[Also elderly patients with hyperlipidemia and coronary disease need lipid lowering agents].
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Age Factors↗
Biomedical subjects
M L Hellénius
Publications and source records attributed to M L Hellénius.
[Commission of inquiry scrutinized complications of carotid surgery. Half of the complications could be explicable by errors or dubious indications].
As carotid endarterectomy is a prophylactic procedure, it would seem particularly important to analyze complications with an aim to avoiding them. All carotid endarterectomies in Sweden are registered, and all serious complications (death and permanent neurological deficit) are analyzed in detail, classified and discussed within the profession. During the period 1994-1996 the frequency was 4.3 percent (technical causes in 17 percent, contraindications in 8 percent and dubious indications in 21 percent, but correct indication and surgery in 54 percent). Thus, even when conditions are optimal there is a certain price to pay for the prevention of ischemic stroke.
Adult↗
[Prescribed exercise can help the patient to change his habits].
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Exercise↗
Differences in postprandial concentrations of very-low-density lipoprotein and chylomicron remnants between normotriglyceridemic and hypertriglyceridemic men with and without coronary heart disease.
It has been suggested that the postprandial elevation of plasma triglycerides is more closely linked to coronary heart disease (CHD) than the fasting triglyceride level. However, the postprandial situation is complex, as hepatogenous triglyceride-rich lipoprotein (TRL) particles (apolipoprotein [apo]B-100 and very-low-density lipoprotein [VLDL]) are mixed in the blood with apoB-48-containing lipoproteins secreted from the intestine. To analyze the relative proportion of liver-derived and intestinal apoB-containing TRL in subjects with and without CHD, we performed standardized oral fat-loading tests in young survivors of myocardial infarction, a large proportion of whom are hypertriglyceridemic (HTG), as well as sex- and population-matched healthy control subjects. A special effort was made to recruit healthy HTG subjects as controls for the HTG patients. Fasting plasma triglycerides (3.74+/-1.35 v3.01+/-0.83, NS), low-density lipoprotein (LDL) cholesterol, and VLDL lipids, and apoB-100 and apoB-48 content at Svedberg flotation rate (Sf) 60-400, Sf 20-60, and Sf 12-20 did not differ between HTG patients (n = 10) and HTG controls (n = 14). Normotriglyceridemic (NTG) patients (n = 15) had higher fasting plasma triglycerides (1.44+/-0.39 v 0.98+/-0.33 mmol/L, P < .05) and LDL cholesterol (4.07+/-0.71 v 3.43+/-0.64, P < .05) than NTG controls (n = 34). The triglyceride elevation was accounted for by a higher level of small VLDL (apoB-100 in the Sf 20-60 fraction, 52+/-17 v29+/-20 mg/L, P < .05). HTG patients responded with clearly elevated plasma triglycerides in the late postprandial phase, ie, 7, 8, and 9 hours after fat intake. Essentially, this was explained by a retention of large VLDL particles, since HTG patients exhibited no major differences in apoB-48 concentrations in the Sf > 400, Sf 60-400, and Sf 20-60 fractions but showed marked differences in the level of apoB-100 at Sf 60-400 (large VLDL) 9 hours after fat intake when compared with HTG controls (101+/-13 v 57+/-5 mg/L, P < .01). NTG patients were characterized by a more rapid increase of large VLDL in the early postprandial state, ie, 3 hours after fat intake, with a mean increase from baseline to 3 hours of 24.1+/-6.7 mg/L for NTG patients and 11.8+/-2.0 mg/L for controls (P < .05). ApoB-48 levels were also slightly higher, but all TRL parameters returned to baseline within 9 hours after fat intake. In conclusion, elevated triglyceride levels in the postprandial state in CHD patients are explained to a large extent by the accumulation of endogenous TRL. This suggests that the postprandial dyslipidemia encountered in CHD is more dependent on a failure of regulation of endogenous TRL versus the exogenous TRL species.
Alleles↗
Self-report as a selection instrument in screening for cardiovascular disease risk.
INTRODUCTION: Cardiovascular disease (CVD) risk screening may rely partly on self-report information. The accuracy of self-reporting in relation to the actual risk factor status is insufficiently known. DESIGN: Self-report (yes, no, don't know) of presence of hypertension, hyperlipidemia, and overweight was compared to the corresponding risk factor data obtained by physical examination and blood analysis. The examinations carried out in a primary health care setting in Sweden were on a randomized population of 122 men and 127 women aged 20 to 60 years. RESULTS: Unawareness of hyperlipidemia was 71% in women and 56% in men, as compared to 29% or lower for the other risk factors. The sensitivity of self-report was 69% or higher for the other risk factors, with the exception of hypertension in women, where it was 29%. Specificity was generally high, except for hyperlipidemia. CONCLUSION: On a population level, self-reports of hypertension, hyperlipidemia, and overweight provide a feasible selection instrument by which a subpopulation with high risk factor frequency can be identified. However, the rate of misclassification is considerable. For hyperlipidemia, the benefit of self-reporting is presently limited, due to the high unawareness of this risk factor. Individual awareness and accurate knowledge about the presence or absence of risk factors needs to improve before self-reporting can be used as a reliable instrument in risk factor screening.
Adult↗
Serum urate determines antioxidant capacity in middle-aged men - a controlled, randomized diet and exercise intervention study.
OBJECTIVES: To study whether advice on diet and/or exercise, given in order to reduce cardiovascular risk factors in middle-aged men, affects the intake of antioxidants, urate concentration and the total antioxidant capacity in serum. DESIGN: A 6-month randomized controlled intervention study. SETTING: Primary Health Care in Sollentuna, Stockholm, and the Department of Medicine, Karolinska Hospital, Stockholm, Sweden. SUBJECTS: One hundred and fifty-eight healthy men (46.2 +/- 5.0 years) with moderately raised cardiovascular risk factors. INTERVENTIONS: Advice on diet (D, n = 40), exercise (E, n = 39), diet and exercise (DE, n = 39) and a control group (C, n = 39). MAIN OUTCOME MEASURES: Dietary intake, exercise habits, S-urate and the antioxidant capacity in serum (TAOC). RESULTS: After 6 months, changes in dietary and exercise habits were seen in all three intervention groups and favourable effects were seen on BMI, waist circumference, blood pressure, S-cholesterol and fasting insulin. The intake of alpha-tocopherol was decreased in groups D and E (P < 0.01) and beta-carotene was increased in groups D and DE (P < 0.01). In group DE, the intake of vitamin C was increased (P < 0.05). S-urate was reduced in group D from 345 to 325 micromol L-1 (P < 0.05). No significant changes in TAOC were seen in any group. S-urate and TAOC were correlated (r = 0. 58, P < 0.001) and S-urate was correlated to several parameters in the metabolic syndrome. CONCLUSION: Favourable changes in diet and exercise reduced several cardiovascular risk factors but did not affect the total antioxidant capacity in serum. S-urate was a strong determinant of the antioxidant capacity.
Adult↗
Four years experience of a cardiovascular opportunistic screening and prevention programme in the primary health care in Sollentuna, Sweden.
OBJECTIVE: To study the feasibility of a cardiovascular prevention programme. DESIGN: Opportunistic screening for cardiovascular risk factors. Advice and treatment to reduce identified cardiovascular risk factors. Individually designed follow-up. SETTING: Primary health care in Sollentuna (51,000 inhabitants), Sweden. SUBJECTS: Visitors to health care centres. MAIN OUTCOME MEASURES: Feasibility and effectiveness to reduce identified cardiovascular risk factors. RESULTS: During 4 years 5622 persons, of whom 4655 (83%) were in the age group 20-60 years, participated in the programme. The prevalences of risk factors as smoking, overweight, hypertension, hypercholesterolaemia and hypertriglyceridaemia were high. At follow-up investigations, mean S-cholesterol levels were reduced by 7% among men and 10% among women. S-triglycerides were reduced by 24% and 42%, respectively. Diastolic blood pressures were reduced in men from 95 to 90 mmHg and in women from 94 to 88 mmHg. However, no effects on weight were noted and due to a low follow-up rate meaningful analysis of smoking habits was not possible. CONCLUSION: A programme for cardiovascular screening and prevention can be integrated in the primary health care system. Prevalent cardiovascular risk factors like hypercholesterolaemia, hypertriglyceridaemia and high blood pressure were significantly reduced after intervention.
Adult↗
Effects of a cardioselective beta-blocker on postprandial triglyceride-rich lipoproteins, low density lipoprotein particle size and glucose-insulin homeostasis in middle-aged men with modestly increased cardiovascular risk.
Beta-adrenergic receptor-blocking agents are commonly used for treatment of hypertension, angina pectoris and arrhythmias and as secondary prevention after myocardial infarction. The modest protection against myocardial infarction conferred by these compounds in primary-preventive studies has suggested that beneficial effects of beta-blockade are counteracted by known adverse influences on lipid and glucose metabolism. As most beta-blockers increase plasma triglycerides and decrease the high density lipoprotein (HDL) cholesterol concentration, a randomized, double-blind, cross-over study was conducted to evaluate whether a 12-week treatment with metoprolol (100 mg o.d.) or placebo affected the metabolism of postprandial triglyceride-rich lipoproteins in 15 middle-aged men with a modestly increased cardiovascular risk. Metoprolol treatment significantly increased the postprandial responses of very low density lipoprotein (VLDL) and VLDL remnants to a mixed meal-type of oral fat tolerance test. The effect was particularly prominent for larger (Svedberg flotation rate (Sf) > 400 and Sf 60-400) particle species (P < 0.001 in repeated measures ANOVA), whereas the smaller (Sf 20-60) particles were less affected (P < 0.05). The changes in the postprandial responses of the different VLDL species were mainly related to an effect on the fasting plasma concentrations, with limited or no influences on VLDL catabolism during the postprandial state. In contrast, metoprolol treatment did not significantly influence the postprandial responses of chylomicrons and chylomicron remnants. Notably, the enhanced fasting and postprandial triglyceridaemia during metoprolol treatment was neither accompanied by a rise in fasting or postprandial free fatty acid concentrations, nor by alterations of the glucose and insulin responses to a standard oral glucose challenge. The ensuing shift in the LDL particle size distribution towards smaller particles was limited (fraction small LDL: metoprolol 22.8 +/- 15.7% versus placebo 19.3 +/- 15.0%, P < 0.05). In conclusion, metoprolol treatment primarily enhances fasting and postprandial triglyceridaemia in middle-aged men by increasing the basal hepatic production of VLDL.
Adrenergic beta-Antagonists↗
Magnitude of alimentary lipemia is related to intima-media thickness of the common carotid artery in middle-aged men.
Fat intake leads to generation of potentially atherogenic triglyceride-rich lipoproteins (TRL). To investigate the relationship between early atherosclerotic changes and accumulation of hepatic and intestinal TRL after oral fat intake, an estimate of the intima-media thickness (IMT) was made using ultrasound of the common carotid artery, and postprandial TRL was quantified during a standardized oral fat tolerance test in 30 healthy normo- and hypertriglyceridemic middle-aged men. At base line the expected positive association between the LDL cholesterol level and the IMT of the common carotid artery was observed (r = 0.53, P<0.01). In addition, postprandial plasma triglycerides, in particular those measured late (6 h) after intake of the test meal, correlated positively with the IMT (r = 0.44, P<0.05). Of note, this latter correlation was independent of both the LDL cholesterol and the fasting plasma triglyceride concentrations. In a multivariate analysis, 39% of the total variability for the common carotid IMT were explained by age, LDL cholesterol and the postprandial triglyceride level. In univariate analysis, few statistically significant relations were found between common carotid IMT and postprandial levels of chylomicron remnants, VLDL and VLDL remnants of different particle size, the latter determined by specific measurements of ApoB-48 and ApoB-100 in subfractions of TRL. Therefore, in healthy middle-aged men, elevated postprandial triglyceride levels might identify a metabolic state related to early atherosclerosis.
Apolipoprotein B-100↗
Determinants of compliance in men enrolled in a diet and exercise intervention trial: a randomized, controlled study.
Determinants of compliance with a 6-month diet and exercise program were studied among 118 healthy middle-aged men with risk factors for coronary heart disease (CHD). Data were gathered via medical examinations, interviews and questionnaires. Smoking, high levels of hostility, perception of barriers to diet change and low knowledge of risk factors for CHD were linked to poor compliance with increased intake of dietary fiber. Poor compliance with low fat diet was linked with smoking, younger age and not having relatives or friends afflicted with CHD. Poor compliance with the exercise program tended to be associated with younger age and having children at home. Practice implications for health professionals who provide clinical and educational services for middle-aged men with slightly elevated CHD risk factors are discussed.
Coronary Disease↗
Effect of diet and physical exercise intervention programmes on coronary heart disease risk in smoking and non-smoking men in Sweden.
STUDY OBJECTIVE: To investigate differences between smokers and non-smokers in health behaviour, cardiovascular risk factors, coronary heart disease (CHD) risks, health knowledge, health attitudes, and compliance with a CHD prevention programme. DESIGN: Differences between smokers and non-smokers were studied via medical examinations, questionnaires, physical exercise activity logs, and food record sheets. Data were analysed using univariate and multivariate analyses. The five and 10 year CHD risks were assessed using the Framingham CHD risk estimate. SETTING: The Karolinska Hospital, Stockholm, and Sollentuna Primary Health Centre, Sollentuna, Sweden. PARTICIPANTS: The analyses were based on 158 healthy smoking and non-smoking men aged 35-60 years with raised cardiovascular risk factors who enrolled in controlled, randomised six month diet and exercise programmes. MAIN RESULTS: Discriminant analysis suggested that smokers, compared with non-smokers, were characterised by a higher alcohol energy percent, lower HDL cholesterol concentration, lower systolic blood pressure, and a higher plasminogen activator inhibitor-1 (PAI-1) value. Knowledge of the risk factors for CHD was not a discriminating factor. Both smokers and non-smokers increased the exercise taken, improved their diet, and lowered their CHD risk. Before, as well as after the intervention, smokers had a higher CHD risk than non-smokers. CONCLUSIONS: The best CHD prevention action that could be taken by smokers would of course be to quit smoking. Those who cannot stop should be encouraged to improve their diet and increase the amount of physical exercise they take in order to reduce the health hazards of their smoking behaviour.
Adult↗
A decrease in cardiovascular risk factors in healthy 40-year-old Swedish men between 1980-1983 and 1991-1992.
BACKGROUND: Cardiovascular risk factors were compared between two samples of urban middle-aged healthy men investigated in 1980-1983 (n = 106) and 1991-1992 (n = 118), respectively. METHODS: All subjects, who served as controls in an ongoing study on mechanisms behind myocardial infarction, were randomly selected from a register that contains all the inhabitants (1.65 million) in the Stockholm Metropolitan Area. The study programme included recordings of weight, height, smoking habits, blood pressure and blood sampling. Blood and lipoprotein lipid levels, glucose concentrations before and during an oral glucose tolerance test and fibrinogen levels were determined. RESULTS: The 1991-1992 sample had lower systolic blood pressure and lower concentrations of total blood cholesterol, fasting blood glucose and fibrinogen than the 1980-1983 sample. The lower total blood cholesterol level in the 1991-1992 sample was due to a decrease in low- and high-density lipoprotein cholesterol concentrations. In addition, a tendency was seen towards a decrease in prevalence of smoking in the latter sample. No differences were noted in body mass index, diastolic blood pressure, oral glucose tolerance or total triglycerides between the two samples.
Adult↗
Quality of life is not negatively affected by diet and exercise intervention in healthy men with cardiovascular risk factors.
Health-related quality of life was assessed in a diet and exercise intervention study among 157 healthy men aged 35-60 years (mean +/- s.d.; 46.2 +/- 5.0) with moderately raised cardiovascular risk factors. The men were randomized to four groups, diet (D, n = 40), exercise (E, n = 39), diet plus exercise (DE, n = 39), and no active intervention (controls (C) n = 39). Quality of life was measured with two self-administered questionnaires; Subjective Symptoms Assessment Profile and Minor Symptom Evaluation Profile, at baseline and after 1.5, 3 and 6 months. Cardiovascular risk factors were investigated at baseline and after 6 months. As a result of changes in dietary habits and physical exercise in the three intervention groups, several important cardiovascular risk factors were significantly reduced. The quality of life/well-being did not differ between the four groups and did not change significantly in any of the groups during the study. There was, however, a tendency towards fewer gastrointestinal symptoms in group D and fewer cardiac symptoms in group DE. We conclude that advice on lifestyle changes in the form of diet and exercise reduce risk factors in middle-aged men without negative effects on their quality of life.
Adult↗
Effects on glucose tolerance, insulin secretion, insulin-like growth factor 1 and its binding protein, IGFBP-1, in a randomized controlled diet and exercise study in healthy, middle-aged men.
OBJECTIVES: To study the effects of advice on diet, exercise and their combination on oral glucose tolerance (OGTT), insulin secretion, insulin-like growth factor-1 (IGF-1) and its binding protein, IGFBP-1. DESIGN: A 6-month, randomized, controlled intervention study. SETTING: Primary health care centres in Sollentuna, Stockholm and the Department of Medicine, Karolinska Hospital, Stockholm, Sweden. SUBJECTS: One hundred and fifty-seven normoglycaemic healthy men, mean age 46 years, range 35-60 years, with slightly to moderately raised cardiovascular risk factors. INTERVENTIONS: Advice on diet (D, n = 40), exercise (E, n = 39) a combination of both (DE, n = 39) and a control group (C, n = 39). MAIN OUTCOME MEASURES: An OGTT, insulin secretion, IGF-1 and its binding protein, IGFBP-1. RESULTS: The number of pathological OGTTs in the intervention groups decreased from 42/118 to 33/118 whilst the number in the control group did not change. Fasting insulin levels decreased in groups E and DE from 8.8-7.4 mU L-1 (P < 0.01) and from 8.3-6.7 mU L-1 (P < 0.01), respectively. Accordingly, the insulin area under the curve decreased from 5278 to 4828 (P < 0.05) in group E, and from 5482 to 4809 (P < 0.01) in group DE. IGF-1 only increased in group D. The most prominent changes were noted for IGFBP-1, which increased in all three intervention groups and to the highest degree in group DE (from 33.7-42.6 micrograms L-1, P < 0.001). CONCLUSIONS: A combination of increased exercise and improved diet, as well as increased exercise alone, favourably affect glucose and insulin homeostasis in middle-aged men with moderately elevated cardiovascular risk factors. The most marked changes were noted for IGFBP-1, possibly suggesting a decreased insulin secretion and an enhanced insulin sensitivity.
Adult↗
Diet and exercise are equally effective in reducing risk for cardiovascular disease. Results of a randomized controlled study in men with slightly to moderately raised cardiovascular risk factors.
To study the impact of diet and exercise and the combination thereof on cardiovascular risk factors, 157 healthy men aged 35-60 years (mean +/- S.D.; 46.2 +/- 5.0) with slightly to moderately raised cardiovascular risk factors, were randomized to 4 groups, diet (D, n = 40), exercise (E, n = 39), diet plus exercise (DE, n = 39), and no active intervention (controls (C, n = 39)), and investigated at baseline and after 6 months. BMI was significantly reduced in Groups E and DE (mean difference and 95% confidence intervals (CI), -0.3 (-0.5, -0.01) and -0.6 (-0.9, -0.3) kg/m2, respectively). Waist circumference was reduced in all 3 intervention groups (D, E, and DE), -1.3 (-2.5, -0.1), -2.2 (-3.2, -1.3) and -3.0 (-3.9, -2.0) cm, but not in the control group. Blood pressure (BP) was reduced in all 3 intervention groups, systolic BP 4-7 mmHg and diastolic BP 2-6 mmHg. Serum cholesterol was reduced in Group DE, -0.45 (-0.77, -0.13) mmol/l. VLDL-cholesterol was reduced in Groups E and DE, -0.14 (-0.26, -0.03) and -0.09 (-0.18, -0.01) mmol/l, whereas LDL-cholesterol was reduced in Groups D and DE -0.30 (-0.54, -0.06) and -0.35 (-0.64, -0.05) mmol/l. In contrast, neither HDL-cholesterol nor serum triglycerides were influenced by the interventions. According to the coronary risk profile derived from the Framingham study, all 3 intervention groups (D, E, and DE) significantly reduced their estimated 10-year risk (-13, -12, and -14%, respectively). We conclude that even with rather moderate changes in diet and exercise, several important cardiovascular risk factors can be affected and that diet and exercise were about equally effective in reducing cardiovascular risk.
Adult↗
Prevention of cardiovascular disease within the primary health care system--feasibility of a prevention programme within the Sollentuna primary health care catchment area.
OBJECTIVE: To integrate prevention of cardiovascular disease within the primary health care. DESIGN: A prevention programme which combines population and individual high-risk strategy. SETTING: The Primary Health Care in Sollentuna, Stockholm, Sweden. MAIN OUTCOME MEASURE: Characteristics of, and risk factor prevalence among, persons registered in the prevention programme. RESULTS: During the first year more than 2000 persons, representing every tenth visitor and 6% of the population aged 15-60 years, were registered in the prevention programme. 90% were < or = 60 years and 62% were women. A large proportion (70%) had risk factors that required advice, treatment, and follow up. 24% of the men and 27% of the women were smokers, 68% and 62% respectively, had serum cholesterol > or = 5.2 mmol/l, and 33% and 22% had a diastolic blood pressure > or = 90 mmHg. CONCLUSION: The present study implies that it is possible to integrate a large scale prevention programme in the existing primary health care organization. The prevalence of risk factors in those who enter the prevention programme is high, which places great demands for treatment and follow up.
Adolescent↗
[Serum cholesterol in primary health care--the pattern of orders and resource needs].
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Adult↗