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Henein, Michael
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Publications (10 of 252) Show all publications
Jashari, F., Ibrahimi, P., Johansson, E., Grönlund, C., Wester, P. & Henein, M. Y. (2018). Carotid IM-GSM is better than IMT for identifying patients with multiple arterial disease. Scandinavian Cardiovascular Journal, 52(2), 93-99
Open this publication in new window or tab >>Carotid IM-GSM is better than IMT for identifying patients with multiple arterial disease
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2018 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 2, p. 93-99Article in journal (Refereed) Published
Abstract [en]

Objective. Atherosclerosis is a systemic inflammatory disease that can affect more than one arterial bed simultaneously. The aim of this study was to determine the relationship between ultrasound markers of atherosclerosis and multiple arterial disease. Design. We have included 87 currently asymptomatic carotid disease patients (mean age 69 +/- 6 year, 34% females) in this study. Intima media thickness (IMT) and intima media-grey scale median (IM-GSM) were measured in the common carotid artery (CCA), and correlated with previous and/or current atherosclerotic vascular disease in the coronary, carotid and lower extremities. Patients were divided into three groups: (1) asymptomatic, (2) previous symptoms in one arterial territory and (3) previous symptoms in multiple arterial territories. Results. Patients with previous disease in the coronary arteries had higher IMT (p=.034) and lower IM-GSM (p<.001), and those with prior stroke had lower IM-GSM (p=.007). Neither IMT nor IM-GSM was different between patients with and without previous lower extremity vascular disease. IM-GSM was significantly different between groups, it decreased significantly with increasing number of arterial territories affected (37.7 +/- 15.4 vs. 29.3 +/- 16.4 vs. 20.7 +/- 12.9) p<.001, for asymptomatic, symptoms in one and in multiple arterial systems, respectively. Conventional IMT was not significantly different between groups p=.49. Conclusion. Carotid IMT was higher and IM-GSM lower in patients with symptomatic nearby arterial territories but not in those with peripheral disease. In contrast to conventional IMT, IM-GSM can differentiate between numbers of arterial territories affected by atherosclerosis, suggesting that it is a better surrogate for monitoring multiple arterial territory disease.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
Keywords
Atherosclerosis, carotid artery, intimal-media complex, IMT, IM-GSM
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-146595 (URN)10.1080/14017431.2018.1435903 (DOI)000428305000006 ()29402147 (PubMedID)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-06-09Bibliographically approved
Boles, U., Johansson, A., Wiklund, U., Sharif, Z., David, S., McGrory, S. & Henein, M. Y. (2018). Cytokine Disturbances in Coronary Artery Ectasia Do Not Support Atherosclerosis Pathogenesis. International Journal of Molecular Sciences, 19(1), Article ID 260.
Open this publication in new window or tab >>Cytokine Disturbances in Coronary Artery Ectasia Do Not Support Atherosclerosis Pathogenesis
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2018 (English)In: International Journal of Molecular Sciences, ISSN 1422-0067, E-ISSN 1422-0067, Vol. 19, no 1, article id 260Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Coronary artery ectasia (CAE) is a rare disorder commonly associated with additional features of atherosclerosis. In the present study, we aimed to examine the systemic immune-inflammatory response that might associate CAE.

METHODS: Plasma samples were obtained from 16 patients with coronary artery ectasia (mean age 64.9 ± 7.3 years, 6 female), 69 patients with coronary artery disease (CAD) and angiographic evidence for atherosclerosis (age 64.5 ± 8.7 years, 41 female), and 140 controls (mean age 58.6 ± 4.1 years, 40 female) with normal coronary arteries. Samples were analyzed at Umeå University Biochemistry Laboratory, Sweden, using the V-PLEX Pro-Inflammatory Panel 1 (human) Kit. Statistically significant differences (p < 0.05) between patient groups and controls were determined using Mann-Whitney U-tests.

RESULTS: The CAE patients had significantly higher plasma levels of INF-γ, TNF-α, IL-1β, and IL-8 (p = 0.007, 0.01, 0.001, and 0.002, respectively), and lower levels of IL-2 and IL-4 (p < 0.001 for both) compared to CAD patients and controls. The plasma levels of IL-10, IL-12p, and IL-13 were not different between the three groups. None of these markers could differentiate between patients with pure (n = 6) and mixed with minimal atherosclerosis (n = 10) CAE.

CONCLUSIONS: These results indicate an enhanced systemic pro-inflammatory response in CAE. The profile of this response indicates activation of macrophages through a pathway and trigger different from those of atherosclerosis immune inflammatory response.

Place, publisher, year, edition, pages
Basel, Switzerland: MDPI, 2018
Keywords
atherosclerosis, coronary artery disease, coronary artery ectasia, cytokines, immune inflammatory response, macrophage activation
National Category
Cardiac and Cardiovascular Systems
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-144041 (URN)10.3390/ijms19010260 (DOI)000424407200254 ()29337902 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2018-01-26 Created: 2018-01-26 Last updated: 2018-06-09Bibliographically approved
Bajraktari, G., Pugliese, N. R., D'Agostino, A., Rosa, G. M., Ibrahimi, P., Perçuku, L., . . . Dini, F. L. (2018). Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients. Cardiology Research and Practice, Article ID 3139861.
Open this publication in new window or tab >>Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients
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2018 (English)In: Cardiology Research and Practice, ISSN 2090-8016, E-ISSN 2090-0597, article id 3139861Article in journal (Refereed) Published
Abstract [en]

Recent European Society of Cardiology and American Heart Association/American College of Cardiology Guidelines did not recommend biomarker-guided therapy in the management of heart failure (HF) patients. Combination of echo- and B-type natriuretic peptide (BNP) may be an alternative approach in guiding ambulatory HF management. Our aim was to determine whether a therapy guided by echo markers of left ventricular filling pressure (LVFP), lung ultrasound (LUS) assessment of B-lines, and BNP improves outcomes of HF patients. Consecutive outpatients with LV ejection fraction (EF) <= 50% have been prospectively enrolled. In Group I (n=224), follow-up was guided by echo and BNP with the goal of achieving E-wave deceleration time (EDT) >= 150 ms, tissue Doppler index E/e' < 13, B-line numbers < 15, and BNP <= 125 pg/ml or decrease > 30%; in Group II (n=293), follow-up was clinically guided, while the remaining 277 patients (Group III) did not receive any dedicated follow-up. At 60 months, survival was 88% in Group I compared to 75% in Group II and 54% in Group III (chi(2) 53.5; p<0.0001). Survival curves exhibited statistically significant differences using Mantel-Cox analysis. The number needed to treat to spare one death was 7.9 (Group I versus Group II) and 3.8 (Group I versus Group III). At multivariate Cox regression analyses, major predictors of all-cause mortality were follow-up E/e' (HR: 1.05; p=0.0038) and BNP > 125 pg/ml or decrease <= 30% (HR: 4.90; p=0.0054), while BNP > 125 pg/ml or decrease <= 30% and B-line numbers >= 15 were associated with the combined end point of death and HF hospitalization. Evidence-based HF treatment guided by serum biomarkers and ultrasound with the goal of reducing elevated BNP and LVFP, and resolving pulmonary congestion was associated with better clinical outcomes and can be valuable in guiding ambulatory HF management.

Place, publisher, year, edition, pages
HINDAWI LTD, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-153147 (URN)10.1155/2018/3139861 (DOI)000447542300001 ()30363950 (PubMedID)2-s2.0-85055328734 (Scopus ID)
Available from: 2018-11-07 Created: 2018-11-07 Last updated: 2018-11-07Bibliographically approved
Matteo, L., Cameli, M., Di Tommaso, C., Curci, V., Reccia, R., D'Ascenzi, F., . . . Henein, M. (2018). Mitral regurgitation severity correlates with symptoms and extent of left atrial dysfunction: Effect of mitral valve repair. Journal of Clinical Ultrasound, 46(1), 32-40
Open this publication in new window or tab >>Mitral regurgitation severity correlates with symptoms and extent of left atrial dysfunction: Effect of mitral valve repair
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2018 (English)In: Journal of Clinical Ultrasound, ISSN 0091-2751, E-ISSN 1097-0096, Vol. 46, no 1, p. 32-40Article in journal (Refereed) Published
Abstract [en]

Purpose: We aimed to assess the relationship between mitral regurgitation (MR) severity, symptoms, and left atrial (LA) structure and function, before and after mitral valve repair (MVR).

Methods: Global peak atrial longitudinal strain (PALS) was evaluated in 37 patients with severe symptomatic MR and preserved left ventricular (LV) ejection fraction (60.4% ± 4.6%) before and 3 months after MVR and was compared with values from 30 age- and gender-matched controls.

Results: Before surgery, PALS was worse in patients than in controls and indexed LA volume was greater (P < .0001 for both). After MVR, PALS deteriorated further and LA volume decreased (P = .001 and P = .05, respectively) as did LV ejection fraction, longitudinal strain (P = .05 and P < .001, respectively), and LV mass (P < .0001). Before surgery, LA volume correlated modestly with LV end-diastolic volume (R = 0.51; P = .01); effective regurgitant orifice area (EROA) correlated with PALS (R = −0.69, P < .001) and with LV longitudinal strain (R = 0.54, P = .01), and New York Heart Association class correlated with PALS (R = −0.69, P < .001), EROA (R = 0.69, P < .001), and LA volume (R = 0.51, P = .04). LA volume was the strongest predictor of global PALS reduction (P < .001), whereas global PALS was the main predictor of postoperative atrial fibrillation (AF) (P < .001).

Conclusions: In patients with severe MR, EROA correlate with symptoms and LA PALS, which itself predicts the occurrence of postoperative AF. Strain values were superior to 2D data for the prediction of postoperative AF.

Keywords
heart failure, left atrial strain, mitral regurgitation, mitral valve repair, symptoms
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-127291 (URN)10.1002/jcu.22521 (DOI)000418242100005 ()28949022 (PubMedID)
Note

Originally published in manuscript form

Available from: 2016-11-04 Created: 2016-11-04 Last updated: 2018-06-09Bibliographically approved
Vancheri, F., Vancheri, S. & Henein, M. (2018). Relationship between QRS measurements and left ventricular morphology and function in asymptomatic individuals. Echocardiography, 35(3), 301-307
Open this publication in new window or tab >>Relationship between QRS measurements and left ventricular morphology and function in asymptomatic individuals
2018 (English)In: Echocardiography, ISSN 0742-2822, E-ISSN 1540-8175, Vol. 35, no 3, p. 301-307Article in journal (Refereed) Published
Abstract [en]

Background and aim: QRS amplitude and duration are associated with increased left ventricular (LV) volume, mass and dysfunction. However, the diagnostic concordance between QRS measurements and LV morphology and function, as shown by Doppler echocardiography, is not well established. We investigated the relationships of QRS duration and amplitude with echocardiographic measurements of LV morphology and systolic and diastolic function in normal individuals.

Methods: Individuals without signs or symptoms of coronary artery disease or heart failure, who underwent clinical examination as a part of a cross-sectional survey for the prevalence of coronary risk factors, randomly selected from the population list in Caltanissetta, Italy, were included in the study. QRS duration and amplitude were automatically measured using inbuilt software. LV ejection and filling patterns were studied using Doppler echocardiography.

Results: We studied 184 individuals (96 men and 88 women), mean age 55.9 (11.3). QRS duration increased by 5.4ms for every 100g increase in LV mass, and by 4.6ms for each 10mm increase in LV end-diastolic diameter. The amplitude increased by 0.8mm for every 100g increase in LV mass. There was no relationship with LV dimensions. A nonlinear correlation was found between QRS amplitude and indexes of global dyssynchrony. The time-voltage QRS area correlated with LV mass, dimensions and indexes of dyssynchrony. There was no relationship between QRS measurements and ejection fraction.

Conclusions: QRS prolongation and increase in amplitude are strongly influenced by LV increased mass and volume, as well as by dyssynchrony, independently of ejection fraction.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018
Keywords
diastolic function, Doppler index of overall myocardial performance, ejection fraction, systolic nction, Tei index, ventricular function
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-146233 (URN)10.1111/echo.13782 (DOI)000426610300002 ()29280530 (PubMedID)
Available from: 2018-04-09 Created: 2018-04-09 Last updated: 2018-06-09Bibliographically approved
Bytyci, I., Bajraktari, G., Ibrahimi, P., Lindqvist, P. & Henein, M. (2018). The relationship between left atrial measurements and cavity pressure: a systematic review and meta-analysis. Paper presented at 67th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), MAR 10-12, 2018, Orlando, FL. Journal of the American College of Cardiology, 71(11), 911-911
Open this publication in new window or tab >>The relationship between left atrial measurements and cavity pressure: a systematic review and meta-analysis
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2018 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 71, no 11, p. 911-911Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-147472 (URN)10.1016/S0735-1097(18)31452-9 (DOI)000429659702161 ()
Conference
67th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), MAR 10-12, 2018, Orlando, FL
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-06-09Bibliographically approved
Nicoll, R. & Henein, M. (2017). Arterial calcification: A new perspective?. International Journal of Cardiology, 228, 11-22
Open this publication in new window or tab >>Arterial calcification: A new perspective?
2017 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 228, p. 11-22Article, review/survey (Refereed) Published
Abstract [en]

Arterial calcification is commonly seen in atherosclerosis, chronic kidney disease (CKD) and diabetes and has long been considered a natural progression of atherosclerosis. Yet it is a systemic condition, occurring in a wide and diverse range of disease states and no medical treatment for cardiovascular disease has yet found a way to regress it; on the contrary, lipid-lowering therapy may worsen its progression. Although numerous studies have found associations between calcification and biomarkers, none has yet found a unifying mechanism that explains the calcification found in atherosclerosis, CKD or diabetes and many of the biomarkers are equally associated with atheroma development and cardiovascular events. Furthermore, both presence and absence of coronary artery calcification appear predictive of plaque rupture and cardiovascular events, indicating that the association is not causal. This suggests that we are no further forward in understanding the true nature of arterial calcification or its pathogenesis, other than noting that it is 'multifactorial'. This is because most researchers view arterial calcification as a progressive pathological condition which must be treated. Instead, we hypothesise that calcification develops as an immune response to endothelial injury, such as shear stress or oxidative stress in diabetics, and is consequently part of the body's natural defences. This would explain why it has been found to be protective of plaque rupture and why it is unresponsive to lipid-lowering agents. We propose that instead of attempting to treat arterial calcification, we should instead be attempting to prevent or treat all causes of endothelial injury.

Keywords
Arterial calcification, Plaque rupture, Response to injury
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-130926 (URN)10.1016/j.ijcard.2016.11.099 (DOI)000393408600003 ()27863350 (PubMedID)
Available from: 2017-02-01 Created: 2017-02-01 Last updated: 2018-06-09Bibliographically approved
Jashari, H., Lannering, K., Mellander, M., Ibrahimi, P., Rydberg, A. & Henein, M. Y. (2017). Coarctation repair normalizes left ventricular function and aorto-septal angle in neonates. Congenital Heart Disease, 12(2), 218-225
Open this publication in new window or tab >>Coarctation repair normalizes left ventricular function and aorto-septal angle in neonates
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2017 (English)In: Congenital Heart Disease, ISSN 1747-079X, E-ISSN 1747-0803, Vol. 12, no 2, p. 218-225Article in journal (Refereed) Published
Abstract [en]

Background and aims: Patients with coarctation of the aorta (CoA) have increased left ventricular (LV) afterload that has been shown to impact the LV and ascending aortic function. We aimed to examine the effect of coarctation on LV function and aorto-septal angle (AoSA) before and after surgical repair.

Methods: We retrospectively studied 21 patients with surgically repaired CoA at a median age of 9 (2-53) days at three time points: (1) just before intervention, (2) at short-term follow-up, and (3) at medium-term follow-up after intervention. AoSA was measured from the parasternal long axisview, at three time points during the cardiac cycle: (1) end diastole, (2) beginning of systole, and (3) at peak ejection in the descending aorta. In addition to conventional LV structure and function, global longitudinal strain, and strain rate were measured using STE technique and Tomtec soft-ware. Three groups of age matched healthy children served as controls at each time point.

Results: AoSA was significantly wider before intervention, in particular at peak ejection in the descending aorta (1448 6 6.48 vs. 1368 6 4.18; P < .0001), and correlated with CoA pressure gradi-ent. After intervention, AoSA normalized and significantly correlated with the increase of LV cavity function and overall LV deformation parameters.

Conclusions: AoSA is abnormally wide in neonates with CoA and is associated with severity ofobstruction, LV dysfunction and compromised LV global deformation.

Keywords
aorto-septal angle, coarctation of the aorta, left ventricular function, neonate
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-128146 (URN)10.1111/chd.12430 (DOI)000398705700014 ()27874244 (PubMedID)
Available from: 2016-11-24 Created: 2016-11-24 Last updated: 2018-06-09Bibliographically approved
Henein, M. Y., Bengrid, T., Nicoll, R., Zhao, Y., Johansson, B. & Schmermund, A. (2017). Coronary calcification compromises myocardial perfusion irrespective of luminal stenosis. IJC HEART & VASCULATURE, 14, 41-45
Open this publication in new window or tab >>Coronary calcification compromises myocardial perfusion irrespective of luminal stenosis
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2017 (English)In: IJC HEART & VASCULATURE, ISSN 2352-9067, Vol. 14, p. 41-45Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to evaluate the relationship between coronary artery calcification (CAC) assessed by multi-detector computed tomography (MDCT) and myocardial perfusion assessed by cardiac magnetic resonance imaging (CMR) in a group of symptomatic patients. Method: Retrospective analysis of 120 patients (age 65.1 +/- 8.9 years, 88 males) who presented with atypical chest pain to Bethanien Hospital, Frankfurt, Germany, between 2007 and 2010 and who underwent CAC scoring using MDCT, CMR, and conventional coronary angiography. Patients were divided into those with high-grade (HG) stenosis (n = 67, age 65.1 +/- 9.4 years) and those with no-HG stenosis (n = 53, age 65.1 +/- 8.6 years). Results: There were more males with HG stenosis (82.1% vs. 62.3%, p = 0.015), in whom the percentage and number of abnormal perfusion segments were higher at rest (37.3% vs. 17%, p = 0.014) but not different with stress (p = 0.83) from those with no-HG stenosis. Thirty-four patients had myocardial perfusion abnormalities at rest and 26 patients developed perfusion defects with stress. Stress-induced myocardial perfusion defects were 22.4% sensitive and 79.2% specific for detecting HG stenosis. The CAC score was lower in patients with no-HG stenosis compared to those with HG stenosis (p < 0.0001). On the ROC curve, a CAC score of 293 had a sensitivity of 71.6% and specificity of 83% in predicting HG stenosis [(AUC 0.80 (p < 0.0001)]. A CAC score of 293 or the presence of at least 1 segment myocardial perfusion abnormality was 74.6% sensitive and 71.7% specific in detecting HG stenosis, the respective values for the 2 abnormalities combined being 19.4% and 90.6%. The severity of CAC correlated with the extent of myocardial perfusion in the patient group as a whole with stress (r = 0.22, p = 0.015), particularly in those with no-HG stenosis (r = 0.31, p = 0.022). A CAC score of 293 was 31.6% sensitive and 87.3% specific in detecting myocardial perfusion abnormalities. Conclusion: In a group of patients with exertional angina, coronary calcification is more accurate in detecting high-grade luminal stenosis than myocardial perfusion defects. In addition, in patients with no stenosis, the incremental relationship between coronary calcium score and the extent of myocardial perfusion suggests coronary wall hardening as an additional mechanism for stress-induced angina other than luminal narrowing. These preliminary findings might have a clinical impact on management strategies of these patients other than conventional therapy.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2017
Keywords
Coronary calcification, CMR, Coronary CT, Exertional angina and myocardial perfusion
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-134263 (URN)10.1016/j.ijcha.2016.12.001 (DOI)000399044600009 ()
Available from: 2017-05-16 Created: 2017-05-16 Last updated: 2018-06-09Bibliographically approved
Nicoll, R., Zhao, Y., Wiklund, U., Diederichsen, A., Mickley, H., Ovrehus, K., . . . Henein, M. (2017). Diabetes and male sex are key risk factor correlates of the extent of coronary artery calcification: a Euro-CCAD study. Journal of diabetes and its complications, 31(7), 1096-1102
Open this publication in new window or tab >>Diabetes and male sex are key risk factor correlates of the extent of coronary artery calcification: a Euro-CCAD study
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2017 (English)In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 31, no 7, p. 1096-1102Article in journal (Refereed) Published
Abstract [en]

Background and Aims: Although much has been written about the conventional cardiovascular risk factor correlates of the extent of coronary artery calcification (CAC), few studies have been carried out on symptomatic patients. This paper assesses the potential ability of risk factors to associate with an increasing CAC score. Methods: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and the USA. All had conventional cardiovascular risk factor assessment and CI scanning for CAC scoring. Results: Among all patients, male sex (OR = 4.85, p < 0.001) and diabetes (OR = 236, p < 0.001) were the most important risk factors of CAC extent, with age, hypertension, dyslipidemia and smoking also showing a relationship. Among patients with CAC, age, diabetes, hypertension and dyslipidemia were associated with an increasing CAC score in males and females, with diabetes being the strongest dichotomous risk factor (p < 0.001 for both). These results were echoed in quantile regression, where diabetes was consistently the most important correlate with CAC extent in every quantile in both males and females. To a lesser extent, hypertension and dyslipidemia were also associated in the high CAC quantiles and the low CAC quantiles respectively. Conclusion: In addition to age and male sex in the total population, diabetes is the most important correlate of CAC extent in both sexes.

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Coronary calcification extent, Risk factors, Diabetes, Gender, Hypertension
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-137796 (URN)10.1016/j.jdiacomp.2017.03.013 (DOI)000404088700006 ()28499962 (PubMedID)
Available from: 2017-07-27 Created: 2017-07-27 Last updated: 2018-06-09Bibliographically approved
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