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Biomedical subjects

A Rosengren

Publications and source records attributed to A Rosengren.

At least 55 records · Page 3Linked to original sources
PubMed1999

Coronary risk factors, diet and vitamins as possible explanatory factors of the Swedish north-south gradient in coronary disease: a comparison between two MONICA centres.

OBJECTIVE: To investigate whether differences in serum lipids, diet, plasma vitamins or other risk factors explain the higher incidence of cardiovascular disease in the northern parts of Sweden, compared to Göteborg on the west coast. DESIGN: A comparison between the two Swedish MONICA populations in northern Sweden (NSW) and in Göteborg (GOT) in 1990. SETTING: Norrbotten and Västerbotten counties in the north of Sweden and the city of Göteborg on the west coast. SUBJECTS: In the north 1583 men and women aged 25-64 years were investigated, and in Göteborg 1574 men and women. Plasma vitamins were examined in a subsample of men aged 40-49 (n = 259). MAIN OUTCOME MEASURES: Serum lipids, blood pressure, anthropometric measurements, smoking habits, physical activity, diet, education, and plasma vitamins. RESULTS: NSW men and women had mean serum total cholesterol of 6.30 (standard deviation 1.23) mmol L-1 and 6.12 (1. 33) mmol L-1, compared to 5.75 (1.14) mmol L-1 and 5.67 (1.24) mmol L-1 in GOT men and women (P = 0.0001). NSW men and women were shorter and had higher body mass index than in Göteborg. Cigarette smoking was slightly more prevalent amongst GOT men and women. Göteborg men and women more often had more than compulsory school education, compared to NSW men and women, whereas there were no differences in physical activity during leisure time. There were no differences in vegetable consumption, whereas fruit was consumed more frequently by NSW women compared to GOT women, with a higher intake of fibre and ascorbate. Consumption of wine and total alcohol consumption were higher in Göteborg, whereas NSW men and women drank significantly more coffee. In the subsample of men (aged 40-49) who had plasma vitamins measured, men in Göteborg had slightly higher mean retinol concentrations (P = 0.005) and lutein and zeaxanthine levels (P = 0.006 and 0.009, respectively) compared to northern men, but there were no differences with respect to alpha- or beta-carotene, ascorbic acid or lipid-adjusted vitamin E. NSW men had slightly higher plasma iron and magnesium concentrations (P = 0.005 and 0.001, respectively). CONCLUSION: The largest and most consistent differences between Göteborg and northern Sweden were found for serum cholesterol, probably reflecting differences in intake of saturated fat. The differences in serum cholesterol may explain a substantial part of the differences in coronary heart disease morbidity and mortality. We found no consistent differences concerning vegetable and fruit consumption. More alcohol was consumed in Göteborg. Differences in education and childhood conditions, as reflected in differences in height, may contribute to the north-south gradient with respect to CHD incidence and mortality.

Adult↗
PubMed1999

Relative importance of improved hospital treatment and primary prevention. Results from 20 years of the Myocardial Infarction Register, Göteborg, Sweden.

OBJECTIVE: To analyse to what extent declines in incidence and mortality of coronary artery disease can be attributed to improved hospital and post-hospital treatment in contrast to how much is due to primary prevention. DESIGN: A register for non-fatal and fatal myocardial infarction and sudden coronary death registered in in-hospital as well as out-of-hospital events between 1975 and 1994. SETTING: City of Göteborg, Sweden, with 450,000 inhabitants. RESULTS: Seventy-one per cent of the decline in attacks could be attributed to a decline in first infarctions. Of the decrease in coronary deaths, 63% was due to a decline in out-of-hospital mortality. Previous registrations for myocardial infarction were considerably more common amongst people who died in hospital (29%) than amongst those who died out-of-hospital (11-16%) or who survived an infarction (11-13%). Out-of-hospital resuscitation contributed to about half of the reduction in out-of-hospital mortality. Thus, most of the decline in incidence and about half of the decline in sudden coronary deaths was due to primary preventive measures. Population data on risk factors indicate a decline of 37% between 1963 and 1995 in coronary risk amongst consecutive cohorts of 50-year-old men in the community. CONCLUSION: Out-of-hospital resuscitation, treatment in coronary care units and post-infarct treatment improved considerably, but changes in primary risk factors were also of major importance for the decline in incidence and mortality.

Adult↗
PubMed1999

Time-trends in thrombolytics: women are catching up.

Reports on gender differences in the management of acute coronary syndromes indicate that women do not receive as much active treatment as men. Other conflicting findings have also been published. To investigate whether previously reported gender differences in the treatment of acute myocardial infarction (AMI) still persist, we included all patients admitted to our coronary care unit (CCU) in 1984-1995, and discharged with a diagnosis of AMI, in a retrospective study. A total of 1991 female admissions was compared with 4067 male admissions. The time-span was divided into two-year periods comprising approximately 1000 patients each. During one period, 1988 to 1989, women received significantly less thrombolytic therapy which, however, could reflect that women admitted with AMI were older than men. Analysis of time-trends showed a significant increase in the use of thrombolytic treatment in women and elderly men. In clinical praxis there has been a gender-gap in acute treatment of AMI, but age-dependent or not, this is now no longer apparent.

Age Factors↗
PubMed1999

Job control, job demands and social support at work in relation to cardiovascular risk factors in MONICA 1995, Göteborg.

BACKGROUND: Job control and work environment are related to risk of coronary heart disease (CHD), but there is limited understanding of the independent risks associated with these factors. OBJECTIVE: To investigate the association between psychosocial work characteristics and biological risk factors for both sexes for a random population sample in Göteborg, Sweden. DESIGN: A cross-sectional study. METHODS: We used an age-stratified random sample of men and women aged 25-64 years comprising 1200 men and 1412 women, from which 746 men and 872 women responded to the invitation for screening, which included questionnaires and physical/laboratory investigations in 1995. RESULTS: Women had lower job control than did men (P=0.00001); job demands were equal and social support at work slightly higher among women (P=0.04). Job control was positively related to education and social group. Smoking women had low job control and high job demands. Women with high grades of psychological stress had low job control and low social support at work (P=0.001 and P=0.01). For both sexes job demands were high (P=0.0001) among those who reported high psychological stress. Men with high job control and high social support at work were more physically active during leisure time. Subjects with job strain had low social support (P=0.01). Job-stress factors were not related to biological coronary risk factors. CONCLUSIONS: Women had lower job control than did men. Job control was positively related to education, social class and physical activity. Psychosocial factors were not related to biological coronary risk factors.

Adult↗
PubMed1999

Body weight and weight gain during adult life in men in relation to coronary heart disease and mortality. A prospective population study.

AIMS: To assess the risk of death from coronary disease, and all causes associated with body mass index and weight gain from age 20 to middle age. METHODS AND RESULTS: In this study, 6874 men aged 47 to 55 years at baseline and free of a history of myocardial infarction were followed with respect to mortality from coronary disease and from all causes over an average follow-up of 19.7 years, and with respect to non-fatal myocardial infarction for 11.8 years. High body mass index predicted death from coronary disease, but only at levels above 27.5 m.kg-2. Men with stable weight (defined as +/- 4% change from age 20) had the lowest death rate from coronary disease and the lowest risk of non-fatal myocardial infarction. Relative risk of coronary death increased with increasing weight gain, from 1.57 (1.14-2.15) (after adjustment for age, physical activity, and smoking) in the group who gained 4 to 10%, to 2.76 (1.97-3.85) in men with a weight gain of more than 35% (P for trend 0.0001), compared to men who remained stable. After further adjustment for serum cholesterol, systolic blood pressure, and diabetes, relative risks were reduced but still significantly elevated in all weight gain groups (P for trend 0.004). Data concerning non-fatal myocardial infarction were available for the first 11.8 years and showed a relative risk of 3.35 (2.05-5.47) after adjustment for age, physical activity, and smoking in men with a weight gain of more than 35%. CONCLUSION: Weight gain from age 20, even a very moderate increase, is strongly associated with an increased risk of coronary death and non-fatal myocardial infarction.

Adult↗
PubMed1998

"Nonspecific" chest pain associated with high long-term mortality: results from the primary prevention study in Göteborg, Sweden.

BACKGROUND: The syndrome angina pectoris with effort-related chest pain or discomfort is usually easy to recognize. However, vague and nonspecific symptoms may cause little reason for extensive evaluation. The prognosis of such patients in the general population has so far not been well described. HYPOTHESIS: The study was undertaken to investigate long-term prognosis in men with chest pain considered to be nonspecific in comparison with men with typical angina pectoris (AP) or prior myocardial infarction (MI), and men without chest pain. METHODS: At the second screening of the Göteborg Primary Prevention Study in 1974-1977, 6,488 men aged 51 to 59 years at baseline were available for the present analysis. Men who had responded positively to a postal questionnaire about chest pain during exercise or at rest were interviewed by a physician according to a Rose questionnaire at the screening examination. Those with typical or probable AP were further examined by single experienced physician. The following four groups were formed: Group 1: men who did not complain of chest pain (n = 5,545). Group 2: men who had not consulted any doctor because of chest pain, but who had chest pain according to a questionnaire (n = 441); these men were not considered to have AP according to a three-step examination by experienced physicians. Group 3: typical AP (n = 232). Group 4: men who had suffered an MI (n = 134). RESULTS: During 16 years of follow-up, coronary heart disease (CHD) mortality for Groups 1-4 was 8.0, 19.5, 24.8, and 48.5%, respectively. Mortality from all cardiovascular diseases was 11.5, 24.5, 31.2, and 59.0%, respectively. Noncardiovascular disease mortality was 14.1, 17.7, 14.3, and 8.7%, respectively. Thus, the relative risk (RR) for CHD mortality among men with nonspecific chest pain (Group 2) was 2.77 [95% confidence interval (CI) 2.20, 3.50], for all cardiovascular disease mortality 2.46 (95% CI 2.00, 3.02), and for noncardiovascular disease mortality 1.60 (95% CI 1.28, 2.00). Total mortality in this group was as high (44%) as among those with typical AP (45%), but the highest mortality was found among men with a previous MI (68%). In men without chest pain it was 26%. Patients of Groups 2-4 had higher levels of cardiovascular risk factors than those in Group 1. Neither any specific questions in the Rose questionnaire, nor electrocardiographic changes at rest (uncommon) were of prognostic significance. Serum cholesterol, systolic blood pressure, diabetes, and smoking were significant predictors of outcome, both with respect to fatal CHD and to total mortality during the 16-year follow-up. CONCLUSION: We found a high cardiovascular as well as noncardiovascular mortality among patients with chest pain who had not been considered to have AP at a three-step examination procedure. It is important to be suspicious of early CHD symptoms in men (and women?) with "nonspecific" chest symptoms and to analyze their cardiovascular risk factor pattern further because they are at considerably higher risk for future events than those in whom CHD is not suspected.

Angina Pectoris↗
PubMed1998

Analysis of the inflammatory response to titanium and PTFE implants in soft tissue by macrophage phenotype quantification.

Implants of commercially pure titanium and polytetrafluoroethylene (PTFE) were inserted in the rat abdominal wall for 1, 6 or 12 wk. The foreign body reaction was evaluated by immunohistochemical quantification of monocytes/macrophages and by the thickness of the foreign-body capsule. At all time intervals, the majority of interfacial cells were ED1-positive while ED2-positive cells were localized deeper in the tissue. Neither titanium nor PTFE displayed a significant change in capsule thickness over time. The total cell numbers decreased overtime for both types of material. At 12 wk the PTFE implants, compared to titanium, were surrounded by a significantly thicker reactive capsule with larger total cell numbers. No significant differences were seen in the macrophage subset response between the two types of implants. Thus, the present study showed differences between titanium and PTFE at 12 wk but not at earlier time points.

Journal Article↗
PubMed1998

Improved long-term prognosis after myocardial infarction 1984-1991.

AIMS: We set out to examine whether long term prognosis in terms of 2-year mortality after myocardial infarction has improved after the introduction of intravenous beta-blockers, nitroglycerin infusion, aspirin and thrombolytics, in an unselected population of patients hospitalized with a myocardial infarction. METHODS AND RESULTS: We investigated retrospectively 3791 acute myocardial infarctions in 3187 Göteborg women and men (1039 women and 2148 men), who were consecutively admitted to the coronary care unit at the Ostra hospital during 1984-1991. Throughout this period, data were entered continuously into the coronary care unit database. Mortality data were collected through the Swedish cause-specific mortality register. The primary end-point was mortality within 2 years after the onset of the index infarction. Two-year mortality decreased from 36% in 1984 to 25% in 1991. In a Cox regression model (including myocardial infarctions up to 1993) year of hospitalization, age, diabetes mellitus, sex, prior myocardial infarction and indeterminable infarct location all had a significant impact on survival after myocardial infarct. Thrombolytic therapy and hypertension had no prognostic significance. CONCLUSION: Against a background of radical changes in the treatment of acute myocardial infarction during 1984-1991 we have seen decreasing in-hospital mortality as well as a substantial decrease in 2-year mortality.

Aged↗
PubMed1998

Respiratory symptoms and long-term risk of death from cardiovascular disease, cancer and other causes in Swedish men.

BACKGROUND: Depressed respiratory function and respiratory symptoms are associated with impaired survival. The present study was undertaken to assess the relation between respiratory symptoms and mortality from cardiovascular causes, cancer and all causes in a large population of middle-aged men. METHODS: Prospective population study of 6442 men aged 51-59 at baseline, free of clinical angina pectoris and prior myocardial infarction. RESULTS: During 16 years there were 1804 deaths (786 from cardiovascular disease, 608 from cancer, 103 from pulmonary disease and 307 from any other cause). Men with effort-related breathlessness had increased risk of dying from all of the examined diseases. After adjustment for age, smoking habit and other risk factors, the relative risk (RR) associated with breathlessness of dying from coronary disease was 1.43 (95% CI : 1.16-1.77), from stroke 1.77 (95% CI: 1.07-2.93), from any cardiovascular disease 1.48 (95% CI : 1.24-1.76), cancer 1.36 (95% CI : 1.11-1.67) and from any cause 1.62 (95% CI: 1.44-1.81). An independent effect of breathlessness on cardiovascular death, cancer death and mortality from all causes was found in life-time non-smokers, and also if men with chest pain not considered to be angina were excluded. An independent effect was also found if all deaths during the first half of the follow-up were excluded. Men with cough and phlegm, without breathlessness, also had an elevated risk of dying from cardiovascular disease and cancer, but after adjustment for smoking and other risk factors this was no longer significant. However, a slightly elevated independent risk of dying from any cause was found (RR = 1.18 [95% CI: 1.02-1.36]). CONCLUSION: A positive response to a simple question about effort related breathlessness predicted subsequent mortality from several causes during a follow-up period of 16 years, independently of smoking and other risk factors.

Cardiovascular Diseases↗
PubMed1998

Hypertension and long-term cancer incidence and mortality among Swedish men.

OBJECTIVE: To examine incidence of cancer and cancer mortality in relation to high blood pressure. DESIGN: A longitudinal study of middle-aged men from a random population sample. SETTING: Göteborg, Sweden. SUBJECTS: We studied 7396 men aged 47-55 years without diagnosed cancer at baseline (1970-1973). MAIN OUTCOME MEASURES: Incidence of cancer and mortality from cancer. RESULTS: By the end of December 1992, 1401 men had been diagnosed with cancer at any site and 651 had died from cancer. Of the men in the highest fifth of the systolic blood pressure distribution (above 166 mmHg) 126 per 10000 observation years were diagnosed with cancer at any site, compared with 91 per 10000 in the lowest fifth [below 130 mmHg; relative risk after adjustment for age, smoking, body mass index, treatment for hypertension and leisure time physical activity 1.41 (95% confidence interval 1.19-1.68); P for trend 0.0001]. Of men in the highest fifth, 55 per 10000 observation years died from cancer, compared with 42 in the lowest [adjusted relative risk 1.41 (1.09-1.82); P for trend 0.01]. Several types of tumour tended to be more common among men with hypertension, but only genito-urinary cancers [age-adjusted relative risk 1.39 (1.04-1.85)] and non-melanoma skin cancer [age-adjusted relative risk 1.98 (1.12-3.51)] were significantly so. Findings were similar for diastolic blood pressure and if data for the first 5 years of follow-up were excluded. There was an increase in risk of cancer also during the first 5 years [adjusted relative risk 1.80 (1.10-2.92) for systolic blood pressure and 1.77 (1.05-2.99) for diastolic blood pressure]. CONCLUSIONS: We found an excess risk of cancer and of death from cancer for men with high blood pressure. Although the increase in risk was comparatively modest, the findings are of public health importance, insofar as both hypertension and cancer are common conditions.

Aged↗
PubMed1998

Natural history of myocardial infarction and angina pectoris in a general population sample of middle-aged men: a 16-year follow-up of the Primary Prevention Study, Göteborg, Sweden.

OBJECTIVES: Although many studies have described prognosis in patients with coronary heart disease (CHD), few have compared outcome in men with clinical evidence of CHD with healthy men from the general population over an extended follow-up. This study aimed to compare long-term prognosis in men with a history of myocardial infarction (MI) and in men with angina pectoris (AP) without MI, with men without clinical signs of CHD. DESIGN: Longitudinal general population study. SETTING: City of Göteborg, Sweden. SUBJECTS: From a general population sample, 195 men who had survived an MI for 0-19 years (median 3 years) and 314 men with AP but no MI (uncomplicated AP) at baseline in 1974-77 were identified and compared with 6591 men without clinical coronary disease. All were aged 51-59 years. Incident non-fatal and fatal cases occurring until the beginning of 1983 were also followed (n = 317). MAIN OUTCOME MEASURES: Death from CHD, from other causes and from all causes during a follow-up of at least 16 years. RESULTS: Overall survival was 72% amongst men without coronary disease, 53% amongst men with uncomplicated AP and 34% amongst men with past MI at baseline. In survivors of MI the risk-factor-adjusted relative risk (RR) of coronary death during follow-up was 6.67 (95% confidence interval (CI) 5.29-8.39), of dying from non-cardiovascular causes 1.35 (0.96-1.91), and of dying from any cause 3.20 (2.67-3.83). During the first 4 years after the baseline examination, the adjusted RR of CHD death was 15.96 (10. 29-24.74), and of dying from any cause 5.22 (3.68-7.41). During the last 4 years of follow-up, relative risk was still 5.87 (3.44-10.01) for CHD death and 2.93 (2.05-4.18) for death from any cause. In men with uncomplicated AP, the adjusted relative risk of CHD death during the first 4 years was 4.05 (2.27-7.22) and 3.23 (2.10-4.96) during the last 4-year period. After the first year, the incident MI cases had the same average annual mortality (about 5%) as the prevalent cases. CONCLUSIONS: In survivors of MI, mortality risk remained high even after an extended follow-up. Men with angina had a better prognosis, but still a compromised survival compared with the general population.

Angina Pectoris↗
PubMed1998

Socioeconomic differences in health indices, social networks and mortality among Swedish men. A study of men born in 1933.

BACKGROUND: In previous survey we found large socioeconomic differences in mortality among urban Swedish men which remained unexplained after controlling for smoking and standard coronary risk factors. The present analysis was undertaken in order to investigate a broader set of possible explanatory factors in another cohort of Swedish men. STUDY POPULATION AND METHODS: Occupation was coded into five occupational classes for 717 of 776 participant men from a random population sample of 1016 men who were born in 1933. All were living in Göteborg and were 50 years old at the baseline examination. After 12 years' follow-up, 68 of the 717 men had died (9.5%). RESULTS: Low occupational class was associated with a higher prevalence of smoking at baseline, but no association was found with systolic blood pressure, body mass index, waist to hip ratio, serum triglycerides or serum cholesterol. Subjects from higher socioeconomic strata were taller, had higher maximum peak respiratory flow, lower plasma fibrinogen and lower body temperature. Low occupational class was associated with low social integration, low home activity levels, low levels of activity outside home and low social activity levels (p = 0.001 for all) and with low emotional support (p = 0.018). There were also associations between low occupational class and poor self-perceived health, as well as with several cardiovascular symptoms. During 12 years' follow-up, there was a graded and inverse relationship between occupational class and mortality from all causes. The highest mortality was found among the men who could not be classified (23 per 1,000 person years) Of the men in the lowest occupational class, 12 per 1,000 died, compared to 3 per 1,000 in the highest class (relative risk 3.7 (1.4-9.8)). After controlling for smoking, the relative risk decreased to 3.2 (1.2-8.6) and after further adjustment for emotional support, self-perceived health, activity level at home, and peak expiratory flow, the relative risk was still twofold but not significantly so (RR 2.1 (0.8-5.8)). CONCLUSION: We were able to confirm earlier results as to the wide mortality differentials in urban middle-aged men in Sweden. There were also large differences in several other factors, including constitutional factors, health variables, lifestyle and social support indices, which explained important parts of the social mortality gradient, the most prominent being smoking, respiratory function, social network factors and subjective health.

Aged↗
PubMed1998

Diabetes and long-term risk of mortality from coronary and other causes in middle-aged Swedish men. A general population study.

OBJECTIVE: To assess the relation between cardiovascular risk factors and long-term cause-specific mortality risk in middle-aged diabetic men, compared with men without diabetes. RESEARCH DESIGN AND METHODS: This prospective study analyzes a large random population sample of men over a follow-up of 16 years. At baseline in 1974-1977, 249 men with diabetes and 6,851 men without diabetes, all aged 51-59 years, were identified. There were 2,126 deaths, 724 of which were due to coronary heart disease (CHD) and 1,001 deaths were due to any cardiovascular disease (CVD) cause. RESULTS: After adjustment for age, serum cholesterol, systolic blood pressure, smoking, BMI, and coronary disease at baseline, the relative risk of dying from any cause was 2.50 (95% CI, 2.11-2.95) in men with diabetes, compared with nondiabetic men, and 2.87 (2.31-3.57) for cardiovascular death. Men with diabetes had no significant excessive risk of dying from cancer or violent causes, but the relative risk of dying from any other noncardiovascular cause was 3.69 (2.55-5.34). Most of these deaths were due to diabetes and its complications. Hypercholesterolemia, smoking, and elevated systolic blood pressure predicted both coronary and all-cause mortality in diabetic as well as in nondiabetic men. Men with diabetes and serum cholesterol > 7.2 mmol/l had a risk of dying from coronary disease of 45.3 and from any cause of 76.1 per 1,000 observation-years. In men with diabetes, the relative risk of dying associated with serum cholesterol > 7.2 mmol/l, as compared with < 5.2 mmol/l, was 1.78 (95% CI, 1.05-3.02). The corresponding risk for nondiabetic men was 1.23 (1.04-1.46), and there was a statistically significant interaction between serum cholesterol and diabetes (P = 0.004). CONCLUSIONS: In men with diabetes, hypercholesterolemia, smoking, and hypertension predict coronary mortality risk, as well as mortality risk from all causes. Men with both diabetes and hypercholesterolemia have severely compromised survival and should be targeted for intervention aimed at lowering their lipid levels.

Age Factors↗
PubMed1997

Cigarette smoking is associated with abnormal involuntary movements in the general male population--a study of men born in 1933.

Abnormal involuntary movements, i.e., spontaneous and tardive dyskinesias, were studied in a random population sample of 559 men, aged 59 years, who were participating in an epidemiological study focused on cardiovascular health. The research diagnostic criteria for tardive dyskinesia were fulfilled by 8.2% (n = 46), discounting the fact that all had not been exposed to neuroleptics. The mean Abnormal Involuntary Movements Scale score in the dyskinetic group was 5.0 (SD = 1.8), indicating mild to moderate symptoms. Dyskinetic men had higher daily cigarette consumption and higher scores for parkinsonian symptoms. They also had higher frequencies of psychiatric morbidity, exposure to neuroleptics, and alcohol dependence than the men without dyskinesia. In a logistic regression model, exposure to neuroleptics (p < .05) and daily cigarette consumption (p < .0005) were independently associated with dyskinesia. The probability of dyskinesia in a person smoking 20 or more cigarettes per day was 19%, whereas the probability associated with exposure to neuroleptics was 30%.

Alcohol Drinking↗