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Lundstrom, E., Isaksson, E., Wester, P., Laska, A.-C. & Näsman, P. (2018). Enhancing Recruitment Using Teleconference and Commitment Contract (ERUTECC): study protocol for a randomised, stepped-wedge cluster trial within the EFFECTS trial. Trials, 19, Article ID 14.
Open this publication in new window or tab >>Enhancing Recruitment Using Teleconference and Commitment Contract (ERUTECC): study protocol for a randomised, stepped-wedge cluster trial within the EFFECTS trial
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2018 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 19, article id 14Article in journal (Refereed) Published
Abstract [en]

Background: Many randomised controlled trials (RCTs) fail to meet their recruitment goals in time. Trialists are advised to include study recruitment strategies within their trials. EFFECTS is a Swedish, academic-led RCT of fluoxetine for stroke recovery. The trial's primary objective is to investigate whether 20 mg fluoxetine daily compared with placebo for 6 months after an acute stroke improves the patient's functional outcome. The first patient was included on 20 October 2014 and, as of 31 August 2017, EFFECTS has included 810 of planned 1500 individuals. EFFECTS currently has 32 active centres. The primary objective of the ERUTECC (Enhancing Recruitment Using Teleconference and Commitment Contract) study is to investigate whether a structured teleconference re-visit with the study personnel at the centres, accompanied by a commitment contract, can enhance recruitment by 20% at 60 days post intervention, compared with 60 days pre-intervention, in an ongoing RCT. Methods: ERUTECC is a randomised, stepped-wedge cluster trial embedded in EFFECTS. The plan is to start ERUTECC with a running-in period of September 2017. The first intervention is due in October 2017, and the study will continue for 12 months. We are planning to intervene at all active centres in EFFECTS, except the five top recruiting centres (n=27). The rationale for not intervening at the top recruiting centres is that we believe they have reached their full potential and the intervention would be too weak for them. The hypothesis of this study is that a structured teleconference re-visit with the study personnel at the centres, accompanied by a commitment contract, can enhance recruitment by 20% 60 days post intervention, compared to 60 days pre-intervention, in an ongoing RCT. Discussion: EFFECTS is a large, pragmatic RCT of stroke in Sweden. Results from the embedded ERUTECC study could probably be generalised to high-income Western countries, and is relevant to trial management and could improve trial management in the future. It might also be useful in clinical settings outside the field of stroke.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2018
Keyword
Stroke, Randomised controlled trial, RCT, Recruitment, Randomised stepped-wedge cluster trial
National Category
Clinical Medicine
Identifiers
urn:nbn:se:kth:diva-221943 (URN)10.1186/s13063-017-2367-8 (DOI)000419608100004 ()29310679 (PubMedID)2-s2.0-85040447644 (Scopus ID)
Note

QC 20180130

Available from: 2018-01-30 Created: 2018-01-30 Last updated: 2018-01-30Bibliographically approved
Smaradottir, M. I., Ritsinger, V., Gyberg, V., Norhammar, A., Näsman, P. & Mellbin, L. G. (2017). Copeptin in patients with acute myocardial infarction and newly detected glucose abnormalities - A marker of increased stress susceptibility?: A report from the Glucose in Acute Myocardial Infarction cohort. Diabetes & Vascular Disease Research, 14(2), 69-76
Open this publication in new window or tab >>Copeptin in patients with acute myocardial infarction and newly detected glucose abnormalities - A marker of increased stress susceptibility?: A report from the Glucose in Acute Myocardial Infarction cohort
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2017 (English)In: Diabetes & Vascular Disease Research, ISSN 1479-1641, E-ISSN 1752-8984, Vol. 14, no 2, p. 69-76Article in journal (Refereed) Published
Abstract [en]

Objective: To characterize copeptin levels and to explore its prognostic importance in patients with acute myocardial infarction with newly detected glucose abnormalities. Methods: Copeptin was measured in 166 patients with acute myocardial infarction without known diabetes and in 168 age- and gender-matched controls. Participants were classified as having normal glucose tolerance or abnormal glucose tolerance (impaired glucose tolerance + type 2 diabetes mellitus) by oral glucose tolerance test. Study participants were followed over a decade for major cardiovascular event (acute myocardial infarction/stroke/congestive heart failure/cardiovascular death), cardiovascular and total death. Results: Median copeptin level was higher in patients (10.5 pmol/L) than controls (5.9 pmol/L; p < 0.01). Patients with abnormal glucose tolerance had higher copeptin (12.2 pmol/L) than those with normal glucose tolerance (7.9 pmol/L; p < 0.01) but levels of copeptin did not differ in controls with abnormal glucose tolerance or normal glucose tolerance. Copeptin predicted major cardiovascular events [n = 64; hazard ratio = 1.15 (1.01-1.32; p = 0.04)], cardiovascular mortality [n = 29; hazard ratio = 1.24 (1.06-1.46; p = 0.01)] and total death [n = 51; hazard ratio = 1.21 (1.05-1.40; p = 0.01)] in unadjusted Cox regression analyses in the patient cohort. In controls, copeptin predicted major cardiovascular events [n = 26; hazard ratio = 1.17 (1.01-1.36; p = 0.03)]. Conclusion: Copeptin levels are highest among acute myocardial infarction patients with glucose disturbances and predict an adverse prognosis in unadjusted analyses. These findings imply that raised copeptin reflects stress rather than acting as a pathogenic factor for glucose abnormalities.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keyword
acute coronary syndrome, arginine vasopressin, biomarker, copeptin, Diabetes mellitus, prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-207968 (URN)10.1177/1479164116664490 (DOI)000394677900002 ()28118730 (PubMedID)2-s2.0-85012069966 (Scopus ID)
Note

QC 20170531

Available from: 2017-05-31 Created: 2017-05-31 Last updated: 2017-11-10Bibliographically approved
Ritsinger, V., Brismar, K., Malmberg, K., Mellbin, L., Näsman, P., Rydén, L., . . . Norhammar, A. (2017). Elevated levels of adipokines predict outcome after acute myocardial infarction: A long-term follow-up of the Glucose Tolerance in Patients with Acute Myocardial Infarction cohort. Diabetes & Vascular Disease Research, 14(2), 77-87
Open this publication in new window or tab >>Elevated levels of adipokines predict outcome after acute myocardial infarction: A long-term follow-up of the Glucose Tolerance in Patients with Acute Myocardial Infarction cohort
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2017 (English)In: Diabetes & Vascular Disease Research, ISSN 1479-1641, E-ISSN 1752-8984, Vol. 14, no 2, p. 77-87Article in journal (Refereed) Published
Abstract [en]

Objective: Adiponectin and leptin are associated with insulin resistance and cardiovascular disease. Information on the prognostic value after an acute myocardial infarction is still conflicting. Methods: Patients (n = 180) without known diabetes and with admission glucose of <11 mmol/L admitted for an acute myocardial infarction in 1998-2000 were followed for mortality and cardiovascular events (first of cardiovascular mortality/acute myocardial infarction/stroke/heart failure) until the end of 2011 (median: 11.6 years). Plasma adiponectin and leptin were related to outcome in Cox proportional-hazard regression analyses. Results: Median age was 64 years and 69% were male. Total mortality was 34% (n = 61) and 44% (n = 80) experienced a cardiovascular event. Adiponectin at discharge predicted cardiovascular events (hazard ratio; 95% confidence interval; 1.45; 1.02-2.07, p = 0.038), total mortality (2.53; 1.64-3.91, p < 0.001) and cancer mortality (3.64; 1.51-8.74, p = 0.004). After adjustment for age, sex, body mass index, previous myocardial infarction and heart failure, adiponectin predicted total mortality (1.79; 1.07-3.00, p = 0.027) but not cardiovascular events. High levels of leptin were associated with cardiovascular events during the first 7 years, after which the association was attenuated. Leptin did not predict total mortality. Conclusion: In patients with acute myocardial infarction but without previously known diabetes, high levels of adiponectin at discharge predicted total mortality. The present results support the hypothesis that high rather than low levels of adiponectin predict mortality after acute myocardial infarction.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keyword
Acute myocardial infarction, adipokines, diabetes, prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-207983 (URN)10.1177/1479164116678156 (DOI)000394677900003 ()28185529 (PubMedID)2-s2.0-85012104646 (Scopus ID)
Funder
Swedish Heart Lung FoundationThe Kamprad Family FoundationSwedish Diabetes AssociationThe Karolinska Institutet's Research FoundationNovo Nordisk
Note

QC 20170531

Available from: 2017-05-31 Created: 2017-05-31 Last updated: 2017-11-10Bibliographically approved
Ivert, T., Dalen, M., Ander, C., Stalesen, R., Näsman, P., Lordkipanidze, M. & Hjemdahl, P. (2017). Platelet function one and three months after coronary bypass surgery in relation to once or twice daily dosing of acetylsalicylic acid. Thrombosis Research, 149, 64-69
Open this publication in new window or tab >>Platelet function one and three months after coronary bypass surgery in relation to once or twice daily dosing of acetylsalicylic acid
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2017 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 149, p. 64-69Article in journal (Refereed) Published
Abstract [en]

Introduction: Current guidelines recommend acetylsalicylic acid (ASA) treatment after coronary artery bypass grafting (CABG) to reduce thrombotic vein graft occlusion. The optimal dosage of ASA is not known. Materials and methods: Forty-two patients undergoing elective CABG were randomized to receive either ASA 75 mg or 160 mg once daily (OD) or 75 mg twice daily (BID) after the operation. Platelet function testing was performed before, and one and three months after the operation. Results: White blood cell counts increased during the initial postoperative days whereas platelet countswere initially slightly reduced after the operation but increased after one month without any major changes of mean platelet volumes. Serum thromboxane B-2 was more effectively suppressed at one and three months after the operation with ASA 75 mg BID or 160 mg OD than with 75 mg OD (p < 0.001). ASA 75 mg BID and 160 mg OD were equally effective. Adenosine diphosphate stimulated platelet aggregation in whole blood (Multiplate (R)) was increased one and three months after the operation, and this was counteracted by ASA 75 mg BID but not by 75 or 160 mg OD. Arachidonic acid-induced aggregation was more effectively inhibited by 75 mg BID or 160 mg OD compared to 75 mg OD at three months. Conclusions: Less effective inhibition of platelet activation was obtained with ASA 75 mg OD than with ASA 160mg OD or 75mg BID up to three months after CABG. Especially the latter dose is of interest for further studies of efficacy and clinical outcomes after CABG.

Place, publisher, year, edition, pages
Elsevier, 2017
Keyword
Aspirin, Coronary artery bypass grafting, Individualized therapy, Platelet function, Thromboxane
National Category
Hematology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-200755 (URN)10.1016/j.thromres.2016.11.018 (DOI)000391287300011 ()2-s2.0-84998656244 (Scopus ID)
Note

QC 20170209

Available from: 2017-02-09 Created: 2017-02-09 Last updated: 2017-11-29Bibliographically approved
Ritsinger, V., Brismar, K., Malmberg, K., Mellbin, L., Näsman, P., Ryden, L., . . . Norhammar, A. (2016). Elevated levels of adipokines predict outcome after acute myocardial infarction. Long-term follow-up of the GAMI cohort. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY. EUROPEAN HEART JOURNAL, 37, 459-459
Open this publication in new window or tab >>Elevated levels of adipokines predict outcome after acute myocardial infarction. Long-term follow-up of the GAMI cohort
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2016 (English)In: EUROPEAN HEART JOURNAL, ISSN 0195-668X, Vol. 37, p. 459-459Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Oxford University Press, 2016
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-199997 (URN)000383869502195 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY
Note

QC 20170206

Available from: 2017-02-06 Created: 2017-01-20 Last updated: 2017-02-06Bibliographically approved
Johansson, I., Dahlström, U., Edner, M., Näsman, P., Ryden, L. & Norhammar, A. (2016). Glycosylated haemoglobin predicts mortality in patients with heart failure and unknown diabetes: insights from the Swedish heart failure registry (SwedeHF). Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY. EUROPEAN HEART JOURNAL, 37, 733-733
Open this publication in new window or tab >>Glycosylated haemoglobin predicts mortality in patients with heart failure and unknown diabetes: insights from the Swedish heart failure registry (SwedeHF)
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2016 (English)In: EUROPEAN HEART JOURNAL, ISSN 0195-668X, Vol. 37, p. 733-733Article in journal (Refereed) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-199998 (URN)000383869503439 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY
Note

QC 20170206

Available from: 2017-02-06 Created: 2017-01-20 Last updated: 2017-02-06Bibliographically approved
Johansson, I., Dahlstrom, U., Edner, M., Näsman, P., Ryden, L. & Norhammar, A. (2016). Glycosylated haemoglobin predicts mortality in patients with heart failure and unknown diabetes: insights from the Swedish Heart Failure registry (SwedeHF). Paper presented at 52nd Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 12-16, 2016, Munich, GERMANY. Diabetologia, 59, S532-S532
Open this publication in new window or tab >>Glycosylated haemoglobin predicts mortality in patients with heart failure and unknown diabetes: insights from the Swedish Heart Failure registry (SwedeHF)
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2016 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 59, p. S532-S532Article in journal (Refereed) Published
Place, publisher, year, edition, pages
SPRINGER, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:kth:diva-206715 (URN)000398373703072 ()
Conference
52nd Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), SEP 12-16, 2016, Munich, GERMANY
Note

QC 20170508

Available from: 2017-05-08 Created: 2017-05-08 Last updated: 2017-05-08Bibliographically approved
Ekstrand, E. E., Gustafsson, A. G., Norhammar, A. N., Näsman, P. N., Ryden, L. R. & Kjellstrom, B. K. (2016). Periodontal disease: A potential risk factor for myocardial infarction in younger women. Paper presented at Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY. EUROPEAN HEART JOURNAL, 37, 350-350
Open this publication in new window or tab >>Periodontal disease: A potential risk factor for myocardial infarction in younger women
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2016 (English)In: EUROPEAN HEART JOURNAL, ISSN 0195-668X, Vol. 37, p. 350-350Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Oxford University Press, 2016
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:kth:diva-199996 (URN)000383869501498 ()
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 27-31, 2016, Rome, ITALY
Note

QC 20170131

Available from: 2017-01-31 Created: 2017-01-20 Last updated: 2017-01-31Bibliographically approved
Ryden, L., Buhlin, K., Ekstrand, E., de Faire, U., Gustafsson, A., Holmer, J., . . . Klinge, B. (2016). Periodontitis Increases the Risk of a First Myocardial Infarction A Report From the PAROKRANK Study. Circulation, 133(6), 576-583
Open this publication in new window or tab >>Periodontitis Increases the Risk of a First Myocardial Infarction A Report From the PAROKRANK Study
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2016 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 133, no 6, p. 576-583Article in journal (Refereed) Published
Abstract [en]

Background The relationship between periodontitis (PD) and cardiovascular disease is debated. PD is common in patients with cardiovascular disease. It has been postulated that PD could be causally related to the risk for cardiovascular disease, a hypothesis tested in the Periodontitis and Its Relation to Coronary Artery Disease (PAROKRANK) study. Methods and Results Eight hundred five patients (<75 years of age) with a first myocardial infarction (MI) and 805 age- (mean 628), sex- (male 81%), and area-matched controls without MI underwent standardized dental examination including panoramic x-ray. The periodontal status was defined as healthy (80% remaining bone) or as mild-moderate (from 79% to 66%) or severe PD (<66%). Great efforts were made to collect information on possibly related confounders (approximate to 100 variables). Statistical comparisons included the Student pairwise t test and the McNemar test in 2x2 contingency tables. Contingency tables exceeding 2x2 with ranked alternatives were tested by Wilcoxon signed rank test. Odds ratios (95% confidence intervals) were calculated by conditional logistic regression. PD was more common (43%) in patients than in controls (33%; P<0.001). There was an increased risk for MI among those with PD (odds ratio, 1.49; 95% confidence interval, 1.21-1.83), which remained significant (odds ratio, 1.28; 95% confidence interval, 1.03-1.60) after adjusting for variables that differed between patients and controls (smoking habits, diabetes mellitus, years of education, and marital status). Conclusions In this large case-control study of PD, verified by radiographic bone loss and with a careful consideration of potential confounders, the risk of a first MI was significantly increased in patients with PD even after adjustment for confounding factors. These findings strengthen the possibility of an independent relationship between PD and MI.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
Keyword
case-control study, causality, myocardial infarction, periodontitis, radiography, panoramic, risk factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-183188 (URN)10.1161/CIRCULATIONAHA.115.020324 (DOI)000369504400006 ()26762521 (PubMedID)2-s2.0-84957843769 (Scopus ID)
Funder
AFA InsuranceSwedish Heart Lung FoundationSwedish Research CouncilStockholm County Council
Note

QC 20160303

Available from: 2016-03-03 Created: 2016-03-03 Last updated: 2017-11-30Bibliographically approved
Johansson, I., Dahlström, U., Edner, M., Näsman, P., Rydén, L. & Norhammar, A. (2016). Prognostic Implications of Type 2 Diabetes Mellitus in Ischemic and Nonischemic Heart Failure. Journal of the American College of Cardiology, 68(13), 1404-1416
Open this publication in new window or tab >>Prognostic Implications of Type 2 Diabetes Mellitus in Ischemic and Nonischemic Heart Failure
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2016 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 68, no 13, p. 1404-1416Article in journal (Refereed) Published
Abstract [en]

Background Heart failure (HF) is a common and serious complication in type 2 diabetes mellitus (T2DM). The prognosis of ischemic HF and impact of revascularization in such patients have not been investigated fully in a patient population representing everyday practice. Objectives This study examined the impact of ischemic versus nonischemic HF and previous revascularization on long-term prognosis in an unselected population of patients with and without T2DM. Methods Patients stratified by diabetes status and ischemic or nonischemic HF and history of revascularization in the Swedish Heart Failure Registry (SwedeHF) from 2003 to 2011 were followed up for mortality predictors and longevity. A propensity score analysis was applied to evaluate the impact of previous revascularization. Results Among 35,163 HF patients, those with T2DM were younger, and 90% had 1 or more associated comorbidities. Ischemic heart disease (IHD) occurred in 62% of patients with T2DM and 47% of those without T2DM, of whom 53% and 48%, respectively, had previously undergone revascularization. T2DM predicted mortality regardless of the presence of IHD, with adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.40 (1.33 to 1.46) and 1.30 (1.22 to 1.39) in those with and without IHD, respectively. Patients with both T2DM and IHD had the highest mortality, which was further accentuated by the absence of previous revascularization (adjusted HR: 0.82 in favor of such treatment; 95% CI: 0.75 to 0.91). Propensity score adjustment did not change these results (HR: 0.87; 95% CI: 0.78 to 0.96). Revascularization did not abolish the impact of T2DM, which predicted mortality in those with (HR: 1.36; 95% CI: 1.24 to 1.48) and without (HR: 1.45; 95% CI: 1.33 to 1.56) a history of revascularization. Conclusions Ninety percent of HF patients with T2DM have preventable comorbidities. IHD in patients with T2DM had an especially negative influence on mortality, an impact that was beneficially influenced by previous revascularization.

Place, publisher, year, edition, pages
Elsevier, 2016
Keyword
heart failure, ischemic heart disease, prognosis, revascularization, type 2 diabetes mellitus
National Category
Clinical Medicine
Identifiers
urn:nbn:se:kth:diva-195313 (URN)10.1016/j.jacc.2016.06.061 (DOI)000385933800005 ()27659462 (PubMedID)2-s2.0-84990929254 (Scopus ID)
Funder
Swedish Heart Lung FoundationAFA InsuranceSwedish Diabetes AssociationThe Karolinska Institutet's Research Foundation
Note

QC 20161110

Available from: 2016-11-10 Created: 2016-11-02 Last updated: 2017-11-29Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-7606-8771

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