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Editor's Choice - Epidemiology, Diagnostics, and Outcomes of Acute Occlusive Arterial Mesenteric Ischaemia: A Population Based Study. Eur J Vasc Endovasc Surg 2022; 64:646-653. [PMID: 35931276 DOI: 10.1016/j.ejvs.2022.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/24/2022] [Accepted: 07/10/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The exact incidence and outcomes of acute occlusive arterial mesenteric ischaemia (AMI) are unclear as most studies include only patients diagnosed correctly while alive. The aim of this study was to assess the incidence, mortality, and diagnostics of AMI by also including patients diagnosed post-mortem. METHODS This retrospective study comprised patients diagnosed with AMI either alive or post-mortem between 2006 and 2015 within a healthcare district serving 1.6 million inhabitants. Key exclusion criteria were venous or non-obstructive ischaemia. RESULTS A total of 470 patients were included in the study of which 137 (29%) were diagnosed post-mortem. The most common misdiagnoses on those not diagnosed alive were unspecified infection (n = 19, 17%), gastrointestinal bleeding (n = 13, 11%), and ileus (n = 13, 11%). Of those diagnosed alive (n = 333), 187 (56%) underwent active surgical or endovascular treatment. During the 2006 - 2015 period, the overall incidence of AMI was 3.05 (95% CI 2.78 - 3.34)/100 000 person years and 26.66 (95% CI 24.07 - 29.45) for those aged 70 years or more. The mean autopsy rate during the study period was 29% for the overall population (32% during 2006 - 2010 and 25% during 2011 - 2015) and 18% for those aged 70 years or more. Overall, the 90-day mortality was 83% in all patients. The ninety day mortality decreased, being 87% during the first period (2006 - 2010) and 79% during the second period (2011 - 2015) (p = .029), while at the same time the proportion of patients diagnosed alive rose from 71% to 80% (p = .030) and the number of endovascular revascularisations rose from 1% to 5% (p = .022). CONCLUSION A significant proportion of patients with AMI are not diagnosed alive, which is reflected in the mortality rates. Post-mortem examinations and autopsy rate data continue to be key factors in epidemiological studies on AMI.
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Scarborough P, Kaur A, Cobiac LJ. Forecast of myocardial infarction incidence, events and prevalence in England to 2035 using a microsimulation model with endogenous disease outcomes. PLoS One 2022; 17:e0270189. [PMID: 35771859 PMCID: PMC9246106 DOI: 10.1371/journal.pone.0270189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Models that forecast non-communicable disease rates are poorly designed to predict future changes in trend because they are based on exogenous measures of disease rates. We introduce microPRIME, which forecasts myocardial infarction (MI) incidence, events and prevalence in England to 2035. microPRIME can forecast changes in trend as all MI rates emerge from competing trends in risk factors and treatment. Materials and methods microPRIME is a microsimulation of MI events within a sample of 114,000 agents representative of England. We simulate 37 annual time points from 1998 to 2035, where agents can have an MI event, die from an MI, or die from an unrelated cause. The probability of each event is a function of age, sex, BMI, blood pressure, cholesterol, smoking, diabetes and previous MI. This function does not change over time. Instead population-level changes in MI rates are due to competing trends in risk factors and treatment. Uncertainty estimates are based on 450 model runs that use parameters calibrated against external measures of MI rates between 1999 and 2011. Findings Forecasted MI incidence rates fall for men and women of different age groups before plateauing in the mid 2020s. Age-standardised event rates show a similar pattern, with a non-significant upturn by 2035, larger for men than women. Prevalence in men decreases for the oldest age groups, with peaks of prevalence rates in 2019 for 85 and older at 25.8% (23.3–28.3). For women, prevalence rates are more stable. Prevalence in over 85s is estimated as 14.5% (12.6–16.5) in 2019, and then plateaus thereafter. Conclusion We may see an increase in event rates from MI in England for men before 2035 but increases for women are unlikely. Prevalence rates may fall in older men, and are likely to remain stable in women over the next decade and a half.
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Affiliation(s)
- Peter Scarborough
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- National Institute of Health and Care Research Biomedical Research Centre at Oxford, Oxford, United Kingdom
- * E-mail:
| | - Asha Kaur
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Linda J. Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Griffith University, Queensland, Australia
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Chipayo-Gonzales D, Ramakrishna H, Nuñez-Gil IJ. Score2: A New Updated Algorithm to Predict Cardiovascular Disease Risk in Europe. J Cardiothorac Vasc Anesth 2021; 36:18-21. [PMID: 34686439 DOI: 10.1053/j.jvca.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/11/2022]
Abstract
The recently published guidelines of the European Society of Cardiology for the prevention of cardiovascular diseases presented in August 2021 at the virtual European Society of Cardiology congress recommend the use of the SCORE2 risk index instead of the classic SCORE risk index to calculate the cardiovascular risk (specifically, ten-year fatal and nonfatal risk) in a healthy population under the age of 70 years, with a level of evidence IB. This new risk index was developed with the collaboration of about 200 investigators, including 45 cohorts in 13 countries with 700,000 participants, and covers the known risk factors for heart and circulatory diseases such as age, sex, lipid levels, blood pressure, and smoking. In addition, it divides the countries into four groups of risk and uses a competing risk model, adjusting the risk for the probability of having another event, which enables better estimation of the risk of fatal and nonfatal events in a younger population (40-69 years).
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Affiliation(s)
- David Chipayo-Gonzales
- Division of Interventional Cardiology, Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester Minnesota, MN.
| | - Ivan J Nuñez-Gil
- Division of Interventional Cardiology, Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
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Hageman S, Pennells L, Ojeda F, Kaptoge S, Kuulasmaa K, de Vries T, Xu Z, Kee F, Chung R, Wood A, McEvoy JW, Veronesi G, Bolton T, Achenbach S, Aleksandrova K, Amiano P, Sebastian DS, Amouyel P, Andersson J, Bakker SJL, Da Providencia Costa RB, Beulens JWJ, Blaha M, Bobak M, Boer JMA, Bonet C, Bonnet F, Boutron-Ruault MC, Braaten T, Brenner H, Brunner F, Brunner EJ, Brunström M, Buring J, Butterworth AS, Capkova N, Cesana G, Chrysohoou C, Colorado-Yohar S, Cook NR, Cooper C, Dahm CC, Davidson K, Dennison E, Di Castelnuovo A, Donfrancesco C, Dörr M, Doryńska A, Eliasson M, Engström G, Ferrari P, Ferrario M, Ford I, Fu M, Gansevoort RT, Giampaoli S, Gillum RF, Gómez de la Cámara A, Grassi G, Hansson PO, Huculeci R, Hveem K, Iacoviello L, Ikram MK, Jørgensen T, Joseph B, Jousilahti P, Wouter Jukema J, Kaaks R, Katzke V, Kavousi M, Kiechl S, Klotsche J, König W, Kronmal RA, Kubinova R, Kucharska-Newton A, Läll K, Lehmann N, Leistner D, Linneberg A, Pablos DL, Lorenz T, Lu W, Luksiene D, Lyngbakken M, Magnussen C, Malyutina S, Ibañez AM, Masala G, Mathiesen EB, Matsushita K, Meade TW, Melander O, Meyer HE, Moons KGM, Moreno-Iribas C, Muller D, Münzel T, Nikitin Y, Nordestgaard BG, Omland T, Onland C, Overvad K, Packard C, Pająk A, Palmieri L, Panagiotakos D, Panico S, Perez-Cornago A, Peters A, Pietilä A, Pikhart ,H, Psaty BM, Quarti-Trevano F, Garcia JRQ, Riboli E, Ridker PM, Rodriguez B, Rodriguez-Barranco M, Rosengren A, Roussel R, Sacerdote C, Sans S, Sattar N, Schiborn C, Schmidt B, Schöttker B, Schulze M, Schwartz JE, Selmer RM, Shea S, Shipley MJ, Sieri S, Söderberg S, Sofat R, Tamosiunas A, Thorand B, Tillmann T, Tjønneland A, Tong TYN, Trichopoulou A, Tumino R, Tunstall-Pedoe H, Tybjaerg-Hansen A, Tzoulaki J, van der Heijden A, van der Schouw YT, Verschuren WMM, Völzke H, Waldeyer C, Wareham NJ, Weiderpass E, Weidinger F, Wild P, Willeit J, Willeit P, Wilsgaard T, Woodward M, Zeller T, Zhang D, Zhou B, Dendale P, Ference BA, Halle M, Timmis A, Vardas P, Danesh J, Graham I, Salomaa V, Visseren F, De Bacquer D, Blankenberg S, Dorresteijn J, Di Angelantonio E. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 2021; 42:2439-2454. [PMID: 34120177 PMCID: PMC8248998 DOI: 10.1093/eurheartj/ehab309] [Citation(s) in RCA: 449] [Impact Index Per Article: 149.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe. METHODS AND RESULTS We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. CONCLUSION SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe.
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Muller CJ, Noonan CJ, MacLehose RF, Stoner JA, Lee ET, Best LG, Calhoun D, Jolly SE, Devereux RB, Howard BV. Trends in Cardiovascular Disease Morbidity and Mortality in American Indians Over 25 Years: The Strong Heart Study. J Am Heart Assoc 2019; 8:e012289. [PMID: 31648583 PMCID: PMC6898852 DOI: 10.1161/jaha.119.012289] [Citation(s) in RCA: 11] [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: 12/15/2022]
Abstract
Background American Indians experience high rates of cardiovascular disease. We evaluated whether cardiovascular disease incidence, mortality, and prevalence changed over 25 years among American Indians aged 30 to 85. Methods and Results The SHS (Strong Heart Study) and SHFS (Strong Heart Family Study) are prospective studies of cardiovascular disease in American Indians. Participants enrolled in 1989 to 1990 or 2000 to 2003 with birth years from 1915 to 1984 were followed for cardiovascular disease events through 2013. We used Poisson regression to analyze data for 5627 individuals aged 30 to 85 years during follow-up. Outcomes reflect change in age-specific cardiovascular disease incidence, mortality, and prevalence, stratified by sex. To illustrate generational change, 5-year relative risk compared most recent birth years for ages 45, 55, 65, and 75 to same-aged counterparts born 1 generation (23-25 years) earlier. At all ages, cardiovascular disease incidence was lower for people with more recent birth years. Cardiovascular disease mortality declined consistently among men, while prevalence declined among women. Generational comparisons were similar for women aged 45 to 75 (relative risk, 0.39-0.46), but among men magnitudes strengthened from age 45 to 75 (relative risk, 0.91-0.39). For cardiovascular disease mortality, risk was lower in the most recent versus the earliest birth years for women (relative risk, 0.56-0.83) and men (relative risk, 0.40-0.54), but results for women were inconclusive. Conclusions Cardiovascular disease incidence declined over a generation in an American Indian cohort. Mortality declined more for men, while prevalence declined more for women. These trends might reflect more improvement in case survival among men compared with women.
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Affiliation(s)
- Clemma J Muller
- Elson S. Floyd College of Medicine Washington State University Seattle WA
| | - Carolyn J Noonan
- Elson S. Floyd College of Medicine Washington State University Seattle WA
| | - Richard F MacLehose
- Department of Epidemiology and Community Health University of Minnesota Minneapolis MN
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center Oklahoma City OK
| | - Elisa T Lee
- Department of Biostatistics and Epidemiology University of Oklahoma Health Sciences Center Oklahoma City OK
| | - Lyle G Best
- Missouri Breaks Industries Research Inc. Eagle Butte SD
| | - Darren Calhoun
- Phoenix Field Office MedStar Health Research Institute Phoenix AZ
| | - Stacey E Jolly
- Cleveland Clinic Lerner College of Medicine Cleveland OH.,Cleveland Clinic Department of General Internal Medicine Cleveland OH
| | | | - Barbara V Howard
- MedStar Health Research Institute Georgetown/Howard University Center for Clinical and Translational Sciences Hyattsville MD
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Koukkunen H, Havulinna AS, Lehto S, Ketonen M, Mustonen J, Airaksinen JK, Ukkola O, Kesäniemi YA, Salomaa V. Case fatality of acute coronary events is improving even among elderly patients; the FINAMI study 1995-2012. Ann Med 2018; 50:35-45. [PMID: 28927303 DOI: 10.1080/07853890.2017.1382713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AIM To examine trends in incidence and 28-day case fatality of myocardial infarction (MI) in persons aged 75-99 years in four areas of Finland. METHODS AND RESULTS The Finnish Acute Myocardial Infarction (FINAMI) register is a population-based MI register study, which during 1995-2012 recorded 30561 suspected acute coronary syndromes in persons aged ≥75 years. Of them, 16229 fulfilled the American Heart Association criteria for a definite, probable or possible MI or coronary death. This age-group contributed 56.8% of all MIs of which 62.7% occurred in women. The incidence of MI decreased by -3.3%/year (95% CI -4.2; -2.4) in women aged 75-84 years, and by -1.2%/year (-1.9; -0.5) in women aged 85-99 years, but among men in these age-groups, only a non-significant reduction occurred. The 28-day case fatality of MI was high. In the age-group 75-84 years, it decreased non-significantly by -1.6%/year in men, and significantly by -2.4%/year (-3.9; -0.8) in women. In the age-group 85-99 years, the decrease was more remarkable: -5.1%/year (-7.8; -2.3) and -3.9%/year (-5.5; -2.2), respectively. CONCLUSIONS In Finland, more than half of MIs occur in the age-group 75-99 years, and most of them in women. The incidence of MI decreased significantly in elderly women but non-significantly in elderly men. The 28-day case fatality decreased especially in the age-group 85-99 years. Key Messages In Finland, more than one half of all myocardial infarctions (MIs) occur in the age-group of 75 years or older. Furthermore, 62.7% of MIs among elderly patients occur among women, although 58.0% of the elderly population are women. The incidence of MI decreased significantly in elderly women but not in elderly men. The 28-day case fatality in elderly patients was high but decreased significantly during the study period 1995-2012. This study provides population-based data on treatment strategies and trends in incidence, event rate, mortality and case fatality of MI in elderly individuals. Elderly patients with acute coronary syndromes still present a remarkable burden to the healthcare system in Finland as well as in many other developed countries. Especially considering the modern trend of reducing hospital resources and shifting patient care to outpatient clinics, the epidemiology of MI in elderly patients remains an important issue for the future planning of the healthcare system.
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Affiliation(s)
- Heli Koukkunen
- a Department of Medicine , Kuopio University Hospital , Kuopio , Finland.,b Department of Medicine , University of Eastern Finland , Kuopio , Finland
| | - Aki S Havulinna
- c Department of Health , National Institute for Health and Welfare (THL) , Helsinki , Finland
| | - Seppo Lehto
- b Department of Medicine , University of Eastern Finland , Kuopio , Finland
| | - Matti Ketonen
- d Department of Medicine , North Karelia Central Hospital , Joensuu , Finland
| | - Juha Mustonen
- d Department of Medicine , North Karelia Central Hospital , Joensuu , Finland
| | - Juhani K Airaksinen
- e Heart Center , Turku University Hospital and University of Turku , Turku , Finland
| | - Olavi Ukkola
- f Research Unit of Internal Medicine, Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Y Antero Kesäniemi
- f Research Unit of Internal Medicine, Medical Research Center Oulu , Oulu University Hospital and University of Oulu , Oulu , Finland
| | - Veikko Salomaa
- c Department of Health , National Institute for Health and Welfare (THL) , Helsinki , Finland
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Jousilahti P, Laatikainen T, Salomaa V, Pietilä A, Vartiainen E, Puska P. 40-Year CHD Mortality Trends and the Role of Risk Factors in Mortality Decline: The North Karelia Project Experience. Glob Heart 2018; 11:207-12. [PMID: 27242088 DOI: 10.1016/j.gheart.2016.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022] Open
Abstract
In the 1960s and early 1970s, coronary heart disease (CHD) mortality in Finland was the highest in the world, and within Finland, mortality was particularly high in the eastern part of the country. The North Karelia Project, the first large community-based cardiovascular diseases prevention program was established in 1972 to reduce the extremely high CHD mortality through behavioral change and reduction of the main cardiovascular disease risk factors among the whole population of North Karelia, the easternmost province of Finland. During the 40-year period from 1972 to 2012, smoking prevalence, serum total cholesterol, and systolic blood pressure declined markedly, except a small increase in serum cholesterol levels between 2007 and 2012. From the early 1970s to 2012, CHD mortality decreased by 82% (from 643 to 118 per 100,000) among working-age (35 to 64 years) men. Among working-age women, the decline was 84% (from 114 to 17 per 100,000). During the first 10 years, changes in these 3 target risk factors explained nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than the predicted reduction. In the early 1970s, premature CHD mortality (35 to 74 years) was about 37% higher among Eastern Finnish men and 23% higher among Eastern Finnish women, compared with men and women in Southwestern Finland. During the last 40 years, premature CHD mortality declined markedly in both areas, but the decline was larger in Eastern Finland and the mortality gap between the two areas nearly disappeared.
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Affiliation(s)
- Pekka Jousilahti
- National Institute for Health and Welfare, Department of Health, Helsinki, Finland.
| | | | - Veikko Salomaa
- National Institute for Health and Welfare, Department of Health, Helsinki, Finland
| | - Arto Pietilä
- National Institute for Health and Welfare, Department of Health, Helsinki, Finland
| | - Erkki Vartiainen
- National Institute for Health and Welfare, Department of Health, Helsinki, Finland
| | - Pekka Puska
- National Institute for Health and Welfare, Department of Health, Helsinki, Finland
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Kärkkäinen JM, Acosta S. Acute mesenteric ischemia (part I) - Incidence, etiologies, and how to improve early diagnosis. Best Pract Res Clin Gastroenterol 2017; 31:15-25. [PMID: 28395784 DOI: 10.1016/j.bpg.2016.10.018] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/31/2016] [Indexed: 01/31/2023]
Abstract
Acute mesenteric ischemia (AMI) is generally thought to be a rare disease, but in fact, it is more common cause of acute abdomen than appendicitis or ruptured abdominal aortic aneurysm in patients over 75 years of age. In occlusive AMI, surgical treatment without revascularization is associated with as high as 80% overall mortality. It has been shown that early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI by up to 50%. However, only a minority of patients with AMI are being treated actively with revascularization in the United States, and the situation is very likely similar in Europe as well. What can we do to improve diagnostic performance, so that more patients get proper treatment? The diagnosis is a collaborative effort of emergency department surgeons, gastrointestinal and vascular surgeons, and radiologists. The etiological categorization of AMI should be practical and guide the therapy. Furthermore, the limitations of the diagnostic examinations need to be understood with special emphasis on computed tomography findings on patients with slowly progressing "acute-on-chronic" mesenteric ischemia.
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Affiliation(s)
- Jussi M Kärkkäinen
- Heart Center, Kuopio University Hospital, P.O. Box 100, 70029 Kuopio, Finland.
| | - Stefan Acosta
- Department of Clinical Sciences Malmö, Lund University, Sweden.
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Piironen M, Ukkola O, Huikuri H, Havulinna AS, Koukkunen H, Mustonen J, Ketonen M, Lehto S, Airaksinen J, Antero Kesäniemi Y, Salomaa V. Trends in long-term prognosis after acute coronary syndrome. Eur J Prev Cardiol 2016; 24:274-280. [DOI: 10.1177/2047487316679522] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marjo Piironen
- Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland
- Oulu University Hospital, and University of Oulu, Finland
| | - Olavi Ukkola
- Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland
- Oulu University Hospital, and University of Oulu, Finland
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland
- Oulu University Hospital, and University of Oulu, Finland
| | - Aki S Havulinna
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Heli Koukkunen
- University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | | | | | - Seppo Lehto
- University of Eastern Finland, Kuopio, Finland
| | | | - Y Antero Kesäniemi
- Research Unit of Internal Medicine, Medical Research Centre Oulu, Finland
- Oulu University Hospital, and University of Oulu, Finland
| | - Veikko Salomaa
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
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Tuomikoski P, Salomaa V, Havulinna A, Airaksinen J, Ketonen M, Koukkunen H, Ukkola O, Kesäniemi YA, Lyytinen H, Ylikorkala O, Mikkola TS. Decreased mortality risk due to first acute coronary syndrome in women with postmenopausal hormone therapy use. Maturitas 2016; 94:106-109. [PMID: 27823727 DOI: 10.1016/j.maturitas.2016.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The role of postmenopausal hormone therapy (HT) in the incidence of acute coronary syndrome (ACS) has been studied extensively, but less is known of the impact of HT on the mortality risk due to an ACS. STUDY DESIGN AND MAIN OUTCOME MEASURES We extracted from a population-based ACS register, FINAMI, 7258 postmenopausal women with the first ACS. These data were combined with HT use data from the National Drug Reimbursement Register; 625 patients (9%) had used various HT regimens. The death risks due to ACS before admission to hospital, 2-28, or 29-365days after the incident ACS were compared between HT users and non-users with logistic regression analyses. RESULTS In all follow-up time points, the ACS death risks in HT ever-users were smaller compared to non-users. Of women with HT ever use, 42% died within one year as compared with 52% of non-users (OR 0.62, p<0.001). Most deaths (84%) occurred within 28days after the ACS, and in this group 36% of women with ever use of HT (OR 0.73, p=0.002) and 30% of women with ≥5year HT use (OR 0.54, p<0.001) died as compared to 43% of the non-users. Age ≤60 or >60 years at the HT initiation was accompanied with similar reductions in ACS mortality risk. CONCLUSIONS Postmenopausal HT use is accompanied with reduced mortality risk after primary ACS.
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Affiliation(s)
- Pauliina Tuomikoski
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland
| | - Veikko Salomaa
- THL-National Institute for Health and Welfare, PO BOX 30, 00271 Helsinki, Finland
| | - Aki Havulinna
- THL-National Institute for Health and Welfare, PO BOX 30, 00271 Helsinki, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland
| | | | | | - Olavi Ukkola
- Research Institute of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Y Antero Kesäniemi
- Research Institute of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Heli Lyytinen
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland
| | - Olavi Ylikorkala
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland
| | - Tomi S Mikkola
- University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, 00029 Helsinki, Finland; Folkhälsan Research Center, Biomedicum, 00029 Helsinki, Finland.
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Salomaa V, Pietilä A, Peltonen M, Kuulasmaa K. Changes in CVD Incidence and Mortality Rates, and Life Expectancy: North
Karelia and National. Glob Heart 2016; 11:201-5. [DOI: 10.1016/j.gheart.2016.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022] Open
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Jousilahti P, Laatikainen T, Peltonen M, Borodulin K, Männistö S, Jula A, Salomaa V, Harald K, Puska P, Vartiainen E. Primary prevention and risk factor reduction in coronary heart disease mortality among working aged men and women in eastern Finland over 40 years: population based observational study. BMJ 2016; 352:i721. [PMID: 26932978 PMCID: PMC4772739 DOI: 10.1136/bmj.i721] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To estimate how much changes in the main risk factors of cardiovascular disease (smoking prevalence, serum cholesterol, and systolic blood pressure) can explain the reduction in coronary heart disease mortality observed among working aged men and women in eastern Finland. DESIGN Population based observational study. SETTING Eastern Finland. PARTICIPANTS 34,525 men and women aged 30-59 years who participated in the national FINRISK studies between 1972 and 2012. INTERVENTIONS Change in main cardiovascular risk factors through population based primary prevention. MAIN OUTCOME MEASURES Predicted and observed age standardised mortality due to coronary heart disease. Predicted change was estimated with a logistic regression model using risk factor data collected in nine consecutive, population based, risk factor surveys conducted every five years since 1972. Data on observed mortality were obtained from the National Causes of Death Register. RESULTS During the 40 year study period, levels of the three major cardiovascular risk factors decreased except for a small increase in serum cholesterol levels between 2007 and 2012. From years 1969-1972 to 2012, coronary heart disease mortality decreased by 82% (from 643 to 118 deaths per 100,000 people) and 84% (114 to 17) among men and women aged 35-64 years, respectively. During the first 10 years of the study, changes in these three target risk factors contributed to nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than predicted. In the last 10 years of the study, about two thirds (69% in men and 66% in women) of the reduction could be explained by changes in the three main risk factors, and the remaining third by other factors. CONCLUSION Reductions in disease burden and mortality due to coronary heart disease can be achieved through the use of population based primary prevention programmes. Secondary prevention among high risk individuals and treatment of acute events of coronary heart disease could confer additional benefit.
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Affiliation(s)
- Pekka Jousilahti
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Tiina Laatikainen
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Markku Peltonen
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Katja Borodulin
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Satu Männistö
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Kennet Harald
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Pekka Puska
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Erkki Vartiainen
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
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Kytö V, Sipilä J, Rautava P. Gender-specific and age-specific differences in unstable angina pectoris admissions: a population-based registry study in Finland. BMJ Open 2015; 5:e009025. [PMID: 26474941 PMCID: PMC4611570 DOI: 10.1136/bmjopen-2015-009025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate gender-specific and age-specific differences in the occurrence of unstable angina pectoris (UAP) caused admissions. DESIGN Population-based retrospective registry study in Finland. PARTICIPANTS All consecutive patients aged ≥30 years hospitalised with a primary diagnosis of UAP in 22 hospitals with a coronary catheterisation laboratory during 5/2000-10/2009. PRIMARY OUTCOME MEASURES Gender-specific and age-specific differences and trends in occurrence of UAP admissions. RESULTS The study period included 27 282 admissions caused primarily by UAP. Of these, 61.9% occurred to men and 38.1% to women with age-adjusted relative risk (RR) of 1.85 (CI 1.61 to 2.14) for the male gender (p<0.0001). The standardised incidence rate of UAP during the whole study was 92.8 (CI 91.8 to 93.9)/100,000 person-years. The incidence rate increased gradually from 1.3 in the population aged 30-34 years to 268.0/100,000 in the population aged 75-84 years. Men had a 2.4-fold risk for UAP admission compared with women in the general population (incidence rate ratio 2.39; CI 2.24 to 2.56; p<0.0001). Gender difference was present in all age groups. UAP caused 22.4% of acute coronary syndrome admissions and 4.7% of all cardiovascular admissions. UAP was more likely to be the cause of cardiovascular admission in male patients (RR=1.25; CI 1.21 to 1.30, p<0.0001 compared with female patients), but there was no gender difference in acute coronary syndrome admissions. The incidence rate of UAP hospitalisations in the general population declined by an estimated 8% per study-year (p<0.0001). Declining incidence was evident regardless of gender and age. CONCLUSIONS Men have a 2.4-fold overall RR for UAP admission compared to women in the general population. Admissions due to UAP have a declining incidence trend across the adult Finnish population.
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Affiliation(s)
- Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland
- Department of Medicine, Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Jussi Sipilä
- Division of Clinical Neurosciences, Neurology, Turku University Hospital, Turku, Finland
- Department of Neurology, University of Turku, Turku, Finland
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
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Acute Mesenteric Ischemia Is a More Common Cause than Expected of Acute Abdomen in the Elderly. J Gastrointest Surg 2015; 19:1407-14. [PMID: 25917534 DOI: 10.1007/s11605-015-2830-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/15/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of acute mesenteric ischemia (AMI) increases exponentially with age. The significance of AMI as a differential diagnosis in elderly patients with acute abdomen may be underestimated. METHODS Consecutive patients hospitalized for AMI between 2009 and 2013 were retrospectively identified in a well-defined population. Acute appendicitis, ruptured abdominal aortic aneurysm, acute pancreatitis, and acute cholecystitis were used as reference diagnoses, and the age-specific incidence rates were calculated. In addition, long-term mortality risk was assessed for AMI survivors. RESULTS The in-hospital incidence rates of AMI, acute obstructive mesenteric ischemia, and non-obstructive mesenteric ischemia were 7.3, 4.5, and 2.0/100,000/year, respectively. AMI was more common than ruptured abdominal aortic aneurysm, and the age-specific incidence of AMI was higher than the incidence of acute appendicitis in patients over age 75 years with acute abdomen. During the follow-up, the age-adjusted risk of death was 1.8 times higher in AMI survivors than in survivors of acute cholecystitis. CONCLUSION AMI may be a more common cause of acute abdomen in elderly patients than is generally thought, emphasizing the importance of performing urgent computed tomography with contrast enhancement preferably in arterial and venous phases in these patients.
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Dégano IR, Salomaa V, Veronesi G, Ferriéres J, Kirchberger I, Laks T, Havulinna AS, Ruidavets JB, Ferrario MM, Meisinger C, Elosua R, Marrugat J. Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations. Heart 2015; 101:1413-21. [PMID: 25855798 DOI: 10.1136/heartjnl-2014-307310] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/22/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Due to the burden of coronary heart disease (CHD), the monitoring of CHD trends is required. This study sought to examine the acute myocardial infarction (AMI) trends in attack and mortality rates, and in 28-day case-fatality, in six European populations during 1985-2010. METHODS Data consisted of 78 128 AMI events included in eight population-based registries from Finland (several populations), Italy (Brianza and Varese), Germany (Augsburg), France (Haute-Garonne), Spain (Girona) and Estonia (Tallinn). AMI event rates and case-fatality trends were analysed using the annual percentage change (APC) obtained by negative binomial and joinpoint regression. RESULTS AMI attack and mortality rates decreased in most populations. Finland experienced the steepest decline in attack rates (APC=-4.4% (95% CI -5.1 to -2.9) in men; -4.0% (-5.1 to -2.8), in women). Total-hospital and inhospital case-fatality decreased in all populations except in Tallinn. The steepest decline in total case-fatality occurred in Spain (-3.8% (-5.3 to -2.4) in men; -5.1% (-6.9 to -3.3) in women). Prehospital case-fatality trends differed significantly by population and sex. The trends for all included populations showed a significant decline in AMI event rates and case-fatality, in both sexes and all age groups. However, in women aged 65-74 years, a significant increase in total case-fatality occurred in 2005-2010 (4.7% (0.7 to 8.8)). CONCLUSIONS AMI event rates and inhospital case-fatality declined in 1985-2010 in almost all populations analysed. Prehospital case-fatality declined only in certain population groups, showing differences by sex. These results highlight the need of specific strategies in AMI prevention for certain groups and populations.
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Affiliation(s)
- Irene R Dégano
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Veikko Salomaa
- Department of Health, THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Giovanni Veronesi
- Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Jean Ferriéres
- Department of Cardiology, Toulouse University School of Medicine-Rangueil Hospital, Toulouse, France
| | - Inge Kirchberger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital Augsburg, Augsburg, Germany Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany
| | - Toivo Laks
- Department of Internal Medicine, North Estonia Medical Centre, Tallinn, Estonia Institute of Cardiovascular Medicine, Tallinn University of Technology, Tallinn, Estonia
| | - Aki S Havulinna
- Department of Health, THL-National Institute for Health and Welfare, Helsinki, Finland
| | | | - Marco M Ferrario
- Research Centre in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Christa Meisinger
- MONICA/KORA Myocardial Infarction Registry, Central Hospital Augsburg, Augsburg, Germany Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute for Epidemiology II, Neuherberg, Germany
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jaume Marrugat
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Wikström K, Lindström J, Harald K, Peltonen M, Laatikainen T. Clinical and lifestyle-related risk factors for incident multimorbidity: 10-year follow-up of Finnish population-based cohorts 1982-2012. Eur J Intern Med 2015; 26:211-6. [PMID: 25747490 DOI: 10.1016/j.ejim.2015.02.012] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multimorbidity is a huge burden to individuals and societies and more attention should be paid on its risk factors and prevention possibilities. The aim of this study was to investigate which clinical and lifestyle characteristics predict the development of multimorbidity both among initially disease-free people and among people who have diabetes or CVD. METHODS Data comprised 25-64 year old, randomly selected men and women (n=32,972) who participated in one of the five national FINRISK surveys between 1982 and 2002 in Finland. The surveys included anthropometric measurements, blood samples and structured questionnaire. Data on incident diagnoses of the five most common chronic diseases during 10 years were received from the national registers on mortality, hospitalizations, and reimbursement rights. RESULTS Predisposing factors for multimorbidity among disease-free population were smoking, physical inactivity, and BMI. Among men also systolic blood pressure and low education predicted multimorbidity. Among men with DM at baseline, high blood pressure, physical inactivity, and smoking increased the likelihood of incident multimorbidity. Among women, significant predictors of multimorbidity were high BMI and smoking. Among men and women with CVD, the only baseline factor that was significantly associated with the development of multimorbidity in the multivariate prediction model was low fruit and vegetable consumption. CONCLUSION Several modifiable clinical and lifestyle risk factors were found to predict incident multimorbidity. Better recognition and management of these risk factors could potentially have a large impact on the development of multimorbidity, and consequently, premature mortality and costs of care among the aging populations.
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Affiliation(s)
- Katja Wikström
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, PO Box 30, 00271 Helsinki, Finland.
| | - Jaana Lindström
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, PO Box 30, 00271 Helsinki, Finland
| | - Kennet Harald
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, PO Box 30, 00271 Helsinki, Finland
| | - Markku Peltonen
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, PO Box 30, 00271 Helsinki, Finland
| | - Tiina Laatikainen
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, PO Box 30, 00271 Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, Kuopio, Finland; Hospital District of North Karelia, Tikkamäentie 16, Joensuu, Finland
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Sarink D, Nedkoff L, Briffa T, Shaw JE, Magliano DJ, Stevenson C, Mannan H, Knuiman M, Peeters A. Projected age- and sex-specific prevalence of cardiovascular diseases in Western Australian adults from 2005-2045. Eur J Prev Cardiol 2014; 23:23-32. [PMID: 25305272 DOI: 10.1177/2047487314554865] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 09/19/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND For decades, the incidence and mortality of cardiovascular diseases (CVDs) have declined. More recently, we have seen a halting in these declines, especially at younger ages. It is difficult to predict how these changing trends will impact CVD prevalence. We aimed to predict future prevalence of CVDs in Western Australian adults from 2005-2045 based on current incidence and mortality probabilities, population growth and ageing. METHODS AND RESULTS Multi-state life table models were developed using 2005-2009 age- and sex-specific incidence and mortality probabilities from the Western Australian Data Linkage System. Prevalence of CVD, coronary heart disease (CHD) and stroke was projected until 2045. Life expectancy and lifetime risk were estimated. We estimate that compared to 2005-2009, we will see 37,235 (CVD), 23,129 (CHD) and 9806 (stroke) more incident cases in 2040-2044. The prevalence of total CVD is predicted to increase from 8.4% in men and 5.1% in women in 2005 to 12.7% and 7.9% respectively in 2045. This seems to be mainly due to population growth and ageing, with some effect of changing incidence and mortality. In Western Australia this represents an additional 106,949 adults living with CVD, of which 65,951 with CHD and 10,928 with stroke, in 2045 compared to 2005. CONCLUSIONS Assuming no major changes in prevention and treatment of CVD, the prevalence will likely increase, with consequent increases in health care need and cost. These findings need to be confirmed by studies in which prevalence is consistently and empirically measured and monitored over time.
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Affiliation(s)
- Danja Sarink
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Australia
| | - Lee Nedkoff
- School of Population Health, The University of Western Australia, Australia
| | - Tom Briffa
- School of Population Health, The University of Western Australia, Australia
| | - Jonathan E Shaw
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Australia
| | - Dianna J Magliano
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Australia
| | | | - Haider Mannan
- Department of Epidemiology and Preventive Medicine, Monash University, Australia
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Australia
| | - Anna Peeters
- Obesity and Population Health, Baker IDI Heart and Diabetes Institute, Australia
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Kytö V, Sipilä J, Rautava P. Likelihood and predictors of ST-elevation in patients hospitalized for myocardial infarction. PLoS One 2014; 9:e108440. [PMID: 25254632 PMCID: PMC4177929 DOI: 10.1371/journal.pone.0108440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/28/2014] [Indexed: 12/31/2022] Open
Abstract
Importance Emergency treatment options in myocardial infarction are guided by presence or absence of ST-elevations in electrocardiography. Occurrence and factors associated with ST-presentation in different population groups are however inadequately known. Objective To determine likelihood and patient features associated with ST-elevations in myocardial infarction. Design Nationwide registry study including 22 hospitals with angiolaboratory during an eight year period in Finland. Setting Hospitalized care. Participants 68,162 consecutive patients aged ≥30 with myocardial infarction. Measures Likelihood and patient features associated with presence of ST-elevations. Results Myocardial infarction presented with ST-elevation in 37.5% (CI 37.0–37.9%) and without in 62.5% (CI 61.9–63.1%) of patients, p<0.0001. Majority of patients aged 30–59 years with myocardial infarction had ST-elevation, but among octogenarians ST-elevations were present in only 24.7%. Presence of ST-elevations decreased with age by estimated 15.6% (CI 15.0–16.2%) per 10 year increase (p<0.0001). Men aged 40–79 years had significantly higher rate for ST-elevation myocardial infarction compared to women. Sex-based difference in presentation of myocardial infarction declined with increasing age. Overall, men had a 13% (CI 11–15%, p<0.0001) higher relative risk for ST-elevations compared to women when adjusted for age and co-morbidities. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency were associated with absence of ST-elevations in myocardial infarction in multivariate analysis. Conclusions and Relevance Myocardial infarction presents with ST-elevations more commonly in men. Presence of ST-elevations decreases with increasing age. Diabetes, atrial fibrillation, peripheral or cerebral artery disease, chronic pulmonary disease, malignancy, and renal insufficiency are associated with absence of ST-elevations in myocardial infarction. These findings may help to predict likelihood of ST-elevations in a patient with myocardial infarction.
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Affiliation(s)
- Ville Kytö
- Heart Center, Division of Clinical Neurosciences, Neurology and Clinical Research Center, Turku University Hospital, Turku, Finland
- PET Center, Medicine, Neurology and Public Health, University of Turku, Turku, Finland
- * E-mail:
| | - Jussi Sipilä
- Heart Center, Division of Clinical Neurosciences, Neurology and Clinical Research Center, Turku University Hospital, Turku, Finland
- PET Center, Medicine, Neurology and Public Health, University of Turku, Turku, Finland
| | - Päivi Rautava
- Heart Center, Division of Clinical Neurosciences, Neurology and Clinical Research Center, Turku University Hospital, Turku, Finland
- PET Center, Medicine, Neurology and Public Health, University of Turku, Turku, Finland
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Kytö V, Sipilä J, Rautava P. Association of age and gender with risk for non-ST-elevation myocardial infarction. Eur J Prev Cardiol 2014; 22:1003-8. [PMID: 24914027 DOI: 10.1177/2047487314539434] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 05/22/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Age and gender associated risks for non-ST-elevation myocardial infarction (NSTEMI) at the population level are largely uncharacterized. DESIGN Nationwide, population (26,724,165 person-years) based eight-year registry-study in Finland. METHODS Gender- and age-associated frequency and incidence of NSTEMI were studied using a nationwide, population based registry of hospital admissions in patients aged ≥30 years during 2001-2008. Patients with NSTEMI as primary (88%), secondary (10%) or tertiary (2%) discharge diagnosis were included. Data was collected nationwide from all 22 hospitals with a coronary angiolaboratory. RESULTS The study period included 48,584 NSTEMI admissions of which 55.3% (95% confidence interval (CI) 54.6-56.0%) were of men and 44.7% (CI 44.1-45.3%) were of women, with age-adjusted relative risk of 1.86 (CI 1.60-2.16, p < 0.0001) for male gender. Female patients were significantly older than males (77.8 SD 10.2 vs. 70.2 SD 11.9 years, p < 0.0001). Standardized incidence rate of NSTEMI was 20.6 (CI 20.4-20.8)/10,000 person-years overall, 28.7 (CI 28.3-29.0)/10,000 in men and 15.0 (CI 14.7-15.2)/10,000 in women. Men had a 2.36-fold (CI 2.23-2.49; p < 0.0001) age-adjusted relative risk for NSTEMI compared with women, with highest risk difference in population under 40 years of age (relative risk 4.48; CI 3.10-6.48, p < 0.0001). Incidence increased with age by an estimated gender-adjusted increase rate of 61% (CI 59-62%; p < 0.0001) per five-year increase in age. CONCLUSIONS Men have a 2.4-fold overall risk for NSTEMI compared with women, with highest relative risk in young adults. Incidence rate of non-ST-elevation myocardial infarction increases by an estimated 61% per five-year increase in age.
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Affiliation(s)
- Ville Kytö
- Heart Centre, Turku University Hospital, Finland PET Centre, University of Turku, Finland
| | - Jussi Sipilä
- Division of Clinical Neurosciences, Department of Neurology, Turku University Hospital, Finland Department of Neurology, University of Turku, Finland
| | - Päivi Rautava
- Clinical Research Centre, Turku University Hospital, Finland Public Health, University of Turku, Finland
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Hedberg P, Hammar C, Selmeryd J, Viklund J, Leppert J, Hellberg A, Henriksen E. Left ventricular systolic dysfunction in outpatients with peripheral atherosclerotic vascular disease: prevalence and association with location of arterial disease. Eur J Heart Fail 2014; 16:625-32. [DOI: 10.1002/ejhf.95] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/06/2014] [Accepted: 03/14/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- Pär Hedberg
- Department of Clinical Physiology; Västmanland County Hospital; Västerås Sweden
- Center for Clinical Research; University of Uppsala, Västmanland County Hospital; Västerås Sweden
| | - Charlotta Hammar
- Division of Internal Medicine, Department of Cardiology; Västmanland County Hospital; Västerås Sweden
| | - Jonas Selmeryd
- Department of Clinical Physiology; Västmanland County Hospital; Västerås Sweden
- Center for Clinical Research; University of Uppsala, Västmanland County Hospital; Västerås Sweden
| | - Josefin Viklund
- Division of Internal Medicine, Department of Cardiology; Västmanland County Hospital; Västerås Sweden
| | - Jerzy Leppert
- Center for Clinical Research; University of Uppsala, Västmanland County Hospital; Västerås Sweden
| | - Anders Hellberg
- Department of Vascular Surgery; Västmanland County Hospital; Västerås Sweden
| | - Egil Henriksen
- Department of Clinical Physiology; Västmanland County Hospital; Västerås Sweden
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Havulinna A. Bayesian age-period-cohort models with versatile interactions and long-term predictions: mortality and population in Finland 1878-2050. Stat Med 2013; 33:845-56. [DOI: 10.1002/sim.5954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 07/02/2013] [Accepted: 07/26/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Aki S. Havulinna
- Chronic Disease Epidemiology and Prevention Unit; National Institute for Health and Welfare; Helsinki Finland
- Department of Biomedical Engineering and Computational Science; Aalto University; Espoo Finland
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