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B Hedblad

Publications and source records attributed to B Hedblad.

80 records · Page 5Linked to original sources
PubMed1994

Hypertension and silent myocardial ischemia: their influence on cardiovascular mortality and morbidity.

The presence of ST-segment depression during ambulatory electrocardiographic monitoring, in relation to blood pressure treatment and control, was monitored in a non-randomized study in 167 men (49%) from the 'Men born in 1914' Malmö study, who were considered to have hypertension (diastolic blood pressure [DBP], > or = 95 mm Hg or receiving antihypertensive therapy). Men were excluded if they had a history of ischemic heart disease. A high frequency of ST-segment depression (41%) and associated high cardiac event rate (14%) were found in hypertensive elderly men who had inadequately controlled blood pressure (i.e. DBP > or = 95 mm Hg). This was associated with a relative risk of a cardiac event of 9.8 (95% confidence interval: 2.6-36.9), even after adjustment for smoking, blood lipids and alcohol consumption. The lower frequency of ST-segment depression (21%) and lower cardiac event rate (5%) in hypertensive men with adequate blood pressure control suggests that effective antihypertensive treatment leads to a reduced event rate. In conclusion, the occurrence of ST-segment depression during ambulatory electrocardiographic monitoring in this group of subjects may be an expression of silent myocardial ischemia, with or without left ventricular hypertrophy. The incidence of asymptomatic ST-segment depression and the rate of cardiac events in hypertensive patients may be, in part, related to the level of blood pressure control attained.

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PubMed1993

Non-invasively detected carotid stenosis and ischaemic heart disease in men with leg arteriosclerosis.

Since the excess mortality rate associated with an ankle-brachial blood-pressure index (ABPI) less than 0.9 was only partly explained by an excess cardiovascular mortality, we believe that leg artery disease should not only be regarded as a marker of generalised arteriosclerosis but also as a sign associated with an increased risk of premature death. 439 men who were part of a prospective population study in Malmö, Sweden, were, at 68 years of age, invited to a health examination including, ABPI, carotid-artery ultrasonography, and 24 h ambulatory electrocardiographic monitoring. Cause-specific mortality and incidence of myocardial infarction (MI) during 8 years of follow-up was compared in men with and without signs of arteriosclerotic disease. Of 60 men with an ABPI < 0.9, 20 (33%) had angina pectoris or previous MI. Another 11 (18%) had silent ST-segment depression (> or = 1 mm); 3 (5%) had a history of stroke; and 17 (28%) had symptom-free carotid stenosis (> 30% reduction of the cross-sectional diameter). Total mortality rate in men with no signs of arteriosclerotic disease was 19.6 per 1000 person-years and cardiac event rate (fatal and non-fatal MI and death from chronic ischaemic heart disease was 8.6 per 1000 person-years). Leg artery disease, carotid stenosis, and ischaemic heart disease were in a univariate analysis all associated with an increased cardiac event rate and an increased total mortality rate. In a multivariate analysis an ABPI less than 0.9 was associated with a 2.4 times higher total mortality (95% CI 1.5-3.9) and a 2.0 times higher cardiac event rate (1.1-3.9). Carotid stenosis and ischaemic heart disease contributed to the risk for MI (RR 2.1; 95% CI 1.2-3.8; and 2.1; 1.2-3.9, respectively), whereas no independent association with total mortality was found.

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PubMed1993

Low ankle-brachial pressure index in 68-year-old men: prevalence, risk factors and prognosis. Results from prospective population study "Men born in 1914", Malmö, Sweden.

The objectives were to study the distribution of ankle-brachial pressure indices (ABPI) in elderly men in relation to arteriosclerotic risk factors, cardiovascular morbidity and total mortality. The data are taken from the prospective cohort study "Men born in 1914" in Malmö, a city in southern Sweden with 220,000 inhabitants and a single referral hospital. Prevalence of low ABPI (< 0.90) at 68 years of age, total mortality, mortality from ischaemic heart disease (IHD) International Classification of Diseases (ICD) code 410.0-412.9) and cardiac event rate [fatal and non-fatal myocardial infarction (MI) and mortality from chronic ischaemic heart disease] during 8 years of follow-up was measured. Sixty-seven of 477 randomly selected men (14.0%) had an ABPI < 0.90 in one or both legs, 18/477 (3.8%) had intermittent claudication according to the Rose questionnaire, which had a sensitivity of 14.9% and a specificity of 98% when using ABPI as a reference method. Ninety-two per cent of the men with an ABPI < 0.90 were or had been smokers, compared with 80% of the men with an ABPI > or = 0.90. Mean systolic blood pressure and median plasma triglyceride levels were significantly higher in the group with low ABPI. Thirty (45%) of the men with low ABPI and 87 (21%) of the men with pressure indices above 0.90 died during follow-up (p < 0.001). Cardiac event rate was 25% (17/67) in the group with low ABPI and 10% (41/410) in the other group (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1992

Influence of social support on cardiac event rate in men with ischaemic type ST segment depression during ambulatory 24-h long-term ECG recording. The prospective population study 'Men born in 1914', Malmö, Sweden.

Three-hundred and ninety-four 68-year-old men, representing 60.3% of a cohort of men born in 1914, were examined with ambulatory ECG during 24 h in 1982-83. Ninety-eight (24.8%) men had one or more episodes of ischaemic type ST segment depression (greater than or equal to 0.10 mV), 79 of whom had no history of previous ischaemic heart disease (IHD). During 63 months follow-up, 17 of the 98 suffered a cardiac event, i.e. fatal or non-fatal myocardial infarction (MI) or death due to chronic IHD. The objective of this study was to assess the influence of psychosocial factors, such as social network and social support, on cardiac event rate in men with ischaemic ST segment depression. A higher risk was found among men with little material and informational support (i.e. access to practical services and material resources and access to guidance, advice and information (crude relative risk 4.8; 95% CI; 1.6-14.8) and men with low availability of emotional support (i.e. opportunity for care, encouragement of personal value and feelings of confidence and trust) (crude relative risk 4.3; 95% CI: 1.4-13.3). This association was independent of history of IHD and other known risk factors for myocardial infarction (MI).

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PubMed1992

Hypertension and ST segment depression during ambulatory electrocardiographic recording. Results from the prospective population study 'men born in 1914' from Malmö, Sweden.

The aim of this study in 341 men (aged 68 years) without history of ischemic heart disease was to study the relation between hypertension and silent ischemic-type ST segment depression during ambulatory long-term electrocardiographic recording and to assess the influence between these two variables on cardiovascular morbidity and mortality rates. Seventy-nine men (23%) demonstrated one or more episodes of silent ischemic ST segment depression. One hundred and sixty-seven men (49%) were considered to have hypertension (i.e., they had a diastolic blood pressure of 95 mm Hg or greater or were treated with antihypertensive therapy). Forty-nine (72%) of the 68 treated hypertensive subjects were classified as uncontrolled (i.e., their diastolic blood pressure was 95 mm Hg or greater). The occurrence of ischemic ST depression was higher in hypertensive men (28%) than in normotensive men (19%). The highest incidence of ischemic ST depression (41%) was observed in treated hypertensive men with inadequate blood pressure control. Cardiac event rate during a 53-month follow-up was 6.6% in hypertensive men and 4.6% in normotensive men. Uncontrolled treated hypertensive men had a higher event rate (14%) than hypertensive men overall. Hypertensive men with inadequate blood pressure control and who demonstrated ST segment depression had the highest event rate (25%).

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PubMed1991

Increased occurrence of arrhythmias in men with ischaemic type ST-segment depression during long-term ECG recording. Prognostic impact on ischaemic heart disease: results from the prospective population study 'Men born in 1914', Malmö, Sweden.

The objective of this long-term ECG (LTER) study in 394 68-year-old men, selected at random from the general population of Malmö, Sweden, was to determine the prevalence and occurrence of cardiac arrhythmias and their impact on morbidity and mortality from IHD. According to Lown classification, 29.4% (116 men) had ventricular arrhythmia (VA) group 4-5. Serious ventricular arrhythmia (Lown group 4-5) was more common in men with asymptomatic ischaemic type ST-segment depression (STD) than in those without it (37.8% vs. 26.7%: P less than 0.05). During the mean follow-up period of 53.1 months there were seven IHD deaths (6%) among the 116 patients with VA, Lown 4-5, and nine IHD deaths (3.2%) among the 278 patients without serious VA, Lown 0-3, (P = 0.26). Six and three of these deaths, respectively, were considered to be sudden (P = 0.022). The increased cardiac event rate (fatal or non-fatal MI or deaths due to chronic IHD) associated with a serious ventricular arrhythmia disappeared when history of IHD at baseline and occurrence of STD during LTER were taken into account. The study did not provide any evidence to suggest that ventricular arrhythmia was triggered by myocardial ischaemia. Five of 9 (56%) deaths due to IHD in men with STD occurred among the 38% (37/98) of patients who belonged to Lown class 4-5. It is concluded that the prognostic information derived from LTER can be improved by combined monitoring of STD and ventricular arrhythmias.

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PubMed1989

Increased mortality in men with ST segment depression during 24 h ambulatory long-term ECG recording. Results from prospective population study 'Men born in 1914', from Malmö, Sweden.

'Men born in 1914', from Malmö, Sweden, is a cohort study of the morbidity and mortality of cardiovascular diseases among 68-year-old men in an urban population. Ambulatory long-term ECG recording was part of the health examination that these men were invited to undergo in 1982. Five hundred attended (80.5%) of the 621 invited. Ninety-eight of the 394 men in whom the ECG recording was technically satisfactory had at least one episode with horizontal or downsloping ST segment depression greater than or equal to 0.1 mV. The median total duration of ST segment depression was 135 min. 90% of these episodes were not preceeded by any increase in heart rate. In only eight of the 47 men who reported an occurrence of chest symptoms during the recording period did ST segment depression and chest symptoms occur simultaneously. 43 months after the health examination, 33 (8.4%) men had died. The mortality in men without ST segment depression and without any history of coronary heart disease was 6.5%. The incidence of fatal and non-fatal myocardial infarction in men without ST depression greater than or equal to 0.1 mV and without a history of IHD was 2.3%. Men with ST depression greater than or equal to 0.1 mV in comparison with this group had a 4.4 times greater relative risk. The risk in men with both ST segment depression greater than or equal to 0.1 mV and history of coronary heart disease was 16.0 times greater. This study shows that asymptomatic ST segment depression is a frequent finding in elderly men. The occurrence of asymptomatic ST segment depression is associated with an increased cardiovascular mortality. This increased mortality is independent of a history compatible with angina pectoris or previous myocardial infarction.

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