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Diabetes Mellitus: HELP
Articles by Per Näsman
Based on 9 articles published since 2010
(Why 9 articles?)
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Between 2010 and 2020, P. Näsman wrote the following 9 articles about Diabetes Mellitus.
 
+ Citations + Abstracts
1 Article Undetected Dysglycemia Is an Important Risk Factor for Two Common Diseases, Myocardial Infarction and Periodontitis: A Report From the PAROKRANK Study. 2019

Norhammar, Anna / Kjellström, Barbro / Habib, Natalie / Gustafsson, Anders / Klinge, Björn / Nygren, Åke / Näsman, Per / Svenungsson, Elisabet / Rydén, Lars. ·Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden anna.norhammar@ki.se. · Capio St. Görans Hospital, Stockholm, Sweden. · Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden. · Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden. · Faculty of Odontology, Department of Periodontology, Malmö University, Malmö, Sweden. · Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden. · Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden. ·Diabetes Care · Pubmed #31182493.

ABSTRACT: OBJECTIVE: Information on the relationship among dysglycemia (prediabetes or diabetes), myocardial infarction (MI), and periodontitis (PD) is limited. This study tests the hypothesis that undetected dysglycemia is associated with both conditions. RESEARCH DESIGN AND METHODS: The PAROKRANK (Periodontitis and Its Relation to Coronary Artery Disease) study included 805 patients with a first MI and 805 matched control subjects. All participants without diabetes (91%) were examined with an oral glucose tolerance test. Abnormal glucose tolerance (AGT) (impaired glucose tolerance or diabetes) was categorized according to the World Health Organization. Periodontal status was categorized from dental X-rays as healthy (≥80% remaining alveolar bone height), moderate (79-66%), or severe (<66%) PD. Odds ratios (ORs) and 95% CIs were calculated by logistic regression and were adjusted for age, sex, smoking, education, marital status, and explored associated risks of dysglycemia to PD and MI, respectively. RESULTS: AGT was more common in patients than in control subjects (32% vs. 19%; CONCLUSIONS: In this large case-control study previously undetected dysglycemia was independently associated to both MI and severe PD. In principal, it doubled the risk of a first MI and of severe PD. This supports the hypothesis that dysglycemia drives two common diseases, MI and PD.

2 Article Dynamics of testosterone levels in patients with newly detected glucose abnormalities and acute myocardial infarction. 2018

Wang, Anne / Arver, Stefan / Flanagan, John / Gyberg, Viveca / Näsman, Per / Ritsinger, Viveca / Mellbin, Linda G. ·1 Division of Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. · 2 Department of Medicine, Center for Andrology and Sexual Medicine, Karolinska Institutet, Huddinge, Sweden. · 3 Department of Neurobiology, Centre for Family Medicine, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. · 4 Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden. · 5 Department of Research and Development, Region Kronoberg, Växjö, Sweden. · 6 Heart & Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. ·Diab Vasc Dis Res · Pubmed #30280926.

ABSTRACT: OBJECTIVE: Low testosterone has been associated with increased cardiovascular risk and glucose abnormalities. This study explored the prevalence of low testosterone, dynamics over time and prognostic implications in acute myocardial infarction patients with or without glucose abnormalities. METHODS: Male acute myocardial infarction patients (n = 123) and healthy controls (n = 124) were categorised as having normal or abnormal glucose tolerance (impaired glucose tolerance or diabetes) by oral glucose tolerance testing. Testosterone was measured at hospital admission, discharge, 3 and 12 months thereafter in patients. Patients and controls were followed for 11 years for major cardiovascular events (cardiovascular death/acute myocardial infarction/stroke/severe heart failure). RESULTS: At hospital admission, more patients had low testosterone (⩽300 ng/dl) and lower median levels than controls (64 vs 28%; p < 0.001 and 243 vs 380 ng/dl; p < 0.01). At the subsequent time points, testosterone had increased to 311, 345 and 357 ng/dl. Patients with abnormal glucose tolerance had the highest prevalence (75%) of low levels. In adjusted Cox regression models, neither total nor free testosterone predicted major cardiovascular events. CONCLUSION: Low testosterone levels were common in male acute myocardial infarction patients in the acute phase, especially in the presence of abnormal glucose tolerance, but increased over time indicating that testosterone measured in close proximity to acute myocardial infarction should be interpreted with caution.

3 Article Type 2 diabetes and heart failure: Characteristics and prognosis in preserved, mid-range and reduced ventricular function. 2018

Johansson, Isabelle / Dahlström, Ulf / Edner, Magnus / Näsman, Per / Rydén, Lars / Norhammar, Anna. ·1 Karolinska University Hospital Solna and Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden. · 2 Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden. · 3 Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden. · 4 Capio St. Göran's Hospital, Stockholm, Sweden. ·Diab Vasc Dis Res · Pubmed #30176743.

ABSTRACT: OBJECTIVE: To study the characteristics and prognostic implications of type 2 diabetes in different heart failure entities from a nationwide perspective. METHODS: This observational study comprised 30,696 heart failure patients prospectively included in the Swedish Heart Failure Registry (SwedeHF) 2003-2011 from specialist care, with mortality information available until December 2014. Patients were categorized into three heart failure entities by their left ventricular ejection fraction (heart failure with preserved ejection fraction: ⩾50%, heart failure with mid-range ejection fraction: 40%-49% and heart failure with reduced ejection fraction: <40%). All-cause mortality stratified by type 2 diabetes and heart failure entity was studied by Cox regression. RESULTS: Among the patients, 22% had heart failure with preserved ejection fraction, 21% had heart failure with mid-range ejection fraction and 57% had heart failure with reduced ejection fraction. The proportion of type 2 diabetes was similar, ≈25% in each heart failure entity. Patients with type 2 diabetes and heart failure with preserved ejection fraction were older, more often female and burdened with hypertension and renal impairment compared with heart failure with mid-range ejection fraction and heart failure with reduced ejection fraction patients among whom ischaemic heart disease was more common. Type 2 diabetes remained an independent mortality predictor across all heart failure entities after multivariable adjustment, somewhat stronger in heart failure with left ventricular ejection fraction below 50% (hazard ratio, 95% confidence interval; heart failure with preserved ejection fraction: 1.32 [1.22-1.43], heart failure with mid-range ejection fraction: 1.51 [1.39-1.65], heart failure with reduced ejection fraction: 1.46 [1.39-1.54]; p-value for interaction, p = 0.0049). CONCLUSION: Type 2 diabetes is an independent mortality predictor across all heart failure entities increasing mortality risk by 30%-50%. In type 2 diabetes, the heart failure with mid-range ejection fraction entity resembles heart failure with reduced ejection fraction in clinical characteristics, risk factor pattern and prognosis.

4 Article Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics. 2018

Eriksson, B / Wändell, P / Dahlström, U / Näsman, P / Lund, L H / Edner, M. ·a Division of Family Medicine, Department of Neurobiology , Care Sciences and Society (NVS), Karolinska Institutet , Huddinge , Sweden. · b Division of Family Medicine , NVS, Karolinska Institutet , Sweden. · c Department of Cardiology and Department of Medical and Health Sciences , Linköping University , Sweden Linköping. · d Centre for Safety Research , KTH Royal Institute of Technology , Stockholm , Sweden. · e Karolinska Institutet, Department of Medicine, Unit of Cardiology , Karolinska University Hospital , Stockholm , Sweden. · f Cardiology Unit, N3: 06, Department of Medicine , Karolinska Institute and University Hospital , Stockholm , Sweden. ·Scand J Prim Health Care · Pubmed #29633886.

ABSTRACT: OBJECTIVE: The aim of this study is to describe patients with heart failure and an ejection fraction (EF) of more than or equal to 40%, managed in both Primary- and Hospital based outpatient clinics separately with their prognosis, comorbidities and risk factors. Further to compare the heart failure medication in the two groups. DESIGN: We used the prospective Swedish Heart Failure Registry to include 9654 out-patients who had HF and EF ≥40%, 1802 patients were registered in primary care and 7852 in hospital care. Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately. SETTING: The prospective Swedish Heart Failure Registry. SUBJECTS: Patients with heart failure and an ejection fraction (EF) of more than or equal to 40%. MAIN OUTCOME MEASURES: Comorbidities, risk factors and mortality. RESULTS: Mean-age was 77.5 (primary care) and 70.3 years (hospital care) p < 0.0001, 46.7 vs. 36.3% women respectively (p < 0.0001) and EF ≥50% 26.1 vs. 13.4% (p < 0.0001). Co-morbidities were common in both groups (97.2% vs. 92.3%), the primary care group having more atrial fibrillation, hypertension, ischemic heart disease and COPD. According to the multivariate logistic regression analysis smoking, COPD and diabetes were the most important independent risk factors in the primary care group and valvular disease in the hospital care group. All-cause mortality during mean follow-up of almost 4 years was 31.5% in primary care and 27.8% in hospital care. One year-mortality rates were 7.8%, and 7.0% respectively. CONCLUSION: Any co-morbidity was noted in 97% of the HF-patients with an EF of more than or equal to 40% managed at primary care based out-patient clinics and these patients had partly other independent risk factors than those patients managed in hospital care based outpatients clinics. Our results indicate that more attention should be payed to manage COPD in the primary care group. KEY POINTS 97% of heart failure patients with an ejection fraction of more than or equal to 40% managed at primary care based out-patient clinics had any comorbidity. Patients in primary care had partly other independent risk factors than those in hospital care. All-cause mortality during mean follow-up of almost 4 years was higher in primary care compared to hospital care. In matched HF-patients RAS-antagonists, beta-blockers as well as the combination of the two drugs were more seldom prescribed when managed in primary care compared with hospital care.

5 Article Severe Periodontitis Is Associated with Myocardial Infarction in Females. 2018

Nordendahl, E / Gustafsson, A / Norhammar, A / Näsman, P / Rydén, L / Kjellström, B / Anonymous10630941. ·1 Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden. · 2 Department of Medicine, Karolinska Institutet, Stockholm, Sweden. · 3 Capio S:t Görans Hospital, Stockholm, Sweden. · 4 Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden. ·J Dent Res · Pubmed #29596754.

ABSTRACT: The aim of the present study was to test the hypothesis that there is a sex difference in the association between periodontitis (PD) and a first myocardial infarction (MI). The analysis in the case-control study was based on 785 patients (147 females and 638 males) with a first MI and 792 matched controls (147 females and 645 males), screened for cardiovascular risk factors and subjected to a panoramic dental X-ray. Periodontal status was defined by alveolar bone loss and diagnosed as no PD (≥80% remaining alveolar bone), mild to moderate PD (66% to 79%), or severe PD (<66%). Logistic regression was used when analyzing PD as a risk factor for MI, adjusting for age, smoking, diabetes, education, and marital status. The mean age was 64 ± 7 y for females and 62 ± 8 y for males. Severe PD was more common in female patients than female controls (14 vs. 4%, P = 0.005), with an increased risk for severe PD among female patients with a first MI (odds ratio [OR] = 3.92, 95% confidence interval [CI] =1.53 to 10.00, P = 0.005), which remained (OR = 3.72, 95% CI = 1.24 to 11.16, P = 0.005) after adjustments. Male patients had more severe PD (7% vs. 4%; P = 0.005) than male controls and an increased risk for severe PD (OR = 1.88, 95% CI = 1.14 to 3.11, P = 0.005), but this association did not remain following adjustment (OR = 1.67, 95% CI = 0.97 to 2.84, NS). Severe PD was associated with MI in both females and males. After adjustments for relevant confounders, this association did, however, remain only in females. These data underline the importance of considering poor dental health when evaluating cardiovascular risk, especially in females.

6 Article Copeptin in patients with acute myocardial infarction and newly detected glucose abnormalities - A marker of increased stress susceptibility? A report from the Glucose in Acute Myocardial Infarction cohort. 2017

Smaradottir, Maria Isabel / Ritsinger, Viveca / Gyberg, Viveca / Norhammar, Anna / Näsman, Per / Mellbin, Linda G. ·1 Cardiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. · 2 Department of Research and Development, Region Kronoberg, Växjö, Sweden. · 3 Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden. · 4 Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden. ·Diab Vasc Dis Res · Pubmed #28118730.

ABSTRACT: OBJECTIVE: To characterize copeptin levels and to explore its prognostic importance in patients with acute myocardial infarction with newly detected glucose abnormalities. METHODS: Copeptin was measured in 166 patients with acute myocardial infarction without known diabetes and in 168 age- and gender-matched controls. Participants were classified as having normal glucose tolerance or abnormal glucose tolerance (impaired glucose tolerance + type 2 diabetes mellitus) by oral glucose tolerance test. Study participants were followed over a decade for major cardiovascular event (acute myocardial infarction/stroke/congestive heart failure/cardiovascular death), cardiovascular and total death. RESULTS: Median copeptin level was higher in patients (10.5 pmol/L) than controls (5.9 pmol/L; p < 0.01). Patients with abnormal glucose tolerance had higher copeptin (12.2 pmol/L) than those with normal glucose tolerance (7.9 pmol/L; p < 0.01) but levels of copeptin did not differ in controls with abnormal glucose tolerance or normal glucose tolerance. Copeptin predicted major cardiovascular events [ n = 64; hazard ratio = 1.15 (1.01-1.32; p = 0.04)], cardiovascular mortality [ n = 29; hazard ratio = 1.24 (1.06-1.46; p = 0.01)] and total death [ n = 51; hazard ratio = 1.21 (1.05-1.40; p = 0.01)] in unadjusted Cox regression analyses in the patient cohort. In controls, copeptin predicted major cardiovascular events [ n = 26; hazard ratio = 1.17 (1.01-1.36; p = 0.03)]. CONCLUSION: Copeptin levels are highest among acute myocardial infarction patients with glucose disturbances and predict an adverse prognosis in unadjusted analyses. These findings imply that raised copeptin reflects stress rather than acting as a pathogenic factor for glucose abnormalities.

7 Article Prognostic Implications of Type 2 Diabetes Mellitus in Ischemic and Nonischemic Heart Failure. 2016

Johansson, Isabelle / Dahlström, Ulf / Edner, Magnus / Näsman, Per / Rydén, Lars / Norhammar, Anna. ·Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden. Electronic address: isabelle.johansson@ki.se. · Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. · Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden. · Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden. ·J Am Coll Cardiol · Pubmed #27659462.

ABSTRACT: BACKGROUND: Heart failure (HF) is a common and serious complication in type 2 diabetes mellitus (T2DM). The prognosis of ischemic HF and impact of revascularization in such patients have not been investigated fully in a patient population representing everyday practice. OBJECTIVES: This study examined the impact of ischemic versus nonischemic HF and previous revascularization on long-term prognosis in an unselected population of patients with and without T2DM. METHODS: Patients stratified by diabetes status and ischemic or nonischemic HF and history of revascularization in the Swedish Heart Failure Registry (SwedeHF) from 2003 to 2011 were followed up for mortality predictors and longevity. A propensity score analysis was applied to evaluate the impact of previous revascularization. RESULTS: Among 35,163 HF patients, those with T2DM were younger, and 90% had 1 or more associated comorbidities. Ischemic heart disease (IHD) occurred in 62% of patients with T2DM and 47% of those without T2DM, of whom 53% and 48%, respectively, had previously undergone revascularization. T2DM predicted mortality regardless of the presence of IHD, with adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.40 (1.33 to 1.46) and 1.30 (1.22 to 1.39) in those with and without IHD, respectively. Patients with both T2DM and IHD had the highest mortality, which was further accentuated by the absence of previous revascularization (adjusted HR: 0.82 in favor of such treatment; 95% CI: 0.75 to 0.91). Propensity score adjustment did not change these results (HR: 0.87; 95% CI: 0.78 to 0.96). Revascularization did not abolish the impact of T2DM, which predicted mortality in those with (HR: 1.36; 95% CI: 1.24 to 1.48) and without (HR: 1.45; 95% CI: 1.33 to 1.56) a history of revascularization. CONCLUSIONS: Ninety percent of HF patients with T2DM have preventable comorbidities. IHD in patients with T2DM had an especially negative influence on mortality, an impact that was beneficially influenced by previous revascularization.

8 Article Risk factors, treatment and prognosis in men and women with heart failure with and without diabetes. 2015

Johansson, Isabelle / Dahlström, Ulf / Edner, Magnus / Näsman, Per / Rydén, Lars / Norhammar, Anna. ·Cardiology Unit, Department of Medicine Solna, Karolinska Institute, Stockholm. · Department of Cardiology and Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden. · Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden. ·Heart · Pubmed #26034118.

ABSTRACT: OBJECTIVE: To test the hypothesis that risk factor pattern, treatment and prognosis differ between men and women with heart failure (HF) with and without diabetes in the Swedish Heart Failure Registry. METHODS: Patients with (n=8809) and without (n=27 465) type 2 diabetes (T2DM) included in the Swedish Heart Failure Registry (2003-2011) were followed for mortality during a median follow-up of 1.9 years (range 0-8.7 years). All-cause mortality, differences in background and HF characteristics were analysed in women and men with and without T2DM and with a special regard to different age groups. RESULTS: Of 36 274 patients, 24% had T2DM and 39% were women. In patients with T2DM, women were older than men (78 years vs 73 years), more frequently had hypertension, renal dysfunction and preserved ventricular function. Regardless of T2DM status, women with reduced ventricular function, compared with their male counterparts, were less frequently offered, for example, ACE inhibitors/angiotensin receptor II blockers (ARB). Absolute mortality was 48% in women with T2DM, 40% in women without; corresponding male mortality rates were 43% and 35%, respectively. Kaplan-Meier curves revealed shorter longevity in women with T2DM but female sex did not remain a significant mortality predictor following adjustment (OR 95% CI 0.90; 0.79 to 1.03). In those without T2DM, women compared with men lived longer; this pattern remained after adjustment (OR 0.72; 0.66 to 0.78). T2DM was a stronger predictor of mortality in women (OR 1.72; 1.53 to 1.94) than in men (OR 1.47; 1.34 to 1.61). CONCLUSIONS: T2DM is a strong mortality predictor in men and women with HF, somewhat stronger in women. The shorter survival time in women with T2DM and HF related to comorbidities rather than sex per se. Evidence-based management was less prevalent in women. Mechanisms behind these findings remain incompletely understood and need further attention.

9 Article Sustained prognostic implications of newly detected glucose abnormalities in patients with acute myocardial infarction: long-term follow-up of the Glucose Tolerance in Patients with Acute Myocardial Infarction cohort. 2015

Ritsinger, Viveca / Tanoglidi, Eleni / Malmberg, Klas / Näsman, Per / Rydén, Lars / Tenerz, Åke / Norhammar, Anna. ·Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden Unit for Research and Development Kronoberg County Council, Växjö, Sweden viveca.ritsinger@ki.se. · Department of Medicine and Centre for Clinical Research, Central Hospital Västerås, Västerås, Sweden. · Cardiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. · Centre for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden. ·Diab Vasc Dis Res · Pubmed #25311248.

ABSTRACT: OBJECTIVE: To investigate long-term prognostic importance of newly discovered glucose disturbances in patients with acute myocardial infarction (AMI). METHODS: During 1998-2001, consecutive patients with AMI (n = 167) and healthy controls (n = 184) with no previously known diabetes were investigated with an oral glucose tolerance test (OGTT). Patients and controls were separately followed up for cardiovascular events (first of cardiovascular mortality/AMI/stroke/heart failure) during a decade. RESULTS: In all, 68% of the patients and 35% of the controls had newly detected abnormal glucose tolerance (AGT). Cardiovascular event (n = 72, p = 0.0019) and cardiovascular mortality (n = 31, p = 0.031) were more frequent in patients with newly detected AGT. Regarding patients, a Cox proportional-hazard regression analysis identified AGT (hazard ratio (HR): 2.30; 95% confidence interval (CI): 1.24-4.25; p = 0.008) and previous AMI (HR: 2.39; CI: 1.31-4.35; p = 0.004) as prognostically important. CONCLUSION: An OGTT at discharge after AMI disclosed a high proportion of patients with previously unknown AGT which had a significant and independent association with long-term prognosis.