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Wagner AK, D'Souza M, Bang CN, Holmstrup P, Blanche P, Fiehn NE, Gislason G, Pedersen CT, Damgaard C, Nielsen CH, Hansen PR. Treated periodontitis and recurrent events after first-time myocardial infarction: A Danish nationwide cohort study. J Clin Periodontol 2023; 50:1305-1314. [PMID: 37464548 DOI: 10.1111/jcpe.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023]
Abstract
AIM To investigate the association between previous periodontal treatment and recurrent events after first-time myocardial infarction (MI). MATERIALS AND METHODS From the Danish nationwide registries, patients with first-time MI between 2000 and 2015 were divided into three groups according to oral health care within 1 year prior to first-time MI. A multiple logistic regression model provided adjusted odds ratios (ORs) with 95% confidence intervals (CIs) to assess the 3-year risk of major adverse cardiovascular events (MACE). RESULTS A total of 103,949 patients were included. Patients with treated periodontitis (PD) prior to first-time MI had an adjusted 3-year risk of MACE similar to patients presumed periodontally healthy (OR 0.97 [95% CI 0.92-1.03]). Patients with no prior dental visits were significantly older, had more comorbidities and showed significantly increased adjusted 3-year risks of MACE (OR 1.47 [95% CI 1.42-1.52]), cardiovascular death (OR 1.71 [95% CI 1.64-1.78]) and heart failure (OR 1.13 [95% CI 1.07-1.20]) compared with patients presumed periodontally healthy. CONCLUSIONS Patients with treated PD 1 year prior to first-time MI had a similar risk of recurrent cardiovascular events as patients presumed periodontally healthy. No dental visit prior to first-time MI was an independent risk factor for recurrent events.
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Affiliation(s)
- Andrea Kjellström Wagner
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Maria D'Souza
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Casper N Bang
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Palle Holmstrup
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Paul Blanche
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Nils-Erik Fiehn
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Christian Damgaard
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claus Henrik Nielsen
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Peter Riis Hansen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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2
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Halili A, Holt A, Eroglu TE, Haxha S, Zareini B, Torp-Pedersen C, Bang CN. The effect of discontinuing beta-blockers after different treatment durations following acute myocardial infarction in optimally treated, stable patients without heart failure: a Danish, nationwide cohort study. Eur Heart J Cardiovasc Pharmacother 2023; 9:553-561. [PMID: 37391361 DOI: 10.1093/ehjcvp/pvad046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/17/2023] [Accepted: 06/29/2023] [Indexed: 07/02/2023]
Abstract
AIMS We studied the effect of discontinuing beta-blockers following myocardial infarction in comparison to continuous beta-blocker use in optimally treated, stable patients without heart failure. METHODS AND RESULTS Using nationwide registers, we identified first-time myocardial infarction patients treated with beta-blockers following percutaneous coronary intervention or coronary angiography. The analysis was based on landmarks selected as 1, 2, 3, 4, and 5 years after the first redeemed beta-blocker prescription date. The outcomes included all-cause death, cardiovascular death, recurrent myocardial infarction, and a composite outcome of cardiovascular events and procedures. We used logistic regression and reported standardized absolute 5-year risks and risk differences at each landmark year. Among 21 220 first-time myocardial infarction patients, beta-blocker discontinuation was not associated with an increased risk of all-cause death, cardiovascular death, or recurrent myocardial infarction compared with patients continuing beta-blockers (landmark year 5; absolute risk difference [95% confidence interval]), correspondingly; -4.19% [-8.95%; 0.57%], -1.18% [-4.11%; 1.75%], and -0.37% [-4.56%; 3.82%]). Further, beta-blocker discontinuation within 2 years after myocardial infarction was associated with an increased risk of the composite outcome (landmark year 2; absolute risk [95% confidence interval] 19.87% [17.29%; 22.46%]) compared with continued beta-blocker use (landmark year 2; absolute risk [95% confidence interval] 17.10% [16.34%; 17.87%]), which yielded an absolute risk difference [95% confidence interval] at -2.8% [-5.4%; -0.1%], however, there was no risk difference associated with discontinuation hereafter. CONCLUSION Discontinuation of beta-blockers 1 year or later after a myocardial infarction without heart failure was not associated with increased serious adverse events.
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Affiliation(s)
- Andrim Halili
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Anders Holt
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, 22-30 Park Avenue, Auckland 1023, New Zealand
| | - Talip E Eroglu
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Saranda Haxha
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
- Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Bochra Zareini
- Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
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Haxha S, Halili A, Malmborg M, Pedersen-Bjergaard U, Philbert BT, Lindhardt TB, Hoejberg S, Schjerning AM, Ruwald MH, Gislason GH, Torp-Pedersen C, Bang CN. Type 2 diabetes mellitus and higher rate of complete atrioventricular block: a Danish Nationwide Registry. Eur Heart J 2023; 44:752-761. [PMID: 36433808 DOI: 10.1093/eurheartj/ehac662] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/10/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022] Open
Abstract
AIMS The present study aimed to determine the association between Type 2 diabetes mellitus (T2DM) and third-degree (complete) atrioventricular block. METHODS AND RESULTS This nationwide nested case-control study included patients older than 18 years, diagnosed with third-degree atrioventricular block between 1 July 1995 and 31 December 2018. Data on medication, comorbidity, and outcomes were collected from Danish registries. Five controls, from the risk set of each case of third-degree atrioventricular block, were matched on age and sex to fit a Cox regression model with time-dependent exposure and time-dependent covariates. Subgroup analysis was conducted with Cox regression models for each subgroup. We located 25 995 cases with third-degree atrioventricular block that were matched with 130 004 controls. The mean age was 76 years and 62% were male. Cases had more T2DM (21% vs. 11%), hypertension (69% vs. 50%), atrial fibrillation (25% vs. 10%), heart failure (20% vs. 6.3%), and myocardial infarction (19% vs. 9.2%), compared with the control group. In Cox regression analysis, adjusting for comorbidities and atrioventricular nodal blocking agents, T2DM was significantly associated with third-degree atrioventricular block (hazard ratio: 1.63, 95% confidence interval: 1.57-1.69). The association remained in several subgroup analyses of diseases also suspected to be associated with third-degree atrioventricular block. There was a significant interaction with comorbidities of interest including hypertension, atrial fibrillation, heart failure, and myocardial infarction. CONCLUSION In this nationwide study, T2DM was associated with a higher rate of third-degree atrioventricular block compared with matched controls. The association remained independent of atrioventricular nodal blocking agents and other comorbidities known to be associated with third-degree atrioventricular block.
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Affiliation(s)
- Saranda Haxha
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.,Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Andrim Halili
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.,Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Morten Malmborg
- Danish Heart Foundation, Randersgade 60, 2100 Copenhagen, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b 33.5, 2200 Copenhagen, Denmark
| | - Berit T Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tommi B Lindhardt
- Department of Cardiology, Herlev-Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Soeren Hoejberg
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Anne-Marie Schjerning
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark
| | - Martin H Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.,Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, build. 24 Q, 1st floor 1353 Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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Wood-Kurland HK, Phelps M, Thune JJ, Philbert B, Larroudé CE, Schou M, Hansen ML, Gislason GH, Bang CN. Impact of Nationwide COVID-19 Lockdowns on the Implantation Rate of Cardiac Implantable Electronic Devices. Heart Lung Circ 2023; 32:364-372. [PMID: 36513581 PMCID: PMC9741195 DOI: 10.1016/j.hlc.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/05/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
AIM The COVID-19 pandemic resulted in a significant decrease in the number of hospital admissions for severe emergent cardiovascular diseases during lockdowns worldwide. This study aimed to determine the impact of both the first and the second Danish nationwide lockdown on the implantation rate of cardiac implantable electronic devices (CIEDs). METHODS We retrospectively analysed the number of CIED implantations performed in Denmark and stratified them into 3-week intervals. RESULTS The total number of de novo CIED implantations decreased during the first lockdown by 15.5% and during the second by 5.1%. Comparing each 3-week interval using rate ratios, a significant decrease in the daily rates of the total number of de novo and replacement CIEDs (0.82, 95% CI [0.70, 0.96]), de novo CIEDs only (0.82, 95% CI [0.69, 0.98]), and non-acute pacemaker implantations (0.80, 95% CI [0.63, 0.99]) was observed during the first interval of the first lockdown. During the second lockdown (third interval), a significant decrease was seen in the daily rates of de novo CIEDs (0.73, 95% CI [0.55, 0.97]), and of pacemakers in total during both the second (0.78, 95% CI [0.62, 0.97]) and the third (0.60, 95% CI [0.42, 0.85]) intervals. Additionally, the daily rates of acute pacemaker implantation decreased during the second interval (0.47, 95% CI [0.27, 0.79]) and of non-acute implantation during the third interval (0.57, 95% CI [0.38, 0.84]). A significant increase was observed in the number of replacement procedures during the first interval of the second lockdown (1.70, 95% CI [1.04, 2.85]). CONCLUSIONS Our study found only modest changes in CIED implantations in Denmark during two national lockdowns.
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Affiliation(s)
- Hannah K Wood-Kurland
- Department of Cardiology, Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Jens Jakob Thune
- Department of Cardiology, Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark
| | - Berit Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | | | - Gunnar H Gislason
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark; Danish Heart Foundation, Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Bispebjerg & Frederiksberg Hospitals, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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5
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El-Chouli M, Meddis A, Christensen DM, Gerds TA, Sehested T, Malmborg M, Phelps M, Bang CN, Ahlehoff O, Torp-Pedersen C, Sindet-Pedersen C, Raunsø J, Idorn L, Gislason G. Lifetime risk of comorbidity in patients with simple congenital heart disease: a Danish nationwide study. Eur Heart J 2022; 44:741-748. [PMID: 36477305 PMCID: PMC9976987 DOI: 10.1093/eurheartj/ehac727] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 05/09/2022] [Revised: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS In a continuously ageing population of patients with congenital heart disease (CHD), understanding the long-term risk of morbidity is crucial. The aim of this study was to compare the lifetime risks of developing comorbidities in patients with simple CHD and matched controls. METHODS AND RESULTS Using the Danish nationwide registers spanning from 1977 to 2018, simple CHD cases were defined as isolated atrial septal defect (ASD), ventricular septal defect (VSD), pulmonary stenosis, or patent ductus arteriosus in patients surviving until at least 5 years of age. There were 10 controls identified per case. Reported were absolute lifetime risks and lifetime risk differences (between patients with simple CHD and controls) of incident comorbidities stratified by groups and specific cardiovascular comorbidities. Of the included 17 157 individuals with simple CHD, the largest subgroups were ASD (37.7%) and VSD (33.9%), and 52% were females. The median follow-up time for patients with CHD was 21.2 years (interquartile range: 9.4-39.0) and for controls, 19.8 years (9.0-37.0). The lifetime risks for the investigated comorbidities were higher and appeared overall at younger ages for simple CHD compared with controls, except for neoplasms and chronic kidney disease. The lifetime risk difference among the comorbidity groups was highest for neurological disease (male: 15.2%, female: 11.3%), pulmonary disease (male: 9.1%, female: 11.7%), and among the specific comorbidities for stroke (male: 18.9%, female: 11.4%). The overall risk of stroke in patients with simple CHD was mainly driven by ASD (male: 28.9%, female: 17.5%), while the risks of myocardial infarction and heart failure were driven by VSD. The associated lifetime risks of stroke, myocardial infarction, and heart failure in both sexes were smaller in invasively treated patients compared with untreated patients with simple CHD. CONCLUSION Patients with simple CHD had increased lifetime risks of all comorbidities compared with matched controls, except for neoplasms and chronic kidney disease. These findings highlight the need for increased attention towards early management of comorbidity risk factors.
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Affiliation(s)
| | - Alessandra Meddis
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | - Thomas A Gerds
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Sehested
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Roskilde University Hospital, Zealand, Denmark
| | - Morten Malmborg
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Matthew Phelps
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Departments of Clinical Investigation and Cardiology, North Zealand University Hospital, Hillerød, Denmark
| | | | - Jakob Raunsø
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Lars Idorn
- Department of Pediatric Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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6
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Pallisgaard J, Greve AM, Lock-Hansen M, Thune JJ, Fosboel EL, Devereux RB, Okin PM, Gislason GH, Torp-Pedersen C, Bang CN. Atrial fibrillation onset before heart failure or vice versa: what is worst? A nationwide register study. Europace 2022; 25:283-290. [PMID: 36349557 PMCID: PMC9935045 DOI: 10.1093/europace/euac186] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/16/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Atrial fibrillation (AF) and heart failure (HF) often coexist. However, whether AF onset before HF or vice versa is associated with the worst outcome remains unclear. A consensus of large studies can guide future research and preventive strategies to better target high-risk patients. METHODS AND RESULTS We included all Danish cases with the coexistence of AF and HF (2005-17) using nationwide registries. Patients were divided into three separate groups (i) AF before HF, (ii) HF before AF, or (iii) AF and HF diagnosed concurrently (±30 days). Adjusting landmark Cox analyses (index date was the time of the latter diagnosis of AF or HF) were used for evaluating the association of the three groups with a composite outcome of ischaemic stroke or death. Among a total of 49 042 patients included, 40% had AF before HF, 27% had HF before AF, and 33% had AF and HF diagnosed concurrently. The composite endpoint accrued more often in patients with HF before AF compared to the two other groups (<0.001), and this remained significant in the adjusted analyses with hazard ratios (95% confidence intervals) of 1.26 (1.22-1.30) compared to AF before HF. Finally, antihypertensive treatment, oral anticoagulants, amiodarone, statins, and AF ablation were associated with a lower hazard ratio of the composite endpoint (all < 0.001). CONCLUSIONS In this large Danish national cohort, diagnosis of HF before AF was associated with an increased absolute risk of death compared to AF before HF and AF and HF diagnosed concurrently. Antihypertensive treatment, oral anticoagulants, amiodarone, statins, and AF ablation may improve prognosis.
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Affiliation(s)
- Jannik Pallisgaard
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen 2900, Denmark
| | - Anders M Greve
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University, Copenhagen 2100, Denmark
| | - Morten Lock-Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen 2900, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Copenhagen University, Copenhagen 2400, Denmark
| | - Emil Loldrup Fosboel
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University, Copenhagen 2100, Denmark
| | - Richard B Devereux
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Peter M Okin
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, NY 10065, USA
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen 2900, Denmark,Department of Research, Danish Heart Foundation, Copenhagen 1120, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Copenhagen University, Copenhagen 3400, Denmark
| | - Casper N Bang
- Corresponding author. Tel: +4538635000. E-mail address:
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7
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Hendriksen S, Karlsen FM, Philbert BT, Person S, Koeber L, Torp-Pedersen C, Bang CN. Mobitz type I 2nd degree atrioventricular (Wenckebach) block and cardiovascular death using 978,901 12 lead ECGs recordings. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mobitz type I 2nd degree atrioventricular (AV) block (Wenckebach) is usually considered benign. Guidelines recommend permanent cardiac pacing for patients with Mobitz type II second degree AV block (Mobitz II), but for patients with Wenckebach, permanent pacing is only indicated if the AV block causes symptoms or if the conductions delay occurs below the bundle of His. However, these guidelines are based on evidence of modest quality and a consensus amongst experts (1).
Purpose
This study aims to investigate if Wenckebach really is benign by comparing the risk of cardiovascular death for patients with Wenckebach to patients with normal ECGs.
Methods
This retrospective cohort study included 978,901 ECGs obtained from general practitioners in Denmark from 01/02/2001 to 31/10/2014. Index date was the day of the ECG recording and the patients were followed until death or end of follow up at December 2019.
The association between Wenckebach and cardiovascular death was analyzed using: 1) multivariate Cox models adjusted for age and comorbidities, 2) cause-specific Cox models and 3) cumulative risk and cause-specific hazard function plots, compared to matched controls. Information about comorbidities, pacemaker, indications, and death was retrieved from Danish nationwide registries.
Results
From the 978,901 ECG recordings, we found 262 patients with Wenckebach, 131 patients with Mobitz II, and 229,056 patients with normal ECGs. In Wenckebach, Mobitz II, and normal ECG the median age was 76, 80, and 50 years, 76%, 63%, and 41% were male, 25%, 16%, and 3% had diabetes, 35%, 30%, and 8% had hypertension, respectively.
During a mean follow-up of 11.2 years, cardiovascular death occurred in a total of 11,301 patients: 77 (29%) patients with Wenckebach, 40 (31%) patients with Mobitz II, and 11,184 (5%) patients with normal ECGs. In a matched cohort 262 Wenckebach patients were matched with 520 controls with normal ECGs. In the multivariate Cox model, Wenckebach was associated with cardiovascular death (HR: 2.14 [95% CI: 1.46–3.13], P<0.001). Furthermore, in multivariate cause-specific Cox analysis with non-cardiovascular death and pacemaker as competing risk, Wenckebach was still associated with cardiovascular death (HR: 2.27 [95% CI: 1.37–3.75], P=0.001).
Furthermore, the results showed that 43% of the Wenckebach patients received pacemaker with a median time to pacemaker from ECG recording being 252 days. The vast majority of the Wenckebach patients who received pacemaker had a higher degree AV block than Wenckebach as indication for the implantation.
Conclusion
Wenckebach on routine ECG was associated with a significant higher hazard rate of cardiovascular death compared to matched controls with normal ECGs.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Danish Heart Association
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Affiliation(s)
| | | | - B T Philbert
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - S Person
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Torp-Pedersen
- Hillerod Hospital, Department of Cardiology , Hillerod , Denmark
| | - C N Bang
- Bispebjerg Hospital , Copenhagen , Denmark
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8
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Haxha S, Halili A, Malmborg M, Pedersen-Bjergaard U, Philbert BT, Lindhardt TB, Hoejberg S, Schjerning AM, Ruwald MH, Gislason GH, Torp-Pedersen C, Bang CN. Type 2 diabetes is associated with higher risk of 3rd degree atrioventricular block: a Danish nationwide registry study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Type 2 diabetes (T2DM) is suggested to affect the function of the cardiomyocytes and electrical pathways which could cause conduction abnormalities and cardiac arrhythmias, such as 3rd degree atrioventricular block. The association of T2DM and 3rd degree atrioventricular block has never been confirmed in large nationwide studies.
Purpose
To determine the association between T2DM and 3rd degree atrioventricular block.
Method
This nationwide nested case-control study design included patients older than 18 years, diagnosed with 3rd degree atrioventricular block between 1st of July 1995 and 31st of December 2018. Five controls from the risk set of each case of 3rd degree atrioventricular block were matched on age and sex to fit a Cox regression model with time-dependent exposure (T2DM) and time-dependent covariates and baseline hazard function stratified for age and sex. Subgroup analysis was conducted with Cox models for each subgroup.
Results
We identified 31.177 cases with 3rd degree atrioventricular block that were matched with 155.885 controls. The mean age was 78 years and 60% were males. Cases had higher prevalence of T2DM (20% vs 7.8%), hypertension (70% vs 43%) myocardial infarction (16% vs 6.6%), and heart failure (21% vs 5.9%) compared to the control group. In a Cox analysis T2DM was significantly associated with a higher rate of 3rd degree atrioventricular block [HR 2.61 (95% CI: 2.54–2.71)]. The association remained in several subgroup analyses of diseases suspected to be associated with 3rd degree atrioventricular block. There was a significant interaction with sex and age groups and comorbidities of interest including hypertension, atrial fibrillation, heart failure and myocardial infarction (Figure 1).
Conclusion
T2DM is associated with a higher rate of 3rd degree atrioventricular block. The findings were consistent across subgroups.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was funded by the independent research foundation Skibsreder Per Henrik, R. og Hustrus Fond
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Affiliation(s)
- S Haxha
- Bispebjerg University Hospital , Copenhagen , Denmark
| | - A Halili
- Bispebjerg University Hospital , Copenhagen , Denmark
| | - M Malmborg
- The Danish Heart Foundation , Copenhagen , Denmark
| | | | - B T Philbert
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - T B Lindhardt
- Herlev-Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - S Hoejberg
- Bispebjerg University Hospital , Copenhagen , Denmark
| | | | - M H Ruwald
- Herlev-Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - G H Gislason
- Herlev-Gentofte University Hospital, Department of Cardiology , Copenhagen , Denmark
| | - C Torp-Pedersen
- Nordsjaellands Hospital, Department of Cardiology , Hilleroed , Denmark
| | - C N Bang
- Bispebjerg University Hospital , Copenhagen , Denmark
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9
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Zhou Y, Haxha S, Torp-Pedersen C, Philbert B, Nielsen OW, Sajadieh A, Koeber L, Gislason GH, Bang CN. Risk of pericardiac effusion after cardiac implantable electronic device implantation a nationwide study. Europace 2022. [DOI: 10.1093/europace/euac053.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Procedural pericardiac effusion (PE) is considered a major complication to implantation of cardiac implantable electronic devices (CIED), including permanent pacemakers (PM), cardiac resynchronization therapy devices with defibrillators (CRT-D) or without (CRT-P), and implantable cardioverter defibrillators (ICD), as it can cause life threatening cardiac tamponade. Very little is known about risk factors for procedural PE.
Aim
To identify the patient- and procedure related risk factors associated with clinically relevant procedural PE.
Methods & Results
This is a nationwide retrospective observational cohort study based on data on 51.599 patients from the Danish Pacemaker Register. Included were all Danish patients who received their first PM, CRT or ICD from 2000 – 2018. Procedural PE was defined related to the invasive procedure if it occurred within 1 months after the invasive procedure and no cancer was diagnosed before the procedure. Pre-specified risk factors, including sex, age, year, implantation center-type and device type were analyzed by multivariable logistic regression models to estimate the association with PE. A total of 78 (0.2%) patients were diagnosed with procedural PE, with a median age of 73 years and 43% were females. In adjusted logistic regression analysis age > 70, heart failure [aOR 1.64 (1.01;2.67)], ischemic heart disease [aOR 1.84 (1.13;2.99)], direct oral anticoagulation [aOR 1.77 (1.13–2.77.)], amiodarone use [aOR 3.03 (1.75–5.22)], beta blocking agent [aOR 2.26 (1.23 –4.14)], university hospitals [aOR 2.59 (1.18 –5.67)] and PM implantation [aOR 3.38 (1.77;6.45)], were associated with PE.
Conclusion
Procedural PE is a rare complication after CIED implantation in Denmark. Importantly most of the risk factors for PE are modifiable. Optimizing the modifiable risk factors may reduce the risk of complication.
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Affiliation(s)
- Y Zhou
- Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - S Haxha
- Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - C Torp-Pedersen
- Hillerod Hospital, Department of Cardiology, Hillerod, Denmark
| | - B Philbert
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - O W Nielsen
- Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - A Sajadieh
- Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G H Gislason
- Herlev and Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C N Bang
- Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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10
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Bang CN, Li Z, Stokke IM, Kjeldsen SE, Julius S, Hille DA, Wachtell K, Devereux RB, Okin PM. Incident left bundle branch block predicts cardiovascular events and death in hypertensive patients with left ventricular hypertrophy. The LIFE Study. Exploration of Medicine 2022. [DOI: 10.37349/emed.2022.00081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: Whether incident left bundle branch block (LBBB) is associated with increased cardiovascular (CV) morbidity and mortality in treated hypertensive patients with left ventricular hypertrophy (LVH) is unknown. Thus, the present study aimed to examine CV outcomes of incident LBBB in treated hypertensive patients with LVH.
Methods: In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, 9,193 hypertensive patients with LVH on screening electrocardiogram (ECG) were randomized to losartan or atenolol based treatment. Participants (n = 8,567) did not have LBBB (Minnesota code 7.1) on baseline ECG. Cox regression models controlling for significant covariates assessed independent associations of incident LBBB with CV events and all-cause mortality during 4.8 years mean follow-up.
Results: Annual follow-up ECGs identified 295 patients (3.4%) with incident LBBB associated with male gender (P < 0.05), older age, higher Cornell voltage (both P < 0.005) and history of diabetes, isolated systolic hypertension and prevalent CV disease. When adjusted for the history of previous CV disease, diabetes, isolated systolic hypertension, the Framingham risk score, ECG-LVH and randomized study treatment, Cox regression models showed that incident LBBB predicted higher risk of the composite endpoint CV death, myocardial infarction and stroke [hazard ratio (HR) 1.9, 95% confidence intervals (CIs) 1.3–2.9, P < 0.001], CV death (HR 3.0, 95% CIs 1.84–5.0, P < 0.001), heart failure (HR 3.6, 95% CIs 1.9–6.6, P < 0.001) and all-cause mortality (HR 3.0, 95% CIs 2.0–4.3, P < 0.001).
Conclusions: These data suggest that among hypertensive patients with ECG-LVH receiving aggressive antihypertensive therapy, incident LBBB independently predicts increased risk of subsequent CV events including congestive heart failure and CV and all-cause mortality (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Casper N. Bang
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA 2Department of Cardiology, Frederiksberg and Bispebjerg Hospital, 2200 Copenhagen, Denmark
| | - Zhibin Li
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Ildri M. Stokke
- 3Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- 3Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway 4Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- 4Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Darcy A. Hille
- 5Merck Research Laboratories, North Wales, PA 19454, USA
| | - Kristian Wachtell
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Richard B. Devereux
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Peter M. Okin
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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11
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Bang CN, Greve AM, Køber L, Muthiah A, Kjeldsen SE, Julius S, Wachtell K, Devereux RB, Okin PM. Incident atrial fibrillation and heart failure in treated hypertensive patients with left ventricular hypertrophy. The LIFE Study. Exploration of Medicine 2022. [DOI: 10.37349/emed.2022.00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: The present study investigated the appearance and severity of atrial fibrillation (AF) and heart failure (HF) in 8,702 hypertensive patients with left ventricular hypertrophy (LVH) receiving antihypertensive treatment in a prospective trial.
Methods: Patients who had a history of AF or HF were not included, and the participants had sinus rhythm when they were randomly allocated to blinded study medication. Endpoints were adjudicated.
Results: Incident AF occurred in 679 patients (7.8%) and HF in 246 patients (2.8%) during 4.7 ± 1.1 years mean follow-up. Incident AF was associated with a > 4-fold increased risk of developing subsequent HF [hazards ratios (HRs) = 4.7; 95% confidence intervals (CIs), 3.1–7.0; P < 0.001] in multivariable Cox analyses adjusting for age, sex, race, randomized treatment, standard cardiovascular risk factors and incident myocardial infarction. The development of HF as a time-dependent variable was associated with a multivariable-adjusted 3-fold increase of the primary study endpoint (HRs = 3.11; 95% CIs, 1.52–6.39; P < 0.001) which was a composite of myocardial infarction, stroke or cardiovascular death. Incident HF was associated with a > 3-fold increased risk of developing subsequent AF (HRs = 3.3; 95% CIs, 2.3–4.9; P < 0.001). This development of AF was associated with a > 2-fold increase of the composite primary study endpoint in multivariable Cox analysis (HRs = 2.26; 95% CIs, 1.09–4.67; P = 0.028).
Conclusions: Incident atrial fibrillation and heart failure are associated with increased risk of the other in treated hypertensive patients with left ventricular hypertrophy. Such high-risk hypertensive patients who subsequently develop both atrial fibrillation and heart failure have particular high risk of composite myocardial infarction, stroke or cardiovascular death (ClinicalTrials.gov identifier: NCT00338260).
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Affiliation(s)
- Casper N. Bang
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA 2Department of Cardiology, Frederiksberg and Bispebjerg Hospital, 2200 Copenhagen, Denmark
| | - Anders M. Greve
- 3Department of Clinical Biochemistry, Rigshopsitalet, 2200 Copenhagen, Denmark
| | - Lars Køber
- 4The Heart Center, Department of Cardiology, Rigshospitalet, 2200 Copenhagen, Denmark
| | - Anujan Muthiah
- 5Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway
| | - Sverre E. Kjeldsen
- 5Department of Cardiology, Ullevaal Hospital, University of Oslo, 0407 Oslo, Norway 6Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stevo Julius
- 6Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kristian Wachtell
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Richard B. Devereux
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Peter M. Okin
- 1Greenberg Division of Cardiology, Weill Cornell Medicine, New York, NY 10021, USA
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12
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Lilja-Cyron A, Bang CN, Gerdts E, Larstorp AC, Kjeldsen SE, Julius S, Okin PM, Wachtell K, Devereux RB. Aortic Root Dilatation in Hypertensive Patients with Left Ventricular Hypertrophy–Application of A New Multivariate Predictive Model. The Life Study. Rev Cardiovasc Med 2022; 23:95. [DOI: 10.31083/j.rcm2303095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 11/06/2022] Open
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13
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Polcwiartek C, Krogager ML, Andersen MP, Butt JH, Pallisgaard J, Fosbøl E, Schou M, Bhatt DL, Singh A, Køber L, Gislason GH, Bang CN, Torp-Pedersen C, Kragholm K, Pareek M. Prognostic implications of serial high-sensitivity cardiac troponin testing among patients with COVID-19: A Danish nationwide registry-based cohort study. Am Heart J Plus 2022; 14:100131. [PMID: 35463196 PMCID: PMC9013153 DOI: 10.1016/j.ahjo.2022.100131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023]
Abstract
Background Although troponin elevation is associated with worse outcomes among patients with coronavirus disease 2019 (COVID-19), prognostic implications of serial troponin testing are lacking. We investigated the association between serial troponin measurements and adverse COVID-19 outcomes. Methods Using Danish registries, we identified COVID-19 patients with a high-sensitivity troponin measurement followed by a second measurement within 1–24 h. All measurements during follow-up were also utilized in subsequent time-varying analyses. We assessed all-cause mortality associated with the absence/presence of myocardial injury (≥1 troponin measurement >99th percentile upper reference limit) and absence/presence of dynamic troponin changes (>20% relative change if first measurement elevated, >50% relative change if first measurement normal). Results Of 346 included COVID-19 patients, 56% had myocardial injury. Overall, 20% had dynamic troponin changes. In multivariable Cox regression models, myocardial injury was associated with all-cause mortality (HR = 2.56, 95%CI = 1.46–4.51), as were dynamic troponin changes (HR = 1.66, 95%CI = 1.04–2.64). We observed a low incidence of myocardial infarction (4%) and invasive coronary procedures (4%) among patients with myocardial injury. Conclusions Myocardial injury and dynamic troponin changes determined using serial high-sensitivity troponin testing were associated with poor prognosis among patients with COVID-19. The risk of developing myocardial infarction requiring invasive management during COVID-19 hospitalization was low.
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Affiliation(s)
- Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maria L Krogager
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mikkel P Andersen
- Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Jawad H Butt
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jannik Pallisgaard
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Emil Fosbøl
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Avinainder Singh
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Lars Køber
- The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Manan Pareek
- Department of Clinical Research and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
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14
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El-Chouli M, Mohr GH, Bang CN, Malmborg M, Ahlehoff O, Torp-Pedersen C, Gerds TA, Idorn L, Raunsø J, Gislason G. Time Trends in Simple Congenital Heart Disease Over 39 Years: A Danish Nationwide Study. J Am Heart Assoc 2021; 10:e020375. [PMID: 34219468 PMCID: PMC8483486 DOI: 10.1161/jaha.120.020375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/16/2022]
Abstract
Background We describe calendar time trends of patients with simple congenital heart disease. Methods and Results Using the nationwide Danish registries, we identified individuals diagnosed with isolated ventricular septal defect, atrial septal defect, patent ductus arteriosus, or pulmonary stenosis during 1977 to 2015, who were alive at 5 years of age. We reported incidence per 1 000 000 person‐years with 95% CIs, 1‐year invasive cardiac procedure probability and age at time of diagnosis stratified by diagnosis age (children ≤18 years, adults >18 years), and 1‐year all‐cause mortality stratified by diagnosis age groups (5–30, 30–60, 60+ years). We identified 15 900 individuals with simple congenital heart disease (ventricular septal defect, 35.2%; atrial septal defect, 35.0%; patent ductus arteriosus, 25.2%; pulmonary stenosis, 4.6%), of which 75.7% were children. From 1977 to 1986 and 2007 to 2015, the incidence rates increased for atrial septal defect in adults (8.8 [95% CI, 7.1–10.5] to 31.8 [95% CI, 29.2–34.5]) and in children (26.6 [95% CI, 20.9–32.3] to 150.8 [95% CI, 126.5–175.0]). An increase was only observed in children for ventricular septal defect (72.1 [95% CI, 60.3–83.9] to 115.4 [95% CI, 109.1–121.6]), patent ductus arteriosus (49.2 [95% CI, 39.8–58.5] to 102.2 [95% CI, 86.7–117.6]) and pulmonary stenosis (5.7 [95% CI, 3.0–8.3] to 21.5 [95% CI, 17.2–25.7]) while the incidence rates remained unchanged for adults. From 1977–1986 to 2007–2015, 1‐year mortality decreased for all age groups (>60 years, 30.1%–9.6%; 30–60 years, 9.5%–1.0%; 5–30 years, 1.9%–0.0%), and 1‐year procedure probability decreased for children (13.8%–6.6%) but increased for adults (13.3%–29.6%) were observed. Conclusions Increasing incidence and treatment and decreasing mortality among individuals with simple congenital heart disease point toward an aging and growing population. Broader screening methods for asymptomatic congenital heart disease are needed to initiate timely treatment and follow‐up.
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Affiliation(s)
| | | | - Casper N Bang
- Danish Heart Foundation Copenhagen Denmark.,Department of Cardiology Bispebjerg and Frederiksberg Hospital Copenhagen Denmark
| | | | - Ole Ahlehoff
- Department of Cardiology Odense University Hospital Odense Denmark
| | - Christian Torp-Pedersen
- Departments of Clinical Investigation and Cardiology North Zealand University Hospital Hillerød Denmark.,Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - Thomas A Gerds
- Danish Heart Foundation Copenhagen Denmark.,Section of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Lars Idorn
- Department of Pediatric Cardiology, Rigshospitalet Copenhagen Denmark
| | - Jakob Raunsø
- Department of Cardiology Herlev and Gentofte Hospital Herlev Denmark
| | - Gunnar Gislason
- Danish Heart Foundation Copenhagen Denmark.,Department of Cardiology Herlev and Gentofte Hospital Herlev Denmark
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15
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Hodges G, Pallisgaard J, Schjerning Olsen AM, McGettigan P, Andersen M, Krogager M, Kragholm K, Køber L, Gislason GH, Torp-Pedersen C, Bang CN. Association between biomarkers and COVID-19 severity and mortality: a nationwide Danish cohort study. BMJ Open 2020; 10:e041295. [PMID: 33268425 PMCID: PMC7712929 DOI: 10.1136/bmjopen-2020-041295] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/23/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the association between common biomarkers, death and intensive care unit (ICU) admission in patients with COVID-19. DESIGN Retrospective cohort study. From electronic national registry data, we used Cox analysis and bootstrapping to evaluate associations between baseline levels of biomarkers and standardised absolute risks of death/ICU admission, adjusted for age and gender. SETTING All hospitals in Denmark. PARTICIPANTS 1310 patients aged ≥18 years admitted to hospital with COVID-19 from 27th of February to 1st of May 2020, with available biochemistry data. MAIN OUTCOME MEASURES A composite of death/ICU admission occurring within 30 days. RESULTS Of the 1310 patients admitted to hospital (54.6% men; median age 73.6 years), 352 (26.9%) experienced the composite endpoint and 263 (20.1%) died. For the composite endpoint, the absolute risks for moderately and severely elevated C reactive protein (CRP) were significantly higher, 21.5% and 39.2%, respectively, compared with 5.0% for those with normal CRP. Moderately and severely elevated leucocytes were significantly higher, 34.5% and 46.6% risk, respectively, compared with 23.2% for those with normal leucocytes. Moderately and severely decreased estimated glomerular filtration rates (eGFR) were significantly higher, 41.5% and 45.9% risk, respectively, compared with 30.4% for those with normal/mildly decreased eGFR. Normal and elevated ureas were significantly higher, 22.3% and 40.6% risk, respectively, compared with 7.3% for those with low urea. Elevated D-dimer was significantly higher, 31.8% risk, compared with 17.5% for those with normal D-dimer. Moderately and severely elevated troponins were significantly higher, 27.7% and 57.3% risk, respectively, compared with 9.4% for those with normal troponin. Elevated procalcitonin was significantly higher, 52.1% risk, compared with 28.0% for those with normal procalcitonin. CONCLUSION In this nationwide study of patients admitted with COVID-19, elevated levels of CRP, leucocytes, procalcitonin, urea, troponins and D-dimer, and low levels of eGFR were associated with higher standardised absolute risk of death/ICU admission within 30 days.
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Affiliation(s)
- Gethin Hodges
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Jannik Pallisgaard
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Anne-Marie Schjerning Olsen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- The Danish Heart Foundation, Department of Research, Copenhagen, Denmark
| | - Patricia McGettigan
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mikkel Andersen
- Unit of Clinical Biostatistics and Epidemiology and Department of Cardiology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | - Maria Krogager
- Unit of Clinical Biostatistics and Epidemiology and Department of Cardiology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
- Department of Cardiology, North Denmark Regional Hospital & Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Kragholm
- Department of Cardiology, North Denmark Regional Hospital & Aalborg University Hospital, Aalborg, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Department of Research, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Denmark Regional Hospital & Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Investigation and Cardiology, North Zealand Hospital, Hillerød, Denmark
| | - Casper N Bang
- The Danish Heart Foundation, Department of Research, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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16
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Kragholm K, Gerds TA, Fosbøl E, Andersen MP, Phelps M, Butt JH, Østergaard L, Bang CN, Pallisgaard J, Gislason G, Schou M, Køber L, Torp-Pedersen C. Association Between Prescribed Ibuprofen and Severe COVID-19 Infection: A Nationwide Register-Based Cohort Study. Clin Transl Sci 2020; 13:1103-1107. [PMID: 32970921 PMCID: PMC7537121 DOI: 10.1111/cts.12904] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/10/2020] [Indexed: 01/01/2023] Open
Abstract
Recommendations regarding ibuprofen use in relation to coronavirus disease 2019 (COVID-19) have been conflicting. We examined the risk of severe COVID-19 between ibuprofen-prescribed and non-ibuprofen patients with COVID-19 in a nationwide register-based study of patients with COVID-19 in Denmark between the end of February 2020 and May 16, 2020. Patients with heart failure (n = 208), < 30 years (n = 575), and prescribed other nonsteroidal anti-inflammatory drugs (n = 57) were excluded. Patients with ibuprofen prescription claims between January 1, 2020, and before COVID-19 diagnosis or April 30, 2020 (last available prescription) were compared with patients without ibuprofen prescription claims. Outcome was a 30-day composite of severe COVID-19 diagnosis with acute respiratory syndrome, intensive care unit admission, or death. Absolute risks and average risk ratios comparing outcome for ibuprofen vs. non-ibuprofen patients standardized to the age, sex, and comorbidity distribution of all patients were derived from multivariable Cox regression. Among 4,002 patients, 264 (6.6%) had ibuprofen prescription claims before COVID-19. Age, sex, and comorbidities were comparable between the two study groups. Standardized absolute risks of the composite outcome for ibuprofen-prescribed vs. non-ibuprofen patients were 16.3% (95% confidence interval (CI) 12.1-20.6) vs. 17.0% (95% CI 16.0-18.1), P = 0.74. The standardized average risk ratio for ibuprofen-prescribed vs. non-ibuprofen patients was 0.96 (95% CI 0.72-1.23). Standardized absolute risks of the composite outcome for patients with ibuprofen prescription claims > 14 days before COVID-19 vs. ≤ 14 days of COVID-19 were 17.1% (95% CI 12.3-22.0) vs. 14.3% (95% CI 7.1-23.1). In conclusion, in this nationwide study, there was no significant association between ibuprofen prescription claims and severe COVID-19.
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Affiliation(s)
- Kristian Kragholm
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark.,Departments of Cardiology, North Denmark Regional Hospital and Aalborg University Hospital, Aalborg, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, Copenhagen University, Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Casper N Bang
- Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Gunnar Gislason
- The Danish Heart Foundation, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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17
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Hodges G, Lyngbæk S, Selmer C, Ahlehoff O, Theilade S, Sehestedt TB, Abildgaard U, Eugen-Olsen J, Galløe AM, Hansen PR, Jeppesen JL, Bang CN. SuPAR is associated with death and adverse cardiovascular outcomes in patients with suspected coronary artery disease. SCAND CARDIOVASC J 2020; 54:339-345. [DOI: 10.1080/14017431.2020.1762917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Gethin Hodges
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Stig Lyngbæk
- Department of Medicine Glostrup, Amager Hvidvore Hospital Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Christian Selmer
- Department of Endocrinology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ole Ahlehoff
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Thomas Berend Sehestedt
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Abildgaard
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Peter Riis Hansen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Jørgen L. Jeppesen
- Department of Medicine Glostrup, Amager Hvidvore Hospital Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Casper N. Bang
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, North Zealand University Hospital, Hillerød, Denmark
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18
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Bonde AN, Martinussen T, Lee CJY, Lip GY, Staerk L, Bang CN, Bhattacharya J, Gislason G, Torp-Pedersen C, Olesen JB, Hlatky MA. Rivaroxaban Versus Apixaban for Stroke Prevention in Atrial Fibrillation. Circ Cardiovasc Qual Outcomes 2020; 13:e006058. [DOI: 10.1161/circoutcomes.119.006058] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background:
The comparative effectiveness of non-vitamin K antagonist oral anticoagulants (NOACs) is uncertain, as they have not been compared directly in randomized trials. Previous observational comparisons of NOACs are likely to be biased by unmeasured confounders. We sought to compare the efficacy and safety of rivaroxaban and apixaban for stroke prevention in patients with atrial fibrillation (AF), using practice variation in preference for NOAC as an instrumental variable.
Methods and Results:
Patients started on apixaban or rivaroxaban after newly diagnosed AF were identified using Danish nationwide registries. Patients were categorized according to facility preferences for type of NOAC, independent of actual treatment, measured as fraction of the prior 20 patients with AF initiated on rivaroxaban in the same facility. Facility preference for NOAC was used as an instrumental variable. The occurrence of stroke/thromboembolism, major bleeding, myocardial infarction, and all-cause mortality over 2 years of follow-up were investigated using adjusted Cox regressions. We analyzed 6264 patients with AF initiated on rivaroxaban or apixaban. NOAC preference was strongly related to actual choice of treatment but not associated with any other measured baseline characteristics. Patients treated in facilities that had preference for rivaroxaban had more major bleeding: compared with patients treated in facilities that used rivaroxaban in 0% to 20% of cases, the adjusted hazard ratio for bleeding was 1.06 when treated in a facility with 25% to 40% use; 1.41 with 45% to 60% use; 1.51 with 65% to 80% use; and 1.81 with 0% to 100% use (
P
trend
=0.01). Higher facility preference for rivaroxaban was not significantly associated with increased risk of stroke/thromboembolism (
P
trend
=0.06), myocardial infarction (
P
trend
=0.65), or all-cause mortality (
P
trend
=0.89). When we used the instrumental variable to model the causal relationship between choice of NOAC and major bleeding, relative risk with rivaroxaban was 1.89 (95% CI, 1.06–2.72) compared with apixaban.
Conclusions:
Using instrumental variable estimation in a cohort of patients with AF, rivaroxaban was associated with higher risk of major bleeding compared with apixaban. No significant associations to other outcomes were found in main analyses.
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Affiliation(s)
- Anders N. Bonde
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (A.N.B., C.J.-Y.L., L.S., G.G., C.T.-P., J.B.O.)
- Department of Health Research and Policy, Stanford University School of Medicine, CA (A.N.B., J.B., M.A.H.)
| | - Torben Martinussen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Denmark (T.M.)
| | - Christina J.-Y. Lee
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (A.N.B., C.J.-Y.L., L.S., G.G., C.T.-P., J.B.O.)
- Department of Health Science and Technology, Aalborg University (C.J.-Y.L.)
- Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital (C.J.-Y.L.)
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart and Chest Hospital, United Kingdom (C.J.-Y.L.)
| | | | - Laila Staerk
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (A.N.B., C.J.-Y.L., L.S., G.G., C.T.-P., J.B.O.)
| | - Casper N. Bang
- Department of Cardiology, Zealand University Hospital Roskilde, Denmark (C.N.B., C.T.-P.)
- Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen (C.N.B., G.G.)
| | - Jay Bhattacharya
- Department of Health Research and Policy, Stanford University School of Medicine, CA (A.N.B., J.B., M.A.H.)
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (A.N.B., C.J.-Y.L., L.S., G.G., C.T.-P., J.B.O.)
- Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen (C.N.B., G.G.)
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (A.N.B., C.J.-Y.L., L.S., G.G., C.T.-P., J.B.O.)
- Department of Cardiology, Zealand University Hospital Roskilde, Denmark (C.N.B., C.T.-P.)
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (A.N.B., C.J.-Y.L., L.S., G.G., C.T.-P., J.B.O.)
| | - Mark A. Hlatky
- Department of Health Research and Policy, Stanford University School of Medicine, CA (A.N.B., J.B., M.A.H.)
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19
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Greve AM, Bang CN, Boman K, Egstrup K, Kesäniemi YA, Ray S, Pedersen TR, Wachtell K. Relation of Lipid-Lowering Therapy to Need for Aortic Valve Replacement in Patients With Asymptomatic Mild to Moderate Aortic Stenosis. Am J Cardiol 2019; 124:1736-1740. [PMID: 31586530 DOI: 10.1016/j.amjcard.2019.08.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023]
Abstract
In this study, we aimed to determine if pretreatment low-density lipoprotein (LDL) levels and aortic stenosis (AS) severity alter the efficacy of lipid-lowering therapy on reducing aortic valve replacement (AVR). We used 1,687 patients with asymptomatic mild-to-moderate AS, who were randomly assigned (1:1) to 40/10 mg simvastatin/ezetimibe combination versus. placebo in the simvastatin and ezetimibe in aortic stenosis (SEAS) trial. Pretreatment LDL levels (>4 mmol/L) and peak aortic jet velocity (3 m/s) were used to partition study participants into 4 groups, which were followed for a primary endpoint of AVR. Cox regression with tests for interaction was used to study the effect of randomized treatment in each subgroup. During a median follow-up of 4.3 years (IQR 4.2 to 4.7 years; total 7,396 patient-years of follow-up), 478 (28%) patients underwent AVR and 146 (9%) died. A significant risk dependency was detected between simvastatin/ezetimibe combination, LDL levels and mild versus moderate AS on rates of AVR (p = 0.01 for interaction). In stratified analyses, randomized treatment, therefore, reduced the rate of AVR in patients with LDL levels >4 mmol and mild AS at baseline (HR 0.4; 95% CI: 0.2 to 0.9). There was no detectable effect of randomized treatment on the need for AVR in the 3 other participants subgroups. We conclude, that in a secondary analysis from a prospective randomized clinical trial, treatment with simvastatin/ezetimibe combination reduced the need for AVR in a subset of patients with mild AS and high pretreatment LDL levels (Unique identifier on clinicaltrials.gov: NCT00092677).
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20
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Kamil S, Sehested TSG, Carlson N, Houlind K, Lassen JF, N Bang C, Dominguez H, Pedersen CT, Gislason GH. Diabetes and risk of peripheral artery disease in patients undergoing first-time coronary angiography between 2000 and 2012 - a nationwide study. BMC Cardiovasc Disord 2019; 19:234. [PMID: 31651241 PMCID: PMC6813965 DOI: 10.1186/s12872-019-1213-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/30/2019] [Indexed: 12/20/2022] Open
Abstract
Background The risk of peripheral artery disease (PAD) in patients with diabetes mellitus (DM) and coronary artery disease (CAD) is an important and inadequately addressed issue. Our aim is to examine the impact of DM on risk of PAD in patients with different degrees of CAD characterized by coronary angiography (CAG). Methods Using nationwide registers we identified all patients aged ≥18 years, undergoing first time CAG between 2000 and 2012. Patients were categorized into DM/Non-DM group, and further classified into categories according to the degree of CAD i.e., no-vessel disease, single-vessel disease, double-vessel disease, triple-vessel disease, and diffuse disease. Risk of PAD was estimated by 5-year cumulative-incidence and adjusted multivariable Cox-regression models. Results We identified 116,491 patients undergoing first-time CAG. Among these, a total of 23.969 (20.58%) had DM. Cumulative-incidence of PAD among DM patients vs. non-DM were 8.8% vs. 4.9% for no-vessel disease, 8.2% vs. 4.8% for single-vessel disease, 10.2% vs. 6.0% for double-vessel disease, 13.0% vs. 8.4% for triple-vessel disease, and 6.8% vs. 6.1% for diffuse disease, respectively. For all patients with DM, the cox-regression analysis yielded significantly higher hazards of PAD compared with non-DM patients with HR 1.70 (no-vessel disease), 1.96 (single-vessel disease), 2.35 (double-vessel disease), 2.87 (triple-vessel disease), and 1.46 (diffuse disease), respectively (interaction-p 0.042). Conclusion DM appears to be associated with increased risk of PAD in patients with and without established CAD, with increasing risk in more extensive CAD. This observation indicates awareness on PAD risk in patients with DM, especially among patients with advanced CAD.
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Affiliation(s)
- Sadaf Kamil
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Denmark. .,Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark. .,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas S G Sehested
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
| | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Kim Houlind
- Department of Vascular Surgery, Kolding Hospital, Kolding, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jens F Lassen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Casper N Bang
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Helena Dominguez
- Department of Cardiology, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Herlev and Gentofte Hospital, Kildegaardsvej 28, 2900, Hellerup, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
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21
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Bang CN, Greve AM, Boman K, Egstrup K, Olsen MH, Kober L, Nienaber CA, Ray S, Rossebo AM, Nielsen OW, Willenheimer R, Wachtell K. P3779NT-proBNP adds incremental predictive information on incident atrial fibrillation in patients with asymptomatic aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Incident atrial fibrillation (AF) marks an adverse shift in the prognosis of patients with aortic stenosis (AS). Identifying risk factors for AF is therefore of paramount importance for timely intervention in patients with AS. In patients without AS, brain natriuretic peptides (BNP) is a well-established biomarker for left ventricular pressure overload on the pathway to heart failure and atrial fibrillation. However, a potential role of NT-proBNP to predict risk of new-onset AF in asymptomatic patients with mild to moderate AS is not well studied.
Methods
We included 1,434 patients with mild to moderate AS from the SEAS Study (Simvastatin and Ezetimibe in Aortic Stenosis) without AF or clinically overt heart failure at baseline. The primary endpoint for this substudy was time to incident AF, as determined by the first annual in-study 12-lead ECG with AF. Multivariable Cox model were adjusted for other important predictors of incident AF as selected by Bayesian statistics. Fine and Gray competing risk regression was used to evaluate the influence of all-cause mortality on selected predictor variables of incident AF.
Results
During a median follow-up of 4.3 years (range 0.1–6.9 years), incident AF occurred in 114 (6.1%) patients (13.8 per 1,000 person-years of follow-up), who at baseline were older (69±10 vs. 67±10 years, p<0.001), had larger systolic left atrial diameter (46±24 vs. 34±18 mm, p<0.001) and higher NT-proBNP level (286 [132; 613] vs. 154 [82; 297] pg/ml, p<0.001); but same left ventricular ejection fraction (66±6 mm vs. 67±6, p=0.4). In multivariable Cox regression, adjusted for age, circumferential end-systolic stress, left atrial volume and ECG PR interval, Ln(NT-proBNP) was associated with higher risk of new-onset AF (HR: 1.9 [95% CI: 1.6–2.3], p<0.001). Similar results were found when using Fine and Gray estimates with all-cause mortality (HR: 2.0 [95% CI: 1.7–2.4], p<0.001 (Figure, panel A). NT-proBNP level added incremental predictive information on incident AF over the other important, as selected by Bayesian statistics, predictor variables (C-index 0.81, p<0.001, Figure, panel B). There was no interaction with aortic valve area (p>0.05).
Figure 1
Conclusions
In patients with asymptomatic aortic stenosis and sinus rhythm at baseline, NT-proBNP levels were significantly higher in patients who subsequently developed AF. NT-proBNP significantly improved prognostic information of incident AF over other important predictor variables. This supports the notion that incident AF is a marker of left ventricular pressure overload and possibly a novel marker of timely intervention with aortic valve replacement.
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Affiliation(s)
- C N Bang
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - A M Greve
- Rigshospitalet - Copenhagen University Hospital, Clinical Biochemistry, Copenhagen, Denmark
| | - K Boman
- Skelleftea Hospital, Department of Medicine, Skeleftaa Laseratt, Umeå University Hospital, Skelleftea, Sweden
| | - K Egstrup
- Svendborg Hospital, Department of Medicine, Svendborg, Denmark
| | - M H Olsen
- Holbaek Hospital, Cardiology, Holbaek, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - C A Nienaber
- University Hospital Rostock, Cardiology, Rostock, Germany
| | - S Ray
- Manchester Academic Health Sciences Centre, Cardiology, Manchester, United Kingdom
| | - A M Rossebo
- Ulleval University Hospital, Cardiology, Oslo, Norway
| | - O W Nielsen
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | | | - K Wachtell
- Oslo University Hospital, Cardiology, Oslo, Norway
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22
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Bonde AN, Staerk L, Lee CJY, Vinding NE, Bang CN, Torp-Pedersen C, Gislason G, Lip GYH, Olesen JB. Outcomes Among Patients With Atrial Fibrillation and Appropriate Anticoagulation Control. J Am Coll Cardiol 2019; 72:1357-1365. [PMID: 30213328 DOI: 10.1016/j.jacc.2018.06.065] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/24/2018] [Accepted: 06/25/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) patients on a vitamin K antagonist (VKA) with time in therapeutic range (TTR) ≥70% are not recommended to switch to a direct oral anticoagulant according to guidelines. OBJECTIVES This study sought to assess future TTR and risk of stroke/thromboembolism and major bleeding among AF patients on VKA with TTR ≥70%. METHODS The authors used Danish nationwide registries to identify AF patients on VKA from 1997 to 2011 with available international normalized ratio values. Patients were included 6 months after VKA initiation, divided according to TTR, and followed for 12 months after inclusion. Cox proportional hazard models estimated hazard ratios (HRs). TTR was examined both as a baseline variable and as a time-dependent covariate in the Cox models. RESULTS Of the 4,772 included AF patients still on VKA 6 months after initiation, 1,691 (35.4%) had a TTR ≥70%, and 3,081 (65.6%) had a TTR <70%. Among patients with prior TTR ≥70% still on treatment 12 months after inclusion, only 513 (55.7%) still had a TTR ≥70%. Compared with prior TTR ≥70%, prior TTR <70% was not associated with a higher risk of stroke/thromboembolism (HR: 1.14; 95% confidence interval [CI]: 0.77 to 1.70) or major bleeding (HR: 1.12; 95% CI: 0.84 to 1.49). When the authors estimated TTR time-dependently during follow-up, TTR <70% was associated with an increased risk of stroke/thromboembolism (HR: 1.91; 95% CI: 1.30 to 2.82) and major bleeding (HR: 1.34; 95% CI: 1.02 to 1.76). CONCLUSIONS Among AF patients on VKA, almost one-half of patients with prior TTR ≥70% had TTR <70% during the following year. Prior TTR ≥70% per se had limited long-term prognostic value.
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Affiliation(s)
| | - Laila Staerk
- Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Christina J-Y Lee
- Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
| | | | - Casper N Bang
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark; Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg University Hospital, Aalborg, Denmark
| | - Gunnar Gislason
- Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Cardiovascular Epidemiology and Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
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23
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Hodges GW, Bang CN, Forman JL, Olsen MH, Boman K, Ray S, Kesäniemi YA, Eugen-Olsen J, Greve AM, Jeppesen JL, Wachtell K. Effect of simvastatin and ezetimibe on suPAR levels and outcomes. Atherosclerosis 2018; 272:129-136. [PMID: 29602140 DOI: 10.1016/j.atherosclerosis.2018.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/27/2018] [Accepted: 03/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory marker associated with cardiovascular disease. Statins lower both low-density lipoprotein (LDL)-cholesterol and C-reactive protein (CRP), resulting in improved outcomes. However, whether lipid-lowering therapy also lowers suPAR levels is unknown. METHODS We investigated whether treatment with Simvastatin 40 mg and Ezetimibe 10 mg lowered plasma suPAR levels in 1838 patients with mild-moderate, asymptomatic aortic stenosis, included in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, using a pattern mixture model. A 1-year Cox analysis, adjusted for established cardiovascular risk factors, allocation to study treatment, peak aortic valve velocity and baseline suPAR, was performed to evaluate relationships between change in suPAR with all-cause mortality and the composite endpoint of major cardiovascular events (MCE) composed of ischemic cardiovascular events (ICE) and aortic valve related events (AVE). RESULTS After 4.3 years of follow-up, suPAR levels had increased by 9.2% (95% confidence interval [CI]: 7.0%-11.5%) in the placebo group, but only by 4.1% (1.9%-6.2%) in the group with lipid-lowering treatment (p<0.001). In a multivariate 1-year analysis, 1-year suPAR was strongly associated with all-cause mortality, hazard ratio (HR) = 2.05 (1.17-3.61); MCE 1.40 (1.01-1.92); and AVE 1.42 (1.02-1.99) (all p<0.042) for each doubling of suPAR; but was not associated with ICE. CONCLUSIONS Simvastatin and Ezetimibe treatment impeded the progression of the time-related increase in plasma suPAR levels. Year-1 suPAR was associated with all-cause mortality, MCE, and AVE irrespective of baseline levels (SEAS study: NCT00092677).
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Affiliation(s)
- Gethin W Hodges
- Department of Medicine Glostrup, Amager Hvidvore Hospital Glostrup, University of Copenhagen, Denmark.
| | - Casper N Bang
- The Danish Heart Foundation, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital, Denmark; Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, University of Southern Denmark, Denmark
| | - Kurt Boman
- Research Unit, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Simon Ray
- Department of Cardiology, University Hospitals of South Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Y Antero Kesäniemi
- Research Institute of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anders M Greve
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen L Jeppesen
- Department of Medicine Glostrup, Amager Hvidvore Hospital Glostrup, University of Copenhagen, Denmark
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24
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Greve AM, Bang CN, Boman K, Egstrup K, Forman JL, Kesäniemi YA, Ray S, Pedersen TR, Best P, Rajamannan NM, Wachtell K. Effect Modifications of Lipid-Lowering Therapy on Progression of Aortic Stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis [SEAS] Study). Am J Cardiol 2018; 121:739-745. [PMID: 29361285 DOI: 10.1016/j.amjcard.2017.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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] [Received: 09/26/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 01/28/2023]
Abstract
Observational studies indicate that low-density lipoprotein (LDL) cholesterol acts as a primary contributor to an active process leading to aortic stenosis (AS) development. However, randomized clinical trials have failed to demonstrate an effect of lipid lowering on impeding AS progression. This study explored if pretreatment LDL levels and AS severity altered the efficacy of lipid-lowering therapy. The study goal was evaluated in the analysis of surviving patients with baseline data in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial of 1,873 asymptomatic patients with mild-to-moderate AS. Serially measured peak aortic jet velocity was the primary effect estimate. Linear mixed model analysis adjusted by baseline peak jet velocity and pretreatment LDL levels was used to assess effect modifications of treatment. Data were available in 1,579 (84%) patients. In adjusted analyses, lower baseline peak aortic jet velocity and higher pretreatment LDL levels increased the effect of randomized treatment (p = 0.04 for interaction). As such, treatment impeded progression of AS in the highest quartile of LDL among patients with mild AS at baseline (0.06 m/s per year slower progression vs placebo in peak aortic jet velocity, 95% confidence interval 0.01 to 0.11, p = 0.03), but not in the 3 other quartiles of LDL. Conversely, among patients with moderate AS, there was no detectable effect of treatment in any of the pretreatment LDL quartiles (all p ≥0.14). In conclusion, in a non-prespecified post hoc analysis, the efficacy of lipid-lowering therapy on impeding AS progression increased with higher pretreatment LDL and lower peak aortic jet velocity (SEAS study: NCT00092677).
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Affiliation(s)
- Anders M Greve
- Department of clinical biochemistry, Rigshospitalet University Hospital, Copenhagen, Denmark.
| | - Casper N Bang
- Department of Cardiology, Zealand University Hospital-Roskilde, Roskilde, Denmark
| | - Kurt Boman
- Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden
| | | | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Y Antero Kesäniemi
- Institute of Clinical Medicine, Department of Medicine, University of Oulu and Clinical Research center, Oulu University Hospital, Oulu, Finland
| | - Simon Ray
- Manchester Academic Health Sciences Centre, University Hospitals of South Manchester, Manchester, United Kingdom
| | - Terje R Pedersen
- Center for Preventive medicine, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway
| | - Patricia Best
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Nalini M Rajamannan
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota; Most Sacred Heart of Jesus Cardiology and Valvular Institute, Sheboygan, Wisconsin
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25
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Hodges GW, Bang CN, Eugen-Olsen J, Olsen MH, Boman K, Ray S, Kesäniemi AY, Jeppesen JL, Wachtell K. SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis. Open Heart 2018; 5:e000743. [PMID: 29387432 PMCID: PMC5786924 DOI: 10.1136/openhrt-2017-000743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/30/2017] [Accepted: 12/20/2017] [Indexed: 12/25/2022] Open
Abstract
Background We evaluated whether early measurement of soluble urokinase plasminogen activator receptor (suPAR) could predict future risk of postoperative complications in initially asymptomatic patients with mild-moderate aortic stenosis (AS) undergoing aortic valve replacement (AVR) surgery. Methods Baseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Cox analyses were used to evaluate suPAR in relation to all-cause mortality and the composite endpoint of postoperative complications (all-cause mortality, congestive heart failure, stroke and renal impairment) occurring in the 30-day postoperative period. Results Patients with initially higher levels of suPAR were at increased risk of postoperative mortality with a HR of 3.5 (95% CI 1.4 to 9.0, P=0.008) and postoperative complications with a HR of 2.7 (95% CI 1.5 to 5.1, P=0.002), per doubling in suPAR. After adjusting for the European System for Cardiac Operative Risk Evaluation or Society of Thoracic Surgeons risk score, suPAR remained associated with postoperative mortality with a HR 3.2 (95% CI 1.2 to 8.6, P=0.025) and 2.7 (95% CI 1.0 to 7.8, P=0.061); and postoperative complications with a HR of 2.5 (95% CI 1.3 to 5.0, P=0.007) and 2.4 (95% CI 1.2 to 4.8, P=0.011), respectively. Conclusion Higher baseline suPAR levels are associated with an increased risk for postoperative complications and mortality in patients with mild-moderate, asymptomatic AS undergoing later AVR surgery. Further validation in other subsets of AS individuals are warranted. Trial registration number NCT00092677; Post-results.
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Affiliation(s)
- Gethin W Hodges
- Department of Medicine, Amager Hvidovre Hospital Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbæk, Denmark.,Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Kurt Boman
- Research Unit, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Simon Ray
- Department of Cardiology, University Hospitals of South Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Antero Y Kesäniemi
- Research Institute of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jørgen L Jeppesen
- Department of Medicine, Amager Hvidovre Hospital Glostrup, University of Copenhagen, Copenhagen, Denmark
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Bang CN, Greve AM, Rossebø AB, Ray S, Egstrup K, Boman K, Nienaber C, Okin PM, Devereux RB, Wachtell K. Antihypertensive Treatment With β-Blockade in Patients With Asymptomatic Aortic Stenosis and Association With Cardiovascular Events. J Am Heart Assoc 2017; 6:JAHA.117.006709. [PMID: 29180457 PMCID: PMC5779004 DOI: 10.1161/jaha.117.006709] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 01/19/2023]
Abstract
Background Patients with aortic stenosis (AS) often have concomitant hypertension. Antihypertensive treatment with a β‐blocker (Bbl) is frequently avoided because of fear of depression of left ventricular function. However, it remains unclear whether antihypertensive treatment with a Bbl is associated with increased risk of cardiovascular events in patients with asymptomatic mild to moderate AS. Methods and Results We did a post hoc analysis of 1873 asymptomatic patients with mild to moderate AS and preserved left ventricular ejection fraction in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. Propensity‐matched Cox regression and competing risk analyses were used to assess risk ratios for all‐cause mortality, sudden cardiac death, and cardiovascular death. A total of 932 (50%) patients received Bbl at baseline. During a median follow‐up of 4.3±0.9 years, 545 underwent aortic valve replacement, and 205 died; of those, 101 were cardiovascular deaths, including 40 sudden cardiovascular deaths. In adjusted analyses, Bbl use was associated with lower risk of all‐cause mortality (hazard ratio 0.5, 95% confidence interval 0.3‐0.7, P<0.001), cardiovascular death (hazard ratio 0.4, 95% confidence interval 0.2‐0.7, P<0.001), and sudden cardiac death (hazard ratio 0.2, 95% confidence interval 0.1‐0.6, P=0.004). This was confirmed in competing risk analyses (all P<0.004). No interaction was detected with AS severity (all P>0.1). Conclusions In post hoc analyses Bbl therapy did not increase the risk of all‐cause mortality, sudden cardiac death, or cardiovascular death in patients with asymptomatic mild to moderate AS. A prospective study may be warranted to determine if Bbl therapy is in fact beneficial. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.
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Affiliation(s)
- Casper N Bang
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark .,Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Anders M Greve
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Anne B Rossebø
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Simon Ray
- Department of Cardiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - Kurt Boman
- Institution of Public Health and Clinical Medicine, Medicine Skellefteå, Umeå University, Skellefteå, Sweden
| | | | - Peter M Okin
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Kristian Wachtell
- Department of Medicine, Weill Cornell Medicine, New York, NY.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
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Bang CN, Soliman EZ, Simpson LM, Davis BR, Devereux RB, Okin PM. Electrocardiographic Left Ventricular Hypertrophy Predicts Cardiovascular Morbidity and Mortality in Hypertensive Patients: The ALLHAT Study. Am J Hypertens 2017; 30:914-922. [PMID: 28430947 DOI: 10.1093/ajh/hpx067] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/31/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Electrocardiographic (ECG) left ventricular hypertrophy (LVH) is a strong predictor of cardiovascular (CV) morbidity and mortality. However, the predictive value of ECG LVH in treated hypertensive patients remains unclear. METHODS A total of 33,357 patients (aged ≥ 55 years) with hypertension and at least 1 other coronary heart disease (CHD) risk factor were randomized to chlorthalidone, amlodipine, or lisinopril. The outcome of the present study was all-cause mortality; and secondary endpoints were CHD, nonfatal myocardial infarction (MI), stroke, angina, heart failure (HF), and peripheral arterial disease. Cornell voltage criteria (S in V3 + R in aVL > 28 [men] or >22 mm [women]) defined ECG LVH. RESULTS ECGs were available at baseline in 26,384 patients. Baseline Cornell voltage LVH was present in 1,741 (7%) patients, who were older (67.4 vs. 66.6 years, P < 0.001), more likely to be female (74 vs. 44%, P < 0001) with a higher systolic blood pressure (151 vs. 146 mm Hg, P < 0.001) than patients without ECG LVH. During 5.0 ± 1.4 years mean follow-up, baseline and in-study ECG LVH was significantly associated with 29 to 98% increased risks of all-cause mortality, MI, CHD, stroke, and HF in multivariable Cox analyses. CONCLUSIONS Baseline Cornell voltage LVH is associated with increased CV morbidity and all-cause mortality in treated hypertensive patients independent of treatment modality and other CV risk factors. CLINICAL TRIALS REGISTRATION Trial Number NCT00000542.
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Affiliation(s)
- Casper N Bang
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Section of Cardiology, Department of Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Lara M Simpson
- Department of Biostatistics
- Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Barry R Davis
- Department of Biostatistics
- Coordinating Center for Clinical Trials, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Richard B Devereux
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Peter M Okin
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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Hodges GW, Bang CN, Eugen-Olsen J, Olsen MH, Boman K, Ray S, Gohlke-Bärwolf C, Kesäniemi YA, Jeppesen JL, Wachtell K. SuPAR Predicts Cardiovascular Events and Mortality in Patients With Asymptomatic Aortic Stenosis. Can J Cardiol 2016; 32:1462-1469. [DOI: 10.1016/j.cjca.2016.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 11/17/2022] Open
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Kampaktsis PN, Bang CN, Chiu Wong S, Skubas NJ, Singh H, Voudris K, Baduashvili A, Pastella K, Swaminathan RV, Kaple RK, Minutello RM, Feldman DN, Kim L, Hriljac I, Lin F, Bergman GS, Salemi A, Devereux RB. Prognostic Importance of Diastolic Dysfunction in Relation to Post Procedural Aortic Insufficiency in Patients Undergoing Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv 2016; 89:445-451. [PMID: 27218599 DOI: 10.1002/ccd.26582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/21/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We sought to examine whether baseline diastolic dysfunction (DD) is associated with increased mortality in patients who develop aortic insufficiency (AI) after transcatheter aortic valve replacement (TAVR). BACKGROUND Significant post-TAVR AI is associated with increased mortality, likely secondary to adverse hemodynamics secondary to volume overload and decreased LV compliance from chronic pressure overload. However, the effect of baseline DD on outcomes of patients with post-TAVR AI has not been studied. METHODS A total of 195 patients undergoing TAVR were included in the study. Patients with moderate-to-severe mitral stenosis, prior mitral valve replacement or atrial fibrillation were excluded. DD was classified at baseline by a 2-step approach as recommended by the American Society of Echocardiography while AI was evaluated 30 days post-TAVR. Follow up data up to 2 years post-TAVR was used in survival analysis. RESULTS Patients with severe baseline DD who developed ≥mild post-TAVR AI had increased mortality compared to all other patients (HR = 3.89, CI: 1.76-8.6, P = 0.001), which remained significant after adjusting for post-TAVR AI, pre-TAVR AI, baseline mitral regurgitation, ejection fraction, pulmonary artery pressure, creatinine clearance and history of stroke. CONCLUSIONS Even mild post-TAVR AI may have a negative impact on outcomes of patients with underlying severe DD. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Polydoros N Kampaktsis
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Department of Internal Medicine, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Casper N Bang
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark
| | - S Chiu Wong
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Nikolaos J Skubas
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Anesthesiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Harsimran Singh
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Konstantinos Voudris
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Amiran Baduashvili
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Department of Internal Medicine, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Kalliopi Pastella
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Rajesh V Swaminathan
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Ryan K Kaple
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Robert M Minutello
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Dmitriy N Feldman
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Luke Kim
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Ingrid Hriljac
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Fay Lin
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Geoffrey S Bergman
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Arash Salemi
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Richard B Devereux
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
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Bang CN, Greve AM, La Cour M, Boman K, Gohlke-Bärwolf C, Ray S, Pedersen T, Rossebø A, Okin PM, Devereux RB, Wachtell K. Effect of Randomized Lipid Lowering With Simvastatin and Ezetimibe on Cataract Development (from the Simvastatin and Ezetimibe in Aortic Stenosis Study). Am J Cardiol 2015; 116:1840-4. [PMID: 26602073 DOI: 10.1016/j.amjcard.2015.09.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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] [Received: 06/17/2015] [Revised: 09/25/2015] [Accepted: 09/25/2015] [Indexed: 11/17/2022]
Abstract
Recent American College of Cardiology/American Heart Association guidelines on statin initiation on the basis of total atherosclerotic cardiovascular disease risk argue that the preventive effect of statins on cardiovascular events outweigh the side effects, although this is controversial. Studies indicate a possible effect of statin therapy on reducing risk of lens opacities. However, the results are conflicting. The Simvastatin and Ezetimibe in Aortic Stenosis study (NCT00092677) enrolled 1,873 patients with asymptomatic aortic stenosis and no history of diabetes, coronary heart disease, or other serious co-morbidities were randomized (1:1) to double-blind 40 mg simvastatin plus 10 mg ezetimibe versus placebo. The primary end point in this substudy was incident cataract. Univariate and multivariate Cox models were used to analyze: (1) if the active treatment reduced the risk of the primary end point and (2) if time-varying low-density lipoproteins (LDL) cholesterol lowering (annually assessed) was associated with less incident cataract per se. During an average follow-up of 4.3 years, 65 patients (3.5%) developed cataract. Mean age at baseline was 68 years and 39% were women. In Cox multivariate analysis adjusted for age, gender, prednisolone treatment, smoking, baseline LDL cholesterol and high sensitivity C-reactive protein; simvastatin plus ezetimibe versus placebo was associated with 44% lower risk of cataract development (hazard ratio 0.56, 95% confidence interval 0.33 to 0.96, p = 0.034). In a parallel analysis substituting time-varying LDL-cholesterol with randomized treatment, lower intreatment LDL-cholesterol was in itself associated with lower risk of incident cataract (hazard ratio 0.78 per 1 mmol/ml lower total cholesterol, 95% confidence interval 0.64 to 0.93, p = 0.008). In conclusion, randomized treatment with simvastatin plus ezetimibe was associated with a 44% lower risk of incident cataract development. This effect should perhaps be considered in the risk-benefit ratio of statin treatment.
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Affiliation(s)
- Casper N Bang
- Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Cardiology, Roskilde University Hospital, Copenhagen University, Roskilde, Denmark.
| | - Anders M Greve
- Department of Cardiology, Frederiksberg University Hospital, Copenhagen University, Copenagen, Denmark
| | - Morten La Cour
- Department of Ophthalmology, Glostrup University Hospital, Copenhagen University, Glostrup, Denmark
| | - Kurt Boman
- Research Unit, Department of Public Health and Clinical Medicine, Umeå University, Skellefteå, Sweden
| | | | - Simon Ray
- Department of Cardiology, University Hospitals of South Manchester, Manchester, United Kingdom
| | - Terje Pedersen
- Center of Preventive Medicine, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Anne Rossebø
- Department of Cardiology, Oslo University Hospital, Oslo University, Oslo, Norway
| | - Peter M Okin
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Richard B Devereux
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Kristian Wachtell
- Department of Cardiology, Oslo University Hospital, Oslo University, Oslo, Norway
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Hodges GW, Bang CN, Wachtell K, Eugen-Olsen J, Jeppesen JL. suPAR: A New Biomarker for Cardiovascular Disease? Can J Cardiol 2015; 31:1293-302. [DOI: 10.1016/j.cjca.2015.03.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/20/2015] [Accepted: 03/20/2015] [Indexed: 12/21/2022] Open
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Devereux RB, Bang CN, Roman MJ, Palmieri V, Boman K, Gerdts E, Nieminen MS, Papademetriou V, Wachtell K, Hille DA, Dahlöf B. Left Ventricular Wall Stress-Mass-Heart Rate Product and Cardiovascular Events in Treated Hypertensive Patients: LIFE Study. Hypertension 2015; 66:945-53. [PMID: 26418019 DOI: 10.1161/hypertensionaha.114.05582] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/24/2015] [Indexed: 11/16/2022]
Abstract
In the Losartan Intervention for End Point Reduction in Hypertension (LIFE) study, 4.8 years' losartan- versus atenolol-based antihypertensive treatment reduced left ventricular hypertrophy and cardiovascular end points, including cardiovascular death and stroke. However, there was no difference in myocardial infarction (MI), possibly related to greater reduction in myocardial oxygen demand by atenolol-based treatment. Myocardial oxygen demand was assessed indirectly by the left ventricular mass×wall stress×heart rate (triple product) in 905 LIFE participants. The triple product was included as time-varying covariate in Cox models assessing predictors of the LIFE primary composite end point (cardiovascular death, MI, or stroke), its individual components, and all-cause mortality. At baseline, the triple product in both treatment groups was, compared with normal adults, elevated in 70% of patients. During randomized treatment, the triple product was reduced more by atenolol, with prevalences of elevated triple product of 39% versus 51% on losartan (both P≤0.001). In Cox regression analyses adjusting for age, smoking, diabetes mellitus, and prior stroke, MI, and heart failure, 1 SD lower triple product was associated with 23% (95% confidence interval 13%-32%) fewer composite end points, 31% (18%-41%) less cardiovascular mortality, 30% (15%-41%) lower MI, and 22% (11%-33%) lower all-cause mortality (all P≤0.001), without association with stroke (P=0.34). Although losartan-based therapy reduced ventricular mass more, greater heart rate reduction with atenolol resulted in larger reduction of the triple product. Lower triple product during antihypertensive treatment was strongly, independently associated with lower rates of the LIFE primary composite end point, cardiovascular death, and MI, but not stroke.
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Affiliation(s)
- Richard B Devereux
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.).
| | - Casper N Bang
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Mary J Roman
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Vittorio Palmieri
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Kurt Boman
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Eva Gerdts
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Markku S Nieminen
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Vasilios Papademetriou
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Kristian Wachtell
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Darcy A Hille
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
| | - Björn Dahlöf
- From the Department of Medicine, Weill Medical College of Cornell University, New York, NY (R.B.D., C.N.B., M.J.R., V.P.); Research Unit, Department of Medicine Skellefteå, Umeå University, Skellefteå, Sweden (K.B.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland (M.S.N.); Division of Cardiology, A.O.S.G. Moscati, Avellino, Italy (V.P.); Department of Medicine, Glostrup University Hospital, Glostrup, Denmark (K.W.); Section on Biostatistics, Merck Research Laboratories, North Wales, PA (D.A.H.); and Department of Medicine, Sahlgrenska University Hospital, Östra, Sweden (B.D.)
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Bang CN, Soliman E, Simpson LM, Davis B, Devereux R, Okin P. ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY PREDICTS CARDIOVASCULAR MORBIDITY AND MORTALITY IN HYPERTENSIVE PATIENTS: THE ALLHAT STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61460-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Greve AM, Bang CN, Berg RMG, Egstrup K, Rossebø AB, Boman K, Nienaber CA, Ray S, Gohlke-Baerwolf C, Nielsen OW, Okin PM, Devereux RB, Køber L, Wachtell K. Resting heart rate and risk of adverse cardiovascular outcomes in asymptomatic aortic stenosis: the SEAS study. Int J Cardiol 2014; 180:122-8. [PMID: 25438232 DOI: 10.1016/j.ijcard.2014.11.181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/07/2014] [Accepted: 11/23/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND An elevated resting heart rate (RHR) may be an early sign of cardiac failure, but its prognostic value during watchful waiting in asymptomatic aortic stenosis (AS) is largely unknown. METHODS RHR was determined by annual ECGs in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study of asymptomatic mild-to-moderate AS patients. Primary endpoint in this substudy was major cardiovascular events (MCEs) and secondary outcomes its individual components. Multivariable Cox-models using serially-measured RHR were used to examine the prognostic impact of RHR per se. RESULTS 1563 patients were followed for a mean of 4.3years (6751 patient-years of follow-up), 553 (35%) MCEs occurred, 10% (n=151) died, including 75 cardiovascular deaths. In multivariable analysis, baseline RHR was independently associated with MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.0-1.3) and cardiovascular mortality (HR 1.3 per 10min(-1) faster, 95% CI: 1.0-1.7, both p≤0.03). Updating RHR with annual in-study reexaminations, time-varying RHR was highly associated with excess MCEs (HR 1.1 per 10min(-1) faster, 95% CI: 1.1-1.3) and cardiovascular mortality (HR 1.4 per 10min(-1) faster, 95% CI: 1.2-1.7, both p≤0.006). The association of RHR with MCEs and cardiovascular mortality was not dependent on atrial fibrillation status (both p≥0.06 for interaction). CONCLUSIONS RHR is independently associated with MCEs and cardiovascular death in asymptomatic AS (Clinicaltrials.gov; unique identifier NCT00092677).
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Affiliation(s)
- Anders M Greve
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
| | - Casper N Bang
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Ronan M G Berg
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark
| | | | - Anne B Rossebø
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Kurt Boman
- Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden
| | - Christoph A Nienaber
- Department of Cardiology and Angiology, University Heart Center Rostock, Rostock School of Medicine, Rostock, Germany
| | - Simon Ray
- Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | | | | | - Peter M Okin
- Weill Cornell Medical College, New York, NY, United States
| | | | - Lars Køber
- Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Wachtell
- Weill Cornell Medical College, New York, NY, United States; Glostrup University Hospital, Copenhagen, Denmark
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Abstract
Statin treatment prevents cardiovascular diseases probably beyond their lipid-lowering effect. Increasing evidence suggests that statins might increase the risk of new-onset diabetes; however, diabetes is known to increase the risk of cardiovascular diseases. The majority of the literature suggests an increased risk of new-onset diabetes in patients treated with statins in a number of different settings and that the risk appears greatest among the more potent statins. Furthermore, a dose-response curve has been shown between statin treatment and the development of diabetes. Possible mechanisms include muscle insulin resistance, lower expression of GLUT-4 in adipocytes impairing glucose tolerance and suppression of glucose-induced elevation of intracellular Ca(2+) level. However, other side effects have been reported such as increased risk of myotoxicity, increased liver enzymes, cataracts, mood disorders, dementias, hemorrhagic stroke and peripheral neuropathy, which should maybe be added to the increased risk of new-onset diabetes, when considering the risk- benefit ratio of statin treatment.
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Affiliation(s)
- Casper N Bang
- Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York, NY, USA,
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Bang CN, Devereux RB, Okin PM. Regression of electrocardiographic left ventricular hypertrophy or strain is associated with lower incidence of cardiovascular morbidity and mortality in hypertensive patients independent of blood pressure reduction – A LIFE review. J Electrocardiol 2014; 47:630-5. [DOI: 10.1016/j.jelectrocard.2014.07.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Indexed: 11/28/2022]
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Greve AM, Dalsgaard M, Bang CN, Egstrup K, Rossebø AB, Boman K, Cramariuc D, Nienaber CA, Ray S, Gohlke-Baerwolf C, Okin PM, Devereux RB, Køber L, Wachtell K. Usefulness of the electrocardiogram in predicting cardiovascular mortality in asymptomatic adults with aortic stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis Study). Am J Cardiol 2014; 114:751-6. [PMID: 25048345 DOI: 10.1016/j.amjcard.2014.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
Hypertension and coronary heart disease are common in aortic stenosis (AS) and may impair prognosis for similar AS severity. Different changes in the electrocardiogram may be reflective of the separate impacts of AS, hypertension, and coronary heart disease, which could lead to enhanced risk stratification in AS. The aim of this study was therefore to examine if combining prognostically relevant electrocardiographic (ECG) findings improves prediction of cardiovascular mortality in asymptomatic AS. All patients with baseline electrocardiograms in the SEAS study were included. The primary end point was cardiovascular death. Backward elimination (p >0.01) identified heart rate, Q waves, and Cornell voltage-duration product as independently associated with cardiovascular death. Multivariate logistic and Cox regression models were used to evaluate if these 3 ECG variables improved prediction of cardiovascular death. In 1,473 patients followed for a mean of 4.3 years (6,362 patient-years of follow-up), 70 cardiovascular deaths (5%) occurred. In multivariate analysis, heart rate (hazard ratio [HR] 1.5 per 11.2 minute(-1) [1 SD], 95% confidence interval [CI] 1.2 to 1.8), sum of Q-wave amplitude (HR 1.3 per 2.0 mm [1 SD], 95% CI 1.1 to 1.6), and Cornell voltage-duration product (HR 1.4 per 763 mm × ms [1 SD], 95% CI 1.2 to 1.7) remained independently associated with cardiovascular death. Combining the prognostic information contained in each of the 3 ECG variables improved integrated discrimination for prediction of cardiovascular death by 2.5%, net reclassification by 14.3%, and area under the curve by 0.06 (all p ≤0.04) beyond other important risk factors. ECG findings add incremental predictive information for cardiovascular mortality in asymptomatic patients with AS.
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Greve AM, Dalsgaard M, Bang CN, Egstrup K, Ray S, Boman K, Rossebø AB, Gohlke-Baerwolf C, Devereux RB, Køber L, Wachtell K. Stroke in Patients With Aortic Stenosis. Stroke 2014; 45:1939-46. [DOI: 10.1161/strokeaha.114.005296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting influenced the predicted outcomes.
Methods—
Patients with mild-to-moderate aortic stenosis enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Diabetes mellitus, known atherosclerotic disease, and oral anticoagulation were exclusion criteria. Ischemic stroke was the primary end point, and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65–74 years and female sex (CHA
2
DS
2
-VASc) scores.
Results—
One thousand five hundred nine patients were followed for 4.3±0.8 years (6529 patient-years). Rates of stroke were 5.6 versus 21.8 per 1000 patient-years pre- and post-AVR; 429 (28%) underwent AVR and 139 (9%) died. Atrial fibrillation (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.1–6.6), CHA
2
DS
2
-VASc score (HR 1.4 per unit; 95% CI, 1.1–1.8), diastolic blood pressure (HR, 1.4 per 10 mm Hg; 95% CI, 1.1–1.8), and AVR with concomitant coronary artery bypass grafting (HR, 3.2; 95% CI, 1.4–7.2, all
P
≤0.026) were independently associated with stroke. Incident stroke predicted death (HR, 8.1; 95% CI, 4.7–14.0;
P
<0.001).
Conclusions—
In patients with aortic stenosis not prescribed oral anticoagulation, atrial fibrillation, AVR with concomitant coronary artery bypass grafting, and CHA
2
DS
2
-VASc score were the major predictors of stroke. Incident stroke was strongly associated with mortality.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00092677.
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Affiliation(s)
- Anders M. Greve
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Morten Dalsgaard
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Casper N. Bang
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Kenneth Egstrup
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Simon Ray
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Kurt Boman
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Anne B. Rossebø
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Christa Gohlke-Baerwolf
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Richard B. Devereux
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Lars Køber
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
| | - Kristian Wachtell
- From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., M.D., C.N.B., L.K.); Department of Cardiology, OUH Svendborg Sygehus, Denmark (K.E.); Department of Cardiology, Manchester Academic Health Sciences Center, Manchester, United Kingdom (S.R.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden (K.B.); Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway (A.B.R.); Department
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Okin PM, Bang CN, Wachtell K, Hille DA, Kjeldsen SE, Julius S, Dahlöf B, Devereux RB. Racial differences in incident atrial fibrillation among hypertensive patients during antihypertensive therapy. Am J Hypertens 2014; 27:966-72. [PMID: 24552888 DOI: 10.1093/ajh/hpu006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blacks have a higher prevalence of risk factors for atrial fibrillation (AF), such as hypertension, obesity, and heart failure, than nonblacks. Although population-based studies have demonstrated a lower prevalence and incidence of AF in blacks, the relationship of incident AF to race among hypertensive patients undergoing blood pressure lowering has been less extensively examined. METHODS Incident AF was examined in 518 black and 8,313 nonblack hypertensive patients with electrocardiographic left ventricular hypertrophy (LVH) with no history of AF in sinus rhythm on their baseline electrocardiogram, who were randomly assigned to losartan- or atenolol-based treatment. RESULTS During a mean of 4.7±1.1 years of follow-up, new-onset AF occurred in 701 patients (7.9%); 5-year AF incidence was significantly lower in black than nonblack patients (6.1 vs. 8.3%; P = 0.03). In univariable Cox analyses, black race was associated with a 37% lower risk of new AF (hazard ratio (HR) = 0.63; 95% confidence interval (CI) = 0.45-1.00; P = 0.05). In multivariable Cox analyses adjusting for randomized treatment, age, sex, diabetes, history of heart failure, myocardial infarction, ischemic heart disease, stroke, peripheral vascular disease, smoking status, baseline body mass index, serum total and high-density lipoprotein cholesterol, creatinine, glucose, and urine albumin/creatinine ratio as standard risk factors, and for incident myocardial infarction, in-treatment heart rate, systolic and diastolic pressure, Cornell product, and Sokolow-Lyon voltage LVH treated as time-varying covariables, black race remained associated with a 45% decreased risk of developing new AF (HR = 0.55; 95% CI = 0.35-0.87; P = 0.01). CONCLUSIONS Incident AF is substantially less common among black than nonblack hypertensive patients.
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Affiliation(s)
- Peter M Okin
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York;
| | - Casper N Bang
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
| | | | | | - Sverre E Kjeldsen
- Department of Cardiology, University of Oslo, Ullevål Hospital, Oslo, Norway; Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Björn Dahlöf
- Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Richard B Devereux
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York
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40
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Bang CN, Gerdts E, Aurigemma GP, Boman K, de Simone G, Dahlöf B, Køber L, Wachtell K, Devereux RB. Four-group classification of left ventricular hypertrophy based on ventricular concentricity and dilatation identifies a low-risk subset of eccentric hypertrophy in hypertensive patients. Circ Cardiovasc Imaging 2014; 7:422-9. [PMID: 24723582 DOI: 10.1161/circimaging.113.001275] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Left ventricular hypertrophy (LVH; high LV mass [LVM]) is traditionally classified as concentric or eccentric based on LV relative wall thickness. We evaluated the prediction of subsequent adverse events in a new 4-group LVH classification based on LV dilatation (high LV end-diastolic volume [EDV] index) and concentricity (mass/end-diastolic volume [M/EDV](2/3)) in hypertensive patients. METHODS AND RESULTS In the Losartan Intervention for Endpoint Reduction (LIFE) echocardiography substudy, 939 hypertensive patients with measurable LVM at baseline were randomized to a mean of 4.8 years of losartan- or atenolol-based treatment. Patients with LVH (LVM/body surface area ≥116 and ≥96 g/m(2) in men and woman, respectively) were divided into 4 groups-concentric nondilated (increased M/EDV, normal EDV), eccentric dilated (increased EDV, normal M/EDV), concentric dilated (increased M/EDV and EDV), and eccentric nondilated (normal M/EDV and EDV)-and compared with patients with normal LVM. Time-varying LVH classes were tested for association with all-cause and cardiovascular mortality and a composite end point of myocardial infarction, stroke, heart failure, and cardiovascular death in multivariable Cox analyses. At baseline, the LVs were categorized as eccentric nondilated in 12%, eccentric dilated in 20%, concentric nondilated in 29%, concentric dilated in 14%, and normal LVM in 25%. Treatment changed the prevalence of 4 LVH groups to 23%, 4%, 5%, and 7%; 62% had normal LVM after 4 years. In time-varying Cox analyses, compared with normal LVM, those with eccentric dilated and both concentric nondilated and dilated LVH had increased risks of all-cause or cardiovascular mortality or the composite end point, whereas the eccentric nondilated group did not. CONCLUSIONS Hypertensive patients with relatively mild LVH without either increased LV volume or concentricity have similar risk of all-cause mortality or cardiovascular events because hypertensive patients with normal LVM seem to be a low-risk group. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00338260.
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Affiliation(s)
- Casper N Bang
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.).
| | - Eva Gerdts
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Gerard P Aurigemma
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Kurt Boman
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Giovanni de Simone
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Björn Dahlöf
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Lars Køber
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Kristian Wachtell
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
| | - Richard B Devereux
- From the Department of Medicine, Weill Cornell Medical College, New York, NY (C.N.B., G.d.S., K.W., R.B.D.); Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark (C.N.B., L.K.); Department of Clinical Science, University of Bergen, Bergen, Norway (E.G.); Department of Medicine, Division of Cardiology, University of Massachusetts Medical School, Worcester (G.P.A.); Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.B.); Department of Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.); Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (B.D.); and Department of Cardiology, Copenhagen University Hospital Glostrup, Glostrup, Denmark (K.W.)
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Bang CN, Greve A, Cour ML, Boman K, Gohlke-Baerwolf C, Ray S, Pedersen T, Rossebø A, Okin P, Devereux R, Wachtell K. EFFECT OF RANDOMIZED LIPID LOWERING WITH SIMVASTATIN AND EZETIMIBE ON CATARACT DEVELOPMENT: THE SEAS STUDY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61314-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bang CN, Gislason GH, Greve AM, Bang CA, Lilja A, Torp-Pedersen C, Andersen PK, Køber L, Devereux RB, Wachtell K. New-onset atrial fibrillation is associated with cardiovascular events leading to death in a first time myocardial infarction population of 89,703 patients with long-term follow-up: a nationwide study. J Am Heart Assoc 2014; 3:e000382. [PMID: 24449803 PMCID: PMC3959680 DOI: 10.1161/jaha.113.000382] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 11/16/2022]
Abstract
Background New‐onset atrial fibrillation (AF) is reported to increase the risk of death in myocardial infarction (MI) patients. However, previous studies have reported conflicting results and no data exist to explain the underlying cause of higher death rates in these patients. Methods and Results All patients with first acute MI between 1997 and 2009 in Denmark, without prior AF, were identified from Danish nationwide administrative registers. The impact of new‐onset AF on all‐cause mortality, cardiovascular death, fatal/nonfatal stroke, fatal/nonfatal re‐infarction and noncardiovascular death, were analyzed by multiple time‐dependent Cox models and additionally in propensity score matched analysis. In 89 703 patients with an average follow‐up of 5.0±3.5 years event rates were higher in patients developing AF (n=10 708) versus those staying in sinus‐rhythm (n=78 992): all‐cause mortality 173.9 versus 69.4 per 1000 person‐years, cardiovascular death 137.2 versus 50.0 per 1000 person‐years, fatal/nonfatal stroke 19.6/19.9 versus 6.2/5.6 per 1000 person‐years, fatal/nonfatal re‐infarction 29.0/60.7 versus 14.2/37.9 per 1000 person‐years. In time‐dependent multiple Cox analyses, new‐onset AF remained predictive of increased all‐cause mortality (HR: 1.9 [95% CI: 1.8 to 2.0]), cardiovascular death (HR: 2.1 [2.0 to 2.2]), fatal/nonfatal stroke (HR: 2.3 [2.1 to 2.6]/HR: 2.5 [2.2 to 2.7]), fatal/nonfatal re‐infarction (HR: 1.7 [1.6 to 1.8]/HR: 1.8 [1.7 to 1.9]), and non‐ cardiovascular death (HR: 1.4 [1.3 to 1.5]) all P<0.001). Propensity‐score matched analyses yielded nearly identical results (all P<0.001). Conclusions New‐onset AF after first‐time MI is associated with increased mortality, which is largely explained by more cardiovascular deaths. Focus on the prognostic impact of post‐infarct AF is warranted.
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Affiliation(s)
- Casper N Bang
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
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Bang CN. Atrial fibrillation. Dan Med J 2013; 60:B4731. [PMID: 24083535] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Atrial fibrillation (AF) is a common complication after myocardial infarction (MI) and new-onset AF has been demonstrated to be associated with adverse outcome and a large excess risk of death in both MI and aortic stenosis (AS) patients. Prevention of new-onset AF is therefore a potential therapeutic target in AS and MI patients. Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent AF. Accordingly, statins are recommended as a class IIa recommendation for prevention of new-onset AF after coronary artery bypass grafting (CABG). However, this preventive effect has not been investigated on new-onset AF in asymptomatic patients with AS or a large scale first-time MI patient sample and data in patients not undergoing invasive cardiac interventions are limited. This PhD thesis was conducted at the Heart Centre, Rigshospitalet, Denmark, with the aim to investigate the three aforementioned questions and to add to the existing evidence of AF prevention with statins. This was done using three different settings: 1) a randomized patients sample of 1,873 from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, 2) a register patient sample of 97,499 with first-time MI, and 3) all published studies until beginning of June 2011 examining statin treatment on new-onset and recurrent AF in patients not undergoing cardiac surgery. This thesis revealed that statins did not lower the incidence or the time to new-onset AF in patients with asymptomatic AS. However, statin treatment showed an independently preventive effect on new-onset AF, including type-dependent effect and a trend to dosage-dependent effect. In addition, this thesis showed that good compliance to statin treatment was important to prevent new-onset AF. Finally, the meta-analysis in this PhD thesis showed a preventive effect in the observational studies although this effect was absent in the randomized controlled trials. Based on this PhD thesis, although there might be an effect in MI patients, primary statin treatment to prevent new-onset AF cannot be recommended in AS patients or in patients not undergoing cardiac surgery.
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Affiliation(s)
- Casper N Bang
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark.
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Okin PM, Bang CN, Wachtell K, Hille DA, Kjeldsen SE, Dahlöf B, Devereux RB. Relationship of Sudden Cardiac Death to New-Onset Atrial Fibrillation in Hypertensive Patients With Left Ventricular Hypertrophy. Circ Arrhythm Electrophysiol 2013; 6:243-51. [PMID: 23403268 DOI: 10.1161/circep.112.977777] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter M. Okin
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Casper N. Bang
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Kristian Wachtell
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Darcy A. Hille
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Sverre E. Kjeldsen
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Björn Dahlöf
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
| | - Richard B. Devereux
- From the Greenberg Division of Cardiology, Weill Cornell Medical College, New York, NY (P.M.O., C.N.B., R.B.D.); the Department of Cardiology, Gentofte Hospital, Copenhagen, Denmark (K.W.); Merck Research Labs, West Point, PA (D.A.H.); University of Oslo, Ullevål Hospital, Oslo, Norway (S.E.K.); University of Michigan Medical Center, Ann Arbor, MI (S.E.K.); Sahlgrenska University Hospital/Östra, Göteborg, Sweden (B.D.)
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Bang CN, Roman M, Best L, Lee E, Howard B, Simone GD, Okin P, Kober L, Wachtell K, Devereux R. A NEW FOUR-GROUP CLASSIFICATION OF LEFT VENTRICULAR HYPERTROPHY BASED ON LEFT VENTRICULAR GEOMETRY LOCATED A NEW HIGH-RISK GROUP WITHIN ECCENTRIC HYPERTROPHY IN A POPULATION-BASED STUDY: THE STRONG HEART STUDY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60860-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bang CN, Dalsgaard M, Greve AM, Køber L, Gohlke-Baerwolf C, Ray S, Rossebø AB, Egstrup K, Wachtell K. Left atrial size and function as predictors of new-onset of atrial fibrillation in patients with asymptomatic aortic stenosis: the simvastatin and ezetimibe in aortic stenosis study. Int J Cardiol 2013; 168:2322-7. [PMID: 23416018 DOI: 10.1016/j.ijcard.2013.01.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS). METHODS Data were obtained in asymptomatic patients with mild-to-moderate AS (2.5 ≤ transaortic Doppler velocity ≤ 4.0m/s), preserved LV ejection fraction (EF), no previous AF, and were enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study. Peak-aortic velocity, LA(max) volume & LAmin volume were measured by echocardiography. LA conduit (LA(con)) volume was defined as LV stroke volume-LA stroke volume. LA function was expressed as LA-EF (LA(max)-LAmin volume/LA(max)). RESULTS In the 1159 patients included, new-onset AF occurred in 71 patients (6.1%) within a mean follow-up of 4.2 ± 0.9 years. Mean age was 66 ± 9.7 years, aortic valve area index 0.6 ± 0.2 cm(2)/m(2), LV mass 99.2 ± 29.7 g/m(2), LA(max) volume 34.6 ± 12.0 mL/m(2), LAmin volume 17.9 ± 9.3 mL/m(2), LA-EF 50 ± 15% and LA(con) volume 45 ± 21 mL/m(2). Baseline LAmin volume predicted new-onset AF in Cox multivariable analysis (HR:2.3 [95%CI:1.3-4.4], P<0.01), and added prognostic information on AF development beyond conventional risk factors (likelihood ratio, P<0.01). In comparison of c-indexes LAmin volume was superior to all other LA measurements. Net reclassification index improved by 15.9% when adding LAmin volume to a model with classic risk factors for AF (P=0.01). CONCLUSION LAmin volume independently predicted new-onset AF in patients with asymptomatic AS and was superior to LA-EF, LA(con) and LA(max) volumes and conventional risk factors.
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Affiliation(s)
- Casper N Bang
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen Denmark.
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Bang CN, Greve AM, Wachtell K, Kober L. Global systolic load, left ventricular hypertrophy, and atrial fibrillation. Am Heart J 2012; 164:e13. [PMID: 23067925 DOI: 10.1016/j.ahj.2012.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Bang CN, Gislason GH, Greve AM, Torp-Pedersen C, Køber L, Wachtell K. Statins reduce new-onset atrial fibrillation in a first-time myocardial infarction population: a nationwide propensity score-matched study. Eur J Prev Cardiol 2012; 21:330-8. [DOI: 10.1177/2047487312462804] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Casper N Bang
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Anders M Greve
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | | | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Wachtell
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
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Bang CN, Greve AM, Abdulla J, Køber L, Gislason GH, Wachtell K. The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions: a systematic review and meta-analysis. Int J Cardiol 2012; 167:624-30. [PMID: 22999824 DOI: 10.1016/j.ijcard.2012.08.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 08/31/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous meta-analyses suggest that pre-procedural use of statin therapy may reduce atrial fibrillation (AF) following invasive cardiac interventions (coronary artery by-pass grafting and percutaneous coronary intervention). However, the current evidence on the benefit of statins unrelated to invasive cardiac interventions has not been clarified systematically. METHODS Through a systematic literature search, trials examining the effect of statin therapy on AF were selected. Trials using statins before any percutaneous or surgical cardiac interventions were excluded. RESULTS The search identified 11 randomized and 16 observational eligible studies, totaling 106,640 patients receiving statin therapy and 129,305 serving as controls. Fourteen studies investigated the effect of statins on new-onset AF, 13 studies investigated the effect of statins on recurrent AF and one in both new-onset and recurrent AF. In the statin versus control group the mean age was 60.7 ± 8.3 versus 68.6 ± 6.2 years and females comprised 8.4% versus 10.3%. Statin therapy was associated with significant reduction of AF (Risk ratio (RR): 0.81 [95% confidence interval (CI): 0.80-0.83], p<0.001) combining all studies. Assessing exclusively randomized trials, statin therapy showed no significant risk reduction (RR: 0.97 [95%CI: 0.90-1.05], p=0.509), heterogeneity p>0.05. Assessing exclusively observational studies the risk reduction of new-onset AF was 12% (RR: 0.88 [95%CI: 0.85-0.91], p<0.001) and recurrent AF 15% (RR: 0.85 [95%CI: 0.80-0.90], p<0.001), heterogeneity p<0.001. CONCLUSION The hitherto published randomized clinical trials do not support a beneficial effect of statins on AF in patients not undergoing invasive cardiac interventions. This is in contrast to the results of observational and interventional studies.
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Affiliation(s)
- Casper N Bang
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
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Bang CN, Greve AM, Boman K, Egstrup K, Gohlke-Baerwolf C, Køber L, Nienaber CA, Ray S, Rossebø AB, Wachtell K. Effect of lipid lowering on new-onset atrial fibrillation in patients with asymptomatic aortic stenosis: the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Am Heart J 2012; 163:690-6. [PMID: 22520536 DOI: 10.1016/j.ahj.2012.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 01/26/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent atrial fibrillation (AF). This effect has not been investigated on new-onset AF in asymptomatic patients with aortic stenosis (AS). METHODS Asymptomatic patients with mild-to-moderate AS (n = 1,421) were randomized (1:1) to double-blind simvastatin 40 mg and ezetimibe 10 mg combination or placebo and followed up for a mean of 4.3 years. The primary end point was the time to new-onset AF adjudicated by 12-lead electrocardiogram at a core laboratory reading center. Secondary outcomes were the correlates of new-onset AF with nonfatal nonhemorrhagic stroke and a combined end point of AS-related events. RESULTS During the course of the study, new-onset AF was detected in 85 (6%) patients (14.2/1,000 person-years of follow-up). At baseline, patients who developed AF were, compared with those remaining in sinus rhythm, older and had a higher left ventricular mass index a smaller aortic valve area index. Treatment with simvastatin and ezetimibe was not associated with less new-onset AF (odds ratio 0.89 [95% CI 0.57-1.97], P = .717). In contrast, age (hazard ratio [HR] 1.07 [95% CI 1.05-1.10], P < .001) and left ventricular mass index (HR 1.01 [95% CI 1.01-1.02], P < .001) were independent predictors of new-onset AF. The occurrence of new-onset AF was independently associated with 2-fold higher risk of AS-related outcomes (HR 1.65 [95% CI 1.02-2.66], P = .04) and 4-fold higher risk of nonfatal nonhemorrhagic stroke (HR 4.04 [95% CI 1.18-13.82], P = .03). CONCLUSIONS Simvastatin and ezetimibe were not associated with less new-onset AF. Older age and greater left ventricular mass index were independent predictors of AF development. New-onset AF was associated with a worsening of prognosis.
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