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Hasselstrøm Jensen J, Vestergaard P, Hasselstrøm Jensen M. Association between Glucose-lowering Treatments and Risk of Diabetic Retinopathy in People with Type 2 Diabetes: A Nationwide Cohort Study. Curr Drug Saf 2024; 19:236-243. [PMID: 37078347 DOI: 10.2174/1574886318666230420084701] [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: 08/30/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Glycaemic variability is possibly linked to the development of diabetic retinopathy, and newer second-line glucose-lowering treatments in type 2 diabetes might reduce glycaemic variability. AIM This study aimed to investigate whether newer second-line glucose-lowering treatments are associated with an alternative risk of developing diabetic retinopathy in people with type 2 diabetes. METHODS A nationwide cohort of people with type 2 diabetes on second-line glucose-lowering treatment regimens in 2008-2018 was extracted from the Danish National Patient Registry. Adjusted time to diabetic retinopathy was estimated with a Cox Proportional Hazards model. The model was adjusted for age, sex, diabetes duration, alcohol abuse, treatment start year, education, income, history of late-diabetic complications, history of non-fatal major adverse cardiovascular events, history of chronic kidney disease, and history of hypoglycaemic episodes. RESULTS Treatment regimens of metformin + basal insulin (HR: 3.15, 95% CI: 2.42-4.10) and metformin + glucagon-like peptide-1 receptor agonist (GLP-1-RA, HR: 1.46, 95% CI: 1.09-1.96) were associated with an increased risk of diabetic retinopathy compared with metformin + dipeptidyl peptidase-4 inhibitors (DPP-4i). Treatment with metformin + sodium-glucose cotransporter-2 inhibitor (SGLT2i, HR: 0.77, 95% CI: 0.28-2.11) was associated with the numerically lowest risk of diabetic retinopathy compared with all regimens investigated. CONCLUSION Findings from this study indicate that basal insulin and GLP-1-RA are suboptimal second- line choices for people with type 2 diabetes at risk of developing diabetic retinopathy. However, many other considerations concerning the choice of second-line glucose-lowering treatment for type 2 diabetes patients should be taken into account.
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Affiliation(s)
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark
| | - Morten Hasselstrøm Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, 9220, Aalborg, Denmark
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Elgaard AF, Dinesen PT, Riahi S, Hansen J, Lundbye-Christensen S, Johansen JB, Nielsen JC, Lip GYH, Larsen JM. Long-term risk of cardiovascular implantable electronic device reinterventions following external cardioversion of atrial fibrillation and flutter: A nationwide cohort study. Heart Rhythm 2023; 20:1227-1235. [PMID: 36965653 DOI: 10.1016/j.hrthm.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND External cardioversion (ECV) is an essential part of rhythm control of atrial fibrillation and flutter in patients with and without cardiovascular implantable electronic devices (CIEDs). Long-term follow-up data on ECV-related CIED dysfunctions are limited. OBJECTIVE The purpose of this study was to investigate the risk of CIED reintervention following ECV in a nationwide cohort. METHODS We identified CIED implants and surgical reinterventions from 2005 to 2021 in the Danish Pacemaker and ICD Register. We included CIED patients undergoing ECV from 2010 to 2019 from the Danish National Patient Registry. For each ECV-exposed generator, 5 matched generators without ECV were identified, and for each ECV-exposed lead, 3 matched leads were identified. The primary endpoints were generator replacement and lead reintervention. RESULTS We compared 2582 ECV-exposed patients with 12,910 matched patients with a pacemaker (47%), implantable cardioverter-defibrillator (ICD) (29%), cardiac resynchronization therapy-pacemaker (6%), or cardiac resynchronization therapy-defibrillator (18%). During 2 years of follow-up, 210 ECV-exposed generators (8.1%) vs 670 matched generators (5.2%) underwent replacements, and 247 ECV-exposed leads (5.6%) vs 306 matched leads (2.3%) underwent reintervention. Unadjusted hazard ratios were 1.61 (95% confidence interval [CI] 1.37-1.91; P <.001) for generator replacement and 2.39 (95% CI 2.01-2.85; P <.001) for lead reintervention. One-year relative risks were 1.73 (95% CI 1.41-2.12; P <.001) for generator replacement and 2.85 (95% CI 2.32-3.51; P <.001) for lead reintervention, and 2-year relative risks were 1.39 (95% CI 1.19-1.63; P <.001) and 2.18 (95% CI 1.84-2.57; P <.001), respectively. CONCLUSION ECV in patients with a CIED is associated with a higher risk of generator replacement and lead reintervention. The risks of reinterventions were more pronounced within the first year after cardioversion.
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Affiliation(s)
- Anders Fyhn Elgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Hematology, Aalborg University Hospital, Clinical Cancer Research Center, Aalborg, Denmark.
| | - Pia Thisted Dinesen
- Department of Anesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - John Hansen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Jacob Moesgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Pedersen SB, Nielsen JC, Bøtker HE, Udupi A, Goldberger JJ. Long-Term Follow-Up After Acute Myocardial Infarction According to Beta-Blocker Dose. Am J Med 2023; 136:458-465.e3. [PMID: 36822258 PMCID: PMC10244476 DOI: 10.1016/j.amjmed.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Our purpose was to examine the association between beta-blocker dose and mortality following acute myocardial infarction. METHODS This nationwide cohort study enrolled all patients admitted for first-time acute myocardial infarction in Denmark between July 1, 2004 and December 31, 2014, using the Danish National Patient Registry. Patients alive 15 days after admission were followed until death, emigration, or December 31, 2014. Patients were categorized according to daily beta-blocker consumption (0%, >0%-12.5%, >12.5%-25%, >25%-50%, >50%-100%, or >100% of the currently recommended target dose) based on prescriptions registered in the Danish National Database of Reimbursed Prescriptions. Doses were continuously updated during follow-up. Mortality rate ratios (MRRs) were computed and adjusted for confounders using Cox proportional hazard regression. RESULTS Among 65,125 patients followed, any beta-blocker dose was associated with significant mortality reduction compared with no treatment (adjusted MRR ≤ 0.92 [95% confidence interval {CI}: 0.86-0.98]). The largest reduction was observed within the first year for beta-blocker doses >25%-50% (adjusted MRR = 0.55 [95% CI: 0.50-0.60]). After 1 year, doses >50%-100% were associated with the largest mortality reduction (adjusted MRR = 0.58 [95% CI: 0.50-0.67]), but it did not differ significantly from that associated with doses >25%-50% (adjusted MRR = 0.68 [95% CI: 0.61-0.77]). CONCLUSIONS Any beta-blocker dose was associated with significant mortality reduction following acute myocardial infarction compared with no treatment. Doses >25%-50% of the currently recommended target dose were associated with maximal mortality reduction within the first year after acute myocardial infarction, suggesting that higher doses are unnecessary.
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Affiliation(s)
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Aparna Udupi
- Biostatistical Advisory Service, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jeffrey J Goldberger
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Chiusolo S, Bork CS, Gentile F, Lundbye-Christensen S, Harris WS, Schmidt EB, De Caterina R. Adipose tissue n-3/n-6 fatty acids ratios versus n-3 fatty acids fractions as predictors of myocardial infarction. Am Heart J 2023; 262:38-48. [PMID: 37086938 DOI: 10.1016/j.ahj.2023.03.019] [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: 09/18/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Tissue levels of n-3 polyunsaturated fatty acids (PUFAs) have been inversely related with risk of myocardial infarction (MI). Whether ratios of n-3 to n-6 PUFAs, reflecting both dietary intake of n-3 PUFAs and competing n-6 PUFAs, are better predictors of future MI than n-3 PUFA fractions is unclear. We aimed at investigating whether such ratios in adipose tissue better predict MI than n-3 PUFA fractions. METHODS Subcutaneous adipose tissue biopsies were obtained in a random sample (n=3,500) of the Diet, Cancer and Health cohort (n=57,053). Adipose tissue content of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), arachidonic acid (AA) and linoleic acid (LA) was determined using gas chromatography. Fractions of selected n-3 PUFAs and n-3/n-6 PUFA ratios were correlated to the 15-year occurrence of MI in a case-cohort design. RESULTS A total of 2,406 participants experienced an MI during follow-up. Adipose tissue total marine n-3 PUFAs, EPA+DHA, EPA, EPA/AA, DHA/AA and (EPA+DPA+DHA)/AA were all inversely associated with risk of incident MI. Evaluating the predictive power (Harrel's C-index) of the selected metrics, fractions of marine n-3 PUFAs and ratios of EPA/AA, DHA/AA, (EPA+DHA)/AA and (EPA+DPA+DHA)/AA all refined risk prediction over age and sex alone. At multivariable analyses, however, the above ratios were the only metrics providing additional risk prediction. Differences in ratios were related to differences in food intake. CONCLUSIONS Both adipose tissue n-3 PUFAs fractions and ratios of n-3 PUFAs/AA were associated with a lower occurrence of MI, but ratios provided superior risk prediction. Dietary strategies affecting n-3/n-6 PUFA ratios should be further investigated for prediction of MI with dietary interventions at the population level and in intervention studies.
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Affiliation(s)
- Simona Chiusolo
- Cardiology Division, University of Modena and Reggio Emilia, Modena Hospital, Modena, Italy
| | | | - Francesco Gentile
- Cardiology Division, Pisa University Hospital and University of Pisa, Pisa, Italy
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Unit of Clinical Biostatistics, Aalborg University Hospital, and Department of Clinical Medicine-Aalborg University, Aalborg, Denmark
| | - William S Harris
- Fatty Acid Research Institute and the Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, U.S.A
| | - Erik Berg Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Raffaele De Caterina
- Cardiology Division, Pisa University Hospital and University of Pisa, Pisa, Italy.
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Bork CS, Lundbye-Christensen S, Venø SK, Lasota AN, Tjønneland A, Schmidt EB, Overvad K. Intake of marine and plant-derived n-3 fatty acids and development of atherosclerotic cardiovascular disease in the Danish Diet, Cancer and Health cohort. Eur J Nutr 2023; 62:1389-1401. [PMID: 36592188 DOI: 10.1007/s00394-022-03081-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The objective of this study was to investigate the association between intake of seafood and plant-derived n-3 polyunsaturated fatty acids (PUFA) and development of total atherosclerotic cardiovascular disease (ASCVD) and acute major ischemic events. METHODS A total of 53,909 men and women were enrolled between 1993 and 1997 into the Danish Diet, Cancer and Health cohort and followed through nationwide Danish registries for development of total ASCVD defined as a first registration of myocardial infarction, peripheral artery disease, or ischemic stroke due to large artery atherosclerosis or small-vessel occlusion. At recruitment, the intake of the major marine n-3 PUFA, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the plant-derived n-3 PUFA, alpha-linolenic acid (ALA), was assessed using a validated food frequency questionnaire. Statistical analyses were conducted using sex-stratified multivariable Cox proportional hazard regression models. RESULTS During a median of 13.5 years of follow-up, 3958 participants developed ASCVD including 3270 patients with an acute major ischemic event. In multivariable analyses including adjustment for established risk factors, we found no associations for intake of ALA, but indications of inverse associations between intake of EPA, DHA and EPA + DHA and the rate of total ASCVD and acute major ischemic events. CONCLUSIONS A high intake of marine n-3 PUFA was associated with a lower risk of total ASCVD and acute major ischemic events, whereas no association could be demonstrated for the plant-derived ALA.
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Affiliation(s)
- Christian S Bork
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | | | - Stine K Venø
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne N Lasota
- Department of Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erik B Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Pareek M, Kragholm KH, Kristensen AMD, Vaduganathan M, Pallisgaard JL, Byrne C, Biering-Sørensen T, Lee CJY, Bonde AN, Mortensen MB, Maeng M, Fosbøl EL, Køber L, Olsen NT, Gislason GH, Bhatt DL, Torp-Pedersen C. Serial troponin-T and long-term outcomes in suspected acute coronary syndrome. Eur Heart J 2023; 44:502-512. [PMID: 36329643 DOI: 10.1093/eurheartj/ehac629] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 09/11/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Long-term prognostic implications of serial high-sensitivity troponin concentrations in subjects with suspected acute coronary syndrome are unknown. METHODS AND RESULTS Individuals with a first diagnosis of myocardial infarction, unstable angina, observation for suspected myocardial infarction, or chest pain from 2012 through 2019 who underwent two high-sensitivity troponin-T (hsTnT) measurements 1-7 h apart were identified through Danish national registries. Absolute and relative risks for death at days 0-30 and 31-365, stratified for whether subjects had normal or elevated hsTnT concentrations, and whether these concentrations changed by <20%, > 20 to 50%, or >50% in either direction from first to second measurement, were calculated through multivariable logistic regression with average treatment effect modeling. Of the 28 902 individuals included, 2.8% had died at 30 days, whereas 4.9% of those who had survived the first 30 days died between days 31-365. The standardized risk of death was highest among subjects with two elevated hsTnT concentrations (0-30 days: 4.3%, 31-365 days: 7.2%). In this group, mortality was significantly higher in those with a > 20 to 50% or >50% rise from first to second measurement, though only at 30 days. The risk of death was very low in subjects with two normal hsTnT concentrations (0-30 days: 0.1%, 31-365 days: 0.9%) and did not depend on relative or absolute changes between measurements. CONCLUSIONS Individuals with suspected acute coronary syndrome and two consecutively elevated hsTnT concentrations consistently had the highest risk of death. Mortality was very low in subjects with two normal hsTnT concentrations, irrespective of changes between measurements.
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Affiliation(s)
- Manan Pareek
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 4, 2900 Hellerup, Denmark.,Department of Cardiology, Copenhagen University Hospital - North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.,Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, 02115 Boston, MA, USA
| | - Kristian H Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Anna Meta Dyrvig Kristensen
- Department of Cardiology, Copenhagen University Hospital - North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, 02115 Boston, MA, USA
| | - Jannik L Pallisgaard
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 4, 2900 Hellerup, Denmark
| | - Christina Byrne
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 4, 2900 Hellerup, Denmark.,Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 4, 2900 Hellerup, Denmark.,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Christina Ji-Young Lee
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Anders Nissen Bonde
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 4, 2900 Hellerup, Denmark
| | - Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 4, 2900 Hellerup, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 4, 2900 Hellerup, Denmark
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis St, 02115 Boston, MA, USA
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
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Eckerström F, Nyboe C, Redington A, Hjortdal VE. Lifetime Burden of Morbidity in Patients With Isolated Congenital Ventricular Septal Defect. J Am Heart Assoc 2023; 12:e027477. [PMID: 36565179 PMCID: PMC9973591 DOI: 10.1161/jaha.122.027477] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/24/2022] [Indexed: 12/25/2022]
Abstract
Background The lifetime burden of morbidity in patients with isolated congenital ventricular septal defect (VSD) is not completely described. Methods and Results In a population-based cohort study in Denmark using nationwide medical registries, we included 8006 patients diagnosed with a congenital VSD before 2018 along with 79 568 randomly selected controls from the general Danish population matched by birth year and sex. Concomitant congenital cardiac malformations and chromosomal abnormalities were excluded. Cox proportional hazard regression, Fine and Gray competing risk regression, and Kaplan-Meier survival function were used to estimate burden of morbidity, compared with matched controls. Median follow-up was 23 years (interquartile range, 11-37 years). The hazard ratio (HR) of heart failure was high in both patients with unrepaired and surgically closed VSD when compared with their corresponding matched controls (5.4 [95% CI, 4.6-6.3] and 30.5 [95% CI, 21.8-42.7], respectively). Truncated analyses with time from birth until 1 year after VSD diagnosis (unrepaired) or surgery (surgically closed) censored revealed reduced but persisting late hazard of heart failure. Similarly, the late hazard of arrhythmias and pulmonary arterial hypertension was high irrespective of defect closure. The HR of endocarditis was 28.0 (95% CI, 19.2-40.9) in patients with unrepaired defect and 82.7 (95% CI, 37.5-183.2) in patients with surgically closed defect. The increased HR diminished after VSD surgery. In general, the incidence of morbidity among patients with unrepaired VSD accelerated after the age of 40 years. Conclusions Patients with isolated congenital VSD carry a substantial burden of cardiovascular morbidity throughout life, irrespective of defect closure.
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Affiliation(s)
- Filip Eckerström
- Department of Cardiothoracic SurgeryCopenhagen University HospitalCopenhagenDenmark
- Department of Clinical MedicineCopenhagen University HospitalCopenhagenDenmark
| | - Camilla Nyboe
- Department of Cardiothoracic and Vascular SurgeryAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Andrew Redington
- The Heart Institute, Cincinnati Children’s Hospital Medical CenterCincinnatiOhioUSA
| | - Vibeke Elisabeth Hjortdal
- Department of Cardiothoracic SurgeryCopenhagen University HospitalCopenhagenDenmark
- Department of Clinical MedicineCopenhagen University HospitalCopenhagenDenmark
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Overvad TF, Skjøth F, Piazza G, Noble S, Ording AG, Larsen TB, Nielsen PB. The Khorana score and venous and arterial thrombosis in patients with cancer treated with immune checkpoint inhibitors: A Danish cohort study. J Thromb Haemost 2022; 20:2921-2929. [PMID: 36112135 PMCID: PMC9828438 DOI: 10.1111/jth.15883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Thrombosis is common among patients with cancer. Primary thromboprophylaxis guided by the Khorana score is endorsed by guidelines but recommendations rely mainly on data from patients treated with chemotherapy. OBJECTIVES To explore if the Khorana score could risk stratify patients with cancer treated with immune checkpoint inhibitors according to risk of venous and arterial thrombosis. PATIENTS/METHODS The study population and Khorana score were defined using administrative Danish health registries. The primary outcome was 6-month risk of venous thromboembolism after initiation of checkpoint inhibitor treatment. Secondary outcomes were arterial thrombosis and any thromboembolic event. Death was considered a competing risk event. RESULTS Among 3946 patients with cancer initiating checkpoint inhibitor treatment without other indications for anticoagulation, the overall 6-month incidence of venous thromboembolism was 2.6% (95% confidence interval [CI]: 2.1-3.1). Risks were 2.1% (95% CI: 1.5-3.0), 2.6% (95% CI: 2.0-3.4), and 3.7% (95% CI: 2.1-5.9) in low (score 0), intermediate (score 1-2), and high risk (score ≥3) Khorana categories, respectively. Among patients eligible for primary thromboprophylaxis according to guidelines (Khorana score ≥2), risk of venous thromboembolism was 4.1% (95% CI: 3.1-5.4). Higher Khorana risk category was also associated with higher 6-month risk of both arterial thrombosis and any thromboembolic events. CONCLUSIONS The Khorana score was able to risk stratify patients with cancer treated with immune checkpoint inhibitors according to 6-month risk of thromboembolic events. Risks of venous thromboembolism were lower than in randomized thromboprophylaxis trials, thus questioning the absolute benefit of routine primary thromboprophylaxis in an unselected population of patients treated with immune checkpoint inhibitors.
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Affiliation(s)
- Thure F. Overvad
- Department of Clinical PharmacologyAalborg University HospitalAalborgDenmark
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Unit of Clinical BiostatisticsAalborg University HospitalAalborgDenmark
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Simon Noble
- Marie Curie Palliative Care Research CentreCardiff UniversityCardiffUK
| | - Anne G. Ording
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of CardiologyAalborg University HospitalAalborgDenmark
| | - Torben B. Larsen
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of CardiologyAalborg University HospitalAalborgDenmark
| | - Peter B. Nielsen
- Aalborg Thrombosis Research Unit, Department of Clinical MedicineAalborg UniversityAalborgDenmark
- Department of CardiologyAalborg University HospitalAalborgDenmark
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Helgeland J, Kristoffersen DT, Skyrud KD. Does a Code for Acute Myocardial Infarction Mean the Same in All Norwegian Hospitals? A Likelihood Approach to a Medical Record Review. Clin Epidemiol 2022; 14:1155-1165. [PMID: 36268007 PMCID: PMC9577561 DOI: 10.2147/clep.s369763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/24/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Health registries are important data sources for epidemiology, quality monitoring, and improvement. Acute myocardial infarction (AMI) is a common, serious condition. Little is known about variation in the positive predictive value (PPV) of a coded AMI diagnosis and its association with hospital quality indicators. The present study aimed to investigate the relationship between PPV and registry-based 30-day mortality after AMI admission and between-hospital variation in PPV. Study Design and Setting An electronic record review was performed in a nationwide sample of Norwegian hospitals. Clinical signs and cardiac troponin measurements were abstracted and analyzed using a mixture model for likelihood ratios and parametric bootstrapping. Results The overall PPV was estimated to be 97%. We found no statistically significant association between hospital PPV and the classification of hospitals into low, intermediate, and high registry-based 30-day mortality. There was significant variation between hospitals, with a PPV range of 91–100%. Conclusion We found no evidence that variation in PPV of AMI diagnosis can explain variation between hospitals in registry-based 30-day mortality after admission. However, PPV varied significantly between hospitals. We were able to use a very efficient statistical approach to the analysis and handling of various sources of uncertainty.
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Affiliation(s)
- Jon Helgeland
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway,Correspondence: Jon Helgeland, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, 0213, Norway, Tel +47 464 00 443, Email
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Lau FF, Bollerup S, Engsig F, Krarup H, Mygind LH, Hansen JB, Madsen LG, Thielsen P, Balslev U, Nielsen LN, Barfod TS, Clausen MR, Hobolth L, Laursen AL, Tarp B, Roege BT, Gerstoft J, Christensen PB, Weis N. Ischemic Heart Disease in Chronic Hepatitis B: A Danish Nationwide Cohort Study. Clin Epidemiol 2022; 14:879-888. [PMID: 35879942 PMCID: PMC9307867 DOI: 10.2147/clep.s361910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/19/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Data on the risk of ischemic heart disease (IHD) in patients with chronic hepatitis B virus (CHB) are conflicting. Our objective was to address the rate of IHD in patients with CHB compared with individuals without CHB (control-persons) from the general population. Study Design and Setting We conducted a cohort study of prospectively obtained data from Danish nationwide registries. We produced cumulative incidence curves and calculated the unadjusted incidence rate ratio (IRR) of IHD in persons with and without CHB. The adjusted association between having CHB and developing IHD was examined using a cause-specific Cox regression model. Results In total, 6472 persons with CHB and 62,251 age- and sex-matched individuals from the general population were followed for 48,840 and 567,456 person-years, respectively, during which 103 (1,59%) with CHB and 1058 (1,70%) control-persons developed IHD. The crude IRR was 1.13 (95% CI: 0.91–1.39). CHB did not have a statistically significant effect on the rate of IHD after adjusting for several confounding factors (adjusted hazard ratio: 0.96, 95% CI: 0.76–1.21). Conclusion In this nationwide cohort study, we did not find any difference between rate of IHD in persons with CHB in comparison with the general population.
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Affiliation(s)
- Frederik Faergemann Lau
- Department of Infectious Diseases, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Signe Bollerup
- Department of Infectious Diseases, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Frederik Engsig
- Department of Infectious Diseases, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Henrik Krarup
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Lone Hagens Mygind
- Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Bach Hansen
- Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Lone Galmstrup Madsen
- Department of Medical Gastroenterology, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Thielsen
- Department of Gastroenterology, Copenhagen University Hospital-Herlev, Herlev, Denmark
| | - Ulla Balslev
- Department of Infectious Diseases, Copenhagen University Hospital-Herlev, Herlev, Denmark
| | - Lars Nørregaard Nielsen
- Department of Lung- and Infectious Diseases, North Zealand Hospital-Hilleroed, Hilleroed, Denmark
| | - Toke S Barfod
- Department of Internal Medicine and Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Mette Rye Clausen
- Department of Medical Gastroenterology and Hepatology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Lise Hobolth
- Department of Gastroenterology, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Alex Lund Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Britta Tarp
- Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Birgit T Roege
- Department of Internal Medicine, Kolding Hospital, Kolding, Denmark
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Peer Brehm Christensen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Rebordosa C, Farkas DK, Montonen J, Laugesen K, Voss F, Aguado J, Bothner U, Rothman KJ, Zint K, Mines D, Ehrenstein V. Cardiovascular Events and All-Cause Mortality in Patients With Chronic Obstructive Pulmonary Disease Using Olodaterol and Other Long-Acting Beta2-Agonists. Pharmacoepidemiol Drug Saf 2022; 31:827-839. [PMID: 35320605 PMCID: PMC9545725 DOI: 10.1002/pds.5432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/12/2022] [Accepted: 03/18/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE We examined the effect of olodaterol on the risk of myocardial ischaemia, cardiac arrhythmia, and all-cause mortality compared with use of other long-acting beta2-agonists (LABAs). Channelling bias was also explored. METHODS This Danish population-based cohort study used data linked from registries of hospital diagnoses, outpatient dispensings, and deaths. It included patients (aged ≥40 years) with a diagnosis of chronic obstructive pulmonary disease (COPD) who initiated olodaterol or another LABA. Using matching and propensity score (PS) stratification, we calculated adjusted incidence rate ratios (IRRs) using Poisson regression, followed by several additional analyses to evaluate and control channelling bias. RESULTS The IRRs of cardiac arrhythmias or myocardial ischaemia among users of olodaterol (n=14,239) compared to users of other LABA (n=51,167) ranged from 0.96 to 1.65 in various analyses, although some estimates had low precision. Initial analysis suggested an increased risk for death with olodaterol compared with other LABAs (IRR, 1.63; 95% CI, 1.44-1.84). Because olodaterol prescribing was associated with COPD severity, the mortality association was attenuated by using different methods of tighter confounding control: the IRRs were 1.26 (95% CI, 0.97-1.64) among LABA-naïve LABA/LAMA users without recent COPD hospitalisation; 1.27 (95% CI, 1.03-1.57) in a population with additional trimming from the tails of the PS distribution; and 1.32 (95% CI, 1.19-1.48) after applying overlap-weights analysis. CONCLUSIONS Olodaterol users had a similar risk for cardiac arrhythmias or myocardial ischaemia as other LABA users. The observed excess all-cause mortality associated with olodaterol use could be due to uncontrolled channelling bias.
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Affiliation(s)
| | | | | | | | - Florian Voss
- Boehringer Ingelheim International GmbH; Ingelheim
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12
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Tindborg M, Koch A, Andersson M, Juul K, Geisler UW, Soborg B, Michelsen SW. Heart disease among Greenlandic children and young adults: a nationwide cohort study. Int J Epidemiol 2022; 51:1568-1580. [PMID: 35201265 PMCID: PMC9558066 DOI: 10.1093/ije/dyac024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The incidences of heart disease (HD) and congenital heart disease (CHD) among Inuit in Greenland (GL) and Denmark (DK) are unknown. This study aims to estimate incidence rates (IRs) of HD and CHD among the young Inuit populations in Greenland and Denmark compared with rates among young non-Inuit populations in the same countries. METHODS A register-based nationwide cohort including all individuals living in Greenland and Denmark from birth to age <40 years through 1989-2014 was formed. Ethnicity was considered Inuit/mixed if at least one parent was registered as being born in Greenland. Information on HD and CHD hospitalization was obtained from national inpatient registers using ICD-8 and ICD-10 codes. RESULTS HD IR was lower among individuals living in Greenland compared with those living in Denmark, [73.35GL (95% confidence interval (CI) 68.07 to 79.03)] vs [88.07DK (95% CI 87.38 to 88.76)], whereas CHD IRs were almost similar in the two countries [IR 34.44GL (95% CI 30.89 to 38.40) vs IR 34.67DK (95% CI 34.24 to 35.10)]. Being of Inuit/mixed ethnicity was associated with an increased risk of both HD and CHD compared with non-Inuit in Greenland and Denmark [adjusted hazard ratio HD 2.07GL (95% CI 1.25 to 3.42)] and CHD [2.92GL (95% CI 1.34 to 6.38)]. CONCLUSION HD IR was lower in individuals living in Greenland compared with individuals living in Denmark, whereas the CHD IRs were almost the same for both countries. However, the risk of HD including CHD was higher among individuals of Inuit/mixed ethnicity compared with non-Inuit in both countries, suggesting a role of ethnicity among children and younger adults.
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Affiliation(s)
- Marie Tindborg
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Paediatric and Adolescent Medicine, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Anders Koch
- Department of Internal Medicine, Queen Ingrids Hospital, Nuuk, Greenland.,Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark.,Department of Infectious Diseases, Rigshospitalet University Hospital, Copenhagen, Denmark.,Ilisimatusarfik, University of Greenland, Nuuk, Greenland
| | - Mikael Andersson
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Klaus Juul
- Department of Paediatric and Adolescent Medicine, Paediatric Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark
| | | | - Bolette Soborg
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Sascha Wilk Michelsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Paediatric and Adolescent Medicine, Rigshospitalet University Hospital, Copenhagen, Denmark
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13
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Replacement of potatoes with other vegetables and risk of myocardial infarction in the Danish Diet, Cancer and Health cohort. Br J Nutr 2021; 126:1709-1716. [PMID: 33509308 DOI: 10.1017/s0007114521000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intake of vegetables is recommended for the prevention of myocardial infarction (MI). However, vegetables make up a heterogeneous group, and subgroups of vegetables may be differentially associated with MI. The aim of this study was to examine replacement of potatoes with other vegetables or subgroups of other vegetables and the risk of MI. Substitutions between subgroups of other vegetables and risk of MI were also investigated. We followed 29 142 women and 26 029 men aged 50-64 years in the Danish Diet, Cancer and Health cohort. Diet was assessed at baseline by using a detailed validated FFQ. Hazard ratios (HR) with 95 % CI for the incidence of MI were calculated using Cox proportional hazards regression. During 13·6 years of follow-up, 656 female and 1694 male cases were identified. Among women, the adjusted HR for MI was 1·02 (95 % CI 0·93, 1·13) per 500 g/week replacement of potatoes with other vegetables. For vegetable subgroups, the HR was 0·93 (95 % CI 0·77, 1·13) for replacement of potatoes with fruiting vegetables and 0·91 (95 % CI 0·77, 1·07) for replacement of potatoes with other root vegetables. A higher intake of cabbage replacing other vegetable subgroups was associated with a statistically non-significant higher risk of MI. A similar pattern of associations was found when intake was expressed in kcal/week. Among men, the pattern of associations was overall found to be similar to that for women. This study supports food-based dietary guidelines recommending to consume a variety of vegetables from all subgroups.
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14
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Kerr AJ, Wang TKM, Jiang Y, Grey C, Wells S, Poppe KK. The importance of considering both primary and secondary diagnostic codes when using administrative health data to study acute coronary syndrome epidemiology (ANZACS-QI 47). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:548-555. [PMID: 32592466 DOI: 10.1093/ehjqcco/qcaa056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
AIMS Routinely collected health administrative data have become an important data source for investigators assessing disease epidemiology. Our aim was to investigate the implications of identifying acute coronary syndrome (ACS) events in New Zealand (NZ) national hospitalization data using either the first (primary) or subsequent (secondary) codes. METHODS AND RESULTS Using national health datasets, we identified all NZ hospitalizations (2014-16) for patients ≥20 years with a primary or secondary International Classification of Diseases 10th Revision, Australian Modification (ICD10-AM) ACS code. Outcomes included 1-year all-cause and cause-specific mortality, hospitalized non-fatal myocardial infarction, heart failure, stroke, or major bleeding, and a composite comprising these outcomes. Of 35 646 ACS hospitalizations, 78.5% were primary and 21.5% secondary diagnoses. Compared to primary coding, patients with a secondary diagnosis were older (mean 77 vs. 69 years), more likely to be females (48% vs. 36%), had more comorbidity, and were less likely to receive coronary angiography or revascularization. Higher adverse event rates were observed for the secondary diagnosis group including a three-fold higher 1-year mortality (40% vs. 13%) and two-fold higher composite adverse outcome (54% vs. 26%). The use of primary codes alone, rather than combined primary and secondary codes, resulted in overestimation of coronary angiography and revascularization rates, and underestimation of the 1-year case fatality (13.1% vs. 19.0%) and composite adverse event rate (26% vs. 32%). CONCLUSION Patient characteristics and outcomes of ACS events recorded as primary vs. secondary codes are very different. These findings have important implications for designing studies utilizing ICD10-AM codes.
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Affiliation(s)
- Andrew J Kerr
- Department of Cardiology, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand.,Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, School of Population Health, Grafton Campus, 22-30 Park Ave, Grafton, Auckland 1023, New Zealand.,School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1023, New Zealand
| | - Tom Kai Ming Wang
- Department of Cardiology, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, School of Population Health, University of Auckland, 22 Park Avenue, Grafton, Auckland 1023, New Zealand
| | - Corina Grey
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, School of Population Health, Grafton Campus, 22-30 Park Ave, Grafton, Auckland 1023, New Zealand
| | - Sue Wells
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, School of Population Health, Grafton Campus, 22-30 Park Ave, Grafton, Auckland 1023, New Zealand
| | - Katrina K Poppe
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, School of Population Health, Grafton Campus, 22-30 Park Ave, Grafton, Auckland 1023, New Zealand
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15
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Selçuk H, Roos EM, Grønne DT, Ernst MT, Skou ST. Agreement Between Self-Reported Information and Administrative Data on Comorbidities, Imaging and Treatment in Denmark - A Validation Study of 38,745 Patients with Knee or Hip Osteoarthritis. Clin Epidemiol 2021; 13:779-790. [PMID: 34512031 PMCID: PMC8416180 DOI: 10.2147/clep.s309364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To validate self-reported information obtained from patients with knee or hip osteoarthritis (OA) in primary care against administrative data from the three national Danish registries. Patients and Methods We compared the baseline and 12-month follow-up data from 38,745 patients with knee or hip OA participating in the Good Life with osteoArthritis in Denmark (GLA:D®) program with registry-based data on joint surgeries, pain medication dispensing, radiographs, and hospital diagnoses. Agreement was calculated using Cohen's Kappa (k) and percentage agreement, both with 95% CI. Results There was a moderate agreement between self-report and registry-based data for previous knee surgery (k=0.58, 84.99%) and a substantial agreement for previous hip surgery (k=0.73, 97.05%). Agreement varied from 0.05 to 0.95 and 84.99% to 99.94% for different types of surgeries with lowest agreement for collateral ligament surgery (k=0.05, 99.82%) and highest agreement for joint replacement (k=0.95, 99.54% for knee; k=0.95, 99.48% for hip). There was a moderate agreement (k=0.41, 81.59%) for knee and a slight agreement (k=0.20, 64.79%) for hip radiographs. Agreement varied from 0.01 to 0.53 and 65.39% to 99.90% for pain medication with lowest agreement for topical NSAID (k=0.01, 95.00%) and highest agreement for opioids (k=0.53, 92.56%). For comorbidities, agreement varied from 0.14 to 0.90 and 78.07% to 98.91%, with lowest agreement for anemia or other blood disease (k=0.14, 97.63%) and highest agreement for diabetes (k=0.90, 98.73%). Conclusion As the most common types of pain medication used by patients with OA can be bought over-the-counter and as most OA patients are treated in primary care, which is often not covered by national registries, self-report of pain medication use and comorbidities is preferred but cannot be sufficiently validated against registry-based data. Future studies collecting self-reported information on joint surgery and pain medication from patients with OA should use a less detailed categorization to improve accuracy.
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Affiliation(s)
- Halit Selçuk
- Department of Physiotherapy and Rehabilitation, Marmara University, İstanbul, Turkey
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Dorte T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Martin T Ernst
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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16
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The familial and genetic contribution to the association between depression and cardiovascular disease: a twin cohort study. Mol Psychiatry 2021; 26:4245-4253. [PMID: 33219357 DOI: 10.1038/s41380-020-00954-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 11/08/2022]
Abstract
Depression and cardiovascular disease (ischemic heart disease and stroke) are associated in a bidirectional manner. Their relatively high heritability has led to the hypothesis that this co-occurrence is related to shared familial and genetic factors; this study aims to test this hypothesis. We included 23,498 monozygotic and 39,540 same-sex dizygotic twins from the Danish Twin Registry followed from January 1977 until December 2011 in nationwide Danish registries. We used survival analyses accounting for censoring and competing risk of death to estimate cumulative incidence, casewise concordance, relative recurrence risk, and heritability of the co-occurrence of depression and cardiovascular disease by age using monozygotic and same-sex dizygotic twin pairs. The casewise concordance of ischemic heart disease or stroke in twins whose co-twin was diagnosed with depression was at all ages similar for the monozygotic and dizygotic twin pairs and to the cumulative incidence of ischemic heart disease or stroke, respectively, in the entire twin population. A similar pattern was seen in analyses of depression risk given the co-twin being diagnosed with ischemic heart disease or stroke. Relative recurrence risk and heritability estimates were also of modest size and with confidence intervals including unity. Results were similar after stratification by gender as well as when redefining depression to include the use of antidepressant medication from 1995. Our findings do not support that co-occurrence between depression and cardiovascular disease is explainable by shared genetic factors, nor did we find strong evidence of a familial effect.
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17
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Sears CG, Poulsen AH, Eliot M, Howe CJ, James KA, Harrington JM, Roswall N, Overvad K, Tjønneland A, Raaschou-Nielsen O, Wellenius GA, Meliker J. Urine cadmium and acute myocardial infarction among never smokers in the Danish Diet, Cancer and Health cohort. ENVIRONMENT INTERNATIONAL 2021; 150:106428. [PMID: 33571817 PMCID: PMC7940585 DOI: 10.1016/j.envint.2021.106428] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 05/11/2023]
Abstract
Cadmium exposure has been associated with cardiovascular disease. Cigarette smoking is a key source of cadmium exposure and thus a potential confounder in observational studies of environmental cadmium and cardiovascular disease that include tobacco smokers. We leveraged up to 20 years of follow-up in the Danish Diet, Cancer and Health cohort to test the hypothesis that cadmium exposure is associated with acute myocardial infarction (AMI) among people who never smoked. Between 1993 and 1997, 19,394 never-smoking participants (ages 50-64 years) were enrolled and provided a urine sample. From this sample, we randomly selected a subcohort of 600 males and 600 females. We identified 809 AMI cases occurring between baseline and the end of 2015 using the Danish National Patient Registry. We quantified cadmium, creatinine, and osmolality in baseline urine samples. Using an unweighted case-cohort approach, we estimated adjusted hazard ratios (aHR) for AMI in Cox proportional hazards models with age as the time axis. Participants had relatively low concentrations of urinary cadmium, as expected for never smokers (median = 0.20; 25th, 75th = 0.13, 0.32 μg cadmium/g creatinine). We did not find strong evidence to support an association between higher urinary cadmium and AMI when comparing the highest versus lowest quartile (aHR = 1.16; 95% CI: 0.86 - 1.56) and per IQR increment in cadmium concentration (aHR = 1.02; 95% CI: 0.93 - 1.12). Results were not materially different across strata defined by sex. Results were generally similar using creatinine or osmolality to account for differences in urine dilution. While cadmium exposure has been identified as a risk factor for cardiovascular disease, we did not find strong evidence that urinary cadmium at relatively low-levels is associated with AMI among people who have never smoked.
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Affiliation(s)
- Clara G Sears
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | | | - Melissa Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Katherine A James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, CO, USA
| | - James M Harrington
- Center for Analytical Science, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Nina Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Gregory A Wellenius
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Environmental Health, Boston University, Boston, MA, USA
| | - Jaymie Meliker
- Program in Public Health, Department of Family, Population, & Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
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18
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Linoleic acid in adipose tissue and the risk of myocardial infarction: a case-cohort study. Eur J Nutr 2021; 60:3639-3646. [PMID: 33687534 DOI: 10.1007/s00394-021-02526-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE We investigated risk of myocardial infarction (MI) associated with the content of linoleic acid (LA) in adipose tissue, a biomarker of long-term dietary intake of LA and a marker of endogenous LA exposure. METHODS Between 1993 and 1997, 57,053 middle-aged subjects were included in the Danish Diet, Cancer and Health cohort. We performed a case-cohort study that included a random sample of the full cohort (n = 3167) and all incident MI cases appearing during 16 years of follow-up (n = 2819). Information on incident MI cases was obtained by linkage with Danish nationwide registries. Adipose tissue biopsies were taken from the buttocks of the participants, and their fatty acid composition was determined using gas chromatography. HRs (hazard ratios) with 95% confidence intervals (CIs) were used to describe the associations between content of LA in adipose tissue and the risk of MI. HRs were calculated using weighted Cox proportional hazards regression with robust variance. RESULTS After adjustment for established risk factors of MI, adipose tissue content of LA was not associated with the risk of MI in men and women combined (quintiles 5 versus 1, HR, 1.03 (95% CI, 0.85-1.25), P-trend = 0.970) or in men and women separately (quintiles 5 versus 1, HR, 1.05 (95% CI, 0.83-1.33), P-trend = 0.871 and quintiles 5 versus 1, HR, 0.99 (95% CI 0.72-1.37), P-trend = 0.928, respectively). Investigating the association between LA and MI with a shorter, 5- or 10-year duration of follow-up provided similar results. CONCLUSION Content of LA in adipose tissue was not associated with the risk of MI.
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19
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Fedchenko M, Mandalenakis Z, Hultsberg-Olsson G, Dellborg H, Eriksson P, Dellborg M. Validation of myocardial infarction diagnosis in patients with congenital heart disease in Sweden. BMC Cardiovasc Disord 2020; 20:460. [PMID: 33096985 PMCID: PMC7584083 DOI: 10.1186/s12872-020-01737-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/11/2020] [Indexed: 12/28/2022] Open
Abstract
Background The population of adults with congenital heart disease (CHD) is growing, and increasingly more patients with CHD reach older ages. Patients with CHD are at an increased risk of myocardial infarction (MI) with increased age. Diagnosing MI in patients with CHD can be challenging in clinical practice owing to a high prevalence of aberrant electrocardiograms, ventricular hypertrophy, and heart failure, among other factors. The National Swedish Patient Register (NPR) is widely used in epidemiological studies; however, MI diagnoses specifically in patients with CHD have never been validated in the NPR. Methods We contacted hospitals and medical archive services to request medical records for 249 patients, born during 1970–2012, with both CHD and MI diagnoses and who were randomly selected from the NPR by the Swedish National Board of Health and Welfare. Follow-up was until 2015. We performed a medical chart review to validate the MI diagnoses; we also validated CHD diagnoses to ensure that only patients with confirmed CHD diagnoses were included in the MI validation process. Results We received medical records for 96.4% (n = 238/249) of patients for validation of CHD diagnoses. In total, 74.8% (n = 178/238) had a confirmed CHD diagnosis; of these, 70.2% (n = 167) had a fully correct CHD diagnosis in the NPR; a further 4.6% (n = 11) had a CHD diagnosis, but it was misclassified. MI diagnoses were validated in 167 (93.8%) patients with confirmed CHD. Of the patients with confirmed CHD, 88.0% (n = 147/167) had correct MI diagnoses. Patients with non-complex CHD diagnoses had more correct MI diagnoses than patients with complex CHD (91.0%, n = 131 compared with 69.6%, n = 16). The main cause for incorrect MI diagnoses was typographical error, contributing to 50.0% of the incorrect diagnoses. Conclusions The validity of MI diagnoses in patients with confirmed CHD in the NPR is high, with nearly 9 of 10 MI diagnoses being correct (88.0%). MI in patients with CHD can safely be studied using the NPR.
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Affiliation(s)
- Maria Fedchenko
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden.
| | - Zacharias Mandalenakis
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Görel Hultsberg-Olsson
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Helena Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Peter Eriksson
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
| | - Mikael Dellborg
- Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 50, Gothenburg, Sweden
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20
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Davidson J, Banerjee A, Muzambi R, Smeeth L, Warren-Gash C. Validity of Acute Cardiovascular Outcome Diagnoses Recorded in European Electronic Health Records: A Systematic Review. Clin Epidemiol 2020; 12:1095-1111. [PMID: 33116903 PMCID: PMC7569174 DOI: 10.2147/clep.s265619] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Electronic health records are widely used in cardiovascular disease research. We appraised the validity of stroke, acute coronary syndrome and heart failure diagnoses in studies conducted using European electronic health records. METHODS Using a prespecified strategy, we systematically searched seven databases from dates of inception to April 2019. Two reviewers independently completed study selection, followed by partial parallel data extraction and risk of bias assessment. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value estimates were narratively synthesized and heterogeneity between sensitivity and PPV estimates were assessed using I2. RESULTS We identified 81 studies, of which 20 validated heart failure diagnoses, 31 validated acute coronary syndrome diagnoses with 29 specifically recording estimates for myocardial infarction, and 41 validated stroke diagnoses. Few studies reported specificity or negative predictive value estimates. Sensitivity was ≤66% in all but one heart failure study, ≥80% for 91% of myocardial infarction studies, and ≥70% for 73% of stroke studies. PPV was ≥80% in 74% of heart failure, 88% of myocardial infarction, and 70% of stroke studies. PPV by stroke subtype was variable, at ≥80% for 80% of ischaemic stroke but only 44% of haemorrhagic stroke. There was considerable heterogeneity (I2 >75%) between sensitivity and PPV estimates for all diagnoses. CONCLUSION Overall, European electronic health record stroke, acute coronary syndrome and heart failure diagnoses are accurate for use in research, although validity estimates for heart failure and individual stroke subtypes were lower. Where possible, researchers should validate data before use or carefully interpret the results of previous validation studies for their own study purposes.
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Affiliation(s)
- Jennifer Davidson
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Rutendo Muzambi
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Warren-Gash
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
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21
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Jensen MH, Kjolby M, Hejlesen O, Jakobsen PE, Vestergaard P. Risk of Major Adverse Cardiovascular Events, Severe Hypoglycemia, and All-Cause Mortality for Widely Used Antihyperglycemic Dual and Triple Therapies for Type 2 Diabetes Management: A Cohort Study of All Danish Users. Diabetes Care 2020; 43:1209-1218. [PMID: 32238426 DOI: 10.2337/dc19-2535] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/26/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The vast number of antihyperglycemic medications and growing amount of evidence make clinical decision making difficult. The aim of this study was to investigate the safety of antihyperglycemic dual and triple therapies for type 2 diabetes management with respect to major adverse cardiovascular events, severe hypoglycemia, and all-cause mortality in a real-life clinical setting. RESEARCH DESIGN AND METHODS Cox regression models were constructed to analyze 20 years of data from the Danish National Patient Registry with respect to effect of the antihyperglycemic therapies on the three end points. RESULTS A total of 66,807 people with type 2 diabetes were treated with metformin (MET) plus a combination of second- and third-line therapies. People on MET plus sulfonylurea (SU) had the highest risk of all end points, except for severe hypoglycemia, for which people on MET plus basal insulin (BASAL) had a higher risk. The lowest risk of major adverse cardiovascular events was seen for people on a regimen including a glucagon-like peptide 1 (GLP-1) receptor agonist. People treated with MET, GLP-1, and BASAL had a lower risk of all three end points than people treated with MET and BASAL, especially for severe hypoglycemia. The lowest risk of all three end points was, in general, seen for people treated with MET, sodium-glucose cotransporter 2 inhibitor, and GLP-1. CONCLUSIONS Findings from this study do not support SU as the second-line treatment choice for patients with type 2 diabetes. Moreover, the results indicate that adding a GLP-1 in people treated with MET and BASAL could be considered, especially if those people suffer from severe hypoglycemia.
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Affiliation(s)
- Morten Hasselstrøm Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark .,Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mads Kjolby
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Danish Diabetes Academy, Novo Nordisk Foundation, Aarhus, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Poul Erik Jakobsen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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22
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Kvist K, Laursen ASD, Overvad K, Jakobsen MU. Substitution of Milk with Whole-Fat Yogurt Products or Cheese Is Associated with a Lower Risk of Myocardial Infarction: The Danish Diet, Cancer and Health cohort. J Nutr 2020; 150:1252-1258. [PMID: 31919508 DOI: 10.1093/jn/nxz337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/06/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Food-based dietary guidelines recommend replacement of whole-fat dairy products with low-fat variants based on data suggesting that diets high in saturated fat are associated with a higher risk of ischemic heart disease. However, the health effects of saturated fat may depend on the source. OBJECTIVES The aim was to investigate substitutions between different subgroups of dairy products and the risk of myocardial infarction (MI). METHODS Data were from the Danish Diet, Cancer and Health cohort and included 54,903 men and women aged 50-64 y at enrollment and without an MI diagnosis. Information about intake of dairy products was obtained by a semiquantitative food-frequency questionnaire. Incident MI cases were identified through nationwide registries. We used Cox proportional hazards regression to estimate associations between specified substitutions of dairy products and MI risk. RESULTS During a median follow-up of 15.9 y, 3033 cases were identified. Whole-fat yogurt products in place of low-fat or whole-fat milk were associated with a lower risk of MI (HR: 0.89; 95% CI: 0.80, 0.99 per 200 g/d replaced; and HR: 0.87; 95% CI: 0.78, 0.98 per 200 g/d replaced, respectively). Substitution of 20 g/d of cheese for 200 g/d of low-fat or whole-fat milk was also associated with a lower risk of MI (HR: 0.96; 95% CI: 0.92, 0.99; and HR: 0.95; 95% CI: 0.89, 0.99, respectively). CONCLUSIONS Among middle-aged Danish men and women, intake of whole-fat yogurt products or cheese in place of milk, regardless of fat content, was associated with a lower risk of development of MI.
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Affiliation(s)
- Karina Kvist
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Marianne Uhre Jakobsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,National Food Institute, Division for Diet, Disease Prevention and Toxicology, Technical University of Denmark, Kgs Lyngby, Denmark
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23
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Cramer J, Jørgensen JT, Hoffmann B, Loft S, Bräuner EV, Prescott E, Ketzel M, Hertel O, Brandt J, Jensen SS, Backalarz C, Simonsen MK, Andersen ZJ. Long-Term Exposure to Air Pollution and Incidence of Myocardial Infarction: A Danish Nurse Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:57003. [PMID: 32438827 PMCID: PMC7263451 DOI: 10.1289/ehp5818] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Air pollution exposure has been linked to coronary heart disease, although evidence on PM2.5 and myocardial infarction (MI) incidence is mixed. OBJECTIVES This prospective cohort study aimed to investigate associations between long-term exposure to air pollution and MI incidence, adjusting for road traffic noise. METHODS We used data from the nationwide Danish Nurse Cohort on 22,882 female nurses (>44 years of age) who, at recruitment in 1993 or 1999, reported information on cardiovascular disease risk factors. Data on MI incidence was collected from the Danish National Patient Register until the end of 2014. Annual mean concentrations of particulate matter (PM) with a diameter <2.5 μg/m3 (PM2.5), PM10, nitrogen dioxide (NO2), and nitrogen oxides (NOx) at the nurses' residences since 1990 (PM10 and PM2.5) or 1970 (NO2 and NOx) were estimated using the Danish Eulerian Hemispheric Model/Urban Background Model/AirGIS (DEHM/UBM/AirGIS) dispersion model. We used time-varying Cox regression models to examine the association between 1- and 3-y running means of these pollutants, as well as 23-y running means of NO2 and NOx, with both overall and fatal incident MI. Associations were explored in three progressively adjusted models: Model 1, adjusted for age and baseline year; Model 2, with further adjustment for potential confounding by lifestyle and cardiovascular disease risk factors; and Model 3, with further adjustment for road traffic noise, modeled as the annual mean of a weighted 24-h average (Lden). RESULTS Of the 22,882 women, 641 developed MI during a mean follow-up of 18.6 y, 121 (18.9%) of which were fatal. Reported hazard ratios (HRs) were based on interquartile range increases of 5.3, 5.5, 8.1, and 11.5 μg/m3 for PM2.5, PM10, NO2, and NOx, respectively. In Model 1, we observed a positive association between a 3-y running mean of PM2.5 and an overall incident MI with an HR= 1.20 (95% CI: 1.07, 1.35), which attenuated to HR= 1.06 (95% CI: 0.92, 1.23) in Model 2. In Model 1 for incident fatal MI, we observed a strong association with a 3-y running mean of PM2.5, with an HR= 1.69 (95% CI: 1.33, 2.13), which attenuated to HR= 1.35 (95% CI: 1.01, 1.81) in Model 2. Similar associations were seen for PM10, with 3-y, Model 2 estimates for overall and fatal incident MI of HR= 1.06 (95% CI: 0.91, 1.23) and HR= 1.35 (95% CI: 1.01, 1.81), respectively. No evidence of an association was observed for NO2 or NOx. For all pollutants, associations in Model 2 were robust to further adjustment for road traffic noise in Model 3 and were similar for a 1-y running mean exposure. CONCLUSIONS We found no association between long-term exposure to PM2.5, PM10, NO2, or NOx and overall MI incidence, but we observed positive associations for PM2.5 and PM10 with fatal MI. We present novel findings that the association between PM and MI incidence is robust to adjustment for road traffic noise. https://doi.org/10.1289/EHP5818.
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Affiliation(s)
- Johannah Cramer
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Barbara Hoffmann
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, Heinrich Heine University, Dusseldorf, Germany
| | - Steffen Loft
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elvira V Bräuner
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eva Prescott
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research, Department of Civil and Environmental Engineering, University of Surrey, Guildford, UK
| | - Ole Hertel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Steen S Jensen
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | | | - Mette K Simonsen
- Diakonissestiftelsen and Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Zorana J Andersen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Centre for Epidemiological Research, Nykøbing F. Hospital, Nykøbing Falster, Denmark
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Jørgensen TSH, Wium-Andersen MK, Jørgensen MB, Osler M. The impact of mental vulnerability on the relationship between cardiovascular disease and depression. Eur Psychiatry 2020; 63:e16. [PMID: 32093792 PMCID: PMC7315880 DOI: 10.1192/j.eurpsy.2020.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background. The mechanisms linking cardiovascular disease (CVD) and depression are still not established. We investigated the impact of mental vulnerability on the relationship between CVD and depression. Methods. A total of 19,856 individuals from five cohorts of random samples of the background population in Copenhagen were followed from baseline (1983–2011) until 2017 in Danish registries. Additive hazard and Cox proportional hazard models were used to analyze the effects of confounding by mental vulnerability as well as interactions between mental vulnerability and CVD on the risk of depression. Results. During follow-up, 15.3% developed CVD, while 18.1% experienced depression. A strong positive association between CVD and depression (hazard ratio: 3.60 [95% confidence intervals (CI): 3.30; 3.92]) corresponding to 35.4 (95% CI: 31.7; 39.1) additional cases per 1,000 person-years was only slightly attenuated after adjustment for mental vulnerability in addition to other confounders. Synergistic interaction between CVD and mental vulnerability was identified in the additive hazard model. Due to interaction between CVD and mental vulnerability, CVD was associated with 50.9 more cases of depression per 1,000 person-years among individuals with high mental vulnerability compared with individuals with low mental vulnerability. Conclusions. Mental vulnerability did not explain the strong relationship between CVD and depression. CVD was associated with additional cases of depression among individuals with higher mental vulnerability indicating that this group holds the greatest potential for intervention, for example, in rehabilitation settings.
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Affiliation(s)
- Terese Sara Høj Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marie Kim Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Department O, Psychiatric Center Copenhagen, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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25
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Jensen MH, Hejlesen O, Vestergaard P. Risk of major cardiovascular events, severe hypoglycaemia, and all-cause mortality for users of insulin degludec versus insulin glargine U100-A Danish cohort study. Diabetes Metab Res Rev 2020; 36:e3225. [PMID: 31647163 DOI: 10.1002/dmrr.3225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/06/2019] [Accepted: 09/14/2019] [Indexed: 12/29/2022]
Abstract
AIMS Real-world evidence of the safety of insulin degludec compared with insulin glargine U100 is sparse. This study sought to investigate the risk of major cardiovascular events, severe hypoglycaemia, and all-cause mortality after initiation of degludec or glargine U100 in the population of Denmark. MATERIALS AND METHODS All Danish people with diabetes initiating treatment on degludec (n=5159) or glargine (n=4041) in 2016 to 2017 were included in the study. The effect of insulin treatment on the endpoints of major cardiovascular events, severe hypoglycaemia, and all-cause mortality was analysed with Cox proportional hazard models. The models were adjusted for age, sex, diabetes duration, diabetes type, highest completed education, and annual income. The model of severe hypoglycaemia was also adjusted for severe hypoglycaemia prior to baseline. The model of mortality was also adjusted for history of alcohol abuse, use of antidepressants, use of opioids, and use of anxiolytics. Lastly, the models of major cardiovascular events and mortality were also adjusted for Charlson comorbidity index. RESULTS Use of degludec resulted in an almost twofold decrease in risk of death (hazard rate [HR]: 0.54, 95% CI: 0.44-0.65) compared with use of glargine. No statistically significant risk changes were found for major cardiovascular events (HR: 0.86, 95% CI: 0.62-1.19) and severe hypoglycaemia (HR: 1.13, 95% CI: 0.66-1.93). The proportion of cause of death due to malignant neoplasm of pancreas was almost doubled for glargine compared with degludec. CONCLUSIONS These results indicate that insulin degludec has a safer profile with respect to all-cause mortality as compared with insulin glargine U100.
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Affiliation(s)
- Morten Hasselstrøm Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
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26
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Lomakin NV, Buryachkovskaya LI, Sumarokov AB, Gerasimov AN, Gabbasov ZA. [Acute Coronary Syndrome Registry of High Risk Patients: 30-Day Outcome]. ACTA ACUST UNITED AC 2019; 59:14-20. [PMID: 31849295 DOI: 10.18087/cardio.2019.11.n723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/02/2019] [Accepted: 10/29/2019] [Indexed: 11/18/2022]
Abstract
AIM The aim of the study is to evaluate important additional cardiovascular (CV) risk factors of major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS) during the first 30 days after index event. MATERIALS AND METHODS Overall 750 patients with ACS were enrolled in the single center prospective registry from 2012-2015yy. 569 patients received dual antiplatelet therapy and in 425 cases platelet function testing (PFT) were performed. Most of the patients characterized as high risk elderly patients with multiple CV risk factors and high comorbidity index. RESULTS At 30-day follow-up the mortality rate was 10,1%. Singlevariate analysis showed strong association between MACE and age, atrial fibrillation, stroke, chronic kidney disease, low ejection fraction, type 2 myocardial infarction (T2MI). Multivariate analysis showed that high-on-treatment platelet reactivity (PFT> 45%) with odds ratio 4.418 (p=0.0001), chronic kidney disease (OR 6.538 p=0.001) and T2MI (OR 1.925 p=0.0001) were significantly associated with adverse outcome. CONCLUSION ACS registry showed high mortality level in real-life practice compared with randomized clinical trials due to the high prevalence of elderly patients with high comorbidity index. Patients with T2MI have significantly more severe prognosis and chronic kidney disease associated with increased MACE. PFT in this category of patients is reasonable for more accurate risk stratification.
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Affiliation(s)
- N V Lomakin
- Central Clinical Hospital of the Management Affair of President RF
| | | | | | - A N Gerasimov
- Sechenov First Moscow State Medical University (Sechenov University)
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27
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Wium-Andersen MK, Wium-Andersen IK, Jørgensen MB, McGue M, Jørgensen TSH, Christensen K, Osler M. The association between depressive mood and ischemic heart disease: a twin study. Acta Psychiatr Scand 2019; 140:265-274. [PMID: 31306494 PMCID: PMC8039049 DOI: 10.1111/acps.13072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/01/2019] [Accepted: 07/07/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Individuals with mood disorders have increased risk of cardiovascular disease. The aims of this study were to evaluate if the risk of cardiovascular disease in individuals with mood disorder could be explained by shared genetic and early environmental factors. METHODS We included 6714 Danish middle and old aged twins from two large population-based studies. Cox proportional hazards regression was used to perform individual-level and intra-pair analyses of the association between self-reported depression symptomatology scores and register-based diagnoses of ischemic heart disease. RESULTS Higher depression symptomatology scores (both total, affective, and somatic) were associated with higher incidence of ischemic heart disease after multivariable adjustment in individual-level analyses. In intra-pair analyses, this association was similar but with slightly larger confidence intervals. There was no interaction with gender and no major differences between mono- or dizygotic twins. Within twin pairs, the twin scoring highest on depressive symptoms developed ischemic heart disease more often or earlier than the lower scoring twin. A sensitivity analysis including a 2-year time lag of depression symptomatology to limit the risk of reverse causality showed similar results. CONCLUSION Genetic factors and early life environment do not seem to explain the association between depressive mood and ischemic heart disease.
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Affiliation(s)
- M. K. Wium-Andersen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - M. B. Jørgensen
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M. McGue
- The Danish Aging Research Center and The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense, Denmark,Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - T. S. H. Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - K. Christensen
- The Danish Aging Research Center and The Danish Twin Registry, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M. Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
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Kriegbaum M, Hougaard CØ, Andersen I, Brønnum-Hansen H, Lund R. Life course analysis on income and incident AMI: a Danish register-based cohort study. J Epidemiol Community Health 2019; 73:810-816. [PMID: 31142610 DOI: 10.1136/jech-2018-212043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Social inequality in ischaemic heart disease has been related to socioeconomic position in childhood, early adulthood and late adulthood. However, the impact of relative level of accumulated income periods across adult life course and the potential gender and age differences have not been investigated. The aim was to investigate the association between relative level of accumulated income across the life course and acute myocardial infarction (AMI) from age 60+ years and to study if the associations differ by gender and in different age groups (30-39 years, 40-49 years and 50-59 years). METHODS All Danes born 1935-1954 (N=1 235 139) were followed up in registers for incident AMI (42 669 cases). The accumulated proportional deviation from median equivalised income (APDMEI) for each gender/age/calendar year strata was constructed and divided in quartiles. The associations were analysed by means of Cox's proportional hazard models. RESULTS Among men, those in the lowest APDMEI quartile had an HR 1.40 (1.35-1.45) of AMI compared with the highest quartile. Those in the second and third highest quartiles had HR of 1.24 (1.20-1.28) and 1.14 (1.10-1.18), respectively. Among women, the lowest quartile had an HR of 1.78 (1.69-1.88), the second 1.45 (1.37-1.53) and the third 1.19 (1.13-1.26). The social gradient was similar across the different age groups. CONCLUSION The risk of AMI increased with lower levels of relative accumulated income across the life course. While men generally had a higher risk of AMI, the social gradient was steeper in women. There was no indication of a specific sensitive age period for exposure to relative level of accumulated income.
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Affiliation(s)
- Margit Kriegbaum
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ingelise Andersen
- Institute of Public Health, Section of Social Medicine, Copenhagen University, Copenhagen, Denmark
| | | | - Rikke Lund
- Institute of Public Health, Section of Social Medicine, Copenhagen University, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Dalsgaard EM, Witte DR, Charles M, Jørgensen ME, Lauritzen T, Sandbæk A. Validity of Danish register diagnoses of myocardial infarction and stroke against experts in people with screen-detected diabetes. BMC Public Health 2019; 19:228. [PMID: 30795763 PMCID: PMC6387546 DOI: 10.1186/s12889-019-6549-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/15/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Administrative patient registers are often used to estimate morbidity in epidemiological studies. The validity of register data is thus important. This study aims to assess the positive predictive value of myocardial infarction and stroke registered in the Danish National Patient Register, and to examine the association between cardiovascular risk factors and cardiovascular disease based on register data or validated diagnoses in a well-defined diabetes population. METHODS We included 1533 individuals found with screen-detected type 2 diabetes in the ADDITION-Denmark study in 2001-2006. All individuals were followed for cardiovascular outcomes until the end of 2014. Hospital discharge codes for myocardial infarction and stroke were identified in the Danish National Patient Register. Hospital medical records and other clinically relevant information were collected and an independent adjudication committee evaluated all possible events. The positive predictive value for myocardial infarction and stroke were calculated as the proportion of cases recorded in the Danish National Patient Register confirmed by the adjudication committee. RESULTS The positive predictive value was 75% (95% CI: 64;84) for MI and 70% (95% CI: 54;80) for stroke. The association between cardiovascular risk factors and incident cardiovascular disease did not depend on using register-based or verified diagnoses. However, a tendency was seen towards stronger associations when using verified diagnoses. CONCLUSIONS Our results show that studies using only register-based diagnoses are likely to misclassify cardiovascular outcomes. Moreover, the results suggest that the magnitude of associations between cardiovascular risk factors and cardiovascular outcomes may be underestimated when using register-based diagnoses.
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Affiliation(s)
- Else-Marie Dalsgaard
- Department of Public Health, Aarhus University, Bartholins allé 2, DK-8000, Aarhus C, Denmark.
| | - Daniel Rinse Witte
- Department of Public Health, Aarhus University and Danish Diabetes Academy, Odense, Denmark
| | - Morten Charles
- Department of Public Health, Aarhus University, Bartholins allé 2, DK-8000, Aarhus C, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Copenhagen, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Aarhus University, Bartholins allé 2, DK-8000, Aarhus C, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University and Steno Diabetes Center, Aarhus, Denmark
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Wang Y, Zhu J, Handberg A, Overvad K, Tjønneland A, Rimm EB, Jensen MK. Association between plasma CD36 levels and incident risk of coronary heart disease among Danish men and women. Atherosclerosis 2018; 277:163-168. [PMID: 30218892 DOI: 10.1016/j.atherosclerosis.2018.08.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 08/07/2018] [Accepted: 08/29/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIMS CD36 is a cholesterol receptor involved in the uptake of oxidized low-density lipoprotein cholesterol and development of atherosclerotic plaques. Cross-sectional studies have shown correlations between plasma CD36 and atherosclerosis but no prospective study has examined the association yet. We prospectively examined the association between plasma CD36 levels and risk of incident coronary heart disease (CHD) in a Danish population. METHODS Plasma CD36 levels were measured in a case-cohort study nested within the Danish population-based cohort, the Diet, Cancer and Health Study. A total of 1963 incident CHD events occurred between baseline (1993-1997) and 2008, and a sub-cohort of 1759 participants were randomly selected as reference. Cox proportional hazard regression models were used to compute the hazard ratio (HR) and corresponding 95% confidence interval (CI). RESULTS After adjusting for CHD risk factors, including history of hypercholesterolemia and diabetes, elevated plasma CD36 levels were not associated with higher CHD risk in the total population, and the HR comparing the highest versus lowest tertile of CD36 levels was 1.02 (95% CI: 0.84-1.23). High CD36 levels were only found to be associated with risk of CHD in combination with prevalent diabetes (HR = 2.83, 95% CI: 1.08-7.45) vs. the joint reference group of lowest CD36 tertile and no diabetes. CONCLUSIONS Plasma CD36 levels were not predictive of CHD risk in the general population.
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Affiliation(s)
- Yeli Wang
- Health Services and Systems Research, Duke-NUS Medical School, 169857, Singapore
| | - Jingwen Zhu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, 9100, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, 9100, Denmark
| | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, 9100, Denmark; Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, 8000, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, 2100, Denmark
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Majken K Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
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Trans fatty acids in adipose tissue and risk of myocardial infarction: A case-cohort study. PLoS One 2018; 13:e0202363. [PMID: 30133507 PMCID: PMC6104995 DOI: 10.1371/journal.pone.0202363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/01/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The risk of coronary heart disease associated with intake of individual trans fatty acids (TFAs) is not clear. Adipose tissue content of TFAs is a biomarker of TFA intake and metabolism. OBJECTIVE We investigated the rate of myocardial infarction (MI) associated with the adipose tissue content of total 18:1t, isomers of 18:1t (18:1 Δ6-10t and 18:1 Δ11t) and 18:2 Δ9c, 11t. METHODS A case-cohort study, nested within the Danish Diet, Cancer and Health cohort (n = 57,053), was conducted, which included a random sample (n = 3156) of the total cohort and all incident MI cases (n = 2148) during follow-up (14 years). Information on MI cases was obtained by linkage with nationwide registers and validated. Adipose tissue was taken from the participants buttocks and the fatty acid composition was determined by gas chromatography. RESULTS Women with higher adipose tissue content of total 18:1t had a 57% higher MI rate (quintiles 5 versus 1, hazard ratio, 1.57; 95% confidence interval, 1.12-2.20; P-trend = 0.011) and women with higher content of 18:1 Δ6-10t had a 76% higher MI rate (quintiles 5 versus 1, hazard ratio, 1.76; 95% confidence interval, 1.23-2.51; P-trend = 0.002). No association between 18:1 Δ11t content and MI rate was observed. In men, no associations between adipose tissue content of total 18:1t and 18:1 Δ6-10t and MI rate were observed. However, men with higher content of 18:1 Δ11t had a 48% higher MI rate (quintiles 5 versus 1, hazard ratio, 1.48; 95% confidence interval, 1.17-1.86; P-trend = 0.003). Adipose tissue content of 18:2 Δ9c, 11t was not associated with MI rate in women or men. CONCLUSIONS Adipose tissue content of 18:2 Δ9c, 11t was not associated with MI rate in women or men, whereas higher contents of isomers of 18:1t were associated with higher MI rates but the associations for individual 18:1t isomers differed, however, in women and men.
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Wium-Andersen IK, Wium-Andersen MK, Jørgensen MB, Osler M. Anti-inflammatory treatment and risk of depression in 91,842 patients with acute coronary syndrome and 91,860 individuals without acute coronary syndrome in Denmark. Int J Cardiol 2018; 246:1-6. [PMID: 28867006 DOI: 10.1016/j.ijcard.2017.05.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/06/2017] [Accepted: 05/29/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND We examined if treatment with acetylsalicylic acid (ASA), non-steroid anti-inflammatory drugs (NSAID), or statins after acute coronary syndrome (ACS) are associated with decreased risk of depression. METHOD This register-based cohort study included all individuals with a first-time hospital admissions with an ACS diagnosis registered between January 2001 to December 2009 (N=91,842) and a comparable reference population without ACS (N=91,860). Information of ASA, NSAID, and statin use were retrieved from a national prescription register. The study population was followed for hospitalization with depression or receiving prescription of antidepressant medication for up to one year after ACS or study entry (early depression) or one to twelve years after ACS or study entry (late depression). RESULTS ASA use after ACS was associated with decreased risk of early depression with hazard ratios (HR) of 0.89 (95% confidence interval 0.85-0.93) but not with late depression 0.96 (0.90-1.01). The corresponding HRs for statin were 0.90 (0.86-0.94) and 0.86 (0.82-0.90). In the non-ACS population, statin use was not associated with neither early nor late depression (HRs 1.04 (0.96-1.12) and 1.00 (0.95-1.06)), while ASA was associated with increased risk of late (HR 1.09 (1.04-1.14)) but not early depression (HR 1.03 (0.97-1.09)). In both populations, NSAID use was associated with increased risk of late but not early depression. CONCLUSION Use of ASA or statins were associated with decreased risk of depression in ACS patients but not in individuals without ACS, while use of NSAID was associated with increased risk of late depression in both populations.
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Affiliation(s)
- Ida Kim Wium-Andersen
- Psychiatric Center Copenhagen, Department O, Copenhagen, Denmark; Research Center for Prevention and Health, Rigshospitalet-Glostrup, Glostrup, Denmark.
| | - Marie Kim Wium-Andersen
- Psychiatric Center Frederiksberg, Frederiksberg, Denmark; Research Center for Prevention and Health, Rigshospitalet-Glostrup, Glostrup, Denmark
| | | | - Merete Osler
- Research Center for Prevention and Health, Rigshospitalet-Glostrup, Glostrup, Denmark; Department of Public Health, University of Copenhagen, Denmark
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Morton AM, Koch M, Mendivil CO, Furtado JD, Tjønneland A, Overvad K, Wang L, Jensen MK, Sacks FM. Apolipoproteins E and CIII interact to regulate HDL metabolism and coronary heart disease risk. JCI Insight 2018; 3:98045. [PMID: 29467335 DOI: 10.1172/jci.insight.98045] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/17/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Subspecies of HDL contain apolipoprotein E (apoE) and/or apoCIII. Both proteins have properties that could affect HDL metabolism. The relation between HDL metabolism and risk of coronary heart disease (CHD) is not well understood. METHODS Eighteen participants were given a bolus infusion of [D3]L-leucine to label endogenous proteins on HDL. HDL was separated into subspecies containing apoE and/or apoCIII and then into 4 sizes. Metabolic rates for apoA-I in HDL subspecies and sizes were determined by interactive modeling. The concentrations of apoE in HDL that contain or lack apoCIII were measured in a prospective study in Denmark including 1,949 incident CHD cases during 9 years. RESULTS HDL containing apoE but not apoCIII is disproportionately secreted into the circulation, actively expands while circulating, and is quickly cleared. These are key metabolic steps in reverse cholesterol transport, which may protect against atherosclerosis. ApoCIII on HDL strongly attenuates these metabolic actions of HDL apoE. In the epidemiological study, the relation between HDL apoE concentration and CHD significantly differed depending on whether apoCIII was present. HDL apoE was associated significantly with lower risk of CHD only in the HDL subspecies lacking apoCIII. CONCLUSIONS ApoE and apoCIII on HDL interact to affect metabolism and CHD. ApoE promotes metabolic steps in reverse cholesterol transport and is associated with lower risk of CHD. ApoCIII, when coexisting with apoE on HDL, abolishes these benefits. Therefore, differences in metabolism of HDL subspecies pertaining to reverse cholesterol transport are reflected in differences in association with CHD. TRIAL REGISTRATION Clinicaltrials.gov NCT01399632. FUNDING This work was supported by NIH grant R01HL095964 to FMS and by a grant to the Harvard Clinical and Translational Science Center (8UL1TR0001750) from the National Center for Advancing Translational Science.
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Affiliation(s)
- Allyson M Morton
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Manja Koch
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Carlos O Mendivil
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Medicine, Universidad de los Andes, Bogotá, Colombia.,Section of Endocrinology, Department of Internal Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Jeremy D Furtado
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Liyun Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Majken K Jensen
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank M Sacks
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Adherence to the Danish food-based dietary guidelines and risk of myocardial infarction: a cohort study. Public Health Nutr 2018; 21:1286-1296. [PMID: 29331164 DOI: 10.1017/s1368980017003822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A direct way to evaluate food-based dietary guidelines is to assess if adherence is associated with development of non-communicable diseases. Thus, the objective was to develop an index to assess adherence to the 2013 Danish food-based dietary guidelines and to investigate the association between adherence to the index and risk of myocardial infarction (MI). DESIGN Population-based cohort study with recruitment of participants in 1993-1997. Information on dietary intake was collected at baseline using an FFQ and an index ranging from 0 to 6 points was created to assess adherence to the 2013 Danish food-based dietary guidelines. MI cases were identified by record linkage to the Danish National Patient Register and the Causes of Death Register. Cox proportional hazards models were used to estimate hazard ratios (HR) of MI. SETTING Greater areas of Aarhus and Copenhagen, Denmark. SUBJECTS Men and women aged 50-64 years (n 55 021) from the Diet, Cancer and Health study. RESULTS A total of 3046 participants were diagnosed with first-time MI during a median follow-up of 16·9 years. A higher Danish Dietary Guidelines Index score was associated with a lower risk of MI. After adjustment for potential confounders, the hazard of MI was 13 % lower among men with a score of 3-<4 (HR=0·87; 95 % CI 0·78, 0·96) compared with men with a score of <3. The corresponding HR among women was 0·76 (95 % CI 0·63, 0·93). CONCLUSIONS Adherence to the 2013 Danish food-based dietary guidelines was inversely associated with risk of MI.
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Jakobsen L, Terkelsen CJ, Søndergaard L, De Backer O, Aarøe J, Nissen H, Johnsen SP, Christiansen EH. Short- and Long-Term Mortality and Stroke Risk After Transcatheter Aortic Valve Implantation. Am J Cardiol 2018; 121:78-85. [PMID: 29103605 DOI: 10.1016/j.amjcard.2017.09.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 01/05/2023]
Abstract
No published studies have compared the outcome after transcatheter aortic valve implantation (TAVI) with the outcome in the general population. Thus, it is unknown whether TAVI restores normal life expectancy and stroke risk. Furthermore, despite the increasing use of TAVI, only little is known about the temporal trends for TAVI regarding patient characteristics and outcomes. We identified all Danish patients treated with TAVI from 2006 to 2014 (n = 1,631) and 9,737 general population controls matched by gender, age, and co-morbidity. The primary end point was a composite end point of all-cause mortality and stroke. During the first 90 days, the risk of the combined end point, the stroke risk, and mortality were significantly higher among TAVI patients compared with controls (9.4%, 7.5%, and 2.5%, respectively, in TAVI patients compared with 2.0%, 1.6%, and 0.5% in controls). After 90 days, there were no differences (adjusted mortality rate ratio, stroke rate ratio, and mortality or stroke rate ratio 0.92 [0.79 to 1.06], 1.32 [0.98 to 1.78], and 1.00 [0.90 to 1.10], respectively). During the study period, there were small changes in the characteristics of patients treated with TAVI; however, more patients were treated by transfemoral access; fewer needed blood transfusions, hospital stays were shorter, and the overall mortality rate decreased. In conclusion, 90 days after TAVI, the stroke risk and mortality of the TAVI patients were comparable with the stroke risk and mortality of the general population. Over time, the patient risk profiles have remained largely unchanged; however, outcomes have improved substantially, including lower short- and long-term mortality.
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Affiliation(s)
- Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | | | | | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Jens Aarøe
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Søren P Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Lip G, Lindhardsen J, Lane D, Ahlehoff O, Hansen M, Raunsø J, Tolstrup J, Hansen P, Gislason G, Torp-Pedersen C, Olesen J. Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: A net clinical benefit analysis using a ‘real world’ nationwide cohort study. Thromb Haemost 2017; 106:739-49. [PMID: 21789337 DOI: 10.1160/th11-05-0364] [Citation(s) in RCA: 306] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 07/18/2011] [Indexed: 11/05/2022]
Abstract
SummaryIt was the aim of this study to determine the efficacy and safety of vitamin K antagonists (VKAs) and acetylsalicylic acid (ASA) in patients with non-valvular atrial fibrillation (AF), with separate analyses according to predicted thromboembolic and bleeding risk. By individual levellinkage of nationwide registries, we identified all patients discharged with non-valvular AF in Denmark (n=132,372). For every patient, the risk of stroke and bleeding was calculated by CHADS2, CHA2DS2-VASc, and HAS-BLED. During follow-up, treatment with VKA and ASA was determined time-dependently. VKA consistently lowered the risk of thromboembolism compared to ASA and no treatment; the combination of VKA+ASA did not yield any additional benefit. In patients at high thromboembolic risk, hazard ratios (95% confidence interval) for thromboembolism were: 1.81 (1.73–1.90), 1.14 (1.06–1.23), and 1.86 (1.78–1.95) for ASA, VKA+ASA, and no treatment, respectively, compared to VKA. The risk of bleeding was increased with VKA, ASA, and VKA+ASA compared to no treatment, the hazard ratios were: 1.0 (VKA; reference), 0.93 (ASA; 0.89–0.97), 1.64 (VKA+ASA; 1.55–1.74), and 0.84 (no treatment; 0.81–0.88), respectively. There was a neutral or positive net clinical benefit (ischaemic stroke vs. intracranial haemorrhage) with VKA alone in patients with a CHADS2 score of ≥ 0, and CHA2DS2-VASc score of ≥ 1. This large cohort study confirms the efficacy of VKA and no effect of ASA treatment on the risk of stroke/thromboembolism. Also, the risk of bleeding was increased with both VKA and ASA treatment, but the net clinical benefit was clearly positive, in favour of VKA in patients with increased risk of stroke/thromboembolism.
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Ibfelt EH, Sørensen J, Jensen DV, Dreyer L, Schiøttz-Christensen B, Thygesen PH, Colic A, Raun JL, Manilo N, Rødgaard A, Poulsen UE, Rasmussen C, Hansen T, Unger B, Pelck R, Kincses A, Nordin H, Lorenzen T, Theibich A, Jensen Hansen IM, Espesen J, Grydehøj J, Holland-Fischer M, Loft AG, Hetland ML. Validity and completeness of rheumatoid arthritis diagnoses in the nationwide DANBIO clinical register and the Danish National Patient Registry. Clin Epidemiol 2017; 9:627-632. [PMID: 29238225 PMCID: PMC5713680 DOI: 10.2147/clep.s141438] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives In Denmark, patients with rheumatoid arthritis (RA) are registered in the nationwide clinical DANBIO quality register and the Danish National Patient Registry (DNPR). The aim was to study the validity of the RA diagnosis and to estimate the completeness of relevant RA cases in each registry. Study design and setting Patients registered for the first time in 2011 with a diagnosis of RA were identified in DANBIO and DNPR in January 2013. For DNPR, filters were applied to reduce false-positive cases. The diagnosis was verified by a review of patient records. We calculated the positive predictive values (PPVs) of the RA diagnosis registrations in DANBIO and DNPR, and estimated the registry completeness of relevant RA cases for both DANBIO and DNPR. Updated data from 2011 to 2015 from DANBIO were retrieved to identify patients with delayed registration, and the registry completeness and PPV was recalculated. Results We identified 1,678 unique patients in DANBIO or in DNPR. The PPV (2013 dataset) was 92% in DANBIO and 79% in DNPR. PPV for DANBIO on the 2015 update was 96%. The registry completeness of relevant RA cases was 43% in DANBIO, increasing to 91% in the 2015 update and 90% in DNPR. Conclusion DANBIO held a high proportion of true RA cases (96%) and was found to be superior to the DNPR (79%) with regard to the validity of the diagnosis. Both registries were estimated to have a high completeness of RA cases treated in hospital care (~90%).
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Affiliation(s)
- Else Helene Ibfelt
- Research Centre for Prevention and Health, Capital Region of Denmark, Rigshospitalet - Glostrup, Denmark
| | - Jan Sørensen
- Centre of Health Economics Research, Institute of Public health, University of Southern Denmark, Odense, Denmark.,Healthcare Outcome Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dorte V Jensen
- DANBiO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup.,Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Hellerup
| | - Lene Dreyer
- Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Hellerup.,The Parker Institute, Frederiksberg and Bispebjerg Hospital, Frederiksberg
| | | | - Pia H Thygesen
- Department of Rheumatology, Odense University Hospital, Odense
| | - Ada Colic
- Department of Rheumatology, Sydvestjysk Sygehus, Esbjerg/Grintsted
| | - Johnny L Raun
- Department of Internal Medicine and Rheumatology, SLB - Fredericia Hospital, Fredericia
| | - Natalia Manilo
- Department of Rheumatology, Frederiksberg Hospital, Copenhagen
| | - Anne Rødgaard
- DANBiO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup
| | - Uta E Poulsen
- Department of Rheumatology, Gigthospital Gråsten, Gråsten
| | - Claus Rasmussen
- Clinic of Internal Medicine, Rheumatology, Regionshospital Nordjylland, Hjørring
| | | | - Babara Unger
- Department of Internal Medicine/Rheumatology, Hospitalsenheden Horsens, Horsens
| | - Randi Pelck
- Department of Rheumatology, Zealand University Hospital, Køge
| | - Anita Kincses
- Department of Rheumatology, Nordsjællands Hospitaler, Hillerød
| | - Henrik Nordin
- Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Copenhagen
| | - Tove Lorenzen
- Department of Rheumatology, Silkeborg Regional Hospital and University Clinic, Silkeborg
| | - Ali Theibich
- Department of Rheumatology, Slagelse Hospital, Slagelse
| | | | - Jakob Espesen
- Department of Internal Medicine, Vejle Hospital, Vejle
| | - Jolanta Grydehøj
- Department of Rheumatology, Regional Hospital, West Jutland, Herning
| | | | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus
| | - Merete Lund Hetland
- DANBiO and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Jensen MK, Aroner SA, Mukamal KJ, Furtado JD, Post WS, Tsai MY, Tjønneland A, Polak JF, Rimm EB, Overvad K, McClelland RL, Sacks FM. High-Density Lipoprotein Subspecies Defined by Presence of Apolipoprotein C-III and Incident Coronary Heart Disease in Four Cohorts. Circulation 2017; 137:1364-1373. [PMID: 29162611 DOI: 10.1161/circulationaha.117.031276] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/31/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND The causal role of high-density lipoprotein (HDL) cholesterol in cardioprotection has been questioned by genetic and randomized studies. Novel measures that relate to HDL function may contribute new information to the prediction of cardiovascular risk. Apolipoprotein C-III (apoC-III) is a key regulator of lipoprotein metabolism. We investigated whether subspecies of HDL defined by apoC-III are associated with coronary heart disease (CHD). METHODS We used immunoaffinity chromatography to measure the apoA-I concentrations of HDL that contains and lacks apoC-III in 2 prospective studies of adults free of CHD. In MESA (Multi-Ethnic Study of Atherosclerosis), 5657 participants (52% women, 52-72 years of age) were followed for risk of CHD from 2000 to 2002 through 2013. In a case-cohort study nested within the DCH study (Danish Diet, Cancer, and Health), 3642 participants (47% women, 51-64 years of age) were followed from 1994 to 1997 through 2010. Subsequently, we conducted a meta-analysis that combined these results with the previously published findings from 2 cohort studies that used similar laboratory methodology to measure lipoproteins, totaling 2997 incident cases. RESULTS ApoC-III was found on 6% to 8% of apoA-I. The 2 HDL subspecies showed opposing associations, with risk of CHD in each of the individual cohorts and in the meta-analysis (P heterogeneity between the 2 subspecies <0.01). HDL that contains apoC-III was associated with a higher risk of CHD (pooled relative risk per standard deviation, 1.09; 95% confidence interval, 1.01-1.18), whereas HDL that lacks apoC-III was associated with lower risk (relative risk, 0.76; 95% confidence interval, 0.70-0.83). The relative risk for HDL lacking apoC-III was even more negative than the relative risk for total HDL (relative risk, 0.80; 95% confidence interval, 0.74-0.87). CONCLUSIONS Our findings from 4 prospective studies support the hypothesis that apoC-III may mark a subfraction of HDL that is associated with higher risk of CHD. New measures reflecting HDL structure and function may provide novel insights for cardiovascular risk that extend beyond traditional plasma HDL cholesterol concentrations.
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Affiliation(s)
- Majken K Jensen
- Departments of Nutrition (M.K.J., S.A.A., E.B.R., J.D.F., F.M.S.) .,Harvard T. H. Chan School of Public Health; and the Channing Division of Network Medicine (M.K.J., E.B.R., F.M.S.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sarah A Aroner
- Departments of Nutrition (M.K.J., S.A.A., E.B.R., J.D.F., F.M.S.)
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.)
| | - Jeremy D Furtado
- Departments of Nutrition (M.K.J., S.A.A., E.B.R., J.D.F., F.M.S.)
| | - Wendy S Post
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD (W.S.P.)
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (M.Y.T.)
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark (A.T.)
| | - Joseph F Polak
- Department of Radiology, Tufts Medical Center, Boston, MA (J.F.P.)
| | - Eric B Rimm
- Departments of Nutrition (M.K.J., S.A.A., E.B.R., J.D.F., F.M.S.).,Epidemiology (E.B.R.).,Harvard T. H. Chan School of Public Health; and the Channing Division of Network Medicine (M.K.J., E.B.R., F.M.S.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus Denmark & Department of Cardiology, Aalborg University Hospital, Denmark (K.O.)
| | | | - Frank M Sacks
- Departments of Nutrition (M.K.J., S.A.A., E.B.R., J.D.F., F.M.S.).,Harvard T. H. Chan School of Public Health; and the Channing Division of Network Medicine (M.K.J., E.B.R., F.M.S.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Alzuhairi KS, Søgaard P, Ravkilde J, Azimi A, Mæng M, Jensen LO, Torp-Pedersen C. Long-term prognosis of patients with non-ST-segment elevation myocardial infarction according to coronary arteries atherosclerosis extent on coronary angiography: a historical cohort study. BMC Cardiovasc Disord 2017; 17:279. [PMID: 29145828 PMCID: PMC5689183 DOI: 10.1186/s12872-017-0710-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/08/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Patients with non-ST-segment elevation myocardial infarction (NSTEMI) without obstructive coronary artery disease (CAD) are often managed differently than those with obstructive CAD, therefore we aimed in this study to examine the long-term prognosis of patients with NSTEMI according to the degree of CAD on coronary angiography (CAG). METHODS We examined 8.889 consecutive patients admitted for first time NSTEMI during 2000-2011, to whom CAG was performed. Patients were classified by CAG into: 0-vessel disease (0VD), diffuse atherosclerosis (DA) (0% < stenosis <50%), 1-vessel disease (1VD), 2VD, and 3VD with stenosis ≥50%. Follow-up period: 13 years (median 4.5). RESULTS One-year mortality for NSTEMI patients with 0VD was 3.7%, DA 5.7%, 1VD 2.5%, 2VD 4.8%, and 3VD 11.5%. Non-diabetic 0VD patients had higher risk of mortality than 1VD patients (HR:1.59; 95% CI:1.21-2.02; P < 0.001), while those with diabetes mellitus (DM) had not significantly different risk. In addition 0VD group had higher risk of heart failure (HF) (HR 1.61; 95% CI: 1.39-1.88; P < 0.001), and lower risk of recurrent MI (HR:0.55; 95% CI:0.39-0.77; P < 0.001) compared with 1VD. For patients with DA; mortality and HF risks were higher than 1VD and not different than 2VD, while recurrent MI risk was not different than 1VD and lower than 2VD. Finally, the DA group had higher risk of mortality if they had DM, higher risk of recurrent MI, and not different risk of HF and stroke compared with the 0VD group patients. CONCLUSION Patients with NSTEMI and non-obstructive CAD (both normal coronaries and diffuse atherosclerosis) have a comparable prognosis to patients with one- or two-vessel disease. Patients with diffuse atherosclerosis have worse prognosis than those with angiographically normal coronary arteries.
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Affiliation(s)
- Karam Sadoon Alzuhairi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, -9000, Aalborg, DK, Denmark.
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, -9000, Aalborg, DK, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18, -9000, Aalborg, DK, Denmark
| | - Aziza Azimi
- Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark
| | - Michael Mæng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Osler M, Wium-Andersen IK, Jørgensen MB, Jørgensen TSH, Wium-Andersen MK. Migraine and risk of stroke and acute coronary syndrome in two case-control studies in the Danish population. Clin Epidemiol 2017; 9:439-449. [PMID: 28919819 PMCID: PMC5587091 DOI: 10.2147/clep.s144441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Migraine has consistently been associated with increased risk of ischemic stroke, while the evidence for a relation with other types of stroke or coronary outcomes is limited. We examined the association between migraine and stroke and acute coronary syndrome (ACS) subtypes and the influence of potential confounding factors. METHODS All first-time hospital contacts for stroke (n=155,216) or ACS (n=97,799) were identified in Danish National Patient Registers and matched with 2 control groups of the background population. A hospital diagnosis of migraine and use of migraine medication were the main exposures and associations (odds ratios [OR]) were estimated using multiple logistic regression. Confounding was also addressed by including use of general headache medication as a negative control exposure. RESULTS The diagnosis of migraine was associated with increased odds of both stroke (ORcrude, age <50 years: 4.80 [95% CI: 3.75-6.21]; ORcrude, age ≥50 years:1.91 [95% CI: 1.67-2.19]) and ACS (ORcrude:1.88 [95% CI: 1.53-2.32]), while the ORs for the associations between migraine medication and stroke and ACS were lower. Patients with a diagnosis of migraine or redeemed migraine medication had increased ORs of all stroke subtypes (ischemic, hemorrhagic stroke and transient ischemic attacks). The diagnosis of migraine was also associated with both angina and myocardial infarction (ST-elevation Myocardial Infarction [STEMI], non-STEMI and unspecified) with the highest OR for angina. These associations were not fully explained by adjustment for confounding co-variables or when compared with the negative control exposure that were assumed to be influenced by similar confounding factors, but no shared pathogenesis. CONCLUSION Hospital-diagnosed migraine was associated with all stroke and ACS subtypes, with ischemic stroke and angina having the highest odds. Confounding did not explain the associations.
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Affiliation(s)
- Merete Osler
- Research Center for Prevention and Health, Rigshospitalet – Glostrup, Copenhagen University, Glostrup, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen
| | - Ida Kim Wium-Andersen
- Research Center for Prevention and Health, Rigshospitalet – Glostrup, Copenhagen University, Glostrup, Denmark
- Department of Psychiatry O, Rigshospitalet, Copenhagen, Denmark
| | | | - Terese Sara Høj Jørgensen
- Research Center for Prevention and Health, Rigshospitalet – Glostrup, Copenhagen University, Glostrup, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen
| | - Marie Kim Wium-Andersen
- Research Center for Prevention and Health, Rigshospitalet – Glostrup, Copenhagen University, Glostrup, Denmark
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Lühdorf P, Overvad K, Schmidt EB, Johnsen SP, Bach FW. Predictive value of stroke discharge diagnoses in the Danish National Patient Register. Scand J Public Health 2017; 45:630-636. [PMID: 28701076 DOI: 10.1177/1403494817716582] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To determine the positive predictive values for stroke discharge diagnoses, including subarachnoidal haemorrhage, intracerebral haemorrhage and cerebral infarction in the Danish National Patient Register. METHODS Participants in the Danish cohort study Diet, Cancer and Health with a stroke discharge diagnosis in the National Patient Register between 1993 and 2009 were identified and their medical records were retrieved for validation of the diagnoses. RESULTS A total of 3326 records of possible cases of stroke were reviewed. The overall positive predictive value for stroke was 69.3% (95% confidence interval (CI) 67.8-70.9%). The predictive values differed according to hospital characteristics, with the highest predictive value of 87.8% (95% CI 85.5-90.1%) found in departments of neurology and the lowest predictive value of 43.0% (95% CI 37.6-48.5%) found in outpatient clinics. CONCLUSIONS The overall stroke diagnosis in the Danish National Patient Register had a limited predictive value. We therefore recommend the critical use of non-validated register data for research on stroke. The possibility of optimising the predictive values based on more advanced algorithms should be considered.
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Affiliation(s)
| | - Kim Overvad
- 2 Department of Cardiology, Aalborg University Hospital, Denmark
- 3 Section for Epidemiology, Department of Public Health, Aarhus University, Denmark
| | - Erik B Schmidt
- 2 Department of Cardiology, Aalborg University Hospital, Denmark
| | - Søren P Johnsen
- 4 Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | - Flemming W Bach
- 1 Department of Neurology, Aalborg University Hospital, Denmark
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Roswall N, Raaschou-Nielsen O, Ketzel M, Gammelmark A, Overvad K, Olsen A, Sørensen M. Long-term residential road traffic noise and NO 2 exposure in relation to risk of incident myocardial infarction - A Danish cohort study. ENVIRONMENTAL RESEARCH 2017; 156:80-86. [PMID: 28334645 DOI: 10.1016/j.envres.2017.03.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/14/2017] [Accepted: 03/15/2017] [Indexed: 05/03/2023]
Abstract
BACKGROUND Road traffic is a source of both air pollution and noise; two environmental hazards both found to increase the risk of ischemic heart disease. Given the high correlation between these pollutants, it is important to investigate combined effects, in relation to myocardial infarction (MI). METHODS Among 50,744 middle-aged Danes enrolled into the Diet, Cancer and Health cohort from 1993 to 97, we identified 2403 cases of incident MI during a median follow-up of 14.5 years. Present and historical residential addresses from 1987 to 2011 were found in national registries, and traffic noise (Lden) and air pollution (NO2) were modelled for all addresses. Analyses were performed using Cox proportional hazard models. RESULTS Road traffic noise and NO2 were both individually associated with a higher risk of MI, with hazard ratios of 1.14 (1.07-1.21) and 1.08 (1.03-1.12) per inter-quartile range higher 10-year mean of road traffic noise and NO2, respectively. Mutual exposure adjustment reduced the association with 10-year NO2 exposure (1.02 (0.96-1.08)), whereas the association with road traffic noise remained: 1.12 (1.03-1.21). For fatal incident MI, the pattern was similar, but the associations for both pollutants were stronger. In analyses of tertiles across both pollutants, the strongest effects were seen for combined medium/high exposure, especially for fatal MI's. CONCLUSION Both road traffic noise and NO2 were associated with a higher risk of MI in single-pollutant models. In two-pollutant models, mainly noise was associated with MI. Combined exposure to both pollutants was associated with the highest risk.
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Affiliation(s)
- Nina Roswall
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark.
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark
| | - Anders Gammelmark
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark; Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
| | - Anja Olsen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark
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Acar E, Gürdeniz G, Savorani F, Hansen L, Olsen A, Tjønneland A, Dragsted LO, Bro R. Forecasting Chronic Diseases Using Data Fusion. J Proteome Res 2017; 16:2435-2444. [DOI: 10.1021/acs.jproteome.7b00039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Evrim Acar
- Department
of Food Science, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Gözde Gürdeniz
- Department
of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Francesco Savorani
- Department
of Applied Science and Technology (DISAT), Polytechnic University of Turin, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - Louise Hansen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Anja Olsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Lars Ove Dragsted
- Department
of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark
| | - Rasmus Bro
- Department
of Food Science, Faculty of Science, University of Copenhagen, 1958 Frederiksberg C, Denmark
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Lasota A, Overvad K, Eriksen H, Tjønneland A, Schmidt E, Grønholdt ML. Validity of Peripheral Arterial Disease Diagnoses in the Danish National Patient Registry. Eur J Vasc Endovasc Surg 2017; 53:679-685. [DOI: 10.1016/j.ejvs.2016.12.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/24/2016] [Indexed: 01/03/2023]
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Hviid MM, Skovlund CW, Mørch LS, Lidegaard Ø. Maternal age and child morbidity: A Danish national cohort study. PLoS One 2017; 12:e0174770. [PMID: 28380000 PMCID: PMC5381873 DOI: 10.1371/journal.pone.0174770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/15/2017] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The mean age at delivery has increased over the latest half of a century. Women of advanced maternal age have increased obstetrical risks and increased risk of chromosomal abnormalities and some other specified diagnoses in the offspring. The aim of this study was to assess the association between maternal age and overall child morbidity according to main diagnosis groups. MATERIAL AND METHODS We conducted a national cohort study including 352 027 live firstborn singleton children. The children were born between Jan 1994 and Dec 2009 and followed to Dec 2012. Children were divided into groups according to maternal age: 15-24, 25-29, 30-34, and 35+ years. Poisson regression analyses calculated adjusted incidence rate ratios (IRR) of child morbidities according to main diagnoses groups A-Q of the International Classification of Disease 10 with adjustment for year of birth, body mass index, smoking, and mother's level of education. RESULTS Average follow-up time was 11 years. Compared to children born to women 25-29 years, firstborn children to mothers aged 35+ had higher child morbidity in 8 of 19 main diagnosis groups and firstborn children to mothers 15-24 years had higher child morbidity in 12 of 19 main diagnosis groups. Thus, for a majority of diseases a U-shaped correlation was found, with lowest rates in women 25-29 years. CONCLUSION Firstborn children to both older and younger mothers have higher overall morbidity as compared to children born by mothers 25-29 years.
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Affiliation(s)
| | | | - Lina Steinrud Mørch
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Monrad M, Ersbøll AK, Sørensen M, Baastrup R, Hansen B, Gammelmark A, Tjønneland A, Overvad K, Raaschou-Nielsen O. Low-level arsenic in drinking water and risk of incident myocardial infarction: A cohort study. ENVIRONMENTAL RESEARCH 2017; 154:318-324. [PMID: 28157645 DOI: 10.1016/j.envres.2017.01.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 05/25/2023]
Abstract
BACKGROUND Epidemiological studies have shown that intake of drinking water with high levels of arsenic (>100μg/L) is associated with risk for cardiovascular diseases, but studies on lower levels of arsenic show inconsistent results. OBJECTIVE The aim of this study was to investigate the relationship between exposure to low level arsenic in drinking water and risk of myocardial infarction in Denmark. METHODS From the Danish Diet, Cancer and Health cohort of 57,053 people aged 50-64 years at enrolment in 1993-1997, we identified 2707 cases of incident myocardial infarction from enrolment to end of follow-up in February 2012. Cohort participants were enrolled in the Copenhagen and Aarhus areas. We geocoded residential addresses of the cohort members and used a geographic information system to link addresses with water supply areas. Arsenic in tap water at each cohort members address from 1973 to 2012 was estimated for all cohort members. Poisson regression was used to estimate incidence rate ratios (IRRs) for myocardial infarction after adjustment for lifestyle factors and educational level. RESULTS Arsenic levels in drinking water at baseline addresses ranged from 0.03 to 25.34μg/L, with the highest concentrations in the Aarhus area. We found no overall association between 20-years average concentration of arsenic and risk of myocardial infarction. However, in the Aarhus area, fourth arsenic quartile (2.21-25.34μg/L) was associated with an IRR of 1.48 (95% confidence interval (CI): 1.19-1.83) when compared with first quartile (0.05-1.83μg/L). An IRR of 1.26 (95% CI: 0.89-1.79) was found for ever (versus never) having lived at an address with 10μg/L or more arsenic in the drinking water. CONCLUSIONS This study provides some support for an association between low levels of arsenic in drinking water and the risk of myocardial infarction.
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Affiliation(s)
- Maria Monrad
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Rikke Baastrup
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Birgitte Hansen
- Danish Ministry for Energy, Utilities and Climate, Geological Survey of Denmark and Greenland - GEUS Department of Groundwater and Quaternary Geology Mapping C.F. Aarhus, Denmark
| | - Anders Gammelmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ole Raaschou-Nielsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark
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Koch M, Furtado JD, Jiang GZ, Gray BE, Cai T, Sacks F, Tjønneland A, Overvad K, Jensen MK. Associations of anthropometry and lifestyle factors with HDL subspecies according to apolipoprotein C-III. J Lipid Res 2017; 58:1196-1203. [PMID: 28365588 DOI: 10.1194/jlr.p073288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/13/2017] [Indexed: 11/20/2022] Open
Abstract
The presence of apoC-III on HDL impairs HDL's inverse association with coronary heart disease (CHD). Little is known about modifiable factors explaining variation in HDL subspecies defined according to apoC-III. The aim was to investigate cross-sectional associations of anthropometry and lifestyle with HDL subspecies in 3,631 participants from the Diet, Cancer, and Health study originally selected for a case-cohort study (36% women; age 50-65 years) who were all free of CHD. Greater adiposity and less activity were associated with higher HDL containing apoC-III and lower HDL lacking apoC-III. Per each 15 cm higher waist circumference, the level of HDL containing apoC-III was 2.8% higher (95% CI: 0.4, 5.3; P = 0.024) and the level of HDL not containing apoC-III was 4.7% lower (95% CI: -6.0, -3.4; P = <0.0001). Associations for physical activity were most robust to multivariable modeling. Each 20 metabolic equivalent task hours per week reported higher physical activity was associated with 0.9% (95% CI: -1.7, -0.1; P = 0.031) lower HDL containing apoC-III and 0.5% higher (95% CI: 0.1, 1.0; P = 0.029) HDL lacking apoC-III. Lower alcohol consumption was associated with lower HDL lacking apoC-III (percent difference per 15 g/day: 1.58 (95% CI: 0.84, 2.32; P = <0.0001). Adiposity and sedentary lifestyle were associated with a less favorable HDL subspecies profile.
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Affiliation(s)
- Manja Koch
- Departments of Nutrition Harvard T. H. Chan School of Public Health, Boston, MA
| | - Jeremy D Furtado
- Departments of Nutrition Harvard T. H. Chan School of Public Health, Boston, MA
| | - Gordon Z Jiang
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Brianna E Gray
- Departments of Nutrition Harvard T. H. Chan School of Public Health, Boston, MA
| | - Tianxi Cai
- Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Frank Sacks
- Departments of Nutrition Harvard T. H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | | | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark and Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Majken K Jensen
- Departments of Nutrition Harvard T. H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
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Adherence to a healthy Nordic food index and risk of myocardial infarction in middle-aged Danes: the diet, cancer and health cohort study. Eur J Clin Nutr 2017; 71:652-658. [PMID: 28247857 DOI: 10.1038/ejcn.2017.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 09/25/2016] [Accepted: 12/28/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES For decades, the Mediterranean diet has been in focus regarding healthy eating as it has been associated with reduced risk of non-communicable diseases. Less interest has been given to health benefits of other regional diets. The aim of the present study was to assess whether adherence to a healthy Nordic food index was associated with lower risk of myocardial infarction (MI) among middle-aged Danes. SUBJECTS/METHODS Data were obtained from the Danish Diet, Cancer and Health cohort study of 57 053 men and women aged 50-64 years recruited between 1993 and 1997. The healthy Nordic food index comprised healthy Nordic food items selected a priori (fish, cabbage, rye bread, oatmeal, apple and pears and root vegetables). Information on incident MI was ascertained through linkage with national registries. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated from sex-specific Cox proportional hazard models. RESULTS In total, 1669 men and 653 women developed MI during follow-up (13.6 median years). In adjusted models, those with an index score of 5-6 points (highest scores) had significantly lower MI risk (men: HR=0.77, 95% CI=0.62, 0.97; women: HR=0.55, 95% CI=0.37, 0.82) relative to those scoring 0 points in the index (lowest score). A significantly lower MI risk was found per 1-point increment in the index in both men (HR=0.95, 95% CI=0.92, 0.99) and women (HR=0.93, 95% CI=0.88, 0.98). CONCLUSIONS A healthy Nordic diet is associated with lower MI risk among middle-aged Danes, suggesting that Nordic diets should be considered in recommendations for dietary changes in the promotion of coronary health.
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Dekkers OM, Horváth-Puhó E, Cannegieter SC, Vandenbroucke JP, Sørensen HT, Jørgensen JOL. Acute cardiovascular events and all-cause mortality in patients with hyperthyroidism: a population-based cohort study. Eur J Endocrinol 2017; 176:1-9. [PMID: 27697972 DOI: 10.1530/eje-16-0576] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/28/2016] [Accepted: 10/03/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main aim was to assess the association among hyperthyroidism, acute cardiovascular events and mortality. DESIGN It is a nationwide population-based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals. We compared the rate of all-cause mortality as well as venous thromboembolism (VTE), acute myocardial infarction (AMI), ischemic and non-ischemic stroke, arterial embolism, atrial fibrillation (AF) and percutaneous coronary intervention (PCI) in the two cohorts. Hazard ratios (HR) with 95% confidence intervals (95% CI) were estimated. RESULTS The study included 85 856 hyperthyroid patients and 847 057 matched population-based controls. Mean follow-up time was 9.2 years. The HR for mortality was highest in the first 3 months after diagnosis of hyperthyroidism: 4.62, 95% CI: 4.40-4.85, and remained elevated during long-term follow-up (>3 years) (HR: 1.35, 95% CI: 1.33-1.37). The risk for all examined cardiovascular events was increased, with the highest risk in the first 3 months after hyperthyroidism diagnosis. The 3-month post-diagnosis risk was highest for atrial fibrillation (HR: 7.32, 95% CI: 6.58-8.14) and arterial embolism (HR: 6.08, 95% CI: 4.30-8.61), but the risks of VTE, AMI, ischemic and non-ischemic stroke and PCI were increased also 2- to 3-fold. CONCLUSIONS We found an increased risk for all-cause mortality and acute cardiovascular events in patients with hyperthyroidism.
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Affiliation(s)
- Olaf M Dekkers
- Department of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark
- Department of Clinical Endocrinology and Metabolism
- Department of Clinical EpidemiologyLeiden University Medical Centre, Leiden, The Netherlands
| | | | - Suzanne C Cannegieter
- Department of Clinical EpidemiologyLeiden University Medical Centre, Leiden, The Netherlands
| | - Jan P Vandenbroucke
- Department of Clinical EpidemiologyAarhus University Hospital, Aarhus, Denmark
- Department of Clinical EpidemiologyLeiden University Medical Centre, Leiden, The Netherlands
| | | | - Jens Otto L Jørgensen
- Department of Endocrinology and Internal MedicineAarhus University Hospital Aarhus, Aarhus, Denmark
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Common Polymorphisms in the 5-Lipoxygenase Pathway and Risk of Incident Myocardial Infarction: A Danish Case-Cohort Study. PLoS One 2016; 11:e0167217. [PMID: 27893808 PMCID: PMC5125697 DOI: 10.1371/journal.pone.0167217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/10/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The 5-lipoxygenase pathway (5-LOX) has been implicated in the development of cardiovascular disease and studies have suggested that genetic polymorphisms related to key enzymes in this pathway may confer risk of myocardial infarction (MI). This study investigated the association of pre-selected genetic polymorphisms in four candidate genes of 5-LOX (arachidonate 5-lipoxygenase and its activating protein (ALOX-5 and FLAP), leukotriene A4 hydroxylase (LTA4-H) and leukotriene C4 synthase (LTC4-S)) with incident MI. METHODS In a Danish cohort including 57,053 participants, aged 50-64 at enrolment and recruited from 1993-97, we conducted a case-cohort study including cases with incident MI and a randomly selected sub cohort of 3,000 participants. Cases were identified from national registries through July 2013. A total of 22 SNPs were selected and genotyped using the commercially available KASP™ assay. A tandem-repeat polymorphism, located in the ALOX-5 gene, was genotyped by multi-titre plate sequencing. Haplotypes were inferred using PHASE 2.1. RESULTS During a median follow-up of 17.0 years we identified 3,089 cases of incident MI. In FLAP, two SNPs were negatively associated with incident MI (rs9551963 & rs17222842) while one SNP (rs2247570) located in LTA4-H, was associated with higher risk of MI when comparing subjects with two copies of the variant allele to homozygotes for the wild type. However, only rs17222842 remained significantly associated with MI after correcting for multiple testing. Furthermore, the promoter polymorphism rs59439148 was associated with risk of MI in men. For male carriers of two variant alleles we found a hazard ratio of 1.63 (95% CI: 1.06;2.52) compared to homozygotes for the wild type. Previously described haplotypes (Hap-A -B, -E and -K) were not associated with MI in our population. CONCLUSION In conclusion, some common polymorphisms in the 5-lipoxygenase pathway were modestly associated with incident MI, suggesting a potential role for this pathway in the development of cardiovascular disease.
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