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van Oort S, Rutters F, Warlé‐van Herwaarden MF, Schram MT, Stehouwer CD, Tack CJ, Abbink EJ, Wolffenbuttel BH, van der Klauw MM, DeVries JH, Siegelaar SE, Sijbrands EJ, Özcan B, de Valk HW, Silvius B, Schroijen MA, Jazet IM, van Ballegooijen AJ, Beulens JWJ, Elders PJ, Kramers C. Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort. Diabet Med 2021; 38:e14406. [PMID: 32961611 PMCID: PMC8048843 DOI: 10.1111/dme.14406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/15/2020] [Accepted: 09/11/2020] [Indexed: 12/30/2022]
Abstract
AIM To describe the prevalence and characteristics of polypharmacy in a Dutch cohort of individuals with type 2 diabetes. METHODS We included people with type 2 diabetes from the Diabetes Pearl cohort, of whom 3886 were treated in primary care and 2873 in academic care (secondary/tertiary). With multivariable multinomial logistic regression analyses stratified for line of care, we assessed which sociodemographic, lifestyle and cardiometabolic characteristics were associated with moderate (5-9 medications) and severe polypharmacy (≥10 medications) compared with no polypharmacy (0-4 medications). RESULTS Mean age was 63 ± 10 years, and 40% were women. The median number of daily medications was 5 (IQR 3-7) in primary care and 7 (IQR 5-10) in academic care. The prevalence of moderate and severe polypharmacy was 44% and 10% in primary care, and 53% and 29% in academic care respectively. Glucose-lowering and lipid-modifying medications were most prevalent. People with severe polypharmacy used a relatively large amount of other (i.e. non-cardiovascular and non-glucose-lowering) medication. Moderate and severe polypharmacy across all lines of care were associated with higher age, low educational level, more smoking, longer diabetes duration, higher BMI and more cardiovascular disease. CONCLUSIONS Severe and moderate polypharmacy are prevalent in over half of people with type 2 diabetes in primary care, and even more in academic care. People with polypharmacy are characterized by poorer cardiometabolic status. These results highlight the significance of polypharmacy in type 2 diabetes.
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Affiliation(s)
- S. van Oort
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of Pharmacology and ToxicologyRadboud University Medical CenterNijmegenthe Netherlands
| | - F. Rutters
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | | | - M. T. Schram
- Department of Internal MedicineCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+Maastrichtthe Netherlands
| | - C. D. Stehouwer
- Department of Internal MedicineCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+Maastrichtthe Netherlands
| | - C. J. Tack
- Department of Internal MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - E. J. Abbink
- Department of Internal MedicineRadboud University Medical CenterNijmegenthe Netherlands
| | - B. H. Wolffenbuttel
- Department of EndocrinologyUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - M. M. van der Klauw
- Department of EndocrinologyUniversity of Groningen, University Medical Centre GroningenGroningenthe Netherlands
| | - J. H. DeVries
- Department of Internal MedicineAmsterdam University Medical Center, University of AmsterdamAmsterdamthe Netherlands
| | - S. E. Siegelaar
- Department of Internal MedicineAmsterdam University Medical Center, University of AmsterdamAmsterdamthe Netherlands
| | - E. J. Sijbrands
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - B. Özcan
- Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
| | - H. W. de Valk
- Department of Internal MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - B. Silvius
- Department of Internal MedicineUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - M. A. Schroijen
- Department of Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
| | - I. M. Jazet
- Department of Medicine, Division of EndocrinologyLeiden University Medical CenterLeidenthe Netherlands
| | - A. J. van Ballegooijen
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Department of NephrologyAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research InstituteAmsterdamthe Netherlands
| | - J. W. J. Beulens
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center, location VUmc, Amsterdam Cardiovascular Sciences Research Institute and Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - P. J. Elders
- Department of General Practice and Elderly Care MedicineAmsterdam University Medical Center, location VUmc, Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - C. Kramers
- Department of Pharmacology and ToxicologyRadboud University Medical CenterNijmegenthe Netherlands
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van Oort S, Beulens JWJ, van Ballegooijen AJ, Burgess S, Larsson SC. Cardiovascular risk factors and lifestyle behaviours in relation to longevity: a Mendelian randomization study. J Intern Med 2021; 289:232-243. [PMID: 33107078 PMCID: PMC7894570 DOI: 10.1111/joim.13196] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The American Heart Association introduced the Life's Simple 7 initiative to improve cardiovascular health by modifying cardiovascular risk factors and lifestyle behaviours. It is unclear whether these risk factors are causally associated with longevity. OBJECTIVES This study aimed to investigate causal associations of Life's Simple 7 modifiable risk factors, as well as sleep and education, with longevity using the two-sample Mendelian randomization design. METHODS Instrumental variables for the modifiable risk factors were obtained from large-scale genome-wide association studies. Data on longevity beyond the 90th survival percentile were extracted from a genome-wide association meta-analysis with 11,262 cases and 25,483 controls whose age at death or last contact was ≤ the 60th survival percentile. RESULTS Risk factors associated with a lower odds of longevity included the following: genetic liability to type 2 diabetes (OR 0.88; 95% CI: 0.84;0.92), genetically predicted systolic and diastolic blood pressure (per 1-mmHg increase: 0.96; 0.94;0.97 and 0.95; 0.93;0.97), body mass index (per 1-SD increase: 0.80; 0.74;0.86), low-density lipoprotein cholesterol (per 1-SD increase: 0.75; 0.65;0.86) and smoking initiation (0.75; 0.66;0.85). Genetically increased high-density lipoprotein cholesterol (per 1-SD increase: 1.23; 1.08;1.41) and educational level (per 1-SD increase: 1.64; 1.45;1.86) were associated with a higher odds of longevity. Fasting glucose and other lifestyle factors were not significantly associated with longevity. CONCLUSION Most of the Life's Simple 7 modifiable risk factors are causally related to longevity. Prevention strategies should focus on modifying these risk factors and reducing education inequalities to improve cardiovascular health and longevity.
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Affiliation(s)
- S van Oort
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J W J Beulens
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A J van Ballegooijen
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute and Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Nephrology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, the Netherlands
| | - S Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.,Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - S C Larsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Jansz TT, Goto NA, van Ballegooijen AJ, Willems HC, Verhaar MC, van Jaarsveld BC. The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone. Osteoporos Int 2020; 31:515-524. [PMID: 31728605 PMCID: PMC7076061 DOI: 10.1007/s00198-019-05187-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022]
Abstract
UNLABELLED The risk of vertebral fracture is unclear in end-stage renal disease. We report a high vertebral fracture prevalence and incidence in transplantation-eligible patients on dialysis, suggesting that these patients may benefit from radiographic screening for vertebral fractures. Parathyroid hormone had a U-shaped association with vertebral fracture risk. INTRODUCTION Vertebral fractures are often overlooked, but even undiagnosed vertebral fractures negatively impact physical functioning, quality of life, and mortality. The risk of vertebral fractures in end-stage renal disease (ESRD) patients is unclear, and parathyroid hormone (PTH) might play a role in the development of vertebral fractures. We therefore determined vertebral fracture prevalence and incidence in ESRD patients and assessed associations of vertebral trabecular bone mineral density (BMD) and PTH with vertebral fracture. METHODS In 146 transplantation-eligible patients on dialysis, we determined vertebral fractures on lateral chest radiographs, which image the thoracic and upper lumbar spine. We determined incident vertebral fractures in 70 patients with follow-up radiographs (23 received a kidney transplant) after median 1.8 years. Vertebral trabecular BMD was measured with computed tomography, and PTH measured with 2-site immunoassays, categorized in tertiles with the middle tertile as reference. We used Poisson regression to assess associations of vertebral trabecular BMD and PTH with vertebral fracture. RESULTS Mean age of the study population was 52 ± 13 years, and 98 (67%) were male. Median dialysis duration was 26 (IQR 13-55) months. Vertebral fractures were present in 50/146 patients (34%) and incident vertebral fractures occurred in 20/70 patients (29%). Vertebral trabecular BMD was not associated with vertebral fracture prevalence (relative risk 0.97, 95% CI 0.89 to 1.04). For the lowest PTH tertile (< 11 pmol/L), the relative risk of vertebral fracture was greater although not significant (2.28, 95% CI 0.97 to 5.97) and was significantly greater for the highest PTH tertile (≥ 30 pmol/L; 2.82, 95% CI 1.22 to 7.27) after adjustment for potential confounders. CONCLUSIONS The prevalence and incidence of vertebral fractures is high even in relatively young and healthy ESRD patients. Vertebral trabecular BMD is not associated with vertebral fracture, and the association of PTH with vertebral fracture risk appears U-shaped. Nevertheless, our study did not measure vertebral BMD using DXA and assessed vertebral fractures using lateral chest radiographs and not spine radiographs.
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Affiliation(s)
- T T Jansz
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Dianet Dialysis Centers, Utrecht, the Netherlands
| | - N A Goto
- Dianet Dialysis Centers, Utrecht, the Netherlands
- Department of Geriatrics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A J van Ballegooijen
- Department of Nephrology and Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. box 7507, 1007 MB, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - H C Willems
- Department of Geriatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - B C van Jaarsveld
- Dianet Dialysis Centers, Utrecht, the Netherlands.
- Department of Nephrology and Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit Amsterdam, P.O. box 7507, 1007 MB, Amsterdam, the Netherlands.
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Abstract
PURPOSE OF REVIEW Vitamin K is a fat-soluble vitamin required for the activation of several vitamin K-dependent proteins to confer functioning. A growing body of evidence supports that vitamin K has beneficial effects on bone and cardiovascular health. This review summarizes key evidence on vitamin K status as measured by circulating measures and cardiovascular outcomes. RECENT FINDINGS Overall, observational studies indicate that low vitamin K status as measured by high dephosphorylated uncarboxylated matrix gla protein concentrations plays a potential role in cardiovascular disease development, particularly in high-risk and chronic kidney disease populations. Very few vitamin K intervention trials have been conducted with cardiovascular-related outcomes. A couple of intervention trials studied the effect of the combination of vitamin D + K supplementation, which might have synergistic effects compared to vitamin K supplementation alone. SUMMARY Assessing vitamin K status in prospective studies and well-designed randomized trials would provide important insight whether vitamin K is causally related to vascular calcification and cardiovascular disease.
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Affiliation(s)
- A J van Ballegooijen
- Department of Health Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - J W Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Abstract
A systematic literature review was conducted to summarize the existing evidence on presumed determinants of heart failure (HF) medication adherence. The aim was to assess the evidence and provide directions for future medication adherence interventions for HF patients. Based on a search in relevant databases and a quality assessment, eleven articles were included in the review. A best evidence synthesis was used to combine the results of presumed determinants that were found more than once in the literature. Results were classified according the World Health Organization's (WHO) multidimensional adherence model. Results demonstrated a relationship between having been institutionalized in the past (including hospitalizations and nursing home visits) and higher adherence levels. This finding is related to the healthcare system dimension of the WHO model. The presumed determinants related to the other dimensions, such as social and economic factors, condition-related, therapy-related, and patient-related factors of the multidimensional adherence model all had inconsistent evidence. However, there was also an indication that patients' educational level and the number of healthcare professionals they have visited are not related to higher adherence levels. Based on the current review, HF patients who have been institutionalized in the past are more adherent to HF medication. Many other presumed determinants were investigated, but displayed inconsistent evidence. Due to the lack of evidence, it was not possible to make recommendations for future interventions.
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van Ballegooijen AJ, Visser M, Cotch MF, Arai AE, Garcia M, Harris TB, Launer LJ, Eiríksdóttir G, Gudnason V, Brouwer IA. Serum vitamin D and parathyroid hormone in relation to cardiac structure and function: the ICELAND-MI substudy of AGES-Reykjavik. J Clin Endocrinol Metab 2013; 98:2544-52. [PMID: 23585664 PMCID: PMC3667250 DOI: 10.1210/jc.2012-4252] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CONTEXT Emerging evidence suggests that vitamin D and PTH may play a role in the development of cardiac diseases. OBJECTIVE We investigated whether 25-hydroxyvitamin D (25OHD) and PTH concentrations are cross-sectionally associated with cardiac structure and function using magnetic resonance imaging (MRI). DESIGN, SETTING, AND PARTICIPANTS ICELAND-MI is a substudy of the Age, Gene/Environment Susceptibility-Reykjavik Study, an older-aged community-dwelling cohort with oversampling of participants with diabetes (29%) and measurements between 2004 and 2007. Serum 25OHD concentrations were measured using an immunoassay (n = 992). Intact PTH concentrations were measured using a 2-site immunoassay (n = 203). We included 969 participants for this cross-sectional analysis (mean age 76 ± 5.3 years, 51% female). Mean 25OHD was 54.2 ± 25.5 nmol/L and the median PTH was 4.5 pmol/L (range 1.5-18). MAIN OUTCOMES MRI to measure cardiac structure and function was the main outcome. RESULTS The lowest 25OHD category (<25 nmol/L) compared with the highest category (≥75 nmol/L) was associated with a smaller left and right atrial area in unadjusted analyses; however, the associations became nonsignificant after adjustment for covariates. The highest PTH quartile compared with the lowest quartile was significantly associated with a 7.3 g (95% confidence interval 0.8, 13.8) greater left ventricular (LV) mass and a 5.1% (-9.1, -1.1) lower LV ejection fraction compared with the lowest PTH quartile in the fully adjusted model. CONCLUSIONS Serum 25OHD concentrations were not associated with MRI measures in an older white population. Higher PTH concentrations were associated with greater LV mass and lower systolic function and may point to a potential role for PTH as a determinant of cardiac remodeling.
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Affiliation(s)
- A J van Ballegooijen
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University, 1081 HV Amsterdam, The Netherlands.
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van Ballegooijen AJ, Reinders I, Visser M, Dekker JM, Nijpels G, Stehouwer CDA, Pilz S, Brouwer IA. Serum parathyroid hormone in relation to all-cause and cardiovascular mortality: the Hoorn study. J Clin Endocrinol Metab 2013; 98:E638-45. [PMID: 23408568 DOI: 10.1210/jc.2012-4007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Higher PTH concentrations have been associated with fatal cardiovascular diseases (CVDs), but data in the general population are scarce. OBJECTIVE We investigated whether higher PTH concentrations are prospectively associated with all-cause and CVD mortality. DESIGN, SETTING, PARTICIPANTS This study used data from the Hoorn Study, a prospective population-based cohort with baseline measurements between 2000 and 2001. We included 633 participants, mean age 70.1 ± 6.6 years, 51% female. Serum intact PTH was measured using a 2-site immunoassay. MAIN OUTCOME MEASURES Outcomes were all-cause and CVD mortality based on clinical files and coded according to the International Classification of Diseases, ninth revision. We used Kaplan-Meier plots to estimate survival curves and Cox regression to estimate hazard ratios (HRs) using season-specific PTH quartiles. RESULTS During a median follow-up of 7.8 years, 112 participants died, of which 26 deaths (23%) were cardiovascular. Survival curves by PTH quartiles differed for all-cause mortality (log-rank P = .054) and CVD mortality (log-rank P = .022). In a multivariate model, the highest PTH quartile was associated with all-cause mortality; HR = 1.98 (1.08, 3.64). Kidney function slightly attenuated the PTH risk association, but risk persisted; HR = 1.93 (1.04, 3.58). The results for CVD mortality showed a similar pattern, although the association was significant only in a threshold model (quartile 4 vs quartile 1-3); HR = 2.56 (1.11, 5.94). CONCLUSIONS Among a general older population, higher PTH concentrations were associated with higher all-cause mortality risk, mostly explained by fatal CVD events. We suggest to evaluate whether individuals with high PTH concentrations benefit from therapeutic approaches targeted to decrease PTH concentrations.
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Affiliation(s)
- A J van Ballegooijen
- Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands.
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van Ballegooijen AJ, Snijder MB, Visser M, van den Hurk K, Kamp O, Dekker JM, Nijpels G, Stehouwer CDA, Henry RMA, Paulus WJ, Brouwer IA. Vitamin D in relation to myocardial structure and function after eight years of follow-up: the Hoorn study. Ann Nutr Metab 2012; 60:69-77. [PMID: 22343754 DOI: 10.1159/000336173] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 12/21/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS To investigate associations between baseline serum 25-hydroxyvitamin D [25(OH)D] levels and myocardial structure and function after 8 years of follow-up in older Dutch subjects. METHODS We included 256 subjects of the Hoorn Study, a population-based cohort. They underwent a standardized 2-dimensional echocardiogram at baseline between 2000 and 2001, and again between 2007 and 2009. We studied the association of 25(OH)D quartiles with echocardiographic measures of the left ventricular mass index (LVMI), left ventricular systolic function and markers of diastolic function using linear regression analyses. RESULTS At baseline, subjects had a mean age of 67.4 ± 5.2 years and 41.4% had prior cardiovascular disease (CVD). Low serum 25(OH)D levels were only associated with higher LVMI at 8-year follow-up in subjects without prior CVD and in subjects with low kidney function (median estimated glomerular filtration rate ≤77.5 ml/min/1.73m(2)). The associations attenuated after adjustments for parathyroid hormone (PTH), which was associated with higher LVMI (g/m(2.7)) in subjects with low kidney function (regression coefficient highest quartile 6.3, 95% CI: 0.2, 12.5). CONCLUSION This study showed no strong associations of 25(OH)D with myocardial structure and function. However, PTH - a possible modifiable mediator in the relation between 25(OH)D and myocardial structure - was positively associated with LVMI in subjects with low kidney function.
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Affiliation(s)
- A J van Ballegooijen
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
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Oosterom-Calo R, van Ballegooijen AJ, Terwee CB, te Velde SJ, Brouwer IA, Jaarsma T, Brug J. Determinants of heart failure self-care: a systematic literature review. Heart Fail Rev 2011; 17:367-85. [DOI: 10.1007/s10741-011-9292-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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