bluuebunny/crossref_metadata_2025_split huggingface dataset:
The hypothalamic–pituitary–adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke
Authors: Rosmond R. , Björntorp P. 
Published: March 2003

Abstract. Rosmond R, Björntorp P (University of Göteborg, Sahlgrenska University Hospital, Göteborg, Sweden). The hypothalamic–pituitary–adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Intern Med 2000; 247: 188–197.Objectives. The hypothalamic–pituitary–adrenal (HPA) axis, the mediator of cortisol, plays a central role in the homeostatic processes. In this study, we addressed the potential impact of HPA axis activity on established anthropometric, metabolic and haemodynamic risk factors for cardiovascular disease (CVD), type 2 diabetes mellitus and stroke.Design. A cross‐sectional study.Subjects. A subgroup of 284 men from a population sample of 1040 at the age of 51 years.Main outcome measures. Anthropometric measurements included body mass index (BMI, kg m–2), waist/hip circumference ratio (WHR) and abdominal sagittal diameter (D). Overnight fasting values of blood glucose, serum insulin, triglycerides, total, low (LDL) and high density (HDL) lipoprotein cholesterol, as well as resting heart rate and blood pressure, were also determined. By using repeated diurnal salivary cortisol measurements during everyday conditions, methods were developed to characterize the status of the HPA axis, and set in relation to the anthropometric, metabolic and haemodynamic measurements.Results. In bivariate analyses, risk factors intercorrelated in clusters of anthropometric (BMI, WHR, D), metabolic (insulin, glucose and their ratio, triglycerides, cholesterol [total and LDL], HDL cholesterol [negative]) and haemodynamic (systolic and diastolic blood pressure and heart rate) measurements. This was also the case in the two‐dimensional scaling analysis, where, however, HDL separated out. A normal HPA axis status, characterized by high variability and morning cortisol values, as well as a clear response to a standardized lunch and dexamethasone suppression test, was then introduced by a statistical weighting procedure. This did not essentially change the results of either the bivariate correlation matrix or the two‐dimensional scaling analysis. A similar introduction of a pathological HPA axis, characterized by low variability and morning cortisol values, a poor lunch‐induced cortisol response and a blunted dexamethasone suppression of cortisol, changed the results markedly. Now strong and consistent correlations were found not only within but also between different clusters of risk factors, which also congregated into one distinct cluster, again except for HDL cholesterol.Conclusions. These results disclose the prospect of an overriding function of a pathological HPA axis on other, established risk factors for CVD, type 2 diabetes and stroke. Its close association to HPA axis dysfunction may explain the previously reported powerful risk indication of abdominal obesity for the diseases mentioned. The HPA axis abnormality has been reported to be a characteristic consequence of frequently repeated or chronic environmental stress challenges.
Dietary and other non‐pharmacological treatments in patients with drug‐treated hypertension and control subjects
Authors: Silaste M.‐L. , Junes R. , Rantala A. O. , Kauma H. , Lilja M. , Savolainen M. J. , Reunanen A. , Kesäniemi Y. A. 
Published: March 2003

Abstract. Silaste M‐L, Junes R, Rantala AO, Kauma H, Lilja M, Savolainen MJ, Reunanen A, Kesäniemi YA (University of Oulu, Oulu, and The National Public Health Institute, Helsinki, Finland). Dietary and other non‐pharmacological treatments in patients with drug‐treated hypertension and control subjects. J Intern Med 2000; 247: 318–324.Objective. To study the nutrient intakes and other lifestyle patterns of drug‐treated hypertensives and control subjects.Design. A cross‐sectional population‐based epidemiological study.Setting. The participating study subjects visited the research laboratory of the Department of Internal Medicine of the University of Oulu, Oulu, Finland.Participants. A total of 1045 Finnish men and women aged 40–60 years, of whom 716 (69%) completed 7‐day food records.Main outcome measures. Intakes of energy, protein, total fat, saturated, monounsaturated and polyunsaturated fatty acids, carbohydrate, alcohol, fibre, calcium, magnesium, potassium and sodium were assessed from 7‐day food records. The study also included measurements of blood pressure, blood glucose and plasma lipids, and anthropometric variables. Information about alcohol consumption, smoking habits and physical activity was collected by interviewing.Results. Obesity was common amongst the hypertensive subjects, whose body mass indices were significantly higher than those of the control subjects. Only minor differences existed in the energy intake levels and nutrient intakes of the hypertensive and control cohorts, but the control subjects performed more physical activity than the hypertensive subjects. The dietary recommendations concerning the intakes of total and saturated fats, carbohydrate and fibre were poorly met by both the hypertensive and the control subjects. Alcohol consumption was high amongst the hypertensive men, especially amongst the smokers.Conclusions. Non‐pharmacological treatment, including dietary management, of hypertensive patients at high risk for cardiovascular complications seems still to be inadequate. Additional well‐focused efforts are needed to intensify the dietary treatment as well as to reduce alcohol consumption and smoking amongst hypertensives.
Increased plasma concentrations of TGF‐β1 after hormone replacement therapy
Authors: Djurovic S. , Os I. , Hofstad A. E. , Abdelnoor M. , Westheim A. , Berg K. 
Published: March 2003

Abstract. Djurovic S, Os I, Hofstad AE, Abdelnoor M, Westheim A, Berg K (Ullevål University Hospital and the University of Oslo, Oslo, Norway). Increased plasma concentrations of TGF‐β1 after hormone replacement therapy. J Intern Med 2000; 247: 279–285.Objectives and design.   Hormone replacement therapy (HRT) in postmenopausal women may reduce the cardiovascular risk. A dominant protective role of transforming growth factor beta (TGF‐β1) on coronary arteries has been proposed. Lp(a) lipoprotein may block the activation of latent TGF‐β1. Given this background, we examined the effects of HRT on TGF‐β1 and Lp(a) lipoprotein in 99 postmenopausal women. The women had angiographically documented coronary heart disease (CHD) and were randomized to either sequential transdermal 17β‐oestradiol for 14 weeks and then medroxyprogesterone (MPA) for 14 days (HRT) or to a control group (C).Results. Serum levels of TGF‐β1 were increased in the HRT group compared with the C group after 3 months’ treatment and this effect was sustained after 12 months. There was a significant reduction in Lp(a) lipoprotein serum levels after 3 months’ treatment in the HRT group compared with the C group. However, after 12 months, no significant difference in changes in Lp(a) lipoprotein serum levels was detected between the two groups.Conclusion. The novel observation that transdermal 17β‐oestradiol in postmenopausal women increases levels of TGF‐β1 and lowers the concentration of Lp(a) lipoprotein suggests yet another possible mechanism for the cardioprotective effect of HRT. Whereas combination therapy of oestradiol and MPA preserves the beneficial effect on TGF‐β1, it reduces the unopposed oestradiol effects on Lp(a) lipoprotein.
Disease‐related syncope. Analysis of a community‐based hospital registry
Authors: Bandinelli G. , Cencetti S. , Bacalli S. , Lagi A. 
Published: March 2003

Abstract. Bandinelli G, Cencetti S, Bacalli S, Lagi A (Ospedale Santa Maria Nuova, Firenze, Italy). Disease‐related syncope. Analysis of a community‐based hospital registry. J Intern Med 2000; 247: 513–516.Syncope is characterized by sudden and transient loss of consciousness that follows a reduction or interruption of cerebral blood flow. The present study was designed to assess the prevalence of disease‐related syncope in a wide sample of in‐patients admitted for different diseases. A total of 16 809 patients (age range 18–99 years) were recruited from three hospitals in Florence in 1998. The community‐based registry was reviewed to identify all patients suffering from complaints associated with syncope. Each disease‐related syncope was matched with the number of patients suffering from that disease. Furthermore, each disease was expressed as a percentage of total cases included in the study. The odds ratio was calculated to determine the index of significant correlation between syncope and occasional diseases. Total syncopes were 775 (prevalence 4.46%), vasovagal syncopes were 336 (1.9% of total sample and 44% of total syncopes), and the disease‐related syncopes were 439 (56% of total syncopes). We found a significant association between syncope and orthostatic hypotension, complete heart block, chronic cerebral disease, migraine, acute gastrointestinal haemorrhages and aortic stenosis. Furthermore, we found a significant association with acute gastrointestinal haemorrhage, which has not been described previously. Significant relationships emerged from our data which yield a new insight into the association between syncope and a wide range of systemic diseases.
Immune responses to oxidative neoepitopes on LDL and phospholipids modulate the development of atherosclerosis
Authors: Palinski W. , Witztum J. L. 
Published: March 2003

Abstract. Palinski W, Witztum JL (University of California San Diego, La Jolla, California, USA). Immune responses to oxidative neoepitopes on LDL and phospholipids modulate the development of atherosclerosis (Minisymposium). J Intern Med 2000; 247: 371–380.Extensive evidence suggests that humoral and cellular immune responses against lipid peroxidation products occur in vivo and that they modulate the progression of atherosclerosis. The biological significance of these immune responses is the focus of this review. Lipid peroxidation generates reactive aldehydes and oxidized phospholipids which form complex, immunogenic adducts with proteins or other phospholipids. Autoantibodies against oxidative neoepitopes are present in humans and other species and their titre may be an indicator of the extent of atherosclerosis. Interventions boosting immune responses to oxidized LDL reduce the progression of atherosclerosis in animal models. However, other interventions inhibiting immune cells or signalling factors enhance atherogenesis, suggesting that different elements of the immune system exert opposite effects. Evaluation of the role of immune mechanisms in atherosclerosis is further complicated by the fact that other chronic inflammatory conditions induce similar humoral immune responses to oxidative neoepitopes, in particular oxidized phospholipids. Naturally occurring antibodies cloned from atherosclerotic mice provide insights into the nature of antigens formed in vivo and on biological effects of some antibody populations. For example, antibodies to oxidized phospholipid adducts inhibit macrophage uptake of oxidized LDL by blocking scavenger receptors. Antibodies to oxidation‐specific epitopes may also be suitable for non‐invasive diagnosis of atherosclerosis.
A comparison between patients suffering in‐hospital and out‐of‐hospital cardiac arrest in terms of treatment and outcome
Authors: Herlitz J. , Bång A. , Ekström L. , Aune S. , Lundström G. , Holmberg S. , Holmberg M. , Lindqvist J. 
Published: March 2003

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.
Polymorphisms of the β2‐adrenergic receptor gene (ADRB2) in relation to cardiovascular risk factors in men
Authors: Rosmond R. , Ukkola O. , Chagnon M. , Bouchard C. , Björntorp P. 
Published: March 2003

Abstract. Rosmond R, Ukkola O, Chagnon M, Bouchard C & Björntorp P (Department of Heart and Lung Diseases, Göteborg University, Sweden; Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA; Department of Internal Medicine, University of Oulu, Oulu, Finland). Polymorphisms of the β2‐adrenergic receptor gene (ADRB2) in relation to cardiovascular risk factors in men. J Intern Med 2000; 248: 239–244.Objective. To investigate the effect of polymorphisms in codon 16 (Arg16Gly) and codon 27 (Gln27Glu) of the β2‐adrenergic receptor gene (ADRB2) on anthropometric, endocrine, metabolic and haemodynamic variables.Design. A cross‐sectional study.Subjects. A subgroup of 284 Swedish men from a population sample of 1040 at the age of 51 years.Main outcome measures. Genotype examination of ADRB2 polymorphisms in codon 16 and codon 27 with polymerase chain reaction and restriction fragment length polymorphism. Anthropometric measurements included body mass index, waist‐to‐hip ratio and abdominal sagittal diameter. Endocrine measurements included blood levels of testosterone, insulin‐like growth factor I, and leptin plus salivary cortisol. Overnight fasting values of serum insulin, blood glucose, triglycerides, total, low and high density lipoprotein cholesterol, as well as blood pressure and resting heart rate, were also determined.Results.   Polymorphisms were frequent in both codon 16 and codon 27. The Arg16Gly genotype showed significant relationships to elevated central distribution of body fat and to systolic blood pressure, whilst the Glu27Glu genotype was associated with elevated leptin and triglyceride levels but not to other measurements, including obesity variables.Conclusions.   We conclude that only a few cardiovascular risk factors are associated with DNA sequence variation in the ADRB2 in Swedish men.
A pilot study of streptokinase‐induced endothelial injury and platelet activation following acute myocardial infarction
Authors: Lip G. Y. H. , Lydakis C. , Nuttall S. L. , Landray M. J. , Watson R. D. S. , Blann A. D. 
Published: March 2003

Abstract. Lip GYH, Lydakis C, Nuttall SL, Landray MJ, Watson RDS, Blann AD (Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK). A pilot study of streptokinase‐induced endothelial injury and platelet activation following acute myocardial infarction. J Intern Med248: 316–318.Objective. To relate the changes in serum vitamin E, an essential antioxidant, to changes in fibrinogen, as well as indices of endothelial damage [as indicated by plasma markers, soluble thrombomodulin (sTM) and von Willebrand factor (vWf)], and an index of platelet activation [soluble P selectin (sPsel)], in myocardial infarction treated with thrombolytic therapy.Design and Setting. Prospective longitudinal pilot study in a teaching hospital Coronary Care Unit.Subjects and intervention. Seventeen patients (12 men; mean age 62 years ± SD 11 years) admitted with acute myocardial infarction (AMI), who were given thrombolytic therapy, and 59 healthy controls.Results. Baseline levels of fibrinogen (Mann–Whitney test, P = 0.0055) and vWf (P < 0.001) were significantly higher than controls, but sPsel, sTM or vitamin E levels were not significantly different. Following thrombolysis, as expected, median concentrations of plasma fibrinogen fell profoundly (Friedman
anovaP < 0.001) so that after 45 min, levels were undetectable in 13 patients. At 24‐h median fibrinogen concentration had recovered to approximately 30% of baseline (P < 0.01) and was still undetectable in three patients. Levels of vWf and sPsel increased steadily, reaching significance after three hours (both P < 0.05). However, levels of sTM rose immediately after thrombolysis, peaking between 1 and 3 h, and remained elevated at 24 h. These increases corresponded to a simultaneous early fall in serum vitamin E concentrations.Conclusion. The present pilot study demonstrates significant endothelial damage and platelet activation in association with increased oxidative stress following streptokinase therapy for AMI.
The inpatient care of patients with diabetes mellitus and foot ulcers. A validation study of the correspondence between medical records and the Swedish Inpatient Registry with the consequences for cost estimations
Authors: Ragnarson Tennvall G. , Apelqvist J. , Eneroth M. 
Published: March 2003

Abstract. Ragnarson Tennvall G, Apelqvist J, Eneroth M (Swedish Institute for Health Economics and Departments of Internal Medicine and Orthopaedics, Lund University Hospital, Lund, Sweden). The inpatient care of patients with diabetes mellitus and foot ulcers. A validation study of the correspondence between medical records and the Swedish Inpatient Registry with the consequences for cost estimations. J Intern Med 2000; 248: 397–405.Objectives. To compare the correspondence of discharges and diagnoses between medical records and an administrative database in diabetic patients with foot ulcers and to calculate inpatient costs from the different sources.Design. Discharge data from 117 prospectively followed patients were compared with information from the Swedish Inpatient Registry during the same treatment period for each patient. Non corresponding discharges were retrospectively reviewed in patient records. Costs of inpatient care were calculated from clinical sources and from data selected in three different ways from the database. Information in medical records was assumed to represent the ‘Gold Standard’.Setting. In‐hospital treatment, multidisciplinary foot‐care team.Subjects. A total of 117 diabetic patients with deep foot infections.Main outcome measures. Degree of database completeness and inpatient costs.Results. The degree of completeness of discharges in the database was 98%, but 8.6% of discharges had no code for diabetes and 13% were registered without any foot related diagnosis code. Less than 20% of discharges were found with selection based on primary diagnosis 250.G only. Total inpatient costs varied from 2.7 to 13.3 million SEK (Swedish Kronor) depending on selected diagnosis codes. Approximately 84% of all foot ulcer discharges could be found in the database if codes with both diabetes mellitus and foot ulcer diagnoses were selected.Conclusions. Inpatient costs for foot complications cannot be accurately estimated from the Inpatient Registry when based on primary diagnosis exclusively. Fairly good estimates at a low data acquisition cost can be made with a combination of foot related diagnoses together with codes for diabetes.
Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3‐year progression of carotid atherosclerosis
Authors: Salonen J. T. , Nyyssönen K. , Salonen R. , Lakka H.‐M. , Kaikkonen J. , Porkkala‐Sarataho E. , Voutilainen S. , Lakka T. A. , Rissanen T. , Leskinen L. , Tuomainen T.‐P. , Valkonen V.‐P. , Ristonmaa U. , Poulsen H. E. 
Published: March 2003

Abstract. Salonen JT, Nyyssönen K, Salonen R, Lakka H‐M, Kaikkonen J, Porkkala‐Sarataho E, Voutilainen S, Lakka TA, Rissanen T, Leskinen L, tuomainen T‐P, Valkonen V‐P, Ristonmaa U (University of Kuopio, Finland), Poulsen HE (University of Copenhagen, Copenhagen, Denmark). Antioxidant Supplementation in Atherosclerosis Prevention (ASAP) study: a randomized trial of the effect of vitamins E and C on 3‐year progression of carotid atherosclerosis. J Intern Med 2000; 248: 377–386.Objectives. To study the efficacy of vitamin E and C supplementation on the progression of carotid atherosclerosis, hypothesizing an enhanced preventive effect in men and in smokers and synergism between vitamins.Design and subjects. Double‐masked two‐by‐two factorial trial, randomization in four strata (by gender and smoking status) to receive twice daily either 91 mg (136 IU) of d‐α‐tocopherol, 250 mg of slow‐release vitamin C, a combination of these or placebo for three years. A randomized sample of 520 smoking and nonsmoking men and postmenopausal women aged 45–69 years with serum cholesterol ≥ 5.0 mmol L–1 were studied.Setting. The population of the city of Kuopio in Eastern Finland.Intervention. Twice daily either a special formulation of 91 mg of d‐α‐tocopherol, 250 mg of slow‐release vitamin C, a combination of these (CellaVie®) or placebo for three years.Measurements. Atherosclerotic progression, defined as the linear regression slope of ultrasonographically assessed common carotid artery mean intima–media thickness (IMT), was calculated over semi‐annual assessments.Results. The average increase of the mean IMT was 0.020 mm year–1 amongst men randomized to placebo and 0.018 mm year–1 in vitamin E, 0.017 mm year–1 in vitamin C and 0.011 mm year–1 in the vitamin combination group (P = 0.008 for E + C vs. placebo). The respective means in women were 0.016, 0.015, 0.017 and 0.016 mm year–1. The proportion of men with progression was reduced by 74% (95% CI 36–89%, P = 0.003) by supplementation with the formulation containing both vitamins, as compared with placebo.Conclusions. Our study shows that a combined supplementation with reasonable doses of both vitamin E and slow‐release vitamin C can retard the progression of common carotid atherosclerosis in men. This may imply benefits with regard to other atherosclerosis‐based events.