Lars Rydén - Academia.edu (original) (raw)

Papers by Lars Rydén

European Heart Journal Supplements, Nov 1, 2002

European Journal of Cardiovascular Nursing, Oct 1, 2002

The global prevalence of diabetes mellitus has continuously and rapidly increased, and the number... more The global prevalence of diabetes mellitus has continuously and rapidly increased, and the number of diabetic people in the adult population is predicted to double within 30 years. The prevalence of and mortality from all forms of cardiovascular diseases is two-to eight-fold higher in diabetic individuals as compared with their non-diabetic counterparts. The excess of risk attributable to diabetes related heart disease accounts for 2.9% of the all cause annual mortality. Moreover, the cardiovascular risk increases continuously throughout a wide spectrum of glycaemia starting already at what, according to present definitions, is considered as normal blood glucose levels. Therefore, screening for diabetes and hyperglycaemia is recommended in various clinical settings. Criteria for classification of hyperglycaemic states are provided together with their relation to risk for cardiovascular events. The evidence-based treatment of cardiovascular disease in patients with concomitant diabetes is summarised. Degree of under-treatment of patients with diabetes and cardiovascular diseases is discussed. Finally, the potential impact that nurses may have on the quality and efficacy of care in the vulnerable patient with combined chronic diseases such as diabetes and cardiovascular disease and the improvement of the outcomes are discussed.

Diabetes and Vascular Disease Research, May 1, 2014

The content of these European Society of Cardiology (ESC) Guidelines has been published for perso... more The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC. Disclaimer: The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific 525548D VR0010.

Heart, Dec 12, 2006

The aim of the study was to compare time-trends in mortality rates and treatment patterns between... more The aim of the study was to compare time-trends in mortality rates and treatment patterns between patients with and without diabetes based on the Swedish register of coronary care (Register of Information and Knowledge about Swedish Heart Intensive Care Admission [RIKS-HIA]). Methods: Post myocardial infarction mortality rate is high in diabetic patients, who seem to receive less evidence-based treatment. Mortality rates and treatment in 1995-1998 and 1999-2002 were studied in 70 882 patients (age ,80 years), 14 873 of whom had diabetes (the first registry recorded acute myocardial infarction), following adjustments for differences in clinical and other parameters. Results: One-year mortality rates decreased from 1995 to 2002 from 16.6% to 12.1% in patients without diabetes and from 29.7% to 19.7%, respectively, in those with diabetes. Patients with diabetes had an adjusted relative 1-year mortality risk of 1.44 (95% CI 1.36 to 1.52) in 1995-1998 and 1.31 (95% CI 1.24 to 1.38) in 1999-2002. Despite improved pre-admission and in-hospital treatment, diabetic patients were less often offered acute reperfusion therapy (adjusted OR 0.85, 95% CI 0.80 to 0.90), acute revascularisation (adjusted OR 0.78, 95% CI 0.69 to 0.87) or revascularisation within 14 days (OR 0.80, 95% CI 0.75 to 0.85), aspirin (OR 0.90, 95% CI 0.84 to 0.98) and lipid-lowering treatment at discharge (OR 0.81, 95% CI 0.77 to 0.86). Conclusion: Despite a clear improvement in the treatment and myocardial infarction survival rate in patients with diabetes, mortality rate remains higher than in patients without diabetes. Part of the excess mortality may be explained by co-morbidities and diabetes itself, but a lack of application of evidence-based treatment also contributes, underlining the importance of the improved management of diabetic patients.

Kardiologia Polska, Nov 20, 2013

Za treść reklam redakcja nie ponosi odpowiedzialności. Wszelkie prawa zastrzeżone, włącznie z tłu... more Za treść reklam redakcja nie ponosi odpowiedzialności. Wszelkie prawa zastrzeżone, włącznie z tłumaczeniem na języki obce. Żaden fragment tego czasopisma zarówno tekstu, jak i grafiki nie może być wykorzystywany w jakiejkolwiek formie. W szczególności zabronione jest dokonywanie reprodukcji oraz przekładanie na język mechaniczny lub elektroniczny, a także utrwalanie w jakiejkolwiek postaci, przechowywanie w jakimkolwiek układzie pamięci oraz transmitowanie w formie elektronicznej, mechanicznej czy za pomocą fotokopii, mikrofilmu, nagrań, skanów bądź w jakikolwiek inny sposób, bez wcześniejszej pisemnej zgody wydawcy. Prawa wydawcy podlegają ochronie przez krajowe prawo autorskie oraz konwencje międzynarodowe, a ich naruszenie jest ścigane na drodze karnej.

Diabetes & vascular disease research, 2016

To investigate whether sitagliptin affects copeptin and osmolality, suggesting arginine vasopress... more To investigate whether sitagliptin affects copeptin and osmolality, suggesting arginine vasopressin activation and a potential for fluid retention, compared with placebo, in patients with a recent acute coronary syndrome and newly discovered type 2 diabetes or impaired glucose tolerance. A second aim was to confirm whether copeptin correlated with insulin-like growth factor binding protein-1. Fasting blood samples were used from the BEta-cell function in Glucose abnormalities and Acute Myocardial Infarction trial, in which patients recently hospitalized due to acute coronary syndrome and with newly detected abnormal glucose tolerance were randomized to sitagliptin 100 mg once daily (n = 34) or placebo (n = 37). Copeptin, osmolality and insulin-like growth factor binding protein-1 were analysed at baseline and after 12 weeks. Copeptin and osmolality were unaffected by sitagliptin. There was no correlation between copeptin and insulin-like growth factor binding protein-1. Sitagliptin ...

Diabetes Management, 2011

Heart, 2006

European Journal of Cardiovascular Prevention & Rehabilitation, 2008

Despite considerable improvements in the management of cardiovascular diseases, patients with dia... more Despite considerable improvements in the management of cardiovascular diseases, patients with diabetes mellitus have not benefited to the same extent as those without. Possible explanations are advanced atherosclerosis, inferior efficacy or insufficient use of evidence-based treatment, or inadequate glycemic control in these patients. The Euro Heart Survey on Diabetes and the Heart (EHS) was a multicentre prospective observational study involving 110 centres in 25 European countries. The aims of the survey were to describe the prevalence of abnormal glucose regulation to assess clinical practice in relation to existing guidelines and to compare the impact of evidence-based medication and procedures on mortality and morbidity in patients with coronary artery disease (CAD). Patient enrolment was performed between February 2003 and January 2004. Consecutive patients with established CAD were recruited when admitted to hospital cardiology wards or visiting outpatient clinics. All patients were assessed, investigated and treated at the discretion of their physician according to the institution's practice. The present review describes the main findings of the EHS and puts them into perspective.

European Heart Journal, 2007

Glucose lowering (GL) therapy in patients with diabetes mellitus (DM) and coronary artery disease... more Glucose lowering (GL) therapy in patients with diabetes mellitus (DM) and coronary artery disease (CAD) is prognostically important. This report from the Euro Heart Survey on Diabetes and the Heart describes present practice in relation to 1 year prognosis. The survey enrolled 4676 patients with CAD from 110 centres out of whom 1425 had known and 452 newly detected DM. The impact of different GL modalities on cardiovascular events (CVE: death, myocardial infarction, or stroke) was followed. Insulin treated patients with known DM (n ¼ 378) had an adjusted 1 year hazard ratio (HR) for mortality of 2.23 (95% CI 1.24-4.03; P ¼ 0.006) and for CVE of 1.27 (95% CI 0.85-1.87; P ¼ 0.230) compared with those on oral GL drugs (n ¼ 675). Of patients with newly detected DM 77 (17%) were started on GL drugs. None of them died compared with 25 (P ¼ 0.002) among those without such treatment and their 1 year CVE HR was 0.22 (95% CI 0.05-0.97; P ¼ 0.041) compared with untreated subjects. Insulin therapy may relate to a more serious prognosis in CAD-patients with DM. There was a pronounced decrease in cardiovascular events in patients with newly detected DM prescribed GL drugs compared with those not receiving such treatment.

European Heart Journal, 2004

Aim The objective behind the Euro Heart Survey on diabetes and the heart was to study the prevale... more Aim The objective behind the Euro Heart Survey on diabetes and the heart was to study the prevalence of abnormal glucose regulation in adult patients with coronary artery disease (CAD). The survey engaged 110 centres in 25 countries recruiting 4196 patients referred to a cardiologist due to CAD out of whom 2107 were admitted on an acute basis and 2854 had an elective consultation. Patient data were collected via a web-based case record form. An oral glucose tolerance test (OGTT) was used for the characterisation of the glucose metabolism. Thirty-one per cent of the patients had diabetes. An OGTT was performed on the 1920 patients without known diabetes, of whom 923 had acute and 997 had a stable manifestation of CAD, respectively. In patients with acute CAD, 36% had impaired glucose regulation and 22% newly detected diabetes. In the stable group these proportions were 37% and 14%. Conclusion This survey demonstrates that normal glucose regulation is less common than abnormal glucose regulation in patients with CAD. OGTT easily discloses the glucometabolic state and should be a routine procedure. The knowledge of glucometabolic state among these patients should influence their future management because it has great potential to improve the outcome.

European Heart Journal, 2012

Hyperglycaemia during hospitalization for acute myocardial infarction (AMI) is a risk predictor, ... more Hyperglycaemia during hospitalization for acute myocardial infarction (AMI) is a risk predictor, but attempts to improve the prognosis by insulin-based glucose control have not been consistently successful. Increased glycaemic variability, a potential effect of insulin treatment, has been linked to a worse prognosis in critically ill patients. The present aim was to study the possibility of such a relation in patients with type 2 diabetes (T2DM) and AMI. We studied 578 T2DM patients who had glucose levels measured hourly while receiving an insulin-glucose infusion during the first 48 h of hospitalization for AMI. Three measures of glycaemic variability: root mean square error (RMSE), range, and slope were studied in relation to a composite endpoint of mortality, stroke, and reinfarction and to mortality. In unadjusted analyses, the mean level of glycaemic variability did not differ between patients who died during 12 months of follow-up compared with those who survived. In a Cox regression model adjusting for age and previous congestive heart failure, there was no increased risk for the composite endpoint associated with increased glycaemic variability; RMSE: hazard ratio (HR) 1.09 [95% confidence interval (CI) 0.

European Heart Journal, 1996

Diabetic patients with acute myocardial infarction have a poor prognosis, which has been attribut... more Diabetic patients with acute myocardial infarction have a poor prognosis, which has been attributed to a higher incidence of congestive heart failure and fatal reinfarction. This study reports on the one-year morbidity and mortality in a randomized study with the aim of testing whether insulin-glucose infusion initiated as soon as possible after onset of myocardial infarction and followed by long-term subcutaneous insulin treatment may have a beneficial effect on outcome in diabetic patients. In all, 306 patients were recruited to the insulin-treated group, while 314 patients served as controls. The overall mortality after one year was 19% in the insulin group compared to 26% among controls {P<005). The treatment effect was most pronounced in patients without prior insulin medication and at low cardiovascular risk. In this stratum the in-hospital mortality was reduced by 58% (/><005) and the one-year mortality by 52% (P<002). The most frequent cause of death in all patients was congestive heart failure (66%), but cardiovascular mortality (congestive heart failure, fatal reinfarction, sudden death and stroke) tended to be decreased in insulin-treated patients. However, this difference did not reach the level of statistical significance. The number of reinfarctions was 53 (28% fatal) in the insulin group compared to 55 (45% fatal) in the control group. The two groups did not differ as regards need for hospital care or coronary revascularization during the year of follow-up. In summary, left ventricular failure and fatal reinfarctions contribute to increased mortality in diabetic patients following acute myocardial infarction. Intensive insulin treatment lowered this mortality during one year of follow-up.

European Heart Journal, 2005

Aims Patients with diabetes have an unfavourable prognosis after an acute myocardial infarction. ... more Aims Patients with diabetes have an unfavourable prognosis after an acute myocardial infarction. In the first DIGAMI study, an insulin-based glucose management improved survival. In DIGAMI 2, three treatment strategies were compared: group 1, acute insulin-glucose infusion followed by insulin-based long-term glucose control; group 2, insulin-glucose infusion followed by standard glucose control; and group 3, routine metabolic management according to local practice. Methods and results DIGAMI 2 recruited 1253 patients (mean age 68 years; 67% males) with type 2 diabetes and suspected acute myocardial infarction randomly assigned to groups 1 (n ¼ 474), 2 (n ¼ 473), and 3 (n ¼ 306). The primary endpoint was all-cause mortality between groups 1 and 2, and a difference was hypothesized as the primary objective. The secondary objective was to compare total mortality between groups 2 and 3, whereas morbidity differences served as tertiary objectives. The median study duration was 2.1 (interquartile range 1.03-3.00) years. At randomization, HbA1c was 7.2, 7.3, and 7.3% in groups 1, 2, and 3, respectively, whereas blood glucose was 12.8, 12.5, and 12.9 mmol/L, respectively. Blood

Diabetologia, 2011

Aims/hypothesis This post hoc analysis from the Diabetes Mellitus Insulin-Glucose Infusion in Acu... more Aims/hypothesis This post hoc analysis from the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) 2 trial reports on extended long-term outcome in relation to glucose-lowering agents in patients with myocardial infarction and type 2 diabetes. Methods Patients were randomised as follows: group 1, insulin-based treatment; group 2, insulin during hospitalisation followed by conventional glucose control; and group 3, conventional treatment. Treatment according to the above protocol lasted 2.1 years. Using the total DIGAMI 2 cohort as an epidemiological database, this study presents mortality rates in the randomised groups, and mortality and morbidity rates by glucose-lowering treatment during an extended period of follow-up (median 4.1 and max 8.1 years). Results Follow-up data were available in 1,145 of the 1,253 patients. The mortality rate was 31% (72% cardiovascular) without significant differences between treatment groups. The total number of fatal malignancies was 37, with a trend towards a higher risk in group 1. The HR for death from malignant disease, compared with group 2, was 1.77 (95% CI 0.87-3.61; p=0.11) and 3.60 (95% CI 1.24-10.50; p=0.02) compared with group 3. Insulin treatment was associated with non-fatal cardiovascular events (OR 1.89 95% CI 1.35-2.63; p=0.0002), but not with mortality (OR 1.30, 95% CI 0.93-1.81; p=0.13). Metformin was associated with a lower mortality rate (HR 0.65, 95% CI 0.47-0.90; p=0.01) and a lower risk of death from malignancies (HR 0.25, 95% CI 0.08-0.83; p=0.02). Conclusions/interpretation Patients with type 2 diabetes and myocardial infarction have a poor prognosis. Glucoselowering drugs appear to be of prognostic importance. Insulin may be associated with an increased risk of nonfatal cardiac events, while metformin seems to be protective against risk of death.

Diabetes Care, 1994

OBJECTIVE To investigate the effect of insulin-glucose infusion on metabolic control and hypoglyc... more OBJECTIVE To investigate the effect of insulin-glucose infusion on metabolic control and hypoglycemie episodes and its feasibility and safety in patients with diabetes and myocardial infarction (MI) compared with conventional treatment. RESEARCH DESIGN AND METHODS Of 327 patients with suspected acute MI, 158 were randomized to insulin-glucose infusion for at least 24 h and 169 received conventional therapy. We determined the 24-h blood glucose profile in the infusion group, the degree of metabolic control, hypoglycemie events, and in-hospital complications within the two study groups. RESULTS Blood glucose fell from 14.6 ± 2.9 to 9.2 ± 2.9 mM during the first 24 h in patients receiving insulin-glucose and from 15.8 ± 4.3 to 12.0 ± 4.4 mM in control patients (P < 0.01). Serum potassium decreased 0.21 ± 0.56 mM in the infusion group (P < 0.001) and 0.11 ± 0.59 mM in the control group (P < 0.05). The difference between the groups was not significant. Twenty-eight of the 158 pa...

Diabetes Care, 1999

OBJECTIVE: To investigate whether a relationship exists between admission plasma glucose level an... more OBJECTIVE: To investigate whether a relationship exists between admission plasma glucose level and long-term outcome in nondiabetic patients after an acute myocardial infarction. RESEARCH DESIGN AND METHODS: This was a retrospective study with prospective follow-up of 197 consecutive nondiabetic patients with acute myocardial infarction followed for 1.5-2.5 years at the Department of Cardiology at Karolinska Hospital. RESULTS: The mean admission plasma glucose level was 8.15 +/- 3.0 mmol/l. During follow-up, 60 (30%) patients died, 20 (10%) were rehospitalized for heart failure, 12 (6%) were rehospitalized for nonfatal reinfarction, and 79 (40%) had at least one of these events. In univariate analysis, admission plasma glucose level was significantly higher in patients who had any of the predefined events than in those without these events. In a multivariate Cox proportional hazard regression model that allowed for confounding baseline predictors, admission plasma glucose level was ...

Diabetes Care, 2010

OBJECTIVE To determine whether C-terminal provasopressin (copeptin) explains the prognostic impor... more OBJECTIVE To determine whether C-terminal provasopressin (copeptin) explains the prognostic importance of insulin growth factor binding protein-1 (IGFBP-1) in patients with myocardial infarction and type 2 diabetes. RESEARCH DESIGN AND METHODS Copeptin and IGFBP-1 were analyzed in 393 patients participating in the Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) 2 trial. RESULTS Copeptin was associated with IGFBP-1 (Spearman rank correlation test, r = 0.53; P < 0.001). During follow-up there were 138 cardiovascular events (cardiovascular death, myocardial infarction, and stroke). In univariate Cox proportional hazard regression analyses both biomarkers were predictors of events: the hazard ratio for log copeptin was 1.59 (95% CI 1.41–1.81; P < 0.001) and for log IGFBP-1 was 1.49 (1.26–1.77; P < 0.001). In the final model, adjusting for age and renal function, copeptin was the only independent predictor (1.35 [1.16–1.57]; P < 0.001). CONC...

Diabetes and Vascular Disease Research, 2009

Objective: We investigated the impact of glucose control on target lesion restenosis after PCI in... more Objective: We investigated the impact of glucose control on target lesion restenosis after PCI in patients with type 2 diabetes. Methods: Ninety-three consecutive patients with type 2 diabetes accepted for PCI were randomised to intensified glucose control based on insulin (I-group; n=44) or to continue ongoing glucose-lowering treatment (C-group; n=49).The treatment target was a FBG of 5—7 mmol/L and HbA1c <6.5%. Information on target lesion restenosis after six months was available in 82 patients. Results: At baseline HbA1c and FBG did not differ between the I- and C-groups, respectively (HbA1c: 6.5 vs. 6.5%; p=1.0 and FBG: 7.0 vs. 7.3 mmol/L; p=0.3). After six months there was no significant change in HbA1c or FBG in either group (change in HbA1c: -0.2 vs.-0.1%; p=0.3 and in FBG: +0.2 vs. -0.3 mmol/L; p=0.3 in the I- and C-groups, respectively). Target lesion restenosis at six months did not differ, I vs. C = 41 and 44% (p=0.8). Independent predictors for restenosis were previ...

Diabetes & vascular disease research : official journal of the International Society of Diabetes and Vascular Disease, 2005

Acute coronary syndromes are associated with a high risk for subsequent major cardiovascular even... more Acute coronary syndromes are associated with a high risk for subsequent major cardiovascular events and with a risk for mortality that remains substantially increased for many months following the acute phase. Patients with type 2 diabetes mellitus are especially vulnerable and encounter excessive long-term mortality. Effective management of patients with type 2 diabetes following acute coronary syndromes requires aggressive multidisciplinary efforts for reduction of several risk factors, including meticulous control of blood glucose. The evidence for different medication and treatment strategies capable of improving the outcomes is reviewed and the currently available recommendations are summarised.