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Biomedical subjects

B Scherstén

Publications and source records attributed to B Scherstén.

At least 19 recordsLinked to original sources
PubMed1995

The impact of health care advice given in primary care on cardiovascular risk. CELL Study Group.

OBJECTIVE: To evaluate the additional benefit of "intensive" health care advice through six group sessions, compared with the advice usually offered to subjects with multiple risk factors for cardiovascular disease. DESIGN: Prospective, randomised controlled clinical study lasting 18 months. SETTING: 681 subjects aged 30-59 years, with at least two cardiovascular risk factors in addition to moderately high lipid concentrations: total cholesterol > or = 6.5 mmol/l on three occasions, triglycerides < 4.0 mmol/l, and ratio of low density lipoprotein cholesterol to high density lipoprotein cholesterol > 4.0. Most (577) of the subjects were men. MAIN OUTCOME MEASURE: Percentage reduction in total cholesterol concentration (target 15%); quantification of the differences between the two types of health care advice (intensive v usual) for the Framingham cardiovascular risk and for individual risk factors. RESULTS: In the group receiving intensive health care advice total cholesterol concentration decreased by 0.15 mmol/l more (95% confidence interval 0.04 to 0.26) than in the group receiving usual advice. The overall Framingham risk dropped by 0.068 more (0.014 to 0.095) in the group receiving intensive advice, and most of the risk factors showed a greater change in a favourable direction in this group than in the group receiving usual advice, but the differences were seldom significant. The results from questionnaires completed at the group sessions showed that the subjects improved their lifestyle and diet. CONCLUSION: Limited additional benefit was gained from being in the group receiving the intensive health care advice. It is difficult to make an important impact on cardiovascular risk in primary care by using only the practice staff. Better methods of communicating the messages need to be devised.

Adult↗
PubMed1995

Preventing non-insulin-dependent diabetes.

Many risk factors for non-insulin-dependent diabetes mellitus (NIDDM), such as obesity, physical inactivity, and high-fat diet, can potentially be modified. Furthermore, some of the metabolic abnormalities, such as insulin resistance and impaired glucose tolerance, that predict diabetes can be improved by behavior modification and drug treatment. Thus, at least to some extent, NIDDM may be preventable. Several small clinical trials have addressed the hypothesis that NIDDM can be prevented by dietary modification, physical activity, or drug treatment. Some studies suggest a preventive effect, but the conclusions are limited by considerations of sample size, randomization, or intensity of the interventions. Consequently, the hypothesis that NIDDM is preventable requires further testing.

Behavior Therapy↗
PubMed1995

A new symphysis-fundus height growth chart based on a well defined female population with ultrasound-dated singleton pregnancies.

BACKGROUND: The aim was to construct a new symphysis-fundus (SF) height growth chart, based on ultrasound-dated singleton pregnancies. METHODS: We made a population-based study of all women, from the catchment areas of three district antenatal clinics, who registered for antenatal care during 1986. The growth of the SF height was measured on 403 women with singleton pregnancies. RESULTS: During pregnancy each woman made on average 14.0 (s.d. 2.8) visits to the antenatal clinic, where the SF height was measured on average 10.4 (s.d. 2.6) times. All but two women had an ultrasound examination. Using proper longitudinal methods a new SF height growth chart was constructed. CONCLUSION: The mean values of the present curve, based on longitudinal data, were almost identical with the mean values of a recently presented curve based on stratified cross-sectional data. Both these Swedish studies were population-based and the pregnancies were ultrasound-dated.

Adult↗
PubMed1994

Can social class differentials in hypertension be explained by the general susceptibility hypothesis?

In a population-based, cross-sectional study of 310 treated hypertensives (HT) and 288 matched normotensive controls (NT), social and biological variables were investigated. HT comprised a higher proportion of individuals in lower socioeconomic strata (P < 0.001) and lower social class distribution (defined by occupation and educational level) than NT. However, lower estimated risks (odds ratios, OR) for hypertension were found in lower social strata than in higher ones for most biological variables. This does not support the hypothesis of an increased general susceptibility in lower social classes to standard risk factors as a main factor behind the higher prevalence of hypertension, in as much as the ORs for most variables were not higher in the lower classes than in the higher ones. Thus, there may exist some, as yet undefined, and more specific risk factors for hypertension which are more prevalent in lower social strata. Interestingly, it was demonstrated that the prevention potential regarding intervention against biological risk factors had about the same magnitude in the different social strata.

Case-Control Studies↗
PubMed1994

Cardiovascular risk factors in a Melanesian population apparently free from stroke and ischaemic heart disease: the Kitava study.

OBJECTIVES: To compare cardiovascular risk factor levels between non-westernized Melanesians, apparently free from stroke and ischaemic heart disease, nd healthy Swedish populations, and to analyse, among adult Melanesians, relations with age, sex and smoking status. DESIGN: Cross-sectional survey. SUBJECTS: (i) Traditional horticulturalists in Kitava, Trobriand Islands, Papua New Guinea, uninfluenced by western diet. this study tested 151 males and 69 females aged 14-87 years with 76% and 80% smokers over 20 years. (ii) Healthy Swedish reference populations. MAIN OUTCOME MEASURES: Sitting systolic and diastolic blood pressure, weight, height, body mass index, circumferences of waist, pelvis and mid upper arm, triceps skinfold thickness, fasting serum total cholesterol, triglycerides, high-density lipoprotein cholesterol, estimated low-density lipoprotein cholesterol, apolipoprotein B, apolipoprotein A1 and apolipoprotein (a). RESULTS: Compared to Sweden, diastolic blood pressure, body mass index and triceps skinfold thickness were substantially lower in Kitava, where all subjects > or = 40 years were below Swedish medians. Among males > or = 20 and females > or = 60 years systolic blood pressure was lower in Kitavans. Fasting serum total cholesterol, low-density lipoprotein cholesterol and apolipoprotein B were 10-30% lower in Kitavan males > or = 40 and females > or = 60 years. Triglycerides were higher in Kitavans aged 20-39. High-density lipoprotein cholesterol did not differ while apolipoprotein A1 was lower in Kitavans. Apolipoprotein (a) tended to be lower in Kitavans, but the differences were small. CONCLUSIONS: Of the analysed variables, leanness and low diastolic blood pressure seem to offer the best explanations for the apparent absence of stroke and ischaemic heart disease in Kitava. The lower serum cholesterol may provide some additional benefit. Differences in dietary habits may explain the findings.

Adolescent↗
PubMed1994

A 5-year prospective, observational study of the withdrawal of antihypertensive treatment in elderly people.

OBJECTIVES: To observe blood pressure, cardiovascular events, and total mortality after withdrawing antihypertensive treatment for elderly patients. DESIGN: Multicentre observational study. SETTING: Sweden. A 5-year follow-up of 333 elderly hypertensive patients, aged 70-84 years (mean age 75.2 +/- SD 3.8 years, 68% females). In all, 74 out of the 333 patients (22%) died during the study period. METHOD: After withdrawal of the antihypertensive therapy, all patients started in the untreated state and during the 5-year follow-up they could then either remain in the untreated state, or be reverted to blood-pressure-lowering drug treatment because of hypertension or other diseases, e.g. angina pectoris, oedema, congestive heart failure, etc. RESULTS: The probability of remaining without treatment for 5 years was estimated to be 20%. During the state of no treatment the patients had a lower total mortality risk than that of the general Swedish population, matched for age and sex. They also had a lower risk of cardiovascular events than those in the treated states. Markers indicating a successful withdrawal were monotherapy in low doses and relatively low blood pressure before withdrawal. CONCLUSION: These results suggest that with frequent check-ups, withdrawal of antihypertensive therapy in the elderly can be tried without increased risk of cardiovascular events.

Aged↗
PubMed1994

Antihyperglycaemic efficacy, response prediction and dose-response relations of treatment with metformin and sulphonylurea, alone and in primary combination.

The short-term (2-12 weeks) antihyperglycaemic efficacy of metformin (M), glibenclamide (G), and their primary combination (MG) was assessed in a double-blind study including 165 unselected patients with Type 2 diabetes. Patients with diet failure were randomized to M, G or MG. The dose was titrated with a fasting blood glucose concentration (FBG) of < 6.7 mmol l-1 as the target, using at most six dose levels, the first three comprising increasing monotherapy (M or G) or low-dose primary combination (MGL), and the second three add-on therapies (M/G and G/M) and primary combination therapy escalated to high dose (MGH). Success rates were higher on MGL than on monotherapy. The difference in achieving acceptable control (FBG < or = 7.8 mmol 1(-1)) was 70% versus 51% (95% confidence interval 3-36%, p = 0.032). When the drugs were combined, a slightly greater FBG reduction (p = 0.026) was observed, at lower dosage (p = 0.013). The response could not be predicted from body weight, but depended upon initial FBG (p = 0.019) and meal-stimulated C-peptide (p = 0.007). FBG declined progressively with increasing doses of metformin, whereas glibenclamide exerted most of its effect at low dose. Primary combination therapy with metformin and sulphonylurea may be clinically useful.

Adult↗
PubMed1994

Therapeutic comparison of metformin and sulfonylurea, alone and in various combinations. A double-blind controlled study.

OBJECTIVE: To assess and compare the therapeutic efficacy and safety of metformin (M) and sulfonylurea (glyburide, G), alone and in various combinations, in patients with non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: Of 165 patients (fasting blood glucose [FBG] > or = 6.7 mmol/l) initially treated with diet alone, 144 (FBG still > or = 6.7 mmol/l) were randomized to double-blind, double-dummy controlled treatment with M, G, or primary combination therapy (MG). The dose was titrated, with FBG < 6.7 mmol/l as target, using, at most, six dose levels. The first three dose levels comprised increasing single-drug therapy (M or G) or primary combination at increasing but low dosage (MGL), and the second three levels were composed of various high-dose combinations, i.e., add-on therapy (M/G or G/M) and primary combination escalated to high dosage (MGH). Medication was maintained for 6 months after completed dose titration. RESULTS: The FBG target was achieved in 9% of patients after diet alone. Single-drug therapy was insufficient in 36% and MGL in 25% (NS) of the randomized patients. There was further improvement in glucose control by the high-dose combinations. Mean FBG +/- SE was reduced (P = 0.001) from 9.1 +/- 0.4 to 7.0 +/- 0.2 mmol/l in those maintained on single-drug treatment or low-dose primary combination. Those treated with different high-dose combinations had a large mean FBG reduction, from 13.3 +/- 0.8 to 7.8 +/- 0.6 mmol/l. HbA1c levels showed corresponding reductions, and glycemic levels rose after drug discontinuation. Fasting C-peptide rose during treatment with G and MGL but not with M, while fasting insulin was not significantly changed. Meal-stimulated C-peptide and insulin levels were unchanged by M but increased by G and, to a lesser extent, by MGL. There were no significant insulin or C-peptide differences between the different high-dose combinations (M/G, G/M, and MGH). Body weight did not change following treatment with M or combination but increased by 2.8 +/- 0.7 kg following G alone. Blood pressure was unchanged. Overall effects on plasma lipids were small, with no significant differences between groups. Drug safety was satisfactory, even if the reporting of (usually modest) adverse events was high; the profile, but not the frequency, differed between groups. CONCLUSIONS: Dose-effect titrated treatment with either metformin or glyburide promotes equal degrees of glycemic control. The former, but not the latter, is able to achieve this control without increasing body weight or hyperinsulinemia. Near-normal glycemia can be obtained by a combination of metformin and sulfonylurea, even in advanced NIDDM.

Adult↗
PubMed1994

Reference intervals and decision limits for plasma lipids and lipoproteins: a practical evaluation of current recommendations.

As part of a longitudinal study--the Kristianstad Survey--we measured plasma cholesterol, HDL- and LDL-cholesterol, triglycerides and lipoprotein (a) in a reference group consisting of 203 men and women aged 20-80, randomly sampled from a well-defined area in the southernmost part of Sweden. The selection of reference individuals and the collection of specimens for assay of the constituents were performed in accordance with current recommendations. The results were subjected to statistical analyses both with and without application of exclusion criteria. Application of the theoretical exclusion criteria resulted in the exclusion of 22% of the participants; however, this procedure had a remarkably weak impact on the results: the mean values and the standard deviations were almost unaltered. The mean (standard deviation) for cholesterol was 5.9 (1.3) mmol l-1, for HDL-C 1.1 (0.3) mmol l-1, and for LDL-C 4.3 (1.2) mmol l-1. Women had higher values than men. Plasma triglycerides were positively skewed; their median and Q3-Q1-values were 1.0 and 0.5 mmol l-1 respectively, men higher than women. There was an increase with age for cholesterol and LDL-C in both sexes and for triglycerides in women. The steepest increase of cholesterol values with age in women coincided with menopause, which have a more clear-cut separation between high and low cholesterol values than did any age limit.

Adult↗
PubMed1993

The cost-effectiveness of treating hypertension in elderly people--an analysis of the Swedish Trial in Old Patients with Hypertension (STOP Hypertension).

OBJECTIVES: The aim of this study was to estimate the cost-effectiveness of antihypertensive treatment in elderly people based on the results of the Swedish Trial in Old Patients with Hypertension (STOP Hypertension). DESIGN: The STOP Hypertension study was a randomized trial comparing active antihypertensive treatment with a placebo. The risk of stroke, cardiovascular disease and total mortality was significantly reduced in the actively treated group compared to placebo. SETTING: One hundred and sixteen primary health care centres in Sweden. SUBJECTS: A total of 1627 hypertensive patients aged 70-84. No patient was lost to follow-up. INTERVENTIONS: Antihypertensive treatment with beta blockers and diuretics for a mean follow-up of 25 months. MAIN OUTCOME MEASURE: The cost-effectiveness ratio estimated as the net cost (the treatment cost minus saved costs of reduced cardiovascular morbidity) divided by the number of life-years gained (the increase in life expectancy from treatment). RESULTS: The cost per life-year gained was estimated as SEK 5000 for men and SEK 15,000 for women ($1 = SEK 6; 1 pound = SEK 10). The cost per life-year gained did not exceed SEK 100,000 in any of the sensitivity analyses. CONCLUSIONS: It is concluded that treatment of elderly hypertensive patients with beta blockers and/or diuretics is cost-effective according to the results of the STOP Hypertension study.

Aged↗
PubMed1993

STOP-Hypertension 2: a prospective intervention trial of "newer" versus "older" treatment alternatives in old patients with hypertension. Swedish Trial in Old Patients with Hypertension.

It is well established that hypertensive patients benefit from drug treatment of their disorder. In recent years three major out-come studies of antihypertensive treatment in elderly hypertensives have shown substantial benefits, i.e. a reduction in the risk of stroke and other cardiovascular mortality and morbidity. In all these studies beta-blockers and/or diuretics were used in comparison with placebo. Newer therapeutic alternatives have, however, at least theoretically, many advantages which could result in further improvements in prognosis. The initial Swedish Trial in Old Patients with Hypertension (STOP-Hypertension 1) was conducted in men and women aged 70-84 years. STOP-Hypertension 2 will evaluate the therapy used in STOP-Hypertension 1 against therapy based on either ACE-inhibitors (enalapril and lisinopril) or on calcium antagonists (isradipine and felodipine), using the PROBE design (Prospective, Randomised, Open, Blinded Endpoint evaluation). The primary aim will be to assess the effect on cardiovascular mortality. Statistical calculations indicate that 6,600 patients, followed for four years will be needed (2p < 0.05, power 90%) to obtain significance if there is a 25% difference between the new and the established therapy. Patients in primary health care (300 centres) will be included if their supine blood pressure is > or = 180/105 mmHg (and/or). Recruitment of patients started in September 1992 and so far more than 100 patients/week have been included.

Aged↗
PubMed1993

Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) analyses performed up to 1992.

Hypertension is increasingly common with advancing age and a risk factor for all kinds of cardiovascular complications. Moreover, cardiovascular disease is a major cause of morbidity and mortality in the elderly. The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was set up by the Swedish Hypertension Society to investigate the value of antihypertensive treatment in the elderly. In this placebo controlled randomised prospective study 1,627 men and women aged 70-84 years with a supine blood pressure > or = 180/105 mmHg (and/or) but not isolated systolic hypertension participated. Three beta-blockers and one diuretic were used as blood pressure lowering agents and the average follow-up in the study was 25 months (3,390 patient-years). Administration of active antihypertensive therapy, reduced supine blood pressure from 195/102 mmHg to 167/87 mmHg at longest follow-up in comparison with placebo. A majority of the patients needed combined treatment to reach the goal blood pressure (160/95 mmHg). Associated with a fall in blood pressure were significant reductions in all cardiovascular primary endpoints (-40%, p = 0.0031), in fatal and non-fatal stroke (-47%, p = 0.0081) and in total mortality (-43%, p = 0.0079). In addition to the substantial effects on primary endpoints active treatment also showed clinically relevant effects on secondary endpoints (e.g. heart failure). The impact on cardiovascular morbidity and mortality with antihypertensive treatment in this elderly cohort was greater than previously seen in middle-aged hypertensive patients, with maintained tolerability and a favourable cost-effectiveness ratio. Finally, women benefited from treatment at least as much as men.

Adrenergic beta-Antagonists↗
PubMed1993

Care of hypertensives in Dalby: organisation and health economic aspects.

We have investigated 1,051 treated hypertensives of both sexes in the Dalby primary health care (PHC) district, Sweden, to evaluate the organisation and the total cost of treatment. Male hypertensives (n = 486) made 1.78 physician visits annually and had a mean on-treatment BP of 160/91 mmHg. Correspondingly, female hypertensives (n = 565) made 1.67 visits and had a mean attained BP of 164/91 mmHg. The drug profile was dominated by the use of beta-receptor-blockers in 38% of all patients but the newer antihypertensive drugs (calcium antagonists, ACE inhibitors) were also commonly used. The total cost of treatment (drugs, consultations, time and travel expenses) was calculated to 2,680 SEK/patient/year, which is similar to that found in a previous study from another PHC district in Sweden, 2,660 SEK/drug-treated patient/year (after adjustment for increasing consumer price index, +29%, between the years of the studies, 1988-91). In conclusion, the hypertensives in Dalby were fairly well controlled according to BP levels. The treatment cost was higher than that of other PHC areas, which should be the focus of further analyses of cost-effectiveness.

Aged↗