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Pleym K, Sverre E, Weedon-Fekjaer H, Kahlon M, Husebye E, Tonstad S, Dammen T, Munkhaugen J. Effect of in-hospital nurse-led smoking cessation intervention for patients with atherosclerotic cardiovascular disease: a randomised pilot study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Smoking remains prevalent after cardiovascular disease (CVD) events and knowledge on how to facilitate effective cessation in clinical practice is needed.
Purpose
To test the effect of an in-hospital nurse-led intervention on the participation rate at municipal Healthy Life Centres (HLC) and the use of smoking cessation drugs. Secondary, to determine long-term effects on cessation rates.
Methods
A prospective, randomized, open-label, parallel-group intervention pilot-study was conducted at a Norwegian secondary care hospital in 2021. Patients with atherosclerotic CVD who smoked at least one cigarette daily when admitted with an acute CVD event were consecutively included. The nurse-led intervention included cessation counselling utilizing motivational interview technique, information and guidance in proper use of cessation drugs and direct referral to a 12-weeks digital (video ± phone) HLC program where patients received free cessation drugs. The low-threshold intervention included written information about the offer in the HLC with free cessation drugs. The primary endpoints were between-group differences in attendance rates at the HLC program and the use of cessation drugs.
Results
Of 99 potential participants, 24 did not meet the entry criteria whereas 17 declined to participate. Of 58 randomised patients, three died during follow-up and 55 completed the study. Mean age was 65.7 (SD 9.2) years, 35% were female, 88% had low education, 88% had smoked >20 years, and motivation for quitting smoking was high (mean 8.5 on a 0 [no motivation] to 10 [high motivation] Likert scale). Comorbidity was common (mean Charlson score 5.1) and 40% had symptoms of anxiety and/or depression. The nurse-led intervention resulted in significantly higher participation rate at the HLC (48% vs. 4%, difference: 44% [95% CI: 24%, 65%], P<0.0001) and more frequent use of cessation drugs (48% vs. 11%, difference: 37% [95% CI: 15%, 60%], P=0.002) compared to the low-threshold intervention (Figure A). All participants in the intervention group who attended the HLC program were offered follow-up within 21 days following randomisation. In the intervention group 15% used varenicline and 33% used a combination of short and long-acting nicotine replacements. Clinically significant differences in cessation rates after six months were observed between the groups (Figure B). Concomitant carbon monoxide measurements were obtained of 5 participants in the intervention group and 4 in the control group who reported cessation and all confirmed non-smoking.
Conclusion
Among multi-morbid patients hospitalised for a CVD event, a nurse-led intervention resulted in substantially higher participation rate at a municipal HLC program and higher use of smoking cessation drugs compared to written information. We also found clinically significant long-term effects on cessation rates which needs to be confirmed in a large-scale study.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Dam Foundation
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Affiliation(s)
- K Pleym
- Drammen Hospital , Drammen , Norway
| | - E Sverre
- Drammen Hospital , Drammen , Norway
| | - H Weedon-Fekjaer
- Oslo University Hospital Rikshospitalet, Oslo Center for Biostatistics and Epidemiology, Research Support Services , Oslo , Norway
| | - M Kahlon
- Kongsberg Hospital , Kongsberg , Norway
| | | | - S Tonstad
- Oslo University Hospital , Oslo , Norway
| | - T Dammen
- University of Oslo , Oslo , Norway
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Opstad T, Tonstad S, Sundfør T, Seljeflot I. Effect of intermittent and continuous caloric restriction on Sirtuin1 concentration depends on sex and body mass index. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Malik N, Tonstad S, Haddad E. Beyond Counting Macros: Are Common Fad Diets Nutritionally Adequate? An Examination of Their Micronutrient Content. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Botteri E, de Lange T, Tonstad S, Berstad P. Exploring the effect of a lifestyle intervention on cancer risk: 43-year follow-up of the randomized Oslo diet and antismoking study. J Intern Med 2018; 284:282-291. [PMID: 29790221 DOI: 10.1111/joim.12765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES The Oslo diet and antismoking study showed that counselling for a healthy lifestyle reduced lifelong coronary mortality in high-risk men. We explored whether the same counselling reduced also cancer risk. METHODS The study randomly allocated males at high coronary risk to either a 5-year intervention for lifestyle changes (cholesterol-lowering dietary changes, weight loss and stopping smoking) or a control group (1 : 1) in 1972/73. We explored the incidence and mortality of all cancers and cancer forms related to smoking, BMI or diet up to 43 years after randomization. RESULTS A total of 595 men in the intervention and 621 in the control group were included. At inclusion median age was 45 years, 588 (48.4%) subjects were overweight (BMI > 25 kg m-2 ) and 925 (76.1%) current smokers. The intervention did not reduce the risk of cancer after 43 years (adjusted hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.80-1.15). In the first 25 years of follow-up, among the 1088 (89.5%) men who were overweight/obese and/or smokers, the intervention reduced the incidence of those cancer forms related to smoking, BMI or diet (including carcinoma of the respiratory, digestive and urinary tracts; adjusted HR 0.69; 95% CI 0.49-0.99). The intervention had no significant effect on incidence beyond 25 years, or on mortality. CONCLUSIONS The 5-year counselling for a healthy lifestyle did not reduce the overall cancer risk in the very long term. However, in the first 25 years, the counselling reduced the risk of relevant cancer types in overweight/obese subjects and smokers.
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Affiliation(s)
- E Botteri
- Department of Bowel cancer screening, Cancer Registry of Norway, Oslo, Norway.,Norwegian National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway
| | - T de Lange
- Department of Bowel cancer screening, Cancer Registry of Norway, Oslo, Norway.,Unit for Research, Innovation and Education, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, Oslo, Norway.,School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - P Berstad
- Department of Bowel cancer screening, Cancer Registry of Norway, Oslo, Norway
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Dusanov S, Ruzzin J, Kiviranta H, Klemsdal TO, Retterstøl L, Rantakokko P, Airaksinen R, Djurovic S, Tonstad S. Associations between persistent organic pollutants and metabolic syndrome in morbidly obese individuals. Nutr Metab Cardiovasc Dis 2018; 28:735-742. [PMID: 29699815 DOI: 10.1016/j.numecd.2018.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Persons with "metabolically healthy" obesity may develop cardiometabolic complications at a lower rate than equally obese persons with evident metabolic syndrome. Even morbidly obese individuals vary in risk profile. Persistent organic pollutants (POPs) are widespread environmental chemicals that impair metabolic homeostasis. We explored whether prevalence of metabolic syndrome in morbidly obese individuals is associated with serum concentrations of POPs. METHODS AND RESULTS A cross-sectional study among 161 men and 270 women with BMI >35 kg/m2 and comorbidity, or >40 kg/m2. Circulating concentrations of 15 POPs were stratified by number of metabolic syndrome components. In multiple logistic regression analysis odds ratios between top quartile POPs and metabolic risk factors versus POPs below the top quartile were calculated adjusting for age, gender, body mass index, smoking status, alcohol consumption and cholesterol concentrations. Age-adjusted concentrations of trans-nonachlor and dioxin-like and non-dioxin-like polychlorinated biphenyls (PCBs) increased with number of metabolic syndrome components in both genders (p < 0.001), while the organochlorine pesticides HCB, β-HCH and p,p'DDE increased only in women (p < 0.008). Organochlorine pesticides in the top quartile were associated with metabolic syndrome as were dioxin-like and non-dioxin-like PCBs (OR 2.3 [95% CI 1.3-4.0]; OR 2.5 [95% CI 1.3-4.8] and 2.0 [95% CI 1.1-3.8], respectively). Organochlorine pesticides were associated with HDL cholesterol and glucose (OR = 2.0 [95% CI = 1.1-3.4]; 2.4 [95% CI = 1.4-4.0], respectively). Dioxin-like PCBs were associated with diastolic blood pressure, glucose and homeostatic model assessment-insulin resistance index (OR = 2.0 [95% CI = 1.1-3.6], 2.1 [95% CI = 1.2-3.6] and 2.1 [95% CI = 1.0-4.3], respectively). CONCLUSION In subjects with morbid obesity, metabolic syndrome was related to circulating levels of organochlorine pesticides and PCBs suggesting that these compounds aggravate clinically relevant complications of obesity.
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Affiliation(s)
- S Dusanov
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, P.b. 4956 Nydalen, N-0424, Oslo, Norway.
| | - J Ruzzin
- Department of Biology, University of Bergen, Bergen, Norway
| | - H Kiviranta
- National Institute for Health and Welfare, THL, Department of Health Security, P.O. Box 95, FI-70701, Kuopio, Finland
| | - T O Klemsdal
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, P.b. 4956 Nydalen, N-0424, Oslo, Norway
| | - L Retterstøl
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - P Rantakokko
- National Institute for Health and Welfare, THL, Department of Health Security, P.O. Box 95, FI-70701, Kuopio, Finland
| | - R Airaksinen
- National Institute for Health and Welfare, THL, Department of Health Security, P.O. Box 95, FI-70701, Kuopio, Finland
| | - S Djurovic
- Department of Medical Genetics, Oslo University Hospital, Bergen, Norway; KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - S Tonstad
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, P.b. 4956 Nydalen, N-0424, Oslo, Norway
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Sundfør TM, Svendsen M, Tonstad S. Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial. Nutr Metab Cardiovasc Dis 2018; 28:698-706. [PMID: 29778565 DOI: 10.1016/j.numecd.2018.03.009] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS Long-term adherence to conventional weight-loss diets is limited while intermittent fasting has risen in popularity. We compared the effects of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk factors in adults with abdominal obesity and ≥1 additional component of metabolic syndrome. METHODS & RESULTS In total 112 participants (men [50%] and women [50%]) aged 21-70 years with BMI 30-45 kg/m2 (mean 35.2 [SD 3.7]) were randomized to intermittent or continuous energy restriction. A 6-month weight-loss phase including 10 visits with dieticians was followed by a 6-month maintenance phase without additional face-to-face counselling. The intermittent energy restriction group was advised to consume 400/600 kcal (female/male) on two non-consecutive days. Based on dietary records both groups reduced energy intake by ∼26-28%. Weight loss was similar among participants in the intermittent and continuous energy restriction groups (8.0 kg [SD 6.5] versus 9.0 kg [SD 7.1]; p = 0.6). There were favorable improvements in waist circumference, blood pressure, triglycerides and HDL-cholesterol with no difference between groups. Weight regain was minimal and similar between the intermittent and continuous energy restriction groups (1.1 kg [SD 3.8] versus 0.4 kg [SD 4.0]; p = 0.6). Intermittent restriction participants reported higher hunger scores than continuous restriction participants on a subjective numeric rating scale (4.7 [SD 2.2] vs 3.6 [SD 2.2]; p = 0.002). CONCLUSIONS Both intermittent and continuous energy restriction resulted in similar weight loss, maintenance and improvements in cardiovascular risk factors after one year. However, feelings of hunger may be more pronounced during intermittent energy restriction. TRIAL REGISTRATION www.clinicaltrials.govNCT02480504.
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Affiliation(s)
- T M Sundfør
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - M Svendsen
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - S Tonstad
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Aune D, Sen A, Leitzmann MF, Tonstad S, Norat T, Vatten LJ. Tobacco smoking and the risk of diverticular disease - a systematic review and meta-analysis of prospective studies. Colorectal Dis 2017; 19:621-633. [PMID: 28556447 DOI: 10.1111/codi.13748] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/22/2016] [Indexed: 02/08/2023]
Abstract
AIM This systematic review and meta-analysis aimed to clarify whether tobacco smoking is associated with an increased risk of diverticular disease. METHOD The PubMed and Embase databases were searched for studies of smoking and diverticular disease up to 19 February 2016. Prospective studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of diverticular disease associated with current or previous smoking were included. Summary RRs were estimated using a random effects model. RESULTS We identified five prospective studies which comprised 6076 cases of incident diverticular disease (diverticulosis and diverticulitis) among 385 291 participants and three studies with 1118 cases of complications related to diverticular disease (abscess or perforation) among 292 965. The summary RR for incident diverticular disease was 1.36 (95% CI 1.15-1.61, I2 = 84%, n = 4) for current smokers, 1.17 (95% CI 1.05-1.31, I2 = 49%, n = 4) for former smokers and 1.29 (95% CI 1.16-1.44, I2 = 62%, n = 5) for ever smokers. The summary RR was 1.11 (95% CI 0.99-1.25, I2 = 82%, n = 4) per 10 cigarettes per day. Although there was some indication of nonlinearity there was a dose-dependent positive association with increasing number of cigarettes smoked per day. There was some evidence that smoking also increases the risk of complications of diverticular disease, but the number of studies was small. CONCLUSION The current meta-analysis provides evidence that tobacco smoking is associated with an increased incidence of diverticular disease and related complications.
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Affiliation(s)
- D Aune
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK.,Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Bjørknes University College, Oslo, Norway
| | - A Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - M F Leitzmann
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg, Germany
| | - S Tonstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - T Norat
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - L J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Aune D, Sen A, ó'Hartaigh B, Janszky I, Romundstad PR, Tonstad S, Vatten LJ. Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality - A systematic review and dose-response meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 2017; 27:504-517. [PMID: 28552551 DOI: 10.1016/j.numecd.2017.04.004] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/06/2017] [Accepted: 04/13/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIM Epidemiological studies have reported increased risk of cardiovascular disease, cancer and all-cause mortality with greater resting heart rate, however, the evidence is not consistent. Differences by gender, adjustment for confounding factors, as well as the potential impact of subclinical disease are not clear. A previous meta-analysis missed a large number of studies, and data for atrial fibrillation have not been summarized before. We therefore aimed to clarify these associations in a systematic review and meta-analysis of prospective studies. METHODS AND RESULTS PubMed and Embase were searched up to 29 March 2017. Summary RRs and 95% confidence intervals (CIs) were calculated using random effects models. Eighty seven studies were included. The summary RR per 10 beats per minute increase in resting heart rate was 1.07 (95% CI: 1.05-1.10, I2 = 61.9%, n = 31) for coronary heart disease, 1.09 (95% CI: 1.00-1.18, I2 = 62.3%, n = 5) for sudden cardiac death, 1.18 (95% CI: 1.10-1.27, I2 = 74.5%, n = 8) for heart failure, 0.97 (95% CI: 0.92-1.02, I2 = 91.4%, n = 9) for atrial fibrillation, 1.06 (95% CI: 1.02-1.10, I2 = 59.5%, n = 16) for total stroke, 1.15 (95% CI: 1.11-1.18, I2 = 84.3%, n = 35) for cardiovascular disease, 1.14 (95% CI: 1.06-1.23, I2 = 90.2%, n = 12) for total cancer, and 1.17 (95% CI: 1.14-1.19, I2 = 94.0%, n = 48) for all-cause mortality. There was a positive dose-response relationship for all outcomes except for atrial fibrillation for which there was a J-shaped association. CONCLUSION This meta-analysis found an increased risk of coronary heart disease, sudden cardiac death, heart failure, atrial fibrillation, stroke, cardiovascular disease, total cancer and all-cause mortality with greater resting heart rate.
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Affiliation(s)
- D Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Epidemiology and Public Health, Imperial College, London, UK; Bjørknes University College, Oslo, Norway.
| | - A Sen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - B ó'Hartaigh
- Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, USA; Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, Adler Geriatric Center, New Haven, USA
| | - I Janszky
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - P R Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S Tonstad
- Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - L J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Aune D, Schlesinger S, Henriksen T, Saugstad OD, Tonstad S. Physical activity and the risk of preterm birth: a systematic review and meta-analysis of epidemiological studies. BJOG 2017; 124:1816-1826. [PMID: 28374930 DOI: 10.1111/1471-0528.14672] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical activity has been inconsistently associated with risk of preterm birth, and the strength of the association and the shape of the dose-response relationship needs clarification. OBJECTIVES To conduct a systematic review and dose-response meta-analysis to clarify the association between physical activity and risk of preterm birth. SEARCH STRATEGY PubMed, Embase and Ovid databases were searched for relevant studies up to 9 February 2017. SELECTION CRITERIA Studies with a prospective cohort, case-cohort, nested case-control or randomized study design were included. DATA COLLECTION AND ANALYSIS Data were extracted by one reviewer and checked for accuracy by a second reviewer. Summary relative risks (RRs) were estimated using a random effects model. MAIN RESULTS Forty-one studies (43 publications) including 20 randomized trials and 21 cohort studies were included. The summary RR for high versus low activity was 0.87 [95% confidence interval (CI): 0.70-1.06, I2 = 17%, n = 5] for physical activity before pregnancy, and it was 0.86 (95% CI: 0.78-0.95, I2 = 0%, n = 30) for early pregnancy physical activity. The summary RR for a 3 hours per week increment in leisure-time activity was 0.90 (95% CI: 0.85-0.95, I2 = 0%, n = 5). There was evidence of a nonlinear association between physical activity and preterm birth, Pnonlinearity < 0.0001, with the lowest risk observed at 2-4 hours per week of activity. CONCLUSION This meta-analysis suggests that higher leisure-time activity is associated with reduced risk of preterm birth. Further randomized controlled trials with sufficient frequency and duration of activity to reduce the risk and with larger sample sizes are needed to conclusively demonstrate an association. TWEETABLE ABSTRACT Physically active compared with inactive women have an 10-14% reduction in the risk of preterm birth.
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Affiliation(s)
- D Aune
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,Bjørknes University College, Oslo, Norway
| | - S Schlesinger
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - T Henriksen
- Section of Obstetrics, Division of Obstetrics and Gynaecology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - O D Saugstad
- Department of Pediatric Research, Rikshospitalet, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - S Tonstad
- Department of Preventive Cardiology, Oslo University Hospital, University of Oslo, Oslo, Norway
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Heggen E, Svendsen M, Tonstad S. Smoking cessation improves cardiometabolic risk in overweight and obese subjects treated with varenicline and dietary counseling. Nutr Metab Cardiovasc Dis 2017; 27:335-341. [PMID: 28216282 DOI: 10.1016/j.numecd.2016.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/18/2016] [Accepted: 12/29/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Weight gain after stopping smoking potentially counteracts improvements in cardiometabolic risks. We investigated changes in metabolic syndrome (MetS) components and homeostasis assessment model insulin resistance (HOMA-IR) in smokers given dietary counseling during their quit attempt. METHODS AND RESULTS Smokers (≥10 cigarettes/day) with BMI 25-40 kg/m2 were randomized to a low-carbohydrate or low-fat diet and treated with a standard course of varenicline for 12 weeks. Quitters were assessed according to the Russell standard (≤5 cigarettes after the quit date) validated with expired breath carbon monoxide (CO) < 10 ppm. Of 122 randomized participants, 108 (89%) completed clinical and laboratory assessments at 12 weeks. As changes in metabolic risk factors did not differ between dietary groups, we combined the groups to compare quitters to continuing smokers. We found similar weight change among 78 validated quitters as 30 continuing smokers (-0.1 ± 3.0 kg vs 0.3 ± 3.1 kg; p = 0.7) and change in waist circumference (-2.0 ± 3.8 cm vs -0.9 ± 3.9 cm; p = 0.2). Changes in triglyceride concentrations (-0.16 ± 0.52 mmol/l vs 0.21 ± 0.95 mmol/l; p = 0.015) and diastolic blood pressure (-0.9 ± 6 mmHg vs 1.9 ± 8 mmHg; p = 0.039) were more favorable in quitters. Changes in other cardiometabolic risks and HOMA-IR did not differ between quitters and continuous smokers, nor did energy intake or resting metabolic rate. CONCLUSION Dyslipidemia and blood pressure improved and no early weight gain was seen in quitters, suggesting that dietary intervention can mitigate some of the effects of stopping smoking on cardiometabolic risk factors in overweight and obese smokers. CLINICAL TRIALS REGISTRATION NCT01069458.
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Affiliation(s)
- E Heggen
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway.
| | - M Svendsen
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
| | - S Tonstad
- Section for Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
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Tonstad S, Anderssen S, Khoury J, Ose L, Reseland J, Retterstøl L. Weight concerns and beliefs about obesity in the Norwegian population. Scandinavian Journal of Food and Nutrition 2016. [DOI: 10.1080/11026480600632658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Tonstad
- Departments of Preventive Cardiology, Ulleva°l University Hospital, Oslo, Norway
| | - S. Anderssen
- Oral Research Laboratory, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - J. Khoury
- Departments of Preventive Cardiology, Ulleva°l University Hospital, Oslo, Norway
| | - L. Ose
- Lipid Clinic, National Hospital, Oslo, Norway
| | - J. Reseland
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - L. Retterstøl
- Departments of Medical Genetics,, Ulleva°l University Hospital, Oslo, Norway
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Kahleova H, Tonstad S, Rosmus J, Fisar P, Mari A, Hill M, Pelikanova T. The effect of a vegetarian versus conventional hypocaloric diet on serum concentrations of persistent organic pollutants in patients with type 2 diabetes. Nutr Metab Cardiovasc Dis 2016; 26:430-438. [PMID: 27107842 DOI: 10.1016/j.numecd.2016.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/18/2015] [Accepted: 01/21/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to explore the effect of a vegetarian versus conventional diet on the serum levels of persistent organic pollutants (POPs) in patients with T2D after 12 weeks of dietary intervention and to assess their relationships with metabolic parameters. METHODS AND RESULTS Men and women with T2D were randomly assigned to follow either a vegetarian diet without fish or meat (n = 37) or an isocaloric conventional antidiabetic diet (n = 37). Both diets were energy restricted (minus 500 kcal/day). All foods were provided to the participants. At randomization (week 0) and 12 weeks, the meal test was performed to assess the β-cell function and serum levels of 24 POPs. Dioxins and dioxin-like POPs were analyzed by isotope dilution high-resolution gas chromatography (HRGC) and mass spectrometry after cleanup of the silica and carbon columns. Non-dioxin-like POPs were analyzed by gas chromatography with an electron capture detector (GC-ECD). Statistical analyses used were repeated-measures analysis of variance (ANOVA), a multivariate regression model, and Pearson's correlations. We observed a statistically nonsignificant trend toward increases in the serum levels of most POPs in response to both hypocaloric diets with no differences between groups. In the groups combined, the change in serum concentrations of total POPs was correlated to changes in HbA1c (r = +0.34; p < 0.01), fasting plasma glucose (r = +0.41; p < 0.01) levels, and β-cell function measured as insulin secretion at a reference glucose level (r = -0.37; p < 0.01), independent of the changes in body weight and volume of visceral fat. CONCLUSION Short-term hypocaloric vegetarian and conventional diets did not reduce the POP levels, possibly due to mobilization of fat stores. Our findings support the relationship between POPs and diabetes, especially β-cell function. TRIAL REGISTRATION ClinicalTrials.gov number, NCT00883038, completed.
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Affiliation(s)
- H Kahleova
- Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic.
| | - S Tonstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - J Rosmus
- State Veterinary Institute Prague, Sidlistni 24, 165 03 Prague, Czech Republic
| | - P Fisar
- State Veterinary Institute Prague, Sidlistni 24, 165 03 Prague, Czech Republic
| | - A Mari
- C.N.R. (National Research Council) Institute of Systems Science and Biomedical Engineering, Padua, Italy
| | - M Hill
- Institute of Endocrinology, Narodni 8, 11394 Prague, Czech Republic
| | - T Pelikanova
- Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21 Prague, Czech Republic
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Rogozinska E, D'Amico MI, Khan KS, Cecatti JG, Teede H, Yeo S, Vinter CA, Rayanagoudar G, Barakat R, Perales M, Dodd JM, Devlieger R, Bogaerts A, van Poppel MNM, Haakstad L, Shen GX, Shub A, Luoto R, Kinnunen TI, Phelan S, Poston L, Scudeller TT, El Beltagy N, Stafne SN, Tonstad S, Geiker NRW, Ruifrok AE, Mol BW, Coomarasamy A, Thangaratinam S. Development of composite outcomes for individual patient data (IPD) meta-analysis on the effects of diet and lifestyle in pregnancy: a Delphi survey. BJOG 2015; 123:190-8. [DOI: 10.1111/1471-0528.13764] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 12/01/2022]
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Khoury J, Knutsen M, Stray-Pedersen B, Thaulow E, Tonstad S. A lower reduction in umbilical artery pulsatility in mid-pregnancy predicts higher infant blood pressure six months after birth. Acta Paediatr 2015; 104:796-800. [PMID: 25865616 DOI: 10.1111/apa.13020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 03/04/2015] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Abstract
AIM The Norwegian-based Cardiovascular Risk Reduction Diet in Pregnancy study found that a cholesterol-lowering diet during pregnancy was associated with an accentuated reduction in the umbilical artery pulsatility index. This follow-up study assessed the possible association between the index and the infants' blood pressure at six months of age. METHODS In the original study, pregnant women consumed an anti-atherogenic or usual diet from gestational weeks 17-20 to birth and underwent Doppler velocimetry at 24, 30 and 36 gestational weeks. In this follow-up study, blood pressure was measured in 105 mother-infant pairs in the intervention group and 106 mother-infant pairs in the control group six months after birth. RESULTS Mean systolic and diastolic blood pressures were not significantly different between both groups. When the groups were combined, multivariate linear analyses showed that a lower versus higher reduction (≥-0.17 versus <-0.17) in the umbilical artery pulsatility index between gestational weeks 24 and 30 and maternal diastolic blood pressure at six months postpartum were significant predictors of higher infant systolic blood pressure (p = 0.03, 0.01, respectively). CONCLUSION A lower reduction in umbilical pulsatility index in mid-pregnancy was associated with higher infant blood pressure at six months of age. This suggests that fetoplacental intrauterine factors may influence future cardiovascular risk.
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Affiliation(s)
- J Khoury
- Division of Women and Children; Oslo University Hospital; Oslo Norway
- Bryn Medical Center; Oslo Norway
| | - M Knutsen
- Department of Pediatric Cardiology; Oslo University Hospital; Oslo Norway
| | - B Stray-Pedersen
- Division of Women and Children; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - E Thaulow
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Section of Congenital Heart Disease; Division of Women and Children; Oslo University Hospital; Oslo Norway
| | - S Tonstad
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Section for Preventive Cardiology; Department of Endocrinology, Morbid Obesity and Preventive Medicine; Oslo University Hospital; Oslo Norway
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Nenseter MS, Volden V, Tonstad S, Gudmundsen O, Ose L, Drevon CA. Modification of low density lipoprotein in relation to intake of fatty acids and antioxidants. World Rev Nutr Diet 2015; 75:144-8. [PMID: 7871817 DOI: 10.1159/000423570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M S Nenseter
- Institute for Nutrition Research, University of Oslo, Norway
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Sakamoto R, Jaceldo-Siegl K, Haddad E, Oda K, Fraser G, Tonstad S. Relationship of vitamin D levels to blood pressure in a biethnic population. Nutr Metab Cardiovasc Dis 2013; 23:776-784. [PMID: 22770642 PMCID: PMC3522760 DOI: 10.1016/j.numecd.2012.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 04/07/2012] [Accepted: 04/25/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Accumulating epidemiological and clinical studies have suggested that vitamin D insufficiency may be associated with hypertension. Blacks tend to have lower vitamin D levels than Whites, but it is unclear whether this difference explains the higher blood pressure (BP) observed in Blacks in a population with healthy lifestyle practices. METHODS AND RESULTS We examined cross-sectional data in the Adventist Health Study-2 (AHS-2), a cohort of non-smoking, mostly non-drinking men and women following a range of diets from vegan to non-vegetarian. Each participant provided dietary, demographic, lifestyle and medical history data. Measurements of weight, height, waist circumference, percent body fat and blood pressure and fasting blood samples were obtained from a randomly selected non-diabetic sample of 284 Blacks and 284 Whites aged 30-95 years. Multiple regression analyses were used to assess independent relationships between blood pressure and 25(OH)D levels. Levels of 25(OH)D were inversely associated with systolic BP in Whites after control for age, gender, BMI, and use of BP-lowering medications (β-coefficient -0.23 [95% CI, -0.43, -0.03; p = 0.02]). This relationship was not seen in Blacks (β-coefficient 0.08 [95% CI, -0.14, 0.30; p = 0.4]). Results were similar when controlling for waist circumference or percentage body fat instead of BMI. No relationship between serum 25(OH)D and diastolic BP was seen. CONCLUSION Systolic BP is inversely associated with 25(OH)D levels in Whites but not in Blacks. Vitamin D may not be a major contributor to the White-Black differential in BP.
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Affiliation(s)
- R. Sakamoto
- Department of Health Promotion and Education, School of Public Health, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA 92350, USA
| | - K. Jaceldo-Siegl
- Department of Nutrition, School of Public Health, Loma Linda University, USA
| | - E. Haddad
- Department of Nutrition, School of Public Health, Loma Linda University, USA
| | - K. Oda
- Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, USA
| | - G.E. Fraser
- Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, USA
| | - S. Tonstad
- Department of Health Promotion and Education, School of Public Health, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA 92350, USA
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Abstract
BACKGROUND High-fibre and low-carbohydrate diets may enhance satiety and promote weight loss. We compared a diet rich in beans aiming to increase dietary fibre and promote weight loss with a low-carbohydrate diet in a randomised controlled trial to assess effect and tolerability of the high-fibre bean-rich diet. METHODS AND RESULTS One hundred and seventy-three women and men, with a mean body mass index of approximately 36 kg m(-2) (one-fifth with diabetes type 2) were randomised to a high-fibre bean-rich diet that achieved mean (SD) fibre intakes of 35.5 (18.6) g day(-1) for women and 42.5 (30.3) g day(-1) for men, or a low-carbohydrate diet. Both diets were induced gradually over 4 weeks and included a 3-day feeding phase. Among 123 (71.1%) completers at 16 weeks, mean (SD) weight loss was 4.1 (4.0) kg in the high-fibre versus 5.2 (4.5) kg in the low-carbohydrate group [difference, 1.1 kg, 95% confidence interval (CI) = -2.6 to -0.5; P = 0.2], with results similar to the intent-to-treat population. Low-density lipoprotein (LDL)-cholesterol levels decreased with the high-fibre diet (difference in LDL-cholesterol versus low-carbohydrate diet, 0.2 mmol L(-1) , 95% CI = 0.01-0.44 mmol L(-1) ; P = 0.045), as did total cholesterol (P = 0.038), whereas changes in other lipids and glucose did not differ. After 52 weeks, the low-carbohydrate (n = 24) group tended to retain weight loss better than the high-fibre group (P = 0.06), although total cholesterol remained lower with the bean-rich diet (P = 0.049). CONCLUSIONS A high-fibre bean-rich diet was as effective as a low-carbohydrate diet for weight loss, although only the bean-rich diet lowered atherogenic lipids.
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Affiliation(s)
- S Tonstad
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
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Tonstad S, Stewart K, Oda K, Batech M, Herring RP, Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr Metab Cardiovasc Dis 2013; 23:292-299. [PMID: 21983060 PMCID: PMC3638849 DOI: 10.1016/j.numecd.2011.07.004] [Citation(s) in RCA: 226] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 07/13/2011] [Accepted: 07/15/2011] [Indexed: 12/24/2022]
Abstract
AIM To evaluate the relationship of diet to incident diabetes among non-Black and Black participants in the Adventist Health Study-2. METHODS AND RESULTS Participants were 15,200 men and 26,187 women (17.3% Blacks) across the U.S. and Canada who were free of diabetes and who provided demographic, anthropometric, lifestyle and dietary data. Participants were grouped as vegan, lacto ovo vegetarian, pesco vegetarian, semi-vegetarian or non-vegetarian (reference group). A follow-up questionnaire after two years elicited information on the development of diabetes. Cases of diabetes developed in 0.54% of vegans, 1.08% of lacto ovo vegetarians, 1.29% of pesco vegetarians, 0.92% of semi-vegetarians and 2.12% of non-vegetarians. Blacks had an increased risk compared to non-Blacks (odds ratio [OR] 1.364; 95% confidence interval [CI], 1.093-1.702). In multiple logistic regression analysis controlling for age, gender, education, income, television watching, physical activity, sleep, alcohol use, smoking and BMI, vegans (OR 0.381; 95% CI 0.236-0.617), lacto ovo vegetarians (OR 0.618; 95% CI 0.503-0.760) and semi-vegetarians (OR 0.486, 95% CI 0.312-0.755) had a lower risk of diabetes than non-vegetarians. In non-Blacks vegan, lacto ovo and semi-vegetarian diets were protective against diabetes (OR 0.429, 95% CI 0.249-0.740; OR 0.684, 95% CI 0.542-0.862; OR 0.501, 95% CI 0.303-0.827); among Blacks vegan and lacto ovo vegetarian diets were protective (OR 0.304, 95% CI 0.110-0.842; OR 0.472, 95% CI 0.270-0.825). These associations were strengthened when BMI was removed from the analyses. CONCLUSION Vegetarian diets (vegan, lacto ovo, semi-) were associated with a substantial and independent reduction in diabetes incidence. In Blacks the dimension of the protection associated with vegetarian diets was as great as the excess risk associated with Black ethnicity.
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Affiliation(s)
- S Tonstad
- Loma Linda University School of Public Health, Department of Health Promotion and Education, Loma Linda, CA 92354, USA.
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Jennings CS, Kotseva K, De Bacquer D, Hoes A, De Velasco J, Brusaferro S, Tonstad S, Wood DA. 144 Nurses meet the challenge of helping high CVD risk smokers to quit with the help of varenicline in a preventive cardiology programme. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kotseva K, Jennings C, De Bacquer D, Hoes A, De Velasco J, Brusaferro S, Jones J, Mead A, Tonstad S, Wood D. 145 EUROACTION PLUS: a randomised controlled trial on preventive cardiology programme plus intensive smoking cessation with Varenicline for vascular and high CVD risk smokers and their partners—principal results. Heart 2012. [DOI: 10.1136/heartjnl-2012-301877b.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Norheim OF, Gjelsvik B, Klemsdal TO, Madsen S, Meland E, Narvesen S, Negard A, Njolstad I, Tonstad S, Ulvin F, Wisloff T. Norway's new principles for primary prevention of cardiovascular disease: age differentiated risk thresholds. BMJ 2011. [DOI: 10.1136/bmj.d3626] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Heggen E, Granlund L, Pedersen JI, Holme I, Ceglarek U, Thiery J, Kirkhus B, Tonstad S. Plant sterols from rapeseed and tall oils: effects on lipids, fat-soluble vitamins and plant sterol concentrations. Nutr Metab Cardiovasc Dis 2010; 20:258-265. [PMID: 19748247 DOI: 10.1016/j.numecd.2009.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 02/22/2009] [Accepted: 04/01/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Data comparing the impact of different sources of plant sterols on CVD risk factors and antioxidant levels is scarce. We evaluated the effects of plant sterols from rapeseed and tall oils on serum lipids, lipoproteins, fat-soluble vitamins and plant sterol concentrations. METHODS AND RESULTS This was a double-blinded, randomized, crossover trial in which 59 hypercholesterolemic subjects consumed 25 g/day of margarine for 4 weeks separated by 1 week washout periods. The two experimental margarines provided 2g/day of plant sterols from rapeseed or tall oil. The control margarine had no added plant sterols. The control margarine reduced LDL cholesterol by 4.5% (95% CI 1.4, 7.6%). The tall and rapeseed sterol margarines additionally reduced LDL cholesterol by 9.0% (95% CI 5.5, 12.4%) and 8.2% (95% CI 5.2, 11.4%) and apolipoprotein B by 5.3% (95% CI 1.0, 9.6%) and 6.9% (95% CI 3.6, 10.2%), respectively. Lipid-adjusted beta-carotene concentrations were reduced by both sterol margarines (P<0.017). alpha-Tocopherol concentrations were reduced by the tall sterol compared to the rapeseed sterol margarine (P=0.001). Campesterol concentrations increased more markedly with the rapeseed sterol versus tall sterol margarine (P<0.001). The rapeseed sterol margarine increased while the tall sterol margarine decreased brassicasterol concentrations (P<0.001). CONCLUSIONS Plant sterols from tall and rapeseed oils reduce atherogenic lipids and lipoproteins similarly. The rapeseed sterol margarine may have more favorable effects on serum alpha-tocopherol concentrations.
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Affiliation(s)
- E Heggen
- Department of Preventive Cardiology, Ullevaal University Hospital, Oslo, Norway.
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Klemsdal TO, Holme I, Nerland H, Pedersen TR, Tonstad S. Effects of a low glycemic load diet versus a low-fat diet in subjects with and without the metabolic syndrome. Nutr Metab Cardiovasc Dis 2010; 20:195-201. [PMID: 19502017 DOI: 10.1016/j.numecd.2009.03.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 03/11/2009] [Accepted: 03/13/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Although many studies report benefits of low glycemic diets, the clinical effects as a whole are mixed. The study aim was to compare a low glycemic load (LGL) diet versus a low-fat diet in a trial with a moderately intense dietary intervention in subjects with varying degrees of metabolic syndrome. METHODS AND RESULTS Men and women aged 30-65 years, with a BMI of 28-40 kg/m(2) (28-35 for women) and at least one criterion of metabolic syndrome were randomized to the two diets. A total of 202 subjects were included, of which 126 (62%) had metabolic syndrome (>or=3 criteria). The completion rate was 81%. At 3 months, weight loss was greater in the LGL group (-4.8+/-3.9 kg versus -3.8+/-3.5 kg; P=0.06) compared to the low-fat group. At 1 year, however, weight loss was similar in both groups (-4.0+/-5.5 kg versus -4.3+/-6.2 kg; n.s.), but waist circumference reduction was less in the LGL group (-3.9+/-5.3 cm versus -5.8+/-6.8 cm; P=0.03). In contrast, diastolic blood pressure decreased significantly more in the LGL group (-4.0+/-8.7 mmHg versus -1.1+/-8.5 mmHg; P=0.02). We also observed a significant interaction between the presence of the metabolic syndrome and the effect of the two diets on waist circumference, with a less favorable effect of the LGL diet in subjects without the syndrome (P=0.039). CONCLUSION After 12 months, both diets reduced body weight and the metabolic disturbances similarly, but the LGL diet appeared more suitable for subjects with metabolic syndrome, and was less effective in those without it.
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Affiliation(s)
- T O Klemsdal
- Department of Preventive Cardiology, Center for Preventive Medicine, Ullevaal University Hospital, Oslo, Kirkeveien 166, N-0407 Oslo, Norway.
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Abstract
OBJECTIVE The objective of this study was to analyze whether maternal negative affectivity assessed in pregnancy is related with subsequent infant food choices. DESIGN The study design was a cohort study. SUBJECTS The subjects were mothers (N=37 919) and their infants participating in the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. MEASUREMENTS Maternal negative affectivity assessed prepartum (Hopkins Symptom Checklist 5 (SCL-5) at weeks 17 and 30 of pregnancy), introduction of solid foods by month 3 and feeding of sweet drinks by month 6 (by the reports of the mothers) were analyzed. RESULTS Mothers with higher negative affectivity were 64% more likely (95% confidence interval 1.5-1.8) to feed sweet drinks by month 6, and 79% more likely (95% confidence interval 1.6-2.0) to introduce solid foods by month 3. These odds decreased to 41 and 30%, respectively, after adjusting for mother's age, body mass index (BMI) and education. CONCLUSION The maternal trait of negative affectivity is an independent predictor of infant feeding practices that may be related with childhood weight gain, overweight and obesity.
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Affiliation(s)
- S E Hampson
- Oregon Research Institute, Eugene, OR, USA [2] Department of Nutrition, University of Oslo, Blindern, Oslo, Norway.
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Abstract
BACKGROUND Cigarette smoking is a classical and a major risk factor in the development of several diseases with an inflammatory component, including cardiovascular disease and chronic obstructive pulmonary disease. Improvements in assays for protein markers of inflammation have led to many studies on these factors and their roles in disease. AIMS C-reactive protein (CRP) is one such marker and this review focuses on the evidence for using CRP as a diagnostic marker and how levels of this protein are modified according to the smoking status of the patient, both in terms of the current amount of cigarettes smoked and how CRP levels change following smoking cessation. CONCLUSIONS Assay of CRP levels may be useful in monitoring disease progression and determining risk of future cardiovascular complications. However, as this marker is also an indicator of acute inflammation and challenges to the immune system, some caution must be exercised in interpreting the available data on CRP levels in patients with different chronic comorbidities.
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Affiliation(s)
- S Tonstad
- School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA.
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Michelsen TM, Tonstad S, Dahl AA, Pripp AH, Tropé CG, Dørum A. Framingham risk score after risk-reducing salpingo-oophorectomy in women at risk for hereditary breast ovarian cancer: A controlled observational study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.11048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11048 Background: Risk-reducing salpingo-oophorectomy (RRSO) effectively prevents ovarian cancer in BRCA mutation carriers and in women at risk for hereditary breast-ovarian cancer. RRSO induces immediate menopause, which may increase the risk of coronary heart disease (CHD). Our aim was to determine CHD risk using Framingham risk score and examine factors associated with this risk in women who had undergone RRSO compared to population-based controls. Methods: A sample of 326 (65% of invited) women who underwent RRSO after genetic counseling from 1980–2005 provided completed questionnaires, physical measures, and blood samples. Controls were 1,630 age-matched controls from the Norwegian Nord-Trøndelag Health Study (HUNT-2) (1995- 97). Results: Mean age in both the RRSO and control groups at survey was 54.4 years. Mean follow-up after surgery was 6.5 years (SD 4.4). The RRSO group had a more favorable CHD risk profile (higher education, more physical activity, less smoking, lower total cholesterol, higher HDL cholesterol, lower systolic blood pressure and lower BMI) and lower Framingham total score compared to controls (p<0.05). In multiple logistic regression analyses RRSO was inversely associated with Framingham 10-year risk ≥5% (Odds Ratio 0.49, 95% CI [0.34, 0.71] p<0.001). Conclusions: In contrast to expectation, women at increased risk of hereditary breast ovarian cancer had a favorable CHD risk profile after RRSO compared to age-matched controls from the general population, and RRSO was associated with lower Framingham risk score. Follow-up time, self-selection of women seeking genetic counseling, changes in lifestyle after surgery and survival bias are possible explanations of this finding. No significant financial relationships to disclose.
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Affiliation(s)
- T. M. Michelsen
- Sørlandet Hospital Arendal, Arendal, Norway; Ullevål University Hospital, University of Oslo, Oslo, Norway; The Norwegian Radium Hospital, Oslo, Norway; Rikshospitalet University Hospital, Oslo, Norway
| | - S. Tonstad
- Sørlandet Hospital Arendal, Arendal, Norway; Ullevål University Hospital, University of Oslo, Oslo, Norway; The Norwegian Radium Hospital, Oslo, Norway; Rikshospitalet University Hospital, Oslo, Norway
| | - A. A. Dahl
- Sørlandet Hospital Arendal, Arendal, Norway; Ullevål University Hospital, University of Oslo, Oslo, Norway; The Norwegian Radium Hospital, Oslo, Norway; Rikshospitalet University Hospital, Oslo, Norway
| | - A. H. Pripp
- Sørlandet Hospital Arendal, Arendal, Norway; Ullevål University Hospital, University of Oslo, Oslo, Norway; The Norwegian Radium Hospital, Oslo, Norway; Rikshospitalet University Hospital, Oslo, Norway
| | - C. G. Tropé
- Sørlandet Hospital Arendal, Arendal, Norway; Ullevål University Hospital, University of Oslo, Oslo, Norway; The Norwegian Radium Hospital, Oslo, Norway; Rikshospitalet University Hospital, Oslo, Norway
| | - A. Dørum
- Sørlandet Hospital Arendal, Arendal, Norway; Ullevål University Hospital, University of Oslo, Oslo, Norway; The Norwegian Radium Hospital, Oslo, Norway; Rikshospitalet University Hospital, Oslo, Norway
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Svendsen M, Helgeland M, Tonstad S. The long-term influence of orlistat on dietary intake in obese subjects with components of metabolic syndrome. J Hum Nutr Diet 2009; 22:55-63. [PMID: 19192027 DOI: 10.1111/j.1365-277x.2008.00920.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Orlistat is a lipase inhibitor that reduces the intestinal absorption of fat and may enhance the effects of dietary and behavioural therapy on weight loss and maintenance. The present study examined the effect of orlistat on dietary intake, especially fat intake, during long-term weight maintenance. METHODS Subjects comprised 44 men and women (aged 18-63 years; body mass index 37.5 +/- 4.3 kg m(-2)) included in the Scandinavian Multicenter study of Obese subjects with the metabolic syndrome, a 3-year clinical trial of orlistat or placebo following an 8-week, very low energy diet (VLED). Two months after the end of the trial when the use of orlistat was optional, 33 subjects remained in the study. A dietary interview based on a validated food frequency questionnaire was conducted before the VLED, after 1 year of treatment with orlistat or placebo and 2 months after the end of the trial. RESULTS At 1 year, dietary intake did not differ between the orlistat and placebo group. Energy percent (E%) fat was reduced and E% carbohydrate was increased within both groups. Two months after the end of the trial, E% fat was 32.6% (SD 6.2%) in subjects that chose to take orlistat and 27.7% (SD 5.5%) in subjects not taking orlistat [between group difference -5.0% (95% confidence interval -9.2 to -0.7); P = 0.021]. CONCLUSIONS The use of orlistat compared with placebo in a lifestyle modification programme does not appear to influence dietary intake. Subjects that chose to take orlistat after the end of the programme did not comply with dietary recommendations and this may hamper the effect of the drug.
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Affiliation(s)
- M Svendsen
- Department of Preventive Cardiology, Ullevål University Hospital, Oslo, Norway.
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Wangensteen T, Pollestad Kolsgaard M, Mattingsdal M, Joner G, Tonstad S, Undlien D, Retterstol L. Mutations in the Melanocortin 4 Receptor (MC4R) Gene in Obese Patients in Norway. Exp Clin Endocrinol Diabetes 2009; 117:266-73. [DOI: 10.1055/s-0028-1102942] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rødningen OK, Røsby O, Tonstad S, Ose L, Berg K, Leren TP. A 9.6 kilobase deletion in the low density lipoprotein receptor gene in Norwegian familial hypercholesterolemia subjects. Clin Genet 2008; 42:288-95. [PMID: 1362925 DOI: 10.1111/j.1399-0004.1992.tb03258.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Haplotype analysis of the low density lipoprotein receptor (LDLR) gene was performed in Norwegian subjects heterozygous for familial hypercholesterolemia (FH). Southern blot analysis of genomic DNA, using an exon 18 specific probe and the restriction enzyme NcoI, showed that two out of 57 unrelated FH subjects had an abnormal 3.6 kb band. Further analyses revealed that this abnormal band was due to a 9.6 kb deletion that included exons 16 and 17. The 5' deletion breakpoint was after 245 bp of intron 15, and the 3' deletion breakpoint was in exon 18 after nucleotide 3390 of cDNA. Thus, both the membrane-spanning and cytoplasmatic domains of the receptor had been deleted. A polymerase chain reaction (PCR) method was developed to identify this deletion among other Norwegian FH subjects. As a result of this screening one additional subject was found out of 124 subjects screened. Thus, three out of 181 (1.7%) unrelated Norwegian FH subject possessed this deletion. The deletion was found on the same haplotype in the three unrelated subjects, suggesting a common mutagenic event. The deletion is identical to a deletion (FH-Helsinki) that is very common among Finnish FH subjects. However, it is not yet known whether the mutations evolved separately in the two countries.
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Affiliation(s)
- O K Rødningen
- Department of Medical Genetics, Ullevål Hospital, Oslo, Norway
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Abstract
In Western countries, more women than men die every year of cardiovascular disease (CVD) and women spend more life years with cardiovascular disease than men. Fortunately, premature cardiovascular disease in women is preventable. Evidence-based guidelines for the prevention of cardiovascular disease in women recommend an initial risk assessment. However, recommended risk-assessment tools such as the Systematic Coronary Risk Evaluation (SCORE) system may not be sufficient to detect risk in women with obesity. A further barrier to prevention in women is the fact that physicians may underestimate the effects of risk factors that are particularly dangerous or prevalent in women. These include type 2 diabetes, hypertension, smoking, abdominal obesity, poor exercise capacity and the metabolic syndrome. Several of these factors, as well as some novel biomarkers, may increase the risk of cardiovascular disease relatively more in women than in men. To assess risk in obese women, a multifactorial assessment that encompasses assessment of body-fat distribution should be undertaken. Weight loss and lifestyle changes that have been shown to improve risk-factor profiles are crucial interventions and should be considered, even if standard risk calculators do not indicate an elevated cardiovascular risk.
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Affiliation(s)
- S Tonstad
- Department of Preventive Cardiology, Center for Preventive Medicine, Ullevål University Hospital, Oslo, Norway.
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Ellingsen I, Hjerkinn EM, Seljeflot I, Arnesen H, Tonstad S. Consumption of fruit and berries is inversely associated with carotid atherosclerosis in elderly men. Br J Nutr 2008; 99:674-81. [PMID: 17894919 DOI: 10.1017/s0007114507832521] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Epidemiological data suggest that fruit and vegetable consumption is associated with a lowered risk of CVD. We assessed the association between the intima-media thickness (IMT) of the carotid artery and dietary intake of vegetables, fruit and berries in elderly men with a high risk of CVD. Subjects (age 70 ± 5 years) were survivors from a cohort of 1232 men that participated in the Oslo Diet and Antismoking Study in 1972–3.Measurements of the carotid IMT by high resolution B-mode ultrasound, risk factor assessment and dietary data based on an FFQ were collected in 1997–9.Complete dietary and ultrasound data were available for 547 subjects. The carotid IMT in the highest quartile of dietary intake of fruit and berries was 0·89 (se 0·18) mm compared with 0·96 (se 0·25) mm in the lowest quartile, giving a mean difference of 0·075 (se 0·027) mm (P = 0·033). In multivariate regression analysis increased intake of fruit and berries remained inversely associated with IMT after adjustment for age, cigarette smoking, dietary cholesterol and saturated fat, consumption of milk, cream and ice cream and energy intake (multivariate regression coefficient 0·257; R2 0·066; se 0·209; P < 0·001). The difference of 348 g of fruit and berries per d between the lowest and highest quartile of intake was associated with a 5·5 % adjusted difference in mean IMT. These findings suggest that consumption of fruit and berries may be protective against carotid atherosclerosis in elderly men at high risk of CVD.
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Affiliation(s)
- I Ellingsen
- Department of Preventive Cardiology, Ullevål University Hospital, N-0047 Oslo, Norway.
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Halvorsen B, Lund Sagen E, Ueland T, Aukrust P, Tonstad S. Effect of smoking cessation on markers of inflammation and endothelial cell activation among individuals with high risk for cardiovascular disease. Scand J Clin Lab Invest 2008; 67:604-11. [PMID: 17852807 DOI: 10.1080/00365510701283878] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To prospectively determine the effect of smoking cessation on markers of inflammation and endothelial cell activation. MATERIAL AND METHODS Thirty male and 22 female smokers of >7 cigarettes daily, aged 32-64 years with cardiovascular disease (CVD) or additional risk factors to smoking, participated in a program of smoking cessation with a follow-up period of 1 year. Cessation was validated by carbon monoxide measurement in expired breath, and 41 of the patients completed the study (17 quitters and 24 non-quitters). Plasma samples were drawn at baseline and after 1 year, and inflammatory markers were analyzed by enzyme immunoassays. Peripheral blood mononuclear cells (PBMCs) were isolated at baseline and 1 year in 6 quitters and 6 smokers and mRNA levels of interleukin-8 (IL-8), tumor necrosis factor x (TNFx) and intercellular adhesion molecule 1 (ICAM-1) were analyzed by real-time quantitative RT-PCR. RESULTS Our main findings were: (i) While the concentration of soluble (s) ICAM-1 decreased in quitters, it increased in smokers, with a significant difference in changes between the groups (p=0.04). (ii) While there was only minor change in mRNA levels of IL-8 in smokers, those who stopped smoking showed a decrease in the gene expression of IL-8 (p < 0.09; comparing difference in changes). (iii) Concentrations of the other measured parameters (E-selectin, IL-6, sCD40 ligand, TNFx, von Willebrand factor, and C-reactive protein) were unchanged during follow-up in both groups. CONCLUSION Smoking cessation induced a reduction in ICAM-1, suggesting a novel mechanism for the rapid reduction in the risk of CVD following smoking cessation.
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Affiliation(s)
- B Halvorsen
- Institute for Internal Medicine Research, University of Oslo, Oslo, Norway.
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Tonstad S, Sandvik E, Larsen PGL, Thelle D. Gender Differences in the Prevalence and Determinants of the Metabolic Syndrome in Screened Subjects at Risk for Coronary Heart Disease. Metab Syndr Relat Disord 2007; 5:174-82. [DOI: 10.1089/met.2006.0037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S. Tonstad
- Ullevål University Hospital, Oslo, Norway, Sahlgrenska Academi, Göteborgs University, Göteborg, Sweden
| | - E. Sandvik
- Ullevål University Hospital, Oslo, Norway, Sahlgrenska Academi, Göteborgs University, Göteborg, Sweden
| | - P. G. Lund Larsen
- Norwegian Institute of Public Health, Oslo, Norway, Sahlgrenska Academi, Göteborgs University, Göteborg, Sweden
| | - D. Thelle
- Akershus University Hospital, Oslo, Norway, Sahlgrenska Academi, Göteborgs University, Göteborg, Sweden
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Khoury J, Henriksen T, Seljeflot I, Mørkrid L, Frøslie KF, Tonstad S. Effects of an antiatherogenic diet during pregnancy on markers of maternal and fetal endothelial activation and inflammation: the CARRDIP study. BJOG 2007; 114:279-88. [PMID: 17217362 PMCID: PMC1974834 DOI: 10.1111/j.1471-0528.2006.01187.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To study the effect of an antiatherogenic diet on maternal and cord blood concentrations of systemic biomarkers of endothelial cell activation, haemostasis and inflammation. Design Single blinded randomised controlled clinical trial. Setting Obstetric outpatient clinic and maternity unit of a university hospital in Norway. Population Nonsmoking pregnant women aged 21–38 years carrying a single fetus and with no previous pregnancy-related complications. Methods Subjects (n = 290) were randomised to continue their usual diet or to adopt a diet low in saturated fat and cholesterol from gestational week 17–20 to birth. Soluble forms of cellular adhesion molecules, high-sensitivity C-reactive protein (CRP) and haemostatic markers were measured at 17–20 weeks of gestation (baseline) and subsequently up to week 36. All the above, except CRP, were also measured in cord blood. Main outcome measures Concentrations of maternal and fetal biomarkers and maternal CRP. Results All biomarkers except CRP levels increased significantly during the study period in both the intervention and control groups. None of the maternal or fetal biomarkers were influenced by the intervention (P > 0.05) except for a tendency to lower concentrations of cord blood tissue plasminogen activator antigen in the intervention group compared with the control group, median (interquartile range) 5.4 ng/ml (3.1–7.7) versus 5.8 ng/ml (3.5–11.8), P = 0.05. Conclusion An antiatherogenic diet in pregnancy did not significantly influence maternal or fetal blood concentrations of a range of biomarkers for inflammation. Thus, the previously reported effects of a cholesterol-lowering diet on maternal lipid profile and preterm delivery (<37 complete weeks of gestation) do not seem to involve changes in the systemic inflammatory responses of pregnancy.
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Affiliation(s)
- J Khoury
- Department of Obstetrics and Gynaecology, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway.
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Svendsen M, Blomhoff R, Holme I, Tonstad S. The effect of an increased intake of vegetables and fruit on weight loss, blood pressure and antioxidant defense in subjects with sleep related breathing disorders. Eur J Clin Nutr 2007; 61:1301-11. [PMID: 17268408 DOI: 10.1038/sj.ejcn.1602652] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the effect of an increased consumption of vegetables and fruit on body weight, risk factors for cardiovascular disease (CVD) and antioxidant defense in obese patients with sleep-related breathing disorders (SRBD). DESIGN Randomized, controlled trial of an intervention to increase the intake of vegetables to 400 g/day and fruit to 300 g/day. Dietary intake was calculated from a food frequency questionnaire. Antioxidant status was assessed with the ferric-reducing/antioxidant power (FRAP) assay. Plasma carotenoids were biomarkers for the intake of vegetables and fruit. SETTING A hospital clinic preventing risk factors for CVD. SUBJECTS Subjects were 103 men and 35 women with a body mass index of 36.7+/-5.8 kg/m(2) of which 57 (86%) in the control and 68 (94%) in the intervention group completed the study. INTERVENTION Group-based behavioral program during 3 months. RESULTS The mean between group differences in body weight was -2.0% (95% CI -3.6, -0.5), P<0.0001. The mean between group difference in systolic and diastolic blood pressure (BP) was -7.1 mm Hg (95% CI: -11.6, -2.6), P=0.0022 and -3.9 mm Hg (95% CI: -7.0, -0.9), P=0.0120, respectively. The mean change in daily intake of vegetables and fruit was 12 g (95% CI: -33, 57) and -4 g (95% CI: -79, 71) versus 245 g (95% CI: 194, 296) and 248 g (95% CI: 176, 320) in the control and intervention groups, respectively. This was reflected in higher concentrations of alpha-carotene and beta-carotene. No change in FRAP was seen. In a multiple regression analysis the change in intake of vegetables was a significant contributor (R(adj)(2)=0.073 (95% CI: 0.019, 0.214)) to the change in weight. CONCLUSION Targeted dietary advice to increase the intake of vegetables and fruit among subjects with SRBD contributed to weight reduction and reduced systolic and diastolic BP, but had no effect on antioxidant defense measured with FRAP.
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Affiliation(s)
- M Svendsen
- Department of Preventive Cardiology, Ullevål University Hospital, Oslo, Norway.
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Iversen P, Khoury J, Sandset P, Seljeflot I, Ose L, Tonstad S, Henriksen T, Retterstøl K, Amundsen Å. 38 Development of a procoagulant pattern during pregnancy among women with familial hypercholesterolemia. Thromb Res 2007. [DOI: 10.1016/s0049-3848(07)70083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ellingsen I, Hjerkinn EM, Arnesen H, Seljeflot I, Hjermann I, Tonstad S. Follow-up of diet and cardiovascular risk factors 20 years after cessation of intervention in the Oslo Diet and Antismoking Study. Eur J Clin Nutr 2006; 60:378-85. [PMID: 16306931 DOI: 10.1038/sj.ejcn.1602327] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Oslo Diet and Antismoking study was a 5-year randomised trial initiated in 1972-1973, which studied the effect of dietary change and smoking cessation for the prevention of coronary heart disease among high-risk middle-aged men. To test the long-term maintenance of lifestyle change, we examined diet and cardiovascular risk factors in subjects initially randomised to the control and intervention groups 20 years after cessation of the intervention. SUBJECTS AND DESIGN Of the original cohort that included 1232 participants, 910 survivors were identified in 1997 and cardiovascular risk factors were measured in 563 (62%) in 1997-1999. Of these, 558 (99%) also completed questionnaires about their food intake and attitudes to health and diet. RESULTS Cigarette smoking was nearly halved between baseline and 20-year follow-up in each of the intervention and control groups (P<0.001 within groups), but did not differ between the intervention group (39%) versus the control group (34%); P=0.07. Body mass index increased by 1.4+/-2.6 and 1.6+/-2.6 kg/m(2) between baseline and 20-year follow-up in the intervention and control groups, respectively (P<0.001 within groups; NS between groups). Serum total cholesterol and triglyceride concentrations decreased substantially in subjects treated or untreated with statins (P<0.001 within the intervention and control groups) but did not differ between the groups (total cholesterol change of -1.4+/-1.3 and -1.3+/-1.2 mmol/l, respectively, and triglyceride change of -0.5+/-1.0 mmol/l in both groups). Men in the intervention group reported a less atherogenic fat quality score and lower intakes of fat, saturated fat and cholesterol, higher intakes of long chain polyunsaturated fatty acids, protein and beta-carotene and greater attention to lifestyle and change of diet than the control group (all P<0.05). The fatty acid concentrations did not differ, however, between the intervention and control groups (P>0.05). CONCLUSIONS No long-term differences in smoking rates or lipid concentrations between the intervention and control groups were observed in the surviving attendees two decades after the end of the trial. Lifestyle intervention still influenced the dietary intake, though modestly.
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Affiliation(s)
- I Ellingsen
- Department of Preventive Medicine, Ullevål University Hospital, Oslo, Norway.
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Holme I, Haaheim LL, Tonstad S, Hjermann I. Effect of dietary and antismoking advice on the incidence of myocardial infarction: a 16-year follow-up of the Oslo Diet and Antismoking Study after its close. Nutr Metab Cardiovasc Dis 2006; 16:330-338. [PMID: 16829341 DOI: 10.1016/j.numecd.2005.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Accepted: 04/19/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM The Oslo Diet and Antismoking Study was a 5-year randomised controlled trial initiated in 1972-1973 and ended in 1977-1978, which showed that dietary change and smoking cessation reduced the incidence of coronary heart disease among high risk middle-aged men. In an extended follow-up we studied the incidence of myocardial infarction (MI) 16 years after the end of the trial in the intervention and control groups. METHODS The primary endpoint was the first occurrence of non-fatal and fatal MI including sudden death up to December 31 1993. Cases of fatal MI were identified by linkage to Statistics Norway using each subject's individual personal number. Cases of non-fatal MI were extracted from the hospital records. Cox proportional hazards regression models estimated relationships between changes in total cholesterol and triglyceride concentrations and smoking status and the primary endpoints up to 16 years following the end of the trial. RESULTS At 5 and 10 years following the end of the trial the incidence of MI among the 604 men in the intervention (I) and 628 in the control (C) group differed significantly (5-year event rate (I/C) =0.059/0.090; P=0.038 and 10-year event rate (I/C) =0.111/0.155; P=0.023), but the difference faded slowly and subsequently (P=0.069 at 16 years). The reduction in MI in the intervention group was primarily explained by the differences in total cholesterol and triglyceride concentrations between the groups. CONCLUSION This extended follow-up of the Oslo Diet and Antismoking Study found a prolonged benefit of the intervention lasting for at least a decade after the close of the trial. This finding is in accordance with statin and other studies showing that the effect of cholesterol lowering may be prolonged after the end of the intervention.
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Affiliation(s)
- I Holme
- Department of Epidemiology, Preventive Medicine Clinic, Ullevål University Hospital, N-407 Oslo, Norway.
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Svendsen M, Blomhoff R, Holme I, Tonstad S. Th-W55:5 The effect of an increased intake of vegetables and fruit on weight, blood pressure and antioxidant defense in subjects with sleep apnea disorders. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81911-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Khoury J, Henriksen T, Seljeflot I, Christophersen B, Morderid L, Fey Froslic K, Tonstad S. Mo-P5:364 Effects of a cholesterol-lowering diet during pregnancy on cardiovascular risk factors and pregnancy outcome: A randomized clinical trial. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fagerberg B, Edwards S, Halmos T, Lopatynski J, Schuster H, Stender S, Stoa-Birketvedt G, Tonstad S, Halldórsdóttir S, Gause-Nilsson I. Tesaglitazar, a novel dual peroxisome proliferator-activated receptor alpha/gamma agonist, dose-dependently improves the metabolic abnormalities associated with insulin resistance in a non-diabetic population. Diabetologia 2005; 48:1716-25. [PMID: 16001233 DOI: 10.1007/s00125-005-1846-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 04/16/2005] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Insulin resistance is associated with abnormalities in lipid and glucose metabolism, which are major components of metabolic syndrome and risk factors for vascular disease. This study examined the effect of tesaglitazar (Galida), a novel, dual-acting peroxisome proliferator-activated receptor alpha/gamma agonist, on lipid and glucose metabolism in patients with evidence of insulin resistance. METHODS A 12-week, multicentre, randomised, double-blind, placebo-controlled, dose-finding study compared the efficacy and safety of oral tesaglitazar (0.1, 0.25, 0.5 and 1.0 mg/day) and placebo in 390 non-diabetic patients with hypertriglyceridaemia (plasma triglyceride concentration >1.7 mmol/l) and abdominal obesity (waist-to-hip ratio >0.90 for men and >0.85 for women). RESULTS A 1.0-mg dose of tesaglitazar reduced fasting triglycerides (the primary endpoint) by 37% (95% CI: -43% to -30%; p<0.0001), non-HDL-cholesterol by 15% (95% CI: -20% to -10%; p<0.0001) and NEFA by 40% (95% CI: -51% to -27%; p<0.0001), and increased HDL-cholesterol by 16% (95% CI: 8 to -24%; p<0.0001). At the end of treatment there was a dose-dependent increase in patients with pattern A LDL particle diameter (40% at baseline vs 87% at 12 weeks for tesaglitazar 1.0 mg). Tesaglitazar produced significant reductions in fasting insulin concentration (-35%; p<0.0001) and plasma glucose concentration (-0.47 mmol/l; p<0.0001). Respiratory infection and gastrointestinal symptoms were the most common adverse events and were similarly frequent in all groups. CONCLUSIONS/INTERPRETATION Tesaglitazar was well tolerated and produced significant, dose-dependent improvements in lipid and glucose metabolism and insulin sensitivity. Tesaglitazar may have the potential to prevent vascular complications and delay progression to diabetes in these patients.
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Affiliation(s)
- B Fagerberg
- Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska University Hospital, 41345 Göteborg, Sweden.
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Ose L, Tonstad S, Harris S, Marotti M. W16-P-064 Ezetimibe added to rosuvastatin for severely hypercholesterolemic patients: Effects on lipid measures and C-reactive protein. ATHEROSCLEROSIS SUPP 2005. [DOI: 10.1016/s1567-5688(05)80460-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
OBJECTIVES We evaluated mortality from cardiovascular disease (CVD), coronary heart disease (CHD) and all causes in relation to use of any hormone therapy (HT) and HT with oestradiol and norethisterone or levonorgestrel. DESIGN Population-based cohort study. SETTING AND SUBJECTS Women in three Norwegian counties were invited to a health survey in 1985-88 and 82.8% participated. In all 14 324 post- or perimenopausal women aged 35-62 years, including 702 HT users with a mean age of 48.8 years, were followed for 14 years. RESULTS Women using HT had mortality from all causes and CVD comparable with that of nonusers. The relative risk (RRs) for CVD mortality amongst all women were 0.69 (95% CI: 0.35-1.33) for users of HT, and 0.96 (95% CI: 0.43-2.17) for users of HT with norethisterone or levonorgestrel. Amongst women free of self-reported cardiovascular health problems at baseline all-cause, CVD and CHD mortality tended to be lower amongst users of HT whilst HT use was linked with increased mortality amongst women with cardiovascular health problems. CONCLUSIONS In this cohort of women around the usual age of menopause all-cause or CVD mortality amongst users of HT, most often oestradiol combined with norethisterone or levonorgestrel, was not markedly different from that of nonusers. Early CHD events amongst HT users prior to the baseline survey, together with selective inclusion of healthy subjects, may in part explain protective effects of HT on CHD reported from previous observational studies.
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Bergersen BM, Sandvik L, Bruun JN, Tonstad S. Elevated Framingham risk score in HIV-positive patients on highly active antiretroviral therapy: results from a Norwegian study of 721 subjects. Eur J Clin Microbiol Infect Dis 2004; 23:625-30. [PMID: 15322938 DOI: 10.1007/s10096-004-1177-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Highly active antiretroviral therapy (HAART) may induce dyslipidemia and thus increase the risk of future cardiovascular heart disease (CHD). In this cross-sectional study performed in 2000-2001, the prevalence of a Framingham CHD risk score of >20% in HIV-positive individuals treated or not treated with HAART was compared with that in age- and gender-matched controls. The study included 721 subjects: 219 HIV-positive individuals on HAART, 64 HIV-positive, HAART-naïve individuals, and 438 age- and gender-matched controls randomly selected from a simultaneous health survey. The prevalence of a 10-year estimated CHD risk of >20% was 11.9% in patients on HAART compared to 5.3% in controls ( P=0.004). The main contributors to the increased CHD risk in patients on HAART were increased prevalence of daily smoking (54.5% vs 30.1%; P<0.001), total cholesterol of >6.2 mmol/l (36.1% vs 21.7%; P<0.001), and HDL cholesterol of < 0.9 mmol/l (20.9% vs 8.0%; P<0.001). In HAART-naïve patients, the prevalence of a 10-year estimated CHD risk of >20% was 6.3% ( P=0.25 vs HAART patients, P=0.76 vs controls), the prevalence of daily smoking was 56.3% ( P=0.89 vs HAART patients, P<0.001 vs controls), the prevalence of total cholesterol >6.2 mmol/l was 9.4% ( P<0.001 vs HAART patients, P=0.019 vs controls), and the prevalence of HDL cholesterol of <0.9 mmol/l was 30.9% ( P=0.16 vs HAART patients, P<0.001 vs controls). The results show that, compared to controls, twice as many patients on HAART have an estimated 10-year CHD risk above 20%. These patients are candidates for intensive interventions. HAART patients should be encouraged to permanently stop smoking, make healthy food choices, and increase physical activity. In patients with elevated lipid levels, a change in the HAART regimen or treatment with lipid-lowering drugs should be considered.
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Affiliation(s)
- B M Bergersen
- Department of Infectious Diseases, Ullevål University Hospital, 0407 Oslo, Norway.
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Scholz H, Aukrust P, Damås JK, Tonstad S, Sagen EL, Kolset SO, Hall C, Yndestad A, Halvorsen B. 8-isoprostane increases scavenger receptor A and matrix metalloproteinase activity in THP-1 macrophages, resulting in long-lived foam cells. Eur J Clin Invest 2004; 34:451-8. [PMID: 15255781 DOI: 10.1111/j.1365-2362.2004.01376.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Oxidative stress is a key factor in atherogenesis, in which it is closely associated with the inflammation and formation of bioactive lipids. Although 8-isoprostane is regarded as a reliable marker of oxidative stress in vivo, the pathogenic role of this F(2)-isoprostane in atherogenesis is far from clear. Based on the important role of foam cells in the initiation and progression of atherosclerosis we hereby examined the ability of 8-isoprostane to modulate oxidized (ox)LDL-induced foam cell formation and the function of these cells, particularly focusing on the effect on matrix degradation. METHODS AND RESULTS 8-isoprostane (10 micro M) augmented the oxLDL-induced (20 micro g mL(-1)) lipid accumulation of THP-1 macrophages evaluated by Oil-Red-O staining and lipid mass quantification (colourimetric assay). Additionally, 8-isoprostane induced the expression of the scavenger receptor A type 1 (MSR-1) [mRNA and protein level], assessed by RT-PCR and Western blotting, respectively. Moreover, 8-isoprostane counteracted the oxLDL-induced apoptosis of these cells, involving both mitochondrial-protective and caspase-suppressive mechanisms. Along with these changes, 8-isoprostane increased the oxLDL-induced gene expression of matrix metalloproteinase (MMP)-9 and its endogenous inhibitor [i.e. tissue inhibitor of MMP (TIMP)-1] accompanied by enhanced total MMP activity. CONCLUSIONS We show that 8-isoprostane increases foam cell formation at least partly by enhancing MSR-1 expression and by inhibiting apoptosis of these cells, inducing long-lived foam cells with enhanced matrix degrading capacity. Our findings further support a role for 8-isoprostane not only as a marker of oxidative stress in patients with atherosclerotic disorders, but also as a mediator in atherogenesis and plaque destabilization.
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Affiliation(s)
- H Scholz
- Rikshospitalet University Hospital, University of Oslo, Norway
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Abstract
OBJECTIVE We examined the prevalence and factors associated with use of cholesterol-lowering statins in the population. METHODS Demographic, medical, anthropometric and lifestyle data was obtained from 6233 men and 7521 women born in 1924/25, 1940/41, 1955 and 1960 that participated in the Oslo Health Study 2000-2001. A nonfasting blood sample was collected. RESULTS Of subjects with a heart attack, angina, stroke or diabetes 45% of men and 35% of women were taking a statin (P < 0.001). Of subjects with cardiovascular disease (CVD) or diabetes taking statins 61% of men and 40% of women achieved total serum cholesterol levels < or =5 mmol L(-1). The odds ratio for taking a statin was increased amongst subjects who also took antihypertensive drug(s) or acetylsalicylic acid, subjects with a family history of coronary heart disease (CHD) and women who had visited the general practitioner within the last year. Amongst presumed healthy subjects use of statins increased from about 1% in women aged 40-45 years, to 7% at age 60 and to 12% at age 75 whilst the corresponding figures for men were 3%, 8% and 9%, respectively. About 22% of men but <2% of women aged 60 who were not taking statins had a 10-year Framingham CHD risk score >20%. Determinants of statin use were similar to those amongst subjects with CVD or diabetes. CONCLUSION People with CVD or diabetes remain undertreated with statins, women more so than men. Use of other preventive drugs, the family history and recent contact with the general practitioner were the most important determinants of statin use in primary and secondary prevention. Amongst healthy subjects aged 60 or 75 years women received statins disproportionately to their low CHD risk compared with men.
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Affiliation(s)
- S Tonstad
- Department of Preventive Cardiology, Preventive Medicine Clinic, Ullevål University Hospital, Oslo, Norway.
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Tonstad S. W09.261 Prevalence of the metabolic syndrome among statin-treated patients with premature CHD. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
UNLABELLED Use of statins is increasing among children with familial hypercholesterolaemia who previously have had to take unpalatable resins. In a selected group with no controls, children taking statins had similar scores for quality of life and anxiety as normative scores. The question that remains is how to improve dietary and disease information. CONCLUSION Children with familial hypercholesterolaemia who are taking statins have no reduction in quality of life or increase in anxiety.
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Affiliation(s)
- S Tonstad
- Department of Preventive Cardiology, Ullevål University Hospital, Oslo, Norway.
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