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Larsen KL, Kavaliunaite E, Rasmussen LM, Hallas J, Diederichsen A, Steffensen FH, Busk M, Frost L, Urbonaviciene G, Lambrechtsen J, Egstrup K, Lindholt JS. The association between diabetes and abdominal aortic aneurysms in men: results of two Danish screening studies, a systematic review, and a meta-analysis of population-based screening studies. BMC Cardiovasc Disord 2023; 23:139. [PMID: 36927295 PMCID: PMC10022183 DOI: 10.1186/s12872-023-03160-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND A paradoxical protective effect of diabetes on the development and progression of abdominal aortic aneurysms (AAA) has been known for years. This study aimed to investigate whether the protective role of diabetes on AAAs has evolved over the years. METHODS A cross-sectional study, a systematic review and meta-analysis. This study was based on two large, population-based, randomised screening trials of men aged 65-74; VIVA (2008-2011) and DANCAVAS (2014-2018), including measurement of the abdominal aorta by ultrasound or CT, respectively. Analyses were performed using multiple logistic regressions to estimate the odds ratios (ORs) for AAAs in men with diabetes compared to those not having diabetes. Moreover, a systematic review and meta-analysis of population-based screening studies of AAAs to visualise a potential change of the association between diabetes and AAAs. Studies reporting only on women or Asian populations were excluded. RESULTS In VIVA, the prevalence of AAA was 3.3%, crude OR for AAA in men with diabetes 1.04 (95% confidence interval, CI, 0.80-1.34), and adjusted OR 0.64 (CI 0.48-0.84). In DANCAVAS, the prevalence of AAA was 4.2%, crude OR 1.44 (CI 1.11-1.87), and adjusted OR 0.78 (CI 0.59-1.04). Twenty-three studies were identified for the meta-analysis (N = 224 766). The overall crude OR was 0.90 (CI 0.77-1.05) before 2000 and 1.16 (CI 1.03-1.30) after 1999. The overall adjusted OR was 0.63 (CI 0.59-0.69) before 2000 and 0.69 (CI 0.57-0.84) after 1999. CONCLUSION Both the crude and adjusted OR showed a statistically non-significant trend towards an increased risk of AAA by the presence of diabetes. If this represents an actual trend, it could be due to a change in the diabetes population. TRIAL REGISTRATION DANCAVAS: Current Controlled Trials: ISRCTN12157806. VIVA: ClinicalTrials.gov NCT00662480.
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Affiliation(s)
- Katrine Lawaetz Larsen
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- grid.7143.10000 0004 0512 5013The Danish Diabetes Academy, Odense University Hospital, Kløvervænget 6, 5000 Odense C, Denmark
| | - Egle Kavaliunaite
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Lars Melholt Rasmussen
- grid.7143.10000 0004 0512 5013Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jesper Hallas
- grid.7143.10000 0004 0512 5013Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- grid.10825.3e0000 0001 0728 0170Clinical Pharmacology and Pharmacy, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Axel Diederichsen
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Flemming Hald Steffensen
- grid.459623.f0000 0004 0587 0347Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Martin Busk
- grid.459623.f0000 0004 0587 0347Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Jess Lambrechtsen
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700 Svendborg, Denmark
| | - Kenneth Egstrup
- grid.7143.10000 0004 0512 5013Department of Cardiology, Odense University Hospital Svendborg, Baagøes Àlle 15, 5700 Svendborg, Denmark
| | - Jes Sanddal Lindholt
- grid.7143.10000 0004 0512 5013Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
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Mortensen MB, Dzaye O, Razavi AC, Jensen JM, Steffensen FH, Bøtker HE, Cainzos-Achirica M, Sørensen HT, Maeng M, Blaha MJ, Nasir K, Nørgaard BL. Association between REDUCE-IT criteria, coronary artery disease severity and cardiovascular events: The Western Denmark Heart Registry. Eur J Prev Cardiol 2022; 29:1802-1810. [PMID: 35653637 DOI: 10.1093/eurjpc/zwac104] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/11/2022]
Abstract
AIMS The REDUCE-IT trial demonstrated that icosapent ethyl lowered the risk of atherosclerotic cardiovascular disease (ASCVD) among patients with elevated triglycerides. However, how to appropriately implement its use in clinical practice is not well-defined.We aimed to determine whether plaque burden as assessed by coronary artery calcium (CAC) could stratify ASCVD risk among patients eligible for icosapent ethyl. METHODS AND RESULTS Among 23,759 patients who underwent computed tomography angiography (CTA) in the Western Denmark Heart Registry, we identified eligibility for the REDUCE-IT trial. A total of 2146 participants (9%) met enrollment criteria for REDUCE-IT. During a median of 4.3 years of follow-up, 146 ASCVD events occurred. Overall, there was a stepwise increase in ASCVD event rates per 1,000 person-years with increasing CAC (CAC = 0: 10.5, CAC 1-299: 18.7, CAC ≥300: 49.8). REDUCE-IT eligible patients with CAC ≥300 had a multivariable-adjusted hazard ratio of 3.1 compared to CAC = 0 (95%CI: 1.9-4.9). CAC differentiated risk similarly in patients with and without obstructive CAD. Overall, the 5-year estimated number needed to treat to prevent one event with icosapent ethyl was 45 and ranged from 87 in those with CAC = 0 to 17 in those with CAC ≥300. Some patients with non-obstructive CAD had lower estimated NNT than patients with obstructive CAD when their plaque burden was higher. CONCLUSION Atherosclerotic plaque burden as assessed by CAC can identify REDUCE-IT eligible patients who are expected to derive most, and least, absolute benefit from treatment with icosapent ethyl regardless of obstructive versus nonobstructive CAD status.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Alexander C Razavi
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | | | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, United States
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, United States
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Mortensen MB, Caínzos-Achirica M, Steffensen FH, Bøtker HE, Jensen JM, Sand NPR, Maeng M, Bruun JM, Blaha MJ, Sørensen HT, Pareek M, Nasir K, Nørgaard BL. Association of Coronary Plaque With Low-Density Lipoprotein Cholesterol Levels and Rates of Cardiovascular Disease Events Among Symptomatic Adults. JAMA Netw Open 2022; 5:e2148139. [PMID: 35147685 PMCID: PMC8837910 DOI: 10.1001/jamanetworkopen.2021.48139] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Atherosclerosis burden and coronary artery calcium (CAC) are associated with the risk for atherosclerotic cardiovascular disease (ASCVD) events, with absence of plaque and CAC indicating low risk. Whether this is true in patients with elevated levels of low-density lipoprotein cholesterol (LDL-C) is not known. Specifically, a high prevalence of noncalcified plaque might signal high risk. OBJECTIVE To determine the prevalence of noncalcified and calcified plaque in symptomatic adults and assess its association with cardiovascular events across the LDL-C spectrum. DESIGN, SETTING, AND PARTICIPANTS This cohort study included symptomatic patients undergoing coronary computed tomographic angiography from January 1, 2008, to December 31, 2017, from the seminational Western Denmark Heart Registry. Follow-up was completed on July 6, 2018. Data were analyzed from April 2 to December 2, 2021. EXPOSURES Prevalence of calcified and noncalcified plaque according to LDL-C strata of less than 77, 77 to 112, 113 to 154, 155 to 189, and at least 190 mg/dL. Severity of coronary artery disease was categorized using CAC scores of 0, 1 to 99, and ≥100, where higher numbers indicate greater CAC burden. MAIN OUTCOMES AND MEASURES Atherosclerotic cardiovascular disease events (myocardial infarction and stroke) and death. RESULTS A total of 23 143 patients with a median age of 58 (IQR, 50-65) years (12 857 [55.6%] women) were included in the analysis. During median follow-up of 4.2 (IQR, 2.3-6.1) years, 1029 ASCVD and death events occurred. Across all LDL-C strata, absence of CAC was a prevalent finding (ranging from 438 of 948 [46.2%] in patients with LDL-C levels of at least 190 mg/dL to 4370 of 7964 [54.9%] in patients with LDL-C levels of 77-112 mg/dL) and associated with no detectable plaque in most patients, ranging from 338 of 438 (77.2%) in those with LDL-C levels of at least 190 mg/dL to 1067 of 1204 (88.6%) in those with LDL-C levels of less than 77 mg/dL. In all LDL-C groups, absence of CAC was associated with low rates of ASCVD and death (6.3 [95% CI, 5.6-7.0] per 1000 person-years), with increasing rates in patients with CAC scores of 1 to 99 (11.1 [95% CI, 10.0-12.5] per 1000 person-years) and CAC scores of at least 100 (21.9 [95% CI, 19.9-24.4] per 1000 person-years). Among those with CAC scores of 0, the event rate per 1000 person-years was 6.3 (95% CI, 5.6-7.0) in the overall population compared with 6.9 (95% CI, 4.0-11.9) in those with LDL-C levels of at least 190 mg/dL. Across all LDL-C strata, rates were similar and low in those with CAC scores of 0, regardless of whether they had no plaque or purely noncalcified plaque. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that in symptomatic patients with severely elevated LDL-C levels of at least 190 mg/dL who are universally considered to be at high risk by guidelines, absence of calcified and noncalcified plaque on coronary computed tomographic angiography was associated with low risk for ASCVD events. These results further suggest that atherosclerosis burden, including CAC, can be used to individualize treatment intensity in patients with severely elevated LDL-C levels.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Miguel Caínzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist, Houston, Texas
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, Maryland
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, Maryland
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Manan Pareek
- Department of Internal Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist, Houston, Texas
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Fredgart MH, Lindholt JS, Brandes A, Steffensen FH, Frost L, Lambrechtsen J, Karon M, Busk M, Urbonaviciene G, Egstrup K, Khurrami L, Gerke O, Diederichsen ACP. Association of Left Atrial Size Measured by Non-Contrast Computed Tomography with Cardiovascular Risk Factors—The Danish Cardiovascular Screening Trial (DANCAVAS). Diagnostics (Basel) 2022; 12:diagnostics12020244. [PMID: 35204336 PMCID: PMC8871467 DOI: 10.3390/diagnostics12020244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 02/06/2023] Open
Abstract
Left atrium (LA) size is associated with adverse cardiovascular events. The purpose of this study was to investigate the association of LA enlargement measured by non-contrast CT (NCCT) with traditional cardiovascular risk factors. Individuals aged 60–75 years from the population-based multicentre Danish Cardiovascular Screening (DANCAVAS) trial were included in this cross-sectional study. The LA was manually traced on the NCCT scans, and the largest cross-section area was indexed to body surface area. All traditional risk factors were recorded, and a subgroup received an echocardiographic examination. We enrolled 14,987 individuals. Participants with known cardiovascular disease or lacking measurements of LA size or body surface area were excluded, resulting in 10,902 men for the main analysis and 616 women for a sensitivity analysis. Adjusted multivariable analysis showed a significantly increased indexed LA size by increasing age and pulse pressure, while smoking, HbA1c, and total cholesterol were associated with decreased indexed LA size. The findings were confirmed in a supplementary analysis including left ventricle ejection fraction and mass. In this population-based cohort of elderly men, an association was found between age and pulse pressure and increasing LA size. Surprisingly, smoking, HbA1c, and total cholesterol were associated with a decrease in LA size. This indicates that the pathophysiology behind atrial cardiomyopathy is not only reflected by enlargement, but also shrinking.
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Affiliation(s)
- Maise Høigaard Fredgart
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital, 5000 Odense, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, 5000 Odense, Denmark;
- Cardiovascular Centre of Excellence (CAVAC), Odense University Hospital, 5000 Odense, Denmark
- Elitary Research Centre of Individualised Medicine in Arterial Disease, Odense University Hospital, 5000 Odense, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
| | | | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, 8600 Silkeborg, Denmark; (L.F.); (G.U.)
| | - Jess Lambrechtsen
- Department of Cardiology, Svendborg Hospital, 5700 Svendborg, Denmark; (J.L.); (K.E.)
| | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, 4800 Nykøbing Falster, Denmark;
| | - Martin Busk
- Department of Cardiology, Hospital Lillebælt, 7100 Vejle, Denmark; (F.H.S.); (M.B.)
| | - Grazina Urbonaviciene
- Department of Cardiology, Regional Hospital Central Jutland, 8600 Silkeborg, Denmark; (L.F.); (G.U.)
| | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, 5700 Svendborg, Denmark; (J.L.); (K.E.)
| | - Lida Khurrami
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark;
| | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Odense University Hospital, 5000 Odense, Denmark; (M.H.F.); (A.B.); (L.K.)
- Elitary Research Centre of Individualised Medicine in Arterial Disease, Odense University Hospital, 5000 Odense, Denmark
- Correspondence:
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Rasmussen JH, Fredgart MH, Lindholt JS, Johansen JB, Sandgaard N, Yousef AH, Hasific S, Sønderskov P, Steffensen FH, Frost L, Lambrechtsen J, Karon M, Busk M, Urbonaviciene G, Egstrup K, Diederichsen ACP. Mitral Annulus Calcification and Cardiac Conduction Disturbances: a DANCAVAS Sub-study. J Cardiovasc Imaging 2022; 30:62-75. [PMID: 35086172 PMCID: PMC8792721 DOI: 10.4250/jcvi.2021.0110] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Due to its location very close to the bundle of His, mitral annulus calcification (MAC) might be associated with the development of atrioventricular (AV) conduction disturbances. This study assessed the association between MAC and AV conduction disturbances identified by cardiac implantable electronic device (CIED) use and electrocardiographic parameters. The association between MAC and traditional cardiovascular risk factors was also assessed. METHODS This cross-sectional study analyzed 14,771 participants, predominantly men aged 60–75 years, from the population-based Danish Cardiovascular Screening trial. Traditional cardiovascular risk factors were obtained. Using cardiac non-contrast computed tomography imaging, MAC scores were measured using the Agatston method and divided into absent versus present and score categories. CIED implantation data were obtained from the Danish Pacemaker and Implantable Cardioverter Defibrillator Register. A 12-lead electrocardiogram was available for 2,107 participants. Associations between MAC scores and AV conduction disturbances were assessed using multivariate regression analyses. RESULTS MAC was present in 22.4% of the study subjects. Participants with pacemakers for an AV conduction disturbance had significantly higher MAC scores (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.01–1.23) than participants without a CIED, whereas participants with a CIED for other reasons did not. Prolonged QRS-interval was significantly associated with the presence of MAC (OR, 1.45; 95% CI, 1.04–2.04), whereas prolonged PQ-interval was not. Female sex and most traditional cardiovascular risk factors were significantly associated with high MAC scores. CONCLUSIONS MAC was associated with AV conduction disturbances, which could improve our understanding of the development of AV conduction disturbances.
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Affiliation(s)
- Jeppe Holm Rasmussen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | | | - Niels Sandgaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Selma Hasific
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | | | - Marek Karon
- Department of Medicine, Nykoebing Falster Hospital, Nykoebing Falster, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | | | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, Svendborg, Denmark
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Mortensen MB, Dzaye O, Bødtker H, Steffensen FH, Bøtker HE, Jensen JM, Rønnow Sand NP, Maeng M, Warnakula Olesen KK, Sørensen HT, Kanstrup H, Blankstein R, Blaha MJ, Nørgaard BL. Interplay of Risk Factors and Coronary Artery Calcium for CHD Risk in Young Patients. JACC Cardiovasc Imaging 2021; 14:2387-2396. [PMID: 34147446 DOI: 10.1016/j.jcmg.2021.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/08/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to examine prevalence, predictors, and impact of coronary artery calcium (CAC) across different risk factor burdens on the prevalence of obstructive coronary artery disease (CAD) and future coronary heart disease (CHD) risk in young patients. BACKGROUND The interplay of risk factors and CAC for predicting CHD in young patients aged ≤45 years is not clear. METHODS The study included 3,691 symptomatic patients (18-45 years of age) from the WDHR (Western Denmark Heart Registry) undergoing coronary computed tomographic angiography. CHD events were myocardial infarction and late revascularization. RESULTS During a median of 4.1 years of follow-up, 57 first-time CHD events occurred. In total, 3,180 patients (86.1%) had CAC = 0 and 511 patients (13.9%) had CAC >0. Presence of CAC increased with number of risk factors (odds ratio: 4.5 [95% CI: 2.7-7.3] in patients with >3 vs 0 risk factors). The prevalence of obstructive CAD at baseline and the rate of future CHD events increased in a stepwise manner with both higher CAC and number of risk factors. The CHD event rate was lowest at 0.5 (95% CI: 0.1-3.6) per 1,000 person-years in patients with 0 risk factors and CAC = 0. Among patients with >3 risk factors, the event rate was 3.1 (95% CI: 1.0-9.7) in patients with CAC = 0 compared with 36.3 (95% CI: 17.3-76.1) in patients with CAC >10. CONCLUSIONS In young patients, there is a strong interplay between CAC and risk factors for predicting the presence of obstructive CAD and for future CHD risk. In the presence of risk factors, even a low CAC score is a high-risk marker. These results demonstrate the importance of assessing risk factors and CAC simultaneously when assessing risk in young patients.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Henrik Bødtker
- Department of Clinical Medicine, Aarhus University Hospital, Denmark
| | | | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Kanstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Mortensen MB, Gaur S, Frimmer A, Bøtker HE, Sørensen HT, Kragholm KH, Niels Peter SR, Steffensen FH, Jensen RV, Mæng M, Kanstrup H, Blaha MJ, Shaw LJ, Dzaye O, Leipsic J, Nørgaard BL, Jensen JM. Association of Age With the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Coronary Stenosis in Symptomatic Patients. JAMA Cardiol 2021; 7:36-44. [PMID: 34705022 DOI: 10.1001/jamacardio.2021.4406] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 01/16/2023]
Abstract
Importance The diagnostic value is unclear of a 0 coronary artery calcium (CAC) score to rule out obstructive coronary artery disease (CAD) and near-term clinical events across different age groups. Objective To assess the diagnostic value of a CAC score of 0 for reducing the likelihood of obstructive CAD and to assess the implications of such a CAC score and obstructive CAD across different age groups. Design, Setting, and Participants This cohort study obtained data from the Western Denmark Heart Registry and had a median follow-up time of 4.3 years. Included patients were aged 18 years or older who underwent computed tomography angiography (CTA) between January 1, 2008, and December 31, 2017, because of symptoms that were suggestive of CAD. Data analysis was performed from April 5 to July 7, 2021. Exposures Obstructive CAD, which was defined as 50% or more luminal stenosis. Main Outcomes and Measures Proportion of individuals with obstructive CAD who had a CAC score of 0. Risk-adjusted diagnostic likelihood ratios were used to assess the diagnostic value of a CAC score of 0 for reducing the likelihood of obstructive CAD beyond clinical variables. Risk factors associated with myocardial infarction and death were estimated. Results A total of 23 759 symptomatic patients, of whom 12 771 (54%) had a CAC score of 0, were included. This cohort had a median (IQR) age of 58 (49-65) years and was primarily composed of women (13 160 [55%]). Overall, the prevalence of obstructive CAD was relatively low across all age groups, ranging from 3% (39 of 1278 patients) in those who were younger than 40 years to 8% (52 of 619) among those who were 70 years or older. In patients with obstructive CAD, 14% (725 of 5043) had a CAC score of 0, and the prevalence varied across age groups from 58% (39 of 68) among those who were younger than 40 years, 34% (192 of 562) among those aged 40 to 49 years, 18% (268 of 1486) among those aged 50 to 59 years, 9% (174 of 1963) among those aged 60 to 69 years, to 5% (52 of 964) among those who were 70 years or older. The added diagnostic value of a CAC score of 0 decreased at a younger age, with a risk factor-adjusted diagnostic likelihood ratio of a CAC score of 0 ranging from 0.68 (approximately 32% lower likelihood of obstructive CAD than expected) in those who were younger than 40 years to 0.18 (approximately 82% lower likelihood than expected) in those who were 70 years or older. The presence of obstructive vs nonobstructive CAD among those with a CAC score of 0 was associated with a multivariable adjusted hazard ratio of 1.51 (95% CI, 0.98-2.33) for myocardial infarction and all-cause death; however, this hazard ratio varied from 1.80 (95% CI, 1.02-3.19) in those who were younger than 60 years to 1.24 (95% CI, 0.64-2.39) in those who were 60 years or older. Conclusions and Relevance This cohort study found that the diagnostic value of a CAC score of 0 to rule out obstructive CAD beyond clinical variables was dependent on age, with the added diagnostic value being smaller for younger patients. In symptomatic patients who were younger than 60 years, a sizable proportion of obstructive CAD occurred among those without CAC and was associated with an increased risk of myocardial infarction and all-cause death.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Johns Hopkins, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Sara Gaur
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Attila Frimmer
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sand Rønnow Niels Peter
- Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Denmark
| | | | | | - Michael Mæng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Kanstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael J Blaha
- Johns Hopkins, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York
| | - Omar Dzaye
- Johns Hopkins, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
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8
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Khurrami L, Møller JE, Lindholt JS, Dahl JS, Fredgart MH, Obel LM, Steffensen FH, Urbonaviciene G, Lambrechtsen J, Diederichsen ACP. Aortic valve calcification among elderly males from the general population, associated echocardiographic findings, and clinical implications. Eur Heart J Cardiovasc Imaging 2021; 23:177-184. [PMID: 34491310 DOI: 10.1093/ehjci/jeab182] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Aortic valve calcification (AVC) detected by non-contrast computed tomography (NCCT) associates with morbidity and mortality in patients with aortic valve stenosis. However, the importance of AVC in the general population is sparsely evaluated. We intend to describe the associations between AVC score on NCCT and echocardiographic findings as left atrial (LA) dilatation, left ventricular (LV) hypertrophy, aortic valve area (AVA), peak velocity, mean gradient, and aortic valve replacement (AVR) in a population with AVC scores ≥300 AU. METHODS AND RESULTS Of 10 471 males aged 65-74 years from the Danish Cardiovascular Screening trial (DANCAVAS), participants with AVC score ≥300 AU were invited for transthoracic echocardiography and 828 (77%) of 1075 accepted the invitation. AVC scores were categorized (300-599, 600-799, 800-1199, and ≥1200 AU). AVR was obtained from registries. AVC was significantly associated with a steady increase in LA dilation (10.5%, 16.3%, 15.8%, 19.6%, P = 0.031), LV hypertrophy (3.9%, 6.6%, 8.9%, 10.1%, P = 0.021), peak velocity (1.7, 1.9, 2.1, 2.8 m/s, P = 0001), mean gradient (6, 8, 11, 19 mmHg, P = 0.0001), and a decrease in AVA (2.0, 1.9, 1.7, 1.3 cm2, P = 0.0001). The area under the curve was 0.79, 0.93, and 0.92 for AVA ≤1.5 cm2, peak velocity ≥3.0 m/s, and mean gradient ≥20 mmHg, respectively, and the associated optimal AVC score thresholds were 734, 1081, and 1019 AU. AVC > 1200 AU was associated with AVR (P < 0.0001). CONCLUSION Among males from the background population, increasing AVC scores were associated with LA dilatation, LV hypertrophy, AVA, peak aortic velocity, mean aortic gradient, and AVR.
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Affiliation(s)
- Lida Khurrami
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark.,Department of Cardiology, Copenhagen University Hospital, Blegdamsvej 9, 2100 København, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Jordi Sancez Dahl
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Maise Hoeigaard Fredgart
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - Lasse M Obel
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | | | - Grazina Urbonaviciene
- Department of Cardiology, Regional Hospital Central Jutland, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Baagøes Alle 31, 5700 Svendborg, Denmark
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9
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Winther S, Andersen IT, Gormsen LC, Steffensen FH, Nielsen LH, Grove EL, Diederichsen ACP, Urbonaviciene G, Lambrechtsen J, Zaremba T, Elpert FP, Husain M, Zelechowski MW, Bøtker HE, Bøttcher M. Prognostic value of myocardial perfusion imaging after first-line coronary computed tomography angiography: A multi-center cohort study. J Cardiovasc Comput Tomogr 2021; 16:34-40. [PMID: 34475016 DOI: 10.1016/j.jcct.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/31/2021] [Revised: 07/27/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Further diagnostic testing may be required after a coronary computed tomography angiography (CTA) showing suspected coronary stenosis. Whether myocardial perfusion imaging (MPI) provides further prognostic information post-CTA remains debated. We evaluated the prognosis for patients completing CTA stratified for post-CTA diagnostic work-up using real-world data. METHODS We identified all patients in our uptake area with angina symptoms undergoing first-time CTA over a 10-year period. Follow-up time was a median of 3.7 years [1.9-5.8]. The primary endpoint was a composite of myocardial infarction or death. The secondary endpoint was late revascularization. RESULTS During the study period 53,351 patients underwent CTA. Of these, 24% were referred for further down-stream testing, 3,547 (7%) to MPI and 9,135 (17%) to invasive coronary angiography (ICA). The primary and secondary endpoints occurred in 2,026 (3.8%) and 954 (1.8%) patients. Patient-characteristic-adjusted hazard ratios for the primary and secondary endpoint using patients with a normal CTA as reference were 1.37 (1.21-1.55) and 2.50 (1.93-3.23) for patient treated medically, 1.68 (1.39-2.03) and 6.13 (4.58-8.21) for patients referred to MPI and 1.94 (1.69-2.23) and 9.18 (7.16-11.78) for patients referred for ICA, respectively. Adjusted analysis with stratification for disease severity at CTA showed similar hazard ratios for patients treated medically after CTA and patients referred for MPI and treated medically after the MPI. CONCLUSION In patients completing coronary CTA, second-line MPI testing seems to identify patients at low risk of future events. MPI seems to have the potential to act as gatekeeper for ICA after coronary CTA.
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Affiliation(s)
- Simon Winther
- Department of Cardiology, Hospital Unit West, Herning, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
| | | | | | | | | | - Erik Lerkevang Grove
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark.
| | | | | | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark.
| | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Frank-Peter Elpert
- Department of Cardiology, Regional Hospital of South Jutland, Aabenraa, Denmark.
| | - Majed Husain
- Department of Cardiology, Regional Hospital of South West Denmark, Esbjerg, Denmark.
| | | | - Hans Erik Bøtker
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark.
| | - Morten Bøttcher
- Department of Cardiology, Hospital Unit West, Herning, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
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10
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Khurrami L, Møller JE, Lindholt JS, Urbonaviciene G, Steffensen FH, Lambrechtsen J, Karon M, Frost L, Busk M, Egstrup K, Fredgart MH, Diederichsen ACP. Cross-sectional study of aortic valve calcification and cardiovascular risk factors in older Danish men. Heart 2021; 107:1536-1543. [PMID: 34376488 DOI: 10.1136/heartjnl-2021-319023] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/27/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Aortic valve calcification (AVC) and coronary artery calcification (CAC) are predictors of cardiovascular disease (CVD), presumably sharing risk factors. Our objectives were to determine the prevalence and extent of AVC in a large population of men aged 60-74 years and to assess the association between AVC and cardiovascular risk factors including CAC and biomarkers. METHODS Participants from the DANish CArdioVAscular Screening and intervention trial (DANCAVAS) with AVC and CAC scores and without previous valve replacement were included in the study. Calcification scores were calculated on non-contrast CT scans. Cardiovascular risk factors were self-reported, measured or both, and further explored using descriptive and regression analysis for AVC association. RESULTS 14 073 men aged 60-74 years were included. The AVC scores ranged from 0 to 9067 AU, with a median AVC of 6 AU (IQR 0-82). In 8156 individuals (58.0%), the AVC score was >0 and 215 (1.5%) had an AVC score ≥1200. In the regression analysis, all cardiovascular risk factors were associated with AVC; however, after inclusion of CAC ≥400, only age (ratio of expected counts (REC) 1.07 (95% CI 1.06 to 1.09)), hypertension (REC 1.24 (95% CI 1.09 to 1.41)), obesity (REC 1.34 (95% CI 1.20 to 1.50)), known CVD (REC 1.16 (95% CI 1.03 to 1.31)) and serum phosphate (REC 2.25 (95% CI 1.66 to 3.10) remained significantly associated, while smoking, diabetes, hyperlipidaemia, estimated glomerular filtration rate and serum calcium were not. CONCLUSIONS AVC was prevalent in the general population of men aged 60-74 years and was significantly associated with all modifiable cardiovascular risk factors, but only selectively after adjustment for CAC ≥400 AU. TRIAL REGISTRATION NUMBER NCT03946410 and ISRCTN12157806.
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Affiliation(s)
- Lida Khurrami
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Cardiovascular Centre of Excellence (CAVAC), Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | | | | | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, Region Zealand, Denmark
| | - Lars Frost
- Department of Cardiology, Regional Hospital of Central Jutland, Silkeborg, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Cardiovascular Centre of Excellence (CAVAC), Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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11
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Gerke O, Lindholt JS, Abdo BH, Lambrechtsen J, Frost L, Steffensen FH, Karon M, Egstrup K, Urbonaviciene G, Busk M, Mickley H, Diederichsen ACP. Prevalence and extent of coronary artery calcification in the middle-aged and elderly population. Eur J Prev Cardiol 2021; 28:2048-2055. [PMID: 34179988 DOI: 10.1093/eurjpc/zwab111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/12/2021] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 01/21/2023]
Abstract
AIMS Coronary artery calcification (CAC) measured on cardiac computed tomography (CT) is an important risk marker for cardiovascular disease (CVD) and has been included in the prevention guidelines. The aim of this study was to describe CAC score reference values in the middle-aged and elderly population and to develop a freely available CAC calculator. METHODS AND RESULTS All participants from two population-based cardiac CT screening cohorts (DanRisk and DANCAVAS) were included. The CAC score was measured as a part of a screening session. Positive CAC scores were log-transformed and non-parametrically regressed on age for each gender, and percentile curves were transposed according to proportions of zero CAC scores. Men had higher CAC scores than women, and the prevalence and extend of CAC increased steadily with age. An online CAC calculator was developed, http://flscripts.dk/cacscore. After entering sex, age, and CAC score, the CAC score percentile and the coronary age are depicted including a figure with the specific CAC score and 25%, 50%, 75%, and 90% percentiles. The specific CAC score can be compared to the entire background population or only those without prior CVD. CONCLUSION This study provides modern population-based reference values of CAC scores in men and woman and a freely accessible online CAC calculator. Physicians and patients are very familiar with blood pressure and lipids, but unfamiliar with CAC scores. Using the calculator makes it easy to see if a CAC value is low, moderate, or high, when a physician in the future communicate and discusses a CAC score with a patient.
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Affiliation(s)
- Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
| | - Jes S Lindholt
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark.,Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Barzan H Abdo
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Svendborg Hospital, Baagøes Àlle 15 5700 Svendborg, Denmark
| | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Central Jutland, Falkevej 1, 8600 Silkeborg, Denmark
| | | | - Marek Karon
- Department of Medicine, Nykøbing Falster Hospital, Hospitalsvej, 4800 Nykøbing Falster, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, Baagøes Àlle 15 5700 Svendborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Central Jutland, Falkevej 1, 8600 Silkeborg, Denmark
| | - Martin Busk
- Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Hans Mickley
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Axel C P Diederichsen
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense C, Denmark.,Centre of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
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12
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Mortensen MB, Dzaye O, Steffensen FH, Bøtker HE, Jensen JM, Maeng M, Sørensen HT, Blankstein R, Blaha MJ, Nørgaard BL. Prognostic Value of Coronary Artery Calcium in Symptomatic Young Individuals Age 18 to 45 Years. J Am Coll Cardiol 2021; 77:2980-2982. [PMID: 34112325 DOI: 10.1016/j.jacc.2021.04.032] [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] [Received: 01/22/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
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13
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Winther S, Schmidt SE, Rasmussen LD, Juárez Orozco LE, Steffensen FH, Bøtker HE, Knuuti J, Bøttcher M. Validation of the European Society of Cardiology pre-test probability model for obstructive coronary artery disease. Eur Heart J 2021; 42:1401-1411. [PMID: 33180904 DOI: 10.1093/eurheartj/ehaa755] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/22/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Estimation of pre-test probability (PTP) of disease in patients with suspected coronary artery disease (CAD) is a common challenge. Due to decreasing prevalence of obstructive CAD in patients referred for diagnostic testing, the European Society of Cardiology suggested a new PTP (2019-ESC-PTP) model. The aim of this study was to validate that model. METHODS AND RESULTS Symptomatic patients referred for coronary computed tomography angiography (CTA) due to suspected CAD in a geographical uptake area of 3.3 million inhabitants were included. The reference standard was a combined endpoint of CTA and invasive coronary angiography (ICA) with obstructive CAD defined at ICA as a ≥50% diameter stenosis or fractional flow reserve ≤0.80 when performed. The 2019-ESC-PTP, 2013-ESC-PTP, and CAD Consortium basic PTP scores were calculated based on age, sex, and symptoms. Of the 42 328 identified patients, coronary stenosis was detected in 8.8% using the combined endpoint. The 2019-ESC-PTP and CAD Consortium basic scores classified substantially more patients into the low PTP groups (PTP < 15%) than did the 2013-ESC-PTP (64% and 65% vs. 16%, P < 0.001). Using the combined endpoint as reference, calibration of the 2019-ESC-PTP model was superior to the 2013-ESC-PTP and CAD Consortium basic score. CONCLUSION The new 2019-ESC-PTP model is well calibrated and superior to the previously recommended models in predicting obstructive stenosis detected by a combined endpoint of CTA and ICA.
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Affiliation(s)
- Simon Winther
- Department of Cardiology, Gødstrup Hospital, Gl. Landevej 61, Herning 7400, Denmark
| | - Samuel Emil Schmidt
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D2. 9220 Aalborg Øst, Denmark
| | | | - Luis Eduardo Juárez Orozco
- Department of Clinical Physiology, Nuclear Medicine and PET and Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, FI20520 Turku, Finland
| | - Flemming Hald Steffensen
- Department of Cardiology, Lillebaelt Hospital, Kabbeltoft 25, 7100 Vejle, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45. 8200 Aarhus N, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus N, Denmark
| | - Juhani Knuuti
- Department of Clinical Physiology, Nuclear Medicine and PET and Turku PET Centre, Turku University Hospital, Kiinamyllynkatu 4-8, FI20520 Turku, Finland
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Gl. Landevej 61, Herning 7400, Denmark
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14
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Wiggers H, Køber L, Gislason G, Schou M, Poulsen MK, Vraa S, Nielsen OW, Bruun NE, Nørrelund H, Hollingdal M, Barasa A, Bøttcher M, Dodt K, Hansen VB, Nielsen G, Knudsen AS, Lomholdt J, Mikkelsen KV, Jonczy B, Brønnum-Schou J, Poenaru MP, Abdulla J, Raymond I, Mahboubi K, Sillesen K, Serup-Hansen K, Madsen JS, Kristensen SL, Larsen AH, Bøtker HE, Torp-Petersen C, Eiskjær H, Møller J, Hassager C, Steffensen FH, Bibby BM, Refsgaard J, Høfsten DE, Mellemkjær S, Gustafsson F. The DANish randomized, double-blind, placebo controlled trial in patients with chronic HEART failure (DANHEART): A 2 × 2 factorial trial of hydralazine-isosorbide dinitrate in patients with chronic heart failure (H-HeFT) and metformin in patients with chronic heart failure and diabetes or prediabetes (Met-HeFT). Am Heart J 2021; 231:137-146. [PMID: 33039340 PMCID: PMC7544566 DOI: 10.1016/j.ahj.2020.09.020] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The DANHEART trial is a multicenter, randomized (1:1), parallel-group, double-blind, placebo-controlled study in chronic heart failure patients with reduced ejection fraction (HFrEF). This investigator driven study will include 1500 HFrEF patients and test in a 2 × 2 factorial design: 1) if hydralazine-isosorbide dinitrate reduces the incidence of death and hospitalization with worsening heart failure vs. placebo (H-HeFT) and 2) if metformin reduces the incidence of death, worsening heart failure, acute myocardial infarction, and stroke vs. placebo in patients with diabetes or prediabetes (Met-HeFT). METHODS Symptomatic, optimally treated HFrEF patients with LVEF ≤40% are randomized to active vs. placebo treatment. Patients can be randomized in either both H-HeFT and Met-HeFT or to only one of these study arms. In this event-driven study, it is anticipated that 1300 patients should be included in H-HeFT and 1100 in Met-HeFT and followed for an average of 4 years. RESULTS As of May 2020, 296 patients have been randomized at 20 centers in Denmark. CONCLUSION The H-HeFT and Met-HeFT studies will yield new knowledge about the potential benefit and safety of 2 commonly prescribed drugs with limited randomized data in patients with HFrEF.
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Affiliation(s)
- Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Morten Schou
- Department of Cardiology, Herlev Hospital, Denmark
| | | | - Søren Vraa
- Department of Cardiology, Aalborg University Hospital, Denmark
| | | | | | | | | | - Anders Barasa
- Department of Cardiology, Hvidovre Hospital, Denmark
| | | | - Karen Dodt
- Department of Cardiology, Horsens Hospital, Denmark
| | | | - Gitte Nielsen
- Department of Cardiology, Hjørring Hospital, Denmark
| | | | - Jens Lomholdt
- Department of Cardiology, Slagelse Hospital, Denmark
| | | | | | | | | | - Jawdat Abdulla
- Department of Medicine, Cardiology Section, Glostrup Hospital, Denmark
| | - Ilan Raymond
- Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
| | | | | | | | | | | | | | | | | | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Jacob Møller
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Bo Martin Bibby
- Department of Biostatistics, Aarhus University, Aarhus, Denmark
| | | | - Dan Eik Høfsten
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
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15
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Fredgart MH, Lindholt JS, Brandes A, Steffensen FH, Frost L, Lambrechtsen J, Karon M, Busk M, Urbonaviciene G, Egstrup K, Diederichsen ACP. Prognostic importance of left atrial size measured by non-contrast cardiac computed tomography - A DANCAVAS study. Int J Cardiol 2020; 328:220-226. [PMID: 33359284 DOI: 10.1016/j.ijcard.2020.12.029] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Enlargement of left atrium (LA) is a valuable marker of cardiovascular events, and LA size is readily available while performing non-contrast cardiac computed tomography (NCCT) for preventive purposes. We aimed to evaluate the predictive value of a single LA area from NCCT in a population-based cohort. METHOD Mainly men aged 60-75 years from DANCAVAS were included. Traditional risk factors were recorded, and an NCCT scan performed at baseline. Coronary artery calcifications (CAC) score and the largest LA area were measured. LA was indexed to body surface area and categorised into four groups. Data on incident atrial fibrillation (AF), thromboembolic events, heart failure (HF) and death were obtained from Danish national registries. RESULTS In total, 14,557 individuals were eligible, excluding those without LA measurement (N = 232) and with heart valve replacement (N = 197). Known AF or HF were respectively excluded from follow-up. Median follow-up time was 2.1 to 3.4 years. In total, 304 developed AF, 149 had thromboembolism, 129 developed HF and 482 died. In adjusted analysis, LA enlargement was associated with AF (HR (95% CI): large 1.99 (1.46-2.71) and very large LA 3.77 (2.31-6.14)) and HF (large 2.40 (1.50-3.85) and very large LA 6.54 (4.07-10.51)). A very large LA significantly increased mortality (HR: 2.01 (1.44-2.82)), and was associated with a two-fold increased risk of thromboembolism; however, not significantly in adjusted analysis (p = 0.09). CONCLUSION We demonstrated that determination of LA area from NCCT was an important predictor of AF, HF and death. This knowledge could inform current risk assessment beyond CAC score.
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Affiliation(s)
- Maise Hoeigaard Fredgart
- Department of Cardiology, Odense University Hospital, Odense, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Cardiovascular Centre of Excellence (CAVAC), Denmark; Odense University Hospital, Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | | | - Marek Karon
- Department of Medicine, Nykoebing Falster Hospital, Nykoebing Falster, Denmark
| | - Martin Busk
- Department of Cardiology, Sygehus Lillebaelt, Vejle, Denmark
| | | | - Kenneth Egstrup
- Department of Cardiology, Svendborg Hospital, Svendborg, Denmark
| | - Axel Cosmus Pyndt Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Odense University Hospital, Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
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Mortensen MB, Dzaye O, Steffensen FH, Bøtker HE, Jensen JM, Rønnow Sand NP, Kragholm KH, Sørensen HT, Leipsic J, Mæng M, Blaha MJ, Nørgaard BL. Impact of Plaque Burden Versus Stenosis on Ischemic Events in Patients With Coronary Atherosclerosis. J Am Coll Cardiol 2020; 76:2803-2813. [DOI: 10.1016/j.jacc.2020.10.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/25/2023]
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Lambrechtsen J, Mayntz SK, Engdam KB, Egstrup K, Nielsen J, Steffensen FH, Frohn LM, Brandt J, Ketzel M, Pyndt Diederichsen AC, Lindholt JS. Relation between Accumulated Air Pollution Exposure and Sub-Clinical Cardiovascular Disease in 33,723 Danish 60-74-Year-Old Males from the Background Population (AIR-CARD): A Method Article. Cardiology 2020; 146:19-26. [PMID: 33238279 DOI: 10.1159/000511128] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease is one of the main causes of death and disability in the Western world, and there is increasing evidence that air pollution is a risk factor for developing sub-clinical cardiovascular diseases. Previous studies have shown a correlation between cardiovascular disease and short-term exposure to elevated air pollution levels. However, the literature on the impact of long-term effect of air pollution is limited. We have a unique opportunity to evaluate this correlation. The DEHM/UBM/AirGIS model system calculates air pollution in a high temporal and spatial resolution and traces air pollution retrospectively to year 1979. The model calculates accumulated exposure using annual exposure from PM2.5 in relation to home and work addresses and takes into account working hours and holidays. We link the results from this model system to a population-based cardiovascular screening cohort of 33,723 individuals in the age of 60-74 to assess the contribution of the specific accumulated air pollution to the presence of sub-clinical arteriosclerosis in the coronary vessels, abdominal aortic aneurysms, and peripheral arterial disease. This correlation will be further analyzed in relation to specific air pollutants. This study will introduce more precise data for a longer period of time and incorporate participant's home and work addresses.
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Affiliation(s)
- Jess Lambrechtsen
- Cardiovascular Research Unit, Odense University Hospital - Svendborg, Svendborg, Denmark,
| | - Stephan Krog Mayntz
- Cardiovascular Research Unit, Odense University Hospital - Svendborg, Svendborg, Denmark
| | | | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital - Svendborg, Svendborg, Denmark
| | - Jan Nielsen
- Department of Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | | | - Lise M Frohn
- Department of Environmental Science, Faculty of Technical Sciences, Aarhus University, Aarhus, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Faculty of Technical Sciences, Aarhus University, Aarhus, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Faculty of Technical Sciences, Aarhus University, Aarhus, Denmark
| | | | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery T, Odense University Hospital, Odense, Denmark
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18
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Mortensen MB, Steffensen FH, Bøtker HE, Jensen JM, Rønnow Sand NP, Kragholm KH, Kanstrup H, Sørensen HT, Leipsic J, Blaha MJ, Nørgaard BL. Heterogenous Distribution of Risk for Cardiovascular Disease Events in Patients With Stable Ischemic Heart Disease. JACC Cardiovasc Imaging 2020; 14:442-450. [PMID: 33221243 DOI: 10.1016/j.jcmg.2020.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/22/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors sought to assess the distribution of 5-year risk of cardiovascular disease (CVD) events (myocardial infarction, revascularizations, ischemic stroke) and death among symptomatic patients with varying degrees of coronary artery disease (CAD) ascertained from computed tomography angiography (CTA). BACKGROUND CTA is used increasingly as the first-line test for evaluating patients with symptoms suggestive of CAD. This creates the daily clinical challenge of best using the information available from CTA to guide appropriate downstream allocation of preventive treatments. METHODS Among 21,275 patients from the Western Denmark Heart Registry, the authors developed a model predicting 5-year risk for CVD and death based on traditional risk factors and CAD severity. Only events occurring >90 days after CTA were included. RESULTS During a median follow-up of 4.2 years, 1,295 CVD events and deaths occurred. The median 5-year risk for events was 4% (interquartile range: 3% to 8%), and ranged from <5% to >50% in individual patients. The degree of CAD severity was the strongest risk factor; however, traditional risk factors also contributed significantly to risk. Thus, risk distributions in patients with varying degree of CAD overlapped considerably, and patients with extensive nonobstructive CAD could have higher estimated risk than patients with obstructive CAD (stenosis >50%). Among patients with obstructive CAD, 12% had 5-year risk <10% whereas 24% had risk >20%. A similar large overlap in risk was found when revascularizations were excluded from the endpoint. CONCLUSIONS The 5-year risk for CVD events and death varies substantially in symptomatic patients undergoing CTA, even in the presence of obstructive CAD. These results provide support for individual risk assessment to improve potential benefit when allocating preventive therapies following CTA.
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Affiliation(s)
| | - Flemming Hald Steffensen
- Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Niels Peter Rønnow Sand
- Department of Cardiology, University Hospital of Southwest Jutland and Institute of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | | | - Helle Kanstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
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19
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Mortensen MB, Steffensen FH, Bøtker HE, Jensen JM, Rønnow Sand NP, Kragholm KH, Kanstrup H, Sørensen HT, Leipsic J, Blaha MJ, Nørgaard BL. CAD Severity on Cardiac CTA Identifies Patients With Most Benefit of Treating LDL-Cholesterol to ACC/AHA and ESC/EAS Targets. JACC Cardiovasc Imaging 2020; 13:1961-1972. [DOI: 10.1016/j.jcmg.2020.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 12/20/2022]
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20
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Sønderskov PS, Lindholt JS, Hallas J, Gerke O, Hasific S, Lambrechtsen J, Steffensen FH, Busk M, Frost L, Urbonaviciene G, Karon M, Kikar AM, Rasmussen LM, Diederichsen AA. Association of aortic valve calcification and vitamin K antagonist treatment. Eur Heart J Cardiovasc Imaging 2020; 21:718-724. [DOI: 10.1093/ehjci/jeaa065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 01/22/2020] [Revised: 02/18/2020] [Accepted: 03/22/2020] [Indexed: 12/21/2022] Open
Abstract
Abstract
Aims
Vitamin K antagonists (VKAs) are suspected of causing aortic valve calcification (AVC). The objective of this study was to clarify whether patients undergoing VKA treatment have increased AVC scores compared to patients treated with new oral anticoagulants (NOACs) and patients who never have been treated with VKA/NOAC.
Methods and results
We included participants from the population-based DANCAVAS trial (n = 15 048). Information on confounders was collected, and the AVC scores were measured on non-contrast computed tomography scans. The participants’ medication data, including VKA and NOAC data, were collected from the Danish National Health Service Prescription Database. The final population consisted of 14 604 participants (67.4 years, 95% men) of whom 873 had been treated with VKA and 602 with NOAC. The association between AVC score and duration of anticoagulant use was investigated in an adjusted zero-inflated negative binomial regression model. For every year treated with VKA, the AVC score increased, on average, by 6% [ratio of expected counts (RECs) = 1.06; 95% confidence interval (CI) 1.02–1.10] compared to non-use. The results were consistent in sensitivity analyses excluding patients with known cardiovascular disease and statin users (REC = 1.07; 95% CI 1.02–1.11 and REC = 1.10; 95% CI 1.03–1.17, respectively). NOAC treatment was not significantly associated with AVC score in any of the corresponding models (REC = 1.03, 1.02, and 0.96).
Conclusion
Compared to no treatment with anticoagulants, VKA use was associated with increased AVC score, while a similar association could not be established for NOAC.
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Affiliation(s)
| | - Jes Sandal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Selma Hasific
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Jess Lambrechtsen
- Department of Cardiology, Odense University Hospital, Baagøes Àlle15, 5700 Svendborg, Denmark
| | | | - Martin Busk
- Department of Cardiology, Little Belt Hospital, Beriderbakken 4, 7100 Vejle, Denmark
| | - Lars Frost
- Department of Cardiology, Regional Hospital Central Jutland, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Grazina Urbonaviciene
- Department of Cardiology, Regional Hospital Central Jutland, Falkevej 1A, 8600 Silkeborg, Denmark
| | - Marek Karon
- Department of Medicine, Nykoebing Falster Hospital, Hospitalsvej, 4800 Nykøbing Falster, Denmark
| | - Abdel Monem Kikar
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Lars Melholt Rasmussen
- Department of Clinical Biochemistry, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - and Axel Diederichsen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
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21
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Berntsen MH, Kristensen KL, Diederichsen A, Steffensen FH, Busk M, Frost L, Urbonaviciene G, Lambrechtsen J, Egstrup K, Lindholt JS. Familial Abdominal Aortic Aneurysms Don't Occur Earlier in Life, Neither do they Progress More Rapidly – Observations from Two Population Based Screening Trials. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.020] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Ording AG, Horváth-Puhó E, Prandoni P, Leisner MZ, Farkas DK, Steffensen FH, Olsen M, Sørensen HT, Schmidt M. Usefulness of CHA 2DS 2-VASc Score to Predict Stroke Risk Independent of Atrial Fibrillation. Am J Cardiol 2019; 124:1059-1063. [PMID: 31376914 DOI: 10.1016/j.amjcard.2019.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/30/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 11/16/2022]
Abstract
The CHA2DS2-VASc score is used to predict stroke risk among patients with atrial fibrillation (AF). We examined whether a CHA2DS2-VASc score predicts stroke risk among individuals without hospital-diagnosed AF and quantified the magnitude of the association in comparison to AF patients. We used data from population-based medical registries (1995 to 2005) covering all Danish hospitals to identify patients diagnosed with AF (n = 122,980). We matched ≤5 non-AF individuals (n = 612,723) to each AF patient on the individual risk factors included in the CHA2DS2-VASc score. We calculated 10-year absolute risk of ischemic and all-cause stroke in AF and non-AF individuals and compared the stroke risk between cohorts within strata of CHA2DS2-VASc scores using Cox regression. The 10-year risk of ischemic/all-cause stroke was 4.4%/8.8% among non-AF individuals and 6.2%/12% in AF patients, corresponding to a risk difference of 1.8% for ischemic stroke and 3.3% for all-cause stroke. In both cohorts, the stroke risk correlated with increasing CHA2DS2-VASc scores. However, in individuals with CHA2DS2-VASc scores ≥5 who were <75 years or male, the absolute risk of ischemic stroke in individuals without AF exceeded the risk in AF patients. In the same subgroups, the hazard ratio approached unity. Similar results were observed for all-cause stroke. The CHA2DS2-VASc score was associated with 10-year stroke risk also among individuals without hospital-diagnosed AF. In conclusion, primary prophylactic anticoagulation therapy may be relevant in male and younger non-AF individuals with CHA2DS2-VASc scores ≥5. These findings should be confirmed in clinical trials.
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Affiliation(s)
- Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
| | | | - Paolo Prandoni
- Department of Cardiothoracic and Vascular Science, Vascular Medicine Unit, University of Padua, Padua, Italy; Arianna Foundation on Anticoagulation, Bologna, Italy
| | | | | | - Flemming Hald Steffensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - Morten Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
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23
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Christensen NL, Dahl JS, Carter-Storch R, Jensen K, Pecini R, Steffensen FH, Søndergaard EV, Videbæk LM, Møller JE. Association between left ventricular diastolic function and right ventricular function and morphology in asymptomatic aortic stenosis. PLoS One 2019; 14:e0215364. [PMID: 31361748 PMCID: PMC6667115 DOI: 10.1371/journal.pone.0215364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 04/01/2019] [Indexed: 02/04/2023] Open
Abstract
Background Aortic stenosis (AS) is a progressive disease in which left ventricular (LV) diastolic dysfunction is common. However, the association between diastolic dysfunction and right ventricular (RV) loading conditions and function has not been investigated in asymptomatic AS patients. Methods and findings A total of 41 patients underwent right heart catheterization and simultaneous echocardiography at rest and during maximal supine exercise, stratified according to resting diastolic function. Cardiac chamber size and morphology was assessed using cardiac magnetic resonance imaging (cMRI). RV stroke work index, pulmonary artery (PA) compliance, PA elastance, PA pulsatility index, and right atrial pressure (RAP) were calculated at rest and maximal exercise. Ten patients (24%) had normal LV filling pattern, 20 patients (49%) had grade 1, and 11 patients (27%) had grade 2 diastolic dysfunction. Compared to patients with normal diastolic filling pattern, patients with diastolic dysfunction had lower RV end-diastolic volume (66 ± 11 ml/m2 vs. 79 ± 15 ml/m2, p = 0.02) and end-systolic volume (25 ± 7 ml/m2 vs. 32 ± 9 ml/m2, p = 0.04). An increase in mean RAP to ≥15 mmHg following exercise was not seen in patients with normal LV filling, compared to 4 patients (20%) with mild and 7 patients (63%) with moderate diastolic dysfunction (p = 0.003). PA pressure and PA elastance was increased in grade 2 diastolic dysfunction and correlated with RV volume and maximal oxygen consumption (r = -0.71, p < 0.001). Conclusions Moderate diastolic dysfunction is associated with increased RV afterload (elastance), which is compensated at rest, but is associated with increased RAP and inversely related to maximal oxygen consumption during maximal exercise.
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Affiliation(s)
| | | | | | - Kurt Jensen
- Department of Sports Science and Clinical Biomechanics University of Southern Denmark, Odense, Denmark
| | - Redi Pecini
- Department of Cardiology Odense University Hospital, Odense, Denmark
| | | | | | | | - Jacob Eifer Møller
- Department of Cardiology Odense University Hospital, Odense, Denmark
- * E-mail:
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24
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Schmidt SE, Winther S, Larsen BS, Groenhoej MH, Nissen L, Westra J, Frost L, Holm NR, Mickley H, Steffensen FH, Lambrechtsen J, Nørskov MS, Struijk JJ, Diederichsen ACP, Boettcher M. Coronary artery disease risk reclassification by a new acoustic-based score. Int J Cardiovasc Imaging 2019; 35:2019-2028. [PMID: 31273633 PMCID: PMC6805823 DOI: 10.1007/s10554-019-01662-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/27/2019] [Indexed: 01/08/2023]
Abstract
To determine the potential of a non-invasive acoustic device (CADScor®System) to reclassify patients with intermediate pre-test probability (PTP) and clinically suspected stable coronary artery disease (CAD) into a low probability group thereby ruling out significant CAD. Audio recordings and clinical data from three studies were collected in a single database. In all studies, patients with a coronary CT angiography indicating CAD were referred to coronary angiography. Audio recordings of heart sounds were processed to construct a CAD-score. PTP was calculated using the updated Diamond-Forrester score and patients were classified according to the current ESC guidelines for stable CAD: low < 15%, intermediate 15–85% and high > 85% PTP. Intermediate PTP patients were re-classified to low probability if the CAD-score was ≤ 20. Of 2245 patients, 212 (9.4%) had significant CAD confirmed by coronary angiography ( ≥ 50% diameter stenosis). The average CAD-score was higher in patients with significant CAD (38.4 ± 13.9) compared to the remaining patients (25.1 ± 13.8; p < 0.001). The reclassification increased the proportion of low PTP patients from 13.6% to 41.8%, reducing the proportion of intermediate PTP patients from 83.4% to 55.2%. Before reclassification 7 (3.1%) low PTP patients had CAD, whereas post-reclassification this number increased to 28 (4.0%) (p = 0.52). The net reclassification index was 0.209. Utilization of a low-cost acoustic device in patients with intermediate PTP could potentially reduce the number of patients referred for further testing, without a significant increase in the false negative rate, and thus improve the cost-effectiveness for patients with suspected stable CAD.
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Affiliation(s)
- S E Schmidt
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark.
| | - S Winther
- Department of Cardiology, Region Hospital Herning, Herning, Denmark
| | - B S Larsen
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark
- Acarix, Lyngby, Denmark
| | - M H Groenhoej
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - L Nissen
- Department of Cardiology, Region Hospital Herning, Herning, Denmark
| | - J Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Frost
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - N R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - H Mickley
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - F H Steffensen
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - J Lambrechtsen
- Department of Cardiology, Svendborg Hospital, Svendborg, Denmark
| | | | - J J Struijk
- Department of Health Science and Technology, Biomedical Engineering & Informatics, Aalborg University, Fredrik Bajers Vej 7 C1-204, 9220, Aalborg Ø, Denmark
| | | | - M Boettcher
- Department of Cardiology, Region Hospital Herning, Herning, Denmark
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25
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Lindholt JS, Rasmussen LM, Søgaard R, Lambrechtsen J, Steffensen FH, Frost L, Egstrup K, Urbonaviciene G, Busk M, Olsen MH, Hallas J, Diederichsen AC. Baseline findings of the population-based, randomized, multifaceted Danish cardiovascular screening trial (DANCAVAS) of men aged 65–74 years. Br J Surg 2019; 106:862-871. [DOI: 10.1002/bjs.11135] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background
The challenge of managing age-related diseases is increasing; routine checks by the general practitioner do not reduce cardiovascular mortality. The aim here was to reduce cardiovascular mortality by advanced population-based cardiovascular screening. The present article reports the organization of the study, the acceptability of the screening offer, and the relevance of multifaceted screening for prevention and management of cardiovascular disease.
Methods
Danish men aged 65–74 years were invited randomly (1 : 2) to a cardiovascular screening examination using low-dose non-contrast CT, ankle and brachial BP measurements, and blood tests.
Results
In all, 16 768 of 47 322 men aged 65–74 years were invited and 10 471 attended (uptake 62·4 per cent). Of these, 3481 (33·2 per cent) had a coronary artery calcium score above 400 units. Thoracic aortic aneurysm was diagnosed in the ascending aorta (diameter 45 mm or greater) in 468 men (4·5 per cent), in the arch (at least 40 mm) in 48 (0·5 per cent) and in the descending aorta (35 mm or more) in 233 (2·2 per cent). Abdominal aortic aneurysm (at least 30 mm) and iliac aneurysm (20 mm or greater) were diagnosed in 533 (5·1 per cent) and 239 (2·3 per cent) men respectively. Peripheral artery disease was diagnosed in 1147 men (11·0 per cent), potentially uncontrolled hypertension (at least 160/100 mmHg) in 835 (8·0 per cent), previously unknown atrial fibrillation confirmed by ECG in 50 (0·5 per cent), previously unknown diabetes mellitus in 180 (1·7 per cent) and isolated severe hyperlipidaemia in 48 men (0·5 per cent).
In all, 4387 men (41·9 per cent), excluding those with potentially uncontrolled hypertension, were referred for additional cardiovascular prevention. Of these, 3712 (35·5 per cent of all screened men, but 84·6 per cent of those referred) consented and were started on medication.
Conclusion
Multifaceted cardiovascular screening is feasible and may optimize cardiovascular disease prevention in men aged 65–74 years. Uptake is lower than in aortic aneurysm screening.
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Affiliation(s)
- J S Lindholt
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - L M Rasmussen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - R Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J Lambrechtsen
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - F H Steffensen
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - L Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - K Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M Busk
- Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark
| | - M H Olsen
- CIMA, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark
| | - J Hallas
- Institute of Pharmacology, University of Southern Denmark, Odense, Denmark
| | - A C Diederichsen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiology, Odense University Hospital, Odense, Denmark
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Grove EL, Steffensen FH, Riis AH, Nielsen LH, Jensen JM, Mathiasen ON, Ovrehus K, Botker HE, Sorensen HT, Norgaard BL. P3189Aspirin for prevention of cardiovascular events: an analysis of 27,451 patients from the Western Denmark Cardiac Computed Tomography Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Affiliation(s)
- E L Grove
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - F H Steffensen
- Vejle Hospital, Department of Cardiology, Vejle, Denmark
| | - A H Riis
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - L H Nielsen
- Vejle Hospital, Department of Cardiology, Vejle, Denmark
| | - J M Jensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - O N Mathiasen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K Ovrehus
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - H E Botker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - H T Sorensen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - B L Norgaard
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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Fredgart MH, Lindholt JS, Gerke O, Steffensen FH, Frost L, Lambrechtsen J, Busk M, Urbonaviciene G, Egstrup K, Brandes A, Moeller JE, Diederichsen ACP. P4447Association of left atrial size by non-contrast computed tomography with cardiovascular risk factors - the danish cardiovascular screening trial (DANCAVAS). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Affiliation(s)
- M H Fredgart
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J S Lindholt
- Odense University Hospital, Department of Cardiothoracic and Vascular Surgery, Odense, Denmark
| | - O Gerke
- Odense University Hospital, Department of Nuclear Medicine, Odense, Denmark
| | - F H Steffensen
- Vejle Hospital, Department of Cardiology, Vejle, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - J Lambrechtsen
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - M Busk
- Vejle Hospital, Department of Cardiology, Vejle, Denmark
| | - G Urbonaviciene
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - K Egstrup
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - A Brandes
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J E Moeller
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - A C P Diederichsen
- Odense University Hospital, Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
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28
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Diederichsen ACP, Rasmussen LM, Sogaard R, Lambrechtsen J, Steffensen FH, Frost L, Busk M, Egstrup K, Urbonaviciene G, Mickley H, Hallas J, Olsen MH, Lindholt JS. P1531Baseline findings of the population-based, randomized danish cardiovascular screening trial (DANCAVAS). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Affiliation(s)
| | - L M Rasmussen
- Odense University Hospital, Department of Clinical Biochemistry and Pharmacology, Odense, Denmark
| | - R Sogaard
- Aarhus University, Department of Public Health, Aarhus, Denmark
| | - J Lambrechtsen
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - F H Steffensen
- Lillebaelt Hospital, Department of Cardiology, Vejle, Denmark
| | - L Frost
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - M Busk
- Lillebaelt Hospital, Department of Cardiology, Vejle, Denmark
| | - K Egstrup
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - G Urbonaviciene
- Regional Hospital Central Jutland, Department of Cardiology, Silkeborg, Denmark
| | - H Mickley
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - J Hallas
- University of Southern Denmark, Institute of Pharmacology, Odense, Denmark
| | - M H Olsen
- Holbaek Hospital, Department of Cardiology, Holbaek, Denmark
| | - J S Lindholt
- Odense University Hospital, Department of Cardiothoracic and Vascular Surgery, Odense, Denmark
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29
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Andersen BS, Olsen J, Nielsen GL, Steffensen FH, Sørensen HT, Baech J, Gregersen H. Third Generation Oral Contraceptives and Heritable Thrombophilia as Risk Factors of Non-fatal Venous Thromboembolism. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614213] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThird generation oral contraceptives (OCs) are apparently stronger risk factors for venous thromboembolism (VTE) than other OCs, however, the increased risk may be due to confounding by indication related to differences in prescription behaviour.We estimated the risk of VTE associated with use of OCs with and without the presence of Factor V Leiden mutation, protein C-, protein S- or antithrombin deficiency.Sixty-seven cases with VTE were compared with 134 controls. The risk of VTE in the presence of thrombophilia was of the same magnitude for third generation OC users as for users of other OCs; OR: 52.5 (95% CI: 3.7-738.1) and OR: 63.3 (95% CI: 6.2-648.4), respectively.It is unlikely that confounding by indication entirely explains the risk of VTE associated with third generation OCs since the combined effect exceeds what could be explained if this source of error was the only determinant of the association.
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30
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Christensen NL, Dahl JS, Carter-Storch R, Bakkestrøm R, Pecini R, Steffensen FH, Søndergaard EV, Videbæk LM, Møller JE. Relation of Left Atrial Size, Cardiac Morphology, and Clinical Outcome in Asymptomatic Aortic Stenosis. Am J Cardiol 2017; 120:1877-1883. [PMID: 28947308 DOI: 10.1016/j.amjcard.2017.07.101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/13/2017] [Accepted: 07/20/2017] [Indexed: 12/20/2022]
Abstract
Left atrial (LA) dilation in asymptomatic severe aortic stenosis (AS) may be an indicator of advanced disease. We aimed to investigate the association between LA volume index and left ventricular (LV) morphology assessed with cardiac magnetic resonance imaging (cMRI), and to assess the association with cardiac events. Ninety-two asymptomatic patients with aortic valve area <1 cm2, aortic peak jet velocity >3.5 m/s, and ejection fraction ≥50% were prospectively enrolled and divided according to echocardiographic-derived LA volume index <35 ml/m2. Patients underwent echocardiography, cMRI, exercise testing, and were followed for the composite end point of death, readmission, or aortic valve replacement. Aortic valve area index was similar (0.45 ± 0.08 cm2/m2 vs 0.45 ± 0.09 cm2/m2, p = 0.85) in patients with a dilated and normal LA. On cMRI patients with dilated LA were characterized by higher LV mass index (73 ± 17 g/m2 vs 66 ± 16 g/m2, p = 0.03), increased right ventricle (70 ± 14 ml/m2 vs 63 ± 12 ml/m2, p = 0.01) and LV end-diastolic volume index (84 ± 18 ml/m2 vs 77 ± 16 ml/m2, p = 0.05), and higher brain natriuretic peptide. Late enhancement pattern was similar. During follow-up 20 events were recorded in patients with LA dilation compared with 8 in patients with normal LA (adjusted hazard ratio 2.77, 95% confidence interval 1.19 to 6.46, p = 0.02); also B-type natriuretic peptide >125 pg/ml was associated with adverse outcome (adjusted hazard ratio 3.63, 95% confidence interval interval 1.28 to 10.32, p = 0.02). LA dilation is associated with LV remodeling and provides prognostic information in severe asymptomatic AS.
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31
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Warnakula Olesen KK, Riis AH, Nielsen LH, Steffensen FH, Norgaard B, Thim T, Henrik Sørensen T, Maeng M. TCT-173 Myocardial infarction in a real-world population of diabetes and non-diabetes patients after coronary computed tomography angiography. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.241] [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: 11/16/2022]
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32
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Diederichsen SZ, Grønhøj MH, Mickley H, Gerke O, Steffensen FH, Lambrechtsen J, Rønnow Sand NP, Rasmussen LM, Olsen MH, Diederichsen A. CT-Detected Growth of Coronary Artery Calcification in Asymptomatic Middle-Aged Subjects and Association With 15 Biomarkers. JACC Cardiovasc Imaging 2017; 10:858-866. [DOI: 10.1016/j.jcmg.2017.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 02/05/2023]
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Larsen TR, Gerke O, Diederichsen ACP, Lambrechtsen J, Steffensen FH, Sand NP, Antonsen S, Mickley H. Lack of association between cystatin C and different coronary atherosclerotic manifestations. Scand J Clin Lab Invest 2017; 77:574-581. [PMID: 28749732 DOI: 10.1080/00365513.2017.1355980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cystatin C (CysC) is known to be related to cardiovascular disease (CVD), including the presence and severity of coronary artery disease (CAD) and future clinical events. In this study, the association between CysC levels and (1) coronary artery calcification (CAC) in asymptomatic individuals from the general population as well as (2) different subgroups of patients with suspected or definite acute myocardial infarction (MI) was investigated. CysC levels were measured in serum from asymptomatic individuals as part of a screening study for CAC using non-contrast cardiac CT scan (N = 1039) as well as in subgroups of hospitalized patients with a suspected MI (N = 769). CysC was not associated with CAC in asymptomatic individuals after adjusting for relevant risk factors. No difference in CysC levels was observed between patients with type 1 MI (1.07 mg/L) and patients with normal troponin (with or without prior CAD: 1.14 and 1.01 mg/L, respectively). However, patients with type 2 MI and patient subgroups with elevated troponin but without MI had significantly higher CysC levels (1.24, 1.23 and 1.31 mg/L), even after adjusting for other risk factors. CysC was not associated with CAC in middle-aged asymptomatic individuals from the general population. Furthermore, CysC levels were found to be significantly lower in patients with type 1 MI compared to patients with type 2 MI and patients with elevated troponins but without MI. Thus, in two independent and clinically different populations, no association between CysC and coronary atherosclerotic manifestations could be demonstrated.
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Affiliation(s)
- Trine R Larsen
- a Department of Clinical Biochemistry , Svendborg Hospital , Svendborg , Denmark
| | - Oke Gerke
- b Department of Nuclear Medicine , Odense University Hospital , Odense C , Denmark.,c Centre of Health Economics Research , University of Southern Denmark , Odense M , Denmark
| | | | - Jess Lambrechtsen
- e Department of Cardiology , Svendborg Hospital , Svendborg , Denmark
| | | | - Niels Peter Sand
- g Department of Cardiology , Hospital of Southwest Denmark , Esbjerg , Denmark.,h Institute of Regional Health Research, University of Southern Denmark , Odense M , Denmark
| | - Steen Antonsen
- a Department of Clinical Biochemistry , Svendborg Hospital , Svendborg , Denmark
| | - Hans Mickley
- d Department of Cardiology , Odense University Hospital , Odense C , Denmark
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34
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Kvist TV, Lindholt JS, Rasmussen LM, Søgaard R, Lambrechtsen J, Steffensen FH, Frost L, Olsen MH, Mickley H, Hallas J, Urbonaviciene G, Busk M, Egstrup K, Diederichsen ACP. The DanCavas Pilot Study of Multifaceted Screening for Subclinical Cardiovascular Disease in Men and Women Aged 65-74 Years. Eur J Vasc Endovasc Surg 2016; 53:123-131. [PMID: 27890524 DOI: 10.1016/j.ejvs.2016.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 03/17/2016] [Accepted: 10/14/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE/BACKGROUND This pilot study of a large population based randomised screening trial investigated feasibility, acceptability, and relevance (prevalence of clinical and subclinical cardiovascular disease [CVD] and proportion receiving insufficient prevention) of a multifaceted screening for CVD. METHODS In total, 2060 randomly selected Danish men and women aged 65-74 years were offered (i) low dose non-contrast computed tomography to detect coronary artery calcification (CAC) and aortic/iliac aneurysms; (ii) detection of atrial fibrillation (AF); (iii) brachial and ankle blood pressure measurements; and (iv) blood levels of cholesterol and hemoglobin A1c. Web based self booking and data management was used to reduce the administrative burden. RESULTS Attendance rates were 64.9% (n = 678) and 63.0% (n = 640) for men and women, respectively. In total, 39.7% received a recommendation for medical preventive actions. Prevalence of aneurysms was 12.4% (95% confidence interval [CI] 9.9-14.9) in men and 1.1% (95% CI 0.3-1.9) in women, respectively (p < .001). A CAC score > 400 was found in 37.8% of men and 11.3% of women (p < .001), along with a significant increase in median CAC score with age (p = .03). Peripheral arterial disease was more prevalent in men (18.8%, 95% CI 15.8-21.8) than in women (11.2%, 95% CI 8.7-13.6). No significant differences between the sexes were found with regard to newly discovered AF (men 1.3%, women 0.5%), potential hypertension (men 9.7%, women 11.5%), hypercholesterolemia (men 0.9%, women 1.1%) or diabetes mellitus (men 2.1%, women 1.3%). CONCLUSION Owing to the higher prevalence of severe conditions, such as aneurysms and CAC ≥ 400, screening for CVD seemed more prudent in men than women. The attendance rates were acceptable compared with other screening programs and the logistical structure of the screening program proved successful.
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Affiliation(s)
- T V Kvist
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark.
| | - J S Lindholt
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - L M Rasmussen
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - R Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - J Lambrechtsen
- Department of Cardiology, University Hospital Odense Svendborg, Svendborg, Denmark
| | - F H Steffensen
- Department of Cardiology, Vejle Hospital, Vejle, Denmark
| | - L Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M H Olsen
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark
| | - H Mickley
- Department of Cardiology, Odense University Hospital, Odense C, Denmark
| | - J Hallas
- Institute of Pharmacology, University of Southern Denmark, Odense C, Denmark
| | - G Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark
| | - M Busk
- Department of Cardiology, Vejle Hospital, Vejle, Denmark
| | - K Egstrup
- Department of Cardiology, University Hospital Odense Svendborg, Svendborg, Denmark
| | - A C P Diederichsen
- Elitary Research Centre of Individualised Medicine in Arterial Disease (CIMA), Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense C, Denmark
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Christensen NL, Dahl JS, Carter-Storch R, Bakkestrøm R, Jensen K, Steffensen FH, Søndergaard EV, Videbæk L, Møller JE. Association Between Left Atrial Dilatation and Invasive Hemodynamics at Rest and During Exercise in Asymptomatic Aortic Stenosis. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005156. [DOI: 10.1161/circimaging.116.005156] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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] [Received: 05/19/2016] [Accepted: 08/26/2016] [Indexed: 01/05/2023]
Abstract
Background—
Transition from an asymptomatic to symptomatic state in severe aortic stenosis is often difficult to assess. Identification of a morphological sign of increased hemodynamic load may be important in asymptomatic aortic stenosis to identify patients at risk.
Methods and Results—
Thirty-nine patients with asymptomatic severe aortic stenosis (aortic valve area <1 cm
2
, peak jet velocity >3.5 m/s) underwent exercise testing with simultaneous invasive hemodynamic monitoring and Doppler echocardiography. Cardiac index, pulmonary artery pressure, and pulmonary capillary wedge pressure (PCWP) were recorded. Patients were followed up for the composite end point of death, unplanned hospitalization, or aortic valve replacement. Patients were stratified into 2 groups according to left atrial (LA) volume index ≥35 mL/m
2
. In 25 patients (64%) LA volume index was ≥35 mL/m
2
. Aortic valve area was similar between groups (0.81±0.15 versus 0.84±0.18 cm
2
;
P
=0.58). PCWP was higher at rest and during exercise in patients with LA volume index ≥35 mL/m
2
(
P
<0.01), despite similar cardiac index. At rest, PCWP was <12 mm Hg in 11 patients (44%) with LA dilatation, whereas PCWP was <25 mm Hg in 1 patient (4%) with exercise. LA volume index and E/e′ predicted exercise PCWP>30 mm Hg with areas under the receiver operating curve of 0.75 and 0.84, respectively. During follow-up, 14 cardiac events were recorded. LA volume was associated with a hazard ratio of 1.90 (95% confidence interval, 0.92–4.15).
Conclusions—
LA size reflects hemodynamic burden in patients with asymptomatic severe aortic stenosis. Quantitative measurements of LA and diastolic function are associated with left ventricular filling pressures with exercise and could be used to identify asymptomatic patients with increased hemodynamic burden.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02395107.
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Affiliation(s)
- Nicolaj Lyhne Christensen
- From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.)
| | - Jordi Sanchez Dahl
- From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.)
| | - Rasmus Carter-Storch
- From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.)
| | - Rine Bakkestrøm
- From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.)
| | - Kurt Jensen
- From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.)
| | - Flemming Hald Steffensen
- From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.)
| | - Eva Vad Søndergaard
- From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.)
| | - Lars Videbæk
- From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.)
| | - Jacob Eifer Møller
- From the Department of Cardiology, Odense University Hospital, Denmark (N.L.C., J.S.D., R.C.-S., R.B., E.V.S., L.V., J.E.M.); Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense (K.J.), and Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.)
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Thune JJ, Pehrson S, Nielsen JC, Haarbo J, Videbæk L, Korup E, Jensen G, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Egstrup K, Hastrup-Svendsen J, Høfsten DE, Torp-Pedersen C, Køber L. Rationale, design, and baseline characteristics of the DANish randomized, controlled, multicenter study to assess the efficacy of Implantable cardioverter defibrillators in patients with non-ischemic Systolic Heart failure on mortality (DANISH). Am Heart J 2016; 179:136-41. [PMID: 27595688 DOI: 10.1016/j.ahj.2016.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 06/30/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The effect of an implantable cardioverter defibrillator (ICD) in patients with symptomatic systolic heart failure (HF) caused by coronary artery disease is well documented. However, the effect of primary prophylactic ICDs in patients with systolic HF not due to coronary artery disease is much weaker. In addition, HF management has improved, since the landmark ICD trials and a large proportion of patients now receive cardiac resynchronization therapy (CRT) where the effect of ICD treatment is unknown. METHODS In the DANISH study, 1,116 patients with symptomatic systolic HF not caused by coronary artery disease have been randomized to receive an ICD or not, in addition to contemporary standard therapy. The primary outcome of the trial is time to all-cause death. Follow-up will continue until June 2016 with a median follow-up period of 5 years. Baseline characteristics show that enrolled patients are treated according to current guidelines. At baseline, 97% of patients received an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, 92% received a β-blocker, 58% a mineralocorticoid receptor antagonist, and 58% were scheduled to receive CRT. Median age was 63 years (range, 21-84 years) at baseline, and 28% were women. CONCLUSION DANISH will provide pertinent information about the effect on all-cause mortality of a primary prophylactic ICD in patients with symptomatic systolic HF not caused by coronary artery disease on contemporary standard therapy including CRT.
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Diederichsen ACP, Rasmussen LM, Søgaard R, Lambrechtsen J, Steffensen FH, Frost L, Egstrup K, Urbonaviciene G, Busk M, Olsen MH, Mickley H, Hallas J, Lindholt JS. The Danish Cardiovascular Screening Trial (DANCAVAS): study protocol for a randomized controlled trial. Trials 2015; 16:554. [PMID: 26637993 PMCID: PMC4670524 DOI: 10.1186/s13063-015-1082-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/24/2015] [Indexed: 12/28/2022] Open
Abstract
Background The significant increase in the average life expectancy has increased the societal challenge of managing serious age-related diseases, especially cancer and cardiovascular diseases. A routine check by a general practitioner is not sufficient to detect incipient cardiovascular disease. Design Population-based randomized clinically controlled screening trial. Methods Participants: 45,000 Danish men aged 65–74 years living on the Island of Funen, or in the surrounding communities of Vejle and Silkeborg. No exclusion criteria are used. Interventions: One-third will be invited to cardiovascular seven-faceted screening examinations at one of four locations. The screening will include: (1) low-dose non-contrast CT scan to detect coronary artery calcification and aortic/iliac aneurysms, (2) brachial and ankle blood pressure index to detect peripheral arterial disease and hypertension, (3) a telemetric assessment of the heart rhythm, and (4) a measurement of the cholesterol and plasma glucose levels. Up-to-date cardiovascular preventive treatment is recommended in case of positive findings. Objective: To investigate whether advanced cardiovascular screening will prevent death and cardiovascular events, and whether the possible health benefits are cost effective. Outcome: Registry-based follow-up on all cause death (primary outcome), and costs after 3, 5 and 10 years (secondary outcome). Randomization: Each of the 45,000 individuals is, by EPIDATA, given a random number from 1–100. Those numbered 67+ will be offered screening; the others will act as a control group. Blinding: Only those randomized to the screening will be invited to the examination;the remaining participants will not. Numbers randomized: A total of 45,000 men will be randomized 1:2. Recruitment: Enrollment started October 2014. Outcome: A 5 % reduction in overall mortality (HR = 0.95), with the risk for a type 1 error = 5 % and the risk for a type II error = 80 %, is expected. We expect a 2-year enrollment, a 10-year follow-up, and a median survival of 15 years among the controls. The attendance to screening is assumed to be 70 %. Discussion The primary aim of this so far stand-alone population-based, randomized trial will be to evaluate the health benefits and costeffectiveness of using non-contrast full truncus computer tomography (CT) scans (to measure coronary artery calcification (CAC) and identify aortic/iliac aneurysms) and measurements of the ankle brachial blood pressure index (ABI) as part of a multifocal screening and intervention program for CVD in men aged 65–74. Attendance rate and compliance to initiated preventive actions must be expected to become of major importance. Trial registration Current Controlled Trials: ISRCTN12157806 (21 March 2015).
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Affiliation(s)
- Axel Cosmus Pyndt Diederichsen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiology, University Hospital Odense, Odense, Denmark.
| | - Lars Melholt Rasmussen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Clinical Biochemistry and Pharmacology, University Hospital Odense, Odense, Denmark.
| | - Rikke Søgaard
- Department of Public Health and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Jess Lambrechtsen
- Department of Cardiology, University Hospital Odense, Svendborg, Denmark.
| | | | - Lars Frost
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.
| | - Kenneth Egstrup
- Department of Cardiology, University Hospital Odense, Svendborg, Denmark.
| | - Grazina Urbonaviciene
- Department of Cardiology, Diagnostic Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.
| | - Martin Busk
- Department of Cardiology, Vejle Hospital, Vejle, Denmark.
| | - Michael Hecht Olsen
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Endocrinology, University Hospital Odense, Odense, Denmark.
| | - Hans Mickley
- Department of Cardiology, University Hospital Odense, Odense, Denmark.
| | - Jesper Hallas
- Institute of Pharmacology, University of Southern Denmark, Odense, Denmark.
| | - Jes Sanddal Lindholt
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
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Sørensen HT, Steffensen FH, Ejlersen E, Møller-Petersen J, Kristensen K. Research in the Danish health service system: completeness and validity of prescription data, illustrated by analysis of utilization of oral anticoagulants. Int J Risk Saf Med 2013; 7:33-41. [PMID: 23511670 DOI: 10.3233/jrs-1995-7104] [Citation(s) in RCA: 14] [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: 11/15/2022]
Abstract
We studied the utilization of oral anticoagulants and the degree of completeness and validity of some key research variables from the Danish health service in the county of North Jutland (482 000 inhabitants), studying the records of 12 855 prescriptions of oral anticoagulants during 1991 and 1992. The utilization of oral anticoagulants showed an increase of 16% from 1991 to 1992, when 0.3% of all women and 0.4% of all men were treated during one year. The increase was less than expected based on newly introduced indications for treatment of atrial fibrillation. The following variables were studied: the name (ATC commodity number) and amount of the prescribed drug, the defined daily dose, the personal registration number of the patient, type of prescription (e.g. in writing or by telephone), number of repeat prescriptions, date of prescription issued by the doctor, the registration number of the GP or hospital department (if the prescription is made by a hospital doctor) and date of expedition from the pharmacy. The number of wrong and missing data was less than 1%. The study suggests that Danish prescription information is of such quality that it can be used for pharmacoepidemiological studies.
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Affiliation(s)
- H T Sørensen
- The Danish Epidemiology Science Centre, Aarhus University, Nørrebrogade 44, 8000 Aarhus C, Denmark Department of Internal Medicine V, Aarhus University Hospital, 8000 Aarhus C, Denmark
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Sørensen HT, Steffensen FH, Nielsen GL, Grøn P. Variation in antibiotic prescribing costs in Danish general practice: an epidemiological pharmaco-economic analysis. Int J Risk Saf Med 2013; 8:243-50. [PMID: 23511984 DOI: 10.3233/jrs-1996-8308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Based on 49,621 prescriptions during a period of 6 months we analysed factors relevant to the use of antibiotics among 137 general practitioners based on the reimbursement by the Danish Health Service. The background population constituted 167,105 adults and 42,392 children. The Danish Health Service refunds either 50 or 75% of the costs of antibiotics. The mean reimbursement per prescription was 96.45 DKK ranging between 56.10 DKK and 141.95 DKK. The total prescribed amount of antibiotics per GP measured in defined daily dose (DDD), the reimbursement per prescription for all other drugs than antibiotics, the proportion of patients above the age of 65 years and the number of cultures per 1,000 patients were positively associated with the reimbursement per prescription of antibiotics. The four variables explained 29% of the variation. The number of cultures and consultations per general practitioner were positively associated with the total reimbursement for antibiotics per general practitioner, while the number of throat swabs per general practitioner was negatively associated. The prescribed amount of DDD per prescription and the reimbursement per DDD of antibiotics contributed almost equally to the variation in reimbursement for each prescription. The study thus shows that the doctors prescribing the highest amounts of antibiotics measured as DDD also choose the most expensive drugs and that this choice of expensive drugs seems to be a general trend independent of the ATC group.
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Affiliation(s)
- H T Sørensen
- Department of Epidemiology and Social Medicine, The Danish Epidemiology Science Centre, University of Aarhus, 8000 Aarhus C, Denmark Department of Internal Medicine V, Aarhus University Hospital, 8000 Aarhus C, Denmark
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Zhou W, Steffensen FH, Sørensen HT, Nielsen GL, Olsen J. Drug use in pregnancy in the county of North Jutland - preliminary analyses based on 6142 pregnancies. Int J Risk Saf Med 2013; 10:189-90. [PMID: 23511370 DOI: 10.3233/jrs-1997-10304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- W Zhou
- The Danish Epidemiology Science Centre, Høegh Guldbergsgade 10, Aarhus University, DK-8000 Aarhus C, Denmark
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Sothynathan I, Jensen JK, Nørgaard BL, Steffensen FH, Krag S. [Papillary fibroelastoma of the heart as the cause of transitory cerebral ischaemia]. Ugeskr Laeger 2009; 171:1517-1518. [PMID: 19419634] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A case of mitral papillary fibroelastoma as a cause of cardiogenic embolic stroke in a young man is presented. This case demonstrates the importance of thorough echocardiographic evaluation in younger patients presenting with possible embolic clinical manifestations. Furthermore, the echocardiographic characteristics of papillary fibroelastoma are discussed.
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Sloth AD, Jensen JK, Steffensen FH, Nørgaard BL. [Congenital transposition of the great arteries newly diagnosed in a 76-year-old woman]. Ugeskr Laeger 2009; 171:319-321. [PMID: 19176164] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A case of congenitally corrected transposition presenting for the first time with second-degree AV block in a 76-year-old woman is presented. This case demonstrates that congenitally corrected transposition can remain asymptomatic and undiagnosed, especially when no other cardiac defects are present.
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Andersen BS, Steffensen FH, Sørensen HT, Nielsen GL, Olsen J. The cumulative incidence of venous thromboembolism during pregnancy and puerperium. Acta Obstet Gynecol Scand 2003. [DOI: 10.1034/j.1600-0412.1998.770207.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sørensen HT, Czeizel AE, Rockenbauer M, Steffensen FH, Olsen J. The risk of limb deficiencies and other congenital abnormalities in children exposed in utero to calcium channel blockers. Acta Obstet Gynecol Scand 2001; 80:397-401. [PMID: 11328214] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
AIM Calcium channel blockers given to pregnant rats have shown an increased prevalence of digital and limb defects and their safety in pregnant women has thus been questioned. We examined the risk of malformations following exposure in utero to calcium channel blockers. METHOD We conducted a nationwide case-control study based on the Hungarian Case-Control Surveillance of Congenital Abnormalities and identified 22,865 cases with congenital abnormalities and 31,151 population controls during the period 1980-1996. Data on drug exposure were obtained from official questionnaires and obligatory prenatal care logbooks. RESULTS Among the cases, 586 mothers (2.6%) had been exposed to calcium channel blockers during pregnancy compared with 907 controls (2.4%). The overall prevalence ratios for 17 congenital abnormalities varied between 1.1 and 1.4, and there was no significant increased risk of limb deficiencies or other congenital abnormalities. CONCLUSION Our data did not indicate an increased prevalence of congenital abnormalities in offspring exposed to calcium channel blockers in utero.
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Affiliation(s)
- H T Sørensen
- Danish Epidemiology Science Centre at the Department of Epidemiology and Social Medicine, University of Aarhus, Aarhus, Denmark
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Olsen J, Sørensen HT, Steffensen FH, Sabroe S, Gillman MW, Fischer P, Rothman KJ. The association of indicators of fetal growth with visual acuity and hearing among conscripts. Epidemiology 2001; 12:235-8. [PMID: 11246586 DOI: 10.1097/00001648-200103000-00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Impaired fetal growth is associated with increased susceptibility to several chronic diseases. We studied the association between birth weight, indicators of disproportional fetal growth, and impaired visual acuity and hearing in 4,300 conscripts from a well-defined region in Denmark from August 1, 1993, to July 31, 1994. From the standard health examination for conscripts, we obtained data on sight based on the Snellen's chart and data on hearing acuity based on audiometry. By means of record linkage, we obtained data on outcomes for the conscripts at birth from the Medical Birth Registry. From this registry, we have data on birth weight, gestational age, and birth length that were recorded from existing computerized registers based on the records of midwives. A birth weight of less than 3,000 gm and a body mass index at birth of less than 3.4 were associated with reduced visual acuity and impaired hearing. The results could be due to fetal brain programming or due to confounding, by early birth trauma or other factors.
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Affiliation(s)
- J Olsen
- Danish Epidemiology Science Centre at the Institute of Epidemiology and Social Medicine, University of Aarhus
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Abstract
We examined the relation between place of birth and cognitive function in young adult life in a historical cohort study based upon birth data from the computerized Danish Medical Birth Registry and cognitive function as measured at time of drafting for military service in two Danish counties. The cohort included 4,296 Danish conscripts born between 1973 and 1976, 123 born at home and 4,173 born in hospital or at a birth clinic. Cognitive function was measured by the Boerge Prien test in men, 18 to 20 years of age. The highest possible score is 78. The mean Boerge Prien test score was 43.1 for conscripts born in specialized hospital departments, 2.4 higher for conscripts born in a birth clinic (95% confidence interval = 0.9-4.0), and 2.1 lower for conscripts born at home (95% confidence limits = -3.8 to -0.4) after adjusting for birth weight, length at birth, birth order, gestational age, maternal age, and marital and occupational status. Our findings raise the possibility that home birth can lead to lower cognitive function in adulthood; however, from our data we could not distinguish between planned and unplanned births at home.
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Affiliation(s)
- H T Sørensen
- Department of Medicine V, Aarhus University Hospital, Denmark
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Sørensen HT, Mellemkjaer L, Blot WJ, Nielsen GL, Steffensen FH, McLaughlin JK, Olsen JH. Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin. Am J Gastroenterol 2000; 95:2218-24. [PMID: 11007221 DOI: 10.1111/j.1572-0241.2000.02248.x] [Citation(s) in RCA: 226] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Aspirin products are known to cause irritation and injury to the gastric mucosa. We examined the risk of hospitalization for upper gastrointestinal bleeding with use of low-dose aspirin. METHODS This was a cohort study based on record linkage between a population-based prescription database and a hospital discharge registry in North Jutland County, Denmark, from January 1, 1991, to December 31, 1995. Incidence rates of upper gastrointestinal bleeding in 27,694 users of low-dose aspirin were compared with the incidence rates in the general population in the county. RESULTS A total of 207 exclusive users of low-dose aspirin experienced a first episode of upper gastrointestinal bleeding with admission to the hospital during the study period. The standardized incidence rate ratio was 2.6 (95% confidence interval, 2.2-2.9), 2.3 in women and 2.8 in men. The standardized incidence rate ratio for combined use of low-dose aspirin and other nonsteroidal anti-inflammatory drugs was 5.6 (95% confidence interval, 4.4-7.0). The risk was similar among users of noncoated low-dose aspirin (standardized incidence rate ratio, 2.6; 95% confidence interval, 1.8-3.5) and coated low-dose aspirin (standardized incidence rate ratio, 2.6; 95% confidence interval, 2.2-3.0). CONCLUSIONS Use of low-dose aspirin was associated with an increased risk of upper gastrointestinal bleeding, with still higher risks when combined with other nonsteroidal anti-inflammatory drugs. Enteric coating did not seem to reduce the risk. The findings from this observational study raise the possibility that prophylactic use of low-dose aspirin may convey an increased risk of gastrointestinal bleeding, which may offset some of its benefits.
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Affiliation(s)
- H T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aalborg Hospitals, Denmark
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Abstract
OBJECTIVE Aspirin products are known to cause irritation and injury to the gastric mucosa. We examined the risk of hospitalization for upper gastrointestinal bleeding with use of low-dose aspirin. METHODS This was a cohort study based on record linkage between a population-based prescription database and a hospital discharge registry in North Jutland County, Denmark, from January 1, 1991, to December 31, 1995. Incidence rates of upper gastrointestinal bleeding in 27,694 users of low-dose aspirin were compared with the incidence rates in the general population in the county. RESULTS A total of 207 exclusive users of low-dose aspirin experienced a first episode of upper gastrointestinal bleeding with admission to the hospital during the study period. The standardized incidence rate ratio was 2.6 (95% confidence interval, 2.2-2.9), 2.3 in women and 2.8 in men. The standardized incidence rate ratio for combined use of low-dose aspirin and other nonsteroidal anti-inflammatory drugs was 5.6 (95% confidence interval, 4.4-7.0). The risk was similar among users of noncoated low-dose aspirin (standardized incidence rate ratio, 2.6; 95% confidence interval, 1.8-3.5) and coated low-dose aspirin (standardized incidence rate ratio, 2.6; 95% confidence interval, 2.2-3.0). CONCLUSIONS Use of low-dose aspirin was associated with an increased risk of upper gastrointestinal bleeding, with still higher risks when combined with other nonsteroidal anti-inflammatory drugs. Enteric coating did not seem to reduce the risk. The findings from this observational study raise the possibility that prophylactic use of low-dose aspirin may convey an increased risk of gastrointestinal bleeding, which may offset some of its benefits.
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Affiliation(s)
- H T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aalborg Hospitals, Denmark
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Abstract
BACKGROUND Data regarding the association between the use of calcium channel blockers and cancer risk have been conflicting. In the current study, the authors examined the cancer risk and mortality in users of calcium channel blockers in North Jutland County, Denmark. METHODS The authors conducted a cohort study using record linkage between a population-based prescription database, the Danish Cancer Registry, and the Danish Death Registry including 23, 167 users of calcium channel blockers who received >/=2 prescriptions between January 1, 1989 and December 31, 1995. The authors calculated the standardized incidence ratios and standard mortality ratios for cancer, along with corresponding 95% confidence intervals (95% CI). RESULTS Overall, 967 incident cases of cancer occurred, resulting in a standardized incidence ratio of 1.04 (95% CI, 0.98-1.11). There was a slightly elevated nonsignificant risk of tobacco-related cancer. No increased risk of breast or colon carcinoma was observed. The cancer mortality was close to that expected in the background population (standardized mortality ratio of 0.97; 95% CI, 0.89-1.04). CONCLUSIONS This large-scale, population-based cohort study adds to the increasing evidence indicating no substantial association between the use of calcium channel blockers and the incidence rate of cancer or cancer mortality.
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Affiliation(s)
- H T Sørensen
- Department of Medicine V, Aarhus University Hospital, Aarhus, Denmark
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Sørensen HT, Nielsen GL, Schønheyder HC, Steffensen FH, Hansen I, Sabroe S, Dahlerup JF, Hamburger H, Olsen J. [Antibiotic pre-hospital treatment and the course of meningococcal disease]. Ugeskr Laeger 2000; 162:2882-5. [PMID: 10860427] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The aim of the study was to assess the effect of pre-hospital antibiotic treatment given by general practitioners to patients with meningococcal disease. It was carried out as a 16-year population-based historical follow-up study based on referral letters and hospital records in the County of North Jutland, Denmark, and included 320 patients with meningococcal disease, of whom 302 were examined by a general practitioner before admission to hospital. The main outcome measure was death. We found that 44 patients (14.6%) were given antibiotic treatment by the referring general practitioner. Nine of these (20.5%) died, compared with 16 (6.2%) patients who did not receive pre-hospital antibiotic treatment. The presence of skin bleeding, petechiae and impaired consciousness were strongly associated with case fatality. Even after adjustment for these variables the odds ratio for death in patients treated with antibiotics was high (3.2; 95% CI 0.9-10.6). In the 15 patients with skin bleeding (ecchymoses, suggillations) the case fatality rate was 100% in patients treated with antibiotics, and 50% in patients who did not receive antibiotics before hospitalization. It is concluded that pre-hospital treatment is mainly given to the most severe cases with expected high case fatality, and this confounding by indication was probably not fully adjusted for with the available data. The results contradict previous findings and provide reason to doubt the benefit of pre-hospital antibiotic treatment in patients with meningococcal disease.
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Affiliation(s)
- H T Sørensen
- Aarhus Universitet, Institut for Epidemiologi og Socialmedicin
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