Secular trends in lipid-lowering treatment and lipid levels after a first acute myocardial infarction

Lena Björck1, Catharina Welin2, Annika Rosengren11Department of medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden; 2Institute of Health and Care Sciences, the Sahlgrenska Academy at Göteborg University, Göteborg, SwedenBackground: The beneficial effects of statins were unequivocally demonstrated in the Scandinavian Simvastatin Survival Study (4S) in 1994, leading to an increase in the use of lipid-lowering drugs. However, to what extent this translates into serum cholesterol levels in a real-life setting has not been systematically investigated.Objective: To estimate secular trends from 1994 to 2002 in blood lipid levels among unselected younger patients after a first acute myocardial infarction (AMI).Method: Descriptive single centre study using consecutive data collection in 781 patients (aged <65 years) hospitalized with a first AMI during the period 1994–2002.Results: From 1994–2002, the use of lipid-lowering drugs increased from 10% to 94% for men and from 23% to 90% for women. In 1994, the mean serum cholesterol levels were 6.53 mmol/l in men and 6.32 mmol/l in women, decreasing to 4.31 mmol/l and 5.13 mmol/l in men and women, respectively, in 2002. Still, only 56% of the men and 35% of the women had total serum cholesterol levels <4.5 mmol/l in 2002.Conclusion: Despite a marked increase in lipid-lowering drug treatment in which there was an increase from about 10% in 1994 to more than 90% in 2002, current target levels of <4.5 mmol/l for serum cholesterol were not achieved in a significant proportion of post-AMI patients.Keywords: lipid levels, lipid-lowering medication, myocardial infarction, risk factor

BMI and mortality in patients with new-onset type 2 diabetes: a comparison with age- and sex-matched control subjects from the general population

Objective: Type 2 diabetes is strongly associated with obesity, but the mortality risk related to elevated body weight in people with type 2 diabetes compared with people without diabetes has not been established. Research Design and Methods: We prospectively assessed short- and long-term mortality in people with type 2 diabetes with a recorded diabetes duration ≤5 years identified from the Swedish National Diabetes Registry between 1998 and 2012 and five age- and sex-matched control subjects per study participant from the general population. Results: Over a median follow-up of 5.5 years, there were 17,546 deaths among 149,345 patients with type 2 diabetes (mean age 59.6 years [40% women]) and 68,429 deaths among 743,907 matched control subjects. Short-term all-cause mortality risk (≤5 years) displayed a U-shaped relationship with BMI, with hazard ratios (HRs) ranging from 0.81 (95% CI 0.75-0.88) among patients with diabetes and BMI 30 to <35 kg/m2 to 1.37 (95% CI 1.11-1.71) with BMI ≥40 kg/m2 compared with control subjects after multiple adjustments. Long-term, all weight categories showed increased mortality, with a nadir at BMI 25 to <30 kg/m2 and a stepwise increase up to HR 2.00 (95% CI 1.58-2.54) among patients with BMI ≥40 kg/m2, that was more pronounced in patients <65 years old. Conclusions: Our findings suggest that the apparent paradoxical findings in other studies in this area may have been affected by reverse causality. Long-term, overweight (BMI 25 to <30 kg/m2) patients with type 2 diabetes had low excess mortality risk compared with control subjects, whereas risk in those with BMI ≥40 kg/m2 was substantially increased

Body Mass Index in young women and risk of cardiomyopathy: a long-term follow-up study in Sweden

Incidence rates of cardiomyopathies, which are a common cause of heart failure in young people, have increased during the last decades. An association between body weight in adolescence and future cardiomyopathy among men was recently identified. Whether or not this holds true also for women is unknown. The aim was therefore to determine whether for young women being overweight or obese is associated with a higher risk of developing cardiomyopathy. This was a registry-based national prospective cohort study with data collected from the Swedish Medical Birth Register, 1982 to 2014, with up to 33 years of follow-up. Included women were of childbearing age (18-45 years) during the initial antenatal visit in their first or second pregnancy (n=1 393 346). We obtained baseline data on body mass index (BMI), smoking, education, and previous disorders. After exclusions, mainly because of previous disorders, the final sample was composed of 1 388 571 women. Cardiomyopathy cases were identified by linking the Medical Birth Register to the National Patient and Cause of Death registers. In total, we identified 1699 cases of cardiomyopathy (mean age at diagnosis, 46.2 [SD 9.1] years) during the follow-up with an incidence rate of 5.9 per 100 000 observation years. Of these, 481 were diagnosed with dilated cardiomyopathy, 246 had hypertrophic cardiomyopathy, 61 had alcohol/drug-induced cardiomyopathy, and 509 had other forms. The lowest risk for being diagnosed with a cardiomyopathy was detected at a BMI of 21 kg/m , with a gradual increase in risk with higher BMI, particularly for dilated cardiomyopathy, where a hazard ratio of 4.71 (95% CI, 2.81-7.89) was found for severely obese subjects (BMI ≥35 kg/m ), as compared with BMI 20 to <22.5. Elevated BMI among young women was associated with an increased risk of being diagnosed with a subsequent cardiomyopathy, especially dilated cardiomyopathy, starting already at mildly elevated body weight, whereas severe obesity entailed an almost 5-fold increase in risk. With the increasing numbers of persons who are overweight or obese, higher rates of cardiomyopathy can be expected in the future, along with an altered disease burden related to adiposity

Changes in Dietary Fat Intake and Projections for Coronary Heart Disease Mortality in Sweden: A Simulation Study.

OBJECTIVE: In Sweden, previous favourable trends in blood cholesterol levels have recently levelled off or even increased in some age groups since 2003, potentially reflecting changing fashions and attitudes towards dietary saturated fatty acids (SFA). We aimed to examine the potential effect of different SFA intake on future coronary heart disease (CHD) mortality in 2025. METHODS: We compared the effect on future CHD mortality of two different scenarios for fat intake a) daily SFA intake decreasing to 10 energy percent (E%), and b) daily SFA intake rising to 20 E%. We assumed that there would be moderate improvements in smoking (5%), salt intake (1g/day) and physical inactivity (5% decrease) to continue recent, positive trends. RESULTS: In the baseline scenario which assumed that recent mortality declines continue, approximately 5,975 CHD deaths might occur in year 2025. Anticipated improvements in smoking, dietary salt intake and physical activity, would result in some 380 (-6.4%) fewer deaths (235 in men and 145 in women). In combination with a mean SFA daily intake of 10 E%, a total of 810 (-14%) fewer deaths would occur in 2025 (535 in men and 275 in women). If the overall consumption of SFA rose to 20 E%, the expected mortality decline would be wiped out and approximately 20 (0.3%) additional deaths might occur. CONCLUSION: CHD mortality may increase as a result of unfavourable trends in diets rich in saturated fats resulting in increases in blood cholesterol levels. These could cancel out the favourable trends in salt intake, smoking and physical activity

Corrigendum to "European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. [Eur J Vasc Endovasc Surg (2022) 63, 184-267]"

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Editor's Choice – European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs

Corrigendum: Volume 64, Issues 2–3, 2022, 284-285Peer reviewe

Impact of Risk Factors and Treatment in Coronary Heart Disease

Aims: The aim of the present study was to explore how risk factors and medication influence clinical presentation and mortality in coronary heart disease (CHD) and to explain how much of the decrease in CHD mortality in Sweden that could be attributed to medical and surgical treatments, and how much to changes in cardiovascular risk factors. Subjects and methods: We included 781 consecutive patients with a first acute myocardial infarction (AMI) during the period 1994 to 2002, to investigate trends in the use of lipid-lowering treatment, and changes in serum lipids. The second part of the study is based on 93,416 consecutive patients aged 25 to 84 years from RIKS-HIA, a national quality of care register that includes all patients admitted to CCUs in Sweden and admitted to hospital between 1996 and 2004 with a first AMI. The IMPACT mortality model was used to combine and analyze data on uptake and effectiveness of cardiological treatments and risk factor trends in Sweden, to investigate the relative contributions of these factors on the decline in CHD mortality in Sweden. The main data sources were official statistics, national quality of care registers, published trials and meta-analyses and national population surveys. Results: In the single-centre study almost all patients under 65 years of age with a first AMI were treated with lipid-lowering drugs in 2002. Still, target levels for serum cholesterol were not met in a substantial number of patients. In the RIKS-HIA population, more than 50% of younger patients presenting with STEMI were smokers at the time of hospitalization. After adjustments, smoking was found to be an independent determinant for presenting with STEMI compared to non-STEMI. In addition, use of aspirin, β-blocker, ACE-inhibitor and statin prior to hospitalization were all associated with lower odds of presenting with STEMI compared to non-STEMI in both men and women. Between 1986 and 2002, CHD mortality rates in Sweden decreased by 53.4% in men and 52.0% in women aged 25 to 84 years. This resulted in 13,180 fewer deaths in 2002. By using the IMPACT model approximately 36% of this decrease could be attributed to treatments in individuals and 55% to population risk factor reductions. Adverse trends were seen for diabetes and overweight. Conclusions: Despite a marked increase in lipid-lowering drug treatment, current target levels of <4.5 mmol/l for serum cholesterol are not met in a significant proportion of post-AMI patients.Tobacco smoking is a major determinant for presenting with STEMI, indicating that smoking is one of the major risk factors for presenting with more severe AMIs. Previous medication with aspirin, β-blocker, ACE inhibitor or statin is associated with substantially lower risk of presenting with STEMI. More than half of the CHD mortality decrease between 1986 and 2002 was attributable to reductions in major risk factors, mainly a large decrease in serum cholesterol, emphasizing the value of a comprehensive strategy that promotes primary prevention and evidence-based medical treatments, especially secondary prevention

Förskolebarns strategier vid längdmätning

Matematiska problem finns och uppstår naturligt i vardagen. Barn upptäcker inte dem själva utan vi måste göra dem synliga för att de ska lära sig förstå. Hur barn utvecklar matematiken beror på hur vi vuxna lyfter fram den vid olika rutinsituationer. Syftet med examensarbetet är att undersöka barns strategier, då de utmanas att mäta längden på ett föremål. Vidare observerade vi hur barn delger ett annat barn sitt resultat och hur det mottagande barnet sedan tar emot och återskapar ett eget resultat utifrån det de blivit delgivna. För att kunna besvara vår frågeställning observerade vi barn födda 2001, både enskilt och två och två. De iakttagelser vi gjorde var att barnen inte låstes i sina tankar, utan använde sig av olika hjälpmedel när de skulle mäta föremålets längd. Även deras kamrater hade olika tillvägagångssätt när de återskapade resultatet