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A Reikvam

Publications and source records attributed to A Reikvam.

At least 19 recordsLinked to original sources
PubMed2001

Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors.

UNLABELLED: Selective serotonin reuptake inhibitors (SSRIs) are a new group of antidepressants used in mild to moderate cases of depression. In studies evaluating the safety of SSRIs during pregnancy, no increase in major anomalies has been reported. This might have led to increasing off-label prescription of SSRIs to pregnant women. Neonatal withdrawal syndrome commonly occurs in infants exposed during the third trimester to drugs known to cause addiction. We report five cases of neonatal withdrawal syndrome after third trimester in utero SSRI exposure. In three cases the mother used paroxetine in doses from 10 to 40 mg, one mother used citalopram 30 mg, and one mother fluoxetine 20 mg. Withdrawal symptoms occurred within few days after birth and lasted up to one month after birth. Four of the infants needed treatment with chlorpromazine. Symptoms were irritability, constant crying, shivering, increased tonus, eating and sleeping difficulties and convulsions. CONCLUSION: Neonatal withdrawal syndrome can occur after third trimester in utero SSRI exposure. Further research should focus on whether it is safe to use SSRIs during the last trimester. All neonates exposed to SSRIs during the last trimester should be followed-up closely for withdrawal symptoms after birth.

Antidepressive Agents↗
PubMed2000

[How should ACE inhibitors be used in myocardial infarction?].

BACKGROUND: Based on the results of large clinical trials, ACE inhibitors are established as routine treatment after acute myocardial infarction accompanied by heart failure. Pathophysiologically, the benefit of ACE inhibitors has been attributed to an effect on remodelling of the left ventricle. In the past decade, it has been suggested that ACE inhibitors might have other important mechanisms of action and accordingly be useful for other conditions than those they have been used for until now. MATERIAL AND METHODS: We reviewed clinical studies of ACE inhibitors with special emphasis on the use of these agents in the acute phase of myocardial infarction and in the follow-up period. These studies were assessed together with the recently published Heart Outcomes Prevention Evaluation (HOPE) study. RESULTS: In the HOPE study it was found that ACE inhibition protected against cardiovascular events in patients at high risk due to atherosclerotic disease, but without dysfunction of the left ventricle. The effect is most likely a retarding of the atherothrombotic process in the coronary arteries. INTERPRETATION: The latest results are important for clinical practice. Other post-infarction patients than those with myocardial failure may benefit from treatment with ACE inhibitors. We also discuss the timing of ACE inhibitor treatment, the importance of an adequate ACE inhibitor dose, and combination with other treatment regimens used in secondary prevention.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2000

[Nutrition, dietary supplementation and coronary heart disease].

BACKGROUND: During the last decade, lipid lowering agents, in particular statins, have become increasingly important in the treatment of cardiovascular diseases and dyslipidaemias. This might imply that emphasis on diet and supplementary nutrients do not receive sufficient attention. MATERIAL AND METHODS: On the basis of studies of the literature, the scientific documentation for a possible beneficial effect of the following elements are reviewed: intake of fat, fish and fish oil, alpha-linolenic acid, folic acid, vitamin B6 and vitamin B12, nuts, plant sterols and psyllium. RESULTS: Reduced intake of saturated fat causes improvement in serum lipid values and prevents cardiovascular events. Intake of fish, fish oils and alpha-linolenic acid has positive effects on several clinical end points, often without marked decrease in serum cholesterol. Homocysteine appears to be an independent risk factor for cardiovascular diseases, but a causal relationship remains to be proven. The cofactors folic acid, vitamin B6 and B12 reduce the homocysteine level, but effects of this intervention on hard clinical end points are lacking. There are indications that intake of nuts can prevent coronary events. Plant sterols and psyllium in the diet reduce cholesterol levels. INTERPRETATION: Thus, dietary intervention is important in the prevention and treatment of coronary heart disease. Also when drug treatment is indicated, a focus on diet and nutrient supplementation is highly warranted. Some nutrients may have preventive effect in relation to coronary events, despite their small effect on cholesterol levels.

Coronary Disease↗
PubMed1999

Hospital mortality from acute myocardial infarction has been modestly reduced after introduction of thrombolytics and aspirin: results from a new analytical approach. European Secondary Prevention Study Group.

The objective of this study was to investigate how the introduction of thrombolytics and aspirin has affected hospital mortality (case fatality) among patients with acute myocardial infarction. The study design was the application of the therapeutic effects found in the clinical trials in a nonselected myocardial infarction population characterized in detail. The study took place in health region 1 in Norway, population 850,000, and subjects were all patients hospitalized and discharged, alive or dead, with a diagnosis of acute myocardial infarction in the 10 hospitals in the region over a period of 2 months. The main outcome measures were deaths in hospital and estimation of expected hospital mortality without thrombolytics or aspirin, weighing and evaluating the effects of delay of different lengths from onset of symptoms to admission, different ages, and different electrocardiogram changes. We found that 32% of the patients received thrombolytics, and 72% received aspirin. Hospital mortality was 18.1% compared with 20.6% had neither of the treatments been administered, implying that the two regimens had reduced mortality by 12%, aspirin contributing about four fifths and thrombolytics one fifth. We conclude that hospital mortality in a nonselected myocardial infarction population has been reduced to moderate extent since the introduction of thrombolytics and aspirin. The effects observed in clinical trials are not translated into epidemiologically documented reduction in mortality, as the optimal conditions are found only in a proportion of the patient groups constituting a nonselected myocardial infarction population.

Aged↗
PubMed1998

[The effect of reduced cholesterol on coronary arteries].

High levels of cholesterol increase the influx of calcium ions into vascular smooth muscle cells, thereby increasing vascular tone and resistance. Simultaneously, endothelium-dependent (NO-mediated) vasodilatation is inhibited in the arteries. Brief reductions in cholesterol induced by dietary intervention or with lipid lowering therapy normalize endothelial dysfunction, and myocardial perfusion will increase well before any beneficial effects on atherosclerosis are detected. These phenomena may explain, at least in part, that in spite of even small differences in angiographic findings between patients who have undergone treatment and those who have not, lowering lipids will cause major reductions in cardiovascular events. Lowering the levels of cholesterol will alter the content and composition of atherosclerotic plaques, thereby making them more stable. The result is probably a substantial reduction in the frequency of plaque rupture, and if rupture should occur, the thrombotic mechanisms will probably be weaker. Consequently, the risk of a thrombotic occlusion of a coronary vessel will be reduced.

Anticholesteremic Agents↗
PubMed1998

Acute myocardial infarction mortality related to use of calcium antagonists before admission to hospital.

We investigated whether prior use of calcium antagonists in 80 (16.8%) out of 477 patients (64% males) admitted with acute myocardial infarction (MI) had any impact on in-hospital mortality. Patients using calcium antagonists were slightly older (74 years vs. 72 years, 2P = 0.039) than those not taking them and fewer were male patients. Previous MI, diabetes mellitus, and prior use of aspirin, beta-blockers, and long-acting nitrates were more frequent in patients on calcium antagonists. In contrast, fewer patients on calcium antagonists prior to symptoms received thrombolytic treatment (21.3% vs. 34.8%, 2P = 0.018). The study had an observational exposed/nonexposed design, and we looked for both crude and adjusted effects. Of the 83 patients (17.4%) who died during hospitalization, 18 patients were in the calcium antagonist group (22.5%). The odds ratio (OR) for these patients to die in the hospital was 1.48 and the 95% confidence interval (CI) 0.78-2.78; 2P = 0.19. When adjusting for confounders (gender, age, smoking habit, previous MI, and diabetes mellitus, as well as prior use of aspirin, beta-blockers, long-acting nitrates, and thrombolytic treatment at entry) OR was 1.08 and 95% CI 0.57-2.05; 2P = 0.85. Thus, we found no excess in-hospital mortality in patients with acute MI using calcium antagonists prior to the onset of symptoms.

Acute Disease↗
PubMed1998

Has hospital mortality from acute myocardial infarction been markedly reduced since the introduction of thrombolytics and aspirin? European Secondary Prevention Study Group.

OBJECTIVES: There are conflicting views on how hospital mortality with respect to acute myocardial infarction (AMI) has changed since the introduction of thrombolytics and aspirin. Our purpose therefore was to explain this by studying hospital mortality in a nonselected AMI population. and then assess how patients allocated to different treatment groups contribute to overall mortality. DESIGN: Extensive data were collected on all AMI patients admitted to the 10 hospitals in health region 1 (population 850,000) in Norway during a 2 month period. A protocol approved by the European Secondary Prevention Study Group was used. RESULTS: Of the 487 patients, 32% received thrombolytics, 72% aspirin and 22%) none of the treatments. Average in-hospital mortality was 18%. Mortality within the different groups was as follows: no thrombolytics nor aspirin group 35.0% (39/111), aspirin group 13.7%, (30/218), thrombolytics group 17.3% (4/23), and thrombolytics plus aspirin group 11.0% (15/135). The characteristics of the nontreated group compared to the aspirin and aspirin plus thrombolytics groups were more females, older, increased frequency of previous AMI, left ventricular failure, cardiopulmonary resuscitation, history of stroke and peptic ulcer, and electrocardiogram (ECG) findings other than ST elevation. CONCLUSION: In a nonselected AMI population, a patient group receiving neither thrombolytics nor aspirin contributed most significantly to an overall high mortality. This indicates a modest reduction in total AMI mortality after the new therapies were introduced, as the mortality for this group, with a high risk profile, has presumably remained unchanged.

Aged↗
PubMed1998

Beta-blockers and antithrombotic treatment for secondary prevention after acute myocardial infarction. Towards an understanding of factors influencing clinical practice. The European Secondary Prevention Study Group.

AIMS: Long-term beta-blockade reduced mortality after acute myocardial infarction by about a quarter in a series of published trials. Representative data on beta-blocker use for secondary prevention are scanty but indicate wide variations. We have analysed European practice, and sources of variation, by regional sampling of acute myocardial infarction patients admitted to hospital in 11 countries during the period January 1993-June 1994. METHODS AND RESULTS: Treatment data for 4035 representative patients were collected for the hospital phase and 6 months after discharge. A logistic regression model was developed to describe the predictors of beta-blocker use. In the 11 regional samples, 6-38% (20% overall) of patients had no recorded contraindications but were discharged without a beta-blocker. In the absence of perceived contraindications, there was a strong, independent negative association between age and odds of treatment (P < 0.001), and women were less likely to be treated than men (adjusted odds ratio 0.76, 95% CI 0.58-0.99). Discontinuation of beta-blocker treatment by 6 months was significantly less likely in regions where the proportion given such treatment at discharge was high. In contrast, use of antithrombotic agents in the samples was consistently high. CONCLUSIONS: There is persisting low use of beta-blocker secondary prophylaxis, particularly in the elderly and in women, not attributable to perceived contraindications or intolerance. Considerable regional variations persist despite shared trials evidence. Discharge treatment strongly influences long-term medication.

Adrenergic beta-Antagonists↗
PubMed1998

Use of coronary angiography and revascularization procedures following acute myocardial infarction. A European perspective.

AIMS: There is little evidence to inform routine practice in the use of coronary angiography and revascularization procedures after acute myocardial infarction. Large differences in the uptake of these procedures have been reported but representative data are scarce. Outcome studies have produced opposing conclusions concerning the impact of the high rate of these cardiac procedures. METHODS AND RESULTS: A population-based patient sampling approach was utilized to identify routine practice in representative samples from 11 European countries. Data were collected retrospectively on treatment in the 6 months following acute myocardial infarction (n=2807). There was wide variation in utilization of coronary angiography and revascularization procedures. Even after restricting the analysis to patients <65 years (n=1262), there remained a 6 13 fold variation in the use of these procedures. A decreased likelihood of undergoing these procedures was associated with older age. In addition, there was an independent and negative association between female sex and utilization of coronary angiography and coronary artery bypass grafting (CABG). CONCLUSION: The effect on patient outcome of the observed variation in use of these procedures is not known but has important cost and resource implications for the health services. Outcome research is needed to define patient selection criteria and to measure the cost-utility of different angiography and revascularization rates.

Adult↗
PubMed1997

Thrombolytic eligibility in acute myocardial infarction patients admitted to Norwegian hospitals.

We characterised the population of acute myocardial infarction patients admitted to Norwegian hospitals and quantified the actual use and potential maximal use of thrombolytic therapy. Data were collected by medical record review of all acute myocardial infarction patients discharged from hospital in April and May 1993 in Health region 1. The clinical population differed significantly from the patients recruited to the thrombolytic clinical trials. Patients were more likely to have ST depression on admission (23% vs. 7%) and to be over 74 years (42% vs. 10%) than in the trials. A fifth of patients presented more than 12 h after symptom onset (or time indeterminate). Thrombolysis was given to 32% of patients, mainly utilising streptokinase. Late presentation or diagnostic difficulty appeared to be the main reasons for non- thrombolysis. Approximately 50% of the clinical population were eligible for thrombolysis. Eligibility for thrombolytic therapy was therefore severely restricted by the presenting characteristics of the clinical population. Substantial numbers of patients belonged to subgroups where the reported benefit from thrombolysis is equivocal. Uncertainty remains on the extrapolation of the trials evidence to those subgroups who were under-represented in the clinical trials.

Age Distribution↗
PubMed1996

[Patient characteristics and mortality in acute myocardial infarction].

Data on all patients with myocardial infarctions treated in the ten hospitals in Health region 1 in Norway were extensively analysed. Of the 487 patients with the diagnosis acute myocardial infarction, 429 (88%) had definite or suspected acute myocardial infarction; 440 (90%) were treated in an intensive care unit. Average age was 70 years, for men 68 years and for women 75 years, and 69% of the patients suffered their first acute myocardial infarction. Within six hours 59% of the patients were admitted to hospital and within 12 hours 76%. On admission, 58% of the patients had an electrocardiogram showing ST elevation or bundle branch block. The remainder showed other findings, of which ST depression was the most frequent (23%). In-hospital mortality was 18% and of those discharged 10% died within six months. It is concluded that the true acute myocardial infarction population differs from the population of patients in clinical trials as follows: higher age, longer delay before admission to hospital, a different distribution of EGG findings, and higher mortality.

Aged↗
PubMed1996

[Use of thrombolytic agents and other drugs in acute myocardial infarction].

Data on all patients with acute myocardial infarction who were treated in the ten hospitals in Health region 1 in Norway were extensively analysed over a two month period. Of all the 487 patients 32% received thrombolytic treatment; i.e 36% of those with definite or suspected myocardial infarction on admission. Thrombolytics were withheld, mainly because only 58% of the patients showed ST elevation or bundle branch block on their ECG, and because of a long delay from onset of symptoms to admission to hospital. With increasing age use of thrombolytics decreased, and high age seemed to some degree to act as a contraindication. Relative contraindications such as history of stroke or peptic ulcer contributed modestly to the limited use of thrombolytics. Aspirin was used by 72% of the patients, and either aspirin or anticoagulants in 87%. At six month follow-up 50% used aspirin and 32% warfarin. Betablockers were given to 57% of the patients in hospital, but were not used to any extent in the acute phase of the disease; at six months the proportion of patients on betablockers was about the same. Oral nitrates were used more extensively than betablockers and there is a clear indication that angiotensin converting enzyme inhibitors are used increasingly for secondary prevention.

Aged↗
PubMed1994

[From clinical trials to routine treatment. General aspects of clinical trials in cardiovascular diseases].

The first of two articles deals with general aspects of clinical cardiological research: hard end points -mortality and morbidity-in relation to intermediate end points, power of clinical studies, multicentre studies, meta-analyses, and the relationship between the trial population and the total patient population. The article takes up the kind of problems that are addressed in clinical research, and the relationship between the medical profession and the pharmaceutical industry. The author discusses the situation as regards clinical research in Norway, and emphasizes the need for greater efforts in this field.

Cardiovascular Diseases↗