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Krarup KB, Krarup HB, Mørk M, Lundbye-Christensen S, Handberg A, Nguyen HTT, Pedersen IS, Kristensen SR. Are Gamers Prone to eThrombosis during Long Gaming Sessions? Life (Basel) 2024; 14:525. [PMID: 38672795 PMCID: PMC11051545 DOI: 10.3390/life14040525] [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] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
During the last two decades, several cases of venous thrombosis (VTE) after a prolonged period at a computer have been described, denominated as "eThrombosis". Video gaming on a computer has become very popular and can be a social activity where several players gather to play against each other or in a virtual environment for several days ("LAN (i.e., Local Area Network) parties") where the participants are sedentary and consuming calorie-rich food items. The aim of this study was to investigate potential coagulation activation during a 42 h LAN party. Nine male gamers volunteered for the LAN party. Citrated blood was sampled before and every 6 h, and plasma was analyzed for thrombin generation, thrombin-antithrombin complexes (TAT), prothrombin fragment 1 + 2 (F1 + 2), and D-dimer. Thrombin generation increased slightly but not significantly during the LAN party, whereas the coagulation activation markers were unchanged. These results do not indicate that the coagulation system is activated significantly during 42 h of gaming with minimal physical activity. Although increased activity cannot be excluded, it does not directly indicate a risk of VTE in general.
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Affiliation(s)
- Kasper B. Krarup
- Department of Geriatrics, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Sports Medicine Center, Region Hospital North Jutland, 9900 Frederikshavn, Denmark
| | - Henrik B. Krarup
- Department of Molecular Diagnostics, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.B.K.); (H.T.T.N.); (I.S.P.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (S.L.-C.)
| | - Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | | | - Aase Handberg
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (S.L.-C.)
- Department of Clinical Biochemistry, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Hien T. T. Nguyen
- Department of Molecular Diagnostics, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.B.K.); (H.T.T.N.); (I.S.P.)
| | - Inge S. Pedersen
- Department of Molecular Diagnostics, Aalborg University Hospital, 9000 Aalborg, Denmark; (H.B.K.); (H.T.T.N.); (I.S.P.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (S.L.-C.)
| | - Søren R. Kristensen
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark; (S.L.-C.)
- Department of Clinical Biochemistry, Aalborg University Hospital, 9000 Aalborg, Denmark;
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Danstrup CS, Andersen M, Lundbye-Christensen S, Sommer M, Lyhne NM. Survey of Danish Head and Neck Cancer Patients' Positions on Personalized Medicine, Gene Tests, and Personalized Follow-Up. J Pers Med 2024; 14:404. [PMID: 38673031 PMCID: PMC11051027 DOI: 10.3390/jpm14040404] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
The field of personalized medicine (PM) has grown rapidly because of the "omics revolution", but PM may be difficult for patients to comprehend. This study sought to explore head and neck cancer (HNC) patients' positions and knowledge of PM, gene tests, and follow-up and to compare HNC patients' positions to a sample from a national Danish questionnaire. To do this, patients with prior HNC were invited to participate in a questionnaire. Initial interviews revealed a heterogenic understanding of PM between patients. A total of 226 patients were included in the survey and 177 patients with complete data were included for analysis. Most patients were more positive than negative towards gene tests and gene research (83% and 93%, respectively), but 72% had little or no knowledge of the subject. Almost all patients, 98%, were satisfied with their follow-up. Significantly more patients with HNC were positive towards gene research compared to a sample from a national Danish questionnaire (p < 0.001). Patients with HNC were positive towards gene tests and PM, but patients may not understand or comprehend the information given, and it is important to inform and educate patients and health professionals to establish common ground in PM.
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Affiliation(s)
- Christian Sander Danstrup
- Department of Otorhinolaryngology-Head and Neck Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Maria Andersen
- Department of Clinical Oncology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Research Data and Biostatistics, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Mia Sommer
- Department of Hematology, Aalborg University Hospital, 9000 Aalborg, Denmark
- School of Nursing, University College Northern Denmark, 9000 Aalborg, Denmark
| | - Nina Munk Lyhne
- Department of Otorhinolaryngology-Head and Neck Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Straarup D, Gotschalck KA, Christensen PA, Rasmussen RW, Krarup H, Lundbye-Christensen S, Handberg A, Thorlacius-Ussing O. Exploring D-Lactate as a Biomarker for Acute Intestinal Necrosis in 2958 Patients: A Prospective Cross-Sectional Study. J Emerg Med 2024:S0736-4679(24)00005-2. [PMID: 38556374 DOI: 10.1016/j.jemermed.2024.01.001] [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] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/16/2023] [Accepted: 01/06/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Timely diagnosis of acute intestinal necrosis (AIN) is lifesaving, but challenging due to unclear clinical presentation. D-lactate has been proposed as an AIN biomarker. OBJECTIVES We aimed to test the diagnostic performance in a clinical setting. METHODS We performed a cross-sectional prospective study, including all adult patients with acute referral to a single tertiary gastrointestinal surgical department during 2015-2016 and supplemented by enrollment of high-risk in-hospital patients suspected of having AIN during 2016-2019. AIN was verified intraoperatively, and D-lactate was analyzed using an automatic spectrophotometric set-up. A D-lactate cut-off for AIN was estimated using the receiver operating characteristic curve. The performance according to patient subgroups was estimated using the area under the receiver operating characteristic curve (AUC). Given the exploratory nature of this study, a formal power calculation was not feasible. RESULTS Forty-four AIN patients and 2914 controls were enrolled. The D-lactate cut-off was found to be 0.0925 mM. Due to lipemic interference, D-lactate could not be quantified in half of the patients, leaving 23 AIN patients and 1456 controls for analysis. The AUC for the diagnosis of AIN by D-lactate was 0.588 (95% confidence interval 0.475-0.712), with a sensitivity of 0.261 and specificity of 0.892. Analysis of high-risk patients showed similar results (AUC 0.579; 95% confidence interval 0.422-0.736). CONCLUSION D-lactate showed low sensitivity for AIN in both average-risk and high-risk patients. Moreover, lipemic interference precluded valid spectrophotometric assessment of D-lactate in half of the patients, further disqualifying the clinical utility of D-lactate as a diagnostic marker for AIN.
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Affiliation(s)
- David Straarup
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Kåre A Gotschalck
- Department of Gastrointestinal Surgery, Horsens Regional Hospital, Horsens, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter A Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry
| | | | - Henrik Krarup
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry; Department of Molecular Diagnostics
| | | | - Aase Handberg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Biochemistry
| | - Ole Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Al-Hussainy N, Kragholm KH, Lundbye-Christensen S, Torp-Pedersen C, Pareek M, Therkelsen SK, Lip GYH, Riahi S. Gastrointestinal bleeding with direct oral anticoagulants in patients with atrial fibrillation and anaemia. Thromb Res 2023; 232:62-69. [PMID: 37939578 DOI: 10.1016/j.thromres.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION A high risk of gastrointestinal bleeding has been reported with the use of some direct oral anticoagulants (DOACs). This risk may be of particular concern in individuals with associated anaemia. The aim of this study is to investigate potential differences in the risks of gastrointestinal bleeding and stroke among the four available DOACs in patients with atrial fibrillation (AF) and moderate or severe anaemia. MATERIALS AND METHODS All Danish patients diagnosed with incident AF who had a baseline haemoglobin measurement and subsequently initiated DOAC therapy between 2012 and 2021 were identified through administrative registries. Only patients with moderate or severe anaemia (N = 7269) were included and evaluated regarding the risk of hospitalization for gastrointestinal bleeding and stroke. Standardized absolute 1-year risks of stroke and gastrointestinal bleeding were calculated from multivariable Cox regression analyses. DOACs were compared pairwise RESULTS: Compared with apixaban, both dabigatran and rivaroxaban were associated with a significantly increased risk of gastrointestinal bleeding with standardized 1-year risk ratios of 1.73 (95 % confidence interval [CI], 1.10-2.35) and 1.56 (95 % CI, 1.18-1.93), respectively, while no significant difference was seen in the comparison of apixaban with edoxaban 1.32 (95 % CI, 0.41-2.32). No significant differences in gastrointestinal bleeding were observed with pairwise comparisons of dabigatran, rivaroxaban and edoxaban. Finally, no significant difference in stroke risk among the four DOACs was observed. CONCLUSION In AF patients with moderate or severe anaemia, apixaban was associated with a significantly lower risk of gastrointestinal bleeding than dabigatran and rivaroxaban. No significant difference in stroke risk was observed across all four available DOACs.
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Affiliation(s)
- Nour Al-Hussainy
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Sam Riahi
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Hjelmgaard K, Bork CS, Lundbye-Christensen S, Lühdorf P, Bach FW, Schmidt EB, Overvad K, Venø SK. Intake of marine n-3 polyunsaturated fatty acids and risk of hemorrhagic stroke and its subtypes: a Danish follow-up study. Cerebrovasc Dis 2023:000533506. [PMID: 37967539 DOI: 10.1159/000533506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/05/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND A diet rich in marine n-3 polyunsaturated fatty acids (PUFAs) may lower the risk of coronary heart disease and ischemic stroke. However, the association between intake of marine n-3 PUFAs and risk of hemorrhagic stroke has only been sparsely explored. We aimed to investigate the associations between intake of the major marine n-3 PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and their sum in relation to incident hemorrhagic stroke and its subtypes intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). METHODS We analyzed data from the Danish Diet, Cancer and Health Cohort, which was established between 1993 and 1997. Information on dietary intake of marine n-3 PUFAs was obtained through a validated food frequency questionnaire. Potential hemorrhagic stroke cases were identified by linkage to the Danish National Patient Register and subsequently validated. Hazard ratios obtained by Cox proportional hazard regression were used as measures of association. RESULTS A total of 394 subjects among 55,519 individuals developed hemorrhagic stroke during a median follow-up period of 13.5 years. In multivariable analyses including adjustment for established risk factors, we observed weak and statistically non-significant indications of inverse associations between intake of EPA, DHA, and EPA + DHA and the rate of incident hemorrhagic stroke. In analyses of hemorrhagic stroke subtypes, we found indications of lower rates of ICH among participants in the highest quartile of EPA, DHA, and EPA + DHA compared with those in the lowest quartile, and indications of lower rates of SAH in the highest quartile of EPA intake compared to the lowest quartile but the findings were statistically non-significant. CONCLUSIONS Indications of inverse statistically non-significant associations were found between EPA, DHA, and EPA + DHA and hemorrhagic stroke.
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Borg SÁ, Joensen AM, Nielsen MRS, Olsen ÁW, Lolas IBY, Okkels H, Lundbye-Christensen S, Schmidt EB, Bork CS. Possible explanations for the common clinical familial hypercholesterolemia phenotypes in the Faroe Islands. J Clin Lipidol 2023; 17:633-642. [PMID: 37482509 DOI: 10.1016/j.jacl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The prevalence of clinical familial hypercholesterolemia (FH) is very high in the Faroe Islands, but the possible causes are unknown. OBJECTIVES We aimed to describe potential genetic causes of FH in the Faroe Islands and to investigate whether levels of lipoprotein(a) and measures of dietary habits were associated with clinical FH in the Faroe Islands. METHODS In this case-control study, we identified potential clinical FH cases aged 18-75 years registered within a nationwide clinical laboratory database in the Faroe Islands and invited them for diagnostic evaluation according to clinical FH scoring systems. Controls were identified in the background population. Lipoprotein(a) was measured in plasma, while the fatty acid composition was determined in adipose tissue. The habitual diet of the participants was assessed using a food frequency questionnaire. Genetic testing for FH and polygenic variants was performed in a selection of clinical FH cases. RESULTS A total of 121 clinical FH cases and 123 age- and sex-matched controls were recruited. We found a very low frequency of monogenic FH (2.5%), but a high level of polygenic FH (63%) in those genetically tested (67%). High levels of plasma lipoprotein(a) were associated with high odds of clinical FH. Clinical FH cases had a lower intake of saturated fatty acids (SFAs) measured by a high fat-score and a lower content of SFAs in adipose tissue compared with controls. CONCLUSION The high prevalence of FH in the Faroe Islands may be due to polygenic causes of hypercholesterolemia and to a lesser extent other genetic factors and elevated plasma lipoprotein(a) levels.
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Affiliation(s)
- Sanna Á Borg
- Department of Medicine, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands.
| | | | | | - Ása Wraae Olsen
- Department of Medicine, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | | | - Henrik Okkels
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Erik Berg Schmidt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Elgaard AF, Dinesen PT, Riahi S, Hansen J, Lundbye-Christensen S, Johansen JB, Nielsen JC, Lip GYH, Larsen JM. Long-term risk of cardiovascular implantable electronic device reinterventions following external cardioversion of atrial fibrillation and flutter: A nationwide cohort study. Heart Rhythm 2023; 20:1227-1235. [PMID: 36965653 DOI: 10.1016/j.hrthm.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND External cardioversion (ECV) is an essential part of rhythm control of atrial fibrillation and flutter in patients with and without cardiovascular implantable electronic devices (CIEDs). Long-term follow-up data on ECV-related CIED dysfunctions are limited. OBJECTIVE The purpose of this study was to investigate the risk of CIED reintervention following ECV in a nationwide cohort. METHODS We identified CIED implants and surgical reinterventions from 2005 to 2021 in the Danish Pacemaker and ICD Register. We included CIED patients undergoing ECV from 2010 to 2019 from the Danish National Patient Registry. For each ECV-exposed generator, 5 matched generators without ECV were identified, and for each ECV-exposed lead, 3 matched leads were identified. The primary endpoints were generator replacement and lead reintervention. RESULTS We compared 2582 ECV-exposed patients with 12,910 matched patients with a pacemaker (47%), implantable cardioverter-defibrillator (ICD) (29%), cardiac resynchronization therapy-pacemaker (6%), or cardiac resynchronization therapy-defibrillator (18%). During 2 years of follow-up, 210 ECV-exposed generators (8.1%) vs 670 matched generators (5.2%) underwent replacements, and 247 ECV-exposed leads (5.6%) vs 306 matched leads (2.3%) underwent reintervention. Unadjusted hazard ratios were 1.61 (95% confidence interval [CI] 1.37-1.91; P <.001) for generator replacement and 2.39 (95% CI 2.01-2.85; P <.001) for lead reintervention. One-year relative risks were 1.73 (95% CI 1.41-2.12; P <.001) for generator replacement and 2.85 (95% CI 2.32-3.51; P <.001) for lead reintervention, and 2-year relative risks were 1.39 (95% CI 1.19-1.63; P <.001) and 2.18 (95% CI 1.84-2.57; P <.001), respectively. CONCLUSION ECV in patients with a CIED is associated with a higher risk of generator replacement and lead reintervention. The risks of reinterventions were more pronounced within the first year after cardioversion.
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Affiliation(s)
- Anders Fyhn Elgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Hematology, Aalborg University Hospital, Clinical Cancer Research Center, Aalborg, Denmark.
| | - Pia Thisted Dinesen
- Department of Anesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - John Hansen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Jacob Moesgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Arendt Nielsen T, Lundbye-Christensen S, Krasimirova Dimitrova Y, Riahi S, Brock B, Mohr Drewes A, Brock C. Adynamic response to cold pain reflects dysautonomia in type 1 diabetes and polyneuropathy. Sci Rep 2023; 13:11318. [PMID: 37443134 PMCID: PMC10344906 DOI: 10.1038/s41598-023-37617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Cardiac autonomic neuropathy (CAN), widely assessed by heart rate variability (HRV), is a common complication of long-term diabetes. We hypothesized that HRV dynamics during tonic cold pain in individuals with type 1 diabetes mellitus (T1DM) could potentially demask CAN. Forty-eight individuals with long-term T1DM and distal symmetrical polyneuropathy and 21 healthy controls were included. HRV measures were retrieved from 24-h electrocardiograms. Moreover, ultra-short-term HRV recordings were used to assess the dynamic response to the immersion of the hand into 2 °C cold water for 120 s. Compared to healthy, the T1DM group had expectedly lower 24-h HRV measures for most components (p < 0.01), indicating dysautonomia. In the T1DM group, exposure to cold pain caused diminished sympathetic (p < 0.001) and adynamic parasympathetic (p < 0.01) HRV responses. Furthermore, compared to healthy, cold pain exposure caused lower parasympathetic (RMSSD: 4% vs. 20%; p = 0.002) and sympathetic responses (LF: 11% vs. 73%; p = 0.044) in the T1MD group. QRISK3-scores are negatively correlated with HRV measures in 24-h and ultra-short-term recordings. In T1DM, an attenuated sympathovagal response was shown as convincingly adynamic parasympathetic responses and diminished sympathetic adaptability, causing chronometric heart rhythm and rigid neurocardiac regulation threatening homeostasis. The findings associate with an increased risk of cardiovascular disease, emphasizing clinical relevance.
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Affiliation(s)
- Thomas Arendt Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sam Riahi
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Birgitte Brock
- Steno Diabetes Center Copenhagen, Region Hovedstaden, Gentofte, Denmark
| | - Asbjørn Mohr Drewes
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark.
- Steno Diabetes Center North Denmark, Aalborg, Denmark.
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Straarup D, Gotschalck KA, Christensen PA, Krarup H, Lundbye-Christensen S, Handberg A, Thorlacius-Ussing O. Exploring I-FABP, endothelin-1 and L-lactate as biomarkers of acute intestinal necrosis: a case-control study. Scand J Gastroenterol 2023; 58:1359-1365. [PMID: 37403410 DOI: 10.1080/00365521.2023.2229930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Acute intestinal necrosis (AIN) is a disease with devastating high mortality. AIN due to obstructed arterial blood flow has a blurred clinical presentation. Timely diagnosis is paramount, and a blood-based biomarker is warranted to increase patient survival. We aimed to assess intestinal fatty acid binding protein (I-FABP) and endothelin-1 as diagnostic biomarkers for AIN. To our knowledge, this is the first study exploring endothelin-1 in AIN patients from a general surgical population. DESIGN We conducted a single-centre nested case-control study comparing acutely admitted AIN patients to age- and sex-matched non-AIN patients during 2015-2016. I-FABP and endothelin-1 were analysed using an enzyme-linked immunosorbent assay. L-lactate levels were also measured in all patients. Cut-offs were estimated using receiver operator characteristic curves, and the diagnostic performance was estimated using the area under the receiver operator characteristic curve (AUC). RESULTS We identified 43 AIN patients and included 225 matched control patients. Median levels of I-FABP, endothelin-1 and L-lactate were 3550 (IQR: 1746-9235) pg/ml, 3.91 (IQR: 3.33-5.19) pg/ml and 0.92 (IQR: 0.74-1.45) mM in AIN patients and 1731 (IQR: 1124-2848) pg/ml, 2.94 (IQR: 2.32-3.82) pg/ml and 0.85 (IQR: 0.64-1.21) mM in control patients, respectively. The diagnostic performances of endothelin-1 and of I-FABP + endothelin-1 combined were moderate. Endothelin-1 alone revealed an AUC of 0.74 (0.67; 0.82). The sensitivity and specificity of endothelin-1 were 0.81 and 0.64, respectively. CONCLUSION I-FABP and endothelin-1 are promising biomarkers for AIN, with moderate diagnostic performance compared with the commonly used biomarker L-lactate. PREREGISTRATION ClinicalTrials.gov: NCT05665946.
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Affiliation(s)
- David Straarup
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Kåre A Gotschalck
- Department of Gastrointestinal Surgery, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter A Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Krarup
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Aase Handberg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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10
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Stubbe BE, Larsen AC, Madsen PH, Krarup HB, Pedersen IS, Lundbye-Christensen S, Hansen CP, Hasselby JP, Johansen AZ, Thorlacius-Ussing O, Johansen JS, Henriksen SD. Promoter hypermethylation of SFRP1 as a prognostic and potentially predictive blood-based biomarker in patients with localized pancreatic ductal adenocarcinoma. Front Oncol 2023; 13:1211292. [PMID: 37333823 PMCID: PMC10272559 DOI: 10.3389/fonc.2023.1211292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Current prognostic blood-based biomarkers for pancreatic adenocarcinoma (PDAC) are limited. Recently, promoter hypermethylation of SFRP1 (phSFRP1) has been linked to poor prognosis in patients with gemcitabine-treated stage IV PDAC. This study explores the effects of phSFRP1 in patients with lower stage PDAC. Methods Based on a bisulfite treatment process, the promoter region of the SFRP1 gene was analyzed with methylation-specific PCR. Kaplan-Meier curves, log-rank tests, and generalized linear regression analysis were used to assess restricted mean survival time survival at 12 and 24 months. Results The study included 211 patients with stage I-II PDAC. The median overall survival of patients with phSFRP1 was 13.1 months, compared to 19.6 months in patients with unmethylated SFRP1 (umSFRP1). In adjusted analysis, phSFRP1 was associated with a loss of 1.15 months (95%CI -2.11, -0.20) and 2.71 months (95%CI -2.71, -0.45) of life at 12 and 24 months, respectively. There was no significant effect of phSFRP1 on disease-free or progression-free survival. In stage I-II PDAC, patients with phSFRP1 have worse prognoses than patients with umSFRP1. Discussion Results could indicate that the poor prognosis may be caused by reduced benefit from adjuvant chemotherapy. SFRP1 may help guide the clinician and be a possible target for epigenetically modifying drugs.
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Affiliation(s)
- Benjamin Emil Stubbe
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Anders Christian Larsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Poul Henning Madsen
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Bygum Krarup
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Inge Søkilde Pedersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Carsten Palnæs Hansen
- Department of Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jane Preuss Hasselby
- Department of Pathology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Astrid Zedlitz Johansen
- Department of Oncology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
| | - Ole Thorlacius-Ussing
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Julia Sidenius Johansen
- Department of Oncology, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
- Department of Medicine, Copenhagen University Hospital – Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stine Dam Henriksen
- Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
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Fisker FY, Udholm N, Fuglsang M, Lundbye-Christensen S, Marshall NS, Bille J, Nyboe C, Udholm S. Risk of permanent social security benefits and overview of work participation among patients with obstructive sleep apnea. Sleep Med 2023; 108:16-21. [PMID: 37307696 DOI: 10.1016/j.sleep.2023.05.011] [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: 01/19/2023] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND In this nationwide study, we used Danish population registries to estimate the excess risk of receiving permanent social security benefits for patients with obstructive sleep apnea (OSA) and to track their labour force participation. METHODS We identified all Danish citizens receiving a diagnosis of OSA between 1995 and 2015. As a reference cohort, we randomly selected 10 citizens for each patient, matched by sex and birth year. Using the Fine and Gray competing risk regression, we estimated the cumulative incidences of receiving permanent social security benefits. Cox proportional hazard models were used to compare the risk of receiving permanent social security benefits in patients with OSA compared to the reference cohort. The Danish Rational Economic Agents' Model (DREAM) database was used to identify the labour market status prior to diagnosis, at time of diagnosis, and after diagnosis. RESULTS We identified 48,168 patients with OSA. A total of 12,413 (25.8%) patients with OSA had received permanent social security benefits, compared with 75,812 (15.7%) individuals in the reference cohort. Patients with OSA had a significantly increased risk of receiving permanent social security benefits when compared with the reference cohort (hazard ratio, 1.95; 95% CI, 1.88-2.02; and subhazard ratio, 1.92; 95% CI, 1.85-1.98). Work participation was lower for OSA patients compared to references at all time-points. CONCLUSION Patients with OSA have a moderately increased risk of receiving permanent social security benefits in Denmark after controlling for available confounders.
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Affiliation(s)
- Filip Yang Fisker
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nichlas Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Milos Fuglsang
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Nathaniel S Marshall
- The Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute for Medical Research, Sydney, Australia
| | - Jesper Bille
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Nyboe
- Department of Cardiothoracic and Vascular Surgery, Anaesthesia Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark.
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12
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Fruelund PZ, Sommer A, Lundbye-Christensen S, Graff C, Søgaard P, Riahi S, Zaremba T. The role of contractile dyssynchrony in pacing-induced cardiomyopathy: detailed assessment using index of contractile asymmetry. Cardiovasc Ultrasound 2023; 21:8. [PMID: 37127676 PMCID: PMC10150541 DOI: 10.1186/s12947-023-00308-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023] Open
Abstract
AIMS The pathophysiological effects of chronic right ventricular pacing and the role of right ventricular lead position are not well understood. Therefore, we investigated the association between left ventricular contractile dyssynchrony and pacing-induced cardiomyopathy (PICM) in patients with chronic right ventricular pacing. Furthermore, we assessed the association between right ventricular lead location and left ventricular contractile dyssynchrony. METHODS This was a retrospective study using data from 153 pacemaker patients with normal (≥ 50%) pre-implant left ventricular ejection fraction (LVEF). Baseline and follow-up echocardiograms were analyzed, and PICM was defined as LVEF < 50% with ≥ 10% decrease in LVEF after pacemaker implantation. Relative index of contractile asymmetry (rICA), a novel strain rate-based method, was calculated to quantify left ventricular contractile dyssynchrony between opposing walls in the three apical views. Right ventricular lead position was categorized into anterior septum, posterior septum, free wall, and apex based on contrast-enhanced cardiac computed tomography. RESULTS Forty-seven (31%) developed PICM. Overall contractile dyssynchrony, measured by mean rICA, was higher in the PICM group compared with the non-PICM group (1.19 ± 0.21 vs. 1.03 ± 0.19, p < 0.001). Left ventricular anterior-inferior dyssynchrony, assessed in the apical two-chamber view, was independently associated with PICM (p < 0.001). Thirty-seven (24%) leads were implanted anterior septal, 11 (7.2%) posterior septal, 74 (48.4%) apical, and 31 (20.3%) free wall. Left ventricular anterior-inferior dyssynchrony was significantly different between the four pacing lead locations (p < 0.01) with the highest rICA observed in the posterior septal group (1.30 ± 0.37). CONCLUSIONS PICM is significantly associated increased contractile dyssynchrony assessed by rICA. This study suggests that especially left ventricular dyssynchrony in the anterior-inferior direction is associated with PICM, and pacing the right ventricular posterior septum resulted in the highest degree of anterior-inferior dyssynchrony. Quantification of left ventricular dyssynchrony by rICA provides important insights to the potential pathophysiology of PICM and the impact of right ventricular lead position.
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Affiliation(s)
- Patricia Zerlang Fruelund
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark.
- Department of Clinical Medicine, Aalborg University, Forskningens Hus, Sdr. Skovvej 15, Aalborg, 9000, Denmark.
- Department of Internal Medicine, Regional Hospital of Randers, Randers, Denmark.
| | - Anders Sommer
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
| | - Søren Lundbye-Christensen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, 9000, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Frederik Bajers Vej 7, Aalborg Øst, 9220, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Forskningens Hus, Sdr. Skovvej 15, Aalborg, 9000, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Forskningens Hus, Sdr. Skovvej 15, Aalborg, 9000, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
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13
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Chiusolo S, Bork CS, Gentile F, Lundbye-Christensen S, Harris WS, Schmidt EB, De Caterina R. Adipose tissue n-3/n-6 fatty acids ratios versus n-3 fatty acids fractions as predictors of myocardial infarction. Am Heart J 2023; 262:38-48. [PMID: 37086938 DOI: 10.1016/j.ahj.2023.03.019] [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: 09/18/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Tissue levels of n-3 polyunsaturated fatty acids (PUFAs) have been inversely related with risk of myocardial infarction (MI). Whether ratios of n-3 to n-6 PUFAs, reflecting both dietary intake of n-3 PUFAs and competing n-6 PUFAs, are better predictors of future MI than n-3 PUFA fractions is unclear. We aimed at investigating whether such ratios in adipose tissue better predict MI than n-3 PUFA fractions. METHODS Subcutaneous adipose tissue biopsies were obtained in a random sample (n=3,500) of the Diet, Cancer and Health cohort (n=57,053). Adipose tissue content of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), alpha-linolenic acid (ALA), arachidonic acid (AA) and linoleic acid (LA) was determined using gas chromatography. Fractions of selected n-3 PUFAs and n-3/n-6 PUFA ratios were correlated to the 15-year occurrence of MI in a case-cohort design. RESULTS A total of 2,406 participants experienced an MI during follow-up. Adipose tissue total marine n-3 PUFAs, EPA+DHA, EPA, EPA/AA, DHA/AA and (EPA+DPA+DHA)/AA were all inversely associated with risk of incident MI. Evaluating the predictive power (Harrel's C-index) of the selected metrics, fractions of marine n-3 PUFAs and ratios of EPA/AA, DHA/AA, (EPA+DHA)/AA and (EPA+DPA+DHA)/AA all refined risk prediction over age and sex alone. At multivariable analyses, however, the above ratios were the only metrics providing additional risk prediction. Differences in ratios were related to differences in food intake. CONCLUSIONS Both adipose tissue n-3 PUFAs fractions and ratios of n-3 PUFAs/AA were associated with a lower occurrence of MI, but ratios provided superior risk prediction. Dietary strategies affecting n-3/n-6 PUFA ratios should be further investigated for prediction of MI with dietary interventions at the population level and in intervention studies.
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Affiliation(s)
- Simona Chiusolo
- Cardiology Division, University of Modena and Reggio Emilia, Modena Hospital, Modena, Italy
| | | | - Francesco Gentile
- Cardiology Division, Pisa University Hospital and University of Pisa, Pisa, Italy
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Unit of Clinical Biostatistics, Aalborg University Hospital, and Department of Clinical Medicine-Aalborg University, Aalborg, Denmark
| | - William S Harris
- Fatty Acid Research Institute and the Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, U.S.A
| | - Erik Berg Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Raffaele De Caterina
- Cardiology Division, Pisa University Hospital and University of Pisa, Pisa, Italy.
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14
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Bork CS, Lundbye-Christensen S, Venø SK, Lasota AN, Tjønneland A, Schmidt EB, Overvad K. Intake of marine and plant-derived n-3 fatty acids and development of atherosclerotic cardiovascular disease in the Danish Diet, Cancer and Health cohort. Eur J Nutr 2023; 62:1389-1401. [PMID: 36592188 DOI: 10.1007/s00394-022-03081-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The objective of this study was to investigate the association between intake of seafood and plant-derived n-3 polyunsaturated fatty acids (PUFA) and development of total atherosclerotic cardiovascular disease (ASCVD) and acute major ischemic events. METHODS A total of 53,909 men and women were enrolled between 1993 and 1997 into the Danish Diet, Cancer and Health cohort and followed through nationwide Danish registries for development of total ASCVD defined as a first registration of myocardial infarction, peripheral artery disease, or ischemic stroke due to large artery atherosclerosis or small-vessel occlusion. At recruitment, the intake of the major marine n-3 PUFA, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the plant-derived n-3 PUFA, alpha-linolenic acid (ALA), was assessed using a validated food frequency questionnaire. Statistical analyses were conducted using sex-stratified multivariable Cox proportional hazard regression models. RESULTS During a median of 13.5 years of follow-up, 3958 participants developed ASCVD including 3270 patients with an acute major ischemic event. In multivariable analyses including adjustment for established risk factors, we found no associations for intake of ALA, but indications of inverse associations between intake of EPA, DHA and EPA + DHA and the rate of total ASCVD and acute major ischemic events. CONCLUSIONS A high intake of marine n-3 PUFA was associated with a lower risk of total ASCVD and acute major ischemic events, whereas no association could be demonstrated for the plant-derived ALA.
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Affiliation(s)
- Christian S Bork
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | | | - Stine K Venø
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne N Lasota
- Department of Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erik B Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
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15
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Fruelund PZ, Van Dam PM, Melgaard J, Sommer A, Lundbye-Christensen S, Søgaard P, Zaremba T, Graff C, Riahi S. Novel non-invasive ECG imaging method based on the 12-lead ECG for reconstruction of ventricular activation: A proof-of-concept study. Front Cardiovasc Med 2023; 10:1087568. [PMID: 36818351 PMCID: PMC9932809 DOI: 10.3389/fcvm.2023.1087568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Aim Current non-invasive electrocardiographic imaging (ECGi) methods are often based on complex body surface potential mapping, limiting the clinical applicability. The aim of this pilot study was to evaluate the ability of a novel non-invasive ECGi method, based on the standard 12-lead ECG, to localize initial site of ventricular activation in right ventricular (RV) paced patients. Validation of the method was performed by comparing the ECGi reconstructed earliest site of activation against the true RV pacing site determined from cardiac computed tomography (CT). Methods This was a retrospective study using data from 34 patients, previously implanted with a dual chamber pacemaker due to advanced atrioventricular block. True RV lead position was determined from analysis of a post-implant cardiac CT scan. The ECGi method was based on an inverse-ECG algorithm applying electrophysiological rules. The algorithm integrated information from an RV paced 12-lead ECG together with a CT-derived patient-specific heart-thorax geometric model to reconstruct a 3D electrical ventricular activation map. Results The mean geodesic localization error (LE) between the ECGi reconstructed initial site of activation and the RV lead insertion site determined from CT was 13.9 ± 5.6 mm. The mean RV endocardial surface area was 146.0 ± 30.0 cm2 and the mean circular LE area was 7.0 ± 5.2 cm2 resulting in a relative LE of 5.0 ± 4.0%. Conclusion We demonstrated a novel non-invasive ECGi method, based on the 12-lead ECG, that accurately localized the RV pacing site in relation to the ventricular anatomy.
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Affiliation(s)
- Patricia Zerlang Fruelund
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,*Correspondence: Patricia Zerlang Fruelund,
| | - Peter M. Van Dam
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jacob Melgaard
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Anders Sommer
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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16
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Elgaard AF, Dinesen PT, Riahi S, Hansen J, Lundbye-Christensen S, Thøgersen AM, Larsen JM. External cardioversion of atrial fibrillation and flutter in patients with cardiac implantable electrical devices. Pacing Clin Electrophysiol 2023; 46:108-113. [PMID: 36333921 DOI: 10.1111/pace.14616] [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: 08/12/2022] [Revised: 10/05/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Atrial fibrillation and flutter are often treated with external electrical cardioversion (ECV) in patients with potentially electrically sensitive cardiovascular implantable electronic devices (CIED). Long-term follow-up data on contemporary CIED undergoing ECV is sparse. The aim is to investigate shock-related complications and impact on CIEDs. METHODS All ECV procedures from 2010 to 2020 in patients with CIED performed at a tertiary university hospital were identified in the Danish National Patient Registry. Changes in device measurements after ECV were retrospectively studied and procedure-related complications were identified by review of medical records. RESULTS We analyzed 763 ECV procedures in 372 patients, median device implant time 1.9 years. The mean age of patients was 69.9 ± 9.9 years of which 73.4% were men. We identified two cases of device programming changes and four cases of premature battery depletion (≤3 years after device implant). Minor changes in device measurements were found for impedances, sensing, and pacing thresholds. No patients died due to ECV-related device dysfunctions within the first 12 months after cardioversions. CONCLUSION External cardioversion in patients with contemporary pacemakers and implantable cardioverter-defibrillators seems safe in the majority of patients. Clinically important changes in device function following cardioversion were rarely observed but may be critical for device function. In an observational study, causality between cardioversion and device dysfunction cannot be established. For patient safety, we suggest that routine device interrogation after cardioversion still should be part of standard care.
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Affiliation(s)
- Anders Fyhn Elgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Pia Thisted Dinesen
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - John Hansen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | - Jacob Moesgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Feilberg Rasmussen L, Andreasen JJ, Riahi S, Lip GYH, Lundbye-Christensen S, Melgaard J, Graff C. Prediction of postoperative atrial fibrillation with postoperative epicardial electrograms. SCAND CARDIOVASC J 2022; 56:378-386. [DOI: 10.1080/14017431.2022.2130421] [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: 10/24/2022]
Affiliation(s)
- Louise Feilberg Rasmussen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Sam Riahi
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gregory Y. H. Lip
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Atrial Fibrillation Study Group, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Melgaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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18
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Lyng Lindgren F, Brix Christensen S, Lundbye-Christensen S, Kragholm K, Johannessen A, Jacobsen PK, Kristiansen SB, Hansen PS, Djurhuus MS, Gang UJO, Jørgensen OD, Riahi S. Validation of the national Danish ablation database: a retrospective, registry-based validation study. Scand Cardiovasc J Suppl 2022; 56:285-291. [PMID: 35866506 DOI: 10.1080/14017431.2022.2099009] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Aim.To validate the National Danish Ablation Database (NDAD) by investigating to what extent data in NDAD correspond to medical records.Type of study. Non-blinded, registry-based, retrospective, validation study. Material and methods. A sample of patients who underwent ablation for atrial fibrillation in Denmark between 1 January 2016 and 31 December 2016 were included. By utilizing medical records as gold standard, positive predictive (PPV) and negative predictive values (NPV) for NDAD were assessed and presented as five main categories: arrhythmia characteristics, demographics, cardiac history, complications, and medication. PPV's and NPV's exceeding 90% were considered as high agreement. Results. 597 patients (71.0% males) were included in the study. Median age was 63.1 (IQR: 54.9-68.4) years. The median PPV and NPV estimates across all variables were respectively 90.4% (95% CI: 68%-95.2%) (PPV) and 99.4% (95% CI: 98.4%-99.8%) (NPV) at baseline, and 91.7% (95% CI: 67.4%-95.4%) (PPV) and 99.3% (98.2%-99.3%) (NPV) at follow-up. Conclusion. The data registered in NDAD agrees to a great extent with the patients' medical records, suggesting NDAD is a database with high validity. As a result of low complication rate, the PPV- and NPV-estimates among complication variables were prone to somewhat greater uncertainty compared to the rest.
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Affiliation(s)
| | | | - Søren Lundbye-Christensen
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Arne Johannessen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology, Gentofte Hospital Copenhagen University Hospital, Hellerup, Denmark
| | - Steen Buus Kristiansen
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Kobenhavn, Denmark
| | | | | | | | - Ole Dan Jørgensen
- Department of Thoracic, Cardiac and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark
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Al-Hussainy N, Kragholm KH, Lundbye-Christensen S, Torp-Pedersen C, Pareek M, Therkelsen SK, Lip GYH, Riahi S. Safety and efficacy of direct oral anticoagulants in patients with anaemia and atrial fibrillation: an observational nationwide Danish cohort study. Eur Heart J Qual Care Clin Outcomes 2022; 8:840-851. [PMID: 34931662 DOI: 10.1093/ehjqcco/qcab095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 12/29/2022]
Abstract
AIMS The aim of this study was to evaluate the risk of stroke and bleeding among patients with atrial fibrillation (AF) treated with direct oral anticoagulants (DOACs) despite anaemia at treatment initiation time. METHODS AND RESULTS All Danish patients (N = 41 321) diagnosed with incident AF, having a baseline haemoglobin (Hb), and subsequently initiated DOAC therapy between 2012 and 2019 were identified through administrative registry databases. Patients with anaemia were subdivided according to the World Health Organization classification of anaemia and evaluated regarding risk of stroke and composite bleeding endpoint [hospitalization due to urogenital, gastrointestinal (GI), or intracranial bleeding or epistaxis]. Standardized absolute 1-year risks of stroke and composite bleeding endpoint were calculated using multivariable Cox regression analyses. The standardized absolute 1-year risk difference for composite bleeding increased by 0.96% [95% confidence interval (CI) 0.38-1.54] for patients with moderate/severe anaemia compared with patients with no anaemia. This risk was mainly driven by an increase in standardized absolute 1-year risk for serious GI bleeding, which increased by 0.41% (95% CI 0.19-0.63). No significant difference in standardized absolute 1-year bleeding risk was observed among patients with mild anaemia compared with patients with no anaemia 0.36% (95% CI -0.10 to 0.82). No significant difference in standardized absolute 1-year risk of stroke was observed among patients with mild anaemia, -0.16% (95% CI -0.13 to 0.15), and moderate/severe anaemia, -0.47% (95% CI -0.16 to 0.19), compared with patients with no anaemia. CONCLUSION For AF patients receiving DOACs, moderate/severe anaemia is a risk factor for serious GI bleeding, while stroke risk is the same regardless of whether anaemia was present at baseline or not.
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Affiliation(s)
- Nour Al-Hussainy
- Department of Medicine, Slagelse Hospital, Ingemannsvej 30, 4200 Slagelse, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,AF Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Manan Pareek
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark
| | | | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,AF Study Group, Aalborg University Hospital, Aalborg, Denmark
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20
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Borg SÁ, Sørensen Bork C, Skjelbo Nielsen MR, Jóanesarson J, Zaremba T, Lolas IBY, Lundbye-Christensen S, Søgaard P, Berg Schmidt E, Joensen AM. Subclinical atherosclerosis determined by coronary artery calcium deposition in patients with clinical familial hypercholesterolemia. Atheroscler Plus 2022; 50:65-71. [PMID: 36643796 PMCID: PMC9833248 DOI: 10.1016/j.athplu.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/18/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
Background and aims Limited knowledge exists regarding the association between coronary artery calcium (CAC) deposition in patients with clinical familial hypercholesterolemia (FH) and FH subtypes such as polygenic causes. We studied CAC score in patients with clinical FH and subtypes including polygenic causes of FH compared to healthy controls. Methods In a case-control study, we identified potential clinical FH cases registered with an LDL-C >6.7 mmol/l within a nationwide clinical laboratory database on the Faroe Islands and invited them for diagnostic evaluation according to clinical FH scoring systems. Controls were identified in the background population. All subjects were aged 18-75 years and without a history of cardiovascular disease. FH mutation testing and genotypes of twelve LDL-C associated single nucleotide polymorphisms were determined using conventional methods in selected individuals. CAC scores were assessed by cardiac CT. Odds ratios obtained using multivariate logistic regression were used as measures of association. Results A total of 120 clinical FH patients and 117 age- and sex-matched controls were recruited. We found a very low frequency of monogenic FH (3%), but a high level of polygenic FH (60%) in those genetically tested (54%). There was a statistically significant association between the CAC score and a diagnosis of clinical FH with the highest observed odds ratio of 5.59 (95% CI 1.65; 18.94, p = 0.006) in those with a CAC score ≥300 compared to those with a CAC of zero. In supplemental analyses, there was a strong association between CAC scores and clinical FH of a polygenic cause. Conclusion We found a statistically significant association between CAC levels and clinical FH with the highest observed risk estimates among clinical FH cases of a presumed polygenic cause.
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Affiliation(s)
- Sanna á Borg
- Department of Medicine, National Hospital of the Faroe Islands, Faroe Islands,Corresponding author. Department of Medicine, National Hospital of the Faroe Islands, J.C. Svabosgøta 41-19, 100, Tórshavn, Faroe Islands.
| | | | | | - Jan Jóanesarson
- Department of Medicine, National Hospital of the Faroe Islands, Faroe Islands
| | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Denmark
| | | | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Denmark
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21
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Fruelund PZ, Sommer AM, Lundbye-Christensen S, Zaremba T, Soegaard P, Graff C, Vraa S, Mahalingasivam AA, Pedersen MR, Riahi S. Risk of pacing-induced cardiomyopathy in patients with high-degree atrioventricular block – comparison between right ventricular pacing sites using computed tomography. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) pacing may induce significant left ventricular (LV) dyssynchrony resulting in pacing-induced cardiomyopathy (PICM). LV activation sequence is affected by RV pacing site and previous studies suggest that RV septal pacing may be superior compared to traditional RV apical pacing. However, results are conflicting and randomized controlled trials have failed to show clear benefits from RV septal pacing. Traditionally, studies have applied fluoroscopy to determine RV lead implantation site. However, locating pacing site using this method is known to be inaccurate and poorly reproducible compared with cardiac computed tomography (CT). The purpose of our study was to evaluate the association between RV pacing site determined by cardiac CT and risk of PICM.
Methods
We retrospectively included 153 patients with pre-implant LV ejection fraction (LVEF) ≥50% who underwent fluoroscopy-guided dual chamber pacemaker implantation due to high-degree atrioventricular block between March 2012 and May 2020. All patients attended a follow-up visit including cardiac CT and transthoracic echocardiography. RV lead position was evaluated from CT dividing the RV into three segments: apical, septum or free wall (Figure 1). Furthermore, RV lead position estimated by the implanting physician, using fluoroscopy during pacemaker implantation, was retrieved from medical records. The primary endpoint was PICM defined as ≥10% decrease in LVEF from time of pacemaker implantation to follow-up, resulting in LVEF <50%.
Results
Mean duration of follow-up was 3.7 years (range 2.1–8.7). The implanting physician estimated 131 (85.6%) leads to be located septal, 5 (3.3%) located non-septal and 17 (11.1%) were unknown. Based on CT, 48 (31.4%) leads were located septal and 105 (68.6%) were located non-septal of which 31 were located on the free wall (20.4%). With CT as the golden standard, 47 (35%) leads were estimated correctly during fluoroscopy-guided implantation. No significant differences between patient characteristics in the CT-estimated septal and non-septal groups were observed except for ischemic heart disease (P=0.05) (Table 1). There were 16 (33.3%) patients in the septal group who developed PICM compared to 31 (29.5%) in the non-septal group (P=0.6). Adjusting for ischemic heart disease did not change this result. In the septal group, the change in LVEF from baseline to follow-up was −9.0±10.4% compared to −7.5±9.1% in the non-septal group (P=0.4).
Conclusion
In total 31% developed PICM despite having a normal pre-implant LVEF with no observed difference between RV septal and non-septal pacing. With CT as the golden standard, RV leads were inaccurately located during fluoroscopy-guided pacemaker implantation with only 35% being located correctly. Misclassification of pacing sites in previous studies may have contributed to the inconsistent results.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Svend Andersens FondKarl G Andersens Fond
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Affiliation(s)
- P Z Fruelund
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - A M Sommer
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | | | - T Zaremba
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - P Soegaard
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - C Graff
- Aalborg University, Department of Health Science and Technology, Faculty of Medicine , Aalborg , Denmark
| | - S Vraa
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - A A Mahalingasivam
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - M R Pedersen
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - S Riahi
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
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22
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Elgaard AF, Dinesen PT, Riahi S, Hansen J, Lundbye-Christensen S, Johansen JB, Nielsen JC, Larsen JM. Long-term risk of replacement of cardiovascular implantable electronic devices following external cardioversion. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
External cardioversion (ECV) with transthoracic shock is a recommended and important part of the rhythm control strategy regardless of cardiovascular implantable electronic devices (CIED). Studies and case reports have demonstrated rare, but serious CIED malfunctions related to the ECV procedure. However, follow-up data on contemporary CIEDs undergoing ECV procedures are limited. The aim of this study is to investigate the long-term risk of generator replacements following an ECV procedure.
Methods
All CIED implants and surgical re-interventions in Denmark were identified in the Danish Pacemaker and ICD Register from January 2005 to April 2021. The ECV procedures were identified in the Danish National Patient Registry from January 2010 to February 2019. For each patient undergoing ECV, five matched (age, sex, and type of CIED) controls without previous ECV were identified. Time to generator replacement was estimated using competing risk analyses, with death, extraction and up-/down-grade being competing events. Risks were estimated by the pseudo-observation method.
Results
We identified in total 3,924 ECV-events in 2,610 CIED patients with 74.4% male. Mean age of patients at first ECV-procedure were 68.6±11.7 years, and median implant time was 1.5 year. The type of CIED included 50% of pacemakers, 28% of Implantable Cardioverter Defibrillators, and 22% of Cardiac Resynchronization Therapy-systems. During the first 5 years of follow-up, 451 (17.3%) of the shock-exposed devices were replaced vs. 2,000 (15.2%) of the unexposed devices. The relative risks (RR) of device replacement were 1.43 (95% CI: 0.5; 2.4) after 12 months, 1.44 (95% CI: 0.1; 2.8) after 24 months, and −0.53 (95% CI: −2.8; 1.7) after 5 years. The cumulated incidence of first endpoint: Replacement, death, extraction, and up-/down-grade are illustrated in Figure 1. A larger proportion of patients died in the shock-exposed group with n=427 (16.4%) compared to n=1,588 (12.2%) in the unexposed group during 5-years of follow-up with RR=3.2 (95% CI: 1.2; 5.3) of dead before other events.
Conclusion
Contemporary CIEDs do not indicate different risk of generator replacement following external cardioversion with transthoracic shocks. Shock-exposed device patients were more prone for extraction and death.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): This is work was financed by Department of Cardiology, Aalborg University Hospital and supported by Karl G. Andersen foundation.
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Affiliation(s)
- A F Elgaard
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - P T Dinesen
- Aalborg University Hospital, Department of Anaesthesia and Intensive Care Medicine , Aalborg , Denmark
| | - S Riahi
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - J Hansen
- Aalborg University, Department of Health Science and Technology , Aalborg , Denmark
| | - S Lundbye-Christensen
- Aalborg University Hospital, Department of Research data and Statistics , Aalborg , Denmark
| | - J B Johansen
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - J C Nielsen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - J M Larsen
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
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23
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Elgaard AF, Dinesen PT, Riahi S, Hansen J, Lundbye-Christensen S, Thoegersen AM, Larsen JM. External cardioversion of atrial fibrillation and flutter in patients with cardiac implantable electrical devices. Europace 2022. [DOI: 10.1093/europace/euac053.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Atrial tachyarrhythmias are often treated with external cardioversion (ECV) with direct current shocks in patients with potentially electrically sensitive cardiovascular implantable electronic devices (CIED). Long-term follow-up data on contemporary pacemakers and implantable cardioverter defibrillators (ICD) undergoing ECV is sparsely described. This study investigated shock-related complications and impact on CIEDs.
Methods
All ECV procedures of atrial fibrillation and flutter from 2010 to 2020 in patients with CIED performed at a tertiary hospital (Denmark) were identified in the Danish National Patient Registry. Data on device interrogation before and after ECV and procedure-related complications were retrieved retrospectively by review of medical records.
Results
We analysed 664 ECV-events performed in 362 CIEDs, median implant time 1.5 year. Mean age of patients at first ECV-event were 69.4±9.7 years and 72.2% were men. We identified two cases of major programming changes and two cases of premature battery depletion (≤3 years after generator implant) following ECV. Minor shock-related device changes were found for impedances, atrial sensing values and pacing thresholds of right ventricle lead. In two cases increased pacing threshold of right ventricle leads following ECV triggered exit-blocks after few months. No patients died due to shock-related device dysfunctions.
Conclusion
Following external cardioversion with transthoracic direct current shocks, sporadic (<1%) but potentially critical changes in device function were identified in patients with contemporary pacemakers and implantable cardioverter-defibrillators. The present study suggests that routine post-cardioversion device interrogation is imperative for patient safety.
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Affiliation(s)
- AF Elgaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - PT Dinesen
- Aalborg University Hospital, Department of Anaesthesia and Intensive Care Medicine, Aalborg, Denmark
| | - S Riahi
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J Hansen
- Aalborg University, Department of Health Science and Technology, Aalborg, Denmark
| | - S Lundbye-Christensen
- Aalborg University Hospital, Department of Research data and Statistics, Aalborg, Denmark
| | - AM Thoegersen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - JM Larsen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
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24
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Fruelund PZ, Van Dam P, Melgaard J, Soegaard P, Sommer A, Lundbye-Christensen S, Riahi S, Zaremba T, Graff C. Novel non-invasive 12-lead ECG-based imaging method with potential to guide and optimise right ventricular lead implantation. Europace 2022. [DOI: 10.1093/europace/euac053.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Svend Andersens Foundation
Karl G Andersens Foundation
Helsefonden
Background
Right ventricular (RV) pacing may induce electrical and mechanical dyssynchrony which may lead to heart failure. Often, the physician aims for lead implantation at the RV septum as this is expected to result in a more physiologic activation compared to alternative RV lead locations. Fluoroscopy, often in combination with QRS morphology derived from the 12-lead ECG, is used to guide lead implantation. However, this method is inaccurate and can result in a non-optimal RV lead location. We present a novel non-invasive method to create patient-specific 3D electrical activation maps from the 12-lead ECG that has potential to support RV lead implantation.
Methods
Data from 34 patients with an implanted dual chamber pacemaker were used. A contrast-enhanced cardiac CT scan showing the RV lead implantation site was obtained as well as recording of a 12-lead ECG during RV pacing together with a 3D photo documenting the ECG electrode positions. Discrete patient-specific torso and heart models were created from the CT scans. Each torso model was merged with the 3D photo for precise placement of the ECG electrodes in relation to the heart (figure 1). Combining the 12-lead ECGs and the heart/torso models, patient-specific 3D electrical activation maps originating from the RV were created using a novel inverse-ECG technique applying electrophysiological rules. The accuracy of the inverse-ECG method was determined by comparing the earliest site of activation from the 3D activation map with the known RV insertion site marked on the CT scan.
Results
Documented by the implanting physician in the medical records, 33 RV leads were estimated to be septal and one apical. Estimated from the CT scan 9 leads were placed septal, 18 apical and 7 on the free wall. The mean geodesic distance between the initial site of activation in the 3D activation map and the marked RV insertion site from CT was 13.6 ±5.7 mm (range 4.3-28.6). The distance for each patient is shown in figure 2. The initial site of activation was constrained to the discrete nodes of the ventricular model whereas the marker for RV lead position was localized freely on the CT scan. The average distance from the RV CT marker to the nearest discrete node was 4.3 ±2.2 mm. Correcting for this error, the geodesic distance between the initial site of activation and RV CT marker was 9.3 ±5.4 mm (range 0.0-24.6). The average time used for 3D activation map computation was 1.1 ±0.4 s per ECG.
Conclusions
We demonstrated a novel non-invasive 12-lead ECG-based method to accurately and effectively localize the RV lead in relation to the ventricular anatomy during RV pacing. Furthermore, we confirmed that the RV lead was often implanted in an unintended position. With further advancements, this method has the potential to support physicians during pacemaker implantation to ensure optimal RV lead positioning. Further studies are needed to confirm the accuracy.
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Affiliation(s)
- PZ Fruelund
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - P Van Dam
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands (The)
| | - J Melgaard
- Aalborg University, CardioTech Research Group, Department of Health Science and Technology, Faculty of Medicine, Aalborg, Denmark
| | - P Soegaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - A Sommer
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | | | - S Riahi
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - T Zaremba
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - C Graff
- Aalborg University, CardioTech Research Group, Department of Health Science and Technology, Faculty of Medicine, Aalborg, Denmark
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25
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Lunde ED, Fonager K, Joensen AM, Johnsen SP, Lundbye-Christensen S, Larsen ML, Riahi S. Association Between Newly Diagnosed Atrial Fibrillation and Work Disability (from a Nationwide Danish Cohort Study). Am J Cardiol 2022; 169:64-70. [PMID: 35090696 DOI: 10.1016/j.amjcard.2021.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/01/2022]
Abstract
It is previously shown that cardiovascular conditions have a negative effect on the ability to work. However, it is unknown if incident atrial fibrillation (AF) influences the ability to work. We examined the association between AF and the risk of work disability and the influence of socioeconomic factors. All Danish residents with a hospital diagnosis of AF and aged ≥30 and ≤63 years in the period January 1, 2000, to September 31, 2014, were included and matched 1:10 with an AF-free gender and age-matched random person from the general population. Permanent social security benefit was used as a marker of work disability. Risk difference (RD) and 95% confidence interval (95% CI) of work disability were calculated over 15 months. The analyses were furthermore stratified in low, medium, and high levels of socioeconomic factors. In total, 28,059 patients with AF and 312,667 matched reference persons were included. The risk of receiving permanent social security benefits within 15 months was 4.5% (4.3% to 4.8%) for the AF cohort and 1.3% (95% CI 1.3% to 1.4%) for the matched reference cohort. Adjusted RD (95% CI) was 2.3% (2.0% to 2.5%). Stratified on income, RDs were higher in low-income groups (adjusted RD 3.7% [95% CI 3.1% to 4.3%]) versus high-income groups (RD 1.3% [1.0% to 1.5%]). In conclusion, the risk of work disability within 15 months after incident AF was more than 3 times as high in patients with AF compared with the general population, especially when comparing individuals in lower socioeconomic strata.
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Borg SÁ, Nielsen MRS, Søgaard P, Lundbye-Christensen S, Jóanesarson J, Zaremba T, Kollslíð R, Schmidt EB, Joensen AM, Bork CS. Familial hypercholesterolaemia: a study protocol for identification and investigation of potential causes and markers of subclinical coronary artery disease in the Faroe Islands. BMJ Open 2022; 12:e050857. [PMID: 35414540 PMCID: PMC9006835 DOI: 10.1136/bmjopen-2021-050857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Familial hypercholesterolaemia (FH) is the most common monogenic autosomal dominant genetic disorder and is associated with a high risk of premature atherosclerotic cardiovascular disease. The prevalence of FH has been reported to be particularly high in certain founder populations. The population of the Faroe Islands is a founder population, but the prevalence of FH has never been investigated here. We aim to assess the prevalence of FH and to describe the genetic and clinical characteristics and potential causes of FH in the Faroe Islands. Furthermore, we aim to investigate whether indicators of subclinical coronary artery disease are associated with FH. METHODS AND ANALYSIS The prevalence of FH will be estimated based on an electronic nationwide laboratory database that includes all measurements of plasma lipid levels in the Faroe Islands since 2006. Subsequently, we will identify and invite subjects aged between 18 and 75 years registered with a plasma low-density lipoprotein cholesterol above 6.7 mmol/L for diagnostic evaluation. Eligible FH cases will be matched to controls on age and sex. We aim to include 120 FH cases and 120 controls.Detailed information will be collected using questionnaires and interviews, and a physical examination will be undertaken. An adipose tissue biopsy and blood samples for genetic testing, detailed lipid analyses and samples for storage in a biobank for future research will be collected. Furthermore, FH cases and controls will be invited to have a transthoracic echocardiography and a cardiac CT performed. ETHICS AND DISSEMINATION The project has been approved by the Ethical Committee and the Data Protection Agency of the Faroe Islands. The project is expected to provide important information, which will be published in international peer-reviewed journals.
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Affiliation(s)
- Sanna Á Borg
- Department of Medicine, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Jóanesarson
- Department of Medicine, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Rudi Kollslíð
- Department of Medicine, National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | - Erik Berg Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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27
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Borg SÁ, Sørensen Bork C, Skjelbo Nielsen MR, Berg Schmidt E, Kollslíð R, Lundbye-Christensen S, Joensen AM. Lipids, lipoproteins and prevalence of familial hypercholesterolemia in the Faroe Islands - Results from a nationwide laboratory database. Atheroscler Plus 2022; 48:55-59. [PMID: 36644563 PMCID: PMC9833255 DOI: 10.1016/j.athplu.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is one of the most common hereditary disorders. The population of the Faroe Islands was established by few founders, and genetic drift may have influenced lipid levels. The aim of this study was to describe the lipid distribution by providing age and sex-specific lipid values and to investigate the prevalence of FH in the Faroe Islands. METHODS We used an electronic nationwide laboratory database that included lipid measurements obtained in the Faroe Islands between January 2006 and September 2020. Percentiles of lipid levels were calculated using quantile regression. The prevalence of FH was estimated according to the Make Early Diagnosis Prevent Early Death (MEDPED) diagnostic criteria and according to the LDL-C cut-off levels included in the Dutch Lipid Clinic Network (DLCN) criteria using generalized linear models with robust variance. RESULTS According to the MEDPED age-specific cut-offs for LDL-C, a total of 216 subjects met the criteria for definite FH among 30,711 individuals corresponding to a prevalence of 0.70% (1:142). According to the LDL-C cut-offs included in the DLCN criteria, a total of 3,823 (1:8) subjects could be classified as having possible FH, and 10 (1:3,071) subjects could be classified as probable FH corresponding to a prevalence of 12.4% and 0.03%, respectively. Also, we found significant differences in lipid levels according to sex and age groups. CONCLUSION The Faroe Islands might represent a founder population with a prevalence of possible FH as high as 1 in 8. Further investigation of genetic and clinical characteristics of FH in the Faroe Islands is needed.
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Affiliation(s)
- Sanna á Borg
- Department of Medicine, National Hospital of the Faroe Islands, Faroe Islands
| | | | | | | | - Rudi Kollslíð
- Department of Medicine, National Hospital of the Faroe Islands, Faroe Islands
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Rasmussen LF, Andreasen JJ, Lundbye-Christensen S, Riahi S, Johnsen SP, Lip GY. Using the C2HEST score for predicting postoperative atrial fibrillation after cardiac surgery: A report from the Western Denmark Heart Registry, the Danish National Patient Registry, and the Danish National Prescription Registry. J Cardiothorac Vasc Anesth 2022; 36:3730-3737. [DOI: 10.1053/j.jvca.2022.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/11/2022] [Accepted: 03/30/2022] [Indexed: 11/11/2022]
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Rix TA, Dinesen P, Lundbye-Christensen S, Joensen AM, Riahi S, Overvad K, Schmidt EB. Omega-3 fatty acids in adipose tissue and risk of atrial fibrillation. Eur J Clin Invest 2022; 52:e13649. [PMID: 34233016 DOI: 10.1111/eci.13649] [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: 04/27/2021] [Revised: 06/22/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the present study was to examine the relation between adipose tissue content of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the risk of incident atrial fibrillation (AF). METHODS In this case-cohort study based on data from the Danish Diet, Cancer and Health cohort, a total of 5255 incident cases of AF was identified during 16.9 years of follow-up. Adipose tissue biopsies collected at baseline from all cases and from a randomly drawn subcohort of 3440 participants were determined by gas chromatography. Data were analysed using weighted Cox regression. RESULTS Data were available for 4741 incident cases of AF (2920 men and 1821 women). Participants in the highest vs. the lowest quintile of EPA experienced a 45% lower risk of AF (men HR 0.55 (95% CI 0.41-0.69); women HR 0.55 (0.41-0.72)). For DHA, no clear association was found in men, whereas in women, participants in the highest quintile of DHA in adipose tissue had a 30% lower risk of incident AF (HR 0.70 (0.54-0.91)) compared to participants in the lowest quintile. CONCLUSIONS A monotonous inverse association was found for the content of EPA in adipose tissue and risk of AF in both men and women. The content of DHA was inversely associated with the risk of AF in women, whereas no clear association was found for men.
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Affiliation(s)
- Thomas Andersen Rix
- Aalborg AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Pia Dinesen
- Aalborg AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Aalborg AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Albert Marni Joensen
- Aalborg AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sam Riahi
- Aalborg AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kim Overvad
- Aalborg AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Public Health, Aarhus University, Aalborg, Denmark
| | - Erik Berg Schmidt
- Aalborg AF Study Group, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Udholm N, Fuglsang M, Lundbye-Christensen S, Bille J, Udholm S. Obstructive Sleep Apnea and Risk of Suicide and Self-Harm: A Danish Nationwide Cohort Study. Sleep 2021; 45:6458465. [PMID: 34888700 DOI: 10.1093/sleep/zsab286] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES In this nationwide study, we used the unique Danish registries to estimate the risk of suicide and deliberate self-harm in patients with obstructive sleep apnea (OSA). METHODS We identified all Danish citizens receiving a diagnosis of OSA between 1995 and 2015. As a reference cohort, we randomly selected 10 citizens for each patient, matched by sex and birth year. Using the Fine and Gray competing risk regression, we estimated the cumulative incidences of suicide, and Cox proportional regression analysis was used to compare the risk of suicide and deliberate self-harm in patients with OSA with the reference cohort. RESULTS We identified 48,168 patients with OSA. A total of 135 patients had died by suicide, compared with 999 suicides in the reference cohort. Patients with OSA had an increased risk of dying by suicide when compared with the reference cohort (hazard ratio, 1.29; 95%CI, 1.07-1.55; and subhazard ratio, 1.23; 95%CI, 1.10-1.45). We identified 1,004 events of self-harm among patients with OSA, and 5,270 events in the reference group. The overall risk of self-harm was increased in patients with OSA when compared with the reference group (hazard ratio, 1.28; 95%CI, 1.19-1.37). CONCLUSION This is the first study to estimate the risk of suicide and deliberate self-harm in patients with OSA. We found that patients with OSA have an increased risk of both suicide and deliberate self-harm when compared with a large reference cohort, thereby highlighting the importance of a mental health screening in these patients.
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Affiliation(s)
- Nichlas Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Milos Fuglsang
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jesper Bille
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Udholm
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
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Soussi BG, Bork CS, Kristensen S, Lundbye-Christensen S, Duch K, Cordtz RL, Christensen JH, Schmidt EB, Dreyer L. Intake of marine n-3 polyunsaturated fatty acids and the risk of rheumatoid arthritis: protocol for a cohort study using data from the Danish Diet, Cancer and Health cohort and Danish health registers. BMJ Open 2021; 11:e047982. [PMID: 34607859 PMCID: PMC8491288 DOI: 10.1136/bmjopen-2020-047982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory joint disease with multifactorial aetiology. Smoking is a well-established lifestyle risk factor, but diet may also have an impact on the risk of RA. Intake of the major marine n-3 polyunsaturated fatty acids in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been hypothesised to lower the risk of RA due to their anti-inflammatory effects, although based on limited knowledge. Therefore, we aim to investigate the associations between dietary intake of EPA and DHA and the risk of incident RA. METHODS AND ANALYSIS A cohort study. The follow-up design will be based on data from the Danish Diet, Cancer and Health cohort, which was established between 1993 and 1997. The participants will be followed through record linkage using nationwide registers including the Danish Civil Registration System, the Danish National Patient Registry and the Danish National Prescription Registry using the unique Civil Personal Registration number. Time-to-event analyses will be conducted with RA as the outcome of interest. The participants will be followed from inclusion until date of RA diagnosis, death, emigration or end of follow-up. HRs with 95% CIs obtained using Cox proportional hazard regression models, with age as underlying time scale and adjustment for established and potential risk factors, will be used as measures of association. ETHICS AND DISSEMINATION The study has been approved by the Data Protection Committee of Northern Jutland, Denmark (2019-87) and the North Denmark Region Committee on Health Research Ethics (N-20190031). Study results will be disseminated through peer-reviewed journals and presentations at international conferences.
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Affiliation(s)
| | | | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten Duch
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jeppe Hagstrup Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
| | - Erik Berg Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Borg S, Bork C, Nielsen M, Schmidt E, Joensen A, Lundbye-Christensen S. The Faroe Islands - A possible founder population with a very high prevalence of familial hypercholesterolemia. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lunde ED, Joensen AM, Fonager K, Lundbye-Christensen S, Johnsen SP, Larsen ML, Lip GYH, Riahi S. Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study. BMJ Open 2021; 11:e048839. [PMID: 34059516 PMCID: PMC8169491 DOI: 10.1136/bmjopen-2021-048839] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The study aimed to examine the association between socioeconomic factors (SEFs) and oral anticoagulation (OAC) therapy and whether it was influenced by changing guidelines. We hypothesised that inequities in initiation of OAC reduced over time as more detailed and explicit clinical guidelines were issued. DESIGN Register-based observational study. SETTINGS All Danish patients with an incident hospital diagnosis of atrial fibrillation (AF), aged ≥30 years old and with high risk of stroke from 1 May 1999 to 2 October 2015 were included. Absolute risk differences (RD) (95% CI) were used to measure the association. PARTICIPANTS 154 448 patients (mean age 78.2 years, men 47.3%). EXPOSURE Education, family income and cohabiting status were the SEFs used as exposure. OUTCOME A prescription of OAC within -30 to +90 days of baseline (incident AF). RESULTS During 2002-2007, the crude RD of initiation of OAC for men with high education was 14.9% (12.8 to 16.9). Inequality reduced when new guidelines were published, and in 2013-2016 the crude RD was 5.6% (3.5 to 7.7). After adjusting for age, the RD substantially reduced. The same pattern was seen for cohabiting status, while inequality was smaller and more constant for income. CONCLUSION Patients with low income, low education and living alone were associated with lower chance of being initiated with OAC. For education and cohabiting status, the crude difference reduced around 2011, when more detailed clinical guidelines were implemented in Denmark. Our results indicate that new guidelines might reduce inequality in OAC initiation and that new, high-cost drugs increase inequality.
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Affiliation(s)
- Elin Danielsen Lunde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Kirsten Fonager
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Bork CS, Lundbye-Christensen S, Venø SK, Lasota AN, Schmidt EB, Overvad K. Plant n-3 PUFA intake may lower the risk of atherosclerotic cardiovascular disease only among subjects with a low intake of marine n-3 PUFAs. Eur J Nutr 2021; 61:557-559. [PMID: 33963430 DOI: 10.1007/s00394-021-02581-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
The role of the major plant-derived n-3 PUFA, alpha-linolenic acid (ALA), on the risk of atherosclerotic cardiovascular (ASCVD) remains unclear, but most studies have reported no association. However, the association between intake of ALA and the risk of ASCVD may depend on the intake of marine n-3 PUFAs. We investigated this hypothesis among more than 53,909 middle-aged, Danish men and women followed for a median of 13.4 years. We found a statistically significant inverse association between ALA intake modelled as a restricted cubic spline and the rate of ASCVD in subjects with a low intake of marine n-3 PUFAs, while no association was observed among subjects with a higher intake of marine n-3 PUFAs. Our findings suggest that the intake of ALA may be associated with a lower risk of total ASCVD, but only among subjects with a low intake of marine n-3 PUFAs.
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Affiliation(s)
- Christian S Bork
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | | | - Stine K Venø
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne N Lasota
- Department of Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Erik B Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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Andersen SL, Andersen S, Liew Z, Vestergaard P, Lundbye-Christensen S, Sørensen TIA, Olsen J. Maternal thyroid disease and adiposity in mother and child. Clin Endocrinol (Oxf) 2021; 94:484-493. [PMID: 32794201 DOI: 10.1111/cen.14314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/28/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Thyroid hormones are crucial developmental factors, and thyroid disease in pregnant women is a concern. Overweight and obesity are also important health concerns, and we hypothesized that in utero exposure to maternal thyroid disease could programme the foetus to development of adiposity. DESIGN Cohort and case-cohort studies. PARTICIPANTS Pregnant women from the Danish National Birth Cohort and their 7-year-old children. MEASUREMENTS Maternal thyroid disease (hyperthyroidism and hypothyroidism) was assessed from registrations of diagnoses and treatment (n = 71 706) or from the measurement of thyroid-stimulating hormone (TSH) in a stored blood sample from the early pregnancy (n = 7624). Maternal prepregnancy body mass index (BMI) and child BMI at 7 years of age were used to define overweight and obesity, and associations were evaluated using regression models adjusting for potential confounders. RESULTS No association was found between maternal thyroid disease in pregnancy and child overweight (hyperthyroidism: adjusted risk ratio (aRR): 1.02 (95% confidence interval (CI): 0.58-1.82); hypothyroidism: 1.31 (0.86-1.97)) or obesity (hyperthyroidism: 0.96 (0.53-1.75); hypothyroidism: 1.25 (0.76-2.05)). On the other hand, pregnant women with hypothyroidism in early pregnancy had a higher risk of being overweight (aRR: 1.20 (95% CI: 1.03; 1.41)) and obese (1.45 (1.07; 1.96)), whereas women with hyperthyroidism had a lower risk of being overweight (0.79 (0.64; 0.98)). CONCLUSIONS Results provide no evidence that maternal thyroid disease in pregnancy programmes adiposity in the child, but corroborate an association between maternal thyroid disease and adiposity in the mother.
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Affiliation(s)
- Stine Linding Andersen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Biochemistry, Viborg Regional Hospital, Viborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stig Andersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Thorkild I A Sørensen
- Section of Epidemiology, Department of Public Health, Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Johansen MN, Lundbye-Christensen S, Larsen JM, Parner ET. Regression models for interval censored data using parametric pseudo-observations. BMC Med Res Methodol 2021; 21:36. [PMID: 33588771 PMCID: PMC7883580 DOI: 10.1186/s12874-021-01227-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Time-to-event data that is subject to interval censoring is common in the practice of medical research and versatile statistical methods for estimating associations in such settings have been limited. For right censored data, non-parametric pseudo-observations have been proposed as a basis for regression modeling with the possibility to use different association measures. In this article, we propose a method for calculating pseudo-observations for interval censored data. Methods We develop an extension of a recently developed set of parametric pseudo-observations based on a spline-based flexible parametric estimator. The inherent competing risk issue with an interval censored event of interest necessitates the use of an illness-death model, and we formulate our method within this framework. To evaluate the empirical properties of the proposed method, we perform a simulation study and calculate pseudo-observations based on our method as well as alternative approaches. We also present an analysis of a real dataset on patients with implantable cardioverter-defibrillators who are monitored for the occurrence of a particular type of device failures by routine follow-up examinations. In this dataset, we have information on exact event times as well as the interval censored data, so we can compare analyses of pseudo-observations based on the interval censored data to those obtained using the non-parametric pseudo-observations for right censored data. Results Our simulations show that the proposed method for calculating pseudo-observations provides unbiased estimates of the cumulative incidence function as well as associations with exposure variables with appropriate coverage probabilities. The analysis of the real dataset also suggests that our method provides estimates which are in agreement with estimates obtained from the right censored data. Conclusions The proposed method for calculating pseudo-observations based on the flexible parametric approach provides a versatile solution to the specific challenges that arise with interval censored data. This solution allows regression modeling using a range of different association measures. Supplementary Information The online version contains supplementary material available at (10.1186/s12874-021-01227-8).
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Affiliation(s)
- Martin Nygård Johansen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Sdr Skovvej 15, Aalborg, 9000, Denmark.
| | - Søren Lundbye-Christensen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Sdr Skovvej 15, Aalborg, 9000, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jacob Moesgaard Larsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
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Borch L, Thorsteinsson K, Warner TC, Mikkelsen CS, Bjerring P, Lundbye-Christensen S, Arvesen K, Hagstroem S. COVID-19 reopening causes high risk of irritant contact dermatitis in children. Dan Med J 2020; 67:A05200357. [PMID: 32800064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Childhood irritant contact dermatitis (ICD) is the most common cause for developing chronic hand eczema as an adult. The COVID-19 reopening in Denmark included regulations introducing frequent hand washing. The aim of the present study was to evaluate if frequent hand washing increases the incidence of ICD in children. METHODS We conducted an observational study in Denmark during the reopening of schools and daycare facilities for children aged 0-12 years (April 22nd to May 1st 2020). A questionnaire was sent out to parents in four municipalities consisting of 20 questions about frequency of hand washing, use of hand sanitiser, symptoms of ICD, atopic dermatitis, allergy and predispositions. RESULTS The study included 6,273 children. In children without any prior symptoms of dermatitis, 42.4% experienced ICD (dry, red and itchy skin) due to increased hand hygiene. Schoolchildren had a 1.5 times greater relative risk of developing ICD than preschool children. Frequency of hand washing was a strong risk factor, whereas this was not the case for alcohol-based hand sanitiser. Hand washing 7-10 times/day and >10 times/day increased the relative risk by 1.83 and 2.23 times, respectively. CONCLUSIONS A higher frequency of hand washing during the COVID-19 reopening increased the incidence of ICD in children. Hand hygiene is essential in our fight against novel coronavirus, but prophylactic initiatives are important to reduce the possible long-term consequences of ICD in children. FUNDING none TRIAL REGISTRATION: Clinicaltrials.gov (NCT04375410).
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Ellegaard Nielsen J, Sofie Pedersen K, Vestergård K, Georgiana Maltesen R, Christiansen G, Lundbye-Christensen S, Moos T, Risom Kristensen S, Pedersen S. Novel Blood-Derived Extracellular Vesicle-Based Biomarkers in Alzheimer's Disease Identified by Proximity Extension Assay. Biomedicines 2020; 8:E199. [PMID: 32645971 PMCID: PMC7400538 DOI: 10.3390/biomedicines8070199] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 12/14/2022] Open
Abstract
Easily accessible biomarkers for Alzheimer's dementia (AD) are lacking and established clinical markers are limited in applicability. Blood is a common biofluid for biomarker discoveries, and extracellular vesicles (EVs) may provide a matrix for exploring AD related biomarkers. Thus, we investigated proteins related to neurological and inflammatory processes in plasma and EVs. By proximity extension assay (PEA), 182 proteins were measured in plasma and EVs from patients with AD (n = 10), Mild Cognitive Impairment (MCI, n = 10), and healthy controls (n = 10). Plasma-derived EVs were enriched by 20,000× g, 1 h, 4 °C, and confirmed using nanoparticle tracking analysis (NTA), western blotting, and transmission electron microscopy with immunolabelling (IEM). Presence of CD9+ EVs was confirmed by western blotting and IEM. No group differences in particle concentration or size were detected by NTA. However, significant protein profiles were observed among subjects, particularly for EVs. Several proteins and their ratios could distinguish cognitively affected from healthy individuals. For plasma TGF-α│CCL20 (AUC = 0.96, 95% CI = 0.88-1.00, p = 0.001) and EVs CLEC1B│CCL11 (AUC = 0.95, 95% CI = 0.86-1.00, p = 0.001) showed diagnostic capabilities. Using PEA, we identified protein profiles capable of distinguishing healthy controls from AD patients. EVs provided additional biological information related to AD not observed in plasma alone.
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Affiliation(s)
- Jonas Ellegaard Nielsen
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark; (S.L.-C.); (S.R.K.)
- Department of Clinical Biochemistry, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | | | - Karsten Vestergård
- Department of Neurology, Aalborg University Hospital, DK-9000 Aalborg, Denmark;
| | - Raluca Georgiana Maltesen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, DK-9000 Aalborg, Denmark;
| | - Gunna Christiansen
- Department of Biomedicine, Aarhus University, DK-8000 Aarhus, Denmark;
- Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg, Denmark;
| | - Søren Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark; (S.L.-C.); (S.R.K.)
- Unit of Clinical Biostatistics, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Torben Moos
- Department of Health Science and Technology, Aalborg University, DK-9220 Aalborg, Denmark;
| | - Søren Risom Kristensen
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark; (S.L.-C.); (S.R.K.)
- Department of Clinical Biochemistry, Aalborg University Hospital, DK-9000 Aalborg, Denmark
| | - Shona Pedersen
- Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark; (S.L.-C.); (S.R.K.)
- Department of Clinical Biochemistry, Aalborg University Hospital, DK-9000 Aalborg, Denmark
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Nygård Johansen M, Lundbye-Christensen S, Thorlund Parner E. Regression models using parametric pseudo-observations. Stat Med 2020; 39:2949-2961. [PMID: 32519771 DOI: 10.1002/sim.8586] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/01/2020] [Accepted: 05/05/2020] [Indexed: 11/07/2022]
Abstract
Pseudo-observations based on the nonparametric Kaplan-Meier estimator of the survival function have been proposed as an alternative to the widely used Cox model for analyzing censored time-to-event data. Using a spline-based estimator of the survival has some potential benefits over the nonparametric approach in terms of less variability. We propose to define pseudo-observations based on a flexible parametric estimator and use these for analysis in regression models to estimate parameters related to the cumulative risk. We report the results of a simulation study that compares the empirical standard errors of estimates based on parametric and nonparametric pseudo-observations in various settings. Our simulations show that in some situations there is a substantial gain in terms of reduced variability using the proposed parametric pseudo-observations compared with the nonparametric pseudo-observations. The gain can be measured as a reduction of the empirical standard error by up to about one third; corresponding to an additional 125% larger sample size. We illustrate the use of the proposed method in a brief data example.
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Affiliation(s)
| | | | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
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Hashemi B, Berg Schmidt E, Svensson M, Lundbye-Christensen S, Bork C, Hagstrup Christensen J. P0945STUDY PROTOCOL: ADIPOSE TISSUE CONTENT OF N-3 POLYUNSATURATED FATTY ACIDS AND THE RISK OF CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chronic kidney disease (CKD) is associated with life style diseases such as hypertension and type 2 diabetes. However the role of diet is not yet clearly defined for development of CKD.
Recent studies have shown that n-3 polyunsaturated fatty acids (PUFAs) may exert favourable effects on several processes that may inhibit the development and progression of CKD.
A gold standard biomarker for long-term intake and metabolism of n-3 PUFAs, is their content in adipose tissue; because these fatty acids are essential and not endogenously produced.
Aims
The primary aim of this study is to investigate the association of adipose tissue content of marine and plant-based n-3 PUFAs to the risk of incident CKD.
This study will also examine associations between the content of n-3 PUFAs in adipose tissue and the risk of main subtypes of CKD: Proteinuria with unknown cause, Hypertensive nephropathy, Glomerular diseases, Diabetic nephropathy and Chronic renal failure of unknown cause.
Method
In this case-cohort study based on data from the prospective Danish Diet, Cancer and Health cohort (DCH), information concerning diet and other lifestyle factors was obtained from 57,053 Danish men and women aged 50 to 65 years, using questionnaires and interviews. Anthropometric measurements were undertaken, and adipose tissue biopsies were taken from the buttocks of all participants at baseline.
The follow-up period was from December 1993 to September 2017. The outcome CKD is defined as having a diagnosis of one of the CKDs causes in the Danish National Patient Registry (DNPR). Cases of CKD will be identified and included together with a randomly drawn subcohort, representative for all participants of the cohort. Adipose tissue samples will be analyzed by gas chromatography in all incident CKD cases and in 5,000 randomly drawn participants from the whole cohort.
The outcome will be adjusted for age, sex, body mass index, physical activity, energy intake, alcohol consumption, fermented dairy products, education, smoking status, hormone replacement therapy and comorbidity.
The study is approved by the Danish National Committee on Health Research Ethics (N-20180074) and the Danish Data Protection Agency (2018-139).
Results
No results are available yet.
Conclusion
Our hypothesis is that the content of total n-3 PUFAs, as well as both marine and plant-based n-3 PUFAs, in adipose tissue is inversely associated with the risk of CKD and its subtypes.
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Affiliation(s)
- Bahram Hashemi
- Aalborg University Hospital, Nephrology, Aalborg, Denmark
| | | | - My Svensson
- Akershus University Hospital, Nephrology, Oslo, Norway
| | | | - Christian Bork
- Aalborg University Hospital, Cardiology, Aalborg, Denmark
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Abstract
Background In this nationwide study, we used the unique Danish registries to estimate the risk of suicide and deliberate self‐harm in patients with congenital heart disease (CHD). Methods and Results We identified all Danish citizens receiving a diagnosis of CHD between 1977 and 2007. As a reference cohort, we randomly selected 10 citizens for each patient, matched by sex and birth year. Using the Fine and Gray competing risk regression, we estimated the cumulative incidences of suicide and self‐harm, and Cox proportional regression analysis was used to compare the risk of suicide and deliberate self‐harm in patients with CHD with the reference cohort. We identified 14 433 patients with CHD. Mean follow‐up was 21.3 years, with a maximum follow‐up of 42 years. Since the time of diagnosis, 2659 patients had died, with a median age of death of 23 years. A total of 15 patients had died by suicide, compared with 232 suicides in the reference cohort. Patients with CHD had a low and similar risk of dying by suicide when compared with the reference cohort (cause‐specific hazard ratio, 0.81; 95% CI, 0.48–1.37; and subhazard ratio, 0.68; 95% CI, 0.41–1.16). We identified 336 events of self‐harm among patients with CHD, and 3484 events in the reference group. The overall risk of deliberate self‐harm was not increased in patients with CHD when compared with the reference group (subhazard ratio, 0.95; 95% CI, 0.85–1.06). Conclusions This is the first study to estimate the risk of suicide and deliberate self‐harm in patients with CHD. We found that patients with CHD do not have an increased risk of suicide or deliberate self‐harm when compared with a large reference cohort.
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Affiliation(s)
- Sebastian Udholm
- Department of Cardiothoracic Surgery Aarhus University Hospital Aarhus N Denmark
| | - Camilla Nyboe
- Department of Cardiothoracic Surgery Aarhus University Hospital Aarhus N Denmark
| | | | - Merete Nordentoft
- CORE-Copenhagen Research Center for Mental Health Danish Research Institute for Suicide Prevention Mental Health Center Copenhagen Copenhagen University Hospital Copenhagen Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery Rigshospitalet Copenhagen Ø Denmark
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Kjaergaard B, Holdgaard HO, Magnusdottir SO, Lundbye-Christensen S, Christensen EF. An impedance threshold device did not improve carotid blood flow in a porcine model of prolonged cardiac arrest. J Transl Med 2020; 18:83. [PMID: 32059732 PMCID: PMC7023771 DOI: 10.1186/s12967-020-02264-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An impedance threshold device (ITD) was developed to increase venous return to the heart and therefore increase cardiac output and organ blood flow during cardiopulmonary rescue (CPR). Basic CPR aims to maintain coronary and cerebral blood flow at the minimum level necessary for survival. The present study compared the effects of an ITD on cerebral blood flow assessed as blood flow in both carotid arteries to the blood flow of a control group during prolonged CPR. METHODS Fourteen anaesthetized pigs were monitored during 60 min of CPR after induced ventricular fibrillation. The primary outcome was blood flow in both carotid arteries, and the secondary outcomes were blood pressure, acid-base parameters, plasma potassium, and plasma lactate. The pigs were randomized to mechanical compressions and ventilation with an ITD added to the ventilation or to a control group treated only with mechanical compressions and ventilation. The time course for the parameters was tested using analysis of variance. RESULTS The cumulative carotid blood flow in the ITD group decreased from 64 to 42 ml/min, and it decreased from 69 to 51 ml/min in the control group during 60 min of CPR. The difference was not significant. The secondary outcome measures were also not significantly different. CONCLUSIONS This study did not show any beneficial effect of an ITD on carotid blood flow.
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Affiliation(s)
- Benedict Kjaergaard
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark. .,Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark. .,Biomedical Research Laboratory, Aalborg University Hospital, Aalborg, Denmark.
| | - Hans O Holdgaard
- Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Center for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Sigridur O Magnusdottir
- Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Biomedical Research Laboratory, Aalborg University Hospital, Aalborg, Denmark
| | - Søren Lundbye-Christensen
- Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Erika F Christensen
- Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Center for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.,Clinic of Medicine and Emergency Care, Aalborg University Hospital, Aalborg, Denmark
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43
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Bork CS, Lasota AN, Lundbye-Christensen S, Jakobsen MU, Tjønneland A, Overvad K, Schmidt EB. Adipose tissue content of alpha-linolenic acid and development of peripheral artery disease: a Danish case-cohort study. Eur J Nutr 2019; 59:3191-3200. [PMID: 31832750 DOI: 10.1007/s00394-019-02159-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the association between adipose tissue content of the plant-derived n-3 fatty acid, alpha-linolenic acid, and the rate of incident peripheral artery disease (PAD). METHODS We conducted a case-cohort study nested within the Danish Diet, Cancer and Health cohort (n = 57,053), which was established between 1993 and 1997. Potential PAD cases were identified using linkage with The Danish National Patient Register and all potential cases were validated. Adipose tissue samples from the buttock were collected at baseline and fatty acid composition was determined in cases and in a random sample (n = 3500) from the cohort by gas chromatography. Statistical analyses were performed using weighted Cox regression allowing for different baseline hazards among sexes. RESULTS During a median of 13.5 years of follow-up, we identified 863 PAD cases with complete information. The median adipose tissue content of ALA in the sub-cohort (n = 3197) was 0.84% (interquartile range 0.73-0.94%) of total fatty acids. In multivariate analyses including adjustment for established risk factors, we observed a U-shaped association between ALA in adipose tissue and rate of PAD, but the association was not statistically significant (P = 0.131). Similar pattern of associations were observed between ALA content in adipose tissue and the rate of PAD among men and women. CONCLUSIONS We found indications of a U-shaped association between adipose tissue content of ALA and the rate of PAD, but the association was not statistically significant.
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Affiliation(s)
- Christian S Bork
- Department of Cardiology, Aalborg University Hospital, Søndre Skovvej 15, 9000, Aalborg, Denmark.
| | - Anne N Lasota
- Department of Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark
| | | | - Marianne U Jakobsen
- Division of Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Overvad
- Department of Cardiology, Aalborg University Hospital, Søndre Skovvej 15, 9000, Aalborg, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Erik B Schmidt
- Department of Cardiology, Aalborg University Hospital, Søndre Skovvej 15, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Nyboe C, Fonager K, Larsen ML, Andreasen JJ, Lundbye-Christensen S, Hjortdal V. Effect of Atrial Septal Defect in Adults on Work Participation (from a Nation Wide Register-Based Follow-Up Study Regarding Work Participation and Use of Permanent Social Security Benefits). Am J Cardiol 2019; 124:1775-1779. [PMID: 31590912 DOI: 10.1016/j.amjcard.2019.08.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
Low work participation is well known in patients with chronic disease but has not been described in patients with atrial septal defect (ASD). In this nation-wide cohort study, we report the first long-term follow-up of use of permanent social security benefits and work participation in adults with ASD. All Danes born before 1994 and diagnosed with ASD from 1959 to 2013 (n = 2,277) were identified from the Danish medical registries. We used Cox proportional hazards regression to compare the risk of receiving permanent social security benefits in the ASD patients compared with an age- and gender-matched general population cohort. Using the DREAM database, we calculated work participation score and proportion of patients working or not working at the age of 30 years. Median follow-up from ASD diagnosis was 23.4 years (range 0.2 to 59.3). ASD patients had a higher risk of receiving permanent social security benefits (hazard ratio 2.3 [95% confidence interval 2.1 to 2.6]) compared with the comparison cohort with 24% of the ASD patients receiving permanent social security benefits at the end of follow-up compared with 12% of the comparison cohort. At the age of 30 years, the proportion not working was 28% in the ASD cohort and 18% in the comparison cohort. In patients with ASD, 23% of those without a job had a psychiatric diagnosis. In conclusion, the risk of receiving permanent social security benefits was twice as high in patients with ASD and the work participation score was reduced compared with the background population.
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Lasota AN, Grønholdt MLM, Lundbye-Christensen S, Schmidt EB, Overvad K. A Prospective Cohort Study of Substitutions of Poultry, Red Meat or Lean Fish with Fatty Fish and the Risk of Incident Peripheral Arterial Disease in Men. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.844] [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: 11/29/2022]
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Nyebo C, Fonager K, Larsen ML, Andreasen JJ, Lundbye-Christensen S, Hjortdal VE. Socioeconomic consequences for adults with atrial septal defect: A register based follow-up study. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrial Septal Defect (ASD) is considered one of the most benign defects among congenital heart disease. The very good short and midterm outcomes after closure in the recent decades has led to believe that the ASD population is almost comparable to the background population after treatment. However, recent studies indicate that these patients are much more affected by their disease than first assumed. In this nationwide cohort study, we report the first long-term follow-up of use of permanent social security benefits and work participation in adults with ASD.
Methods
All Danish patients born before 1994 and diagnosed with ASD between 1959-2013 (n = 2,277) were identified from the Danish registries. A comparison cohort was created using the Danish Civil Registration System, matching every verified ASD patient with 10 persons from the general population on gender and birth year. We used Cox proportional hazards regression to compare the risk of receiving permanent social security benefits in the ASD patients compared with the matched cohort. Using the DREAM database we calculated the proportion of patients and controls not working at the age of 30 years.
Results
ASD patients had a higher risk of receiving permanent social security benefits (hazard ratio 2.3 (95% confidence interval 2.1-2.6)) compared with the comparison cohort; 24% of the ASD patients was receiving permanent social security benefits at the end of follow up compared with 12% of the comparison cohort. At the age of 30 years, the proportion not working was 28% in the ASD cohort and 18% in the comparison cohort. Of patients not working 23% had a psychiatric diagnose compared to 6.8% of the controls.
Conclusions
The risk of receiving permanent social security benefits was twice as high in patients with ASD and the work participation was reduced compared with the background population.
Key messages
The poor affiliation to the work force and high prevalence of psychiatric morbidity is worrying. It demands for an increased psychosocial support by professionals caring for patients with ASD.
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Affiliation(s)
- C Nyebo
- Department of Cardiothoracic and Vascular Surgery, Aarhus Universityhospital, Aarhus, Denmark
| | - K Fonager
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - M L Larsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiology, University Hospital, Aalborg, Denmark
| | - J J Andreasen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiothoracic Surgery, University Hospital, Aalborg, Denmark
| | - S Lundbye-Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - V E Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus Universityhospital, Aarhus, Denmark
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Lunde ED, Joensen AM, Lundbye-Christensen S, Fonager K, Paaske Johnsen S, Larsen ML, Berg Johansen M, Riahi S. Socioeconomic position and risk of atrial fibrillation: a nationwide Danish cohort study. J Epidemiol Community Health 2019; 74:7-13. [PMID: 31619458 DOI: 10.1136/jech-2019-212720] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/28/2019] [Accepted: 09/16/2019] [Indexed: 11/04/2022]
Abstract
AIM To examine the association between socioeconomic position and the risk of atrial fibrillation (AF) in different stages of life in a population of Danish citizens. METHODS Register-based study. We followed all individuals turning 35, 50, 65 or 80 years from 1 January 1996 to 31 December 2005 until AF, death, emigration or the end of study period (31 December 2015). Exposure was education and income. We used Cox regression for the HRs (95% CI) and the pseudo-observation method for the adjusted risk difference (RD) (%). RESULTS A total of 2 173 857 participants were enrolled and 151 340 incident cases of AF occurred over a median of 13.6 years of follow-up. Adjusted HR (95% CI) of incident AF for the youngest age group with the highest education (ref lowest) was 0.62 (0.50 to 0.77) (women) and 0.85 (0.76 to 0.96) (men). The associations attenuated with increasing age, that is, HRs for the oldest age group were 1.04 (0.97 to 1.10) and 0.98 (0.96 to 1.04), respectively. The corresponding adjusted RDs (%) were: -0.28 (-0.43 to -0.14), -0.18 (-0.36 to -0.01), 3.04 (-0.55 to 6.64) and -0.74 (-3.38 to 2.49), respectively. Similar but weaker associations were found for income. CONCLUSION Higher level of education and income was associated with a lower risk of being diagnosed with AF in young individuals but the association decreased with increasing age and was almost absent for the oldest age cohort. However, since AF is relatively rare in the youngest the RDs were low.
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Affiliation(s)
- Elin Danielsen Lunde
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark .,Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Lundbye-Christensen
- Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mogens Lytken Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Danish Centre against Inequality in Health (DACUS), Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Aalborg AF Study Group, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Bork CS, Venoe SK, Lasota AN, Lundbye-Christensen S, Tjoenneland A, Overvad K, Schmidt EB. P3425Alpha-linolenic acid may lower the rate of atherosclerotic cardiovascular disease in subjects with a low intake of marine n-3 fatty acids. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0299] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Previous studies investigating the association between intake of the plant-derived n-3 fatty acid alpha-linolenic and atherosclerotic cardiovascular disease (ASCVD) have shown conflicting results. However, the effect of ALA intake on ASCVD may depend on the intake of marine n-3 fatty acids.
Purpose
We aimed to explore the association between ALA intake and risk of ASCVD in subjects consuming below and above the 10th percentile of marine n-3 fatty acids, respectively.
Methods
We followed men and women enrolled into the Danish Diet, Cancer and Health cohort (n=57.053) by linkage with nationwide registers and identified all incident ASCVD cases. All participants were aged 50 to 65 years at baseline. ASCVD was defined as the first registration of myocardial infarction, peripheral artery disease or ischemic stroke due to large artery atherosclerosis or small-vessel occlusions. Intake of ALA and marine n-3 fatty acids was assessed using a validated food frequency questionnaire and expressed as energy-adjusted intake. Statistical analyses were conducted using Cox proportional hazard regression.
Results
During a median of 13.4 years of follow-up, we identified a total of 3958 incident ASCVD cases including 366 cases among subjects in the lowest 10th percentile of consumption of marine n-3 fatty acids (<252 mg/day). In multivariable analyses, we found a statistically significant inverse association between ALA modelled as a restricted cubic spline and the rate of ASCVD (p=0.005) in subjects with a low intake of marine n-3 fatty acids, whereas no statistically significant association was found between ALA intake and ASCVD in subjects with a higher intake of marine n-3 fatty acids (p=0.155) (Figure).
Conclusion
Intake of ALA may be associated with a lower rate of ASCVD in subjects with a low intake of marine n-3 fatty acids.
Acknowledgement/Funding
The Danish Heart Foundation (17-R115-A7415-22060), Helene and Georg Jensens and Ethel Merethe and Christian Pontoppidan's Fund.
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Affiliation(s)
- C S Bork
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - S K Venoe
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - A N Lasota
- Aalborg University Hospital, Department of Vascular Surgery, Aalborg, Denmark
| | | | - A Tjoenneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - K Overvad
- Aarhus University, Department of Public Health, Aarhus, Denmark
| | - E B Schmidt
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
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Joensen AM, Dinesen PT, Svendsen LT, Hoejbjerg TK, Fjerbaek A, Andreasen J, Sottrup MB, Lundbye-Christensen S, Vadmann H, Riahi S. Effect of patient education and physical training on quality of life and physical exercise capacity in patients with paroxysmal or persistent atrial fibrillation: A randomized study. J Rehabil Med 2019; 51:442-450. [PMID: 30931484 DOI: 10.2340/16501977-2551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/16/2022] Open
Abstract
OBJECTIVE To examine the effect of a rehabilitation programme on quality of life and physical capacity in patients with atrial fibrillation. METHODS Patients with paroxysmal or persistent atrial fibrillation were randomized to either a 12-week rehabilitation programme with education and physical training (intervention group) or standard care (control group). At baseline, after 3, 6 and 12 months participants completed 5 different quality of life questionnaires (Quality of Life in patients with Atrial Fibrillation (AF-QoL-18), Atrial Fibrillation Effect on QualiTy of Life (AFEQT), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Assessment (GAD-7) and EuroQol 5D (EQ-5D)), and physical exercise tests. Differences in mean] scores between groups were analysed by repeated measures analysis of variance (ANOVA). RESULTS Fifty-eight patients (age range 43-78 years, 31% female) were included. In the intervention group the AF-QoL-18 score increased from baseline (48.4 (standard deviation (SD) 22.8)) to 6 months (68.0 (SD 15.2)) compared with the control group (baseline 51.6 (SD 22.3), 6 months 59.2 (SD 27.3)). After 12 months, there was no difference. Similar patterns were found for the other questionnaires. Maximum exercise capacity improved in the intervention group from baseline (176 W (SD 48)) to 6 months (190 W (SD 55)). There was no change in the control group. CONCLUSION Education and physical training may have a short-term (but no long-term) beneficial effect on quality of life and physical exercise capacity in patients with atrial fibrillation.
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Affiliation(s)
- Albert M Joensen
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
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50
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Bork C, Venø S, Lasota A, Lundbye-Christensen S, Overvad K, Schmidt E. Alpha-Linolenic Acid Intake And The Risk Of Atherosclerotic Cardiovascular Disease. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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