Background:The extent to which moderate overweight (body mass index [BMI], 25.0-29.9 [calculated as weight in kilograms divided by height in meters squared]) and obesity (BMI, Ն30.0) are associated with increased risk of coronary heart disease (CHD) through adverse effects on blood pressure and cholesterol levels is unclear, as is the risk of CHD that remains after these mediating effects are considered.Methods: Relative risks (RRs) of CHD associated with moderate overweight and obesity with and without adjustment for blood pressure and cholesterol concentrations were calculated by the members of a collaboration of prospective cohort studies of healthy, mainly white persons and pooled by means of random-effects models (RRs for categories of BMI in 14 cohorts and for continuous BMI in 21 cohorts; total N = 302 296).Results: A total of 18 000 CHD events occurred during follow-up. The age-, sex-, physical activity-, and smoking-adjusted RRs (95% confidence intervals) for moderate overweight and obesity compared with normal weight were 1.32 (1.24-1.40) and 1.81 (1.56-2.10), respectively. Additional adjustment for blood pressure and cholesterol levels reduced the RR to 1.17 (1.11-1.23) for moderate overweight and to 1.49 (1.32-1.67) for obesity. The RR associated with a 5-unit BMI increment was 1.29 (1.22-1.35) before and 1.16 (1.11-1.21) after adjustment for blood pressure and cholesterol levels.Conclusions: Adverse effects of overweight on blood pressure and cholesterol levels could account for about 45% of the increased risk of CHD. Even for moderate overweight, there is a significant increased risk of CHD independent of these traditional risk factors, although confounding (eg, by dietary factors) cannot be completely ruled out.

Objective: The elderly are an increasing group and large consumers of care in Sweden. Development of mobile information technology shows promising results of interventions for prevention and treatment of chronic diseases. Exploring the elderly patients’ beliefs, attitudes, experiences and expectations of e-health services helps us understand the factors that influence adherence to such tools in primary care. Material and methods: We conducted focus group interviews with 15 patients from three primary health care centers (PHCCs) in Southern Sweden. Data were analysed with thematic content analysis with codes and categories emerged from data during analysis. Results: We found one comprehensive theme: ‘The elderly’s ambivalence towards e-health:  reluctant curiosity, a wish to join and need for information and learning support’. Eight categories emerged from the text during analysis: ‘E-health – a solution for a non-existing problem?’, ‘The elderly’s experiences of e-health’, ‘Lack of will, skills, self-trust or mistrust in the new technology’, ‘Organizational barriers’, ‘Wanting and needing to move forward’, ‘Concerns to be addressed for making e-health a good solution’, ‘Potential advantages with e-health versus ordinary health care’ and ‘Need for speed, access and correct comprehensive information’. Conclusions: Elderly patients in Sweden described feelings of ambivalence towards e-health, raising concerns as accessibility to health care, mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly. Key points Exploring the elderly patients’ beliefs, experiences, attitudes and expectations of the fast developing e-health services helps us understand the factors that influence adherence to such tools in primary care. Elderly patients in Sweden reported ambivalence and different experiences and attitudes towards e-health, raising concerns as accessibility to health care, costs and mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly.

ObjectivesTo explore staff experiences of working with a digital communication platform implemented throughout several primary healthcare centres in Sweden.DesignA descriptive qualitative approach using focus group interviews. Qualitative content analysis was used to code, categorise and thematise data.SettingPrimary healthcare centres across Sweden, in both rural and urban settings.ParticipantsA total of three mixed focus groups, comprising 19 general practitioners and nurses with experience using a specific digital communication platform.ResultsFive categories emerged: ‘Fears and Benefits of Digital Communication’, ‘Altered Practice Workflow’, ‘Accepting the Digital Society’, ‘Safe and Secure for Patients’ and ‘Doesn't Suit Everyone and Everything’. These were abstracted into two comprehensive themes: ‘Adjusting to a novel medium of communication’ and ‘Digitally filtered primary care’, describing how staff experienced integrating the software as a useful tool for certain clinical contexts while managing the communication challenges associated with written communication.ConclusionsFamily medicine staff were ambivalent concerning the use of digital communication but, after a period of adjustment, it was seen as a useful communication tool especially when combined with continuity of care. Staff acknowledged limitations regarding use by inappropriate patient populations, information overload and misinterpretation of text by both staff and patients.

Objective: Body mass index (BMI) is associated with increased incidence of cardiovascular disease (CVD). However, the risk could be very different for individuals with the same body mass. The present study explored whether regional fat distribution, as measured by waist-hip ratio (WHR), could modify the impact of BMI on the risk of CVD in men and women. Design: Prospective population-based study. Subjects: A total of 10 369 men and 16 638 women, 45-73 years old, from general population in Malmö, Sweden. Measurements: All subjects were followed over 7 years for the incidences of first-ever cardiac event (CE) and ischemic stroke in relation to BMI category (o25.0, 25.0-29.9, X30.0) and WHR. Results: The prevalence of overweight and obesity was 39.4 and 13.0%, respectively. During follow-up, 1280 subjects suffered a CVD event (750 CE, 530 ischemic stroke). The risk of CVD in women increased with increasing levels of WHR, irrespective of BMI category. In men, WHR (per 1 s.d. increase) was associated with increased incidence of CVD in those with normal weight (relative risk (RR) ¼ 1.24; 95% CI: 1.13-1.37) after adjustments for confounding factors. However, WHR was not related to CVD in overweight men (RR ¼ 1.06; 95%CI: 0.94-1.20) or obese men (RR ¼ 1.04; 95%CI: 0.87-1.24). A significant interaction was observed between sex and WHR on the CVD risk. Conclusion: The effect of WHR on incidence of CVD is modified by the overall body weight and by gender. WHR adds prognostic information on the cardiovascular risk in women at all levels of BMI, and in men with normal weight. Keywords: cohort study; body fat distribution; waist-to-hip ratio; body mass index; CVD risk; gender IntroductionBody mass index (BMI) is an easily assessable and commonly used measure of overweight and obesity. Several prospective studies have shown that obesity, as measured by BMI, is associated with increased incidence of cardiovascular diseases (CVDs).1,2 However, the risk could be very different for individuals with the same body mass. Recent studies show that the cardiovascular risk among obese subjects varies substantially depending on the levels of other risk factors associated with obesity. 1,3,4 It has been shown that abdominal obesity, as measured by the waist circumference or waist-hip ratio (WHR), is associated with an adverse metabolic profile as well as increased cardiovascular risk. [5][6][7] It has also been suggested that WHR is a better indicator of the cardiovascular risk in comparison to BMI. 5-7 However, it is unclear whether the impact of body fat distribution on CVD risk is similar at all BMI levels, and whether this association is similar for men and women. The present cohort study explored whether the cardiovascular risk for different levels of BMI was modified by the regional fat distribution as measured by WHR in men and in women. Materials and methods Study populationParticipants of the 'Malmö Diet and Cancer (MDC)' cohort were eligible for the present study. Detailed information of the MDC study has been described previousl...

BF% is a risk factor for CE, ischaemic stroke, and CVD mortality. An interaction between BF% and sex suggests that BF% is a stronger CVD risk factor in women. The raised cardiovascular risk associated with high BF% is reduced by physical activity.