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Determinants and risk factors for early risk stratification and optimal secondary pevention in ischemic heart disease

Abstract
Background: Ischemic heart disease is the leading cause of death globally. To combat ischemic heart disease and its challenges we must improve secondary prevention for those already affected and prevent its onset in a general population. Aim: To study risk factors for the incidence of ischemic heart disease and identify determinants of suboptimal secondary prevention. Methods: In Paper I, a prospective cohort of patients with a first myocardial infarction underwent a structured interview and examinations two years after their myocardial infarction. Papers II and III analyzed data from two cohorts of men from the general Swedish population, the “Study of Men Born In 1913” and the “Study of Men Born In 1943”, who had been followed longitudinally from 50 to 70 years of age. In Paper IV, patients with a first myocardial infarction in the Swedish National Inpatient Register were linked to the Prescribed Drug Register to examine the relationship between secondary preventive, pharmacological treatment, and mortality and/or recurrent myocardial infarction. Results: Secondary prevention two years after a myocardial infarction was suboptimal and multifactorial. The use of pharmacological treatment as secondary prevention decreased in the first years after an acute myocardial infarction and remained low during the follow-up of up to 16 years. The incidence of myocardial infarction has decreased over time among men in Sweden, and in parallel, the risk profile has changed. The addition of the biomarker hs‐TNT to risk factors, was able to enhance prediction of ischemic heart disease at an earlier stage in the general population. Conclusions: Secondary prevention including pharmacological treatment is vital to improve the prognosis in patients with ischemic heart disease, but it remains suboptimal. Despite the reduced incidence of myocardial infarction, it is still challenging to modify risk factors before the onset of an ischemic event. For a better risk stratification, early prediction and detection of ischemic heart disease is crucial.
Parts of work
I. Maria Sakalaki, Salim Barywani, Annika Rosengren, Lena Björck, Michael Fu. Determinants of suboptimal long-term secondary prevention of acute myocardial infarction: the structural interview method and physical examinations. BMC Cardiovasc Disord. 2019 Nov 6;19(1):243. http://doi.org/10.1186/s12872-019-1238-5
 
II. Maria Sakalaki, Per-Olof Hansson, Annika Rosengren, Erik Thunström, Aldina Pivodic, Michael Fu. Multi-modality biomarkers in the early prediction of ischaemic heart disease in middle-aged men during a 21-year follow-up. BMC Cardiovasc Disord. 2021 Feb 2;21(1):65. http://doi.org/10.1186/s12872-021-01886-x
 
III. Maria Sakalaki, Aldina Pivodic, Kurt Svärdsudd, Per-Olof Hansson, Michael Fu. Cumulative incidence and risk factors of myocardial infarction during 20 years of follow-up: comparing two cohorts of middle-aged men born 30 years apart. Clin Res Cardiol. 2023 Sep 27. http://doi.org/10.1007/s00392-023-02308-y
 
IV. Maria Sakalaki, Michael Fu, Aldina Pivodic, Annika Rosengren, Lena Björck. Secondary prevention pharmacological treatment after a first myocardial infarction in Sweden - long-term adherence and association with prognosis. Manuscript.
 
Degree
Doctor of Philosophy (Medicine)
University
University of Gothenburg. Sahlgrenska Academy
Institution
Institute of Medicine. Department of Molecular and Clinical Medicine
Disputation
Fredagen den 25 oktober 2024, kl 9.00, Hjärtats aula, Sahlgrenska Universitetssjukhuset, Göteborg
Date of defence
2024-10-25
E-mail
maria.sakalaki@vgregion.se
URI
https://hdl.handle.net/2077/81813
Collections
  • Doctoral Theses / Doktorsavhandlingar Institutionen för medicin
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Abstract (221.4Kb)
Thesis frame (1.418Mb)
Cover (2.668Mb)
Date
2024-09-26
Author
Sakalaki, Maria
Keywords
ischemic heart disease
myocardial infarction
secondary prevention
prediction
Publication type
Doctoral thesis
ISBN
978-91-8069-791-0 (PRINT)
978-91-8069-792-7 (PDF)
Language
eng
Metadata
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