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  • 1. Berggren, H
    et al.
    Ekroth, R
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Hjalmarson, Å
    Schlossman, D
    Waldenström, A
    Waldenström, J
    William Olsson, C
    Myocardial Protective Effect of Maintained Beta-Blockade in Aorto-Coronary Bypass Surgery1983In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 17, no 1, p. 29-32Article in journal (Refereed)
    Abstract [en]

    Twenty-nine patients were randomly allocated to two groups before undergoing aorto-coronary bypass surgery. In one group the beta-blocking medication was withdrawn three days preoperatively, and in the other group it was maintained. The patients in the latter group were additionally given 100 mg metoprolol per os two hours before surgery. The degree of myocardial injury, as judged from cumulated activity of S-CK B, was less when the beta-blockade was maintained.

  • 2. From Attebring, M
    et al.
    Hartford, M
    Berndt, AK
    Herlitz, Johan
    [external].
    Has the interest in secondary prevention increased among the physicians after the 4S study?2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 2, p. 164-167Article in journal (Refereed)
    Abstract [en]

    This study evaluates the occurrence of various risk indicators, with particular emphasis on serum lipids one year after a coronary event (development of acute mycoardial infarction (AMI); exposure to either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), prior to and after presentation of the main results from the 4S study. Patients under 70 years of age either hospitalized for AMI or undergoing CABG or PTCA at Sahlgrenska University Hospital in Göteborg were evaluated one year after the event. Patients who had an event during the period January 1, 1993 until December 31, 1993 were evaluated one year later (Period I) and those who had an event during the period September 1, 1995 until August 31, 1996 were evaluated one year thereafter (Period II). In total, 293 patients were evaluated during Period I and 284 during Period II. Mean total serum cholesterol levels fell from 6.2 mmol/l during Period I to 5.3 mmol/l during Period II (p < 0.001). The proportion of patients with serum cholesterol < or =5.0 mmol/l increased from 15% during Period I to 40% during Period II (p < 0.001). The mean low-density lipoprotein (LDL) levels fell from 4.0 mmol/l during Period I to 3.2 mmol/l during Period II (p < 0.001). The proportion of patients with LDL < or =3.5 mmol/l increased from 32% during Period I to 68% during Period II (p < 0.001). The proportion of patients using lipid-lowering drugs increased from 25% during Period I to 57% during Period II (p < 0.001). Among patients with coronary artery disease who had either developed AMI or undergone CABG or PTCA, a marked increase in the use of lipid-lowering drugs has been observed in a university hospital in Sweden after presentation of the results of the 4S study. Parallel to the increased use of lipid-lowering drugs, we observed a substantial lowering of serum lipids.

  • 3. From Attebring, M
    et al.
    Hartford, M
    Holm, G
    Wiklund, O
    Währborg, P
    Herlitz, Johan
    [external].
    Risk indicators for recurrence among patients with coronary artery disease. Problems associated with their modification.1998In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 32, no 1, p. 9-16Article in journal (Refereed)
    Abstract [en]

    Various risk indicators associated with recurrence of a new ischemic event among patients with coronary artery disease are described and the impact of the implementation of a secondary preventive program on such risk indicators is evaluated. At Sahlgrenska Hospital in Göteborg 293 consecutive patients under the age of 70 years were followed for one to two years after an acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty (PTCA). Enrollment and follow-up began after institution of a secondary preventive program among physicians and nurses at the hospital. A secondary preventive nurse was appointed and guidelines for risk factor modification were provided. The lipid guidelines were rather modest, with hyperlipidemia defined as cholesterol > 6.5 mmol/l or triglycerides > 3.0 mmol/l. The mean value for low density lipoprotein (LDL) cholesterol was 3.96 mmol/l at first screening and 3.94 mmol/l at second screening. Smoking was modestly reduced, from 36% at first screening to 26% at second screening (p < 0.01) It was found that 70% of all the patients had one or more of the following risk indicators at the first screening: s-cholesterol > 6.5 mmol/l (30%), s-triglycerides > 3.0 mmol/l (19%), fasting blood glucose > 6.7 mmol/l (29%), systolic blood pressure > 160 mmHg (9%), diastolic blood pressure > 90 mmHg (8%) or smoking, compared with 67% one to two years later (p > 0.2). This is a clear demonstration of the difficulty in modifying risk indicators in patients, even with the aid of health-care professionals, in order to achieve risk-factor reduction in coronary artery disease.

  • 4. Gottfridsson, C
    et al.
    Nyström, B
    Karlsson, T
    Herlitz, Johan
    [external].
    Edvardsson, N
    Sex difference and factors associated with outcome in patients with sustained ventricular arrhythmias.2008In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 3, p. 182-191Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe gender differences and factors of importance for outcome in patients referred for sustained ventricular arrhythmias. RESULTS: Two hundred and fifty three patients took part in the survey, 126 (20 women) had sustained monomorphic ventricular tachycardia (VT) and 127 (31 women) had polymorphic VT/ventricular fibrillation. Ischemic heart disease was less common in women than in men (47 vs. 80%). At discharge, an ICD implant was similarly common in women (33%) and men (29%). One hundred and twenty five (65%) men and 37 (79%) women were alive at follow-up, p =0.08 (median follow-up 53 months). Independent predictors of long-term mortality were: 1) PVT/VF as the presenting arrhythmia, 2) a low ejection fraction, 3) increased QRS duration and 4) diabetes mellitus. CONCLUSION: The lower proportion of women compared to men being referred for evaluation of sustained ventricular arrhythmias may contribute to the lower number of ICD implants in women. The long-term survival in women and men did not differ significantly.

  • 5. Gottfridsson, C
    et al.
    Nyström, B
    Karlsson, T
    Herlitz, Johan
    University of Borås, School of Health Science.
    Edvardsson, N
    Sex difference and factors associated with outcome in patients with sustained ventricular arrhythmias2008In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 3, p. 182-191Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe gender differences and factors of importance for outcome in patients referred for sustained ventricular arrhythmias. RESULTS: Two hundred and fifty three patients took part in the survey, 126 (20 women) had sustained monomorphic ventricular tachycardia (VT) and 127 (31 women) had polymorphic VT/ventricular fibrillation. Ischemic heart disease was less common in women than in men (47 vs. 80%). At discharge, an ICD implant was similarly common in women (33%) and men (29%). One hundred and twenty five (65%) men and 37 (79%) women were alive at follow-up, p =0.08 (median follow-up 53 months). Independent predictors of long-term mortality were: 1) PVT/VF as the presenting arrhythmia, 2) a low ejection fraction, 3) increased QRS duration and 4) diabetes mellitus. CONCLUSION: The lower proportion of women compared to men being referred for evaluation of sustained ventricular arrhythmias may contribute to the lower number of ICD implants in women. The long-term survival in women and men did not differ significantly.

  • 6.
    Herlitz, Johan
    [external].
    Can we change patients' behaviour in the early phase of an acute coronary syndrome?2003In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 37, no 4, p. 181-182Article in journal (Other (popular science, discussion, etc.))
  • 7.
    Herlitz, Johan
    [external].
    Secondary Prevention After Coronary Artery Bypass Graft Surgery2004In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 38, p. 69-74Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    There is insufficient knowledge about secondary prevention after coronary artery bypass grafting (CABG). Most of it is gathered from patients suffering from myocardial infarction and angina pectoris, only a minority of whom have undergone CABG. Whereas it seems clear that these patients should give up smoking and reduce low‐density lipoprotein (LDL) cholesterol, there is uncertainty about the optimal antiplatelet regimen and antithrombotic treatment. There are some data indicating the benefit of behaviour modification. There is room for improvement and more knowledge when it comes to secondary prevention after CABG.

  • 8.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid-Evander, M
    Hartford, M
    Karlsson, T
    Karlson, BW
    Sjöland, H
    Cause of death during 13 years after coronary artery bypass grafting with emphasis on cardiac death.2004In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 38, no 5, p. 283-286Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the cause of death in the long term after coronary artery bypass grafting (CABG) with particular emphasis on cardiac death. PATIENTS AND SETTING: All the patients in western Sweden without simultaneous valve surgery and without previous CABG who underwent CABG in 1988-1991 in Göteborg, Sweden. DESIGN: Prospective, observational study for 10.6-13.6 years (i.e. until the end of 2001). Various factors contributing to death were described, with the emphasis on cardiac death. RESULTS: In all, 2000 patients were included in the survey. The all-cause mortality rate was 39%. Fifty-eight per cent of all deaths were judged as cardiac deaths. The most frequent cause of death was heart failure (65% among patients who died within 30 days after CABG and 36% among those who died >30 days after CABG). The second most common cause of death was myocardial infarction (56 and 29%, respectively), followed by cancer (0 and 24%, respectively), stroke (21 and 18%, respectively) and infection (8 and 11%, respectively). CONCLUSION: The factors most commonly contributing to death in the long term after CABG were, in order of frequency, heart failure, myocardial infarction, cancer, stroke and infection.

  • 9.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Karlson, BW
    Karlsson, T
    Hartford, M
    Caidahl, K
    Limitation of physical activity, dyspnea and chest pain prior to and two years after coronary artery bypass grafting in relation to preoperative ejection fraction2000In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, no 1, p. 65-72Article in journal (Refereed)
    Abstract [en]

    To investigate the relationships between limitation of physical activity and dyspnoea and chest pain before and 2 years after coronary artery bypass grafting (CABG) and preoperative left ventricular ejection fraction (LVEF), questionnaires were issued to all patients from Western Sweden who underwent CABG during 1988-1991. The analysis comprised 985 patients. Physical activity improved significantly after CABG regardless of the preoperative LVEF. No significant association was found between LVEF and degree of limitation of physical activity before or after surgery. Dyspnoea and chest pain improved markedly, irrespective of LVEF. There was significant association between freedom from dyspnoea and LVEF preoperatively (less dyspnoea with higher LVEF), but not after CABG. The frequency of chest-pain attacks was not related to LVEF, before or after the operation. Thus physical activity, dyspnoea and chest pain improved in the 2 years after CABG irrespective of preoperative LVEF. Absence of dyspnoea was related to LVEF before, but not after surgery, and there was no association between preoperative LVEF and frequency of anginal attacks before or after CABG.

  • 10. Peker, Y
    et al.
    Glantz, H
    Thunstrom, E
    Kallryd, A
    Herlitz, Johan
    University of Borås, School of Health Science.
    Ejdeback, J
    Rationale and Design of the Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnoea: RICCADSA Trial2009In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 43, no 1, p. 24-31Article in journal (Refereed)
    Abstract [en]

    Rationale. Obstructive sleep apnoea (OSA) is common in coronary artery disease (CAD) and a possible cause of increased mortality. To date, there is a lack of randomized controlled trials to draw the conclusion that all CAD patients should be investigated for OSA and subsequently be treated with continuous positive airway pressure (CPAP). Objective. The Randomized Intervention with CPAP in CAD and OSA (RICCADSA) trial is designed to address if CPAP treatment reduces the combined rate of new revascularization, myocardial infarction, stroke and cardiovascular mortality over a 3-year period in CAD patients with OSA. Secondary outcomes include cardiovascular biomarkers, cardiac function and maximal exercise capacity at 3-month- and 1-year follow-ups. Patients and methods. A sample of 400 CAD patients (100 non-sleepy OSA patients randomized to CPAP, 100 to non-CPAP; 100 sleepy OSA patients on CPAP, and 100 CAD patients without OSA) will be included. So far, 240 patients have been enrolled in the trial since December 31, 2005. Conclusion. The RICCADSA trial will contribute to defining the impact of CPAP on prognosis of CAD patients with OSA.

  • 11. Peker, Y
    et al.
    Glatz, H
    Thunström, E
    Kallryd, A
    Herlitz, Johan
    [external].
    Ejdebäck, J
    Rationale and design of the Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnoea--RICCADSA trial.2009In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 43, no 1, p. 24-31Article in journal (Refereed)
    Abstract [en]

    RATIONALE: Obstructive sleep apnoea (OSA) is common in coronary artery disease (CAD) and a possible cause of increased mortality. To date, there is a lack of randomized controlled trials to draw the conclusion that all CAD patients should be investigated for OSA and subsequently be treated with continuous positive airway pressure (CPAP). OBJECTIVE: The Randomized Intervention with CPAP in CAD and OSA (RICCADSA) trial is designed to address if CPAP treatment reduces the combined rate of new revascularization, myocardial infarction, stroke and cardiovascular mortality over a 3-year period in CAD patients with OSA. Secondary outcomes include cardiovascular biomarkers, cardiac function and maximal exercise capacity at 3-month- and 1-year follow-ups. PATIENTS AND METHODS: A sample of 400 CAD patients (100 non-sleepy OSA patients randomized to CPAP, 100 to non-CPAP; 100 sleepy OSA patients on CPAP, and 100 CAD patients without OSA) will be included. So far, 240 patients have been enrolled in the trial since December 31, 2005. CONCLUSION: The RICCADSA trial will contribute to defining the impact of CPAP on prognosis of CAD patients with OSA.

  • 12. Petursson, P
    et al.
    Herlitz, Johan
    [external].
    Caidahl, K
    From Attebring, M
    Gudbjörnsdottir, S
    Sjöland, H
    Hartford, M
    Association between glycometabolic status in the acute phase and 2½ years after an acute coronary syndrome2006In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 40, no 3, p. 145-151Article in journal (Refereed)
    Abstract [en]

    Objectives. To evaluate the association between glycometabolic status in the acute phase and 2½ years later in patients with acute coronary syndrome (ACS). Methods. Non-diabetic patients (n = 762) presenting with ACS were prospectively followed up for 2½ years. Patients were stratified by admission plasma glucose (<6.1 mmol/l, 6.1 – 6.9 mmol/l and ≥7.0 mmol/l) and HbA1c (≤4.5%, 4.6 – 5.4% and ≥5.5%). The predictive value of glucose levels ≥ 7.0 mmol/l and HbA1c ≥ 5.5% for glycometabolic disturbance (i.e. diabetes or impaired fasting glycaemia (IFG)) was analysed. Results. Of 762 patients, 13% had a diagnosis of diabetes and 16% had IFG at follow-up. The prevalence of glycometabolic disturbance at follow-up increased with increasing plasma glucose at admission, from 19% in patients with < 6.1 mmol/l to 42% in patients with ≥ 7.0 mmol/l. Sixty-one percent of patients with HbA1c ≥ 5.5% had glycometabolic disturbance after 2½ years compared to only 25% of those with HbA1c < 5.5%. Conclusion. Non-diabetic patients with ACS and hyperglycaemia are at high risk for developing glycometabolic disturbance. HbA1c may be an even stronger predictor of glycometabolic disturbance than plasma glucose.

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