In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years: Evidence from a Randomized Controlled Trial

Søren Ballegaard; Jens Faber; Christian Selmer; Finn Gyntelberg; Svend Kreiner; Benny Karpatschof; Tobias Wirenfeldt Klausen; Åke Hjalmarson; Albert Gjedde

doi:10.3390/jcm12247585

In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years: Evidence from a Randomized Controlled Trial

Søren Ballegaard^*, Jens Faber, Christian Selmer, Finn Gyntelberg, Svend Kreiner, Benny Karpatschof, Tobias Wirenfeldt Klausen, Åke Hjalmarson, Albert Gjedde

^*Corresponding author for this work

Department of Clinical Medicine - Translational Neuropsychiatry Unit

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

2 Citations (Scopus)

Abstract

Background: Autonomic nervous system dysfunction (ANSD) is associated with negative prognosis of ischemic heart disease (IHD). Elevated periosteal pressure sensitivity (PPS) at the sternum relates to ANSD and sympathetic hyperactivity. Two previous observational case–control studies of the effect of reduction of PPS suggested lower all-cause mortality from IHD and stroke. We now used a specific daily, adjunct, non-pharmacological program of reduction of elevated PPS to test the hypothetical association between the intervention and reduced all-cause mortality in patients with stable IHD in a randomized controlled trial (RCT). Methods: We completed active (n = 106) and passive interventions (n = 107) and compared the five-year mortalities. We also compared the five-year individual all-cause mortality of each participant to approximately 35.000 members of the general population of Denmark. Pooling the mortality data from the active group of the RCT with the two preliminary studies, we registered the mortality following active intervention of 1.168 person-years, compared to 40 million person-years of the pooled general population. Results: We recorded fewer deaths of the active RCT intervention group than of the corresponding control group from the general population (p = 0.01), as well as of the passive RCT intervention group (p = 0.035). The meta-analysis of the three studies together demonstrated reduced 4.2-year all-cause mortality of 60% (p = 0.007). Conclusions: The test of the hypothetical effect of an intervention aimed at the attenuation of ANSD accompanied by a lowered PPS revealed reduced all-cause mortality in patients with stable IHD.

Original language	English
Article number	7585
Journal	Journal of Clinical Medicine
Volume	12
Issue	24
ISSN	2077-0383
DOIs	https://doi.org/10.3390/jcm12247585
Publication status	Published - Dec 2023

Keywords

autonomic nervous system
autonomic nervous system dysfunction
ischemic heart disease
mortality
periosteal pressure sensitivity
sympathetic hyperactivity

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10.3390/jcm12247585Licence: CC BY

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Ballegaard, S., Faber, J., Selmer, C., Gyntelberg, F., Kreiner, S., Karpatschof, B., Klausen, T. W., Hjalmarson, Å., & Gjedde, A. (2023). In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years: Evidence from a Randomized Controlled Trial. Journal of Clinical Medicine, 12(24), Article 7585. https://doi.org/10.3390/jcm12247585

@article{cca1329159424cb889a5160de738bfff,

title = "In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years: Evidence from a Randomized Controlled Trial",

abstract = "Background: Autonomic nervous system dysfunction (ANSD) is associated with negative prognosis of ischemic heart disease (IHD). Elevated periosteal pressure sensitivity (PPS) at the sternum relates to ANSD and sympathetic hyperactivity. Two previous observational case–control studies of the effect of reduction of PPS suggested lower all-cause mortality from IHD and stroke. We now used a specific daily, adjunct, non-pharmacological program of reduction of elevated PPS to test the hypothetical association between the intervention and reduced all-cause mortality in patients with stable IHD in a randomized controlled trial (RCT). Methods: We completed active (n = 106) and passive interventions (n = 107) and compared the five-year mortalities. We also compared the five-year individual all-cause mortality of each participant to approximately 35.000 members of the general population of Denmark. Pooling the mortality data from the active group of the RCT with the two preliminary studies, we registered the mortality following active intervention of 1.168 person-years, compared to 40 million person-years of the pooled general population. Results: We recorded fewer deaths of the active RCT intervention group than of the corresponding control group from the general population (p = 0.01), as well as of the passive RCT intervention group (p = 0.035). The meta-analysis of the three studies together demonstrated reduced 4.2-year all-cause mortality of 60% (p = 0.007). Conclusions: The test of the hypothetical effect of an intervention aimed at the attenuation of ANSD accompanied by a lowered PPS revealed reduced all-cause mortality in patients with stable IHD.",

keywords = "autonomic nervous system, autonomic nervous system dysfunction, ischemic heart disease, mortality, periosteal pressure sensitivity, sympathetic hyperactivity",

author = "S{\o}ren Ballegaard and Jens Faber and Christian Selmer and Finn Gyntelberg and Svend Kreiner and Benny Karpatschof and Klausen, {Tobias Wirenfeldt} and {\AA}ke Hjalmarson and Albert Gjedde",

note = "Publisher Copyright: {\textcopyright} 2023 by the authors.",

year = "2023",

month = dec,

doi = "10.3390/jcm12247585",

language = "English",

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Ballegaard, S, Faber, J, Selmer, C, Gyntelberg, F, Kreiner, S, Karpatschof, B, Klausen, TW, Hjalmarson, Å & Gjedde, A 2023, 'In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years: Evidence from a Randomized Controlled Trial', Journal of Clinical Medicine, vol. 12, no. 24, 7585. https://doi.org/10.3390/jcm12247585

In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years: Evidence from a Randomized Controlled Trial. / Ballegaard, Søren; Faber, Jens; Selmer, Christian et al.
In: Journal of Clinical Medicine, Vol. 12, No. 24, 7585, 12.2023.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years

T2 - Evidence from a Randomized Controlled Trial

AU - Ballegaard, Søren

AU - Faber, Jens

AU - Selmer, Christian

AU - Gyntelberg, Finn

AU - Kreiner, Svend

AU - Karpatschof, Benny

AU - Klausen, Tobias Wirenfeldt

AU - Hjalmarson, Åke

AU - Gjedde, Albert

PY - 2023/12

Y1 - 2023/12

N2 - Background: Autonomic nervous system dysfunction (ANSD) is associated with negative prognosis of ischemic heart disease (IHD). Elevated periosteal pressure sensitivity (PPS) at the sternum relates to ANSD and sympathetic hyperactivity. Two previous observational case–control studies of the effect of reduction of PPS suggested lower all-cause mortality from IHD and stroke. We now used a specific daily, adjunct, non-pharmacological program of reduction of elevated PPS to test the hypothetical association between the intervention and reduced all-cause mortality in patients with stable IHD in a randomized controlled trial (RCT). Methods: We completed active (n = 106) and passive interventions (n = 107) and compared the five-year mortalities. We also compared the five-year individual all-cause mortality of each participant to approximately 35.000 members of the general population of Denmark. Pooling the mortality data from the active group of the RCT with the two preliminary studies, we registered the mortality following active intervention of 1.168 person-years, compared to 40 million person-years of the pooled general population. Results: We recorded fewer deaths of the active RCT intervention group than of the corresponding control group from the general population (p = 0.01), as well as of the passive RCT intervention group (p = 0.035). The meta-analysis of the three studies together demonstrated reduced 4.2-year all-cause mortality of 60% (p = 0.007). Conclusions: The test of the hypothetical effect of an intervention aimed at the attenuation of ANSD accompanied by a lowered PPS revealed reduced all-cause mortality in patients with stable IHD.

AB - Background: Autonomic nervous system dysfunction (ANSD) is associated with negative prognosis of ischemic heart disease (IHD). Elevated periosteal pressure sensitivity (PPS) at the sternum relates to ANSD and sympathetic hyperactivity. Two previous observational case–control studies of the effect of reduction of PPS suggested lower all-cause mortality from IHD and stroke. We now used a specific daily, adjunct, non-pharmacological program of reduction of elevated PPS to test the hypothetical association between the intervention and reduced all-cause mortality in patients with stable IHD in a randomized controlled trial (RCT). Methods: We completed active (n = 106) and passive interventions (n = 107) and compared the five-year mortalities. We also compared the five-year individual all-cause mortality of each participant to approximately 35.000 members of the general population of Denmark. Pooling the mortality data from the active group of the RCT with the two preliminary studies, we registered the mortality following active intervention of 1.168 person-years, compared to 40 million person-years of the pooled general population. Results: We recorded fewer deaths of the active RCT intervention group than of the corresponding control group from the general population (p = 0.01), as well as of the passive RCT intervention group (p = 0.035). The meta-analysis of the three studies together demonstrated reduced 4.2-year all-cause mortality of 60% (p = 0.007). Conclusions: The test of the hypothetical effect of an intervention aimed at the attenuation of ANSD accompanied by a lowered PPS revealed reduced all-cause mortality in patients with stable IHD.

KW - autonomic nervous system

KW - autonomic nervous system dysfunction

KW - ischemic heart disease

KW - mortality

KW - periosteal pressure sensitivity

KW - sympathetic hyperactivity

UR - http://www.scopus.com/inward/record.url?scp=85180656734&partnerID=8YFLogxK

U2 - 10.3390/jcm12247585

DO - 10.3390/jcm12247585

M3 - Journal article

AN - SCOPUS:85180656734

SN - 2077-0383

VL - 12

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

IS - 24

M1 - 7585

ER -

In Ischemic Heart Disease, Reduced Sensitivity to Pressure at the Sternum Accompanies Lower Mortality after Five Years: Evidence from a Randomized Controlled Trial

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