Torbjörn Messner

Sudden cardiac death in 15-35-year olds in Sweden during 1992-99.

Abstract.  Wisten A, Forsberg H, Krantz P, Messner T (Sunderby Hospital, Luleå; National Board of Forensic Medicine, Lund; Kiruna District Hospital, Kiruna; and Umeå University Hospital, Umeå; Sweden). Sudden cardiac death in persons 15–35‐year old in Sweden, 1992–99. J Intern Med 2002; 252: 529–536.

Symptoms preceding sudden cardiac death in the young are common but often misinterpreted.

Objectives. To identify patients at risk of sudden cardiac death (SCD) by analysis of clinical history. Design. A retrospective study of the Swedish cohort of 15–35 year olds having suffered an SCD during 1992–1999 and having undergone a forensic autopsy (162 individuals). We sought information in forensic, police and medical records and from interviews with family members. Results. Syncope/presyncope, chest pain, palpitations or dyspnoea were present in 92/162, unspecific symptoms such as fatigue, influenza, headache or nightmares in 35/162. Syncope/presyncope was most common (42/162). In 74 seeking medical attention, 32 had an ECG recorded (24 pathological). In 26 subjects there was a family history of SCD. Conclusions. The patient seeking medical advice before suffering an SCD is characterized by one to three of the following: 1) cardiac-related symptoms or non-specific symptoms often after an infectious disease, 2) a pathological ECG, 3) a family history of SCD. In 6 out of 10 a cardiac diagnosis was not considered. We conclude that symptoms preceding SCD were common but often misinterpreted.

The effects of commuting activity and occupational and leisure time physical activity on risk of myocardial infarction

Background Risk reduction of myocardial infarction has been shown for leisure time physical activity. The results of studies on occupational physical activity and risk of myocardial infarction are incongruous and studies on commuting activity are scarce. The aim of this study was to investigate how commuting activity, occupational physical activity and leisure time physical activity were associated with risk of future first myocardial infarction. Design We used a prospective incident case-referent study design nested in Västerbotten Intervention Program and the Northern Sweden MONICA study. Methods Commuting habits, occupational physical activity, leisure time physical activity and cardiovascular risk factors were assessed at baseline screening and compared in 583 cases (20% women) with a first myocardial infarction and 2098 matched referents. Results Regular car commuting was associated with increased risk of myocardial infarction versus commuting by bus, cycling or walking [odds ratio (OR) 1.74; 95% confidence interval (CI), 1.20–2.52] after multivariate adjustment. High versus low leisure time physical activity was associated with reduced risk of myocardial infarction (OR 0.69; 95% CI, 0.50–0.95) after adjustment for occupational physical activity and commuting activity, but the association was not statistically significant after further multivariate adjustment. After multivariate adjustment we observed a reduced risk for myocardial infarction in men with moderate (OR 0.70; 95% CI, 0.50–0.98) or high (OR 0.67; 95% CI, 0.42–1.08) versus low occupational physical activity. Conclusions We found a clear association between car commuting and a first myocardial infarction and a corresponding inverse association with leisure time physical activity, while the impact of occupational physical activity on the risk of myocardial infarction was weaker.

Influence of energy drinks and alcohol on post-exercise heart rate recovery and heart rate variability

Background:  Media have anecdotally reported that drinking energy drinks in combination with alcohol and exercise could cause sudden cardiac death. This study investigated changes in the electrocardiogram (ECG) and heart rate variability after intake of an energy drink, taken in combination with alcohol and exercise.

Favourable trends in the incidence and outcome of myocardial infarction in nondiabetic, but not in diabetic, subjects : findings from the MONICA myocardial infarction registry in northern Sweden in 1989-2000

Background:  The aim of this study was to compare time trends in incidence, case fatality and mortality due to myocardial infarction (MI) in patients with or without diabetes.

Trends in sudden cardiac death in the northern Sweden MONICA area 1985-99.

Abstract.  Messner T, Lundberg V (Kiruna District Hospital, Kiruna; Kalix District Hospital, Kalix; Umeå University Hospital, Umeå, Sweden). Trends in sudden cardiac death in the northern Sweden MONICA area 1985–99. J Intern Med 2003; 253: 320–328.

Trends in event rates of first and recurrent, fatal and non-fatal acute myocardial infarction, and 28-day case fatality in the Northern Sweden MONICA area 1985 - 98

Aims: This study looks at trends in event rates of first and recurrent fatal and non-fatal acute myocardial infarction (AMI), and 28-day case fatality in AMI within the Northern Sweden MONICA area. Methods: The AMI event rate and 28-day case fatality in acute myocardial infarction were registered between 1985 and 1998 in the two northernmost counties in Sweden in men and women in the age groups 25 - 64 years. Results: Statistically significant mean annual decreases were found in fatal and non-fatal combined event rates (4% for men and 2.3% for women), fatal event rate (7.1% for men and 5% for women), fatal first acute myocardial infarction (7.1% for men and 4.4% for women), and both non-fatal and fatal recurrent AMI for both sexes (5.5% for both men and women for non-fatal and, for fatal AMI, 7.1% for men and 5.7% for women). In addition, there were significant decreases for men in non-fatal event rate (2.4%), and non-fatal first AMI (1.4%). The decreases in case fatality were small, especially so for women. Conclusions: There is a trend of decreasing event rates in both fatal and non-fatal AMI, and first and recurrent AMI, most pronounced for men. The case fatality also decreased although to a lesser degree, suggesting that the decreasing mortality in ischaemic heart disease mainly is caused by reduced disease incidence.

A temperature rise is associated with an increase in the number of acute myocardial infarctions in the subarctic area.

Objectives: To examine the impact of meteorologic variables on the incidence of and case fatality in acute myocardial infarction (AMI) in the subarctic area of Northern Sweden. Study design: The MONICA (multinational MONItoring of trends and determinants of CArdiovascular disease) database for northern Sweden was linked to weather report files. We then had information linking the weather condition at the time of each myocardial infarction with each patient. This database was analysed for whether the myocardial infarctions were fatal or nonfatal. We also analysed data on the daily number of myocardial infarctions in the area with day-to-day changes in the weather conditions. Results: We found that no static weather conditions were linked to an increased risk of dying from a myocardial infarction. A temperature rise was associated with an increase in the number of nonfatal acute myocardial infarctions — a 1 degree Celsius rise was associated with a 1,5 % increase in the number of AMI cases. Conclusion: No extreme values of either temperature, humidity or air pressure was associated with an increase in the case fatality in AMI. A temperature increase was associated with an increase in the number of nonfatal myocardial infarctions. However, this increase was probably mediated via other risk factors or risk behaviours that also increased with rising temperature.

Trends in blood pressure, lipids, lipoproteins and glucose metabolism in the Northern Sweden MONICA project 1986 - 99

Aim: The authors present an analysis of time trends in blood pressure, hypertension, and lipids in the adult population of Northern Sweden over the period 1986 - 99. Method: Four population surveys were undertaken with new and independent cohorts, 25 - 64 years old. Results: Small changes in blood pressure were observed during the study period with increased systolic blood pressure in men and decreased diastolic blood pressure in women. The proportion with high blood pressure was found to be constant over time and only 50% were prescribed antihypertensive drugs and of these only a minority were normotensive. Total serum cholesterol decreased from 6.4 to 5.7 mmol/l in men and from 6.3 to 5.7 mmol/l in women over the study period, and this was accompanied by an increase in HDL cholesterol by about 10% in both sexes. The proportion with high cholesterol decreased from 41% to 26%. Triglycerides increased between 1986 and 1990 and no further changes were found in the following surveys. Conclusion: In the Northern Sweden MONICA population total cholesterol has declined and HDL cholesterol has increased during the past 13 years and small changes in blood pressure have been observed for both men and women.

Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis

Objectives.  To study electrocardiogram (ECG) in relation to forensic diagnosis in young persons who suffered a sudden cardiac death (SCD) in Sweden during 1992–99.