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Background: The ABO blood group system has shown an association with cardiovascular disease. The susceptibility to CVD is proposed to be partly mediated by dyslipidaemia in non-O individuals. Previous studies are scarce for the RhD blood group, but we recently showed that RhD − young individuals are associated with subclinical atherosclerosis. Hence, we sought to examine whether the ABO blood groups and RhD factor are associated with dyslipidaemia.

Methods: All participants were part of the VIPVIZA study, including 3532 individuals with available plasma lipid levels. Lipids were assessed as total, LDL, HDL, remnant, non-HDL cholesterol and triglycerides. Information about ABO and RhD was retrieved by linking VIPVIZA with the SCANDAT-3 database, where 85% of VIPVIZA participants were registered.

Results: For the ABO blood groups, no significant differences in lipid levels between non-O and O individuals were seen. In 40-year-old males, RhD − individuals compared to RhD + had higher levels of non-HDL cholesterol, LDL cholesterol, and remnant cholesterol, with ratios of geometric means of 1.21 (CI95% 1.03; 1.43), 1.20 (1.02; 1.41) and 1.38 (1.00; 1.92), respectively. No differences in lipid levels depending on the RhD blood group were seen in women or the older age groups.

Conclusion: Our study indicates that younger RhD − men have increased non-HDL, LDL, and remnant cholesterol levels. Thus, the RhD blood group, but not ABO, seems to be associated with dyslipidaemia and may act as a future possible risk marker of cardiovascular disease.

Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population.

Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program.

Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively.

Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population.

OBJECTIVES: The study investigated the association between occupational biomechanical risk factors and the occurrence of thumb carpometacarpal joint osteoarthritis (CMC1 OA) in construction workers.

METHODS: Male construction workers (n=237 525), participating in a Swedish occupational surveillance programme between 1971 and 1993, were followed between 1997 and 2019. CMC1 OA diagnoses were identified through linkage with national medical registries. Job title, smoking status, height, weight and age were collected from the surveillance programme. A job exposure matrix (JEM) was developed with exposure estimates on biomechanical risk factors for each occupational group. Relative risk (RR) of CMC1 OA diagnosis was calculated using a Poisson regression model.

RESULTS: There was an increased risk of CMC1 OA for all biomechanical risk factors (RR range 1.3-1.5). Exposure-response patterns were seen for repetitive wrist flexion and extension (low: RR 1.30 (95% CI 1.07 to 1.59), moderate: 1.32 (95% CI 1.07 to 1.62), high: 1.45 (95% CI 1.19 to 1.75)), wrist extension (low: 1.31 (95% CI 1.09 to 1.59), moderate: 1.41 (95% CI 1.17 to 1.70) and heavy lifting (low: 1.13 (95% CI 0.92 to 1.38), moderate: 1.45 (95% CI 1.18 to 1.77), high: 1.50 (95% CI 1.24 to 1.82). Electricians (1.29 (95% CI 1.03 to 1.89)), concrete workers (1.31 (95% CI 1.02 to 1.67)), plumbers (1.37 (95% CI 1.07 to 1.76)), sheet-metal workers (1.58 (95% CI 1.18 to 2.10)), wood workers (1.66 (95% CI 1.36 to 2.03)), repairers (1.75 (95% CI 1.06 to 2.90)) and glass workers (2.21 (95% CI 1.42 to 3.44) had an increased risk of CMC1 OA compared with the reference group.

CONCLUSION: Wrist movements and hand loading were associated with CMC1 OA.

Aims: To study the importance of decreasing tobacco smoking on the occurrence of larynx cancer in men and women.

Methods: The incidence rates of larynx cancer in the Swedish population between 1970 and 2021 were retrieved from the Swedish Cancer Register for ages 50–84 years, stratified for sex, age and calendar year. Data on the population’s smoking habits was retrieved from surveys and from taxation on the sale of cigarettes. The occurrence of larynx cancer was compared to smoking habits, sex and age. The time trends were compared between larynx and lung cancer.

Results: Over the years, Swedish men and women have had different smoking habits, especially older persons during the 1970s. In 1963, the prevalence of current smokers in women 50–69 years was 11%, while it was 46% in men. Around 2020, less than 10% of men and women in all age groups were current smokers. However, men had higher incidence rates of larynx cancer than women, even when their smoking habits were similar. For example, men and women 60–64 years of age in 2017–2021 had similar smoking habits during their life but the relative risk of larynx cancer in men compared to women was 3.3 (95% CI 1.7–4.8). However, pipe smoking was much more common in men.

Conclusions: The study indicates that other causes than cigarette smoking have an impact on the occurrence of larynx cancer in Sweden. Pipe smoking and occupational exposure to carcinogenic materials such as asbestos may be underlying causes of the difference in cancer risk between Swedish men and women.

Background: The role of cognitive abilities in the development of arteriosclerotic disease is still not fully understood. The purpose of the present study was to evaluate the mediating role of lifestyle, socioeconomic status (SES) and conventional cardiovascular disease (CVD) risk factors in the association between cognitive ability at age 19 and subclinical atherosclerosis at age 60 years.

Methods: An observational study design was employed. Data on the results from cognitive tests of conscripts tested at age 19 were collected for 1009 men. At the age of 60, they were included in the trial VIsualiZation of asymptomatic Atherosclerotic disease for optimum cardiovascular prevention, which was conducted as part of the Västerbotten Intervention Program (VIPVIZA). VIPVIZA is a randomised controlled trial, aimed at primary prevention of CVD in Västerbotten County, Sweden. Prior to any intervention, they underwent carotid ultrasonography and CVD risk factor assessment. Lifestyle habits and marital status were self-reported, and education and urban or rural residency were registered. Crude associations between cognitive ability at age 19 and the risk of CVD, assessed with the European Systematic Coronary Risk Evaluation 2 (SCORE2), as well as subclinical atherosclerosis, as demonstrated by the presence of carotid plaques (no plaque, plaque unilateral, or plaque bilateral), were evaluated. A path-analytic model tested mediating factors from cognitive ability in young adulthood to subclinical atherosclerosis at age 60.

Results: Results from cognitive tests at age 19 were in separate unadjusted analyses inversely and linearly associated with SCORE2 and with subclinical atherosclerosis. The association with carotid plaque at age 60 was mainly indirect and mediated by adult SES, which in turn had its main effect through adherence to healthy lifestyle habits via CVD risk of carotid plaques.

Conclusions: Cognitive ability at age 19 is a factor that is upstream of adult SES and our study indicates that cognitive ability at a young age has long-term consequences via SES and lifestyle habits for CVD risk and atherosclerosis.

Decision-making for temporomandibular disorders (TMDs) is reported being a clinical challenge, partly due to uncertainities in assessment of long-term prognosis. Therefore, our aim was to explore variations over time in TMD symptoms and possible sex or age differences. In this cohort study, data were prospectively collected 2010-2017 from the general population in Västerbotten, Northern Sweden. Adults were eligible if they had undergone at least two routine dental check-ups that included screening for TMDs (3Q/TMD) from which states were defined as absence or presence of TMD pain and/or jaw catching/locking. The rate of transitions was estimated between TMD states within a time span of one year. A total of 94,769 individuals were included (49.9% women) with 205,684 repeated visits and 9,006 state transitions recorded over the 8-year period. Compared to men, women had higher rates of transitions from no TMDs to any TMD symptoms. Furthermore, women had a lower rate of transition from TMD pain only to no TMDs. The finding of a poorer prognosis in women, as well as previously reported potential gender differences in pain perception and reporting, reinforces that gender differences should be accounted for in the treatment planning stage for patients with onset of TMDs.

Background: The ABO blood group system has previously been associated with cardiovascular disease (CVD), where non-O blood group individuals have shown an increased risk. Studies assessing early atherosclerotic disease while also including RhD are few. We aimed to determine whether the ABO and RhD blood groups are associated with subclinical atherosclerosis in a healthy population.

Methods: We included 3532 participants from the VIPVIZA trial with available carotid ultrasonography results to assess subclinical disease. Information about blood groups was obtained from the SCANDAT-3 database, where 85% of VIPVIZA participants were registered.

Results: RhD− individuals aged 40 years showed increased carotid intima–media thickness (B 1.09 CI 95% 1.03; 1.14) compared to RhD+ individuals. For ABO, there were no differences in ultrasonography results when assessing the whole study population. However, 60-year-old individuals with heredity for CVD and a non-O blood group had decreased odds for carotid plaques (OR 0.54 CI 95% 0.33; 0.88).

Conclusions: RhD blood group is associated with subclinical atherosclerosis in younger individuals, indicating a role as a mediator in the atherosclerotic process. In addition, a non-O blood group was associated with decreased subclinical atherosclerosis in individuals aged 60 and with heredity (corresponding to the group with the highest atherosclerotic burden).

Purpose: Aortic stiffness, assessed as estimated aortic pulse wave velocity (aPWV), and carotid intima-media thickness (cIMT) are markers of vascular age, and carotid plaques are a marker of early atherosclerosis. In this cross-sectional study we aimed to investigate the association between aPWV, cIMT and plaques across different age groups and in women and men, in a middle-aged healthy population.

Materials and methods: Participants in the 6.5-year follow-up of the VIPVIZA trial who were aged 47, 57 and 67 underwent an oscillometric measurement which estimates aPWV between 2020 and 2023. Carotid ultrasound examinations were also performed. Linear and ordinal regression models were used to investigate how aPWV associates with cIMT and with carotid plaques, for the overall study group and stratified for age groups and sex.

Results: A total of 1046 subjects were included in the analyses. Linear associations between aPWV and cIMT (β = 0.018, 95% CI: 0.006–0.030, p = 0.003), and between aPWV and plaques (OR: 1.19, 95% CI: 1.03–1.38, p = 0.018), were seen in the 57-year-olds. In the 47-year-olds a significant association was seen between aPWV and plaques (OR: 2.98 95% CI: 1.44–6.14, p = 0.003). No significant associations were seen in the 67-year-olds. For women, a significant association between aPWV and cIMT (β = 0.011, 95% CI: 0.004–0.017, p = 0.002) was shown.

Conclusion: Estimated aPWV was positively associated with increasing cIMT and the presence of carotid plaques in younger middle-aged individuals, and with cIMT in women, suggesting that measurement of estimated aPWV may improve cardiovascular risk assessment in younger middle-aged individuals and women.

Clinical Trial Registration date 8 May 2013: URL: www.clinicaltrials.gov. Unique identifier: NCT01849575.

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.

Background: The objective is to estimate the importance of the decrease of smoking habits in Sweden for the occurrence of lung cancer.

Methods: The change in smoking habits in the general population was retrieved from surveys and on taxation of sale of cigarettes. We used data from the Swedish Cancer Register on incidence of lung cancer between 1970 and 2021, stratified for sex, age and cell type, and compared the occurrence overtime in ages between 40 and 84 years.

Results: The sale of cigarettes peaked in 1980 to 1800 cigarettes per person and decreased to 600 per person in 2021. The change in incidence rates of squamous cell cancer and other cell types varied over time, sex, and age in a pattern that partly seems to be explained by change in the prevalence of daily smokers. The incidence of adenocarcinoma was similar in men and women 1970–2021 and increased, e.g. for women and men 75–79 years of age from around 20 cases in early 1970s to around 120 cases per 100 000 person-years in the 2020s.

Conclusions: Our data indicate that the risk of lung cancer several years after smoking cessation is less favourable than previously studies have indicated. There is a similar increase in the incidence of adenocarcinoma in men and women which is hard to explain only with changing smoking habits. The change from non-filter to filter cigarettes in the 1960s–1970s may be a contributing factor.