Characteristics of Anaemic Women The Population Study of Women in Göteborg 1968–1969

Anaemic women (Hb concentration < 120 g/1) who participated in a population study of women in Göteborg, Sweden were compared to the women in the population sample as a whole. Due to the way of sampling and a high participation rate the sample was representative of women in Göteborg in the ages studied (age strata between 38 and 60). In the same way the anaemic women were representative of anaemic women in the same general population. Iron deficiency was found to be the main reason for the anaemia in the ages of 38–50 years. Except for big menstrual blood losses in anaemic women no reason for iron deficiency could be found. History of infectious diseases was about as common in anaemic women as in women in the total population sample. Sleeping habits, time off work and physical activity at work and during leisure time were similar in anaemic women and in women in the general population. The proportion of women who reported a subjective feeling of tiredness was also similar.     

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

Abstract. Rosengren A, Stegmayr B, Johansson I, Huhtasaari F, Wilhelmsen L (Sahlgrenska University Hospital/Östra, Göteborg, Umeå University Hospital and Umeå University, Umeå and Luleå Hospital, Luleå, Sweden). 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. J Intern Med 1999; 246: 577–586. 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 α- or β-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.     

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

Rosengren A, Wilhelmsen L, Hagman M, Wedel H (Östra University Hospital, Göteborg; Kungälv Hospital, Kungälv; and Nordic School of Public Health, Göteborg, Sweden). 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. J Intern Med 1998; 244 : 495–505. 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.     

Does immigration contribute to decreasing CHD incidence? Coronary risk factors among immigrants in Göteborg,Sweden

Abstract. Dotevall A, Rosengren A, Lappas G, Wilhelmsen L (Sahlgrenska University Hospital at Ostra, Göteborg University, Göteborg, Sweden). Does immigration contribute to decreasing CHD incidence? Coronary risk factors among immigrants in Göteborg, Sweden. J Intern Med 2000; 247: 331–339. Objectives. To investigate if an increasing proportion of immigrants may have contributed to the decreasing trend in coronary heart disease (CHD) in Sweden during the last few decades and to analyse the cardiovascular risk factor pattern in immigrants compared to Swedish‐born subjects. Population and methods. CVD risk factors were investigated within the framework of the WHO MONICA project. A random sample of 1618 men and women aged 25–64 years responded to the invitation to a screening procedure including questionnaires and physical and laboratory examination. Data on myocardial infarctions (MI) were collected from the Göteborg Myocardial Infarction Register. Data from the City Council secretariat were used to estimate the number of immigrants in the total population. Results. In 1995, immigrants constituted 22.4% of the population between 25 and 64 years of age in Göteborg. The incidence of MI in immigrants, 21.7%, was similar to that in Swedish‐born subjects. Non‐Finnish immigrants reported more unemployment, low physical activity during leisure time and psychological stress than Swedish subjects. Immigrant men also smoked more. BMI and WHR were significantly higher in immigrant women and Finnish immigrants had higher blood pressure than Swedes. Total‐ and LDL‐cholesterol were higher in Finnish men. HDL‐cholesterol was significantly lower and s‐triglycerides significantly higher in non‐Finnish immigrants of both genders. Conclusion. The decreasing trend in CHD in Sweden during the last few decades is not due to an increasing number of immigrants from ‘low‐risk countries’. On the contrary, the immigrants in the present study seem to have a worse CVD risk factor profile than Swedes.     

Angina Pectoris,Intermittent Claudication and Congestive Heart Failure in Middle-aged Male Hypertensives

ABSTRACT. Samuelsson O, Wilhelmsen L, Pennert K, Berglund G (Section of Preventive Cardiology, Department of Internal Medicine I, Sahlgrenska and Östra Hospitals, University of Göteborg, Göteborg, Sweden). Angina pectoris, intermittent claudication and congestive heart failure in middle-aged male hypertensives. Acta Med Scand 1987; 221:23–32. A group of middle-aged male hypertensives, derived from a random sample of a Swedish urban population, has been treated and followed for 10 years. The development of angina pectoris, intermittent claudication and congestive heart failure have been analysed. The initial prevalence and the average yearly incidence of angina pectoris was 3.9% and 1.3% p.a., of intermittent claudication 1.7% and 0.6% p.a. and of heart failure 1.0% and 0.8% p.a. ECG signs indicating subclinical heart disease (major Q wave, STdepression, T wave inversion) were risk factors for development of angina pectoris and congestive heart failure. Heart enlargement on chest X-ray was also a risk factor for development of congestive heart failure, as were a high serum creatinine, body mass index, serum uric acid and proteinuria. Smoking was found to be a strong and independent risk factor for any one of these cardiovascular disorders. After 10 years about one fourth of all patients, still attending the clinic, had at least one cardiovascular complication. Hence, the risk of developing cardiovascular disorders is substantial and seems to be potentiated by the same risk factors known to operate in the general population.     

Coffee and incidence of diabetes in Swedish women: a prospective 18-year follow-up study

Abstract. Rosengren A, Dotevall A, Wilhelmsen L, Thelle D, Johansson S (Sahlgrenska University Hospital/Östra, Göteborg; Göteborg University, Göteborg; AstraZeneca Research and Development, Mölndal; Sweden). Coffee and incidence of diabetes in Swedish women: a prospective 18‐year follow‐up study. J Intern Med 2004; 255: 89–95. Objectives. To examine the long‐term incidence of diabetes in relation to coffee consumption in Swedish women. Design. Prospective longitudinal cohort study. Setting. City of Göteborg, Sweden. Subjects. A random population sample of 1361 women, aged 39–65 years, without prior diabetes or cardiovascular disease took part in a screening study in 1979–1981 with questionnaires, physical examination and blood sampling. Main outcome measures. The development of diabetes until 1999 was identified by questionnaires in a second screening and the Swedish hospital discharge register. Results. Altogether, there were 74 new cases of diabetes. The risk of developing diabetes was 475 per 100 000 person‐years in women who consumed two cups of coffee or less per day, 271 in women who consumed three to four cups per day, 202 with a consumption of five to six cups per day, and 267 in drinkers of seven cups or more per day. Associated hazard ratios, after adjustment for age, smoking, low physical activity, education and body mass index were 0.55 (0.32–0.95), 0.39 (0.20–0.77) and 0.48 (0.22–1.06) for daily consumption of three to four, five to six and seven cups or more, respectively, with a consumption of less than two per day as reference. Additional adjustment for serum cholesterol and triglycerides attenuated the relation between coffee and diabetes slightly, indicating a possible mediating effect on the effect of coffee by serum lipids. Conclusions. The findings of the present study support the hypothesis that coffee consumption protects from the development of diabetes in women.     

Prevalence of hereditary haemochromatosis in two Swedish urban areas

Abstract. The prevalence of hereditary haemochromatosis (HH) was studied in Stockholm and Göteborg, the two largest cities in Sweden, using screening with transferrin saturation in combination with serum ferritin and further clinical and laboratory examinations. In Göteborg, none of 1660 men aged 50 and 51 years, randomly selected from the census register, was found to have HH. In Stockholm, nine out of 11920 male hospital inpatients were diagnosed as having HH. The calculated mean and 95% confidence ranges were consistent with earlier findings in two studies on men in Malmö, the third largest urban area in Sweden. Pooling results from these three main urban areas, the mean prevalence was 0.073% (17/23, 355), which is considerably lower than figures reported from one area in northern Sweden and from pedigree analyses in several other areas in the world. Screening of the US population in the N-HANES II study also showed much lower figures. The reasons for these discrepancies are discussed and it is suggested that the average prevalence of HH in Caucasian populations is probably around 0.1 %.     

高同型半胱氨酸水平与脑卒中患者心脑血管事件再发风险的关系

目的探讨初发脑卒中患者的血浆同型半胱氨酸水平与心脑血管事件再发风险的关系。方法对1823例初发脑卒中患者进行前瞻性随访,Cox生存回归模型分析血浆同型半胱氨酸与心脑血管事件再发风险的关系。结果随访4．5年（中位数0．1～6．0年）过程中,412例发生心脑血管事件,其中347例为脑卒中复发,65例为心肌梗死。与同型半胱氨酸水平最低组比较,校正年龄、性别、吸烟、饮酒等传统危险因素后,高同型半胱氨酸显著增加初发脑卒中患者的心脑血管事件再发风险（风险比1．54,95％可信区间为1．18～2．21）和脑卒中复发风险（风险比1．74,95％可信区间为1．3～2．3）。亚型分析显示,不仅在初发脑梗塞组,而且在初发脑出血组中,高同型半胱氨酸水平与4．5年内的心脑血管事件再发风险均显著相关。结论脑卒中患者血浆同型半胱氨酸水平升高是卒中复发和心脑血管事件再发风险增加的独立危险因素。     

Calcaneal ultrasound measurements are determined by age and physical activity. Studies in two Swedish random population samples

Abstract. Landin‐Wilhelmsen K, Johansson S, Rosengren A, Dotevall A, Lappas G, Bengtsson B‐A, Wilhelmsen L (Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden). Calcaneal ultrasound measurements are determined by age and physical activity. Studies in two Swedish random population samples. J Intern Med 2000; 247 : 269–278. Aim. To present reference values and correlations with body composition, blood variables and lifestyle factors. Subjects. Two random population samples from Göteborg, Sweden, one comprising 184 men and 455 women aged 25–64 years (MONICA) and the other 860 women aged 55–82 years (BEDA) were studied. Methods. Calcaneal ultrasound measurement (LUNAR Achilles) and bioimpedance were measured. Smoking habits, coffee consumption, physical activity, psychological stress, education and marital status, as well as blood lipids, blood pressure, and fractures were studied. Results. Broadband ultrasound attenuation and stiffness were higher in men than in women (P < 0.001), but speed of sound did not differ between sexes. Speed of sound, broadband ultrasound attenuation and stiffness decreased with age (P < 0.001). In both sexes speed of sound, broadband ultrasound attenuation and stiffness correlated positively to body size variables, and negatively with smoking in women after adjustment for age. Speed of sound, broadband ultrasound attenuation and stiffness were positively related to physical activity in both sexes, and these relationships were the only ones that remained in multivariate analyses in addition to age (negative). Osteoporotic fractures increased with age. Speed of sound, broadband ultrasound attenuation and stiffness were lower amongst women with osteoporotic fractures. Conclusion. Speed of sound, broadband ultrasound attenuation and stiffness decreased with age and increased with physical activity, but body weight and height were not correlated in multivariate analyses. Osteoporotic fractures increased with age and were associated with lower calcaneal ultrasound values.     

Prediction of Glomerular Filtration Rate from Serum Creatinine,Age, Sex and Body Weight

ABSTRACT. Trollfors B, Alestig K, Jagenburg R (Department of Infectious Diseases, Regional Hospital, University of Umeå, Umeå, and Departments of Infectious Diseases and Clinical Chemistry, Östra Hospital, University of Göteborg, Göteborg, Sweden). Prediction of glomerular filtration rate from serum creatinine, age, sex and body weight. Acta Med Scand 1987; 221:495–8. The accuracy and precision of estimates of glomerular filtration rate (GFR) from serum creatinine, age, sex and body weight using the methods proposed by Cockroft and Gault and by Siersbaeck-Nielsen et al. were determined in 234 subjects on 574 occasions. The two methods gave almost identical estimates of GFR. As reference for determination of GFR plasma clearance of ⁵¹Cr-EDTA as described by Bröchner-Mortensen was used. The estimates of GFR gave a systematic deviation of about 10 ml/min and a precision of about ±15 ml/min (1 SD) in the GFR range between 30 and 90 ml/min.     

Costs of coronary heart disease and stroke: the case of Sweden

Zethraeus N, Molin T, Henriksson P, Jönsson B (Stockholm School of Economics, Stockholm; and Södertälje Hospital, Södertälje; Sweden). Costs of coronary heart disease and stroke: the case of Sweden. J Intern Med 1999; 246: 151–159. Objectives. To estimate the annual costs in Sweden of coronary heart disease (CHD) and stroke, and the potential cost savings if these clinical ‘events’ are avoided. The analysis is undertaken from a societal perspective, including both direct and indirect costs. Costs are calculated for five clinical conditions : (i) acute myocardial infarction (AMI), (ii) angina pectoris (AP), (iii) unstable angina (UA), (iv) congestive heart failure (CHF), and (v) stroke. Design. A retrospective study including patients admitted to the Department of Medicine at Södertälje Hospital during the period January 1993 to March 1995 with CHD or a stroke. Each patient was followed for 1 year after admission to the hospital. To estimate potential cost savings, the patient was used as his or her own control. The potential savings in direct costs if CHD or a stroke is avoided were estimated as the difference between costs for 1 year after and 1 year before the event. The indirect costs were calculated as the difference between the values of market production of goods and services the year before the event and the year after. Setting. The Department of Medicine at Södertälje Hospital, Södertälje, Sweden. Subjects. The patients included in the study were patients at the Department of Medicine at Södertälje Hospital in Sweden. The inclusion criterion was that the patients should have been admitted for the first time for CHD or stroke during the year 1994. To obtain 25 patients for each clinical category we first had to expand the inclusion period to cover January 1993 to March 1995. Secondly, we also had to include 36 patients with an earlier established uncomplicated CHD or stroke. Despite this, no more than 22 patients with UA were found. Interventions. Patients were followed in medical practice. Main outcome measures. Costs, direct and indirect costs, and potential savings. Results. The mean direct costs during the year after a clinical event range between Swedish kronor (SEK) 41 000 for CHF and SEK 96 000 for stroke, whereas the mean potential savings in direct costs range from SEK 36 000 for CHF to SEK 91 000 for UA. The potential mean savings in indirect costs range between SEK 24 000 for CHF and SEK 102 000 for AMI. The direct costs for first-time patients are lower than those for patients with an earlier established CHD or stroke. No systematic differences have been found in potential direct cost savings and indirect costs between the two patient groups. Conclusions. CHD and stroke are associated with high costs during the year after admission to the Department of Medicine. There are also large potential cost savings from the prevention of CHD and stroke. However, further studies, including more patients and costs arising in the municipality, are needed to establish more precise and complete estimates of the costs related to CHD and stroke.     

老年人脑血管病的合理用药

脑血管疾病是一类发病率高、致残率高和死亡率高的疾病,急性脑血管病又称为脑卒中。老年卒中患者较青年卒中患者预后较差。规范化诊疗有利于降低其死亡率和致残率。药物治疗为脑血管病治疗的主要方式之一,但老年人存在代谢慢、血管弹性差、常并发多器官疾病等特点,应考虑其特殊性给予合理用药。急性缺血性脑卒中（AIS）和脑出血（ICH）为老年人中最常见的脑血管病,本文主要针对其合理药物治疗进行总结和概述。     

Non‐alcoholic cirrhosis and the risk of stroke: a 5‐year follow‐up study

Background/Aims: As habitual heavy alcohol consumption is one of the major causes of cirrhosis in the western world, the majority of studies on the relationship between cirrhosis and stroke have focused on patients with alcohol‐related liver diseases. Using a nationwide population‐based dataset, this study therefore aimed to examine the risk of stroke among non‐alcoholic cirrhosis patients over a 5‐year period following their diagnosis with non‐alcoholic cirrhosis, as compared with the general population during the same period. Methods: We used the ‘Longitudinal Health Insurance Database’, derived from the Taiwan National Health Insurance program. The study cohort comprised 2336 patients with cirrhosis and the comparison cohort consisted of 11 680 randomly selected subjects. Stratified Cox's proportional hazard regressions were performed to compare the 5‐year stroke survival rate for the two cohorts. Results: In the total sample of 14 016 patients, 1187 patients (8.5%) experienced stroke during the 5‐year follow‐up period: 176 from the study cohort (7.5% of the patients with cirrhosis) and 1011 from the comparison cohort (8.7% of patients without cirrhosis) (P=0.076). After adjusting for the patients' geographical location, hypertension, diabetes, coronary heart disease, heart failure, atrial fibrillation and hyperlipidaemia, the regression analysis shows that patients with cirrhosis were less likely to experience stroke compared with those without cirrhosis during the 5‐year period (hazard ratio=0.59, 95% confidence interval=0.52–0.67, P<0.001). Conclusion: We conclude that patients with non‐alcoholic cirrhosis were at a reduced risk for stroke compared with the general population.     

Obesity, smoking and secular trends in cardiovascular risk factors in middle-aged women: data from population studies in Göteborg from 1980 to 2003

Abstract. Johansson S, Wilhelmsen L, Welin C, Eriksson H, Welin L, Rosengren A. (Sahlgrenska University Hospital/Östra, Göteborg; AstraZeneca R&D, Mölndal; and Lidköping Hospital, Lidköping, Sweden) Obesity, smoking and secular trends in cardiovascular risk factors in middle‐aged women: data from population studies in Göteborg from 1980 to 2003. J Intern Med 2010; 268 : 594–603. Background. To study the trends in cardiovascular risk factors in middle‐aged city‐dwelling Swedish women from 1980 to 2003. Methods. Using cross‐sectional population‐based surveys, five random population samples of a total of 1915 women aged between 45 and 54 years, participating in the BEDA study in 1980, WHO MONICA studies in 1985, 1990 and 1995, and a study of 50‐year‐old women in 2003 were measured for the following parameters: anthropometry, serum cholesterol and triglyceride levels, smoking habits, blood pressure, physical activity and stress. Results. Over almost 25 years, middle‐aged women gained on average 4.4 kg in weight, with a net increase in body mass index (BMI) from 24.7 to 25.6 kg m^?2. The proportion of participants classified as obese (≥30 kg m^?2) increased by 50% from 10.4% to 15.1%. Women who were smokers in 2003 did not have lower BMI values than nonsmokers. Mean serum cholesterol concentrations decreased markedly, whereas smoking habits did not significantly change. The prevalence of hypertension decreased by 8%, whereas that of diabetes remained stable at around 2%. Optimal risk factor status – no smoking, normotension and serum cholesterol <5 mmol l^?1– was present in less than one in six women in 2003, and similar across BMI categories. Conclusion. The favourable decline in cholesterol levels and hypertension and the increase in leisure time physical activity were offset by an increase in obesity, triglyceride levels and experience of stress, with only a minority of participants (less than one in six) having an optimal level of risk factors with respect to smoking, serum cholesterol and hypertension in 2003. This applied also to overweight and obese women. In earlier cohorts, subjects with low BMI values were more often smokers, whereas the opposite is observed in recent cohorts. Thus, women who smoke no longer have the advantage of lower weight.     

Are patients truthful about their smoking habits? A validation of self‐report about smoking cessation with biochemical markers of smoking activity amongst patients with ischaemic heart disease

Abstract. From Attebring M, Herlitz J, Berndt A‐K, Karlsson T, Hjalmarson A (Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden). Are patients truthful about their smoking habits? A validation of self‐report about smoking cessation with biochemical markers of smoking activity amongst patients with ischaemic heart disease. J Intern Med 2001; 249: 145–151. Aim. To validate self‐report about smoking cessation with biochemical markers of smoking activity amongst patients with ischaemic heart disease. Patients and methods. Outpatients at the Division of Cardiology, 75 years of age or younger, who had been Hospitalized at Sahlgrenska University Hospital in Göteborg due to an ischaemic event and who consecutively participated in a nurse‐monitored routine care programme for secondary prevention, from 6 February 1997 to 5 February 1998. Data concerning smoking habits were collected through interviews. Two chemical markers, cotinine in plasma and carbon monoxide (CO) in expired air, validated self‐reports concerning smoking cessation. Results. 260 former smokers were validated. In the vast majority of the study population, the anamnestic information concurred with the chemical marker. However, 17 patients had chemical markers that contradicted their self‐report with raised CO (n = 6) and/or raised cotinine levels (n = 13) without alternative nicotine delivery. Conclusion. Most patients with coronary artery disease relating information concerning cessation of smoking are truthful. A few patients, however, seem to conceal their smoking. Testing by chemical markers may be questionable for ordinary care but should, however, be included in studies concerning the association between smoking and health.     

A comparison between patients suffering in-hospital and out-of-hospital cardiac arrest in terms of treatment and outcome

Abstract. Herlitz J, Bång A, Ekström L, Aune S, Lundström G, Holmberg S, Holmberg M, Lindqvist J (Sahlgrenska University Hospital, Göteborg, Sweden). A comparison between patients suffering in‐hospital and out‐of‐hospital cardiac arrest in terms of treatment and outcome. J Intern Med 2000; 248: 53–60. Aim. To compare treatment and outcome amongst patients suffering in‐hospital and out‐of‐hospital cardiac arrest in the same community. Patients. All patients suffering in‐hospital cardiac arrest in Sahlgrenska University Hospital covering half the catchment area of the community of Göteborg (500 000 inhabitants) and all patients suffering out‐of‐hospital cardiac arrest in the community of Göteborg. Criteria for inclusion were that resuscitation efforts should have been attempted. Time of survey. From 1 November 1994 to 1 November 1997. Methods. Data were recorded both prospectively and retrospectively. Results. In total, 422 patients suffered in‐hospital cardiac arrest and 778 patients suffered out‐of‐hospital cardiac arrest. Patients with in‐hospital cardiac arrest included more women and were more frequently found in ventricular fibrillation. The median interval between collapse and defibrillation was 2 min in in‐hospital cardiac arrest compared with 7 min in out‐of‐hospital cardiac arrest (< 0.001). The proportion of patients being discharged from hospital was 37.5% after in‐hospital cardiac arrest, compared with 8.7% after out‐of‐hospital cardiac arrest (P < 0.001). Corresponding figures for patients found in ventricular fibrillation were 56.9 vs. 19.7% (P < 0.001) and for patients found in asystole 25.2 vs. 1.8% (P < 0.001). Conclusion. In a survey evaluating patients with in‐hospital and out‐of‐hospital cardiac arrest in whom resuscitation efforts were attempted, we found that the former group had a survival rate more than four times higher than the latter. Possible strong contributing factors to this observation are: (i) shorter time interval to start of treatment, and (ii) a prepared selection for resuscitation efforts.     

Consequences of severity at stroke onset for health-related quality of life (HRQL) and informal care: a 1-year follow-up in elderly stroke survivors

Severity of stroke influences the possibility of living at homes after stroke and has been discussed as one possible prognostic factor for functional outcome and future residence. The objective was to explore how severity at stroke onset affects health-related quality of life (HRQL) and informal care among 147 stroke survivors and their spouses living in their own homes 1 year after acute stroke. This study is part of "The G?teborg 70+ Stroke Study" which included 249 elderly persons after acute stroke. One year after stroke 59% of the survivors, 94 women and 53 men, lived in their own homes. This group forms the present study population. They were subdivided according to the severity of stroke at onset, as assessed by Barthel index (BI) ratings in the acute phase. The stroke survivors rated their HRQL and were interviewed in their own homes to assess the effects of stroke on daily life activities and informal care after 1 year. Informal caregivers were found to assist their spouses to a great extent, regardless of severity of stroke. Persons with moderate/severe stroke at onset received more informal as well as more formal help than the ones with mild stroke. As expected, the group with moderate/severe stroke also was more dependent on personal assistance, used more assistive devices (ADs) and rated their HRQL lower. However, persons who were assessed as mild stroke at onset also needed informal care, particularly with more complex tasks. Gender differences were obvious, since many women were living alone after their partner had died, while the men usually had assistance from their spouses. Noteworthy is that informal caregivers assisted their spouses to a large extent, regardless of severity of stroke at onset. Different kind of support programs, extended day rehabilitation centers and more relieve places should be developed. That could possibly improve the life situation for the elderly stroke survivors and their caregivers, generally an elderly spouse.     

Waist circumference,body mass index,and risk for stroke in older people: a 15 year longitudinal population study of 70- year-olds

OBJECTIVES: To investigate waist circumference (WC) and body mass index (BMI) at age 70 as risk factors for stroke. DESIGN: Cohort study of 70-year-olds with 15-year follow-up. SETTING: Geriatric Medicine Department, G?teborg University, Sweden. PARTICIPANTS: Two thousand two hundred eighty-seven (1,045 men; 1,242 women) 70-year-olds examined between 1971 and 1981 in G?teborg, Sweden. MEASUREMENTS: Cox regression model was used to calculate relative risk (RR) and 95% confidence interval (CI) for first-ever stroke (fatal and nonfatal) in reference to the lowest quartiles of WC and BMI. Tests for trend were performed fitting WC and BMI in their original continuous form. RESULTS: In men and women, RRs for stroke, in the highest WC quartile were 1.65 (95% CI = 1.08-2.51) and 1.31 (95% CI = 0.88-1.92), respectively, after adjustment for cohorts, smoking habit, coronary heart disease (CHD), diabetes mellitus, total cholesterol (TC), systolic blood pressure (SBP), and height at age 70. In men, RR for stroke in the highest BMI quartile (> or=28 kg/m2) was 1.68 (95% CI = 1.12-2.53) after adjustment for cohorts, smoking habits, CHD, diabetes mellitus, TC, and SBP at age 70. In women, adjusted RRs for stroke across the BMI quartiles were not significantly different. In men, population attributable fractions of stroke were 24.8% and 25.2% for the highest quartiles of WC and BMI, respectively. CONCLUSIONS: High WC (> or =99 cm) and BMI (> or =28 kg/m2) are risks for stroke in older men but not in older women.     

Risk of haemorrhagic stroke in patients with oral anticoagulation compared with the general population

Abstract. Själander A, Engström G, Berntorp E, Svensson P (Malmö University Hospital, University of Lund, Sweden). Risk of haemorrhagic stroke in patients with oral anticoagulation compared with the general population. J Intern Med 2003; 254: 434–438. Objectives. To compare the incidence of haemorrhagic stroke (HS), and the risk of fatal outcome after HS in patients with oral anticoagulation (OA) treatment and in the general population. Design. Five‐year cohort study. Setting. The Anticoagulation Clinic, Malmö University Hospital, Lund, Sweden. Subjects. A total of 4434 patients treated with OA (6693 treatment years) from 1 Oct 1993 to 30 Sept 1998. The population‐based Stroke Register of Malmö, Lund, Sweden (STROMA). Results. Forty‐eight patients had HS according to ICD  9 code 430 and 431. HS occurred at a higher age in women compared with men (mean age 79.5 years vs. 74.7 years, P = 0.009). The age‐adjusted relative risk of HS during OA treatment was 10.9 (CI 6.7–17.6) for men and 9.3 (CI 5.7–15.0) for women, as compared with the untreated general population. Number needed to harm (NNH) (person‐years) was 103 for men and 188 for women. Adjusted for age and sex, OA treatment was significantly associated with fatal outcome in patients with HS (OR = 2.6, CI 1.4–4.8). Conclusions. Patients with OA treatment had approximately 10 times higher risk of HS as compared with the general population, and the risk increased markedly with age. OA treatment is associated with an increased case fatality in patients with HS.     

Elevation of biochemical markers for myocardial damage prior to hospital admission in patients with acute chest pain or other symptoms raising suspicion of acute coronary syndrome

Abstract. Svensson L, Axelsson C, Nordlander R, Herlitz J (South Hospital, Stockholm; and Sahlgrenska University Hospital, Göteborg; Sweden). Elevation of biochemical markers for myocardial damage prior to hospital admission in patients with acute chest pain or other symptoms raising suspicion of acute coronary syndrome. J Intern Med 2003; 253: 311–319. Objectives. To evaluate the occurrence of elevation of serum biochemical markers for myocardial damage in the prehospital setting amongst patients who called for an ambulance due to a suspected acute coronary syndrome (ACS). Design. Prospective observational study. Subjects. All the patients who called for an ambulance due to suspected ACS. Setting. South Hospital's catchment area in Stockholm and in the Municipality of Göteborg, Sweden between January and November in the year 2000, were included. Interventions. On arrival of the ambulance crew, a blood sample was drawn for bedside analysis of serum myoglobin, creatine kinase MB and troponin I. A 12‐lead electrocardiogram (ECG) was simultaneously recorded. Main outcome measures. Elevation of biochemical markers prior to hospital admission. Results. In all, 511 patients participated on 538 occasions. Elevation of any biochemical marker was observed in 11% of all patients. The corresponding figure for patients developing myocardial infarction was 21%; for patients with myocardial ischaemia 8%; for patients with a possible myocardial ischaemia 4% and for patients with other diagnoses 5%. Amongst those who had a final diagnosis of acute myocardial infarction (AMI), 47% had ST‐elevation on initial ECG and 57% had either ST‐elevation or elevation of any biochemical marker. Conclusion. Bedside analysis of biochemical markers in serum is already feasible prior to hospital admission amongst patients with a suspected ACS. About 20% of patients with AMI have elevated biochemical markers at that stage. When found this data might increase the possibility of diagnosing an AMI very early in the course. However, false positives were found and whether this strategy will improve the triage of these patients in the prehospital setting remains to be proven.