Fredrik Nystrom

Aims The aim of this study was to determine if single items in the quality of life questionnaire short form 36 (SF36) were associated with cardiovascular events in patients with type 2 diabetes mellitus (T2DM). Methods In 756 T2DM patients (260 women) from the CARDIPP study, nine questions from the domains vitality and well‐being in SF36 were analysed. Patients, 55–66 years, were recruited in 2005–2008 and followed up until 31 December 2018 for the incidence of major adverse cardiovascular events (MACE), that is, myocardial infarction, stroke or cardiovascular death. Results Median follow‐up time: 11.6 years, during which 119 (16%) MACE occurred. The SF36 items: ‘seldom full of pep’ (HR 1.2, 95% CI: 1.1–1.4, p = 0.006), ‘seldom a lot of energy’ (HR 1.3, 95%CI: 1.1–1.5, p < 0.001), ‘worn out’ (HR 1.2, 95%CI: 1.0–1.4, p = 0.020) and ‘seldom happy’ (HR 1.2, 95%CI: 1.0–1.4, p = 0.012) were independent risk factors for MACE in separate models, as well as male sex, diabetes duration, HbA 1c , sagittal abdominal diameter and aortic pulse wave velocity. The variables ‘seldom full of pep’ and ‘seldom a lot of energy’ remained associated with MACE when conducting separate analyses for sexes. Only ‘seldom a lot of energy’ remained associated with MACE when all items from SF‐36 were comprised in the same model. Conclusions One single question regarding energy levels from SF36 may be used as an independent risk factor for cardiovascular events in T2DM patients in primary care, for both men and women. This item may be included in future risk assessment for use in clinical practice for cardiovascular risk stratification of T2DM patients. Trial registration The study was registered in clinicaltrial.gov (NCT 01049737) in 14 January 2010.

Frequent fruit consumption has been associated with lower office blood pressure. Less is known about associations between fruit consumption and home blood pressure. Our aim was to study the correlation between consumption of specific fruits and home blood pressure in a large randomly selected study population. The main outcome was systolic home blood pressure. Home blood pressure measurements were performed with calibrated oscillometric meters during seven consecutive days. Means for all available measurements were used. Validated food frequency questionnaires were used for estimating frequency of fruit consumption. The specified fruits were bananas, apples/pears and oranges/citrus fruit. Complete case analysis regarding fruit consumption, office‐ and home blood pressure measurements and other relevant variables was performed in 2283 study participants out of 2603 available. Multivariable linear regression analysis was performed. There were statistically significant associations between consumption of all fruit types and lower systolic home blood pressure unadjusted ( p for trend; bananas, apples/pears and oranges/citrus fruit p < .001). The numerical differences between most and least frequent consumption of fruit were for bananas ‐2.7 mm Hg, apples/pears ‐3.9 mm Hg and for oranges/citrus fruit ‐3.4 mm Hg. When adjusted for covariates, both consumption of apples/pears and oranges/citrus fruit had an independent statistically significant association with lower blood pressure ( p = .048 resp. p = .009). Future controlled interventional studies are needed to evaluate the effect of specific fruit on home blood pressure.