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Sundström, J., Björkelund, C., Giedraitis, V., Hansson, P.-O., Högman, M., Janson, C., . . . Svennblad, B. (2019). Rationale for a Swedish cohort consortium. Upsala Journal of Medical Sciences, 124(1), 21-28
Open this publication in new window or tab >>Rationale for a Swedish cohort consortium
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2019 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 124, no 1, p. 21-28Article in journal (Refereed) Published
Abstract [en]

We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2019
Keywords
Common infrastructure, epidemiological research, pilot study, rare outcomes, Swedish cohort consortium
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-381205 (URN)10.1080/03009734.2018.1556754 (DOI)000461811100006 ()30618330 (PubMedID)
Available from: 2019-04-10 Created: 2019-04-10 Last updated: 2019-04-10Bibliographically approved
Stilling, F., Wolk, A., Religa, D., Leppert, J., Bergkvist, L., Michaëlsson, K. & Larsson, S. C. (2018). Adipose tissue fatty acid composition and cognitive impairment. Nutrition (Burbank, Los Angeles County, Calif.), 54, 153-157
Open this publication in new window or tab >>Adipose tissue fatty acid composition and cognitive impairment
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2018 (English)In: Nutrition (Burbank, Los Angeles County, Calif.), ISSN 0899-9007, E-ISSN 1873-1244, Vol. 54, p. 153-157Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to examine the association among adipose tissue eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), and the ratios of EPA to AA and DHA to AA with impaired cognitive function.

Methods: This cross-sectional analysis comprised 481 men participating in the Cohort of Swedish Men Clinical and for whom adipose tissue fatty acid composition and results from a telephone-based cognitive test were available. Impaired cognitive function was defined using a predefined cutoff on the cognitive test. Binomial log-linear regression models were used to estimate prevalence ratios. In secondary analyses, Cox proportional hazards models were used to estimate relative risk for incident dementia ascertained by linkage with population-based registers.

Results: We observed a graded reduction in the prevalence of impaired cognitive function across tertiles of adipose tissue EPA/AA- ratio (P-trend = 0.01); compared with the lowest tertile, the multivariable-adjusted prevalence ratios were, respectively, 0.89 (95% confidence interval [CI], 0.67-1.17) and 0.64 (95% CI, 0.45-0.91) for the second and third tertiles. EPA, DHA, and the DHA/AA ratio showed similar patterns of association; however, the CIs included the null. AA alone was not associated with impaired cognitive function. Although with lower precision, estimates obtained from the prospective analysis were broadly consistent with the main analysis.

Conclusions: Findings from this study suggest that a high ratio of EPA to AA in adipose tissue may be associated with better cognitive function. A similar association was observed with EPA, DHA, and the ratio of DHA to AA, but the results did not exclude a null association.

Keywords
Cognitive impairment, omega-3 Fatty acids, Biomarker, Adipose tissue, Aging
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-366941 (URN)10.1016/j.nut.2018.04.006 (DOI)000445322100022 ()29982142 (PubMedID)
Funder
EU, Horizon 2020, 633589Swedish Research Council, 2015-05997Swedish Research Council, 2012-2291
Available from: 2018-11-27 Created: 2018-11-27 Last updated: 2018-11-27Bibliographically approved
Nilsson, G., Hedberg, P., Leppert, J. & Öhrvik, J. (2018). Basic Anthropometric Measures in Acute Myocardial Infarction Patients and Individually Sex- and Age-Matched Controls from the General Population. Journal of Obesity, Article ID 3839482.
Open this publication in new window or tab >>Basic Anthropometric Measures in Acute Myocardial Infarction Patients and Individually Sex- and Age-Matched Controls from the General Population
2018 (English)In: Journal of Obesity, ISSN 2090-0708, E-ISSN 2090-0716, article id 3839482Article in journal (Refereed) Published
Abstract [en]

We compared weight, height, waist and hip circumferences (hip), body mass index (BMI), and waist-to-hip ratio in acute myocardial infarction (MI) patients and individually sex-and age-matched control subjects from the general population in the catchment area of the patients and predicted the risk of MI status by these basic anthropometric measures. The study cohort comprised 748 patients <= 80 years of age with acute MI from a major Swedish cardiac center and their individually sex- and age-matched controls. The analyses were stratified for sex and age (<= 65/>= 66 years). Risk of MI was assessed by conditional logistic regression. A narrow hip in men >66 years was the single strongest risk factor of MI among the anthropometric measures. The combination of hip and weight was particularly efficient in discriminating men >= 66 years with MI from their controls (area under the receiver operating characteristic (AUROC) curve = 0.82). In men <= 65 years, the best combination was hip, BMI, and height (AUROC = 0.79). In women >= 66 years, the best discriminatory model contained only waist-to-hip ratio (AUROC = 0.67), whereas in women <= 65 years, the best combination was hip and BMI (AUROC = 0.68). A narrow hip reasonably reflects small gluteal muscles. This finding might suggest an association between MI and sarcopenia, possibly related to deficiencies in physical activity and nutrition.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-371133 (URN)10.1155/2018/3839482 (DOI)000451233500001 ()30533220 (PubMedID)
Note

Corrigendum in: Journal of Obesity, Volume 2018, Article ID 3126805, https://doi.org/10.1155/2018/3126805

Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2019-01-17Bibliographically approved
Doerstling, S., Hedberg, P., Öhrvik, J., Leppert, J. & Henriksen, E. (2018). Growth differentiation factor 15 in a community-based sample: age-dependent reference limits and prognostic impact. Upsala Journal of Medical Sciences, 123(2), 86-93
Open this publication in new window or tab >>Growth differentiation factor 15 in a community-based sample: age-dependent reference limits and prognostic impact
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2018 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 2, p. 86-93Article in journal (Refereed) Published
Abstract [en]

Background: Despite the growing body of evidence on growth differentiation factor 15 (GDF-15) reference values for patients with existing cardiovascular disease, limited investigation has been dedicated to characterizing the distribution and prognostic impact of GDF-15 in predominantly healthy populations. Furthermore, current cutoff values for GDF-15 fail to account for the well-documented age-dependence of circulating GDF-15. Methods: From 810 community-dwelling older adults, we selected a group of apparently healthy participants (n = 268). From this sample, circulating GDF-15 was modeled using the generalized additive models for location scale and shape (GAMLSS) to develop age-dependent centile values. Unadjusted and adjusted Cox proportional hazards models were used to assess the association between the derived GDF-15 reference values (expressed as centiles) and all-cause mortality. Results: Smoothed centile curves showed increasing GDF-15 with age in the apparently healthy participants. An approximately three-fold difference was observed between the 95th and 5th GDF-15 centiles across ages. In a median 8.0 years of follow-up, 97 all-cause deaths were observed in 806 participants with eligible values. In unadjusted Cox regression analyses, the hazard ratio (95% CI) for all-cause mortality per 25-unit increase in GDF-15 centile was 1.80 (1.48-2.20) and dichotomized at the 95th centile, >= 95th versus <95th, was 3.04 (1.99-4.65). Age-dependent GDF-15 centiles remained a significant predictor of all-cause mortality in all subsequent adjusted models. Conclusions: Age-dependent GDF-15 centile values developed from a population of apparently healthy older adults are independently predictive of all-cause mortality. Therefore, GDF-15 reference values could be a useful tool for risk-stratification in a clinical setting.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
All-cause mortality, GDF-15, reference values, survival analysis, protein biomarkers
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-360558 (URN)10.1080/03009734.2018.1460427 (DOI)000438159000003 ()29714603 (PubMedID)
Funder
Swedish Society of Medicine
Available from: 2018-09-14 Created: 2018-09-14 Last updated: 2018-09-14Bibliographically approved
Calais, F., Ostman, M. E., Hedberg, P., Karlsson, A., Leppert, J. & Fröbert, O. (2018). Incremental prognostic value of coronary and systemic atherosclerosis after myocardial infarction. International Journal of Cardiology, 261, 6-11
Open this publication in new window or tab >>Incremental prognostic value of coronary and systemic atherosclerosis after myocardial infarction
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 261, p. 6-11Article in journal (Refereed) Published
Abstract [en]

Background: The role of systemic atherosclerosis in myocardial infarction (MI) patients is not fully understood. We investigated the incremental prognostic value of coronary and systemic atherosclerosis after acute MI by estimating extra-cardiac artery disease (ECAD) and extent of coronary atherosclerosis.

Methods and results: The study included 544 prospective MI patients undergoing coronary angiography. For all patients, the longitudinal coronary atherosclerotic extent, expressed as Sullivan extent score (SES) was calculated. In addition, the patients underwent non-invasive screening for ECAD in the carotid, aortic, renal and lower limb. SES was found to be associated with ECAD independent of baseline clinical parameters [adjusted odds ratio (OR) 1.04 95% confidence interval (CI) 1.02–1.06, P < 0.001]. Extensive systemic atherosclerosis, defined as the combination of extensive coronary disease (SES ≥ 17) and ECAD, was associated with higher risk for all-cause mortality compared to limited systemic atherosclerosis (SES < 17 and no ECAD) (hazard ratio [HR] 2.9 95% CI 1.9–4.5, P < 0.001, adjusted for Global Registry of Acute Coronary Events risk score parameters 1.8, 95% CI 1.1–3.0, P = 0.019). The risk for the composite endpoint of cardiovascular death or hospitalization was significantly higher in patients with extensive systemic atherosclerosis compared to patients with limited systemic atherosclerosis (HR 3.1, 95% CI 2.1–4.7, P < 0.001, adjusted HR 1.9, 95% CI 1.2–3.1, P < 0.004).

Conclusions: Visual estimation of the longitudinal coronary atherosclerotic extent at the time of MI predicts ECAD. Coexistence of extensive coronary disease and ECAD defines a group with particularly poor prognosis after MI.

Keywords
Atherosclerosis, Myocardial infarction, Coronary artery disease, Extra-cardiac artery disease, Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-353355 (URN)10.1016/j.ijcard.2018.02.035 (DOI)000430081000002 ()29657058 (PubMedID)
Available from: 2018-06-12 Created: 2018-06-12 Last updated: 2018-06-12Bibliographically approved
Nowak, C., Carlsson, A. C., Östgren, C. J., Nyström, F. H., Alam, M., Feldreich, T., . . . Ärnlöv, J. (2018). Multiplex proteomics for prediction of major cardiovascular events in type 2 diabetes. Diabetologia, 61(8), 1748-1757
Open this publication in new window or tab >>Multiplex proteomics for prediction of major cardiovascular events in type 2 diabetes
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2018 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, no 8, p. 1748-1757Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis Multiplex proteomics could improve understanding and risk prediction of major adverse cardiovascular events (MACE) in type 2 diabetes. This study assessed 80 cardiovascular and inflammatory proteins for biomarker discovery and prediction of MACE in type 2 diabetes. Methods We combined data from six prospective epidemiological studies of 30-77-year-old individuals with type 2 diabetes in whom 80 circulating proteins were measured by proximity extension assay. Multivariable-adjusted Cox regression was used in a discovery/replication design to identify biomarkers for incident MACE. We used gradient-boosted machine learning and lasso regularised Cox regression in a random 75% training subsample to assess whether adding proteins to risk factors included in the Swedish National Diabetes Register risk model would improve the prediction of MACE in the separate 25% test subsample. Results Of 1211 adults with type 2 diabetes (32% women), 211 experienced a MACE over a mean (+/- SD) of 6.4 +/- 2.3 years. We replicated associations (< 5% false discovery rate) between risk of MACE and eight proteins: matrix metalloproteinase (MMP)-12, IL-27 subunit alpha (IL-27a), kidney injury molecule (KIM)-1, fibroblast growth factor (FGF)-23, protein S100-A12, TNF receptor (TNFR)-1, TNFR-2 and TNF-related apoptosis-inducing ligand receptor (TRAIL-R)2. Addition of the 80-protein assay to established risk factors improved discrimination in the separate test sample from 0.686 (95% CI 0.682, 0.689) to 0.748 (95% CI 0.746, 0.751). A sparse model of 20 added proteins achieved a C statistic of 0.747 (95% CI 0.653, 0.842) in the test sample. Conclusions/interpretation We identified eight protein biomarkers, four of which are novel, for risk of MACE in community residents with type 2 diabetes, and found improved risk prediction by combining multiplex proteomics with an established risk model. Multiprotein arrays could be useful in identifying individuals with type 2 diabetes who are at highest risk of a cardiovascular event.

Place, publisher, year, edition, pages
SPRINGER, 2018
Keywords
Biomarkers, Major adverse cardiovascular event, Proteomics, Risk, Type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-361262 (URN)10.1007/s00125-018-4641-z (DOI)000437432200006 ()29796748 (PubMedID)
Funder
EU, Horizon 2020, 634869Swedish Research Council, 2012-2215Swedish Research Council, 2015-03477Swedish Society of MedicineSwedish Heart Lung Foundation
Available from: 2018-10-11 Created: 2018-10-11 Last updated: 2018-10-11Bibliographically approved
Nowak, C., Carlsson, A. C., Östgren, C. J., Nyström, F. H., Alam, M., Feldreich, T. R., . . . Arnlöv, J. (2018). Multiplex proteomics for prediction of major cardiovascular events in type 2 diabetes. Paper presented at 54th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), OCT 01-05, 2018, Berlin, GERMANY. Diabetologia, 61, S65-S65
Open this publication in new window or tab >>Multiplex proteomics for prediction of major cardiovascular events in type 2 diabetes
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2018 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, p. S65-S65Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Springer, 2018
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-367131 (URN)000443556001125 ()
Conference
54th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), OCT 01-05, 2018, Berlin, GERMANY
Funder
Swedish Research CouncilEU, Horizon 2020Swedish Heart Lung Foundation
Available from: 2018-11-30 Created: 2018-11-30 Last updated: 2018-11-30Bibliographically approved
Hysing, P., Jonason, T., Leppert, J. & Hedberg, P. (2018). Prevalence and prognostic impact of electrocardiographic abnormalities in outpatients with extracardiac artery disease. Clinical Physiology and Functional Imaging, 38(5), 823-829
Open this publication in new window or tab >>Prevalence and prognostic impact of electrocardiographic abnormalities in outpatients with extracardiac artery disease
2018 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 38, no 5, p. 823-829Article in journal (Refereed) Published
Abstract [en]

Identifying cardiac disease in patients with extracardiac artery disease (ECAD) is essential for clinical decision-making. Electrocardiography (ECG) is an easily accessible tool to unmask subclinical cardiac disease and to risk stratify patient with or without manifest cardiovascular disease (CV). We aimed to examine the prevalence and prognostic impact of ECG changes in outpatients with ECAD. Outpatients with carotid or lower extremity artery disease (n = 435) and community-based controls (n = 397) underwent resting ECG. The patients were followed during a median of 4.8 years for CV events (hospitalization or death caused by ischaemic heart disease, cardiac arrest, heart failure, or stroke). ECG abnormalities were classified according to the Minnesota Code. Major (33% versus 15%, P<0.001) but not minor ECG abnormalities (23% versus 26%, P = 0.42) were significantly more common in patients versus controls. During the follow-up, 141 patients experienced CV events. Both major ECG abnormalities [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.11-2.25, P = 0.012] and any ECG abnormalities (HR 1.57, 95% CI 1.06-2.33, P = 0.024) were significantly associated with CV events after adjustment for potential risk factors. In conclusion, ECG abnormalities were common in these outpatients with ECAD. Major and any ECG abnormalities were independent predictors of CV events. Addition of easily accessible ECG information might be useful in risk stratification for such patients.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
carotid artery disease, electrocardiography, peripheral artery disease, prevalence, prognosis
National Category
Cardiac and Cardiovascular Systems Physiology
Identifiers
urn:nbn:se:uu:diva-362485 (URN)10.1111/cpf.12488 (DOI)000440988100011 ()29171136 (PubMedID)
Funder
Erik, Karin och Gösta Selanders FoundationThe Swedish Medical Association
Available from: 2018-10-10 Created: 2018-10-10 Last updated: 2018-10-10Bibliographically approved
Calais, F., Ostman, M. E., Hedberg, P., Karlsson, A., Leppert, J. & Fröbert, O. (2018). Reply to "Letter to editor, Assessing the effect of coronary and systemic atherosclerosis following myocardial infarction" by dr Su Yueqiu et al. [Letter to the editor]. International Journal of Cardiology, 271, 29-29
Open this publication in new window or tab >>Reply to "Letter to editor, Assessing the effect of coronary and systemic atherosclerosis following myocardial infarction" by dr Su Yueqiu et al.
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 271, p. 29-29Article in journal, Letter (Other academic) Published
Keywords
Atherosclerosis, Myocardial infarction, Coronary artery disease, Extra-cardiac artery disease, Prognosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-366381 (URN)10.1016/j.ijcard.2018.06.047 (DOI)000444611600012 ()30223358 (PubMedID)
Available from: 2018-11-21 Created: 2018-11-21 Last updated: 2018-11-21Bibliographically approved
Hellström, C., Wagner, P., Nillson, K. W., Leppert, J. & Aslund, C. (2017). Gambling frequency and symptoms of attention-deficit hyperactivity disorder in relation to problem gambling among Swedish adolescents: A population-based study. Upsala Journal of Medical Sciences, 22(2), 119-126
Open this publication in new window or tab >>Gambling frequency and symptoms of attention-deficit hyperactivity disorder in relation to problem gambling among Swedish adolescents: A population-based study
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2017 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 22, no 2, p. 119-126Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate the associations between gambling frequency, attention-deficit hyperactivity disorder (ADHD) symptoms, and problem gambling among adolescent boys and girls. One hypothesis was that adolescents with increased ADHD symptoms have a higher frequency of gambling compared to adolescents with fewer ADHD symptoms.

Method: A population-based sample of adolescents (aged 15–18 years) completed a questionnaire on demographics, gambling habits, ADHD symptoms, and problematic gambling; 1412 adolescents (from 4440 sampled) with gambling experience were included in the final sample.

Results: A zero-inflated negative binomial regression analysis revealed that increased ADHD symptoms, higher gambling frequency, and higher age were associated with lower odds for being non-susceptible to gambling problems. Moreover, gambling frequency interacted with ADHD symptoms in predicting probability of being non-susceptible to gambling problems. However, when analysing those already susceptible to problem gambling, ADHD symptoms did not modify the effect of gambling frequency on the expected magnitude of gambling problems. In susceptible individuals, problem gambling increased with both increased ADHD symptoms and increased gambling frequency, but the level of problems due to gambling frequency did not change depending on the ADHD symptom level. There was an interaction effect between sex and gambling frequency in relation to gambling problems.

Conclusions: Adolescents with ADHD symptoms seem to be more sensitive to gambling, in terms of being susceptible to developing gambling problems. However, once susceptible, adolescents with ADHD symptoms are affected by gambling frequency similarly to other susceptible participants.

Keywords
Adolescent, attention-deficit hyperactivity disorder symptoms, gambling, problem gambling, Problem Gambling Severity Index
National Category
Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-261154 (URN)10.1080/03009734.2017.1294636 (DOI)000401756500008 ()28436719 (PubMedID)
Available from: 2015-08-31 Created: 2015-08-31 Last updated: 2018-09-14Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1433-0329

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