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Bergström G, Hagberg E, Björnson E, Adiels M, Bonander C, Strömberg U, Andersson J, Brunström M, Carlhäll CJ, Engström G, Erlinge D, Goncalves I, Gummesson A, Hagström E, Hjelmgren O, James S, Janzon M, Jonasson L, Lind L, Magnusson M, Oskarsson V, Sundström J, Svensson P, Söderberg S, Themudo R, Östgren CJ, Jernberg T. Self-Report Tool for Identification of Individuals With Coronary Atherosclerosis: The Swedish CardioPulmonary BioImage Study. J Am Heart Assoc 2024:e034603. [PMID: 38958022 DOI: 10.1161/jaha.124.034603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/23/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Coronary atherosclerosis detected by imaging is a marker of elevated cardiovascular risk. However, imaging involves large resources and exposure to radiation. The aim was, therefore, to test whether nonimaging data, specifically data that can be self-reported, could be used to identify individuals with moderate to severe coronary atherosclerosis. METHODS AND RESULTS We used data from the population-based SCAPIS (Swedish CardioPulmonary BioImage Study) in individuals with coronary computed tomography angiography (n=25 182) and coronary artery calcification score (n=28 701), aged 50 to 64 years without previous ischemic heart disease. We developed a risk prediction tool using variables that could be assessed from home (self-report tool). For comparison, we also developed a tool using variables from laboratory tests, physical examinations, and self-report (clinical tool) and evaluated both models using receiver operating characteristic curve analysis, external validation, and benchmarked against factors in the pooled cohort equation. The self-report tool (n=14 variables) and the clinical tool (n=23 variables) showed high-to-excellent discriminative ability to identify a segment involvement score ≥4 (area under the curve 0.79 and 0.80, respectively) and significantly better than the pooled cohort equation (area under the curve 0.76, P<0.001). The tools showed a larger net benefit in clinical decision-making at relevant threshold probabilities. The self-report tool identified 65% of all individuals with a segment involvement score ≥4 in the top 30% of the highest-risk individuals. Tools developed for coronary artery calcification score ≥100 performed similarly. CONCLUSIONS We have developed a self-report tool that effectively identifies individuals with moderate to severe coronary atherosclerosis. The self-report tool may serve as prescreening tool toward a cost-effective computed tomography-based screening program for high-risk individuals.
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Affiliation(s)
- Göran Bergström
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Clinical Physiology Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Eva Hagberg
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Clinical Physiology Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Elias Björnson
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
| | - Martin Adiels
- School of Public Health and Community Medicine Institute of Medicine, University of Gothenburg Gothenburg Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine Institute of Medicine, University of Gothenburg Gothenburg Sweden
- Centre for Societal Risk Research Karlstad University Karlstad Sweden
| | - Ulf Strömberg
- School of Public Health and Community Medicine Institute of Medicine, University of Gothenburg Gothenburg Sweden
- Department of Research and Development Region Halland Halmstad Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Carl-Johan Carlhäll
- Center for Medical Image Science and Visualization (CMIV) Linköping University Linköping Sweden
- Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
| | - David Erlinge
- Department of Clinical Sciences Lund, Cardiology Lund University, Skåne University Hospital Lund Sweden
| | - Isabel Goncalves
- Department of Cardiology Skåne University Hospital Malmö Sweden
- Cardiovascular Research Translational Studies, Department of Clinical Sciences Malmö Lund University Malmö Sweden
| | - Anders Gummesson
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Clinical Genetics and Genomics Sahlgrenska University Hospital Gothenburg Sweden
| | - Emil Hagström
- Department of Medical Sciences Cardiology, Uppsala University Uppsala Sweden
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Ola Hjelmgren
- Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Pediatric Heart Centre, Queen Silvias Childrens hospital Sahlgrenska University Hospital Gothenburg Sweden
| | - Stefan James
- Department of Medical Sciences Cardiology, Uppsala University Uppsala Sweden
- Uppsala Clinical Research Center Uppsala University Uppsala Sweden
| | - Magnus Janzon
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences Linköping University Linköping Sweden
| | - Lena Jonasson
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences Linköping University Linköping Sweden
| | - Lars Lind
- Department of Medical Sciences, Clinical Epidemiology Uppsala University Uppsala Sweden
| | - Martin Magnusson
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
- Department of Cardiology Skåne University Hospital Malmö Sweden
- North-West University Potchefstroom South Africa
- Wallenberg Center for Molecular Medicine Lund University Lund Sweden
| | - Viktor Oskarsson
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
- Piteå Research Unit Region Norrbotten Piteå Sweden
| | - Johan Sundström
- Department of Medical Sciences Uppsala University Uppsala Sweden
- The George Institute for Global Health University of New South Wales Sydney New South Wales Australia
| | - Per Svensson
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden
- Department of Cardiology Södersjukhuset Stockholm Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Raquel Themudo
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology Karolinska Institute Stockholm Sweden
- Department of Radiology Karolinska University Hospital in Huddinge Stockholm Sweden
| | - Carl Johan Östgren
- Center for Medical Image Science and Visualization (CMIV) Linköping University Linköping Sweden
- Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences Danderyd University Hospital, Karolinska Institutet Stockholm Sweden
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Bramsved R, Bygdell M, Martikainen J, Mårild S, Lindh I, Rosengren A, Ohlsson C, Kindblom JM. Birth Weight, Childhood and Young Adult Overweight, and the Risk of Coronary Heart Disease in Men. Arterioscler Thromb Vasc Biol 2024; 44:314-321. [PMID: 37970719 PMCID: PMC10749680 DOI: 10.1161/atvbaha.123.320095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Low birth weight is a known risk factor for adult coronary heart disease (CHD), but the additional effect of weight development during childhood and early adult life has not been studied. METHODS We included 35 659 men born 1945 to 1961 from the population-based BMI Epidemiology Study Gothenburg, with data available on birthweight, BMI in childhood (8 years), and BMI in young adulthood (20 years). Information on CHD diagnoses was retrieved from national registers. We used Cox proportional hazards regression to estimate hazard ratios and 95% CIs for the risk of early and late CHD (before and after 58.4 years of age, respectively). RESULTS During follow-up, a total of 3380 cases of CHD (fatal and nonfatal) were registered. Birth weight was inversely associated with the risk of both early (hazard ratio, 0.88 per SD increase [95% CI, 0.84-0.92]) and late (hazard ratio, 0.94 per SD increase [95% CI, 0.90-0.98]) CHD, independently of BMI at 8 years and BMI change during puberty. In a model including birth weight (below or above the median) together with overweight at 8 and 20 years, only birth weight and young adult overweight, but not overweight in childhood, were significantly associated with the risk of CHD. A birth weight below the median, followed by overweight at 20 years of age was associated with a more than doubled risk of early CHD (hazard ratio, 2.29 [95% CI, 1.86-2.81]), compared with the reference (birth weight above the median and normal weight at 20 years of age). This excess risk was even more pronounced for a birthweight below 2.5 kg. CONCLUSIONS We demonstrate that low birth weight and young adult overweight are important developmental markers of risk for adult CHD. These findings motivate a life course perspective for prevention and risk assessment of adult CHD.
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Affiliation(s)
- Rebecka Bramsved
- Department of Pediatrics, Institute of Clinical Sciences (R.B., S.M.), The Sahlgrenska Academy, University of Gothenburg, Sweden
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (R.B., M.B., C.O., J.M.K.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Maria Bygdell
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (R.B., M.B., C.O., J.M.K.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jari Martikainen
- Bioinformatics and Data Centre (J.M.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Staffan Mårild
- Department of Pediatrics, Institute of Clinical Sciences (R.B., S.M.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ingela Lindh
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences (I.L.), The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at Gothenburg University, Sweden (A.R.)
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (R.B., M.B., C.O., J.M.K.), The Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden (C.O., J.M.K.)
| | - Jenny M. Kindblom
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine (R.B., M.B., C.O., J.M.K.), The Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden (C.O., J.M.K.)
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Lemieux I, Després JP. Weight gain with age and coronary atherosclerosis: Only the tip of a deadly iceberg. Atherosclerosis 2023; 373:55-57. [PMID: 37142537 DOI: 10.1016/j.atherosclerosis.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Isabelle Lemieux
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, Québec, Canada.
| | - Jean-Pierre Després
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Québec, Québec, Canada; Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Québec, Canada; VITAM - Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Québec, Québec, Canada
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