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Ärnlöv, Johan
Alternative names
Publications (10 of 181) Show all publications
Griswold, M., Fullman, N., Hawley, C., Arian, N., Zimsen, S., Tymeson, H., . . . Gakidou, E. (2018). Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 392(10152), 1015-1035
Open this publication in new window or tab >>Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016
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2018 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10152, p. 1015-1035Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.

METHODS: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.

FINDINGS: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5-3·0) of age-standardised female deaths and 6·8% (5·8-8·0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2-4·3) of female deaths and 12·2% (10·8-13·6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2·3% (95% UI 2·0-2·6) and male attributable DALYs were 8·9% (7·8-9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0-1·7] of total deaths), road injuries (1·2% [0·7-1·9]), and self-harm (1·1% [0·6-1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2-33·3) of total alcohol-attributable female deaths and 18·9% (15·3-22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0-0·8) standard drinks per week.

INTERPRETATION: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

FUNDING: Bill & Melinda Gates Foundation.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-363656 (URN)10.1016/S0140-6736(18)31310-2 (DOI)000445098800025 ()30146330 (PubMedID)
Available from: 2018-11-02 Created: 2018-11-02 Last updated: 2018-12-12Bibliographically approved
Wuopio, J., Hilden, J., Bring, C., Kastrup, J., Sajadieh, A., Jensen, G. B., . . . Ärnlöv, J. (2018). Cathepsin B and S as markers for cardiovascular risk and all-cause mortality in patients with stable coronary heart disease during 10 years: a CLARICOR trial sub-study.. Atherosclerosis, 278, 97-102, Article ID S0021-9150(18)31367-4.
Open this publication in new window or tab >>Cathepsin B and S as markers for cardiovascular risk and all-cause mortality in patients with stable coronary heart disease during 10 years: a CLARICOR trial sub-study.
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2018 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 278, p. 97-102, article id S0021-9150(18)31367-4Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND AND AIMS: The lysosomal cysteine proteases cathepsin B and S have been implicated in the atherosclerotic process. The present paper investigates the association between serum levels of cathepsin B and S and cardiovascular events and mortality in patients with stable coronary heart disease.

METHODS: The CLARICOR trial is a randomised, placebo-controlled trial investigating the effect of clarithromycin versus placebo in patients with stable coronary heart disease. The outcome was time to either a cardiovascular event or all-cause mortality. The placebo group was used as discovery sample and the clarithromycin group as replication sample: n = 1998, n = 1979; mean age (years) 65, 65; 31%, 30% women; follow-up for 10 years; number of composite outcomes n = 1204, n = 1220; respectively. We used a pre-defined multivariable Cox regression model adjusting for inflammation, established cardiovascular risk factors, kidney function, and use of cardiovascular drugs.

RESULTS: Cathepsin B was associated with an increased risk of the composite outcome in both samples after multivariable adjustment (discovery: multivariable ratio (HR) per standard deviation increase 1.12, 95% confidence interval (CI) 1.05-1.19, p < 0.001, replication; HR 1.14, 95% CI 1.07-1.21, p < 0.001). There was no significant association between cathepsin S and the composite outcome in either the discovery or replication sample after multivariable adjustment (p>0.45). Secondary analyses suggest that cathepsin B was predominantly associated with mortality rather than specific cardiovascular events.

CONCLUSIONS: Cathepsin B, but not serum cathepsin S, was associated with an increased risk of cardiovascular events in patients with stable coronary heart disease. The clinical implications of our findings remain to be established.

Keywords
Cardiovascular biomarker, Cardiovascular risk, Cathepsin, Coronary heart disease, Ischemic heart disease, Mortality
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-363384 (URN)10.1016/j.atherosclerosis.2018.09.006 (DOI)30261474 (PubMedID)
Available from: 2018-10-17 Created: 2018-10-17 Last updated: 2019-01-23Bibliographically approved
Ruge, T., Carlsson, A. C., Ingelsson, E., Risérus, U., Sundström, J., Larsson, A., . . . Ärnlöv, J. (2018). Circulating endostatin and the incidence of heart failure.. Scandinavian Cardiovascular Journal, 1-6
Open this publication in new window or tab >>Circulating endostatin and the incidence of heart failure.
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2018 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, p. 1-6Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: Circulating levels of endostatin are elevated in many underlying conditions leading to heart failure such as hypertension, diabetes, chronic kidney disease and ischemic heart disease. Yet, the association between endostatin and the incidence of heart failure has not been reported previously in the community.

DESIGN: We investigated the longitudinal association between serum endostatin levels and incident heart failure in two community-based cohorts of elderly: Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS, n = 966; mean age 70 years, 51% women, 81 events, mean follow-up 10 years) and Uppsala Longitudinal Study of Adult Men (ULSAM, n = 747 men; mean age 78 years, 98 heart failure events, mean follow-up 8 years). We also investigated the cross-sectional association between endostatin and echocardiographic left ventricular systolic function and diastolic function (ejection fraction and E/A-ratio, respectively).

RESULTS: Higher serum endostatin was associated with an increased risk for heart failure in both cohorts after adjustment for established heart failure risk factors, glomerular filtration rate and N-terminal pro-brain natriuretic peptide (NT-proBNP) (PIVUS: multivariable hazard ratio (HR) per 1-standard deviation (SD) increase, HR 1.46 (95%CI, 1.17-1.82, p < .001); ULSAM: HR 1.29 (95%CI, 1.00-1.68, p < .05). In cross-sectional analyses at baseline, higher endostatin was significantly associated with both worsened left ventricular systolic and diastolic function in both cohorts. Conclusion Higher serum endostatin was associated with left ventricular dysfunction and an increased heart failure risk in two community-based cohorts of elderly. Our findings encourage further experimental studies that investigate the role of endostatin in the development of heart failure.

Keywords
Heart failure, angiogenesis, anti-angiogenesis, epidemiology, left ventricular systolic function, population based studies, remodelling of extracellular matrix
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-363655 (URN)10.1080/14017431.2018.1483080 (DOI)29893146 (PubMedID)
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2019-01-23Bibliographically approved
Corsonello, A., Tap, L., Roller-Wirnsberger, R., Wirnsberger, G., Zoccali, C., Kostka, T., . . . Lattanzio, F. (2018). Design and methodology of the screening for CKD among older patients across Europe (SCOPE) study: a multicenter cohort observational study. BMC Nephrology, 19, Article ID 260.
Open this publication in new window or tab >>Design and methodology of the screening for CKD among older patients across Europe (SCOPE) study: a multicenter cohort observational study
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2018 (English)In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 19, article id 260Article in journal (Refereed) Published
Abstract [en]

Background: Decline of renal function is common in older persons and the prevalence of chronic kidney disease (CKD) is rising with ageing. CKD affects different outcomes relevant to older persons, additionally to morbidity and mortality which makes CKD a relevant health burden in this population. Still, accurate laboratory measurement of kidney function is under debate, since current creatinine-based equations have a certain degree of inaccuracy when used in the older population. The aims of the study are as follows: to assess kidney function in a cohort of 75+ older persons using existing methodologies for CKD screening; to investigate existing and innovative biomarkers of CKD in this cohort, and to align laboratory and biomarker results with medical and functional data obtained from this cohort. The study was registered at ClinicalTrials.gov, identifier NCT02691546, February 25th 2016. Methods/design: An observational, multinational, multicenter, prospective cohort study in community dwelling persons aged 75 years and over, visiting the outpatient clinics of participating institutions. The study will enroll 2450 participants and is carried out in Austria, Germany, Israel, Italy, the Netherlands, Poland and Spain. Participants will undergo clinical and laboratory evaluations at baseline and after 12 and 24 months-follow-up. Clinical evaluation also includes a comprehensive geriatric assessment (CGA). Local laboratory will be used for 'basic' parameters (including serum creatinine and albumin-to-creatinine ratio), whereas biomarker assessment will be conducted centrally. An intermediate telephone follow-up will be carried out at 6 and 18 months. Discussion: Combining the use of CGA and the investigation of novel and existing independent biomarkers within the SCOPE study will help to provide evidence in the development of European guidelines and recommendations in the screening and management of CKD in older people.

Place, publisher, year, edition, pages
BMC, 2018
Keywords
Chronic kidney disease, Older people, Disability, Frailty, Ageing
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-369107 (URN)10.1186/s12882-018-1030-2 (DOI)000447187600005 ()30309342 (PubMedID)
Funder
EU, Horizon 2020, 634869
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2018-12-17Bibliographically approved
Corsonello, A., Roller-Wirnsberger, R., Di Rosa, M., Fabbietti, P., Wirnsberger, G., Kostka, T., . . . Lattanzio, F. (2018). Estimated glomerular filtration rate and functional status among older people: A systematic review. European journal of internal medicine, 56, 39-48
Open this publication in new window or tab >>Estimated glomerular filtration rate and functional status among older people: A systematic review
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2018 (English)In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 56, p. 39-48Article, review/survey (Refereed) Published
Abstract [en]

Background: The association between chronic kidney disease (CKD) and functional status may change as a function of the equation used to estimate glomerular filtration rate (eGFR). We reviewed the predictive value of different eGFR equations in regard to frailty and disability outcomes. Methods: We searched Pubmed from inception to March 2018 for studies investigating the association between eGFR and self-reported and/or objective measures of frailty or disability. Cross-sectional and longitudinal studies were separately analysed. Results: We included 16 studies, one of which reporting both cross-sectional and longitudinal data. Three out of 7 cross-sectional studies compared different eGFR equations in regard to their association with functional status: two studies showed that cystatin C-based, but not creatinine-based eGFR may be associated with hand-grip strength or frailty; another study showed that two different creatinine-based eGFR equations may be similarly associated with disability. Four out of 10 longitudinal studies provided comparative data: two studies reported similar association with disability for different creatinine-based eGFR equations; one study showed that creatinine-based eGFR was not associated with frailty, but a not significant trend for association was observed with cystatin C-based eGFR; one study showed that cystatin C-based but not creatinine-based eGFR may predict incident mobility disability, while both methods may predict gait speed decline. High heterogeneity was observed in regard to confounders included in reviewed studies. None of them included the most recently published equations. Conclusion: Available data do not support the superiority of one of the eGFR equations in terms of measuring or predicting functional decline.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Estimated glomerular filtration rate (eGFR), Creatinine, Cystatin C, Frailty, Disability
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-368372 (URN)10.1016/j.ejim.2018.05.030 (DOI)000446216600007 ()29936073 (PubMedID)
Funder
EU, Horizon 2020, 634869
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2018-12-05Bibliographically approved
Lind, L., Sundström, J., Ärnlöv, J. & Lampa, E. (2018). Impact of Aging on the Strength of Cardiovascular Risk Factors: A Longitudinal Study Over 40 Years. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(1), Article ID e007061.
Open this publication in new window or tab >>Impact of Aging on the Strength of Cardiovascular Risk Factors: A Longitudinal Study Over 40 Years
2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 1, article id e007061Article in journal (Refereed) Published
Abstract [en]

Background-The knowledge of the impact of cardiovascular risk factors at different ages has mainly been based on different studies performed at different ages. This study aimed to investigate the change in impact of traditional cardiovascular risk factors over the aging process in subjects followed for 4 decades. Methods and Results-In the ULSAM (Uppsala Longitudinal Study of Adult Men) study, 2322 men originally investigated in 1970 to 1974 have been followed regarding cardiovascular diseases until the end of 2013. This cohort has been investigated physically at ages 50, 60, 70, 77, and 82 years regarding body mass index, low-density lipoprotein-and high-density lipoprotein-cholesterol, triglycerides, systolic blood pressure and diastolic blood pressure, fasting glucose, and smoking. These data were used to model the interactions between risk factors and age regarding incident myocardial infarction (n=540), ischemic stroke (n=343), or heart failure (n=397). Significant interactions were observed between age and the set of traditional risk factors regarding all 3 outcomes (P<0.05 for all). Generally, a decline in the rate ratios was seen with aging for most risk factors, being most pronounced for body mass index regarding myocardial infarction and for systolic blood pressure regarding ischemic stroke and heart failure. However, low-density lipoprotein-cholesterol was significantly related to incident myocardial infarction, whereas both body mass index and fasting glucose were significantly related to incident heart failure also at a high age. Conclusions-Using a longitudinal design in middle-aged men spanning 4 decades showed that the impact of traditional cardiovascular risk factors generally declined with aging. However, some of the risk factors remained significantly associated with incident cardiovascular disease also at old age.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
blood pressure, cardiovascular disease, lipids and cholesterol, obesity, risk factor
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-351062 (URN)10.1161/JAHA.117.007061 (DOI)000428139900011 ()
Funder
Swedish Research Council
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-05-30Bibliographically approved
Wandell, P., Carlsson, A. C., Holzmann, M. J., Ärnlöv, J., Sundquist, J. & Sundquist, K. (2018). The association between relevant co-morbidities and prevalent as well as incident heart failure in patients with atrial fibrillation. Journal of Cardiology, 72(1-2), 26-32
Open this publication in new window or tab >>The association between relevant co-morbidities and prevalent as well as incident heart failure in patients with atrial fibrillation
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2018 (English)In: Journal of Cardiology, ISSN 0914-5087, E-ISSN 1876-4738, Vol. 72, no 1-2, p. 26-32Article in journal (Refereed) Published
Abstract [en]

Background: Congestive heart failure (CHF) is a serious complication in patients with atrial fibrillation (AF). Objective: To study associations between relevant co-morbidities and CHF in patients with AF. Methods: Study population included all adults (n = 12,283) >= 45 years diagnosed with AF at 75 primary care centers in Sweden 2001-2007. Logistic regression was used to calculate odds ratios with 95% confidence intervals (Cls) for the associations between co-morbidities, and prevalent CHF. In a subsample (n = 9424), (excluding patients with earlier CHF), Cox regression was used to estimate hazard ratios with 95% as for the association between co-morbidities, and a first hospital diagnosis of CHF, after adjustment for age and socio-economic factors. Results: During 5.4 years' follow-up (standard deviation 2.5), 2259 patients (24.0%; 1135 men, 21.8%, and 1124 women, 26.7%) were diagnosed with CHF. Patients with hypertension were less likely to have CHF, while a diagnosis of coronary heart disease, valvular heart disease, diabetes, or chronic obstructive pulmonary disease (COPD), was consistently associated with CHF among men and women. CHF was more common among women with depression. The relative fully adjusted risk of incident CHF was increased for the following diseases in men with AF: valvular heart disease, cardiomyopathy, and diabetes; and for the following diseases in women: valvular heart disease, diabetes, obesity, and COPD. The corresponding risk was decreased among women for hypertension. Conclusions: In this clinical setting we found hypertension to be associated with a decreased risk of CHF among women; valvular heart disease and diabetes to be associated with an increased risk of CHF in both sexes; and cardiomyopathy to be associated with an increased risk of CHF among men. (C) 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Atrial fibrillation, Congestive heart failure, Gender, Hypertension
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-364012 (URN)10.1016/j.jjcc.2017.12.010 (DOI)000442063100004 ()29358024 (PubMedID)
Funder
Swedish Research CouncilForte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2018-10-30Bibliographically approved
Carrero, J. J., Grams, M. E., Sang, Y., Ärnlöv, J., Gasparini, A., Matsushita, K., . . . Coresh, J. (2017). Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality. Kidney International, 91(1), 244-251
Open this publication in new window or tab >>Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality
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2017 (English)In: Kidney International, ISSN 0085-2538, E-ISSN 1523-1755, Vol. 91, no 1, p. 244-251Article in journal (Refereed) Published
Abstract [en]

Current guidelines for chronic kidney disease (CKD) recommend using albuminuria as well as estimated glomerular filtration rate (eGFR) to stage CKD. However, CKD progression is solely defined by change in eGFR with little regard to the risk implications of change in albuminuria. This is an observational study from the Stockholm CREAtinine Measurements (SCREAM) project, a health care utilization cohort from Stockholm, Sweden, with laboratory measures from 2006-2011 and follow-up through December 2012. Included were 31,732 individuals with two or more ambulatory urine albumin to creatinine ratio (ACR) tests. We assessed the association between change in ACR during a baseline period of 1, 2, or 3 years and end-stage renal disease (ESRD) or death. Using a 2-year baseline period, there were 378 ESRD events and 1712 deaths during a median of 3 years of follow-up. Compared to stable ACR, a 4-fold increase in ACR was associated with a 3.08-times (95% confidence interval 2.59 to 3.67) higher risk of ESRD while a 4-fold decrease in ACR was associated with a 0.34-times (0.26 to 0.45) lower risk of ESRD. Similar associations were found in people with and without diabetes mellitus, with and without hypertension, and also when adjusted for the change in eGFR during the same period. The association between change in ACR and mortality was weaker: ACR increase was associated with mortality, but the relationship was largely flat for ACR decline. Results were consistent for 1-, 2-, and 3-year ACR changes. Thus, changes in albuminuria are strongly and consistently associated with the risk of ESRD and death.

Keywords
albuminuria, changes in albuminuria, death, end-stage renal disease, estimated glomerular filtration rate
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:uu:diva-315067 (URN)10.1016/j.kint.2016.09.037 (DOI)000391162700028 ()27927597 (PubMedID)
Funder
Stockholm County CouncilSwedish Heart Lung FoundationSwedish Research CouncilMarianne and Marcus Wallenberg Foundation
Available from: 2017-02-28 Created: 2017-02-28 Last updated: 2017-11-29Bibliographically approved
Roos, V., Elmstahl, S., Ingelsson, E., Sundström, J., Ärnlöv, J. & Lind, L. (2017). Alterations in Multiple Lifestyle Factors in Subjects with the Metabolic Syndrome Independently of Obesity. Metabolic Syndrome and Related Disorders, 15(3), 118-123
Open this publication in new window or tab >>Alterations in Multiple Lifestyle Factors in Subjects with the Metabolic Syndrome Independently of Obesity
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2017 (English)In: Metabolic Syndrome and Related Disorders, ISSN 1540-4196, E-ISSN 1557-8518, Vol. 15, no 3, p. 118-123Article in journal (Refereed) Published
Abstract [en]

Background: Many lifestyle factors have been associated with the metabolic syndrome (MetS). However, most of these studies have not considered the potential impact of obesity and have often only investigated one lifestyle factor at the time. We aimed to investigate the interplay between body mass index (BMI) and MetS with respect to multiple lifestyle factors. Methods: BMI and MetS [National Cholesterol Education Program (NCEP)/Adult Treatment Panel III criteria] were assessed in a sample of 18,880 subjects aged 45-75 years from the population-based EpiHealth study. Participants were categorized into six groups according to BMI category (normal weight/BMI <25 kg/m(2), overweight/BMI 25-30 kg/m(2), and obesity/BMI > 30 kg/m(2)) and MetS status (+/-, NCEP criteria). A wide range of lifestyle factors related to physical activity, smoking, alcohol, sleep quality, working conditions, quality of life and stress, and eating patterns were assessed using a questionnaire. Results: Prevalent MetS (23% in the sample) was associated with less physical activity (P < 0.0001), more TV watching (P < 0.0001), more years of smoking (P < 0.0001), lower education level (P = 0.007), and experiencing a poor general quality of life (P < 0.0001). These lifestyle factors were all associated with MetS, independently of each other and independently of BMI. Similar results were generated when number of MetS components and presence/absence of individual MetS components were used as outcomes. Conclusions: This cross-sectional study identified alterations in a number of lifestyle factors associated with MetS independently of each other and independently of BMI. Future longitudinal studies are needed to assess causal and temporal relationships between lifestyle factors and MetS development.

Keywords
metabolic syndrome, obesity, lifestyle factors, MHO
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-321438 (URN)10.1089/met.2016.0120 (DOI)000397585500003 ()28339343 (PubMedID)
Available from: 2017-05-09 Created: 2017-05-09 Last updated: 2017-05-09Bibliographically approved
Wandell, P., Carlsson, A. C., Holzmann, M., Ärnlöv, J., Johansson, S.-E., Sundquist, J. & Sundquist, K. (2017). Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation-a cohort study in primary care. European Journal of Clinical Pharmacology, 73(2), 215-221
Open this publication in new window or tab >>Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation-a cohort study in primary care
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2017 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 73, no 2, p. 215-221Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to study the association between antithrombotic treatment and risk of hemorrhagic stroke (HS) in patients with atrial fibrillation (AF) treated in primary health care. Study population included all adults (n = 12,215) 45 years and older diagnosed with AF at 75 primary care centers in Sweden 2001-2007. Outcome was defined as a first hospital episode with a discharge episode of HS after the AF diagnosis. Association between HS and persistent treatment with antithrombotic agents (warfarin, acetylsalicylic acid (ASA), clopidogrel) was explored using Cox regression analysis, with hazard ratios (HRs) and 95 % CIs. Adjustment was made for age, socioeconomic status, and co-morbid cardiovascular conditions. During a mean of 5.8 years (SD 2.4) of follow-up, 162 patients (1.3 %; 67 women and 95 men) with HS were recorded. The adjusted risk associated with persistent warfarin treatment compared to no antithrombotic treatment consistently showed no increased HS risk, HR for women 0.53 (95 % CI 0.23-1.27) and for men 0.55 (95 % CI 0.29-1.04); corresponding HRs for ASA were, for women, 0.45 (95 % CI 0.14-1.44) and, for men, 0.56 (95 % CI 0.24-1.29). In this clinical setting, we found no evidence pointing to an increased risk of HS with antithrombotic treatment.

Keywords
Atrial fibrillation, Hemorrhagic stroke, Gender, Cardiovascular co-morbidity, Anticoagulants, Mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-316015 (URN)10.1007/s00228-016-2152-8 (DOI)000392308200010 ()27826643 (PubMedID)
Funder
Swedish Research Council, K2012-70X-15428-08-3
Available from: 2017-02-24 Created: 2017-02-24 Last updated: 2017-11-29Bibliographically approved
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