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Biomedical subjects

J Ranstam

Publications and source records attributed to J Ranstam.

At least 55 records · Page 3Linked to original sources
PubMed1996

Incidence of myocardial infarction in elderly men being treated with antihypertensive drugs: population based cohort study.

OBJECTIVE: To analyse the association between use of antihypertensive treatment, diastolic blood pressure, and long term incidence of ischaemic cardiac events in elderly men. DESIGN: Population based cohort study. Baseline examination in 1982-3 and follow up for up to 10 years. SETTING: Malmŏ, Sweden. SUBJECTS: 484 randomly selected men born in 1914 and living in Malmŏ during 1982. MAIN OUTCOME MEASURES: Observational comparisons of incidence rates and rate and hazard ratios of ischaemic cardiac events (myocardial infarction or death due to chronic ischaemic cardiac disease). RESULTS: The crude incidence rate of ischaemic cardiac events was higher in those subjects who were taking antihypertensive drugs than in those who were not (rate ratio 2.6 (95% confidence interval 1.7 to 3.9)). After adjustment for potential confounders (differences in baseline smoking habits, blood pressure, time since diagnosis of hypertension, ischaemic or other cardiovascular disease, hypercholesterolaemia, hypertriglyceridaemia, diabetes mellitus, obesity, and raised serum creatinine concentration) this rate was reduced but still raised (hazard ratio 1.9 (1.0 to 3.7)). In men with diastolic blood pressure > 90 mm Hg, antihypertensive treatment was associated with a twofold increase in the incidence of ischaemic cardiac events (rate ratio 2.0 (1.1 to 3.6)), which vanished after adjustment for potential confounders (hazard ratio 1.1 (0.5 to 2.6)). In those subjects with diastolic blood pressure < or = 90 mm Hg, antihypertensive treatment was associated with fourfold increase in incidence (rate ratio 3.9 (2.1 to 7.1)), which remained after adjustment for potential confounders (hazard ratio 3.8 (1.3 to 11.0)). CONCLUSION: Antihypertensive treatment may increase the risk of myocardial infarction in elderly men with treated diastolic blood pressures < or = 90 mm Hg.

Aged↗
PubMed1996

Increased risk of ischaemic heart disease mortality in elderly men using anxiolytics-hypnotics and analgesics. Results of the 10-year follow-up of the prospective population study "Men born in 1914", Malmo, Sweden.

OBJECTIVES: An increased risk of all-cause and cardiovascular mortality in users of anxiolytic-hypnotic drugs (AHD) has been reported, and use of analgesics may be an additional factor. Therefore, we examined the association of AHD and analgesic use, alone and in combination, with all-cause and ischaemic heart disease (IHD) mortality. METHODS: Multivariate 10-year survival analysis in a population based cohort of 500 men born in 1914. Relative risks (RR) were adjusted by relevant confounders (blood pressure, serum cholesterol, diabetes mellitus, smoking habit, high alcohol consumption, history of previous IHD, cancer, and other diseases). RESULTS: The RR of both all-cause and IHD mortality were significantly increased among those using both AHD and analgesics compared to those who took neither of these drugs: RR = 1.8 for all-cause mortality, and RR = 2.7 for IHD mortality. CONCLUSION: Although the number of cases was small, warranting interpretative caution, the current study suggests that the combined use of AHD (mainly benzodiazepines) and analgesics seems to be associated with an increase in all-cause and IHD mortality in elderly men.

Aged↗
PubMed1996

A mental-functional risk score for prediction of hip fracture.

We examined the apparent value of questions of functional status and mental score in determining the risk of hip fracture from a large retrospective case--control study undertaken in six countries. Of nine questions utilized in 75% of the MEDOS study population, four questions were found to be statistically significant and independently related to the risk of hip fracture. From this an additive score was devised with three points for not being able to wash or dress, six points for not knowing one's age, and ten points for not knowing the day of the week, which gave a gradient of risk of 5.7 when categorized into quartiles. Similar gradients of risk were observed in all countries. A less than perfect score was associated with a specificity of 79% and sensitivity of 46%, comparable to the power of bone mineral density measurements. The risk factor score accounted only partially for the increase in risk associated with dementia, cardiovascular accidents and parkinsonism. We conclude that the steep gradient of risk associated with this simple score should be evaluated prospectively.

Activities of Daily Living↗
PubMed1996

Body mass index and disability pension in middle-aged men--non-linear relations.

BACKGROUND: Obesity has, in a number of studies, been found to correlate to disability and mortality, primarily due to diseases of the circulatory and musculoskeletal systems. In addition, an excess mortality among underweight subjects has been observed in previous studies. METHODS: Five complete birth-year cohorts (1926-1930) of male residents in Malmö (n = 7697) were invited to the survey at the Department of Preventive Medicine, Malmö General Hospital, and 5926 (77%) attended with complete data. Each subject was followed from inclusion, defined by the date of examination, until the end of the calendar year when he turned 58, a total study period of approximately 11 years. Data on about 300 questionnaire items and laboratory tests were determined at the health survey visit. Nationwide Swedish data registers were used for surveillance. RESULTS: Of the participants, 4.7% were underweight, 37.7% overweight, 7.3% obese and 50.3% normal weight; 849 (14.3%) had been granted disability pension at the end of follow-up, 717 after screening. After adjustment for smoking there was a J-shaped relation between body mass index (BMI) and incidence of disability pension, the relative risk ( with the normal group as reference) among underweight men being 1.9. For the overweight subjects it was 1.3 and for the obese 2.8, all differences were significant. Disease of the musculoskeletal and circulatory systems and mental disorders accounted for 67.2% of all main diagnoses resulting in disability pensions during follow-up. A total of 377 (6.4%) men died during follow-up. Diseases of the circulatory system, neoplasms, injury/poisoning and diseases of the respiratory system accounted for 91.8% of the deaths. CONCLUSIONS: Both underweight, overweight and obesity were related to risk of disability pension, with a J-shaped risk relationship.

Body Mass Index↗
PubMed1996

Psychosocial resources and persistent smoking in early pregnancy--a population study of women in their first pregnancy in Sweden.

STUDY OBJECTIVE: To test the stress hypothesis by characterising women during their first pregnancy who continue to smoke in early pregnancy in comparison with women who quit smoking, with special reference to psychosocial factors like social network, social support, demands, and control in work and daily life. DESIGN: The study is based on a cohort of primigravidas followed during pregnancy. Data were collected by self administered questionnaires during the pregnant womens' first antenatal visit at about 12 weeks. SETTING: The study was performed in the antenatal clinics in the city of Malmö, Sweden. PARTICIPANTS: The participants were all primigravidas living in the city of Malmö, Sweden, over a one year period, 1991-92. A total of 872 (87.7%) of the 994 invited women agreed to participate. The population of this study on smoking includes all primigravidas who at the time of conception were smoking (n = 404, 46.3%). MAIN RESULTS: At the first antenatal visit (63.6% (n = 257) of the prepregnancy smokers were still smoking (a total smoking prevalence of 29.5%). The pregnant smokers were on average younger and had a lower educational level. The highest relative risk (RR) of continued smoking was found among unmarried women RR 2.7 (95% confidence interval) (1.5, 4.8), women having unplanned pregnancies RR 2.2 (1.2, 4.0) and those with a low social participation RR 1.6 (1.0, 2.7), low instrumental support RR 2.6 (1.2, 6.0), low support from the child's father RR 2.1 (1.0, 4.2) and those exposed to job strain RR = 2.3 (1.1, 4.8). The associations were independent of potential confounders such as age, educational level, nationality, cohabiting status, passive smoking, and previous years of smoking. CONCLUSIONS: This study supports the stress hypothesis. Smoking can be one way women handle stress when demands become too great. In order to reduce smoking among pregnant women, maternity centre resources need to be focused more on women with low psychosocial resources who are at highest risk for continued smoking. It is also important to involve actively the woman's partner or other important people in the woman's social network.

Adolescent↗
PubMed1996

Falls and hip fracture. A reasonable basis for possibilities for prevention? Some preliminary data from the MEDOS study Mediterranean Osteoporosis Study.

UNLABELLED: The Mediterranean Osteoporosis Study (MEDOS), a multicentre study on incidence, risk factors, and means of prevention of hip fracture in the Mediterranean region, started in 1986 and involved 14 centres, in Portugal, Spain, France, Italy, Greece, and Turkey. The design includes a case-control study comparing 8,185 individuals in age groups above 50 (2,816 cases and 5,369 controls; two controls per case). Information on falls was only collected for a small fraction of the controls. In a questionnaire including 160 main questions eleven referred to circumstances around the fall. Falls were classified according to a) high risk environment, e.g. occurred in darkness and b) high risk fallers, e.g. confusion, reduced functional ability. There was great variation between centra for a majority of the results. However, 2/3 of fractures happened during daylight. 9% of fractures, same for both males and females, took place in darkness. Females have more indoor fractures than males. Around 15% of fractures took place in connection with going to the toilet. Mental factors play a minor role as reported immediate cause to the fall. Before the fall that caused the hip fracture between 28-84% could get up from a chair without any difficulties. Of the males 0-26% lived alone as against 0-37% or females. CONCLUSION: The data on circumstances around the fall shows a complex pattern with substantial variation between different cultures, but where a, however, minority took place under risk circumstances that have a clear preventive potential.

Accidental Falls↗
PubMed1995

Influence of age and body mass on the effects of vitamin D on hip fracture risk.

The role of vitamin D in the prevention of hip fracture is controversial and protective effects appear to be confined to the institutionalized and elderly population. The aim of this study was to assess the interaction of age and body mass index (BMI) on the effects of vitamin D on the risk of hip fracture in the community. We studied 1634 women with low-energy fractures of the hip aged 50 years or older, and 3532 age-matched controls from 14 centres in six Mediterranean countries (the MEDOS study), with a structured retrospective questionnaire. The use of vitamin D supplements was associated with a modest and non-significant decrease in the risk of hip fracture (RR = 0.74; 95% confidence interval (CI) 0.53-1.03; p = 0.07). The risk reduction was influenced by age and body mass. Women aged above 80 years had a significant decrease in the relative risk of hip fracture (RR = 0.63; 95% CI 0.40-0.98) as did women with a BMI below 20 kg/m2 (RR = 0.45; 95% CI 0.24-0.84). Elderly women were more likely to have a low BMI but the elderly did not appear to benefit from vitamin D where their BMI was 20 kg/m2 or higher. The findings could not be explained by differences in sun exposure or in physical exercise. We conclude that the use of vitamin D for the prevention of hip fracture might usefully be targeted to the frail and elderly.

Age Factors↗
PubMed1995

Social network, social support and the prevalence of neck and low back pain after retirement. A population study of men born in 1914 in Malmö, Sweden.

In this study we investigated the importance of social network and social support systems outside the workplace and workload and psychological job strain in former work for the prevalence of daily neck and low back pain. The study population (n = 621) comprised a random half of all male residents in Malmö, Sweden, born in 1914, of whom 500 (80.5%) participated. Two of the social network and social support indices (social anchorage and availability of material and informational support) were independent of life-style factors (leisure time physical activity, smoking and alcohol consumption) related to daily neck and back pain after retirement (OR = 2.0, 95% CI 1.2-3.4 and OR = 1.7, 95% CI 1.0-2.7, respectively), while the psycho-social and physical factors in former work were not. As no conclusion about the direction of the association can be drawn, prospective studies are needed to further explore these findings.

Aged↗
PubMed1995

Alcohol, cigarette smoking, and the risk of breast cancer.

A case-control study of 177 premenopausal and 216 postmenopausal breast cancer patients diagnosed in the southern Swedish Health Care Region between 1981 and 1984, and 195 premenopausal and 254 postmenopausal controls randomly chosen during 1984 from the same population by means of a computerized population register was used to estimate the relations among alcohol consumption, cigarette smoking, and the risk of cancer. Cigarette smoking did not seem to be related to the risk for breast cancer among pre- or postmenopausal women. Beer consumption did not show any consistent relation to the risk of breast cancer. An occasional (less frequent than once a week) or a weekly consumption of wine and spirits appeared to be protective compared with abstaining (RRadj = 0.4, 95% CI = 0.3-0.7 for weekly wine consumption, and RRadj = 0.6, 95% CI = 0.4-0.9 for occasional consumption of spirits) among postmenopausal but not among premenopausal women (RRadj = 0.8, 95% CI = 0.7-2.3 and RRadj = 1.0, 95% CI = 0.7-1.8 respectively). The risk estimates were adjusted for differences between cases and controls in age at menarche, age at first full-term pregnancy, age at diagnosis, smoking, and use of exogenous hormones, and for postmenopausal women, age at menopause. The study was based on observations of women with a relatively low exposure to cigarette smoking and alcohol. More frequent exposure or exposure to greater quantities of alcohol and smoking may exhibit different relationships with breast cancer risk.

Adolescent↗
PubMed1994

Control of blood pressure and risk of first acute myocardial infarction: Skaraborg hypertension project.

OBJECTIVE: To analyse the relation between treated blood pressure and concomitant risk factor and morbidity from acute myocardial infarction. DESIGN: Prospective longitudinal study. Treated blood pressures and other variables were used to predict acute myocardial infarction. SETTING: Primary health care in Skaraborg, Sweden. SUBJECTS: 1121 men and 1453 women aged 40-69 years at registration at outpatient clinics, 1977-81, with no evidence of previous myocardial infarction were followed up for an average of 7.4 years. Subjects were undergoing treatment with drugs to lower blood pressure or had blood pressure that exceeded the systolic or diastolic limits, or both, for diagnosis (> 170/> 105 mm Hg (patients aged 40-60 years) and > 180/> 110 mm Hg (older than 60 years)) on three different occasions, or both. MAIN OUTCOME MEASURES: First validated event of fatal or non-fatal acute myocardial infarction. RESULTS: In men but not in women there was a negative relation between treated diastolic blood pressure and risk of acute myocardial infarction. Left ventricular hypertrophy and smoking were contributory risk factors in both sexes, as was serum cholesterol concentration in men. In men with normal electrocardiograms (n = 345) risk increased with increasing diastolic blood pressure (P = 0.047), whereas the opposite was found in men with electrocardiograms suggesting ischaemia or hypertrophy, or both (n = 499, P = 0.009). In those with a reading of 95-99 mm Hg the relative risk was 0.30 (P = 0.034); at > or = 100 mm Hg it was 0.37 (P = 0.027). No similar relations were seen in women or for systolic blood pressure. CONCLUSION: It may be hazardous to lower diastolic blood pressure below 95 mm Hg in hypertensive men with possible ischaemia or hypertrophy, or both. Electrocardiographic findings should be considered when treatment goals are decided for men with hypertension.

Adult↗