[Spanish adaptation of the European guidelines on cardiovascular prevention (and II)].
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Cardiovascular Diseases↗
Biomedical subjects
K Orth-Gomér
Publications and source records attributed to K Orth-Gomér.
A common polymorphism in the fatty acid transport protein-1 gene associated with elevated post-prandial lipaemia and alterations in LDL particle size distribution.
The fatty acid transport proteins (FATPs) have been implicated in facilitated cellular uptake of non-esterified fatty acids (NEFAs), thus having the potential to regulate local and systemic NEFA concentrations and metabolism. Hypothesising that genetic variation within the FATP genes may affect lipid metabolism, we investigated a G/A substitution at position 48 in intron 8 of the fatty acid transport-1 (FATP1) gene with respect to associations with fasting and post-prandial plasma lipid and lipoprotein variables in 628 healthy 50-year-old Swedish men and 426 Swedish women, aged 37-65 years. A subset of 105 men with the apoE3/E3 genotype underwent an oral fat tolerance test. Although fasting plasma TG concentrations were not different, male A/A individuals had significantly higher post-prandial TG concentrations and VLDL(1) (S(f) 60-400 apoB100)-to-VLDL(2) (S(f) 20-60 apoB100) ratio compared to male G/A and G/G individuals. A/A individuals apparently failed to suppress plasma NEFA concentrations during the oral fat tolerance test. Furthermore, fasting plasma concentrations of the largest, most buoyant LDL subfraction (LDL-I) were significantly lower in carriers of the A allele in the male cohort. Electromobility shift assays and reporter gene studies indicated that binding of nuclear factors and effect on transcriptional activity differ between the intron 8 alleles. These findings suggest that through regulation of NEFA trafficking, FATP1 might play a role in post-prandial lipid metabolism and development of cardiovascular disease.
Adult↗
Significant predictors of poor prognosis in women aged </=65 years hospitalized for an acute coronary event.
OBJECTIVES: The aim of this study was to evaluate the importance of different clinical parameters predicting long-term cardiac prognosis in younger women with an acute coronary event. DESIGN: The Stockholm Female Coronary Risk Study is a follow-up study in women </=65 years. SETTING: Patients were included between 1991 and 1994 from all 10 coronary care or intensive care units in the greater Stockholm area. SUBJECTS: A total of 335 consecutive female patients hospitalized for an acute coronary event. MAIN OUTCOME MEASURES: Cardiac death and nonfatal myocardial infarction (AMI). RESULTS: During the follow-up period of 5 years there were 26 (8%) all cause deaths and 39 (12%) recurrent cardiac events. In the group that participated in the complete study, the following age adjusted parameters were found as strong predictors of adverse outcome: AMI as index event [Hazard Ratio (HR) 9.13, 95% CI 3.09-26.99], diabetes mellitus (HR 4.13, 95% CI 1.68-10.17), left ventricular dysfunction (HR 3.94, 95% CI 1.52-10.17), serum HDL cholesterol <1.0 mmol L-1 (HR 4.01, 95% CI 1.62-6.12), and serum triglycerides >2.0 mmol L-1 (HR 2.46, 95% CI 1.06-5.54). AMI as index event and diabetes mellitus were the most significant predictors in a multivariate statistical model. Diabetes mellitus was the strongest predictor when the analysis was repeated in the total patient cohort, integrating patients that did not participate in the extended investigations. CONCLUSION: Women aged </=65-year-old hospitalized for an acute coronary event has a low rate of cardiac events during the following 5-year period. Easily obtained clinical variables such as diabetes mellitus predict adverse prognosis and implicates a need for a more active diagnostic and treatment strategy.
Adult↗
Marital status and cardiovascular risk in French and Swedish automotive industry workers--cross sectional results from the Renault-Volvo Coeur study.
OBJECTIVES: To compare the coronary risk profiles in a sample of the French and Swedish automotive industry employees who were married/cohabitant, divorced or single (never married). DESIGN: A cross-sectional study comparison from biological and questionnaire data between the French and Swedish samples. SETTING: Occupational health departments at Renault (employees from the north-west of France) and Volvo (employees from the south-west of Sweden). SUBJECTS: Two random samples of males aged between 45 and 50 years were examined in 1993, from Renault 1000, and from Volvo 1000. MAIN OUTCOME MEASURES: Biological data including cholesterol, blood pressure as well as the Framingham risk index. Self reported information regarding marital status, smoking, exercise, alcohol habits, and work stress assessed by the Karasek method, private social support indices, and type A behaviour according to the Bortner scale. RESULTS: More employees were married/cohabitant and fewer divorced or single at Renault. Apart from waist/hip ratio being marginally lower in Swedish single men, compared with married and divorced, no significant difference in biological cardiac risk factors (total cholesterol, blood pressure or Framingham risk index) was seen between the subgroups from any of the two countries. Compared with married/cohabitant men, it was shown that in men living alone smoking was more prevalent at Renault and Volvo. These men also showed less type A behaviour, a lower work control and a lower work support and fewer close friends. Alcohol consumption was reported in smaller amounts for Volvo employees living alone compared with married or divorced employees. Married/cohabitant and divorced staff showed similar values regarding all measured variables when compared within each country. CONCLUSIONS: Employees living alone in both France (Renault) and Sweden (Volvo) automotive companies seem to have increased nontraditional cardiac risk factors pertaining to life style and social network compared with married or divorced men. These results, in combination with the finding that more Volvo than Renault employees were living alone, suggest a higher risk for coronary heart disease amongst Volvo employees. This hypothesis will be evaluated in the 5 and 10 years follow up study.
Alcohol Drinking↗
Coronary risk factor modification after the acute event--why are effects not maintained?
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Coronary Disease↗
Coagulation factor VII in middle-aged women with and without coronary heart disease.
Epidemiological studies of coagulation factor VII as a risk factor for coronary heart disease (CHD), mainly conducted in men, have shown discrepant results. We examined the associations of coagulation factor VII antigen (VIIag) and activated factor VII (VIIa) with manifest CHD in a community-based case-control study of women aged < or =65 years. Mean plasma concentrations of VIIag and VIIa in patients and controls were 443 +/- 10(8) and 418 +/- 89 ng/L (p <0.01) and 5.26 +/- 2.21 and 4.90 +/- 1.65 ng/L (NS), respectively. The odds ratio (OR) for CHD for the highest versus the lowest quartile of VIIag was 1.75 (95% CI, 1.05 to 2.92). The adjusted OR was 0.76 (95% CI, 0.28-1.98) after controlling for other cardiovascular risk factors. The corresponding ORs for VIIa were non-significant. In conclusion, the plasma concentration of VIIa was not significantly increased in a large group of women with precocious CHD, and VIIag levels, although elevated, were not independently associated with manifest disease.
Case-Control Studies↗
Risk factors for coronary heart disease in different socioeconomic groups of Lithuania and Sweden--the LiVicordia Study.
AIMS: Lithuanian middle-aged men have a fourfold higher risk for coronary heart disease (CHD) mortality compared with Swedish men. In Sweden, CHD mortality is twice as high in blue- compared with white-collar workers. Whether the same risk factors that characterized Lithuanian men, compared with Swedish men, could be found in low socioeconomic groups within the cities was investigated. METHODS: The LiVicordia study compared both traditional and new possible risk factors for CHD among 150 50-year-old men in Linköping, Sweden and Vilnius, Lithuania. A comparison was made of the prevalence of these risk factors in high and low socioeconomic groups within the cities and, after controlling for the city, variations across socioeconomic groups in the total sample. RESULTS: Small differences were found in traditional risk factors between cities. However, Vilnius men were shorter, had lower serum levels of antioxidant vitamins, more psychosocial strain, and lower cortisol response to a standardized laboratory stress test. These characteristics were also found among men in low social classes in both cities. In linear regression models, short stature, low serum beta-carotene, low social integration, coping and self-esteem, high vital exhaustion, high baseline and low cortisol response to stress were related to low social class. CONCLUSIONS: The same set of risk factors, mainly relating to oxidative and psychosocial stress, that characterized Vilnius men was also found in men in low social classes within the cities. The results suggest that a common set of risk factors may help to explain health differences both between and within countries.
Antioxidants↗
Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study.
CONTEXT: Psychosocial stress has been associated with incidence of coronary heart disease (CHD) in men, but the prognostic impact of such stress rarely has been studied in women. OBJECTIVE: To investigate the prognostic impact of psychosocial work stress and marital stress among women with CHD. DESIGN AND SETTING: Population-based, prospective follow-up study conducted in the city of Stockholm, Sweden. PARTICIPANTS: A total of 292 consecutive female patients aged 30 to 65 years (n = 279 working or cohabiting with a male partner) who were hospitalized for acute myocardial infarction or unstable angina pectoris between February 1991 and February 1994. Patients were followed up from the date of clinical examination until August 1997 (median, 4.8 years). MAIN OUTCOME MEASURES: Recurrent coronary events, including cardiac death, acute myocardial infarction, and revascularization procedures, by marital stress (assessed using the Stockholm Marital Stress Scale, a structured interview) and by work stress (assessed using the ratio of work demand to work control). RESULTS: Among women who were married or cohabiting with a male partner (n = 187), marital stress was associated with a 2.9-fold (95% confidence interval [CI], 1.3-6. 5) increased risk of recurrent events after adjustment for age, estrogen status, education level, smoking, diagnosis at index event, diabetes mellitus, systolic blood pressure, smoking, triglyceride level, high-density lipoprotein cholesterol level, and left ventricular dysfunction. Among working women (n = 200), work stress did not significantly predict recurrent coronary events (hazard ratio, 1.6; 95% CI, 0.8-3.3). CONCLUSIONS: Our results indicate that marital stress but not work stress predicts poor prognosis in women aged 30 to 65 years with CHD. These findings differ from previous findings in men and suggest that specific preventive measures be tailored to the needs of women with CHD.
Adult↗
Prognostic value of exercise testing in women after acute coronary syndromes (The Stockholm Female Coronary Risk Study).
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Angina, Unstable↗
Job stress and the occupational gradient in coronary heart disease risk in women. The Stockholm Female Coronary Risk Study.
Recent studies of men have shown that job stress is important in understanding the occupational gradient in coronary heart disease (CHD), but these relationships have rarely been studied in women. With increasing numbers of women in the workforce it is important to have a more complete understanding of how CHD risk may be mediated by job stress as well as other biological and behavioural risk factors. The objective of this study was to examine the occupational gradient in CHD risk in relation to job stress and other traditional risk factors in currently employed women. We used data from the Stockholm Female Coronary Risk Study, a population based case-control study, comprising 292 women with CHD aged 65 years or younger and 292 age-matched healthy women (controls). An inversely graded association was observed between occupational class and CHD risk. Compared with the highest (executive/professional), women in the lowest occupational class (semi/unskilled) had a four-fold (95% CI 1.75-8.83) increased age-adjusted risk for CHD. Simultaneous adjustment for traditional risk factors and job stress attenuated this risk to 2.45 (95% CI 1.01-6.14). Neither job control nor the Karasek demand-control model of job stress substantially explained the increased CHD risk of women in the lowest occupational classes. It is likely that lower occupational class working women face multiple and sometimes interacting sources of work and non-work stress that are mediated by behavioural and biological factors that increase their CHD risk.
Case-Control Studies↗
Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Coronary Risk Study.
AIMS: Several studies have reported that women with coronary heart disease have a poorer prognosis than men. Psychosocial factors, including social isolation and depressive symptoms have been suggested as a possible cause. However, little is known about these factors and their independent predictive value in women. Therefore, we investigated the prognostic impact of depression, lack of social integration and their interaction in the Stockholm Female Coronary Risk Study. METHODS AND RESULTS: Two hundred and ninety-two women patients aged 30 to 65 years and admitted for an acute coronary event between 1991 and 1994, were followed for 5 years from baseline assessments, which were performed between 3 and 6 months after admission. Lack of social integration and depressive symptoms, assessed at baseline by standardized questionnaires, were associated with recurrent events, including cardiovascular mortality, acute myocardial infarction and revascularization procedures (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). Adjusting for age, diagnosis at index event, symptoms of heart failure, diabetes mellitus, high density lipoprotein (HDL) cholesterol, history of hypertension, systolic blood pressure, smoking, sedentary lifestyle, body mass index, and severity of angina pectoris symptoms, the hazard ratio associated with low (lowest quartile) as compared to high social integration (upper quartile) was 2.3 (95% CI 1.2-4.5) and the hazard ratio associated with two or more (upper three quartiles) as compared to one or no depressive symptoms was 1.9 (95% CI 1.02-3.6). CONCLUSIONS: The presence of two or more depressive symptoms and lack of social integration independently predicted recurrent cardiac events in women with coronary heart disease. Women who were free of both these risk factors, had the best prognosis.
Acute Disease↗
Clinical importance of risk factors and exercise testing for prediction of significant coronary artery stenosis in women recovering from unstable coronary artery disease: the Stockholm Female Coronary Risk Study.
BACKGROUND: The objectives of this study were to investigate the relation between coronary risk factors, exercise testing parameters, and the presence of angiographically significant coronary artery disease (CAD) (> or =50% luminal stenosis) in female patients previously hospitalized for an acute CAD event. METHODS AND RESULTS: All women younger than age 66 years in the greater Stockholm area in Sweden who were hospitalized for acute coronary syndromes during a 3-year period were recruited. Besides collection of clinical parameters, coronary angiography and a symptom-limited exercise test were performed in 228 patients 3 to 6 months after the index hospitalization. The mean age was 56 +/- 7 years. Angiographically nonsignificant CAD (stenosis <50%) was verified in 37% of the patients; significant CAD was found in 63%. The clinical parameters that showed the strongest relation with the presence of significant CAD after adjusting for age were history of myocardial infarction (odds ratio [OR] 4.91, 95% confidence interval [CI] 2.35 to 7.49), history of diabetes mellitus (OR 3.83, 95% CI 1.63 to 14.31), serum high-density lipoprotein cholesterol <1.4 mmol/L (OR 2.11, 95% CI 1. 20 to 3.72), and waist-to-hip ratio >0.85 (OR 1.78, 95% CI 1.02 to 3. 10). A low exercise capacity and associated low change of rate-pressure product from rest to peak exercise were the only exercise testing parameters that were significantly related to angiographically verified significant CAD (<90% of the predicted maximal work capacity adjusted for age and weight, OR 1.91, 95% CI 1. 04 to 3.50). CONCLUSIONS: In female patients recovering from unstable CAD, exercise capacity was the only exercise testing parameter of value in the prediction of significant CAD. The consideration of certain clinical characteristics and coronary risk factors offer better or complementary information when deciding on further coronary assessment.
Adult↗
Short stature and prognosis of coronary heart disease in women.
OBJECTIVES: To investigate the effect of short stature on prognosis following an acute event of coronary heart disease (CHD) in women. SETTING: All women who were hospitalized for an acute event of CHD in any of the 10 cardiology clinics in greater Stockholm were investigated for the first time in the Stockholm Female Coronary Risk Study between 1991 and 1994, and were followed until August 1997 for recurrent coronary events. DESIGN: A follow-up study of women with either acute myocardial infarction (AMI) or unstable angina pectoris. Median follow-up period was 4.8 years. SUBJECTS: A total of 292 Swedish women. aged 65 years or younger. MAIN OUTCOME MEASURES: Recurrent AMI, death from CHD or revascularization procedure (percutaneous transluminal coronary angioplasty and coronary artery bypass grafting). RESULTS: Independent of the confounding effects of other risk factors of clinical importance for CHD (age, socioeconomic status, menopausal status, index event, congestive heart failure, angina severity, diabetes, hypertension, smoking, triglycerides and HDL cholesterol), the shortest 25% of women (< 160 cm) had a 2.1-fold (95% CI = 1.0-4.4) increased rate of developing adverse cardiac events (cardiovascular death, recurrent AMI or revascularization procedure) compared with the tallest 25% (> 165 cm). In addition, an increased rate was observed for each 10 cm difference in height (hazard ratio = 1.7, 95% CI = 1.4-2.7). Similar results were observed when analysing each outcome separately. CONCLUSIONS: These data indicate that short stature is a strong predictor of poor prognosis after an acute coronary event in women, independent of socioeconomic status and other risk factors for CHD.
Angina, Unstable↗
Relationship between plasma fibrinogen and coronary heart disease in women.
Plasma fibrinogen is an independent risk factor for coronary heart disease (CHD) in men; however, its role in women is less clear. We examined the ability of plasma fibrinogen to predict CHD in a community-based, case-control study of women aged 65 years or younger living in the greater Stockholm area. Cases were all patients hospitalized for an acute coronary event between February 1991 and February 1994. Controls were randomly selected from the city census and were matched to cases by age and catchment area. Plasma fibrinogen was measured 3 to 6 months after hospitalization by using a fibrinogen assay based on fibrinogen polymerization time measurement. Of the 292 consecutive cases, 110 (37%) were hospitalized for an acute myocardial infarction and 182 (63%) for angina pectoris. The mean age+/-SD in both patients and controls was 56+/-7 years. Mean levels of plasma fibrinogen in patients and controls were 3.66+/-0.81 and 3.25+/-0.64 g/L (P<0.0001), respectively. The age-adjusted odds ratio (OR) for CHD in the highest versus the lowest quartile of plasma fibrinogen was 6.0 (95% confidence interval [CI], 3.5 to 10.4). After adjustment for age, cigarette smoking, body mass index, systolic blood pressure, total cholesterol, high density lipoprotein cholesterol, triglycerides, and educational level, the OR was 3.0 (95% CI, 1.6 to 5.5). Further adjustment for C-reactive protein yielded the same result. In both premenopausal and postmenopausal women, the multivariate-adjusted ORs were 7.0 (95% CI, 1.8 to 28.3) and 2.1 (95% CI, 1.0 to 4.4), respectively. These results provide evidence that plasma fibrinogen is associated with an excess risk of CHD in women.
Adult↗
Socioeconomic status and determinants of hemostatic function in healthy women.
Hemostatic factors are reported to be associated with coronary heart disease (CHD). Socioeconomic status (SES) is 1 of the determinants of the hemostatic profile, but the factors underlying this association are not well known. Our aim was to examine determinants of the socioeconomic differences in hemostatic profile. Between 1991 and 1994, we studied 300 healthy women, aged 30 to 65 years, who were representative of women living in the greater Stockholm area. Fibrinogen, factor VII mass concentration (FVII:Ag), activated factor VII (FVIIa), von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1) were measured. Educational attainment was used as a measure of SES. Low educational level and an unfavorable hemostatic profile were both associated with older age, unhealthful life style, psychosocial stress, atherogenic biochemical factors, and hypertension. Levels of hemostatic factors increased with lower educational attainment. Independently of age, the differences between the lowest (mandatory) and highest (college/university) education in FVII:Ag levels were 41 microg/L (95% confidence interval [CI], 15 to 66 microg/L, P=0.001), 0.26 g/L (95% CI, 0.10 to 0.42 g/L, P=0.001) in fibrinogen levels, and 0.11 U/mL (95% CI, 0.09 to 0.12 U/mL, P=0.03) in levels of vWF. The corresponding differences in FVIIa and PAI-1 were not statistically significant. With further adjustment for menopausal status, family history of CHD, marital status, psychosocial stress, lifestyle patterns, biochemical factors, and hypertension, statistically significant differences between mandatory and college/university education were observed in FVII:Ag (difference=34 microg/L; 95% CI, 2 to 65 microg/L, P=0.05) but not in fibrinogen (difference=0.03 g/L; 95% CI, -0.13 to 0.19 g/L, P=0.92) or in vWF (difference=0.06 U/mL; 95% CI, -0.10 to 0.22 U/mL, P=0.45). An educational gradient was most consistent and statistically significant for FVII:Ag, fibrinogen, and vWF. Age, psychosocial stress, unhealthful life style, atherogenic biochemical factors, and hypertension mediated the association of low educational level with elevated levels of fibrinogen and vWF. Psychosocial stress and unhealthful life style were the most important contributing factors. There was an independent association between education and FVII:Ag, which could not be explained by any of these factors.
Adult↗
Social relations and the metabolic syndrome in middle-aged Swedish women.
BACKGROUND: Both social isolation and the metabolic syndrome are independently associated with greater than normal cardiovascular risk. DESIGN: A population-based cross-sectional study of middle-aged Swedish women. METHODS: The study group consisted of 300 healthy women (aged 31-65 years) who were representative of women living in the greater Stockholm area. Social isolation was measured by using a condensed version of the Interpersonal Support Evaluation List. Health behaviours were assessed and a full serum-lipid-level and haemostatic profile was obtained by standardized methods. The metabolic syndrome was defined as the presence of two or more of these components: fasting serum level of glucose > or = 7.0 mmol/l, arterial blood pressure > or = 160/90 mmHg, fasting serum level of triglycerides > or = 1.7 mmol/l or high-density lipoprotein < 1.0 mmol/l, or both, and central obesity (waist:hip ratio > 0.85 or body mass index > 30 kg/m2, or both). RESULTS: After adjustment for age, menopausal status, educational level, smoking, exercise habits and consumption of alcohol, the risk ratio for the metabolic syndrome for women in the lower compared with women in the upper social-support quartile was 3.5 (95% confidence interval 1.1-11.4), whereas that of women in the two middle quartiles was 2.2 (95% confidence interval 0.67-7.2; P for trend 0.02). CONCLUSIONS: Social isolation was associated with the metabolic syndrome for these middle-aged women. The findings suggest that the metabolic syndrome and its components may be mediators of the reported association between social isolation and cardiovascular disease.
Adult↗
Potential explanations for the educational gradient in coronary heart disease: a population-based case-control study of Swedish women.
OBJECTIVES: This study examined the association between educational attainment and coronary heart disease (CHD) and the factors that may explain this association. METHODS: This population-based case-control study included 292 women with CHD who were 65 years or younger and 292 age-matched controls. RESULTS: Compared with the adjusted odds ratio for CHD associated with college education, the age-adjusted odds ratio associated with mandatory education (< or = 9 years) was 1.87 (95% confidence interval [CI] = 1.23, 2.84) and the odds ratio for high school education was 1.35 (95% CI = 0.81, 2.25) (P for trend < .01). The odds ratio for mandatory education was reduced by 82%, to 1.16 (95% CI = 0.69, 2.09), after adjustment for psychosocial stress, unhealthy lifestyle patterns, hemostatic factors, hypertension, and lipids. CONCLUSIONS: Much of the increased risk of CHD in women with low education appears to be linked to psychosocial stress and lifestyle factors. Hemostatic factors, lipids, and hypertension also contribute to a lesser extent. These factors may be considered in strategies geared to reducing socioeconomic inequalities in cardiovascular health.
Adult↗