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Young adulthood cognitive ability predicts statin adherence in middle-aged men after first myocardial infarction: A Swedish National Registry study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
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2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 6, p. 639-646Article in journal (Refereed) Published
Abstract [en]

Background

Cognitive ability (CA) is positively related to later health, health literacy, health behaviours and longevity. Accordingly, a lower CA is expected to be associated with poorer adherence to medication. We investigated the long-term role of CA in adherence to prescribed statins in male patients after a first myocardial infarction (MI).

Methods

CA was estimated at 18–20 years of age from Military Conscript Register data for first MI male patients (≤60 years) and was related to the one- and two-year post-MI statin adherence on average 30 years later. Background and clinical data were retrieved through register linkage with the unselected national quality register SWEDEHEART for acute coronary events (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) and secondary prevention (Secondary Prevention after Heart Intensive Care Admission). Previous and present statin prescription data were obtained from the Prescribed Drug Register and adherence was calculated as ≥80% of prescribed dispensations assuming standard dosage. Logistic regression was used to estimate crude and adjusted associations. The primary analyses used 2613 complete cases and imputing incomplete cases rendered a sample of 4061 cases for use in secondary (replicated) analyses.

Results

One standard deviation increase in CA was positively associated with both one-year (OR 1.15 (CI 1.01–1.25), P < 0.001) and two-year (OR 1.14 (CI 1.02–1.27), P < 0.001) adherence to prescribed statins. Only smoking attenuated the CA–adherence association after adjustment for a range of > 20 covariates. Imputed and complete case analyses yielded very similar results.

Conclusions

CA estimated on average 30 years earlier in young adulthood is a risk indicator for statin adherence in first MI male patients aged ≤60 years. Future research should include older and female patients and more socioeconomic variables.

Place, publisher, year, edition, pages
2017. Vol. 24, no 6, p. 639-646
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-315609DOI: 10.1177/2047487317693951ISI: 000397435200009PubMedID: 28195516OAI: oai:DiVA.org:uu-315609DiVA, id: diva2:1074887
Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2020-03-23Bibliographically approved
In thesis
1. Forecasting myocardial infarction and subsequent behavioural outcomes
Open this publication in new window or tab >>Forecasting myocardial infarction and subsequent behavioural outcomes
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis is compiled from four studies dealing with the prediction of myocardial infarction (MI) and some associated risk behaviours post MI.

Study 1 extends the field of possible psychosocial stress-triggering of MI to Sweden, and to the phenomenon of temporal crests and troughs in national MI rates. These findings are in the present thesis integrated into a more comprehensive theoretical framework than provided by previous studies. By controlling for different confounders, analysis in subgroups, and more, the probable effect of psychosocial stress on the triggering of MI producing slight oscillations in daily MI rates at different temporal cycles was supported.

Study 2 extends the existing literature of cognitive epidemiology to secondary preventive cardiology. Males with higher cognitive ability (CA), as assessed at mandatory military conscription in young adulthood, were found to be more adherent to their statin medication post MI, approximately 30 years later. The association is likely causal, given the fundamental importance of CA as a predictor for our individual ability to understand, plan, and execute everyday behaviour, including such health promoting behaviour as adhering to statin medication after MI.

Study 3 continues the thesis thread of predicting clinically relevant health-promoting behaviour. It generated important hypotheses of what predicts adherence to internet-based cognitive behaviour therapy (ICBT) for symptoms of anxiety and/or depression after MI. In particular, the linguistic variables which were derived from what the patients actually wrote online to their ICBT therapist, predicted adherence. Using a flexible random forest model with a moderately sized sample, the aim was to handle a range of predictors and possible higher order effects in the relative strength estimation of these predictors.

Study 4 presents the derivation and external validation of a new risk model, STOPSMOKE. Developed as a linear support vector machine with robust resampling, STOPSMOKE proved accurate in the unseen validation cohort for predicting one-year smoking abstinence at the start of cardiac rehabilitation (CR) post MI. STOPSMOKE predictions may inform the targeting of more elaborate interventions to high risk patients. Today, such intervention is not systematic as standard counselling does not account for the individual probability of future smoking abstinence failure. STOPSMOKE thus provides a novel real-world probabilistic basis for the risk of future smoking abstinence failure after MI. This basis may then be used by clinicians, patients, and organisations to tailor smoking intervention as best suited the particular individual or high-risk group. Implemented as part of a spectrum of models in a semi-automatic system, cost-effective tailored risk assessment could allow for augmented CR for future patients.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2020. p. 93
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1655
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-407334 (URN)978-91-513-0912-5 (ISBN)
Public defence
2020-06-09, Room 4 (IV), Universitetshuset, Biskopsgatan 3, Uppsala, 13:15 (English)
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Supervisors
Available from: 2020-04-22 Created: 2020-03-23 Last updated: 2020-05-19

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Wallert, JohnHeld, ClaesOlsson, Erik

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