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Amidou SA, Houehanou YC, Gbaguidi GN, Lacroix P, Aboyans V, Sonou A, Magne J, Saka D, Lafia K, Houenassi MD, Preux PM, Houinato DS. Normal limits of electrocardiogram in Africans and their consequences on the prevalence of left ventricular hypertrophy in hypertensive individuals: Insights from the TAHES study. J Electrocardiol 2023; 76:71-78. [PMID: 36462323 DOI: 10.1016/j.jelectrocard.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 11/01/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
AIMS To determine normal limits for major ECG variables, and the electrocardiographic impact of hypertension, in a rural sub-Saharan African setting. METHODS This cross-sectional study included adults aged ≥25 years from Tanvè Health Study (TAHES) cohort. ECG were recorded at rest at 25 mm/s using a standard 12‑lead device. Wave amplitudes and durations were measured. Corrected QT interval (QTc) was calculated using Bazett's formula. Sokolow-Lyon, Cornell and Peguero-Lo Presti criteria were determined to assess left ventricular hypertrophy (LVH). RESULTS ECG was recorded among 997 out of 1407 TAHES participants. After exclusion of subjects with hypertension or diabetes, normal limits, defined as the 2nd and 98th percentiles, were evaluated in 622 healthy participants (median: 37 years; 60.1% women). The following limits were established in men (women): heart rate: 50 to 100 (55 to 102) beats/min, P wave duration: 80 to 120 (80 to 120) ms, PR interval: 120 to 200 (120 to 200) ms, QTc: 315 to 470 (323 to 465) ms, QRS duration: 50 to 120 (50 to 110) ms. Upper limits (in millimeter) for the Sokolow-Lyon, Cornell and Peguero-Lo Presti for men (women) were 47 (38), 30 (22) and 39 (30), respectively, all above current reference limits. The prevalence of LVH in hypertensive subjects according to these criteria were lower than those estimated according to current LVH criteria. CONCLUSION The normal limits of ECG variables determined in this African population differ from those in Caucasians, indicating that ethnicity must be considered in ECG interpretation.
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Affiliation(s)
- Salmane Ariyoh Amidou
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France.
| | - Yessito Corine Houehanou
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Gwladys Nadia Gbaguidi
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France
| | - Philippe Lacroix
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France; Department of Thoracic and Vascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France
| | - Victor Aboyans
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France; Dept. of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Arnaud Sonou
- Dept. of Cardiology, National University Hospital, Cotonou, Benin
| | - Julien Magne
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France
| | - Dominique Saka
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Kamel Lafia
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | | | - Pierre-Marie Preux
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France
| | - Dismand Stephan Houinato
- Laboratory of Chronic and Neurological Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin; INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut d'Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France
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Calvo I, Merayo MG, Núñez M. A methodology to analyze heart data using fuzzy automata1. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2019. [DOI: 10.3233/jifs-179348] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Iván Calvo
- Universidad Complutense de Madrid, Spain
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Magodoro IM, Albano AJ, Muthalaly R, Koplan B, North CM, Vořechovská D, Downey J, Kraemer J, Vaglio M, Badilini F, Kakuhire B, Tsai AC, Siedner MJ. Population Prevalence and Correlates of Prolonged QT Interval: Cross-Sectional, Population-Based Study From Rural Uganda. Glob Heart 2019; 14:17-25.e4. [PMID: 30584028 PMCID: PMC6737252 DOI: 10.1016/j.gheart.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/11/2018] [Accepted: 11/20/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES We aimed to estimate the prevalence and correlates of QT interval prolongation in rural Uganda. BACKGROUND Major electrocardiographic abnormalities, including prolonged QT interval, have been shown to be independently predictive of adverse cardiovascular events among Western populations. Cardiovascular diseases are on the rise in sub-Saharan Africa with poorly characterized context-specific risk factors. An important question is whether ECG screening might have value in cardiovascular disease risk stratification in SSA. METHODS We conducted a cross-sectional survey in a sample of adults participating in an ongoing whole-population cohort in Mbarara, Uganda, in 2015. Of 1,814 subjects enrolled in the parent whole-population cohort, 856 (47%) participated in the study. Participants completed 12-lead electrocardiography and cardiovascular disease risk factors assessment. We summarized sex-specific, heart rate variation-adjusted QT (QTa) defining prolonged QTa as >460 ms in women and >450 ms in men. We fit linear and logistic regression models to estimate correlates of (continuous) QTa interval length and (dichotomous) prolonged QTa. Models included inverse probability of sampling weights to generate population-level estimates accounting for study nonparticipation. RESULTS We assessed data from 828 participants with electrocardiograms. The weighted population mean age was 38.4 years (95% confidence interval: 36.3-40.4). The weighted population was 50.4% female, 11.5% had elevated blood pressure, and 57.6% had a high-sensitivity C-reactive protein >1 mg/dl. The population mean QTa was 409.1 ms (95% confidence interval: 405.1-413.1), and 10.3% (95% confidence interval: 7.8-13.5) met criteria for prolonged QTa. Women had a higher mean QTa (421.6 ms vs. 396.3 ms; p < 0.001), and a higher proportion of women had a prolonged QTa (14.0% vs. 9.3%; p = 0.122) than did men. In multivariable-adjusted regression models, female sex and hypertension correlated with higher mean QTa and meeting criteria for prolonged QTa, respectively. CONCLUSIONS QT interval prolongation is highly prevalent in rural Uganda and may be more common than in high-income settings. Female sex, age, and high blood pressure correlated with QT interval prolongation. Future work should assess whether genetic predisposition or environmental factors in sub-Saharan African populations contribute to prolonged QT and clarify consequences.
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Affiliation(s)
- Itai M Magodoro
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; University of Cape Town, Cape Town, South Africa.
| | - Alfred J Albano
- Michigan State University School of Medicine, East Lansing, MI, USA
| | - Rahul Muthalaly
- Harvard Medical School, Boston, MA, USA; Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Bruce Koplan
- Harvard Medical School, Boston, MA, USA; Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Crystal M North
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA
| | | | - Jordan Downey
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Kraemer
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Martino Vaglio
- Analyzing Medical Parameters for Solutions, LLC, New York, NY, USA
| | - Fabio Badilini
- Analyzing Medical Parameters for Solutions, LLC, New York, NY, USA
| | | | - Alexander C Tsai
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Analyzing Medical Parameters for Solutions, LLC, New York, NY, USA
| | - Mark J Siedner
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Boston, MA, USA; Mbarara University of Science and Technology, Mbarara, Uganda; Africa Health Research Institute, KwaZulu-Natal, South Africa
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Sia CH, Dalakoti M, Tan BYQ, Lee ECY, Shen X, Wang K, Lee JS, Arulanandam S, Chow W, Yeo TJ, Yeo KK, Chua TSJ, Tan RS, Lam CSP, Chong DTT. A Population-wide study of electrocardiographic (ECG) norms and the effect of demographic and anthropometric factors on selected ECG characteristics in young, Southeast Asian males-results from the Singapore Armed Forces ECG (SAFE) study. Ann Noninvasive Electrocardiol 2019; 24:e12634. [PMID: 30707472 DOI: 10.1111/anec.12634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/15/2018] [Accepted: 12/28/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Routine use of pre-participation electrocardiograms (ECGs) has been used by the Singapore Armed Forces, targeting early detection of significant cardiac diseases. We aim to describe the impact of demographic and anthropometric factors on ECG variables and establish a set of electrocardiographic reference ranges specific to a young male multiethnic Southeast Asian cohort. METHODS AND RESULTS Between November 1, 2009, and December 31, 2014, 144,346 young male conscripts underwent pre-participation screening that included a 12-lead ECG, demographic and anthropometric measurements. The Chinese population had the longest PR interval (146.7 ± 19.7 vs. 145.21 ± 19.2 in Malays vs. 141.2 ± 18.8 ms in Indians), QRS duration (94.5 ± 9.8 vs. 92.6 ± 9.7 in Malays vs. 92.5 ± 9.4 ms in Indians) and QTcB interval (408.3 ± 21.3 vs. 403.5 ± 21.6 in Malays vs. 401.2 ± 21.4 ms in Indians) (all p < 0.001). Body mass index (BMI) >25 kg/m2 and body fat >25% were independently associated with lower prevalence of increased QRS voltage on ECG. Systolic blood pressure of >140 mmHg or diastolic blood pressure of >90 mmHg independently increased the prevalence of increased QRS voltage on ECG. CONCLUSIONS Electrocardiographic parameters vary across different ethnicities and in comparison with international norms. In our population, diagnosis of increased QRS voltage by ECG is less prevalent with obesity and increased body fat. Further analysis of gold standard measurements for the diagnosis of LVH in our population is ongoing, to improve the accuracy of the ECG screening process.
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Affiliation(s)
- Ching-Hui Sia
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Mayank Dalakoti
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Benjamin Y Q Tan
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Edward C Y Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Xiayan Shen
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Kangjie Wang
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Joshua S Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Shalini Arulanandam
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Weien Chow
- HQ Medical Corps, Singapore Armed Forces, Singapore, Singapore
| | - Tee Joo Yeo
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Terrance S J Chua
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Daniel T T Chong
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Effect of age and gender on the QTc-interval in healthy individuals and patients with long-QT syndrome. Trends Cardiovasc Med 2017; 28:64-75. [PMID: 28869094 DOI: 10.1016/j.tcm.2017.07.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/15/2022]
Abstract
Age- and gender-related differences in QTc-interval are most likely the result of changes in sex-specific hormones. Although the exact mechanisms and pathophysiology of sex hormones on the QTc-interval are not known, testosterone appears to shorten the QTc-interval. In females, however, there is a more complex interaction between progesterone and estrogen. In patients with an impaired repolarization, such as long-QT syndrome (LQTS), the effect of these sex hormones on the QTc-interval is more pronounced with a differing sensitivity between the LQTS genotypes.
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Palhares DMF, Marcolino MS, Santos TMM, da Silva JLP, Gomes PR, Ribeiro LB, Macfarlane PW, Ribeiro ALP. Normal limits of the electrocardiogram derived from a large database of Brazilian primary care patients. BMC Cardiovasc Disord 2017; 17:152. [PMID: 28610624 PMCID: PMC5470250 DOI: 10.1186/s12872-017-0572-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 05/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background Knowledge of the normal limits of the electrocardiogram (ECG) is mandatory for establishing which patients have abnormal ECGs. No studies have assessed the reference standards for a Latin American population. Our aim was to establish the normal ranges of the ECG for pediatric and adult Brazilian primary care patients. Methods This retrospective observational study assessed all the consecutive 12-lead digital electrocardiograms of primary care patients at least 1 year old in Minas Gerais state, Brazil, recorded between 2010 and 2015. ECGs were excluded if there were technical problems, selected abnormalities were present or patients with selected self-declared comorbidities or on drug therapy. Only the first ECG from patients with multiple ECGs was accepted. The University of Glasgow ECG analysis program was used to automatically interpret the ECGs. For each variable, the 1st, 2nd, 50th, 98th and 99th percentiles were determined and results were compared to selected studies. Results A total of 1,493,905 ECGs were recorded. 1,007,891 were excluded and 486.014 were analyzed. This large study provided normal values for heart rate, P, QRS and T frontal axis, P and QRS overall duration, PR and QT overall intervals and QTc corrected by Hodges, Bazett, Fridericia and Framingham formulae. Overall, the results were similar to those from other studies performed in different populations but there were differences in extreme ages and specific measurements. Conclusions This study has provided reference values for Latinos of both sexes older than 1 year. Our results are comparable to studies performed in different populations.
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Affiliation(s)
- Daniel M F Palhares
- Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, 1º Andar, Ala Sul, Sala 107, Belo Horizonte, 30130-100, Minas Gerais, Brazil.,Medical School, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Milena S Marcolino
- Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, 1º Andar, Ala Sul, Sala 107, Belo Horizonte, 30130-100, Minas Gerais, Brazil.,Medical School, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Thales M M Santos
- Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, 1º Andar, Ala Sul, Sala 107, Belo Horizonte, 30130-100, Minas Gerais, Brazil.,Medical School, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - José L P da Silva
- Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, 1º Andar, Ala Sul, Sala 107, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Paulo R Gomes
- Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, 1º Andar, Ala Sul, Sala 107, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Leonardo B Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, 1º Andar, Ala Sul, Sala 107, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Peter W Macfarlane
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Antonio L P Ribeiro
- Telehealth Network of Minas Gerais, Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, 1º Andar, Ala Sul, Sala 107, Belo Horizonte, 30130-100, Minas Gerais, Brazil. .,Medical School, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Belo Horizonte, 30130-100, Minas Gerais, Brazil.
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van der Ende MY, Siland JE, Snieder H, van der Harst P, Rienstra M. Population-based values and abnormalities of the electrocardiogram in the general Dutch population: The LifeLines Cohort Study. Clin Cardiol 2017; 40:865-872. [PMID: 28605034 DOI: 10.1002/clc.22737] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Our aim is to present average values and prevalence of electrocardiographic (ECG) abnormalities among the general Dutch population in the LifeLines Cohort. HYPOTHESIS The ECG values previously studied in the Caucasian population of smaller cohorts will be confirmed with ECG data from LifeLines. METHODS ECG data of 152 180 individuals age 18 to 93 years were available. Individuals with cardiovascular risk factors were excluded to analyze the healthy population. Average values of the ECG for the healthy population were presented as means with 95% and 99% confidence intervals and as medians with first and 99th percentiles. RESULTS Median heart rate was highest in the youngest and oldest individuals of the healthy population. Median duration of P wave, PQ interval, and QRS duration were longer in males compared with females. In contrast, median QT interval corrected for heart rate was higher in females. In general, the above-mentioned parameters increased with age. The prevalences of ECG abnormalities adjusted for the Dutch population were 0.9% for atrial fibrillation or flutter, 1.4% for premature atrial complexes, 0.5% for myocardial infarction, 2.1% for ventricular premature complexes, 1.0% for left ventricular hypertrophy, 8.1% for P-R interval >200 ms, and 0.8% for bundle branch block. CONCLUSIONS Our study provides an overview of average values and ECG abnormalities and confirms data of previous smaller studies. In addition, we evaluate the age- and sex-dependent normal limits of the P wave and QRS duration and confirm in detail the frontal plane QRS-T angle on the ECG.
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Affiliation(s)
- M Yldau van der Ende
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joylene E Siland
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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