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  • 1. Aleksandrova, Krasimira
    et al.
    Boeing, Heiner
    Jenab, Mazda
    Bueno-de-Mesquita, H. Bas
    Jansen, Eugene
    van Duijnhoven, Franzel J. B.
    Rinaldi, Sabina
    Fedirko, Veronika
    Romieu, Isabelle
    Riboli, Elio
    Gunter, Marc J.
    Westphal, Sabine
    Overvad, Kim
    Tjonneland, Anne
    Halkjaer, Jytte
    Racine, Antoine
    Boutron-Ruault, Marie-Christine
    Clavel-Chapelon, Francoise
    Kaaks, Rudolf
    Lukanova, Annekatrin
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Mattiello, Amalia
    Pala, Valeria
    Palli, Domenico
    Tumino, Rosario
    Vineis, Paolo
    Buckland, Genevieve
    Sanchez, Maria-Jose
    Amiano, Pilar
    Maria Huerta, Jose
    Barricarte, Aurelio
    Menendez, Virginia
    Peeters, Petra H.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Allen, Naomi E.
    Crowe, Francesca L.
    Khaw, Kay-Tee
    Wareham, Nickolas
    Pischon, Tobias
    Leptin and soluble leptin receptor in risk of colorectal cancer in the European prospective investigation into Cancer and nutrition cohort2012Inngår i: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 72, nr 20, s. 5328-5337Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Leptin, a peptide hormone produced primarily by the adipocytes, is hypothesized to play a role in the pathogenesis of colorectal cancer (CRC). Soluble leptin receptor (sOB-R) may regulate leptin's physiologic functions; however its relation to CRC risk is unknown. This study explored the association of leptin and sOB-R with risk of CRC in a prospective nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. A total of 1,129 incident CRC cases (713 colon, 416 rectal) were matched within risk sets to 1,129 controls. Conditional logistic regression was used to calculate relative risks (RR) and 95% confidence intervals (CI). After multivariable adjustment including body mass index (BMI), waist circumference, and baseline leptin concentrations, sOB-R was strongly inversely associated with CRC (RR comparing the highest quintile vs. the lowest, 0.55; 95% CI, 0.40-0.76; P-trend = 0.0004) and colon cancer (RR, 0.42; 95% CI, 0.28-0.63, P-trend = 0.0001); whereas no association was seen for rectal cancer (RR adjusted for BMI and waist circumference, 0.83; 95% CI, 0.48-1.44, P-trend = 0.38). In contrast, leptin was not associated with risk of CRC (RR adjusted for BMI and waist circumference, 0.85; 95% CI, 0.56-1.29, P-trend = 0.23). Additional adjustments for circulating metabolic biomarkers did not attenuate these results. These novel findings suggest a strong inverse association between circulating sOB-R and CRC risk, independent of obesity measures, leptin concentrations, and other metabolic biomarkers. Further research is needed to confirm the potentially important role of sOB-R in CRC pathogenesis. Cancer Res; 72(20); 5328-37. (C) 2012 AACR.

  • 2.
    Almevall, Albin Dahlin
    et al.
    Department of Health Science, Luleå University of Technology, Luleå, Sweden; Department of Healthcare, Region Norrbotten, Luleå, Sweden.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Zingmark, Karin
    Department of Health Science, Luleå University of Technology, Luleå, Sweden.
    Öhlin, Jerry
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Nordmark, Sofi
    Department of Health Science, Luleå University of Technology, Luleå, Sweden.
    Niklasson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Associations between everyday physical activity and morale in older adults2022Inngår i: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 48, s. 37-42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Studies that objectively investigate patterns of everyday physical activity in relation to well-being and that use measures specific to older adults are scarce. This study aimed to explore objectively measured everyday physical activity and sedentary behavior in relation to a morale measure specifically constructed for older adults. A total of 77 persons (42 women, 35 men) aged 80 years or older (84.3 ± 3.8) wore an accelerometer device for at least 5 days. Morale was measured with the Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS scores were significantly positively associated with number of steps, time spent stepping, and time spent stepping at >75 steps per minute. Sedentary behavior did not associate with PGCMS. Promoting PA in the form of walking at any intensity–or even spending time in an upright position—and in any quantity may be important for morale, or vice versa, or the influence may be bidirectional.

    Fulltekst (pdf)
    fulltext
  • 3.
    Almevall, Ariel
    et al.
    Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden.
    Dahlin Almevall, Albin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Öhlin, Jerry
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Zingmark, Karin
    Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden.
    Niklasson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Rosendahl, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi. Umeå universitet, Medicinska fakulteten, Institutionen för diagnostik och intervention.
    Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort2024Inngår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 122, artikkel-id 105392Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population.

    Aim: To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival.

    Methods: All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests.

    Findings: Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05).

    Conclusion: This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population.

    Fulltekst (pdf)
    fulltext
  • 4.
    Amadou, Amina
    et al.
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, Lyon, France; Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France.
    Freisling, Heinz
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, Lyon, France.
    Jenab, Mazda
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, Lyon, France.
    Tsilidis, Konstantinos K.
    Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
    Trichopoulou, Antonia
    Hellenic Health Foundation, Athens, Greece.
    Boffetta, Paolo
    Stony Brook Cancer Center, Stony Brook University, NY, Stony Brook, United States; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
    van Guelpen, Bethany
    Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM). Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Mokoroa, Olatz
    Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain.
    Wilsgaard, Tom
    Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Kee, Frank
    Institute for Health Sciences Risk and Inequality, Centre for Public Health, Belfast, United Kingdom.
    Schöttker, Ben
    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Ordóñez-Mena, José M.
    Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, United Kingdom; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
    Männistö, Satu
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Vermeulen, Roel C. H.
    Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, Netherlands.
    Quirós, J. Ramón
    Public Health Directorate, Asturias, Spain.
    Liao, Linda M.
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, MD, Bethesda, United States.
    Sinha, Rashmi
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, MD, Bethesda, United States.
    Kuulasmaa, Kari
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Brenner, Hermann
    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
    Romieu, Isabelle
    International Agency for Research on Cancer (IARC/WHO), Nutrition and Metabolism Branch, Lyon, France.
    Prevalent diabetes and risk of total, colorectal, prostate and breast cancers in an ageing population: meta-analysis of individual participant data from cohorts of the CHANCES consortium2021Inngår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 124, nr 11, s. 1882-1890Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: We investigated whether associations between prevalent diabetes and cancer risk are pertinent to older adults and whether associations differ across subgroups of age, body weight status or levels of physical activity.

    Methods: We harmonised data from seven prospective cohort studies of older individuals in Europe and the United States participating in the CHANCES consortium. Cox proportional hazard regression was used to estimate the associations of prevalent diabetes with cancer risk (all cancers combined, and for colorectum, prostate and breast). We calculated summary risk estimates across cohorts using pooled analysis and random-effects meta-analysis.

    Results: A total of 667,916 individuals were included with an overall median (P25–P75) age at recruitment of 62.3 (57–67) years. During a median follow-up time of 10.5 years, 114,404 total cancer cases were ascertained. Diabetes was not associated with the risk of all cancers combined (hazard ratio (HR) = 0.94; 95% confidence interval (CI): 0.86–1.04; I2 = 63.3%). Diabetes was positively associated with colorectal cancer risk in men (HR = 1.17; 95% CI: 1.08–1.26; I2 = 0%) and a similar HR in women (1.13; 95% CI: 0.82–1.56; I2 = 46%), but with a confidence interval including the null. Diabetes was inversely associated with prostate cancer risk (HR = 0.81; 95% CI: 0.77–0.85; I2 = 0%), but not with postmenopausal breast cancer (HR = 0.96; 95% CI: 0.89–1.03; I2 = 0%). In exploratory subgroup analyses, diabetes was inversely associated with prostate cancer risk only in men with overweight or obesity.

    Conclusions: Prevalent diabetes was positively associated with colorectal cancer risk and inversely associated with prostate cancer risk in older Europeans and Americans.

  • 5.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Karpe, Fredrik
    NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK.
    Sjöström, Lars-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Riklund, Katrine
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Association of adipose tissue blood flow with fat depot sizes and adipokines in women2012Inngår i: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 36, nr 6, s. 783-789Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore possible associations between adipose tissue (AT) blood flow (ATBF), AT depot sizes and adipocyte-derived hormones (adipokines) in women.

    Subjects: In all, 43 healthy women were divided into four groups: normal-weight (n=11) and obese (n=11) pre-menopausal women and normal-weight (n=10) and obese (n=11) post-menopausal women.

    Methods: Fasting levels of adipokines were obtained, and a single-slice computed tomography scan at the level of L4-L5 was used to estimate fat depot sizes. ATBF was assessed by xenon washout while in a fasting state and after oral glucose load. We also measured glucose, insulin and non-esterified fatty acids.

    Results: Total, subcutaneous and visceral AT areas strongly correlated with ATBF (all P<0.001). Circulating leptin levels strongly and inversely correlated with ATBF (P=0.001), but this association did not remain after adjustment for body mass index. Adiponectin was not associated with blood flow.

    Conclusion: ATBF is closely linked to subcutaneous and visceral AT size. Further analyses are needed to determine possible mediators of this association, including mechanistic studies to assess a putative role for leptin as a significant modulator of blood flow. International Journal of Obesity advance online publication, 26 July 2011; doi:10.1038/ijo.2011.152.

    Fulltekst (pdf)
    fulltext
  • 6.
    Andersson, T. A.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Larsen, F.
    Karolinska Inst, Stockholm, Sweden.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Pulmonary embolism in Sweden, a national cohort and survival analysis2012Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, nr suppl. 1, s. 29-29Artikkel i tidsskrift (Annet vitenskapelig)
  • 7.
    Andersson, T.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Larsen, F.
    Soderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Searching for CTEPH: a Swedish National Follow-Up after en Episode of Acute Pulmonary Embolism2016Inngår i: The Journal of Heart and Lung Transplantation, ISSN 1053-2498, E-ISSN 1557-3117, Vol. 35, nr 4, s. S149-S149Artikkel i tidsskrift (Annet vitenskapelig)
  • 8.
    Andersson, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Isaksson, Anja
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Khalil, Hesham
    Department of Cardiology, King Fahad General Hospital, Jeddah, Saudi Arabia.
    Lapidus, Leif
    Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Validation of the Swedish National Inpatient Register for the diagnosis of pulmonary embolism in 20052022Inngår i: Pulmonary Circulation, ISSN 2045-8932, E-ISSN 2045-8940, Vol. 12, nr 1, artikkel-id e12037Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Swedish National Inpatient Register (NPR) has near-complete coverage of in-hospital admissions and ICD codes in Sweden. Acute pulmonary embolism (PE) is a serious condition presenting challenges regarding diagnosis, treatment, and follow-up. Here we aimed to validate the accuracy of acute PE diagnosis in the NPR, investigational findings, antithrombotic treatment, and follow-up of PE patients in Sweden. From a nation-wide cohort of all patients with in-hospital diagnoses of acute PE (ICD-10-SE codes I26.0–I26.9) in 2005 (n = 5793), we selected those from two Swedish regions for thorough manual review of hospital records. We identified 599 patients with PE diagnoses according to the ICD-10 coding system. We excluded 58 patients with admissions related to previous PE (47; 8%) or incorrect ICD codes (11; 2%), leaving 501 patients with probable PE diagnoses. We confirmed the diagnosis in 441 (79%) cases, which was based on imaging (435 patients; 73%) or autopsy (6; 1%). In the remaining 60 (11%) cases, the PE diagnosis was based on clinical findings and can therefore not be confirmed. Of the surviving patients with PE, 231 (47%) were offered follow-up within 6 months after the acute event. At follow-up, 67 patients (29%) had symptoms requiring clinical attention (dyspnoea or reduced general condition). The Swedish NPR showed acceptable accuracy for PE diagnosis, and could be reliably used for register-based research regarding acute PE.

    Fulltekst (pdf)
    fulltext
  • 9.
    Andersson, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Nilsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Larsen, Flemming
    Department of Molecular Medicine and Surgery, Section of Clinical Physiology, Karolinska Institute, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Long-term sequelae following acute pulmonary embolism: a nationwide follow-up study regarding the incidence of CTEPH, dyspnea, echocardiographic and V/Q scan abnormalities2023Inngår i: Pulmonary Circulation, ISSN 2045-8932, E-ISSN 2045-8940, Vol. 13, nr 4, artikkel-id e12306Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We aimed to follow a nationwide cohort of patients with pulmonary embolism (PE) without any exclusions to generate information regarding long-term symptoms, investigational findings and to determine the prevalence of chronic thromboembolic pulmonary hypertension (CTEPH). We hypothesized that this approach would yield generalizable estimates of CTEPH prevalence and incidence. All individuals diagnosed with acute PE in Sweden in 2005 were identified using the National Patient Register. In 2007, survivors were asked to complete a questionnaire regarding current symptoms. Those with dyspnea were referred for further examinations with laboratory tests, electrocardiogram (ECG), and a ventilation/perfusion scan (V/Q scan). If CTEPH was suspected, a referral to the nearest pulmonary arterial hypertension-center was recommended. Of 5793 unique individuals with PE diagnosis in 2005, 3510 were alive at the beginning of 2007. Altogether 53% reported dyspnea at some degree whereof a large proportion had V/Q scans indicating mismatched defects. Further investigation revealed 6 cases of CTEPH and in parallel 18 cases were diagnosed outside this study. The overall prevalence of CTEPH was 0.4% (95% confidence interval [CI]: 0.2%–0.6%) and 0.7% (95% CI: 0.4%–1.0%) among the survivors. The cumulative incidence of CTEPH in the group of patients who underwent a V/Q scan was 1.1% (95% CI: 0.2%–2.0%). There was a high mortality following an acute PE, a high proportion of persistent dyspnea among survivors, whereof several had pathological findings on V/Q scans and echocardiography. Only a minority developed CTEPH, indicating that CTEPH is the tip of the iceberg of post-PE disturbances.

    Fulltekst (pdf)
    fulltext
  • 10.
    Andersson, Therese
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Incidence of acute pulmonary embolism, related comorbidities and survival: analysis of a Swedish national cohort2017Inngår i: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 17, artikkel-id 155Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The aim of the study was to determine the incidence of acute pulmonary embolism (PE) in Sweden and any regional differences. To assess short-and long-term survival analysis after an episode of PE, before and after excluding patients with known malignancies, and to determine the most common comorbidities prior to the PE event. Methods: All in-hospital patients, including children, diagnosed with acute PE in 2005 were retrieved from the Swedish National Patient Registry (NPR) and incidence rates were calculated. All registered comorbidities from 1998 until the index events were collected and survival up to 4 years after the event were calculated and compared to matched controls. Results: There were 5793 patients of all ages diagnosed with acute PE in 2005 resulting in a national incidence of 0.6/1000/year. The mean age was 70 years and 52% were women. The most frequent comorbidities were cardiac-, vascular-, infectious-and gastrointestinal diseases, injuries and malignancies. The mortality rates were more than doubled in patients with recent PE compared to that in a matched control group (49.1% vs 21.9%), and the excess mortality remained after exclusion of deaths occurring within one year and after exclusion of patients with any malignancy prior to the event. Conclusions: PE is associated with high age as well as with multiple comorbidities, and with an increased shortand long-term mortality. This study highlights the importance of a proper follow-up after an acute PE.

    Fulltekst (pdf)
    fulltext
  • 11.
    Arnold, Natalie
    et al.
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Blaum, Christopher
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Goßling, Alina
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Brunner, Fabian J.
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Bay, Benjamin
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Ferrario, Marco M.
    Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Brambilla, Paolo
    Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
    Cesana, Giancarlo
    Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
    Leoni, Valerio
    Laboratory of Clinical Pathology, Hospital Pio XI of Desio, ASST Brianza, School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
    Palmieri, Luigi
    Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità-ISS, Rome, Italy.
    Donfrancesco, Chiara
    Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità-ISS, Rome, Italy.
    Padró, Teresa
    Cardiovascular-Program ICCC, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
    Andersson, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Jousilahti, Pekka
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Ojeda, Francisco
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Zeller, Tanja
    German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany.
    Linneberg, Allan
    Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Iacoviello, Licia
    Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Gianfagna, Francesco
    Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Mediterranea Cardiocentro, Naples, Italy.
    Sans, Susana
    Catalan Department of Health, Barcelona, Spain.
    Veronesi, Giovanni
    Research Center in Epidemiology and Preventive Medicine-EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Thorand, Barbara
    Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
    Peters, Annette
    Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, Ludwig-Maximilians University of Munich, Munich, Germany; German Center for Cardiovascular Disease Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.
    Tunstall-Pedoe, Hugh
    Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom.
    Kee, Frank
    Centre for Public Health, Queens University of Belfast, Northern Ireland, Belfast, United Kingdom.
    Salomaa, Veikko
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Schnabel, Renate B.
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Kuulasmaa, Kari
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Blankenberg, Stefan
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Koenig, Wolfgang
    German Center for Cardiovascular Disease Research (DZHK), partner site Munich Heart Alliance, Munich, Germany; German Heart Center, Munich, Technical University of Munich, Lazarettstr. 36, Munich, Germany; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
    Waldeyer, Christoph
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany; Center for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    C-reactive protein modifies lipoprotein(a)-related risk for coronary heart disease: the BiomarCaRE project2024Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 45, nr 12, s. 1043-1054Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Aims: Recent investigations have suggested an interdependence of lipoprotein(a) [Lp(a)]-related risk for cardiovascular disease with background inflammatory burden. The aim the present analysis was to investigate whether high-sensitive C-reactive protein (hsCRP) modulates the association between Lp(a) and coronary heart disease (CHD) in the general population.

    Methods: Data from 71 678 participants from 8 European prospective population-based cohort studies were used (65 661 without/6017 with established CHD at baseline; median follow-up 9.8/13.8 years, respectively). Fine and Gray competing risk-adjusted models were calculated according to accompanying hsCRP concentration (<2 and ≥2 mg/L).

    Results: Among CHD-free individuals, increased Lp(a) levels were associated with incident CHD irrespective of hsCRP concentration: fully adjusted sub-distribution hazard ratios [sHRs (95% confidence interval)] for the highest vs. lowest fifth of Lp(a) distribution were 1.45 (1.23-1.72) and 1.48 (1.23-1.78) for a hsCRP group of <2 and ≥2 mg/L, respectively, with no interaction found between these two biomarkers on CHD risk (Pinteraction = 0.82). In those with established CHD, similar associations were seen only among individuals with hsCRP ≥ 2 mg/L [1.34 (1.03-1.76)], whereas among participants with a hsCRP concentration <2 mg/L, there was no clear association between Lp(a) and future CHD events [1.29 (0.98-1.71)] (highest vs. lowest fifth, fully adjusted models; Pinteraction = 0.024).

    Conclusions: While among CHD-free individuals Lp(a) was significantly associated with incident CHD regardless of hsCRP, in participants with CHD at baseline, Lp(a) was related to recurrent CHD events only in those with residual inflammatory risk. These findings might guide adequate selection of high-risk patients for forthcoming Lp(a)-targeting compounds.

  • 12.
    Barath, Stefan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Mills, Nicholas L
    Lundbäck, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Törnqvist, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Lucking, Andrew J
    Langrish, Jeremy P
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Boman, Christoffer
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för tillämpad fysik och elektronik, Energiteknik och termisk processkemi.
    Westerholm, Roger
    Löndahl, Jakob
    Donaldson, Ken
    Mudway, Ian S
    Sandström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Newby, David E
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Impaired vascular function after exposure to diesel exhaust generated at urban transient running conditions2010Inngår i: Particle and Fibre Toxicology, E-ISSN 1743-8977, Vol. 7, nr 1, s. 19-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Traffic emissions including diesel engine exhaust are associated with increased respiratory and cardiovascular morbidity and mortality. Controlled human exposure studies have demonstrated impaired vascular function after inhalation of exhaust generated by a diesel engine under idling conditions.

    OBJECTIVES: To assess the vascular and fibrinolytic effects of exposure to diesel exhaust generated during urban-cycle running conditions that mimic ambient 'real-world' exposures.

    METHODS: In a randomised double-blind crossover study, eighteen healthy male volunteers were exposed to diesel exhaust (approximately 250 mug/m3) or filtered air for one hour during intermittent exercise. Diesel exhaust was generated during the urban part of the standardized European Transient Cycle. Six hours post-exposure, vascular vasomotor and fibrinolytic function was assessed during venous occlusion plethysmography with intra-arterial agonist infusions.

    MEASUREMENTS AND MAIN RESULTS: Forearm blood flow increased in a dose-dependent manner with both endothelial-dependent (acetylcholine and bradykinin) and endothelial-independent (sodium nitroprusside and verapamil) vasodilators. Diesel exhaust exposure attenuated the vasodilatation to acetylcholine (P < 0.001), bradykinin (P < 0.05), sodium nitroprusside (P < 0.05) and verapamil (P < 0.001). In addition, the net release of tissue plasminogen activator during bradykinin infusion was impaired following diesel exhaust exposure (P < 0.05).

    CONCLUSION: Exposure to diesel exhaust generated under transient running conditions, as a relevant model of urban air pollution, impairs vasomotor function and endogenous fibrinolysis in a similar way as exposure to diesel exhaust generated at idling. This indicates that adverse vascular effects of diesel exhaust inhalation occur over different running conditions with varying exhaust composition and concentrations as well as physicochemical particle properties. Importantly, exposure to diesel exhaust under ETC conditions was also associated with a novel finding of impaired of calcium channel-dependent vasomotor function. This implies that certain cardiovascular endpoints seem to be related to general diesel exhaust properties, whereas the novel calcium flux-related effect may be associated with exhaust properties more specific for the ETC condition, for example a higher content of diesel soot particles along with their adsorbed organic compounds.

    Fulltekst (pdf)
    FULLTEXT01
  • 13.
    Benckert, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lilja, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Eliasson, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Improved metabolic health among the obesein six population surveys 1986 to 2009: the Northern Sweden MONICA study2015Inngår i: BMC Obesity, ISSN 2052-9538, Vol. 2, nr 7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    The incidence of CVD is decreasing in spite of increasing BMI in the population. We examined trends in metabolic health among overweight and obese individuals and the influence of lifestyle and socioeconomic status. Six cross sectional population surveys in the Northern Sweden MONICA Study between 1986 and 2009. 8 874 subjects 25 to 64 years participated (74% participation rate). Metabolic health was defined as a total cholesterol level below 5.0 mmol/l, blood pressure below 140/90 mmHg and not having diabetes. In 2009 the age span 25 to 74 years was studied.

    Results

    The prevalence of metabolic health among obese subjects increased by 7.9 % per year (95% confidence interval 5.4; 10.5), reaching 21.0% in 2009. The corresponding figures for overweight subjects were 5.9% per year (4.6; 7.3), reaching 18% in 2009, whereas for the normal-weight subjects, the increase was 6.2% per year (5.3; 7.2), reaching 39% in 2009. The prevalence of metabolic health among subjects with abdominal obesity increased by 5.8% (4.6; 7.0) per year, reaching 17.3% in 2009. Among those with no abdominal obesity the increase was 6.2% (5.2; 7.1), reaching 38% in 2009 (p = <0.001 for all groups). Only among non-obese men and obese women did the increase continue between 2004 and 2009. In the other groups a slight decline or levelling off was noted.

    In 2009 women had a 27% higher prevalence of metabolic health than men. The prevalence of metabolic health among the obese was 19.8% which declined to 15.8% if subjects treated for hypertension or hypercholesterolemia were classified as not healthy. Overweight and obese subjects were less often metabolically healthy (odds ratio 0.54 and 0.59 respectively) compared with normal-weight subjects, independent of sex and age as were subjects with abdominal obesity (odds ratio 0.52). Adjustments for smoking, physical activity and education level did not influence any estimates.

    Conclusions

    This report shows a large increase in prevalence of metabolic health from 1986 to 2009 for all anthropometric categories. Metabolic health remains considerably less prevalent among overweight and obese subjects than among those with normal weight.

    Fulltekst (pdf)
    fulltext
  • 14. Benedict, Christian
    et al.
    Axelsson, Tomas
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Heart Centre.
    Larsson, Anders
    Ingelsson, Erik
    Lind, Lars
    Schioeth, Helgi B.
    Fat Mass and Obesity-Associated Gene (FTO) Is Linked to Higher Plasma Levels of the Hunger Hormone Ghrelin and Lower Serum Levels of the Satiety Hormone Leptin in Older Adults2014Inngår i: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 63, nr 11, s. 3955-3959Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The mechanisms through which common polymorphisms in the fat mass and obesity-associated gene (FTO) drive the development of obesity in humans are poorly understood. Using cross-sectional data from 985 older people (50% females) who participated at age 70 years in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS), circulating levels of ghrelin and leptin were measured after an overnight fast. In addition, subjects were genotyped for FTO rs17817449 (AA, n = 345 [35%]; AC/CA, n = 481 [48.8%]; CC, n = 159 [16.1%]). Linear regression analyses controlling for sex, selfreported physical activity level, fasting plasma glucose, and BMI were used. A positive relationship between the number of FTO C risk alleles and plasma ghrelin levels was found (P = 0.005; relative plasma ghrelin difference between CC and AA carriers = similar to 9%). In contrast, serum levels of the satiety-enhancing hormone leptin were inversely linked to the number of FTO C risk alleles (P = 0.001; relative serum leptin difference between CC and AA carriers = similar to 11%). These associations were also found when controlling for waist circumference. The present findings suggest that FTO may facilitate weight gain in humans by shifting the endocrine balance from the satiety hormone leptin toward the hunger-promoting hormone ghrelin.

  • 15. Bentham, James
    et al.
    Di Cesare, Mariachiara
    Stevens, Gretchen A.
    Zhou, Bin
    Bixby, Honor
    Cowan, Melanie
    Fortunato, Lea
    Bennett, James E.
    Danaei, Goodarz
    Hajifathalian, Kaveh
    Lu, Yuan
    Riley, Leanne M.
    Laxmaiah, Avula
    Kontis, Vasilis
    Paciorek, Christopher J.
    Riboli, Elio
    Ezzati, Majid
    Abdeen, Ziad A.
    Hamid, Zargar Abdul
    Abu-Rmeileh, Niveen M.
    Acosta-Cazares, Benjamin
    Adams, Robert
    Aekplakorn, Wichai
    Aguilar-Salinas, Carlos A.
    Agyemang, Charles
    Ahmadvand, Alireza
    Ahrens, Wolfgang
    Al-Hazzaa, Hazzaa M.
    Al-Othman, Amani Rashed
    Al Raddadi, Rajaa
    Ali, Mohamed M.
    Alkerwi, Ala'a
    Alvarez-Pedrerol, Mar
    Aly, Eman
    Amouyel, Philippe
    Amuzu, Antoinette
    Andersen, Lars Bo
    Anderssen, Sigmund A.
    Anjana, Ranjit Mohan
    Aounallah-Skhiri, Hajer
    Ariansen, Inger
    Aris, Tahir
    Arlappa, Nimmathota
    Arveiler, Dominique
    Assah, Felix K.
    Avdicova, Maria
    Azizi, Fereidoun
    Babu, Bontha V.
    Bahijri, Suhad
    Balakrishna, Nagalla
    Bandosz, Piotr
    Banegas, Jose R.
    Barbagallo, Carlo M.
    Barcelo, Alberto
    Barkat, Amina
    Barros, Mauro V.
    Bata, Iqbal
    Batieha, Anwar M.
    Batista, Rosangela L.
    Baur, Louise A.
    Beaglehole, Robert
    Ben Romdhane, Habiba
    Benet, Mikhail
    Bernabe-Ortiz, Antonio
    Bernotine, Gailute
    Bettiol, Heloisa
    Bhagyalaxmi, Aroor
    Bharadwaj, Sumit
    Bhargava, Santosh K.
    Bhatti, Zaid
    Bhutta, Zulfiqar A.
    Bi, Hongsheng
    Bi, Yufang
    Bjerregaard, Peter
    Bjertness, Espen
    Bjertness, Marius B.
    Bjorkelund, Cecilia
    Blokstra, Anneke
    Bo, Simona
    Bobak, Martin
    Boddy, Lynne M.
    Boehm, Bernhard O.
    Boeing, Heiner
    Boissonnet, Carlos P.
    Bongard, Vanina
    Bovet, Pascal
    Braeckman, Lutgart
    Bragt, Marjolijn C. E.
    Brajkovich, Imperia
    Branca, Francesco
    Breckenkamp, Juergen
    Brenner, Hermann
    Brewster, Lizzy M.
    Brian, Garry R.
    Bruno, Graziella
    Bueno-de-Mesquita, H. B(as)
    Bugge, Anna
    Burns, Con
    Cabrera de Leon, Antonio
    Cacciottolo, Joseph
    Cama, Tilema
    Cameron, Christine
    Camolas, Jose
    Can, Gunay
    Candido, Ana Paula C.
    Capuano, Vincenzo
    Cardoso, Viviane C.
    Carlsson, Axel C.
    Carvalho, Maria J.
    Casanueva, Felipe F.
    Casas, Juan-Pablo
    Caserta, Carmelo A.
    Chamukuttan, Snehalatha
    Chan, Angelique W.
    Chan, Queenie
    Chaturvedi, Himanshu K.
    Chaturvedi, Nishi
    Chen, Chien-Jen
    Chen, Fangfang
    Chen, Huashuai
    Chen, Shuohua
    Chen, Zhengming
    Cheng, Ching-Yu
    Chetrit, Angela
    Chiolero, Arnaud
    Chiou, Shu-Ti
    Chirita-Emandi, Adela
    Cho, Belong
    Cho, Yumi
    Christensen, Kaare
    Chudek, Jerzy
    Cifkova, Renata
    Claessens, Frank
    Clays, Els
    Concin, Hans
    Cooper, Cyrus
    Cooper, Rachel
    Coppinger, Tara C.
    Costanzo, Simona
    Cottel, Dominique
    Cowell, Chris
    Craig, Cora L.
    Crujeiras, Ana B.
    D'Arrigo, Graziella
    d'Orsi, Eleonora
    Dallongeville, Jean
    Damasceno, Albertino
    Damsgaard, Camilla T.
    Dankner, Rachel
    Dauchet, Luc
    De Backer, Guy
    De Bacque, Dirk
    de Gaetano, Giovanni
    De Hanauw, Stefaan
    De Smedt, Delphine
    Deepa, Mohan
    Deev, Alexander D.
    Dehghan, Abbas
    Delisle, Helene
    Delpeuch, Francis
    Deschamps, Valerie
    Dhana, Klodian
    Di Castelnuovo, Augusto F.
    Dias-da-Costa, Juvenal Soares
    Diaz, Alejandro
    Djalalinia, Shirin
    Do, Ha T. P.
    Dobson, Annette J.
    Donfrancesco, Chiara
    Donoso, Silvana P.
    Doering, Angela
    Doua, Kouamelan
    Drygas, Wojciech
    Dzerve, Vilnis
    Egbagbe, Eruke E.
    Eggertsen, Robert
    Ekelund, Ulf
    El Ati, Jalila
    Elliott, Paul
    Engle-Stone, Reina
    Erasmus, Rajiv T.
    Erem, Cihangir
    Eriksen, Loise
    Escobedo-de la Pena, Jorge
    Evans, Alun
    Faeh, David
    Fall, Caroline H.
    Farzadfar, Farshad
    Felix-Redondo, Francisco J.
    Ferguson, Trevor S.
    Fernandez-Berges, Daniel
    Ferrante, Daniel
    Ferrari, Marika
    Ferreccio, Catterina
    Ferrieres, Jean
    Finn, Joseph D.
    Fischer, Krista
    Monterubio Flores, Eric
    Foeger, Bernhard
    Foo, Leng Huat
    Forslund, Ann-Sofie
    Forsner, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Högskolan Dalarna.
    Fortmann, Stephen P.
    Francis, Heba M.
    Francis, Damian K.
    do Carmo Franco, Maria
    Franco, Oscar H.
    Frontera, Guillermo
    Fuchs, Flavio D.
    Fuchs, Sandra C.
    Fujita, Yuki
    Furusawa, Takuro
    Gaciong, Zbigniew
    Gafencu, Mihai
    Gareta, Dickman
    Garnett, Sarah P.
    Gaspoz, Jean-Michel
    Gasull, Magda
    Gates, Louise
    Geleijnse, Johanna M.
    Ghasemian, Anoosheh
    Giampaoli, Simona
    Gianfagna, Francesco
    Giovannelli, Jonathan
    Giwercman, Aleksander
    Goldsmith, Rebecca A.
    Goncalves, Helen
    Gonzalez Gross, Marcela
    Gonzalez Rivas, Juan P.
    Bonet Gorbea, Mariano
    Gottrand, Frederic
    Graff-Iversen, Sidsel
    Grafnetter, Dusan
    Grajda, Aneta
    Grammatikopoulou, Maria G.
    Gregor, Ronald D.
    Grodzicki, Tomasz
    Grontved, Anders
    Gruden, Grabriella
    Grujic, Vera
    Gu, Dongfeng
    Gualdi-Russo, Emanuela
    Guan, Ong Peng
    Gudnason, Vilmundur
    Guerrero, Ramiro
    Guessous, Idris
    Guimaraes, Andre L.
    Gulliford, Martin C.
    Gunnlaugsdottir, Johanna
    Gunter, Marc
    Guo, Xiuhua
    Guo, Yin
    Gupta, Prakash C.
    Gureje, Oye
    Gurzkowska, Beata
    Gutierrez, Laura
    Gutzwiller, Felix
    Halkjaer, Jytte
    Hambleton, Ian R.
    Hardy, Rebecca
    Kumar, Rachakulla Hari
    Hata, Jun
    Hayes, Alison J.
    He, Jiang
    Hendriks, Marleen Ekisabeth
    Hernandez Cadena, Leticia
    Herrala, Sauli
    Heshmat, Ramin
    Hihtaniemi, Ilpo Tapani
    Ho, Sai Yin
    Ho, Suzanne C.
    Hobbs, Michael
    Hofman, Albert
    Hormiga, Claudi M.
    Horta, Bernardo L.
    Houti, Leila
    Howitt, Christina
    Htay, Thein Thein
    Htet, Aung Soe
    Htike, Maung Maung Than
    Hu, Yonghua
    Husseini, Abdullatif
    Huu, Chinh Nguyen
    Huybrechts, Inge
    Hwalla, Nahla
    Iacoviello, Licia
    Iannone, Anna G.
    Ibrahim, Mohsen M.
    Ikeda, Nayu
    Ikram, M. Arfan
    Irazola, Vilma E.
    Islam, Muhammad
    Ivkovic, Vanja
    Iwasaki, Masanori
    Jackson, Rod T.
    Jacobs, Jeremy M.
    Jafar, Tazeen
    Jamil, Kazi M.
    Jamrozik, Konrad
    Janszky, Imre
    Jasienska, Grazyna
    Jelakovic, Bojan
    Jiang, Chao Qiang
    Joffres, Michel
    Johansson, Mattias
    Jonas, Jost B.
    Jorgensen, Torben
    Joshi, Pradeep
    Juolevi, Anne
    Jurak, Gregor
    Juresa, Vesno
    Kaaks, Rudolf
    Kafatos, Anthony
    Kalter-Leibovici, Ofra
    Kapantais, Efthymios
    Kasaeian, Amir
    Katz, Joanne
    Kaur, Prabhdeep
    Kavousi, Maryam
    Keil, Ulrich
    Boker, Lital Keinan
    Keinanen-Kiukaanniemi, Sirkka
    Kelishadi, Roya
    Kemper, Han C. G.
    Kengne, Andre P.
    Kersting, Mathilde
    Key, Timothy
    Khader, Yousef Saleh
    Khalili, Davood
    Khang, Young-Ho
    Khaw, Kay-Tee H.
    Khouw, Ilse M. S. L.
    Kiechl, Stefan
    Killewo, Japhet
    Kim, Jeongseon
    Klimont, Jeannette
    Klumbiene, Jurate
    Koirala, Bhawesh
    Kolle, Elin
    Kolsteren, Patrick
    Korrovits, Paul
    Koskinen, Seppo
    Kouda, Katsuyasu
    Koziel, Slawomir
    Kratzer, Wolfgang
    Krokstad, Steinar
    Kromhout, Daan
    Kruger, Herculina S.
    Kubinova, Ruzena
    Kujala, Urho M.
    Kula, Krzysztof
    Kulaga, Zbigniew
    Kumar, R. Krishna
    Kurjata, Pawel
    Kusuma, Yadlapalli S.
    Kuulasmaa, Kari
    Kyobutungi, Catherine
    Laamiri, Fatima Zahra
    Laatikainen, Tiina
    Lachat, Carl
    Laid, Youcef
    Lam, Tai Hing
    Landrove, Orlando
    Lanska, Vera
    Lappas, Georg
    Larijani, Bagher
    Laugsand, Lars E.
    Bao, Khanh Le Nguyen
    Le, Tuyen D
    Leclercq, Catherine
    Lee, Jeannette
    Lee, Jeonghee
    Lehtimaki, Terho
    Lekhraj, Rampal
    Leon-Munoz, Luz M.
    Li, Yanping
    Lilly, Christa L.
    Lim, Wei-Yen
    Fernanda Lima-Costa, M.
    Lin, Hsien-Ho
    Lin, Xu
    Linneberg, Allan
    Lissner, Lauren
    Litwin, Mieczyslaw
    Liu, Jing
    Lorbeer, Roberto
    Lotufo, Paulo A.
    Eugenio Lozano, Jose
    Luksiene, Dalia
    Lundqvist, Annamari
    Lunet, Nuno
    Ma, Guansheng
    Ma, Jun
    Machado-Coelho, George L. L.
    Machi, Suka
    Maggi, Stefania
    Magliano, Dianna J.
    Maire, Bernard
    Makdisse, Marcia
    Malekzadeh, Reza
    Malhotra, Rahul
    Rao, Kodavanti Mallikharjuna
    Malyutina, Sofia
    Manios, Yannis
    Mann, Jim I.
    Manzato, Enzo
    Margozzini, Paula
    Markey, Oonagh
    Marques-Vidal, Pedro
    Marrugat, Jaume
    Martin-Prevel, Yves
    Martorell, Reynaldo
    Masoodi, Shariq R.
    Mathiesen, Ellisiv B.
    Matsha, Tandi E.
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    Mbanya, Jean Claude N.
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    McGarvey, Stephen T.
    McKee, Martin
    McLachlan, Stela
    McLean, Rachael M.
    McNulty, Breige A.
    Yusof, Safiah Md
    Mediene-Benchekor, Sounnia
    Meirhaeghe, Aline
    Meisinger, Christa
    Menezes, Ana Maria B.
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    Mi, Jie
    Michaelsen, Kim F.
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    Francisco Miquel, Juan
    Jaime Miranda, J.
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    Mohammad, Kazem
    Mohammadifard, Noushin
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    Yusoff, Muhammad Fadhli Mohd
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    Morgan, Karen
    Mortensen, Erik Lykke
    Moschonis, George
    Mossakowska, Malgorzata
    Mostafa, Aya
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    Motlagh, Mohammad Esmaeel
    Motta, Jorge
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    Narake, Sameer
    Maria Navarrete-Munoz, Eva
    Neal, William A.
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    Neovius, Martin
    Nervi, Flavio
    Neuhauser, Hannelore K.
    Nguyen, Nguyen D.
    Nguyen, Quang Ngoc
    Nieto-Martinez, Ramfis E.
    Ning, Guang
    Ninomiya, Toshiharu
    Nishtar, Sania
    Noale, Marianna
    Norat, Teresa
    Noto, Davide
    Al Nsour, Mohannad
    O'Reilly, Dermot
    Oh, Kyungwon
    Olayan, Iman H.
    Anselmo Olinto, Maria Teresa
    Oltarzewski, Maciej
    Omar, Mohd A.
    Onat, Altan
    Ordunez, Pedro
    Ortiz, Ana P.
    Osler, Merete
    Osmond, Clive
    Ostojic, Sergej M.
    Otero, Johanna A.
    Overvad, Kim
    Owusu-Dabo, Ellis
    Paccaud, Fred Michel
    Padez, Cristina
    Pahomova, Elena
    Pajak, Andrzej
    Palli, Domenico
    Palloni, Alberto
    Palmieri, Luigi
    Panda-Jonas, Songhomitra
    Panza, Francesco
    Parnell, Winsome R.
    Parsaeian, Mahboubeh
    Pecin, Ivan
    Pednekar, Mangesh S.
    Peeters, Petra H.
    Peixoto, Sergio Viana
    Peltonen, Markku
    Pereira, Alexandre C.
    Perez, Cynthia M.
    Peters, Annette
    Petkeviciene, Janina
    Peykari, Niloofar
    Pham, Son Thai
    Pigeot, Iris
    Pikhart, Hynek
    Pilav, Aida
    Pilotto, Lorenza
    Pistelli, Francesco
    Pitakaka, Freda
    Piwonska, Aleksandra
    Plans-Rubio, Pedro
    Poh, Bee Koon
    Porta, Miquel
    Portegies, Marileen L. P.
    Poulimeneas, Dimitrios
    Pradeepa, Rajendra
    Prashant, Mathur
    Price, Jacqueline F.
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    Punab, Margus
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    Bao, Tran Quoc
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    de Wit, Tobias F. Rinke
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    Sabanayagam, Charumathi
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    Salanave, Benoit
    Salazar Martinez, Eduardo
    Salomaa, Veikko
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    Sandjaja,
    Sans, Susana
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    dos Santos, Renata Nunes
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    Sarrafzadegan, Nizal
    Saum, Kai-Uwe
    Savva, Savvas C.
    Scazufca, Marcia
    Rosario, Angelika Schaffrath
    Schargrodsky, Herman
    Schienkiewitz, Anja
    Schmidt, Ida Maria
    Schneider, Ione J.
    Schultsz, Constance
    Schutte, Aletta E.
    Sein, Aye Aye
    Sen, Abhijit
    Senbanjo, Idowu O.
    Sepanlou, Sadaf G.
    Shalnova, Svetlana A.
    Sharma, Sanjib K.
    Shaw, Jonathan E.
    Shibuya, Kenji
    Shin, Dong Wook
    Shin, Youchan
    Shiri, Rahman
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    Sibai, Abla M.
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    Smeeth, Liam
    Smith, Margaret C.
    Snijder, Marieke B.
    So, Hung-Kwan
    Sobngwi, Eugene
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Soekatri, Moesijanti Y. E.
    Solfrizzi, Vincenzo
    Sonestedt, Emily
    Song, Yi
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    Jerome, Charles Sossa
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    Stehle, Peter
    Stein, Aryeh D.
    Stergiou, George S.
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    Stieber, Jutta
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    Stocks, Tanja
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    Stratton, Gareth
    Stronks, Karien
    Strufaldi, Maria Wany
    Sun, Chien-An
    Sundstroem, Johan
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    Sunyer, Jordi
    Suriyawongpaisal, Paibul
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    Sy, Rody G.
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    Tai, E. Shyong
    Tammesoo, Mari-Liis
    Tamosiunas, Abdonas
    Tang, Line
    Tang, Xun
    Tanser, Frank
    Tao, Yong
    Tarawneh, Mohammed Rasoul
    Tarp, Jakob
    Tarqui-Mamani, Carolina B.
    Taylor, Anne
    Tchibindat, Felicite
    Theobald, Holger
    Thijs, Lutgarde
    Thuesen, Betina H.
    Tjonneland, Anne
    Tolonen, Hanna K.
    Tolstrup, Janne S.
    Topbas, Murat
    Topor-Madry, Roman
    Torrent, Maties
    Toselli, Stefania
    Traissac, Pierre
    Trichopoulou, Antonia
    Trichopoulos, Dimitrios
    Trinh, Oanh T. H.
    Trivedi, Atul
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    Turley, Maria L.
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    Tzourio, Christophe
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    Ukoli, Flora A. M.
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    Uusitalo, Hannu M. T.
    Valdivia, Gonzalo
    Vale, Susana
    Valvi, Damaskini
    van der Schouw, Yvonne T.
    Van Herck, Koen
    Minh, Hoang Van
    van Rossem, Lenie
    van Valkengoed, Irene G. M.
    Vanderschueren, Dirk
    Vanuzzo, Diego
    Vatten, Lars
    Vega, Tomas
    Velasquez-Melendez, Gustavo
    Veronesi, Giovanni
    Verschuren, W. M. Monique
    Verstraeten, Roosmarijn
    Victora, Cesar G.
    Viegi, Giovanni
    Viet, Lucie
    Viikari-Juntura, Eira
    Vineis, Paolo
    Vioque, Jesus
    Virtanen, Jyrki K.
    Visvikis-Siest, Sophie
    Viswanathan, Bharathi
    Vollenweider, Peter
    Voutilainen, Sari
    Vrdoljak, Ana
    Vrijheid, Martine
    Wade, Alisha N.
    Wagner, Aline
    Walton, Janette
    Mohamud, Wan Nazaimoon Wan
    Wang, Ming-Dong
    Wang, Qian
    Wang, Ya Xing
    Wannamethee, S. Goya
    Wareham, Nicholas
    Weerasekera, Deepa
    Whincup, Peter H.
    Widhalm, Kurt
    Widyahening, Indah S.
    Wiecek, Andrzej
    Wijga, Alet H.
    Wilks, Rainford J.
    Willeit, Johann
    Wilsgaard, Tom
    Wojtyniak, Bogdan
    Wong, Jyh Eiin
    Wong, Tien Yin
    Woo, Jean
    Woodward, Mark
    Wu, Frederick C.
    Wu, Jianfeng
    Wu, Shou Ling
    Xu, Haiquan
    Xu, Liang
    Yamborisut, Uruwan
    Yan, Weili
    Yang, Xiaoguang
    Yardim, Nazan
    Ye, Xingwang
    Yiallouros, Panayiotis K.
    Yoshihara, Akihiro
    You, Qi Sheng
    Younger-Coleman, Novie O.
    Yusoff, Ahmad F.
    Zainuddin, Ahmad A.
    Zambon, Sabina
    Zdrojewski, Tomasz
    Zeng, Yi
    Zhao, Dong
    Zhao, Wenhua
    Zheng, Yingfeng
    Zhou, Maigeng
    Zhu, Dan
    Zimmermann, Esther
    Cisneros, Julio Zuniga
    A century of trends in adult human height2016Inngår i: eLIFE, E-ISSN 2050-084X, Vol. 5, artikkel-id e13410Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.522.7) and 16.5 cm (13.319.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

    Fulltekst (pdf)
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  • 16. Bergström, G
    et al.
    Berglund, G
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Brandberg, J
    Engström, G
    Engvall, J
    Eriksson, M
    de Faire, U
    Flinck, A
    Hansson, M G
    Hedblad, B
    Hjelmgren, O
    Janson, C
    Jernberg, T
    Johnsson, Å
    Johansson, L
    Lind, L
    Löfdahl, C-G
    Melander, O
    Östgren, C J
    Persson, A
    Persson, M
    Sandström, Anette
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Schmidt, C
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Sundström, J
    Toren, K
    Waldenström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Thoracic Center, Umeå University Hospital.
    Wedel, H
    Vikgren, J
    Fagerberg, B
    Rosengren, A
    The Swedish CArdioPulmonary BioImage Study: objectives and design.2015Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 278, nr 6, s. 645-659Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started.

  • 17. Bergström, Göran
    et al.
    Persson, Margaretha
    Adiels, Martin
    Björnson, Elias
    Bonander, Carl
    Ahlström, Håkan
    Alfredsson, Joakim
    Angerås, Oskar
    Berglund, Göran
    Blomberg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Brandberg, John
    Börjesson, Mats
    Cederlund, Kerstin
    de Faire, Ulf
    Duvernoy, Olov
    Ekblom, Örjan
    Engström, Gunnar
    Engvall, Jan E.
    Fagman, Erika
    Eriksson, Mats
    Erlinge, David
    Fagerberg, Björn
    Flinck, Agneta
    Gonçalves, Isabel
    Hagström, Emil
    Hjelmgren, Ola
    Lind, Lars
    Lindberg, Eva
    Lindqvist, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Ljungberg, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Magnusson, Martin
    Mannila, Maria
    Markstad, Hanna
    Mohammad, Moman A.
    Nystrom, Fredrik H.
    Ostenfeld, Ellen
    Persson, Anders
    Rosengren, Annika
    Sandström, Anette
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Själander, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Sköld, Magnus C.
    Sundström, Johan
    Swahn, Eva
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Torén, Kjell
    Östgren, Carl Johan
    Jernberg, Tomas
    Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population2021Inngår i: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 144, nr 12, s. 916-929Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.

    Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.

    Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.

    Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.

    Fulltekst (pdf)
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  • 18.
    Bergström, Göran
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rosengren, Annika
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Gothenburg, Sweden.
    Bacsovics Brolin, Elin
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Department of Radiology, Capio S:t Göran Hospital, Stockholm, Sweden.
    Brandberg, John
    Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Cederlund, Kerstin
    Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Engström, Gunnar
    Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
    Engvall, Jan E.
    CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Eriksson, Maria J.
    Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
    Gonçalves, Isabel
    Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Cardiovascular Research Translational Studies, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Hagström, Emil
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    James, Stefan K.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Jernberg, Tomas
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Lilja, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Unit of Research, Education, and Development, Östersund Hospital, Umeå University, Umeå, Sweden.
    Magnusson, Martin
    Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden; Hypertension in Africa Research Team HART, North-West University, Potchefstroom, South Africa.
    Persson, Anders
    CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Radiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Clinical Sciences, Huddinge University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Persson, Margaretha
    Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
    Sandström, Anette
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Schmidt, Caroline
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Skoglund Larsson, Linn
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sundström, Johan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden; The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Swahn, Eva
    Department of Cardiology and Department of Health, Medicine, and Caring Sciences, Linköping University, Linköping, Sweden.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Torén, Kjell
    Section of Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Östgren, Carl Johan
    CMIV, Centre of Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Lampa, Erik
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS2023Inngår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 373, s. 46-54Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims: Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change.

    Methods: We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomography angiography (CCTA) and expressed as segment involvement score (SIS).

    Results: The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p < 0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women.

    Conclusions: Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.

    Fulltekst (pdf)
    fulltext
  • 19. Boman, J
    et al.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Forsberg, J
    Birgander, L S
    Allard, A
    Persson, K
    Jidell, E
    Kumlin, U
    Juto, P
    Waldenström, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wadell, G
    High prevalence of Chlamydia pneumoniae DNA in peripheral blood mononuclear cells in patients with cardiovascular disease and in middle-aged blood donors.1998Inngår i: Journal of Infectious Diseases, ISSN 0022-1899, E-ISSN 1537-6613, Vol. 178, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Nested polymerase chain reaction (nPCR) demonstrated the presence of Chlamydia pneumoniae-specific DNA in peripheral blood mononuclear cells (PBMC). PBMC samples were obtained from 103 consecutive patients (62 male, 41 female) aged 22-85 years (mean, 64) admitted for coronary angiography because of suspected coronary heart disease and from 52 blood donors (43 male, 9 female) aged 40-64 years (mean, 49). Of the 101 evaluable patients, 60 (59%) were identified by nPCR assay as C. pneumoniae DNA carriers; C. pneumoniae-specific microimmunofluorescence (MIF) serology confirmed exposure to the bacterium in 57 (95%) of the 60 nPCR-positive patients. Among the 52 blood donors, the nPCR assay identified 24 (46%) C. pneumoniae DNA carriers, all of whom were positive by C. pneumoniae-specific serology. Thirty-two patients (32%) and 23 blood donors (44%) were MIF antibody-positive but repeatedly nPCR-negative; Bartonella henselae- or Bartonella quintana-specific antibodies were not detected among any of these subjects. In this study, C. pneumoniae DNA was common in PBMC of patients with coronary heart disease and in middle-aged blood donors.

  • 20. Bouzina, Habib
    et al.
    Rådegran, Göran
    Butler, Oisin
    Hesselstrand, Roger
    Hjalmarsson, Clara
    Holl, Katsiaryna
    Jansson, Kjell
    Klok, Rogier
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Kjellström, Barbro
    Longitudinal changes in risk status in pulmonary arterial hypertension2021Inngår i: ESC Heart Failure, E-ISSN 2055-5822, Vol. 8, nr 1, s. 680-690Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: Low‐risk status in pulmonary arterial hypertension (PAH) predicts better survival. The present study aimed to describe changes in risk status and treatment approaches over multiple clinical assessments in PAH, taking age and comorbidity burden into consideration.

    Methods and results: The study included incident patients from the Swedish PAH registry, diagnosed with PAH in 2008–2019. Group A (n = 340) were ≤75 years old with <3 comorbidities. Group B (n = 163) were >75 years old with ≥3 comorbidities. Assessments occurred at baseline, first‐year (Y1) and third‐year (Y3) follow‐ups. The study used an explorative and descriptive approach. Group A: median age was 65 years, 70% were female, and 46% had no comorbidities at baseline. Baseline risk assessment yielded low (23%), intermediate (66%), and high risk (11%). Among patients at low, intermediate, or high risk at baseline, 51%, 18%, and 13%, respectively, were at low risk at Y3. At baseline, monotherapy was the most common therapy among low (68%) and intermediate groups (60%), while dual therapy was the most common among high risk (69%). In patients assessed as low, intermediate, or high risk at Y1, 66%, 12%, and 0% were at low risk at Y3, respectively. Of patients at intermediate or high risk at Y1, 35% received monotherapy and 13% received triple therapy. In low‐risk patients at Y1, monotherapy (40%) and dual therapy (43%) were evenly distributed. Group B: median age was 77 years, 50% were female, and 44% had ≥3 comorbidities at baseline. At baseline, 8% were at low, 80% at intermediate, and 12% at high risk. Monotherapy was the most common therapy (62%) in Group B at baseline. Few patients maintained or reached low risk at follow‐ups.

    Conclusions: Most patients with PAH did not meet low‐risk criteria during the 3 year follow‐up. The first year from diagnosis seems important in defining the longitudinal risk status.

    Fulltekst (pdf)
    fulltext
  • 21. Brunner, Fabian J.
    et al.
    Waldeyer, Christoph
    Ojeda, Francisco
    Salomaa, Veikko
    Kee, Frank
    Sans, Susana
    Thorand, Barbara
    Giampaoli, Simona
    Brambilla, Paolo
    Tunstall-Pedoe, Hugh
    Moitry, Marie
    Iacoviello, Licia
    Veronesi, Giovanni
    Grassi, Guido
    Mathiesen, Ellisiv B.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Linneberg, Allan
    Brenner, Hermann
    Amouyel, Philippe
    Ferrieres, Jean
    Tamosiunas, Abdonas
    Nikitin, Yuriy P.
    Drygas, Wojciech
    Melander, Olle
    Jöckel, Karl-Heinz
    Leistner, David M.
    Shaw, Jonathan E.
    Panagiotakos, Demosthenes B.
    Simons, Leon A.
    Kavousi, Maryam
    Vasan, Ramachandran S.
    Dullaart, Robin P. F.
    Wannamethee, S. Goya
    Riserus, Ulf
    Shea, Steven
    de Lemos, James A.
    Omland, Torbjorn
    Kuulasmaa, Kari
    Landmesser, Ulf
    Blankenberg, Stefan
    Zeller, T.
    Lackner, K.
    Wild, P.
    Peters, A.
    Meisinger, C.
    Voelzke, H.
    Doerr, M.
    Nauck, M.
    Schoettker, B.
    Lorenz, T.
    Makarova, N.
    Schmidt, B.
    Klotsche, J.
    Koenig, W.
    Kontto, J.
    Mannisto, S.
    Jaaskelainen, T.
    Niiranen, T.
    Jousilahti, P.
    Metspalu, A.
    Alver, M.
    Donfrancesco, C.
    Signorini, S. G.
    Gianfagna, F.
    Costanzo, S.
    Woodward, M.
    Dobson, A.
    Giles, G.
    Hodge, A.
    Magliano, D. J.
    Wilsgaard, T.
    Lyngbakken, M. N.
    Hveem, K.
    Eliasson, M.
    Engstrom, G.
    Ingelsson, M.
    Jorgensen, T.
    Twerenbold, R.
    Dallongeville, J.
    Malyutina, S.
    Pajak, A.
    Bobak, M.
    Whincup, P.
    Pitsavos, C.
    Benjamin, E. J.
    Bakker, S. J. L.
    Ikram, M. K.
    Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium2019Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 394, nr 10215, s. 2173-2183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The relevance of blood lipid concentrations to long-term incidence of cardiovascular disease and the relevance of lipid-lowering therapy for cardiovascular disease outcomes is unclear. We investigated the cardiovascular disease risk associated with the full spectrum of bloodstream non-HDL cholesterol concentrations. We also created an easy-to-use tool to estimate the long-term probabilities for a cardiovascular disease event associated with non-HDL cholesterol and modelled its risk reduction by lipid-lowering treatment.

    Methods: In this risk-evaluation and risk-modelling study, we used Multinational Cardiovascular Risk Consortium data from 19 countries across Europe, Australia, and North America. Individuals without prevalent cardiovascular disease at baseline and with robust available data on cardiovascular disease outcomes were included. The primary composite endpoint of atherosclerotic cardiovascular disease was defined as the occurrence of the coronary heart disease event or ischaemic stroke. Sex-specific multivariable analyses were computed using non-HDL cholesterol categories according to the European guideline thresholds, adjusted for age, sex, cohort, and classical modifiable cardiovascular risk factors. In a derivation and validation design, we created a tool to estimate the probabilities of a cardiovascular disease event by the age of 75 years, dependent on age, sex, and risk factors, and the associated modelled risk reduction, assuming a 50% reduction of non-HDL cholesterol.

    Findings: Of the 524 444 individuals in the 44 cohorts in the Consortium database, we identified 398 846 individuals belonging to 38 cohorts (184 055 [48·7%] women; median age 51·0 years [IQR 40·7–59·7]). 199 415 individuals were included in the derivation cohort (91 786 [48·4%] women) and 199 431 (92 269 [49·1%] women) in the validation cohort. During a maximum follow-up of 43·6 years (median 13·5 years, IQR 7·0–20·1), 54 542 cardiovascular endpoints occurred. Incidence curve analyses showed progressively higher 30-year cardiovascular disease event-rates for increasing non-HDL cholesterol categories (from 7·7% for non-HDL cholesterol <2·6 mmol/L to 33·7% for ≥5·7 mmol/L in women and from 12·8% to 43·6% in men; p<0·0001). Multivariable adjusted Cox models with non-HDL cholesterol lower than 2·6 mmol/L as reference showed an increase in the association between non-HDL cholesterol concentration and cardiovascular disease for both sexes (from hazard ratio 1·1, 95% CI 1·0–1·3 for non-HDL cholesterol 2·6 to <3·7 mmol/L to 1·9, 1·6–2·2 for ≥5·7 mmol/L in women and from 1·1, 1·0–1·3 to 2·3, 2·0–2·5 in men). The derived tool allowed the estimation of cardiovascular disease event probabilities specific for non-HDL cholesterol with high comparability between the derivation and validation cohorts as reflected by smooth calibration curves analyses and a root mean square error lower than 1% for the estimated probabilities of cardiovascular disease. A 50% reduction of non-HDL cholesterol concentrations was associated with reduced risk of a cardiovascular disease event by the age of 75 years, and this risk reduction was greater the earlier cholesterol concentrations were reduced.

    Interpretation: Non-HDL cholesterol concentrations in blood are strongly associated with long-term risk of atherosclerotic cardiovascular disease. We provide a simple tool for individual long-term risk assessment and the potential benefit of early lipid-lowering intervention. These data could be useful for physician–patient communication about primary prevention strategies.

    Fulltekst (pdf)
    fulltext
  • 22. Brunström, Mattias
    et al.
    Andersson, Jonas
    Eliasson, Mats
    Fu, Michael
    Geriatrik och akutmottagning Östra, Sahlgrenska universitetssjukhuset, Göteborg.
    Hansson, Per-Olof
    Sahlgrenska universitetssjukhuset, Göteborg.
    Söderberg, Stefan
    SCORE2 – ett uppdaterat verktyg för att skatta kardiovaskulär risk: [SCORE2 - an updated model for cardiovascular risk prediction]2021Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, artikkel-id 21164Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cardiovascular disease is the most important cause of death and life-years lost in Sweden today. Cardiovascular risk prediction is a cornerstone in primary prevention; the use of antihypertensive and lipid-lowering therapy is guided by absolute cardiovascular risk. The Systematic COronary Risk Evaluation (SCORE) model has been the most widely applied model in Sweden for almost two decades. Recently, an updated model called SCORE2 was published. The new risk prediction model is based on contemporary data, predicts the risk of incident cardiovascular disease in addition to cardiovascular mortality, and accounts for competing risks, thus overcoming some major limitations with SCORE. Sweden is classified as a moderate-risk country according to the new model; here we report the risk chart for moderate-risk countries translated into Swedish.

  • 23. Byhamre, Marja Lisa
    et al.
    Blankenberg, Stefan
    Dahlqvist, Per
    Eriksson, Marie
    Oskarsson, Viktor
    Söderberg, Stefan
    Zeller, Tanja
    Wennberg, Patrik
    Associations between snus use and concentrations of CRP, 25(OH)D and testosterone – a population-based studyManuskript (preprint) (Annet vitenskapelig)
  • 24.
    Byhamre, Marja Lisa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Eliasson, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Oskarsson, Viktor
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Association between snus use and lipid status in Swedish men2023Inngår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 83, nr 4, s. 241-250Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Snus is a common tobacco product in Sweden, but the cardiovascular risk profile for snus users is less known than for cigarette smokers. We examined the association of snus use with lipid status, particularly in comparison to non-tobacco use and cigarette smoking, using data from 5930 men in the Northern Sweden MONICA study. Tobacco use was self-reported in 1986 to 2014 (24.4% used snus) and blood samples were collected at the same time. Harmonized analyses on non-high-density lipoprotein (non-HDL) cholesterol, HDL cholesterol, and triglycerides were conducted in 2016 to 2018. Three hundred eighty-one snus users had also been examined more than once, allowing us to study the effect of discontinued use (achieved by 21.0%). In multivariable linear regression models, snus use was associated with higher HDL cholesterol and triglyceride concentrations compared to non-tobacco use (p values ≤ 0.04), and it was associated with higher HDL cholesterol concentrations and lower triglyceride concentrations compared to cigarette smoking (p values ≤ 0.02). Snus use was not associated with non-HDL cholesterol concentrations, irrespective of the comparison group (p values ≥ 0.07). There was no indication that higher intensity of snus use led to a worse lipid profile, given that high-consumers had higher HDL cholesterol concentrations than low-consumers (p value = 0.02), or that discontinuation of snus use led to a better lipid profile, given that continued users had lower triglyceride concentrations than discontinued users (p value = 0.03). Further studies are needed to confirm or refute our findings.

    Fulltekst (pdf)
    fulltext
  • 25.
    Börschel, Christin S.
    et al.
    Department of Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    Geelhoed, Bastiaan
    Department of Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    Niiranen, Teemu
    Finnish Institute for Health and Welfare, Helsinki, Finland; Deparment of Internal Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland.
    Camen, Stephan
    Department of Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    Donati, Maria Benedetta
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Havulinna, Aki S.
    Finnish Institute for Health and Welfare, Helsinki, Finland; Institute for Molecular Medicine Finland (FIMM), Helsinki, Finland.
    Gianfagna, Francesco
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy; Mediterranea Cardiocentro, Naples, Italy.
    Palosaari, Tarja
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Jousilahti, Pekka
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Kontto, Jukka
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Vartiainen, Erkki
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Ojeda, Francisco M.
    Department of Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Hamburg, Germany.
    den Ruijter, Hester M.
    Laboratory for Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
    Costanzo, Simona
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    de Gaetano, Giovanni
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Di Castelnuovo, Augusto
    Mediterranea Cardiocentro, Naples, Italy.
    Linneberg, Allan
    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.
    Vishram-Nielsen, Julie K.
    Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Løchen, Maja-Lisa
    Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Koenig, Wolfgang
    German Heart Centre Munich, Technical University of Munich, Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance Munich, Munich, Germany; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
    Jørgensen, Torben
    Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Kuulasmaa, Kari
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Blankenberg, Stefan
    Department of Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    Iacoviello, Licia
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Zeller, Tanja
    Department of Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg-Eppendorf, Hamburg, Germany.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Salomaa, Veikko
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Schnabel, Renate B.
    Department of Cardiology, University Heart and Vascular Centre Hamburg-Eppendorf, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    Risk prediction of atrial fibrillation and its complications in the community using hs troponin I2023Inngår i: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 53, nr 5, artikkel-id e13950Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: Atrial fibrillation (AF) is becoming increasingly common. Traditional cardiovascular risk factors (CVRF) do not explain all AF cases. Blood-based biomarkers reflecting cardiac injury such as high-sensitivity troponin I (hsTnI) may help close this gap.

    Methods: We investigated the predictive ability of hsTnI for incident AF in 45,298 participants (median age 51.4 years, 45.0% men) across European community cohorts in comparison to CVRF and established biomarkers (C-reactive protein, N-terminal pro B-type natriuretic peptide).

    Results: During a median follow-up of 7.7 years, 1734 (3.8%) participants developed AF. Those in the highest hsTnI quarter (≥4.2 ng/L) had a 3.91-fold (95% confidence interval (CI) 3.30, 4.63; p <.01) risk for developing AF compared to the lowest quarter (<1.4 ng/L). In multivariable-adjusted Cox proportional hazards models a statistically significant association was seen between hsTnI and AF (hazard ratio (HR) per 1 standard deviation (SD) increase in log10(hsTnI) 1.08; 95% CI 1.01, 1.16; p =.03). Inclusion of hsTnI did improve model discrimination (C-index CVRF 0.811 vs. C-index CVRF and hsTnI 0.813; p <.01). Higher hsTnI concentrations were associated with heart failure (HR per SD 1.37; 95% CI 1.12, 1.68; p <.01) and overall mortality (HR per SD 1.24; 95% CI 1.09, 1.41; p <.01).

    Conclusion: hsTnI as a biomarker of myocardial injury does not improve prediction of AF incidence beyond classical CVRF and NT-proBNP. However, it is associated with the AF-related disease heart failure and mortality likely reflecting underlying subclinical cardiovascular impairment.

    Fulltekst (pdf)
    fulltext
  • 26.
    Calcutteea, Avin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Center.
    Lindqvist, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Center.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Center.
    Henein, Michael Y.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Center.
    Global and regional right ventricular dysfunction in pulmonary hypertension2014Inngår i: Echocardiography, ISSN 0742-2822, E-ISSN 1540-8175, Vol. 31, nr 2, s. 164-171Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Pulmonary hypertension (PH) is known to affect the right ventricular (RV) function.

    AIMS: To assess the extent of global and regional RV dysfunction in PH patients.

    METHODS: We performed a cross-sectional study on 20 controls (age 62 ± 15 years, 7 males) and 35 patients (age 67 ± 12 years, 13 males) with PH of mixed etiologies and assessed RV inflow and outflow tracts (OTs) function, using speckle tracking echocardiography (STE) based myocardial deformation and its time relations. RV inlet and OT dimensions (2D), inlet myocardial velocities (TDI), myocardial strain and strain rate (SR), TAPSE (M-mode), ejection and filling times (pulsed-wave [PW] Doppler), and pulmonary artery acceleration (PAc) were measured.

    RESULTS: RV inlet and OT were dilated (P < 0.001 for both) and TAPSE (P < 0.001), inlet velocities (P < 0.001), basal and mid-cavity strain, SR and longitudinal displacement reduced (P < 0.001 for all). The time to peak systolic SR at basal, mid-cavity (P < 0.001 for both), and RVOT (P = 0.007) was short as was that to peak displacement (P < 0.001 for all). The time to peak pulmonary ejection correlated with time to peak SR at RVOT (r = 0.7, P < 0.001) in controls, but with that of the mid-cavity in patients (r = 0.71, P < 0.001). PAc was faster (P = 0.001) and RV filling time shorter in patients (P = 0.03) with respect to controls.

    CONCLUSIONS: PH has drastic effects on RV structure and intrinsic myocardial function, significantly disturbing its ejection time relations and overall pump performance. Increased RV afterload results in RV configuration changes with the inflow tract determining peak ejection rather than OT.

  • 27. Camen, S.
    et al.
    Ojeda, F. M.
    Niiranen, T.
    Gianfagna, F.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lochen, M. L.
    Kee, F.
    Blankenberg, S.
    Jørgensen, T.
    Zeller, T.
    Kuulasmaa, K.
    Linneberg, A.
    Salomaa, V.
    Iacoviello, L.
    Schnabel, R.
    Temporal relations between atrial fibrillation and ischemic stroke and their prognostic impact on mortality2018Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, s. 204-205Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Introduction: Atrial fibrillation (AF) and stroke are common diseases and AF is a well-established risk factor for stroke. The physiological mechanism of atrial dysfunction, disturbed hemodynamics and arterial thromboembolism links the pathologies. However, limited evidence is available on the temporal relationship between stroke and AF and the impact of subsequent disease onset on mortality in the community.

    Methods and results: Across five prospective community cohorts (DanMONICA, FINRISK, Moli-Sani project, Northern Sweden MONICA study, The Tromsø Study) of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE)-project we assessed baseline cardiovascular risk factors in 101164 individuals, median age 46.1 (25th, 75th percentile 35.8, 57.6) years, 48.4% men. We followed them for incident stroke and AF and determined the relation of subsequent disease diagnosis with overall mortality. Follow-up (FU) for stroke and AF was based upon linkage with national hospitalization registries or administrative registries for ambulatory visits to specialized hospitals.

    Over a median FU of 16.1 years N=4556 individuals were diagnosed solely with AF, N=2269 had a stroke but no AF diagnosed, and N=898 developed both stroke and AF during FU. Participants who developed either AF or stroke as the index event revealed a similar baseline risk factor profile. Temporal relations showed a peak of the diagnosis of both diseases within the years around the diagnosis of the other disease. The highest incidence rates of stroke were observed within a five-year interval prior to AF diagnosis. Cox regression showed an association of baseline stroke with diagnosis of AF during FU (hazard ratio (HR) 1.29; 95% confidence interval (CI) 1.11–1.50; p<0.001).

    In multivariable-adjusted Cox regression analyses with time-dependent covariates excluding individuals with diagnosis of both AF and stroke or death within 30 days, subsequent diagnosis of AF after stroke was associated with a higher overall mortality (HR, 3.51; 95% CI 1.87–6.59; p<0.001); subsequent stroke after the diagnosis of AF was associated with a HR of 2.39 (95% CI 1.59–3.60; p<0.001).

    Conclusions: Stroke and AF are common comorbidities in older adults with an overlapping risk factor profile. The temporal relations appear to be bidirectional, although uncertainty regarding disease onset remains due to the often paroxysmal and asymptomatic nature of AF. Stroke may precede detection of AF by years. The subsequent diagnosis of both diseases significantly increases mortality risk. Whether targeting modifiable risk factors or improved screening for AF after stroke would improve survival needs to be determined.

  • 28. Camen, S.
    et al.
    Palosaari, T.
    Kuulasmaa, K.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Palmieri, L.
    Ferrario, M. M.
    Blankenberg, S.
    Niiranen, T.
    Tunstall-Pedoe, H.
    Peters, A.
    Zeller, T.
    Linneberg, A.
    Salomaa, V
    Iacoviello, L.
    Schnabel, R. B.
    Cardiac troponin I and incident stroke in European cohorts - insights from the BiomarCaRE project2020Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 41, nr Supplement_2, s. 2409-2409Artikkel i tidsskrift (Annet vitenskapelig)
  • 29.
    Camen, Stephan
    et al.
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
    Csengeri, Dora
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Geelhoed, Bastiaan
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Niiranen, Teemu
    Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland.
    Gianfagna, Francesco
    Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Mediterranea Cardiocentro, Napoli, Italy.
    Vishram-Nielsen, Julie K.
    Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Costanzo, Simona
    Department of Epidemiology and Prevention, Istituto Neurologico Mediterraneo è un Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Heart Centre, Umeå University, Umeå, Sweden.
    Vartiainen, Erkki
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Börschel, Christin S.
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
    Donati, Maria Benedetta
    Department of Epidemiology and Prevention, Istituto Neurologico Mediterraneo è un Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy.
    Løchen, Maja-Lisa
    Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Ojeda, Francisco M.
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Kontto, Jukka
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Mathiesen, Ellisiv B.
    Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway.
    Jensen, Steen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Heart Centre, Umeå University, Umeå, Sweden.
    Koenig, Wolfgang
    German Heart Center Munich, Technical University of Munich, Munich, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany; Institute of Epidemiology and Medical Biometry, University of Ulm, Germany.
    Kee, Frank
    Centre for Public Health, Queens University of Belfast, Belfast, United Kingdom.
    de Gaetano, Giovanni
    Department of Epidemiology and Prevention, Istituto Neurologico Mediterraneo è un Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy.
    Zeller, Tanja
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
    Jørgensen, Torben
    Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Tunstall-Pedoe, Hugh
    Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom.
    Blankenberg, Stefan
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
    Kuulasmaa, Kari
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Linneberg, Allan
    Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Salomaa, Veikko
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Iacoviello, Licia
    Research Center in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy; Department of Epidemiology and Prevention, Istituto Neurologico Mediterraneo è un Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy.
    Schnabel, Renate B.
    Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany.
    Risk Factors, Subsequent Disease Onset, and Prognostic Impact of Myocardial Infarction and Atrial Fibrillation2022Inngår i: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 11, nr 7, artikkel-id e024299Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Although myocardial infarction (MI) and atrial fibrillation (AF) are frequent comorbidities and share common cardiovascular risk factors, the direction and strength of the association of the risk factors with disease onset, subsequent disease incidence, and mortality are not completely understood.

    METHODS AND RESULTS: In pooled multivariable Cox regression analyses, we examined temporal relations of disease onset and identified predictors of MI, AF, and all-cause mortality in 108 363 individuals (median age, 46.0 years; 48.2% men) free of MI and AF at baseline from 6 European population-based cohorts. During a maximum follow-up of 10.0 years, 3558 (3.3%) individuals were diagnosed exclusively with MI, 1922 (1.8%) with AF but no MI, and 491 (0.5%) individuals developed both MI and AF. Association of sex, systolic blood pressure, antihypertensive treatment, and diabetes appeared to be stronger with incident MI than with AF, whereas increasing age and body mass index showed a higher risk for incident AF. Total cholesterol and daily smoking were significantly related to incident MI but not AF. Combined population attributable fraction of cardiovascular risk factors was >70% for incident MI, whereas it was only 27% for AF. Subsequent MI after AF (hazard ratio [HR], 1.68; 95% CI, 1.03–2.74) and subsequent AF after MI (HR, 1.75; 95% CI, 1.31–2.34) both significantly increased overall mortality risk.

    CONCLUSIONS: We observed different associations of cardiovascular risk factors with both diseases indicating distinct pathophysiological pathways. Subsequent diagnoses of MI and AF significantly increased mortality risk.

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  • 30. Camen, Stephan
    et al.
    Ojeda, Francisco M.
    Niiranen, Teemu
    Gianfagna, Francesco
    Vishram-Nielsen, Julie K.
    Costanzo, Simona
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Vartiainen, Erkki
    Donati, Maria Benedetta
    Løchen, Maja-Lisa
    Pasterkamp, Gerard
    Magnussen, Christina
    Kee, Frank
    Jousilahti, Pekka
    Hughes, Maria
    Kontto, Jukka
    Mathiesen, Ellisiv B.
    Koenig, Wolfgang
    Palosaari, Tarja
    Blankenberg, Stefan
    de Gaetano, Giovanni
    Jorgensen, Torben
    Zeller, Tanja
    Kuulasmaa, Kari
    Linneberg, Allan
    Salomaa, Veikko
    Iacoviello, Licia
    Schnabel, Renate B.
    Temporal relations between atrial fibrillation and ischaemic stroke and their prognostic impact on mortality2020Inngår i: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 22, nr 4, s. 522-529Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims Limited evidence is available on the temporal relationship between atrial fibrillation (AF) and ischaemic stroke and their impact on mortality in the community. We sought to understand the temporal relationship of AF and ischaemic stroke and to determine the sequence of disease onset in relation to mortality. Methods and results Across five prospective community cohorts of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project we assessed baseline cardiovascular risk factors in 100 132 individuals, median age 46.1 (25th-75th percentile 35.8-57.5) years, 48.4% men. We followed them for incident ischaemic stroke and AF and determined the relation of subsequent disease diagnosis with overall mortality. Over a median follow-up of 16.1 years, N = 4555 individuals were diagnosed solely with AF, N = 2269 had an ischaemic stroke but no AF diagnosed, and N = 898 developed both, ischaemic stroke and AF. Temporal relationships showed a clustering of diagnosis of both diseases within the years around the diagnosis of the other disease. In multivariable-adjusted Cox regression analyses with time-dependent covariates subsequent diagnosis of AF after ischaemic stroke was associated with increased mortality [hazard ratio (HR) 4.05, 95% confidence interval (CI) 2.17-7.54; P < 0.001] which was also apparent when ischaemic stroke followed after the diagnosis of AF (HR 3.08, 95% CI 1.90-5.00; P < 0.001). Conclusion The temporal relations of ischaemic stroke and AF appear to be bidirectional. Ischaemic stroke may precede detection of AF by years. The subsequent diagnosis of both diseases significantly increases mortality risk. Future research needs to investigate the common underlying systemic disease processes.

  • 31. Camen, Stephan
    et al.
    Palosaari, Tarja
    Reinikainen, Jaakko
    Spruenker, Ngoc Anh
    Niiranen, Teemu
    Gianfagna, Francesco
    Vishram-Nielsen, Julie K. K.
    Costanzo, Simona
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Palmieri, Luigi
    Ferrario, Marco
    Peters, Annette
    Vartiainen, Erkki
    Donati, Maria Benedetta
    Donfrancesco, Chiara
    Borchini, Rossana
    Boerschel, Christin Susanna
    Giampaoli, Simona
    Di Castelnuovo, Augusto
    Magnussen, Christina
    Kee, Frank
    Koenig, Wolfgang
    Blankenberg, Stefan
    de Gaetano, Giovanni
    Tunstall-Pedoe, Hugh
    Rospleszcz, Susanne
    Jorgensen, Torben
    Zeller, Tanja
    Kuulasmaa, Kari
    Linneberg, Allan
    Salomaa, Veikko
    Iacoviello, Licia
    Schnabel, Renate B.
    Cardiac Troponin I and Incident Stroke in European Cohorts: Insights From the BiomarCaRE Project2020Inngår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 51, nr 9, s. 2770-2777Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Purpose: Stroke is a common cause of death and a leading cause of disability and morbidity. Stroke risk assessment remains a challenge, but circulating biomarkers may improve risk prediction. Controversial evidence is available on the predictive ability of troponin concentrations and the risk of stroke in the community. Furthermore, reports on the predictive value of troponin concentrations for different stroke subtypes are scarce.

    Methods: High-sensitivity cardiac troponin I (hsTnI) concentrations were assessed in 82 881 individuals (median age, 50.7 years; 49.7% men) free of stroke or myocardial infarction at baseline from 9 prospective European community cohorts. We used Cox proportional hazards regression to determine relative risks, followed by measures of discrimination and reclassification using 10-fold cross-validation to control for overoptimism. Follow-up was based upon linkage with national hospitalization registries and causes of death registries.

    Results: Over a median follow-up of 12.7 years, 3033 individuals were diagnosed with incident nonfatal or fatal stroke (n=1654 ischemic strokes, n=612 hemorrhagic strokes, and n=767 indeterminate strokes). In multivariable regression models, hsTnI concentrations were associated with overall stroke (hazard ratio per 1-SD increase, 1.15 [95% CI, 1.10-1.21]), ischemic stroke (hazard ratio, 1.14 [95% CI, 1.09-1.21]), and hemorrhagic stroke (hazard ratio, 1.10 [95% CI, 1.01-1.20]). Adding hsTnI concentrations to classical cardiovascular risk factors (C indices, 0.809, 0.840, and 0.736 for overall, ischemic, and hemorrhagic stroke, respectively) increased the C index significantly but modestly. In individuals with an intermediate 10-year risk (5%-20%), the net reclassification improvement for overall stroke was 0.038 (P=0.021).

    Conclusions: Elevated hsTnI concentrations are associated with an increased risk of incident stroke in the community, irrespective of stroke subtype. Adding hsTnI concentrations to classical risk factors only modestly improved estimation of 10-year risk of stroke in the overall cohort but might be of some value in individuals at an intermediate risk.

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  • 32. Cameron, A. J.
    et al.
    Magliano, D. J.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    A systematic review of the impact of including both waist and hip circumference in risk models for cardiovascular diseases, diabetes and mortality2013Inngår i: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 14, nr 1, s. 86-94Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Both a larger waist and narrow hips are associated with heightened risk of diabetes, cardiovascular diseases and premature mortality. We review the risk of these outcomes for levels of waist and hip circumferences when terms for both anthropometric measures were included in regression models. MEDLINE and EMBASE were searched (last updated July 2012) for studies reporting the association with the outcomes mentioned earlier for both waist and hip circumferences (unadjusted and with both terms included in the model). Ten studies reported the association between hip circumference and death and/or disease outcomes both unadjusted and adjusted for waist circumference. Five studies reported the risk associated with waist circumference both unadjusted and adjusted for hip circumference. With the exception of one study of venous thromboembolism, the full strength of the association between either waist circumference or hip circumference with morbidity and/or mortality was only apparent when terms for both anthropometric measures were included in regression models. Without accounting for the protective effect of hip circumference, the effect of obesity on risk of death and disease may be seriously underestimated. Considered together (but not as a ratio measure), waist and hip circumference may improve risk prediction models for cardiovascular disease and other outcomes.

  • 33. Cameron, A J
    et al.
    Zimmet, P Z
    Söderberg, Stefan
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin.
    Alberti, K G M M
    Sicree, R
    Tuomilehto, J
    Chitson, P
    Shaw, J E
    The metabolic syndrome as a predictor of incident diabetes mellitus in Mauritius.2007Inngår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 24, nr 12, s. 1460-1469Artikkel i tidsskrift (Fagfellevurdert)
  • 34. Cameron, Adrian J
    et al.
    Boyko, Edward J
    Sicree, Richard A
    Zimmet, Paul Z
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Alberti, K George M M
    Tuomilehto, Jaakko
    Chitson, Pierrot
    Shaw, Jonathan E
    Central obesity as a precursor to the metabolic syndrome in the AusDiab study and Mauritius.2008Inngår i: Obesity (Silver Spring, Md.), ISSN 1930-7381, Vol. 16, nr 12, s. 2707-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Evidence from epidemiologic studies that central obesity precedes future metabolic change and does not occur concurrently with the appearance of the blood pressure, glucose, and lipid abnormalities that characterize the metabolic syndrome (MetS) has been lacking. Longitudinal surveys were conducted in Mauritius in 1987, 1992, and 1998, and in Australia in 2000 and 2005 (AusDiab). This analysis included men and women (aged > or = 25 years) in three cohorts: AusDiab 2000-2005 (n = 5,039), Mauritius 1987-1992 (n = 2,849), and Mauritius 1987-1998 (n = 1,999). MetS components included waist circumference, systolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein (HDL) cholesterol, triglycerides, and homeostasis model assessment of insulin sensitivity (HOMA-S) (representing insulin sensitivity). Linear regression was used to determine which baseline components predicted deterioration in other MetS components over 5 years in AusDiab and 5 and 11 years in Mauritius, adjusted for age, sex, and ethnic group. Baseline waist circumference predicted deterioration (P < 0.01) in four of the other six MetS variables tested in AusDiab, five of six in Mauritius 1987-1992, and four of six in Mauritius 1987-1998. In contrast, an increase in waist circumference between baseline and follow-up was only predicted by insulin sensitivity (HOMA-S) at baseline, and only in one of the three cohorts. These results suggest that central obesity plays a central role in the development of the MetS and appears to precede the appearance of the other MetS components.

  • 35. Cameron, Adrian J.
    et al.
    Magliano, Dianna J.
    Shaw, Jonathan E.
    Zimmet, Paul Z.
    Carstensen, Bendix
    Alberti, K. George M. M.
    Tuomilehto, Jaakko
    Barr, Elizabeth L. M.
    Pauvaday, Vassen K.
    Kowlessur, Sudhirsen
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    The influence of hip circumference on the relationship between abdominal obesity and mortality2012Inngår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 41, nr 2, s. 484-494Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Higher waist circumference and lower hip circumference are both associated with increased cardiovascular disease (CVD) risk, despite being directly correlated. The real effects of visceral obesity may therefore be underestimated when hip circumference is not fully taken into account. We hypothesized that adding waist and hip circumference to traditional risk factors would significantly improve CVD risk prediction. Methods In a population-based survey among South Asian and African Mauritians (n = 7978), 1241 deaths occurred during 15 years of follow-up. In a model that included variables used in previous CVD risk calculations (a Framingham-type model), the association between waist circumference and mortality was examined before and after adjustment for hip circumference. The percentage with an increase in estimated 10-year cumulative mortality of > 25% and a decrease of > 20% after waist and hip circumference were added to the model was calculated. Results Waist circumference was strongly related to mortality only after adjustment for hip circumference and vice versa. Adding waist and hip circumference to a Framingham-type model increased estimated 10-year cumulative CVD mortality by > 25% for 23.7% of those who died and 15.7% of those censored. Cumulative mortality decreased by > 20% for 4.5% of those who died and 14.8% of those censored. Conclusions The effect of central obesity on mortality risk is seriously underestimated without adjustment for hip circumference. Adding waist and hip circumference to a Framingham-type model for CVD mortality substantially increased predictive power. Both may be important inclusions in CVD risk prediction models.

  • 36. Cameron, Adrian J.
    et al.
    Romaniuk, Helena
    Orellana, Liliana
    Dallongeville, Jean
    Dobson, Annette J.
    Drygas, Wojciech
    Ferrario, Marco
    Ferrieres, Jean
    Giampaoli, Simona
    Gianfagna, Francesco
    Iacoviello, Licia
    Jousilahti, Pekka
    Kee, Frank
    Moitry, Marie
    Niiranen, Teemu J.
    Pajak, Andrzej
    Palmieri, Luigi
    Palosaari, Tarja
    Satu, Männistö
    Tamosiunas, Abdonas
    Thorand, Barbara
    Toft, Ulla
    Vanuzzo, Diego
    Veikko, Salomaa
    Veronesi, Giovanni
    Wilsgaard, Tom
    Kuulasmaa, Kari
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Combined Influence of Waist and Hip Circumference on Risk of Death in a Large Cohort of European and Australian Adults2020Inngår i: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 9, nr 13, artikkel-id e015189Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Waist circumference and hip circumference are both strongly associated with risk of death; however, their joint association has rarely been investigated.

    Methods and Results: The MONICA Risk, Genetics, Archiving, and Monograph (MORGAM) Project was conducted in 30 cohorts from 11 countries; 90 487 men and women, aged 30 to 74 years, predominantly white, with no history of cardiovascular disease, were recruited in 1986 to 2010 and followed up for up to 24 years. Hazard ratios were estimated using sex‐specific Cox models, stratified by cohort, with age as the time scale. Models included baseline categorical obesity measures, age, total and high‐density lipoprotein cholesterol, systolic blood pressure, antihypertensive drugs, smoking, and diabetes mellitus. A total of 9105 all‐cause deaths were recorded during a median follow‐up of 10 years. Hazard ratios for all‐cause death presented J‐ or U‐shaped associations with most obesity measures. With waist and hip circumference included in the same model, for all hip sizes, having a smaller waist was strongly associated with lower risk of death, except for men with the smallest hips. In addition, among those with smaller waists, hip size was strongly negatively associated with risk of death, with ≈20% more people identified as being at increased risk compared with waist circumference alone.

    Conclusions: A more complex relationship between hip circumference, waist circumference, and risk of death is revealed when both measures are considered simultaneously. This is particularly true for individuals with smaller waists, where having larger hips was protective. Considering both waist and hip circumference in the clinical setting could help to best identify those at increased risk of death.

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  • 37. Cameron, AJ
    et al.
    Soderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Magliano, DJ
    Comment on 'General and abdominal obesity parameters and their combination in relation to mortality: a systematic review and meta-regression analysis'2014Inngår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 68, nr 1, s. 140-140Artikkel i tidsskrift (Fagfellevurdert)
  • 38. Carlsson, Axel C.
    et al.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ruge, Toralph
    Larsson, Anders
    Arnlov, Johan
    Levels of soluble tumor necrosis factor receptor 1 and 2, gender, and risk of myocardial infarction in Northern Sweden2018Inngår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 272, s. 41-46Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims: Soluble receptors for tumor necrosis factor alpha (sTNFR1 and sTNFR2) have been associated with cardiovascular diseases, and some evidence points towards a difference in associated risk between men and women. We aimed to study the association between sTNFR1 and sTNFR2 and incident myocardial infarctions (MI) and to explore the influence of established cardiovascular risk factors in men and women.& para;& para;Methods: We conducted a nested case control study in three large Swedish cohorts, including 533 myocardial infarction cases, and 1003 age-, sex- and cohort-matched controls. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.& para;& para;Results: An association between circulating sTNFR1 and sTNFR2 and an increased risk for MI was found when comparing cases and controls. The odds ratios were significant after adjustment for established cardiovascular risk factors and C-reactive protein in women (OR 1.44, 95% CI 1.08-1.93 for TNFR1, and 1.61, 95% CI 1.11-2.34 for TNFR2), but was abolished in men. Women with a combination of elevated CRP and values in the upper quartile of TNFR1 or TNFR2 had a 5-fold higher risk of myocardial infarction versus those with normal CRP and values in the lower three quartiles of TNFR1 or TNFR2.& para;& para;Conclusions: As the risk estimates for TNFR1 and TNFR2 were higher and remained significant after adjustments for established cardiovascular risk factors in women but not in men, a potential role for TNFR1 and TNFR2 in identifying women with a higher MI risk is possible. The future clinical role of TNFR1 and TNFR2 in combination with CRP to identify high risk patients for coronary heart disease has yet to be determined. 

  • 39.
    Cederström, Sofia
    et al.
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Lundman, Pia
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Alfredsson, Joakim
    Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden.
    Hagström, Emil
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Ravn-Fischer, Annica
    Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Yndigegn, Troels
    Department of Cardiology, Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden.
    Tornvall, Per
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Jernberg, Tomas
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Association between high-sensitivity C-reactive protein and coronary atherosclerosis in a general middle-aged population2023Inngår i: Scientific Reports, E-ISSN 2045-2322, Vol. 13, nr 1, artikkel-id 12171Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Despite abundant knowledge about the relationship between inflammation and coronary atherosclerosis, it is still unknown whether systemic inflammation measured as high-sensitivity C-reactive protein (hsCRP) is associated with coronary atherosclerosis in a general population. This study aimed to examine the association between hsCRP and coronary computed tomography angiography (CCTA)-detected coronary atherosclerosis in a population-based cohort. Out of 30,154 randomly invited men and women aged 50 to 64 years in the Swedish Cardiopulmonary Bioimage Study (SCAPIS), 25,408 had a technically acceptable CCTA and analysed hsCRP. Coronary atherosclerosis was defined as presence of plaque of any degree in any of 18 coronary segments. HsCRP values were categorised in four groups. Compared with hsCRP below the detection limit, elevated hsCRP (≥ 2.3 mg/L) was weakly associated with any coronary atherosclerosis (OR 1.15, 95% CI 1.07–1.24), coronary diameter stenosis ≥ 50% (OR 1.27, 95% CI 1.09–1.47), ≥ 4 segments involved (OR 1.13, 95% CI 1.01–1.26 ) and severe atherosclerosis (OR 1.33, 95% CI 1.05–1.69) after adjustment for age, sex and traditional risk factors. The associations were attenuated after further adjustment for body mass index (BMI), although elevated hsCRP still associated with noncalcified plaques (OR 1.16, 95% CI 1.02–1.32), proposed to be more vulnerable. In conclusion, the additional value of hsCRP to traditional risk factors in detection of coronary atherosclerosis is low. The association to high-risk noncalcified plaques, although unlikely through a causal pathway, could explain the relationship between hsCRP and clinical coronary events in numerous studies.

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  • 40.
    Chadalavada, Sucharitha
    et al.
    William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom.
    Reinikainen, Jaakko
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Andersson, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Di Castelnuovo, Augusto
    Mediterranea Cardiocentro, Naples, Italy.
    Iacoviello, Licia
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Research Center in Epidemiology and Preventive Medicine—EPIMED, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Jousilahti, Pekka
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Kårhus, Line Lund
    Center for Clinical Research and Prevention, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark.
    Linneberg, Allan
    Center for Clinical Research and Prevention, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Tunstall-Pedoe, Hugh
    Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom.
    Lekadir, Karim
    Artificial Intelligence in Medicine Lab (BCN-AIM), Departament de Matemàtiques and Informàtica, Universitat de Barcelona, Barcelona, Spain.
    Aung, Nay
    William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom.
    Jensen, Magnus T.
    William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, Denmark.
    Kuulasmaa, Kari
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Niiranen, Teemu J.
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Department of Internal Medicine, University of Turku and Turku University Hospital, Turku, Finland.
    Petersen, Steffen E.
    William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Health Data Research UK, London, United Kingdom; National Institute for Health and Care Research, London, United Kingdom.
    Diabetes and heart failure associations in women and men: Results from the MORGAM consortium2023Inngår i: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 10, artikkel-id 1136764Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Diabetes and its cardiovascular complications are a growing concern worldwide. Recently, some studies have demonstrated that relative risk of heart failure (HF) is higher in women with type 1 diabetes (T1DM) than in men. This study aims to validate these findings in cohorts representing five countries across Europe.

    Methods: This study includes 88,559 (51.8% women) participants, 3,281 (46.3% women) of whom had diabetes at baseline. Survival analysis was performed with the outcomes of interest being death and HF with a follow-up time of 12 years. Sub-group analysis according to sex and type of diabetes was also performed for the HF outcome.

    Results: 6,460 deaths were recorded, of which 567 were amongst those with diabetes. Additionally, HF was diagnosed in 2,772 individuals (446 with diabetes). A multivariable Cox proportional hazard analysis showed that there was an increased risk of death and HF (hazard ratio (HR) of 1.73 [1.58–1.89] and 2.12 [1.91–2.36], respectively) when comparing those with diabetes and those without. The HR for HF was 6.72 [2.75–16.41] for women with T1DM vs. 5.80 [2.72–12.37] for men with T1DM, but the interaction term for sex differences was insignificant (p for interaction 0.45). There was no significant difference in the relative risk of HF between men and women when both types of diabetes were combined (HR 2.22 [1.93–2.54] vs. 1.99 [1.67–2.38] respectively, p for interaction 0.80).

    Conclusion: Diabetes is associated with increased risks of death and heart failure, and there was no difference in relative risk according to sex.

    Fulltekst (pdf)
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  • 41. Chen, Hao Yu
    et al.
    Cairns, Benjamin J.
    Small, Aeron M.
    Burr, Hannah A.
    Ambikkumar, Athithan
    Martinsson, Andreas
    Thériault, Sébastien
    Munter, Hans Markus
    Steffen, Brian
    Zhang, Richard
    Levinson, Rebecca T.
    Shaffer, Christian M.
    Rong, Jian
    Sonestedt, Emily
    Dufresne, Line
    Ljungberg, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Näslund, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ranatunga, Dilrini K.
    Whitmer, Rachel A.
    Budoff, Matthew J.
    Nguyen, Albert
    Vasan, Ramachandran S.
    Larson, Martin G.
    Harris, William S.
    Damrauer, Scott M.
    Stark, Ken D.
    Boekholdt, S. Matthijs
    Wareham, Nicholas J.
    Pibarot, Philippe
    Arsenault, Benoit J.
    Mathieu, Patrick
    Gudnason, Vilmundur
    O'Donnell, Christopher J.
    Rotter, Jerome I.
    Tsai, Michael Y.
    Post, Wendy S.
    Clarke, Robert
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Bossé, Yohan
    Wells, Quinn S.
    Smith, J. Gustav
    Rader, Daniel J.
    Lathrop, Mark
    Engert, James C.
    Thanassoulis, George
    Association of FADS1/2 Locus Variants and Polyunsaturated Fatty Acids With Aortic Stenosis2020Inngår i: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 5, nr 6, s. 694-702Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Importance: Aortic stenosis (AS) has no approved medical treatment. Identifying etiological pathways for AS could identify pharmacological targets.

    Objective: To identify novel genetic loci and pathways associated with AS.

    Design, Setting, and Participants: This genome-wide association study used a case-control design to evaluate 44 703 participants (3469 cases of AS) of self-reported European ancestry from the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort (from January 1, 1996, to December 31, 2015). Replication was performed in 7 other cohorts totaling 256 926 participants (5926 cases of AS), with additional analyses performed in 6942 participants from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium. Follow-up biomarker analyses with aortic valve calcium (AVC) were also performed. Data were analyzed from May 1, 2017, to December 5, 2019.

    Exposures: Genetic variants (615 643 variants) and polyunsaturated fatty acids (ω-6 and ω-3) measured in blood samples.

    Main Outcomes and Measures: Aortic stenosis and aortic valve replacement defined by electronic health records, surgical records, or echocardiography and the presence of AVC measured by computed tomography.

    Results: The mean (SD) age of the 44 703 GERA participants was 69.7 (8.4) years, and 22 019 (49.3%) were men. The rs174547 variant at the FADS1/2 locus was associated with AS (odds ratio [OR] per C allele, 0.88; 95% CI, 0.83-0.93; P = 3.0 × 10-6), with genome-wide significance after meta-analysis with 7 replication cohorts totaling 312 118 individuals (9395 cases of AS) (OR, 0.91; 95% CI, 0.88-0.94; P = 2.5 × 10-8). A consistent association with AVC was also observed (OR, 0.91; 95% CI, 0.83-0.99; P = .03). A higher ratio of arachidonic acid to linoleic acid was associated with AVC (OR per SD of the natural logarithm, 1.19; 95% CI, 1.09-1.30; P = 6.6 × 10-5). In mendelian randomization, increased FADS1 liver expression and arachidonic acid were associated with AS (OR per unit of normalized expression, 1.31 [95% CI, 1.17-1.48; P = 7.4 × 10-6]; OR per 5-percentage point increase in arachidonic acid for AVC, 1.23 [95% CI, 1.01-1.49; P = .04]; OR per 5-percentage point increase in arachidonic acid for AS, 1.08 [95% CI, 1.04-1.13; P = 4.1 × 10-4]).

    Conclusions and Relevance: Variation at the FADS1/2 locus was associated with AS and AVC. Findings from biomarker measurements and mendelian randomization appear to link ω-6 fatty acid biosynthesis to AS, which may represent a therapeutic target.

    Fulltekst (pdf)
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  • 42. Christakoudi, Sofia
    et al.
    Tsilidis, Konstantinos K.
    Muller, David C.
    Freisling, Heinz
    Weiderpass, Elisabete
    Overvad, Kim
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Häggström, Christel
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Pischon, Tobias
    Dahm, Christina C.
    Zhang, Jie
    Tjonneland, Anne
    Halkjaer, Jytte
    MacDonald, Conor
    Boutron-Ruault, Marie-Christine
    Mancini, Francesca Romana
    Kuehn, Tilman
    Kaaks, Rudolf
    Schulze, Matthias B.
    Trichopoulou, Antonia
    Karakatsani, Anna
    Peppa, Eleni
    Masala, Giovanna
    Pala, Valeria
    Panico, Salvatore
    Tumino, Rosario
    Sacerdote, Carlotta
    Quiros, J. Ramon
    Agudo, Antonio
    Sanchez, Maria-Jose
    Cirera, Lluis
    Barricarte-Gurrea, Aurelio
    Amiano, Pilar
    Memarian, Ensieh
    Sonestedt, Emily
    Bueno-de-Mesquita, Bas
    May, Anne M.
    Khaw, Kay-Tee
    Wareham, Nicholas J.
    Tong, Tammy Y. N.
    Huybrechts, Inge
    Noh, Hwayoung
    Aglago, Elom K.
    Ellingjord-Dale, Merete
    Ward, Heather A.
    Aune, Dagfinn
    Riboli, Elio
    A Body Shape Index (ABSI) achieves better mortality risk stratification than alternative indices of abdominal obesity: results from a large European cohort2020Inngår i: Scientific Reports, E-ISSN 2045-2322, Vol. 10, nr 1, artikkel-id 14541Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abdominal and general adiposity are independently associated with mortality, but there is no consensus on how best to assess abdominal adiposity. We compared the ability of alternative waist indices to complement body mass index (BMI) when assessing all-cause mortality. We used data from 352,985 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) and Cox proportional hazards models adjusted for other risk factors. During a mean follow-up of 16.1 years, 38,178 participants died. Combining in one model BMI and a strongly correlated waist index altered the association patterns with mortality, to a predominantly negative association for BMI and a stronger positive association for the waist index, while combining BMI with the uncorrelated A Body Shape Index (ABSI) preserved the association patterns. Sex-specific cohort-wide quartiles of waist indices correlated with BMI could not separate high-risk from low-risk individuals within underweight (BMI<18.5 kg/m(2)) or obese (BMI<greater than or equal to>30 kg/m(2)) categories, while the highest quartile of ABSI separated 18-39% of the individuals within each BMI category, which had 22-55% higher risk of death. In conclusion, only a waist index independent of BMI by design, such as ABSI, complements BMI and enables efficient risk stratification, which could facilitate personalisation of screening, treatment and monitoring.

    Fulltekst (pdf)
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  • 43. Cornelis, M. C.
    et al.
    Gustafsson, S.
    Arnlov, J.
    Elmstahl, S.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Sundstrom, J.
    Michaelsson, K.
    Lind, L.
    Ingelsson, E.
    Targeted proteomic analysis of habitual coffee consumption2018Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, nr 2, s. 200-211Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Coffee drinking has been implicated in mortality and a variety of diseases but potential mechanisms underlying these associations are unclear. Large‐scale systems epidemiological approaches may offer novel insights to mechanisms underlying associations of coffee with health.

    Objective: We performed an analysis of known and novel protein markers linked to cardiovascular disease and their association with habitual coffee intake in the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS, n = 816) and followed up top proteins in the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 635) and EpiHealth (n = 2418).

    Methods: In PIVUS and ULSAM, coffee intake was measured by 7‐day dietary records whilst a computer‐based food frequency questionnaire was used in EpiHealth. Levels of up to 80 proteins were assessed in plasma by a proximity extension assay.

    Results: Four protein–coffee associations adjusted for age, sex, smoking and BMI, met statistical significance in PIVUS (FDR < 5%, P < 2.31 × 10−3): leptin (LEP), chitinase‐3‐like protein 1 (CHI3L), tumour necrosis factor (TNF) receptor 6 and TNF‐related apoptosis‐inducing ligand. The inverse association between coffee intake and LEP replicated in ULSAM (β, −0.042 SD per cup of coffee, P = 0.028) and EpiHealth (β, −0.025 SD per time of coffee, P = 0.004). The negative coffee–CHI3L association replicated in EpiHealth (β, −0.07, P = 1.15 × 10−7), but not in ULSAM (β, −0.034, P = 0.16).

    Conclusions: The current study supports an inverse association between coffee intake and plasma LEP and CHI3L1 levels. The coffee–CHI3L1 association is novel and warrants further investigation given links between CHI3L1 and health conditions that are also potentially influenced by coffee.

  • 44. Crawford, Andrew A.
    et al.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Kirschbaum, Clemens
    Murphy, Lee
    Eliasson, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Sunderby Research Unit, Umeå University, Umeå, Sweden.
    Ebrahim, Shah
    Smith, George Davey
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Sattar, Naveed
    Lawlor, Debbie A.
    Timpson, Nicolas J.
    Reynolds, Rebecca M.
    Walker, Brian R.
    Morning plasma cortisol as a cardiovascular risk factor: findings from prospective cohort and Mendelian randomization studies2019Inngår i: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 181, nr 4, s. 429-438Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The identification of new causal risk factors has the potential to improve cardiovascular disease (CVD) risk prediction and the development of new treatments to reduce CVD deaths. In the general population, we sought to determine whether cortisol is a causal risk factor for CVD and coronary heart disease (CHD).

    Design and methods: Three approaches were adopted to investigate the association between cortisol and CVD/CHD. First, we used multivariable regression in two prospective nested case-control studies (total 798 participants, 313 incident CVD/CHD with complete data). Second, a random-effects meta-analysis of these data and previously published prospective associations was performed (total 6680 controls, 696 incident CVD/CHD). Finally, one- and two-sample Mendelian randomization analyses were performed (122,737 CHD cases, 547,261 controls for two-sample analyses).

    Results: In the two prospective nested case-control studies, logistic regression adjusting for sex, age, BMI, smoking and time of sampling, demonstrated a positive association between morning plasma cortisol and incident CVD (OR: 1.28 per 1 SD higher cortisol, 95% CI: 1.06-1.54). In the meta-analysis of prospective studies, the equivalent result was OR: 1.18, 95% CI: 1.06-1.31. Results from the two-sample Mendelian randomization were consistent with these positive associations: OR: 1.06, 95% Cl: 0.98-1.15.

    Conclusions: All three approaches demonstrated a positive association between morning plasma cortisol and incident CVD. Together, these findings suggest that elevated morning cortisol is a causal risk factor for CVD. The current data suggest strategies targeted at lowering cortisol action should be evaluated for their effects on CVD.

    Fulltekst (pdf)
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  • 45. Csengeri, D.
    et al.
    Spruenker, N. A.
    Di Castelnuovo, A.
    Niiranen, T.
    Söderberg, Stefan
    Umeå University Hospital.
    Magnussen, C.
    Lochen, M. J.
    Kee, F.
    Blankenberg, S.
    Jørgensen, T.
    Kuulasmaa, K.
    Zeller, T.
    Salomaa, V.
    Iacoviello, L.
    Schnabel, R.
    Alcohol consumption and risk of atrial fibrillation - results from the BiomarCaRE Consortium2018Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, s. 902-903Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: Atrial fibrillation (AF) is an arrhythmia with high impact on public health. Among modifiable risk factors for the disease the role of alcohol consumption (AC) has remained inconsistent.

    Purpose: To assess the association between AC and incident AF across European cohorts.

    Methods: To study the association between self-reported AC and incident AF in N=107,845 community-based individuals from the BiomarCaRE consortium, 106,915 individuals free of AF at baseline were followed up for AF and stroke after AF. We assessed AC using validated questionnaires. Biomarkers N-terminal pro B-type natriuretic peptide (Nt-proBNP) and high sensitivity troponin I (hsTnI) were measured.

    Results: The median age of individuals was 47.8 years, 48.3% were men. The median of right-winsorized AC was 3 g/day. N=6,055 individuals developed AF (median follow-up time: 13.9 years). In a linear multivariable-adjusted Cox regression analyses, AC was linearly and positively associated with incident AF (Figure), hazard ratio (HR) per g/day 1.009, 95% confidence interval (CI) 1.007- 1.012, P<0.001. For one drink (12g) per day the HR was 1.15, CI 1.12–1.18, P<0.001. There was a high heterogeneity in associations across cohorts.

    No significant interactions of the association by Nt-proBNP and hsTnI were observed. AC was positively related to stroke risk after diagnosis of AF (HR 1.18, 95% CI 1.04–1.34, P=0.012).

    Conclusions: In contrast to other cardiovascular diseases, we did not observe a U-shaped association of alcohol with incident AF in the community, but a rather linearly increasing relation.

  • 46.
    Csengeri, Dora
    et al.
    Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.
    Sprünker, Ngoc-Anh
    Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.
    Niiranen, Teemu
    Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland; Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Vishram-Nielsen, Julie Kk.
    Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Frederiksberg, Denmark; Department of Cardiology, Righospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
    Costanzo, Simona
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Jensen, Steen M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Vartiainen, Erkki
    Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Donati, Maria Benedetta
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Magnussen, Christina
    Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
    Camen, Stephan
    Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
    Gianfagna, Francesco
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Løchen, Maja-Lisa
    Department of Community Medicine, UiT The Arctic University of Norway, Norway.
    Kee, Frank
    Center for Public Health, Institute of Clinical Sciences A, Queens University, Belfast, Ireland.
    Kontto, Jukka
    Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Mathiesen, Ellisiv B.
    Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Norway.
    Koenig, Wolfgang
    Deutsches Herzzentrum München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; Institute of Epidemiology and Medial Biometry, University of Ulm, Ulm, Germany.
    Stefan, Blankenberg
    Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
    de Gaetano, Giovanni
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Jørgensen, Torben
    Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Frederiksberg, Denmark; Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; Faculty of Medicine, Aalborg University, Aalborg, Denmark.
    Kuulasmaa, Kari
    Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Zeller, Tanja
    Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.
    Salomaa, Veikko
    Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Iacoviello, Licia
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Schnabel, Renate B.
    Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK), Berlin, Germany.
    Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes2021Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, nr 12, s. 1170-1177Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: There is inconsistent evidence on the relation of alcohol intake with incident atrial fibrillation (AF), in particular at lower doses. We assessed the association between alcohol consumption, biomarkers, and incident AF across the spectrum of alcohol intake in European cohorts.

    METHODS AND RESULTS: In a community-based pooled cohort, we followed 107 845 individuals for the association between alcohol consumption, including types of alcohol and drinking patterns, and incident AF. We collected information on classical cardiovascular risk factors and incident heart failure (HF) and measured the biomarkers N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin I. The median age of individuals was 47.8 years, 48.3% were men. The median alcohol consumption was 3 g/day. N = 5854 individuals developed AF (median follow-up time: 13.9 years). In a sex- and cohort-stratified Cox regression analysis alcohol consumption was non-linearly and positively associated with incident AF. The hazard ratio for one drink (12 g) per day was 1.16, 95% CI 1.11-1.22, P < 0.001. Associations were similar across types of alcohol. In contrast, alcohol consumption at lower doses was associated with reduced risk of incident HF. The association between alcohol consumption and incident AF was neither fully explained by cardiac biomarker concentrations nor by the occurrence of HF.

    CONCLUSIONS: In contrast to other cardiovascular diseases such as HF, even modest habitual alcohol intake of 1.2 drinks/day was associated with an increased risk of AF, which needs to be considered in AF prevention.

    Fulltekst (pdf)
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  • 47. Dalin, Frida
    et al.
    Nordling Eriksson, Gabriel
    Dahlqvist, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Hallgren, Åsa
    Wahlberg, Jeanette
    Ekwall, Olov
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Rönnelid, Johan
    Olcén, Per
    Winqvist, Ola
    Catrina, Sergiu-Bogdan
    Kriström, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Laudius, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Isaksson, Magnus
    Halldin Stenlid, Maria
    Gustafsson, Jan
    Gebre-Medhin, Gennet
    Björnsdottir, Sigridur
    Janson, Annika
    Åkerman, Anna-Karin
    Åman, Jan
    Duchen, Karel
    Bergthorsdottir, Ragnhildur
    Johannsson, Gudmundur
    Lindskog, Emma
    Landin-Olsson, Mona
    Elfving, Maria
    Waldenström, Erik
    Hulting, Anna-Lena
    Kämpe, Olle
    Bensing, Sophie
    Clinical and immunological characteristics of Autoimmune Addison's disease: a nationwide Swedish multicenter study2017Inngår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 102, nr 2, s. 379-389Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    CONTEXT: Studies on clinical and immunological features of Autoimmune Addison's disease (AAD) are needed to understand the disease burden and increased mortality.

    OBJECTIVE: To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles and cardiovascular risk factors.

    DESIGN, SETTING AND PARTICIPANTS: Cross sectional, population-based study. 660 AAD patients were included utilizing the Swedish Addison Registry (SAR) 2008-2014. When analyzing cardiovascular risk factors, 3,594 individuals from the population-based survey in Northern Sweden, MONICA (MONItoring of Trends and Determinants of CArdiovascular Disease), served as controls.

    MAIN OUTCOME MEASURE: Prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.

    RESULTS: Sixty percent of the SAR cohort consisted of females. Mean age at diagnosis was significantly higher for females than for males (36.8 vs. 31.1 years). The proportion of 21-hydroxylase autoantibody positive patients was 83% and 62% of patients had one or more associated autoimmune diseases, more frequently coexisting in females (p<0.0001). AAD patients had lower BMI (p<0.0001) and prevalence of hypertension (p=0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of patients; with the mean dose 28.1±8.5 mg/day. The mean hydrocortisone equivalent dose normalized to body surface was 14.8±4.4 mg/m(2)/day. Higher hydrocortisone equivalent dose was associated with higher incidence of hypertension (p=0.046).

    CONCLUSIONS: Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients do not have increased prevalence of overweight, hypertension, T2DM or hyperlipidemia. However, high glucocorticoid replacement doses may be a risk factor for hypertension.

  • 48.
    de Man Lapidoth, Julia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hultdin, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Jonsson, Andreas P.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Eriksson Svensson, Maria
    Renal Medicine, Uppsala University, Uppsala, Sweden.
    Wennberg, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Zeller, Tanja
    Clinic for General and Interventional Cardiology, University of Hamburg, Hamburg, Germany; German Center of Cardiovascular Research (DZHK), Partner Seite, Hamburg, Germany.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Trends in renal function in Northern Sweden 1986-2014: data from the seven cross-sectional surveys within the Northern Sweden MONICA study2023Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 8, artikkel-id e072664Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The prevalence of chronic kidney disease (CKD) is increasing globally, and CKD is closely related to cardiovascular disease (CVD). CKD and CVD share several risk factors (RF), such as diabetes, hypertension, obesity and smoking, and the prevalence of these RF has changed during the last decades, and we aimed to study the effect on renal function over time.

    Design: Repeated cross-sectional population-based studies.

    Setting: The two Northern counties (Norr- and Västerbotten) in Sweden.

    Participants: Within the MONitoring Trends and Determinants of CArdiovascular Disease (MONICA) study, seven surveys were performed between 1986 and 2014, including participants aged 25-64 years (n=10 185).

    Interventions: None.

    Measures: Information on anthropometry, blood pressure and cardiovascular risk factors was collected. Creatinine and cystatin C were analysed in stored blood samples and the estimated glomerular filtration rate (eGFR) calculated using the creatinine-based Lund-Malmö revised and Chronic Kidney Disease Epidemiology Collaboration (eGFR crea) equations as well as the cystatin C-based Caucasian, Asian, Paediatric and Adult cohort (CAPA) equation (eGFR cysC). Renal function over time was analysed using univariable and multivariable linear regression models.

    Results: Renal function, both eGFR crea and eGFR cysC, decreased over time (both p<0.001) and differed between counties and sexes. In a multivariable analysis, study year remained inversely associated with both eGFR crea and eGFR cysC (both p<0.001) after adjustment for classical cardiovascular RF.

    Conclusion: Renal function has deteriorated in Northern Sweden between 1986 and 2014.

    Fulltekst (pdf)
    fulltext
  • 49.
    Di Castelnuovo, Augusto
    et al.
    Mediterranea Cardiocentro, Naples, Italy.
    Bonaccio, Marialaura
    Department of Epidemiology and Prevention, IRCCS NEUROMED, IS, Pozzilli, Italy.
    Costanzo, Simona
    Department of Epidemiology and Prevention, IRCCS NEUROMED, IS, Pozzilli, Italy.
    McElduff, Patrick
    Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.
    Linneberg, Allen
    Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Salomaa, Veikko
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Männistö, Satu
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Ferrières, Jean
    Department of Cardiology and INSERM UMR 1295, Toulouse University Hospital, Toulouse, France.
    Dallongeville, Jean
    Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE, Lille, France.
    Thorand, Barbara
    Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
    Brenner, Hermann
    Division of Clinical Epidemiology and Aging Research and Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany.
    Ferrario, Marco
    Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy.
    Veronesi, Giovanni
    Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy.
    Tamosiunas, Abdonas
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Grimsgaard, Sameline
    Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway.
    Drygas, Wojciech
    Department of Epidemiology CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland; Calisia University, Kalisz, Poland.
    Malyutina, Sofia
    The Institute of Internal and Preventive Medicine -Branch of the “FRC Institute of Cytology and Genetics SB RAS”, Novosibirsk, Russian Federation.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Nordendahl, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Kee, Frank
    Centre for Public Health, Queens University of Belfast, Belfast, United Kingdom.
    Grassi, Guido
    Clinica Medica, Università Milano-Bicocca, Milan, Italy.
    Dabboura, Salim
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Borchini, Rossana
    Occupational and Preventive Medicine, ASST Lariana, Como, Italy.
    Westermann, Dirk
    Department for Cardiology and Angiology, Medical Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg, Germany.
    Schrage, Benedikt
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Zeller, Tanja
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Kuulasmaa, Kari
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Blankenberg, Stefan
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Donati, Maria Benedetta
    Department of Epidemiology and Prevention, IRCCS NEUROMED, IS, Pozzilli, Italy.
    Iacoviello, Licia
    Department of Epidemiology and Prevention, IRCCS NEUROMED, IS, Pozzilli, Italy; Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy.
    de Gaetano, Giovanni
    Department of Epidemiology and Prevention, IRCCS NEUROMED, IS, Pozzilli, Italy.
    Drinking alcohol in moderation is associated with lower rate of all-cause mortality in individuals with higher rather than lower educational level: findings from the MORGAM project2023Inngår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 38, nr 8, s. 869-881Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking with all-cause mortality is modified by educational level (EL). Using harmonized data from 16 cohorts in the MORGAM Project (N = 142,066) the association of pattern of alcohol intake with hazard of all-cause mortality across EL (lower = primary-school; middle = secondary-school; higher = university/college degree) was assessed using multivariable Cox-regression and spline curves. A total of 16,695 deaths occurred in 11.8 years (median). In comparison with life-long abstainers, participants drinking 0.1–10 g/d of ethanol had 13% (HR = 0.87; 95%CI: 0.74–1.02), 11% (HR = 0.89; 0.84–0.95) and 5% (HR = 0.95; 0.89–1.02) lower rate of death in higher, middle and lower EL, respectively. Conversely, drinkers > 20 g/d had 1% (HR = 1.01; 0.82–1.25), 10% (HR = 1.10; 1.02–1.19) and 17% (HR = 1.17; 1.09–1.26) higher rate of death. The association of alcohol consumption with all-cause mortality was nonlinear, with a different J-shape by EL levels. It was consistent across both sexes and in various approaches of measuring alcohol consumption, including combining quantity and frequency and it was more evident when the beverage of preference was wine. We observed that drinking in moderation (≤ 10 g/d) is associated with lower mortality rate more evidently in individuals with higher EL than in people with lower EL, while heavy drinking is associated with higher mortality rate more evidently in individuals with lower EL than in people with higher EL, suggesting that advice on reducing alcohol intake should especially target individuals of low EL.

  • 50.
    Di Castelnuovo, Augusto
    et al.
    Mediterranea Cardiocentro, Napoli, Italy.
    Costanzo, Simona
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Bonaccio, Marialaura
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    McElduff, Patrick
    University of Newcastle & Hunter Medical Research Institute, Australia.
    Linneberg, Allan
    Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Salomaa, Veikko
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Männistö, Satu
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Moitry, Marie
    Department of Public Health, University Hospital of Strasbourg and Department of Epidemiology and Public Health, University of Strasbourg, France.
    Ferrières, Jean
    Department of Cardiology and INSERM UMR 1295, Toulouse University Hospital, Toulouse, France.
    Dallongeville, Jean
    University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France.
    Thorand, Barbara
    Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany.
    Brenner, Hermann
    Division of Clinical Epidemiology and Aging Research and Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany.
    Ferrario, Marco
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Veronesi, Giovanni
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Pettenuzzo, Emanuela
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Tamosiunas, Abdonas
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Njølstad, Inger
    Department of community Medicine, University of Tromsø - the Arctic University of Norway, Norway.
    Drygas, Wojciech
    Department of Epidemiology CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland.
    Nikitin, Yuri
    The Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Kee, Frank
    Centre for Public Health, Queens University of Belfast, Belfast, United Kingdom.
    Grassi, Guido
    Clinica Medica, Università Milano-Bicocca, Milano, Italy.
    Westermann, Dirk
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Schrage, Benedikt
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Dabboura, Salim
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Zeller, Tanja
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Kuulasmaa, Kari
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Blankenberg, Stefan
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Donati, Maria Benedetta
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    de Gaetano, Giovanni
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Iacoviello, Licia
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Alcohol intake and total mortality in 142 960 individuals from the MORGAM Project: a population-based study2022Inngår i: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 117, nr 2, s. 312-325Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To test the association of alcohol consumption with total and cause-specific mortality risk. Design: Prospective observational multi-centre population-based study.

    Setting: Sixteen cohorts (15 from Europe) in the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project.

    Participants: A total of 142 960 individuals (mean age 50 ± 13 years, 53.9% men).

    Measurements: Average alcohol intake by food frequency questionnaire, total and cause-specific mortality.

    Findings: In comparison with life-time abstainers, consumption of alcohol less than 10 g/day was associated with an average 11% [95% confidence interval (CI) = 7–14%] reduction in the risk of total mortality, while intake > 20 g/day was associated with a 13% (95% CI = 7–20%) increase in the risk of total mortality. Comparable findings were observed for cardiovascular (CV) deaths. With regard to cancer, drinking up to 10 g/day was not associated with either mortality risk reduction or increase, while alcohol intake > 20 g/day was associated with a 22% (95% CI = 10–35%) increased risk of mortality. The association of alcohol with fatal outcomes was similar in men and women, differed somewhat between countries and was more apparent in individuals preferring wine, suggesting that benefits may not be due to ethanol but other ingredients. Mediation analysis showed that high-density lipoprotein cholesterol explained 2.9 and 18.7% of the association between low alcohol intake and total as well as CV mortality, respectively.

    Conclusions: In comparison with life-time abstainers, consuming less than one drink per day (nadir at 5 g/day) was associated with a reduced risk of total, cardiovascular and other causes mortality, except cancer. Intake of more than two drinks per day was associated with an increased risk of total, cardiovascular and especially cancer mortality.

    Fulltekst (pdf)
    fulltext
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