51
|
Carlsson AC, Li X, Holzmann MJ, Wändell P, Gasevic D, Sundquist J, Sundquist K. Neighbourhood socioeconomic status and coronary heart disease in individuals between 40 and 50 years. Heart 2016; 102:775-82. [PMID: 26864672 DOI: 10.1136/heartjnl-2015-308784] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/08/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The incidence of myocardial infarction (MI) has decreased in general but not among younger middle-aged adults. We performed a cohort study of the association between neighbourhood socioeconomic status (SES) at the age of 40 and risk of MI before the age of 50 years. METHODS All individuals in Sweden were included in the year of their 40th birthday, if it occurred between 1998 and 2010. National registers were used to categorise neighbourhood SES into high, middle and low, and to retrieve information on incident MI and coronary heart disease (CHD). Cox regression models, adjusted for marital status, education level, immigrant status and region of residence, provided an estimate of the HRs and 95% CIs for MI or CHD. RESULTS Out of 587 933 men and 563 719 women, incident MI occurred in 2877 (0.48%) men and 932 (0.17%) women; and CHD occurred in 4400 (0.74%) men and 1756 (0.31%) women during a mean follow-up of 5.5 years. Using individuals living in middle-SES neighbourhoods as referents, living in high-SES neighbourhoods was associated with lower risk of MI in both sexes (HR (95% CI): men: 0.72 (0.64 to 0.82), women: 0.66 (0.53 to 0.81)); living in low-SES neighbourhoods was associated with a higher risk of MI (HR (95% CI): men: 1.31 (1.20 to 1.44), women: 1.28 (1.08 to 1.50)). Similar risk estimates for CHD were found. CONCLUSIONS The results of our study suggest an increased risk of MI and CHD among residents from low-SES neighbourhoods and a lower risk in those from high-SES neighbourhoods compared with residents in middle-SES neighbourhoods.
Collapse
Affiliation(s)
- Axel C Carlsson
- Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Martin J Holzmann
- Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Wändell
- Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Danijela Gasevic
- Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | |
Collapse
|
52
|
Sulo G, Igland J, Vollset SE, Nygård O, Ebbing M, Sulo E, Egeland GM, Tell GS. Heart Failure Complicating Acute Myocardial Infarction; Burden and Timing of Occurrence: A Nation-wide Analysis Including 86 771 Patients From the Cardiovascular Disease in Norway (CVDNOR) Project. J Am Heart Assoc 2016; 5:JAHA.115.002667. [PMID: 26744379 PMCID: PMC4859383 DOI: 10.1161/jaha.115.002667] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) represents often the underlying conditions for the development of heart failure (HF). We aimed at exploring the burden and timing of HF complicating an acute myocardial infarction (AMI), using the total population of AMI patients hospitalized during 2001-2009 in Norway. METHODS AND RESULTS A total of 86 771 patients with a first AMI during 2001-2009 and without previous HF were identified in the "Cardiovascular Disease in Norway" project and followed until HF development, death, or December 31, 2009. In 16 219 patients (18.7%), HF was present on admission or developed during hospitalization for the incident AMI. HF occurrence varied according to age (8.9%, 15.2%, and 25.6% among men and 10.2%, 16.8%, and 27.1% among women ages 25-54, 55-74, and 75-85 years). Among 63 853 patients discharged alive without HF, 8058 (12.6%) were hospitalized with or died because of HF during a median follow-up time of 3.2 years. HF incidence rates (IRs) per 1000 person-years during follow-up were 31 (95% CI, 30-32) for men and 46 (95% CI, 44-47) for women (P<0.01). IRs of HF were highest during the first 6 months of follow-up, after which they leveled off and remained stable until the end of follow-up. CONCLUSIONS In this nation-wide cohort study, we observed that HF remains a frequent complication of the first AMI; both during the acute phase and shortly after the discharge from the hospital.
Collapse
Affiliation(s)
- Gerhard Sulo
- Section for Cardiology, Departments of Global Public Health and Primary Care, University of Bergen, Norway (G.S., J.I., S.E.V., E.S., G.M.E., G.S.T.) Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., M.E., G.M.E., G.S.T.)
| | - Jannicke Igland
- Section for Cardiology, Departments of Global Public Health and Primary Care, University of Bergen, Norway (G.S., J.I., S.E.V., E.S., G.M.E., G.S.T.)
| | - Stein Emil Vollset
- Section for Cardiology, Departments of Global Public Health and Primary Care, University of Bergen, Norway (G.S., J.I., S.E.V., E.S., G.M.E., G.S.T.) Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Ottar Nygård
- Section for Cardiology, Department of Clinical Science, University of Bergen, Norway (O.N.) Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.)
| | - Marta Ebbing
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., M.E., G.M.E., G.S.T.)
| | - Enxhela Sulo
- Section for Cardiology, Departments of Global Public Health and Primary Care, University of Bergen, Norway (G.S., J.I., S.E.V., E.S., G.M.E., G.S.T.)
| | - Grace M Egeland
- Section for Cardiology, Departments of Global Public Health and Primary Care, University of Bergen, Norway (G.S., J.I., S.E.V., E.S., G.M.E., G.S.T.) Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., M.E., G.M.E., G.S.T.)
| | - Grethe S Tell
- Section for Cardiology, Departments of Global Public Health and Primary Care, University of Bergen, Norway (G.S., J.I., S.E.V., E.S., G.M.E., G.S.T.) Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., M.E., G.M.E., G.S.T.)
| |
Collapse
|
53
|
Ding Y, Svingen GFT, Pedersen ER, Gregory JF, Ueland PM, Tell GS, Nygård OK. Plasma Glycine and Risk of Acute Myocardial Infarction in Patients With Suspected Stable Angina Pectoris. J Am Heart Assoc 2015; 5:JAHA.115.002621. [PMID: 26722126 PMCID: PMC4859380 DOI: 10.1161/jaha.115.002621] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Glycine is an amino acid involved in antioxidative reactions, purine synthesis, and collagen formation. Several studies demonstrate inverse associations of glycine with obesity, hypertension, and diabetes mellitus. Recently, glycine‐dependent reactions have also been linked to lipid metabolism and cholesterol transport. However, little evidence is available on the association between glycine and coronary heart disease. Therefore, we assessed the association between plasma glycine and acute myocardial infarction (AMI). Methods and Results A total of 4109 participants undergoing coronary angiography for suspected stable angina pectoris were studied. Cox regression was used to estimate the association between plasma glycine and AMI, obtained via linkage to the CVDNOR project. During a median follow‐up of 7.4 years, 616 patients (15.0%) experienced an AMI. Plasma glycine was higher in women than in men and was associated with a more favorable baseline lipid profile and lower prevalence of obesity, hypertension, and diabetes mellitus (all P<0.001). After multivariate adjustment for traditional coronary heart disease risk factors, plasma glycine was inversely associated with risk of AMI (hazard ratio per SD: 0.89; 95% CI, 0.82–0.98; P=0.017). The inverse association was generally stronger in those with apolipoprotein B, low‐density lipoprotein cholesterol, or apolipoprotein A‐1 above the median (all Pinteraction≤0.037). Conclusions Plasma glycine was inversely associated with risk of AMI in patients with suspected stable angina pectoris. The associations were stronger in patients with apolipoprotein B, low‐density lipoprotein cholesterol, or apolipoprotein A‐1 levels above the median. These results motivate further studies to elucidate the relationship between glycine and lipid metabolism, in particular in relation to cholesterol transport and atherosclerosis. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00354081.
Collapse
Affiliation(s)
- Yunpeng Ding
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.)
| | - Gard F T Svingen
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.)
| | - Eva R Pedersen
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.)
| | - Jesse F Gregory
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL (J.F.G.)
| | - Per M Ueland
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.) Bevital AS, Bergen, Norway (P.M.U.)
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway (G.S.T.) Norwegian Institute of Public Health, Bergen, Norway (G.S.T.)
| | - Ottar K Nygård
- Department of Clinical Science, University of Bergen, Norway (Y.D., G.T.S., E.R.P., P.M.U., O.K.N.) Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.K.N.) KG Jebsen Center for Diabetes Research, Haukeland University Hospital, Bergen, Norway (O.K.N.)
| |
Collapse
|
54
|
Jortveit J, Øyen N, Leirgul E, Fomina T, Tell GS, Vollset SE, Eskedal L, Døhlen G, Birkeland S, Holmstrøm H. Trends in Mortality of Congenital Heart Defects. CONGENIT HEART DIS 2015; 11:160-8. [DOI: 10.1111/chd.12307] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Jarle Jortveit
- Department of Cardiology; Sørlandet Hospital; Arendal Norway
- Institute of Clinical Medicine, University of Oslo; Oslo Norway
| | - Nina Øyen
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital; Bergen Norway
| | - Elisabeth Leirgul
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
| | - Tatiana Fomina
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Division of Epidemiology; Norwegian Institute of Public Health; Bergen Norway
| | - Stein Emil Vollset
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
- Division of Epidemiology; Norwegian Institute of Public Health; Bergen Norway
| | - Leif Eskedal
- Research Department; Sørlandet Hospital; Kristiansand Norway
| | - Gaute Døhlen
- Women's and Children's Department, Oslo University Hospital; Oslo Norway
| | - Sigurd Birkeland
- Department of Cardiothoracic Surgery, Oslo University Hospital; Oslo Norway
| | - Henrik Holmstrøm
- Institute of Clinical Medicine, University of Oslo; Oslo Norway
- Women's and Children's Department, Oslo University Hospital; Oslo Norway
| |
Collapse
|
55
|
Jortveit J, Eskedal L, Hirth A, Fomina T, Døhlen G, Hagemo P, Tell GS, Birkeland S, Øyen N, Holmstrøm H. Sudden unexpected death in children with congenital heart defects. Eur Heart J 2015; 37:621-6. [PMID: 26341891 DOI: 10.1093/eurheartj/ehv478] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/24/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Congenital heart defects (CHDs) are the most common birth defects and are an important cause of death in children. The fear of sudden unexpected death has led to restrictions of physical activity and competitive sports. The aim of the present study was to investigate the rate of sudden unexpected deaths unrelated to surgery in children 2-18 years old with CHDs and, secondarily, to determine whether these deaths were related to cardiac disease, comorbidity, or physical activity. METHODS AND RESULTS To identify children with CHDs and to determine the number of deaths, data concerning all 9 43 871 live births in Norway in 1994-2009 were retrieved from the Medical Birth Registry of Norway, the Cardiovascular Disease in Norway project, the Oslo University Hospital's Clinical Registry for Congenital Heart Defects and the Norwegian Cause of Death Registry. Survivors were followed through 2012, and information for the deceased children was retrieved from medical records at Norwegian hospitals. Among 11 272 children with CHDs, we identified 19 (0.2%) children 2-18 years old who experienced sudden unexpected deaths unrelated to cardiac surgery. A cardiac cause of death was identified in seven of these cases. None of the children died during physical activity, whereas two children survived cardiac arrest during sports. CONCLUSION Sudden unexpected death was infrequent among children with CHDs who survived 2 years of age. Comorbidity was common among the children who died. This study indicates that sudden unexpected death in children with CHDs rarely occurs during physical activity.
Collapse
Affiliation(s)
- Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital, PO Box 783, Stoa, 4809 Arendal, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Leif Eskedal
- Research Department, Sørlandet Hospital, Kristiansand, Norway
| | - Asle Hirth
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Tatiana Fomina
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gaute Døhlen
- Women's and Children's Department, Oslo University Hospital, Oslo, Norway
| | - Petter Hagemo
- Women's and Children's Department, Oslo University Hospital, Oslo, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway
| | - Sigurd Birkeland
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Nina Øyen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Henrik Holmstrøm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway Women's and Children's Department, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
56
|
Sulo G, Igland J, Vollset SE, Nygård O, Egeland GM, Ebbing M, Sulo E, Tell GS. Effect of the Lookback Period's Length Used to Identify Incident Acute Myocardial Infarction on the Observed Trends on Incidence Rates and Survival: Cardiovascular Disease in Norway Project. Circ Cardiovasc Qual Outcomes 2015; 8:376-82. [PMID: 26058719 DOI: 10.1161/circoutcomes.114.001703] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In studies using patient administrative data, the identification of the first (incident) acute myocardial infarction (AMI) in an individual is based on retrospectively excluding previous hospitalizations for the same condition during a fixed time period (lookback period [LP]). Our aim was to investigate whether the length of the LP used to identify the first AMI had an effect on trends in AMI incidence and subsequent survival in a nationwide study. METHODS AND RESULTS All AMI events during 1994 to 2009 were retrieved from the Cardiovascular Disease in Norway project. Incident AMIs during 2004 to 2009 were identified using LPs of 10, 8, 7, 5, and 3 years. For each LP, we calculated time trends in incident AMI and subsequent 28-day and 1-year mortality rates. Results obtained from analyses using the LP of 10 years were compared with those obtained using shorter LPs. In men, AMI incidence rates declined by 4.2% during 2004 to 2009 (incidence rate ratio, 0.958; 95% confidence interval, 0.935-0.982). The use of other LPs produced similar results, not significantly different from the LP of 10 years. In women, AMI incidence rates declined by 7.3% (incidence rate ratio, 0.927; 95% confidence interval, 0.901-0.955) when an LP of 10 years was used. The decline was statistically significantly smaller for the LP of 5 years (6.2% versus 7.3%; P=0.02) and 3 years (5.9% versus 7.3%; P=0.03). The choice of LP did not influence trends in 28-day and 1-year mortality rates. CONCLUSIONS The length of LP may influence the observed time trends in incident AMIs. This effect is more evident in older women.
Collapse
Affiliation(s)
- Gerhard Sulo
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.).
| | - Jannicke Igland
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Stein Emil Vollset
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Ottar Nygård
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Grace M Egeland
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Marta Ebbing
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Enxhela Sulo
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| | - Grethe S Tell
- From the Department of Global Public Health and Primary Care (G.S., J.I., S.E.V., G.M.E., E.S., G.S.T.), Section for Cardiology, Department of Clinical Science (O.N.), University of Bergen, Bergen, Norway; Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway (G.S., G.M.E., M.E., G.S.T.); Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (O.N.); and Division of Epidemiology, Norwegian Institute of Public Health, Bergen, Norway (S.E.V.)
| |
Collapse
|
57
|
Solvang MM, Norekvål TM, Tell GS, Berge LI, Iversen MM. Attempts to improve and confidence in improving health behaviour in 40-49 year olds with and without coronary heart disease: The Hordaland Health Study. Eur J Cardiovasc Nurs 2015; 15:e60-9. [PMID: 25888607 DOI: 10.1177/1474515115583399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the overall incidence of acute myocardial infarction in Norway decreased in 2001-2009, this was not observed for younger adults. Smoking cessation, physical activity and healthy diet are associated with reduced risk of recurrent cardiovascular events and mortality among individuals with established coronary heart disease (CHD). AIMS We investigated whether adults in their 40s with or without CHD had 1) attempted to improve their health behaviour during the previous year, and 2) had confidence in their ability to improve their health behaviour over the next five years. METHODS Study participants were 22,019 40-49 year olds from the Hordaland Health Study. Associations between improvements and intentions regarding health behaviours and prevalent CHD were assessed with logistic regression analyses. RESULTS One hundred and seventy-five (0.8%) participants reported to have CHD. After controlling for demographic, lifestyle and psychosocial variables, attempts to improve health behaviour during the prior year were associated with a threefold increased odds of prevalent CHD (odds ratio 3.07; 95% confidence interval, 1.91-4.95). Confidence in improving health behaviour during the subsequent five years was not associated with increased odds of prevalent CHD. CONCLUSIONS Adults in their 40s with CHD were more likely to have attempted to improve their health behaviour during the past year compared with those without CHD. Healthcare providers should take advantage of these positive attitudes to encourage further positive improvements.
Collapse
Affiliation(s)
- Marte M Solvang
- Faculty of Health and Social Sciences, Bergen University College, Norway
| | - Tone M Norekvål
- Faculty of Health and Social Sciences, Bergen University College, Norway Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Line I Berge
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Marjolein M Iversen
- Faculty of Health and Social Sciences, Bergen University College, Norway Department of Endocrinology, Stavanger University Hospital, Norway
| |
Collapse
|
58
|
Dégano IR, Salomaa V, Veronesi G, Ferriéres J, Kirchberger I, Laks T, Havulinna AS, Ruidavets JB, Ferrario MM, Meisinger C, Elosua R, Marrugat J. Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations. Heart 2015; 101:1413-21. [PMID: 25855798 DOI: 10.1136/heartjnl-2014-307310] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/22/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Due to the burden of coronary heart disease (CHD), the monitoring of CHD trends is required. This study sought to examine the acute myocardial infarction (AMI) trends in attack and mortality rates, and in 28-day case-fatality, in six European populations during 1985-2010. METHODS Data consisted of 78 128 AMI events included in eight population-based registries from Finland (several populations), Italy (Brianza and Varese), Germany (Augsburg), France (Haute-Garonne), Spain (Girona) and Estonia (Tallinn). AMI event rates and case-fatality trends were analysed using the annual percentage change (APC) obtained by negative binomial and joinpoint regression. RESULTS AMI attack and mortality rates decreased in most populations. Finland experienced the steepest decline in attack rates (APC=-4.4% (95% CI -5.1 to -2.9) in men; -4.0% (-5.1 to -2.8), in women). Total-hospital and inhospital case-fatality decreased in all populations except in Tallinn. The steepest decline in total case-fatality occurred in Spain (-3.8% (-5.3 to -2.4) in men; -5.1% (-6.9 to -3.3) in women). Prehospital case-fatality trends differed significantly by population and sex. The trends for all included populations showed a significant decline in AMI event rates and case-fatality, in both sexes and all age groups. However, in women aged 65-74 years, a significant increase in total case-fatality occurred in 2005-2010 (4.7% (0.7 to 8.8)). CONCLUSIONS AMI event rates and inhospital case-fatality declined in 1985-2010 in almost all populations analysed. Prehospital case-fatality declined only in certain population groups, showing differences by sex. These results highlight the need of specific strategies in AMI prevention for certain groups and populations.
Collapse
Affiliation(s)
- Irene R Dégano
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Veikko Salomaa
- Department of Health, THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Giovanni Veronesi
- Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Jean Ferriéres
- Department of Cardiology, Toulouse University School of Medicine-Rangueil Hospital, Toulouse, France
| | - Inge Kirchberger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital Augsburg, Augsburg, Germany Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany
| | - Toivo Laks
- Department of Internal Medicine, North Estonia Medical Centre, Tallinn, Estonia Institute of Cardiovascular Medicine, Tallinn University of Technology, Tallinn, Estonia
| | - Aki S Havulinna
- Department of Health, THL-National Institute for Health and Welfare, Helsinki, Finland
| | | | - Marco M Ferrario
- Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Christa Meisinger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital Augsburg, Augsburg, Germany Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jaume Marrugat
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | |
Collapse
|
59
|
Carlsson AC, Ärnlöv J, Sundström J, Michaëlsson K, Byberg L, Lind L. Physical activity, obesity and risk of cardiovascular disease in middle-aged men during a median of 30 years of follow-up. Eur J Prev Cardiol 2015; 23:359-65. [PMID: 25604741 DOI: 10.1177/2047487314568034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 12/21/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND We aimed to investigate associations between combinations of body mass index (BMI)-categories, levels of physical activity and long-term risk of cardiovascular disease. METHOD AND RESULTS At age 50 years, cardiovascular risk factors were assessed in 2196 participating men of the ULSAM-study. This investigation was repeated at age 60, 70, 77 and 82 years. Being physically active (PA) was defined as three hours of recreational or hard physical training per week. The men were categorized according to BMI/PA-status, as PA/normal weight (n = 593 at baseline), non-PA/normal weight (BMI < 25 kg/m(2), n = 580), PA/overweight (n = 418), non-PA/overweight (BMI 25-30 kg/m(2), n = 462), PA/obese (n = 62), non-PA/obese (BMI >30 kg/m(2), n = 81). We used updated data on BMI and physical activity obtained at all examinations. During follow-up (median 30 years) 850 individuals suffered a cardiovascular disease (myocardial infarction, stroke or heart failure). Using updated data on BMI/PA categories, an increased risk for cardiovascular disease was seen with increasing BMI, but a high physical activity was associated with a lower risk of cardiovascular disease within each BMI category: non-PA/normal weight (hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.04-1.66), PA/overweight (HR 1.52, 95% CI 1.20-1.94), non-PA/overweight (HR 1.65, 95% CI 1.31-2.07) PA/obese (HR 2.05, 95% CI 1.44-2.92) and non-PA/obese (HR 2.39, 95% CI 1.74-3.29), using PA/normal weight men as referent. CONCLUSIONS Although physical activity was beneficial at all levels of BMI regarding the risk of future cardiovascular disease, there was still a substantial increased risk associated with being overweight or obese during 30 years of follow-up.
Collapse
Affiliation(s)
- Axel C Carlsson
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden Department of Medical Sciences, Uppsala University, Sweden
| | - Johan Ärnlöv
- Department of Medical Sciences, Uppsala University, Sweden Department of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Sweden Uppsala Clinical Research Centre, Uppsala University, Sweden
| | - Karl Michaëlsson
- Uppsala Clinical Research Centre, Uppsala University, Sweden Department of Surgical Sciences, Uppsala University, Sweden
| | - Liisa Byberg
- Uppsala Clinical Research Centre, Uppsala University, Sweden Department of Surgical Sciences, Uppsala University, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Sweden
| |
Collapse
|
60
|
Ariansen I, Mortensen L, Igland J, Tell GS, Tambs K, Graff-Iversen S, Strand BH, Næss Ø. The educational gradient in coronary heart disease: the association with cognition in a cohort of 57,279 male conscripts. J Epidemiol Community Health 2014; 69:322-9. [PMID: 25395653 DOI: 10.1136/jech-2014-204597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Independently of cardiovascular disease (CVD) risk factors, cognitive ability may account for some of the excess risk of coronary heart disease (CHD) associated with lower education. We aimed to assess how late adolescence cognitive ability and midlife CVD risk factors are associated with the educational gradient in CHD in Norway. METHODS In a cohort of 57 279 men born during 1949-1959, health survey information was linked to military conscription records of cognitive ability, to national educational data, to hospitalisation records from the Cardiovascular Disease in Norway (CVDNOR) project and to the Norwegian Cause of Death Registry. RESULTS Age and period adjusted HR for incident CHD events was 3.62 (95% CI 2.50 to 5.24) for basic relative to tertiary education, and was attenuated after adjustment; to 2.86 (1.87 to 4.38) for cognitive ability, to 1.90 (1.30 to 2.78) for CVD risk factors, and to 1.84 (1.20 to 2.83) when adjusting for both. Age and period adjusted absolute rate difference was 51 (33 to 70) incident CHD events per 100,000 person years between basic and tertiary educated, and was attenuated after adjustment; to 42 (22 to 61) for cognitive ability, to 25 (7 to 42) for CVD risk factors, and to 24 (5 to 43) when adjusting for both. CONCLUSIONS Late adolescence cognitive ability attenuated the educational gradient in incident CHD events. CVD risk factors further attenuated the gradient, and to the same extent regardless of whether cognitive ability was included or not. Cognitive ability might be linked to the educational gradient through CVD risk factors.
Collapse
Affiliation(s)
- Inger Ariansen
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Laust Mortensen
- Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Department of Heart Disease, Norwegian Institute of Public Health, Bergen, Norway
| | - Kristian Tambs
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Bjørn Heine Strand
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Øyvind Næss
- Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
61
|
Educational inequalities in 28 day and 1-year mortality after hospitalisation for incident acute myocardial infarction--a nationwide cohort study. Int J Cardiol 2014; 177:874-80. [PMID: 25453405 DOI: 10.1016/j.ijcard.2014.10.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 10/09/2014] [Accepted: 10/18/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is little recent evidence on the impact of comorbidities and access to revascularisation procedures on educational inequalities in mortality after acute myocardial infarction (AMI). The aim of the study was to investigate educational inequalities in mortality among all patients hospitalised for an incident AMI during 2001-2009 in Norway. METHODS Data were obtained through the Cardiovascular Disease in Norway (CVDNOR) project. Incident AMI was defined as an AMI-hospitalisation without any AMI-events in the previous 7 years. Education was categorised as basic, upper secondary or tertiary (college/university). Cox regression was used to assess educational differences in 28-day and 29-365-day mortality after an incident AMI in terms of hazard ratios and relative index of inequality (RII). RII can be interpreted as the ratio in mortality between the 0 th and the 100th percentile of the education distribution. RESULTS 111 993 incident AMIs were included (39.4% women). Among patients aged 35-69, RIIs (95% CI) adjusted for age, sex and year were 1.86 (1.59-2.18) and 2.10 (1.69-2.59) for 28-day and 29-365-day mortality respectively. Among patients aged 70-94 the corresponding RIIs were 1.12 (1.06-1.30) and 1.28 (1.19-1.38). Educational inequalities in mortality were attenuated after adjustment for comorbidities and revascularisation, but were still significant. Educational inequalities did not decrease during 2001-2009. CONCLUSION Educational inequalities in both 28-day and 29-365 day mortality were strong and persistent during 2001-2009. Further research is needed to investigate if these disparities are driven by inequalities in the severity of the AMI or by inequitable access to treatment and rehabilitation.
Collapse
|
62
|
Igland J, Vollset SE, Nygård OK, Sulo G, Ebbing M, Tell GS. Educational inequalities in acute myocardial infarction incidence in Norway: a nationwide cohort study. PLoS One 2014; 9:e106898. [PMID: 25188248 PMCID: PMC4154768 DOI: 10.1371/journal.pone.0106898] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Increasing differences in cardiovascular disease (CVD) mortality across levels of education have been reported in Norway. The aim of the study was to investigate educational inequalities in acute myocardial infarction (AMI) incidence and whether such inequalities have changed during the past decade using a nationwide longitudinal study design. METHODS Data on 141 332 incident (first) AMIs in Norway during 2001-2009 were obtained through the Cardiovascular Disease in Norway (CVDNOR) project. Educational inequalities in AMI incidence were assessed in terms of age-standardised incidence rates stratified on educational level, incidence rate ratios (IRR), relative index of inequality (RII) and slope index of inequality (SII). All calculations were conducted in four gender and age strata: Men and women aged 35-69 and 70-94 years. RESULTS AMI Incidence rates decreased during 2001-2009 for all educational levels except in women aged 35-69 among whom only those with basic education had a significant decrease. In all gender and age groups; those with the highest educational level had the lowest rates. The strongest relative difference was found among women aged 35-69, with IRR (95% CI) for basic versus tertiary education 3.04 (2.85-3.24)) and RII (95% CI) equal to 4.36 (4.03-4.71). The relative differences did not change during 2001-2009 in any of the four gender and age groups, but absolute inequalities measured as SII decreased among the oldest men and women. CONCLUSIONS There are substantial educational inequalities in AMI incidence in Norway, especially for women aged 35-69. Relative inequalities did not change from 2001 to 2009.
Collapse
Affiliation(s)
- Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Stein Emil Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - Ottar K. Nygård
- Section for Cardiology, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Gerhard Sulo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marta Ebbing
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
| |
Collapse
|
63
|
Trends in acute myocardial infarction event rates and risk of recurrences after an incident event in Norway 1994 to 2009 (from a Cardiovascular Disease in Norway Project). Am J Cardiol 2014; 113:1777-81. [PMID: 24746031 DOI: 10.1016/j.amjcard.2014.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/22/2022]
Abstract
We explored trends in acute myocardial infarction (AMI) event rates in Norway during 1994 to 2009 and trends in the 6-month, 1-year, and 3-year risk of recurrences after an incident AMI during 2001 to 2008 in men and women ≥25 years. Trends in AMI event rates (incident and recurrent) were analyzed using joinpoint regression analyses and expressed as annual percentage change (APC) in rates. Trends in AMI recurrences were explored using conditional risk models for ordered events in Cox regression. Analyses were stratified by gender and age group. Overall, AMI rates were stable during 1994 to 2002 but declined during 2002 to 2009 (APC = -2.0; 95% confidence interval [CI] -3.1 to -0.9 in men; APC = -2.1; 95% CI -3.8 to -0.5 in women). In the younger age group, rates declined during the whole study period in men (APC = -0.6; 95% CI -1.0 to -0.3) but not in women. Among older patients, no changes were observed during 1994 to 2002, whereas rates declined during 2002 to 2009 (APC = -2.6; 95% CI -3.8 to -1.4 in men; APC = -2.4; 95% CI -4.0 to -0.7 in women). During 2001 to 2008, in the older age group, the 6-month, 1-year, and 3-year risks of recurrences were reduced annually by 4.7%, 4.3%, and 5.4% in men and 5.2%, 5.0%, and 5.7% in women (all ptrend <0.001), respectively. No changes were observed in the younger age group. In conclusion, favorable trends in AMI event rates and recurrences observed in Norway were mostly seen among patients aged 65+ years, whereas less favorable trends were observed among younger patients, especially among women.
Collapse
|
64
|
Baumann M, Espeland MZ, Kværner AS, Bogsrud MP, Retterstøl K. M. Baumann og medarbeidere svarer:. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:1685-6. [DOI: 10.4045/tidsskr.13.1023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|