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  • 1.
    Berglund, Fanny
    et al.
    Department of Health and Medical Services, Region Norrbotten, Luleå, Sweden.
    Törmä, Johanna
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Dietary habits among snus users: a population-based cross-sectional study2023In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 67, article id 9537Article in journal (Refereed)
    Abstract [en]

    Background: The dietary habits among snus users are largely unknown and have not been accounted for in observational studies on the health effects of snus use.

    Aim: To examine whether snus users eat unhealthier than never tobacco users.

    Methods: A total of 3,397 male participants, examined between 1994 and 2014 in the Northern Sweden Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, were included. Snus use and dietary habits were self-reported using questionnaires, from which intakes of different food groups, macronutrients, and a healthy diet score (HDS) were calculated (the latter as a proxy for overall diet quality). The association between snus use and dietary habits was examined by quantile regression models.

    Results: In the multivariable-adjusted model, current snus users had a lower HDS (median difference: −0.86 [95% confidence interval: −1.32, −0.40]) than never tobacco users. Snus users also consumed fewer weekly servings of fruits and berries (median difference: −1.03 [−1.65, −0.40]), and their estimated percentage of energy intake con-sisted of less carbohydrates (median difference: −1.43 [−2.12, −0.74]) and of more total fat (median difference: 0.99 [0.30, 1.67]), saturated fat (median difference: 0.67 [0.29, 1.05]), monounsaturated fat (median difference: 0.44 [0.20, 0.68]), trans fat (median difference: 0.03 [0.01, 0.06]), and alcohol (median difference: 0.21 [0.02, 0.40]).

    Conclusion: We observed that snus users had an unhealthier diet than never tobacco users. Future studies on the association between snus use and health outcomes should, therefore, consider diet as a potential confounder.

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  • 2. 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 studyManuscript (preprint) (Other academic)
  • 3.
    Byhamre, Marja Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Association between snus use and lipid status in Swedish men2023In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 83, no 4, p. 241-250Article in journal (Refereed)
    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.

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  • 4.
    Mejia Baranda, Jorge
    et al.
    Piteå Research Unit, Region Norrbotten, Piteå, Sweden.
    Ljungberg, Jenny
    Piteå Research Unit, Region Norrbotten, Piteå, Sweden.
    Wixner, Jonas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Anan, Intissar
    Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. Piteå Research Unit, Region Norrbotten, Piteå, Sweden.
    Epidemiology of hereditary transthyretin amyloidosis in the northernmost region of Sweden: a retrospective cohort study2022In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 29, no 2, p. 120-127Article in journal (Refereed)
    Abstract [en]

    Introduction: Epidemiological data on hereditary transthyretin (ATTRv) amyloidosis from the northernmost region of Sweden (Norrbotten) are sparse.

    Methods: We reviewed the medical records of all incident cases of ATTRv amyloidosis in Norrbotten between 2006 and 2018. Official population and mortality statistics were used to estimate incidence rates and standardised mortality ratios (SMRs).

    Results: Ninety-three patients were diagnosed with ATTRv amyloidosis between 2006 and 2018 (median age, 72.8 years; 68.8% men; 95.7% Val30Met [p.Val50Met] mutation). The incidence rate per 100,000 persons and year increased from 1.50 (95% confidence interval [CI], 0.84–2.47) cases in 2006–2009 to 4.92 (95%CI, 3.46–6.78) cases in 2016–2018. The SMR in the ATTRv amyloidosis cohort was 2.64 times higher than in the general population in 2006–2018 (95%CI, 1.78–3.77). However, there were indications of lower SMRs over time (2006–2012, 2.96 [95%CI, 1.73–4.74]; 2013–2018, 2.32 [95%CI, 1.23–3.96]) and by use of disease-modifying drugs (no, 3.21 [95%CI, 1.87–5.13]; yes, 2.09 [95%CI, 1.08–3.64]).

    Conclusion: The incidence of ATTRv amyloidosis increased 3-fold in Norrbotten between 2006 and 2018, most likely due to a previous underdiagnosis–with suggestions of lowered mortality during later years, possibly due to the introduction of disease-modifying drugs.

  • 5.
    Neumann, Johannes Tobias
    et al.
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
    Twerenbold, Raphael
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    Weimann, Jessica
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Ballantyne, Christie M.
    Center for Cardiometabolic Disease Prevention, Department of Medicine, College of Medicine, Baylor University, TX, Houston, United States.
    Benjamin, Emelia J.
    Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, MA, Boston, United States; Department of Epidemiology, School of Public Health, Boston University, MA, Boston, United States.
    Costanzo, Simona
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    De Lemos, James A.
    Department of Internal Medicine, UT Southwestern Medical Center, TX, Dallas, United States.
    Defilippi, Christopher R.
    Inova Heart and Vascular Institute, VA, Falls Church, United States.
    Di Castelnuovo, Augusto
    Mediterranea Cardiocentro, Naples, Italy.
    Donfrancesco, Chiara
    Department of Cardiovascular Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy.
    Dörr, Marcus
    Department of Internal Medicine B, University Greifswald, Greifswald, Germany; German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany.
    Eggers, Kai M.
    Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden.
    Engström, Gunnar
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Felix, Stephan B.
    Department of Internal Medicine B, University Greifswald, Greifswald, Germany; German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany.
    Ferrario, Marco M.
    Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Gansevoort, Ron T.
    Department of Nephrology, University Medical Center Groningen, Groningen, Netherlands.
    Giampaoli, Simona
    Istituto Superiore di Sanità, Rome, Italy.
    Giedraitis, Vilmantas
    Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.
    Hedberg, Pär
    Department of Clinical Physiology, Centre for Clinical Research, Västmanland County Hospital, Uppsala University, Västerås, Sweden.
    Iacoviello, Licia
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Department of Medicine and Surgery, Libera Università Mediterranea, Casamassima, Italy.
    Jørgensen, Torben
    Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research and Prevention, BFH Hospital, Copenhagen, Denmark.
    Kee, Frank
    UKCRC, Centre of Excellence for Public Health, Queens University of Belfast, Belfast, United Kingdom.
    Koenig, Wolfgang
    German Heart Center, Technical University of Munich, Munich, Germany; Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; German Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany.
    Kuulasmaa, Kari
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Lewis, Joshua R.
    Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; Medical School, University of Western Australia, Perth, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
    Lorenz, Thiess
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Lyngbakken, Magnus N.
    Division of Medicine, Department of Cardiology, Akershus University Hospital, Lorenskog, Norway; K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Magnussen, Christina
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    Melander, Olle
    Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden.
    Nauck, Matthias
    German Center for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany; Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.
    Niiranen, Teemu J.
    Finnish Institute for Health and Welfare, Helsinki, Finland; Division of Medicine, Turku University Hospital, Turku, Finland; Department of Internal Medicine, University of Turku, Turku, Finland.
    Nilsson, Peter M.
    Departments of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden.
    Olsen, Michael H.
    Cardiology Section, Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark; Department of Regional Health, University of Southern Denmark, Odense, Denmark.
    Omland, Torbjorn
    Division of Medicine, Department of Cardiology, Akershus University Hospital, Lorenskog, Norway; K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Palmieri, Luigi
    Department of Cardiovascular Endocrine-Metabolic Diseases, and Aging, National Institute of Health, Rome, Italy.
    Peters, Anette
    German Center for Cardiovascular Disease Research, Partner Site Munich Heart Alliance, Munich, Germany; Institute of Epidemiology Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany.
    Prince, Richard L.
    Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia; Medical School, University of Western Australia, Perth, Australia.
    Qaderi, Vazhma
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Vasan, Ramachandran S.
    Department of Medicine, Boston Medical Center, Chobanian and Avedisian School of Medicine, Boston University, MA, Boston, United States; University of Texas, School of Public Health, The University of Texas, Health Science Center, San Antonio, United States.
    Salomaa, Veikko
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Sans, Susana
    Catalan Department of Health, Barcelona, Spain.
    Smith, J. Gustav
    Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Thorand, Barbara
    Institute of Epidemiology Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing Biometry, and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany.
    Tonkin, Andrew M.
    Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
    Tunstall-Pedoe, Hugh
    Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom.
    Veronesi, Giovanni
    Research Centre in Epidemiology and Preventive Medicine, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Watanabe, Tetsu
    Department of Cardiology Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan.
    Watanabe, Masafumi
    Department of Cardiology Pulmonology, and Nephrology, School of Medicine, Yamagata University, Yamagata, Japan.
    Zeiher, Andreas M.
    Institute for Cardiovascular Regeneration, Goethe University, Frankfurt, Germany; German Center for Cardiovascular Disease Research, Partner Site Rhine-Main, Mainz, Germany.
    Zeller, Tanja
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    Blankenberg, Stefan
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
    Ojeda, Francisco
    Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Prognostic value of cardiovascular biomarkers in the population2024In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598Article in journal (Refereed)
    Abstract [en]

    Importance: Identification of individuals at high risk for atherosclerotic cardiovascular disease within the population is important to inform primary prevention strategies.

    Objective: To evaluate the prognostic value of routinely available cardiovascular biomarkers when added to established risk factors.

    Design, Setting, and Participants: Individual-level analysis including data on cardiovascular biomarkers from 28 general population-based cohorts from 12 countries and 4 continents with assessments by participant age. The median follow-up was 11.8 years.

    Exposure: Measurement of high-sensitivity cardiac troponin I, high-sensitivity cardiac troponin T, N-terminal pro-B-type natriuretic peptide, B-type natriuretic peptide, or high-sensitivity C-reactive protein.

    Main Outcomes and Measures: The primary outcome was incident atherosclerotic cardiovascular disease, which included all fatal and nonfatal events. The secondary outcomes were all-cause mortality, heart failure, ischemic stroke, and myocardial infarction. Subdistribution hazard ratios (HRs) for the association of biomarkers and outcomes were calculated after adjustment for established risk factors. The additional predictive value of the biomarkers was assessed using the C statistic and reclassification analyses.

    Results: The analyses included 164054 individuals (median age, 53.1 years [IQR, 42.7-62.9 years] and 52.4% were women). There were 17211 incident atherosclerotic cardiovascular disease events. All biomarkers were significantly associated with incident atherosclerotic cardiovascular disease (subdistribution HR per 1-SD change, 1.13 [95% CI, 1.11-1.16] for high-sensitivity cardiac troponin I; 1.18 [95% CI, 1.12-1.23] for high-sensitivity cardiac troponin T; 1.21 [95% CI, 1.18-1.24] for N-terminal pro-B-type natriuretic peptide; 1.14 [95% CI, 1.08-1.22] for B-type natriuretic peptide; and 1.14 [95% CI, 1.12-1.16] for high-sensitivity C-reactive protein) and all secondary outcomes. The addition of each single biomarker to a model that included established risk factors improved the C statistic. For 10-year incident atherosclerotic cardiovascular disease in younger people (aged <65 years), the combination of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein resulted in a C statistic improvement from 0.812 (95% CI, 0.8021-0.8208) to 0.8194 (95% CI, 0.8089-0.8277). The combination of these biomarkers also improved reclassification compared with the conventional model. Improvements in risk prediction were most pronounced for the secondary outcomes of heart failure and all-cause mortality. The incremental value of biomarkers was greater in people aged 65 years or older vs younger people.

    Conclusions and Relevance: Cardiovascular biomarkers were strongly associated with fatal and nonfatal cardiovascular events and mortality. The addition of biomarkers to established risk factors led to only a small improvement in risk prediction metrics for atherosclerotic cardiovascular disease, but was more favorable for heart failure and mortality..

  • 6.
    Oskarsson, Viktor
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Salomaa, Veikko
    Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Reinikainen, Jaakko
    Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Männistö, Satu
    Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
    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.
    Sans, Susana
    Catalan Department of Health, Barcelona, Spain.
    Costanzo, Simona
    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; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Veronesi, Giovanni
    Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Ferrario, Marco M
    Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Padro, Teresa
    Cardiovascular-Program ICCC, Research Institute Hospital Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.
    Thorand, Barbara
    Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
    Huth, Cornelia
    Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
    Zeller, Tanja
    University Heart and Vascular Center Hamburg, Medical University Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Blankenberg, Stefan
    University Heart and Vascular Center Hamburg, Medical University Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Anderson, Annie S
    Centre for Public Health Nutrition Research, University of Dundee, Dundee, United Kingdom.
    Tunstall-Pedoe, Hugh
    Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom.
    Kuulasmaa, Kari
    Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Influence of geographical latitude on vitamin D status: cross-sectional results from the BiomarCaRE consortium2022In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 128, no 11, p. 2208-2218Article in journal (Refereed)
    Abstract [en]

    Even though sunlight is viewed as the most important determinant of 25-hydroxyvitamin D (25[OH]D) status, several European studies have observed higher 25(OH)D concentrations among north-Europeans than south-Europeans. We studied the association between geographical latitude (derived from ecological data) and 25(OH)D status in 6 European countries by using harmonized immunoassay data from 81,084 participants in the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project (male sex 48.9%; median age 50.8 years; examination period 1984 to 2014). Quantile regression models, adjusted for age, sex, decade and calendar week of sampling, and time from sampling to analysis, were used for between-country comparisons. Up until the median percentile, the ordering of countries by 25(OH)D status (from highest to lowest) was as follows: Sweden (at 65.6 to 63.8 oN), Germany (at 48.4 oN), Finland (at 65.0 to 60.2 oN), Italy (at 45.6 to 41.5 oN), Scotland (at 58.2 to 55.1 oN), and Spain (at 41.5 oN). From the 75th percentile and upwards, Finland had higher values than Germany. As an example, using the Swedish cohort as comparator, the median 25(OH)D concentration was 3.03, 3.28, 5.41, 6.54, and 9.28 ng/mL lower in the German, Finnish, Italian, Scottish, and Spanish cohort, respectively (P-value < 0.001 for all comparisons). The ordering of countries was highly consistent in subgroup analyses by sex, age, and decade and season of sampling. In conclusion, we confirmed the previous observation of a north-to-south gradient of 25(OH)D status in Europe, with higher percentile values among north-Europeans than south-Europeans.

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  • 7.
    Oskarsson, Viktor
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Hosseini, Servah
    Discacciati, Andrea
    Videhult, Per
    Jans, Anders
    Ekbom, Anders
    Sadr-Azodi, Omid
    Rising incidence of acute pancreatitis in Sweden: national estimates and trends between 1990 and 20132020In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 8, no 4, p. 472-480Article in journal (Refereed)
    Abstract [en]

    Background: Recent reports from western countries have indicated an increased incidence and a decreased mortality in acute pancreatitis. However, the incidence assessment has often been hampered by the inclusion of both first-time and recurrent episodes of acute pancreatitis.

    Methods: In this retrospective cohort study, all Swedish residents hospitalized with a first-time episode of acute pancreatitis between 1990 and 2013 were identified using national registers. Sex- and age-standardized incidence rates per 100,000 individuals and year were calculated, as were annual percent changes (APC) from joinpoint regression models.

    Results: Overall, between 1990 and 2013, 66,131 individuals had a first-time episode of acute pancreatitis in Sweden. Comparing the first five years (1990-1994) to the last four years (2010-2013) of the study period, the overall incidence of acute pancreatitis increased from 25.2 (95% confidence interval (CI): 24.1, 26.3) to 38.3 (95% CI: 37.0, 39.5) cases per 100,000 individuals and year. An increase in incidence was observed irrespective of the subtypes of acute pancreatitis as well as the sex and age of the patients. Although the incidence of complicated acute pancreatitis declined in both men and women between 1990 and 2004, it started to increase in both sexes (APC 3.0; 95% CI: 0.5, 5.5 in men; APC 5.4; 95% CI: 2.6, 8.2 in women) from 2005 onwards.

    Conclusion: Based on nationwide data, the incidence of first-time acute pancreatitis has increased in Sweden over a period of 24 years. The incidence of disease-related complications has also been on the rise during the past few years, after declining for more than 15 years before that.

  • 8.
    Reinikainen, Jaakko
    et al.
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, Finland.
    Kuulasmaa, Kari
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, Finland.
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Amouyel, Philippe
    Inserm, Institut Pasteur de Lille, Lille, France.
    Biasch, Katia
    Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France.
    Brenner, Hermann
    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, Heidelberg University, Heidelberg, Germany.
    De Ponti, Roberto
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Donfrancesco, Chiara
    Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
    Drygas, Wojciech
    Department of Epidemiology, Cardiovascular Disease Prevention and Heart Promotion, National Institute of Cardiology, Warsaw, Poland; Faculty of Medicine, Lazarski University, Warsaw, Poland.
    Ferrieres, Jean
    Department of Cardiology, Inserm Umr 1027, Toulouse University School of Medicine, Rangueil Hospital, Toulous, France.
    Grassi, Guido
    Clinica Medica, University of Milano-Bicocca, Milan, Italy.
    Grimsgaard, Sameline
    Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
    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), P.O. Box 30, Helsinki, Finland.
    Kårhus, Line L.
    Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.
    Kee, Frank
    Centre for Public Health, The Queen's University of Belfast, Belfast, United Kingdom.
    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.
    Luksiene, Dalia
    Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Mariño, Joany
    Unit Quality in the Health Sciences (QIHS), Department SHIP-KEF, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
    Moitry, Marie
    Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France.
    Palmieri, Luigi
    Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy.
    Peters, Annette
    Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Cardiovascular Disease Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
    Piwonska, Aleksandra
    Department of Epidemiology, Cardiovascular Disease Prevention and Heart Promotion, National Institute of Cardiology, Warsaw, Poland.
    Quarti-Trevano, Fosca
    Clinica Medica, University of Milano-Bicocca, Milan, Italy.
    Salomaa, Veikko
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, Finland.
    Sans, Susana
    Catalan Department of Health, Barcelona, Spain.
    Schmidt, Carsten Oliver
    Unit Quality in the Health Sciences (QIHS), Department SHIP-KEF, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
    Schöttker, Ben
    Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, Heidelberg University, Heidelberg, Germany.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Tamosiunas, Abdonas
    Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Thorand, Barbara
    Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany.
    Tunstall-Pedoe, Hugh
    Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Dundee, United Kingdom.
    Vanuzzo, Diego
    MONICA-FRIULI Study Group, Udine, Italy.
    Veronesi, Giovanni
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Woodward, Mark
    The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom; The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Lekadir, Karim
    Artifcial Intelligence in Medicine Lab (BCN AIM), Departament de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain.
    Niiranen, Teemu
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Helsinki, Finland; Department of Internal Medicine, University of Turku, Turku University Hospital, Turku, Finland.
    Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: an analysis of 49 cohorts from 11 European countries2024In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 31, no 5, p. 569-577Article in journal (Refereed)
    Abstract [en]

    Aims: The regional and temporal differences in the associations between cardiovascular disease (CVD) and its classic risk factors are unknown. The current study examined these associations in different European regions over a 30-year period.

    Methods and results: The study sample comprised 553 818 individuals from 49 cohorts in 11 European countries (baseline: 1982-2012) who were followed up for a maximum of 10 years. Risk factors [sex, smoking, diabetes, non-HDL cholesterol, systolic blood pressure (BP), and body mass index (BMI)] and CVD events (coronary heart disease or stroke) were harmonized across cohorts. Risk factor-outcome associations were analysed using multivariable-adjusted Cox regression models, and differences in associations were assessed using meta-regression. The differences in the risk factor-CVD associations between central Europe, northern Europe, southern Europe, and the UK were generally small. Men had a slightly higher hazard ratio (HR) in southern Europe (P = 0.043 for overall difference), and those with diabetes had a slightly lower HR in central Europe (P = 0.022 for overall difference) compared with the other regions. Of the six CVD risk factors, minor HR decreases per decade were observed for non-HDL cholesterol [7% per mmol/L; 95% confidence interval (CI), 3-10%] and systolic BP (4% per 20 mmHg; 95% CI, 1-8%), while a minor HR increase per decade was observed for BMI (7% per 10 kg/m2; 95% CI, 1-13%).

    Conclusion: The results demonstrate that all classic CVD risk factors are still relevant in Europe, irrespective of regional area. Preventive strategies should focus on risk factors with the greatest population attributable risk.

  • 9.
    Sadr-Azodi, Omid
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Ljung, Rickard
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lindblad, Mats
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Antipsychotic drugs and risk of acute pancreatitis: a nationwide case–control study2023In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 148, no 2, p. 199-207Article in journal (Refereed)
    Abstract [en]

    Introduction: Use of antipsychotic drugs, especially second-generation agents, has been suggested to cause acute pancreatitis in multiple case reports; however, such an association has not been corroborated by larger studies. This study examined the association of antipsychotic drugs with risk of acute pancreatitis.

    Methods: Nationwide case–control study, based on data from several Swedish registers and including all 52,006 cases of acute pancreatitis diagnosed in Sweden between 2006 and 2019 (with up to 10 controls per case; n = 518,081). Conditional logistic regression models were used to calculate odds ratios (ORs) in current and past users of first-generation and second-generation antipsychotic drugs (dispensed prescription <91 and ≥91 days of the index date, respectively) compared with never users of such drugs.

    Results: In the crude model, first-generation and second-generation antipsychotic drugs were associated with increased risk of acute pancreatitis, with slightly higher ORs for past use (1.58 [95% confidence interval 1.48–1.69] and 1.39 [1.29–1.49], respectively) than for current use (1.34 [1.21–1.48] and 1.24 [1.15–1.34], respectively). The ORs were largely attenuated in the multivariable model—which included, among others, alcohol abuse and the Charlson comorbidity index—up to the point where only a statistically significant association remained for past use of first-generation agents (OR 1.18 [1.10–1.26]).

    Conclusion: There was no clear association between use of antipsychotic drugs and risk of acute pancreatitis in this very large case–control study, indicating that previous case report data are most likely explained by confounding.

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  • 10.
    Selin, Daniel
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden.
    Maret-Ouda, John
    Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindblad, Mats
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Arnelo, Urban
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Holmberg, Marcus
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden.
    Yang, Bei
    Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Sema, Kristiana
    Department of Surgery, Eskilstuna County Hospital, Eskilstuna, Sweden.
    Nilsson, Magnus
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden.
    Sadr-Azodi, Omid
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden; Unit of Upper Gastrointestinal Surgery, Saint Goran Hospital, Stockholm, Sweden.
    Exploring the association between acute pancreatitis and biliary tract cancer: a large-scale population-based matched cohort study2024In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414Article in journal (Refereed)
    Abstract [en]

    Background: Biliary tract cancer (BTC) often goes undetected until its advanced stages, resulting in a poor prognosis. Given the anatomical closeness of the gallbladder and bile ducts to the pancreas, the inflammatory processes triggered by acute pancreatitis might increase the risk of BTC.

    Objective: To assess the association between acute pancreatitis and the risk of BTC.

    Methods: Using the Swedish Pancreatitis Cohort (SwePan), we compared the BTC risk in patients with a first-time episode of acute pancreatitis during 1990–2018 to a 1:10 matched pancreatitis-free control group. Multivariable Cox regression models, stratified by follow-up duration, were used to calculate hazard ratios (HRs), adjusting for socioeconomic factors, alcohol use, and comorbidities.

    Results: BTC developed in 0.94% of 85,027 acute pancreatitis patients and in 0.23% of 814,993 controls. The BTC risk notably increased within 3 months of hospital discharge (HR 82.63; 95% CI: 63.07–108.26) and remained elevated beyond 10 years of follow-up (HR 1.82; 95% CI: 1.35–2.47). However, the long-term risk of BTC subtypes did not increase with anatomical proximity to the pancreas, with a null association for gallbladder and extrahepatic tumors. Importantly, patients with acute pancreatitis had a higher occurrence of early-stage BTC within 2 years of hospital discharge than controls (13.0 vs. 3.6%; p-value <0.01).

    Conclusion: Our nationwide study found an elevated BTC risk in acute pancreatitis patients; however, the risk estimates for BTC subtypes were inconsistent, thereby questioning the causality of the association. Importantly, the amplified detection of early-stage BTC within 2 years after a diagnosis of acute pancreatitis underscores the necessity for proactive BTC surveillance in these patients.

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  • 11.
    Sujana, Chaterina
    et al.
    Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, Epidemiology (IBE), Pettenkofer School of Public Health, Ludwig-Maximilians-Universität, Munich, Germany; German Center for Diabetes Research (DZD), Partner Munich-Neuherberg, Germany.
    Salomaa, Veikko
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Kee, Frank
    Centre for Public Health, Queens University of Belfast, Northern Ireland, Belfast, United Kingdom.
    Costanzo, Simona
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Jordan, Jens
    Institute of Aerospace Medicine, German Aerospace Center (DLR) and University of Cologne, Cologne, Germany.
    Jousilahti, Pekka
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Neville, Charlotte
    Centre for Public Health, Queens University of Belfast, Northern Ireland, Belfast, United Kingdom.
    Iacoviello, Licia
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Westermann, Dirk
    Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.
    Koenig, Wolfgang
    Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany; Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Munich Heart Alliance, Munich, Germany.
    Kuulasmaa, Kari
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Reinikainen, Jaakko
    Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
    Blankenberg, Stefan
    Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany.
    Zeller, Tanja
    Department for General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Hamburg, Lübeck, Kiel, Hamburg, Germany.
    Herder, Christian
    Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; Division of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), Partner Düsseldorf, Germany.
    Mansmann, Ulrich
    Institute for Medical Information Processing, Biometry, Epidemiology (IBE), Pettenkofer School of Public Health, Ludwig-Maximilians-Universität, Munich, Germany.
    Peters, Annette
    Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research (DZD), Partner Munich-Neuherberg, Germany; German Centre for Cardiovascular Research (DZHK e.V.), partner site Munich Heart Alliance, Munich, Germany.
    Thorand, Barbara
    Institute of Epidemiology, Helmholtz Zentrum Munchen - German Research Center for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research (DZD), Partner Munich-Neuherberg, Munich-Neuherberg, Germany.
    Natriuretic Peptides and Risk of Type 2 Diabetes: Results From the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) Consortium2021In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 44, no 11, p. 2527-2535Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Natriuretic peptide (NP) concentrations are increased in cardiovascular diseases (CVDs) but are associated with a lower diabetes risk. We investigated associations of N-terminal pro-B-type NP (NT-proBNP) and midregional proatrial NP (MR-proANP) with incident type 2 diabetes stratified by the presence of CVD.

    RESEARCH DESIGN AND METHODS: Based on the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) Consortium, we included 45,477 participants with NT-proBNP measurements (1,707 developed type 2 diabetes over 6.5 years of median follow-up; among these, 209 had CVD at baseline) and 11,537 participants with MR-proANP measurements (857 developed type 2 diabetes over 13.8 years of median follow-up; among these, 106 had CVD at baseline). The associations were estimated using multivariable Cox regression models.

    RESULTS: Both NPs were inversely associated with incident type 2 diabetes (hazard ratios [95% CI] per 1-SD increase of log NP: 0.84 [0.79; 0.89] for NT-proBNP and 0.77 [0.71; 0.83] for MR-proANP). The inverse association between NT-proBNP and type 2 diabetes was significant in individuals without CVD but not in individuals with CVD (0.81 [0.76; 0.86] vs. 1.04 [0.90; 1.19]; P multiplicative interaction = 0.001). There was no significant difference in the association of MR-proANP with type 2 diabetes between individuals without and with CVD (0.75 [0.69; 0.82] vs. 0.81 [0.66; 0.99]; P multiplicative interaction = 0.236).

    CONCLUSIONS: NT-proBNP and MR-proANP are inversely associated with incident type 2 diabetes. However, the inverse association of NT-proBNP seems to be modified by the presence of CVD. Further investigations are warranted to confirm our findings and to investigate the underlying mechanisms.

  • 12.
    Summerhays, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lundqvist, Robert
    Research and Innovation Unit, Norrbotten County Council, Luleå, Sweden.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Zeller, Tanja
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Time trends of vitamin D concentrations in northern Sweden between 1986 and 2014: a population-based cross-sectional study2019In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 59, no 7, p. 3037-3044Article in journal (Refereed)
    Abstract [en]

    Purpose: Vitamin D, produced through cutaneous photosynthesis or ingested via foods or supplements, has generated considerable research interest due to its potential health effects. However, epidemiological data on the time trends of vitamin D status are sparse, especially from northern Europe. We examined the time trend of vitamin D concentrations in northern Sweden between 1986 and 2014.

    Methods: We used data on 11,129 men and women (aged 25–74 years) from seven population-based surveys (the Northern Sweden MONICA study), recruited between 1986 and 2014. Serum vitamin D (25-hydroxyvitamin D) status was measured using a one-step immunoassay (Abbott Architect). Multivariable linear regression models, adjusted for age, sex, and a number of other variables, were used to estimate the time trend of vitamin D concentrations.

    Results: The mean value of vitamin D in the entire study population was 19.9 ng/mL [standard deviation (SD) 7.9], with lower values in men (19.4 ng/mL; SD 7.5) than in women (20.5 ng/mL; SD 8.2). Using the survey in 1986 as reference category, the multivariable-adjusted mean difference [95% confidence interval (CI)] in ng/mL was 2.7 (2.2, 3.3) in 1990, 3.2 (2.7, 3.7) in 1994, 1.6 (1.0, 2.1) in 1999, − 2.0 (− 2.5, − 1.4) in 2004, 1.0 (0.4, 1.5) in 2009, and 3.1 (2.5, 3.6) in 2014.

    Conclusion: In this large cross-sectional study, we observed no clear upward or downward trend of vitamin D concentrations in northern Sweden between 1986 and 2014.

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  • 13.
    Törmä, Johanna
    et al.
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden; Department of Development, Region Norrbotten, Luleå, Sweden.
    Lundqvist, Robert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Oskarsson, Viktor
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Comparison of dietary trends between two counties with and without a cardiovascular prevention program: a population-based cross-sectional study in northern Sweden2022In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 25, no 7, p. 1835-1843Article in journal (Refereed)
    Abstract [en]

    Objective: To compare temporal trends, over a 20-year period, in dietary habits between a county (Västerbotten) with a cardiovascular disease (CVD) prevention program and a county (Norrbotten) without such a program.

    Design: Cross-sectional data from the Northern Sweden MONICA study (survey period 1994, 1999, 2004, 2009, 2014). Dietary habits were assessed by a semi-quantitative food frequency questionnaire.

    Setting: Counties of Norrbotten and Västerbotten, Northern Sweden.

    Participants: Five thousand four hundred Swedish adults (mean age 56.9 years; 51.2% women) from Västerbotten (47%) and Norrbotten (53%).

    Results: No differences in temporal trend for estimated percentage of energy intake from total carbohydrates, total fat, total protein, and alcohol were observed between the counties (p for interaction ≥0.33). There were no between-county difference in temporal trends for overall diet quality (assessed by the Healthy Diet Score; p for interaction = 0.36). Nor were there any between-county differences for intake of whole grain products, fruits, vegetables, fish, sweetened beverages or fried potatoes (p for interaction ≥ 0.09). Consumption of meat (p for interaction = 0.05) increased to a greater extent in Norrbotten from 2009 and onwards, mainly in men (sex-specific analyses, p for interaction = 0.04). Men in Västerbotten decreased their intake of sweets to a greater extent than men in Norrbotten (p for interaction <0.01).

    Conclusions: Over a 20-year period in northern Sweden, only small differences in dietary habits were observed in favor of a county with a CVD prevention program compared to a county without such a program.

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