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Holmberg, H., Glader, E.-L., Näslund, U., Carlberg, B., Sönnerstam, E., Norberg, M. & Själander, A. (2024). Improved adherence to statin treatment and differences in results between men and women after pictorial risk communication: a sub-study of the VIPVIZA RCT. European Journal of Clinical Pharmacology
Open this publication in new window or tab >>Improved adherence to statin treatment and differences in results between men and women after pictorial risk communication: a sub-study of the VIPVIZA RCT
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2024 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: People with intermediate CVD risk constitute most of the population. Within this group, the proportion of events is lower compared to the high-risk group, but they contribute with the largest absolute number of events. Atherosclerosis is a dynamic process and progression can be slowed or even reversed with medication and lifestyle changes, but adherence to prescribed treatment is crucial.

Aim: To investigate the long-term effects of interventions with pictorial risk communication of cardiovascular (CVD) risk on average adherence in a group of statin users. Compare response in adherence over time between men and women after intervention.

Methods: Participants on active statin treatment were followed up to 5 years after being randomly assigned to an intervention program aimed at raising CVD risk awareness among participants and their physicians. Merging prescribed medication databases with VIPVIZA study to study adherence over time. A moving average adherence was used to compare groups.

Results: Generally, the average adherence to statins among the 512 participants was high. Men had a higher average adherence over time, while women had a sharper increase in adherence in conjuncture with the intervention program.

Conclusions: Both men and women were receptive to pictorial information regarding CVD risk, but the intervention effect was more pronounced in women. Sex differences are important when considering risk communication strategies. Periodically repeating the intervention was beneficial for maintaining the intervention effect over time.

Trial registration: The VIPVIZA study is registered with ClinicalTrials.gov, May 8, 2013, number NCT01849575.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
Atherosclerosis, Cardiovascular disease prevention, Cardiovascular risk, Pictorial information, Statin initiation, Statins
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-224129 (URN)10.1007/s00228-024-03694-6 (DOI)001209527900001 ()38684558 (PubMedID)2-s2.0-85191700644 (Scopus ID)
Funder
Region Västerbotten, ALFVLL-298001Region Västerbotten, ALFVLL-643391Swedish Research Council, 521-2013-2708Swedish Research Council, 2016-01891Swedish Heart Lung Foundation, 20150369Swedish Heart Lung Foundation, 20170481Swedish Society of MedicineNorrländska HjärtfondenThe Swedish Stroke AssociationSwedish Social Insurance AgencyVisare NorrThe Swedish Heart and Lung Association
Available from: 2024-05-14 Created: 2024-05-14 Last updated: 2024-05-14
Nordin, S., Norberg, M., Braf, I., Johansson, H., Lindahl, B., Lindvall, K., . . . Näslund, U. (2023). Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age. Psychology and Health
Open this publication in new window or tab >>Associations between emotional support and cardiovascular risk factors and subclinical atherosclerosis in middle-age
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2023 (English)In: Psychology and Health, ISSN 0887-0446, E-ISSN 1476-8321Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: To test the hypothesis of low emotional support being associated with lifestyle and biomedical cardiovascular disease (CVD) risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults.

Methods and measures: Cross-sectional data were obtained from participants aged 40–60 years who had one or more conventional CVD risk factor. They underwent assessment based on questionnaires, clinical examination, blood sampling, and carotid ultrasound of plaque formation and carotid intima-media wall thickness (cIMT). Based on the Interview Schedule for Social Interaction, the participants were categorised as either low in emotional support (n = 884) or as a referent (n = 2570). Logistic regression analyses were conducted to study the associations.

Results: Logistic regression analyses showed that low emotional support was significantly associated with smoking, alcohol consumption and physical inactivity (OR = 1.53 − 1.94), estimated risk of CVD morbidity and mortality (OR = 1.56 − 1.68), and plaque formation (OR = 1.39). No significant associations were found regarding biomedical CVD risk factors or cIMT.

Conclusion: The findings suggest that low social support is associated with lifestyle CVD risk factors, estimated risk of CVD morbidity and mortality, and subclinical atherosclerosis in middle-aged healthy adults, encouraging causal evaluation with longitudinal data investigating an impact of emotional support on mechanisms underlying CVD.

Place, publisher, year, edition, pages
Routledge, 2023
Keywords
Cardiovascular disease, cardiovascular risk score, carotid artery plaque, carotid vascular ultrasound, social support
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-217344 (URN)10.1080/08870446.2023.2286296 (DOI)37994844 (PubMedID)2-s2.0-85177567916 (Scopus ID)
Available from: 2023-12-01 Created: 2023-12-01 Last updated: 2023-12-01
Salvador, D., Liv, P., Norberg, M., Pahud de Mortanges, A., Saner, H., Glisic, M., . . . Näslund, U. (2023). Changes in fasting plasma glucose and subclinical atherosclerosis: a cohort study from VIPVIZA trial. Atherosclerosis, Article ID 117326.
Open this publication in new window or tab >>Changes in fasting plasma glucose and subclinical atherosclerosis: a cohort study from VIPVIZA trial
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2023 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, article id 117326Article in journal (Refereed) In press
Abstract [en]

Background and aims: Studies on the influence of fasting plasma glucose (FPG) on the development of carotid plaque (CP) and intima media thickness (CIMT) mainly focused on single FPG measures. We investigated whether changes in FPG (ΔFPG) are associated with incident CP and CIMT change (ΔCIMT) over time.

Methods: Analyses were based on information from 1896 participants from the VIPVIZA trial (Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention), with baseline and 3-year follow-up data on FPG, ultrasonographic CP (none or ≥1 lesion/s) and CIMT assessments. We studied the association between baseline FPG (prior to intervention) or 3-year ΔFPG (mmol/L) and incident CP (logistic regression) or ΔCIMT (linear regression). Analyses were adjusted for multiple potential confounders.

Results: 1896 and 873 individuals, respectively, were included in the analysis on incident CP and ΔCIMT. Participants were 60 years old at baseline and 61% and 54% were females, in the CP and CIMT analyses, respectively. Every mmol/L increase in FPG was associated with an increased odds of incident CP (odds ratio: 1.42, 95% confidence interval [CI]: 1.17, 1.73), but there was no association with ΔCIMT (mean difference: 0.002 mm, 95% CI: −0.003, 0.008) after 3 years. Baseline FPG was not associated with incident CP nor ΔCIMT progression.

Conclusions: In middle-aged individuals with low to moderate risk for cardiovascular diseases, 3-year ΔFPG was positively associated with the risk of incident CP, but not with ΔCIMT. Single measures of FPG may not be sufficient in estimating cardiovascular risk among individuals with low to moderate risk.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Carotid intima media thickness, Carotid plaque, Fasting plasma glucose, Prevention, Subclinical atherosclerosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-216637 (URN)10.1016/j.atherosclerosis.2023.117326 (DOI)37932189 (PubMedID)2-s2.0-85175522942 (Scopus ID)
Funder
EU, Horizon 2020, 801076
Available from: 2023-11-16 Created: 2023-11-16 Last updated: 2024-04-26
Fortuin-de Smidt, M., Bergman, F., Grönlund, C., Hult, A., Norberg, M., Wennberg, M. & Wennberg, P. (2023). Early adulthood exercise capacity, but not muscle strength, associates with subclinical atherosclerosis 40 years later in Swedish men. European Journal of Preventive Cardiology, 30(5), 407-415
Open this publication in new window or tab >>Early adulthood exercise capacity, but not muscle strength, associates with subclinical atherosclerosis 40 years later in Swedish men
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2023 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 30, no 5, p. 407-415Article in journal (Refereed) Published
Abstract [en]

AIMS: Poor exercise capacity and muscle strength in early adulthood are risk factors for cardiovascular disease (CVD). However, it is unclear how these factors relate to subclinical atherosclerosis due to a lack of longitudinal studies. This study investigated whether early adulthood exercise capacity and muscle strength associated with later adulthood subclinical atherosclerosis.

METHODS AND RESULTS: This study included Swedish men (n = 797) who were eligible for military conscription (at ∼18-years of age) and who participated in the baseline assessment of the visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention trial between 2013 and 2016 (at 60 years of age). At conscription, isometric muscle strength (dynamometer) and maximum exercise capacity (maximal load cycle ergometer test) were measured. During later adulthood (at 60 years old), the presence of carotid plaques and intima media thickness were measured by using high-resolution ultrasound. At follow-up, plaques were present in 62% (n = 493) of men. Exercise capacity in early adulthood associated with 19% lower odds of plaques [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.68-0.96], independent of muscle strength. This association was not mediated by any single CVD risk factor. However, the total indirect effect of later, but not early, adulthood CVD risk factors was significant, while the direct effect was non-significant (OR 0.85, 95% CI 0.71-1.02). Associations between muscle strength and subclinical atherosclerosis were non-significant.

CONCLUSION: Higher exercise capacity during early adulthood, but not muscle strength, may protect against carotid plaque development during adulthood mediated by the combination rather than a single later adulthood CVD risk factors.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
Carotid intima media thickness, Carotid plaques, Exercise capacity, Longitudinal study, Muscle strength
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-206445 (URN)10.1093/eurjpc/zwad007 (DOI)000913889800001 ()36631734 (PubMedID)2-s2.0-85151044376 (Scopus ID)
Funder
Region Västerbotten, ALFVLL-298001Region Västerbotten, ALFVLL-643391Swedish Research Council, 521-2013-2708Swedish Research Council, 2016-01891Swedish Heart Lung Foundation, 20150369Swedish Heart Lung Foundation, 20170481Swedish Society of MedicineThe Swedish Stroke AssociationAFA InsuranceVisare Norr
Available from: 2023-04-13 Created: 2023-04-13 Last updated: 2023-04-13Bibliographically approved
Bengtsson, A., Nyman, E., Grönlund, C., Wester, P., Näslund, U., Fhärm, E. & Norberg, M. (2023). Multi-view carotid ultrasound is stronger associated with cardiovascular risk factors than presence of plaque or single carotid intima media thickness measurements in subclinical atherosclerosis. The International Journal of Cardiovascular Imaging, 39(8), 1461-1471
Open this publication in new window or tab >>Multi-view carotid ultrasound is stronger associated with cardiovascular risk factors than presence of plaque or single carotid intima media thickness measurements in subclinical atherosclerosis
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2023 (English)In: The International Journal of Cardiovascular Imaging, ISSN 1569-5794, E-ISSN 1875-8312, Vol. 39, no 8, p. 1461-1471Article in journal (Refereed) Published
Abstract [en]

We aimed to explore the prevalence of atherosclerosis by using multi-view ultrasound examination of the carotid arteries and its association with clinical risk factors in a middle-aged population at low to intermediate risk of cardiovascular disease (CVD). Carotid vascular ultrasound was performed in 3532 participants in the VIPVIZA trial. Mean and maximal carotid intima media thickness (cIMT) at prespecified angles and plaque presence were examined on the left and right side. Associations between CVD risk factors and ultrasound variables were quantified by partial least squares (PLS) regression. A combined ultrasound variable was computed using weights of the first PLS component. Associations between CVD risk factors and the combined multi-view ultrasound variable, single cIMT and plaque measurements, respectively, were determined using linear regression modelling. The participants’ mean age was 55.7 years and 52.9% were women. Plaque prevalence was 51.1% in men and 39.0% in women. cIMT was higher in men than in women and in the left compared with the right carotid artery. The strongest association of CVD risk factors was observed with the combined multi-view ultrasound variable (R2 = 24%), compared with single cIMT variables (R2 = 14–18%) and plaque presence (R2 = 15%). The pattern was similar in both sexes. The association with CVD risk factors and the combined ultrasound variable was stronger in 40-year olds (R2 = 22%) compared with 50- or 60-year olds (R = 12%). CVD risk factors are stronger associated with a combined ultrasound variable than plaque presence or single cIMT measures suggesting that carotid multi-view ultrasonography better captures the focality of early atherosclerosis. Clinical Trial Registration: ClinicalTrials.gov, number NCT01849575. May 8, 2013.

Place, publisher, year, edition, pages
Springer Nature, 2023
Keywords
Atherosclerosis, Cardiovascular disease, Carotid intima media thickness, Carotid plaque, Carotid ultrasound
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-209575 (URN)10.1007/s10554-023-02868-0 (DOI)000998250600001 ()37249653 (PubMedID)2-s2.0-85160655052 (Scopus ID)
Funder
Visare NorrNorrbotten County CouncilUmeå UniversityThe Swedish Medical Association, SLS-405351The Swedish Medical Association, SLS-503111Swedish Research Council, 521-2013-2708
Available from: 2023-06-12 Created: 2023-06-12 Last updated: 2023-09-20Bibliographically approved
Andersson, E. M. & Norberg, M. (2023). Reactions for actions? Trust in protective behaviors and safeguarding measures in the early phase of the Covid-19 pandemic in Sweden. Preventive Medicine Reports, 32, Article ID 102133.
Open this publication in new window or tab >>Reactions for actions? Trust in protective behaviors and safeguarding measures in the early phase of the Covid-19 pandemic in Sweden
2023 (English)In: Preventive Medicine Reports, E-ISSN 2211-3355, Vol. 32, article id 102133Article in journal (Refereed) Published
Abstract [en]

To minimize the spread of Covid-19, changing every-day behavior has been key. Trust in the effectiveness of individual protective measures (response efficacy) and confidence in collective safeguarding measures (strategy efficacy), offers an incitement for acting adequately. Efficacy beliefs of protective measures might be especially relevant to study in the Swedish context, since Sweden, in contrast to countries facing hard lock-downs, launched safeguarding measures based on individual responsibility and voluntary actions. We aimed to assess associations between on the one hand, response efficacy and strategy efficacy, and on the other hand, propensity for behavior change and support of protective measures. Furthermore, to assess associations between the efficacy beliefs and comprehension of and confidence in information about the virus, prosocial beliefs and worry of Covid-19. Reactions were assessed in a Swedish sample close in time to experiences via the SEMA3 app from March 25th to May 17th 2020. Study participants had replied to questions on strategy efficacy (n = 175) or response efficacy (n = 157) and 146 participants had replied to both. High response efficacy was associated with propensity for behavior change, support of protective measures and confidence in Covid-19 information. Low strategy efficacy was associated with lower comprehension of and confidence in information about Covid-19. The results suggest that strengthening efficacy beliefs can be a way to promote protective behaviors. Furthermore, the result underscores the importance of information being easy to understand and trustworthy. Finding ways to increase public understanding of the effectiveness of protective measures, including vaccination, seems crucial in pandemic times.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
COVID-19, Health behavior, Prevention & control, Protective behaviors, Response efficacy, Safeguarding measures, Strategy efficacy, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-204993 (URN)10.1016/j.pmedr.2023.102133 (DOI)000995916900001 ()2-s2.0-85147865868 (Scopus ID)
Funder
Swedish Research Council, 2016-0189
Available from: 2023-03-03 Created: 2023-03-03 Last updated: 2023-09-05Bibliographically approved
Nyman, E., Grönlund, C., Vanoli, D., Liv, P., Norberg, M., Bengtsson, A., . . . Näslund, U. (2023). Reduced progression of carotid intima media thickness by personalised pictorial presentation of subclinical atherosclerosis in VIPVIZA: A randomised controlled trial. Clinical Physiology and Functional Imaging, 43(4), 232-241
Open this publication in new window or tab >>Reduced progression of carotid intima media thickness by personalised pictorial presentation of subclinical atherosclerosis in VIPVIZA: A randomised controlled trial
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2023 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 43, no 4, p. 232-241Article in journal (Refereed) Published
Abstract [en]

Objectives: Reduced progression of atherosclerosis can decrease the risk of cardiovascular disease (CVD). This study aimed at evaluating the effect of a pictorial intervention showing atherosclerotic severity on the progression of carotid atherosclerosis.

Methods: A prospective randomised open-label blinded end-point trial with participants aged 40–60 years enroled from a routine CVD prevention programme. The intervention group (n: 1575) and their treating physicians received an image based presentation of subclinical atherosclerotic severity measured by carotid ultrasound. The control group (n: 1579) did not receive any information about ultrasound results. Carotid ultrasound at baseline and at 3-year follow-up contained plaque detection and measurements of carotid intima media thickness (cIMT). The left, right and bilateral-mean-cIMT, plaque prevalence and total plaque area (TPA) at 3-year follow-up were compared between groups. Significance level was set to p = 0.01 to adjust for multiple comparisons.

Results: The intervention group revealed reduced cIMT progression in the left-mean-cIMT of −0.011 mm (p = 0.001) compared with the control group. The intervention effect on cIMT progression was most prominent in individuals with increased cIMT and plaque prevalence at baseline (−0.021 mm, p = 0.005). There were no differences in progression between groups for the right-and bilateral-mean-cIMT (−0.005 mm, p = 0.223 and −0.005 mm, p = 0.036, respectively), nor any differences between groups for plaque prevalence or TPA (odds ratio 0.88, p = 0.09 and 0.89, p = 0.21, respectively).

Conclusion: Pictorial presentation of subclinical atherosclerotic severity sent to both the individual and their treating physician resulted in significantly reduced left cIMT progression. Pictorial presentation has the potential to increase adherence in CVD prevention.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
adherence, intervention, prevention, randomised controlled trial, ultrasound imaging
National Category
Cardiac and Cardiovascular Systems Physiology
Identifiers
urn:nbn:se:umu:diva-204766 (URN)10.1111/cpf.12811 (DOI)000921350300001 ()36642849 (PubMedID)2-s2.0-85147282676 (Scopus ID)
Funder
Visare NorrSwedish Society of MedicineSwedish Heart Lung Foundation, 20150369Swedish Heart Lung Foundation, 20170481Swedish Research Council, 521‐2013‐2708Swedish Research Council, 2016‐01891Swedish Research Council, 2017‐02246Region Västerbotten, ALFVLL‐298001Region Västerbotten, ALFVLL643391
Available from: 2023-02-20 Created: 2023-02-20 Last updated: 2023-07-14Bibliographically approved
Näslund, U., Norberg, M. & Wennberg, P. (2023). The TANSNIP-PESA trial is not the end of the story [Letter to the editor]. European Heart Journal, 44(17), 1574-1574
Open this publication in new window or tab >>The TANSNIP-PESA trial is not the end of the story
2023 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 44, no 17, p. 1574-1574Article in journal, Letter (Refereed) Published
Abstract [en]

This commentary refers to 'Effects of a comprehensive lifestyle intervention on cardiovascular health: the TANSNIP-PESA trial', by I. Garcia-Lunar et al., https://doi.org/10.1093/eurheartj/ehac378 and the discussion piece 'Motivational interview and imaging of subclinical atherosclerosis for cardiovascular disease prevention: a winning combination?', by I. Garcia-Lunar et al., https://doi.org/10.1093/eurheartj/ehad126.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-209115 (URN)10.1093/eurheartj/ehad135 (DOI)000957569500001 ()36951199 (PubMedID)2-s2.0-85159249677 (Scopus ID)
Available from: 2023-06-07 Created: 2023-06-07 Last updated: 2023-06-07Bibliographically approved
Brunström, M., Ng, N., Dahlström, J., Lindholm, L. H., Norberg, M., Nyström, L., . . . Carlberg, B. (2022). Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease. Blood Pressure, 31(1), 31-39
Open this publication in new window or tab >>Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease
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2022 (English)In: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 31, no 1, p. 31-39Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. MATERIALS AND METHODS: Individuals ≥18 years with a blood pressure (BP) recording in Västerbotten or Södermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Västerbotten County (intervention) compared with Södermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. RESULTS: A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. CONCLUSIONS: This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
Keywords
antihypertensive treatment, continuous medical education, Hypertension, implementation science, primary care
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-192773 (URN)10.1080/08037051.2022.2041393 (DOI)000757622100001 ()35179089 (PubMedID)2-s2.0-85124775764 (Scopus ID)
Funder
Swedish Research Council, K2007-70X-20515-01-2Swedish Research Council, K2009-69X-20515-04-2Swedish Research Council, 2017-02246Västerbotten County CouncilSwedish Society for Medical Research (SSMF)
Available from: 2022-03-09 Created: 2022-03-09 Last updated: 2023-05-22Bibliographically approved
Nilsson Sommar, J., Norberg, M., Grönlund, C., Segersson, D., Näslund, U. & Forsberg, B. (2022). Long-term exposure to particulate air pollution and presence and progression of carotid artery plaques: A northern Sweden VIPVIZA cohort study. Environmental Research, 211, Article ID 113061.
Open this publication in new window or tab >>Long-term exposure to particulate air pollution and presence and progression of carotid artery plaques: A northern Sweden VIPVIZA cohort study
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2022 (English)In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 211, article id 113061Article in journal (Refereed) Published
Abstract [en]

AIMS: To estimate the association between long-term exposure to particulate air pollution and sub-clinical atherosclerosis based on the existence of plaque and the carotid intima-media thickness (cIMT).

METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a randomised controlled trial integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease (CVD) prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional CVD risk factors in Umeå municipality were eligible to participate. The 1425 participants underwent an ultrasound assessment of cIMT and plaque formation during the period 2013-2016 and at 3-year follow-up. Source-specific annual mean concentrations of particulate matter with aerodynamic diameter ≤10 μm (PM10) and ≤2.5 μm (PM2.5), and black carbon (BC) at the individual's residential address were modelled for the calendar years 1990, 2001 and 2011. Poisson regression was used to estimate prevalence ratios for presence of carotid artery plaques, and linear regression for cIMT.

RESULTS: The plaque prevalence was 43% at baseline and 47% at follow-up. An interquartile range (IQR) increase in PM10 (range in year 2011: 7.1-13.5 μg/m3) was associated with a prevalence ratio at baseline ultrasound of 1.11 (95% CI 0.99-1.25), 1.08 (95% CI 0.99-1.17), and 1.00 (95% CI 0.93-1.08) for lag 23, 12 and 2 years, and at follow-up 1.04 (95% CI 0.95-1.14), 1.08 (95% CI 1.00-1.16), and 1.01 (95% CI 0.95-1.08). Similar prevalence ratios per IQR were found for PM2.5 and BC, but with somewhat lower precision for the later. Particle concentrations were however not associated with the progression of plaque. No cross-sectional or longitudinal associations of change were found for cIMT.

CONCLUSIONS: This study of individuals with low/moderate risk for CVD give some additional support for an effect of long-term air pollution in early subclinical atherosclerosis.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Air pollution, Atherosclerosis, Carotid artery plaques, Carotid intima-media thickness, Cohort, Longitudinal
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-192989 (URN)10.1016/j.envres.2022.113061 (DOI)000793147100003 ()35257687 (PubMedID)2-s2.0-85127332287 (Scopus ID)
Available from: 2022-03-09 Created: 2022-03-09 Last updated: 2023-09-05Bibliographically approved
Projects
Direct visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention. A population based pragmatic randomised controlled trial within ordinary care [2013-02708_VR]; Umeå UniversityVIsualiZation of Asymptomatic atherosclerotic disease for optimun cardiovascular prevention ? VIPVIZA ? a RCT nested in routine care in Västerbotten Intervention Programme, Sweden [2016-01891_VR]; Umeå University; Publications
Kadeby, A. (2023). Performance Evaluation of Lumen Segmentation in Ultrasound Images. (Student paper). Umeå universitet
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2475-7131

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