bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of heart failure
Authors: KJEKSHUS J. , SWEDBERG K. 
Published: November 2003

Kjekshus J, Swedberg K (Department of Medicine, The National Hospital, University of Oslo, Oslo, Norway, and Department of Medicine, Östra University Hospital, Göteborg University, Göteborg, Sweden). Treatment of heart failure (Minisymposium: Heart failure). J Intern Med 1996; 239: 335–43.Effective treatment of heart failure depends on a correct functional and aetiological diagnosis. In asymptomatic patients with cardiac dysfunction following myocardial infarction, treatment is directed to prevent recurrent infarction by aggressive lipid lowering with statins and antiplatelet drugs. Beta blockers are important to reduce sudden death. In symptomatic heart failure, clinical improvement is obtained by inhibition of the renin–angiotensin and sympathetic system. Angiotensin‐converting‐enzyme inhibitors in combination with diuretics reduce morbidity and mortality caused by progression of the myocardial dysfunction and recurrent myocardial infarction. Drugs that activate the neurohormonal systems are clearly counteractive. Digitalis has a definite favourable effect on systems, and in patients with atrial fibrillation, but its effect on mortality is still unsettled. Beta blockers in routine treatment of symptomatic heart failure still remains controversial, but may benefit selected patients.
Hyperlipidaemia in renal transplant patients
Authors: AAKHUS S. , DAHL K. , WIDERØE T. E. 
Published: November 2003

Aakhus S, Dahl S, Widerøe TE (Sections of Cardiology and Nephrology, Department of Medicine, University Hospital of Trondheim, Trondheim, Norway). Hyperlipidaemia in renal transplant patients. J Intern Med 1996; 239: 407–15. Objectives. The aim of study was to assess the prevalence and severity of hyperlipidaemia in renal transplant patients in a Nordic country. Design. Multicentre, cross‐sectional study. Setting. Outpatients and ward inpatients registered from 23 hospitals covering all regions of the country. Subjects. Renal transplant patients with a functioning graft were registered: 406 patients in all; that is, 43% of the national renal transplant population. All patients used prednisolone, 71% used cyclosporine, either with (51%) or without (20%) azathioprine. Total cholesterol values from general population were obtained from a national survey. Main outcome measures. Blood lipids and their relation to clinical parameters. Results. Total cholesterol was significantly higher in transplant patients than in the general population for both genders and all age groups (P<0.01). Female patients had higher total cholesterol (mean±SD: 7.49±1.61mmolL‐1) than males (7.01±1.55mmolL‐1; P<0.001), and also higher HDL cholesterol (1.55±0.43 vs. males: 1.32±0.46mmolL‐1; P<0.001). Triglycerides were equally elevated in both genders, and 33% had values above 2.2mmolL‐1. Reduced creatinine clearance, a high body‐mass index, female gender, hypertension, and coronary artery disease were independently associated with higher total cholesterol. Beta blockers were associated with lower HDL cholesterol and higher triglycerides, and diuretics with higher triglycerides. Blood lipid levels were not associated with cyclosporine immunosuppression. Conclusion. Hyperlipidaemia is prevalent after renal transplantation, and is associated with impaired graft function, hypertension, and with the use of beta blockers and diuretics, but not with the use of cyclosporine.
Progression of atherosclerosis in middle‐aged men: effects of multifactorial intervention
Authors: PERSSON JERKER , ISRAELSSON BO , STAVENOW LARS , HOLMSTRÖM EVA , BERGLUND GÖRAN 
Published: November 2003

Persson J, Israelsson B, Stavenow L, Holmström E, Berglund G (Department of Medicine, Lund University Hospital, Malmö, Sweden). Progression of atherosclerosis in middle‐aged men: effects of multifactorial intervention. J Intern Med 1996; 239: 425–33. Objective. To determine the effect of multifactorial intervention against cardiovascular risk factors on ultrasound‐determined progression of atherosclerosis in healthy middle‐aged men. Design. One hundred and forty‐nine healthy middle‐aged men were assigned to an intervention group (IG) or a control group (CG). Subjects. The participants had moderately increased risk‐factor scores for cardiovascular disease. They were recruited from a health screening programme at the Preventive Medicine Section, Department of Medicine, Lund University, University Hospital, Malmö. During the study period, 32 of the subjects were lost to follow‐up, leaving 59 in the IG and 58 in the CG. Intervention. The IG subjects underwent multifactorial intervention for 2 years, the goal being to help them stop smoking and to reduce their blood lipids and blood pressure. Main outcome measures. Intima–media thickness and plaque score in the right carotid artery were ultrasonographically determined initially and after 2 years. Blood lipids and blood pressure were measured at the same time, and in the IG also after 3, 6, 12 and 18 months after entry into the study. Results. At the entry into the study, there were no significant differences in major risk factors or ultrasound variables between IG and CG. Blood lipids and smoking decreased significantly during the 2 years of intervention in the IG, whilst these factors remained unchanged in the CG. Intima–media thickness and plaque scores increased significantly in both groups. Conclusions. No effects on ultrasound variables could be detected after 2 years of multifactorial intervention. A more aggressive intervention programme, possibly more dependent on pharmacological treatment, may be required to obtain reduced progression or regression of atherosclerosis.
Impaired suppression of plasma free fatty acids and triglycerides by acute hyperglycaemia‐induced hyperinsulinaemia and alterations in high density lipoproteins in essential hypertension
Authors: LIGTENBERG J. J. M. , A.  , VAN HAEFTEN T. W. , SLUITER W. J. , REITSMA W. D. , DULLAART R. P. F. 
Published: November 2003

Objectives. Essential hypertension may be associated with abnormalities in free fatty acids (FFA) and triglyceride metabolism, which could lead to alterations in high density lipoproteins (HDL). Lecithin:cholesterol acyltransferase (LCAT) and cholesteryl ester transfer protein (CETP) are key factors in the esterification of cholesterol and the subsequent transfer of cholesteryl ester from HDL towards triglyceride‐rich lipoproteins. We compared baseline plasma lipids, HDL lipids, plasma LCAT and CETP activity as well as the lowering of plasma FFA and triglycerides by acute hyperglycaemia‐induced hyperinsulinaemia in patients with essential hypertension and control subjects. Setting. University Hospital, Groningen. Subjects and design. Eight patients with essential hypertension and eight control subjects were studied during a 3‐h hyperglycaemic glucose clamp (blood glucose, 10 mmol L‐1). Main outcome measures. Plasma insulin, FFA, triglycerides and HDL lipids, plasma LCAT and CETP. Results. Baseline plasma FFA, total cholesterol and HDL cholesterol were not different between the groups, but plasma triglycerides tended to be higher in the hypertensive patients (P<0.10). The baseline HDL free cholesterol content and the HDL free cholesterol/cholesteryl ester ratio were lower (P< 0.05 for both) in the hypertensive than in the control group. Although baseline plasma LCAT and CETP activity were not significantly different between the groups, the plasma LCAT/CETP ratio, reflecting the amount of active LCAT compared to that of CETP, was higher in the hypertensive patients (P<0.05). In the combined subjects and in the hypertensive group, the HDL free cholesterol content was negatively related to plasma triglycerides and to the LCAT/CETP ratio, whereas this ratio was positively correlated with plasma triglycerides (P0.01 for all correlations). During a 3‐h hyperglycaemic clamp (blood glucose 10 mmol L‐1) plasma FFA and triglycerides decreased to a lesser extent (P<0.02 and P=0.05) and remained higher (P<0.05 for both) in the hypertensive patients, despite similar plasma insulin levels. Conclusion. The action of insulin on FFA metabolism is impaired which is likely to contribute to higher plasma triglycerides in essential hypertension. In turn, higher triglycerides influence the HDL lipid composition, either directly or via an effect on the plasma LCAT/CETP ratio.
Evolution of heart rate variability in cardiac transplant recipients: a clinical study
Authors: KOSKINEN PEKKA , VIROLAINEN JUHA , KOSKINEN PETRI K. , HÄYRY PEKKA , KUPARI MARKKU 
Published: November 2003

Koskinen P, Virolainen J, Koskinen Pk, Häyry P, Kupari M (Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, and Transplantation Laboratory, University of Helsinki, Helsinki, Finland). Evolution of heart rate variability in cardiac transplant recipients: a clinical study. J Intern Med 1996; 239: 443–9. Objectives. To investigate in cardiac transplant patients whether post‐transplantation time, graft arteriosclerosis, allograft rejection, or earlier cytomegalovirus infection affect the neural regulatory mechanisms of the donor heart. Design. A consecutive series of heart transplant patients during a 12‐month period. Setting. A university hospital in Finland. Subjects. Consecutive cardiac transplant recipients (n=38) attending the hospital for their annual clinical examintaion were studied. Their mean (SD) age was 45.4 (11.5) years, 37 were male, and the median (range) time since transplantation was 36 (12–72) months. Interventions. Power spectral analysis of R–R intervals (during 5 min of controlled breathing, the Valsalva manoeuvre, and deep breathing), routine coronary arteriography, cytomegalovirus serology. Results. R–R interval (r=0.67; P<0.001), the root mean square difference of successive R–R intervals (r=0.38; P<0.05), the total R–R interval power (r=0.45; P<0.01), the power of the very low frequency (0.0–0.07 Hz) component (r=0.53; P<0.01), and the power of the nonrespiratory (0.0–0.15 Hz) component (r=0.49; P<0.01) were related to the length of time since the operation. Patients having had a transplantation 3 years ago or more had significantly greater median (range) total R–R interval power than those having had the operation less than 3 years ago (59 [10–265] vs. 20 [3–113] ms2; P=0.02). There was also a difference between the two groups in the very low frequency component (18 [1–226] vs. 5 [0–45] ms2; P=0.01), in the nonrespiratory component (30 [1–227] vs. 9 [0–53] ms2; P=0.02), and in the Valsalva ratio (0.995 [0.955–1.065] vs. 1.020 [0.975–1.155]; P=0.03). Patients with and without graft arteriosclerosis, episodes of rejection, or earlier cytomegalovirus infection showed no difference in the power spectral measures. Conclusions. The donor heart rate variability increases with post‐transplantation time. Heart rate variability in transplant recipients is not related to the extent of graft arteriosclerosis, episodes of allograft rejection, or earlier cytomegalovirus infection.
Thyroid antibodies in northern Norway: prevalence, persistence and relevance
Authors: BRYHNI B. , AANDERUD S. , SUNDSFJORD J. , REKVIG O. P. , JORDE R. 
Published: November 2003

Objectives. To investigate the prevalence and persistence of thyroid autoantibodies in a population sample and to assess the development of biochemical hypothyroidism (defined as an elevated serum thyrotropin [TSH] concentration) in relation to their presence. Design and setting. A cross‐sectional and longitudinal study based on the Tromsø Study in 1979–80 and 1986–87. Subjects and main outcome measures. From 2551 random participants in 1979–80 aged 34±8.4 (mean±SD) years, sera were available in 2513 and 2504 persons for determination by passive haemagglutination of the antibody to thyroid microsomal antigen (anti‐Tm) and of the antibody to thyroglobulin (anti‐Tg). Total thyroxine (TT4) and TSH were measured in 114 of 176 antibody‐positive subjects and in 101 controls. After 7 years, anti‐Tm and anti‐Tg were remeasured in 1939 and 1931 subjects, and TT4 and TSH in 92 of the initially antibody‐positive subjects and in 69 controls. Results. Anti‐Tm occurred more frequently than anti‐Tg (in 6.1 vs. 2.8%; P<0.001). Anti‐Tm (P< 0.001) and anti‐Tg (P=0.027) were both more common in women than in men. The prevalence of anti‐Tm (P=0.025), but not of anti‐Tg, increased with age. Changes in titre levels after 7 years were mostly small or moderate. Both in women (P= 0.005) and in men (P<0.001) the TSH concentrations increased with increasing levels of anti‐Tm, whereas in men, the concentrations also increased with increasing anti‐Tg levels (P<0.001). Biochemical hypothyroidism developed with a 2.7% yearly incidence only in antibody‐positive subjects, all except one of whom had anti‐Tm. Conclusions. The prevalences of thyroid antibodies were comparable to those found in similar studies in other areas. Their presence was associated with the development of biochemical hypothyroidism.
Changes in cardiovascular risk factors by combined pharmacological and nonpharmacological strategies: the main results of the CELL Study
Authors: LINDHOLM LARS H. , EKBOM TORD , DASH CLIVE , ISACSSON ÅKE , SCHERSTÉN BENGT 
Published: November 2003

Objective. The objectives of the Cost Effectiveness of Lipid Lowering (CELL) study were twofold: (i) to evaluate the effect on overall cardiovascular risk of two types of health care advice (‘usual’ and ‘intensive’) given in primary care, with or without pharmacological medication, with the target being to attain a moderate decrease in cholesterol; (ii) to evaluate the ritual of daily medication on compliance with the health care advice. Design. A prospective, double‐blind, randomized, controlled trial of 18 months' duration. Setting. The study was carried out in 32 health centres (out of a total of approximately 850) in Sweden. Subjects. In all, 681 subjects, aged 30–59 years, were randomized. They had at least two cardiovascular risk factors in addition to moderate primary hyperlipidaemia (total cholesterol of at least 6.50 mmol L‐1 on three occasions measured by Reflotron, triglycerides less than 4.0 mmol L‐1 and an LDL:HDL cholesterol ratio of more than 4.0). Most (87%) of the subjects were males; 626 subjects (92%) completed the 18‐month follow‐up. Intervention: Half the subjects were randomized to ‘intensive advice’ given in group sessions led by doctors and nurses in primary care. The other half received ‘usual advice’. In each of the two advice groups, one‐third received an active lipid‐lowering drug (pravastatin), one‐third placebo, and one‐third no drug at all. The tablets were titrated to achieve a 15% reduction in cholesterol. Main outcome measures. Changes in the overall Framingham risk score, and the development of adverse events in each group. Results. The change in Framingham risk score was significantly reduced only in subjects taking lipid‐lowering medication (together with intensive advice‐0.13; 95% CI ‐0.20,‐0.06, and together with usual advice ‐0.16; 95% CI ‐0.23,‐0.09). The other subjects receiving intensive advice tended to fare better than those on usual advice. Lifestyle was not influenced significantly over the study period. The ritual of daily medication did not affect the outcome. Conclusion. As expected, lipid‐lowering medication reduced serum cholesterol as well as overall cardiovascular risk in subjects with several risk factors for cardiovascular disease. There was no additive effect of intensive advice to these subjects. However, there was a meagre but significant effect of intensive advice in subjects not receiving active lipid‐lowering drugs. One explanation for this difference may be that those on active lipid‐lowering medication who had substantial drops in cholesterol might have felt less inclined to change their lifestyle compared with those on other treatment regimens who had less successful drops in cholesterol. There was no benefit from the ritual of taking daily medication.
Clinical features in persons with a family history of diabetes compared to controls (The Second Generation Fredericia Study)
Authors: VESTBO E. , DAMSGAARD E. M. , FRØLAND A. , MOGENSEN C. E. 
Published: November 2003

Objective. To compare clinical and biochemical features in non‐diabetic persons with a family history of non‐insulin dependent diabetes mellitus (NIDDM) to non‐diabetic persons without a family history of diabetes. Design. Cross‐sectional study. Setting. Population‐based survey in Fredericia, Denmark. Subjects. Seven hundred and forty subjects, the second generation of an earlier defined cohort was examined. The median age was 48 (range 26–65) years. Of the 740 subjects 696 were non‐diabetic. Interventions. The subjects had a clinical examination. Main outcome measures. Known risk factors for development of diabetes and cardiovascular disease. Results. More offspring of diabetic persons had NIDDM (χ2=6.36, P<0.05). Non‐diabetic males with a family history of diabetes had a higher BMI, fasting blood glucose, and triglycerides compared to males without a family history of diabetes. Non‐diabetic females with a family history of diabetes had a higher BMI, fasting blood glucose, HbA1C, diastolic blood pressure, and lower HDL‐cholesterol than female offspring of non‐diabetics. In a multiple regression model we found that non‐diabetic offspring of diabetic persons had higher fasting blood glucose and HbA1C compared to offspring of non‐diabetic persons when adjusted for the independent variables age, BMI, WHR, and sex. Conclusion. Our results may indicate that the only inherited factors from NIDDM patients are plasma blood glucose, HbA1C and increased BMI which may be an indication for later diabetes, whereas other cardiovascular risk factors may be inherited independently of diabetes but associated with BMI.
Two variants of extracellular‐superoxide dismutase: relationship to cardiovascular risk factors in an unselected middle‐aged population
Authors: Marklund S. L. , Nilsson P. , Israelsson K. , Schampi I. , Peltonen M. , Asplund K. 
Published: November 2003

Marklund SL, Nilsson P, Israelsson K, Schampi I, Peltonen M, Asplund K (University Hospital, Umeå, Sweden). Two variants of extracellular‐superoxide dismutase: relationship to cardiovascular risk factors in an unselected middle‐aged population. J Intern Med 1997; 242: 5–14.ObjectiveDescription of the distribution of plasma levels of two variants of extracellular‐superoxide dismutase (EC‐SOD) and their relationship to cardiovascular risk factors in the general population.DesignA cross‐sectional study.SettingNorrbotten and Västerbotten counties in northern Sweden.SubjectsFour thousand, nine hundred 25–74‐year‐old randomly selected subjects.Main outcome measuresPlasma levels of EC‐SOD. Genotyping by an allele‐specific PCR method.ResultsPlasma EC‐SOD levels showed a distinct bimodal distribution with the smaller group (3.8%) having a variant of the enzyme with about eight‐fold‐higher plasma levels. Genotyping was performed in 65 individuals with the high‐level variant. All but one were found to carry the same mutation, Arg213Gly, affecting the heparin‐binding domain of EC‐SOD. Subjects with the high‐level variant of EC‐SOD had modestly higher body mass index and higher levels of serum cholesterol, serum triglycerides and plasma fibrinogen than those with the common EC‐SOD phenotype. Within the population with common EC‐SOD, the plasma levels were lower in men than in women and increased with age. Low levels of common phenotype EC‐SOD were associated with smoking, high plasma levels of fibrinogen and low activity of tissue plasminogen activator in both univariate and multivariate analyses. Obesity and total serum cholesterol were associated with high common phenotype EC‐SOD levels.ConclusionsA high‐level variant of EC‐SOD caused by one and the same mutation and with low tissue binding and high plasma levels is present in approximately four per cent of an unselected middle‐aged population in northern Sweden. Plasma levels of EC‐SOD may be modulated by lifestyle factors such as smoking and show a complex covariation with many of the conventional cardiovascular risk factors.
Dynamic role of hyaluronan (HYA) in connective tissue activation and inflammation
Authors: Gerdin B. , Hällgren R. 
Published: November 2003

Gerdin B, Hällgren R (University Hospital, Uppsala, Sweden). Dynamic role of hyaluronan (HYA) in connective tissue activation and inflammation (Minisymposium: Hyaluronan). J Intern Med 1997; 242: 49–55.An increased tissue accumulation of HYA occurs in several human and experimental inflammatory conditions. Such is the case in sarcoidosis, idiopathic pulmonary fibrosis and farmer's lung in man, and experimental bleomycin‐induced lung damage in rats. Graft rejection in man and rats, experimental myocarditis in mice and myocardial infarction in rats follow the same pattern. Increased amounts of HYA also appear in gut luminal perfusion fluid in human inflammatory bowel disease. A transient accumulation of HYA is seen in wound healing, which is more sustained in fetuses. An increased accumulation of water and presentation of ligands for receptors on inflammatory cells are two consequences of the HYA accumulation.
Hyaluronan in skin
Authors: Juhlin L. 
Published: November 2003

Juhlin L (University Hospital, Uppsala, Sweden). Hyaluronan in skin (Minisymposium: Hyaluronan) J Intern Med 1997; 242: 61–6.Because of the abundance of hyaluronan in skin, interest was early focused on variation in the content of the polysaccharide in various pathological conditions of this tissue. A large amount of early work utilized histological techniques of insufficient specificity but recent developments of specific analytical and staining methods for hyaluronan have supplied new data on its presence and possible role in skin disorders.
Cognitive function, vascular risk factors and education. A cross‐sectional study based on a cohort of 70‐year‐old men
Authors: Kilander L. , Nyman H. , Boberg M. , Lithell H. 
Published: November 2003

Kilander L, Nyman H, Boberg M, Lithell H (Uppsala University Hospital, Uppsala; and the Karolinska Institute, Stockholm; Sweden). Cognitive function, vascular risk factors and education. A cross‐sectional study based on a cohort of 70‐year‐old men. J Intern Med 1997; 242: 313–21.ObjectivesA low level of education is associated with an increased risk of developing a dementia disorder, as well as with a higher risk of cardiovascular disease. The aim of this study was to investigate the association between education and cardiovascular risk factors, and to study the relation between these factors and cognitive function in elderly men.DesignCross‐sectional population‐based study.SettingUppsala, Sweden.Subjects504 men aged 69–74 years, participants in a longitudinal health survey concerning cardiovascular risk factors.Main outcome measureCognitive function as measured by a composite score of 13 standard psychometric tests.ResultsA low level of education was associated with poorer cognitive performance, as well as with obesity, smoking, diabetes, high concentrations of serum triglycerides and plasma fibrinogen. In the entire cohort, subjects with obesity, smoking, diabetes or hypertriglyceridaemia showed impaired cognitive test results, independent of socio‐economic factors. When stroke cases were excluded, obesity and smoking were still related to impaired cognitive function.ConclusionsSmoking and obesity with associated metabolic disturbances are inversely related both to educational level and to cognitive function. Cognitive decline of vascular origin is potentially preventable by treatment of risk factors. The question of whether the increased vascular risk contributes to the higher prevalence of cognitive disorders in individuals with low socio‐economic status, needs to be further evaluated in longitudinal population‐based studies.