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Biomedical subjects

C Wilhelmsson

Publications and source records attributed to C Wilhelmsson.

At least 73 records · Page 4Linked to original sources
PubMed1983

Plasma concentrations of platelet-specific proteins in young female acute myocardial infarction survivors and their age-matched female controls.

The steady state plasma concentrations of the two platelet-specific proteins beta-thromboglobulin (BTG) and platelet factor 4 (PF4) were determined in two groups of females: 36 acute myocardial infarction (AMI) survivors, and 38 age-matched control subjects. For the AMI patients the mean BTG and PF4 values were 57 +/- 4 and 14.1 +/- 1.7 ng/ml, respectively. These two means significantly exceeded the corresponding means for the controls, 40 +/- 2 and 10.3 +/- 0.6 ng/ml, respectively. Similar results have recently been reported by other workers who investigated patients with coronary artery disease; however, in no previous study were the values for BTG and PF4 related to those obtained for control subjects matched with respect to sex and age. The present results therefore further support the concept that increased platelet activation and secretion is taking place in steady state patients who previously have sustained an AMI.

Adult↗
PubMed1983

Low-back pain in relation to other diseases and cardiovascular risk factors.

The relationship of low-back pain (LBP) to other diseases and to cardiovascular risk factors was studied in a random sample of 940 men from 40 to 47 years of age. The life-time incidence of LBP was 61%, the prevalence 31%. The prevalence of other diseases was the same as in previous studies in the same region. In a univariate analysis nine variables were found to be correlated to LBP; angina pectoris, calf pain, breathlessness on exertion, smoking, physical activity at work and during leisure time, worry and tension, fatigue at the end of the workday, and perception of stress. When the influence of other variables was assessed by analysis of covariance, four of the variables maintained a direct association with LBP, viz, calf pain on exertion, smoking, a high physical activity at work, and a frequent feeling of worry and tension.

Adult↗
PubMed1983

Cessation of smoking after myocardial infarction. Effects on mortality after 10 years.

Ten annual cohorts of men suffering from their first myocardial infarction have been followed up to a maximum period of 10.5 years. One thousand and twenty-three male patients of 1306 were smokers. Three months after the infarction 55% had stopped smoking and 45% continued smoking. These two groups were then compared and followed with regard to non-fatal reinfarctions and deaths. Preinfarction characteristics were shown to be similar for the two groups. The prognostic comparability of the two groups was tested using two multiple logistic models. Those who stopped smoking had a slightly higher predicted two year mortality after the infarction. In different age groups it is shown with life table technique that those who stopped smoking had a considerably higher survival rate and lower cumulative frequency of reinfarction. The present study shows a reversion of the expected prognosis after myocardial infarction caused by changing the smoking habit.

Adult↗
PubMed1983

Characteristics, prevalence, and prognosis of postmyocardial infarction syndrome.

Among 1809 patients with myocardial infarction, 60 (3.3%) later developed a postmyocardial infarction syndrome. These 60 patients were compared with controls with myocardial infarction but without postmyocardial infarction syndrome. Cases with postmyocardial infarction syndrome had larger and more complicated infarcts than control subjects. Five year cumulative mortality was higher among cases (26%) than among control subjects (18%) but this difference was not statistically significant. Corticosteroid treatment did not adversely affect the prognosis of the postmyocardial infarction syndrome, which we conclude is mainly determined by the severity of the underlying coronary heart disease.

Adrenal Cortex Hormones↗
PubMed1983

The Göteborg metoprolol trial. Effects on mortality and morbidity in acute myocardial infarction.

In the Göteborg Metoprolol Trial, 1395 patients with suspected acute myocardial infarction were, on admission, randomly allocated to double-blind treatment, 697 to placebo and 698 to metoprolol (15 mg i.v. + 200 mg/day) for 90 days. During this period, there were 62 deaths in the placebo group (8.9%) and 40 in the metoprolol group (5.7%), a mortality reduction of 36% (p less than 0.03). This effect persisted regardless of age, previous infarction or previous chronic beta blockade. All deaths were classified as cardiovascular. After 3 months, all patients were recommended open treatment with metoprolol, and the difference in mortality between the two groups was maintained after 1 year. Early institution of metoprolol (within 12 hours) influenced infarct development during the first 3 days (infarct diagnosis and indirect measures of infarct size). Metoprolol also reduced the incidence on fatal and nonfatal infarction during the next 4-90 days by 35%. Furthermore, fewer episodes of ventricular fibrillation were recorded in the metoprolol than in the placebo group (six vs 17 patients). The tolerance was judged to be very good. The same percentage of patients (19%) was withdrawn from the blind treatment in the two groups. Fewer patients in the metoprolol group used lidocaine, furosemide and analgesics. We conclude that metoprolol therapy instituted on admission in patients with suspected acute myocardial infarction reduced 3-month mortality and exerted beneficial clinical effects.

Adult↗
PubMed1982

Comparison of once and twice daily sotalol in exercise-induced angina pectoris.

The efficacy of chronic oral treatment with a total daily dose of 320 mg sotalol, given as a single or as two divided doses, was compared with placebo in a double-blind cross-over study of 12 patients with angina pectoris. Sotalol given once or twice daily significantly reduced heart rate and systolic and diastolic blood pressures at rest. The exercise heart rates were significantly decreased in both treatment groups. After sotalol 320 mg once daily, there was a greater reduction in the maximum exercise heart rate 2 h after taking the last tablet than after sotalol 160 mg b.i.d. The systolic blood pressure at the highest comparable work-load was significantly and equally reduced by sotalol both once and twice daily. Total work (watts X minutes in both sotalol treatment groups was significantly increased compared to placebo. There was no difference between the two sotalol dosage regimens. The peak plasma levels were higher after the once daily treatment, but the trough levels were similar for both regimens. No serious side effects were observed.

Adult↗
PubMed1981

Effect on mortality of metoprolol in acute myocardial infarction. A double-blind randomised trial.

The effect of metoprolol on mortality was compared with that of placebo in a double blind randomised trial in patients with definite or suspected acute myocardial infarction. Treatment with metoprolol or placebo started as soon as possible after the patient's arrival in hospital and was continued for 90 days. Metoprolol was given as a 15 mg intravenous dose followed by oral administration of 100 mg twice daily. 1395 patients (697 on placebo and 698 on metoprolol) were included in the trial. Definite acute myocardial infarction developed in 809 and probable infarction in 162. Patients were allocated to various risk groups and within each group patients were randomly assigned to treatment with metoprolol or placebo. There were 62 deaths in the placebo group (8.9%) and 40 deaths in the metoprolol group (5.7%), a reduction of 36% (p less than 0.03). Mortality rates are given according to the treatment group to which the patients were initially randomly allocated.

Adult↗
PubMed1981

Beta blockers after myocardial infarction--aspects on study design based on current knowledge.

The beta-blocker trials published so far may be subdivided into three different categories: 1) retrospective, 2) prospective non-conclusive, 3) prospective conclusive studies. The retrospective studies suffer the weaknesses of the retrospective method and may only be used as supportive evidence. There have so far been four prospective studies producing positive results, three with alprenolol and one with practolol. The studies presented support the concept that practolol and alprenolol reduce the long-term mortality due to sudden death from ischemic heart disease after myocardial infarction. All the studies have been criticized on various grounds and a list of unanswered remaining issues may be made. Acute and long-term effects of betablockade need not be the same. Our knowledge about the necessary doses and plasma levels is incomplete. All the studies published so far cover a maximum period of two years. If the study observation periods were prolonged it is likely that at some time the relative benefit becomes less. Ideal treatment should be reserved for those patients likely to derive significant benefit from it. At the present time identification of such patients is not sufficiently precise. Whether or not the beta-blockers have an antiarrhythmic effect, for instance demonstrated on chronic PVC's, this information is of little value in interpreting the proper mechanism of the beta-blockers in acute ischemia and lethal arrhythmias. In order to contribute new knowledge future studies should involve sufficiently large numbers of representative groups of patients, a stratified study design and a beta-blocker with ancillary properties different from alprenolol.

Adrenergic beta-Antagonists↗
PubMed1981

Methodological aspects in the design of secondary prevention trials.

The aim of a secondary preventive trial is to produce results that may serve as a basis for therapeutic recommendations to other patients. The natural history of a disease studied including the mortality and reinfarction rate must be known and taken into consideration. The patients should be recruited without selection. By comparing the placebo mortality with expected levels the representativeness of patients can be assessed. One type of treatment can be expected to give different results in different groups of patients with the same disease, thus, prognostic prospective stratification may increase the value of comparisons and conclusions. The registration of end-points should preferably be done by a separate independent organization. Carefully classified specific mortality may be used as a major end-point in addition to total mortality. Similarly, different modes of deaths, e.g. sudden death, may be used if reliable definitions are used. Confounding factors are often difficult to isolate and identify and may have profound effects on the interpretation of a study. In all studies it is mandatory that the patient characteristics on entry do not differ between the different treatment groups. Concomitant treatment should be administered according to standardized criteria. The drop-out rate should be kept at a minimum. The possibility of generalization decreases with increasing drop-out rate. If the follow-up time becomes too long it is likely that at some time the relative benefit becomes less. Since the proportion of non-cardiovascular deaths increases with follow-up and age it may be critical to decide on the relevant follow-up time.

Adult↗
PubMed1981

Cost-benefit aspects of post-myocardial infarction intervention.

After myocardial infarction the mortality during the first post hospital year declines from approximately 10 per cent to 5 per cent during the second year. The rates of non-fatal recurrencies are similar. Mortality is related to age but not to the same extent to sex. Non-fatal recurrencies are, however, not related to age. Prediction of mortality is feasible by several prognostic models. Factors related to size of myocardial damage stand out as the important secondary risk factors for the years immediately after infarction. Most of these factors are not generally related to risk of non-fatal recurrencies. The proportion of cardiovascular deaths is 90 per cent during the first years and declines thereafter. Simplistically it may be said that the prognosis during the first years is related to the extent of the myocardial damage and thereafter primary risk factors become more important. Thus, it seems logical in the short-term perspective to influence myocardial factors and related arrhythmias and in the long-term perspective to influence primary risk factors which more likely operate on the vascular factors. Three preventive methods have demonstrated a positive benefit: 1) chronic beta-blockade, 2) cessation of smoking, 3) by-pass surgery in certain categories. After careful calculations it may be argued that at least half of the total mortality may be inhibited by beta-blockade and cessation of smoking. The impact of coronary surgery, lipid lowering and reduction of high blood pressures is more difficult to assess.

Adrenergic beta-Antagonists↗
PubMed1981

Epidemiology.

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Cardiac Output↗
PubMed1980

Serum apolipoprotein levels in relation to acute myocardial infarction and its risk factors--determination of apolipoprotein D.

Apolipoprotein A-I, A-II and apoD are all primarily found in the density region d > 1.063 g/ml. In the present study the serum apoD level was determined by electroimmunoassay in a random population sample of middle-aged men (n = 76). The mean level was 0.075 g/l with a standard deviation of 0.017. The apoD level was also determined in a group of patients, in the same age range, with sustained acute myocardial infarction (n = 25). The patients were compared with the random population sample and with a control group matched to the patients with regard to age, serum cholesterol level and body weight index. There was no difference in apoD level between patients and either control group. This is in contrast with the earlier reported low apoA-I, A-II as well as alphalipoprotein cholesterol levels in the same patient group.

Adult↗
PubMed1980

Serum apolipoprotein levels in relation to acute myocardial infarction and its risk factors. Apolipoprotein A-I levels in male survivors of myocardial infarction.

The significance of high density lipoproteins in the etiology of clinical complications to atherosclerosis has recently received increased attention. The levels of the major apolipoprotein in high density lipoproteins, apoA-I, have been determined in patients who had had an acute myocardial infarction, and compared with a cholesterol-matched and a randomly selected control group. ApoA-I levels were lower in the patients than in the control groups. ApoA-I levels were also lower in smokers than in non-smokers. The difference between patients and control groups persisted even when the groups were stratified according to smoking habits. This suggests that low levels of apo-A-I as well as alphalipoprotein cholesterol are additional characteristics of the infarction patients, even when the established risk factors, smoking and hyperlipidemia are taken into account.

Adult↗
PubMed1980

Duration of action of beta blockers.

Three randomized, placebo-controlled, crossover experimental designs were used to define a suitable interdose interval and to study the adequacy of once-daily administration for applications in preventive trials on manifest or latent ischemic patients. Suppression of exercise tachycardia was used as the major effect variable. All measurements were made at different intervals after the last dose when the healthy subjects had been treated for at least 1 wk. Reductions of exercise tachycardia were found 24 hr after the last dose for atenolol, metoprolol, penbutolol, pindolol, propranolol, sotalol, and timolol. Penbutolol and propranolol induced equal reduction of exercise tachycardia at the end of the dose interval regardless of whether the total daily dose was given once daily or divided in 2 daily doses. Atenolol and sotalol, both with long half-lifes (t1/2s), were not superior to other beta blockers. Neither were slow-release preparations of metoprolol and propranolol markedly more effective 24 hr after the preparation than after ordinary tablets. Plasma concentration-time patterns after slow-release preparations may be important in patients with adverse experiences during peak plasma levels after conventional tablets.

Adrenergic beta-Antagonists↗