleftheria
    Spector, Tim D.
    van der Harst, Pim
    Palmer, Colin N. A.
    Vergnaud, Anne-Claire
    Loos, Ruth J. F.
    Polasek, Ozren
    Starr, John M.
    Girotto, Giorgia
    Hayward, Caroline
    Kooner, Jaspal S.
    Lindgren, Cecila M.
    Vitart, Veronique
    Samani, Nilesh J.
    Tuomilehto, Jaakko
    Gyllensten, Ulf
    Knekt, Paul
    Deary, Ian J.
    Ciullo, Marina
    Elosua, Roberto
    Keavney, Bernard D.
    Hicks, Andrew A.
    Scott, Robert A.
    Gasparini, Paolo
    Laan, Maris
    Liu, YongMei
    Watkins, Hugh
    Hartman, Catharina A.
    Salomaa, Veikko
    Toniolo, Daniela
    Perola, Markus
    Wilson, James F.
    Schmidt, Helena
    Zhao, Jing Hua
    Lehtimaki, Terho
    van Duijn, Cornelia M.
    Gudnason, Vilmundur
    Psaty, Bruce M.
    Peters, Annette
    Rettig, Rainer
    James, Alan
    Jukema, J. Wouter
    Strachan, David P.
    Palmas, Walter
    Metspalu, Andres
    Ingelsson, Erik
    Boomsma, Dorret I.
    Franco, Oscar H.
    Bochud, Murielle
    Newton-Cheh, Christopher
    Munroe, Patricia B.
    Elliott, Paul
    Chasman, Daniel I.
    Chakravarti, Aravinda
    Knight, Joanne
    Morris, Andrew P.
    Levy, Daniel
    Tobin, Martin D.
    Snieder, Harold
    Caulfield, Mark J.
    Ehret, Georg B.
    Alistair, T. Y.
    Betholdson, J. -P.
    Xiao, Limin
    Novel Blood Pressure Locus and Gene Discovery Using Genome-Wide Association Study and Expression Data Sets From Blood and the Kidney2017In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 70, no 3, p. e4-e19Article in journal (Refereed)
    Abstract [en]

    Elevated blood pressure is a major risk factor for cardiovascular disease and has a substantial genetic contribution. Genetic variation influencing blood pressure has the potential to identify new pharmacological targets for the treatment of hypertension. To discover additional novel blood pressure loci, we used 1000 Genomes Project-based imputation in 150 134 European ancestry individuals and sought significant evidence for independent replication in a further 228 245 individuals. We report 6 new signals of association in or near HSPB7, TNXB, LRP12, LOC283335, SEPT9, and AKT2, and provide new replication evidence for a further 2 signals in EBF2 and NFKBIA. Combining large whole-blood gene expression resources totaling 12 607 individuals, we investigated all novel and previously reported signals and identified 48 genes with evidence for involvement in blood pressure regulation that are significant in multiple resources. Three novel kidney-specific signals were also detected. These robustly implicated genes may provide new leads for therapeutic innovation.

  • 31.
    Wang, Rui
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Wisconsin, USA.
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Liang, Yajun
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Shandong University, China.
    The age-related blood pressure trajectories from young-old adults to centenarians: A cohort study2019In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 296, p. 141-148Article in journal (Refereed)
    Abstract [en]

    Background: Blood pressure (BP) trajectories among older adults, especially among the oldest-old, are still poorly characterized. Objective: To investigate the longitudinal trajectories of four BP components with age and their potential influential factors. Methods: This population-based prospective cohort study included 3315 participants (age 60-105 years, 64.6% women) who were regularly examined from 2001 to 2004 through 2013-2016. The longitudinal trajectories of systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP) with age were estimated using linear mixed-effects models. Results: Overall, SBP and PP increased with age until similar to 80 years and then declined, whereas DBP and MAP decreased constantly after 60 years of age. The age-related BP trajectories varied by survival time, birth cohort, use of antihypertensive drugs, and heart disease. Specifically, people who survived < 2 years after the last visit showed higher levels of BP components before similar to 80 years, followed by steeper declines in SBP and PP. At the same age, people who were born earlier showed higher BP than those who were born later. People who used antihypertensive drugs had higher BP than those who did not until similar to 80-90 years old, thereafter BP showed no significant difference. After similar to 80 years old, people with heart disease showed steeper declines in SBP and PP than those without. Conclusions: The late-life longitudinal BP trajectories with age vary with demographics, clinical conditions, and contextual factors. These findings may help better understand the age-dependent relationship of BP with health outcomes as well as help achieve optimal BP control in older people. Perspectives: Competency in medical knowledge: Understanding the age-related blood pressure trajectories and potential influential factors may help improve blood pressure management in older people. Translational outlook 1: Blood pressure trajectories with age in older adults vary by birth cohort, survival time, antihypertensive therapy, and heart disease. The age-related blood pressure trajectories by birth cohorts are featured with lower blood pressure levels at the same age in more recent birth cohorts, which may partially reflect the improvement of blood pressure control over time. Translational outlook 2: The age-related blood pressure trajectories in the oldest old (e.g., age similar to 85 years) are characterized by steeper and faster blood pressure declines associated with heart disease and short survival (e.g., < 2 years). This may have implications for the optimal management of blood pressure as well as for the interpretation of the relationships between blood pressure and health outcomes (e.g., death) among the oldest old. 

  • 32. Yang, Lei
    et al.
    Korhonen, Kaarina
    Moustgaard, Heta
    Silventoinen, Karri
    Martikainen, Pekka
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences. University of Helsinki, Finland; Max Planck Institute for Demographic Research, Germany; Karolinska Institutet, Sweden.
    Pre-existing depression predicts survival in cardiovascular disease and cancer2018In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 72, no 7, p. 617-622Article in journal (Refereed)
    Abstract [en]

    Background Previous studies have found depression to be negatively associated with the prognosis of both cardiovascular disease (CVD) and cancer, but this may partly reflect reverse causality. We limited the possibility of reverse causality by measuring depression before the first diagnosis of CVD or cancer.

    Methods We used an 11% longitudinal random sample of the Finnish population aged 25 years or older who are residents of Finland for at least 1year between 1987 and 2007, with an 80% oversample of those who died during this period. Those who had their first incidence of coronary heart disease (CHD) (n=107966), stroke (n=68685) or cancer (n=113754) between 1998 and 2012 were followed up for cause-specific mortality from the date of diagnosis until the end of 2012. Depression was defined as having antidepressant purchases two to three calendar years before the incidence. Logistic and Cox regression models were used to examine short-term and long-term mortality by depression status.

    Results Long-term mortality after diagnosis was 1.34 (95% CI 1.25 to 1.44) for CHD, 1.26 (95% CI 1.15 to 1.37) for stroke and 1.10 (95% CI 1.04 to 1.16) for cancer in those who had used antidepressants in two consecutive calendar years as compared with those with no purchases. Short-term mortality from CHD was elevated among persons with depression (OR=1.30; 95%CI 1.06 to 1.61), but no association was found for stroke.

    Conclusion Pre-existing depression is associated with a worse prognosis of CHD, stroke and cancer. More attention in the healthcare system is needed for patients with chronic diseases who have a history of depression.

  • 33. Zhang, H.
    et al.
    Deng, M.
    Xu, H.
    Wang, H.
    Song, F.
    Bao, C.
    Paillard-Borg, S.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tianjin Medical University, China.
    Qi, X.
    Pre- and undiagnosed-hypertension in urban Chinese adults: a population-based cross-sectional study2017In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 31, no 4, p. 263-269Article in journal (Refereed)
    Abstract [en]

    Hypertension is common in adults and often undiagnosed, and the prevalence of pre- and undiagnosed-hypertension remains unclear. We aimed to investigate the prevalence of pre- and undiagnosed-hypertension and their correlates among urban Chinese adults. A total of 7435 participants aged 20-79 were included in this study. Data on demographics, lifestyle and medical history were collected through a structured interview. Pre- and undiagnosed-hypertension was defined as systolic blood pressure/diastolic blood pressure (SBP/DBP) of 120-139/80-89 mm Hg and SBP >= 140 mm Hg and/or DBP >= 90 mm Hg, respectively, in participants without a history of hypertension and use of antihypertensive medication. Prevalence rates were calculated and standardized using local age- and gender-specific census data. Data were analysed using multinomial logistic regression with adjustment for potential confounders. Of all the participants, 2726 (36.7%) were diagnosed with pre-hypertension and 919 (12.3%) with undiagnosed hypertension. Undiagnosed-hypertension accounted for 37.3% of all participants with hypertension. The prevalence of prehypertension gradually decreased with age, while undiagnosed-hypertension increased, although presenting different changing patterns among men and women. In a fully adjusted multinomial logistic regression, age, male sex, low socio-economic status (SES), abdominal obesity, alcohol drinking, physical inactivity and type 2 diabetes mellitus (T2DM) were significantly associated with increased odds of pre- and undiagnosed-hypertension. In conclusions, the prevalence of pre- and undiagnosed-hypertension was -50% among urban Chinese adults. Abdominal obesity, low SES, alcohol drinking, physical inactivity and T2DM may be indicators for pre- and undiagnosed-hypertension.

  • 34.
    Åkerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Perski, Aleksander
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sleep, Stress and Heart Disease2012In: Stress and Cardiovascular Disease / [ed] Paul Hjemdahl, Andrew Steptoe, Annika Rosengren, London: Springer London, 2012, p. 257-272Chapter in book (Refereed)
    Abstract [en]

    It is estimated that sleep problems affect around 20% of the adult population in the Western countries.1,2 It has been shown that the short-term consequences of sleep problems lead to adverse physiological changes,3 as well as to long-term health consequences. In experimental and epidemiological studies, both short and long sleep hours have been related to hypertension,4 type-2 diabetes,5,6 increased body mass index (BMI),7 alterations in blood lipids,8 and inflammatory markers9 – all factors known to increase the risk of cardiovascular disease.

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