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Lindholt JS, Rasmussen LM, Søgaard R, Lambrechtsen J, Steffensen FH, Frost L, Egstrup K, Urbonaviciene G, Busk M, Olsen MH, Hallas J, Diederichsen AC. Baseline findings of the population-based, randomized, multifaceted Danish cardiovascular screening trial (DANCAVAS) of men aged 65–74 years. Br J Surg 2019; 106:862-871. [DOI: 10.1002/bjs.11135] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background
The challenge of managing age-related diseases is increasing; routine checks by the general practitioner do not reduce cardiovascular mortality. The aim here was to reduce cardiovascular mortality by advanced population-based cardiovascular screening. The present article reports the organization of the study, the acceptability of the screening offer, and the relevance of multifaceted screening for prevention and management of cardiovascular disease.
Methods
Danish men aged 65–74 years were invited randomly (1 : 2) to a cardiovascular screening examination using low-dose non-contrast CT, ankle and brachial BP measurements, and blood tests.
Results
In all, 16 768 of 47 322 men aged 65–74 years were invited and 10 471 attended (uptake 62·4 per cent). Of these, 3481 (33·2 per cent) had a coronary artery calcium score above 400 units. Thoracic aortic aneurysm was diagnosed in the ascending aorta (diameter 45 mm or greater) in 468 men (4·5 per cent), in the arch (at least 40 mm) in 48 (0·5 per cent) and in the descending aorta (35 mm or more) in 233 (2·2 per cent). Abdominal aortic aneurysm (at least 30 mm) and iliac aneurysm (20 mm or greater) were diagnosed in 533 (5·1 per cent) and 239 (2·3 per cent) men respectively. Peripheral artery disease was diagnosed in 1147 men (11·0 per cent), potentially uncontrolled hypertension (at least 160/100 mmHg) in 835 (8·0 per cent), previously unknown atrial fibrillation confirmed by ECG in 50 (0·5 per cent), previously unknown diabetes mellitus in 180 (1·7 per cent) and isolated severe hyperlipidaemia in 48 men (0·5 per cent).
In all, 4387 men (41·9 per cent), excluding those with potentially uncontrolled hypertension, were referred for additional cardiovascular prevention. Of these, 3712 (35·5 per cent of all screened men, but 84·6 per cent of those referred) consented and were started on medication.
Conclusion
Multifaceted cardiovascular screening is feasible and may optimize cardiovascular disease prevention in men aged 65–74 years. Uptake is lower than in aortic aneurysm screening.
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Affiliation(s)
- J S Lindholt
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - L M Rasmussen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - R Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J Lambrechtsen
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - F H Steffensen
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - L Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - K Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - M H Olsen
- CIMA, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - J Hallas
- Institute of Pharmacology, University of Southern Denmark, Odense, Denmark
| | - A C Diederichsen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiology, Odense University Hospital, Odense, Denmark
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Diederichsen LP, Simonsen JA, Diederichsen AC, Hvidsten S, Hougaard M, Junker P, Søndergaard K, Lundberg IE, Tvede N, Sandgaard NCF, Christensen AF, Dreyer L, Kay S, Eskerud KS, Petersen H, Ejstrup L, Jacobsen S. Cardiac Abnormalities in Adult Patients With Polymyositis or Dermatomyositis as Assessed by Noninvasive Modalities. Arthritis Care Res (Hoboken) 2017; 68:1012-20. [PMID: 26502301 DOI: 10.1002/acr.22772] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/09/2015] [Accepted: 10/20/2015] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Cardiac events are a major cause of death in patients with idiopathic inflammatory myopathies. The study objective was in a controlled setting to describe cardiac abnormalities by noninvasive methods in a cohort of patients with polymyositis (PM) or dermatomyositis (DM) and to identify predictors for cardiac dysfunction. METHODS In a cross-sectional study, 76 patients with PM/DM and 48 matched healthy controls (HCs) were assessed by serum levels of cardiac troponin I, electrocardiography, Holter monitoring, echocardiography with tissue Doppler imaging, and quantitative cardiac (99m) Tc-pyrophosphate ((99m) Tc-PYP) scintigraphy. RESULTS Compared to HCs, patients with PM/DM more frequently had left ventricular diastolic dysfunction (LVDD) (12% versus 0%; P = 0.02) and longer QRS and QT intervals (P = 0.007 and P < 0.0001, respectively). In multivariate analysis, factors associated with LVDD were age (P = 0.001), disease duration (P = 0.004), presence of myositis-specific or -associated autoantibodies (P = 0.05), and high cardiac (99m) Tc-PYP uptake (P = 0.006). In multivariate analysis of the pooled data for patients and HCs, a diagnosis of PM/DM (P < 0.0001) was associated with LVDD. CONCLUSION Patients with PM or DM had an increased prevalence of cardiac abnormalities compared to HCs. LVDD was a common occurrence in PM/DM patients and correlated to disease duration. In addition, the association of LVDD with myositis-specific or -associated autoantibodies and high cardiac (99m) Tc-PYP uptake supports the notion of underlying autoimmunity and myocardial inflammation in patients with PM/DM.
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Affiliation(s)
| | | | | | - S Hvidsten
- Odense University Hospital, Odense, Denmark
| | - M Hougaard
- Odense University Hospital, Odense, Denmark
| | - P Junker
- Odense University Hospital, Odense, Denmark
| | | | - I E Lundberg
- Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - N Tvede
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - L Dreyer
- Gentofte University Hospital, Hellerup, Denmark
| | - S Kay
- Odense University Hospital, Odense, Denmark
| | | | - H Petersen
- Odense University Hospital, Odense, Denmark
| | | | - S Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Diederichsen LP, Simonsen JA, Diederichsen AC, Hvidsten S, Hougaard MV, Junker P, Lundberg LE, Jacobsen S. SAT0200 Abnormal Cardiac SPECT/CT in Newly Diagnosed, Untreated Patients with Idiopathic Inflammatory Myopathies. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dalen H, Thorstensen A, Romundstad PR, Aase SA, Stoylen A, Vatten L, Coll B, Feinstein SB, Fernandez E, Betriu A, Nambi V, Zamorano JL, Hristova K, Katova TZ, D'hooge J, Sandgaard N, Diederichsen AC, Moller JE, Thayssen P, Vlahovic-Stipac A, Otasevic P, Stankovic I, Putnikovic B, Neskovic AN, Chrzanowski L, Kasprzak JD, Busz-Papiez B, Wita K, Gasior Z, Kukulski T, Tomaszewski A, Mizia-Stec K, Wojciechowska C, Plonska-Gosciniak E, Lemarie J, Valla M, Huttin O, Sellal JM, Oliver C, Christophe C, Marcon O, Schwartz J, Popovic B, Selton-Suty C, Trifunovic D, Sobic-Saranovic D, Ostojic M, Stankovic S, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Banovic M, Boricic M, Draganic G, Kiviniemi TO, Ylitalo A, Karjalainen PP, Saraste A, Mikkelsson J, Airaksinen KEJ, Bobescu E, Radoi M, Datcu G, Dobreanu D, Doka BF. Moderated Posters session IV: Viability and recovery of systolic function. The echo approach * Friday 10 December 2010, 15:30-16:30. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Diederichsen AC, Zeuthen J, Christensen PB, Kristensen T. Characterisation of tumour infiltrating lymphocytes and correlations with immunological surface molecules in colorectal cancer. Eur J Cancer 1999; 35:721-6. [PMID: 10505031 DOI: 10.1016/s0959-8049(99)00033-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Using flow cytometry, we studied the phenotype of tumour infiltrating lymphocytes (TILs) in 41 enzymatically dissociated colorectal cancers and compared this to the expression of HLA class I and II and CD80 on tumour cells. We studied the possible enzymatic damage to various surface markers after enzymatic dissociation. The reproducibility of flow cytometric determinations obtained from TILs was good (kappa value: 0.79). The median CD4+/CD8+ ratio was 2.2. Approximately 43-45% (median of cells in each tumour) of both the CD4(+)- and the CD8(+)-TILs expressed HLA class II; 14.2% of the CD4(+)-TILs expressed CD25 and none of the CD8(+)-TILs expressed CD25. CD3-/CD16+/CD56(+)-TILs were very infrequent. Expression of HLA class II did not correlate with any lymphocyte surface markers. Since TILs are "turned off" rather than stimulated when tumour cells express HLA class II but not CD80, the lack of correlations could be due to anergy.
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Affiliation(s)
- A C Diederichsen
- Department of Clinical Immunology, Odense University Hospital, Denmark.
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Diederichsen AC, Stenholm AC, Kronborg O, Fenger C, Jensenius JC, Zeuthen J, Kristensen T, Christensen PB. Immunisation of colorectal cancer patients with autologous tumour cells. Oncol Rep 1998; 5:823-6. [PMID: 9625825 DOI: 10.3892/or.5.4.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patients with colorectal cancer were entered into a clinical phase I trial of immunotherapy with an autologous tumour cell/bacillus Calmette-Guerin (BCG) vaccine. We attempted to describe the possible effects and side effects of the immunisation, and further to investigate whether expression of immune-response-related surface molecules on the tumour cells in the vaccine correlated with survival. The first and second vaccine comprised of 107 irradiated tumour cells mixed with BCG, the third of irradiated tumour cells only. Thirty-nine patients were considered, but only 6 patients fulfilled the criteria for inclusion. No serious side effects were observed. With three years of observation time, two patients are healthy, while the rest have had recurrence, and two of them have died. In all vaccines, all tumour cells expressed HLA class I, some expressed HLA class II and none expressed CD80. There was an inverse relation between survival and HLA class II expression. This highlights an essential problem, in the absence of CD80 expression the expression of HLA class II may induce anergy. In future attempts to develop improved vaccines this problem should be addressed.
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Affiliation(s)
- A C Diederichsen
- Department of Clinical Immunology, Odense University Hospital, DK-5000 Odense C, Denmark
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Diederichsen AC, Stenholm AC, Kronborg O, Fenger C, Jensenius JC, Zeuthen J, Christensen PB, Kristensen T, Ostenhom AC. Flow cytometric investigation of immune-response-related surface molecules on human colorectal cancers. Int J Cancer 1998; 79:283-7. [PMID: 9645352 DOI: 10.1002/(sici)1097-0215(19980619)79:3<283::aid-ijc13>3.0.co;2-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Our purpose was to clarify whether human colorectal cancer cells are equipped to present tumour-associated-antigens to the immune system, and whether this ability correlates with lymphoid infiltration, the Dukes' stage and Jass classification. Enzymatically dissociated tumour cells from 70 different colorectal cancers were monitored by multiparameter flow cytometry. Gating on EP4+ cells, the expression of the surface molecules HLA class I, HLA class II, CD80 (B7-1), CD54 (ICAM-I) and CD58 (LFA-3) was evaluated. In 60 of 70 tumours, all tumour cells expressed HLA class I, in 10 tumours 15-96% of the tumour cells expressed HLA class I. In 1 tumour, all tumour cells expressed HLA class II, in 67 tumours some expressed HLA class II, in 2 tumours none expressed HLA class II. Expression of CD58 was heterogeneous, and there was no or only sparse expression of CD80 and CD54. Expression of the HLA class I molecules, but not the class II, was correlated with lymphoid infiltration and the Jass classification. Expression of these surface molecules was not correlated with the Dukes' stage. The tumour cells were generally equipped to present antigens to the effector arm of the immune system since HLA class I is expressed, but the tumour cells were not optimal in stimulating an immune response, since HLA class II and CD58 were only marginally expressed and CD80 and CD54 were absent.
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Affiliation(s)
- A C Diederichsen
- Department of Clinical Immunology, Odense University Hospital, Denmark.
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Diederichsen AC, Hansen TP, Nielsen O, Fenger C, Jensenius JC, Christensen PB, Kristensen T, Zeuthen J. A comparison of flow cytometry and immunohistochemistry in human colorectal cancers. APMIS 1998; 106:562-70. [PMID: 9674894 DOI: 10.1111/j.1699-0463.1998.tb01385.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In human colorectal cancer it has been reported that some tumours lack the HLA-ABC antigens. This has been interpreted as reflecting tumour escape from the immune system. Earlier data have been obtained by immunohistochemistry. In this study, we compared the expression of HLA-ABC, HLA-DR, CD80 (B7-1) and CD54 (ICAM-1) in 20 tumours using both a conventional immunohistochemistry two-layer technique and multiparameter flow cytometry, gating on an epithelial cell marker. Colorectal cancer tissue used in flow cytometry was dissociated with collagenase, deoxyribonuclease and hyaluronidase. The intensity of expression of HLA-ABC, HLA-DR and CD80 was unaffected by the enzymes, but CD54 was decreased by 30%. The reproducibility of flow cytometry was good. Microscopy of sections revealed that about 5% of each tumour sample consisted of normal epithelium, but even after correction for this, flow cytometry was superior to immunohistochemistry in 33 out of 80 cases, and showed that tumours described as HLA-ABC negative by immunohistochemistry were in fact weakly positive for HLA-ABC. We conclude that flow cytometry and immunohistochemistry are complementary, and that flow cytometry is superior to immunohistochemistry for detecting antigens/epitopes present in low amounts.
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Affiliation(s)
- A C Diederichsen
- Department of Clinical Immunology, Odense University Hospital, Denmark
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