I Hjermann

Oslo University Hospital, Kristiania (historical), Oslo County, Norway

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Publications (180)820.44 Total impact

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    ABSTRACT: In a study of 42 healthy, middle-aged men with high risk of coronary heart disease (CHD), especially on the basis of hyperlipoproteinaemia, a highly significant correlation was found between the euglobulin clot lysis time (ECLT) after venous stasis and serum triglyceride concentration (p < 0.01), whereas no such correlation was found between ECLT and serum cholesterol. In accordance with these findings, delayed clot lysis was mostly associated with types IIB and IV hyperlipoproteinaemia. Twenty-two of the participants had been defined as excellent diet responders on the basis of diet recording and serum lipid lowering, whereas the other 20 were controls. Following dietary changes with normalization of hypertriglyceridaemia, significantly more good diet responders of the intervention group had increased fibrinolytic capacity as compared with the control group (p < 0.02). Thus it seems possible to normalize both the lipoprotein pattern and the fibrinolytic capacity to some extent through dietary advice, which again may contribute to less clinical events of CHD.
    No preview · Article · Dec 2009 · European Journal Of Haematology
  • Paul Leren · Ingvar Hjermann · Jan Björnson
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    ABSTRACT: Electrocardiograms of 412 male post-myocardial infarction patients have been recorded 1–2 years after their first infarction and classified according to the Minnesota code in groups of possible prognostic significance: A: with major Q changes, B: with Q and T changes, C: a mixed group with hypertrophy, conduction defects and arrhythmias, and “O”: a reference group with normal or fairly normal ECGs. The 11-year incidence of subsequent fatal myocardial infarction was significantly increased with a pathologic ECG at entry. The incidence of sudden death was also increased with a myocardial injury ECG pattern. The present study and a previous 5-year follow-up study which correlated non-fatal as well as fatal coronary relapses to the same ECG changes seem to justify the following conclusion: The predictive value of the post-myocardial infarction ECG is limited with regard to the risk of suffering a new infarct. However, the risk of coronary death seems to be increased when there is persistent ECG evidence of myocardial injury.
    No preview · Article · Apr 2009 · Journal of Internal Medicine
  • Paul Leren · Ingvar Hjermann · Jan Björnson
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    ABSTRACT: Electrocardiograms recorded 1–2 years after a first myocardial infarction in 412 males have been classified according to the Minnesota Code, and ECG groups of possible prognostic significance were established. One reference group with normal or fairly normal ECGs; three other groups: (A) with major Q-changes, (B), with Q-and T-changes, and (C), a mixed group with hypertrophy, conduction defects and arrhythmias. The 5-year incidence of myocardial reinfarction and of acquired angina pectoris was uninfluenced by the ECG pattern at the start of the study. The incidence of sudden death and total CHD death was lower when the ECG at the start of the study was normal or fairly normal.
    No preview · Article · Apr 2009 · Journal of Internal Medicine
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    ABSTRACT: In a study of 42 healthy, middle-aged men with high risk of coronary heart disease (CHD), we found a highly significant correlation between low ratio of serum testosterone to oestradiol and delayed clot lysis after venous stasis as measured with the euglobulin clot lysis time (ECLT). The upper normal limit of ECLT was set at 60 min. Half of the examined specimen, i.e. from 21 individuals, lysed as normal; 4 specimen lysed between 60 and 90 min, whereas the remaining 17 specimen did not lyse within 2 hours. Sixteen of these 17 individuals with the most defective fibrinolytic capacity belonged to the group of individuals with the lowest ratio of serum testosterone to oestradiol. The association was highly significant (p < 0.001). In comparison, the correlation between serum triglyceride concentration and the ratio of serum testosterone to oestradiol was significant at the 2% level, whereas serum cholesterol and this ratio were not associated. The significance of the findings remains obscure, but may be important for the incidence of CHD in men.
    No preview · Article · Apr 2009 · European Journal Of Haematology
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    ABSTRACT: The association between physical activity at work and at leisure, coronary risk factors, social class and mortality has been studied in about 15000 Oslo men, aged 40–49, without known cardiovascular disease or diabetes at a screening examination for coronary risk factors. Four-year total and CHD mortality showed a decrease with increasing degree of leisure activity, and an increase with increasing work activity. The three conventional coronary risk factors—serum cholesterol, systolic blood pressure (SBP) and number of cigarettes—associated negatively with physical leisure activity, whereas they all associated positively with physical activity at work. Men in lower social classes were less active at leisure but more active at work than men in the higher classes. In a multivariate analysis of variance with coronary risk score (based on SBP, serum total cholesterol and number of cigarettes), social class and physical activity, the predictive power of physical leisure activity for future death was almost as good as the coronary risk score. Physical activity at work, on the other hand, was not an independent risk factor either for total or for CHD mortality.
    No preview · Article · Apr 2009 · Journal of Internal Medicine
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    ABSTRACT: Forty-year old, normocalcaemic men with mild essential hypertension (n=35) had decreased serum phosphate (p<0.001) concomitant with elevated plasma adrenaline (p<0.03) and heart rate (p<0.001). All had unchanged serum immunoreactive parathyroid hormone concentrations compared to age-matched normotensive control men (n=44). Serum phosphate levels correlated negatively with plasma adrenaline (p<0.05), plasma noradrenaline (p<0.05), mean blood pressure (p<0.001) and heart rate. (p<0.05). Serum phosphate was significantly lowered by infusion of small amounts of adrenaline at all four infusion rates in a hypertensive group (n=12) while a similar effect was obtained only at the two highest infusion rates in a normotensive group (n=10). No change in serum calcium was observed in either group. Thus, hypophosphataemia appears to be inversely related to sympathetic tone in essential hypertension.
    No preview · Article · Apr 2009 · Journal of Internal Medicine
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    ABSTRACT: To test the association between body mass index (BMI) and other coronary risk factors and the risk of a fatal coronary heart disease (CHD) event in different time periods during follow-up. Prospective cohort study with a 21 year follow-up period. A screened sample of 14,403 men aged 40-49 years initially free of CHD. Risk of fatal CHD was calculated for 21 years' cumulative follow-up and for four consecutive 5-year periods. After adjustment for age and the other risk factors, total cholesterol and systolic blood pressure retained their predictive strength for CHD mortality throughout follow-up. Though cigarette smoking remained a significant predictor, the relative risk decreased with time (test of trend: p=0.01). Intermediate to vigorous physical activity at leisure was protective for 10 years of follow-up and a question on mental stress for 5 years. The test of trend indicated that the risk associated with BMI increased with the duration of follow-up (p=0.002). Our data show that coronary risk factors predicted CHD mortality differently according to the length of follow-up, and suggest that the harm associated with obesity may take more than a decade to become evident, in contrast to the classical CHD risk factors.
    No preview · Article · Feb 2007 · Scandinavian Journal of Public Health
  • I Holme · L.L. Haaheim · S Tonstad · I Hjermann
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    ABSTRACT: The Oslo Diet and Antismoking Study was a 5-year randomised controlled trial initiated in 1972-1973 and ended in 1977-1978, which showed that dietary change and smoking cessation reduced the incidence of coronary heart disease among high risk middle-aged men. In an extended follow-up we studied the incidence of myocardial infarction (MI) 16 years after the end of the trial in the intervention and control groups. The primary endpoint was the first occurrence of non-fatal and fatal MI including sudden death up to December 31 1993. Cases of fatal MI were identified by linkage to Statistics Norway using each subject's individual personal number. Cases of non-fatal MI were extracted from the hospital records. Cox proportional hazards regression models estimated relationships between changes in total cholesterol and triglyceride concentrations and smoking status and the primary endpoints up to 16 years following the end of the trial. At 5 and 10 years following the end of the trial the incidence of MI among the 604 men in the intervention (I) and 628 in the control (C) group differed significantly (5-year event rate (I/C) =0.059/0.090; P=0.038 and 10-year event rate (I/C) =0.111/0.155; P=0.023), but the difference faded slowly and subsequently (P=0.069 at 16 years). The reduction in MI in the intervention group was primarily explained by the differences in total cholesterol and triglyceride concentrations between the groups. This extended follow-up of the Oslo Diet and Antismoking Study found a prolonged benefit of the intervention lasting for at least a decade after the close of the trial. This finding is in accordance with statin and other studies showing that the effect of cholesterol lowering may be prolonged after the end of the intervention.
    No preview · Article · Aug 2006 · Nutrition Metabolism and Cardiovascular Diseases
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    ABSTRACT: This randomized study targeted a comparison of the effect of 3-year diet counselling or omega-3 polyunsaturated fatty acid (PUFA) supplementation (2.4 g/day) on the progression of atherosclerosis in carotid arteries and on finger pulse wave propagation. Measurements were assessed by high-resolution B-mode ultrasound and a photopletysmographic finger pulse-sensor, respectively. Altogether, 563 elderly men with long-standing hyperlipidaemia were randomized into four groups: controls (no dietary counselling and placebo); dietary counselling (and placebo); omega-3 PUFA supplementation (no dietary counselling); dietary counselling and omega-3 PUFA supplementation. In the diet only group, the carotid intima-media thickness increase (0.929 to 0.967 mm) was significantly less than in the control group (0.909 to 0.977 mm), (P = 0.018). Significant increase in carotid plaques score and plaques area were observed in all four groups, but without between group differences. Changes in carotid intima-media thickness and in high-density lipoprotein-cholesterol were negatively correlated (adjusted P < 0.001). Pulse wave propagation time decreased significantly in the control group (206 to 198 ms; P = 0.002), reflecting reduced arterial elasticity. In the group receiving omega-3 PUFA only, pulse wave propagation time increased significantly when compared with the control group (P = 0.013). Reduced progression in carotid intima-media thickness was observed after dietary counselling, whereas omega-3 PUFA supplementation imposed a favourable effect on arterial elasticity.
    No preview · Article · Jun 2006 · European Journal of Cardiovascular Prevention and Rehabilitation
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    ABSTRACT: The Oslo Diet and Antismoking study was a 5-year randomised trial initiated in 1972-1973, which studied the effect of dietary change and smoking cessation for the prevention of coronary heart disease among high-risk middle-aged men. To test the long-term maintenance of lifestyle change, we examined diet and cardiovascular risk factors in subjects initially randomised to the control and intervention groups 20 years after cessation of the intervention. Of the original cohort that included 1232 participants, 910 survivors were identified in 1997 and cardiovascular risk factors were measured in 563 (62%) in 1997-1999. Of these, 558 (99%) also completed questionnaires about their food intake and attitudes to health and diet. Cigarette smoking was nearly halved between baseline and 20-year follow-up in each of the intervention and control groups (P<0.001 within groups), but did not differ between the intervention group (39%) versus the control group (34%); P=0.07. Body mass index increased by 1.4+/-2.6 and 1.6+/-2.6 kg/m(2) between baseline and 20-year follow-up in the intervention and control groups, respectively (P<0.001 within groups; NS between groups). Serum total cholesterol and triglyceride concentrations decreased substantially in subjects treated or untreated with statins (P<0.001 within the intervention and control groups) but did not differ between the groups (total cholesterol change of -1.4+/-1.3 and -1.3+/-1.2 mmol/l, respectively, and triglyceride change of -0.5+/-1.0 mmol/l in both groups). Men in the intervention group reported a less atherogenic fat quality score and lower intakes of fat, saturated fat and cholesterol, higher intakes of long chain polyunsaturated fatty acids, protein and beta-carotene and greater attention to lifestyle and change of diet than the control group (all P<0.05). The fatty acid concentrations did not differ, however, between the intervention and control groups (P>0.05). No long-term differences in smoking rates or lipid concentrations between the intervention and control groups were observed in the surviving attendees two decades after the end of the trial. Lifestyle intervention still influenced the dietary intake, though modestly.
    Preview · Article · Mar 2006 · European Journal of Clinical Nutrition
  • Lise Lund Haheim · Ingar Holme · Ingvar Hjermann · Serena Tonstad
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    ABSTRACT: To study the risk-factor profile for the incidence of non-fatal and fatal stroke among middle-aged men according to the stroke subtypes subarachnoid or intracerebral haemorrhage, cerebral infarction, and unspecified stroke. The study design is a prospective cohort study. A total of 16,209 men aged 40-49 years resident in Oslo were screened for cardiovascular disease risk factors in 1972-73. Of these, 14,403 men had no cardiovascular symptoms or diseases or diabetes. The incidence of stroke after 21 years of follow-up of all men was extracted from hospital records and linkage to Statistics Norway. A total of 429 non-fatal and 107 fatal stroke events were registered. Case fatality within 28 days (number and percentage of cases) was 51% (41, 7.7%) for subarachnoid haemorrhage, 39% (67, 12.6%) for cerebral haemorrhage, 10% (246, 46.3%) for cerebral infarct, and 19% (177, 33.4%) for unspecified stroke. Risk of stroke (not subarachnoid haemorrhage) increased with the presence of symptoms or a history of cardiovascular disease or diabetes. In multivariate analysis of men without CVD or diabetes, high blood pressure was a risk factor for all subtypes of stroke; furthermore, daily smoking was a risk factor for all subtypes except subarachnoid haemorrhage. Serum cholesterol and glucose concentrations and height (inverse association) were independently associated with cerebral infarction. Smoking was a significantly stronger predictor of fatal than non-fatal events. The risk-factor profile differed according to the underlying subtype of stroke. Cerebral infarction clearly shared with myocardial infarction the classical risk factors, including non-fasting glucose concentration.
    No preview · Article · Feb 2006 · Scandinavian Journal of Public Health
  • E M Hjerkinn · I Seljeflot · L Sandvik · I Hjermann · H Arnesen
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    ABSTRACT: Circulating cell adhesion molecules (CAMS) are regarded as inflammatory markers related to the process of atherosclerosis and cardiovascular disease (CVD). In the haemostatic system, elevated levels of thrombomodulin (TM), von Willebrand factor (vWF) and tissue-type plasminogen activator antigen (tPAag) have likewise been associated with atherothrombotic cardiovascular disease states. Levels of these circulating markers were investigated in a cross-sectional study including 563 men aged 70 (64-76) years characterized as hypercholesterolaemic in 1972, as related to the following clinical entities: cardiovascular morbidity (28%), diabetes (15%), hypertension (70%) and smoking habits (34%) after 24 years. In patients presenting with CVD, significantly higher levels of tPAag were encountered (12.9 versus 12.0 ng/ml, p = 0.02). In smokers, levels of sICAM-1 were significantly higher (331 versus 298 ng/ml, p < 0.001), whereas levels of sVCAM-1 and sTM were lower compared with those in non-smokers (543 versus 582 ng/ml, p = 0.01, 40.6 versus 44.5 ng/ml, p < 0.01, respectively). In diabetics, levels of sE-selectin and tPAag were significantly higher than those in non-diabetics (55.9 versus 45.7 ng/ml, p < 0.001, 13.6 versus 12.0, p = 0.001, respectively). In subjects with hypertension, levels of TM were elevated (44.0 versus 40.8 ng/ml, p = 0.03). In multivariate regression analyses, tPAag remained significantly associated with the presence of CVD (p = 0.03), sE-selectin with diabetes (p=0.004), sTM with hypertension (p = 0.02) and sVCAM-1, sICAM-1 and sTM with smoking, (p = 0.01, p < 0.001, p < 0.001, respectively). The present results may contribute to the understanding of the multitude of factors influencing these endothelial markers and their evaluation in various disease entities.
    No preview · Article · Apr 2005 · Scandinavian Journal of Clinical and Laboratory Investigation
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    ABSTRACT: Dietary factors and very-long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) may influence the atherothrombotic process. Elevated concentrations of circulating cell adhesion molecules, thrombomodulin (TM), von Willebrand factor (vWF), and tissue-type plasminogen activator antigen (tPAag) are related to atherothrombotic cardiovascular disease. The randomized Diet and Omega-3 Intervention Trial (DOIT) targeted a comparison of the effect of 3-y dietary counseling, n-3 PUFA supplementation (2.4 g/d), or both on circulating markers of endothelial activation. The study included 563 elderly men with long-standing hyperlipidemia. The men were randomly assigned by factorial design into 4 groups: control (no dietary counseling and placebo capsules), dietary counseling (and placebo capsules), n-3 PUFA supplementation (no dietary counseling), and dietary counseling and n-3 PUFA supplementation. Serum concentrations of fatty acids reflected good compliance. Dietary counseling was followed by significantly reduced concentrations of soluble intercellular adhesion molecule 1 (sICAM-1; P < 0.001), sTM (P = 0.004), and tPAag (P < 0.001) than in subjects without dietary counseling. After n-3 PUFA supplementation, significantly reduced concentrations of sICAM-1 (P < 0.001) and sTM (P = 0.006) were observed when compared with subjects receiving placebo capsules. An increase in tPAag was not significantly different from that observed in subjects receiving placebo capsules. For sICAM-1, a significant effect was observed for both interventions combined. Each intervention (dietary counseling or n-3 PUFA supplements) reduced sTM and sICAM-1 concentrations, indicating decreased endothelial activation. The tPAag increase in the groups not receiving dietary counseling (pooled), which indicates progression of atherosclerosis, was significantly counteracted by dietary counseling.
    Full-text · Article · Mar 2005 · American Journal of Clinical Nutrition
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    ABSTRACT: The Hypertension High Risk Management trial (HYRIM) investigated the effect of fluvastatin treatment and lifestyle intervention on development of carotid intima-media thickness (IMT) in drug-treated hypertensive patients. HYRIM was a placebo-controlled, 2 x 2 factorial trial in which 568 drug-treated hypertensive men aged 40-74 years with total cholesterol 4.5-8.0 mmol/L, triglycerides <4.5 mmol/L, body mass index 25-35 kg/m2, and a sedentary lifestyle were randomized to receive either fluvastatin, 40 mg daily, or placebo, and either intensive lifestyle intervention (physical activity and diet) or usual care (treatment of hypertension and other disorders by own private physician). Carotid IMT was assessed by B-mode ultrasound vasculography and left ventricular (LV) mass was calculated from ultrasound recordings of the heart. Fluvastatin alone reduced the primary study endpoint of 4-year development of IMT in the common carotid artery (CCA) compared with placebo (p=0.0297). Carotid bulb IMT progression over 4 years was also significantly (p=0.0214) reduced by fluvastatin compared with placebo. Fluvastatin significantly lowered LDL-C levels (mean net difference through 4 years, 0.6 mmol/L; p<0.0001), and reduced the 2-year development of LV mass (p=0.0144) compared with placebo. Lifestyle intervention had no significant effect on LDL-C, carotid IMT or LV mass, and did not increase the effects of fluvastatin. In drug-treated hypertensive patients in a usual care setting, fluvastatin treatment reduces progression of carotid IMT and LV mass.
    No preview · Article · Feb 2005 · Atherosclerosis
  • Ingar Holme · Serena Tonstad · Ingvar Hjermann
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    ABSTRACT: Between 1981 and 1991, the City of Oslo offered all its 40-year-old citizens screening for risk factors for cardiovascular disease. We describe changes in risk factors over this period. Between 1981 and 1999, a total of 104,482 men and women born between 1941 and 1959 were invited to undergo screening. The attendance rate was slightly above 55% in the initial years when the City of Oslo had a centralised administration. After a decentralisation to 25 city districts in 1988, attendance dropped considerably. Body weight, triglycerides, physical inactivity, prevalence of metabolic syndrome and diabetes all increased over the period. The classic risk factors, including total serum cholesterol, high blood pressure and cigarette smoking, were all gradually reduced. With regard to the classic risk factors, the findings are consistent with other investigations. The increase in body weight and some other characteristics of the metabolic syndrome are causes for concern.
    No preview · Article · Jan 2005 · Tidsskrift for den Norske laegeforening
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    ABSTRACT: To explore changes in the incidence of fatal and nonfatal myocardial infarction (MI) and stroke in the same male population over two decades. Men aged 40-49 born in the years 1923-1932 (N= 16,209) resident in Oslo participated in a cardiovascular screening programme in 1972-1973. Nonfatal cases of MI and stroke were obtained from hospital records and causes of death were ascertained by linkage to Statistics Norway. The closing date was December 31, 1993. The cohort had a lower mortality rate than the general Norwegian population. First nonfatal and fatal MIs declined in each age and birth cohort during the entire follow-up. The incidence of nonfatal and fatal stroke decreased about 10 years after the initial screening. The risk of men with Rose questionnaire-based symptoms of angina or claudication was between that of healthy men and men with established cardiovascular disease or diabetes. There has been a reduction in both nonfatal and fatal incident cases of MI and stroke 10 years later indicating a pronounced change in all age groups and a lasting change throughout the period of follow-up. The Rose questionnaire predicted both future stroke and MI.
    No preview · Article · Sep 2004 · Scandinavian Cardiovascular Journal
  • Tor Ole Klemsdal · Serena Tonstad · Ingvar Hjermann
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    ABSTRACT: In spite of a substantial decline in the morbidity and the mortality from coronary heart disease in Norway since 1970-1975, cardiovascular disease remains the leading cause of death. The prevention of premature cardiovascular disease includes a mass strategy as well an individual strategy. While the first aims at changing life habits in the whole population, the latter is directed towards individuals with elevated cardiovascular risk. Non-pharmacological and pharmacological modes of treatment have been demonstrated to be effective in reducing cardiovascular events. However, the value of such measures depends on our ability to identify high-risk individuals. This paper describes different approaches in preventive medicine, from population screening to the screening of relatives of patients with premature disease. While doctors previously focused on whether blood pressure or cholesterol levels were above the defined limits, a global risk assessment is now recommended. Information regarding family history, smoking and exercise habits, lipid values, blood pressure, and the presence of diabetes must be obtained in a proper risk assessment. In some individuals with intermediate risk, additionally non-invasive tests may be of value in order to ensure that sufficient information has been obtained for a recommendation of preventive measures.
    No preview · Article · Apr 2004 · Tidsskrift for den Norske laegeforening
  • S. Anderssen · A. Hjelstuen · I. Holme · K. Bjerkan · I. Hjermann

    No preview · Article · Apr 2004 · Atherosclerosis Supplements

  • No preview · Article · Apr 2004 · Atherosclerosis Supplements
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    ABSTRACT: We investigated the association between total and cause-specific mortality and individual measures of long-term air pollution exposure in a cohort of Norwegian men followed from 1972-1973 through 1998. Data from a follow-up study on cardiovascular risk factors among 16,209 men 40-49 years of age living in Oslo, Norway, in 1972-1973 were linked with data from the Norwegian Death Register and with estimates of average yearly air pollution levels at the participants' home addresses from 1974 to 1998. Cox proportional-hazards regression was used to estimate associations between exposure and total and cause-specific mortality. During the follow-up time 4,227 men died from a disease corresponding to an ICD-9 (International Classification of Diseases, Revision 9) code < 800. Controlling for a number of potential confounders, the adjusted risk ratio for dying was 1.08 [95% confidence interval (CI), 1.06-1.11] for a 10- microg/m3 increase in average exposure to nitrogen oxides (NOx) at the home address from 1974 through 1978. Corresponding adjusted risk ratios for dying from a respiratory disease other than lung cancer were 1.16 (95% CI, 1.06-1.26); from lung cancer, 1.11 (95% CI, 1.03-1.19); from ischemic heart diseases, 1.08 (95% CI, 1.03-1.12); and from cerebrovascular diseases, 1.04 (95% CI, 0.94-1.15). The findings indicate that urban air pollution may increase the risk of dying. The effect seemed to be strongest for deaths from respiratory diseases other than lung cancer.
    Full-text · Article · Apr 2004 · Environmental Health Perspectives

Publication Stats

6k Citations
820.44 Total Impact Points


  • 1973-2009
    • Oslo University Hospital
      • • Center for Clinical Heart Research
      • • Department of Medical Biochemistry
      • • Department of Medical Genetics
      Kristiania (historical), Oslo County, Norway
  • 2004
    • Norwegian Institute of Public Health
      • Division of Epidemiology
      Kristiania (historical), Oslo County, Norway
  • 1979-2004
    • University of Oslo
      • • Paediatric Research Institute (PFI)
      • • Department of General Internal Medicine
      • • Institute of Medical Informatics (IMI)
      Kristiania (historical), Oslo, Norway
  • 1997
    • Sykehuset i Vestfold HF Tønsberg
      Tønsberg, Vestfold county, Norway
  • 1993
    • Haukeland University Hospital
      • Department of Heart Disease
      Bergen, Hordaland, Norway