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  • 1. Ballin, M.
    et al.
    Neovius, M.
    Ortega, F. B.
    Henriksson, P.
    Nordström, Anna
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV). Uppsala University Hospital; Arctic University of Norway, Tromsø, Norway.
    Berglind, D.
    Nordström, P.
    Ahlqvist, V. H.
    Genetic and Environmental Factors and Cardiovascular Disease Risk in Adolescents2023In: JAMA Network Open, E-ISSN 2574-3805, Vol. 6, no 11, article id e2343947Article in journal (Refereed)
    Abstract [en]

    Importance: Cardiovascular risk factors in youth have been associated with future cardiovascular disease (CVD), but conventional observational studies are vulnerable to genetic and environmental confounding. Objective: To examine the role of genetic and environmental factors shared by full siblings in the association of adolescent cardiovascular risk factors with future CVD. Design, Setting, and Participants: This is a nationwide cohort study with full sibling comparisons. All men who underwent mandatory military conscription examinations in Sweden between 1972 and 1995 were followed up until December 31, 2016. Data analysis was performed from May 1 to November 10, 2022. Exposures: Body mass index (BMI), cardiorespiratory fitness, blood pressure, handgrip strength, and a combined risk z score in late adolescence. Main Outcomes and Measures: The primary outcome was fatal or nonfatal CVD, as recorded in the National Inpatient Register or the Cause of Death Register before 2017. Results: A total of 1138833 men (mean [SD] age, 18.3 [0.8] years), of whom 463995 were full brothers, were followed up for a median (IQR) of 32.1 (26.7-37.7) years, during which 48606 experienced a CVD outcome (18598 among full brothers). All risk factors were associated with CVD, but the effect of controlling for unobserved genetic and environmental factors shared by full siblings varied. In the sibling analysis, hazard ratios for CVD (top vs bottom decile) were 2.10 (95% CI, 1.90-2.32) for BMI, 0.77 (95% CI, 0.68-0.88) for cardiorespiratory fitness, 1.45 (95% CI, 1.32-1.60) for systolic blood pressure, 0.90 (95% CI, 0.82-0.99) for handgrip strength, and 2.19 (95% CI, 1.96-2.46) for the combined z score. The percentage attenuation in these hazard ratios in the sibling vs total cohort analysis ranged from 1.1% for handgrip strength to 40.0% for cardiorespiratory fitness. Consequently, in the sibling analysis, the difference in cumulative CVD incidence at age 60 years (top vs bottom decile) was 7.2% (95% CI, 5.9%-8.6%) for BMI and 1.8% (95% CI, 1.0%-2.5%) for cardiorespiratory fitness. Similarly, in the sibling analysis, hypothetically shifting everyone in the worst deciles of BMI to the middle decile would prevent 14.9% of CVD at age 60 years, whereas the corresponding number for cardiorespiratory fitness was 5.3%. Conclusions and Relevance: In this Swedish national cohort study, cardiovascular risk factors in late adolescence, especially a high BMI, were important targets for CVD prevention, independently of unobserved genetic and environmental factors shared by full siblings. However, the role of adolescent cardiorespiratory fitness in CVD may have been overstated by conventional observational studies.. 

  • 2.
    Bylund, Dan
    et al.
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Natural Sciences.
    Henriksson, Anders E.
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Natural Sciences. Sundsvalls sjukhus.
    Proteomic approaches to identify circulating biomarkers in patients with abdominal aortic aneurysm2015In: American Journal of Cardiovascular Disease, ISSN 2160-200X, Vol. 5, no 3, p. 140-145Article, review/survey (Refereed)
    Abstract [en]

    Abdominal aortic aneurysm (AAA) is a common condition with high mortality when ruptured. Most clinicians agree that small AAAs are best managed by ultrasonographic surveillance. However, it has been stated in recent reviews that a serum/plasma biomarker that predicts AAA rupture risk would be a powerful tool in stratifying patients with small AAAs. Identification of such circulating biomarkers with traditional hypothesis driven studies has been unsuccessful. In this review we summarize six studies using different proteomic approaches to find new, potential plasma AAA biomarker candidates. In conclusion, by using proteomic approaches novel potential plasma biomarkers for AAA have been identified.

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  • 3. Cheema, H. A.
    et al.
    Ehsan, M.
    Ayyan, M.
    Shahid, A.
    Farooq, M.
    Javed, M. U.
    Lak, H. M.
    Ahmad, M. Q.
    Virk, H. U. H.
    Lakhter, V.
    Lee, Ka Yiu
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV).
    In-hospital mortality of COVID-19 patients hospitalized with ST-segment elevation myocardial infarction: A meta-analysis2022In: IJC Heart & Vasculature, E-ISSN 2352-9067, Vol. 43, article id 101151Article in journal (Refereed)
    Abstract [en]

    Introduction: Coronavirus Disease 2019 (COVID-19) has been associated with an increased risk of adverse cardiovascular events including arteriovenous thrombosis, myocarditis and acute myocardial injury. Relevant literature to date has reported widely varying estimates of mortality, ranging from approximately 2 to 11 times higher odds of mortality in COVID-19-positive STEMI (ST-segment elevation myocardial infarction) patients. Hence, we conducted this meta-analysis to resolve these inconsistencies and assess the impact of COVID-19 infection on mortality and other clinical outcomes in patients presenting with STEMI. Methods: This meta-analysis was registered in PROSPERO (CRD42021297458) and performed according to the Cochrane Handbook for Systematic Reviews of Interventions. PubMed and Embase were searched from inception to November 2021 (updated on April 2022) using a search strategy consisting of terms relating to COVID-19, STEMI, and mortality. Results: We identified 435 studies through our initial search. After screening according to our eligibility criteria, a total of 11 studies were included. Compared with the non-COVID-19 STEMI patients, the in-hospital mortality rate was higher in COVID-19-positive STEMI patients. Similarly, the risk of cardiogenic shock was higher in the COVID-19-positive patients. Length of hospital stay was longer in STEMI patients with COVID-19. Conclusions: Our study highlights the necessity for early evaluation of COVID-19 status in all STEMI patients followed by risk stratification, prompt reperfusion and more aggressive management of COVID-19-positive patients. Further research is needed to elucidate the mechanisms behind poorer prognosis in such patients. 

  • 4.
    Fransson, Maria
    et al.
    Department of Surgery, Sundsvall County Hospital, Sundsvall, Sweden.
    Rydningen, Hans
    Department of Surgery, Sundsvall County Hospital, Sundsvall, Sweden.
    Henriksson, Anders E.
    Department of Laboratory Medicine, Sundsvall County Hospital, SE-851 86 Sundsvall, Sweden .
    Early coagulopathy in patients with ruptured abdominal aortic aneurysm.2012In: Clinical and applied thrombosis/hemostasis, ISSN 1076-0296, E-ISSN 1938-2723, Vol. 18, no 1, p. 96-9Article in journal (Refereed)
    Abstract [en]

    Ruptured abdominal aortic aneurysm (AAA) is associated with a high mortality despite surgical management. Earlier reports indicate that a major cause of immediate intraoperative death in patients with ruptured AAA is related to hemorrhage due to coagulopathy. Acidosis is, besides hypothermia and hemodilution, a possible cause of coagulopathy. The aim of the present study was to investigate the incidence of coagulopathy and acidosis preoperatively in patients with ruptured AAA in relation to the clinical outcome with special regard to the influence of shock. For this purpose, 95 consecutive patients who underwent surgery for AAA (43 ruptured with shock, 12 ruptured without shock, and 40 nonruptured) were included. Coagulopathy was defined as prothrombin time (international normalized ratio [INR]) ≥1.5 and acidosis was defined as base deficit ≥6 mmol/L. Mortality and postoperative complications were recorded. The present study shows a state of acidosis at the start of surgery in 30 of 55 patients with ruptured AAA. However, only in 7 of 55 patients with ruptured AAA a state of preoperative coagulopathy was demonstrated. Furthermore, in our patients with shock due to ruptured AAA only 2 of 12 deaths were due to coagulopathy and bleeding. Indeed, our results show a relatively high incidence of thrombosis-related causes of death in patients with ruptured AAA, indicating a relation to an activated coagulation in these patients. These findings indicate that modern emergency management of ruptured AAA has improved in the attempt to prevent fatal coagulopathy.

  • 5. Granholm, Fredrik
    et al.
    Bylund, Dan
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Natural Sciences.
    Shevchenko, Ganna
    Lind, Sara B.
    Henriksson, Anders E.
    Mid Sweden University, Faculty of Science, Technology and Media, Department of Natural Sciences. Sundsvall County Hospital, Sundsvall, Sweden.
    A Feasibility Study on the Identification of Potential Biomarkers in Pulmonary Embolism Using Proteomic Analysis2022In: Clinical and applied thrombosis/hemostasis, ISSN 1076-0296, E-ISSN 1938-2723, Vol. 28Article in journal (Refereed)
    Abstract [en]

    Acute pulmonary embolism (PE) is a common emergency with a high morbidity and mortality. Most clinical presentations are non-specific and there is a lack of suitable biomarkers for PE. For example, the traditional D-dimer tests shows a rather high sensitivity for PE, but yet a rather low positive predictive value due to its lack of specificity. Research on novel biomarkers for PE is thus of interest to improve early diagnostics and reduce the number of unnecessary computed tomography pulmonary angiogram (CTPA) scans performed. In this study we evaluate the feasibility to use label-free quantitative proteomics to discover potential biomarkers for acute PE and to monitor changes in proteins levels in PE patients over time. Blood was collected from 8 patients with CTPA verified PE and from 8 patients presenting with same symptoms but with a negative CTPA. The samples were analyzed by liquid chromatography-mass spectrometry and thirteen protein concentrations were found to be significantly changed in PE patients compared to the CTPA negative controls. This exploratory study shows that proteomic analysis can be used to identify potential biomarkers for PE as well as to monitor changes of protein levels over time. The complement proteins play a part in PE but further studies are needed to clarify their specific role in the pathophysiological process and to look for more specific proteins. 

  • 6.
    Hambraeus, K.
    et al.
    Falun Cent Hosp, Dept Cardiol, Falun, Sweden .
    Burell, G.
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden .
    Johansson, P.
    Heart & Lung Patients Assoc, Stockholm, Sweden .
    Karlsson, R.
    Karlstad Hosp, Karlstad, Sweden .
    Lisspers, Jan
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Perk, J.
    Linnaeus Univ, Sch Hlth & Caring Sci, Kalmar, Sweden.
    Cardiac rehabilitation: demands from elderly patients after percutaneous coronary intervention2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no Supp 1, p. 450-450Article in journal (Other academic)
  • 7. Hjorth-Hansen, A. K.
    et al.
    Magelssen, M. I.
    Andersen, G. N.
    Graven, T.
    Kleinau, J. O.
    Landstad, Bodil
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV). Nord-Trøndelag Hospital Trust, Levanger, Norway.
    Løvstakken, L.
    Skjetne, K.
    Mjølstad, O. C.
    Dalen, H.
    Real-time automatic quantification of left ventricular function by hand-held ultrasound devices in patients with suspected heart failure: a feasibility study of a diagnostic test with data from general practitioners, nurses and cardiologists2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 10, article id e063793Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the feasibility and reliability of hand-held ultrasound (HUD) examinations with real-time automatic decision-making software for ejection fraction (autoEF) and mitral annular plane systolic excursion (autoMAPSE) by novices (general practitioners), intermediate users (registered cardiac nurses) and expert users (cardiologists), respectively, compared to reference echocardiography by cardiologists in an outpatient cohort with suspected heart failure (HF). DESIGN: Feasibility study of a diagnostic test. SETTING AND PARTICIPANTS: 166 patients with suspected HF underwent HUD examinations with autoEF and autoMAPSE measurements by five novices, three intermediate-skilled users and five experts. HUD results were compared with a reference echocardiography by experts. A blinded cardiologist scored all HUD recordings with automatic measurements as (1) discard, (2) accept, but adjust the measurement or (3) accept the measurement as it is. PRIMARY OUTCOME MEASURE: The feasibility of automatic decision-making software for quantification of left ventricular function. RESULTS: The users were able to run autoEF and autoMAPSE in most patients. The feasibility for obtaining accepted images (score of ≥2) with automatic measurements ranged from 50% to 91%. The feasibility was lowest for novices and highest for experts for both autoEF and autoMAPSE (p≤0.001). Large coefficients of variation and wide coefficients of repeatability indicate moderate agreement. The corresponding intraclass correlations (ICC) were moderate to good (ICC 0.51-0.85) for intra-rater and poor (ICC 0.35-0.51) for inter-rater analyses. The findings of modest to poor agreement and reliability were not explained by the experience of the users alone. CONCLUSION: Novices, intermediate and expert users were able to record four-chamber views for automatic assessment of autoEF and autoMAPSE using HUD devices. The modest feasibility, agreement and reliability suggest this should not be implemented into clinical practice without further refinement and clinical evaluation. TRIAL REGISTRATION NUMBER: NCT03547076. 

  • 8.
    Humphries, Sophia Monica
    et al.
    Uppsala Universitet.
    Rondung, Elisabet
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Norlund, Fredrika
    Uppsala universitet.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Tornvall, Per
    Karolinska Institutet.
    Held, Claes
    Uppsala Universitet.
    Spaak, Jonas
    Karolinska Institutet; Danderyds sjukhus.
    Lyngå, Patrik
    Karolinska Institutet.
    Olsson, Erik M.G.
    Uppsala Universitet.
    Designing a Web-Based Psychological Intervention for Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: User-Centered Design Approach2020In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 22, no 9, article id e19066Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The involvement of patient research partners (PRPs) in research aims to safeguard the needs of patient groups and produce new interventions that are developed based on patient input. Myocardial infarction with nonobstructive coronary arteries (MINOCA), unlike acute myocardial infarction (MI) with obstructive coronary arteries, is presented with no significant obstructive coronary artery disease. Patients with this diagnosis are a subset of those diagnosed with traditional MI and often need more psychological support, something that is presently not established in the current treatment scheme in Swedish health care or elsewhere, to our knowledge. An internet-delivered intervention might offer patients with MINOCA the opportunity to access a psychological treatment that is tailored to their specific needs after MINOCA and could therefore supplement the existing medical care in an easily accessible format. OBJECTIVE: This paper aims to describe the development of a therapist-guided, internet-delivered psychological intervention designed specifically for patients with MINOCA. METHODS: The study used a participatory design that involved 7 PRPs diagnosed with MINOCA who collaborated with a team consisting of researchers, cardiologists, and psychologists. Intervention content was developed iteratively and presented to the PRPs across several prototypes, each continually adjusted and redesigned according to the feedback received. The intervention and experience of it were discussed by PRPs in a final meeting and then presented to a panel of 2 clinical psychologists and a cardiologist for further input. RESULTS: The outcome of the collaboration between PRPs and the research group produced a web-based psychological 9-step program focusing on stress, worry, and valued action. The input from PRPs contributed substantially to the therapy content, homework tasks, interactive activities, multimedia, and design presentation. CONCLUSIONS: Working with PRPs to develop an intervention for people with MINOCA produced a web-based intervention that can be further evaluated with the goal of offering a new psychological treatment option to a patient group currently without one. Direct contribution from PRPs enabled us to obtain relevant, insightful, and valuable feedback that was put towards the overall design and content of the intervention. 

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  • 9. Iqbal, J.
    et al.
    Iqbal, A.
    Mukhtar, H.
    Jahangir, K.
    Mashkoor, Y.
    Zeeshan, M. H.
    Nadeem, A.
    Ashraf, A.
    Maqbool, S.
    Sadiq, S. M.
    Lee, Ka Yiu
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV).
    Cardioprotective Effects of Nanoparticles in Cardiovascular Diseases: A State-of-the-Art Review2023In: Current problems in cardiology, ISSN 0146-2806, E-ISSN 1535-6280, Vol. 48, no 8, article id 101713Article, review/survey (Refereed)
    Abstract [en]

    It has been reported that death related to cardiovascular disease has increased up to 12.5% just in the past decade alone with various factors playing a role. In 2015 alone, it has been estimated that there were 422.7 million cases of CVD with 17.9 million deaths. Various therapies have been discovered to control and treat CVDs and their complications including reperfusion therapies and pharmacological approaches but many patients still progress to heart failure. Due to these proven adverse effects of existing therapies, various novel therapeutic techniques have emerged in the near past. Nano formulation is one of them. It is a practical therapeutic strategy to minimize pharmacological therapy's side effects and nontargeted distribution. Nanomaterials are suitable for treating CVDs due to their small size, which enables them to reach more sites of the heart and arteries. The biological safety, bioavailability, and solubility of the drugs have been increased due to the encapsulation of natural products and their derivatives of drugs. 

  • 10.
    Jansson, Josefin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV).
    Jonsson, Linn
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV).
    Livet efter hjärtinfarkt: Personers upplevelser2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 11.
    Jideus, Lena
    et al.
    Dept. Surg. Sci., Thorac. C., University Hospital, Uppsala.
    Ericson, Mats
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Stridsberg, Mats
    Nilsson, Leif
    Blomström, Per
    Dept. Surg. Sci., Thorac. C., University Hospital, Uppsala.
    Blomström-Lundqvist, Carina
    University Hospital, Uppsala.
    Diminished circadian variation in heart rate variability before surgery in patients developing postoperative atrial fibrillation2001In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 35, no 4, p. 238-244Article in journal (Refereed)
    Abstract [en]

    Objective - To evaluate the role of the autonomic nervous system for the development of atrial fibrillation (AF) after coronary artery bypass Surgery. Design - Eighty patients without a previous history of AF were included. The sympathetic and parasympathetic activity were evaluated by the analysis of heart rate variability (HRV) in the frequency domain from 24-h Holter recordings and by measuring neuropeptides (neuropeptide Y, chromogranin A, chromogranin B, and pancreatic polypeptide (PP)) and catecholamines, obtained pre- and postoperatively. Results - Preoperatively, patients (36.3%) developing AF postoperatively showed a statistically significant less circadian variation in the HRV variables, the hi gh-f requency (HF) component (p = 0.013) and the low-frequency (LF)/HF ratio (p = 0.007), than patients remaining in sinus rhythm. The HF component and PP, both reflecting parasympathetic activity, and all other variables in the frequency domain, decreased significantly after surgery in both patient groups (p < 0.0001). Although catecholamines increased significantly postoperatively in both patient groups, neither catecholamines nor neuropeptides expressing sympathetic activity, differed between the two g PP groups. PP was, however, significantly higher in patients with postoperative AF than in those with sinus rhythm postoperatively on day 1. Conclusion - The diminished circadian variation in HRV before surgery and the indirect signs of a higher parasympathetic activity in patients developing postoperative AF compared with patients remaining in sinus rhythm, may indicate a propensity for AF.

  • 12.
    Junehag, Lena
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Asplund, Kenneth
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Svedlund, Marianne
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    A qualitative study: Perceptions of the psychosocial consequences and access to support after an acute myocardial infarction2014In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 30, no 1, p. 22-30Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to describe individuals' perceptions of the psychosocial consequences of an acute myocardial infarction (AMI) and of their access to support one year after the event. Methods: The study included 20 participants (14 men and six women) who lived in rural areas and had experienced their first AMI. Eleven were offered contact with a mentor. The participants were interviewed one year after their AMI. Results: The findings are presented in three themes: having a different life, having to manage the situation and having access to support, with 11 subthemes. During their recovery, the participants experienced psychosocial consequences, consisting of anxiety and the fear of being afflicted again. Most mentees appreciated their mentor and some of those without mentors wished they had received organised support. Participants were often more dissatisfied than satisfied with the follow-up provided during recovery. Conclusions: After an AMI, follow-up is important during recovery, but the standardised information provided is inadequate. During recovery, people need help dealing with existential crises. After discharge, receiving peer support from lay people with similar experiences could be valuable. The knowledge gleaned from this study could be used in education at coronary care units and in health care outside the hospital setting. © 2013 Elsevier Ltd.

  • 13.
    Kivimäki, M.
    et al.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Nyberg, S. T.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Batty, G. D.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Fransson, E. I.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Heikkilä, K.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Alfredsson, L.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bjorner, J. B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, M.
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Burr, H.
    Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany.
    Casini, A.
    School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
    Clays, E.
    Department of Public Health, Ghent University, Ghent, Belgium.
    De Bacquer, D.
    Department of Public Health, Ghent University, Ghent, Belgium.
    Dragano, N.
    Department of Medical Sociology, University of Düsseldorf, Düsseldorf, Germany.
    Ferrie, J. E.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Geuskens, G. A.
    TNO, Hoofddorp, Netherlands.
    Goldberg, M.
    Versailles-Saint Quentin University, Versailles, France.
    Hamer, M.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Hooftman, W. E.
    TNO, Hoofddorp, Netherlands.
    Houtman, I. L.
    TNO, Hoofddorp, Netherlands.
    Joensuu, M.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Jokela, M.
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Kittel, F.
    School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
    Knutsson, Anders
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Koskenvuo, M.
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Koskinen, A.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Kouvonen, A.
    School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, United Kingdom.
    Kumari, M.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Madsen, I. E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Marmot, M. G.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Nielsen, M. L.
    Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
    Nordin, M.
    Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
    Oksanen, T.
    Finnish Institute of Occupational Health, Turku, Finland.
    Pentti, J.
    Finnish Institute of Occupational Health, Turku, Finland.
    Rugulies, R.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Salo, P.
    Finnish Institute of Occupational Health, Turku, Finland.
    Siegrist, J.
    Department of Medical Sociology, University of Düsseldorf, Düsseldorf, Germany.
    Singh-Manoux, A.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Suominen, S. B.
    Department of Public Health, University of Turku, Turku, Finland.
    Väänänen, A.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Vahtera, J.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Virtanen, M.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Westerholm, P. J. M.
    Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
    Westerlund, H.
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Zins, M.
    Versailles-Saint Quentin University, Versailles, France.
    Steptoe, A.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Theorell, T.
    Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Job strain as a risk factor for coronary heart disease: A collaborative meta-analysis of individual participant data2012In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 380, no 9852, p. 1491-1497Article in journal (Refereed)
    Abstract [en]

    Background Published work assessing psychosocial stress (job strain) as a risk factor for coronary heart disease is inconsistent and subject to publication bias and reverse causation bias. We analysed the relation between job strain and coronary heart disease with a meta-analysis of published and unpublished studies. Methods We used individual records from 13 European cohort studies (1985-2006) of men and women without coronary heart disease who were employed at time of baseline assessment. We measured job strain with questions from validated job-content and demand-control questionnaires. We extracted data in two stages such that acquisition and harmonisation of job strain measure and covariables occurred before linkage to records for coronary heart disease. We defined incident coronary heart disease as the first non-fatal myocardial infarction or coronary death. Findings 30 214 (15%) of 197 473 participants reported job strain. In 1•49 million person-years at risk (mean follow-up 7•5 years [SD 1•7]), we recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1•23 (95% CI 1•10-1•37). This effect estimate was higher in published (1•43, 1•15-1•77) than unpublished (1•16, 1•02-1•32) studies. Hazard ratios were likewise raised in analyses addressing reverse causality by exclusion of events of coronary heart disease that occurred in the first 3 years (1•31, 1•15-1•48) and 5 years (1•30, 1•13-1•50) of follow-up. We noted an association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3•4%. Interpretation Our findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking. Funding Finnish Work Environment Fund, the Academy of Finland, the Swedish Research Council for Working Life and Social Research, the German Social Accident Insurance, the Danish National Research Centre for the Working Environment, the BUPA Foundation, the Ministry of Social Affairs and Employment, the Medical Research Council, the Wellcome Trust, and the US National Institutes of Health.

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  • 14.
    Leissner, Philip
    et al.
    Uppsala Univ, Akadem sjukhuset, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden..
    Held, Claes
    Uppsala Univ, Akadem sjukhuset, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden.;Uppsala Univ, Uppsala Clin Res Ctr, Dept Med Sci Cardiol, Uppsala, Sweden..
    Humphries, Sophia
    Uppsala Univ, Akadem sjukhuset, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Rondung, Elisabet
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Olsson, Erik M. G.
    Uppsala Univ, Akadem sjukhuset, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden..
    Association of anxiety and recurrent cardiovascular events: investigating different aspects of anxiety2024In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 23, no 7, p. 720-727Article in journal (Refereed)
    Abstract [en]

    Aims While elevated levels of anxiety are associated with worse prognosis of cardiovascular disease (CVD), this association may vary between different aspects of anxiety. The aim of this study was to analyse self-reported behavioural, physiological, affective, and cognitive aspects of anxiety and their relation to the risk of recurrent CV events.Methods and results This prospective cohort study utilized data from the U-CARE Heart trial. Participants (N = 935, post myocardial infarction) answered the Hospital Anxiety and Depression Scale (HADS: Anxiety subscale) and the Cardiac Anxiety Questionnaire (CAQ: Fear, Avoidance & Attention subscales). HADS Anxiety reflected physiological aspects, CAQ Fear reflected cognitive and affective aspects, CAQ Avoidance reflected behavioural aspects, and CAQ Attention reflected cognitive aspects of anxiety. Cox regression was used to estimate the risk between anxiety and recurrent major adverse cardiac event (MACE). During the follow-up period (mean 2.9 years), 124 individuals (13%) experienced a specified MACE endpoint. HADS Anxiety and CAQ Total were both associated with increased risk of MACE [hazard ratio (HR) = 1.52, 95% confidence interval (CI): 1.15-2.02 and HR = 1.30, 95% CI: 1.04-1.64, respectively]. Among the CAQ subscales, there was support for an association between Avoidance and risk of MACE (HR = 1.37, 95% CI 1.15-1.64), but not for Attention and Fear.Conclusion The results support that anxiety is associated with an increased risk of recurrent MACE in post-myocardial infarction patients. The association between anxiety and risk was strong for the aspects of anxiety relating to behaviour and physiology, while the support for an association with cognitive and affective aspects was lacking. 

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  • 15.
    Perk, J.
    et al.
    Linnaeus Univ, Sch Hlth & Caring Sci, Kalmar, Sweden.
    Burell, G.
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden .
    Hambraeus, K.
    Falun Cent Hosp, Dept Cardiol, Falun, Sweden .
    Johansson, P.
    Heart & Lung Patients Assoc, Stockholm, Sweden .
    Karlsson, R.
    Karlstad Hosp, Karlstad, Sweden .
    Lisspers, Jan
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Harvesting the benefits of a cardioprotective lifestyle after coronary angioplasty2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no Supp 1, p. 446-446Article in journal (Other academic)
  • 16.
    Sjödin, Christina
    et al.
    Mid Sweden University. Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Wall Dahlberg, Malin
    Mid Sweden University. Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Livet för patienter med hjärtsvikt: En litteraturöversikt2010Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Patients with heart failure is a patient group growing in numbers, the most common treatment focuses on reliving symptoms and the only cure is heart transplantation. Objective: Aim of the study was to illuminate patients' experiences of living with heart failure at his home. Method: Qualitative design, with a manifest content analysis. The results are based on 12 scientific articles.  Results: Patients with heart failure find that the disease is limited to their daily lives through mental illness and physical symptoms. The short comings of given information to the Patients are a necessary element to include in the planning for Patients future life. The Patients are experiencing that their lives are hanging on a thread as their life is running out, giving anxiety and worries. The need for palliative care is great, but is experienced by patients as containing large gaps. Discussion: Heart failure is a hidden disease, where patients with heart failure often feel like a burden on the environment. Dependence on other people gives a feeling of hope and hopelessness. Conclusion: information plays a large role in how patients with heart failure are able to live with their everyday lives.

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  • 17.
    Sjödin, Elin
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV).
    Öberg Samson, Ina
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences (HOV).
    Att leva med hjärtsvikt: - En litteraturöversikt2022Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
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  • 18.
    Wallinder, Jonas
    et al.
    Departments of Surgery, Sundsvall County Hospital, Sweden .
    Bergqvist, David
    Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Sweden .
    Henriksson, Anders E.
    Laboratory Medicine, Sundsvall County Hospital, Sweden.
    Haemostatic markers in patients with abdominal aortic aneurysm and the impact of aneurysm size2009In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 124, no 4, p. 423-6Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Abdominal aortic aneurysm is a common condition with high mortality when rupturing. However, the condition is also associated with nonaneurysmal cardiovascular mortality. A possible contributing mechanism for the thrombosis related cardiovascular mortality is an imbalance between the activation of the coagulation system and the fibrinolytic system. The aim of the present study was to investigate haemostatic markers in patients with nonruptured abdominal aortic aneurysm with special regard to the influence of aneurysm size and smoking habits.

    METHODS: Seventy-eight patients with infrarenal aortic aneurysm and forty-one controls without aneurysm matched by age, gender and smoking habits were studied. Thrombin-antithrombin (TAT), prothrombin fragment 1+2 (F 1+2)--markers of thrombin generation, and von Willebrand factor antigen (vWFag)--considered as a reliable marker of endothelial dysfunction--were measured. Plasma levels of tissue plasminogen activator antigen (tPAag), and plasminogen activator inhibitor type 1 (PAI-1) were measured as markers of fibrinolytic activity. D-dimer, a marker of fibrin turnover, was also measured.

    RESULTS: There were significantly higher levels of TAT and D-dimer in patients with abdominal aortic aneurysm. The highest level of TAT and D-dimer were detected in patients with large compared to small AAA.

    CONCLUSIONS: The present data indicate a state of activated coagulation in patients with abdominal aortic aneurysm which is dependent by aneurysm size. The activated coagulation in AAA patients could contribute to an increased cardiovascular risk in patients also with small AAA. The possible impact of secondary prevention apart from smoking cessation has to be further evaluated and is maybe as important as finding patients at risk of rupture.

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