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Ballegaard S, Faber J, Selmer C, Gyntelberg F, Kreiner S, Karpatschof B, Klausen TW, Hjalmarson Å, Gjedde A. In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years: Evidence from a Randomized Controlled Trial. J Clin Med 2023; 12:7585. [PMID: 38137654 PMCID: PMC10744062 DOI: 10.3390/jcm12247585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
Background: Autonomic nervous system dysfunction (ANSD) is associated with negative prognosis of ischemic heart disease (IHD). Elevated periosteal pressure sensitivity (PPS) at the sternum relates to ANSD and sympathetic hyperactivity. Two previous observational case-control studies of the effect of reduction of PPS suggested lower all-cause mortality from IHD and stroke. We now used a specific daily, adjunct, non-pharmacological program of reduction of elevated PPS to test the hypothetical association between the intervention and reduced all-cause mortality in patients with stable IHD in a randomized controlled trial (RCT). Methods: We completed active (n = 106) and passive interventions (n = 107) and compared the five-year mortalities. We also compared the five-year individual all-cause mortality of each participant to approximately 35.000 members of the general population of Denmark. Pooling the mortality data from the active group of the RCT with the two preliminary studies, we registered the mortality following active intervention of 1.168 person-years, compared to 40 million person-years of the pooled general population. Results: We recorded fewer deaths of the active RCT intervention group than of the corresponding control group from the general population (p = 0.01), as well as of the passive RCT intervention group (p = 0.035). The meta-analysis of the three studies together demonstrated reduced 4.2-year all-cause mortality of 60% (p = 0.007). Conclusions: The test of the hypothetical effect of an intervention aimed at the attenuation of ANSD accompanied by a lowered PPS revealed reduced all-cause mortality in patients with stable IHD.
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Affiliation(s)
- Søren Ballegaard
- Endocrine Unit, Department of Medicine, Herlev-Gentofte University Hospitals, 2730 Herlev, Denmark; (J.F.)
| | - Jens Faber
- Endocrine Unit, Department of Medicine, Herlev-Gentofte University Hospitals, 2730 Herlev, Denmark; (J.F.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Christian Selmer
- Endocrine Unit, Department of Medicine, Herlev-Gentofte University Hospitals, 2730 Herlev, Denmark; (J.F.)
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Endocrinology, Bispebjerg-Frederiksberg University Hospitals, 2400 Copenhagen, Denmark
| | - Finn Gyntelberg
- The National Research Center for the Working Environment, 2100 Copenhagen, Denmark
| | - Svend Kreiner
- Institute of Biostatistics, University of Copenhagen, 1017 Copenhagen, Denmark
| | - Benny Karpatschof
- Institute of Psychology, University of Copenhagen, 1017 Copenhagen, Denmark
| | - Tobias Wirenfeldt Klausen
- Endocrine Unit, Department of Medicine, Herlev-Gentofte University Hospitals, 2730 Herlev, Denmark; (J.F.)
| | - Åke Hjalmarson
- Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Albert Gjedde
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen, Denmark
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC H3A 2B4, Canada
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Extension of Public Smoking Ban Was Not Associated with Any Immediate Effect on Stroke Occurrence in Finland. J Clin Med 2021; 10:jcm10102060. [PMID: 34064896 PMCID: PMC8151542 DOI: 10.3390/jcm10102060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 12/01/2022] Open
Abstract
We investigated the association between the widening of a nationwide restaurant smoking ban, enacted on 1 June 2007, and stroke admissions. All acute stroke admissions between 1 May 2005 and 30 June 2009 were retrieved from a mandatory registry covering mainland Finland. Patients aged ≥18 years were included. One annual admission per patient was included. Negative binomial regression accounting for the at-risk population was applied. We found no difference in stroke occurrence before and after the smoking ban within 7 days (p = 0.217), 30 days (p = 0.176), or the whole study period (p = 0.998). Results were comparable for all stroke subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage). There was no sign of decreased occurrence in June 2007 compared to June in 2005–2006, and all subtypes of stroke occurred at least as frequently in both May and June of 2008 as in May and June of 2007. In conclusion, the nationwide restaurant smoking ban Finland enacted in June 2007 was not associated with any immediate reduction in stroke occurrence.
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Affiliation(s)
- Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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