Håkan Odeberg

Severity of acute coronary syndrome is predicted by interactions between fibrinogen concentrations and polymorphisms in the GPIIIa and FXIII genes

Severity of acute coronary syndrome is predicted by interactions between fibrinogen concentrations and polymorphisms in the GPIIIa and FXIII genes

Social Network, Social Support and the Concept of Control — a Qualitative Study Concerning the Validity of Certain Stressor Measures Used in Quantitative Social Epidemiology

Twenty-five in-depth interviews were made with middle-aged persons of both sexes, who had suffered a first myocardial infarction (MI) two months previously. The purpose was to assess the laymans understanding of concepts such as social network, social support and control which are exposures commonly used or suggested for use in quantitative research in the area of social epidemiology. The validity of the instruments and the underlying concepts in assessing such exposures has important implications for the interpretation of the association between psychosocial factors and health or health behavior. The laymans understanding of social network and social support concepts seemed unproblematic, but the concept of control was understood in rather disparate ways among those interviewed. The experience of control/decision latitude in the work environment, seemed to form a model for the overall understanding of control among several of those interviewed and there also seemed to be important differences based on gender. Another impression, was that the individuals level of aspiration might be an important confounder in the assessment of control in population studies. It is therefore suggested that epidemiologcal data should be stratifyed by basic demographic variables like age, sex and social class in analyses including the control variable, to improve the valid use of this type of measure.

Awareness and treatment of cardiovascular disease risk factors among middle-aged Swedish men and women

OBJECTIVE To study awareness and treatment of risk factors for cardiovascular disease in a primary care district where a screening program for hypercholesterolaemia involving one third of the population had been conducted 7 years earlier. DESIGN A semi-structured telephone survey on four risk factors; blood pressure, serum cholesterol, blood sugar, and smoking habits. SETTING The study was performed in a defined area in Blekinge county in Sweden. SUBJECTS A random sample of the general population aged 40-49 years, in total 356 people. MAIN OUTCOME MEASURES Awareness of individual risk factors, for cardiovascular diseases, on-going medication, and lifestyle changes in order to lower individual risks. RESULTS A total of 95% had had their blood pressure measured at least once, compared with 69% for serum cholesterol. Twenty-two per cent had at some time been told that they had high blood pressure, and, of these, almost half (44%) received pharmacological treatment. Among the 62 subjects who were informed about hyperlipidaemia only 5% were taking a lipid-reducing drug. Among present smokers, 38% had had at least one quitting episode during the previous 2 years with a median duration of 60 days. CONCLUSION In a general population there is a difference between blood pressure and cholesterol check-up and medicalization. Screening activities seem to raise the awareness of cardiovascular risk factors in a population, but when evaluating the tendency to change lifestyle the contagious effects of screening activities might be taken into account. Finding quick-relapsing former smokers among current non-smokers may be of importance when planning smoking cessation activities.

The influence of smoking and impaired glucose homoeostasis on the outcome in patients presenting with an acute coronary syndrome: a cross-sectional study.

Objectives Smoking, diabetes, male sex, hypercholesterolaemia and hypertension are well-established risk factors for the development of coronary artery disease (CAD). However, less is known about their role in influencing the outcome in the event of an acute coronary syndrome (ACS). The aim of this study was to determine if these risk factors are associated specifically with acute myocardial infarction (MI) or unstable angina (UA) in patients with suspected ACS. Design Cross-sectional study. Setting Patients admitted to the coronary care unit, via the emergency room, at a central county hospital over a 4-year period (1992–1996). Participants From 5292 patients admitted to the coronary care unit, 908 patients aged 30–74 years were selected, who at discharge had received the diagnosis of either MI (527) or UA (381). A control group consisted of 948 patients aged 30–74 years in whom a diagnosis of ACS was excluded. Main outcome measures MI or UA. Results Current smoking (OR 2.42 (1.61 to 3.62)), impaired glucose homoeostasis defined as glycated haemoglobin ≥5.5% + blood glucose ≥7.5 mM (OR 1.78 (1.19 to 2.67)) and male sex (OR 1.71 (1.21 to 2.40)) were significant factors predisposing to MI over UA, in the event of an ACS. Compared with the non-ACS group, impaired glucose homoeostasis, male sex, cholesterol level and age were significantly associated with development of an ACS (MI and UA). Interestingly, smoking was significantly associated with MI (OR 2.00 (1.32 to 3.02)), but not UA. Conclusions Smoking or impaired glucose homoeostasis is an acquired risk factor for a severe ACS outcome in patients with CAD. Importantly, smoking was not associated with UA, suggesting that it is not a risk factor for all clinical manifestations of CAD, but its influence is important mainly in the acute stages of ACS. Thus, on a diagnosis of CAD, the cessation of smoking and management of glucose homoeostasis are of upmost importance to avoid severe subsequent ACS consequences.

Comparing impedance cardiography and echocardiography in the assessment of reduced left ventricular systolic function

BackgroundAn early and accurate diagnosis of chronic heart failure is a big challenge for a general practitioner. Assessment of left ventricular function is essential for the diagnosis of heart failure and the prognosis. A gold standard for identifying left ventricular function is echocardiography. Echocardiography requires input from specialized care and has a limited access in Swedish primary health care. Impedance cardiography (ICG) is a noninvasive and low-cost method of examination. The survey technique is simple and ICG measurement can be performed by a general practitioner. ICG has been suggested for assessment of left ventricular function in patients with heart failure. We aimed to study the association between hemodynamic parameters measured by ICG and the value of ejection fraction as a determinant of reduced left ventricular systolic function in echocardiography.MethodsA non-interventional, observational study conducted in the outpatients heart failure unit. Thirty-six patients with the diagnosis of chronic heart failure were simultaneously examined by echocardiography and ICG. Distribution of categorical variables was presented as numbers. Distribution of continuous variables was presented as a mean and 95% Confidence Interval. Kruskal-Wallis test was used to compare variables and show differences between the groups. A p-value of <0.05 was considered significant.ResultsWe found that three ICG parameters: pre-ejection fraction, left ventricular ejection time and systolic time ratio were significantly associated with ejection fraction measured by echocardiography.ConclusionsThe association which we found between EF and ICG parameters was not reported in previous studies. We found no association between EF and ICG parameters which were suggested previously as the determinants of reduced left ventricular systolic function.The knowledge concerning explanation of hemodynamic parameters measured by ICG that is available nowadays is not sufficient to adopt the method in practice and use it to describe left ventricular systolic dysfunction.

Influence of pre-existing inflammation on the outcome of acute coronary syndrome: a cross-sectional study

Objectives Inflammation is a well-established risk factor for the development of coronary artery disease (CAD) and acute coronary syndrome (ACS). However, less is known about its influence on the outcome of ACS. The aim of this study was to determine if blood biomarkers of inflammation were associated specifically with acute myocardial infarction (MI) or unstable angina (UA) in patients with ACS. Design Cross-sectional study. Setting Patients admitted to the coronary care unit, via the emergency room, at a central county hospital over a 4-year period (1992–1996). Participants In a substudy of Carlscrona Heart Attack Prognosis Study (CHAPS) of 5292 patients admitted to the coronary care unit, we identified 908 patients aged 30–74 years, who at discharge had received the diagnosis of either MI (527) or UA (381). Main outcome measures MI or UA, based on the diagnosis set at discharge from hospital. Results When adjusted for smoking, age, sex and duration of chest pain, concentrations of plasma biomarkers of inflammation (high-sensitivity C reactive protein>2 mg/L (OR=1.40 (1.00 to 1.96) and fibrinogen (p for trend=0.035)) analysed at admission were found to be associated with MI over UA, in an event of ACS. A strong significant association with MI over UA was found for blood cell markers of inflammation, that is, counts of neutrophils (p for trend<0.001), monocytes (p for trend<0.001) and thrombocytes (p for trend=0.021), while lymphocyte count showed no association. Interestingly, eosinophil count (p for trend=0.003) was found to be significantly lower in patients with MI compared to those with UA. Conclusions Our results show that, in patients with ACS, the blood cell profile and degree of inflammation at admission was associated with the outcome. Furthermore, our data suggest that a pre-existing low-grade inflammation may dispose towards MI over UA.

Using NT-proBNP to Detect Chronic Heart Failure in Elderly Patients with Chronic Obstructive Pulmonary Disease

Objective. To detect chronic heart failure in elderly patients with a registered diagnosis of chronic obstructive pulmonary disease (COPD) treated in Swedish primary health care using natriuretic peptide NT-proBNP. Design. A cross-sectional study. Setting. Two primary health care centres in southeastern Sweden each with about 9000 listed patients. Subjects. Patients aged 65 years and older with a registered diagnosis of COPD. Main Outcome Measures. Percentage of patients with elevated NT-proBNP, percentage of patients with abnormal left ventricular function assessed by echocardiography, and association between elevated NT-proBNP and symptoms, signs, and electrocardiography. Results. Using NT-proBNP threshold of 1200 pg/mL, we could detect and confirm chronic heart failure in 5.6% of the study population with concurrent COPD. An elevated level of NT-proBNP was only associated with nocturia and abnormal electrocardiography. Conclusions. We found considerably fewer cases of heart failure in patients with COPD than could be expected from the results of previous studies. Our study shows the need for developing improved strategies to enhance the validity of a suspected heart failure diagnosis in patients with COPD.