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1.  Exposure to Mebendazole and Pyrvinium during Pregnancy: A Danish Nationwide Cohort Study 
Purpose. Families with children are frequently exposed to pinworm infection and treatment involves the whole family. Information on consequences of exposure during, pregnancy is limited. The aim of this study was to investigate the exposure to pyrvinium and mebendazole before, during, and after pregnancy in a Danish nationwide cohort. Methods. From nationwide administrative registers, we identified 718, 900 births in Denmark between January 1997 and December 2007 as well as maternal prescription data of anthelmintics and maternal characteristics. Redemption of a prescription for pyrvinium or mebendazole was used to identify exposure. Results. 4715 women redeemed a prescription for pyrvinium or mebendazole during pregnancy; 1606 for pyrvinium, 2575 for mebendazole, and 534 for both drugs. Having >2 children compared to having no previous children was associated with exposure to pyrvinium (OR: 7.1, 95% CI: 5.8–8.7) and mebendazole (OR: 20.8, 95% CI: 17.3–24.9). Conclusion. 4715 pregnant women redeemed a prescription for either mebendazole or pyrvinium. We believe the exposure to be even higher since pyrvinium is also sold over-the-counter. Limited information on birth outcomes is available at present time, and considering the number of exposed pregnancies, we recommend that studies are to be undertaken to assess the safety of pyrvinium and mebendazole during pregnancy.
PMCID: PMC3458300  PMID: 23028209
2.  Temporal decline in the prognostic impact of a recurrent acute myocardial infarction 1985 to 2002 
Heart  2006;93(2):210-215.
To investigate trends in case‐fatality and prognostic impact from recurrent acute myocardial infarction (re‐AMI) during 1985–2002.
Retrospective cohort study using nationwide administrative data from Denmark.
National registries on hospital admissions and causes of death were linked to identify patients with first AMI, re‐AMI and subsequent prognosis.
Patients ⩾30 years old with a discharge diagnosis of AMI during 1985–2002 were tracked for first hospital admission for re‐AMI 1 year after discharge.
Main outcome measures
One‐year case‐fatality.
166 472 patients were identified with a first AMI; 14 123 developed re‐AMI. One‐year crude case‐fatality from first AMI/re‐AMI was 39% versus 43% in 1985–1989 and 25% versus 29% in 2000–2002, respectively. In 1985–89, 35 795 patients survived to discharge (71%); of these 2.5% experienced reinfarction within 30 days (early reinfarction) and an additional 9.0% reinfarction within days 31–365 (late re‐AMI). Re‐AMI carried a poor prognosis in 1985–1989 compared to no re‐AMI with age‐ and sex‐adjusted relative risk of 1‐year case‐fatality of 7.5 (95% CI: 6.9 to 8.5) from early re‐AMI and 11.7 (95% CI: 11.0 to 12.4) from late re‐AMI. In 2000–2002, 23 552 patients (86%) survived to discharge; 4.4% had early re‐AMI and 6.6% late re‐AMI. Adjusted relative risk of 1‐year case‐fatality had declined to 2.1 (95% CI: 1.9 to 2.5) from early re‐AMI and 5.6 (95% CI: 5.1 to 6.2) from late re‐AMI compared to patients without reinfarction.
Prognosis after AMI has improved substantially during the latest two decades and extends to patients with re‐AMI.
PMCID: PMC1861398  PMID: 16940389
acute myocardial infarction; mortality; prognosis; reinfarction; trends
3.  A history of arterial hypertension does not affect mortality in patients hospitalised with congestive heart failure 
Heart  2006;92(10):1430-1433.
To evaluate the importance of a history of hypertension on long‐term mortality in a large cohort of patients hospitalised with congestive heart failure (CHF).
Retrospective analysis of 5491 consecutive patients, of whom 24% had a history of hypertension. 60% of the patients had non‐systolic CHF, and 57% had ischaemic heart disease.
38 primary, secondary and tertiary hospitals in Denmark.
Main outcome measures
Total mortality 5–8 years after inclusion in the registry.
Female sex and preserved left ventricular systolic function was more common among patients with a history of hypertension. 72% of the patients died during follow up. A hypertension history did not affect mortality risk (hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.92 to 1.07). Correction for differences between the normotensive and hypertensive groups at baseline in a multivariate model did not alter this result (HR 1.08, 95% CI 1.00 to 1.17, p  =  0.06). The hazard ratio was similar in patients with and without a history of ischaemic heart disease. Hence, a specific effect of hypertension in the group of patients with CHF with ischaemic heart disease, as suggested in earlier studies, could not be confirmed.
A history of arterial hypertension did not affect mortality in patients hospitalised with CHF.
PMCID: PMC1861024  PMID: 16621877
4.  Initiation and Persistence to Statin Treatment in Patients with Diabetes Receiving Glucose-Lowering Medications 1997- 2006 
Since 2001 guidelines recommend statin treatment in most patients with diabetes. We investigated secular changes in initiation and persistence to statin treatment during a 10-year period in a nationwide cohort of patients initiating glucose-lowering medication (GLM).
All Danish citizens 30 years and older who claimed prescriptions of GLM between 1997 and 2006 were identified from nationwide registers of drug dispensing from pharmacies and hospitalizations, and followed until 2006. Statin treatment was registered if a prescription was claimed during the period. By logistic regression we analyzed factors related to initiation and persistence to statin treatment.
In total 128,106 patients were included. In 1997 only 7% of the patients receiving GLM claimed statins within the first year after GLM initiation. Despite increasing statin prescriptions the following years, only 62% were using statins at the end of follow up. The chance of ever receiving statins was lowest if not initiated within 180-days following the first purchase of GLM (OR 0.75, 95% CI 0.74-0.76). A previous myocardial infarction was associated with increased statin treatment (OR 4.51; 95% CI 4.31 - 4.71), while low income was associated with lower use of statins (OR 0.68; 95%CI 0.66-0.72). Between 75-85 % of the patients who initiated statins treatment were persistent to treatment by 2007.
In spite of increasing use of statins in diabetes patients over time, many patients remain untreated. Early initiation of statin treatment in diabetic patients and focus on patients with low socioeconomic status is needed to give long-term benefits.
PMCID: PMC2793397  PMID: 20016749
Diabetes; Statins; compliance; epidemiology; lipids.
5.  Effects of Oral Glucose Load on Endothelial Function and on Insulin and Glucose Fluctuations in Healthy Individuals 
Experimental Diabetes Research  2008;2008:672021.
Background/aims. Postprandial hyperglycemia, an independent risk factor for cardiovascular disease, is accompanied by endothelial dysfunction. We studied the effect of oral glucose load on insulin and glucose fluctuations, and on postprandial endothelial function in healthy individuals in order to better understand and cope with the postprandial state in insulin resistant individuals. Methods. We assessed post-oral glucose load endothelial function (flow mediated dilation), plasma insulin, and blood glucose in 9 healthy subjects. Results. The largest increases in delta FMD values (fasting FMD value subtracted from postprandial FMD value) occurred at 3 hours after both glucose or placebo load, respectively: 4.80 ± 1.41 (P = .009) and 2.34 ± 1.47 (P = .15). Glucose and insulin concentrations achieved maximum peaks at one hour post-glucose load. Conclusion. Oral glucose load does not induce endothelial dysfunction in healthy individuals with mean insulin and glucose values of 5.6 mmol/L and 27.2 mmol/L, respectively, 2 hours after glucose load.
PMCID: PMC2266989  PMID: 18350125
6.  Impact of age and sex on sudden cardiovascular death following myocardial infarction 
Heart  2002;88(6):573-578.
Objective: To evaluate and compare the risk of sudden cardiovascular death (SCD) and non-SCD after myocardial infarction (MI) associated with age and sex.
Design: Cohort study of patients admitted with an enzyme verified acute MI and discharged alive. Patients were followed up for up to four years.
Patients: 5983 consecutive hospital survivors of acute MI were enrolled in the TRACE (trandolapril cardiac evaluation) registry from 1990–92. Four age groups were prespecified: < 56, 56–65, 66–75, and ≥ 76 years.
Main outcome measures: SCD was defined as cardiovascular death within one hour of onset of symptoms.
Results: There were 536 SCD and 725 non-SCD. SCD mortality was 4.8% in the youngest and 15.7% in the oldest age groups. Non-SCD mortality was 3.5% and 25%, respectively. The ratio of SCD to non-SCD mortality varied from 1.44 in the youngest (< 56 years) to 0.55 in the oldest patients (≥ 76 years). Age significantly increased both SCD and non-SCD risk (p < 0.0001), but the increase in non-SCD risk was 40% higher (p < 0.0001). Male sex was associated with increased risk of SCD independently of age (risk ratio 1.34, p < 0.005). However, the absolute three year probability of SCD among women older than 66 years exceeded 10%.
Conclusions: Compared with non-SCD the risk of SCD is relatively highest in the younger age groups, but the absolute risk of SCD is much higher among the upper age groups than the younger. The risk of SCD was slightly lower in women but not enough to warrant a different treatment strategy.
PMCID: PMC1767447  PMID: 12433881
sudden death; women; aging; myocardial infarction
7.  Short and long term prognostic importance of regional dyskinesia versus akinesia in acute myocardial infarction 
Heart  2002;87(5):410-414.
Background: The prognostic importance of dyskinesia after acute myocardial infarction is unknown, and recommendations have been made that dyskinesia be included in calculations of wall motion index (WMI).
Objective: To determine whether it is necessary to distinguish between dyskinesia and akinesia when WMI is estimated for prognostic purposes following acute myocardial infarction.
Design: Multicentre prospective study.
Patients: 6676 consecutive patients, screened one to six days after acute myocardial infarction in 27 Danish hospitals.
Interventions: WMI was measured in 6232 patients, applying the nine segment model, scoring 3 for hyperkinesia, 2 for normokinesia, 1 for hypokinesia, 0 for akinesia, and −1 for dyskinesia. Calculation of WMI either included information on dyskinesia or excluded this information by giving dyskinesia the same score as akinesia.
Main outcome measures: Long term outcome (up to seven years) with respect to mortality.
Results: Dyskinesia occurred in 673 patients (10.8%). In multivariate analysis, WMI was an important prognostic factor, with a relative risk of 2.4 (95% confidence interval (CI), 2.2 to 2.7), while dyskinesia had no independent long term prognostic importance (relative risk 1.00; 95% CI, 0.89 to 1.12). For 30 day mortality dyskinesia had a relative risk of 1.23 (95% CI, 1.00 to 1.53) (p = 0.045).
Conclusions: Echocardiographic evaluation of left ventricular systolic function shortly after an acute myocardial infarct gives important prognostic information, but the presence of dyskinesia only has prognostic importance for the first 30 days.
PMCID: PMC1767089  PMID: 11997405
acute myocardial infarction; regional dyskinesia; wall motion index; akinesia
8.  Relation between dose of bendrofluazide, antihypertensive effect, and adverse biochemical effects. 
BMJ : British Medical Journal  1990;300(6730):975-978.
OBJECTIVE--To determine the relevant dose of bendrofluazide for treating mild to moderate hypertension. DESIGN--Double blind parallel group trial of patients who were given placebo for six weeks and then randomly allocated to various doses of bendrofluazide (1.25, 2.5, 5, or 10 mg daily) or placebo for 12 weeks. SETTING--General practices in Zealand, Denmark. PATIENTS--257 Patients with newly diagnosed or previously treated hypertension, aged 25-70, who had a mean diastolic blood pressure of 100-120 mm Hg after receiving placebo for six weeks. MAIN OUTCOME MEASURES--Reduction in diastolic blood pressure and changes in biochemical variables (potassium, urate, glucose, fructosamine, total cholesterol, apolipoprotein A I, apolipoprotein B, and triglyceride concentrations). RESULTS--All doses of bendrofluazide significantly reduced diastolic blood pressure to the same degree (10-11 mm Hg). Clear relations between dose and effect were shown for potassium, urate, glucose, total cholesterol, and apolipoprotein B concentrations. The 1.25 mg dose increased only urate concentrations, whereas the 10 mg dose affected all the above biochemical variables. CONCLUSION--The relevant range of doses of bendrofluazide to treat mild to moderate hypertension is 1.25-2.5 mg a day. Higher doses caused more pronounced adverse biochemical effects including adverse lipid effects. Previous trials with bendrofluazide have used too high doses.
PMCID: PMC1662719  PMID: 2344503

Results 1-8 (8)