Biomedical subjects

Ingar Holme

Publications and source records attributed to Ingar Holme.

At least 19 recordsLinked to original sources

PubMed2006

[Changes in cardiovascular risk factors among men in Oslo during 28 years].

BACKGROUND: The aim of the study was to measure changes in known risk factors for cardiovascular disease among men over a period of 28 years. MATERIAL AND METHODS: The present cohort study comprises a selection of men previously included in the Oslo-study of 1972/73. The men selected, were either followed-up in the Oslo II study (n = 5,323), or were included in five other studies in the period 1996-2001 (n = 1,834). The total material is named The second screening of the Oslo-study and consists of 7157 men. RESULTS: The men were born between 1923 and 1952. All age groups showed a marked increase in mean weight by 4.4 Kg. Body Mass Index changed from 24.3 to 26.4 kg/m2 , coinciding with reduced level of physical activity in all age groups. A comparison of body mass index in men of the same age in 1972/73 and 2000, show a mean increase in body mass index of two units. An increase of 0.30 mmol/L glucose (non-fasting) was observed. Total cholesterol decreased from 6.19 to 5.95 mmol/L and triglycerides remained unchanged (1.89 to 1.87 mmol/L). Systolic blood pressure increased but not the diastolic pressure. Overall 30.8 % of the men took medication for increased blood pressure, versus 3.1 % at the first screening. The percentage of daily smokers decreased from 44.2 % to 17.4 %. INTERPRETATION: The most encouraging result was the strong reduction in number of daily smokers. The study confirms the weight increase observed among men in Norway.

Aged↗

PubMed2006

[Is a healthy lifestyle worthwhile?].

BACKGROUND: The men invited to participate in the Oslo Study in 1972/3 were invited again to participate in the Oslo II study in 2000. We examined whether self-reported lifestyle habits were associated with biological markers, a range of symptoms and several illnesses in 2000. MATERIAL AND METHODS: In addition to data from Oslo II, were data from those men of the Oslo-cohort who participated in 5 other studies between 1998 and 2001. The total material is named The second screening of the Oslo-study. Levels of lipids and glucose, height, weight, waist and hip circumferences and blood pressure were measured in 6,410 men born in 1923-32 that participated in both surveys. Participants were divided into four groups according to their lifestyle habits in both surveys, as follows: unhealthy, somewhat unhealthy, somewhat healthy and healthy lifestyle. RESULTS: Participants with a healthy lifestyle had a lower number of symptoms and illnesses, prevalence of the metabolic syndrome and waist-hip ratio, compared to those with a less healthy lifestyle. The number of men with psychological distress leading to treatment, was inversely associated with an increasingly healthy lifestyle. After adjustment for level of education and smoking in both 1972/3 and in 2000, the relationship between health profile and lifestyle became more linear. INTERPRETATION: A healthy lifestyle was associated with protective levels of risk factors and lower prevalences of a wide range of illnesses.

Aged↗

PubMed2006

Helmet use and risk of head injuries in alpine skiers and snowboarders.

CONTEXT: Although using a helmet is assumed to reduce the risk of head injuries in alpine sports, this effect is questioned. In contrast to bicycling or inline skating, there is no policy of mandatory helmet use for recreational alpine skiers and snowboarders. OBJECTIVE: To determine the effect of wearing a helmet on the risk of head injury among skiers and snowboarders while correcting for other potential risk factors. DESIGN, SETTING, AND PARTICIPANTS: Case-control study at 8 major Norwegian alpine resorts during the 2002 winter season, involving 3277 injured skiers and snowboarders reported by the ski patrol and 2992 noninjured controls who were interviewed on Wednesdays and Saturdays. The controls comprised every 10th person entering the bottom main ski lift at each resort during peak hours. The number of participants interviewed corresponded with each resort's anticipated injury count based on earlier years. MAIN OUTCOME MEASURE: Injury type, helmet use, and other risk factors (age, sex, nationality, skill level, equipment used, ski school attendance, rented or own equipment) were recorded. A multivariate logistic regression analysis was used to assess the relationship between individual risk factors (including helmet wear) and risk of head injury by comparing skiers with head injuries with uninjured controls, as well as to skiers with injuries other than head injuries. RESULTS: Head injuries accounted for 578 injuries (17.6%). Using a helmet was associated with a 60% reduction in the risk for head injury (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.30-0.55; adjusted for other risk factors) when comparing skiers with head injuries with uninjured controls. The effect was slightly reduced (OR, 0.45; 95% CI, 0.34-0.59) when skiers with other injuries were used as controls. For the 147 potentially severe head injuries, those who were referred to an emergency physician or for hospital treatment, the adjusted OR was 0.43 (95% CI, 0.25-0.77). The risk for head injury was higher among snowboarders than for alpine skiers (adjusted OR, 1.53; 95% CI, 1.22-1.91). CONCLUSION: Wearing a helmet is associated with reduced risk of head injury among snowboarders and alpine skiers.

Adolescent↗

PubMed2006

Does low-density lipoprotein size add to atherogenic particle number in predicting the risk of fatal myocardial infarction?

The lipoprotein-related risk of coronary artery disease is determined principally by the balance between atherogenic lipoprotein particles, i.e., the lipoprotein that contain apolipoprotein-B (apo-B), and the antiatherogenic particles, i.e., high-density lipoprotein particles that contain apo-A-I. However, there is also considerable evidence that patients with predominantly small dense low-density lipoprotein (LDL) have more adverse clinical outcomes than do those with large buoyant LDL. The AMORIS study prospectively examined the relative importance of lipoprotein lipids versus apolipoproteins on the risk of fatal myocardial infarction in a large Swedish cohort. This updated analysis includes 69,029 men and 57,167 women who were followed for a mean of 10.3 years. Our objective was to determine whether LDL size as reflected by the LDL cholesterol/apo-B ratio added significant predictive power to apo-B or the apo-B/apo-A-I ratio. Although apo-A-I added significantly to the predictive power of apo-B, categorical and continuous multivariate analyses showed that this is not the case for LDL size. The strongest single lipoprotein-related risk factor was the apo-B/apo-A-I ratio. In conclusion, these results provide further confirmation of the importance of determining apo-B and apo-A-I in routine clinical practice.

Adult↗

PubMed2006

Markers of inflammation are inversely related to physical activity and fitness in sedentary men with treated hypertension.

BACKGROUND: Physical inactivity is an important risk factor for atherosclerotic disease. We studied the relationship between physical activity and physical fitness and soluble markers of atherosclerotic activity in men with drug-treated hypertension. METHODS: The participants (n = 177, 40 to 74 years of age), who were randomly recruited from the Hypertension High Risk Management Trial (HYRIM), were overweight and had sedentary lifestyles. The inflammatory markers high-sensitivity C-reactive protein (hs-CRP), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (SICAM-1) and soluble E-selectin (sE-selectin) and the hemostatic markers soluble thrombomodulin (sTM), von Willebrand factor (vWf), and tissue plasminogen activator antigen (tPAag) were measured. Physical activity was measured by use of a questionnaire. Time to exhaustion in a bicycle test was used as an expression of physical fitness. RESULTS: The hs-CRP showed a significant inverse relationship with physical fitness independent of major cardiovascular risk factors (P = .017) but was not related to physical activity. The sE-selectin was significantly related to physical activity, although only when other factors were taken into account (P = .033), and it had no significant association with physical fitness. In addition there were strong associations between hs-CRP and sICAM-1 and the Framingham Coronary Heart Disease risk score (P < .001). CONCLUSIONS: The observed inverse relations between physical fitness and hs-CRP and between level of physical activity and sE-selectin in drug-treated, hypertensive sedentary men indicates a beneficial effect of good fitness status as well as activity of low intensity on vessel wall inflammation.

Adult↗

PubMed2006

Risk-factor profile for the incidence of subarachnoid and intracerebral haemorrhage, cerebral infarction, and unspecified stroke during 21 years' follow-up in men.

AIMS: To study the risk-factor profile for the incidence of non-fatal and fatal stroke among middle-aged men according to the stroke subtypes subarachnoid or intracerebral haemorrhage, cerebral infarction, and unspecified stroke. METHODS: The study design is a prospective cohort study. A total of 16,209 men aged 40-49 years resident in Oslo were screened for cardiovascular disease risk factors in 1972-73. Of these, 14,403 men had no cardiovascular symptoms or diseases or diabetes. The incidence of stroke after 21 years of follow-up of all men was extracted from hospital records and linkage to Statistics Norway. RESULTS: A total of 429 non-fatal and 107 fatal stroke events were registered. Case fatality within 28 days (number and percentage of cases) was 51% (41, 7.7%) for subarachnoid haemorrhage, 39% (67, 12.6%) for cerebral haemorrhage, 10% (246, 46.3%) for cerebral infarct, and 19% (177, 33.4%) for unspecified stroke. Risk of stroke (not subarachnoid haemorrhage) increased with the presence of symptoms or a history of cardiovascular disease or diabetes. In multivariate analysis of men without CVD or diabetes, high blood pressure was a risk factor for all subtypes of stroke; furthermore, daily smoking was a risk factor for all subtypes except subarachnoid haemorrhage. Serum cholesterol and glucose concentrations and height (inverse association) were independently associated with cerebral infarction. Smoking was a significantly stronger predictor of fatal than non-fatal events. CONCLUSIONS: The risk-factor profile differed according to the underlying subtype of stroke. Cerebral infarction clearly shared with myocardial infarction the classical risk factors, including non-fasting glucose concentration.

Adult↗

PubMed2006

Promoting physical activity in a low-income multiethnic district: effects of a community intervention study to reduce risk factors for type 2 diabetes and cardiovascular disease: a community intervention reducing inactivity.

OBJECTIVE: The aim was to assess the net effects on risk factors for type 2 diabetes and cardiovascular disease of a community-based 3-year intervention to increase physical activity. RESEARCH DESIGN AND METHODS: A pseudo-experimental cohort design was used to compare changes in risk factors from an intervention and a control district with similar socioeconomic status in Oslo, Norway, using a baseline investigation of 2,950 30- to 67-year-old participants and a follow-up investigation of 1,776 (67% of those eligible, 56% women, 18% non-Western immigrants) participants. A set of theory-based activities to promote physical activity were implemented and tailored toward groups with different psychosocial readiness for change. All results reported are net changes (the difference between changes in the intervention and control districts). At both surveys, the nonfasting serum levels of lipids and glucose were adjusted for time since last meal. RESULTS: The increase in physical activity measured by two self-reported questionnaires was 9.5% (P = 0.008) and 8.1% (P = 0.02), respectively. The proportion who increased their body mass was 14.2% lower in the intervention district (P < 0.001), implying a 50% relative reduction compared with the control district, and was lower across subgroups. Beneficial effects were seen for triglyceride levels (0.16 mmol/l [95% CI 0.06-0.25], P = 0.002), cholesterol-to-HDL cholesterol ratio (0.12 [0.03-0.20], P = 0.007), systolic blood pressure (3.6 mmHg [2.2-4.8], P < 0.001), and for men also in glucose levels (0.35 mmol/l [0.03-0.67], P = 0.03). The net proportion who were quitting smoking was 2.9% (0.1-5.7, P = 0.043). CONCLUSIONS: Through a theory-driven, low-cost, population-based intervention program, we observed an increase in physical activity levels, reduced weight gain, and beneficial changes in other risk factors for type 2 diabetes and cardiovascular disease.

Adult↗

PubMed2005

High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial.

CONTEXT: Evidence suggests that more intensive lowering of low-density lipoprotein cholesterol (LDL-C) than is commonly applied clinically will provide further benefit in stable coronary artery disease. OBJECTIVE: To compare the effects of 2 strategies of lipid lowering on the risk of cardiovascular disease among patients with a previous myocardial infarction (MI). DESIGN, SETTING, AND PARTICIPANTS: The IDEAL study, a prospective, randomized, open-label, blinded end-point evaluation trial conducted at 190 ambulatory cardiology care and specialist practices in northern Europe between March 1999 and March 2005 with a median follow-up of 4.8 years, which enrolled 8888 patients aged 80 years or younger with a history of acute MI. INTERVENTIONS: Patients were randomly assigned to receive a high dose of atorvastatin (80 mg/d; n = 4439), or usual-dose simvastatin (20 mg/d; n = 4449). MAIN OUTCOME MEASURE: Occurrence of a major coronary event, defined as coronary death, confirmed nonfatal acute MI, or cardiac arrest with resuscitation. RESULTS: During treatment, mean LDL-C levels were 104 (SE, 0.3) mg/dL in the simvastatin group and 81 (SE, 0.3) mg/dL in the atorvastatin group. A major coronary event occurred in 463 simvastatin patients (10.4%) and in 411 atorvastatin patients (9.3%) (hazard ratio [HR], 0.89; 95% CI, 0.78-1.01; P = .07). Nonfatal acute MI occurred in 321 (7.2%) and 267 (6.0%) in the 2 groups (HR, 0.83; 95% CI, 0.71-0.98; P = .02), but no differences were seen in the 2 other components of the primary end point. Major cardiovascular events occurred in 608 and 533 in the 2 groups, respectively (HR, 0.87; 95% CI, 0.77-0.98; P = .02). Occurrence of any coronary event was reported in 1059 simvastatin and 898 atorvastatin patients (HR, 0.84; 95% CI, 0.76-0.91; P<.001). Noncardiovascular death occurred in 156 (3.5%) and 143 (3.2%) in the 2 groups (HR, 0.92; 95% CI, 0.73-1.15; P = .47). Death from any cause occurred in 374 (8.4%) in the simvastatin group and 366 (8.2%) in the atorvastatin group (HR, 0.98; 95% CI, 0.85-1.13; P = .81). Patients in the atorvastatin group had higher rates of drug discontinuation due to nonserious adverse events; transaminase elevation resulted in 43 (1.0%) vs 5 (0.1%) withdrawals (P<.001). Serious myopathy and rhabdomyolysis were rare in both groups. CONCLUSIONS: In this study of patients with previous MI, intensive lowering of LDL-C did not result in a significant reduction in the primary outcome of major coronary events, but did reduce the risk of other composite secondary end points and nonfatal acute MI. There were no differences in cardiovascular or all-cause mortality. Patients with MI may benefit from intensive lowering of LDL-C without an increase in noncardiovascular mortality or other serious adverse reactions.Trial Registration ClinicalTrials.gov Identifier: NCT00159835.

Aged↗

PubMed2005

Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial.

OBJECTIVE: To investigate the effect of a structured warm-up programme designed to reduce the incidence of knee and ankle injuries in young people participating in sports. DESIGN: Cluster randomised controlled trial with clubs as the unit of randomisation. SETTING: 120 team handball clubs from central and eastern Norway (61 clubs in the intervention group, 59 in the control group) followed for one league season (eight months). PARTICIPANTS: 1837 players aged 15-17 years; 958 players (808 female and 150 male) in the intervention group; 879 players (778 female and 101 male) in the control group. INTERVENTION: A structured warm-up programme to improve running, cutting, and landing technique as well as neuromuscular control, balance, and strength. MAIN OUTCOME MEASURE: The rate of acute injuries to the knee or ankle. RESULTS: During the season, 129 acute knee or ankle injuries occurred, 81 injuries in the control group (0.9 (SE 0.09) injuries per 1000 player hours; 0.3 (SE 0.17) in training v 5.3 (SE 0.06) during matches) and 48 injuries in the intervention group (0.5 (SE 0.11) injuries per 1000 player hours; 0.2 (SE 0.18) in training v 2.5 (SE 0.06) during matches). Fewer injured players were in the intervention group than in the control group (46 (4.8%) v (76 (8.6%); relative risk intervention group v control group 0.53, 95% confidence interval 0.35 to 0.81). CONCLUSION: A structured programme of warm-up exercises can prevent knee and ankle injuries in young people playing sports. Preventive training should therefore be introduced as an integral part of youth sports programmes.

Adolescent↗

PubMed2005

Fluvastatin and lifestyle modification for reduction of carotid intima-media thickness and left ventricular mass progression in drug-treated hypertensives.

OBJECTIVES: The Hypertension High Risk Management trial (HYRIM) investigated the effect of fluvastatin treatment and lifestyle intervention on development of carotid intima-media thickness (IMT) in drug-treated hypertensive patients. METHODS AND RESULTS: HYRIM was a placebo-controlled, 2 x 2 factorial trial in which 568 drug-treated hypertensive men aged 40-74 years with total cholesterol 4.5-8.0 mmol/L, triglycerides <4.5 mmol/L, body mass index 25-35 kg/m2, and a sedentary lifestyle were randomized to receive either fluvastatin, 40 mg daily, or placebo, and either intensive lifestyle intervention (physical activity and diet) or usual care (treatment of hypertension and other disorders by own private physician). Carotid IMT was assessed by B-mode ultrasound vasculography and left ventricular (LV) mass was calculated from ultrasound recordings of the heart. Fluvastatin alone reduced the primary study endpoint of 4-year development of IMT in the common carotid artery (CCA) compared with placebo (p=0.0297). Carotid bulb IMT progression over 4 years was also significantly (p=0.0214) reduced by fluvastatin compared with placebo. Fluvastatin significantly lowered LDL-C levels (mean net difference through 4 years, 0.6 mmol/L; p<0.0001), and reduced the 2-year development of LV mass (p=0.0144) compared with placebo. Lifestyle intervention had no significant effect on LDL-C, carotid IMT or LV mass, and did not increase the effects of fluvastatin. CONCLUSIONS: In drug-treated hypertensive patients in a usual care setting, fluvastatin treatment reduces progression of carotid IMT and LV mass.

Administration, Oral↗

PubMed2004

[Cardiovascular risk factors among 40-year old men and women in Oslo 1981-1999].

BACKGROUND: Between 1981 and 1991, the City of Oslo offered all its 40-year-old citizens screening for risk factors for cardiovascular disease. We describe changes in risk factors over this period. MATERIAL AND METHODS: Between 1981 and 1999, a total of 104,482 men and women born between 1941 and 1959 were invited to undergo screening. RESULTS: The attendance rate was slightly above 55% in the initial years when the City of Oslo had a centralised administration. After a decentralisation to 25 city districts in 1988, attendance dropped considerably. Body weight, triglycerides, physical inactivity, prevalence of metabolic syndrome and diabetes all increased over the period. The classic risk factors, including total serum cholesterol, high blood pressure and cigarette smoking, were all gradually reduced. INTERPRETATION: With regard to the classic risk factors, the findings are consistent with other investigations. The increase in body weight and some other characteristics of the metabolic syndrome are causes for concern.

Adult↗

PubMed2004

Design and baseline characteristics of the Incremental Decrease in End Points through Aggressive Lipid Lowering study.

The Incremental Decrease in End Points through Aggressive Lipid Lowering (IDEAL) study is an investigator-initiated trial designed to determine whether additional clinical benefit might be gained through a strategy that decreases levels of low-density lipoprotein cholesterol levels better than those currently achieved with established statin therapy in patients who have coronary heart disease. IDEAL is a multicenter prospective, randomized, open-label, blinded, end point classification study. Patients who had myocardial infarction were randomized to prescription treatment with 80 mg/day of atorvastatin or 20 mg/day of simvastatin (the dose was increased to 40 mg/day at week 24 in those patients whose plasma total cholesterol remained >5.0 mmol/L, or 190 mg/dl, or whose low-density lipoprotein cholesterol remained >3.0 mmol/L, or 115 mg/dl). The primary clinical outcome variable is the time to initial occurrence of a major coronary event, which is defined as nonfatal acute myocardial infarction, coronary death, or resuscitated cardiac arrest. The study is designed to have a power of 90% to detect a relative decrease of 20% in the atorvastatin-group compared with the simvastatin-group in the number of major events caused by coronary heart disease over approximately 5.5 years. The 8,888 randomized patients had the following characteristics: mean age 61.7 +/- 9.5 years, 19.1% women (mean age 64.0 +/- 9.5 years), baseline total cholesterol 5.1 +/- 1.0 mmol/L (197 mg/dl), low-density lipoprotein cholesterol 3.2 +/- 0.9 mmol/L (124 mg/dl), and high-density lipoprotein cholesterol 1.2 +/- 0.3 mmol/L (46 mg/dl). Drug treatment before randomization consisted of statins in 77% of patients, aspirin in 78.9%, beta blockers in 75.1%, and angiotensin-converting enzyme inhibitors in 30%.

Adult↗

PubMed2004

Low back pain among endurance athletes with and without specific back loading--a cross-sectional survey of cross-country skiers, rowers, orienteerers, and nonathletic controls.

STUDY DESIGN: Cross-sectional survey among athletes competing at the national elite level in cross-country skiing, rowing, and orienteering, as well as a matched nonathletic control group. OBJECTIVE: To compare the prevalence of symptoms of low back pain between endurance sports with different loading characteristics on the lumbar region: cross-country skiing, rowing, and orienteering, as well as a nonathletic control group. SUMMARY OF BACKGROUND DATA: Although it is claimed that back pain is a frequent problem in endurance sports loading the lower spine such as rowing or cross-country skiing, the prevalence of low back problems in such sports has not been compared with relevant control groups. METHODS: Self-reported questionnaire on low back pain adapted for sports based on standardized Nordic questionnaires for musculoskeletal symptoms. Responders were 257 cross-country skiers (response rate: 100%), 199 rowers (99.5%), and 278 orienteerers (99.3%), and 197 control subjects (66%). RESULTS: Low back pain was reported to be somewhat more common among cross-country skiers and rowers than orienteerers and nonathletic controls. The prevalence among cross-country skiers of reported low back pain ever (65.4%) and low back pain during the previous 12 months (63.0%) was higher than nonathletic controls (OR [95% CI]: 1.94 [1.29-2.92]). Rowers (25.6%) reported missing training because of low back pain more frequently than orienteerers did (13.7%, OR: 2.16 [1.25-3.74]). The athletes reported more low back pain during periods when training and competition load was higher, and cross-country skiers more frequently reported having low back problems using classic than freestyle skiing techniques. CONCLUSIONS: Low back pain appears to be somewhat more common in endurance sports that specifically load the low back during training and competition. The relationship between seasonal training patterns and specific skiing techniques indicate that there is a relationship between low back pain and the specific loading patterns of skiing and rowing.

Adult↗

PubMed2004

[Treatment with statins of the elderly].

BACKGROUND: Previous studies of treatment with statins have included few subjects aged 70 years or above. While the absolute risk of cardiovascular disease in the elderly is very high, the benefits of treatment may be reduced by adverse events, polypharmacy and competing risks. MATERIAL AND METHODS: A statistician and a clinician reviewed the Pravastatin in elderly individuals at risk of vascular disease (PROSPER) study and compared the results with subgroup analyses of previous studies. RESULTS: Subgroup analyses of previous studies showed that treatment with statins reduces cardiovascular events among patients with coronary heart disease aged > or = 65 years. The Heart Protection Study (HPS) included elderly with known atherosclerotic disease, while only 44% of subjects in the PROSPER study had such disease. Among subjects aged 70 or above the difference in events between the groups that received a statin or placebo was 6.1% in the HPS study and 2.1% in the PROSPER study (numbers needed to treat were 6 and 48, respectively). The studies gave conflicting results with regard to stroke and cancer. INTERPRETATION: Elderly people with cardiovascular disease may benefit from treatment with statins. We do not have data that show that statins reduce total mortality among the elderly.

Aged↗

PubMed2004

Trends in the incidence of acute myocardial infarction and stroke: a 21-year follow-up of the Oslo study.

OBJECTIVES: To explore changes in the incidence of fatal and nonfatal myocardial infarction (MI) and stroke in the same male population over two decades. DESIGN: Men aged 40-49 born in the years 1923-1932 (N= 16,209) resident in Oslo participated in a cardiovascular screening programme in 1972-1973. Nonfatal cases of MI and stroke were obtained from hospital records and causes of death were ascertained by linkage to Statistics Norway. The closing date was December 31, 1993. RESULTS: The cohort had a lower mortality rate than the general Norwegian population. First nonfatal and fatal MIs declined in each age and birth cohort during the entire follow-up. The incidence of nonfatal and fatal stroke decreased about 10 years after the initial screening. The risk of men with Rose questionnaire-based symptoms of angina or claudication was between that of healthy men and men with established cardiovascular disease or diabetes. CONCLUSIONS: There has been a reduction in both nonfatal and fatal incident cases of MI and stroke 10 years later indicating a pronounced change in all age groups and a lasting change throughout the period of follow-up. The Rose questionnaire predicted both future stroke and MI.

Adult↗

PubMed2004

Effect of fluvastatin on renal end points in the Assessment of Lescol in Renal Transplant (ALERT) trial.

BACKGROUND: Hyperlipidemia is a risk factor for long-term renal transplant dysfunction, but no prospective clinical trials have investigated the effects of statin treatment on graft function in renal transplant recipients. The aim of the present study was to evaluate the effect of fluvastatin on long-term renal transplant function and development of chronic allograft nephropathy in the ALERT (Assessment of Lescol in Renal Transplantation) study. METHODS: ALERT was a randomized, double-blind, placebo-controlled study of the effect of fluvastatin, 40 mg and 80 mg daily, in renal transplant recipients. Patients were randomized to receive either fluvastatin (N= 1050) or placebo (N= 1052) and followed for five to six years. Renal end points included graft loss or doubling of serum creatinine or death; glomerular filtration rate (GFR) was also measured during follow-up in a subset of patients (N= 439). RESULTS: There were 283 patients (13.5%) with graft loss, mainly due to chronic rejection (82%), yielding an annual rate of 2.4%. Fluvastatin treatment significantly lowered mean low-density lipoprotein (LDL)-cholesterol levels by 32% (95% CI -33 to -30) compared with placebo, but had no significant effect on the incidence of renal graft loss or doubling of serum creatinine, or decline in GFR throughout follow-up in the whole study population. Neither was any treatment effect by fluvastatin found in any of the subgroups analyzed. CONCLUSION: Fluvastatin treatment significantly improves lipid values in renal transplant recipients but has no effect on graft loss or doubling of serum creatinine.

Adult↗

PubMed2004

fluvastatin prevents cardiac death and myocardial infarction in renal transplant recipients: post-hoc subgroup analyses of the ALERT Study.

Renal transplant recipients have a greatly increased risk of premature cardiovascular disease. The ALERT study was a multicenter, randomized, double-blind, placebo-controlled trial of fluvastatin (40-80 mg/day) in 2102 renal transplant recipients followed for 5-6 years. The main study used a composite cardiac end-point including myocardial infarction, cardiac death and cardiac interventions. Although reduced by fluvastatin, this primary end-point failed to achieve statistical significance thus precluding analysis of predefined subgroups. Therefore, in the present survival analysis, we used an alternative primary end-point of cardiac death or definite nonfatal myocardial infarction (as used in other cardiac outcome trials) which was significantly reduced by Fluvastatin therapy and permits subgroup analysis. Fluvastatin reduced LDL-cholesterol by 1 mmol/L compared with placebo, and the incidence of cardiac death or definite myocardial infarction was reduced from 104 to 70 events (RR 0.65; 95% CI 0.48, 0.88; p = 0.005). Fluvastatin use was associated with reduction in cardiac death or nonfatal myocardial infarction, which achieved statistical significance in many subgroups. The subgroups included patients at lower cardiovascular risk, who were younger, nondiabetic, nonsmokers and without pre-existing CVD. These data support the early introduction of statins following renal transplantation.

Adult↗

PubMed2004

Physical fitness, injuries, and team performance in soccer.

PURPOSE: To investigate the relationship between physical fitness and team success in soccer, and to test for differences in physical fitness between different player positions. METHODS: Participants were 306 male soccer players from 17 teams in the two highest divisions in Iceland. Just before the start of the 1999 soccer season, the following variables were tested: height and weight, body composition, flexibility, leg extension power, jump height, and peak O2 uptake. Injuries and player participation in matches and training were recorded through the 4-month competitive season. Team average physical fitness was compared with team success (final league standing) using a linear regression model. Physical fitness was also compared between players in different playing positions. RESULTS: A significant relationship was found between team average jump height (countermovement jump and standing jump) and team success (P = 0.009 and P = 0.012, respectively). The same trend was also found for leg extension power (P = 0.097), body composition (% body fat, P = 0.07), and the total number of injury days per team (P = 0.09). Goalkeepers demonstrated different fitness characteristics from outfield players. They were taller and heavier, more flexible in hip extension and knee flexion, and had higher leg extension power and a lower peak O2 uptake. However, only minor differences were observed between defenders, midfield players, and attackers. CONCLUSION: Coaches and medical support teams should pay more attention to jump and power training, as well as preventive measures and adequate rehabilitation of previous injuries to increase team success.

Adolescent↗