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Jan Erik Otterstad

Publications and source records attributed to Jan Erik Otterstad.

18 recordsLinked to original sources
PubMed2006

Left atrial size and risk of major cardiovascular events during antihypertensive treatment: losartan intervention for endpoint reduction in hypertension trial.

The influence of left atrial size on cardiovascular events during antihypertensive treatment has not been reported previously from a long-term, prospective, randomized hypertension treatment trial. We recorded left atrial diameter by annual echocardiography and cardiovascular events in 881 hypertensive patients (41% women) with electrocardiographic left ventricular hypertrophy aged 55 to 80 (mean: 66) years during a mean of 4.8 years of randomized losartan- or atenolol-based treatment in the Losartan Intervention for Endpoint Reduction in Hypertension Study. During follow-up, a total of 88 primary end points (combined cardiovascular death, myocardial infarction, or stroke) occurred. In Cox regression, baseline left atrial diameter/height predicted incidence of cardiovascular events (hazard ratio: 1.98 per cm/m [95% CI: 1.02 to 3.83 per cm/m]; P=0.042) adjusted for significant effects of Framingham risk score and history of atrial fibrillation. Greater left atrial diameter reduction during follow-up was associated with greater reduction in left ventricular hypertrophy, absence of new-onset atrial fibrillation or mitral regurgitation during follow-up, and losartan-based treatment (B=-0.13+/-0.03 cm/m; P<0.001) in multiple linear regression, adjusting for baseline left atrial diameter/height. However, in time-varying Cox regression analysis, left atrial diameter reduction was not independent of left ventricular hypertrophy regression in predicting cardiovascular events during follow-up. In conclusion, left atrial diameter/height predicts risk of cardiovascular events independent of other clinical risk factors in hypertensive patients with left ventricular hypertrophy and may be useful in pretreatment clinical assessment of cardiovascular risk in these patients.

Aged↗
PubMed2006

The development of heart failure in patients with stable angina pectoris.

BACKGROUND: To describe the clinical characteristics of patients with stable angina pectoris who develop heart failure and the events preceding its onset. METHODS AND RESULTS: Of 7665 patients with stable angina in the ACTION trial, which compared long-acting nifedipine to placebo, 207 (2.7%) developed heart failure (HF) during a mean follow-up of 4.9 years. Those who developed HF were significantly (P<0.05) older, more often had diabetes, had a more extensive history of cardiovascular disease, lower ejection fractions, a higher serum creatinine and glucose, a lower haemoglobin, and were more often on blood pressure lowering drugs. A cardiac event or an intervention (n=155), a significant non-cardiac infection (n=19) or poor control of hypertension (n=12) preceded the development of HF in 186/207 cases (90%). There was no obvious precipitating factor in the remaining 21 patients (10%). Myocardial infarction increased the risk of the development of new HF within one week more than 100-fold. Nifedipine reduced the incidence of HF by 29% (P=0.015). CONCLUSIONS: The development of heart failure is uncommon in patients with stable angina, and even less so in the absence of an obvious precipitating factor.

Aged↗
PubMed2006

High mortality rates in conservatively managed patients with acute coronary syndrome.

OBJECTIVES: The revised diagnostic criteria for the acute coronary syndrome (ACS) have created the need for accurate and representative data on treatment and outcome for the three categories of ACS. DESIGN: Consecutive patients admitted with a suspected ACS (n = 755) from February 1, 2003 to January 31, 2004 was registered and categorised into five diagnostic groups: 1) ST-elevation myocardial infarction (STEMI) (n = 126), 2) Non-ST-elevation myocardial infarction (NSTEMI) (n = 185), 3) Unstable angina pectoris (UAP) (n = 55), 4) Coronary heart disease (CHD) without ACS (n = 164) and 5) Non-coronary chest pain (n = 225). RESULTS: All-cause one-year mortality rates were 20%, 32%, 7%, 10% and 3%, in patients with STEMI, NSTEMI, UAP, CHD without ACS and non-coronary chest pain, respectively. In patients with STEMI, 61% received immediate reperfusion therapy (ratio thrombolysis: primary PCI = 18:1). Only 3% of those with NSTEMI had PCI within two days. CONCLUSION: In this conservatively managed population of consecutive patients with ACS, the one-year mortality rate is significantly higher than seen in most registries and clinical trials.

Aged↗
PubMed2006

Incidence and outcome of atrial fibrillation in stable symptomatic coronary disease.

OBJECTIVES: Evaluate the prevalence, incidence and impact on prognosis of existing and new onset atrial fibrillation (AF) in patients with stable, symptomatic coronary artery disease. DESIGN: Data from the 7 665 participants included in the ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine GITS) trial was used. RESULTS: Over a mean follow-up of 4.9 years, the incidence of recurrent AF in patients with AF at baseline (4.1%) was 13.5/100 patient-years and 1.64/100 patient-years for patients without baseline AF. Patients with AF at baseline had increased mortality and new overt heart failure. New onset AF was associated with increased morbidity and mortality and in particular soon after onset. [adjusted 30-day relative risk for mortality 23, 95% CI 14-36; for debilitating stroke 37, 95% CI 18-77; and for heart failure 54, 95% CI 32-93]. The incidence of AF was not affected by treatment with nifedipine GITS. CONCLUSION: The presence of AF in patients with stable symptomatic CAD is an independent risk factor and in particular in the first 30 days for subsequent mortality and morbidity.

Aged↗
PubMed2006

Physical performance is associated with markers of vascular inflammation in patients with coronary heart disease.

BACKGROUND: Coronary heart disease as well as major cardiovascular risk factors are associated with elevated levels of pro-inflammatory markers. There is, however, limited information about how changes in lifestyle improving the cardiovascular risk profile influence these levels. The aim of the study was to evaluate whether changes in lifestyle measures with special attention to physical activity, were associated with the levels of such markers. DESIGN: Coronary heart disease patients (n = 197) were randomized to either a comprehensive lifestyle intervention programme comprising regular physical activity, low fat diet and smoking cessation, or usual care with routine follow-up in the outpatient clinic for 6 months. An exercise test and fasting blood samples analysed for soluble cell adhesion molecules, C reactive protein and pro-inflammatory cytokines were evaluated before and at the end of the study. RESULTS: Improved diet, physical performance and reduction in smoking were obtained in the intervention programme when compared with usual care patients, but no significant group differences in levels of inflammatory markers were observed. In the total population, however, physical performance significantly and inversely predicted levels of soluble cell adhesion molecule 1, (P < 0.001), C-reactive protein (P < 0.001) and interleukin-6 (P = 0.01) at 6 months. Smokers had elevated levels of soluble cell adhesion molecule 1 when compared with non-smokers (P = 0.011). CONCLUSIONS: We demonstrated that physical performance is inversely correlated with levels of pro-inflammatory markers in coronary heart disease patients, possibly retarding the process of atherosclerosis. No effect on inflammatory markers was obtained with a 6-month lifestyle intervention programme when compared with patients who received usual care follow-up.

Biomarkers↗
PubMed2005

[Referral to elective and emergency coronary investigation from a medium-size central hospital].

BACKGROUND: Little is known about regional differences in the incidence of acute and elective invasive coronary procedures in Norway. Such information is important in the planning of new invasive centres. MATERIALS AND METHODS: In this prospective study all patients referred to coronary angiography at the Rikshospitalet University Hospital in Oslo (100 km remote) from the county of Vestfold (218,000 inhabitants) from 1 December 2002 to 30 November 2003 were included. Referrals were categorised as acute or elective. Based upon the discharge summaries from Oslo, all coronary angiographies, percutaneous interventions and coronary artery bypass grafts were registered. RESULTS: A total of 760 patients were referred, of whom 746 (98 %) underwent coronary angiography (19 % acutely). They were treated as follows: percutaneous coronary intervention, n = 295 (31 % acutely); coronary artery bypass grafting, n = 123 and conservative treatment, n = 342. INTERPRETATION: Based upon these results, the incidence figures for 100,000 inhabitants per year in 2003 were similar to the nation-wide average for percutaneous interventions per year in Norway in 2001 and approximately 30 % below that average for 2003. Therefore, in the planning of an optimal peripheral catheterisation laboratory, the population basis has to be calculated from the local incidence of procedures, since there are obviously significant regional differences in the use of such procedures.

Angioplasty, Balloon, Coronary↗
PubMed2005

Biochemical diagnosis of myocardial infarction evolves towards ESC/ACC consensus: experiences from the Nordic countries.

OBJECTIVES: To investigate the diagnostic approach in Nordic hospitals receiving patients suspected of acute myocardial infarction (MI), especially focusing on implementation of the recently proposed criteria by the European Society of Cardiology (ESC) and the American College of Cardiology (ACC) for the definition of MI. DESIGN: A survey with questionnaires of the diagnostic approach was conducted among all relevant departments (220) in the Nordic countries. RESULTS: Seventy-six percent (167) of hospitals responded. Troponins I and T (TnI and TnT) and creatinine kinase monobasic fraction (mass concentration) (CKMB(mass)) covered 93 and 65% of hospitals, respectively. Of troponin users, 34% indicated use of TnI vs 66% using TnT. Sporadic use of AST, CK, LD and myoglobin was reported. There was a tendency to lower cut-off levels in Sweden and Finland. Among troponin assays, there was considerable heterogeneity regarding cut-off levels. CONCLUSIONS: The Nordic countries are approaching ESC/ACC consensus on cardiac markers. Compared with previous national surveys (1995-1999), there is a shift towards the use of troponins. However, differences in cut-off levels of troponin emphasize the need for harmonization of assays.

Biomarkers↗
PubMed2004

[Prehospital diagnosis and treatment of acute myocardial infarction in Vestfold].

BACKGROUND: Pre-hospital thrombolysis is a relatively new treatment modality in Norway. The present study is a county-based evaluation of the first phase of this procedure after its introduction in 2002. MATERIALS AND METHODS: This is a retrospective cohort study of all patients who, over a nine-month period, had a pre-hospital ECG taken by paramedics and transmitted to the county's two coronary care units. The medical records of all patients who received pre-hospital thrombolysis were analysed and compared with those who received in-hospital thrombolysis over the same period. MATERIAL AND METHODS: A pre-hospital ECG was successfully taken and transmitted in 840 patients. Pre-hospital thrombolytic therapy was given to 45 (5.4%) patients, of whom 38 (84%) developed ST-elevation myocardial infarction (STEMI). Over the same period, 32 patients received in-hospital thrombolysis, of whom 28 (87%) developed STEMI. Among the 738 hospitalised patients who did not receive pre-hospital thrombolytic therapy, 218 (28%) had a diagnosis of acute coronary syndrome, 258 (35%) had established coronary heart disease but no evidence of coronary ischaemia, while 262 (36%) had no evidence of coronary heart disease at all. Median call-to-thrombolysis time was 42 minutes (range 21-75). INTERPRETATION: The findings indicate good paramedical pre-hospital routines with short call-to-thrombolysis-time, but the routines for pre-hospital ECG and thrombolytic therapy need reassessment.

Adult↗
PubMed2003

Results from clinical trials on ST-elevation myocardial infarction in a historic perspective with some pathophysiological aspects.

OBJECTIVE: Since the publication of the large trials on streptokinase and aspirin improving mortality related to an acute ST-elevation myocardial infarction (STEMI) there has been numerous studies on improving treatment results with new fibrinolytics, adjuvant heparin therapy and primary percutaneous intervention (PCI). The aim of the present overview is, in a historic perspective, to link some of the pathophysiology of mechanisms related to plaque rupture and following thrombosis to the effects of drug combinations and PCI observed in major clinical trials conducted in patients with STEMI. DESIGN: The overview comprises short analyses of the initial streptokinase trials (GISSI-1 and ISIS-2), the comparisons between streptokinase and tissue plasminogen activator (rt-PA) and the role of adjuvant heparin treatment (GISSI-2, ISIS-3, GUSTO I). Also included is the comparison between the new bolus-teplases and traditional, accelerated infusion of rt-PA (GUSTO III and ASSENT-2) and between unfractionated heparin (UFH) and low molecular weight heparin (LWMH) given in addition to tenecteplase (ASSENT-3). The pathophysiology of the antiplatelet and antithrombin effects is described, in order to elucidate the treatment differences observed in the trials. In addition, the role of primary PCI is discussed in view of the results in a recent meta-analysis of controlled comparisons with fibrinolytic therapy. RESULTS: Based upon these trials it seems that the optimal thrombolytic treatment is a combination of a bolus-teplase (tenecteplae) and LMWH given on top of aspirin. Primary PCI may be the most optimal treatment, provided given early following STEMI (<1 h), but whether PCI is the best alternative for all patients with STEMI is still a matter of debate. CONCLUSION: During the last 15 years the optimal antithrombotic treatment of STEMI has developed from a combination of streptokinase and aspirin to the new bolus-teplases combined with LMWH and aspirin. The use of primary PCI may be a better alternative than fibrinolytic therapy, but such a statement needs confirmation in a large comparison between PCI and a quick infusion of modern fibrinolytic agents.

Angioplasty, Balloon, Coronary↗
PubMed2002

Correlates of left atrial size in hypertensive patients with left ventricular hypertrophy: the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study.

Left ventricular hypertrophy has been suggested to mediate the relation between hypertension and left atrial enlargement, with associated risks of atrial fibrillation and stroke. However, less is known about correlates of left atrial size in hypertensive patients with left ventricular hypertrophy. We assessed left atrial size by echocardiography in 941 hypertensive patients, age 55 to 80 (mean, 66) years, with electrocardiographic left ventricular hypertrophy at baseline in the Losartan Intervention For Endpoint reduction in hypertension study. Enlarged left atrial diameter (women, >3.8 cm; men, >4.2 cm) was present in 56% of women and 38% of men (P<0.01). Compared with the 512 patients with normal left atrial size, the 429 patients with enlarged left atrium more often had mitral regurgitation, atrial fibrillation, and echocardiographic left ventricular hypertrophy. They also had higher age, systolic blood pressure, pulse pressure, weight, body mass index, left ventricular internal chamber dimension, stroke volume, and mass and lower relative wall thickness and ejection fraction (all, P<0.05). In logistic regression analysis, left atrial enlargement was related to left ventricular hypertrophy and eccentric geometry; greater body mass index, systolic blood pressure, and age; female gender; mitral regurgitation; and atrial fibrillation (all, P<0.05). Thus, left atrial size in hypertensive patients with electrocardiographic left ventricular hypertrophy is influenced by gender, age, obesity, systolic blood pressure, and left ventricular geometry independently of left ventricular mass and presence of mitral regurgitation or atrial fibrillation.

Aged↗
PubMed2002

[Congenital heart defects. Varying degrees of severity; 25 percent of children with heart defects will have persistent cardiac problems in adulthood].

In a population based study including 35,218 infants born alive during the 15-year period 1982-1996, 360 (1%) were diagnosed having a congenital heart defect (CHD). At a follow-up 3-18 years later (median 9.5 years) 154 patients (42.8%) were spontaneously cured, of whom 142 (92.2%) had ventricular septal defects (VSD). 42 patients (11.7%) had died, 22 of whom (52.4%) during the neonatal period (0-28 days after birth). A total of 119 patients (33.1%) underwent therapeutic procedures (surgery, catheter interventions), of whom 24 (20.2%) died. Of the 95 children surviving therapeutic procedures 54 (56.8%) had their defects completely repaired, while 41 (43.2%) had residual defects or cardiac sequelae, often of minor importance. Of 69 children (19.2%) with persistent untreated defects, 43 (62.3%) had VSD. A chromosomal disorder, various syndromes or extracardiac malformations occurred in 72 children (20%). The study underlines the fact that CHD presents itself in varying degrees of severity, including a high neonatal mortality rate as well as a high rate of spontaneous cure.

Abnormalities, Multiple↗
PubMed2002

[A patient with thromboangiitis obliterans].

BACKGROUND: Thromboangiitis obliterans (Buerger's disease) is characterised by inflammatory thrombi in small and middle-sized arteries and in the veins. As opposed to arteriosclerosis, the vessel wall remains normal. Diagnostic criteria are the presence of distal ischaemia in the extremities, documented by noninvasive vascular testing; exclusion of autoimmune diseases, hypercoagulable states, and diabetes mellitus, age less than 45 years and cigarette smoking. MATERIAL AND METHODS: The article is based on a case history and review of the literature. RESULTS AND INTERPRETATION: A 31-year-old man was in 1953 diagnosed with thromboangiitis obliterans. Lumbar sympathectomy on the left side in 1953 and on the right side in 1971 had excellent symptomatic effect. The patient has been treated with anticoagulants for 48 years. Amputation of the left 2nd toe was performed in 1971. At age 80, he is without further cardiovascular events and takes regular physical exercise. Over the last fifty years, the incidence of thromboangiitis obliterans has been drastically reduced. The reason for this is unknown. The only proven treatment is complete discontinuation of tobacco. The effect of sympathectomy and long-term anticoagulation has not been proven.

Adult↗
PubMed2002

The effect of carvedilol in patients with impaired left ventricular systolic function following an acute myocardial infarction. How do the treatment effects on total mortality and recurrent myocardial infarction in CAPRICORN compare with previous beta-blocker trials?

In previous beta-blocker trials, post-myocardial infarction (MI) patients were essentially treated with a beta-blocker or placebo. In the CAPRICORN trial, patients were selected on the basis of a left ventricular (LV) ejection fraction (EF) <40% following the index MI and randomised to carvedilol or placebo, in addition to modern secondary prophylaxis with ACE inhibitors, aspirin and statins. In 1959 patients with a mean LVEF of 33%, treatment with carvedilol over a mean follow-up period of 15 months reduced total mortality from 15.3% with placebo to 11.9% with carvedilol [relative risk reduction (RRR) =23%, absolute risk reduction (ARR) =3.4%]. The incidence of recurrent MI was reduced from 5.8 to 2.3% (RRR 41%, ARR 2.3%). The number needed to treat (NNT) to prevent one death was 28 for the entire study period and 43 for 1 year of treatment. The results of the CAPRICORN trial are compared with three previous beta-blocker post-MI trials: the Gothenburg metoprolol trial (GMT), the Norwegian timolol trial (NTT) and the beta-blocker heart attack trial (BHAT). The RRRs for total mortality were 36% in the GMT and NTT, and 27% in BHAT. The respective NNTs for total mortality were 32, 18 and 38. NNT for 1 year of treatment was 25 in NTT and 80 in BHAT. The RRR for recurrent MIs were 28% in NTT and 16% in BHAT. The reduction of mortality and recurrent MIs in CAPRICORN is within the range of previous post-MI beta-blocker studies. In post-MI patients with LVEF<40%, add-on treatment with a beta-blocker should be given >48 h after initiation with an angiotensin-converting enzyme inhibitor (ACEI) and then with a slow dose escalation as applied in CAPRICORN.

Adrenergic beta-Antagonists↗