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Leening MJG. Overcoming therapeutic inertia in LDL cholesterol-lowering treatment with education and simplified treatment algorithms. Neth Heart J 2024; 32:198-199. [PMID: 38512637 DOI: 10.1007/s12471-024-01863-x] [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] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Affiliation(s)
- Maarten J G Leening
- Departments of Cardiology, Radiology, and Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Leening MJG, Boersma E. The perpetual need of randomized clinical trials: challenges and uncertainties in emulating the REDUCE-AMI trial. Eur J Epidemiol 2024; 39:343-347. [PMID: 38733447 DOI: 10.1007/s10654-024-01127-3] [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: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 05/13/2024]
Abstract
Trial emulations in observational data analyses can complement findings from randomized clinical trials, inform future trial designs, or generate evidence when randomized studies are not feasible due to resource constraints and ethical or practical limitations. Importantly, trial emulation designs facilitate causal inference in observational data analyses by enhancing counterfactual thinking and comparisons of real-world observations (e.g. Mendelian Randomization) to hypothetical interventions. In order to enhance credibility, trial emulations would benefit from prospective registration, publication of statistical analysis plans, and subsequent prospective benchmarking to randomized clinical trials prior to their publication. Confounding by indication, however, is the key challenge to interpreting observed intended effects of an intervention as causal in observational data analyses. We discuss the target trial emulation of the REDUCE-AMI randomized clinical trial (ClinicalTrials.gov ID NCT03278509; beta-blocker use in patients with preserved left ventricular ejection fraction after myocardial infarction) to illustrate the challenges and uncertainties of studying intended effects of interventions without randomization to account for confounding. We furthermore directly compare the findings, statistical power, and clinical interpretation of the results of the REDUCE-AMI target trial emulation to those from the simultaneously published randomized clinical trial. The complexity and subtlety of confounding by indication when studying intended effects of interventions can generally only be addressed by randomization.
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Affiliation(s)
- Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
- Cardiovascular Institute, Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
- Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.
| | - Eric Boersma
- Cardiovascular Institute, Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
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Tukker M, Leening MJG, Mohamedhoesein S, Vanmaele ALA, Caliskan K. Prevalence and clinical correlates of ascending aortic dilatation in patients with noncompaction cardiomyopathy. Int J Cardiovasc Imaging 2023; 39:1687-1695. [PMID: 37258990 PMCID: PMC10520147 DOI: 10.1007/s10554-023-02882-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/20/2023] [Indexed: 06/02/2023]
Abstract
Ascending aortic (AoAsc) dilatation can lead to acute aortic syndromes and has been described in various familial cardiac diseases. Its prevalence and clinical significance in patients with noncompaction cardiomyopathy (NCCM) are however unknown. Establishing the prevalence can facilitate recommendations on routine screening in NCCM. In this cross-sectional cohort study based on the Rijnmond Heart Failure/Cardiomyopathy Registry, the patient were enrolment between 2014 and 2021. All NCCM patients (n = 109) were age and sex matched with 109 dilated cardiomyopathy (DCM) patients as controls. The aortic diameters were measured through the parasternal long-axis transthoracic echocardiographic view at the sinuses of valsalva (SoV-Ao), sinotubular junction (STJ) and ascending aorta (AscAo). Dilatation was defined using published criteria adjusted for body surface area (BSA), sex, and age. Median age of age-sex matched NCCM and DCM patients was 45[31-56] vs. 45 [31-55] years with 53% males in both groups. NCCM patients had more familial hereditary patterns and genetic variants (55% vs. 24%, p < 0.001). DCM patients had more heart failure and left ventricular dysfunction (ejection fraction 34 ± 11 vs. 41 ± 12, p = 0.001). Ascending aortic dilatation was present in 8(7%) patients with NCCM and 5(5%) patients with DCM (p = 0.46). All dilatations were classified as mild. In conclusion, in this cross-sectional cohort study the prevalence of ascending aortic dilatation in NCCM patients was 7%, which were only mild dilatations and not significantly different from an age-sex matched cohort of DCM patients. Routine aortic dilatation screening therefore does not seem warranted in patients with NCCM.
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Affiliation(s)
- Martijn Tukker
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40., Rotterdam, 3015 GD, The Netherlands
| | - Maarten J G Leening
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40., Rotterdam, 3015 GD, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sharida Mohamedhoesein
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40., Rotterdam, 3015 GD, The Netherlands
| | - Alexander L A Vanmaele
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40., Rotterdam, 3015 GD, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40., Rotterdam, 3015 GD, The Netherlands.
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Leening MJG, Bouwer NI, Ikram MA, Kavousi M, Ruiter R, Boersma E, van den Bos EJ, Weevers APJD, Deckers JW, Levin MD. Risk of cancer after ST-segment-elevation myocardial infarction. Eur J Epidemiol 2023; 38:853-858. [PMID: 36947265 PMCID: PMC10421772 DOI: 10.1007/s10654-023-00984-8] [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: 09/07/2022] [Accepted: 02/28/2023] [Indexed: 03/23/2023]
Abstract
Analyses from administrative databases have suggested an increased cancer incidence among individuals who experienced a myocardial infarction, especially within the first 6 months. It remains unclear to what extent this represents an underlying biological link, or can be explained by detection of pre-symptomatic cancers and shared risk factors. Cancer incidence among 1809 consecutive patients surviving hospitalization for thrombotic ST-segment-elevation myocardial infarction (STEMI; mean age 62.6 years; 26% women; 115 incident cancers) was compared to the cancer incidence among 10,052 individuals of the general population (Rotterdam Study; mean age 63.1 years; 57% women; 677 incident cancers). Pathology-confirmed cancer diagnoses were obtained through identical linkage of both cohorts with the Netherlands Cancer Registry. Cox models were used to obtain hazards ratios (HRs) adjusted for factors associated with both atherosclerosis and cancer. Over 5-year follow-up, there was no significant difference in the incidence of cancer between STEMI patients and the general population (HR 0.96, 95% CI 0.78-1.19). In the first 3 months after STEMI, cancer incidence was markedly higher among STEMI patients compared to the general population (HR 2.45, 95% CI 1.13-5.30), which gradually dissolved during follow-up (P-for-trend 0.004). Among STEMI patients, higher C-reactive protein, higher platelet counts, and lower hemoglobin were associated with cancer incidence during the first year after STEMI (HRs 2.93 for C-reactive protein > 10 mg/dL, 2.10 for platelet count > 300*109, and 3.92 for hemoglobin < 7.5 mmol/L). Although rare, thrombotic STEMI might be a paraneoplastic manifestation of yet to be diagnosed cancer, and is hallmarked by a pro-inflammatory status and anemia.Trial registration Registered into the Netherlands National Trial Register and WHO International Clinical Trials Registry Platform under shared catalogue number NTR6831.
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Affiliation(s)
- Maarten J G Leening
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands.
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
| | - Nathalie I Bouwer
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
| | | | - Auke P J D Weevers
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
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Licher S, Wolters FJ, Pavlović J, Kavousi M, Leening MJG, Ikram MK, Ikram MA. Effects of Eligibility Criteria on Patient Selection and Treatment Implications from 10 Multidomain Dementia Prevention Trials: A Population-Based Study. Neuroepidemiology 2023; 57:14-24. [PMID: 36398446 PMCID: PMC10064383 DOI: 10.1159/000528120] [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: 09/05/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Dementia prevention trials have so far shown little benefit of multidomain interventions against cognitive decline. Recruitment strategies in these trials often centre around dementia risk or cardiovascular risk profile, but it is uncertain whether this leads to inclusion of individuals who may benefit most from the intervention. We determined the effects of eligibility criteria on the recruitment of potential trial participants in the general population. METHODS In a systematic search until January 1, 2022, we identified all published and ongoing large (≥500 participants), phase-3 multidomain trials for the prevention of cognitive decline or dementia. We applied trial eligibility criteria to 5,381 participants of the population-based Rotterdam Study (mean age: 72 years, 58% women), to compare participant characteristics, predicted risk of cardiovascular disease, and dementia risk, between trial eligible and ineligible persons. RESULTS We identified 10 trials, of which 5 had been published (DR's EXTRA, FINGER, preDIVA, MAPT, and HATICE) and 5 are ongoing (US-POINTER, MIND-CHINA, MYB, AgeWell.de, and J-Mint). Among all Rotterdam Study participants, eligibility across published trials ranged from 48% for MAPT to 87% for preDIVA, in line with original trial reports. Variability in eligibility was wider for ongoing trials, from 1% for US-POINTER to over 94% for MYB trial. Over 70% of trial eligible individuals are recommended preventive intervention in routine care based on their cardiovascular risk, similar for lipid-lowering (71%) and blood pressure-lowering treatment (73%). Ten-year risks of dementia were similar for eligible compared to ineligible individuals (12 vs. 11%). CONCLUSION Multidomain dementia prevention trials fail to preferentially include those at the highest risk of dementia and mostly include individuals who qualify for interventions already on the basis of cardiovascular prevention guidelines. These findings call for better targeted enrolment of individuals for whom trial results can improve clinical decision-making.
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Affiliation(s)
- Silvan Licher
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jelena Pavlović
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Zhu F, Wolters FJ, Yaqub A, Leening MJG, Ghanbari M, Boersma E, Ikram MA, Kavousi M. Plasma Amyloid-β in Relation to Cardiac Function and Risk of Heart Failure in General Population. JACC Heart Fail 2023; 11:93-102. [PMID: 36372727 DOI: 10.1016/j.jchf.2022.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Amyloid-β (Aβ) may be related to cardiac function. However, there are limited data on the association of plasma Aβ with cardiac function and risk of heart failure (HF) in the general population. OBJECTIVES This study sought to determine the associations of plasma amyloid-β40 (Aβ40) and amyloid-β42 (Aβ42) with echocardiographic measurements of cardiac dysfunction and with incident HF in the general population. METHODS The study included 4,156 participants of the population-based Rotterdam Study (mean age: 71.4 years; 57.1% women), who had plasma Aβ samples collected between 2002 and 2005 and had no established dementia and HF at baseline. Multivariable linear regression models were used to explore the cross-sectional association of plasma Aβ with echocardiographic measures. Participants were followed up until December 2016. Cox proportional hazards models were used to assess the association of Aβ levels with incident HF. Models were adjusted for cardiovascular risk factors. RESULTS A per 1-SD increase in log-transformed plasma Aβ40 was associated with a 0.39% (95% CI: -0.68 to -0.10) lower left ventricular ejection fraction and a 0.70 g/m2 (95% CI: 0.06-1.34) larger left ventricular mass indexed by body surface area. Aβ42 was not significantly associated with echocardiographic measures cross-sectionally. During follow-up (median: 10.2 years), 472 incident HF cases were identified. A per 1-SD increase in log-transformed Aβ40 was associated with a 32% greater risk of HF (HR: 1.32; 95% CI: 1.15-1.51), and the association was significant in men, but not in women. Higher plasma Aβ42 levels were associated with an increased risk of HF (HR: 1.12; 95% CI: 1.02-1.24), although the association was attenuated after further adjustment for concomitant Aβ40 (HR: 1.03; 95% CI: 0.92-1.16). CONCLUSIONS Higher levels of Aβ40 were associated with worse cardiac function and higher risk of new onset HF in the general population, in particular among men.
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Affiliation(s)
- Fang Zhu
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Amber Yaqub
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Zhu F, Arshi B, Leening MJG, Aribas E, Ikram MA, Boersma E, Ikram MK, Kavousi M. Sex-specific added value of cardiac biomarkers for 10-year cardiovascular risk prediction. Eur J Prev Cardiol 2022; 29:1559-1567. [PMID: 35512434 DOI: 10.1093/eurjpc/zwac091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/16/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/14/2022]
Abstract
AIMS To evaluate the sex-specific predictive value of N-terminal pro B-type natriuretic peptide (NT-proBNP), high sensitivity cardiac troponin T (hs-cTnT) and creatine kinase myocardial band (CK-MB) for 10-year risk prediction of coronary heart disease (CHD), stroke, heart failure (HF) and composite outcomes. METHODS Five-thousand four-hundred thirty individuals (mean age 68.6 years, 59.9% women) from the Rotterdam Study, with biomarker measurements between 1997 and 2001, were included. Participants were followed until 2015. We fitted 'basic' models using traditional cardiovascular risk factors. Improvements in c-statistics and net reclassification improvement (NRI) for events and non-events were calculated. RESULTS During a median follow-up of 14 years, 747 (13.8%), 563 (10.4%), and 664 (12.2%) participants were diagnosed with CHD, stroke, and HF, respectively. NT-proBNP improved the discriminative performance of the 'basic' model for all endpoints (c-statistic improvements ranging from 0.007 to 0.050) and provided significant event-NRI for HF (14.3% in women; 10.7% in men) and for stroke in men (9.3%). The addition of hs-cTnT increased c-statistic for CHD in women by 0.029 (95% CI, 0.011-0.047) and for HF in men by 0.034 (95% CI, 0.014-0.053), and provided significant event-NRI for CHD (10.3%) and HF (7.8%) in women, and for stroke (8.4%) in men. The added predictive value of CK-MB was limited. CONCLUSION NT-proBNP and hs-cTnT provided added predictive value for various cardiovascular outcomes above traditional risk factors. Sex differences were observed in the predictive performance of these biomarkers.
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Affiliation(s)
- Fang Zhu
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
- Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Elif Aribas
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
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Velek P, Splinter MJ, Ikram MK, Ikram MA, Leening MJG, van der Lei J, Hartman TO, Peters LL, Tange H, Rutten FH, van Weert H, Wolters FJ, Bindels PJE, Licher S, de Schepper EIT. Changes in the Diagnosis of Stroke and Cardiovascular Conditions in Primary Care During First 2 COVID-19 Waves in the Netherlands. Neurology 2021; 98:e564-e572. [PMID: 34965968 PMCID: PMC8829962 DOI: 10.1212/wnl.0000000000013145] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although there is evidence of disruption in acute cerebrovascular and cardiovascular care during the COVID-19 pandemic, its downstream effect in primary care is less clear. We investigated how the pandemic affected utilization of cerebrovascular and cardiovascular care in general practices (GPs) and determined changes in GP-recorded diagnoses of selected cerebrovascular and cardiovascular outcomes. METHODS From electronic health records of 166,929 primary care patients aged 30 or over within the Rotterdam region, the Netherlands, we extracted the number of consultations related to cerebrovascular and cardiovascular care, and first diagnoses of selected cerebrovascular and cardiovascular risk factors (hypertension, diabetes, lipid disorders), conditions and events (angina, atrial fibrillation, TIA, myocardial infarction, stroke). We quantified changes in those outcomes during the first COVID-19 wave (March-May 2020) and thereafter (June-December 2020) by comparing them to the same period in 2016-2019. We also estimated the number of potentially missed diagnoses for each outcome. RESULTS The number of GP consultations related to cerebrovascular and cardiovascular care declined by 38% (0.62, 95% CI: 0.56-0.68) during the first wave, as compared to expected counts based on pre-pandemic levels. Substantial declines in the number of new diagnoses were observed for cerebrovascular events: 37% for TIA (0.63, 0.41-0.96), and 29% for stroke (0.71, 0.59 to 0.84), while no significant changes were observed for cardiovascular events (myocardial infarction (0.91, 0.74-1.14), angina (0.77, 0.48-1.25)). The counts across individual diagnoses recovered following June 2020, but the number of GP consultations related to cerebrovascular and cardiovascular care remained lower than expected also throughout the June-December period (0.93, 0.88-0.98). DISCUSSION While new diagnoses of acute cardiovascular events remained stable during the COVID19 pandemic, diagnoses of cerebrovascular events declined substantially compared to pre-pandemic levels, possibly due to incorrect perception of risk by patients. These findings emphasize the need to improve symptom recognition of cerebrovascular events among the general public and to encourage urgent presentation despite any physical distancing measures.
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Affiliation(s)
- Premysl Velek
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands .,Department of General Practice, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marije J Splinter
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Cardiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Lilian L Peters
- Department of General Practice & Elderly Medicine/ Midwifery Science, University Medical Centre Groningen, Groningen, The Netherlands.,Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health, The Netherlands
| | - Huibert Tange
- Department of Family Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Frans H Rutten
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Henk van Weert
- Department of General Practice, Amsterdam Public Health, Amsterdam Universities Medical Centre, Amsterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Schop A, Stouten K, Riedl JA, van Houten RJ, Leening MJG, Bindels PJE, Levin MD. The accuracy of mean corpuscular volume guided anaemia classification in primary care. Fam Pract 2021; 38:735-739. [PMID: 34345918 DOI: 10.1093/fampra/cmab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anemia can be categorized into micro-, normo- or macrocytic anemia based on the mean corpuscular volume (MCV). This categorization might help to define the etiology of anemia. METHODS The cohort consisted of patients newly diagnosed with anaemia in primary care. Seven aetiologies of anaemia were defined, based on an extensive laboratory protocol. Two assumptions were tested: (i) MCV <80 fl (microcytic) excludes vitamin B12 deficiency, folic acid deficiency, suspected haemolysis and suspected bone marrow disease as anaemia aetiology. (ii) MCV >100 fl (macrocytic) excludes iron deficiency anaemia, anaemia of chronic disease and renal anaemia as anaemia aetiology. RESULTS Data of 4129 patients were analysed. One anaemia aetiology could be assigned to 2422 (59%) patients, more than one anaemia aetiology to 888 (22%) patients and uncertainty regarding the aetiology remained in 819 (20%) patients. MCV values were within the normal range in 3505 patients (85%). In 59 of 365 microcytic patients (16%), the anaemia aetiology was not in accordance with the first assumption. In 233 of 259 macrocytic patients (90%), the anaemia aetiology was not in accordance with the second assumption. CONCLUSIONS Anaemia aetiologies might be ruled out incorrectly if MCV guided classification is used as a first step in the diagnostic work-up of anaemia. We recommend using a broader set of laboratory tests, independent of MCV.
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Affiliation(s)
- Annemarie Schop
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Karlijn Stouten
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Jürgen A Riedl
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Ron J van Houten
- General Medical Practice van Houten, Hendrik-Ido-Ambacht, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology and Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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Leening MJG, Mahmoud KD. Non-efficacy benefits and non-inferiority margins: a scoping review of contemporary high-impact non-inferiority trials in clinical cardiology. Eur J Epidemiol 2021; 36:1103-1109. [PMID: 34792692 PMCID: PMC8629871 DOI: 10.1007/s10654-021-00820-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Maarten J G Leening
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Karim D Mahmoud
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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11
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Splinter MJ, Velek P, Ikram MK, Kieboom BCT, Peeters RP, Bindels PJE, Ikram MA, Wolters FJ, Leening MJG, de Schepper EIT, Licher S. Prevalence and determinants of healthcare avoidance during the COVID-19 pandemic: A population-based cross-sectional study. PLoS Med 2021; 18:e1003854. [PMID: 34813591 PMCID: PMC8610236 DOI: 10.1371/journal.pmed.1003854] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND During the Coronavirus Disease 2019 (COVID-19) pandemic, the number of consultations and diagnoses in primary care and referrals to specialist care declined substantially compared to prepandemic levels. Beyond deferral of elective non-COVID-19 care by healthcare providers, it is unclear to what extent healthcare avoidance by community-dwelling individuals contributed to this decline in routine healthcare utilisation. Moreover, it is uncertain which specific symptoms were left unheeded by patients and which determinants predispose to healthcare avoidance in the general population. In this cross-sectional study, we assessed prevalence of healthcare avoidance during the pandemic from a patient perspective, including symptoms that were left unheeded, as well as determinants of healthcare avoidance. METHODS AND FINDINGS On April 20, 2020, a paper COVID-19 survey addressing healthcare utilisation, socioeconomic factors, mental and physical health, medication use, and COVID-19-specific symptoms was sent out to 8,732 participants from the population-based Rotterdam Study (response rate 73%). All questionnaires were returned before July 10, 2020. By hand, prevalence of healthcare avoidance was subsequently verified through free text analysis of medical records of general practitioners. Odds ratios (ORs) for avoidance were determined using logistic regression models, adjusted for age, sex, and history of chronic diseases. We found that 1,142 of 5,656 included participants (20.2%) reported having avoided healthcare. Of those, 414 participants (36.3%) reported symptoms that potentially warranted urgent evaluation, including limb weakness (13.6%), palpitations (10.8%), and chest pain (10.2%). Determinants related to avoidance were older age (adjusted OR 1.14 [95% confidence interval (CI) 1.08 to 1.21]), female sex (1.58 [1.38 to 1.82]), low educational level (primary education versus higher vocational/university 1.21 [1.01 to 1.46), poor self-appreciated health (per level decrease 2.00 [1.80 to 2.22]), unemployment (versus employed 2.29 [1.54 to 3.39]), smoking (1.34 [1.08 to 1.65]), concern about contracting COVID-19 (per level increase 1.28 [1.19 to 1.38]) and symptoms of depression (per point increase 1.13 [1.11 to 1.14]) and anxiety (per point increase 1.16 [1.14 to 1.18]). Study limitations included uncertainty about (perceived) severity of the reported symptoms and potentially limited generalisability given the ethnically homogeneous study population. CONCLUSIONS In this population-based cross-sectional study, 1 in 5 individuals avoided healthcare during lockdown in the COVID-19 pandemic, often for potentially urgent symptoms. Healthcare avoidance was strongly associated with female sex, fragile self-appreciated health, and high levels of depression and anxiety. These results emphasise the need for targeted public education urging these vulnerable patients to timely seek medical care for their symptoms to mitigate major health consequences.
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Affiliation(s)
- Marije J. Splinter
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Premysl Velek
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of General Practice, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M. Kamran Ikram
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Neurology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Brenda C. T. Kieboom
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of General Practice, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robin P. Peeters
- Department of Internal Medicine, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Patrick J. E. Bindels
- Department of General Practice, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Frank J. Wolters
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J. G. Leening
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Cardiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Evelien I. T. de Schepper
- Department of General Practice, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus MC—University Medical Center Rotterdam, Rotterdam, the Netherlands
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12
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van der Toorn JE, Bos D, Arshi B, Leening MJG, Vernooij MW, Ikram MA, Ikram MK, Kavousi M. Arterial calcification at different sites and prediction of atherosclerotic cardiovascular disease among women and men. Atherosclerosis 2021; 337:27-34. [PMID: 34757268 DOI: 10.1016/j.atherosclerosis.2021.10.009] [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: 08/04/2021] [Revised: 09/23/2021] [Accepted: 10/14/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The sex-specific contributions of arterial calcification to atherosclerotic cardiovascular disease (ASCVD) risk prediction and stratification in the light of recent modifications by cardiovascular prevention guidelines remain unclear. We assessed the sex-specific value of calcification in different arteries, beyond the Pooled Cohort Equations (PCE) risk factors, for 10-year ASCVD risk prediction. METHODS From 2003 to 2006, participants from the population-based Rotterdam Study (n = 2167) underwent CT to quantify coronary artery calcification (CAC), aortic arch calcification (AAC), extracranial (ECAC) and intracranial carotid artery calcification (ICAC). Follow-up for ASCVD was complete on January 1, 2015. We refitted the PCE (base model), and categorized participants into low (<5%), borderline (5%-7.5%), intermediate (7.5%-20%), and high (≥20%) ASCVD risk. We extended the models with calcifications and calculated c-statistics and net reclassification improvements for events (NRIe) and non-events (NRIne). RESULTS CAC predicted ASCVD in women [hazard-ratio (95%-CI) per 1-SD: 1.40 (1.14-1.73)] and men [1.62 (1.27-1.93)]. After addition of CAC to the base model, the c-statistic improved from 0.71 to 0.72 in women; from 0.65 to 0.68 in men. Addition of CAC led to NRIe of 14.3% in women, 4.8% in men and NRIne of 1.5% in women, 15.1% in men. Only in women, ICAC predicted ASCVD [hazard-ratio (95%-CI) per 1-SD: 1.62 (1.26-2.08)], and improved the model (c-statistic from 0.71 to 0.73, NRIe: 9.8% and NRIne: 5.9%). CONCLUSIONS Assessment of CAC improves ASCVD risk prediction and stratification. In women, the added value of ICAC for ASCVD risk prediction is comparable to that of CAC.
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Affiliation(s)
- Janine E van der Toorn
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Clinical Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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13
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Ligthart S, Hasbani NR, Ahmadizar F, van Herpt TTW, Leening MJG, Uitterlinden AG, Sijbrands EJG, Morrison AC, Boerwinkle E, Pankow JS, Selvin E, Ikram MA, Kavousi M, de Vries PS, Dehghan A. Genetic susceptibility, obesity and lifetime risk of type 2 diabetes: The ARIC study and Rotterdam Study. Diabet Med 2021; 38:e14639. [PMID: 34245042 PMCID: PMC8429251 DOI: 10.1111/dme.14639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/02/2021] [Accepted: 05/17/2021] [Indexed: 12/26/2022]
Abstract
AIMS Both lifestyle factors and genetic background contribute to the development of type 2 diabetes. Estimation of the lifetime risk of diabetes based on genetic information has not been presented, and the extent to which a normal body weight can offset a high lifetime genetic risk is unknown. METHODS We used data from 15,671 diabetes-free participants of European ancestry aged 45 years and older from the prospective population-based ARIC study and Rotterdam Study (RS). We quantified the remaining lifetime risk of diabetes stratified by genetic risk and quantified the effect of normal weight in terms of relative and lifetime risks in low, intermediate and high genetic risk. RESULTS At age 45 years, the lifetime risk of type 2 diabetes in ARIC in the low, intermediate and high genetic risk category was 33.2%, 41.3% and 47.2%, and in RS 22.8%, 30.6% and 35.5% respectively. The absolute lifetime risk for individuals with normal weight compared to individuals with obesity was 24% lower in ARIC and 8.6% lower in RS in the low genetic risk group, 36.3% lower in ARIC and 31.3% lower in RS in the intermediate genetic risk group, and 25.0% lower in ARIC and 29.4% lower in RS in the high genetic risk group. CONCLUSIONS Genetic variants for type 2 diabetes have value in estimating the lifetime risk of type 2 diabetes. Normal weight mitigates partly the deleterious effect of high genetic risk.
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Affiliation(s)
- Symen Ligthart
- Department of EpidemiologyErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
- Department of Adult Intensive CareErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
| | - Natalie R. Hasbani
- Human Genetics CenterDepartment of EpidemiologyHuman Genetics, and Environmental SciencesSchool of Public HealthThe University of Texas Health Science Center at HoustonHoustonTXUSA
| | - Fariba Ahmadizar
- Department of EpidemiologyErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
| | - Thijs T. W. van Herpt
- Department of EpidemiologyErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
- Department of Internal MedicineErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
| | - Maarten J. G. Leening
- Department of EpidemiologyErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
- Department of CardiologyErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - André G. Uitterlinden
- Department of Internal MedicineErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
| | - Eric J. G. Sijbrands
- Department of Internal MedicineErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
| | - Alanna C. Morrison
- Human Genetics CenterDepartment of EpidemiologyHuman Genetics, and Environmental SciencesSchool of Public HealthThe University of Texas Health Science Center at HoustonHoustonTXUSA
| | - Eric Boerwinkle
- Human Genetics CenterDepartment of EpidemiologyHuman Genetics, and Environmental SciencesSchool of Public HealthThe University of Texas Health Science Center at HoustonHoustonTXUSA
- Human Genome Sequencing CenterBaylor College of MedicineHoustonTXUSA
| | - James S. Pankow
- Division of Epidemiology and Community HealthSchool of Public HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Elizabeth Selvin
- Department of EpidemiologyBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMDUSA
| | - M. Arfan Ikram
- Department of EpidemiologyErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
| | - Maryam Kavousi
- Department of EpidemiologyErasmus MC ‐ University Medical Center RotterdamRotterdamthe Netherlands
| | - Paul S. de Vries
- Human Genetics CenterDepartment of EpidemiologyHuman Genetics, and Environmental SciencesSchool of Public HealthThe University of Texas Health Science Center at HoustonHoustonTXUSA
| | - Abbas Dehghan
- Department of Biostatistics and EpidemiologyMRC‐PHE Centre for Environment and HealthSchool of Public HealthImperial College LondonLondonUK
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14
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Pavlović J, Greenland P, Franco OH, Kavousi M, Ikram MK, Deckers JW, Ikram MA, Leening MJG. Recommendations and Associated Levels of Evidence for Statin Use in Primary Prevention of Cardiovascular Disease: A Comparison at Population Level of the American Heart Association/American College of Cardiology/Multisociety, US Preventive Services Task Force, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society Clinical Practice Guidelines. Circ Cardiovasc Qual Outcomes 2021; 14:e007183. [PMID: 34546786 DOI: 10.1161/circoutcomes.120.007183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite using identical evidence to support practice guidelines for lipid-lowering treatment in primary prevention of cardiovascular disease (CVD), it is unclear to what extent the 2018 American Heart Association/American College of Cardiology/Multisociety, 2016 US Preventive Services Task Force (USPSTF), 2020 Department of Veterans Affairs/Department of Defense, 2021 Canadian Cardiovascular Society, and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines differ in grading and assigning levels of evidence and classes of recommendations (LOE/class) at a population level. METHODS We included 7262 participants, aged 45 to 75 years, without history of CVD from the prospective population-based Rotterdam Study. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity for CVD events, and numbers needed to treat at 10 years were calculated. RESULTS Mean age was 61.1 (SD 6.9) years; 58.2% were women. American Heart Association/American College of Cardiology/Multisociety, USPSTF, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society strongly recommended statin initiation in respective 59.4%, 40.2%, 45.2%, 73.7%, and 42.1% of the eligible population based on high-quality evidence. Sensitivity for CVD events for treatment recommendations supported with strong LOE/class was 86.3% for American Heart Association/American College of Cardiology/Multisociety (IA or IB), 69.4% for USPSTF (USPSTF-B), 74.5% for Department of Veterans Affairs/Department of Defense (strong for), 93.3% for Canadian Cardiovascular Society (strong), and 66.6% for European Society of Cardiology/European Atherosclerosis Society (IA). Specificity was highest for the USPSTF at 45.3% and lowest for European Society of Cardiology/European Atherosclerosis Society at 10.0%. Estimated numbers needed to treat at 10 years for those with the strongest LOE/class were ranging from 20 to 26 for moderate-intensity and 12 to 16 for high-intensity statins. CONCLUSIONS Sensitivity, specificity, and numbers needed to treat at 10 years for assigned LOE/class varied greatly among 5 CVD prevention guidelines. The level of variability seems to be driven by differences in how the evidence is graded and translated into LOE/class underlying the treatment recommendations by different professional societies. Efforts towards harmonizing evidence grading systems for clinical guidelines in primary prevention of CVD may reduce ambiguity and reinforce updated evidence-based recommendations.
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Affiliation(s)
- Jelena Pavlović
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University, Chicago, IL (P.G.)
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Switzerland (O.H.F.)
| | - Maryam Kavousi
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Neurology (M.K.I., M.A.I.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Jaap W Deckers
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Cardiology (J.W.D., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Neurology (M.K.I., M.A.I.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Radiology (M.A.I.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Cardiology (J.W.D., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
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15
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van Herpt TTW, Ligthart S, Leening MJG, van Hoek M, Lieverse AG, Ikram MA, Sijbrands EJG, Dehghan A, Kavousi M. Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria. BMJ Open Diabetes Res Care 2020; 8:8/2/e001529. [PMID: 33214188 PMCID: PMC7678236 DOI: 10.1136/bmjdrc-2020-001529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Pre-diabetes, a status conferring high risk of overt diabetes, is defined differently by the American Diabetes Association (ADA) and the WHO. We investigated the impact of applying definitions of pre-diabetes on lifetime risk of diabetes in women and men from the general population. RESEARCH DESIGN AND METHODS We used data from 8844 women without diabetes and men aged ≥45 years from the prospective population-based Rotterdam Study in the Netherlands. In both gender groups, we calculated pre-diabetes prevalence according to ADA and WHO criteria and estimated the 10-year and lifetime risk to progress to overt diabetes with adjustment for competing risk of death. RESULTS Out of 8844 individuals, pre-diabetes was identified in 3492 individuals (prevalence 40%, 95% CI 38% to 41%) according to ADA and 1382 individuals (prevalence 16%, 95% CI 15% to 16%) according to WHO criteria. In both women and men and each age category, ADA prevalence estimates doubled WHO-defined pre-diabetes. For women and men aged 45 years having ADA-defined pre-diabetes, the 10-year risk of diabetes was 14.2% (95% CI 6.0% to 22.5%) and 9.2% (95% CI 3.4% to 15.0%) compared with 23.2% (95% CI 6.8% to 39.6%) and 24.6% (95% CI 8.4% to 40.8%) in women and men with WHO-defined pre-diabetes. At age 45 years, the remaining lifetime risk to progress to overt diabetes was 57.5% (95% CI 51.8% to 63.2%) vs 80.2% (95% CI 74.1% to 86.3%) in women and 46.1% (95% CI 40.8% to 51.4%) vs 68.4% (95% CI 58.3% to 78.5%) in men with pre-diabetes according to ADA and WHO definitions, respectively. CONCLUSION Prevalence of pre-diabetes differed considerably in both women and men when applying ADA and WHO pre-diabetes definitions. Women with pre-diabetes had higher lifetime risk to progress to diabetes. The lifetime risk of diabetes was lower in women and men with ADA-defined pre-diabetes as compared with WHO. Improvement of pre-diabetes definition considering appropriate sex-specific and age-specific glycemic thresholds may lead to better identification of individuals at high risk of diabetes.
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Affiliation(s)
- Thijs T W van Herpt
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Symen Ligthart
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Aloysius G Lieverse
- Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Abbas Dehghan
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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16
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Affiliation(s)
- Maarten J G Leening
- Departments of Epidemiology and Cardiology, Erasmus MC-University Medical Center Rotterdam, The Netherlands. Department of Clinical Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
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17
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Schop A, Stouten K, Riedl JA, van Houten RJ, Leening MJG, van Rosmalen J, Bindels PJE, Levin MD. A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices. BMC Fam Pract 2020; 21:167. [PMID: 32799818 PMCID: PMC7429725 DOI: 10.1186/s12875-020-01241-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/03/2020] [Indexed: 12/28/2022]
Abstract
Background To study etiologies of anemia using an extensive laboratory analysis in general practices. Method An extensive laboratory analysis was performed in blood of newly diagnosed anemia patients aged ≥50 years from the general population in the city of Dordrecht area, the Netherlands. Eight laboratory-orientated etiologies of anemia were defined. Patients were assigned one or more of these etiologies on the basis of their test results. Results Blood of 4152 patients (median age 75 years; 49% male) was analyzed. The anemia etiology was unclear in 20%; a single etiology was established in 59%; and multiple etiologies in 22% of the patients. The most common etiologies were anemia of chronic disease (ACD) (54.5%), iron deficiency anemia (IDA) (19.1%) and renal anemia (13.8%). The most common single etiologies were IDA (82%) and ACD (68%), while the multiple etiologies most commonly included folic acid deficiency (94%) and suspected bone marrow disease (88%). Older age was associated with a lower incidence of IDA and a higher incidence of renal anemia. Mild anemia was more often associated with ACD and uncertain anemia, while severe anemia was mainly seen in patients with IDA. Conclusion Extensive laboratory analysis in anemic patients from the general population helped clarify the etiology of anemia and revealed many various combinations of etiologies in a significant proportion of patients. Age, sex and the severity of anemia are predictive of the underlying etiology.
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Affiliation(s)
- A Schop
- Department of Internal Medicine, Albert Schweitzer Hospital, Postbus 444, 3300, AK, Dordrecht, the Netherlands.
| | - K Stouten
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - J A Riedl
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - R J van Houten
- General practice van Houten, Hendrik-Ido-Ambacht, the Netherlands
| | - M J G Leening
- Departments of Epidemiology and Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
| | - P J E Bindels
- Department of General Practice, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M-D Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Postbus 444, 3300, AK, Dordrecht, the Netherlands
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18
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Fani L, van der Willik KD, Bos D, Leening MJG, Koudstaal PJ, Rizopoulos D, Ruiter R, Stricker BHC, Kavousi M, Ikram MA, Ikram MK. The association of innate and adaptive immunity, subclinical atherosclerosis, and cardiovascular disease in the Rotterdam Study: A prospective cohort study. PLoS Med 2020; 17:e1003115. [PMID: 32379748 PMCID: PMC7205222 DOI: 10.1371/journal.pmed.1003115] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/10/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is driven by multifaceted contributions of the immune system. However, the dysregulation of immune cells that leads to ASCVD is poorly understood. We determined the association of components of innate and adaptive immunity longitudinally with ASCVD, and assessed whether arterial calcifications play a role in this association. METHODS AND FINDINGS Granulocyte (innate immunity) and lymphocyte (adaptive immunity) counts were determined 3 times (2002-2008, mean age 65.2 years; 2009-2013, mean age 69.0 years; and 2014-2015, mean age 78.5 years) in participants of the population-based Rotterdam Study without ASCVD at baseline. Participants were followed-up for ASCVD or death until 1 January 2015. A random sample of 2,366 underwent computed tomography at baseline to quantify arterial calcification volume in 4 vessel beds. We studied the association between immunity components with risk of ASCVD and assessed whether immunity components were related to arterial calcifications at baseline. Of 7,730 participants (59.4% women), 801 developed ASCVD during a median follow-up of 8.1 years. Having an increased granulocyte count increased ASCVD risk (adjusted hazard ratio for doubled granulocyte count [95% CI] = 1.78 [1.34-2.37], P < 0.001). Higher granulocyte counts were related to larger calcification volumes in all vessels, most prominently in the coronary arteries (mean difference in calcium volume [mm3] per SD increase in granulocyte count [95% CI] = 32.3 [9.9-54.7], P < 0.001). Respectively, the association between granulocyte count and incident coronary heart disease and stroke was partly mediated by coronary artery calcification (overall proportion mediated [95% CI] = 19.0% [-10% to 32.3%], P = 0.08) and intracranial artery calcification (14.9% [-10.9% to 19.1%], P = 0.05). A limitation of our study is that studying the etiology of ASCVD remains difficult within an epidemiological setting due to the limited availability of surrogates for innate and especially adaptive immunity. CONCLUSIONS In this study, we found that an increased granulocyte count was associated with a higher risk of ASCVD in the general population. Moreover, higher levels of granulocytes were associated with larger volumes of arterial calcification. Arterial calcifications may explain a proportion of the link between granulocytes and ASCVD.
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Affiliation(s)
- Lana Fani
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Kimberly D van der Willik
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.,Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.,Department of Neurology, Erasmus MC, Rotterdam, the Netherlands
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Pavlović J, Kavousi M, Ikram MA, Leening MJG. Updated treatment thresholds in the 2019 ESC/EAS dyslipidaemia guidelines substantially expand indications for statin use for primary prevention at population level: Results from the Rotterdam Study. Atherosclerosis 2020; 299:64-66. [PMID: 32169303 DOI: 10.1016/j.atherosclerosis.2020.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/25/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Jelena Pavlović
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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20
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Lamballais S, Sajjad A, Leening MJG, Gaillard R, Franco OH, Mattace-Raso FUS, Jaddoe VWV, Roza SJ, Tiemeier H, Ikram MA. Association of Blood Pressure and Arterial Stiffness With Cognition in 2 Population-Based Child and Adult Cohorts. J Am Heart Assoc 2019; 7:e009847. [PMID: 30608188 PMCID: PMC6404174 DOI: 10.1161/jaha.118.009847] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background High blood pressure levels and higher arterial stiffness have been shown to be associated with lower cognition during adulthood, possibly by accumulative changes over time. However, vascular factors may already affect the brain during early life. Methods and Results We examined the relation between cognition and vascular factors within 5853 children from the Generation R Study (mean age 6.2 years) and 5187 adults from the Rotterdam Study (mean age 61.8 years). Diastolic and systolic blood pressure and arterial stiffness were assessed, the latter by measuring pulse‐wave velocity and pulse pressure. For cognition, the Generation R Study relied on nonverbal intelligence, whereas the Rotterdam Study relied on a cognitive test battery to calculate the g‐factor, a measure of global cognition. In the Generation R Study, standardized diastolic blood pressure showed a significant association with standardized nonverbal intelligence (β=−0.030, 95% confidence interval=[−0.054; −0.005]) after full adjustment. This association held up after excluding the top diastolic blood pressure decile (β=−0.042 [−0.075; −0.009]), suggesting that the relation holds in normotensives. Within the Rotterdam Study, standardized cognition associated linearly with standardized systolic blood pressure (β=−0.036 [−0.060; −0.012]), standardized pulse‐wave velocity (β=−0.064 [−0.095; −0.033]), and standardized pulse pressure (β=−0.044 [−0.069; −0.020], and nonlinearly with standardized diastolic blood pressure (quadratic term β=−0.032 [−0.049; −0.015]) after full adjustment. Conclusions Blood pressure and cognition may already be related in the general population during early childhood, albeit differently than during adulthood. See Editorial by Ferreira
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Affiliation(s)
- Sander Lamballais
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,2 The Generation R Study Group Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Ayesha Sajjad
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Maarten J G Leening
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,3 Department of Cardiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,4 Department of Clinical Epidemiology Harvard T. H. Chan School of Public Health Boston MA
| | - Romy Gaillard
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,2 The Generation R Study Group Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Oscar H Franco
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Francesco U S Mattace-Raso
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,5 Department of Internal Medicine Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Vincent W V Jaddoe
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,2 The Generation R Study Group Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,6 Department of Pediatrics Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Sabine J Roza
- 7 Department of Psychiatry Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
| | - Henning Tiemeier
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,7 Department of Psychiatry Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,8 Department of Child and Adolescent Psychiatry and Psychology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,9 Department of Social & Behavioral Sciences Harvard T. H. Chan School of Public Health Boston MA
| | - M Arfan Ikram
- 1 Department of Epidemiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,10 Department of Radiology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands.,11 Department of Neurology Erasmus MC University Medical Center Rotterdam Rotterdam The Netherlands
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21
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Leening MJG, Cook NR, Franco OH, Manson JE, Lakshminarayan K, LaMonte MJ, Leira EC, Robinson JG, Ridker PM, Paynter NP. Comparison of Cardiovascular Risk Factors for Coronary Heart Disease and Stroke Type in Women. J Am Heart Assoc 2019; 7:e007514. [PMID: 30371339 PMCID: PMC6404882 DOI: 10.1161/jaha.117.007514] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Cardiovascular risk factors have differential effects on various manifestations of cardiovascular disease, but to date direct formal comparisons are scarce, have been conducted primarily in men, and include only traditional risk factors. Methods and Results Using data from the multi-ethnic Women's Health Initiative Observational Study, we used a case-cohort design to compare 1731 women with incident cardiovascular disease during follow-up to a cohort of 1914 women. The direction of effect of all 24 risk factors (including various apolipoproteins, hemoglobin A1c, high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and tissue plasminogen activator antigen) was concordant for coronary heart disease (CHD, defined as myocardial infarction and CHD death) and ischemic stroke; however, associations were generally stronger with CHD. Significant differences for multiple risk factors, including blood pressure, lipid levels, and measures of inflammation, were observed when comparing the effects on hemorrhagic stroke with those on ischemic outcomes. For instance, multivariable adjusted hazard ratios per standard deviation increase in non-high-density lipoprotein cholesterol were 1.16 (95% confidence interval, 1.06-1.28) for CHD, 0.97 (0.88-1.07) for ischemic stroke, and 0.76 (0.63-0.91) for hemorrhagic stroke ( P<0.05 for equal association). Model discrimination was better for models predicting CHD or ischemic stroke than for models predicting hemorrhagic stroke or a combined end point. Conclusions Cardiovascular risk factors have largely similar effects on incidence of CHD and ischemic stroke in women, although the magnitude of association varies. Determinants of ischemic and hemorrhagic stroke substantially differ, underscoring their distinct biology. Cardiovascular disease risk may be more accurately reflected when combined cardiovascular disease or cerebrovascular outcomes are broken down into different first manifestations, or when restricted to ischemic outcomes.
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Affiliation(s)
- Maarten J G Leening
- 1 Center for Cardiovascular Disease Prevention Divisions of Preventive Medicine and Cardiology Brigham and Women's Hospital Harvard Medical School Boston MA.,2 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA.,3 Department of Epidemiology Erasmus MC-University Medical Center Rotterdam Rotterdam The Netherlands.,4 Department of Cardiology Erasmus M-University Medical Center Rotterdam Rotterdam The Netherlands
| | - Nancy R Cook
- 1 Center for Cardiovascular Disease Prevention Divisions of Preventive Medicine and Cardiology Brigham and Women's Hospital Harvard Medical School Boston MA.,2 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
| | - Oscar H Franco
- 3 Department of Epidemiology Erasmus MC-University Medical Center Rotterdam Rotterdam The Netherlands
| | - JoAnn E Manson
- 1 Center for Cardiovascular Disease Prevention Divisions of Preventive Medicine and Cardiology Brigham and Women's Hospital Harvard Medical School Boston MA.,2 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
| | - Kamakshi Lakshminarayan
- 5 Division of Epidemiology and Community Health School of Public Health University of Minnesota MN
| | - Michael J LaMonte
- 6 Department of Epidemiology and Environmental Health School of Public Health and Health Professions State University of New York Buffalo NY
| | - Enrique C Leira
- 7 Division of Cerebrovascular Diseases Department of Neurology Carver College of Medicine University of Iowa IA
| | - Jennifer G Robinson
- 8 Departments of Epidemiology and Medicine College of Public Health University of Iowa IA
| | - Paul M Ridker
- 1 Center for Cardiovascular Disease Prevention Divisions of Preventive Medicine and Cardiology Brigham and Women's Hospital Harvard Medical School Boston MA.,2 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
| | - Nina P Paynter
- 1 Center for Cardiovascular Disease Prevention Divisions of Preventive Medicine and Cardiology Brigham and Women's Hospital Harvard Medical School Boston MA.,2 Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
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22
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Affiliation(s)
- Maarten J. G. Leening
- Departments of Cardiology and Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Clinical Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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23
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Leening MJG, Cook NR, Ridker PM. Should we reconsider the role of age in treatment allocation for primary prevention of cardiovascular disease? Eur Heart J 2019; 38:1542-1547. [PMID: 27357357 DOI: 10.1093/eurheartj/ehw287] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 03/15/2016] [Indexed: 01/05/2023] Open
Affiliation(s)
- Maarten J G Leening
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.,Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - Nancy R Cook
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Paul M Ridker
- Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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24
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Licher S, Leening MJG, Yilmaz P, Wolters FJ, Heeringa J, Bindels PJE, Vernooij MW, Stephan BCM, Steyerberg EW, Ikram MK, Ikram MA. Development and Validation of a Dementia Risk Prediction Model in the General Population: An Analysis of Three Longitudinal Studies. Am J Psychiatry 2019; 176:543-551. [PMID: 30525906 DOI: 10.1176/appi.ajp.2018.18050566] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Identification of individuals at high risk of dementia is essential for development of prevention strategies, but reliable tools are lacking for risk stratification in the population. The authors developed and validated a prediction model to calculate the 10-year absolute risk of developing dementia in an aging population. METHODS In a large, prospective population-based cohort, data were collected on demographic, clinical, neuropsychological, genetic, and neuroimaging parameters from 2,710 nondemented individuals age 60 or older, examined between 1995 and 2011. A basic and an extended model were derived to predict 10-year risk of dementia while taking into account competing risks from death due to other causes. Model performance was assessed using optimism-corrected C-statistics and calibration plots, and the models were externally validated in the Dutch population-based Epidemiological Prevention Study of Zoetermeer and in the Alzheimer's Disease Neuroimaging Initiative cohort 1 (ADNI-1). RESULTS During a follow-up of 20,324 person-years, 181 participants developed dementia. A basic dementia risk model using age, history of stroke, subjective memory decline, and need for assistance with finances or medication yielded a C-statistic of 0.78 (95% CI=0.75, 0.81). Subsequently, an extended model incorporating the basic model and additional cognitive, genetic, and imaging predictors yielded a C-statistic of 0.86 (95% CI=0.83, 0.88). The models performed well in external validation cohorts from Europe and the United States. CONCLUSIONS In community-dwelling individuals, 10-year dementia risk can be accurately predicted by combining information on readily available predictors in the primary care setting. Dementia prediction can be further improved by using data on cognitive performance, genotyping, and brain imaging. These models can be used to identify individuals at high risk of dementia in the population and are able to inform trial design.
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Affiliation(s)
- Silvan Licher
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - Maarten J G Leening
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - Pinar Yilmaz
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - Frank J Wolters
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - Jan Heeringa
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - Patrick J E Bindels
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | -
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - Meike W Vernooij
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - Blossom C M Stephan
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - Ewout W Steyerberg
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - M Kamran Ikram
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
| | - M Arfan Ikram
- The Department of Epidemiology (Licher, Leening, Yilmaz, Wolters, Heeringa, Vernooij, M.K. Ikram, M.A. Ikram), the Department of Neurology (Wolters, M.K. Ikram), the Department of Cardiology (Leening), the Department of Radiology and Nuclear Medicine (Yilmaz, Vernooij), and the Department of General Practice (Bindels), Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands; the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (Leening, Wolters); the Institute of Health and Society, Newcastle University, Newcastle, U.K. (Stephan); the Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands (Steyerberg); and the Center for Medical Decision Making, Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands (Steyerberg)
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25
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Leening MJG, Ikram MA. Interpretation of Studies on the Occurrence of Atrial Fibrillation in Elite Athletes. JAMA Cardiol 2019; 4:392. [DOI: 10.1001/jamacardio.2019.0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Maarten J. G. Leening
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Cardiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Clinical Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
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Licher S, Darweesh SKL, Wolters FJ, Fani L, Heshmatollah A, Mutlu U, Koudstaal PJ, Heeringa J, Leening MJG, Ikram MK, Ikram MA. Lifetime risk of common neurological diseases in the elderly population. J Neurol Neurosurg Psychiatry 2019; 90:148-156. [PMID: 30279211 DOI: 10.1136/jnnp-2018-318650] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 04/18/2018] [Revised: 06/28/2018] [Accepted: 10/02/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To quantify the burden of common neurological disease in older adults in terms of lifetime risks, including their co-occurrence and preventive potential, within a competing risk framework. METHODS Within the prospective population-based Rotterdam Study, we studied lifetime risk of dementia, stroke and parkinsonism between 1990 and 2016. Among 12 102 individuals (57.7% women) aged ≥45 years free from these diseases at baseline, we studied co-occurrence, and quantified the combined, and disease-specific remaining lifetime risk of these diseases at various ages for men and women separately. We also projected effects on lifetime risk of hypothetical preventive strategies that delay disease onset by 1, 2 and 3 years, respectively. RESULTS During follow-up of up to 26 years (156 088 person-years of follow-up), 1489 individuals were diagnosed with dementia, 1285 with stroke and 263 with parkinsonism. Of these individuals, 438 (14.6%) were diagnosed with multiple diseases. Women were almost twice as likely as men to be diagnosed with both stroke and dementia during their lifetime. The lifetime risk for any of these diseases at age 45 was 48.2% (95% CI 47.1% to 51.5%) in women and 36.2% (35.1% to 39.3%) in men. This difference was driven by a higher risk of dementia as the first manifesting disease in women than in men (25.9% vs 13.7%; p<0.001), while this was similar for stroke (19.0%vs18.9% in men) and parkinsonism (3.3% vs 3.6% in men). Preventive strategies that delay disease onset with 1 to 3 years could theoretically reduce lifetime risk for developing any of these diseases by 20%-50%. CONCLUSION One in two women and one in three men will develop dementia, stroke or parkinsonism during their life. These findings strengthen the call for prioritising the focus on preventive interventions at population level which could substantially reduce the burden of common neurological diseases in the ageing population.
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Affiliation(s)
- Silvan Licher
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sirwan K L Darweesh
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lana Fani
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alis Heshmatollah
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Unal Mutlu
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Heeringa
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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27
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Licher S, Heshmatollah A, van der Willik KD, Stricker BHC, Ruiter R, de Roos EW, Lahousse L, Koudstaal PJ, Hofman A, Fani L, Brusselle GGO, Bos D, Arshi B, Kavousi M, Leening MJG, Ikram MK, Ikram MA. Lifetime risk and multimorbidity of non-communicable diseases and disease-free life expectancy in the general population: A population-based cohort study. PLoS Med 2019; 16:e1002741. [PMID: 30716101 PMCID: PMC6361416 DOI: 10.1371/journal.pmed.1002741] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 01/07/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are leading causes of premature disability and death worldwide. However, the lifetime risk of developing any NCD is unknown, as are the effects of shared common risk factors on this risk. METHODS AND FINDINGS Between July 6, 1989, and January 1, 2012, we followed participants from the prospective Rotterdam Study aged 45 years and older who were free from NCDs at baseline for incident stroke, heart disease, diabetes, chronic respiratory disease, cancer, and neurodegenerative disease. We quantified occurrence/co-occurrence and remaining lifetime risk of any NCD in a competing risk framework. We additionally studied the lifetime risk of any NCD, age at onset, and overall life expectancy for strata of 3 shared risk factors at baseline: smoking, hypertension, and overweight. During 75,354 person-years of follow-up from a total of 9,061 participants (mean age 63.9 years, 60.1% women), 814 participants were diagnosed with stroke, 1,571 with heart disease, 625 with diabetes, 1,004 with chronic respiratory disease, 1,538 with cancer, and 1,065 with neurodegenerative disease. NCDs tended to co-occur substantially, with 1,563 participants (33.7% of those who developed any NCD) diagnosed with multiple diseases during follow-up. The lifetime risk of any NCD from the age of 45 years onwards was 94.0% (95% CI 92.9%-95.1%) for men and 92.8% (95% CI 91.8%-93.8%) for women. These risks remained high (>90.0%) even for those without the 3 risk factors of smoking, hypertension, and overweight. Absence of smoking, hypertension, and overweight was associated with a 9.0-year delay (95% CI 6.3-11.6) in the age at onset of any NCD. Furthermore, the overall life expectancy for participants without these risk factors was 6.0 years (95% CI 5.2-6.8) longer than for those with all 3 risk factors. Participants aged 45 years and older without the 3 risk factors of smoking, hypertension, and overweight at baseline spent 21.6% of their remaining lifetime with 1 or more NCDs, compared to 31.8% of their remaining life for participants with all of these risk factors at baseline. This difference corresponds to a 2-year compression of morbidity of NCDs. Limitations of this study include potential residual confounding, unmeasured changes in risk factor profiles during follow-up, and potentially limited generalisability to different healthcare settings and populations not of European descent. CONCLUSIONS Our study suggests that in this western European community, 9 out of 10 individuals aged 45 years and older develop an NCD during their remaining lifetime. Among those individuals who develop an NCD, at least a third are subsequently diagnosed with multiple NCDs. Absence of 3 common shared risk factors is associated with compression of morbidity of NCDs. These findings underscore the importance of avoidance of these common shared risk factors to reduce the premature morbidity and mortality attributable to NCDs.
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Affiliation(s)
- Silvan Licher
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alis Heshmatollah
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Neurology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kimberly D. van der Willik
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Bruno H. Ch. Stricker
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Emmely W. de Roos
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Respiratory Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lies Lahousse
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Peter J. Koudstaal
- Department of Neurology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lana Fani
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Guy G. O. Brusselle
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Respiratory Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J. G. Leening
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Cardiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M. Kamran Ikram
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Neurology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC–University Medical Center Rotterdam, Rotterdam, the Netherlands
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Pavlovic J, Greenland P, Deckers JW, Brugts JJ, Kavousi M, Dhana K, Ikram MA, Hofman A, Stricker BH, Franco OH, Leening MJG. Comparison of ACC/AHA and ESC Guideline Recommendations Following Trial Evidence for Statin Use in Primary Prevention of Cardiovascular Disease: Results From the Population-Based Rotterdam Study. JAMA Cardiol 2018; 1:708-13. [PMID: 27439175 DOI: 10.1001/jamacardio.2016.1577] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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]
Abstract
IMPORTANCE The American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) guidelines both recommend lipid-lowering treatment for primary prevention based on global risk for cardiovascular disease (CVD). However, randomized clinical trials (RCTs) for statin use have included participants with specific risk-factor profiles. OBJECTIVE To evaluate the overlap between the ACC/AHA and ESC guideline recommendations and available evidence from RCTs for statin use in primary prevention of CVD. DESIGN, SETTING, AND PARTICIPANTS We calculated the 10-year risk for hard atherosclerotic CVD (ASCVD) following the ACC/AHA guideline, 10-year risk of CVD mortality following the ESC guideline, and we determined eligibility for each of 10 major RCTs for primary prevention of CVD. Conducted from July 2014 to August 2015, this study included 7279 individuals free of CVD, aged 45 to 75 years, examined between 1997 and 2008 for the Rotterdam Study, a prospective population-based cohort. MAIN OUTCOMES AND MEASURES Proportions of individuals qualifying for lipid-lowering treatment per guidelines, proportions of individuals eligible for any of the 10 RCTs, overlap between these groups, and corresponding ASCVD incidence rates. RESULTS Of the 7279 individuals included in the study, 58.2% were women (n = 4238) and had a mean (SD) age of 61.1 (6.9) years. The ACC/AHA guidelines would recommend statin initiation in 4284 participants (58.9%), while the ESC guidelines would in 2399 participants (33.0%) (overlapping by 95.8% with ACC/AHA). A total of 3857 participants (53.0%) met eligibility criteria for at least 1 RCT. Recommendations from both guidelines and trial evidence overlapped for 1546 participants (21.2%), who were at high risk for ASCVD (21.5 per 1000 person-years). A further 1703 participants (23.4%) would be recommended for statins by the guidelines in the absence of direct trial evidence, while 1176 (16.2%) would have been eligible for at least 1 trial without being recommended statin treatment by any guideline. Finally, 1719 participants (23.6%) would not be recommended a statin, nor would qualify for any of the trials. These individuals had low incidence of ASCVD (3.3 per 1000 person-years). CONCLUSIONS AND RELEVANCE Based on this European population study, ACC/AHA and ESC prevention guidelines often did not align at the individual level. However, for one-fifth of the general population, guidelines on both sides of the Atlantic recommend statin initiation, with trial data supporting the efficacy. There should be no controversy about providing optimal preventive medication to these individuals.
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Affiliation(s)
- Jelena Pavlovic
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Jaap W Deckers
- Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Klodian Dhana
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands4Department of Neurology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands5Department of Radiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands6Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands7Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands8Inspectorate for Health Care, Utrecht, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands3Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands6Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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29
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de Vries LM, Leening MJG, Dijk WA, Hooijschuur CAM, Stricker BH, van Hemel NM. Trends in replacement of pacemaker leads in the Netherlands: A long-term nationwide follow-up study. Pacing Clin Electrophysiol 2018; 41:820-827. [PMID: 29749035 DOI: 10.1111/pace.13371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/22/2018] [Accepted: 04/26/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our objective was to investigate trends over time in longevity and reasons for replacement with or without extraction of pacemaker leads after first implantation. METHODS Data collected between 1984 and 2006 in the national Dutch pacemaker registry were used. This registry covered 84% of sold leads. First lead replacement with or without extraction of one or more leads implanted with a first pacemaker generator was the endpoint of interest. The time interval of and reason for first replacement were analyzed. A 7-year follow-up interval after first implantation was used to analyze changes over time. RESULTS During 22 years of data collection, 138,225 leads were implanted with a first pacemaker generator. Within a mean 5.5 (SD 4.4) years for 7,377 patients one or more leads were extracted for the first time. In total, 8,849 leads (6.4%) were replaced or extracted. The main reasons for first replacement of leads with or without extraction were insulation failures (14.6%), infection (8.8%), displacement (7.6%), or for elective reasons (10.0%). The number of insulation failures peaked during 1991-1995. CONCLUSIONS Despite improvements in pacing techniques and experience with cardiac devices, we found that insulation and conductor failures, and complications such as infections, did not diminish over the 20 years of the registry. Continuing attention in clinical practice for the evaluation of these adverse outcomes and maintaining quality registries is warranted, whereas manufacturers should use this information to further improve their devices.
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Affiliation(s)
- L M de Vries
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - W A Dijk
- Thorax Centre, University Medical Center Groningen, Groningen, the Netherlands
| | - C A M Hooijschuur
- Thorax Centre, University Medical Center Groningen, Groningen, the Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N M van Hemel
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Abstract
In a Perspective, M. Afran Ikram and Maarten Leening discuss the evolving approaches to determining cardiovascular risk.
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Affiliation(s)
- Maarten J. G. Leening
- Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Cardiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
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31
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Affiliation(s)
- Maarten J G Leening
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michael J Pencina
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, North Carolina
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Bos D, Leening MJG. Leveraging the coronary calcium scan beyond the coronary calcium score. Eur Radiol 2018; 28:3082-3087. [PMID: 29383526 PMCID: PMC5986828 DOI: 10.1007/s00330-017-5264-3] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/28/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
Abstract
Non-contrast cardiac computed tomography in order to obtain the coronary artery calcium score has become an established diagnostic procedure in the clinical setting, and is commonly employed in clinical and population-based research. This state-of-the-art review paper highlights the potential gain in information that can be obtained from the non-contrast coronary calcium scans without any necessary modifications to the scan protocol. This includes markers of cardio-metabolic health, such as the amount of epicardial fat and liver fat, but also markers of general health including bone density and lung density. Finally, this paper addresses the importance of incidental findings and of radiation exposure accompanying imaging with non-contrast cardiac computed tomography. Despite the fact that coronary calcium scan protocols have been optimized for the visualization of coronary calcification in terms image quality and radiation exposure, it is important for radiologists, cardiologists and medical specialists in the field of preventive medicine to acknowledge that numerous additional markers of cardio-metabolic health and general health can be readily identified on a coronary calcium scan. KEY POINTS • The coronary artery calcium score substantially increased the use of cardiac CT. • Cardio-metabolic and general health markers may be derived without changes to the scan protocol. • Those include epicardial fat, aortic valve calcifications, liver fat, bone density, and lung density. • Clinicians must be aware of this potential additional yield from non-contrast cardiac CT.
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Affiliation(s)
- Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Cardiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Billar RJ, Leening MJG, Merkus D, Brusselle GGO, Hofman A, Stricker BHC, Ghofrani HA, Franco OH, Gall H, Felix JF. Measures of subclinical cardiac dysfunction and increased filling pressures associate with pulmonary arterial pressure in the general population: results from the population-based Rotterdam Study. Eur J Epidemiol 2017; 33:403-413. [PMID: 29236195 PMCID: PMC5945799 DOI: 10.1007/s10654-017-0341-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 03/14/2017] [Accepted: 12/06/2017] [Indexed: 01/13/2023]
Abstract
Pulmonary hypertension is associated with increased mortality and morbidity in the elderly population. Heart failure is a common cause of pulmonary hypertension. Yet, the relation between left heart parameters reflective of subclinical cardiac dysfunction and increased filling pressures, and pulmonary arterial pressures in the elderly population remains elusive. Within the population-based Rotterdam Study, 2592 unselected participants with a mean age of 72.6 years (61.4% women) had complete echocardiography data available. We studied the cross-sectional associations of left heart structure and systolic and diastolic function with echocardiographically measured pulmonary artery systolic pressure. Mean pulmonary artery systolic pressure was 25.4 mmHg. After multivariable-adjustment measures of both structure and function were independently associated with pulmonary artery systolic pressure: E/A ratio [0.63 mmHg (95% CI 0.35–0.91) per 1-SD increase], left atrial diameter [0.79 mmHg (0.50–1.09) per 1-SD increase], E/E′ ratio [1.27 mmHg (0.92–1.61) per 1-SD increase], left ventricular volume [0.62 mmHg (0.25–0.98) per 1-SD increase], fractional shortening [0.45 mmHg (0.17–0.74) per 1-SD increase], aortic root diameter [− 0.43 mmHg (− 0.72 to − 0.14) per 1-SD increase], mitral valve deceleration time [− 0.31 mmHg (− 0.57 to − 0.05) per 1-SD increase], and E′ [1.04 mmHg (0.66–1.42) per 1-SD increase]. Results did not materially differ when restricting the analyses to participants free of symptoms of shortness of breath. Structural and functional echocardiographic parameters of subclinical cardiac dysfunction and increased filling pressures are associated with pulmonary arterial pressures in the unselected general ageing population.
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Affiliation(s)
- Ryan J Billar
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Daphne Merkus
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bruno H Ch Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Inspectorate for Health Care, Utrecht, The Netherlands
| | - H Ardeschir Ghofrani
- Medizinische Klinik II, University of Giessen and Marburg Lung Center (UGMLC) - Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henning Gall
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Medizinische Klinik II, University of Giessen and Marburg Lung Center (UGMLC) - Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Janine F Felix
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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34
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Loth DW, Lahousse L, Leening MJG, Krijthe BP, Felix JF, Gall H, Hofman A, Ghofrani HA, Franco OH, Stricker BH, Brusselle GG. Pulmonary function and diffusion capacity are associated with pulmonary arterial systolic pressure in the general population: The Rotterdam Study. Respir Med 2017; 132:50-55. [PMID: 29229105 DOI: 10.1016/j.rmed.2017.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/03/2017] [Revised: 08/14/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pulmonary hypertension is a progressive heterogeneous syndrome, characterized by elevated pulmonary arterial pressure which can lead to right ventricular failure. Although the presence of elevated pulmonary arterial systolic pressure (PASP) in patients with a lung disease is a well-known occurrence, little is known about the association between pulmonary function and PASP in the general population. We hypothesized that pulmonary function and PASP are associated, irrespective of airflow limitation. METHODS This study was performed within the Rotterdam Study, a prospective population-based cohort. We included 1660 participants with spirometry, performed and interpreted according to ATS/ERS-guidelines, and echocardiography performed according to the ASE/EAE/CSE-guidelines. We analyzed the association of Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), FEV1/FVC and diffusion capacity (DLCO) with estimated PASP (ePASP). Furthermore, we investigated the association between spirometry measures, COPD, and echocardiographic pulmonary hypertension. RESULTS A 10% absolute decrease in FEV1 was associated with an ePASP increase of 0.46 mmHg (95%CI: 0.31; 0.61). Similarly, per absolute 10% decrease, FVC was significantly associated with an increased ePASP of 0.42 mmHg (95%CI: 0.25; 0.59). FEV1/FVC showed an association of 1.01 mmHg (95%CI: 0.58; 1.45) increase in ePASP per 10% absolute decrease. A decrease in DLCO (in mL/min/kPa) was associated with an increased ePASP (0.46 mmHg, 95%CI: 0.17; 0.76). We found significant associations for FEV1 and FVC with echocardiographic pulmonary hypertension. Importantly, an increased ePASP was significantly associated with mortality (Hazard Ratio: 1.042 per mmHg [95%CI: 1.023-1.062; p < 0.001]). CONCLUSION We observed a clearly graded association between pulmonary function and ePASP and pulmonary hypertension, even in individuals without airflow limitation.
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Affiliation(s)
- Daan W Loth
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bouwe P Krijthe
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Janine F Felix
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henning Gall
- Universities of Giessen and Marburg Lung Center (UGMLC) - Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - H Ardeschir Ghofrani
- Universities of Giessen and Marburg Lung Center (UGMLC) - Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands; Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Guy G Brusselle
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Respiratory Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
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de Vries LM, Leening MJG, Dijk WA, Hooijschuur CAM, Stricker BHC, van Hemel NM. Trends in service time of pacemakers in the Netherlands: a long-term nationwide follow-up study. Neth Heart J 2017; 25:581-591. [PMID: 28770398 PMCID: PMC5612868 DOI: 10.1007/s12471-017-1024-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 07/12/2017] [Indexed: 12/18/2022] Open
Abstract
AIMS After decades of experience and strongly improved technology, service time of pacemaker generators is expected to increase. To test this hypothesis, we conducted a retrospective review of a large cohort of patients with a pacemaker. METHODS We reviewed data collected between 1984 and 2006 in the first national Dutch pacemaker registry. This registry covered 96% of all generators implanted. We analysed the time of and reason for explantation of pacemaker generators. A 7-year follow-up interval after first implantation and following replacements was used to analyse changes over time. RESULTS During 22 years of data collection, nearly 97,000 first pacemaker generators were implanted. A total of 27,937 (22.4%) generators were explanted within a mean of 6.3 (standard deviation 3.3) years. Reasons for approximately 60% of these explantations were 'end of life' of the pacemaker generator or elective system change. Complications or failures such as infections and recalls accounted for approximately 20% of the explantations. For the remaining 20%, the reasons for explantation had not been registered. CONCLUSION Despite progress in technology, a substantial proportion of pacemaker generators is explanted before its expected service time, with one in five generators being replaced due to technical failures, infections or other complications. Furthermore, the time interval between pacemaker implantation and explantation due to normal 'end of life' (battery EOL) decreased. Infections continue to rank highly as a cause for pacing system replacement, despite all current preventive measures.
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Affiliation(s)
- L M de Vries
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - W A Dijk
- Thorax Center, University Medical Center Groningen, Groningen, The Netherlands
| | - C A M Hooijschuur
- Thorax Center, University Medical Center Groningen, Groningen, The Netherlands
| | - B H C Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - N M van Hemel
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Affiliation(s)
- Daniel Bos
- From Departments of Epidemiology (D.B., M.A.I., M.J.G.L., M.K.I.), Radiology and Nuclear Medicine (D.B., M.A.I.), Neurology (M.A.I., M.K.I.), and Cardiology (M.J.G.L.), Erasmus MC–University Medical Center Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B., M.J.G.L.)
| | - M. Arfan Ikram
- From Departments of Epidemiology (D.B., M.A.I., M.J.G.L., M.K.I.), Radiology and Nuclear Medicine (D.B., M.A.I.), Neurology (M.A.I., M.K.I.), and Cardiology (M.J.G.L.), Erasmus MC–University Medical Center Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B., M.J.G.L.)
| | - Maarten J. G. Leening
- From Departments of Epidemiology (D.B., M.A.I., M.J.G.L., M.K.I.), Radiology and Nuclear Medicine (D.B., M.A.I.), Neurology (M.A.I., M.K.I.), and Cardiology (M.J.G.L.), Erasmus MC–University Medical Center Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B., M.J.G.L.)
| | - M. Kamran Ikram
- From Departments of Epidemiology (D.B., M.A.I., M.J.G.L., M.K.I.), Radiology and Nuclear Medicine (D.B., M.A.I.), Neurology (M.A.I., M.K.I.), and Cardiology (M.J.G.L.), Erasmus MC–University Medical Center Rotterdam, The Netherlands; and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (D.B., M.J.G.L.)
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Jovanova O, Luik AI, Leening MJG, Noordam R, Aarts N, Hofman A, Franco OH, Dehghan A, Tiemeier H. The long-term risk of recognized and unrecognized myocardial infarction for depression in older men. Psychol Med 2016; 46:1951-1960. [PMID: 26996221 DOI: 10.1017/s0033291716000544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association between myocardial infarction (MI) and depression is well described. Yet, the underlying mechanisms are unclear and the contribution of psychological factors is uncertain. We aimed to determine the risk of recognized (RMI) and unrecognized (UMI) myocardial infections on depression, as both have a similar impact on cardiovascular health but differ in psychological epiphenomena. METHOD Participants of the Rotterdam Study, 1823 men aged ⩾55 years, were followed for the occurrence of depression. RMI and UMI were ascertained using electrocardiography and medical history at baseline. We determined the strength of the association of RMI and UMI with mortality, and we studied the relationship of RMI and UMI with depressive symptoms and the occurrence of major depression. RESULTS The risk of mortality was similar in men with RMI [adjusted hazard ratio (aHR) 1.71, 95% confidence interval (CI) 1.45-2.03] and UMI (aHR 1.58, 95% CI 1.27-1.97). Men with RMI had on average [unstandardized regression coefficient (B) 1.14, 95% CI 0.07-2.21] higher scores for depressive symptoms. By contrast, we found no clear association between UMI and depressive symptoms (B 0.55, 95% CI -0.51 to 1.62) in men. Analysis including occurrence of major depression as the outcome were consistent with the pattern of association. CONCLUSION The discrepant association of RMI and UMI with mortality compared to depression suggests that the psychological burden of having experienced an MI contributes to the long-term risk of depression.
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Affiliation(s)
- O Jovanova
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - A I Luik
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - M J G Leening
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - R Noordam
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - N Aarts
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - A Hofman
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - O H Franco
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - A Dehghan
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - H Tiemeier
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
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Chen LY, Leening MJG, Norby FL, Roetker NS, Hofman A, Franco OH, Pan W, Polak JF, Witteman JCM, Kronmal RA, Folsom AR, Nazarian S, Stricker BH, Heckbert SR, Alonso A. Carotid Intima-Media Thickness and Arterial Stiffness and the Risk of Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study, Multi-Ethnic Study of Atherosclerosis (MESA), and the Rotterdam Study. J Am Heart Assoc 2016; 5:JAHA.115.002907. [PMID: 27207996 PMCID: PMC4889172 DOI: 10.1161/jaha.115.002907] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated the association of carotid intima-media thickness (cIMT), carotid plaque, carotid distensibility coefficient (DC), and aortic pulse wave velocity (PWV) with incident atrial fibrillation (AF) and their role in improving AF risk prediction beyond the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)-AF risk score. METHODS AND RESULTS We analyzed data from 3 population-based cohort studies: Atherosclerosis Risk in Communities (ARIC) Study (n=13 907); Multi-Ethnic Study of Atherosclerosis (MESA; n=6640), and the Rotterdam Study (RS; n=5220). We evaluated the association of arterial indices with incident AF and computed the C-statistic, category-based net reclassification improvement (NRI), and relative integrated discrimination improvement (IDI) of incorporating arterial indices into the CHARGE-AF risk score (age, race, height weight, systolic and diastolic blood pressure, antihypertensive medication use, smoking, diabetes, previous myocardial infarction, and previous heart failure). Higher cIMT (meta-analyzed hazard ratio [95% CI] per 1-SD increment, 1.12 [1.08-1.16]) and presence of carotid plaque (1.30 [1.19-1.42]) were associated with higher AF incidence after adjustment for CHARGE-AF risk-score variables. Lower DC and higher PWV were associated with higher AF incidence only after adjustment for the CHARGE-AF risk-score variables excepting height, weight, and systolic and diastolic blood pressure. Addition of cIMT or carotid plaque marginally improved CHARGE-AF score prediction as assessed by the relative IDI (estimates, 0.025-0.051), but not when assessed with the C-statistic and NRI. CONCLUSIONS Higher cIMT, presence of carotid plaque, and greater arterial stiffness are associated with higher AF incidence, indicating that atherosclerosis and arterial stiffness play a role in AF etiopathogenesis. However, arterial indices only modestly improve AF risk prediction.
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Affiliation(s)
- Lin Y Chen
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Nicholas S Roetker
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wei Pan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Joseph F Polak
- Department of Radiology, Tufts University School of Medicine, Boston, MA
| | - Jacqueline C M Witteman
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Richard A Kronmal
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Saman Nazarian
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands Inspectorate for Health Care, Utrecht, The Netherlands
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA Cardiovascular Health Research Unit, University of Washington, Seattle, WA
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
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Affiliation(s)
- Maarten J G Leening
- Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands2Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jarett D Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas4Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Norrina B Allen
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Bos D, Leening MJG, Kavousi M, Hofman A, Franco OH, van der Lugt A, Vernooij MW, Ikram MA. Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality: The Rotterdam Study. Circ Cardiovasc Imaging 2016; 8:CIRCIMAGING.115.003843. [PMID: 26659376 DOI: 10.1161/circimaging.115.003843] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atherosclerosis is a major contributor to global morbidity and mortality. Although atherosclerosis is a systemic disease, its burden varies considerably across vessel beds, which may translate into differences in mortality risk. METHODS AND RESULTS From 2003 to 2006, a sample of 2408 elderly participants (mean age, 69.6±6.7 years; 52.4% female) from the population-based Rotterdam Study underwent computed tomography to quantify atherosclerotic calcification in the coronary arteries, aortic arch, extracranial, and intracranial internal carotid arteries. Mortality follow-up was complete until January 1, 2012. We investigated associations of calcification in each vessel bed with mortality using Cox regression, adjusting for age, sex, and cardiovascular risk factors. Next, all vessel beds were included into 1 model to investigate independency of associations. Finally, we investigated the predictive value of calcification beyond the predictors included in the Pooled Cohort equations. During 15 775 person-years of follow-up, 283 participants died. Larger calcification volumes in all vessels were related to higher risks of all-cause mortality, cardiovascular, and noncardiovascular mortality, independent of cardiovascular risk factors. Most prominent associations were found for aortic arch calcification and cardiovascular mortality (age- and sex-adjusted hazard ratio per 1-SD increase 2.72 [95% confidence interval, 1.85-4.02]), independent of calcification elsewhere (hazard ratio, 1.75 (95% confidence interval, 1.13-2.72]). Calcification in any vessel improved prediction for all 3 outcomes. CONCLUSIONS Atherosclerotic load in major vessel beds is associated with an increased risk of death. In particular, aortic arch calcification volume yields unique information with regard to mortality in addition to atherosclerosis in other vessel beds.
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Affiliation(s)
- Daniel Bos
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Maarten J G Leening
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Maryam Kavousi
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Albert Hofman
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Oscar H Franco
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Aad van der Lugt
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Meike W Vernooij
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - M Arfan Ikram
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands.
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Kieboom BCT, Niemeijer MN, Leening MJG, van den Berg ME, Franco OH, Deckers JW, Hofman A, Zietse R, Stricker BH, Hoorn EJ. Serum Magnesium and the Risk of Death From Coronary Heart Disease and Sudden Cardiac Death. J Am Heart Assoc 2016; 5:JAHA.115.002707. [PMID: 26802105 PMCID: PMC4859391 DOI: 10.1161/jaha.115.002707] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Low serum magnesium has been implicated in cardiovascular mortality, but results are conflicting and the pathway is unclear. We studied the association of serum magnesium with coronary heart disease (CHD) mortality and sudden cardiac death (SCD) within the prospective population‐based Rotterdam Study, with adjudicated end points and long‐term follow‐up. Methods and Results Nine‐thousand eight‐hundred and twenty participants (mean age 65.1 years, 56.8% female) were included with a median follow‐up of 8.7 years. We used multivariable Cox proportional hazard models and found that a 0.1 mmol/L increase in serum magnesium level was associated with a lower risk for CHD mortality (hazard ratio: 0.82, 95% CI 0.70–0.96). Furthermore, we divided serum magnesium in quartiles, with the second and third quartile combined as reference group (0.81–0.88 mmol/L). Low serum magnesium (≤0.80 mmol/L) was associated with an increased risk of CHD mortality (N=431, hazard ratio: 1.36, 95% CI 1.09–1.69) and SCD (N=217, hazard ratio: 1.54, 95% CI 1.12–2.11). Low serum magnesium was associated with accelerated subclinical atherosclerosis (expressed as increased carotid intima‐media thickness: +0.013 mm, 95% CI 0.005–0.020) and increased QT‐interval, mainly through an effect on heart rate (RR‐interval: −7.1 ms, 95% CI −13.5 to −0.8). Additional adjustments for carotid intima‐media thickness and heart rate did not change the associations with CHD mortality and SCD. Conclusions Low serum magnesium is associated with an increased risk of CHD mortality and SCD. Although low magnesium was associated with both carotid intima‐media thickness and heart rate, this did not explain the relationship between serum magnesium and CHD mortality or SCD. Future studies should focus on why magnesium associates with CHD mortality and SCD and whether intervention reduces these risks.
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Affiliation(s)
- Brenda C T Kieboom
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., M.N.N., M.G.L., O.H.F., A.H., B.H.S.) Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., R.Z., B.H.S., E.J.H.) Inspectorate for Health Care, Utrecht, The Netherlands (B.T.K., B.H.S.)
| | - Maartje N Niemeijer
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., M.N.N., M.G.L., O.H.F., A.H., B.H.S.)
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., M.N.N., M.G.L., O.H.F., A.H., B.H.S.) Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (M.G.L., J.W.D.) Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (M.G.L., A.H.)
| | - Marten E van den Berg
- Department of Medical Informatics, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (M.E.B.)
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., M.N.N., M.G.L., O.H.F., A.H., B.H.S.)
| | - Jaap W Deckers
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (M.G.L., J.W.D.)
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., M.N.N., M.G.L., O.H.F., A.H., B.H.S.) Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (M.G.L., A.H.)
| | - Robert Zietse
- Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., R.Z., B.H.S., E.J.H.)
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., M.N.N., M.G.L., O.H.F., A.H., B.H.S.) Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., R.Z., B.H.S., E.J.H.) Inspectorate for Health Care, Utrecht, The Netherlands (B.T.K., B.H.S.)
| | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands (B.T.K., R.Z., B.H.S., E.J.H.)
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Ligthart S, van Herpt TTW, Leening MJG, Kavousi M, Hofman A, Stricker BHC, van Hoek M, Sijbrands EJG, Franco OH, Dehghan A. Lifetime risk of developing impaired glucose metabolism and eventual progression from prediabetes to type 2 diabetes: a prospective cohort study. Lancet Diabetes Endocrinol 2016; 4:44-51. [PMID: 26575606 DOI: 10.1016/s2213-8587(15)00362-9] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Data are scarce for the lifetime risk of developing impaired glucose metabolism, including prediabetes, as are data for the risk of eventual progression from prediabetes to diabetes and for initiation of insulin treatment in previously untreated patients with diabetes. We aimed to calculate the lifetime risk of the full range of glucose impairments, from normoglycaemia to prediabetes, type 2 diabetes, and eventual insulin use. METHODS In this prospective population-based cohort analysis, we used data from the population-based Rotterdam Study. We identified diagnostic events by use of general practitioners' records, hospital discharge letters, pharmacy dispensing data, and serum fasting glucose measurements taken at the study centre (Rotterdam, Netherlands) visits. Normoglycaemia, prediabetes, and diabetes were defined on the basis of WHO criteria for fasting glucose (normoglycaemia: ≤6·0 mmol/L; prediabetes: >6·0 mmol/L and <7·0 mmol/L; and diabetes ≥7·0 mmol/L or use of glucose-lowering drug). We calculated lifetime risk using a modified version of survival analysis adjusted for the competing risk of death. We also estimated the lifetime risk of progression from prediabetes to overt diabetes and from diabetes free of insulin treatment to insulin use. Additionally, we calculated years lived with healthy glucose metabolism. FINDINGS We used data from 10 050 participants from the Rotterdam Study. During a follow-up of up to 14·7 years (between April 1, 1997, and Jan 1, 2012), 1148 participants developed prediabetes, 828 developed diabetes, and 237 started insulin treatment. At age 45 years, the remaining lifetime risk was 48·7% (95% CI 46·2-51·3) for prediabetes, 31·3% (29·3-33·3) for diabetes, and 9·1% (7·8-10·3) for insulin use. In individuals aged 45 years, the lifetime risk to progress from prediabetes to diabetes was 74·0% (95% CI 67·6-80·5), and 49·1% (38·2-60·0) of the individuals with overt diabetes at this age started insulin treatment. The lifetime risks attenuated with advancing age, but increased with increasing BMI and waist circumference. On average, individuals with severe obesity lived 10 fewer years without glucose impairment compared with normal-weight individuals. INTERPRETATION Impaired glucose metabolism is a substantial burden on population health, and our findings emphasise the need for more effective prevention strategies, which should be implemented as soon in a person's life as possible. The substantial lifetime risk of prediabetes and diabetes in lean individuals also supports risk factor control in non-obese individuals. FUNDING Erasmus MC and Erasmus University Rotterdam; Netherlands Organisation for Scientific Research; Netherlands Organisation for Health Research and Development; Research Institute for Diseases in the Elderly; Netherlands Genomics Initiative; Netherlands Ministry of Education, Culture and Science; Netherlands Ministry of Health, Welfare and Sports; European Commission; and Municipality of Rotterdam.
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Affiliation(s)
- Symen Ligthart
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Thijs T W van Herpt
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Bruno H C Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Inspectorate for Health Care, Utrecht, Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, Netherlands.
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Noordam R, Aarts N, Leening MJG, Tiemeier H, Franco OH, Hofman A, Stricker BH, Visser LE. Use of antidepressants and the risk of myocardial infarction in middle-aged and older adults: a matched case-control study. Eur J Clin Pharmacol 2015; 72:211-8. [PMID: 26546336 PMCID: PMC4713708 DOI: 10.1007/s00228-015-1972-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 06/30/2015] [Accepted: 10/26/2015] [Indexed: 12/28/2022]
Abstract
Purpose Antidepressants, specifically selective serotonin reuptake-inhibiting antidepressants (SSRIs), decrease platelet activation and aggregation in in vitro experiments and could therefore decrease the risk of myocardial infarction (MI). However, prior studies addressing this hypothesis showed contradictory results. Our purpose was to investigate the association between the use of any antidepressant drug and incident MI among middle-aged and older adults. Methods We embedded a case-control study in the prospective Rotterdam Study (1991–2011). Controls were matched to MI cases based on sex and age at the same calendar date, and confounding factors were taken into account as time-varying covariates. The relative risk of MI during current and past use of an antidepressant was analyzed with conditional logistic regression with never use of antidepressant drugs as the reference category. Results A total of 744 out of a cohort of 9499 study participants developed MI during follow-up. After statistical adjustment for traditional cardiovascular risk factors and depression, current use of any antidepressant was associated with a lower risk of MI (odds ratio (OR), 0.71; 95 % confidence interval (CI), 0.51–0.98) compared with never use of any antidepressant. SSRI use showed the lowest relative risk (OR, 0.65; 95 % CI, 0.41–1.02), albeit marginally not statistically significant. Past use of any of the antidepressant classes was not associated with a lower risk of MI. Conclusions Current use of antidepressants was associated with a lower risk of MI. Of the different classes, the use of SSRIs showed the lowest risk of MI, and therefore confirming the research hypothesis. Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1972-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Raymond Noordam
- Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Nikkie Aarts
- Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Cardiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Inspectorate of Health Care, Utrecht, The Netherlands.
| | - Loes E Visser
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Apotheek Haagse Ziekenhuizen-HAGA, The Hague, The Netherlands
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Di Angelantonio E, Kaptoge S, Wormser D, Willeit P, Butterworth AS, Bansal N, O'Keeffe LM, Gao P, Wood AM, Burgess S, Freitag DF, Pennells L, Peters SA, Hart CL, Håheim LL, Gillum RF, Nordestgaard BG, Psaty BM, Yeap BB, Knuiman MW, Nietert PJ, Kauhanen J, Salonen JT, Kuller LH, Simons LA, van der Schouw YT, Barrett-Connor E, Selmer R, Crespo CJ, Rodriguez B, Verschuren WMM, Salomaa V, Svärdsudd K, van der Harst P, Björkelund C, Wilhelmsen L, Wallace RB, Brenner H, Amouyel P, Barr ELM, Iso H, Onat A, Trevisan M, D'Agostino RB, Cooper C, Kavousi M, Welin L, Roussel R, Hu FB, Sato S, Davidson KW, Howard BV, Leening MJG, Leening M, Rosengren A, Dörr M, Deeg DJH, Kiechl S, Stehouwer CDA, Nissinen A, Giampaoli S, Donfrancesco C, Kromhout D, Price JF, Peters A, Meade TW, Casiglia E, Lawlor DA, Gallacher J, Nagel D, Franco OH, Assmann G, Dagenais GR, Jukema JW, Sundström J, Woodward M, Brunner EJ, Khaw KT, Wareham NJ, Whitsel EA, Njølstad I, Hedblad B, Wassertheil-Smoller S, Engström G, Rosamond WD, Selvin E, Sattar N, Thompson SG, Danesh J. Association of Cardiometabolic Multimorbidity With Mortality. JAMA 2015; 314:52-60. [PMID: 26151266 PMCID: PMC4664176 DOI: 10.1001/jama.2015.7008] [Citation(s) in RCA: 521] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). MAIN OUTCOMES AND MEASURES All-cause mortality and estimated reductions in life expectancy. RESULTS In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy. CONCLUSIONS AND RELEVANCE Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pei Gao
- University of Cambridge, Cambridge, England
| | | | | | | | | | - Sanne A Peters
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | - Bu B Yeap
- University of Western Australia, Perth
| | | | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | | | | | | | - Leon A Simons
- University of New South Wales, New South Wales, Australia
| | | | | | - Randi Selmer
- Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Pim van der Harst
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | | | | | | | | | | | | | - Cyrus Cooper
- University of Southampton, Southampton, England32University of Oxford, Oxford, England
| | | | | | - Ronan Roussel
- INSERM, Centre de Recherche des Cordeliers, Paris, France36Université Paris Diderot, Paris, France37Diabétologie, AP-HP, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France
| | - Frank B Hu
- Harvard School of Public Health, Boston, Massachusetts
| | - Shinichi Sato
- Osaka Medical Center for Health Science and Promotion/Chiba Prefectural Institute of Public Health, Suita, Japan
| | | | | | | | | | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marcus Dörr
- University Medicine Greifswald, Greifswald, Germany44DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Dorly J H Deeg
- Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | | | | | | | | | | | | | - Jackie F Price
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany52German Research Center for Cardiovascular Research (DZHK eV), Partner-Site Munich, Munich, Germany
| | - Tom W Meade
- London School of Hygiene and Tropical Medicine, London, England
| | | | | | | | | | | | - Gerd Assmann
- Assmann-Stiftung für Prävention, Munster, Germany
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec, Canada
| | | | | | | | | | | | | | - Eric A Whitsel
- Department of Medicine, University of North Carolina, Chapel Hill65Department of Epidemiology, University of North Carolina, Chapel Hill
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Moreira EM, Gall H, Leening MJG, Lahousse L, Loth DW, Krijthe BP, Kiefte-de Jong JC, Brusselle GG, Hofman A, Stricker BH, Ghofrani HA, Franco OH, Felix JF. Prevalence of Pulmonary Hypertension in the General Population: The Rotterdam Study. PLoS One 2015; 10:e0130072. [PMID: 26102085 PMCID: PMC4478029 DOI: 10.1371/journal.pone.0130072] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 05/15/2015] [Indexed: 11/18/2022] Open
Abstract
Background Pulmonary hypertension is characterized by increased pulmonary artery pressure and carries an increased mortality. Population-based studies into pulmonary hypertension are scarce and little is known about its prevalence in the general population. We aimed to describe the distribution of echocardiographically-assessed pulmonary artery systolic pressure (ePASP) in the general population, to estimate the prevalence of pulmonary hypertension, and to identify associated factors. Methods Participants (n = 3381, mean age 76.4 years, 59% women) from the Rotterdam Study, a population-based cohort, underwent echocardiography. Echocardiographic pulmonary hypertension was defined as ePASP>40 mmHg. Results Mean ePASP was 26.3 mmHg (SD 7.0). Prevalence of echocardiographic pulmonary hypertension was 2.6% (95%CI: 2.0; 3.2). Prevalence was higher in older participants compared to younger ones (8.3% in those over 85 years versus 0.8% in those between 65 and 70), and in those with underlying disorders versus those without (5.9% in subjects with COPD versus 2.3%; 9.2% in those with left ventricular systolic dysfunction versus 2.3%; 23.1% in stages 3 or 4 left ventricular diastolic dysfunction versus 1.9% in normal or stage 1). Factors independently associated with higher ePASP were older age, higher BMI, left ventricular diastolic dysfunction, COPD and systemic hypertension. Conclusion In this large population-based study, we show that pulmonary hypertension as measured by echocardiography has a low prevalence in the overall general population in the Netherlands, but estimates may be higher in specific subgroups, especially in those with underlying diseases. Increased pulmonary arterial pressure is likely to gain importance in the near future due to population aging and the accompanying prevalences of underlying disorders.
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Affiliation(s)
- Eduardo M. Moreira
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- School of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil
| | - Henning Gall
- Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Maarten J. G. Leening
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Lies Lahousse
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Daan W. Loth
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Respiratory Medicine, Amphia Hospital, Breda, the Netherlands
| | - Bouwe P. Krijthe
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Guy G. Brusselle
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Respiratory Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Bruno H. Stricker
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
- Inspectorate for Health Care, The Hague, the Netherlands
| | - Hossein A. Ghofrani
- Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Oscar H. Franco
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Janine F. Felix
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- * E-mail:
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Niemeijer MN, Leening MJG, van den Berg ME, Hofman A, Franco OH, Deckers JW, Rijnbeek PR, Stricker BH, Eijgelsheim M. Subclinical Abnormalities in Echocardiographic Parameters and Risk of Sudden Cardiac Death in a General Population: The Rotterdam Study. J Card Fail 2015; 22:17-23. [PMID: 26093333 DOI: 10.1016/j.cardfail.2015.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Subclinical cardiac dysfunction has been associated with increased mortality, and heart failure increases the risk of sudden cardiac death (SCD). Less well known is whether subclinical cardiac dysfunction is also a risk factor for SCD. Our objective was to assess the association between echocardiographic parameters and SCD in a community-dwelling population free of heart failure. METHODS AND RESULTS We computed hazard ratios (HRs) for left atrium diameter, left ventricular (LV) end-diastolic dimension, LV end-systolic dimension, LV mass, qualitative LV systolic function, LV fractional shortening, and diastolic function. During a median follow-up of 6.3 years in 4,686 participants, 68 participants died because of SCD. Significant associations with SCD were observed for qualitative LV systolic function and LV fractional shortening. For moderate/poor qualitative LV systolic function, the HR for SCD was 2.54 (95% confidence interval [CI] 1.10-5.87). Each standard deviation decrease in LV fractional shortening was associated with an HR of 1.36 (95% CI 1.09-1.70). CONCLUSIONS Subclinical abnormalities in LV systolic function were associated with SCD risk in this general population. Although prediction of SCD remains difficult and traditional cardiovascular risk factors are of greatest importance, this knowledge might guide future directions to prevent SCD in persons with subclinical cardiac dysfunction.
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Affiliation(s)
- Maartje N Niemeijer
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Marten E van den Berg
- Department of Medical Informatics, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands.
| | - Mark Eijgelsheim
- Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands
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Zuurbier LA, Luik AI, Leening MJG, Hofman A, Freak-Poli R, Franco OH, Stricker BH, Tiemeier H. Associations of heart failure with sleep quality: the Rotterdam Study. J Clin Sleep Med 2015; 11:117-21. [PMID: 25406270 DOI: 10.5664/jcsm.4454] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/09/2014] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES The prevalence of sleep disturbances and heart failure increases with age. We aimed to evaluate the associations of incident heart failure and cardiac dysfunction with changes in sleep quality. METHODS This prospective population-based study was conducted in the Rotterdam Study. Of the 3445 eligible persons (mean age 72.0±7.1 years) available for cross-sectional analyses, 8.9% (n = 307) had prevalent clinical heart failure. In longitudinal analyses, 1989 eligible persons (mean age 70.0±5.8 years) were followed for an average of 6.5±0.4 years, of which 4.6% (n = 91) had prevalent or incident clinical heart failure. Heart failure was assessed according to European Society of Cardiology criteria. To estimate cardiac function, we measured left ventricular fractional shortening, left ventricular systolic function, and E/A ratio by echocardiography. Heart failure and cardiac dysfunction were studied with linear regression in relation to sleep quality, assessed by the Pittsburgh Sleep Quality Index. RESULTS No associations between clinical heart failure and sleep quality were observed in cross-sectional analyses. Clinical heart failure predicted a reduction of sleep quality (B = 1.00 points on the Pittsburgh Sleep Quality Index; 95% CI 0.40, 1.60) in longitudinal assessment. This association was driven by the sleep onset latency and sleep quality components of the Pittsburgh Sleep Quality Index. Cardiac dysfunction was not related to sleep quality in cross-sectional or longitudinal analyses. CONCLUSIONS Clinical heart failure, but not cardiac dysfunction measured by echocardiography, increases the risk of poor sleep quality in the general population over time. These findings suggest that clinical manifestations of heart failure negatively affect sleep.
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Affiliation(s)
- Lisette A Zuurbier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rosanne Freak-Poli
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands: Inspectorate for Health Care, The Hague, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands: Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
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Leening MJG, Ferket BS, Steyerberg EW, Kavousi M, Deckers JW, Nieboer D, Heeringa J, Portegies MLP, Hofman A, Ikram MA, Hunink MGM, Franco OH, Stricker BH, Witteman JCM, Roos-Hesselink JW. Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study. BMJ 2014; 349:g5992. [PMID: 25403476 PMCID: PMC4233917 DOI: 10.1136/bmj.g5992] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate differences in first manifestations of cardiovascular disease between men and women in a competing risks framework. DESIGN Prospective population based cohort study. SETTING People living in the community in Rotterdam, the Netherlands. PARTICIPANTS 8419 participants (60.9% women) aged ≥ 55 and free from cardiovascular disease at baseline. MAIN OUTCOME MEASURES First diagnosis of coronary heart disease (myocardial infarction, revascularisation, and coronary death), cerebrovascular disease (stroke, transient ischaemic attack, and carotid revascularisation), heart failure, or other cardiovascular death; or death from non-cardiovascular causes. Data were used to calculate lifetime risks of cardiovascular disease and its first incident manifestations adjusted for competing non-cardiovascular death. RESULTS During follow-up of up to 20.1 years, 2888 participants developed cardiovascular disease (826 coronary heart disease, 1198 cerebrovascular disease, 762 heart failure, and 102 other cardiovascular death). At age 55, overall lifetime risks of cardiovascular disease were 67.1% (95% confidence interval 64.7% to 69.5%) for men and 66.4% (64.2% to 68.7%) for women. Lifetime risks of first incident manifestations of cardiovascular disease in men were 27.2% (24.1% to 30.3%) for coronary heart disease, 22.8% (20.4% to 25.1%) for cerebrovascular disease, 14.9% (13.3% to 16.6%) for heart failure, and 2.3% (1.6% to 2.9%) for other deaths from cardiovascular disease. For women the figures were 16.9% (13.5% to 20.4%), 29.8% (27.7% to 31.9%), 17.5% (15.9% to 19.2%), and 2.1% (1.6% to 2.7%), respectively. Differences in the number of events that developed over the lifespan in women compared with men (per 1000) were -7 for any cardiovascular disease, -102 for coronary heart disease, 70 for cerebrovascular disease, 26 for heart failure, and -1 for other cardiovascular death; all outcomes manifested at a higher age in women. Patterns were similar when analyses were restricted to hard atherosclerotic cardiovascular disease outcomes, but absolute risk differences between men and women were attenuated for both coronary heart disease and stroke. CONCLUSIONS At age 55, though men and women have similar lifetime risks of cardiovascular disease, there are considerable differences in the first manifestation. Men are more likely to develop coronary heart disease as a first event, while women are more likely to have cerebrovascular disease or heart failure as their first event, although these manifestations appear most often at older ages.
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Affiliation(s)
- Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Epidemiology, Harvard School of Public Health, Boston, MA, US
| | - Bart S Ferket
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Institute of Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, US
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jan Heeringa
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marileen L P Portegies
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Epidemiology, Harvard School of Public Health, Boston, MA, US
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - M G Myriam Hunink
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, US
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands Inspectorate for Health Care, The Hague, Netherlands
| | - Jacqueline C M Witteman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
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Akoudad S, Darweesh SKL, Leening MJG, Koudstaal PJ, Hofman A, van der Lugt A, Stricker BH, Ikram MA, Vernooij MW. Use of coumarin anticoagulants and cerebral microbleeds in the general population. Stroke 2014; 45:3436-9. [PMID: 25316276 DOI: 10.1161/strokeaha.114.007112] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE It remains undetermined whether the use of coumarin anticoagulants associates with cerebral microbleeds in the general population. We investigated whether (1) coumarin use relates to higher prevalence and incidence of microbleeds, (2) microbleeds are more frequent in people with higher maximum international normalized ratios (INRs), and (3) among coumarin users, variability in INR associates with microbleed presence. METHODS From the population-based Rotterdam Study, 4945 participants aged ≥45 years were included in the cross-sectional analysis, and 3069 participants had follow-up brain MRI. Information on coumarin use was obtained from automated pharmacy records. Coumarin users were monitored, and INR values were measured in consecutive visits. Presence and location of microbleeds were rated on brain MRI. We investigated the association of coumarin use with microbleeds using multivariable logistic regression. RESULTS Overall, 8.6% had used coumarin anticoagulants before the first MRI and 5.9% before follow-up MRI. The prevalence of microbleeds was 19.4%, and the incidence was 6.9% during a mean follow-up of 3.9 years (SD, 0.5). Compared with never users, coumarin users had a higher prevalence of deep or infratentorial microbleeds and a higher incidence of any microbleeds, although statistical significance was not reached in the latter. A higher maximum INR was associated with deep or infratentorial microbleeds. Among coumarin users, a greater variability in INR was associated with a higher prevalence of microbleeds. CONCLUSIONS Coumarin use is associated with microbleeds. Associations were strongest for people with greater variability in INR.
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Affiliation(s)
- Saloua Akoudad
- From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.)
| | - Sirwan K L Darweesh
- From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.)
| | - Maarten J G Leening
- From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.)
| | - Peter J Koudstaal
- From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.)
| | - Albert Hofman
- From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.)
| | - Aad van der Lugt
- From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.)
| | - Bruno H Stricker
- From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.)
| | - M Arfan Ikram
- From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.)
| | - Meike W Vernooij
- From the Departments of Epidemiology (S.A., S.K.L.D., M.J.G.L., A.H., B.H.S., M.A.I., M.W.V.), Radiology (S.A., A.v.d.L., M.A.I., M.W.V.), Neurology (S.A., P.J.K., M.A.I.), and Cardiology (M.J.G.L.), Erasmus MC, Rotterdam, the Netherlands; and Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.).
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de Keyser CE, Leening MJG, Romio SA, Jukema JW, Hofman A, Ikram MA, Franco OH, Stijnen T, Stricker BH. Comparing a marginal structural model with a Cox proportional hazard model to estimate the effect of time-dependent drug use in observational studies: statin use for primary prevention of cardiovascular disease as an example from the Rotterdam Study. Eur J Epidemiol 2014; 29:841-50. [DOI: 10.1007/s10654-014-9951-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
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