PubMed Health⌕ Search

Biomedical subjects

H Wedel

Publications and source records attributed to H Wedel.

At least 19 recordsLinked to original sources
PubMed1992

Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II)

BACKGROUND: Long-term administration of angiotensin-converting--enzyme (ACE) inhibitors has been shown to improve survival in patients with symptomatic left ventricular failure and to attenuate left ventricular dilatation in patients with myocardial infarction. We studied whether mortality could be reduced during the 6 months after an acute myocardial infarction with use of the ACE inhibitor enalapril. METHODS: At 103 Scandinavian centers patients with acute myocardial infarctions and blood pressure above 100/60 mm Hg were randomly assigned to treatment with either enalapril or placebo, in addition to conventional therapy. Therapy was initiated with an intravenous infusion of enalapril (enalaprilat) within 24 hours after the onset of chest pain, followed by administration of oral enalapril. RESULTS: Of the 6090 patients enrolled, 3046 were assigned to placebo and 3044 to enalapril. The life-table mortality rates in the two groups at one and six months were not significantly different (6.3 and 10.2 percent in the placebo group vs. 7.2 and 11.0 percent in the enalapril group, P = 0.26). The relative risk of death in the enalapril group was 1.10 (95 percent confidence interval, 0.93 to 1.29). Death due to progressive heart failure occurred in 104 patients (3.4 percent) in the placebo group and 132 (4.3 percent) in the enalapril group (P = 0.06). Therapy had to be changed because of worsening heart failure in 30 percent of the placebo group and 27 percent of the enalapril group (P less than 0.006). Early hypotension (systolic pressure less than 90 mm Hg or diastolic pressure less than 50 mm Hg) occurred in 12 percent of the enalapril group and 3 percent of the placebo group (P less than 0.001). CONCLUSIONS: Enalapril therapy started within 24 hours of the onset of acute myocardial infarction does not improve survival during the 180 days after infarction.

Administration, Oral↗
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

Coronary heart disease, cancer and mortality in male middle-aged light smokers.

We examined the effect of light smoking in relation to incidence of coronary heart disease (CHD) in a general population sample consisting of 6879 men aged 47-55 years and free of previous myocardial infarction (MI) at baseline. After a follow-up of mean duration 11.8 years, 11.0% of men smoking 1-4 cigarettes daily (n = 228) had suffered a major CHD event, compared to 3.7% of non-smokers (n = 2049) [adjusted odds ratio 2.8 (1.7-4.7)]. No further increase in risk was observed in men who smoked more. There was an increasing risk of death from cancer with the number of cigarettes smoked per day. Mortality was increased in all categories of cigarette smokers, particularly among the very heavy smokers, who had a mortality risk of 22% compared to 6% among nonsmokers [adjusted odds ratio 4.4 (2.7-7.1)]. Data from an examination 4 years later considered only those men who stated that their smoking habits were identical on both occasions (n = 3981). Among these subjects the incidence of CHD after a mean period of 7.1 years was 10.6% in men smoking 1-4 cigarettes per day, compared to 2.6% in nonsmokers [adjusted O.R. 4.6 (2.1-10.1)]. No dose-response effect was observed. Even very light cigarette smoking considerably increases the risk of CHD in middle-aged men.

Cause of Death↗
PubMed1992

Patient involvement in decision-making in surgical and orthopaedic practice. Effects of outcome of operation and care process on patients' perception of their involvement in the decision-making process.

As part of the project Perioperative Risk,--an epidemiological study of complications associated with surgical and orthopaedic operations--the article reports a study of patients' perception of their involvement in decision-making in medical consultations, and how the outcomes of surgery and subsequent care determine patients' evaluation of the treatment. Patients' view of their involvement in the decision-making process was obtained before as well as after surgery. The results reveal that the more satisfied the patients were with the outcome of the operation, and the post-operative situation, the more they were inclined to assume responsibility for the decision to have surgery. The opposite response pattern, indicating a negative evaluation of either the operation or the post-operative care, resulted in an outcome where patients described others--especially the physician--as being responsible for the decision to have surgery. The results suggest that patients' evaluations of surgery are based upon a more global reaction to what happened during the entire care process. Dissatisfaction with either the operation or the post-operative care leads to a negative outcome in terms of patients' perceptions of their own involvement. This emphasizes the importance of all health care professionals seeing themselves as a team with complementary responsibilities for success in health care.

Decision Making↗
PubMed1992

Fasting insulin in relation to subsequent blood pressure changes and hypertension in women.

The role of hyperinsulinemia in the development of hypertension is not well understood, particularly insofar as both conditions relate to obesity. The present analysis examines the hypothesis that hyperinsulinemia, independent of obesity, precedes hypertension and natural blood pressure increases in women. The subjects were 50-year-old women from a prospective population study in Gothenburg, Sweden. Fasting insulin levels were determined at baseline (1968-1969) and were evaluated in relation to subsequent hypertension. Blood pressures were measured at the initial physical examination and at the 6- and 12-year follow-up examinations. The first analysis presented here (n = 278) identified incident cases of hypertension during the 12-year follow-up period, whereas the second analysis (n = 219) examined continuous changes in blood pressure. In both analyses, degree, type, and changes in obesity were considered as possible confounding factors. High fasting insulin values were predictive of subsequent incidence of hypertension over the 12-year follow-up period. Subjects with insulin values above the 75th percentile experienced three times more hypertension than did those below the 25th percentile. There was also a significant association between insulin at baseline and increases in diastolic (but not systolic) blood pressure. The positive relations between fasting insulin, on one hand, and diastolic blood pressure changes and hypertension, on the other, could not be explained by confounding effects of body mass index, waist/hip ratio, or weight gain. These findings are consistent with the hypothesis that fasting insulin levels may be one predisposing factor in the etiology of hypertension.

Blood Pressure↗
PubMed1990

Lipoprotein (a) and coronary heart disease: a prospective case-control study in a general population sample of middle aged men.

OBJECTIVE: To examine the association between the serum lipoprotein (a) concentration and subsequent coronary heart disease. DESIGN: Prospective case-control study based on a six year follow up of a general population sample of men aged 50 at baseline in 1983-4. Serum samples were frozen at the time of the baseline examination and kept at -70 degrees C for six years, after which the lipoprotein (a) concentrations in the samples were measured in cases and controls. SETTING: City of Gothenburg, Sweden. SUBJECTS: 26 Men, from a general population sample of 776 men, who had sustained a myocardial infarction or died of coronary heart disease during the six years and 109 randomly selected controls from the same sample who had remained free of myocardial infarction. In neither cases nor controls was there a history of myocardial infarction at baseline. MAIN OUTCOME MEASURES: Proportion of myocardial infarction or deaths from coronary heart disease, or both, in relation to the serum lipoprotein (a) concentration. RESULTS: Men who suffered coronary heart disease had significantly higher serum lipoprotein (a) concentrations than controls (mean difference 105 mg/l; 95% confidence interval 18 to 192 mg/l). Men with the highest fifth of serum lipoprotein (a) concentrations (cut off point 365 mg/l) suffered a coronary heart disease rate which was more than twice that of men with the lowest four fifths of concentrations. Logistic regression analysis showed the serum lipoprotein (a) concentration to be significantly associated with coronary heart disease independently of other risk factors. CONCLUSION: The serum lipoprotein (a) concentration in middle aged men is an independent risk factor for subsequent myocardial infarction or death from coronary heart disease.

Case-Control Studies↗
PubMed1990

Social influences and cardiovascular risk factors as determinants of plasma fibrinogen concentration in a general population sample of middle aged men.

OBJECTIVE: To analyse the relation between fibrinogen concentration and social class and other social factors found to be related to mortality. The results regarding cardiovascular disease are unpublished, as yet. DESIGN: Cross sectional population study. SETTING: City of Gothenburg, Sweden. SUBJECTS: 639 Men from a population sample of 1016 men aged 50 in 1983. They were all employed and had no history of myocardial infarction or stroke. Fibrinogen values were available for all of them. MAIN OUTCOME MEASURE: Fibrinogen concentration in relation to socioeconomic state according to occupation, and other social influences determined as number of people in the household and scores of social activities and activities in and outside the house. RESULTS: Men with low scores for activities at home had a mean plasma fibrinogen concentration of 3.34 g/l (95% confidence interval 3.21 to 3.47), whereas those with an intermediate score had a mean concentration of 3.16 (3.00 to 3.32) g/l and those with a high score 3.02 (2.95 to 3.10) g/l. Similar inverse relations were noted for the two other activity scores and for occupational class (class 1 being unskilled and semiskilled workers and class 5 professionals and executives) and the number of people in the household. Smoking exerted a strong influence on fibrinogen concentration, the relations between fibrinogen concentration and social factors being evident only in non-smokers. The mean difference in fibrinogen value between the non-smokers with the lowest activity scores at home and those with the highest scores was 0.36 (0.19 to 0.54) g/l, and similar differences were seen for the two other activity scores. Multiple regression analyses showed smoking, body mass index, the sum of all activities (inverse relation), and diabetes to be independently associated with fibrinogen value, whereas occupational class (p = 0.81) and the number of people in the household (p = 0.09) were not. CONCLUSIONS: Psychosocial influences seem to influence the coagulation system in the body in a way that is associated with cardiovascular disease and premature death.

Body Mass Index↗
PubMed1990

The J-shaped relationship between coronary heart disease and achieved blood pressure level in treated hypertension: further analyses of 12 years of follow-up of treated hypertensives in the Primary Prevention Trial in Gothenburg, Sweden.

The relationship between the blood pressure level achieved through antihypertensive treatment and the incidence of coronary heart disease (CHD) was studied in 686 middle-aged hypertensive men. The patients studied came from a random population sample and were followed-up for 12 years, yielding a total of 6563 patient-years for the study. Eighty-seven patients suffered a non-fatal myocardial infarction or died from CHD. The incidence of CHD showed a J-shaped distribution in relation to achieved treated systolic and diastolic blood pressure levels. The incidence of CHD, adjusted for entry characteristics, age, serum cholesterol, blood pressure and smoking habits, decreased with reductions in blood pressure achieved through treatment, to a level of about 150/85 mmHg, below which the incidence rate again increased. This J-shaped pattern was also observed when data from patients with pre-existing signs or symptoms of ischemic heart disease at entry were excluded. Using a quadratic term as the best fit to the observed relationship between achieved treated diastolic blood pressure level and the incidence of CHD, a Cox regression analysis showed that the nadir of the J-shaped incidence curve was at a diastolic blood pressure value of 81 mmHg. There did not seem to be any association between the absolute size of the blood pressure reduction during treatment and the incidence of CHD. Although we cannot exclude the possibility that the increased incidence of CHD in patients with a low treated blood pressure is due primarily to pre-existing but subclinical ischemic heart disease, our findings indicate that an excessive lowering of blood pressure in hypertensive patients may be harmful.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1989

Patient involvement in decision-making in surgical and orthopaedic practice: the Project Perioperative Risk.

As part of the Project Perioperative Risk (PROPER), which is a clinical and epidemiological study of surgical complications, patient involvement in the decision to operate was evaluated by means of a questionnaire. The sample of 666 patients, on the waiting list for an operation, received a questionnaire on a broad range of issues concerning their involvement in the decision-making process one week before the operation. The results show that 41% regarded the decision to have an operation as a joint patient-doctor decision, in 29% of the cases the doctor advocated an operation and in 8% the patient asked to be operated. A clear majority, 73% felt involved in the decision-making as much as they wished. Two groups--women and immigrants from non-European countries--were least satisfied with their involvement and they also found the decision more difficult to make. In the discussion, it is argued that the comparatively high degree of patient satisfaction with involvement in the decision-making process cannot be taken as evidence of a high level of influence in an absolute sense. In a normative perspective--and considering the fact that the increased responsibility of the health sector is aimed at involving patients in decision-making in health matters--patient satisfaction can just as well be understood as resulting from low expectations with respect to one's own influence. The results also indicate that patient's information needs when facing surgery relate to three issues; possible complications, precise nature of the operation as such, and nature and consequences of anaesthetic procedures.

Adolescent↗
PubMed1989

Marital status and mortality in middle-aged Swedish men.

In a large primary prevention trial among middle-aged men in Gothenburg, Sweden, register data were used to establish marital status, alcohol abuse, and economic problems for nearly all of the study population in 1970-1973. Married men had a higher participation rate in the examinations for the trial than non-married men, with non-married alcoholic men having the lowest participation rates. Among the participants, 26% of divorced men, but only 5% of married men were registered with the social authorities for alcohol problems. Serum cholesterol, body mass index, and diabetes were not associated with marital status, but smoking was more common among widowers and divorced men. Nonfatal myocardial infarction was not related to marital status among participants, after a mean follow-up of 11.8 years. Death from coronary heart disease was more common in non-married men in univariate analysis, but not when other risk factors were taken into consideration. In participants, married men had a mortality rate of 9%, compared with 20% for divorced men. After adjustment for other risk factors, including registration for alcohol problems, smoking, and occupational class, the association between marital status and total mortality was still highly significant. Among nonparticipants in the trial, 13% of married men were registered for alcohol problems, compared with 41% of divorced men. Nonparticipants had higher all-cause mortality, 18% for married men and 33% for divorced men.

Adult↗
PubMed1989

Patients' and health care professionals' views of complications after elective surgery.

In this study, which is a part of a clinical-epidemiological study of post-operative complications, the Project Peri-operative Risk (PROPER), patients' and health professionals' perceptions of complications during the patients' stay in hospital are analysed. Five hundred and ten patients admitted for elective (= planned) surgery and attending a pre-operative outpatient clinic set up for this project were seen pre-operatively and then monitored closely during and after surgery. Three months after having been operated on, they were sent a postal questionnaire in which they were asked to indicate whether they had suffered post-operative complications and to evaluate the care process. The incidence of complications reported by patients and staff was similar, but there were large differences at the individual level. Two-thirds of the staff-reported complications were not reported by the patients and vice versa. Patients generally classified complications as more severe than the staff did. Patients' evaluation of the care process was clearly related to reported complications. Most dissatisfied were those patients who reported complications not reported by the staff, and the most satisfied were those who had complications according to the staff but no complications according to themselves. The implication of these findings is discussed.

Attitude of Health Personnel↗
PubMed1989

CHD in Sweden: mortality, incidence and risk factors over 20 years in Gothenburg.

Mortality from coronary heart disease (CHD) increased among Swedish men between 1968 and 1981, but after that, began to decline. CHD mortality in women decreased slightly, mostly among older women. From 1980, the incidence of non-fatal myocardial infarction (MI) started to decrease among men. Among middle-aged women, however, there was a significantly increased incidence. Mortality during the two years following hospital discharge decreased both in men and women between 1968 and 1985 in Gothenburg. Between one-sixth and one-fifth of major CHD events occur among patients with previous MI or angina pectoris. Serum cholesterol and smoking habits increased among middle-aged men from 1963 to 1973, but decreased thereafter. Blood pressure decreased, and the percentage of people on treatment increased. Blood pressure and serum cholesterol decreased among middle-aged women, but smoking and triglycerides increased. These different trends might explain an increasing CHD incidence among younger women but decreasing incidence and mortality among older women.

Age Factors↗
PubMed1988

Coronary heart disease and mortality in middle aged men from different occupational classes in Sweden.

In the Gothenburg primary prevention study 7083 middle aged men were classified into five categories by occupational state. A retrospective analysis of the data showed that low occupational class was associated with slight increases in smoking rates, systolic blood pressure, serum cholesterol concentration, body mass index, and heart rate. Alcohol abuse was strongly associated with low occupational class. After a mean of 11.8 years' follow up the incidence of coronary heart disease was found to be strongly and inversely related to occupational class. For death from coronary heart disease this association fell just below significance when other risk factors were taken into account, but the inverse association between non-fatal myocardial infarction and occupational class persisted even in multivariate analysis. A weak but independent inverse relation was found between occupational class and fatal cancer. Mortality from all causes in the lowest occupational class was 12% compared with 6% in the highest class, and this difference could only partly be explained by other factors. After 10 years a sub-sample of the men were examined again. Risk factors had decreased in all occupational classes, but the changes in risk were not associated with occupational class. Social class, defined by occupation, in Sweden is clearly related to the incidence of coronary heart disease.

Blood Pressure↗
PubMed1988

Factors of importance for prognosis in men with angina pectoris derived from a random population sample. The Multifactor Primary Prevention Trial, Gothenburg, Sweden.

A random population sample of middle-aged men from the Primary Prevention Trial was followed for 11.3 years from a first screening when different factors known to be associated with coronary artery disease (CAD) were analyzed. Men with uncomplicated angina pectoris (AP) (n = 167) derived from this population had an incidence of fatal and nonfatal CAD events 3 times higher than that of men without AP or myocardial infarction (n = 5,774). Men with myocardial infarction with or without AP had an incidence of CAD events 7 to 8 times higher than that of men without AP or myocardial infarction. Similar differences were found for new cases of uncomplicated AP (n = 128) and myocardial infarction detected at a second screening after 4 years and followed for 7.3 years. Pooled data from this series of men with uncomplicated AP showed the following factors to be associated in multivariate analysis with nonfatal or fatal CAD endpoints during follow-up: elevated serum cholesterol, elevated blood pressure, smoking and attack score. The risk increase associated with the first 3 factors was similar to the general population. These findings indicate that the same factors affecting prognosis after a first appearance of AP affect similarly patients with myocardial infarction and clinically healthy subjects. Preventive measures against these risk factors seem to be of similar importance among patients with AP, post-infarct patients and healthy subjects.

Angina Pectoris↗
PubMed1988

Separate and combined effects of smoking and alcohol abuse in middle-aged men.

Alcohol abuse is a major predictor of premature death, and also an independent risk factor for coronary death. Alcoholics are often heavy smokers. In a large primary prevention trial in middle-aged men with 7,495 participants, registration data were used to identify subjects with alcohol problems. Smokers had slightly lower blood pressure and were somewhat leaner than non-smokers, but had slightly higher serum cholesterol levels. Alcohol-registered subjects also tended to have lower blood pressure levels, and higher serum cholesterol. The relative risk of non-fatal myocardial infarction during the follow-up period of 11.8 years was essentially doubled in smokers compared to non-smokers, regardless of registration for alcohol problems. Among the non-alcoholic subjects, the relative risk of coronary death in smokers was double that of non-smokers, whereas the risk in non-smoking alcoholic subjects was not significantly increased. In smoking alcoholics the relative risk was substantially raised to 4.2 (3.0-7.0; 95% c.i.). In multivariate analysis both smoking and alcohol abuse were independently associated with coronary death. A possible mechanism might be through a combination of tobacco-induced coronary arteriosclerosis and the cardiotoxic effects of alcohol. As to total mortality, a smoking non-alcoholic man had a relative risk of dying almost double that of a non-alcoholic non-smoker. Among non-smoking alcoholics the risk was three times and, in smoking alcoholics over four times that of the non-alcoholic non-smokers.

Age Factors↗
PubMed1987

Risk factors for angina pectoris in a population study of Swedish men.

The Primary Preventive Trial in Göteborg, Sweden, a study of a random population sample of middle-aged men, made it possible to analyse the risk factor pattern cross-sectionally in 166 men with uncomplicated angina pectoris (AP) and compare with 5735 men without angina pectoris or myocardial infarction (MI). A prospective analysis was also performed concerning the risk factor pattern in 128 cases with uncomplicated AP and 34 cases with complicated AP (following an MI) respectively, appearing during a follow-up time of 4 years. At cross-sectional analysis, uncomplicated AP was related to elevated serum cholesterol, elevated systolic and diastolic blood pressure, increased relative body weight, smoking, diabetes mellitus, low physical activity during leisure time, dyspnea and mental stress. However at multivariate, prospective analysis only dyspnea, stress, diabetes mellitus and increased relative body weight were predictors for uncomplicated AP. In contrast, elevated serum cholesterol, high blood pressure, smoking, and high physical activity at work were predictors for complicated AP. Possible reasons for the apparent risk factor differences and different mechanisms in AP and MI are discussed.

Aged↗
PubMed1987

Mortality and morbidity in relation to systolic blood pressure in two populations with different management of hypertension: The Study of Men Born in 1913 and the Multifactorial Primary Prevention Trial.

Total mortality and cardiovascular disease (CVD) mortality and morbidity during 10 years of follow-up in relation to systolic blood pressure (SBP) at entry were compared between a random sample of 7455 men, aged 47-54 years at entry, in whom multifactorial risk-factor intervention including intense efforts to detect and treat hypertension had been performed [the Primary Prevention Trial (PPT)], and a similar population (from an observational study) in which intervention, on CVD risk factors was kept to a minimum (the Study of Men Born in 1913). Total mortality, CVD mortality, coronary heart disease (CHD) and stroke incidence increased with SBP in both populations, but levelled off above the cut-off point for antihypertensive treatment in the population subjected to multifactorial CVD risk factor intervention. In this population total mortality was reduced by 30%, CVD mortality by 37%, CHD morbidity by 13% and stroke morbidity by 30% above the cut-off point for blood pressure intervention compared with the incidence predicted from the observational study. These findings indicate that multifactorial intervention, and especially antihypertensive treatment, have preventive effects in the hypertensive part of the middle-aged male population.

Age Factors↗