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  • 1
    Online Resource
    Online Resource
    Low carbohydrate high fat-diet in real life assessed by diet history interviews
    Springer Science and Business Media LLC ; 2023
    In:  Nutrition Journal Vol. 22, No. 1 ( 2023-03-02)
    Details
    In: Nutrition Journal, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2023-03-02)
    Abstract: Low carbohydrate high fat (LCHF) diet has been a popular low carbohydrate diet in Sweden for 15 years. Many people choose LCHF to lose weight or control diabetes, but there are concerns about the effect on long-term cardiovascular risks. There is little data on how a LCHF diet is composed in real-life. The aim of this study was to evaluate the dietary intake in a population with self-reported adherence to a LCHF diet. Methods A cross-sectional study of 100 volunteers that considered themselves eating LCHF was conducted. Diet history interviews (DHIs) and physical activity monitoring for validation of the DHIs were performed. Results The validation shows acceptable agreement of measured energy expenditure and reported energy intake. Median carbohydrate intake was 8.7 E% and 63% reported carbohydrate intake at potentially ketogenic levels. Median protein intake was 16.9 E%. The main source of energy was dietary fats (72.0 E%). Intake of saturated fat was 32 E% and cholesterol was 700 mg per day, both of which exceeded the recommended upper limits according to nutritional guidelines. Intake of dietary fiber was very low in our population. The use of dietary supplements was high, and it was more common to exceed the recommended upper limits of micronutrients than to have an intake below the lower limits. Conclusions Our study indicates that in a well-motivated population, a diet with very low carbohydrate intake can be sustained over time and without apparent risk of deficiencies. High intake of saturated fats and cholesterol as well as low intake of dietary fiber remains a concern.
    Type of Medium: Online Resource
    ISSN: 1475-2891
    URL: Article
    DOI: 10.1186/s12937-023-00847-8
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2091602-4
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  • 2
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    Prevalence and treatment of diabetes and pre-diabetes in a real-world heart failure population: a single-centre cross-sectional study
    BMJ ; 2022
    In:  Open Heart Vol. 9, No. 2 ( 2022-12), p. e002133-
    Details
    In: Open Heart, BMJ, Vol. 9, No. 2 ( 2022-12), p. e002133-
    Abstract: The aim of this study was to investigate a real-world heart failure (HF) cohort regarding (1) prevalence of known diabetes mellitus (DM), undiagnosed DM and pre-diabetes, (2) if hf treatment differs depending on glycaemic status and (3) if treatment of DM differs depending on HF phenotype. Methods All patients who had received a diagnosis of HF at Umeå University Hospital between 2010 and 2019 were identified and data were extracted from patient files according to a prespecified protocol containing parameters for clinical characteristics, including echocardiogram results, comorbidities, fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) values. Patients’ HF phenotype was determined using the latest available echocardiogram. The number of patients with previous DM diagnosis was assessed. Patients without a previous diagnosis of DM were classified as non-DM, pre-diabetes or probable DM according to FPG and HbA1c levels using WHO criteria. Results In total, 2326 patients (59% male, mean age 76±13 years) with HF and at least one echocardiogram were assessed. Of these, 617 (27%) patients had a previous diagnosis of DM. Of the 1709 patients without a previous diagnosis of DM, 1092 (67%) patients had either an FPG or HbA1c recorded, of which 441 (41%) met criteria for pre-diabetes and 97 (9%) met criteria for probable diabetes, corresponding to 19% and 4% of the entire cohort, respectively. Patients with HF and diabetes were more often treated with diuretics and beta blockers compared with non-DM patients (64% vs 42%, p 〈 0.001 and 88% vs 83%, p 〈 0.001, respectively). There was no difference in DM treatment between HF phenotypes. Conclusions DM and pre-diabetes are common in this HF population with 50% of patients having either known DM, probable DM or pre-diabetes. Patients with HF and DM are more often treated with common HF medications. HF phenotype did not affect choice of DM therapy.
    Type of Medium: Online Resource
    ISSN: 2053-3624
    URL: Article
    DOI: 10.1136/openhrt-2022-002133
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2747269-3
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  • 3
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    Online Resource
    Impaired left ventricular systolic function reserve limits cardiac output and exercise capacity in HFpEF patients due to systemic hypertension
    Elsevier BV ; 2013
    In:  International Journal of Cardiology Vol. 168, No. 2 ( 2013-09), p. 1088-1093
    Details
    In: International Journal of Cardiology, Elsevier BV, Vol. 168, No. 2 ( 2013-09), p. 1088-1093
    Type of Medium: Online Resource
    ISSN: 0167-5273
    URL: Article
    DOI: 10.1016/j.ijcard.2012.11.035
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2013
    detail.hit.zdb_id: 1500478-8
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  • 4
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    Recurrent heart failure hospitalizations increase the risk of cardiovascular and all‐cause mortality in patients with heart failure in Sweden: a real‐world study
    Wiley ; 2021
    In:  ESC Heart Failure Vol. 8, No. 3 ( 2021-06), p. 2144-2153
    Details
    In: ESC Heart Failure, Wiley, Vol. 8, No. 3 ( 2021-06), p. 2144-2153
    Abstract: Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality. We examined the impact of recurrent HF hospitalizations (HFHs) on cardiovascular (CV) mortality among patients with HF in Sweden. Methods and results Adults with incident HF were identified from linked national health registers and electronic medical records from 01 January 2005 to 31 December 2013 for Uppsala and until 31 December 2014 for Västerbotten. CV mortality and all‐cause mortality were evaluated. A time‐dependent Cox regression model was used to estimate relative CV mortality rates for recurrent HFHs. Assessment was also done for ejection fraction‐based HF phenotypes and for comorbid atrial fibrillation, diabetes, or chronic renal impairment. Overall, 3878 patients with HF having an index hospitalization were included, providing 9691.9 patient‐years of follow‐up. Patients were relatively old (median age: 80 years) and were more frequently male (55.5%). Compared with patients without recurrent HFHs, the adjusted hazard ratio (HR [95% confidence interval; CI]) for CV mortality and all‐cause mortality were statistically significant for patients with one, two, three, and four or more recurrent HFHs. The risk of CV mortality and all‐cause mortality increased approximately six‐fold in patients with four or more recurrent HFHs vs. those without any HFHs (HR [95% CI] : 6.26 [5.24–7.48] and 5.59 [4.70–6.64] , respectively). Similar patterns were observed across the HF phenotypes and patients with comorbidities. Conclusions There is a strong association between recurrent HFHs and CV and all‐cause mortality, with the risk increasing progressively with each recurrent HFH.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v8.3
    DOI: 10.1002/ehf2.13296
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2814355-3
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  • 5
    Online Resource
    Online Resource
    Characteristics and management of very elderly patients with heart failure: a retrospective, population cohort study
    Wiley ; 2023
    In:  ESC Heart Failure Vol. 10, No. 1 ( 2023-02), p. 295-302
    Details
    In: ESC Heart Failure, Wiley, Vol. 10, No. 1 ( 2023-02), p. 295-302
    Abstract: Unmet needs exist in the diagnosis and treatment of heart failure (HF) in the elderly population. Our aim was to analyse and compare data of diagnostics and management of very elderly patients (aged ≥85 years) compared with younger patients (aged 18–84 years) with HF in Sweden. Methods Incidence of ≥2 HF diagnosis (ICD‐10) was identified from primary/secondary care in Uppsala and Västerbotten during 2010–2015 via electronic medical records linked to data from national health registers. Analyses investigated the diagnosis, treatment patterns, hospitalizations and outpatient visits, and mortality. Results Of 8702 patients, 27.7% were ≥85 years old, women (60.2%); most patients (80.7%) had unknown left ventricular ejection fraction; key co‐morbidities comprised anaemia, dementia, and cerebrovascular disease. More very elderly patients received cardiovascular disease (CVD)‐related management after diagnosis in primary care (13.6% vs. 6.5%; P   〈  0.0001), but fewer patients underwent echocardiography (19.3% vs. 42.9%; P   〈  0.0001). Within 1 year of diagnosis, very elderly patients were less likely to be hospitalized (all‐cause admissions per patient: 1.9 vs. 2.3; P   〈  0.0001; CVD‐related admissions per patient: 1.8 vs. 2.1; P  = 0.0004) or prescribed an angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) plus a β‐blocker (45.2% vs. 56.9%; P   〈  0.0001) or an ACEI/ARB plus a β‐blocker plus a mineralocorticoid receptor antagonist (15.4% vs. 31.7%; P   〈  0.0001). One‐year mortality was high in patients ≥85 years old, 30.5% (CI: 28.3‐32.7%) out of 1797 patients. Conclusions Despite the large number of very elderly patients with newly diagnosed HF in Sweden, poor diagnostic work‐up and subsequent treatment highlight the inequality of care in this vulnerable population.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v10.1
    DOI: 10.1002/ehf2.14191
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2814355-3
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  • 6
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    Prevalence and prognostic impact of left ventricular systolic dysfunction or pulmonary congestion after acute myocardial infarction
    Wiley ; 2023
    In:  ESC Heart Failure Vol. 10, No. 2 ( 2023-04), p. 1347-1357
    Details
    In: ESC Heart Failure, Wiley, Vol. 10, No. 2 ( 2023-04), p. 1347-1357
    Abstract: The aim was to describe the prevalence, characteristics, and outcome of patients with acute myocardial infarction (MI) developing left ventricular (LV) systolic dysfunction or pulmonary congestion by applying different criteria to define the population. Methods and results In patients with MI included in the Swedish web‐system for enhancement and development of evidence‐based care in heart disease (SWEDEHEART) registry, four different sets of criteria were applied, creating four not mutually exclusive subsets of patients: patients with MI and ejection fraction (EF)  〈  50% and/or pulmonary congestion (subset 1); EF  〈  40% and/or pulmonary congestion (subset 2); EF  〈  40% and/or pulmonary congestion and at least one high‐risk feature (subset 3, PARADISE‐MI like); and EF  〈  50% and no diabetes mellitus (subset 4, DAPA‐MI like). Subsets 1, 2, 3, and 4 constituted 31.6%, 15.0%, 12.8%, and 22.8% of all patients with MI ( n  = 87 177), respectively. The age and prevalence of different co‐morbidities varied between subsets. For median age, 70 to 77, for diabetes mellitus, 22 to 33%; for chronic kidney disease, 22 to 38%, for prior MI, 17 to 21%, for atrial fibrillation, 7 to 14%, and for ST‐elevations, 38 to 50%. The cumulative incidence of death or heart failure hospitalization at 3 years was 17.4% (95% CI: 17.1–17.7%) in all MIs; 26.9% (26.3–27.4%) in subset 1; 37.6% (36.7–38.5%) in subset 2; 41.8% (40.7–42.8%) in subset 3; and 22.6% (22.0–23.2%) in subset 4. Conclusions Depending on the definition, LV systolic dysfunction or pulmonary congestion is present in 13–32% of all patients with MI and is associated with a two to three times higher risk of subsequent death or HF admission. There is a need to optimize management and improve outcomes for this high‐risk population.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v10.2
    DOI: 10.1002/ehf2.14301
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2814355-3
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  • 7
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    Health‐related quality of life in patients with heart failure eligible for treatment with sacubitril–valsartan
    Wiley ; 2020
    In:  Nursing Open Vol. 7, No. 2 ( 2020-03), p. 556-562
    Details
    In: Nursing Open, Wiley, Vol. 7, No. 2 ( 2020-03), p. 556-562
    Abstract: To describe and compare self‐reported health‐related quality of life between younger and older patients with severe heart failure eligible for treatment with sacubitril–valsartan and to explore the association between health‐related quality of life and age, NYHA classification, systolic blood pressure and NT‐proBNP level. Design Cross‐sectional study. Methods A total of 59 patients, eligible for treatment with sacubitril–valsartan were consecutively included and divided into a younger (≤75 years) and older group ( 〉 75 years). Health‐related quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire and the EuroQol 5‐dimensions. Data were collected between June 2016 and January 2018. The STROBE checklist was used. Results There were no differences in overall health‐related quality of life between the age groups. The older patients reported lower scores in two domains measured with the Kansas City Cardiomyopathy Questionnaire, namely self‐efficacy (67.0 SD 22.1 vs. 78.8 SD 19.7) and physical limitation (75.6 SD 19.0 vs. 86.3 SD 14.4). Higher NYHA class was independently associated with lower Kansas City Cardiomyopathy Questionnaire Overall Summary Score.
    Type of Medium: Online Resource
    ISSN: 2054-1058 , 2054-1058
    URL: Issue
    URL: Article
    DOI: 10.1002/nop2.v7.2
    DOI: 10.1002/nop2.420
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2809556-X
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  • 8
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    Online Resource
    Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study
    Elsevier BV ; 2021
    In:  The Lancet Vol. 398, No. 10300 ( 2021-08), p. 599-607
    Details
    In: The Lancet, Elsevier BV, Vol. 398, No. 10300 ( 2021-08), p. 599-607
    Type of Medium: Online Resource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(21)00896-5
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2067452-1
    detail.hit.zdb_id: 3306-6
    detail.hit.zdb_id: 1476593-7
    SSG: 5,21
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  • 9
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    Structure‐Based Drug Design of Mineralocorticoid Receptor Antagonists to Explore Oxosteroid Receptor Selectivity
    Wiley ; 2017
    In:  ChemMedChem Vol. 12, No. 1 ( 2017-01-05), p. 50-65
    Details
    In: ChemMedChem, Wiley, Vol. 12, No. 1 ( 2017-01-05), p. 50-65
    Abstract: The mineralocorticoid receptor (MR) is a nuclear hormone receptor involved in the regulation of body fluid and electrolyte homeostasis. In this study we explore selectivity triggers for a series of nonsteroidal MR antagonists to improve selectivity over other members of the oxosteroid receptor family. A biaryl sulfonamide compound was identified in a high‐throughput screening (HTS) campaign. The compound bound to MR with p K i =6.6, but displayed poor selectivity over the glucocorticoid receptor (GR) and the progesterone receptor (PR). Following X‐ray crystallography of MR in complex with the HTS hit, a compound library was designed that explored an induced‐fit hypothesis that required movement of the Met852 side chain. An improvement in MR selectivity of 11‐ to 79‐fold over PR and 23‐ to 234‐fold over GR was obtained. Given the U‐shaped binding conformation, macrocyclizations were explored, yielding a macrocycle that bound to MR with p K i =7.3. Two protein–ligand X‐ray structures were determined, confirming the hypothesized binding mode for the designed compounds.
    Type of Medium: Online Resource
    ISSN: 1860-7179 , 1860-7187
    URL: Issue
    URL: Article
    DOI: 10.1002/cmdc.v12.1
    DOI: 10.1002/cmdc.201600529
    RVK:
    VA 3569
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2209649-8
    SSG: 15,3
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  • 10
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    Eligibility of Dapagliflozin and Empagliflozin in a Real-World Heart Failure Population
    Hindawi Limited ; 2021
    In:  Cardiovascular Therapeutics Vol. 2021 ( 2021-12-26), p. 1-8
    Details
    In: Cardiovascular Therapeutics, Hindawi Limited, Vol. 2021 ( 2021-12-26), p. 1-8
    Abstract: Aims. This study is aimed at investigating the eligibility in a real-world heart failure population for the DAPA-HF (testing dapagliflozin) and EMPEROR-reduced (testing empagliflozin) trials, comparing the eligible real-world patients to trial participants and to characterize the noneligible patients. Methods. Medical records of all heart failure patients who had a diagnosis of heart failure from the Heart Centre or Department of Internal Medicine at Umeå University Hospital were reviewed. Results. 2433 of the hospital’s uptake population of 150 000 had a diagnosis of heart failure. 681 patients had left   ventricle   ejection   fraction ≤ 40 % , and of these 352 (52%) and 268 (39%) patients met eligibility criteria for DAPA-HF and EMPEROR-reduced, respectively. Comparing eligible patients in our population with the DAPA-HF- and EMPEROR-reduced trial populations, we found that eligible real-world patients were older (79.0 vs. 66.2 years and 80.3 vs. 67.2 years, respectively), had worse renal function (eGFR 54.4 vs. 66.0 ml/min/1.73m2 and 49.5 vs. 61.8 ml/min/1.73m2, respectively), higher prevalence of atrial fibrillation (56.0% vs. 36.1% and 53.0% vs. 35.6%, respectively), and lower prevalence of diabetes mellitus (21.0% vs. 41.8% and 26.1% vs. 49.8%, respectively). The main reasons for ineligibility were low NT-proBNP or low eGFR. Noneligible patients differed according to reason for ineligibility, where patients with low NT-proBNP were generally younger and healthier, and patients with low eGFR were older and had more comorbidities. Conclusions. 39-52% of patients with heart failure and reduced ejection fraction in this real-world heart failure population were eligible for SGLT2-inhibitor treatment, corresponding to 11-14% of all heart failure patients. Compared to trial participants, eligible real-world patients were significantly older with worse renal function, more atrial fibrillation, and less diabetes mellitus. Trial entry criteria exclude comparatively young and healthy patients, as well as comparatively old patients with more comorbid conditions.
    Type of Medium: Online Resource
    ISSN: 1755-5922 , 1755-5914
    URL: Article
    DOI: 10.1155/2021/1894155
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2021
    detail.hit.zdb_id: 2417088-4
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