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H Wedel

Publications and source records attributed to H Wedel.

At least 73 records · Page 4Linked to original sources
PubMed1996

Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures.

OBJECTIVE: To determine the ability of measurements of bone density in women to predict later fractures. DESIGN: Meta-analysis of prospective cohort studies published between 1985 and end of 1994 with a baseline measurement of bone density in women and subsequent follow up for fractures. For comparative purposes, we also reviewed case control studies of hip fractures published between 1990 and 1994. SUBJECTS: Eleven separate study populations with about 90,000 person years of observation time and over 2000 fractures. MAIN OUTCOME MEASURES: Relative risk of fracture for a decrease in bone mineral density of one standard deviation below age adjusted mean. RESULTS: All measuring sites had similar predictive abilities (relative risk 1.5 (95% confidence interval 1.4 to 1.6)) for decrease in bone mineral density except for measurement at spine for predicting vertebral fractures (relative risk 2.3 (1.9 to 2.8)) and measurement at hip for hip fractures (2.6 (2.0 to 3.5)). These results are in accordance with results of case-control studies. Predictive ability of decrease in bone mass was roughly similar to (or, for hip or spine measurements, better than) that of a 1 SD increase in blood pressure for stroke and better than a 1 SD increase in serum cholesterol concentration for cardiovascular disease. CONCLUSIONS: Measurements of bone mineral density can predict fracture risk but cannot identify individuals who will have a fracture. We do not recommend a programme of screening menopausal women for osteoporosis by measuring bone density.

Aged↗
PubMed1996

Cholesterol lowering and the use of healthcare resources. Results of the Scandinavian Simvastatin Survival Study.

BACKGROUND: Advances in the treatment of cardiovascular disease have increased costs; annual cardiovascular healthcare expenditure in the United States currently exceeds $100 billion. Physicians and third-party payers need to assess the economic impact of treatments that reduce cardiovascular morbidity and mortality. METHODS AND RESULTS: The Scandinavian Simvastatin Survival Study is a randomized, double-blind, placebo-controlled trial in which simvastatin reduced the risk of death by 30% (P=.0003) over the median follow-up period of 5.4 years in patients with previous myocardial infarction or stable angina pectoris as a result of a 42% reduction in the risk of coronary deaths (P=.00001). In the present report, data prospectively collected from hospital admissions were analyzed to evaluate the impact of simvastatin on healthcare resource use and perform a cost-minimization analysis. In the placebo group (n=2223), there were 1905 hospitalizations (average duration, 7.9 days) for acute cardiovascular events or coronary revascularization procedures among 937 patients, whereas in the simvastatin group (n=2221), there were 1403 such hospitalizations (average duration, 7.1 days) among 720 patients (all differences, P<.0001). The corresponding number of hospital days was 15089 and 9951 in the two groups, respectively (34% reduction,P<.0001). In the United States, the resulting reduction in hospitalization costs over the 5.4 years of the trial would be $3872 per patient, reducing the effective cost of simvastatin by 88% to $0.28 per day. CONCLUSIONS: In addition to reducing mortality and morbidity in coronary heart disease patients, simvastatin markedly reduces use of hospital services, thus offsetting most of its cost.

Adult↗
PubMed1996

Physical activity levels and changes in relation to longevity. A prospective study of Swedish women.

In 1968-1969, a population-based sample of Swedish women aged 38-60 years was recruited for a health survey, and 20-year survival was later ascertained from national registries. Occupational and leisure-time physical activity data from the baseline and 6-year follow-up examinations were evaluated in relation to all-cause mortality among 1,405 women who were initially free of major diseases. In comparison with being inactive, the mortality relative risk associated with being somewhat active was 0.28 (95% confidence interval 0.17-0.46) for occupational activity and 0.56 (95% confidence interval 0.39-0.82) for leisure-time activity. Being in the most active occupational or leisure activity category further decreased mortality risk to a minor extent. A within-subject decrease in leisure activity over 6 years was also a significant risk factor for all-cause mortality (relative risk = 2.07, relative to no change), although there was no evidence of a benefit from increasing physical activity levels. Since exclusion of early endpoints did not affect the associations in any significant way, underlying illness is unlikely to have played a major role in these analyses. It is concluded that decreases in physical activity as well as low initial levels are strong risk factors for mortality in women, and that their predictive value persists for many years.

Adult↗
PubMed1996

Cost-effectiveness of cholesterol lowering. Results from the Scandinavian Simvastatin Survival Study (4S)

An analysis of the cost-effectiveness of simvastatin was conducted, based on the Scandinavian Simvastatin Survival Study (4S). The total cost of hospitalization in the placebo group was 52.8 million Swedish kronor (SEK) (5.15 million pounds), compared with SEK 36.0 million (3.51 million pounds) in the simvastatin group. This amounts to a 32% reduction, or a saving of SEK 16.8 million (1.6 million pounds) or SEK 7560 (738 pounds) per patient. The net cost per patient for the duration of the study (5.4 years) was SEK 13,540 (1324 pounds). Simvastatin treatment saved an estimated 0.377 undiscounted life years (0.240 life years discounted at 5% per annum). The cost of simvastatin therapy per discounted life-year saved was therefore SEK 56,400 (5502 pounds). Sensitivity analysis, examining the effect of different life expectancies, costs of initiation and monitoring of simvastatin therapy, and discount rates, showed the results to be stable. Conclusion. The cost per life-year saved of simvastatin in the treatment of post-myocardial infarction and angina patients, as determined from 4S data, is well within the range normally considered cost-effective.

Anticholesteremic Agents↗
PubMed1996

Effects of insulin treatment on cause-specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction. DIGAMI Study Group. Diabetes Insulin-Glucose in Acute Myocardial Infarction.

Diabetic patients with acute myocardial infarction have a poor prognosis, which has been attributed to a higher incidence of congestive heart failure and fatal reinfarction. This study reports on the one-year morbidity and mortality in a randomized study with the aim of testing whether insulin-glucose infusion initiated as soon as possible after onset of myocardial infarction and followed by long-term subcutaneous insulin treatment may have a beneficial effect on outcome in diabetic patients. In all, 306 patients were recruited to the insulin-treated group, while 314 patients served as controls. The overall mortality after one year was 19% in the insulin group compared to 26% among controls (P < 0.05). The treatment effect was most pronounced in patients without prior insulin medication and at low cardiovascular risk. In this stratum the in-hospital mortality was reduced by 58% (P < 0.05) and the one-year mortality by 52% (P < 0.02). The most frequent cause of death in all patients was congestive heart failure (66%), but cardiovascular mortality (congestive heart failure, fatal reinfarction, sudden death and stroke) tended to be decreased in insulin-treated patients. However, this difference did not reach the level of statistical significance. The number of reinfarctions was 53 (28% fatal) in the insulin group compared to 55 (45% fatal) in the control group. The two groups did not differ as regards need for hospital care or coronary revascularization during the year of follow-up. In summary, left ventricular failure and fatal reinfarctions contribute to increased mortality in diabetic patients following acute myocardial infarction. Intensive insulin treatment lowered this mortality during one year of follow-up.

Adult↗
PubMed1996

Plasma levels of lipoprotein (a) do not predict progression of human chronic renal failure.

Chronic renal failure is frequently accompanied by elevated plasma levels of lipoprotein (a) [Lp(a)]. Elevated Lp(a) levels have been proposed to contribute not only to increased risk of atherosclerotic and thrombotic complications but also to the progression of renal insufficiency. To investigate whether higher Lp(a) plasma concentrations are associated with an accelerated rate of progression of renal insufficiency, we have correlated baseline plasma concentrations of Lp(a) with the progressive decline of renal function in an observational study of human chronic renal disease. Forty-nine non-diabetic patients (40 men, nine women) were studied as part of an observational study of patients with moderately advanced renal insufficiency. The average follow-up time of the patient population was 3.1 years, and the mean rate of decline in glomerular filtration rate (51Cr-EDTA clearance) was -2.8 (SD 4.1) ml/min/1.73 m2. The mean plasma concentration of Lp(a) at the beginning of the study was 19.2 (SD 18.6) mg/100 ml with a median value of 12.2 mg/100 ml. There was no association between the initial plasma concentration of Lp(a) and the rate of progression as assessed by linear regression analysis. Furthermore, the progression rate in patients within the highest quartile of the Lp(a) distribution (> or = 30 mg/100 ml) did not differ from that in patients with lower levels of Lp(a). In contrast, increased levels of apolipoprotein (apo) B, low-density lipoprotein (LDL)-cholesterol, and proteinuria were all significantly associated with a more rapid decline in renal function. Based on these results, it was concluded that elevated plasma levels of Lp(a) are not associated with an increased rate of progression of renal insufficiency in human chronic renal disease. However, the results of this study suggest that other apoB-containing lipoproteins may play a significant role in this process.

Adult↗
PubMed1996

Economic consequences of sick-leave and early retirement in obese Swedish women.

OBJECTIVES: To describe the pattern of sick-leave and disability pension in an obese sample and to estimate the Incremental, indirect cost due to sick-leave and early retirement for the obese fraction of the Swedish female population. DESIGN: A retrospective study of sick-leave and disability pension in health examined obese subjects was performed. The indirect cost of obesity in Sweden was estimated from reported and recorded sick-leave and disability pension in the sample and from the estimated prevalence of obesity in the country. SUBJECTS: 1298 obese persons aged 30-59 y. The mean age was 46 years. The mean body mass Index was 39 kg/m2 (range 28-68). SETTING: The obese subjects were recruited from eight counties in Sweden. RESULTS: As compared to the general Swedish population the obese subjects had 1.5-1.9 times higher sick-leave during one year. Twelve percent of the obese women had disability pension while the corresponding figure in the general population was 5%. The incremental cost of sick-leave and disability pensions attributable to obesity was 3.6 billion SEK during one year, which is equivalent to about 300 million USD per million female adult population. The total cost for sick-leave and disability pension due to absence from work for the obese fraction of the Swedish female population was 10.5 billion SEK during one year. CONCLUSION: Obesity represents a major health problem with significant economic implications for the society. Approximately 10 percent of the total cost of loss of productivity due to sick-leave and disability pensions in women may be related to obesity and obesity-related diseases.

Adult↗
PubMed1995

Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year.

OBJECTIVES: We tested how insulin-glucose infusion followed by multidose insulin treatment in diabetic patients with acute myocardial infarction affected mortality during the subsequent 12 months of follow-up. BACKGROUND: Despite significant improvements in acute coronary care, diabetic patients with acute myocardial infarction still have a high mortality rate. METHODS: A total of 620 patients were studied: 306 randomized to treatment with insulin-glucose infusion followed by multidose subcutaneous insulin for > or = 3 months and 314 to conventional therapy. RESULTS: The two groups were well matched for baseline characteristics. Blood glucose decreased from 15.4 +/- 4.1 to 9.6 +/- 3.3 mmol/liter (mean +/- SD) in the infusion group during the 1st 24 h, and from 15.7 +/- 4.2 to 11.7 +/- 4.1 among control patients (p < 0.0001). After 1 year 57 subjects (18.6%) in the infusion group and 82 (26.1%) in the control group had died (relative mortality reduction 29%, p = 0.027). The mortality reduction was particularly evident in patients who had a low cardiovascular risk profile and no previous insulin treatment (3-month mortality rate 6.5% in the infusion group vs. 13.5% in the control group [relative reduction 52%, p = 0.046]; 1-year mortality rate 8.6% in the infusion group vs. 18.0% in the control group [relative reduction 52%, p = 0.020]). CONCLUSIONS: Insulin-glucose infusion followed by a multidose insulin regimen improved long-term prognosis in diabetic patients with acute myocardial infarction.

Aged↗
PubMed1993

Stressful life events, social support, and mortality in men born in 1933.

OBJECTIVE: To examine relations between stressful life events and mortality in middle aged men. DESIGN: Prospective population study. Data on stressful life events, social network, occupation, and other psychosocial factors derived from self administered questionnaires. Mortality data obtained from official registers. SETTING: City of Gothenburg, Sweden. SUBJECTS: 752 men from a random population sample of 1016 men aged 50. MAIN OUTCOME MEASURE: Mortality from all causes during seven years' follow up. RESULTS: Life events which had occurred in the year before the baseline examination were significantly associated with mortality from all causes during seven years' follow up. Of the men who had experienced three or more events during the past year 10.9% had died compared with 3.3% among those with no life events (odds ratio 3.6; 95% confidence interval 1.5 to 8.5). The association between recent life events and mortality remained true after smoking, self perceived health, occupational class, and indices of social support were controlled for. Many of the deaths were alcohol related, but the number of deaths was too small to allow for analyses of specific causes of death. The association between life events and mortality was evident only in men with low emotional support. CONCLUSION: Stressful life events are associated with high mortality in middle aged men. Men with adequate emotional support seem to be protected.

Cause of Death↗
PubMed1992

Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II)

BACKGROUND: Long-term administration of angiotensin-converting--enzyme (ACE) inhibitors has been shown to improve survival in patients with symptomatic left ventricular failure and to attenuate left ventricular dilatation in patients with myocardial infarction. We studied whether mortality could be reduced during the 6 months after an acute myocardial infarction with use of the ACE inhibitor enalapril. METHODS: At 103 Scandinavian centers patients with acute myocardial infarctions and blood pressure above 100/60 mm Hg were randomly assigned to treatment with either enalapril or placebo, in addition to conventional therapy. Therapy was initiated with an intravenous infusion of enalapril (enalaprilat) within 24 hours after the onset of chest pain, followed by administration of oral enalapril. RESULTS: Of the 6090 patients enrolled, 3046 were assigned to placebo and 3044 to enalapril. The life-table mortality rates in the two groups at one and six months were not significantly different (6.3 and 10.2 percent in the placebo group vs. 7.2 and 11.0 percent in the enalapril group, P = 0.26). The relative risk of death in the enalapril group was 1.10 (95 percent confidence interval, 0.93 to 1.29). Death due to progressive heart failure occurred in 104 patients (3.4 percent) in the placebo group and 132 (4.3 percent) in the enalapril group (P = 0.06). Therapy had to be changed because of worsening heart failure in 30 percent of the placebo group and 27 percent of the enalapril group (P less than 0.006). Early hypotension (systolic pressure less than 90 mm Hg or diastolic pressure less than 50 mm Hg) occurred in 12 percent of the enalapril group and 3 percent of the placebo group (P less than 0.001). CONCLUSIONS: Enalapril therapy started within 24 hours of the onset of acute myocardial infarction does not improve survival during the 180 days after infarction.

Administration, Oral↗
PubMed1992

Is abdominal body fat distribution a major explanation for the sex difference in the incidence of myocardial infarction? The study of men born in 1913 and the study of women, Göteborg, Sweden.

The authors considered whether the difference in body fat distribution between men and women, measured as waist:hip ratio, might explain part of the sex difference in coronary heart disease incidence in prospective population studies of 1,462 women and 792 men. In these studies, conducted in Sweden, men were found to have about four times higher odds for coronary heart disease than women during a 12-year follow-up period (men, 1967 to 1979; women, 1968-1969 to 1980-1981). Controlling for differences in blood pressure, serum cholesterol, smoking, and body mass index only marginally altered the magnitude of the male-female difference. When waist:hip ratio, which predicted coronary heart disease rates in both sexes, was also considered, the sex difference in coronary heart disease risk was significantly reduced and virtually disappeared (odds ratios = 1.0-1.1; nonsignificant). The findings suggest that body fat distribution or a factor highly correlated with waist:hip ratio (genetic, hormonal, or behavioral) may help to explain the sex differences in coronary heart disease.

Abdomen↗
PubMed1992

Coronary heart disease, cancer and mortality in male middle-aged light smokers.

We examined the effect of light smoking in relation to incidence of coronary heart disease (CHD) in a general population sample consisting of 6879 men aged 47-55 years and free of previous myocardial infarction (MI) at baseline. After a follow-up of mean duration 11.8 years, 11.0% of men smoking 1-4 cigarettes daily (n = 228) had suffered a major CHD event, compared to 3.7% of non-smokers (n = 2049) [adjusted odds ratio 2.8 (1.7-4.7)]. No further increase in risk was observed in men who smoked more. There was an increasing risk of death from cancer with the number of cigarettes smoked per day. Mortality was increased in all categories of cigarette smokers, particularly among the very heavy smokers, who had a mortality risk of 22% compared to 6% among nonsmokers [adjusted odds ratio 4.4 (2.7-7.1)]. Data from an examination 4 years later considered only those men who stated that their smoking habits were identical on both occasions (n = 3981). Among these subjects the incidence of CHD after a mean period of 7.1 years was 10.6% in men smoking 1-4 cigarettes per day, compared to 2.6% in nonsmokers [adjusted O.R. 4.6 (2.1-10.1)]. No dose-response effect was observed. Even very light cigarette smoking considerably increases the risk of CHD in middle-aged men.

Cause of Death↗
PubMed1992

Patient involvement in decision-making in surgical and orthopaedic practice. Effects of outcome of operation and care process on patients' perception of their involvement in the decision-making process.

As part of the project Perioperative Risk,--an epidemiological study of complications associated with surgical and orthopaedic operations--the article reports a study of patients' perception of their involvement in decision-making in medical consultations, and how the outcomes of surgery and subsequent care determine patients' evaluation of the treatment. Patients' view of their involvement in the decision-making process was obtained before as well as after surgery. The results reveal that the more satisfied the patients were with the outcome of the operation, and the post-operative situation, the more they were inclined to assume responsibility for the decision to have surgery. The opposite response pattern, indicating a negative evaluation of either the operation or the post-operative care, resulted in an outcome where patients described others--especially the physician--as being responsible for the decision to have surgery. The results suggest that patients' evaluations of surgery are based upon a more global reaction to what happened during the entire care process. Dissatisfaction with either the operation or the post-operative care leads to a negative outcome in terms of patients' perceptions of their own involvement. This emphasizes the importance of all health care professionals seeing themselves as a team with complementary responsibilities for success in health care.

Decision Making↗
PubMed1992

Fasting insulin in relation to subsequent blood pressure changes and hypertension in women.

The role of hyperinsulinemia in the development of hypertension is not well understood, particularly insofar as both conditions relate to obesity. The present analysis examines the hypothesis that hyperinsulinemia, independent of obesity, precedes hypertension and natural blood pressure increases in women. The subjects were 50-year-old women from a prospective population study in Gothenburg, Sweden. Fasting insulin levels were determined at baseline (1968-1969) and were evaluated in relation to subsequent hypertension. Blood pressures were measured at the initial physical examination and at the 6- and 12-year follow-up examinations. The first analysis presented here (n = 278) identified incident cases of hypertension during the 12-year follow-up period, whereas the second analysis (n = 219) examined continuous changes in blood pressure. In both analyses, degree, type, and changes in obesity were considered as possible confounding factors. High fasting insulin values were predictive of subsequent incidence of hypertension over the 12-year follow-up period. Subjects with insulin values above the 75th percentile experienced three times more hypertension than did those below the 25th percentile. There was also a significant association between insulin at baseline and increases in diastolic (but not systolic) blood pressure. The positive relations between fasting insulin, on one hand, and diastolic blood pressure changes and hypertension, on the other, could not be explained by confounding effects of body mass index, waist/hip ratio, or weight gain. These findings are consistent with the hypothesis that fasting insulin levels may be one predisposing factor in the etiology of hypertension.

Blood Pressure↗
PubMed1990

Lipoprotein (a) and coronary heart disease: a prospective case-control study in a general population sample of middle aged men.

OBJECTIVE: To examine the association between the serum lipoprotein (a) concentration and subsequent coronary heart disease. DESIGN: Prospective case-control study based on a six year follow up of a general population sample of men aged 50 at baseline in 1983-4. Serum samples were frozen at the time of the baseline examination and kept at -70 degrees C for six years, after which the lipoprotein (a) concentrations in the samples were measured in cases and controls. SETTING: City of Gothenburg, Sweden. SUBJECTS: 26 Men, from a general population sample of 776 men, who had sustained a myocardial infarction or died of coronary heart disease during the six years and 109 randomly selected controls from the same sample who had remained free of myocardial infarction. In neither cases nor controls was there a history of myocardial infarction at baseline. MAIN OUTCOME MEASURES: Proportion of myocardial infarction or deaths from coronary heart disease, or both, in relation to the serum lipoprotein (a) concentration. RESULTS: Men who suffered coronary heart disease had significantly higher serum lipoprotein (a) concentrations than controls (mean difference 105 mg/l; 95% confidence interval 18 to 192 mg/l). Men with the highest fifth of serum lipoprotein (a) concentrations (cut off point 365 mg/l) suffered a coronary heart disease rate which was more than twice that of men with the lowest four fifths of concentrations. Logistic regression analysis showed the serum lipoprotein (a) concentration to be significantly associated with coronary heart disease independently of other risk factors. CONCLUSION: The serum lipoprotein (a) concentration in middle aged men is an independent risk factor for subsequent myocardial infarction or death from coronary heart disease.

Case-Control Studies↗