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Biomedical subjects

H Arnesen

Publications and source records attributed to H Arnesen.

At least 19 recordsLinked to original sources
PubMed1992

Effects of long-term treatment with warfarin on fibrinogen, FPA, TAT, and D-dimer in patients with coronary artery disease.

Sixty-four patients undergoing aorto-coronary bypass surgery were randomized to receive antithrombotic treatment with acetylsalicylic acid (ASA), 300 mg/d (n = 30) or warfarin, INR = 2.5 - 4.2 (n = 34). The levels of fibrinogen, thrombin-antithrombin III complexes (TAT), fibrinopeptide A (FPA) and D-dimer were assessed before surgery and 9 months postoperatively. In the warfarin treated group the fibrinogen levels were increased after 9 months, while the levels of TAT, FPA and D-dimer were decreased. In the ASA group TAT levels were increased at 9 months, whereas no significant changes in fibrinogen, FPA or D-dimer from baseline were noted. Thus, a reduced activation of the coagulation system has been demonstrated during long-term treatment with warfarin in patients with coronary artery disease.

Adult↗
PubMed1992

Antiphospholipid antibodies after myocardial infarction and their relation to mortality, reinfarction, and non-haemorrhagic stroke.

Antiphospholipid antibodies have been suggested as markers for a high risk of recurrent cardiovascular events in young survivors of an acute myocardial infarction. However, there are few data to confirm or refute this hypothesis. In a cohort study, we have measured anticephalin (aCEPHA) and anticardiolipin (aCL) antibodies in a group of patients surviving an acute infarct. Of 597 patients studied, 13.2% were IgG or IgM aCEPHA positive compared with 4.4% of a reference population (n = 158; p = 0.002). In a multivariate analysis, adjusted for major cardiovascular risk factors, neither aCEPHA (IgG or IgM) nor a CL (IgG or IgM) was an independent risk factor for mortality, reinfarction, or non-haemorrhagic stroke. Although an increased proportion of survivors of a myocardial infarction have antiphospholipid antibodies, the presence of such antibodies is not a risk factor for subsequent coronary or cerebrovascular thrombosis.

Adult↗
PubMed1992

Introduction: the metabolic cardiovascular syndrome.

During the last few years new knowledge concerning risk factors for cardiovascular diseases (CVD) has emerged. Many of these are metabolically interrelated. The clustering of a variety of metabolic disorders in individuals prone to develop CVD has led to the launching of the so-called metabolic cardiovascular syndrome (MCVS). At the XIIIth Scandinavian Congress of Cardiology in Oslo, Norway, on June 1991, a satellite symposium was arranged on the MCVS. The present supplement comprises articles written by the symposium speakers, who are all experts in various fields of relevance to the MCVS. In addition, Per Björntorp, Stevo Julius, and Arne Westheim were invited to contribute articles to make the coverage of the topic more complete. The present introduction summarizes some of the clinical and biochemical features characteristic of the MCVS, with a special reference to the multiplicity of biochemical changes. The possibilities for at least three basic disorders being of primary or causal importance in different individuals are stressed. These are chronic sympathetic overactivity, insulin resistance, and central or visceral obesity. By including the related changes in the hemostatic systems with "hypercoagulability" and "hypofibrinolysis," whereby the importance of thrombosis for the clinically often dramatic complications of the MCVS is stressed, the more specific name atherothrombogenic syndrome (ATS) has been proposed. The non-pharmacological treatment of the syndrome with low-caloric diet and physical exercise is emphasized.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular Diseases↗
PubMed1992

Effects of long-term anticoagulant therapy in subgroups after acute myocardial infarction.

This post hoc analysis of the Warfarin Re-Infarction Study evaluates the effect of long-term anticoagulant therapy in different subgroups after acute myocardial infarction (MI). The study population comprised 1214 patients. The mean duration of treatment was 37 months. The overall significance of prespecified prognostic factors was assessed by univariate survival analyses. Those risk factors that yielded a statistically significant result were evaluated with regard to response to treatment in a stratified manner. After stratification, heterogeneity across the strata was found to pertain to the effect of treatment with warfarin in subjects with prior MI and diabetes mellitus. Hence, mortality was not found to be influenced favorably by warfarin therapy in patients with previous MI. Likewise, recurrent MI was not significantly reduced by warfarin therapy in patients with prior MI or diabetes mellitus. Although not statistically significant, increasing age was associated with less benefit from therapy. The findings persisted also after controlling for possible confounders in a Cox regression model. Thus, our data suggest a lack of a beneficial effect by warfarin therapy in subjects with prior MI or diabetes mellitus, when the therapy is given for the sole purpose of secondary prophylaxis of MI. Furthermore, a trend toward an attenuated effect of therapy was found among the oldest patients.

Confounding Factors, Epidemiologic↗
PubMed1991

The predictability of bleeding by prothrombin times sensitive or insensitive to PIVKA during intensive oral anticoagulation.

To evaluate the effect of PIVKA (Proteins Induced by Vitamin K Absence or Antagonism) on the bleeding tendency during oral anticoagulation, we studied consecutive patients intensively treated with warfarin (INR greater than 4.8). The level of anticoagulation was measured with the PIVKA-insensitive Normotest (NT) as well as with the PIVKA-sensitive Thrombotest (TT), and the results are expressed as per cent coagulant activity. The NT/TT ratio was determined. Twenty patients with bleeding episodes had a mean NT/TT ratio of 2.06 as compared to 2.20 in 143 patients without bleeding episodes (p = 0.08). As the NT/TT ratio was not higher in patients with bleedings, we conclude that PIVKA are of no importance for bleeding during anticoagulation with vitamin K antagonists.

Adult↗
PubMed1991

Positive psychological and life-style changes after myocardial infarction: a follow-up study after 2-4 years.

An interview study of 84 males recruited from a post-infarction anticoagulant trial revealed a number of positive changes regarding life-style and factors related to quality of life 3-5 months after the index infarction. In the present study we investigated the extent to which such changes persist after 2-4 (additional) years. Seventy-four of 75 survivors responded to a postal questionnaire. The answers concerning the total life situation, as compared with the last month before the myocardial infarction, were as follows (response after 3-5 months in brackets): improved 29% (33%), unchanged/uncertain 47% (47%) and deteriorated 24% (20%). There were still appreciable positive changes at follow-up regarding smoking, physical activity, alcohol consumption and stress at work. Similar changes or a slight reduction were observed in previously reported positive scoring of factors related to quality of life. The same applied to the two General Health Questionnaire scorings. We conclude that positive changes in psychosocial and life-style factors as seen shortly after myocardial infarction generally seem to persist after 2-4 years.

Adult↗
PubMed1990

The effect of warfarin on mortality and reinfarction after myocardial infarction.

BACKGROUND AND METHODS: The use of oral anticoagulation in the long-term treatment of survivors of acute myocardial infarction has been highly controversial. We therefore randomly assigned 1214 patients who had recovered from acute myocardial infarction (mean interval from the onset of symptoms to randomization, 27 days) to treatment with warfarin (607 patients) or placebo (607 patients) for an average of 37 months (range, 24 to 63). RESULTS: At the end of the treatment period, there had been 123 deaths in the placebo group and 94 in the warfarin group--a reduction in risk of 24 percent (95 percent confidence interval, 4 to 44 percent; P = 0.027). A total of 124 patients in the placebo group had reinfarctions, as compared with 82 in the warfarin group--a reduction of 34 percent (95 percent confidence interval, 19 to 54 percent; P = 0.0007). Furthermore, we observed a reduction of 55 percent (95 percent confidence interval, 30 to 77 percent) in the number of total cerebrovascular accidents in the warfarin group as compared with the placebo group (44 vs. 20; P = 0.0015). Serious bleeding was noted in 0.6 percent of the warfarin-treated patients per year. CONCLUSIONS: Long-term therapy with warfarin has an important beneficial effect after myocardial infarction and can be recommended in the treatment of patients who survive the acute phase.

Cerebrovascular Disorders↗
PubMed1990

Effects of gemfibrozil on lipids and haemostasis after myocardial infarction.

The effects of gemfibrozil on haemostatic variables were studied in 43 survivors of myocardial infarction with serum triglycerides (TG) greater than or equal to 2 mmol/l 2 weeks prior to randomization. The study was double-blind, placebo-controlled and stratified for chronic betablockade. Twenty-two individuals were given gemfibrozil 600 mg twice daily and 21 individuals received matching placebo. After 8 weeks the TG level was unchanged in the placebo group, whereas a 44% reduction was noted in the gemfibrozil group (p less than 0.001). Fibrinogen increased in both groups, while bleeding time and platelet count were unchanged. Clotting factor VII-phospholipid complex decreased in both groups, but the change was more marked and attained statistical significance only in the gemfibrozil group (60% reduction, p less than 0.01). By DDAVP-stimulated D-Dimer agglutination test 8 in 21 patients in the placebo group (38%) still had reduced fibronolytic capacity versus none in the gemfibrozil group (p = 0.001). Thus, in this study, gemfibrozil improved reduced fibrinolytic capacity and may have reduced hypercoagulability by lowering the clotting factor VII-phospholipid complex.

Aged↗
PubMed1990

Mortality in non-consenters in a post-myocardial infarction trial.

Follow-up of 270 subjects who declined to participate in a trial of oral anticoagulant therapy after acute myocardial infarction revealed a higher mortality (25.6%) than that for participants in the placebo group (20.2%). The excess mortality in terms of odds ratios was 1.35 (90% confidence interval 1.02-1.79). Age was the only predictor of death. The event rate from ischaemic cardiovascular disease was lower among non-consenters than among participants (49.3% vs. 74.8%), as was the rate of death during the first year of follow-up. In conclusion, the differing mortality and dissimilar patterns of specific causes of death in non-consenters and placebo-treated participants emphasize the need for caution in extrapolation of treatment effects to the non-consenting group. Thus the size of the non-consenting group has implications for generalization of the overall results.

Age Factors↗
PubMed1989

Influence of highly concentrated n-3 fatty acids on serum lipids and hemostatic variables in survivors of myocardial infarction receiving either oral anticoagulants or matching placebo.

Forty patients with previous myocardial infarction were given 4 capsules with 1 g concentrated fish oil preparation daily for 4 weeks. No special diet was applied. The supplementation was equivalent to 3.4 grams of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) daily. Twenty-two of the 40 subjects received concomitant treatment with long-term oral anticoagulants (OAC). The fatty acid composition of serum after the supplementation period showed a significant increase in the proportion of EPA and DHA, while arachidonic acid (AA) remained essentially constant. This resulted in a rise of the EPA/AA ratio from 0.59 to 1.49 (p less than 0.001), confirming satisfying absorption of the concentrate. Blood lipids showed an overall decrease of triglycerides (TG) by 25% (p = 0.02), while total cholesterol rose by 5% (p = 0.03) and HDL-cholesterol was unaffected. Blood glucose and the TG associated factors plasminogen activator inhibitor and factor VII-phospholipid complex revealed trends towards reduction. Ivy bleeding time showed a significant prolongation, the median increasing from 240 to 270 seconds. A significant increase of fibrinogen was seen, as was a decrease of clotting time in the combined prothrombin test in patients receiving concomitant OAC. Thus, given for 4 weeks, the investigated concentrate of n-3 fatty acids exerts not merely beneficial effects as far as the risk profile for atherosclerotic disease is concerned. The results also point towards interactions with OAC that may be of clinical relevance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Non-respondents in a post-myocardial infarction trial: characteristics and reasons for refusal.

We surveyed the 270 survivors of acute myocardial infarction who refused to participate in the Warfarin Re-Infarction Study (WARIS). Information on medical variables were derived from registration forms completed by hospital staff upon discharge, whereas data on a variety of health conditions and reasons for refusal were gathered by mailed questionnaires, 178 (66%) of which were returned. Some disparities were found when comparing non-respondents and participants, the former showing more potential bad risk factors. The diversities between participants and non-respondents are of yet unknown prognostic importance. However, the presence of such differences imply that information on characteristics of non-respondents in clinical trials is desirable in terms of generalizability of the trial results. Reasons stated for non-participation reflect poor motivation, low mobility and saturation with focusing on disease. A slight co-variation between social status and reasons for refusal was noted.

Clinical Trials as Topic↗
PubMed1988

Correlation between plasma levels of selenium and antithrombin-III.

Patients with previous myocardial infarction were tested for antithrombin-III (AT-III) activity and selenium levels in their plasma and compared with sex- and age-matched healthy control individuals. Patients and controls showed a positive correlation between AT-III and selenium levels (r = 0.27, p = 0.015). After calculatory adjustment for this correlation, selenium was found to be significantly negatively correlated with disease. Multivariate analysis of differences between patients and controls indicated that triglyceride levels in serum had the greatest discriminatory ability (r2 = 0.169), followed by AT-III (r2 = 0.072) and selenium (r2 = 0.056). The increased AT-III levels were correlated with the use of warfarin and beta blockers in the patients, but these drugs could not explain the comparatively low selenium levels in the patients. Serum total cholesterol and plasma fatty acid composition had no discriminatory power in multivariate testing. The various fatty acid did not show co-variation with the selenium levels. The clinical significance of these observations is not clear, but they are consistent with the hypothesis that selenium is an important determinant in cardiovascular disease. The relation between AT-III and selenium should be further evaluated.

Antithrombin III↗