1
|
Johnsen B, Martinaityte I, Wilsgaard T, Schirmer H. Incidence of dementia over a period of 20 years in a Norwegian population. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12479. [PMID: 37780861 PMCID: PMC10540268 DOI: 10.1002/dad2.12479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION In Norway, the prevalence of dementia is higher than in demographically comparable, high income countries, but reliable incidence studies are lacking. This study calculated the incidence of age-specific dementia from 2000 to 2019. METHODS Participants from The Tromsø Study (n = 44,214) were included. Participants with a dementia diagnosis (n = 2049 cases) were identified. Poisson regression was used to calculate age-specific yearly and 5-year incidence rates from 2000 to 2019. RESULTS The incidence of dementia has decreased from 2000 to 2019. The trend was highly significant for ages of 60-99 years, and was similar for both sexes. DISCUSSION The incidence of dementia in North Norway has decreased over the past two decades similar to that in Western countries, indicating that the total prevalence is increasing due to an aging population. This decrease of incidence could introduce a reduction in future estimation of dementia prevalence.
Collapse
Affiliation(s)
- Bente Johnsen
- Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Department of Geriatric MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Ieva Martinaityte
- Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Department of Geriatric MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Tom Wilsgaard
- Department of Community MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Henrik Schirmer
- Department of CardiologyAkershus University HospitalLørenskogNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| |
Collapse
|
2
|
Albrektsen G, Wilsgaard T, Heuch I, Løchen ML, Thelle DS, Njølstad I, Grimsgaard S, Bønaa KH. Lipid Levels During Adult Lifetime in Men and Women With and Without a Subsequent Incident Myocardial Infarction: A Longitudinal Analysis of Data From the Tromsø Study 1974 to 2016. J Am Heart Assoc 2023:e030010. [PMID: 37449584 PMCID: PMC10382082 DOI: 10.1161/jaha.122.030010] [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: 03/09/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023]
Abstract
Background The atherosclerotic effect of an adverse lipid profile is assumed to accumulate throughout life, leading to increased risk of myocardial infarction (MI). Still, little is known about age at onset and duration of unfavorable lipid levels before MI. Methods and Results Longitudinal data on serum lipid levels for 26 130 individuals (50.5% women, aged 20-89 years) were obtained from 7 population-based health surveys in Tromsø, Norway. Diagnoses of MI were obtained from national registers. A linear mixed model was applied to compare age- and sex-specific mean values of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglyceride concentration by MI status (MI versus non-MI). Already from young adulthood, 20 to 35 years before the incident MI, individuals with a subsequent incident MI had on average more adverse lipid levels than individuals of the same age and sex without MI. Analogous to a dose-response relationship, there was a clear trend toward more severe adverse lipid levels the lower the age at incident MI (P<0.001, test for trend through ordered categories <55, 55-74, ≥75 years). This trend was particularly pronounced for high-density lipoprotein cholesterol in percentage of total cholesterol (both sexes) and for the relative relationship between triglyceride, high-density lipoprotein cholesterol, and total cholesterol level (women). The difference in mean lipid level by MI status was just as large in women as in men, but the age pattern differed (P≤0.05, tests of 3-way interaction). Conclusions Compared with general population mean levels, adverse lipid levels were seen 20 to 35 years before the incident MI in both men and women.
Collapse
Affiliation(s)
- Grethe Albrektsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Ivar Heuch
- Department of Mathematics University of Bergen Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Dag Steinar Thelle
- Department of Biostatistics Institute of Basic Medical Sciences, University of Oslo Oslo Norway
| | - Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Kaare Harald Bønaa
- Department of Circulation and Medical Images, Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
- Clinic for Heart Disease St. Olav University Hospital Trondheim Norway
| |
Collapse
|
3
|
Ala-Korpela M, Lehtimäki T, Kähönen M, Viikari J, Perola M, Salomaa V, Kettunen J, Raitakari OT, Mäkinen VP. Cross-sectionally Calculated Metabolic Aging Does Not Relate to Longitudinal Metabolic Changes-Support for Stratified Aging Models. J Clin Endocrinol Metab 2023; 108:2099-2104. [PMID: 36658689 PMCID: PMC10348460 DOI: 10.1210/clinem/dgad032] [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: 08/12/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
CONTEXT Aging varies between individuals, with profound consequences for chronic diseases and longevity. One hypothesis to explain the diversity is a genetically regulated molecular clock that runs differently between individuals. Large human studies with long enough follow-up to test the hypothesis are rare due to practical challenges, but statistical models of aging are built as proxies for the molecular clock by comparing young and old individuals cross-sectionally. These models remain untested against longitudinal data. OBJECTIVE We applied novel methodology to test if cross-sectional modeling can distinguish slow vs accelerated aging in a human population. METHODS We trained a machine learning model to predict age from 153 clinical and cardiometabolic traits. The model was tested against longitudinal data from another cohort. The training data came from cross-sectional surveys of the Finnish population (n = 9708; ages 25-74 years). The validation data included 3 time points across 10 years in the Young Finns Study (YFS; n = 1009; ages 24-49 years). Predicted metabolic age in 2007 was compared against observed aging rate from the 2001 visit to the 2011 visit in the YFS dataset and correlation between predicted vs observed metabolic aging was determined. RESULTS The cross-sectional proxy failed to predict longitudinal observations (R2 = 0.018%, P = 0.67). CONCLUSION The finding is unexpected under the clock hypothesis that would produce a positive correlation between predicted and observed aging. Our results are better explained by a stratified model where aging rates per se are similar in adulthood but differences in starting points explain diverging metabolic fates.
Collapse
Affiliation(s)
- Mika Ala-Korpela
- Systems Epidemiology, Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland
- Biocenter Oulu, University of Oulu, Oulu 90014, Finland
- Faculty of Health Sciences, NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio 90014, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Fimlab Laboratories, and Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere 33100, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Faculty of Medicine and Health Technology, Tampere University Hospital, and Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere 33100, Finland
| | - Jorma Viikari
- Department of Medicine, University of Turku, Turku 20520, Finland
- Division of Medicine, Turku University Hospital, Turku 20520, Finland
| | - Markus Perola
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki 00271, Finland
- Estonian Genome Center, University of Tartu, Tartu 51010, Estonia
| | - Veikko Salomaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki 00271, Finland
| | - Johannes Kettunen
- Systems Epidemiology, Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland
- Biocenter Oulu, University of Oulu, Oulu 90014, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki 00271, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku 20520, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku 20520, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku 20520, Finland
| | - Ville-Petteri Mäkinen
- Systems Epidemiology, Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu 90014, Finland
- Computational and Systems Biology Program, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA 5000, Australia
| |
Collapse
|
4
|
Mäkinen VP, Kettunen J, Lehtimäki T, Kähönen M, Viikari J, Perola M, Salomaa V, Järvelin MR, Raitakari OT, Ala-Korpela M. Longitudinal metabolomics of increasing body-mass index and waist-hip ratio reveals two dynamic patterns of obesity pandemic. Int J Obes (Lond) 2023; 47:453-462. [PMID: 36823293 DOI: 10.1038/s41366-023-01281-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND/OBJECTIVE This observational study dissects the complex temporal associations between body-mass index (BMI), waist-hip ratio (WHR) and circulating metabolomics using a combination of longitudinal and cross-sectional population-based datasets and new systems epidemiology tools. SUBJECTS/METHODS Firstly, a data-driven subgrouping algorithm was employed to simplify high-dimensional metabolic profiling data into a single categorical variable: a self-organizing map (SOM) was created from 174 metabolic measures from cross-sectional surveys (FINRISK, n = 9708, ages 25-74) and a birth cohort (NFBC1966, n = 3117, age 31 at baseline, age 46 at follow-up) and an expert committee defined four subgroups of individuals based on visual inspection of the SOM. Secondly, the subgroups were compared regarding BMI and WHR trajectories in an independent longitudinal dataset: participants of the Young Finns Study (YFS, n = 1286, ages 24-39 at baseline, 10 years follow-up, three visits) were categorized into the four subgroups and subgroup-specific age-dependent trajectories of BMI, WHR and metabolic measures were modelled by linear regression. RESULTS The four subgroups were characterised at age 39 by high BMI, WHR and dyslipidemia (designated TG-rich); low BMI, WHR and favourable lipids (TG-poor); low lipids in general (Low lipid) and high low-density-lipoprotein cholesterol (High LDL-C). Trajectory modelling of the YFS dataset revealed a dynamic BMI divergence pattern: despite overlapping starting points at age 24, the subgroups diverged in BMI, fasting insulin (three-fold difference at age 49 between TG-rich and TG-poor) and insulin-associated measures such as triglyceride-cholesterol ratio. Trajectories also revealed a WHR progression pattern: despite different starting points at the age of 24 in WHR, LDL-C and cholesterol-associated measures, all subgroups exhibited similar rates of change in these measures, i.e. WHR progression was uniform regardless of the cross-sectional metabolic profile. CONCLUSIONS Age-associated weight variation in adults between 24 and 49 manifests as temporal divergence in BMI and uniform progression of WHR across metabolic health strata.
Collapse
Affiliation(s)
- Ville-Petteri Mäkinen
- Systems Epidemiology, Faculty of Medicine, University of Oulu, Oulu, Finland. .,Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland. .,Computational and Systems Biology Program, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia. .,Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia.
| | - Johannes Kettunen
- Systems Epidemiology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, Oulu, Finland.,Department of Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jorma Viikari
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markus Perola
- Department of Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.,Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Veikko Salomaa
- Department of Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marjo-Riitta Järvelin
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, OYS, Oulu, Finland.,Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.,Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Ala-Korpela
- Systems Epidemiology, Faculty of Medicine, University of Oulu, Oulu, Finland. .,Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland. .,Biocenter Oulu, Oulu, Finland. .,NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
| |
Collapse
|
5
|
Yan Z, Cai M, Han X, Chen Q, Lu H. The Interaction Between Age and Risk Factors for Diabetes and Prediabetes: A Community-Based Cross-Sectional Study. Diabetes Metab Syndr Obes 2023; 16:85-93. [PMID: 36760587 PMCID: PMC9843502 DOI: 10.2147/dmso.s390857] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/15/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the interaction between age groups and risk factors for diabetes and prediabetes in Shanghai communities and to identify the effect of age on other risk factors for diabetes and prediabetes. METHODS This study recruited 3540 participants with undiagnosed diabetes or prediabetes in 14 communities in Shanghai from February to August 2019. All participants underwent a comprehensive examination, including filling out a detailed questionnaire, physical examination, 75 g oral glucose tolerance test, and blood sample collection. In addition, logistic regression was used to analyze the interaction between age and risk factors for prediabetes and diabetes. RESULTS The statistical analysis included 2776 people. In this study, the prevalence of diabetes and prediabetes were 15.1% and 52.3%, respectively. The prevalence of diabetes and prediabetes is higher in the elderly than in the middle-aged group. Among the risk factors for diabetes, overweight was associated with higher age (P-interaction 0.028). In addition, among the risk factors for prediabetes, a high level of education was associated with higher age (P-interaction 0.039) and elevated serum cholesterol level was associated with lower age (P-interaction 0.019). CONCLUSION This study confirmed an interaction between age and other influencing factors, which may be important in explaining differences in risk factors for diabetes and prediabetes in the middle-aged and elderly populations. Community health facilities can provide health guidance to people of different age groups to prevent and control prediabetes and diabetes.
Collapse
Affiliation(s)
- Zihui Yan
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China
| | - Mengjie Cai
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China
| | - Xu Han
- Diabetes Research Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China
| | - Qingguang Chen
- Diabetes Research Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China
- Correspondence: Qingguang Chen; Hao Lu, Email ;
| | - Hao Lu
- Department of Endocrinology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China
- Diabetes Research Institute, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People’s Republic of China
| |
Collapse
|
6
|
Mäkinen VP, Karsikas M, Kettunen J, Lehtimäki T, Kähönen M, Viikari J, Perola M, Salomaa V, Järvelin MR, Raitakari OT, Ala-Korpela M. Longitudinal profiling of metabolic ageing trends in two population cohorts of young adults. Int J Epidemiol 2022; 51:1970-1983. [PMID: 35441226 DOI: 10.1093/ije/dyac062] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/20/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Quantification of metabolic changes over the human life course is essential to understanding ageing processes. Yet longitudinal metabolomics data are rare and long gaps between visits can introduce biases that mask true trends. We introduce new ways to process quantitative time-series population data and elucidate metabolic ageing trends in two large cohorts. METHODS Eligible participants included 1672 individuals from the Cardiovascular Risk in Young Finns Study and 3117 from the Northern Finland Birth Cohort 1966. Up to three time points (ages 24-49 years) were analysed by nuclear magnetic resonance metabolomics and clinical biochemistry (236 measures). Temporal trends were quantified as median change per decade. Sample quality was verified by consistency of shared biomarkers between metabolomics and clinical assays. Batch effects between visits were mitigated by a new algorithm introduced in this report. The results below satisfy multiple testing threshold of P < 0.0006. RESULTS Women gained more weight than men (+6.5% vs +5.0%) but showed milder metabolic changes overall. Temporal sex differences were observed for C-reactive protein (women +5.1%, men +21.1%), glycine (women +5.2%, men +1.9%) and phenylalanine (women +0.6%, men +3.5%). In 566 individuals with ≥+3% weight gain vs 561 with weight change ≤-3%, divergent patterns were observed for insulin (+24% vs -10%), very-low-density-lipoprotein triglycerides (+32% vs -6%), high-density-lipoprotein2 cholesterol (-6.5% vs +4.7%), isoleucine (+5.7% vs -6.0%) and C-reactive protein (+25% vs -22%). CONCLUSION We report absolute and proportional trends for 236 metabolic measures as new reference material for overall age-associated and specific weight-driven changes in real-world populations.
Collapse
Affiliation(s)
- Ville-Petteri Mäkinen
- Computational and Systems Biology Program, Precision Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia.,Australian Centre for Precision Health, University of South Australia, Adelaide, Australia.,Computational Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mari Karsikas
- Computational Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, Oulu, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Johannes Kettunen
- Computational Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, Oulu, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, and Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jorma Viikari
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markus Perola
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.,Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Veikko Salomaa
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, OYS, Oulu, Finland.,Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.,Department of Life Sciences, College of Health and Life Sciences, Brunel University London, UK
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital
| | - Mika Ala-Korpela
- Computational Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, Oulu, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
7
|
Hagen AN, Ariansen I, Hanssen TA, Lappegård KT, Eggen AE, Løchen ML, Njølstad I, Wilsgaard T, Hopstock LA. Achievements of primary prevention targets in individuals with high risk of cardiovascular disease: an 8-year follow-up of the Tromsø study. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac061. [PMID: 36284643 PMCID: PMC9583183 DOI: 10.1093/ehjopen/oeac061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Aims To study change over 8 years in cardiovascular risk, achievement of national guideline-based treatment targets of lipids, blood pressure (BP) and smoking in primary prevention of cardiovascular disease (CVD), medication use, and characteristics associated with target achievement among individuals with high CVD risk in a general population. Methods and results We followed 2524 women and men aged 40-79 years with high risk of CVD attending the population-based Tromsø study in 2007-08 (Tromsø6) to their participation in the next survey in 2015-16 (Tromsø7). We used descriptive statistics and regression models to study change in CVD risk and medication use, and characteristics associated with treatment target achievement. In total, 71.4% reported use of BP- and/or lipid-lowering medication at second screening. Overall, CVD risk decreased during follow-up, with a larger decrease among medication users compared with non-users. Treatment target achievement was 31.0% for total cholesterol <5 mmol/L, 27.3% for LDL cholesterol <3 mmol/L, 43.4% for BP <140/90 (<135/85 if diabetes) mmHg, and 85.4% for non-smoking. A total of 9.8% reached all treatment targets combined. Baseline risk factor levels and current medication use had the strongest associations with treatment target achievement. Conclusion We found an overall improvement in CVD risk factors among high-risk individuals over 8 years. However, guideline-based treatment target achievement was relatively low for all risk factors except smoking. Medication use was the strongest characteristic associated with achieving treatment targets. This study has demonstrated that primary prevention of CVD continues to remain a major challenge.
Collapse
Affiliation(s)
- Amalie Nilsen Hagen
- Department of Medicine, Nordland Hospital, Parkveien 96, Nordland, 8005 Bodø, Norway
| | - Inger Ariansen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Folkehelseinstituttet, Postboks 222 Skøyen, 0213 Oslo, Norway
| | - Tove Aminda Hanssen
- Department of Cardiology, University Hospital of North Norway, Universitetssykehuset Nord-Norge HF Postboks 100, 9038 Tromsø, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Knut Tore Lappegård
- Department of Medicine, Nordland Hospital, Parkveien 96, Nordland, 8005 Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Cardiology, University Hospital of North Norway, Universitetssykehuset Nord-Norge HF Postboks 100, 9038 Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Laila Arnesdatter Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| |
Collapse
|
8
|
Jodal HC, Juul FE, Barua I, Bretthauer M, Kalager M, Løberg M, Emilsson L. Emergency hospital admissions, prognosis, and population mortality in Norway during the first wave of the Covid-19 epidemic. Scand J Public Health 2022; 50:795-802. [PMID: 35546560 PMCID: PMC9361465 DOI: 10.1177/14034948221082959] [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] [Indexed: 12/02/2022]
Abstract
Background: During the first wave of the Covid-19 epidemic, a national lockdown was
established in Norway, and inhabitants were asked to contact healthcare only
if absolutely necessary. We investigated hospital admissions and mortality
due to non-Covid-19 disease during the lockdown compared to previous
years. Methods: We compared the number of emergency admissions and in-hospital fatality for
diagnoses probably unaffected (acute myocardial infarction, acute abdominal
conditions, cerebrovascular diseases) and affected by the lockdown
(infections, injuries) in the South-Eastern Health Region of Norway during
weeks 12–22, 2020, compared to the mean of the same period in the years
2017–2019. We also compared population mortality March–May 2020, to the mean
of the same period in years 2017–2019. Results: A total of 280,043 emergency admissions were observed; 20,911 admissions
probably unaffected, and 30,905 admissions probably affected by the
lockdown. Admissions due to diagnoses probably unaffected was reduced by 12%
(95% confidence interval (CI) 9–15%), compared to 2017–2019. Admissions for
diagnoses probably affected was reduced by 30% (95% CI 28–32%). There was a
34% reduction in in-hospital fatality due to acute myocardial infarction
(95% CI 4–56%), 19% due to infections (95% CI 1–33%), and no change for the
other diagnoses, compared to 2017–2019. The risk of in-hospital mortality to
total mortality was lower for acute myocardial infarction (relative risk
0.85, 95% CI 0.73–0.99) and injuries (relative risk 0.83, 95% CI
0.70–0.98). Conclusions: Even though fewer patients were admitted to hospital, there was no
increase in in-hospital fatality or population mortality, indicating
that those who were most in need still received adequate care.
Collapse
Affiliation(s)
- Henriette C Jodal
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Norway
| | - Frederik E Juul
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Norway
| | - Ishita Barua
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Norway
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Norway
| | - Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Norway
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Norway
| | - Louise Emilsson
- Department of General Practice, University of Oslo, Norway.,Vårdcentralen Värmlands Nysäter & Center for Clinical Research, Region Värmland, Sweden.,School of Medical Science, University of Örebro, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| |
Collapse
|
9
|
Hopstock LA, Grimsgaard S, Johansen H, Kanstad K, Wilsgaard T, Eggen AE. The seventh survey of the Tromsø Study (Tromsø7) 2015-2016: study design, data collection, attendance, and prevalence of risk factors and disease in a multipurpose population-based health survey. Scand J Public Health 2022; 50:919-929. [PMID: 35509230 PMCID: PMC9578102 DOI: 10.1177/14034948221092294] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Aims: The Tromsø Study is an ongoing population-based health study in Tromsø, Norway, initiated in 1974. The purpose of the seventh survey (Tromsø7) 2015–2016 was to advance the population risk factor surveillance and to collect new types of data. We present the study design, data collection, attendance, and prevalence of risk factors and disease. Methods: All inhabitants in Tromsø municipality, Norway, aged 40 years and older (N=32,591) were invited to a health screening including extensive questionnaires, face-to-face interviews, biological sampling (blood, urine, saliva, nasal/throat swabs, faeces), measurements (anthropometry, blood pressure, pulse, pulse oximetry) and clinical examinations (pain sensitivity, echocardiography, cognitive, physical, and lung function, accelerometer measurements, eye examinations, carotid ultrasound, electrocardiography, dual-energy X-ray absorptiometry, and heart, lung and carotid auscultation). New research areas in this round were dental and oral health examinations, collection of faecal samples for studies of normal bacterial flora and antibiotic resistance, and 24-hour urine samples for examination of sodium and iodine intakes. Results: Attendance was 65% (N=21,083), and was higher in women, age group 50–79 years, previous attenders, and Norwegian-born individuals. Cardiovascular risk factor levels and prevalence of chronic obstructive lung disease decreased since the last survey, while the prevalence of obesity and diabetes increased. Conclusions: Attendance was stable from the sixth survey. Interaction with participants might be key to maintain participation. Favourable trends in risk factors continue, except for a continued increase in obesity. Both new data collection technology and traditional physical examinations will be crucial for the impact of future population studies.
Collapse
Affiliation(s)
- Laila A Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Heidi Johansen
- Northern Norway Regional Health Authority, Tromsø, Norway
| | - Kristin Kanstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
10
|
Arnesen EK, Retterstøl K. Secular trends in serum lipid profiles in young adults in Norway, 2001-19. ATHEROSCLEROSIS PLUS 2022; 48:60-67. [PMID: 36644560 PMCID: PMC9833235 DOI: 10.1016/j.athplu.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/09/2022] [Accepted: 03/21/2022] [Indexed: 01/18/2023]
Abstract
Background Lower prevalence of major cardiovascular disease (CVD) risk factors, such as dyslipidemia, hypertension and smoking, can explain a substantial part of the decline in CVD mortality and incidence for the past decades in Western countries. However, some studies have indicated less favorable trends in risk factors in recent years. We have assessed time trends in lipid profiles among young adults in Norway measured between 2001 and 2019. Methods Samples of serum lipids analyzed at one large medical laboratory in Oslo, Norway, mainly requisitioned by primary care physicians, were analyzed cross-sectionally to estimate year-to-year trends among men and women aged 18-49 years. We also assessed the lipid distributions and proportions with adverse lipid levels. Results In total, more than 2,6 million blood samples, comprising more than 1 million individuals (mean age 37.7 years) from all regions of Norway were included. All measures improved among all age groups in both women and men, especially in total and non-HDL cholesterol (-0.22 and -0.25 mmol/l per decade, respectively). There were downward shifts in the population distribution of total, non-HDL-C and LDL-C. The overall prevalences of total cholesterol ≥5.0 mmol/l and non-HDL-C ≥3.9 mmol/l similarly decreased, from ∼63 to 46% and from ∼52 to 34%, respectively. More than 1/3 had elevated levels of total and/or non-HDL-C in 2019. Conclusion In a large proportion of the Norwegian population aged 18-49 years old, the lipid profiles improved during the last two decades. As the use of lipid-lowering medications is low in this age group, this likely reflects favorable secular trends.
Collapse
Affiliation(s)
- Erik Kristoffer Arnesen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O.Box 1046 Blindern, 0317, Oslo, Norway,Corresponding author.
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O.Box 1046 Blindern, 0317, Oslo, Norway,The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Aker, PO Box 4959, Nydalen, 0424, Oslo, Norway
| |
Collapse
|
11
|
Allaoui G, Rylander C, Averina M, Wilsgaard T, Fuskevåg O, Berg V. Longitudinal changes in blood biomarkers and their ability to predict type 2 diabetes mellitus—The Tromsø study. Endocrinol Diabetes Metab 2022; 5:e00325. [PMID: 35147293 PMCID: PMC8917864 DOI: 10.1002/edm2.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Methods Results Conclusion
Collapse
Affiliation(s)
- Giovanni Allaoui
- Division of Diagnostic Services Department of Laboratory Medicine University Hospital of North Norway Tromsø Norway
- Department of Medical Biology Faculty of Health Sciences UiT‐The Arctic University of Norway Tromsø Norway
| | - Charlotta Rylander
- Department of Community Medicine Faculty of Health Sciences UIT‐The Arctic University of Norway Tromsø Norway
| | - Maria Averina
- Division of Diagnostic Services Department of Laboratory Medicine University Hospital of North Norway Tromsø Norway
- Department of Community Medicine Faculty of Health Sciences UIT‐The Arctic University of Norway Tromsø Norway
| | - Tom Wilsgaard
- Department of Community Medicine Faculty of Health Sciences UIT‐The Arctic University of Norway Tromsø Norway
| | - Ole‐Martin Fuskevåg
- Division of Diagnostic Services Department of Laboratory Medicine University Hospital of North Norway Tromsø Norway
| | - Vivian Berg
- Division of Diagnostic Services Department of Laboratory Medicine University Hospital of North Norway Tromsø Norway
- Department of Medical Biology Faculty of Health Sciences UiT‐The Arctic University of Norway Tromsø Norway
| |
Collapse
|
12
|
Markovič R, Grubelnik V, Vošner HB, Kokol P, Završnik M, Janša K, Zupet M, Završnik J, Marhl M. Age-Related Changes in Lipid and Glucose Levels Associated with Drug Use and Mortality: An Observational Study. J Pers Med 2022; 12:jpm12020280. [PMID: 35207767 PMCID: PMC8876997 DOI: 10.3390/jpm12020280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The pathogenesis of type 2 diabetes mellitus is complex and still unclear in some details. The main feature of diabetes mellitus is high serum glucose, and the question arises of whether there are other statistically observable dysregulations in laboratory measurements before the state of hyperglycemia becomes severe. In the present study, we aim to examine glucose and lipid profiles in the context of age, sex, medication use, and mortality. Methods: We conducted an observational study by analyzing laboratory data from 506,083 anonymized laboratory tests from 63,606 different patients performed by a regional laboratory in Slovenia between 2008 and 2019. Laboratory data-based results were evaluated in the context of medication use and mortality. The medication use database contains anonymized records of 1,632,441 patients from 2013 to 2018, and mortality data were obtained for the entire Slovenian population. Results: We show that the highest percentage of the population with elevated glucose levels occurs approximately 20 years later than the highest percentage with lipid dysregulation. Remarkably, two distinct inflection points were observed in these laboratory results. The first inflection point occurs at ages 55 to 59 years, corresponding to the greatest increase in medication use, and the second coincides with the sharp increase in mortality at ages 75 to 79 years. Conclusions: Our results suggest that medications and mortality are important factors affecting population statistics and must be considered when studying metabolic disorders such as dyslipidemia and hyperglycemia using laboratory data.
Collapse
Affiliation(s)
- Rene Markovič
- Faculty of Natural Sciences and Mathematics, University of Maribor, 2000 Maribor, Slovenia;
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.G.); (P.K.)
| | - Vladimir Grubelnik
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.G.); (P.K.)
| | - Helena Blažun Vošner
- Community Healthcare Center Dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia;
- Faculty of Health and Social Sciences, 2380 Slovenj Gradec, Slovenia
- Alma Mater Europaea—ECM, 2000 Maribor, Slovenia
| | - Peter Kokol
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia; (V.G.); (P.K.)
| | - Matej Završnik
- Department of Endocrinology and Diabetology, University Medical Center Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia;
| | - Karmen Janša
- The Health Insurance Institute of Slovenia, Miklošičeva cesta 24, 1507 Ljubljana, Slovenia; (K.J.); (M.Z.)
| | - Marjeta Zupet
- The Health Insurance Institute of Slovenia, Miklošičeva cesta 24, 1507 Ljubljana, Slovenia; (K.J.); (M.Z.)
| | - Jernej Završnik
- Faculty of Natural Sciences and Mathematics, University of Maribor, 2000 Maribor, Slovenia;
- Community Healthcare Center Dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia;
- Alma Mater Europaea—ECM, 2000 Maribor, Slovenia
- Science and Research Center Koper, 6000 Koper, Slovenia
- Correspondence: (J.Z.); (M.M.)
| | - Marko Marhl
- Faculty of Natural Sciences and Mathematics, University of Maribor, 2000 Maribor, Slovenia;
- Faculty of Education, University of Maribor, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
- Correspondence: (J.Z.); (M.M.)
| |
Collapse
|
13
|
Lahoz C, Cárdenas-Valladolid J, Salinero-Fort MÁ, Mostaza JM. Use of statins and associated factors in nonagenarians in the Community of Madrid, Spain. Aging Clin Exp Res 2022; 34:439-444. [PMID: 34363590 PMCID: PMC8349136 DOI: 10.1007/s40520-021-01945-5] [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: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 11/08/2022]
Abstract
Background The role of statins in the management of dyslipidemia in elderly patients with different cardiovascular risks remains unclear. Objective To study use of statins and associated factors in subjects aged 90 or over in the Community of Madrid, Spain. Methods Observational, cross-sectional study that included all people aged 90 or more residing in the Community of Madrid as of December 31, 2015. The clinical information was obtained from the database that contains the electronic medical records collected by family doctors in primary care. Comorbidity data are collected according to the International Classification of Primary Care, Second Edition (ICPC-2). Results The study population comprised 59,423 subjects, with a mean age of 93.3 (2.5) years (25.8% males). Slightly more than one quarter of the population (28.2%) was in treatment with statins, 21.9% were in primary prevention, and 48.1% in secondary prevention. The multivariate analysis revealed the factors independently associated with statin treatment to be younger age, not being institutionalized, a higher Barthel score, a lower Charlson score, a higher body mass index, and a history of diabetes, dyslipidemia, chronic kidney disease, and cardiovascular disease. Conclusions A significant percentage of nonagenarians—mainly less frail patients with more comorbidities—in the Community of Madrid receive statin treatment. No clear efficacy has been demonstrated in reducing cardiovascular events in an age group with such a short life expectancy.
Collapse
|
14
|
Lundblad MW, Johansson J, Jacobsen BK, Grimsgaard S, Andersen LF, Wilsgaard T, Hopstock LA. Secular and longitudinal trends in body composition: The Tromsø Study, 2001 to 2016. Obesity (Silver Spring) 2021; 29:1939-1949. [PMID: 34523258 DOI: 10.1002/oby.23267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Overweight, defined as excessive fat mass, is a long-standing worldwide public health challenge. Traditional anthropometric measures used to identify overweight and obesity do not assess body composition. The aim of this study was to examine population trends in general and abdominal fat mass during the past two decades. METHODS This study included participants from one or more consecutive surveys of the population-based Tromsø Study, including Tromsø 5 (conducted in 2001, n = 1,662, age 40-84 years), Tromsø 6 (2007-2008, n = 901, age 40-88 years), and Tromsø 7 (2015-2016, n = 3,670, age 40-87 years), with total body dual-energy x-ray absorptiometry scans. Trends in total fat and visceral adipose tissue (VAT) were analyzed by generalized estimation equation models in strata of sex and age groups. RESULTS Total fat and VAT mass increased during 2001 to 2016, with a larger increase during 2007 to 2016 than from 2001 to 2007 and among the youngest age group (40-49 years), particularly in women. Women had higher total fat mass than men, whereas men had higher VAT mass than women. CONCLUSIONS General and abdominal dual-energy x-ray absorptiometry-derived fat mass increased during the past two decades in this general population. Of particular concern is the more pronounced increase in the past decade and in the younger age groups.
Collapse
Affiliation(s)
| | - Jonas Johansson
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Community Medicine, Centre for Sami Health Research, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | | | - Tom Wilsgaard
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Laila A Hopstock
- Department of Community Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
15
|
Janković J, Mandić-Rajčević S, Davidović M, Janković S. Demographic and socioeconomic inequalities in ideal cardiovascular health: A systematic review and meta-analysis. PLoS One 2021; 16:e0255959. [PMID: 34379696 PMCID: PMC8357101 DOI: 10.1371/journal.pone.0255959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/28/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2010, the American Heart Association introduced a new concept of ideal cardiovascular health (CVH) defined as the simultaneous presence of 7 favorable CVH metrics (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting blood glucose). The objective of this study was to conduct a systematic literature review and meta-analysis of studies examining the prevalence of ideal CVH, and each of the ideal CVH metrics as well as the relationship between socio-demographic determinants and ideal CVH. METHODS A comprehensive literature search was conducted in Medline and Scopus databases for studies published between 1 January 2010 and 30 June 2020. A total of 50 studies including 2,148,470 participants were analyzed. Associations were estimated using DerSimonian-Laird random-effect models. Heterogeneity was investigated through subgroup analyses, Q-test, and I2 statistics. RESULTS This study showed a low prevalence of ideal CVH defining as 6 and 7 ideal metrics (3.3%). Among seven ideal CVH metrics, smoking was the best metric (71%), while the poorest CVH metric was a healthy diet (5.8%). Gender was a statistically significant moderator of ideal smoking (81% in females and 60% in males) and ideal blood pressure (42% in females and 30% in males). Females and young adults had better CVH status compared to males and older adults. Also, more educated and better-off individuals had a greater number of ideal CVH metrics. CONCLUSIONS To the best of our knowledge, this is the first systematic review on the relationship between participants' socioeconomic status and ideal CVH. The results suggest that the prevalence of ideal CVH and most metrics was unsatisfactory. In order to achieve the improvement of the CVH metrics and the overall ideal CVH, nationwide prevention efforts at the population and individual levels are urgently needed.
Collapse
Affiliation(s)
- Janko Janković
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maša Davidović
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Slavenka Janković
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
16
|
Nilsen A, Hanssen TA, Lappegård KT, Eggen AE, Løchen ML, Selmer RM, Njølstad I, Wilsgaard T, Hopstock LA. Change in cardiovascular risk assessment tool and updated Norwegian guidelines for cardiovascular disease in primary prevention increase the population proportion at risk: the Tromsø Study 2015-2016. Open Heart 2021; 8:e001777. [PMID: 34462328 PMCID: PMC8407203 DOI: 10.1136/openhrt-2021-001777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
AIMS To compare the population proportion at high risk of cardiovascular disease (CVD) using the Norwegian NORRISK 1 that predicts 10-year risk of CVD mortality and the Norwegian national guidelines from 2009, with the updated NORRISK 2 that predicts 10-year risk of both fatal and non-fatal risk of CVD and the Norwegian national guidelines from 2017. METHODS We included participants from the Norwegian population-based Tromsø Study (2015-2016) aged 40-69 years without a history of CVD (n=16 566). The total proportion eligible for intervention was identified by NORRISK 1 and the 2009 guidelines (serum total cholesterol ≥8 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg) and NORRISK 2 and the 2017 guidelines (serum total cholesterol ≥7 mmol/L, low density lipoprotein (LDL) cholesterol ≥5 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg). RESULTS The total proportion at high risk as defined by a risk score was 12.0% using NORRISK 1 and 9.8% using NORRISK 2. When including single risk factors specified by the guidelines, the total proportion eligible for intervention was 15.5% using NORRISK 1 and the 2009 guidelines and 18.9% using NORRISK 2 and the 2017 guidelines. The lowered threshold for total cholesterol and specified cut-off for LDL cholesterol stand for a large proportion of the increase in population at risk. CONCLUSION The population proportion eligible for intervention increased by 3.4 percentage points from 2009 to 2017 using the revised NORRISK 2 score and guidelines.
Collapse
Affiliation(s)
- Amalie Nilsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Medicine, Nordlands Hospital, Bodo, Norway
| | - Tove Aminda Hanssen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Knut Tore Lappegård
- Department of Medicine, Nordlands Hospital, Bodo, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Randi Marie Selmer
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Laila A Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
17
|
Langholz PL, Wilsgaard T, Njølstad I, Jorde R, Hopstock LA. Trends in known and undiagnosed diabetes, HbA1c levels, cardiometabolic risk factors and diabetes treatment target achievement in repeated cross-sectional surveys: the population-based Tromsø Study 1994-2016. BMJ Open 2021; 11:e041846. [PMID: 33757943 PMCID: PMC7993331 DOI: 10.1136/bmjopen-2020-041846] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate time trends in known and undiagnosed diabetes, glycated haemoglobin (HbA1c) levels and other cardiometabolic risk factors in the general population as well as treatment target achievement among those with diabetes. DESIGN AND SETTING Repeated cross-sectional surveys in the population-based Tromsø Study. METHODS We used age-adjusted generalised estimating equation models to study trends in self-reported and undiagnosed (HbA1c ≥6.5%) diabetes, cardiometabolic risk factors and the metabolic syndrome in 27 281 women and men aged 40-84 years examined in up to four surveys of the Tromsø Study between 1994 and 2016. Further, we analysed trends in diabetes treatment target achievement. RESULTS During 1994-2016, diabetes prevalence increased in women (2.3% to 4.6%) and men (2.4% to 5.8%) and in all age groups, while the proportion of undiagnosed diabetes in women (32% to 17%) and men (37% to 24%) decreased. Blood pressure and total cholesterol decreased, while waist circumference increased in participants with and without diabetes, leading to a relatively stable prevalence of the metabolic syndrome throughout the study period. There was a marginal increase in HbA1c levels among participants without diabetes. Only half of those with diabetes achieved the treatment target of HbA1c ≤7.0%. CONCLUSION In the last two decades, diabetes prevalence increased, while the proportion of undiagnosed diabetes declined. The prevalence of the metabolic syndrome remained stable throughout, driven by opposing trends with an increase in obesity and a decrease in other cardiometabolic risk factors. HbA1c treatment target achievement did not improve.
Collapse
Affiliation(s)
- Petja Lyn Langholz
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rolf Jorde
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | | |
Collapse
|
18
|
Pedersen E, Garcia BH, Halvorsen KH, Eggen AE, Schirmer H, Waaseth M. Adherence to prescription guidelines and achievement of treatment goals among persons with coronary heart disease in Tromsø 7. BMC Cardiovasc Disord 2021; 21:44. [PMID: 33478404 PMCID: PMC7819182 DOI: 10.1186/s12872-021-01866-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adherence to clinical practice guidelines for coronary heart disease (CHD) reduces morbidity, mortality and treatment costs. We aimed to describe and compare adherence to prescription guidelines for persons with CHD, and explore its association with treatment goal achievement. METHOD We included all participants reporting myocardial infarction, angina, percutaneous coronary intervention and/or coronary artery bypass surgery in the seventh wave of the Tromsø Study (2015-2016, n = 1483). Medication use and treatment goal measures (blood pressure, low-density lipoprotein (LDL)-cholesterol and HbA1c) were compared to clinical practice guidelines on secondary CHD prevention. Propensity score matched logistic regression was used to assess the association between the use of antihypertensive drugs and achievement of treatment goal for blood pressure, and the use of lipid-lowering drugs (LLDs) and achievement of treatment goal for LDL-cholesterol. RESULTS The prevalence of pharmacological CHD treatment was 76% for LLDs, 72% for antihypertensive drugs and 66% for acetylsalicylic acid. The blood pressure goal (< 140/90 mmHg, < 140/80 mmHg if diabetic) was achieved by 58% and the LDL-cholesterol goal (< 1.8 mmol/l or < 70 mg/dL) by 9%. There was a strong association between using LLDs and achieving the treatment goal for LDL-cholesterol (OR 14.0, 95% CI 3.6-54.7), but not between using antihypertensive drugs and blood pressure goal achievement (OR 1.4, 95% CI 0.7-2.7). CONCLUSION Treatment goal achievement of LDL-cholesterol and blood pressure was low, despite the relatively high use of LLDs and antihypertensive drugs. Further research is needed to find the proper actions to increase achievement of the treatment goals.
Collapse
Affiliation(s)
- Elisabeth Pedersen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway.
| | | | - Kjell H Halvorsen
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine Campus Ahus, University of Oslo, Oslo, Norway
| | - Marit Waaseth
- Department of Pharmacy, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
19
|
Hughes D, Crowley J, O'Shea P, McEvoy JW, Griffin DG. Lipid reference values in an Irish population. Ir J Med Sci 2020; 190:117-127. [PMID: 32681272 DOI: 10.1007/s11845-020-02309-0] [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: 12/05/2019] [Accepted: 07/08/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS There is limited information on reference values for lipids and lipoproteins in an Irish population. In this observational study, we have described the distributions of lipids in a large Irish cohort. METHODS Over 110,000 lipid profiles were selected from a database of almost 1.5 million consecutive lipid profiles performed in the Clinical Biochemistry Laboratory in University Hospital Galway between 2004 and 2017 to best represent the Irish population. Age- and sex-related reference intervals for both sexes for total cholesterol, triglycerides, HDL cholesterol and LDL cholesterol, from the age of ten to greater than 90 years, were determined. Two methods for estimating LDL cholesterol were also compared. RESULTS Sex-related differences in lipid distributions arise before the age of 20 years and are life-long. In both sexes total and LDL cholesterol levels gradually increased towards middle age with a decrease towards old age. Levels tended to be higher in males than in females up to mid-life at which stage they cross over with females having on average higher levels. The median of the triglyceride distributions show similar age- and sex-related changes to total cholesterol, but the distributions show a very marked positive skew that is particularly obvious in middle aged males. HDL cholesterol distributions change little throughout life with males having lower levels than females. Changing from the Friedewald formula to that proposed by Martin would impact the management of some patients with dyslipidaemia. CONCLUSIONS This study provides lipid reference values for clinical biochemistry laboratories and clinicians working in Ireland. It is informative for public health initiatives wishing to target dyslipidaemia as a modifiable risk for cardiovascular disease and for investigators researching geographical and temporal variances in lipid parameters.
Collapse
Affiliation(s)
- Diarmaid Hughes
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - James Crowley
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Paula O'Shea
- Department of Clinical Biochemistry, University Hospital Galway, Newcastle Road, Galway, Ireland
| | | | - Damian Gerard Griffin
- Department of Clinical Biochemistry, University Hospital Galway, Newcastle Road, Galway, Ireland.
| |
Collapse
|
20
|
Wilsgaard T, Vangen-Lønne AM, Mathiesen E, Løchen ML, Njølstad I, Heiss G, Danaei G. Hypothetical interventions and risk of myocardial infarction in a general population: application of the parametric g-formula in a longitudinal cohort study-the Tromsø Study. BMJ Open 2020; 10:e035584. [PMID: 32448794 PMCID: PMC7252981 DOI: 10.1136/bmjopen-2019-035584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to use the parametric g-formula to estimate the 19-year risk of myocardial infarction (MI) under hypothetical interventions on six cardiovascular risk factors. DESIGN AND SETTING A populations-based cohort study with repeated measurements, the Tromsø Study. PRIMARY OUTCOME MEASURE Myocardial infarction. PARTICIPANTS We estimated the relative and absolute risk reduction under feasible and intensive risk reduction strategies for smoking, physical activity, alcohol drinking, body mass index, total serum cholesterol and systolic blood pressure in 14 965 men and women with 19 years of follow-up (1994-2013). RESULTS The estimated 19-year risk of MI under no intervention was 7.5% in individuals with baseline mean age 49.3 years (range 25-69). This risk was reduced by 30% (95% CI 19% to 39%) under joint feasible interventions on all risk factors, and 70% (60%, 78%) under a set of more intensive interventions. The most effective interventions were lowering of total cholesterol to 5.18 mmol/L and lowering of systolic blood pressure to 120 mm Hg (33% and 37% lower MI risk, respectively). The absolute risk reductions were significantly larger in men, in older participants, in smokers and in those with low education. CONCLUSION Modification of population levels of cardiovascular risk factors could have prevented close to one-third of the cases of MI in the municipality of Tromsø during 19 years of follow-up.
Collapse
Affiliation(s)
- Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Ellisiv Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
21
|
Kuo PL, Schrack JA, Shardell MD, Levine M, Moore AZ, An Y, Elango P, Karikkineth A, Tanaka T, de Cabo R, Zukley LM, AlGhatrif M, Chia CW, Simonsick EM, Egan JM, Resnick SM, Ferrucci L. A roadmap to build a phenotypic metric of ageing: insights from the Baltimore Longitudinal Study of Aging. J Intern Med 2020; 287:373-394. [PMID: 32107805 PMCID: PMC7670826 DOI: 10.1111/joim.13024] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over the past three decades, considerable effort has been dedicated to quantifying the pace of ageing yet identifying the most essential metrics of ageing remains challenging due to lack of comprehensive measurements and heterogeneity of the ageing processes. Most of the previously proposed metrics of ageing have been emerged from cross-sectional associations with chronological age and predictive accuracy of mortality, thus lacking a conceptual model of functional or phenotypic domains. Further, such models may be biased by selective attrition and are unable to address underlying biological constructs contributing to functional markers of age-related decline. Using longitudinal data from the Baltimore Longitudinal Study of Aging (BLSA), we propose a conceptual framework to identify metrics of ageing that may capture the hierarchical and temporal relationships between functional ageing, phenotypic ageing and biological ageing based on four hypothesized domains: body composition, energy regulation, homeostatic mechanisms and neurodegeneration/neuroplasticity. We explored the longitudinal trajectories of key variables within these phenotypes using linear mixed-effects models and more than 10 years of data. Understanding the longitudinal trajectories across these domains in the BLSA provides a reference for researchers, informs future refinement of the phenotypic ageing framework and establishes a solid foundation for future models of biological ageing.
Collapse
Affiliation(s)
- P-L Kuo
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J A Schrack
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M D Shardell
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - M Levine
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - A Z Moore
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Y An
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - P Elango
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - A Karikkineth
- Clinical Research Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - T Tanaka
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - R de Cabo
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - L M Zukley
- Clinical Research Unit, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - M AlGhatrif
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.,Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - C W Chia
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - E M Simonsick
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - J M Egan
- Laboratory of Clinical Investigation, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - S M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - L Ferrucci
- From the, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| |
Collapse
|
22
|
Gasco V, Roncoroni L, Zavattaro M, Bona C, Berton A, Ghigo E, Maccario M, Grottoli S. Untreated adult GH deficiency is not associated with the development of metabolic risk factors: a long-term observational study. J Endocrinol Invest 2020; 43:197-207. [PMID: 31440920 DOI: 10.1007/s40618-019-01100-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 08/13/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Uncertainties exist about the predictors of the severity of the clinical picture of GH deficiency (GHD) syndrome. Aim of the study was to evaluate, in adult patients with GHD, the predictors of the development of hypercholesterolemia, hypertension, diabetes mellitus, and osteoporosis. METHODS We retrospectively studied 327 adult patients (age 47.1 ± 17.1 years) with untreated severe GHD (mean follow-up 110.9 ± 56.8 months). GHD was defined by GHRH + arginine test using BMI cut-offs. The possible development of hypercholesterolemia, hypertension, diabetes mellitus, and osteoporosis was investigated by Kaplan-Meier survival analysis. For each clinical outcome, either a univariate or multivariate analysis according to the Cox proportional-hazards model was performed to identify those factors that were associated with the development of the event. RESULTS GH secretion parameters were not associated with the outcomes. Hypercholesterolemia was positively and negatively predicted by a BMI ≥ 30 kg/m2 (HR 2.50, p 0.00) and the dose of l-thyroxine possibly in place (HR 0.98, p 0.02), respectively. Hypertension was positively predicted by a BMI ≥ 30 kg/m2 (HR 2.64, p 0.00) and IGF-I SDS values (HR 2.26, p 0.00). Diabetes mellitus was positively predicted by hypertension (HR 11.76, p 0.01). Osteoporosis was positively and negatively predicted by hypercholesterolemia (HR 3.25, p 0.01) and hypertension (HR 0.21, p 0.00), respectively. CONCLUSIONS The severity of the impairment of GH secretion does not predict the development of the clinical picture of GHD syndrome: untreated adult GHD does not increase the development of metabolic risk factors in hypopituitaric patients.
Collapse
Affiliation(s)
- V Gasco
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy.
| | - L Roncoroni
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - M Zavattaro
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - C Bona
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - A Berton
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - E Ghigo
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - M Maccario
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| | - S Grottoli
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Turin, Turin, Italy
| |
Collapse
|
23
|
Libby P, Buring JE, Badimon L, Hansson GK, Deanfield J, Bittencourt MS, Tokgözoğlu L, Lewis EF. Atherosclerosis. Nat Rev Dis Primers 2019; 5:56. [PMID: 31420554 DOI: 10.1038/s41572-019-0106-z] [Citation(s) in RCA: 1487] [Impact Index Per Article: 297.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2019] [Indexed: 12/12/2022]
Abstract
Atherosclerosis, the formation of fibrofatty lesions in the artery wall, causes much morbidity and mortality worldwide, including most myocardial infarctions and many strokes, as well as disabling peripheral artery disease. Development of atherosclerotic lesions probably requires low-density lipoprotein, a particle that carries cholesterol through the blood. Other risk factors for atherosclerosis and its thrombotic complications include hypertension, cigarette smoking and diabetes mellitus. Increasing evidence also points to a role of the immune system, as emerging risk factors include inflammation and clonal haematopoiesis. Studies of the cell and molecular biology of atherogenesis have provided considerable insight into the mechanisms that link all these risk factors to atheroma development and the clinical manifestations of this disease. An array of diagnostic techniques, both invasive (such as selective coronary arteriography) and noninvasive (such as blood biomarkers, stress testing, CT and nuclear scanning), permit assessment of cardiovascular disease risk and targeting of therapies. An expanding armamentarium of therapies that can modify risk factors and confer clinical benefit is available; however, we face considerable challenge in providing equitable access to these treatments and in maximizing adherence. Yet, the clinical application of the fruits of research has advanced preventive strategies, enhanced clinical outcomes in affected individuals, and improved their quality of life. Rapidly accelerating knowledge and continued research promise to provide further progress in combating this common chronic disease.
Collapse
Affiliation(s)
- Peter Libby
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Lina Badimon
- Centre d'Investigació Cardiovascular CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Göran K Hansson
- Center for Molecular Medicine, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - John Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Márcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, São Paulo, Brazil.,Faculdade Israelita de Ciencias da Saude Albert Einstein, São Paulo, Brazil.,DASA, São Paulo, Brazil
| | | | - Eldrin F Lewis
- Department of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
24
|
Svendsen K, Jacobs DR, Røyseth IT, Garstad KW, Byfuglien MG, Granlund L, Mørch-Reiersen LT, Telle-Hansen VH, Retterstøl K. Community pharmacies offer a potential high-yield and convenient arena for total cholesterol and CVD risk screening. Eur J Public Health 2019; 29:17-23. [PMID: 30239673 DOI: 10.1093/eurpub/cky190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Moderately elevated blood total cholesterol (TC), blood glucose (BG) and blood pressure (BP) are rarely symptomatic and as such many individuals remain untreated. We studied the yield of an in-pharmacy screening for identifying undetected high TC and strategies to reach those with absence of prior measurement of TC, BG and BP. Methods A cross-sectional TC screening study with complementary TC measurements and self-administered questionnaire was conducted for 1 week in each of 2012 and 2014 in 148 and 149 BootsTM Norge AS community pharmacies nationwide in Norway. Results Non-medicated adults (n = 21 090) with mean age 54.5 ± 16.0 were included. The study population resembled the Norwegian population in regards to body mass index, educational level, smokers and physical inactivity level, but with an overrepresentation of middle-aged women. Of 20 743 with available data, 11% (n = 2337) were unaware of their high TC ≥7.0 mmol/L, and an additional 8% were unaware of TC ≥6.2 mmol/L. More than 40% of the study sample had not measured TC or BG before. In order for future screenings to reach those who are less likely to have previously measured TC and BG, our results suggest that young, low-educated, overweight men and women should be targeted for TC measurement, whereas normal weigh men in all ages should be targeted for BG measurement. Conclusions In total 19% in an in-pharmacy screening were unaware of their elevated TC of ≥6.2 mmol/L. We also identified characteristics that could be used reach those who are less likely to have measured TC and BG.
Collapse
Affiliation(s)
- Karianne Svendsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, Oslo, Norway
| | - David R Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ida Tonning Røyseth
- Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, Oslo, Norway
| | | | | | | | | | - Vibeke H Telle-Hansen
- Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, Oslo, Norway.,The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Nydalen, Oslo, Norway
| |
Collapse
|
25
|
Siri SRA, Eliassen BM, Jacobsen BK, Melhus M, Broderstad AR, Michalsen VL, Braaten T. Changes in conventional cardiovascular risk factors and the estimated 10-year risk of acute myocardial infarction or cerebral stroke in Sami and non-Sami populations in two population-based cross-sectional surveys: the SAMINOR Study. BMJ Open 2019; 9:e028939. [PMID: 31326934 PMCID: PMC6661668 DOI: 10.1136/bmjopen-2019-028939] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe changes in cardiovascular risk factors and in the estimated 10-year risk of acute myocardial infarction (AMI) or cerebral stroke (CS) between SAMINOR 1 (2003-2004) and SAMINOR 2 (2012-2014), and explore if these changes differed between Sami and non-Sami. DESIGN Two cross-sectional surveys. SETTING Inhabitants of rural Northern Norway. PARTICIPANTS Participants were aged 40-79 years and participated in SAMINOR 1 (n=6417) and/or SAMINOR 2 (n=5956). PRIMARY OUTCOME MEASURES Generalised estimating equation regressions with an interaction term were used to estimate and compare changes in cardiovascular risk factors and 10-year risk of AMI or CS between the two surveys and by ethnicity. RESULTS Mean cholesterol declined by 0.50, 0.43 and 0.60 mmol/L in women, Sami men and non-Sami men, respectively (all p<0.001). Sami men had a small decline in mean high-density lipoprotein (HDL) cholesterol and an increase in mean triglycerides (both p<0.001), whereas non-Sami showed no change in these variables. Non-Sami women had an increase in mean HDL cholesterol (p<0.001) whereas Sami women had no change. Triglycerides did not change in non-Sami and Sami women. Systolic and diastolic blood pressure declined by 3.6 and 1.0 mm Hg in women, and 3.1 and 0.7 in men, respectively (all p<0.01). Mean waist circumference increased by 6.7 and 5.9 cm in women and men, respectively (both p<0.001). The odds of being a smoker declined by 35% in women and 46% in men (both p<0.001). Estimated 10-year risk of AMI or CS decreased in all strata of sex and ethnicity (p<0.001), however, Sami women had a smaller decline than non-Sami did. CONCLUSIONS Independent of ethnicity, there was a decline in mean cholesterol, blood pressure, smoking, hypertension (women only) and 10-year risk of AMI or CS, but waist circumference increased. Relatively minor ethnic differences were found in changes of cardiovascular risk factors.
Collapse
Affiliation(s)
| | | | - Bjarne K Jacobsen
- Department of Community Medicine, Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, 9037, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Marita Melhus
- Department of Community Medicine, Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, 9037, Norway
| | - Ann Ragnhild Broderstad
- Department of Community Medicine, Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, 9037, Norway
| | - Vilde Lehne Michalsen
- Department of Community Medicine, Centre for Sami Health Research, UiT The Arctic University of Norway, Tromsø, 9037, Norway
| | - Tonje Braaten
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
26
|
Survival to Age 90 in Men: The Tromsø Study 1974-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16112028. [PMID: 31174416 PMCID: PMC6603911 DOI: 10.3390/ijerph16112028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 12/26/2022]
Abstract
The 738 oldest men who participated in the first survey of the population-based Tromsø Study (Tromsø 1) in Norway in 1974 have now had the chance to reach the age of 90 years. The men were also invited to subsequent surveys (Tromsø 2–7, 1979–2016) and have been followed up for all-cause deaths. This study sought to investigate what could be learned from how these men have fared. The men were born in 1925–1928 and similar health-related data from questionnaires, physical examination, and blood samples are available for all surveys. Survival curves over various variable strata were applied to evaluate the impact of individual risk factors and combinations of risk factors on all-cause deaths. At the end of 2018, 118 (16.0%) of the men had reached 90 years of age. Smoking in 1974 was the strongest single risk factor associated with survival, with observed percentages of men reaching 90 years being 26.3, 25.7, and 10.8 for never, former, and current smokers, respectively. Significant effects on survival were also found for physical inactivity, low income, being unmarried, high blood pressure, and high cholesterol. For men with 0–4 of these risk factors, the percentages reaching 90 years were 33.3, 24.9, 12.4, 14.4, and 1.5, respectively. Quitting smoking and increasing physical activity before 55 years of age improved survival significantly. Men should refrain from smoking and increase their physical activity, especially those with low income, those who are unmarried, and those with high blood pressure and high cholesterol.
Collapse
|
27
|
Langsted A, Vedel-Krogh S, Kobylecki CJ, Nordestgaard BG. Reply to: "Seasonal variations of lipid profiles in a French cohort". Atherosclerosis 2019; 286:184-186. [PMID: 31151744 DOI: 10.1016/j.atherosclerosis.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/21/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Anne Langsted
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Signe Vedel-Krogh
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
| | - Camilla J Kobylecki
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
28
|
Libby P, Everett BM. Novel Antiatherosclerotic Therapies. Arterioscler Thromb Vasc Biol 2019; 39:538-545. [PMID: 30816799 PMCID: PMC6436984 DOI: 10.1161/atvbaha.118.310958] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/14/2019] [Indexed: 12/13/2022]
Abstract
Many measures can control lipid risk factors for atherosclerosis. Yet, even with excellent control of dyslipidemia, other sources of risk remain. Hence, we must look beyond lipids to address residual risk. Lifestyle measures should form the foundation of cardiovascular risk control. Many pharmacological interventions targeting oxidation have proven disappointing. A large program tested inhibition of a LpPLA2 (lipoprotein-associated phospholipase A2), culminating in 2 large-scale clinical trials that did not meet their primary end points. A variety of antioxidants have not shown benefit in clinical trials. Numerous laboratory and clinical studies have inculpated inflammatory pathways in the pathogenesis of atherosclerotic events. The p38 MAPK (mitogen-activated protein kinase) inhibitor losmapimod and an inhibitor of a leukocyte adhesion molecule, P-selectin, did not alter adverse events in trials. Low-dose methotrexate, despite the promising observational studies, did not lower biomarkers of inflammation or alter cardiovascular outcomes in the CIRT (cardiovascular inflammation reduction trial). Four large-scale investigations underway will determine colchicine's ability to reduce recurrent events in secondary prevention. The CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) showed that an antibody that neutralizes IL (interleukin)-1β can reduce recurrent cardiovascular events in secondary prevention. The success of CANTOS points to the pathway that leads from the NLRP3 (NOD-like receptor family, pyrin domain-containing protein 3) inflammasome through IL-1β to IL-6 as an attractive target for further study and clinical development beyond lipid therapies to address the unacceptable burden of risk that remains despite our best current care in secondary prevention.
Collapse
Affiliation(s)
- Peter Libby
- From the Division of Cardiovascular Medicine (P.L., B.M.E.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brendan M Everett
- From the Division of Cardiovascular Medicine (P.L., B.M.E.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Preventive Medicine (B.M.E.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
29
|
Nilsen A, Hanssen TA, Lappegård KT, Eggen AE, Løchen ML, Njølstad I, Wilsgaard T, Hopstock L. Secular and longitudinal trends in cardiovascular risk in a general population using a national risk model: The Tromsø Study. Eur J Prev Cardiol 2019; 26:1852-1861. [DOI: 10.1177/2047487319830806] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Primary prevention guidelines promote the use of risk assessment tools to estimate total cardiovascular risk. We aimed to study trends in cardiovascular risk and contribution of single risk factors, using the newly developed NORRISK 2 risk score, which estimates 10-year risk of fatal and non-fatal cardiovascular events. Design Prospective population-based study. Methods We included women and men aged 45–74 years attending the sixth and seventh survey of the Tromsø Study (Tromsø 6, 2007–2008, n = 7284 and Tromsø 7, 2015–2016, n = 14,858) to study secular trends in NORRISK 2 score. To study longitudinal trends, we followed participants born 1941–1962 attending both surveys ( n = 4534). We calculated NORRISK 2 score and used linear regression models to study the relative contribution (% R2) of each single risk factor to the total score. Results Mean NORRISK 2 score decreased and distribution in risk categories moved from higher to lower risk in both sexes and all age-groups between the first and second surveys ( p < 0.001). In birth cohorts, when age was set to baseline in NORRISK 2 calculations, risk score decreased during follow-up. Main contributors to NORRISK 2 were systolic blood pressure, smoking and total cholesterol, with some sex, age and birth cohort differences. Conclusion We found significant favourable secular and longitudinal trends in total cardiovascular risk and single risk factors during the last decade. Change in systolic blood pressure, smoking and cholesterol were the main contributors to risk score change; however, the impact of single risk factors on the total score differed by sex, age and birth cohort.
Collapse
Affiliation(s)
- Amalie Nilsen
- Department of Medicine, Nordland Hospital, Bodø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tove A Hanssen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Knut T Lappegård
- Department of Medicine, Nordland Hospital, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne E Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Laila Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
30
|
Abstract
The mechanisms that underlie superficial erosion, a cause of coronary thrombosis distinct from plaque rupture, have garnered recent interest. In an era of improved control of traditional risk factors, such as LDL (low-density lipoprotein), plaque erosion may assume greater clinical importance. Plaques complicated by erosion tend to be matrix-rich, lipid-poor, and usually lack prominent macrophage collections, unlike plaques that rupture, which characteristically have thin fibrous caps, large lipid pools, and abundant foam cells. Thrombi that complicate superficial erosion seem more platelet-rich than the fibrinous clots precipitated by plaque rupture. The pathogenesis of plaque rupture probably does not pertain to superficial erosion, a process heretofore little understood mechanistically. We review here data that support a substantial shift in the mechanisms of the thrombotic complications of atherosclerosis. We further consider pathophysiologic processes recently implicated in the mechanisms of erosion. Multiple processes likely predispose plaques to superficial erosion, including experiencing disturbed flow, basement membrane breakdown, endothelial cell death, and detachment potentiated by innate immune activation mediated through pattern-recognition receptors and endothelial-to-mesenchymal transition. Monocytes/macrophages predominate in the pathogenesis of plaque rupture and consequent thrombosis, but polymorphonuclear leukocytes likely promote endothelial damage during superficial erosion. The formation of neutrophil extracellular traps probably perpetuates and propagates intimal injury and potentiates thrombosis due to superficial erosion. These considerations have profound clinical implications. Acute coronary syndromes because of erosion may not require immediate invasive therapy. Understanding the biological bases of erosion points to novel therapies for acute coronary syndrome caused by erosion. Future research should probe further the mechanisms of superficial erosion, and develop point-of-care tests to distinguish acute coronary syndromes provoked by erosion versus rupture that may direct more precision management. Future clinical investigations should evaluate intervening on the targets that have emerged from experimental studies and the management strategies that they inform.
Collapse
Affiliation(s)
- Peter Libby
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Filippo Crea
- F. Policlinico Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Roma
| | - Ik-Kyung Jang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
31
|
Peng Y, Cao S, Yao Z, Wang Z. Prevalence of the cardiovascular health status in adults: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2018; 28:1197-1207. [PMID: 30360955 DOI: 10.1016/j.numecd.2018.08.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/20/2018] [Accepted: 08/09/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS The American Heart Association has outlined seven cardiovascular health (CVH) metrics, including smoking, body mass index, physical activity, dietary pattern, total cholesterol, and fasting plasma glucose, to define and monitor CVH status. Our study was to evaluate the global CVH in adults. METHODS AND RESULTS We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and reference lists of relevant articles for studies published between 1 January 2010 and 30 June 2018. Included studies should report the proportions of ideal status for the seven CVH metrics and/or provide the prevalence of overall poor (having 0-2 ideal metrics) or ideal (having 5-7 ideal metrics) CVH status in adults. 88 articles were identified: 75 for the prevalence of ideal CVH metrics, 58 for the proportion of overall poor CVH status, and 55 for the proportion of overall ideal CVH status. Smoking had the highest prevalence of ideal status (69.1%) while dietary pattern has the lowest (12.1%). 32.2% and 19.6% of participants had overall poor and ideal CVH, respectively. Females and young adults had better CVH status when compared to males and older adults. There existed regional variations in ideal CVH metrics and overall CVH status. The overall CVH status had improved over study time. CONCLUSION The prevalence of ideal status was low for some metrics, such as dietary pattern, and the overall CVH status was still unsatisfactory. We should continue to measure the CVH status and carry out lifestyle interventions to improve the CVH status in the whole population.
Collapse
Affiliation(s)
- Y Peng
- Centre for Chronic Disease, School of Clinical Medicine, The University of Queensland, Herston, Australia.
| | - S Cao
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Herston, Australia
| | - Z Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Z Wang
- Centre for Chronic Disease, School of Clinical Medicine, The University of Queensland, Herston, Australia
| |
Collapse
|
32
|
Balanova YA, Kontsevaya AV, Imaeva AE, Karpov OI, Khudyakov MB. Economic losses due to low coverage of lipid-lowering therapy in patients with cardiovascular diseases in the Russian Federation. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-5-716-724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
| | | | - A. E. Imaeva
- National Medical Research Center for Preventive Medicine
| | | | | |
Collapse
|
33
|
Godang K, Lundstam K, Mollerup C, Fougner SL, Pernow Y, Nordenström J, Rosén T, Jansson S, Hellström M, Bollerslev J, Heck A. The effect of surgery on fat mass, lipid and glucose metabolism in mild primary hyperparathyroidism. Endocr Connect 2018; 7:941-948. [PMID: 30300532 PMCID: PMC6144936 DOI: 10.1530/ec-18-0259] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Mild primary hyperparathyroidism has been associated with increased body fat mass and unfavorable cardiovascular risk factors. OBJECTIVE To assess the effect of parathyroidectomy on fat mass, glucose and lipid metabolism. DESIGN, PATIENTS, INTERVENTIONS, MAIN OUTCOME MEASURES 119 patients previously randomized to observation (OBS; n = 58) or parathyroidectomy (PTX; n = 61) within the Scandinavian Investigation of Primary Hyperparathyroidism (SIPH) trial, an open randomized multicenter study, were included. Main outcome measures for this study were the differences in fat mass, markers for lipid and glucose metabolism between OBS and PTX 5 years after randomization. RESULTS In the OBS group, total cholesterol (Total-C) decreased from mean 5.9 (±1.1) to 5.6 (±1.0) mmol/L (P = 0.037) and LDL cholesterol (LDL-C) decreased from 3.7 (±1.0) to 3.3 (±0.9) mmol/L (P = 0.010). In the PTX group, the Total-C and LDL-C remained unchanged resulting in a significant between-group difference over time (P = 0.013 and P = 0.026, respectively). This difference was driven by patients who started with lipid-lowering medication during the study period (OBS: 5; PTX: 1). There was an increase in trunk fat mass in the OBS group, but no between-group differences over time. Mean 25(OH) vitamin D increased in the PTX group (P < 0.001), but did not change in the OBS group. No difference in parameters of glucose metabolism was detected. CONCLUSION In mild PHPT, the measured metabolic and cardiovascular risk factors were not modified by PTX. Observation seems safe and cardiovascular risk reduction should not be regarded as a separate indication for parathyroidectomy based on the results from this study.
Collapse
Affiliation(s)
- Kristin Godang
- Section of Specialized EndocrinologyOslo University Hospital, Oslo, Norway
| | - Karolina Lundstam
- Department of RadiologyInstitute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotte Mollerup
- Clinic of Breast and Endocrine SurgeryCenter HOC, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Ylva Pernow
- Departments of Molecular MedicineSurgery and Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jörgen Nordenström
- Department of Molecular Medicine and SurgeryKarolinska Institutet, Stockholm, Sweden
| | - Thord Rosén
- Department of MedicineSahlgrenska University Hospital, Gothenburg, Sweden
| | - Svante Jansson
- Department of Endocrine SurgerySahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Hellström
- Department of RadiologyInstitute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jens Bollerslev
- Section of Specialized EndocrinologyOslo University Hospital, Oslo, Norway
- Faculty of MedicineUniversity of Oslo, Oslo, Norway
| | - Ansgar Heck
- Section of Specialized EndocrinologyOslo University Hospital, Oslo, Norway
- Faculty of MedicineUniversity of Oslo, Oslo, Norway
- Correspondence should be addressed to A Heck:
| | | |
Collapse
|
34
|
Gulati AM, Salvesen Ø, Thomsen RS, Kavanaugh A, Semb AG, Rollefstad S, Haugeberg G, Hoff M. Change in cardiovascular risk factors in patients who develop psoriatic arthritis: longitudinal data from the Nord-Trøndelag Health Study (HUNT). RMD Open 2018; 4:e000630. [PMID: 29556420 PMCID: PMC5856915 DOI: 10.1136/rmdopen-2017-000630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/13/2018] [Accepted: 02/21/2018] [Indexed: 01/29/2023] Open
Abstract
Objectives The aim of this population-based study was to compare changes in cardiovascular (CV) risk factors over a decade-long period in patients who developed psoriatic arthritis (PsA) and the background population. Methods Patients diagnosed with PsA (n=151) between 1998 and 2008 and matched controls (n=755) who participated in both the Nord-Trøndelag Health Study (HUNT) 2 (1995–1997) and HUNT3 (2006–2008) were included. Mixed linear and logistic models were used to analyse the difference in mean change between HUNT2 and HUNT3 in patients and controls for body mass index (BMI), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and blood pressure (BP). Results At baseline (HUNT2), the patients who developed PsA compared with controls had higher BMI (27.2 vs 25.9 kg/m2, p<0.001) and lower HDL-c (1.32 vs 1.40 mmol/L, p<0.03) and more were smokers (41.1 vs 28.5%, p<0.01). Seventy-eight per cent had skin psoriasis. The mean PsA disease duration at HUNT3 was 4.8 (+/–3.0) years. The patients who developed PsA gained less weight from HUNT2 to HUNT3 compared with the control group (2.1 vs 3.9 kg, difference in mean change −1.8 kg, 95% CI −3.9 to −0.5, p<0.01). TC, triglycerides, LDL-c or HDL-c values and BP declined in both groups, with no significant differences between groups. Conclusion Longitudinal 10-year data did not show an increase in CV risk factors in patients who developed PsA compared with controls. This study implies that unfavourable CV risk factors in PsA were present before the diagnosis was established.
Collapse
Affiliation(s)
- Agnete Malm Gulati
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement science, Norwegian university of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ruth Stoklund Thomsen
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Kavanaugh
- Department of Rheumatology, Allergy and Immunology, University of California San Diego, San Diego, California, USA
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Glenn Haugeberg
- Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway.,Research Department, Hospital of Southern Norway Trust, Arendal, Norway
| | - Mari Hoff
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.,Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
35
|
Hopstock LA, Eggen AE, Løchen ML, Mathiesen EB, Njølstad I, Wilsgaard T. Secondary prevention care and effect: Total and low-density lipoprotein cholesterol levels and lipid-lowering drug use in women and men after incident myocardial infarction – The Tromsø Study 1994–2016. Eur J Cardiovasc Nurs 2018; 17:563-570. [DOI: 10.1177/1474515118762541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Secondary prevention guidelines after myocardial infarction (MI) are gender neutral, but underutilisation of treatment in women has been reported. Design: We investigated the change in total and low-density lipoprotein (LDL) cholesterol levels and lipid-lowering drug (LLD) use after first-ever MI in a population-based study. Methods: We followed 10,005 participants (54% women) attending the Tromsø Study 1994–1995 and 8483 participants (55% women) attending the Tromsø Study 2007–2008 for first-ever MI up to their participation in 2007–2008 and 2015–2016, respectively. We used linear and logistic regression models to investigate sex differences in change in lipid levels. Results: A total of 395 (MI cohort I) and 132 participants (MI cohort II) had a first-ever MI during 1994–2008 and 2007–2013, respectively. Mean change in total cholesterol was −2.34 mmol/L (SD 1.15) in MI cohort I, and in LDL cholesterol was −1.63 mmol/L (SD 1.12) in MI cohort II. Men had a larger decrease in lipid levels compared to women: the linear regression coefficient for change was −0.33 (95% confidence interval [CI] −0.51 to −0.14) for total cholesterol and −0.21 (95% CI −0.37 to −0.04) for LDL cholesterol, adjusted for baseline lipid value, age and cohort. Men had 73% higher odds (95% CI 1.15−2.61) of treatment target achievement compared to women, adjusted for baseline lipid value, age and cohort. LLD use was reported in 85% of women and 92% of men in MI cohort I, and 80% in women and 89% in men in MI cohort II. Conclusions: Compared to men, women had significantly less decrease in lipid levels after MI, and a smaller proportion of women achieved the treatment target.
Collapse
Affiliation(s)
- Laila A Hopstock
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø Norway
| |
Collapse
|