Karin Schenck-gustafsson - Academia.edu (original) (raw)

Papers by Karin Schenck-gustafsson

Pharmacokinetic properties such as absorption, distribution, metabolism, and elimination of drugs... more Pharmacokinetic properties such as absorption, distribution, metabolism, and elimination of drugs often differ between men and women and change over lifetime. Women experience more adverse events and side-effects of medications than men. Hormonal changes during the menstrual cycle usually have limited effect on the pharmacokinetics of drugs, except for drugs that interfere with QT-interval. It is debated whether there is a systematic difference in compliance to medication in women compared to men. Drug interactions and drug safety during pregnancy are discussed.

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Circulation, Jan 21, 1997

Background Lipoprotein(a) [Lp(a)] appears to be a risk factor for coronary heart disease (CHD) in... more Background Lipoprotein(a) [Lp(a)] appears to be a risk factor for coronary heart disease (CHD) in men. The role of Lp(a) in women, however, is less clear. Methods and Results We examined the ability of Lp(a) to predict CHD in a population-based case-control study of women 65 years of age or younger who lived in the greater Stockholm area. Subjects were all patients hospitalized for an acute CHD event between February 1991 and February 1994. Control subjects were randomly selected from the city census and were matched to patients by age and catchment area. Lp(a) was measured 3 months after hospitalization by use of an immunoturbidometric method (Incstar) calibrated to the Northwest Lipid Research Laboratories (coefficient of variation was <9%). Of the 292 consecutive patients, 110 (37%) were hospitalized for an acute myocardial infarction, and 182 were hospitalized (63%) for angina pectoris. The mean age for both patients and control subjects was 56±7 years. Of participants, 74 patients (25%) and 84 control subjects (29%) were premenopausal. The distributions of Lp(a) were highly skewed in both patients and control subjects, with a range from 0.001 to 1.14 g/L. Age-adjusted odds ratio for CHD in the highest versus the lowest quartile of Lp(a) was 2.3 (95% confidence interval [CI], 1.4 to 3.7). After adjustment for age, smoking, education, body mass index, systolic blood pressure, total cholesterol, triglycerides, and HDL, the odds ratio was 2.9 (95% CI, 1.6 to 5.0). The odds ratios were similar when myocardial infarction and angina patients were compared with their respective control subjects. The odds ratios were 5.1 (95% CI, 1.4 to 18.4) and 2.4 (95% CI, 1.3 to 4.5) in premenopausal and postmenopausal women, respectively. Conclusions These results suggest that Lp(a) is a determinant of CHD in both premenopausal and postmenopausal women.

Circulation, Feb 10, 2004

European journal of cardiovascular prevention & rehabilitation, Dec 1, 1999

Both social isolation and the metabolic syndrome are independently associated with greater than n... more Both social isolation and the metabolic syndrome are independently associated with greater than normal cardiovascular risk. A population-based cross-sectional study of middle-aged Swedish women. The study group consisted of 300 healthy women (aged 31-65 years) who were representative of women living in the greater Stockholm area. Social isolation was measured by using a condensed version of the Interpersonal Support Evaluation List. Health behaviours were assessed and a full serum-lipid-level and haemostatic profile was obtained by standardized methods. The metabolic syndrome was defined as the presence of two or more of these components: fasting serum level of glucose > or = 7.0 mmol/l, arterial blood pressure > or = 160/90 mmHg, fasting serum level of triglycerides > or = 1.7 mmol/l or high-density lipoprotein < 1.0 mmol/l, or both, and central obesity (waist:hip ratio > 0.85 or body mass index > 30 kg/m2, or both). After adjustment for age, menopausal status, educational level, smoking, exercise habits and consumption of alcohol, the risk ratio for the metabolic syndrome for women in the lower compared with women in the upper social-support quartile was 3.5 (95% confidence interval 1.1-11.4), whereas that of women in the two middle quartiles was 2.2 (95% confidence interval 0.67-7.2; P for trend 0.02). Social isolation was associated with the metabolic syndrome for these middle-aged women. The findings suggest that the metabolic syndrome and its components may be mediators of the reported association between social isolation and cardiovascular disease.

European Heart Journal, Aug 1, 2017

appear to be strong determinants of whether a NOAC agent or warfarin is prescribed for AF-related... more appear to be strong determinants of whether a NOAC agent or warfarin is prescribed for AF-related stroke prevention. Acknowledgement/Funding: The SPRINT AF registry was supported by an investigator-initiated grant to CCRN by Bayer Canada Inc.

Maturitas, 2011

Introduction: Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary ... more Introduction: Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a serious cardiovascular event whose incidence rises with increasing age. Aims: To formulate a position statement on the management of the menopause in women with a personal or family history of VTE. Material and methods: Literature review and consensus of expert opinion. Results and conclusions: Randomized controlled trials have shown an increased risk of VTE in oral hormone therapy (HT) users. There are no randomized trial data on the effect of transdermal estrogen on VTE. Recent observational studies and meta-analyses suggest that transdermal estrogen does not increase VTE risk. These clinical observations are supported by experimental data showing that transdermal estrogen has a minimal effect on hepatic metabolism of hemostatic proteins as the portal circulation is bypassed. A personal or family history of VTE, especially in individuals with a prothrombotic mutation, is a strong contraindication to oral HT but transdermal estrogen can be considered after careful individual evaluation of the benefits and risks. Transdermal estrogen should be also the first choice in overweight/obese women requiring HT. Observational studies suggest that micronized progesterone and dydrogesterone might have a better risk profile than other progestins with regard to VTE risk. Although these findings should be confirmed by randomized clinical trials, they strongly suggest that both the route of estrogen administration and the type of progestin may be important determinants of the overall benefit-risk profile of HT.

BMC Family Practice, 2015

Background: Biological and sociocultural differences between men and women may play an important ... more Background: Biological and sociocultural differences between men and women may play an important role in medical treatment. Little is known about the awareness of these differences among general practitioners (GPs) and if they consider such differences in their medical practice. The aim of this study was to explore GPs' perception of sex and gender aspects in medical treatment. Methods: We conducted five focus group discussions (FGDs) with 29 physicians (mainly GPs) in Sweden. A discussion guide with semi-structured questions was used. All FGDs were audio-recorded and transcribed word-byword. Data were analysed through inductive thematic analysis with no predetermined categories. Results: Three main categories emerged from the data. The first category emphasised GPs' experiences of sex and gender differences in diagnosing and assessment of clinical findings. Medical treatment in men and women was central in the second category. The third category emphasised GPs' knowledge of sex differences in drug therapy. Conclusions: The GPs stated they had little knowledge of sex and gender differences in drug treatment, but gave multiple examples of how the patient's sex affects the choice of treatment. Sex and gender aspects were considered in diagnosing and in the treatment decision. However, once the decision to treat was made the choice of drug followed recommendations by local Drug and Therapeutics Committee, which were perceived to be evidence-based. In the analysis we found a gap between perceived and expressed knowledge of sex and gender differences in drug treatment indicating a need of education about this to be included in the curriculum in medical school and in basic and specialist training for physicians. Education could also be a tool to avoid stereotypical thinking about male and female patients.

European Heart Journal, 2002

Circulation, Nov 18, 1997

Background Hypertriglyceridemia is now accepted as a risk factor for coronary heart disease, alth... more Background Hypertriglyceridemia is now accepted as a risk factor for coronary heart disease, although the mechanism behind the increased risk is not well understood. The present study was undertaken to investigate the effects of triglyceridemia on endothelial function, because impaired endothelial function is considered a marker of atherogenesis. Methods and Results Flow- and nitroglycerin-induced dilatation of the brachial artery was investigated noninvasively by high-resolution ultrasound technique in seven young, healthy men without risk factors for coronary heart disease. Transient triglyceridemia was induced by infusion of a triglyceride emulsion, Intralipid, which raised free fatty acid concentrations twofold and triglyceride levels fourfold. Flow-induced vasodilatation decreased from 7.1±3.0% to 1.6±2.6% ( P <.0002), whereas nitroglycerin-induced vasodilatation decreased from 20.5±5.8% to 11.5±3.2% ( P <.002) before and after 1 hour of infusion of Intralipid, respectively. Conclusions Transient triglyceridemia decreases vascular reactivity, presumably by both endothelium-dependent and endothelium-independent mechanisms.

European Heart Journal, Oct 1, 2019

Background: Palpitation is common, particularly in women, and usually benign caused by premature ... more Background: Palpitation is common, particularly in women, and usually benign caused by premature atrial/ventricular beats or stress-induced sinus tachycardia. Palpitations may cause disturbing symptoms, anxiety, depression, and decreased health related quality of life (HRQOL). Uncommonly, arrhythmias of clinical importance such as atrial fibrillation or paroxysmal supraventricular or ventricular tachycardia may be the cause. Purposes: To evaluate if instant analysis of underlying heart rhythm during palpitations reduce symptoms, anxiety, depression, and increase HRQOL. Methods: In all, 913 women (age 56±11 years) with palpitations causing anxiety were recruited from social web sites. Coala Heart Monitor ® was used by participants and ECG recorded twice a day and at symptoms for 60 days. The system uses a well-validated algorithm to analyze heart rhythm, is connected to the user's smartphone and provides immediate response to the user. In cases of non-benign arrhythmias, the result was also analyzed manually. Questionnaires addressing symptom (Symptom severity and frequency checklist (SCL), anxiety, depression Hospital anxiety and depression scale (HADS), Generalized Anxiety Disorder (GAD-7) and HRQOL (RAND-36)) were analyzed before and after two months. Exclusion criterium was known atrial fibrillation. Results: Between June 2018 and November 2018, 280 474 recordings (both chest and thumbs) ECG recordings were automatically analyzed. Frequency and severity of symptoms decreased (frequency from 23.7±8.4 to 19.7±8.5 (p<0.001), severity from 22.7±4.9 to 21±4.4 (p<0.001)). Total anxiety measured by HADS decreased from 6.4±4.2 to 5.7±4.2 (p<0.001) and depression from 5.1±3.9 to 4.6±4.1 (p<0.001). Generalized anxiety disorder decreased from 5.6±4.8 to 4.7±4.6 (p<0.001) and HRQOL increased in all domains (p<0.001). In 83% of recordings during symptomatic palpitation, benign premature atrial or ventricular beats, sinus tachycardia, or normal sinus rhythm were found. Conclusions: Instant analysis of the ECG with direct response to the user during palpitations reduce symptoms, anxiety, depression, and increase HRQOL in women.

Maturitas, Jul 1, 2010

Introduction: Epilepsy is a major public health problem worldwide which is clinically characteriz... more Introduction: Epilepsy is a major public health problem worldwide which is clinically characterized by recurrent seizures. Aim: The aim of this position statement is to provide evidence-based advice on management of the menopause in postmenopausal women derived from the limited data available. Materials and methods: Literature review and consensus of expert opinion. Results and conclusions: Women with epilepsy may undergo an earlier natural menopause, between 3 and 5 years depending on seizure frequency, but the data are limited. Data regarding the effects of the perimenopause and menopause on epilepsy are conflicting: some studies show an increased risk of seizures but others do not. With regard to hormone therapy (HT) one study has shown an increase in seizures with oral therapy with conjugated equine estrogens and medroxyprogesterone acetate, but no data are available for other regimens. Women starting HT should be closely monitored as their antiepileptic drug (AED) needs may change. As vitamin D and calcium metabolism can be affected by AEDS, supplements should be considered. Herbal preparations should be avoided as their efficacy is uncertain and they may interact with AEDs.

Maturitas, May 1, 2015

Proportions of reversible and irreversible magnetization processes in the overall magnetization p... more Proportions of reversible and irreversible magnetization processes in the overall magnetization process were studied in a complex view of magnetic, thermal and electrical properties of iron-phenolphormaldehyde resin composites. They were determined experimentally at different values of magnetic induction along the initial curve. The results of total, differential, reversible and irreversible permeability measurement as well as the analysis of DC energy losses revealed the same tendencies: The numbers of movable domain walls (determining the extent of reversible processes) depend on the magnetic particle size and the resin content through the demagnetizing fields produced by the particle surfaces, lowering the interaction between particles. Thermal diffusivity was compared with Hashin-Shtrikman model indicating good insulation of particles.

European Journal of Cardiovascular Nursing, Mar 8, 2021

Aims Palpitations, particularly common in women, are generally considered benign symptoms rarely ... more Aims Palpitations, particularly common in women, are generally considered benign symptoms rarely caused by clinically important arrhythmias. Nevertheless, palpitations may cause anxiety, depression, and decreased health-related quality of life (HRQOL). This study investigates to what degree palpitations cause symptoms such as anxiety and depression and affect HRQOL in women and whether direct feedback of underlying heart rhythm during palpitations decrease anxiety and depression and increase HRQOL in women. Methods and results The study included 821 women, age 21–88 years (mean 57 ± 11 years), with symptomatic palpitations recruited using social media. For 60 days, the participants used a handheld electrocardiogram (ECG)-recording device (Coala Heart Monitor) connected to their smartphones. ECG was recorded twice a day and when symptoms were present and was automatically algorithm-interpreted with immediate response to the user. Non-benign arrhythmias were also analysed manually. Questionnaires addressing anxiety and depression—Hospital Anxiety and Depression Scale (HADS), Generalized Anxiety Disorder (GAD-7), HRQOL (RAND-36), and Symptoms Checklist: Frequency and Severity (SCL)—were analysed before and after the data were collected. A total of 101 804 ECG recordings were automatically analysed. In 94%, sinus rhythm or premature atrial/ventricular contraction were recorded; in 6%, atrial fibrillation or supraventricular tachycardia were recorded. Apart from premature ventricular contractions, no ventricular arrhythmias were documented. Anxiety and depression (HADS and GAD-7) decreased (P < 0.001) as did frequency and severity of symptoms, and HRQOL increased in all domains (P < 0.001) at the 2-month follow-up. Conclusion Instant analysis of the ECG with direct response during palpitations decreases symptoms, anxiety, and depression and increases HRQOL in women.

Expert Review of Medical Devices, Feb 26, 2020

Introduction: Several handheld thumb ECG devices for on-demand recording of heart rhythm have bec... more Introduction: Several handheld thumb ECG devices for on-demand recording of heart rhythm have become available lately. These can be used both by health-care providers and purchased by laypersons for private use. Area covered: This profile describes the Coala Heart Monitor. This device differs from other handheld ECG monitors in three aspects: 1) it records both thumb and chest ECGs, 2) it uses both RR-dispersion and P-wave morphology for detecting atrial fibrillation, and 3) in synchronization with the chest ECG, it also records heart sounds presented as a phonocardiogram making measurement of systolic time intervals possible. The sensitivity and specificity for detecting atrial fibrillation are high. The use of systolic time interval in patients with heart failure has so far not been evaluated. Expert opinion: The increasing use of long-term prescribed and privately owned handheld ECG devices for on-demand recording of heart rhythm will most probably cause a paradigm shift in arrhythmia diagnostics. Coala Heart Monitor´s use of both chest and thumb recordings as well as analyzing both RR-dispersion and P-wave morphology may offer an advantage in diagnosing atrial fibrillation.

Journal of Science and Medicine in Sport, 2005

Coronary Artery Disease, Dec 1, 2000

Morphologic characteristics of coronary arteries in eight women with myocardial infarction and an... more Morphologic characteristics of coronary arteries in eight women with myocardial infarction and angiographically normal or not significantly stenosed vessels were investigated with intracoronary ultrasound. The infarct-related vessel was assessed by three-dimensional volumetric analysis and compared with a control vessel from a noninfarcted area. Atherosclerosis was found in all infarct-related arteries. The plaques were predominantly soft, eccentric, poorly calcified, and with little lipid pools or none at all. Although the average area and thickness of plaques and cross-sectional narrowing of the infarct-related arteries were greater than those of control arteries, there were no pathognomonic characteristics of plaques in the infarct-related vessels. The possibility that atherosclerosis is the main etiologic factor for myocardial infarction can not be excluded even for women without an angiographically obvious coronary stenosis in the infarct-related vessels.