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Biomedical subjects

G Tibblin

Publications and source records attributed to G Tibblin.

At least 19 recordsLinked to original sources
PubMed1992

Is abdominal body fat distribution a major explanation for the sex difference in the incidence of myocardial infarction? The study of men born in 1913 and the study of women, Göteborg, Sweden.

The authors considered whether the difference in body fat distribution between men and women, measured as waist:hip ratio, might explain part of the sex difference in coronary heart disease incidence in prospective population studies of 1,462 women and 792 men. In these studies, conducted in Sweden, men were found to have about four times higher odds for coronary heart disease than women during a 12-year follow-up period (men, 1967 to 1979; women, 1968-1969 to 1980-1981). Controlling for differences in blood pressure, serum cholesterol, smoking, and body mass index only marginally altered the magnitude of the male-female difference. When waist:hip ratio, which predicted coronary heart disease rates in both sexes, was also considered, the sex difference in coronary heart disease risk was significantly reduced and virtually disappeared (odds ratios = 1.0-1.1; nonsignificant). The findings suggest that body fat distribution or a factor highly correlated with waist:hip ratio (genetic, hormonal, or behavioral) may help to explain the sex differences in coronary heart disease.

Abdomen↗
PubMed1992

Hyperinsulinaemia is not a major coronary risk factor in elderly men. The study of men born in 1913.

Insulin and insulin resistance have attracted considerable interest as possible risk factors for coronary heart disease during the last decade. We therefore examined the 8-year incidence of coronary heart disease in 595 67-year-old men in relation to baseline insulin and other risk factors. The incidence of coronary heart disease increased from 9% among non-diabetic men to 13.5% among those with impaired glucose tolerance, 12.9% among newly-detected diabetic men and up to 31.3% among men with known diabetes. The incidence of coronary heart disease was related to fasting blood glucose and 1 h and 2 h blood glucose during the oral glucose tolerance test and to serum cholesterol and serum triglycerides. Fasting serum insulin was of borderline significance for the risk of coronary heart disease. When known diabetic subjects were excluded only serum cholesterol and serum triglycerides remained as statistically significant risk factors. Among diabetic subjects (known and newly-detected) only blood glucose was related to the risk of coronary heart disease. In multivariate analyses the different degrees of glucose intolerance or fasting blood glucose were independently related to the risk of coronary heart disease (p = 0.008-0.010). Serum triglycerides were also an independent risk factor in three out of four multivariate models (p = 0.02-0.09). Fasting serum insulin was not an independent risk factor. These findings do not support the hypothesis that hyperinsulinaemia is a major risk factor for coronary heart disease in elderly men. Hyperglycaemia (or diabetes mellitus) seems to be the most important risk factor.

Aged↗
PubMed1992

Patient satisfaction in primary health care. A comparative study of two modes of treatment for hypertension.

The object of this study was to compare patients' experiences of two different treatments of hypertension (one mainly non-pharmacological and one pharmacological) and study the degree of patient satisfaction and experiences of treatment in general. The 165 patients in the non-pharmacological group participated in a two-year-long study of non-pharmacological treatment of hypertension (NPTH) at eight health centres in mid-Sweden. In addition to regular visits to the same doctor at the health centre, patients received monthly check-ups by a nurse at the health centre and participated in information programmes and group activities. The NPTH patients also used cuffs for home measurements of blood pressure. The 85 patients in the control group were recruited from two health centres and received traditional, pharmacological treatments of hypertension. The hypothesis was that the patients in the NPTH group would experience satisfaction with the treatment and perceive the treatment in general as more positive than those in the control group. The 250 patients have answered a postal inquiry with structured and open questions concerning the treatment. The results show that the patients in the NPTH group throughout this study have experienced higher satisfaction with the treatment and had a more positive attitude towards the treatment than the controls. The content and design of the treatment obviously had a positive influence on patient satisfaction.

Adult↗
PubMed1992

Cardiovascular mortality and morbidity in seven counties in Sweden in relation to water hardness and geological settings. The project: myocardial infarction in mid-Sweden.

An east-west regional gradient in cardiovascular mortality was found within seven counties in mid-Sweden during the years 1969-1983. The mortality differences were of considerable magnitude for ischaemic heart disease (IHD) as well as for stroke. In previous reports, in which the distribution of risk factors among middle-aged men was presented, the moderate variation among the communities could not explain the mortality variation. Water hardness has previously been reported to be inversely related to cardiovascular mortality in several countries. In this paper, water samples from all 76 communities in seven counties were analysed in relation to mortality rates from IHD and stroke for men and women. Water hardness (Ca+Mg and other minor constituents), and the sulphate and bicarbonate concentrations of the drinking water were inversely related to IHD as well as stroke mortality. The water factors were also inversely related to non-fatal IHD even when account was taken of the age variation and the traditional risk factors as measured by a postal questionnaire. Variation of the water factors accounted for 41% of the variation in IHD mortality rate and 14% of the variation in stroke mortality rate over the 76 communities.

Aged↗
PubMed1992

Metabolic disturbances in hypertension: results from the population study 'men born in 1913'.

A clustering of metabolic disturbances has been indicated in hypertension. The distribution of such factors was assessed among hypertensives and normotensives in a general population sample of 644 men aged 67 years. Fasting serum insulin, glucose and triglyceride levels were measured. In this study hypertension was defined as DBP > or = 95 mmHg or present use of antihypertensives. Impaired glucose tolerance (IGT) or diabetes mellitus, hyperinsulinaemia (> or = 20 mU l-1) and hypertriglyceridaemia (> or = 2.3 mmol l-1) were defined as metabolic disturbances. When all these disturbances were present simultaneously a complete 'metabolic syndrome' was considered to be present. Hypertension was found in 185 (29%) men, IGT in 15%, diabetes mellitus in 11%, hyperinsulinaemia in 18% and hypertriglyceridaemia in 19%. Among hypertensives, 11 (6%) men had a 'metabolic syndrome', compared to 12 (3%) men in the normotensive group (P = 0.039). At least one metabolic disturbance was present in 109 (59%) of the hypertensive men, and in 173 (38%) of the normotensive men (P < 0.001). The prevalence rates of metabolic disturbances did not differ significantly between lean (BMI < 26 kg m-2) and obese (BMI > or = 26 kg m-2) hypertensives. Only hypertriglyceridaemia was more frequent in obese than in lean hypertensives (20% vs. 37%, P = 0.015). The 'metabolic syndrome' was found in 6% of all hypertensives, which was twice as common as in the normotensive population. The 'metabolic syndrome' was uncommon in both lean and obese hypertensives (5% vs. 7%, NS). These findings indicate that hypertension and metabolic disturbances may have a common underlying cause, at least in some individuals.

Aged↗
PubMed1992

Geographical variation and time trends in the attack rate of coronary heart disease in five Swedish cities.

Based upon community myocardial infarction (MI) records in five Swedish cities, geographical variation and time trends in the attack rate of fatal and non-fatal MI have been evaluated. During the study period 1975-1982, a total of 7699 events were registered among men and 1823 events among women. The mean annual mortality was highest in the north, and a declining gradient in mortality was observed from the northern to the southern part of the country. The out-of-hospital death rate was highest in the north, while no difference in in-hospital mortality was observed. However, the geographical variation in the morbidity of MI was less consistent. Changes over time generally followed the same pattern in all cities. The attack rate of fatal and non-fatal MI tended to decline among women and men aged 60-64 years. The pattern was less consistent among younger men. Among women aged 50-59 years the mortality remained unchanged, but the attack rate of non-fatal MI increased in all cities. This increase was not explained by inclusion of less severe infarctions. A considerable proportion, about 85%, were recorded as primary events, emphasizing the possible role of primary prevention in obtaining a decrease in the incidence of the disease. The results of this study support previous findings of an important regional difference in the mortality of MI in Sweden. However, the magnitude of the regional variation in the incidence of coronary heart disease might be overestimated if only the mortality pattern is studied.

Adult↗
PubMed1992

Social network and activities in relation to mortality from cardiovascular diseases, cancer and other causes: a 12 year follow up of the study of men born in 1913 and 1923.

OBJECTIVE: The aim was to examine the relationship between social network and activities and causes of death. DESIGN: The study was a prospective cohort study of middle aged men examined in 1973 and followed for 12 years. SETTING: Gothenburg, Sweden. SUBJECTS: The subjects were 769 60 year old and 220 50 year old men who had participated in a health examination. MEASUREMENTS AND MAIN RESULTS: Main outcome measures were mortality from cardiovascular diseases, cancer and other causes. In multivariate analyses cardiovascular mortality was related to baseline blood pressure (p less than 0.001), smoking habits (p = 0.002), myocardial infarction or stroke (p less than 0.001), and a low level of social activities (p = 0.04). Cancer mortality was related to age (p = 0.003) and smoking habits (p = 0.001). Other causes of death were related to poor perceived health (p = 0.02) and a low level of home activities (p = 0.004). In univariate analyses the above risk factors were strongly related to all three causes of death. In addition cardiovascular mortality was related to age, a low level of home and outside home activities, few persons in the household, and poor perceived health. Cancer mortality was related to poor perceived health, few persons in the household, and a low level of social activities. Other causes of death were related to living alone, poor perceived health, and a low level of social and outside home activities. CONCLUSIONS: Well known risk factors for premature mortality like smoking, hypertension, and major cardiovascular disease are verified. Middle aged men with a good "social network" (here measured as a high level of social, home, and outside home activities) may be partly protected against non-cancer mortality.

Blood Pressure↗
PubMed1991

Self-perceived psychological stress and incidence of coronary artery disease in middle-aged men.

Self-perceived psychological stress as a risk factor for coronary artery disease (CAD) was evaluated in a general population study comprising 6,935 men aged 47 to 55 years at baseline without previous myocardial infarction. In 1970 to 1973, the men answered a question about psychological stress defined as a feeling of tension, irritability or anxiety, or as having sleeping difficulties as a result of conditions at work or at home. Psychological stress was graded as follows: (1) never experienced stress; (2) greater than or equal to 1 period of stress; (3) greater than or equal to 1 period of stress during the last 5 years; (4) several periods of stress during the last 5 years; and (5 to 6) permanent stress during the last year or the last 5 years. After a mean follow-up of 11.8 years, 6% of the men with the lowest 4 stress ratings (n = 5,865) had either developed a nonfatal myocardial infarction or died from CAD, with no increase in risk from grade 1 to 4. The corresponding figure among the men with the highest 2 stress ratings (n = 1,070) was 10%; the odds ratio was 1.5 (95% confidence interval 1.2-1.9) after controlling for age and other risk factors. Similar, independent associations were seen with stroke, and with death from cardiovascular disease and from all causes, but not with death from cancer. With respect to CAD, no decrease in the effect of stress at baseline could be seen over time. No relation between life events and self-perceived psychological stress was found in another sample of 732 fifty-year-old men.

Cause of Death↗
PubMed1991

Identification of cases of myocardial infarction: hospital discharge data and mortality data compared to myocardial infarction community registers.

Identification of incident myocardial infarction (MI) cases in a defined population using hospital discharge data and mortality data in combination has been suggested. This method of case identification was compared to that of use of MI community registers set up in accordance with principles adopted in a World Health Organization collaborative programme. The comparison comprised data for four Swedish cities over a number of years. On average 81% of incident hospital-treated cases below 65 years of age identified through MI community registers were found by the retrospective use of the method based on hospital discharge data and mortality data. Of hospital-treated cases identified by the latter method, 83% were also found by the MI community registers. For cases fulfilling the diagnostic criteria employed by the MI community registers this proportion would be higher, probably 87%-92%. Several reasons for cases being missed by either method were suggested by the results. According to the findings of this study, the case identification of the method based on hospital discharge data and mortality data seems to be somewhat less efficient compared to use of MI community registers. This may be of importance in descriptive epidemiological studies, but is of less significance in analytical studies. The relative efficiency of the former method could be improved by a more reliable system for the recording of hospital discharges. If supplemented by a validation procedure, it could yield sufficiently accurate data for many epidemiological applications at a fairly low cost.

Acute Disease↗
PubMed1991

Geographical variation of mortality from cardiovascular diseases. The Project 'Myocardial Infarction in mid-Sweden'.

In this study, the geographical variation of the mortality rate in mid-Sweden was studied. Data on mortality from all causes and mortality from cardiovascular diseases, cerebrovascular diseases, ischaemic heart disease (IHD) and non-cardiovascular diseases for men and women 45-74 years of age living in 76 communities in mid-Sweden were obtained from the National Bureau of Statistics. After age standardization, the rates for mortality from all causes and cardiovascular mortality were substantially higher in the Westernmost communities compared with those in the East, whereas for non-cardiovascular mortality there were no systematic differences. The county with the higher rate for IHD had a 60% higher rate for men aged 45-64 years and a 53% higher rate for women aged 45-64 years than the county with the lowest rate. The corresponding excess mortality rates from stroke were 73% for men aged 45-74 and 46% for women aged 45-74 years. The cause of this variation is not known. It is not due to the confounding effect of different age distributions in the communities, differences in the registration of causes of death, or differences in case fatality rate.

Aged↗
PubMed1991

Are regional variations in ischaemic heart disease related to differences in coronary risk factors? The project 'myocardial infarction in mid-Sweden'.

In a previous report, a large regional variation was reported in total mortality and mortality rate from ischaemic heart disease (IHD) in mid-Sweden. In this report, IHD prevalence and risk factor data are presented. A postal questionnaire was sent out to a random sample of men aged 45-64 years in each of 40 communities. 14,675 men (88%) responded. Based on a validity study, IHD cases were defined as those with a history of myocardial infarction and/or angina pectoris. Age, smoking habits, antihypertensive treatment, body mass index, food habits, stress and physical activity during leisure time were used as risk factors. IHD prevalence showed the same geographical variation as IHD mortality, with a low prevalence in the east and a high prevalence in the west. There was a moderate variation in risk factor levels over the 40 communities. When this variation was taken into account the geographical IHD variation was somewhat smaller but still substantial. Other factors may involve socio-economics, drinking water qualities, mineral soil content or other environmental factors. Which of these cause the largest IHD variation is at present unknown, but is subject to systematic examination in this project.

Angina Pectoris↗
PubMed1991

Prevalence and incidence of diabetes in a Swedish community 1972-1987.

The prevalence and incidence of diabetes mellitus were studied from 1972 to 1987 in Laxå, a rural community with 8500 inhabitants located in mid-Sweden. Data were collected from clinical records at the primary health care centre in Laxå, from departments of internal medicine and paediatrics and from a general practitioner's office in the area. In addition, a case finding procedure involving 85% of the residents aged 35-79 years was performed in 1983-1987. The age-standardized prevalence of diabetes rose significantly (p less than 0.001) from 26 per 1000 in 1972 to 43 per 1000 in 1987. The largest rise in prevalence for males occurred in the age group 45-54 years and for females in the age group 65-74 years. The age-standardized mean annual incidence of diabetes was 3.46 per 1000 population. A small (non-significant) increase in incidence of Type 2 diabetes over time was seen in men which may in part be an effect of the case finding strategy. The overall incidence rates thus appeared to be rather stable while the prevalences tended to increase, probably mainly due to earlier detection of diabetic individuals in recent years, leaving a larger number of patients with a longer duration of diabetes to be cared for in the future.

Age Factors↗
PubMed1991

Are geographical differences in cardiovascular mortality due to morbidity differences or to methodological differences? The project "myocardial infarction in Mid-Sweden".

Geographical variations in cardiovascular mortality have been reported from Mid-Sweden. IHD mortality for men aged 45-64 was 60% higher in the western part than in the east. Mortality from stroke for men aged 45-74 was 73% higher on the west. Similar differences were found for women. One possible explanation could be that there are no incidence differences but that the mortality differences are due to different survival rates or to differences certifying the cause of death. These two possible explanations were tested in this study. Data for all patients hospitalised during the 10-year period 1972-1981 for myocardial infarction or stroke in a high mortality area, the County of Värmland in the west, and a low mortality area, the County of Uppsala in the east, were collected. In addition, a substudy was performed where the basis for the death certificate diagnosis was studied. The western area generally had a higher case fatality rate than the eastern. However, a larger proportion of the deaths the eastern area, occurred outside hospital, so that the net effect would be that the differences found were not large enough to explain the mortality differences. The autopsy rate in the western part was lower than in the east but since a larger proportion of the deaths occurred in hospital the rank order for IHD and stroke mortality between east and west was the same whether all IHD or stroke deaths were counted or only those considered the most well documented.

Aged↗
PubMed1991

Triglycerides, a major coronary risk factor in elderly men. A study of men born in 1913.

We examined two 'cohorts' of elderly men, 60 and 67 years old. The two 'cohorts' overlapped to a large extent in terms of numbers but not in the follow-up periods. The mean have been followed-up for 7 and 8 years respectively. Among the 748 60-year-old men without prior myocardial infarction the 7-year incidence of coronary heart disease was 8%. The incidence was related to blood pressure, smoking habits and serum triglycerides (but not serum cholesterol) both in univariate and multivariate analyses. The incidence of coronary heart disease increased 5-fold from the lowest to the highest quintile of triglycerides. Among the 595 67-year-old men without prior myocardial infarction the 8-year incidence of coronary heart disease was 11%. Both serum cholesterol and triglycerides were significant risk factors in univariate analyses but only triglycerides in multivariate analyses. The incidence of coronary heart disease increased almost three-fold from the lowest to the highest quintile of triglycerides. Increased serum triglycerides is a major coronary risk factor in elderly men.

Aged↗