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  • 1.
    Andersen, Kasper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Muscle Morphology And Risk Of Cardiovascular Disease2010In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 28, p. E353-E353Article in journal (Other academic)
  • 2.
    Andersen, Kasper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Skeletal muscle morphology and risk of cardiovascular disease in elderly men2015In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 2, p. 231-239Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    While it is well known that physical inactivity is a major risk factor for cardiovascular disease, there is still a search for the mechanisms by which exercise exerts its positive effect. Skeletal muscle fibre type can be affected to some extent by exercise, and different fibre types possess different anti-inflammatory and glucometabolic properties that may influence cardiovascular disease risk.

    DESIGN:

    Population-based cohort study.

    METHODS:

    We investigated relations of skeletal muscle morphology to risk of cardiovascular events in a sample of 466 71-year-old men without cardiovascular disease, of which 295 were physically active (strenuous physical activity at least 3 h/week).

    RESULTS:

    During a median of 13.1 years of follow up, 173 major cardiovascular events occurred. Among physically active men, 10% higher proportion of type-I (slow-twitch oxidative) fibres was associated with a hazard ratio (HR) of 0.84 (95% confidence interval 0.74-0.95) for cardiovascular events, and 10% higher proportion of type-IIx (fast-twitch glycolytic) fibres was associated with a HR of 1.24 (1.06-1.45), adjusting for age. Similar results were observed in several sets of multivariable-adjusted models. No association of muscle fibre type with risk of cardiovascular events was observed among physically inactive men.

    CONCLUSIONS:

    Higher skeletal muscle proportion of type-I fibres was associated with lower risk of cardiovascular events and a higher proportion of type-IIx fibres was associated with higher risk of cardiovascular events. These relations were only observed in physically active men. Skeletal muscle fibre composition may be a mediator of the protective effects of exercise against cardiovascular disease.

  • 3.
    Arefalk, Gabriel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hergens, M. P.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ye, W.
    Nyrén, O.
    Lambe, M.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Smokeless Tobacco (Snus) And Risk Of Heart Failure In Two Swedish Cohorts2010In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 28, p. E48-E49Article in journal (Other academic)
  • 4.
    Arefalk, Gabriel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Hergens, Maria-Pia
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ye, Weimin
    Nyrén, Olof
    Lambe, Mats
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Smokeless Tobacco (Snus) and Risk of Heart Failure: Results from Two Swedish Cohorts2012In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 19, no 5, p. 1120-1127Article in journal (Refereed)
    Abstract [en]

    Background:

    Oral moist snuff (snus) is discussed as a safer alternative to smoking, and its use is increasing. Based on its documented effect on blood pressure, we hypothesized that use of snus increases the risk of heart failure.

    Design:

    Two independent Swedish prospective cohorts; the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based sample of 1076 elderly men, and the Construction Workers Cohort (CWC), a sample of 118,425 never-smoking male construction workers.

    Methods:

    Cox proportional hazards models were used to investigate possible associations of snus use with risk of a first hospitalization for heart failure.

    Results:

    In ULSAM, 95 men were hospitalized for heart failure, during a median follow up of 8.9 years. In a model adjusted for established risk factors including past and present smoking exposure, current snus use was associated with a higher risk of heart failure [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.03-4.22] relative to non-use. Snus use was particularly associated with risk of non-ischaemic heart failure (HR 2.55, 95% CI 1.12-5.82). In CWC, 545 men were hospitalized for heart failure, during a median follow up of 18 years. In multivariable-adjusted models, current snus use was moderately associated with a higher risk of heart failure (HR 1.28, 95% CI 1.00-1.64) and non-ischaemic heart failure (HR 1.28, 95% CI 0.97-1.68) relative to never tobacco use.

    Conclusion:

    Data from two independent cohorts suggest that use of snus may be associated with a higher risk of heart failure.

  • 5. Arking, Dan E
    et al.
    Pulit, Sara L
    Crotti, Lia
    van der Harst, Pim
    Munroe, Patricia B
    Koopmann, Tamara T
    Sotoodehnia, Nona
    Rossin, Elizabeth J
    Morley, Michael
    Wang, Xinchen
    Johnson, Andrew D
    Lundby, Alicia
    Gudbjartsson, Daníel F
    Noseworthy, Peter A
    Eijgelsheim, Mark
    Bradford, Yuki
    Tarasov, Kirill V
    Dörr, Marcus
    Müller-Nurasyid, Martina
    Lahtinen, Annukka M
    Nolte, Ilja M
    Smith, Albert Vernon
    Bis, Joshua C
    Isaacs, Aaron
    Newhouse, Stephen J
    Evans, Daniel S
    Post, Wendy S
    Waggott, Daryl
    Lyytikäinen, Leo-Pekka
    Hicks, Andrew A
    Eisele, Lewin
    Ellinghaus, David
    Hayward, Caroline
    Navarro, Pau
    Ulivi, Sheila
    Tanaka, Toshiko
    Tester, David J
    Chatel, Stéphanie
    Gustafsson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Kumari, Meena
    Morris, Richard W
    Naluai, Asa T
    Padmanabhan, Sandosh
    Kluttig, Alexander
    Strohmer, Bernhard
    Panayiotou, Andrie G
    Torres, Maria
    Knoflach, Michael
    Hubacek, Jaroslav A
    Slowikowski, Kamil
    Raychaudhuri, Soumya
    Kumar, Runjun D
    Harris, Tamara B
    Launer, Lenore J
    Shuldiner, Alan R
    Alonso, Alvaro
    Bader, Joel S
    Ehret, Georg
    Huang, Hailiang
    Kao, W H Linda
    Strait, James B
    Macfarlane, Peter W
    Brown, Morris
    Caulfield, Mark J
    Samani, Nilesh J
    Kronenberg, Florian
    Willeit, Johann
    Smith, J Gustav
    Greiser, Karin H
    Meyer Zu Schwabedissen, Henriette
    Werdan, Karl
    Carella, Massimo
    Zelante, Leopoldo
    Heckbert, Susan R
    Psaty, Bruce M
    Rotter, Jerome I
    Kolcic, Ivana
    Polašek, Ozren
    Wright, Alan F
    Griffin, Maura
    Daly, Mark J
    Arnar, David O
    Hólm, Hilma
    Thorsteinsdottir, Unnur
    Denny, Joshua C
    Roden, Dan M
    Zuvich, Rebecca L
    Emilsson, Valur
    Plump, Andrew S
    Larson, Martin G
    O'Donnell, Christopher J
    Yin, Xiaoyan
    Bobbo, Marco
    D'Adamo, Adamo P
    Iorio, Annamaria
    Sinagra, Gianfranco
    Carracedo, Angel
    Cummings, Steven R
    Nalls, Michael A
    Jula, Antti
    Kontula, Kimmo K
    Marjamaa, Annukka
    Oikarinen, Lasse
    Perola, Markus
    Porthan, Kimmo
    Erbel, Raimund
    Hoffmann, Per
    Jöckel, Karl-Heinz
    Kälsch, Hagen
    Nöthen, Markus M
    den Hoed, Marcel
    Loos, Ruth J F
    Thelle, Dag S
    Gieger, Christian
    Meitinger, Thomas
    Perz, Siegfried
    Peters, Annette
    Prucha, Hanna
    Sinner, Moritz F
    Waldenberger, Melanie
    de Boer, Rudolf A
    Franke, Lude
    van der Vleuten, Pieter A
    Beckmann, Britt Maria
    Martens, Eimo
    Bardai, Abdennasser
    Hofman, Nynke
    Wilde, Arthur A M
    Behr, Elijah R
    Dalageorgou, Chrysoula
    Giudicessi, John R
    Medeiros-Domingo, Argelia
    Barc, Julien
    Kyndt, Florence
    Probst, Vincent
    Ghidoni, Alice
    Insolia, Roberto
    Hamilton, Robert M
    Scherer, Stephen W
    Brandimarto, Jeffrey
    Margulies, Kenneth
    Moravec, Christine E
    Greco M, Fabiola Del
    Fuchsberger, Christian
    O'Connell, Jeffrey R
    Lee, Wai K
    Watt, Graham C M
    Campbell, Harry
    Wild, Sarah H
    El Mokhtari, Nour E
    Frey, Norbert
    Asselbergs, Folkert W
    Mateo Leach, Irene
    Navis, Gerjan
    van den Berg, Maarten P
    van Veldhuisen, Dirk J
    Kellis, Manolis
    Krijthe, Bouwe P
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Franco, Oscar H
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hofman, Albert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Kors, Jan A
    Uitterlinden, André G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Witteman, Jacqueline C M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Kedenko, Lyudmyla
    Lamina, Claudia
    Oostra, Ben A
    Abecasis, Gonçalo R
    Lakatta, Edward G
    Mulas, Antonella
    Orrú, Marco
    Schlessinger, David
    Uda, Manuela
    Markus, Marcello R P
    Völker, Uwe
    Snieder, Harold
    Spector, Timothy D
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Sundström, Johan
    Syvänen, Ann-Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular Medicine. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Kivimaki, Mika
    Kähönen, Mika
    Mononen, Nina
    Raitakari, Olli T
    Viikari, Jorma S
    Adamkova, Vera
    Kiechl, Stefan
    Brion, Maria
    Nicolaides, Andrew N
    Paulweber, Bernhard
    Haerting, Johannes
    Dominiczak, Anna F
    Nyberg, Fredrik
    Whincup, Peter H
    Hingorani, Aroon D
    Schott, Jean-Jacques
    Bezzina, Connie R
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Ferrucci, Luigi
    Gasparini, Paolo
    Wilson, James F
    Rudan, Igor
    Franke, Andre
    Mühleisen, Thomas W
    Pramstaller, Peter P
    Lehtimäki, Terho J
    Paterson, Andrew D
    Parsa, Afshin
    Liu, Yongmei
    van Duijn, Cornelia M
    Siscovick, David S
    Gudnason, Vilmundur
    Jamshidi, Yalda
    Salomaa, Veikko
    Felix, Stephan B
    Sanna, Serena
    Ritchie, Marylyn D
    Stricker, Bruno H
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Stefansson, Kari
    Boyer, Laurie A
    Cappola, Thomas P
    Olsen, Jesper V
    Lage, Kasper
    Schwartz, Peter J
    Kääb, Stefan
    Chakravarti, Aravinda
    Ackerman, Michael J
    Pfeufer, Arne
    de Bakker, Paul I W
    Newton-Cheh, Christopher
    Genetic association study of QT interval highlights role for calcium signaling pathways in myocardial repolarization.2014In: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 46, no 8, p. 826-836Article in journal (Refereed)
    Abstract [en]

    The QT interval, an electrocardiographic measure reflecting myocardial repolarization, is a heritable trait. QT prolongation is a risk factor for ventricular arrhythmias and sudden cardiac death (SCD) and could indicate the presence of the potentially lethal mendelian long-QT syndrome (LQTS). Using a genome-wide association and replication study in up to 100,000 individuals, we identified 35 common variant loci associated with QT interval that collectively explain ∼8-10% of QT-interval variation and highlight the importance of calcium regulation in myocardial repolarization. Rare variant analysis of 6 new QT interval-associated loci in 298 unrelated probands with LQTS identified coding variants not found in controls but of uncertain causality and therefore requiring validation. Several newly identified loci encode proteins that physically interact with other recognized repolarization proteins. Our integration of common variant association, expression and orthogonal protein-protein interaction screens provides new insights into cardiac electrophysiology and identifies new candidate genes for ventricular arrhythmias, LQTS and SCD.

  • 6.
    Arnlov, J
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Lind, L
    Department of Medical Sciences.
    Zethelius, B
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Andren, B
    Department of Medical Sciences.
    Hales, C N
    Department of Medical Sciences.
    Vessby, B
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Lithell, H
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Several factors associated with the insulin resistance syndrome are predictors of left ventricular systolic dysfunction in a male population after 20 years of follow-up.2001In: Am Heart J, ISSN 1097-6744, Vol. 142, no 4, p. 720-4Article in journal (Refereed)
  • 7. Barber, RM
    et al.
    Fullman, N
    Sorensen, RJD
    Bollyky, T
    McKee, M
    Nolte, E
    Abajobir, AA
    Abate, KH
    Abbafati, C
    Abbas, KM
    Abd-Allah, F
    Abdulle, AM
    Ärnlöv, Johan
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Younis, MZ
    Yu, C
    Zaidi, Z
    El Sayed Zaki, M
    Zambrana-Torrelio, C
    Zapata, T
    Zenebe, ZM
    Zodpey, S
    Zoeckler, L
    Zuhlke, LJ
    Murray, CJL
    Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015.2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10091, p. 231-266Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015.

    METHODS: We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time.

    FINDINGS: Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015.

    INTERPRETATION: This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world.

    FUNDING: Bill & Melinda Gates Foundation.

  • 8.
    Basu, Samar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Helmersson, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Cytokine-mediated inflammation is independently associated with insulin sensitivity measured by the euglycemic insulin clamp in a community-based cohort of elderly men2011In: International Journal of Clinical and Experimental Medicine, ISSN 1940-5901, E-ISSN 1940-5901, Vol. 4, no 2, p. 164-168Article in journal (Refereed)
    Abstract [en]

    Both clinical and experimental studies suggest a close relation between an inflammatory state and insulin resistance. We investigated the association between cytokine-mediated inflammation (high sensitivity C reactive protein [hsCRP] and interleukin [IL] 6) and insulin sensitivity (insulin-mediated glucose disposal rate, assessed by the euglycemic insulin clamp) in a community-based cohort, with subgroup analyses of normal weight individuals without diabetes mellitus and metabolic syndrome (NCEP). hsCRP and IL-6 were inversely associated with insulin sensitivity (multivariable-adjusted regression coefficient for 1-SD increase of hsCRP -0.12 (-0.21-(-0.03), p=0.01) and of IL-6 -0.11 (-0.21-(-0.02), p=0.01) in models adjusting for age and components of the metabolic syndrome (systolic and diastolic blood pressure, antihypertensive drugs, HDL-cholesterol, triglycerides, fasting plasma glucose, waist circumference). The multivariable-adjusted association between hsCRP, IL-6 and insulin sensitivity were of a similar magnitude in normal weight individuals without diabetes and without the metabolic syndrome. Our data show that cytokine -mediated subclinical inflammation is independently associated with decreased insulin sensitivity also in apparently metabolically healthy normal weight individuals, indicating that the interplay between inflammatory processes and insulin resistance is present already in the early stages of the development of glucometabolic disease.

  • 9. Bruck, Katharina
    et al.
    Jager, Kitty J.
    Dounousi, Evangelia
    Kainz, Alexander
    Nitsch, Dorothea
    Ärnlov, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Rothenbacher, Dietrich
    Browne, Gemma
    Capuano, Vincenzo
    Ferraro, Pietro Manuel
    Ferrieres, Jean
    Gambaro, Giovanni
    Guessous, Idris
    Hallan, Stein
    Kastarinen, Mika
    Navis, Gerjan
    Otero Gonzalez, Alfonso
    Palmieri, Luigi
    Romundstad, Solfrid
    Spoto, Belinda
    Stengel, Benedicte
    Tomson, Charles
    Tripepi, Giovanni
    Voelzke, Henry
    Wiecek, Andrzej
    Gansevoort, Ron
    Schoettker, Ben
    Wanner, Christoph
    Vinhas, Jose
    Zoccali, Carmine
    Van Biesen, Wim
    Stel, Vianda S.
    Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review2015In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 30, no S4, p. 6-16Article, review/survey (Refereed)
    Abstract [en]

    Background. Many publications report the prevalence of chronic kidney disease (CKD) in the general population. Comparisons across studies are hampered as CKD prevalence estimations are influenced by study population characteristics and laboratory methods. Methods. For this systematic review, two researchers independently searched PubMed, MEDLINE and EMBASE to identify all original research articles that were published between 1 January 2003 and 1 November 2014 reporting the prevalence of CKD in the European adult general population. Data on study methodology and reporting of CKD prevalence results were independently extracted by two researchers. Results. We identified 82 eligible publications and included 48 publications of individual studies for the data extraction. There was considerable variation in population sample selection. The majority of studies did not report the sampling frame used, and the response ranged from 10 to 87%. With regard to the assessment of kidney function, 67% used a Jaffe assay, whereas 13% used the enzymatic assay for creatinine determination. Isotope dilution mass spectrometry calibration was used in 29%. The CKD-EPI (52%) and MDRD (75%) equations were most often used to estimate glomerular filtration rate (GFR). CKD was defined as estimated GFR (eGFR) <60 mL/min/1.73 m(2) in 92% of studies. Urinary markers of CKD were assessed in 60% of the studies. CKD prevalence was reported by sex and age strata in 54 and 50% of the studies, respectively. In publications with a primary objective of reporting CKD prevalence, 39% reported a 95% confidence interval. Conclusions. The findings from this systematic review showed considerable variation in methods for sampling the general population and assessment of kidney function across studies reporting CKD prevalence. These results are utilized to provide recommendations to help optimize both the design and the reporting of future CKD prevalence studies, which will enhance comparability of study results.

  • 10.
    Bruck, Katharina
    et al.
    Amsterdam Med Ctr, European Renal Assoc European Dialysis & Transpla, Dept Med Informat, Meibergdreef 9, NL-1100 DD Amsterdam, Netherlands..
    Stel, Vianda S.
    Amsterdam Med Ctr, European Renal Assoc European Dialysis & Transpla, Dept Med Informat, Meibergdreef 9, NL-1100 DD Amsterdam, Netherlands..
    Gambaro, Giovanni
    Univ Cattolica Sacro Cuore, Columbus Gemelli Univ Hosp, Div Nephrol & Dialysis, I-00168 Rome, Italy..
    Hallan, Stein
    Norwegian Univ Sci & Technol, Fac Med, St Olavs Hosp, Dept Nephrol, N-7034 Trondheim, Norway..
    Volzke, Henry
    Univ Med Greifswald, Dept Clin Epidemiol Res, Greifswald, Germany..
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Kastarinen, Mika
    Kuopio Natl Inst Hlth & Welf, Dept Internal Med & Nephrol, Finnish Med Agcy, Helsinki, Finland..
    Guessous, Idris
    Univ Hosp Geneva, Dept Community Med Primary Care & Emergency Med, Geneva, Switzerland..
    Vinhas, Jose
    Setubal Hosp Ctr, Dept Med, Setubal, Portugal..
    Stengel, Benedicte
    INSERM, U1018, Res Ctr Epidemiol & Populat Hlth, Villejuif, France..
    Brenner, Hermann
    Heidelberg Univ, German Canc Res Ctr, Network Aging Res, Div Clin Epidemiol & Aging Res, Heidelberg, Germany..
    Chudek, Jerzy
    Med Univ Silesia, Dept Nephrol Endocrinol & Metab Dis, Med Fac, Dept Pathophysiol, Katowice, Poland..
    Romundstad, Solfrid
    Norwegian Univ Sci & Technol, Levanger Hosp, Hlth Trust Nord Trendelag, Dept Nephrol, N-7034 Trondheim, Norway..
    Tomson, Charles
    Freeman Rd Hosp, Dept Nephrol, Newcastle Upon Tyne, Tyne & Wear, England..
    Otero Gonzalez, Alfonso
    Univ Hosp Orense, Dept Nephrol, Orense, Spain..
    Bello, Aminu K.
    Univ Alberta, Dept Med, Edmonton, AB, Canada..
    Ferrieres, Jean
    Toulouse Univ, Sch Med, Rangueil Hosp, Dept Cardiol, Toulouse, France..
    Palmieri, Luigi
    Ist Super Sanita, Dept Epidemiol Cerebro & Cardiovasc Dis, Viale Regina Elena 299, I-00161 Rome, Italy..
    Browne, Gemma
    Univ Coll Cork, Dept Epidemiol & Publ Hlth, Cork, Ireland.;Mercy Univ Hosp, Cork, Ireland..
    Capuano, Vincenzo
    Mercato S Severino Hosp, Unite Operat Cardiol, Salerno, Italy.;Mercato S Severino Hosp, UTIC, Salerno, Italy..
    Van Biesen, Wim
    Ghent Univ Hosp, Dept Nephrol, Ghent, Belgium..
    Zoccali, Carmine
    CNR, Ist Fisiol Clin, Clin Epidemiol & Pathophysiol Renal Dis & Hyperte, Reggio Di Calabria, Italy..
    Gansevoort, Ron
    Univ Med Ctr Groningen, Grad Sch Med Sci, Dept Nephrol, NL-9713 AV Groningen, Netherlands..
    Navis, Gerjan
    Univ Med Ctr Groningen, Dept Internal Med, Div Nephrol, NL-9713 AV Groningen, Netherlands..
    Rothenbacher, Dietrich
    Univ Ulm, Inst Epidemiol & Med Biometry, D-89069 Ulm, Germany..
    Ferraro, Pietro Manuel
    Univ Cattolica Sacro Cuore, Columbus Gemelli Univ Hosp, Div Nephrol & Dialysis, I-00168 Rome, Italy..
    Nitsch, Dorothea
    London Sch Hyg & Trop Med, Dept Noncommunicable Dis Epidemiol, London WC1, England.;UCL, London, England..
    Wanner, Christoph
    Univ Hosp Wurzburg, Dept Nephrol, Wurzburg, Germany..
    Jager, Kitty J.
    Amsterdam Med Ctr, European Renal Assoc European Dialysis & Transpla, Dept Med Informat, Meibergdreef 9, NL-1100 DD Amsterdam, Netherlands..
    Consortium, European C. K. D. Burden
    CKD Prevalence Varies across the European General Population2016In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 27, no 7, p. 2135-2147Article in journal (Refereed)
    Abstract [en]

    CKD prevalence estimation is central to CKD management and prevention planning at the population level. This study estimated CKD prevalence in the European adult general population and investigated international variation in CKD prevalence by age, sex, and presence of diabetes, hypertension, and obesity. We collected data from 19 general-population studies from 13 European countries. CKD stages 1-5 was defined as eGFR <60 ml/min per 1.73 m(2), as calculated by the CKD-Epidemiology Collaboration equation, or albuminuria >30 mg/g, and CKD stages 3-5 was defined as eGFR<60 ml/min per 1.73 m(2). CKD prevalence was age- and sex-standardized to the population of the 27 Member States of the European Union (EU27). We found considerable differences in both CKD stages 1-5 and CKD stages 3-5 prevalence across European study populations. The adjusted CKD stages 1-5 prevalence varied between 3.31% (95% confidence interval [95% CI], 3.30% to 3.33%) in Norway and 17.3% (95% Cl, 16.5% to 18.1%) in northeast Germany. The adjusted CKD stages 3-5 prevalence varied between 1.0% (95% CI, 0.7% to 1.3%) in central Italy and 5.9% (95% CI, 5.2% to 6.6%) in northeast Germany. The variation in CKD prevalence stratified by diabetes, hypertension, and obesity status followed the same pattern as the overall prevalence. In conclusion, this large-scale attempt to carefully characterize CKD prevalence in Europe identified substantial variation in CKD prevalence that appears to be due to factors other than the prevalence of diabetes, hypertension, and obesity.

  • 11. Carlsson, A. C.
    et al.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Engstrom, G.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Melander, Olle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Leander, K.
    Gigante, B.
    Hellenius, M-L
    de Faire, U.
    Novel and established anthropometric measures and the prediction of incident cardiovascular disease: a cohort study2013In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 37, no 12, p. 1579-1585Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to compare novel and established anthropometrical measures in their ability to predict cardiovascular disease (CVD), and to determine whether they improve risk prediction beyond classical risk factors in a cohort study of 60-year-old men and women. We also stratified the results according to gender to identify possible differences between men and women. Furthermore, we aimed to replicate our findings in a large independent cohort (The Malmo Diet and Cancer study-cardiovascular cohort). METHODS: This was a population-based study of 1751 men and 1990 women, aged 60 years and without CVD at baseline, with 375 incident cases of CVD during 11 years of follow-up. Weight, height, waist circumference (WC), hip circumference and sagittal abdominal diameter (SAD) were measured at baseline. Body mass index (BMI), waist-hip ratio (WHR), waist-hip-height ratio (WHHR), WC-to-height ratio (WCHR) and SAD-to-height ratio (SADHR) were calculated. RESULTS: All anthropometric measures predicted CVD in unadjusted Cox regression models per s.d. increment (hazard ratios, 95% confidence interval), while significant associations after adjustments for established risk CVD factors were noted for WHHR 1.20 (1.08-1.33), WHR 1.14 (1.02-1.28), SAD 1.13 (1.02-1.25) and SADHR 1.17 (1.06-1.28). WHHR had higher increases in C-statistics, and model improvements (likelihood ratio tests (P<0.001)). In the replication study (MDC-CC, n = 5180), WHHR was the only measure that improved Cox regression models in men (P = 0.01). CONCLUSION: WHHR, a new measure reflecting body fat distribution, showed the highest risk estimates after adjustments for established CVD risk factors. These findings were verified in men but not women in an independent cohort.

  • 12. Carlsson, A. C.
    et al.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Ärnlov, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Borne, Y.
    Leander, K.
    Gigante, B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Hellenius, M. -L
    Bottai, M.
    de Faire, U.
    Prediction of cardiovascular disease by abdominal obesity measures is dependent on body weight and sex - Results from two community based cohort studies2014In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 24, no 8, p. 891-899Article in journal (Refereed)
    Abstract [en]

    Aim: To study waist-hip ratio (WHR), waist circumference (WC), sagittal abdominal diameter (SAD), and waist-hip-height ratio (WHHR) as predictors of CVD, in men and women stratified by BMI (cut-off >= 25). Methods and results: A cohort of n = 3741 (53% women) 60-year old individuals without CVD was followed for 11-years (375 CVD cases). To replicate the results, we also assessed another large independent cohort; The Malmo Diet and Cancer study - cardiovascular cohort (MDCC, (n = 5180, 60% women, 602 CVD cases during 16-years). After adjustment for established risk factors in normal-weight women, the hazard ratio (HR) per one standard deviation (SD) were; WHR; 1.91 (95% confidence interval (CI) 1.35-2.70), WC; 1.81 (95% CI 1.02-3.20), SAD; 1.25 (95% CI 0.74-2.11), and WHHR; 1.97 (95% CI 1.40-2.78). In men the association with WHR, WHHR and WC were not significant, whereas SAD was the only measure that significantly predicted CVD in men (HR 1.19 (95% CI 1.04-1.35). After adjustments for established risk factors in overweight/obese women, none of the measures were significantly associated with CVD risk. In men, however, all measures were significant predictors; WHR; 1.24 (955 CI 1.04-1.47), WC 1.19 (95% CI 1.00-1.42), SAD 1.21 (95% CI 1.00-1.46), and WHHR; 1.23 (95% CI 1.05-1.44). Only the findings in men with BMI >= 25 were verified in MDCC. Conclusion: In normal weight individuals, WHHR and WHR were the best predictors in women, whereas SAD was the only independent predictor in men. Among overweight/obese individuals all measures failed to predict CVD in women, whereas WHHR was the strongest predictor after adjustments for CVD risk factors in men.

  • 13.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Calamia, Michael
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Helmersson-Karlqvist, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Kidney injury molecule (KIM)-1 is associated with insulin resistance: Results from two community-based studies of elderly individuals2014In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 103, no 3, p. 516-521Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Insulin resistance has been shown to be closely associated with glomerular filtration rate and urinary albumin/creatinine ratio, even prior to the development of diabetes. Urinary kidney injury molecule 1 (KIM-1) is a novel, highly specific marker of kidney tubular damage. The role of insulin resistance in the development of kidney tubular damage is not previously reported. Thus, we aimed to investigate the associations between insulin sensitivity (assessed by HOMA) and urinary KIM-1.

    DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Two community-based cohorts of elderly individuals were investigated: Prospective Investigation of the vasculature in Uppsala seniors (PIVUS, n=701; mean age 75 years, 52% women); and Uppsala Longitudinal Study of adult men (ULSAM, n=533; mean age 78 years).

    RESULTS: Lower insulin sensitivity was associated with higher urinary KIM-1 in both cohorts after adjustments for age, BMI, blood pressure, antihypertensive treatment, glomerular filtration rate, and urinary albumin-creatinine ratio (PIVUS: regression coefficient for 1-SD higher HOMA-IR 0.11, 95% CI 0.03-0.20, p=0.009, and ULSAM: 0.13, 95% CI 0.04-0.22, p=0.007). Results were similar in individuals without diabetes, with normal kidney function and normo-albuminuria.

    CONCLUSIONS: Our findings in elderly individuals support the notion that the interplay between an impaired glucose metabolism and renal tubular damage is evident even prior to the development of diabetes and overt kidney disease.

  • 14.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Carrero, Juan-Jesús
    Stenvinkel, Peter
    Bottai, Matteo
    Barany, Peter
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Endostatin, Cathepsin S, and Cathepsin L, and Their Association with Inflammatory Markers and Mortality in Patients Undergoing Hemodialysis2015In: Blood Purification, ISSN 0253-5068, E-ISSN 1421-9735, Vol. 39, no 4, p. 259-265Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/AIMS: Although both endostatin and cathepsins S have been associated with higher mortality, data in patients with end-stage renal disease (ESRD) are scarce.

    METHODS: A longitudinal cohort study of 207 prevalent patients undergoing hemodialysis.

    RESULTS: Cathepsins S and L were associated with soluble receptors for tumor necrosis factor (sTNFR1 and sTNFR2, rho between 0.28 and 0.43, p < 0.001 for all). Weaker or absent associations between endostatin, cathepsins S and L were seen with other inflammatory biomarkers, that is, CRP, interleukin 6, pentraxin 3, and TNF. In Cox and Laplace regression models adjusted for age, sex, dialysis vintage, and diabetes: standard deviation increments of endostatin was associated with a lower mortality (hazard ratio 0.75, 95% confidence interval (CI) 0.57-0.98), and with 6.8 months longer median survival.

    CONCLUSIONS: The high levels of endostatin, cathepsins S and L, and their associations with sTNFR1 and sTNFR2 warrant further studies exploring mortality, and the angiogenic and inflammatory pathways in ESRD.

  • 15.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Carrero, Juan-Jesús
    Stenvinkel, Peter
    Bottai, Matteo
    Barany, Peter
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    High levels of soluble tumor necrosis factor receptors 1 and 2 and their association with mortality in patients undergoing hemodialysis2015In: Cardiorenal medicine, ISSN 1664-3828, Vol. 5, no 2, p. 89-95Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Circulating soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) are associated with chronic kidney disease (CKD) progression in patients with CKD or diabetes, and with higher mortality. However, data in patients with end-stage renal disease are scarce. Therefore, we analyzed serum levels of sTNFR1 and sTNFR2 and investigated their association with inflammatory markers and mortality in dialysis patients.

    RESEARCH DESIGN AND METHODS: This was a longitudinal cohort study of 207 prevalent patients (median age 66 years, 56% men) undergoing hemodialysis in Stockholm, Sweden. Demographics, clinical characteristics, including comorbidities and laboratory data, were obtained at baseline, together with prospective follow-up for mortality.

    RESULTS: The median sTNFR1 and sTNFR2 levels were 17,680 ng/l [95% confidence interval (CI) 17,023-18,337] and 24,450 ng/l (95% CI 23,721-25,179), respectively. During a follow-up of 31 months (interquartile range, 21-38), 77 patients died. There was no association between the levels of sTNFRs and mortality in Cox regression models, and no consistent trend towards higher or lower mortality was seen in Laplace regression models. sTNFR1 and sTNFR2 levels were highly associated with other inflammatory markers including interleukin-6, pentraxin 3 and TNF-α.

    CONCLUSIONS: Prevalent hemodialysis patients have several-fold higher levels of sTNFRs compared to previous studies in CKD stage 4 patients. As no consistent association between TNFR and mortality was observed, clinical implications of measuring these receptors to predict outcome end-stage renal disease patients provide limited results.

  • 16.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Juhlin, C Christofer
    Larsson, Tobias E
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Soluble tumor necrosis factor receptor 1 (sTNFR1) is associated with increased total mortality due to cancer and cardiovascular causes: Findings from two community based cohorts of elderly2014In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 237, no 1, p. 236-242Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experimental evidence support soluble receptors for tumor necrosis factor alpha as important mediators of the underlying pathology leading to cardiovascular disease and cancer. However, prospective data concerning the relation between circulating soluble tumor necrosis factor receptor-1 (sTNFR1) and mortality in humans are lacking. We aimed to explore and validate the association between sTNFR1 and mortality, and to explore the influence of other established risk factors for mortality, including other inflammatory markers.

    METHODS: The association between serum sTNFR1and the risk for mortality was investigated in two community-based cohorts of elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; women 50%, n = 1005, mean age 70 years, median follow-up 7.9 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 775, mean age 77 years, median follow-up 8.1 years).

    RESULTS: In total, 101 participants in PIVUS and 274 in ULSAM died during follow-up. In multivariable Cox regression models adjusted for inflammation, lifestyle and established cardiovascular risk factors, one standard deviation (SD) higher sTNFR1 was associated with a hazard ratio (HR) for mortality of 1.37, 95% confidence interval (CI) 1.17-1.60, in PIVUS and HR 1.22, 95% CI 1.10-1.37 in ULSAM. Moreover, circulatingsTNFR1 was associated with cardiovascular mortality (HR per SD of sTNFR1, 1.24, 95% CI 1.07-1.44) and cancer mortality (HR per SD of sTNFR1, 1.32, 95% CI 1.11-1.57) in the ULSAM cohort. High levels of sTNFR1 identified individuals with increased risk of mortality among those with high as well as low levels of systemic inflammation.

    CONCLUSIONS: An association between circulating sTNFR1 and an increased risk for mortality was found and validated in two independent community-based cohorts. The future clinical role of sTNFR1 to identify high risk patients for adverse outcomes and mortality has yet to be determined.

  • 17.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Helmersson-Karlqvist, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Larsson, Tobias E
    Bottai, Matteo
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Urinary Kidney Injury Molecule-1 and the Risk of Cardiovascular Mortality in Elderly Men2014In: Clinical journal of the American Society of Nephrology : CJASN, ISSN 1555-905X, Vol. 9, no 8, p. 1393-1401Article in journal (Refereed)
    Abstract [en]

    Background and objectives

    Kidney injury molecule-1 (KIM-1) has been suggested as a clinically relevant highly specific biomarker of acute kidney tubular damage. However, community-based data on the association between urinary levels of KIM-1 and the risk for cardiovascular mortality are lacking. This study aimed to investigate the association between urinary KIM-1 and cardiovascular mortality.

    Design, setting, participants, & measurements

    This was a prospective study, using the community-based Uppsala Longitudinal Study of Adult Men (N=590; mean age 77 years; baseline period, 1997–2001; median follow-up 8.1 years; end of follow-up, 2008).

    Results

    During follow-up, 89 participants died of cardiovascular causes (incidence rate, 2.07 per 100 person-years at risk). Models were adjusted for cardiovascular risk factors (age, systolic BP, diabetes, smoking, body mass index, total cholesterol, HDL cholesterol, antihypertensive treatment, lipid-lowering treatment, aspirin treatment, and history of cardiovascular disease) and for markers of kidney dysfunction and damage (cystatin C–based eGFR and urinary albumin/creatinine ratio). Higher urinary KIM-1/creatinine (from 24-hour urine collections) was associated with a higher risk for cardiovascular mortality (hazard ratio per SD increase, 1.27; 95% confidence interval [95% CI], 1.05 to 1.54; P=0.01). Participants with a combination of high KIM-1/creatinine (upper quintile, ≥175 ng/mmol), low eGFR (≤60 ml/min per 1.73 m2), and microalbuminuria/macroalbuminuria (albumin/creatinine ratio≥3 g/mol) had a >8-fold increased risk compared with participants with low KIM-1/creatinine (<175 ng/mmol), normal eGFR (>60 ml/min per 1.73 m2), and normoalbuminuria (albumin/creatinine ratio<3 g/mol) (hazard ratio, 8.56; 95% CI, 4.17 to 17.56; P<0.001).

    Conclusions

    These findings suggest that higher urinary KIM-1 may predispose to a higher risk of cardiovascular mortality independently of established cardiovascular risk factors, eGFR, and albuminuria. Additional studies are needed to further assess the utility of measuring KIM-1 in the clinical setting.

  • 18.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Helmersson-Karlqvist, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ingelsson, Erik
    Larsson, Tobias E
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Urinary kidney injury molecule 1 and incidence of heart failure in elderly men2013In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 15, no 4, p. 441-446Article in journal (Refereed)
    Abstract [en]

    AIMS:

    There is growing recognition of the clinical importance of cardiorenal syndrome-the bidirectional interplay between kidney and cardiac dysfunction. Yet, the role of kidney tubular damage in the development of heart failure is less studied. The objective of this study was to investigate whether urinary kidney injury molecule (KIM)-1, a specific marker of tubular damage, predisposes to an increased heart failure risk.

    METHODS AND RESULTS:

    This was a community-based cohort study [Uppsala Longitudinal study of Adult Men (ULSAM)] of 565, 77-year-old men free from heart failure at baseline. Heart failure hospitalizations were used as outcome. During follow-up (median 8.0 years), 73 participants were hospitalized for heart failure. In models adjusted for cardiovascular risk factors (age, systolic blood pressure, diabetes, smoking, body mass index, LDL/HDL ratio, antihypertensive treatment, lipid-lowering treatment, aspirin treatment, LV hypertrophy, and prevalent cardiovascular disease) and markers of kidney dysfunction and damage [cystatin C-based glomerular filtration rate (GFR) and urinary albumin/creatinine ratio], a higher urinary KIM-1/creatinine ratio was associated with higher risk for heart failure (hazard ratio upper vs. lower tertile, 1.81; 95% confidence interval 1.01-3.29; P < 0.05). Participants with a combination of low GFR (<60 mL/min/1.72 m(2)) and high KIM-1/creatinine (>128 ng/mmol) had a 3-fold increase in heart failure risk compared with participants with normal GFR and KIM-1 (P < 0.001).

    CONCLUSION:

    Our findings suggest that kidney tubular damage predisposes to an increased risk for heart failure in the community. Further studies are needed to clarify the causal role of KIM-1 in the development of heart failure, and to evaluate the clinical utility of urinary KIM-1 measurements.

  • 19.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Larsson, Tobias E
    Helmersson-Karlqvist, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Soluble TNF Receptors and Kidney Dysfunction in the Elderly2014In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 25, no 6, p. 1313-1320Article in journal (Refereed)
    Abstract [en]

    The importance of TNF-α and its soluble receptors (sTNFR1 and sTNFR2) in the development of kidney disease is being unraveled. Yet, community-based data regarding the role of sTNFRs are lacking. We assessed serum sTNFRs and aspects of kidney damage cross-sectionally in two independent community-based cohorts of elderly participants: Prospective Investigation of the Vasculature in Uppsala Seniors (n=815; mean age, 75 years; 51% women) and Uppsala Longitudinal Study of Adult Men (n=778; mean age, 78 years). Serum sTNFR1 correlated substantially with different aspects of kidney pathology in the Uppsala Longitudinal Study of Adult Men cohort (R=-0.52 for estimated GFR, R=0.22 for urinary albumin-to-creatinine ratio, and R=0.17 for urinary kidney injury molecule-1; P<0.001 for all), with similar correlations in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort. These associations remained significant after adjustment for age, sex, inflammatory markers, and cardiovascular risk factors and were also evident in participants without diabetes. Serum sTNFR2 was associated with all three markers in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort (P<0.001 for all). Our findings from two independent community-based cohorts confirm and extend results of previous studies supporting circulating sTNFRs as relevant biomarkers for kidney damage and dysfunction in elderly individuals, even in the absence of diabetes.

  • 20.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Nordquist, Lina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Larsson, Tobias E.
    Carrero, Juan-Jesús
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. gSchool of Health and Social Studies, Dalarna University, Falun , Sweden.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Soluble Tumor Necrosis Factor Receptor 1 Is Associated with Glomerular Filtration Rate Progression and Incidence of Chronic Kidney Disease in Two Community-Based Cohorts of Elderly Individuals2015In: Cardiorenal Medicine, ISSN 1664-3828, Vol. 5, no 4, p. 278-288Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to explore and validate the longitudinal associations between soluble tumor necrosis factor receptor 1 (sTNFR1), glomerular filtration rate (GFR) progression, and chronic kidney disease (CKD) incidence in two independent community-based cohorts of elderly individuals with prespecified subgroup analyses in individuals without prevalent diabetes. Research Design and Methods: Two community-based cohorts of elderly individuals were used with 5-year follow-up data on estimated GFR: the Uppsala Longitudinal Study of Adult Men (ULSAM; n = 437 men; mean age: 78 years) and the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; n = 703; mean age: 70 years; 51% women). GFR categories were defined as >= 60, 30-60, and = 60 ml/min/1.73 m(2) at baseline, higher sTNFRs were associated with incident CKD after 5 years in both cohorts [ULSAM: OR per SD increase 1.49 (95% CI 1.16-1.9) and PIVUS: OR 1.84 (95% CI 1.50-2.26)]. Associations were similar in individuals without diabetes. Conclusions: Higher circulating sTNFR1 independently predicts the progression to a worse GFR category and CKD incidence in elderly individuals even in the absence of diabetes. Further studies are warranted to investigate the underlying mechanisms, and to evaluate the clinical relevance of our findings.

  • 21.
    Carlsson, Axel C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Hypertriglyceridemic Waist Phenotype Is Associated with Decreased Insulin Sensitivity and Incident Diabetes in Elderly Men2014In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 22, no 2, p. 526-529Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association between hypertriglyceridemic waist (HTGW) and insulin sensitivity (assessed by euglycemic clamp method), and the development of diabetes in a longitudinal community-based cohort of elderly men without diabetes at baseline. Design and Methods: The present cross-sectional study comprised 1,026, 70-year-old men without diabetes. The gold standard euglycaemic-hyperinsulinaemic clamp technique was used. Six-year follow-up on diabetes status were available in n = 667. The HTGW phenotype was defined as having waist circumference >= 90 cm, and triglycerides >= 2 mmol L-1. The men were stratified into those having normal WC and TG (n = 299), one HTGW component (n = 606), and HTGW (n = 121). Results: The association between insulin sensitivity and one HTGW component as well as HTGW was highly significant (P < 0.001) in the whole sample, as well as in individuals with high/low BMI (stratified at >= 25). In longitudinal analyses, participants with HTGW was associated with a more than fourfold increased risk for diabetes (Odds ratio 4.64, 95% CI 1.61-13.4, P = 0.004) compared to those with normal WC and TG. Conclusion: The present study both confirm and extend previous research suggesting that the HTGW-phenotype portrays an increased glucometabolic risk, also in lean individuals.

  • 22.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Ruge, Toralph
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Association between circulating endostatin, hypertension duration, and hypertensive target-organ damage2013In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 62, no 6, p. 1146-1151Article in journal (Refereed)
    Abstract [en]

    Our aim is to study associations between circulating endostatin, hypertension duration, and hypertensive target-organ damage. Long-term hypertension induces cardiovascular and renal remodeling. Circulating endostatin, a biologically active derivate of collagen XVIII, has been suggested to be a relevant marker for extracellular matrix turnover and remodeling in various diseases. However, the role of endostatin in hypertension and hypertensive target-organ damage is unclear. Serum endostatin was measured in 2 independent community-based cohorts: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; women 51%; n=812; mean age, 75 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM; n=785; mean age, 77.6 years). Retrospective data on blood pressure measurements and antihypertensive medication (PIVUS >5 years, ULSAM >27 years), and cross-sectional data on echocardiographic left ventricular mass, endothelial function (endothelium-dependent vasodilation assessed by the invasive forearm model), and urinary albumin/creatinine ratio were available. In PIVUS, participants with ≥5 years of history of hypertension portrayed 0.42 SD (95% confidence interval, 0.23-0.61; P<0.001) higher serum endostatin, compared with that of normotensives. This association was replicated in ULSAM, in which participants with 27 years hypertension duration had the highest endostatin (0.57 SD higher; 95% confidence interval, 0.35-0.80; P<0.001). In addition, higher endostatin was associated with higher left ventricular mass, worsened endothelial function, and higher urinary albumin/creatinine ratio (P<0.03 for all) in participants with prevalent hypertension. Circulating endostatin is associated with the duration of hypertension, and vascular, myocardial, and renal indices of hypertensive target-organ damage. Further studies are warranted to assess the prognostic role of endostatin in individuals with hypertension.

  • 23.
    Carlsson, Axel C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med, Dept Neurobiol, Care Sci & Soc, Karlskrona, Sweden..
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Carrero, Juan Jesus
    Karolinska Inst, Div Renal Med, Dept Clin Sci, Intervent & Technol, Karlskrona, Sweden..
    Gustafsson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Stenemo, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Dalarna Univ, Sch Hlth & Social Sci, Dalarna, Sweden..
    Use of a proximity extension assay proteomics chip to discover new biomarkers associated with albuminuria2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, no 4, p. 340-348Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The underlying mechanisms for the development of albuminuria and the increased cardiovascular risk in patients with elevated albuminuria levels are incompletely understood. We therefore investigated the associations between 80 cardiovascular proteins and the urinary albumin to creatinine ratio (ACR).

    METHODS: We used a discovery/replication approach in two independent community-based cohorts of elderly patients: the Uppsala Longitudinal Study of Adult Men (n = 662; mean age 78 years) and the Prospective Investigation of the Vasculature in Uppsala Seniors (n = 757; mean age 75 years; 51% women). A proteomic chip with a panel of 80 plasma proteins associated with different aspects of cardiovascular disease was analysed. In the discovery cohort, we used a false discovery rate of 5% to take into account the multiple statistical testing. Nominal p values were used in the replication.

    RESULTS: Higher levels of T-cell immunoglobulin mucin-1, placenta growth factor, growth/differentiation factor-15, urokinase plasminogen activator surface receptor and kallikrein-11 were robustly associated with a higher ACR in both cohorts in multivariable linear regression models adjusted for sex, established cardiovascular risk factors, antihypertensive treatment, prevalent cardiovascular disease and glomerular filtration rate (p < 0.02 for all). All associations were also significant in separate analyses of patients without diabetes.

    CONCLUSIONS: We discovered and replicated associations between ACR and five cardiovascular proteins involved in tubular injury, atherosclerosis, endothelial function, heart failure, inflammation, glomerulosclerosis and podocyte injury. Our findings put forward multiplex proteomics as a promising approach to explore novel aspects of the complex detrimental interplay between kidney function and the cardiovascular system.

  • 24.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Sundström, Johan
    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.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Physical activity, obesity and risk of cardiovascular disease in middle-aged men during a median of 30 years of follow-up2016In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 4, p. 359-365Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    We aimed to investigate associations between combinations of body mass index (BMI)-categories, levels of physical activity and long-term risk of cardiovascular disease.

    METHOD AND RESULTS:

    At age 50 years, cardiovascular risk factors were assessed in 2196 participating men of the ULSAM-study. This investigation was repeated at age 60, 70, 77 and 82 years. Being physically active (PA) was defined as three hours of recreational or hard physical training per week. The men were categorized according to BMI/PA-status, as PA/normal weight (n = 593 at baseline), non-PA/normal weight (BMI < 25 kg/m(2), n = 580), PA/overweight (n = 418), non-PA/overweight (BMI 25-30 kg/m(2), n = 462), PA/obese (n = 62), non-PA/obese (BMI >30 kg/m(2), n = 81). We used updated data on BMI and physical activity obtained at all examinations. During follow-up (median 30 years) 850 individuals suffered a cardiovascular disease (myocardial infarction, stroke or heart failure). Using updated data on BMI/PA categories, an increased risk for cardiovascular disease was seen with increasing BMI, but a high physical activity was associated with a lower risk of cardiovascular disease within each BMI category: non-PA/normal weight (hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.04-1.66), PA/overweight (HR 1.52, 95% CI 1.20-1.94), non-PA/overweight (HR 1.65, 95% CI 1.31-2.07) PA/obese (HR 2.05, 95% CI 1.44-2.92) and non-PA/obese (HR 2.39, 95% CI 1.74-3.29), using PA/normal weight men as referent.

    CONCLUSIONS:

    Although physical activity was beneficial at all levels of BMI regarding the risk of future cardiovascular disease, there was still a substantial increased risk associated with being overweight or obese during 30 years of follow-up.

  • 25.
    Carlsson, Axel C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Östgren, C. J.
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Lanne, T.
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Nyström, F. H.
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
    The association between endostatin and kidney disease and mortality in patients with type 2 diabetes2016In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 42, no 5, p. 351-357Article in journal (Refereed)
    Abstract [en]

    Aim. - Circulating endostatin, a biologically active derivate of collagen XVIII, is considered to be a marker of kidney disease and a risk factor for its related mortality. However, less is known of the role of endostatin in diabetes and the development of diabetic nephropathy. For this reason, our study investigated the associations between circulating endostatin and the prevalence and progression of kidney disease, and its mortality risk in patients with type 2 diabetes (T2D). Methods. - This was a cohort study of 607 patients with T2D (mean age: 61 years, 44% women). Estimated glomerular filtration rate (eGFR), calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, was used to assess the patients' kidney function decline and mortality. Results. - Of the total study cohort, 20 patients declined by >= 20% in eGFR over 4 years, and 44 died during the follow-up (mean duration: 6.7 years). At baseline, participants with diabetic nephropathy (defined as eGFR < 60 mL/min/1.73 m(2)) and/or microalbuminuria [defined as a urinary albumin-to-creatinine ratio (ACR) > 3 g/mol] had higher median levels of endostatin than those without nephropathy (62.7 mu g/L vs 57.4 mu g/L, respectively; P = 0.031). In longitudinal analyses adjusted for age, gender, baseline eGFR and ACR, higher endostatin levels were associated with a higher risk of decline (>= 20% in eGFR, OR per 1 SD increase: 1.73, 95% CI: 1.13-2.65) and a higher risk of mortality (HR per 1 SD increase: 1.57, 95% CI: 1.19-2.07). Conclusion. - In patients with T2D, circulating endostatin levels can predict the progression of kidney disease and mortality independently of established kidney disease markers. The clinical usefulness of endostatin as a risk marker in such patients merits further studies.

  • 26.
    Carlsson, Axel C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Östgren, Carl Johan
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden..
    Nystrom, Fredrik H
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden..
    Länne, Toste
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden..
    Jennersjö, Pär
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden..
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes2016In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 15, article id 40Article in journal (Refereed)
    Abstract [en]

    AIMS/HYPOTHESIS: Soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) contribute to experimental diabetic kidney disease, a condition with substantially increased cardiovascular risk when present in patients. Therefore, we aimed to explore the levels of sTNFRs, and their association with prevalent kidney disease, incident cardiovascular disease, and risk of mortality independently of baseline kidney function and microalbuminuria in a cohort of patients with type 2 diabetes. In pre-defined secondary analyses we also investigated whether the sTNFRs predict adverse outcome in the absence of diabetic kidney disease.

    METHODS: The CARDIPP study, a cohort study of 607 diabetes patients [mean age 61 years, 44 % women, 45 cardiovascular events (fatal/non-fatal myocardial infarction or stroke) and 44 deaths during follow-up (mean 7.6 years)] was used.

    RESULTS: Higher sTNFR1 and sTNFR2 were associated with higher odds of prevalent kidney disease [odd ratio (OR) per standard deviation (SD) increase 1.60, 95 % confidence interval (CI) 1.32-1.93, p < 0.001 and OR 1.54, 95 % CI 1.21-1.97, p = 0.001, respectively]. In Cox regression models adjusting for age, sex, glomerular filtration rate and urinary albumin/creatinine ratio, higher sTNFR1 and sTNFR2 predicted incident cardiovascular events [hazard ratio (HR) per SD increase, 1.66, 95 % CI 1.29-2.174, p < 0.001 and HR 1.47, 95 % CI 1.13-1.91, p = 0.004, respectively]. Results were similar in separate models with adjustments for inflammatory markers, HbA1c, or established cardiovascular risk factors, or when participants with diabetic kidney disease at baseline were excluded (p < 0.01 for all). Both sTNFRs were associated with mortality.

    CONCLUSIONS/INTERPRETATIONS: Higher circulating sTNFR1 and sTNFR2 are associated with diabetic kidney disease, and predicts incident cardiovascular disease and mortality independently of microalbuminuria and kidney function, even in those without kidney disease. Our findings support the clinical utility of sTNFRs as prognostic markers in type 2 diabetes.

  • 27.
    Carlsson, Axel
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Wändell, Per
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Borné, Yan
    Engström, Gunnar
    Leander, Karin
    Gigante, Bruna
    Hellenius, Mai-Lis
    de Faire, Ulf
    Differences inanthropometric measures in immigrants and Swedish-born individuals: Results from two community based cohort studies2014In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 69, p. 151-156Article in journal (Refereed)
    Abstract [en]

    Aim

    To study differences in body mass index (BMI), waist–hip ratio (WHR), waist circumference (WC), sagittal abdominal diameter (SAD), waist–hip–height ratio (WHHR) and percent body fat in immigrants and Swedish-born men and women in two large population-based samples.

    Methods

    A cross-sectional analysis of 60-year-old individuals, n = 4 232. To replicate the results, we also assessed another large independent cohort cross-sectionally, the Malmö Diet and Cancer Study (MDC, n = 26 777). The data from both cohorts were collected in the 1990s in Sweden.

    Results

    Significant differences between Finnish-born, Middle Eastern and women from the rest of the world were seen for all anthropometric measures, using Swedish-born women as referent. However, WHHR was the only anthropometric measure that identified all these three groups of immigrant women as different from Swedish-born women with high statistical certainty (p < 0.001). Apart from WHHR that identified differences in anthropometry in all immigrant groups of men using Swedish-born men as referent, few significant differences were seen in anthropometry among groups of immigrant men. These finding were observed in both cohorts, and remained after adjustments for smoking, physical activity and educational level.

    Conclusion

    The present study confirms previous findings of more obesity among immigrants and is the first to report that WHHR measurements may detect anthropometric differences between different ethnic groups better than other anthropometrical measures.

  • 28. Carrero, Juan J.
    et al.
    Huang, Xiaoyan
    Jimenez-Moleon, Jose
    Lindholm, Bengt
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Arnlov, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Riserus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Sjögren, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Mediterranean Diet, Kidney Function, And Mortality In Men With Chronic Kidney Disease2013In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 28, no S1, p. 8-8Article in journal (Other academic)
  • 29.
    Carrero, Juan Jesus
    et al.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med & Baxter Novum, Stockholm, Sweden.;Karolinska Inst, Ctr Mol Med, Stockholm, Sweden..
    Grams, Morgan E.
    Johns Hopkins Univ, Sch Med, Div Nephrol, Baltimore, MD USA.;Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA..
    Sang, Yingying
    Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA..
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
    Gasparini, Alessandro
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Matsushita, Kunihiro
    Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA..
    Qureshi, Abdul R.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Evans, Marie
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Barany, Peter
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Lindholm, Bengt
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Ballew, Shoshana H.
    Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA..
    Levey, Andrew S.
    Tufts Med Ctr, Div Nephrol, Boston, MA USA..
    Gansevoort, Ron T.
    Univ Groningen, Univ Med Ctr Groningen, Dept Nephrol, Groningen, Netherlands..
    Elinder, Carl G.
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Renal Med & Baxter Novum, Stockholm, Sweden.;Stockholm Cty Council, Publ Healthcare Serv Comm, Stockholm, Sweden..
    Coresh, Josef
    Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA..
    Albuminuria changes are associated with subsequent risk of end-stage renal disease and mortality2017In: Kidney International, ISSN 0085-2538, E-ISSN 1523-1755, Vol. 91, no 1, p. 244-251Article in journal (Refereed)
    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.

  • 30. Chang, Alex R
    et al.
    Grams, Morgan E
    Ballew, Shoshana H
    Bilo, Henk
    Correa, Adolfo
    Evans, Marie
    Gutierrez, Orlando M
    Hosseinpanah, Farhad
    Iseki, Kunitoshi
    Kenealy, Timothy
    Klein, Barbara
    Kronenberg, Florian
    Lee, Brian J
    Li, Yuanying
    Miura, Katsuyuki
    Navaneethan, Sankar D
    Roderick, Paul J
    Valdivielso, Jose M
    Visseren, Frank L J
    Zhang, Luxia
    Gansevoort, Ron T
    Hallan, Stein I
    Levey, Andrew S
    Matsushita, Kunihiro
    Shalev, Varda
    Woodward, Mark
    Ärnlöv, Johan (Contributor)
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Lannfelt, Lars (Contributor)
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium2019In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 364, article id k5301Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality.

    DESIGN: Individual participant data meta-analysis.

    SETTING: Cohorts from 40 countries with data collected between 1970 and 2017.

    PARTICIPANTS: Adults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607).

    MAIN OUTCOME MEASURES: GFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR <10 mL/min/1.73 m2) and all cause mortality.

    RESULTS: Over a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index.

    CONCLUSIONS: Elevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

  • 31.
    Corsonello, Andrea
    et al.
    INRCA Ancona, Ancona, Fermo & Cosenza, Italy.
    Roller-Wirnsberger, Regina
    Med Univ Graz, Dept Internal Med, Graz, Austria.
    Di Rosa, Mirko
    INRCA Ancona, Ancona, Fermo & Cosenza, Italy.
    Fabbietti, Paolo
    INRCA Ancona, Ancona, Fermo & Cosenza, Italy.
    Wirnsberger, Gerhard
    Med Univ Graz, Dept Internal Med, Graz, Austria.
    Kostka, Tomasz
    Med Univ Lodz, Dept Geriatr, Hlth Ageing Res Ctr, Lodz, Poland.
    Guligowska, Agnieszka
    Med Univ Lodz, Dept Geriatr, Hlth Ageing Res Ctr, Lodz, Poland.
    Tap, Lisanne
    Erasmus Univ, Med Ctr Rotterdam, Dept Internal Med, Sect Geriatr Med, Rotterdam, Netherlands.
    Mattace-Raso, Francesco
    Erasmus Univ, Med Ctr Rotterdam, Dept Internal Med, Sect Geriatr Med, Rotterdam, Netherlands.
    Gil, Pedro
    Hosp Clin San Carlos, Dept Geriatr Med, Madrid, Spain.
    Guardado-Fuentes, Lara
    Hosp Clin San Carlos, Dept Geriatr Med, Madrid, Spain.
    Meltzer, Itshak
    Ben Gurion Univ Negev, Fac Hlth Sci, Recanati Sch Community Hlth Profess, Beer Sheva, Israel.
    Yehoshua, Ilan
    Maccabi Healthcare Serv Southern Reg, Tel Aviv, Israel.
    Artzi-Medevdik, Rada
    Ben Gurion Univ Negev, Fac Hlth Sci, Recanati Sch Community Hlth Profess, Beer Sheva, Israel;Maccabi Healthcare Serv Southern Reg, Tel Aviv, Israel.
    Formiga, Francesc
    Bellvitge Univ Hosp IDIBELL, Internal Med Dept, Geriatr Unit, Barcelona, Spain;Bellvitge Univ Hosp IDIBELL, Nephrol Dept, Barcelona, Spain.
    Moreno-Gonzalez, Rafael
    Bellvitge Univ Hosp IDIBELL, Internal Med Dept, Geriatr Unit, Barcelona, Spain;Bellvitge Univ Hosp IDIBELL, Nephrol Dept, Barcelona, Spain.
    Weingart, Christian
    Friedrich Alexander Univ Erlangen Nurnberg, Krankenhaus Barmherzige Bruder Regensburg, Dept Gen Internal Med & Geriatr, Erlangen, Germany;Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, Erlangen, Germany.
    Freiberger, Ellen
    Friedrich Alexander Univ Erlangen Nurnberg, Krankenhaus Barmherzige Bruder Regensburg, Dept Gen Internal Med & Geriatr, Erlangen, Germany;Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, Erlangen, Germany.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Karolinska Inst, Care Sci & Soc, Dept Neurobiol, Div Family Med, Huddinge, Sweden.
    Lattanzio, Fabrizia
    INRCA Ancona, Ancona, Fermo & Cosenza, Italy.
    Estimated glomerular filtration rate and functional status among older people: A systematic review2018In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 56, p. 39-48Article, review/survey (Refereed)
    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.

  • 32.
    Corsonello, Andrea
    et al.
    INRCA Ancona, Ancona, Italy;INRCA, Fermo, Italy;INRCA, Cosenza, Italy.
    Tap, Lisanne
    Erasmus Univ, Geriatr Med Sect, Dept Internal Med, Med Ctr Rotterdam, Rotterdam, Netherlands.
    Roller-Wirnsberger, Regina
    Med Univ Graz, Dept Internal Med, Auenbruggerpl 15, A-8036 Graz, Austria.
    Wirnsberger, Gerhard
    Med Univ Graz, Dept Internal Med, Auenbruggerpl 15, A-8036 Graz, Austria.
    Zoccali, Carmine
    Osped Riuniti Reggio Calabria, CNR, IFC, Clin Epidemiol & Pathophysiol Hypertens & Renal D, Reggio Di Calabria, Italy.
    Kostka, Tomasz
    Med Univ Lodz, Dept Geriatr, Hlth Ageing Res Ctr, Lodz, Poland.
    Guligowska, Agnieszka
    Med Univ Lodz, Dept Geriatr, Hlth Ageing Res Ctr, Lodz, Poland.
    Mattace-Raso, Francesco
    Erasmus Univ, Geriatr Med Sect, Dept Internal Med, Med Ctr Rotterdam, Rotterdam, Netherlands.
    Gil, Pedro
    Hosp Clin San Carlos, Dept Geriatr Med, Madrid, Spain.
    Guardado Fuentes, Lara
    Hosp Clin San Carlos, Dept Geriatr Med, Madrid, Spain.
    Meltzer, Itshak
    Ben Gurion Univ Negev, Fac Hlth Sci, Recanati Sch Community Hlth Profess, Beer Sheva, Israel.
    Yehoshua, Ilan
    Maccabi Healthcare Serv Southern Reg, Tel Aviv, Israel.
    Formiga-Perez, Francesc
    Bellvitge Univ Hosp, Internal Med Dept, IDIBELL, Geriatr Unit, Barcelona, Spain;Bellvitge Univ Hosp, Nephrol Dept, IDIBELL, Barcelona, Spain.
    Moreno-Gonzalez, Rafael
    Bellvitge Univ Hosp, Internal Med Dept, IDIBELL, Geriatr Unit, Barcelona, Spain;Bellvitge Univ Hosp, Nephrol Dept, IDIBELL, Barcelona, Spain.
    Weingart, Christian
    Friedrich Alexander Univ Erlangen Nurnberg, Krankenhaus Barmherzige Bruder Regensburg, Dept Gen Internal Med & Geriatr, Erlangen, Germany;Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, Erlangen, Germany.
    Freiberger, Ellen
    Friedrich Alexander Univ Erlangen Nurnberg, Krankenhaus Barmherzige Bruder Regensburg, Dept Gen Internal Med & Geriatr, Erlangen, Germany;Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, Erlangen, Germany.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Stockholm, Sweden.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Stockholm, Sweden.
    Bustacchini, Silvia
    INRCA Ancona, Ancona, Italy;INRCA, Fermo, Italy;INRCA, Cosenza, Italy.
    Lattanzio, Fabrizia
    INRCA Ancona, Ancona, Italy;INRCA, Fermo, Italy;INRCA, Cosenza, Italy.
    Design and methodology of the screening for CKD among older patients across Europe (SCOPE) study: a multicenter cohort observational study2018In: BMC Nephrology, ISSN 1471-2369, E-ISSN 1471-2369, Vol. 19, article id 260Article in journal (Refereed)
    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.

  • 33. Fall, T.
    et al.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology, Diabetes and Metabolism.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    The role of obesity-related genetic loci in insulin sensitivity2012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 7, p. E62-E66Article in journal (Refereed)
    Abstract [en]

    Aims Despite rapid advancements and many new diabetes susceptibility loci found in the past few years, few genetic variants associated with insulin sensitivity have been described, potentially attributable to the lack of larger cohorts examined with gold standard methods for insulin sensitivity assessment. There is a strong link between obesity and insulin sensitivity, and we hypothesized that known obesity susceptibility loci may act via effects on insulin sensitivity. Methods A cohort of 71-year-old men without diabetes (Uppsala Longitudinal Study of Adult Men) underwent a euglycaemichyperinsulinaemic clamp and genotyping for genetic variants representing 32 loci recently reported to be associated with BMI (n = 926). The effect of these loci on the insulin sensitivity index (M/I ratio) was examined using linear regression. An in silico replication was performed in publically available data for the three top single-nucleotide polymorphisms from the Meta-Analyses of Glucose and Insulin-related traits Consortium analyses of homeostasis model assessment of insulin resistance (n = 37 037). Results Three loci (SH2B1, MTCH2 and NEGR1) were associated with decreased insulin sensitivity at a nominal significance (P = 0.05) after adjustment for BMI, but did not hold for multiple comparison correction. SH2B1 rs7359397 was also associated with homeostasis model assessment of insulin resistance in the Meta-Analyses of Glucose and Insulin-related traits Consortium data set (P = 3.9 x 10(3)). Conclusions Our study supports earlier reports of SH2B1 to be of importance in insulin sensitivity and, in addition, suggests potential roles of NEGR1 and MTCH2.

  • 34. Fall, Tove
    et al.
    Shiue, Ivy
    af Geijerstam, Per Bergea
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Relations of circulating vitamin D concentrations with left ventricular geometry and function2012In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 14, no 9, p. 985-991Article in journal (Refereed)
    Abstract [en]

    Vitamin D deficiency has been associated with risk of overt cardiovascular disease (CVD), but associations with subclinical disease are not well characterized. Hence, we examined associations of circulating vitamin D concentrations and left ventricular (LV) geometry and function by echocardiography at baseline and after 5 years in a community-based study. In the PIVUS study, we measured serum 25-dihydroxyvitamin-D (25-OH D) at age 70 and performed echocardiography including LV mass, wall thickness, end-diastolic diameter, end-systolic diameter (LVESD), left atrial diameter, fractional shortening, ejection fraction, isovolumic relaxation time, and E/A ratio at both age 70 and 75. We included 870 participants (52 women) without prior myocardial infarctions, heart failure, or prevalent valvular disease. After adjusting for potential confounders, 25-OH D at baseline was found to be significantly associated with LVESD, fractional shortening, and ejection fraction (, 0.42 mm, P 0.03; , 0.70, P 0.03; and , 0.91 P 0.01, respectively), per 1 SD increase in 25-OH D (SD 20 nmol/L) at baseline. In longitudinal analyses, vitamin D levels at baseline were not significantly associated with change in LV geometry and function after 5 years. In our community-based study among the elderly, we found higher circulating vitamin D concentrations to be associated cross-sectionally with better LV systolic function and smaller LVESD at baseline. The association persisted after adjusting for several potential confounders, including cardiovascular risk factors and calcium, phosphate, and parathyroid hormone levels. Randomized clinical trials are needed to establish firmly or refute a causal relationship between vitamin D levels and changes in LV geometry and function.

  • 35.
    Feldreich, T. Rudholm
    et al.
    Dalarna Univ, Med Sci, Falun, Sweden..
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Helmersson-Karlqvist, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Larsson, A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Higher circulating osteopontin specifically predicts cardiovascular death while urinary osteopontin predicts kidney disease progression2016In: EUROPEAN HEART JOURNAL, ISSN 0195-668X, Vol. 37, p. 1282-1282Article in journal (Refereed)
  • 36.
    Feldreich, T. Rudholm
    et al.
    Dalarna Univ, Med Sci, Falun, Sweden..
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Riserus, U
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Larsson, A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    The association between serum cathepsin l and mortality in older adults2016In: EUROPEAN HEART JOURNAL, ISSN 0195-668X, Vol. 37, p. 1283-1283Article in journal (Refereed)
  • 37.
    Feldreich, Tobias
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. School of Health and Social Studies, Dalarna University, Falun, .
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. School of Health and Social Studies, Dalarna University, Falun, .
    The association between serum cathepsin L and mortality in older adults2016In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 254, p. 109-116Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Research suggests that the protease cathepsin L is causally involved in atherosclerosis. However, data on cathepsin L as a risk marker are lacking. Therefore, we investigated associations between circulating cathepsin L and cardiovascular mortality.

    METHODS: Two independent community-based cohorts were used: Uppsala Longitudinal Study of Adult Men (ULSAM); n = 776; mean age 77 years; baseline 1997-2001; 185 cardiovascular deaths during 9.7 years follow-up, and Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS); n = 993; 50% women; mean age 70 years; baseline 2001-2004; 42 cardiovascular deaths during 10.0 years follow-up.

    RESULTS: Higher serum cathepsin L was associated with an increased risk for cardiovascular mortality in age- and sex-adjusted models in both cohorts (ULSAM: hazard ratio (HR) for 1-standard deviation (SD) increase, 1.17 [95% CI, 1.01-1.34], p = 0.032 PIVUS: HR 1.35 [95% CI, 1.07-1.72], p = 0.013). When merging the cohorts, these associations were independent of inflammatory markers and cardiovascular risk factors, but non-significant adjusting for kidney function. Individuals with a combination of elevated cathepsin L and increased inflammation, kidney dysfunction, or prevalent cardiovascular disease had a markedly increased risk, while no increased risk was associated with elevated cathepsin L, in the absence of these disease states.

    CONCLUSIONS: An association between higher serum cathepsin L and increased risk of cardiovascular mortality was found in two independent cohorts. Impaired kidney function appears to be an important moderator or mediator of these associations. Further studies are needed to delineate the underlying mechanisms and to evaluate whether the measurement of cathepsin L might have clinical utility.

  • 38.
    Forouzanfar, Mohammad H.
    et al.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Afshin, Ashkan
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Alexander, Lily T.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Anderson, H. Ross
    St Georges Univ London, Populat Hlth Res Inst, London, England..
    Bhutta, Zulficiar A.
    Aga Khan Univ, Ctr Excellence Women & Child Hlth, Karachi, Pakistan.;Hosp Sick Children, Ctr Global Child Hlth, Toronto, ON, Canada..
    Biryukov, Stan
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Brauer, Michael
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Burnett, Richard
    Hlth Canada, Ottawa, ON, Canada..
    Cercy, Kelly
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Charlson, Fiona J.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia.;Queensland Ctr Mental Hlth Res, Brisbane, Qld, Australia..
    Cohen, Aaron J.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Hlth Effects Inst, Boston, MA USA..
    Dandona, Lalit
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Publ Hlth Fdn India, New Delhi, India..
    Estep, Kara
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Ferrari, Alize J.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia.;Queensland Ctr Mental Hlth Res, Brisbane, Qld, Australia..
    Frostad, Joseph J.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Fullman, Nancy
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Gething, Peter W.
    Univ Oxford, Dept Zool, Oxford, England..
    Godwin, William W.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Griswold, Max
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Kinfu, Yohannes
    Univ Canberra, Fac Hlth, Ctr Res & Act Publ Hlth, Canberra, ACT, Australia..
    Kyu, Hmwe H.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Larson, Heidi J.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;London Sch Hyg & Trop Med, Dept Infect Dis Epidemiol, London, England..
    Liang, Xiaofeng
    Chinese Ctr Dis Control & Prevent, Beijing, Peoples R China..
    Lim, Stephen S.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Liu, Patrick Y.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Lopez, Alan D.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Univ Melbourne, Melbourne Sch Populat & Global Hlth, Melbourne, Vic, Australia..
    Lozano, Rafael
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Marczak, Laurie
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Mensah, George A.
    NHLBI, Ctr Translat Res & Implementat Sci, NIH, Bldg 10, Bethesda, MD 20892 USA..
    Mokdad, Ali H.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Moradi-Lakeh, Maziar
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Iran Univ Med Sci, Dept Community Med, Gastrointestinal & Liver Dis Res Ctr, Prevent Med & Publ Hlth Res Ctr, Tehran, Iran..
    Naghavi, Mohsen
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Neal, Bruce
    George Inst Global Hlth, Sydney, NSW, Australia.;Univ Sydney, Sydney, NSW, Australia.;Royal Prince Alfred Hosp, Sydney, NSW, Australia.;Imperial Coll London, London, England..
    Reitsma, Marissa B.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Roth, Gregory A.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Salomon, Joshua A.
    Harvard Univ, Dept Global Hlth & Populat, Boston, MA 02115 USA..
    Sur, Patrick J.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Vos, Theo
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Wagner, Joseph A.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Wang, Haidong
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Zhao, Yi
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Zhou, Maigeng
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Chinese Ctr Dis Control & Prevent, Ctr Chron & Noncommunicable Dis Control & Prevent, Beijing, Peoples R China..
    Aasvang, Gunn Marit
    Norwegian Inst Publ Hlth, Oslo, Norway..
    Abajobir, Amanuel Alemu
    Abate, Kalkidan Hassen
    Jimma Univ, Jimma, Ethiopia..
    Abbafati, Cristiana
    Univ Roma La Sapienza, Rome, Italy..
    Abbas, Kaja M.
    Virginia Tech, Blacksburg, VA USA..
    Abd-Allah, Foad
    Cairo Univ, Dept Neurol, Cairo, Egypt..
    Abdulle, Abdishakur M.
    New York Univ Abu Dhabi, Abu Dhabi, U Arab Emirates..
    Abera, Semaw Ferede
    Mekelle Univ, Sch Publ Hlth, Coll Hlth Sci, Mekelle, Ethiopia.;Kilte Awlaelohlth & Demog Surveillance Site, Mekelle, Ethiopia.;Univ Hohenheim, Food Secur & Inst Biol Chem & Nutr, Stuttgart, Germany..
    Abraham, Biju
    NM SM Govt Coll Kalpetta, Kalpetta, Kerala, India..
    Abu-Raddad, Laith J.
    Weill Cornell Med Coll Qatar, Infect Dis Epidemiol Grp, Doha, Qatar..
    Abyu, Gebre Yitayih
    Mekelle Univ, Mekelle, Ethiopia..
    Adebiyi, Akindele Olupelumi
    Univ Ibadan, Coll Med, Ibadan, Nigeria.;Univ Coll Hosp, Ibadan, Nigeria..
    Adedeji, Isaac Akinkunmi
    Olabisi Onabanjo Univ, Ago Iwoye, Nigeria..
    Ademi, Zanfina
    Univ Melbourne, Melbourne, Vic, Australia. Natl Inst Publ Hlth, Natl Council Sci & Technol, Cuernavaca, Morelos, Mexico.;Univ Basel, Basel, Switzerland..
    Adou, Arsene Kouablan
    Assoc Ivoirienne Bien Etre Familial, Abidjan, Cote Ivoire..
    Adsuar, Jose C.
    Univ Extremadura, Caceres, Spain..
    Agardh, Emilie Elisabet
    Inst Publ Hlth Sci, Stockholm, Sweden..
    Agarwal, Arnav
    Univ Toronto, Toronto, ON, Canada.;McMaster Univ, Hamilton, ON, Canada..
    Agrawal, Anurag
    CSIR Inst Genom & Integrat Biol, Delhi, India.;Baylor Coll Med, Dept Internal Med, Houston, TX 77030 USA..
    Kiadaliri, Aliasghar Ahmad
    Lund Univ, Clin Epidemiol Unit, Dept Clin Sci Lund, Orthoped, Lund, Sweden.;Kerman Univ Med Sci, Inst Futures Studies Hlth, Hlth Serv Management Res Ctr, Kerman, Iran..
    Ajala, Oluremi N.
    Harvard Univ, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA.;Univ Pittsburgh, Med Ctr, Mckeesport, PA USA..
    Akinyemiju, Tomi F.
    Univ Alabama Birmingham, Dept Epidemiol, Birmingham, AL USA..
    Al-Aly, Ziyad
    Washington Univ, St Louis, MO USA..
    Alam, Khurshid
    Univ Melbourne, Murdoch Childrens Res Inst, Melbourne, Vic, Australia.;Univ Melbourne, Melbourne, Vic, Australia. Natl Inst Publ Hlth, Natl Council Sci & Technol, Cuernavaca, Morelos, Mexico.;Univ Sydney, Sydney, NSW, Australia..
    Alam, Noore K. M.
    Univ Queensland, Brisbane, Qld, Australia.;Queensland Hlth, Herston, Qld, Australia..
    Aldhahri, Saleh Fahed
    King Saud Univ, Riyadh, Saudi Arabia.;King Fahad Med City, Dept Anesthesiol, Riyadh, Saudi Arabia.;King Fahad Med City, Riyadh, Saudi Arabia..
    Aldridge, Robert William
    UCL, Ctr Publ Hlth Data Sci, Inst Hlth Informat, London, England..
    Alemu, Zewdie Aderaw
    Debre Markos Univ, Debre Markos, Ethiopia..
    Ali, Raghib
    Univ Oxford, Oxford, England..
    Alkerwi, Ala'a
    Luxembourg Inst Hlth LIH, Strassen, Luxembourg..
    Alla, Francois
    Univ Lorraine, Sch Publ Hlth, Nancy, France..
    Allebeck, Peter
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden..
    Alsharif, Ubai
    Charite, Berlin, Germany..
    Altirkawi, Khalid A.
    King Saud Univ, Riyadh, Saudi Arabia..
    Alvarez Martin, Elena
    Govt Delegat Natl Plan Drugs, Minist Hlth, Spanish Observ Drugs, Social Policy & Equal, Madrid, Spain..
    Alvis-Guzman, Nelson
    Univ Cartagena, Cartagena De Indias, Colombia..
    Amare, Azmeraw T.
    Univ Adelaide, Sch Med, Adelaide, SA, Australia.;Bahir Dar Univ, Coll Med & Hlth Sci, Bahir Dar, Ethiopia..
    Amberbir, Alemayehu
    Dignitas Int, Zomba, Malawi..
    Amegah, Adeladza Kofi
    Univ Cape Coast, Cape Coast, Ghana..
    Amini, Heresh
    Kurdistan Univ Med Sci, Environm Hlth Res Ctr, Sanandaj, Iran.;Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland..
    Ammar, Walid
    Minist Publ Hlth, Beirut, Lebanon..
    Amrock, Stephen Marc
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA..
    Andersen, Hjalte H.
    Aalborg Univ, Fac Med, Dept Hlth Sci & Technol, Ctr Sensory Motor Interact, Aalborg, Denmark..
    Anderson, Benjamin O.
    Univ Washington, Seattle, WA 98195 USA..
    Antonio, Carl Abelardo T.
    Univ Philippines Manila, Dept Hlth Policy & Adm, Coll Publ Hlth, Manila, Philippines..
    Anwar, Palwasha
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Dalarna Univ, Falun, Sweden. Univ Manitoba, Winnipeg, MB, Canada..
    Artaman, Al
    Asayesh, Hamid
    Qom Univ Med Sci, Sch Paramed, Dept Emergency Med, Qom, Iran..
    Asghar, Rana Jawad
    South Asian Publ Hlth Forum, Islamabad, Pakistan..
    Assadi, Reza
    Mashhad Univ Med Sci, Mashhad, Iran..
    Atique, Suleman
    Taipei Med Univ, Grad Inst Biomed Informat, Taipei, Taiwan..
    Avokpaho, Euripide Frinel G. Arthur
    Inst Rech Clin Benin, Cotonou, Benin.;Lab Etud & Rech Act Sante LERAS Afrique, Parakou, Benin..
    Awasthi, Ashish
    Sanjay Gandhi Postgrad Inst Med Sci, Lucknow, Uttar Pradesh, India..
    Quintanilla, Beatriz Paulina Ayala
    La Trobe Univ, Judith Lumley Ctr Mother Infant & Family Hlth Res, Melbourne, Vic, Australia.;Peruvian Natl Inst Hlth, Lima, Peru..
    Azzopardi, Peter
    Univ Melbourne, Dept Paediat, Melbourne, Vic, Australia.;Univ Melbourne, Murdoch Childrens Res Inst, Melbourne, Vic, Australia.;South Australian Hlth & Med Res Inst, Wardliparingga Aboriginal Res Unit, Adelaide, SA, Australia..
    Bacha, Umar
    Univ Management & Technol, Sch Hlth Sci, Lahore, Pakistan..
    Badawi, Alaa
    Univ Toronto, Dept Nutr Sci, Fac Med, Toronto, ON, Canada.;Publ Hlth Agcy Canada, Toronto, ON, Canada..
    Bahit, Maria C.
    INECO Neurociencias, Rosario, Santa Fe, Argentina..
    Balakrishnan, Kalpana
    Sri Ramachandra Univ, Dept Environm Hlth Engn, Madras, Tamil Nadu, India..
    Barac, Aleksandra
    Univ Belgrade, Fac Med, Belgrade, Serbia..
    Barber, Ryan M.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Barker-Collo, Suzanne L.
    Univ Auckland, Sch Psychol, Auckland, New Zealand..
    Baernighausen, Till
    Harvard Univ, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA.;Africa Hlth Res Inst, Mtubatuba, South Africa.;Heidelberg Univ, Inst Publ Hlth, Heidelberg, Germany..
    Barquera, Simon
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Barregard, Lars
    Univ Gothenburg, Dept Occupat & Environm Hlth, Gothenburg, Sweden..
    Barrero, Lope H.
    Pontificia Univ Javeriana, Sch Engn, Dept Ind Engn, Bogota, Colombia..
    Basu, Sanjay
    Stanford Univ, Stanford, CA 94305 USA..
    Bans, Carolina
    Bazargan-Hejazi, Shahrzad
    Charles R Drew Univ Med & Sci, Coll Med, 1621 E 120th St, Los Angeles, CA 90059 USA.;Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA.;Kermanshah Univ Med Sci, Kermanshah, Iran..
    Beardsley, Justin
    Univ Oxford, Ho Chi Minh City, Vietnam..
    Bedi, Neeraj
    Coll Publ Hlth & Trop Med, Jazan, Saudi Arabia..
    Beghi, Ettore
    IRCCS Ist Ric Farmacol Mario Negri, Milan, Italy..
    Bell, Michelle L.
    Yale Univ, New Haven, CT USA..
    Bello, Aminu K.
    Univ Alberta, Edmonton, AB, Canada..
    Bennett, Derrick A.
    Univ Oxford, Oxford, England..
    Bensenor, Isabela M.
    Univ Sao Paulo, Sao Paulo, Brazil..
    Berhane, Adugnaw
    Debre Berhane Univ, Debre Berhan, Ethiopia..
    Bernabe, Eduardo
    Kings Coll London, London, England. Haramaya Univ, Coll Hlth & Med Sci, Harar, Ethiopia..
    Betsu, Balem Demtsu
    Mekelle Univ, Mekelle, Ethiopia..
    Beyene, Addisu Shunu
    Haramaya Univ, Harar, Ethiopia..
    Bhala, Neeraj
    Queen Elizabeth Hosp Birmingham, Birmingham, W Midlands, England.;Univ Otago, Sch Med, Wellington, New Zealand..
    Bhansali, Anil
    Postgrad Inst Med Educ & Res, Chandigarh, India..
    Bhatt, Samir
    Imperial Coll London, Dept Infect Dis Epidemiol, London, England..
    Biadgilign, Sibhatu
    Independent Publ Hlth Consultants, Addis Ababa, Ethiopia..
    Bikbov, Boris
    Acad VI Shumakov Fed Res Ctr Transplantol & Artif, Dept Nephrol Issues Transplanted Kidney, Moscow, Russia..
    Bisanzio, Donal
    Univ Oxford, Nuffield Dept Med, Oxford, England..
    Bjertness, Espen
    Univ Oslo, Dept Community Med, Oslo, Norway..
    Blore, Jed D.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Borschmann, Rohan
    Univ Melbourne, Murdoch Childrens Res Inst, Melbourne, Vic, Australia.;Univ Melbourne, Melbourne, Vic, Australia. Natl Inst Publ Hlth, Natl Council Sci & Technol, Cuernavaca, Morelos, Mexico..
    Boufous, Soufiane
    Univ New South Wales, Transport & Rd Safety TARS Res, Kensington, NSW, Australia..
    Bourne, Rupert R. A.
    Anglia Ruskin Univ, Vis & Eye Res Unit, Cambridge, England..
    Brainin, Michael
    Danube Univers Krems, Krems, Austria..
    Brazinova, Alexandra
    Trnava Univ, Dept Publ Hlth, Fac Hlth Sci & Social Work, Trnava, Slovakia.;Int Neurotrauma Res Org, Vienna, Austria..
    Breitborde, Nicholas J. K.
    Ohio State Univ, Columbus, OH 43210 USA..
    Brenner, Hermann
    German Canc Res Ctr, Heidelberg, Germany..
    Broday, David M.
    Technion, Haifa, Israel..
    Brugha, Traolach S.
    Univ Leicester, Leicester, Leics, England..
    Brunekreef, Bert
    Univ Utrecht, Inst Risk Assessment Sci, Utrecht, Netherlands..
    Butt, Zahid A.
    Al Shifa Trust Eye Hosp, Rawalpindi, Pakistan..
    Cahill, Leah E.
    Harvard Univ, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA.;Dalhousie Univ, Halifax, NS, Canada..
    Calabria, Bianca
    Univ New South Wales, Kensington, NSW, Australia.;Australian Natl Univ, Natl Ctr Epidemiol & Populat Hlth, Canberra, ACT, Australia..
    Ricardo Campos-Nonato, Ismael
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico.;Harvard Univ, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA..
    Cardenas, Rosario
    Metropolitan Autonomous Univ, Mexico City, DF, Mexico..
    Carpenter, David
    Univ Albany, Rensselaer, NY USA..
    Casey, Daniel C.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Castaneda-Oquela, Carlos A.
    Colombian Natl Hlth Observ, Inst Nacl Salud, Bogota, Colombia.;Univ Nacl Colombia, Dept Publ Hlth, Epidemiol & Publ Hlth Evaluat Grp, Bogota, Colombia..
    Castillo Rivas, Jacqueline
    Caja Costarricense Seguro Social, San Jose, Costa Rica.;Univ Costa Rica, San Pedro, Montes De Oca, Costa Rica..
    Estanislao Castro, Ruben
    Univ Diego Portales, Santiago, Chile..
    Catala-Lopez, Ferran
    Univ Valencia, Dept Med, INCLIVA Hlth Res Inst, Valencia, Spain.;CIBERSAM, Valencia, Spain.;Ottawa Hosp, Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada. Natl Taiwan Univ, Coll Med, Sch Nursing, Taipei, Taiwan..
    Chang, Jung-Chen
    Chiang, Peggy Pei-Chia
    Gold Coast Hlth, Clin Governance Unit, Southport, Qld, Australia..
    Chibalabala, Mirriam
    Crowd Watch Africa, Lusaka, Zambia..
    Chimed-Ochir, Odgerel
    Univ Occupat & Environm Hlth, Dept Environm Epidemiol, Kitakyushu, Fukuoka, Japan..
    Chisumpa, Vesper Hichilombwe
    Univ Zambia, Lusaka, Zambia.;Univ Witwatersrand, Johannesburg, South Africa..
    Chitheer, Abdulaal A.
    Minist Hlth, Baghdad, Iraq..
    Choi, Jee-Young Jasmine
    Seoul Natl Univ, Med Lib, Seoul, South Korea..
    Christensen, Hanne
    Bispebjerg Hosp, Copenhagen, Denmark..
    Christopher, Devasahayam Jesudas
    Christian Med Coll & Hosp, Vellore, Tamil Nadu, India..
    Ciobanu, Liliana G.
    Univ Adelaide, Adelaide, SA, Australia..
    Coates, Matthew M.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Colquhoun, Samantha M.
    Univ Melbourne, Murdoch Childrens Res Inst, Melbourne, Vic, Australia.;Univ Melbourne, Melbourne, Vic, Australia. Natl Inst Publ Hlth, Natl Council Sci & Technol, Cuernavaca, Morelos, Mexico..
    Cooper, Leslie Trumbull
    Mayo Clin, Jacksonville, FL 32224 USA. Mario Negri Inst Pharmacol Res, Milan, Italy..
    Cooperrider, Kimberly
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Cornaby, Leslie
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Cortinovis, Monica
    Crump, John A.
    Univ Otago, Ctr Int Hlth, Dunedin Sch Med, Dunedin, New Zealand..
    Cuevas-Nasu, Lucia
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Damasceno, Albertino
    Eduardo Mondlane Univ, Fac Med, Maputo, Mozambique..
    Dandona, Rakhi
    Publ Hlth Fdn India, New Delhi, India..
    Darby, Sarah C.
    Univ Oxford, Clin Trial Serv Unit, Oxford, England..
    Dargan, Paul I.
    Guys & St Thomas NHS Fdn Trust, London, England..
    das Neves, Jose
    Univ Porto, Inst Invest & Inovacao Saude i3S, Oporto, Portugal.;Univ Porto, INEB Inst Engn Biomed, Oporto, Portugal..
    Davis, Adrian C.
    Publ Hlth England, London, England..
    Davletov, Kairat
    Kazakh Natl Med Univ, Sch Publ Hlth, Alma Ata, Kazakhstan..
    Filipa de Castro, E.
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    De la Cruz-Gongora, Vanessa
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    De Leo, Diego
    Griffith Univ, Brisbane, Qld, Australia..
    Degenhardt, Louisa
    Univ New South Wales, Natl Drug & Alcohol Res Ctr, Kensington, NSW, Australia..
    Del Gobbo, Liana C.
    Stanford Univ, Stanford, CA 94305 USA..
    del Pozo-Cruz, Borja
    Univ Auckland, Auckland, New Zealand..
    Dellavalle, Robert P.
    Univ Colorado, Sch Med, Aurora, CO USA.;Colorado Sch Publ Hlth, Aurora, CO USA..
    Deribew, Amare
    Univ Oxford, Nuffield Dept Med, Oxford, England.;KEMRI Wellcome Trust Res Programme, Kilifi, Kenya..
    Des Jarlais, Don C.
    Mt Sinai Beth Israel, New York, NY USA.;Icahn Sch Med Mt Sinai, New York, NY 10029 USA..
    Dharmaratne, Samath D.
    Univ Peradeniya, Fac Med, Dept Community Med, Peradeniya, Sri Lanka..
    Dhillon, Preet K.
    Publ Hlth Fdn India, Gurgaon, India.;Publ Hlth Fdn India, Gurgaon, India..
    Diaz-Tome, Cesar
    Hosp Santa Creu & Sant Pau, Barcelona, Spain..
    Dicker, Daniel
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Ding, Eric L.
    Harvard Univ, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA..
    Dorsey, E. Ray
    Univ Rochester, Med Ctr, Rochester, NY 14642 USA..
    Doyle, Kerrie E.
    RMIT Univ, Bundoora, Vic, Australia..
    Driscoll, Tim R.
    Univ Sydney, Sydney Sch Publ Hlth, Sydney, NSW, Australia..
    Duan, Leilei
    Chinese Ctr Dis Control & Prevent, Ctr Chron & Noncommunicable Dis Control & Prevent, Beijing, Peoples R China..
    Dubey, Manisha
    Int Inst Populat Sci, Bombay, Maharashtra, India..
    Duncan, Bruce Bartholow
    Univ Fed Rio Grande do Sul, Porto Alegre, RS, Brazil.;Univ Nouth Carolina, Chapel Hill, NC USA..
    Elyazar, Iqbal
    Eijkman Oxford Clin Res Unit, Jakarta, Indonesia..
    Endries, Aman Yesuf
    Arba Minch Univ, Arba Minch, Ethiopia..
    Ermakov, Sergey Petrovich
    Russian Acad Sci, Inst Social & Econ Studies Populat, Moscow, Russia.;Minist Hlth Russian Federat, Fed Res Inst Hlth Org & Informat, Moscow, Russia..
    Erskine, Holly E.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia.;Queensland Ctr Mental Hlth Res, Brisbane, Qld, Australia..
    Eshrati, Babak
    Minist Hlth & Med Educ, Tehran, Iran.;Arak Univ Med Sci, Arak, Iran..
    Esteghamati, Alireza
    Univ Tehran Med Sci, Endocrinol & Metab Populat Sci Inst, Tehran, Iran..
    Fahimi, Saman
    Univ Tehran Med Sci, Digest Dis Res Inst, Tehran, Iran..
    Aquino Faraon, Emerito Jose
    Univ Philippines Manila, Coll Publ Hlth, Manila, Philippines.;Dept Hlth, Manila, Philippines..
    Farid, Talha A.
    Univ Louisville, Louisville, KY USA..
    Sofia E Sa Farinha, Carla
    DGS Directorate Gen Hlth, Lisbon, Portugal.;Univ Aberta, Lisbon, Portugal..
    Faro, Andre
    Univ Fed Sergipe, Aracaju, Brazil..
    Farvid, Maryam S.
    Harvard Univ, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA.;Massachusetts Gen Hosp, Mongan Inst Hlth Policy, Harvard MGH Ctr Genom Vulnerable Populat & Hlth D, Boston, MA 02114 USA..
    Farzadfar, Farshad
    Univ Tehran Med Sci, Noncommunicable Dis Res Ctr, Tehran, Iran..
    Feigin, Valery L.
    Auckland Univ Technol, Natl Inst Stroke & Appl Neurosci, Auckland, New Zealand..
    Fereshtehnejad, Seyed-Mohammad
    Karolinska Inst, Dept Neurobiol, Care Sci & Soc NVS, Stockholm, Sweden..
    Fernandes, Jefferson G.
    German Hosp Oswaldo Cruz, Inst Educ & Sci, Sao Paulo, Brazil..
    Fischer, Florian
    Univ Bielefeld, Bielefeld, Germany..
    Fitchett, Joseph R. A.
    Harvard Univ, Boston, MA 02115 USA..
    Fleming, Tom
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Foigt, Nataliya
    Acad Med Sci, Inst Gerontol, Kiev, Ukraine..
    Foreman, Kyle
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Fowkes, F. Gerry R.
    Univ Edinburgh, Edinburgh, Midlothian, Scotland..
    Franklin, Richard C.
    James Cook Univ, Townsville, Qld, Australia..
    Fuerst, Thomas
    Univ Basel, Basel, Switzerland.;Swiss Trop & Publ Hlth Inst, Dept Epidemiol & Publ Hlth, Basel, Switzerland..
    Futran, Neal D.
    Univ Washington, Seattle, WA 98195 USA..
    Gakidou, Emmanuela
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Garcia-Basteiro, Alberto L.
    Manhica Hlth Res Ctr, Manhica, Mozambique.;Barcelona Inst Global Hlth, Barcelona, Spain..
    Gebrehiwot, Tsegaye Tewelde
    Jimma Univ, Jimma, Ethiopia..
    Gebremedhin, Amanuel Tesfay
    Jimma Univ, Jimma, Ethiopia.;Univ Munich, Munich, Germany..
    Geleijnse, Johanna M.
    Wageningen Univ, Div Human Nutr, Wageningen, Netherlands..
    Gessner, Bradford D.
    Agence Med Prevent, Paris, France..
    Giref, Ababi Zergaw
    Univ Addis Ababa, Addis Ababa, Ethiopia..
    Giroud, Maurice
    Univ Hosp Dijon, Dijon, France. Haramaya Univ, Coll Hlth & Med Sci, Dire Dawa, Ethiopia..
    Gishu, Melkamu Dedefo
    Haramaya Univ, Dire Dawa, Ethiopia.;Kersa Hlth & Demog Surveillance Syst, Harar, Ethiopia..
    Goenka, Shifalika
    Publ Hlth Fdn India, New Delhi, India..
    Carmen Gomez-Cabrera, Mari
    Univ Valencia, Valencia, Spain.;INCLIVA Biomed Res Inst, Valencia, Spain..
    Gomez-Dantes, Hector
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Gona, Philimon
    Univ Massachusetts, Boston, MA 02125 USA..
    Goodridge, Amador
    Inst Invest Cient & Servicios Alta Tecnol INDICAS, Ciudad Del Saber, Panama..
    Gopalani, Sameer Vali
    Govt Federated States Micronesia, Dept Hlth & Social Affairs, Palikir, Micronesia..
    Gotay, Carolyn C.
    Univ British Columbia, Vancouver, BC, Canada..
    Goto, Atsushi
    Natl Canc Ctr, Div Epidemiol, Ctr Publ Hlth Sci, Tokyo, Japan..
    Gouda, Hebe N.
    Univ Queensland, Brisbane, Qld, Australia..
    Gugnani, Harish Chander
    St James Sch Med, Dept Microbiol, The Quarter, Anguilla, Scotland.;St James Sch Med, Dept Epidemiol & Biostat, The Quarter, Anguilla, Scotland. West Virginia Bur Publ Hlth, Charleston, WV USA. Eternal Heart Care Ctr & Res Inst, Jaipur, Rajasthan, India..
    Guillemin, Francis
    Univ Lorraine, Sch Publ Hlth, Nancy, France..
    Guo, Yuming
    Univ Queensland, Brisbane, Qld, Australia..
    Gupta, Rahul
    Gupta, Rajeev
    Gutierrez, Reyna A.
    Natl Inst Psychiat Ramon Fuente, Mexico City, DF, Mexico..
    Haagsma, Juanita A.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Univ Med Ctr, Erasmus MC, Dept Publ Hlth, Rotterdam, Netherlands..
    Hafezi-Nejad, Nima
    Univ Tehran Med Sci, Endocrinol & Metab Populat Sci Inst, Tehran, Iran..
    Haile, Demewoz
    Univ Addis Ababa, Addis Ababa, Ethiopia..
    Hailu, Gessessew Bugssa
    Mekelle Univ, Mekelle, Ethiopia.;Kilte Awlaelo Hlth & Demog Surveillance Syst, Mekelle, Ethiopia..
    Halasa, Yara A.
    Brandeis Univ, Waltham, MA USA..
    Hamadeh, Randah Ribhi
    Arabian Gulf Univ, Manama, Bahrain..
    Hamidi, Samer
    Hamdan Bin Mohammed Smart Univ, Dubai, U Arab Emirates..
    Handal, Alexis J.
    Univ New Mexico, Albuquerque, NM 87131 USA..
    Hankey, Graeme J.
    Univ Western Australia, Sch Med & Pharmacol, Perth, WA, Australia.;Harry Perkins Inst Med Res, Nedlands, WA, Australia.;Western Australian Neurosci Res Inst, Nedlands, WA, Australia..
    Hao, Yuantao
    Sun Yat Sen Univ, Sch Publ Hlth, Guangzhou, Guangdong, Peoples R China..
    Harb, Hilda L.
    Harikrishnan, Sivadasanpillai
    Sree Chitra Tirunal Inst Med Sci & Technol, Trivandrum, Kerala, India..
    Maria Haro, Josep
    Parc Sanitari Sant Joan Deu CIBERSAM, St Boi De Llobregat, Barcelona, Spain.;Univ Barcelona, Barcelona, Spain..
    Hassanvand, Mohammad Sadegh
    Univ Tehran Med Sci, Ctr Air Pollut Res, Inst Environm Res, Tehran, Iran..
    Hassen, Tahir Ahmed
    Haramaya Univ, Harar, Ethiopia..
    Havmoeller, Rasmus
    Karolinska Inst, Stockholm, Sweden..
    Beatriz Heredia-Pi, Ileana
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Francisco Hernandez-Llanes, Norberto
    Comis Nacl Adicc, Mexico City, DF, Mexico..
    Heydarpour, Pouria
    Univ Tehran Med Sci, Multiple Sclerosis Res Ctr, Neurosci Inst, Tehran, Iran..
    Hoek, Hans W.
    Univ Groningen, Univ Med Ctr Groningen, Dept Psychiat, Groningen, Netherlands.;Columbia Univ, Dept Epidemiol, Mailman Sch Publ Hlth, New York, NY USA..
    Hoffman, Howard J.
    Natl Inst Deafness & Other Commun Disorders, Epidemiol & Stat Program, NIH, Bethesda, MD USA..
    Horino, Masako
    Dept Hlth & Human Serv, Nevada Div Publ & Behav Hlth, Carson City, NV USA..
    Horita, Nobuyuki
    Yokohama City Univ, Dept Pulmonol, Grad Sch Med, Yokohama, Kanagawa, Japan..
    Hosgood, H. Dean
    Albert Einstein Coll Med, Bronx, NY 10467 USA..
    Hoy, Damian G.
    Pacific Community, Publ Hlth Div, Noumea, New Caledonia..
    Hsairi, Mohamed
    Salah Azaiz Inst, Dept Epidemiol, Tunis, Tunisia..
    Htet, Aung Soe
    Univ Oslo, Oslo, Norway.;Minist Hlth, Int Relat Div, Nay Pyi Taw, Myanmar..
    Hu, Guoqing
    Cent S Univ, Sch Publ Hlth, Dept Epidemiol & Hlth Stat, Changsha, Hunan, Peoples R China..
    Huang, John J.
    Husseini, Abdullatif
    Birzeit Univ, Birzeit, Israel..
    Hutchings, Sally J.
    Imperial Coll London, London, England..
    Huybrechts, Inge
    Int Agcy Res Canc IARC, Lyon, France.;Univ Ghent, Ghent, Belgium..
    Iburg, Kim Moesgaard
    Aarhus Univ, Aarhus, Denmark..
    Idrisov, Bulat T.
    Boston Univ, Boston Med Ctr, Boston, MA 02215 USA..
    Ileanu, Bogdan Vasile
    Bucharest Univ Econ Studies, Bucharest, Romania..
    Inoue, Manami
    Natl Canc Ctr, Tokyo, Japan.;Univ Tokyo, Grad Sch Med, Tokyo, Japan..
    Jacobs, Troy A.
    HIDN, USAID Global Hlth Bur, MCH Div, Washington, DC USA..
    Jacobsen, Kathryn H.
    George Mason Univ, Dept Global & Community Hlth, Fairfax, VA USA..
    Jahanmehr, Nader
    Shahid Beheshti Univ Med Sci, Sch Publ Hlth, Tehran, Iran..
    Jakovljevic, Mihajlo B.
    Univ Kragujevac, Fac Med Sci, Kragujevac, Serbia..
    Jansen, Henrica A. F. M.
    UNFPA Asia & Pacific Reg Off, Bangkok, Thailand..
    Jassal, Simerjot K.
    Univ Calif San Diego, VA San Diego, San Diego, CA 92103 USA..
    Javanbakht, Mehdi
    Univ Aberdeen, Aberdeen, Scotland..
    Jayatilleke, Achala Upendra
    Postgrad Inst Med, Colombo, Sri Lanka.;Inst Violence & Injury Prevent, Colombo, Sri Lanka..
    Jee, Sun Ha
    Yonsei Univ, Grad Sch Publ Hlth, Seoul, South Korea..
    Jeemon, Panniyammakal
    Publ Hlth Fdn India, Ctr Control Chron Condit, New Delhi, India.;Publ Hlth Fdn India, Ctr Control Chron Condit, Gurgaon, India.;Ctr Chron Dis Control, New Delhi, India..
    Jha, Vivekanand
    Univ Oxford, Oxford, England.;George Inst Global Hlth India, New Delhi, India..
    Jiang, Ying
    Univ Occupat & Environm Hlth, Dept Hlth Dev, Inst Ind Ecol Sci, Kitakyushu, Fukuoka, Japan..
    Jibat, Tariku
    Wageningen Univ, Wageningen, Netherlands.;Univ Addis Ababa, Addis Ababa, Ethiopia.;Univ Addis Ababa, Debre Zeit, Ethiopia..
    Jin, Ye
    Chinese Ctr Dis Control & Prevent, Ctr Chron & Noncommunicable Dis Control & Prevent, Beijing, Peoples R China..
    Johnson, Catherine O.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Jonas, Jost B.
    Heidelberg Univ, Med Fac Mannheim, Dept Ophthalmol, Mannheim, Germany..
    Kabir, Zubair
    Univ Coll Cork, Cork, Ireland..
    Kalkonde, Yogeshwar
    Soc Educ Act & Res Community Hlth, Gadchiroli, India..
    Kamal, Ritul
    CSIR Indian Inst Toxicol Res, Lucknow, Uttar Pradesh, India..
    Kan, Haidong
    Fudan Univ, Shanghai, Peoples R China..
    Karch, Andre
    Helmholtz Ctr Infect Res, Epidemiol & Stat Methods Res Grp, Braunschweig, Germany.;German Ctr Infect Res, Hannover Braunschweig Site, Braunschweig, Germany..
    Karema, Corine Kakizi
    Swiss Trop & Publ Hlth Inst, Basel, Switzerland.;Qual & Equity Hlth Care, Kigali, Rwanda..
    Karimkhani, Chante
    Case Western Univ Hosp, Cleveland, OH USA..
    Kasaeian, Amir
    Univ Tehran Med Sci, Noncommunicable Dis Res Ctr, Tehran, Iran.;Univ Tehran Med Sci, Hematol Oncol & Stem Cell Transplantat Res Ctr, Tehran, Iran..
    Kaul, Anil
    Oklahoma State Univ, Tulsa, OK USA..
    Kawakami, Norito
    Univ Tokyo, Sch Publ Hlth, Tokyo, Japan..
    Kazi, Dhruv S.
    Univ Calif San Francisco, San Francisco, CA 94143 USA..
    Keiyoro, Peter Njenga
    Inst Trop & Infect Dis, Nairobi, Kenya.;Sch Continuing & Distance Educ, Nairobi, Kenya..
    Kemp, Andrew Haddon
    Univ Sydney, Sydney, NSW, Australia.;Swansea Univ, Swansea, W Glam, Wales..
    Kengne, Andre Pascal
    South African Med Researcil, Cape Town, South Africa.;Univ Cape Town, Cape Town, South Africa..
    Keren, Andre
    Assuta Hosp, Assuta Hashalom, Tel Aviv, Israel..
    Kesavachandran, Chandrasekharan Nair
    Khader, Yousef Saleh
    Jordan Univ Sci & Technol, Irbid, Jordan..
    Khan, Abdur Rahman
    Univ Louisville, Louisville, KY USA..
    Khan, Ejaz Ahmad
    Hlth Serv Acad, Islamabad, Pakistan..
    Khan, Gulfaraz
    United Arab Emirates Univ, Coll Med & Hlth Sci, Dept Microbiol & Immunol, Al Ain, U Arab Emirates..
    Khang, Young-Ho
    Seoul Natl Univ, Coll Med, Seoul, South Korea..
    Khatibzadeh, Shahab
    Harvard Univ, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA..
    Khera, Sahil
    New York Med Coll, Valhalla, NY 10595 USA..
    Khoja, Tawfik Ahmed Muthafer
    Execut Board Hlth Ministers Council Cooperat Coun, Riyadh, Saudi Arabia..
    Khubchandani, Jagdish
    Ball State Univ, Muncie, IN 47306 USA..
    Kieling, Christian
    Univ Fed Rio Grande do Sul, Porto Alegre, RS, Brazil.;Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil. Korea Hlth Ind Dev Inst, Cheongju, South Korea..
    Kim, Cho-il
    Kim, Daniel
    Northeastern Univ, Dept Hlth Sci, Boston, MA 02115 USA..
    Kimokoti, Ruth W.
    Simmons Coll, Boston, MA 02115 USA..
    Kissoon, Niranjan
    Univ British Columbia, Vancouver, BC, Canada..
    Kivipelto, Miia
    Karolinska Inst, Aging Res Ctr, Stockholm, Sweden..
    Knibbs, Luke D.
    Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia..
    Kokubo, Yoshihiro
    Natl Cerebral & Cardiovasc Ctr, Dept Prevent Cardiol, Suita, Osaka, Japan..
    Kopec, Jacek A.
    Univ British Columbia, Vancouver, BC, Canada..
    Koul, Parvaiz A.
    Sherikashmir Inst Med Sci, Srinagar, Jammu & Kashmir, India..
    Koyanagi, Ai
    Parc Sanitari St Joan Deu CIBERSAM, Res & Dev Unit, Barcelona, Spain..
    Kravchenko, Michael
    Res Ctr Neurol, Moscow, Russia..
    Kromhout, Hans
    Univ Utrecht, Inst Risk Assessment Sci, Utrecht, Netherlands..
    Krueger, Hans
    Univ British Columbia, Sch Populat & Publ Hlth, Vancouver, BC, Canada..
    Ku, Tiffany
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Defo, Barthelemy Kuate
    Univ Montreal, Dept Demog, Montreal, PQ, Canada.;Univ Montreal, Publ Hlth Res Inst, Montreal, PQ, Canada.;Univ Montreal, Dept Social & Prevent Med, Sch Publ Hlth, Montreal, PQ, Canada..
    Kuchenbecker, Ricardo S.
    Univ Fed Rio Grande do Sul, Graduat Studies Epidemiol, Porto Alegre, RS, Brazil..
    Bicer, Burcu Kucuk
    Hacettepe Univ, Inst Publ Hlth, Ankara, Turkey..
    Kuipers, Ernst J.
    Univ Med Ctr Rotterdam, Erasmus MC, Rotterdam, Netherlands..
    Kumar, G. Anil
    Publ Hlth Fdn India, New Delhi, India..
    Kwan, Gene F.
    Boston Univ, Sch Med, Boston, MA 02118 USA..
    Lal, Dharmesh Kumar
    Publ Hlth Fdn India, Gurgaon, India.;Publ Hlth Fdn India, Gurgaon, India..
    Lalloo, Ratilal
    Univ Queensland, Sch Dent, Brisbane, Qld, Australia..
    Lallukka, Tea
    Finnish Inst Occupat Hlth, Work Disabil Prevent, Work Org, Helsinki, Finland.;Univ Helsinki, Dept Publ Hlth, Fac Med, Helsinki, Finland..
    Lan, Qing
    NCI, Rockville, MD USA..
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Latif, Asma Abdul
    Women Univ, Lahore Coll, Dept Zool, Lahore, Pakistan..
    Beatriz Lawrynowicz, Alicia Elena
    Inst Nacl Epidemiol Dr Juan H Jara, Mar Del Plata, Buenos Aires, Argentina..
    Leasher, Janet L.
    Nova Southeastern Univ, Coll Optometry, Ft Lauderdale, FL 33314 USA..
    Leigh, James
    Univ Sydney, Sydney, NSW, Australia..
    Leung, Janni
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia.;Queensland Ctr Mental Hlth Res, Brisbane, Qld, Australia..
    Levi, Miriam
    Tuscany Reg Ctr Occupat Injuries & Dis, Florence, Italy..
    Li, Xiaohong
    Natl Ctr Birth Defects Monitoring China, Chengdu, Peoples R China..
    Li, Yichong
    Chinese Ctr Dis Control & Prevent, Ctr Chron & Noncommunicable Dis Control & Prevent, Beijing, Peoples R China..
    Liang, Juan
    Sichuan Univ, West China Univ Hosp 2, Natl Off Maternal & Child Hlth Surveillance, Chengdu, Peoples R China..
    Liu, Shiwei
    Chinese Ctr Dis Control & Prevent, Ctr Chron & Noncommunicable Dis Control & Prevent, Beijing, Peoples R China..
    Lloyd, Belinda K.
    Monash Univ, Eastern Hlth Clin Sch, Fitzroy, Vic, Australia.;Eastern Hlth, Turning Point, Melbourne, Vic, Australia..
    Logroscino, Giancarlo
    Univ Bari, Bari, Italy..
    Lotufo, Paulo A.
    Univ Sao Paulo, Sao Paulo, Brazil..
    Lunevicius, Raimundas
    Aintree Univ, Hosp Natl Hlth Serv Fdn Trust, Liverpool, Merseyside, England.;Univ Liverpool, Sch Med, Liverpool, Merseyside, England..
    Maclntyre, Michael
    Mahdavi, Mandi
    Social Secur Org Res Inst, Tehran, Iran.;Erasmus Univ, Inst Hlth Policy & Management, Rotterdam, Netherlands..
    Majdan, Marek
    Trnava Univ, Dept Publ Hlth, Fac Hlth Sci & Social Work, Trnava, Slovakia..
    Majeed, Azeem
    Imperial Coll London, London, England..
    Malekzadeh, Reza
    Univ Tehran Med Sci, Digest Dis Res Inst, Tehran, Iran..
    Malta, Deborah Carvalho
    Univ Fed Minas Gerais, Belo Horizonte, MG, Brazil..
    Manamo, Wondimu Ayele Ayele
    Univ Addis Ababa, Addis Ababa, Ethiopia..
    Mapoma, Chabila C.
    Univ Zambia, Lusaka, Zambia..
    Marcenes, Wagner
    Kings Coll London, Inst Dent, Div Populat & Patient Hlth, London, England..
    Martin, Randall V.
    Dalhousie Univ, Halifax, NS, Canada..
    Martinez-Raga, Jose
    Univ Valencia, Univ Hosp Doctor Peset, Valencia, Spain.;CEU Cardenal Herrera Univ, Moncada, Valencia, Spain..
    Masiye, Felix
    Univ Zambia, Lusaka, Zambia..
    Matsushita, Kunihiro
    Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA..
    Matzopoulos, Richard
    South African Med Researcil, Cape Town, South Africa.;Univ Cape Town, Sch Publ Hlth & Family Med, Cape Town, South Africa..
    Mayosi, Bongani M.
    McGrath, John J.
    Univ Queensland, Brisbane, Qld, Australia..
    McKee, Martin
    London Sch Hyg & Trop Med, London, England..
    Meaney, Peter A.
    Univ Penn, Perelman Sch Med, Philadelphia, PA 19104 USA.;Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA..
    Medina, Catalina
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Mehari, Alem
    Howard Univ, Coll Med, Washington, DC 20059 USA..
    Mena-Rodriguez, Fabiola
    Mekonnen, Alemayehu B.
    Univ Sydney, Sydney, NSW, Australia.;Univ Gondar, Gondar, Ethiopia..
    Melaku, Yohannes Adama
    Mekelle Univ, Sch Publ Hlth, Mekelle, Ethiopia.;Univ Adelaide, Sch Med, Adelaide, SA, Australia..
    Memish, Ziad A.
    Saudi Minist Hlth, Riyadh, Saudi Arabia.;Alfaisal Univ, Coll Med, Riyadh, Saudi Arabia..
    Mendoza, Walter
    United Nations Populat Fund, Lima, Peru..
    Mensink, Gert B. M.
    Robert Koch Inst, Berlin, Germany..
    Meretoja, Atte
    Univ Melbourne, Dept Med, Melbourne, Vic, Australia.;Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland..
    Meretoja, Tuomo J.
    Univ Helsinki, Helsinki, Finland.;Helsinki Univ Hosp, Ctr Comprehens Canc, Breast Surg Unit, Helsinki, Finland..
    Mesfin, Yonatan Moges
    Haramaya Univ, Harar, Ethiopia..
    Mhimbira, Francis Apolinary
    Ifakara Hlth Inst, Bagamoyo, Tanzania..
    Miller, Ted R.
    Pacific Inst Res & Evaluat, Calverton, MD USA.;Curtin Univ, Ctr Populat Hlth, Perth, WA, Australia..
    Mills, Edward J.
    Univ Ottawa, Ottawa, ON, Canada..
    Mirarefin, Mojde
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Misganaw, Awoke
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Mock, Charles N.
    Univ Washington, Harborview Injury Prevent & Res Ctr, Seattle, WA 98195 USA..
    Mohammadi, Alireza
    Baqiyatallah Univ Med Sci, Neurosci Res Ctr, Tehran, Iran..
    Mohammed, Shafiu
    Heidelberg Univ, Inst Publ Hlth, Heidelberg, Germany.;Ahmadu Bello Univ, Hlth Syst & Policy Res Unit, Zaria, Nigeria..
    Mola, Glen Liddell D.
    Univ Papua New Guinea, Boroko, Papua N Guinea..
    Monasta, Lorenzo
    IRCCS Burlo Garofolo, Inst Maternal & Child Hlth, Trieste, Italy..
    Montanez Hernandez, Julio Cesar
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Montico, Marcella
    IRCCS Burlo Garofolo, Inst Maternal & Child Hlth, Trieste, Italy..
    Morawska, Lidia
    Queensland Univ Technol, Int Lab Air Qual & Hlth, Brisbane, Qld, Australia..
    Mori, Rintaro
    Natl Ctr Child Hlth & Dev, Tokyo, Japan..
    Mozaffarian, Dariush
    Tufts Univ, Friedman Sch Nutr Sci & Policy, Boston, MA 02111 USA..
    Mueller, Ulrich O.
    Fed Inst Populat Res, Wiesbaden, Germany..
    Mullany, Erin
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Mumford, John Everett
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Murthy, Gudlavalleti Venkata Satyanarayana
    London Sch Hyg & Trop Med, London, England.;Publ Hlth Fdn India, Indian Inst Publ Hlth, Gurgaon, India..
    Nachega, Jean B.
    Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Baltimore, MD USA.;Univ Pittsburgh, Grad Sch Publ Hlth, Pittsburgh, PA USA.;Univ Stellenbosch, Cape Town, South Africa..
    Naheed, Aliya
    Int Ctr Diarrhoeal Dis Res, Bangladesh Icddr B, Dhaka, Bangladesh..
    Nangia, Vinay
    Suraj Eye Inst, Nagpur, Maharashtra, India..
    Nassiri, Nariman
    Wayne State Univ, Sch Med, Detroit, MI USA..
    Newton, John N.
    Publ Hlth England, London, England..
    Ng, Marie
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Nguyen, Quyen Le
    Nisar, Muhammad Imran
    Aga Khan Univ, Karachi, Pakistan..
    Pete, Patrick Martial Nkamedjie
    Inst Res Socioecon Dev & Commun, Yaounde, Cameroon..
    Norheim, Ole F.
    Univ Bergen, Bergen, Norway..
    Norman, Rosana E.
    Queensland Univ Technol, Inst Hlth & Biomed Innovat, Brisbane, Qld, Australia..
    Norrving, Bo
    Skane Univ Hosp, Dept Clin Sci Lund, Dept Clin Sci, Lund, Sweden..
    Nyakarahuka, Luke
    Makerere Univ, Kampala, Uganda..
    Obermeyer, Carla Makhlouf
    Amer Univ Beirut, Fac Hlth Sci, Ctr Res Populat & Hlth, Beirut, Lebanon..
    Ogbo, Felix Akpojene
    Univ Western Sydney, Ctr Hlth Res, Sydney, NSW, Australia. Kyung Hee Univ, Sch Med, Dept Prevent Med, Seoul, South Korea..
    Oh, In-Hwan
    Oladimeji, Olanrewaju
    Human Sci Res Council, Durban, South Africa.;Univ KwaZulu Natal, Durban, South Africa. Univ Autonoma Chile, Talca, Chile..
    Olivares, Pedro R.
    Olsen, Helen
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Olusanya, Bolajoko Olubukunola
    Ctr Hlth Start Initiat, Lagos, Nigeria..
    Olusanya, Jacob Olusegun
    Ctr Hlth Start Initiat, Lagos, Nigeria..
    Opio, John Nelson
    Lira Municipal Council, Lira Dist Local Govt, Lira, Uganda..
    Oren, Eyal
    Univ Arizona, Tucson, AZ USA..
    Orozco, Ricardo
    Natl Inst Psychiat Ramon Fuente, Mexico City, DF, Mexico..
    Ortiz, Alberto
    II S Fdn Jimenez Diaz UAM, Madrid, Spain..
    Ota, Erika
    St Lukes Int Univ, Tokyo, Japan..
    Mahesh, P. A.
    JSS Univ, JSS Med Coll, Mysore, Karnataka, India. Kosin Univ, Coll Med, Dept Med Human & Social Med, Busan, South Korea..
    Pana, Adrian
    Bucharest Univ Econ Studies, Bucharest, Romania..
    Park, Eun-Kee
    Parry, Charles D.
    South African Med Researcil, Alcohol Tobacco & Other Drug Res Unit, Cape Town, South Africa.;Univ Stellenbosch, Dept Psychiat, Cape Town, South Africa.;South African Med Res Council, Alcohol Tobacco & Other Drug Res Unit, Potchefstroom, South Africa..
    Parsaeian, Mahboubeh
    Univ Tehran Med Sci, Noncommunicable Dis Res Ctr, Tehran, Iran.;Univ Tehran Med Sci, Dept Epidemiol & Biostat, Sch Publ Hlth, Tehran, Iran..
    Patel, Tejas
    Mt Sinai Hlth Syst, New York, NY USA..
    Caicedo, Angel J. Paternina
    Univ Pittsburgh, Publ Hlth Dynam Lab, Pittsburgh, PA USA.;Univ Cartagena, Cartagena, Colombia..
    Patil, Snehal T.
    Deemed Univ, Krishan Inst Med Sci, Sch Dent Sci, Karad, India..
    Patten, Scott B.
    Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada..
    Patton, George C.
    Univ Melbourne, Dept Paediat, Melbourne, Vic, Australia.;Univ Melbourne, Murdoch Childrens Res Inst, Melbourne, Vic, Australia..
    Pearce, Neil
    London Sch Hyg & Trop Med, London, England..
    Pereira, David M.
    Univ Porto, Fac Farm, Dept Quim, REQUIMTE LAQV,Lab Farmacognosia, Oporto, Portugal..
    Perico, Norberto
    IRCCS Ist Ric Farmacol Mario Negri, Bergamo, Italy..
    Pesudovs, Konrad
    Flinders Univ S Australia, Adelaide, SA, Australia..
    Petzold, Max
    Univ Gothenburg, Hlth Metr Unit, Gothenburg, Sweden.;Univ Witwatersrand, Johannesburg, South Africa..
    Phillips, Michael Robert
    Shanghai Jiao Tong Univ, Sch Med, Shanghai, Peoples R China.;Emory Univ, Atlanta, GA 30322 USA..
    Piel, Frederic B.
    Imperial Coll London, Dept Epidemiol & Biostat, Sch Publ Hlth, London, England..
    Pillay, Julian David
    Durban Univ Technol, Durban, South Africa..
    Plass, Dietrich
    German Environm Agcy, Exposure Assessment & Environm Hlth Indicators, Berlin, Germany..
    Polinder, Suzanne
    Erasmus Univ, Med Ctr, Dept Publ Hlth, Rotterdam, Netherlands..
    Pond, Constance D.
    Univ Newcastle, Callaghan, NSW, Australia..
    Pope, C. Arden
    Brigham Young Univ, Provo, UT 84602 USA..
    Pope, Daniel
    Univ Liverpool, Dept Publ Hlth & Policy, Liverpool, Merseyside, England..
    Popova, Svetlana
    Univ Toronto, Ctr Addict & Mental Hlth, Toronto, ON, Canada..
    Poulton, Richie G.
    Univ Otago, Dunedin, New Zealand..
    Pourmalek, Farshad
    Univ British Columbia, Vancouver, BC, Canada..
    Prasad, Noela M.
    Fred Hollows Fdn, Sydney, NSW, Australia.;Ctr Eye Res Australia, Melbourne, Vic, Australia..
    Qorbani, Mostafa
    Alborz Univ Med Sci, Dept Community Med, Karaj, Iran..
    Rabiee, Rynaz H. S.
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden..
    Radfar, Amir
    AT Still Univ, Kirksville, MO USA..
    Rafay, Anwar
    Contech Sch Publ Hlth, Lahore, Pakistan..
    Rahimi-Movaghar, Vafa
    Univ Tehran Med Sci, Sina Trauma & Surg Res Ctr, Tehran, Iran..
    Rahman, Mahfuzar
    BRAC, Res & Evaluat Div, Dhaka, Bangladesh..
    Rahman, Mohammad Hifz Ur
    Int Inst Populat Sci, Bombay, Maharashtra, India..
    Rahman, Sajjad Ur
    Hamad Med Corp, Doha, Qatar..
    Rai, Rajesh Kumar
    Soc Hlth & Demog Surveillance, Suri, India..
    Rajsic, Sasa
    Univ Hlth Sci Med Informat & Technol, ERAWEB Program, Hall In Tirol, Australia..
    Raju, Murugesan
    Univ Missouri, Columbia, MO USA..
    Ram, Usha
    Int Inst Populat Sci, Bombay, Maharashtra, India..
    Rana, Saleem M.
    Contech Sch Publ Hlth, Lahore, Pakistan.;Contech Int Hlth Consultants, Lahore, Pakistan..
    Ranganathan, Kavitha
    Univ Michigan Hlth Syst, Ann Arbor, MI USA..
    Rao, Puja
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Razo Garcia, Christian Aspacia
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Refaat, Amany H.
    Walden Univ, Minneapolis, MN USA.;Suez Canal Univ, Ismailia, Egypt..
    Rehm, Colin D.
    Montefiore Med Ctr, 111 E 210th St, Bronx, NY 10467 USA..
    Rehm, Jurgen
    Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada.;Ctr Addict & Mental Hlth, Toronto, ON, Canada..
    Reinig, Nikolas
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Remuzzi, Giuseppe
    IRCCS Ist Ric Farmacol Mario Negri, Bergamo, Italy.;Azienda Osped Papa Giovanni XXIII, Bergamo, Italy.;Univ Milan, Dept Biomed & Clin Sci L Sacco, Milan, Italy..
    Resnikoff, Serge
    Univ New South Wales, Brien Holden Vision Inst, Kensington, NSW, Australia..
    Ribeiro, Antonio L.
    Univ Fed Minas Gerais, Hosp Clin, Belo Horizonte, MG, Brazil..
    Rivera, Juan A.
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Rolm, Hirbo Shore
    Rodriguez, Anna
    Imperial Coll London, Dept Epidemiol & Biostat, Sch Publ Hlth, London, England.;Lincoln Univ, Sch Psychol, Lincoln, England..
    Rodriguez-Ramirez, Sonia
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Rojas-Rueda, David
    Inst Salud Global Barcelona, Barcelona, Spain..
    Roman, Yesenia
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Ronfani, Luca
    IRCCS Burlo Garofolo, Inst Maternal & Child Hlth, Trieste, Italy..
    Roshandel, Gholamreza
    Univ Tehran Med Sci, Digest Dis Res Inst, Tehran, Iran.;Golestan Univ Med Sci, Golestan Res Ctr Gastroenterol & Hepatol, Gorgan, Iran..
    Rothenbacher, Dietrich
    Univ Ulm, Inst Epidemiol & Med Biometry, Ulm, Germany..
    Roy, Ambuj
    All India Inst Med Sci, New Delhi, India..
    Saleh, Muhammad Muhammad
    Dev Res & Projects Ctr, Abuja, Nigeria..
    Sanabria, Juan R.
    Marshall Univ, J Edwards Sch Med, Huntington, WV USA. Case Western Reserve Univ, Cleveland, OH 44106 USA..
    Dolores Sanchez-Nino, Maria
    II S Fdn Jimenez Diaz, Madrid, Spain..
    Sanchez-Pimienta, Tania G.
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Sandar, Logan
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Santomauro, Damian F.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia.;Queensland Ctr Mental Hlth Res, Brisbane, Qld, Australia..
    Santos, Itamar S.
    Univ Sao Paulo, Dept Internal Med, Sao Paulo, Brazil..
    Sarmiento-Suarez, Rodrigo
    Univ Ciencias Aplicadas & Ambient, Bogota, Colombia..
    Sartorius, Benn
    Univ KwaZulu Natal, Durban, South Africa. Univ Autonoma Chile, Talca, Chile..
    Satpathy, Maheswar
    All India Inst Med Sci, New Delhi, India..
    Savic, Miloje
    Norwegian Inst Publ Hlth, Oslo, Norway..
    Sawhney, Monika
    Marshall Univ, Huntington, WV USA..
    Schmidhuber, Josef
    Food & Agr Org, Global Perspect Studies Unit, Rome, Italy..
    Schmidt, Maria Ines
    Univ Fed Rio Grande do Sul, Porto Alegre, RS, Brazil..
    Schneider, Ione J. C.
    Univ Fed Santa Catarina, Florianopolis, SC, Brazil..
    Schoettker, Ben
    German Canc Res Ctr, Heidelberg, Germany.;FOM Univ, Inst Hlth Care & Social Sci, Essen, Germany..
    Schutte, Aletta E.
    North West Univ, Hypertens Africa Res Team HART, Potchefstroom, South Africa.;South African Med Res Council, Potchefstroom, South Africa..
    Schwebel, David C.
    Univ Alabama Birmingham, Birmingham, AL USA..
    Scott, James G.
    Univ Queensland, Clin Res Ctr, Brisbane, Qld, Australia..
    Seedat, Soraya
    Univ Stellenbosch, Cape Town, South Africa..
    Sepanlou, Sadaf G.
    Univ Tehran Med Sci, Digest Dis Res Inst, Tehran, Iran..
    Servan-Mori, Edson E.
    Natl Inst Publ Hlth, Cuernavaca, Morelos, Mexico..
    Shaheen, Amira
    Shahraz, Saeid
    An Najah Univ, Dept Publ Hlth, Nablus, Israel..
    Shaikh, Masood Ali
    Tufts Med Ctr, Boston, MA USA.;Independent Consultant, Karachi, Pakistan..
    Levy, Teresa Shamah
    Sharma, Rajesh
    Indian Inst Technol Ropar, Rupnagar, India..
    She, Jun
    Fudan Univ, Dept Pulm Med, Zhongshan Hosp, Shanghai, Peoples R China..
    Sheikhbahaei, Sara
    Univ Tehran Med Sci, Endocrinol & Metab Populat Sci Inst, Tehran, Iran..
    Shen, Jiabin
    Ohio State Univ, Coll Med, Columbus, OH 43210 USA.;Nationwide Childrens Hosp, Res Inst, Columbus, OH USA..
    Sheth, Kevin N.
    Yale Univ, Sch Med, New Haven, CT USA..
    Shi, Peilin
    Tufts Univ, Boston, MA 02111 USA..
    Shibuya, Kenji
    Univ Tokyo, Tokyo, Japan..
    Shigematsu, Mika
    Natl Inst Infect Dis, Tokyo, Japan.;Sandia Natl Labs, Albuquerque, NM USA. Korea Univ, Dept Publ Hlth Sci, Grad Sch, Seoul, South Korea. Korea Univ, Dept Prevent Med, Coll Med, Seoul, South Korea..
    Shin, Min-Jeong
    Shiri, Rahman
    Finnish Inst Occupat Hlth, Work Disabil Prevent, Work Org, Helsinki, Finland..
    Shishani, Kawkab
    Washington State Univ, Spokane, WA USA..
    Shiue, Ivy
    Univ Edinburgh, Alzheimer Scotland Dementia Res Ctr, Edinburgh, Midlothian, Scotland.;Northumbria Univ, Fac Hlth & Life Sci, Newcastle Upon Tyne, Tyne & Wear, England..
    Shrime, Mark G.
    Harvard Univ, Harvard Med Sch, Boston, MA 02115 USA..
    Sigfusdottir, Inga Dora
    Reykjavik Univ, Reykjavik, Iceland..
    Silva, Diego Augusto Santos
    Alves Silveira, Dayane Gabriele
    Univ Brasilia, Brasilia, DF, Brazil..
    Silverberg, Jonathan I.
    Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA..
    Simard, Edgar P.
    Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA 30322 USA..
    Sindi, Shireen
    Karolinska Inst, Stockholm, Sweden..
    Singh, Abhishek
    Int Inst Populat Sci, Bombay, Maharashtra, India..
    Singh, Jasvinder A.
    Univ Alabama Birmingham, Birmingham, AL USA..
    Singh, Prashant Kumar
    Inst Human Dev, New Delhi, India..
    Slepak, Erica Leigh
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Soljak, Michael
    Imperial Coll London, London, England..
    Soneji, Samir
    Dartmouth Coll, Hanover, NH 03755 USA..
    Sorensen, Reed J. D.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Sposato, Luciano A.
    Western Univ, Dept Clin Neurol Sci, London, ON, Canada..
    Sreeramareddy, Chandrashekhar T.
    Int Med Univ, Dept Community Med, Kuala Lumpur, Malaysia..
    Stathopoulou, Vasiliki
    Attikon Univ Hosp, Athens, Greece..
    Steckling, Nadine
    Univ Hosp Munich, Inst & Outpatient Clin Occupat Social & Environm, Munich, Germany..
    Steel, Nicholas
    Publ Hlth England, London, England.;Univ East Anglia, Norwich, Norfolk, England..
    Stein, Dan J.
    Univ Cape Town, Dept Psychiat, Cape Town, South Africa.;South African Med Res Council Unit Anxiety & Stre, Cape Town, South Africa..
    Stein, Murray B.
    Univ Calif San Diego, San Diego, CA 92103 USA..
    Stockl, Heidi
    London Sch Hyg & Trop Med, London, England..
    Stranges, Saverio
    Luxembourg Inst Hlth, Strassen, Luxembourg..
    Stroumpoulis, Konstantinos
    Alexandra Gen Hosp Athens, Athens, Greece.;Ctr Hosp Publ Cotentin, Cherbourg, France..
    Sunguya, Bruno F.
    Muhimbili Univ Hlth & Allied Sci, Dar Es Salaam, Tanzania..
    Swaminathan, Soumya
    Indian Council Med Res, New Delhi, India..
    Sykes, Bryan L.
    Univ Calif Irvine, Dept Criminol, Irvine, CA USA.;Univ Calif Irvine, Dept Law & Soc, Irvine, CA USA.;Univ Calif Irvine, Dept Sociol, Irvine, CA USA.;Univ Calif Irvine, Dept Publ Hlth, Irvine, CA USA..
    Szoeke, Cassandra E. I.
    Univ Melbourne, Inst Hlth & Ageing, Melbourne, Vic, Australia..
    Tabares-Seisdedos, Rafael
    Univ Valencia, Dept Med, INCLIVA Hlth Res Inst, Valencia, Spain.;CIBERSAM, Valencia, Spain..
    Takahashi, Ken
    Univ Occupat & Environm Hlth, Inst Ind Ecol Sci, Dept Environm Epidemiol, Kitakyushu, Fukuoka, Japan..
    Talongwa, Roberto Tchio
    MINSANTE, Minist Hlth, Yaounde, Cameroon..
    Landon, Nikhil
    Tanne, David
    Chaim Sheba Med Ctr, Tel Hashomer, Israel.;Tel Aviv Univ, Tel Aviv, Israel..
    Tavakkoli, Mohammad
    Taye, Belaynew Wasie
    Bahir Dar Univ, Bahir Dar, Ethiopia..
    Taylor, Hugh R.
    Univ Melbourne, Melbourne, Vic, Australia. Natl Inst Publ Hlth, Natl Council Sci & Technol, Cuernavaca, Morelos, Mexico..
    Tedla, Bemnet Amare
    Univ Gondar, Gondar, Ethiopia.;James Cook Univ, Cairns, Qld, Australia..
    Tefera, Worku Mekonnen
    Univ Addis Ababa, Coll Hlth Sci, Sch Publ Hlth, Addis Ababa, Ethiopia..
    Tegegne, Teketo Kassaw
    Debre Markos Univ, Debre Markos, Ethiopia..
    Tekle, Dejen Yemane
    Mekelle Univ, Mekelle, Ethiopia..
    Terkawi, Abdullah Sulieman
    King Fahad Med City, Dept Anesthesiol, Riyadh, Saudi Arabia.;Univ Virginia, Dept Anesthesiol, Charlottesville, VA USA.;Cleveland Clin, Outcomes Res Consortium, Cleveland, OH 44106 USA..
    Thakur, J. S.
    Post Grad Inst Med Educ & Res, Sch Publ Hlth, Chandigarh, India. Univ Bath, Bath, Avon, England..
    Thomas, Bernadette A.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Thomas, Matthew Lloyd
    Thomson, Alan J.
    Adapt Knowledge Management, Victoria, BC, Canada..
    Thorne-Lyman, Andrew L.
    Harvard Univ, Dept Nutr, Boston, MA 02115 USA.;WorldFish, George Town, Malaysia..
    Thrift, Amanda G.
    Monash Univ, Sch Clin Sci Monash Hlth, Dept Med, Melbourne, Vic, Australia..
    Thurston, George D.
    New York Univ, Sch Med, Nelson Inst Environm Med, Tuxedo Pk, NY USA..
    Tillmann, Taavi
    UCL, Dept Epidemiol & Publ Hlth, London, England..
    Tobe-Gai, Ruoyan
    Natl Ctr Child Hlth & Dev, Tokyo, Japan..
    Tobollik, Myriam
    German Environm Agcy, Berlin, Germany..
    Topor-Madry, Roman
    Jagiellonian Univ, Coll Med, Fac Hlth Sci, Inst Publ Hlth, Krakow, Poland.;Wroclaw Med Univ, Fac Hlth Sci, Wroclaw, Poland..
    Topouzis, Fotis
    Aristotle Univ Thessaloniki, Thessaloniki, Greece..
    Towbin, Jeffrey Allen
    Le Bonheur Childrens Hosp, Memphis, TN USA.;Univ Tennessee, Hlth Sci Ctr, Memphis, TN USA.;St Jude Childrens Res Hosp, 332 N Lauderdale St, Memphis, TN 38105 USA..
    Tran, Bach Xuan
    Dimbuene, Zacharie Tsala
    Univ Kinshasa, Fac Econ & Management, Dept Populat Sci & Dev, Kinshasa, Congo.;African Populat & Hlth Res Ctr, Nairobi, Kenya..
    Tsilimparis, Nikolaos
    Univ Heart Ctr Hamburg, Hamburg, Germany..
    Tura, Abera Kenay
    Haramaya Univ, Dire Dawa, Ethiopia.;Univ Groningen, Groningen, Netherlands..
    Tuzcu, Emin Murat
    Cleveland Clin, Cleveland, OH 44106 USA..
    Tyrovolas, Stefanos
    Univ Barcelona, CIBERSAM, Fundacio St Joan De Deu, Parc Sanitari Sant Joan De Deu, Barcelona, Spain..
    Ukwaja, Kingsley N.
    Fed Teaching Hosp, Dept Internal Med, Abakaliki, Nigeria..
    Undurraga, Eduardo A.
    Brandeis Univ, Waltham, MA USA..
    Uneke, Chigozie Jesse
    Ebonyi State Univ, Abakaliki, Nigeria..
    Uthman, Olalekan A.
    Univ Warwick, Warwick Med Sch, Coventry, W Midlands, England..
    van Donkelaar, Aaron
    Dalhousie Univ, Dept Phys & Atmospher Sci, Halifax, NS, Canada..
    van Os, Jim
    Maastricht Univ, Med Ctr, Maastricht, Netherlands..
    Varakin, Yuri Y.
    Res Ctr Neurol, Moscow, Russia..
    Vasankari, Tommi
    UKK Inst Hlth Promot Res, Tampere, Finland..
    Veerman, J. Lennert
    Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia..
    Venketasubramanian, Narayanaswamy
    Raffles Hosp, Raffles Neurosci Ctr, Singapore, Singapore..
    Violante, Francesco S.
    Univ Bologna, Bologna, Italy..
    Vollset, Stein Emil
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Norwegian Inst Publ Hlth, Ctr Dis Burden, Oslo, Norway.;Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway..
    Wagner, Gregory R.
    Harvard Univ, Harvard TH Chan Sch Publ Hlth, Boston, MA 02115 USA.;Natl Inst Occupat Safety & Hlth, Washington, DC USA..
    Waller, Stephen G.
    Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA..
    Wang, JianLi
    Univ Calgary, Calgary, AB, Canada..
    Wang, Linhong
    Chinese Ctr Dis Control & Prevent, Ctr Chron & Noncommunicable Dis Control & Prevent, Beijing, Peoples R China..
    Wang, Yanping
    Natl Off Maternal & Child Hlth Surveillance, Chengdu, Peoples R China..
    Weichenthal, Scott
    McGill Univ, Montreal, PQ, Canada..
    Weiderpass, Elisabete
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Inst Populat Based Canc Res, Dept Res, Canc Registry Norway, Oslo, Norway.;Arctic Univ Norway, Univ Tromso, Fac Hlth Sci, Dept Community Med, Tromso, Norway.;Folkhalsan Res Ctr, Genet Epidemiol Grp, Helsinki, Finland..
    Weintraub, Robert G.
    Univ Melbourne, Murdoch Childrens Res Inst, Melbourne, Vic, Australia.;Univ Melbourne, Melbourne, Vic, Australia. Natl Inst Publ Hlth, Natl Council Sci & Technol, Cuernavaca, Morelos, Mexico.;Royal Childrens Hosp, Melbourne, Vic, Australia..
    Werdecker, Andrea
    Fed Inst Populat Res, Competence Ctr Mortal Follow Up German Natl Cohor, Wiesbaden, Germany..
    Westerman, Ronny
    Fed Inst Populat Res, Wiesbaden, Germany.;German Natl Cohort Consortium, Heidelberg, Germany..
    Whiteford, Harvey A.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;Univ Queensland, Sch Publ Hlth, Brisbane, Qld, Australia.;Queensland Ctr Mental Hlth Res, Brisbane, Qld, Australia..
    Wijeratne, Tissa
    Western Hlth, Footscray, Vic, Australia. Guys & St Thomas NHS Fdn Trust, Comprehens Biomed Res Ctr, Natl Inst Hlth Res, London, England. Kings Coll London, London, England..
    Wiysonge, Charles Shey
    South African Med Researcil, Cape Town, South Africa.;Univ Stellenbosch, Cape Town, South Africa..
    Wolfe, Charles D. A.
    Kings Coll London, Div Hlth & Social Care Res, London, England..
    Won, Sungho
    Seoul Natl Univ, Grad Sch Publ Hlth, Seoul, South Korea..
    Woolf, Anthony D.
    Royal Cornwall Hosp, Truro, England..
    Wubshet, Mamo
    St Pauls Hosp, Millennium Med Coll, Addis Ababa, Ethiopia..
    Xavier, Denis
    St Johns Med Coll & Res Inst, Bangalore, Karnataka, India..
    Xu, Gelin
    Nanjing Univ, Sch Med, Jinling Hosp, Dept Neurol, Nanjing, Jiangsu, Peoples R China..
    Yadav, Ajit Kumar
    Int Inst Populat Sci, Bombay, Maharashtra, India..
    Yakob, Bereket
    Univ KwaZulu Natal, Sch Nursing & Publ Hlth, Discipline Publ Hlth Med, Durban, South Africa..
    Yalew, Ayalnesh Zemene
    Mekelle Univ, Mekelle, Ethiopia..
    Yano, Yuichiro
    Northwestern Univ, Dept Prevent Med, Chicago, IL 60611 USA..
    Yaseri, Mehdi
    Univ Tehran Med Sci, Tehran, Iran.;Shahid Beheshti Univ Med Sci, Ophthalm Res Ctr, Tehran, Iran..
    Ye, Pengpeng
    Chinese Ctr Dis Control & Prevent, Ctr Chron & Noncommunicable Dis Control & Prevent, Beijing, Peoples R China..
    Yip, Paul
    Univ Hong Kong, Social Work & Social Adm Dept, Hong Kong, Hong Kong, Peoples R China.;Univ Hong Kong, Hong Kong Jockey Club Ctr Suicide Res & Prevent, Hong Kong, Hong Kong, Peoples R China..
    Yonemoto, Naohiro
    Kyoto Univ, Sch Publ Hlth, Dept Biostat, Kyoto, Japan..
    Yoon, Seok-Jun
    Younis, Mustafa Z.
    Jackson State Univ, Jackson, MS USA..
    Yu, Chuanhua
    Wuhan Univ, Dept Epidemiol & Biostat, Sch Publ Hlth, Wuhan, Peoples R China.;Wuhan Univ, Global Hlth Inst, Wuhan, Peoples R China..
    Zaidi, Zoubida
    Univ Hosp, Setif, Algeria..
    Zaki, Maysaa El Sayed
    Mansoura Univ, Fac Med, Mansoura, Egypt..
    Zhu, Jun
    Natl Off MCH Surveillance China, Chengdu, Peoples R China..
    Zipkin, Ben
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Zodpey, Sanjay
    Publ Hlth Fdn India, Gurgaon, India.;Publ Hlth Fdn India, Gurgaon, India..
    Zuhlke, Liesl Joanna
    Red Cross War Mem Childrens Hosp, Cape Town, South Africa..
    Murray, Christopher J. L.
    Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA..
    Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 20152016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10053, p. 1659-1724Article in journal (Refereed)
    Abstract [en]

    Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd.

  • 39. Forouzanfar, Mohammad H
    et al.
    Alexander, Lily
    Anderson, H Ross
    Bachman, Victoria F
    Biryukov, Stan
    Brauer, Michael
    Burnett, Richard
    Casey, Daniel
    Coates, Matthew M
    Cohen, Aaron
    Delwiche, Kristen
    Estep, Kara
    Frostad, Joseph J
    Kc, Astha
    Kyu, Hmwe H
    Moradi-Lakeh, Maziar
    Ng, Marie
    Slepak, Erica Leigh
    Thomas, Bernadette A
    Wagner, Joseph
    Aasvang, Gunn Marit
    Abbafati, Cristiana
    Ozgoren, Ayse Abbasoglu
    Abd-Allah, Foad
    Abera, Semaw F
    Aboyans, Victor
    Abraham, Biju
    Abraham, Jerry Puthenpurakal
    Abubakar, Ibrahim
    Abu-Rmeileh, Niveen M E
    Aburto, Tania C
    Achoki, Tom
    Adelekan, Ademola
    Adofo, Koranteng
    Adou, Arsène K
    Adsuar, José C
    Afshin, Ashkan
    Agardh, Emilie E
    Al Khabouri, Mazin J
    Al Lami, Faris H
    Alam, Sayed Saidul
    Alasfoor, Deena
    Albittar, Mohammed I
    Alegretti, Miguel A
    Aleman, Alicia V
    Alemu, Zewdie A
    Alfonso-Cristancho, Rafael
    Alhabib, Samia
    Ali, Raghib
    Ali, Mohammed K
    Alla, François
    Allebeck, Peter
    Allen, Peter J
    Alsharif, Ubai
    Alvarez, Elena
    Alvis-Guzman, Nelson
    Amankwaa, Adansi A
    Amare, Azmeraw T
    Ameh, Emmanuel A
    Ameli, Omid
    Amini, Heresh
    Ammar, Walid
    Anderson, Benjamin O
    Antonio, Carl Abelardo T
    Anwari, Palwasha
    Cunningham, Solveig Argeseanu
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Arsenijevic, Valentina S Arsic
    Artaman, Al
    Asghar, Rana J
    Assadi, Reza
    Atkins, Lydia S
    Atkinson, Charles
    Avila, Marco A
    Awuah, Baffour
    Badawi, Alaa
    Bahit, Maria C
    Bakfalouni, Talal
    Balakrishnan, Kalpana
    Balalla, Shivanthi
    Balu, Ravi Kumar
    Banerjee, Amitava
    Barber, Ryan M
    Barker-Collo, Suzanne L
    Barquera, Simon
    Barregard, Lars
    Barrero, Lope H
    Barrientos-Gutierrez, Tonatiuh
    Basto-Abreu, Ana C
    Basu, Arindam
    Basu, Sanjay
    Basulaiman, Mohammed O
    Ruvalcaba, Carolina Batis
    Beardsley, Justin
    Bedi, Neeraj
    Bekele, Tolesa
    Bell, Michelle L
    Benjet, Corina
    Bennett, Derrick A
    Benzian, Habib
    Bernabé, Eduardo
    Beyene, Tariku J
    Bhala, Neeraj
    Bhalla, Ashish
    Bhutta, Zulfiqar A
    Bikbov, Boris
    Abdulhak, Aref A Bin
    Blore, Jed D
    Blyth, Fiona M
    Bohensky, Megan A
    Başara, Berrak Bora
    Borges, Guilherme
    Bornstein, Natan M
    Bose, Dipan
    Boufous, Soufiane
    Bourne, Rupert R
    Brainin, Michael
    Brazinova, Alexandra
    Breitborde, Nicholas J
    Brenner, Hermann
    Briggs, Adam D M
    Broday, David M
    Brooks, Peter M
    Bruce, Nigel G
    Brugha, Traolach S
    Brunekreef, Bert
    Buchbinder, Rachelle
    Bui, Linh N
    Bukhman, Gene
    Bulloch, Andrew G
    Burch, Michael
    Burney, Peter G J
    Campos-Nonato, Ismael R
    Campuzano, Julio C
    Cantoral, Alejandra J
    Caravanos, Jack
    Cárdenas, Rosario
    Cardis, Elisabeth
    Carpenter, David O
    Caso, Valeria
    Castañeda-Orjuela, Carlos A
    Castro, Ruben E
    Catalá-López, Ferrán
    Cavalleri, Fiorella
    Çavlin, Alanur
    Chadha, Vineet K
    Chang, Jung-Chen
    Charlson, Fiona J
    Chen, Honglei
    Chen, Wanqing
    Chen, Zhengming
    Chiang, Peggy P
    Chimed-Ochir, Odgerel
    Chowdhury, Rajiv
    Christophi, Costas A
    Chuang, Ting-Wu
    Chugh, Sumeet S
    Cirillo, Massimo
    Claßen, Thomas Kd
    Colistro, Valentina
    Colomar, Mercedes
    Colquhoun, Samantha M
    Contreras, Alejandra G
    Cooper, Cyrus
    Cooperrider, Kimberly
    Cooper, Leslie T
    Coresh, Josef
    Courville, Karen J
    Criqui, Michael H
    Cuevas-Nasu, Lucia
    Damsere-Derry, James
    Danawi, Hadi
    Dandona, Lalit
    Dandona, Rakhi
    Dargan, Paul I
    Davis, Adrian
    Davitoiu, Dragos V
    Dayama, Anand
    de Castro, E Filipa
    De la Cruz-Góngora, Vanessa
    De Leo, Diego
    de Lima, Graça
    Degenhardt, Louisa
    Del Pozo-Cruz, Borja
    Dellavalle, Robert P
    Deribe, Kebede
    Derrett, Sarah
    Jarlais, Don C Des
    Dessalegn, Muluken
    deVeber, Gabrielle A
    Devries, Karen M
    Dharmaratne, Samath D
    Dherani, Mukesh K
    Dicker, Daniel
    Ding, Eric L
    Dokova, Klara
    Dorsey, E Ray
    Driscoll, Tim R
    Duan, Leilei
    Durrani, Adnan M
    Ebel, Beth E
    Ellenbogen, Richard G
    Elshrek, Yousef M
    Endres, Matthias
    Ermakov, Sergey P
    Erskine, Holly E
    Eshrati, Babak
    Esteghamati, Alireza
    Fahimi, Saman
    Faraon, Emerito Jose A
    Farzadfar, Farshad
    Fay, Derek F J
    Feigin, Valery L
    Feigl, Andrea B
    Fereshtehnejad, Seyed-Mohammad
    Ferrari, Alize J
    Ferri, Cleusa P
    Flaxman, Abraham D
    Fleming, Thomas D
    Foigt, Nataliya
    Foreman, Kyle J
    Paleo, Urbano Fra
    Franklin, Richard C
    Gabbe, Belinda
    Gaffikin, Lynne
    Gakidou, Emmanuela
    Gamkrelidze, Amiran
    Gankpé, Fortuné G
    Gansevoort, Ron T
    García-Guerra, Francisco A
    Gasana, Evariste
    Geleijnse, Johanna M
    Gessner, Bradford D
    Gething, Pete
    Gibney, Katherine B
    Gillum, Richard F
    Ginawi, Ibrahim A M
    Giroud, Maurice
    Giussani, Giorgia
    Goenka, Shifalika
    Goginashvili, Ketevan
    Dantes, Hector Gomez
    Gona, Philimon
    de Cosio, Teresita Gonzalez
    González-Castell, Dinorah
    Gotay, Carolyn C
    Goto, Atsushi
    Gouda, Hebe N
    Guerrant, Richard L
    Gugnani, Harish C
    Guillemin, Francis
    Gunnell, David
    Gupta, Rahul
    Gupta, Rajeev
    Gutiérrez, Reyna A
    Hafezi-Nejad, Nima
    Hagan, Holly
    Hagstromer, Maria
    Halasa, Yara A
    Hamadeh, Randah R
    Hammami, Mouhanad
    Hankey, Graeme J
    Hao, Yuantao
    Harb, Hilda L
    Haregu, Tilahun Nigatu
    Haro, Josep Maria
    Havmoeller, Rasmus
    Hay, Simon I
    Hedayati, Mohammad T
    Heredia-Pi, Ileana B
    Hernandez, Lucia
    Heuton, Kyle R
    Heydarpour, Pouria
    Hijar, Martha
    Hoek, Hans W
    Hoffman, Howard J
    Hornberger, John C
    Hosgood, H Dean
    Hoy, Damian G
    Hsairi, Mohamed
    Hu, Guoqing
    Hu, Howard
    Huang, Cheng
    Huang, John J
    Hubbell, Bryan J
    Huiart, Laetitia
    Husseini, Abdullatif
    Iannarone, Marissa L
    Iburg, Kim M
    Idrisov, Bulat T
    Ikeda, Nayu
    Innos, Kaire
    Inoue, Manami
    Islami, Farhad
    Ismayilova, Samaya
    Jacobsen, Kathryn H
    Jansen, Henrica A
    Jarvis, Deborah L
    Jassal, Simerjot K
    Jauregui, Alejandra
    Jayaraman, Sudha
    Jeemon, Panniyammakal
    Jensen, Paul N
    Jha, Vivekanand
    Jiang, Fan
    Jiang, Guohong
    Jiang, Ying
    Jonas, Jost B
    Juel, Knud
    Kan, Haidong
    Roseline, Sidibe S Kany
    Karam, Nadim E
    Karch, André
    Karema, Corine K
    Karthikeyan, Ganesan
    Kaul, Anil
    Kawakami, Norito
    Kazi, Dhruv S
    Kemp, Andrew H
    Kengne, Andre P
    Keren, Andre
    Khader, Yousef S
    Khalifa, Shams Eldin Ali Hassan
    Khan, Ejaz A
    Khang, Young-Ho
    Khatibzadeh, Shahab
    Khonelidze, Irma
    Kieling, Christian
    Kim, Daniel
    Kim, Sungroul
    Kim, Yunjin
    Kimokoti, Ruth W
    Kinfu, Yohannes
    Kinge, Jonas M
    Kissela, Brett M
    Kivipelto, Miia
    Knibbs, Luke D
    Knudsen, Ann Kristin
    Kokubo, Yoshihiro
    Kose, M Rifat
    Kosen, Soewarta
    Kraemer, Alexander
    Kravchenko, Michael
    Krishnaswami, Sanjay
    Kromhout, Hans
    Ku, Tiffany
    Defo, Barthelemy Kuate
    Bicer, Burcu Kucuk
    Kuipers, Ernst J
    Kulkarni, Chanda
    Kulkarni, Veena S
    Kumar, G Anil
    Kwan, Gene F
    Lai, Taavi
    Balaji, Arjun Lakshmana
    Lalloo, Ratilal
    Lallukka, Tea
    Lam, Hilton
    Lan, Qing
    Lansingh, Van C
    Larson, Heidi J
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Laryea, Dennis O
    Lavados, Pablo M
    Lawrynowicz, Alicia E
    Leasher, Janet L
    Lee, Jong-Tae
    Leigh, James
    Leung, Ricky
    Levi, Miriam
    Li, Yichong
    Li, Yongmei
    Liang, Juan
    Liang, Xiaofeng
    Lim, Stephen S
    Lindsay, M Patrice
    Lipshultz, Steven E
    Liu, Shiwei
    Liu, Yang
    Lloyd, Belinda K
    Logroscino, Giancarlo
    London, Stephanie J
    Lopez, Nancy
    Lortet-Tieulent, Joannie
    Lotufo, Paulo A
    Lozano, Rafael
    Lunevicius, Raimundas
    Ma, Jixiang
    Ma, Stefan
    Machado, Vasco M P
    MacIntyre, Michael F
    Magis-Rodriguez, Carlos
    Mahdi, Abbas A
    Majdan, Marek
    Malekzadeh, Reza
    Mangalam, Srikanth
    Mapoma, Christopher C
    Marape, Marape
    Marcenes, Wagner
    Margolis, David J
    Margono, Christopher
    Marks, Guy B
    Martin, Randall V
    Marzan, Melvin B
    Mashal, Mohammad T
    Masiye, Felix
    Mason-Jones, Amanda J
    Matsushita, Kunihiro
    Matzopoulos, Richard
    Mayosi, Bongani M
    Mazorodze, Tasara T
    McKay, Abigail C
    McKee, Martin
    McLain, Abigail
    Meaney, Peter A
    Medina, Catalina
    Mehndiratta, Man Mohan
    Mejia-Rodriguez, Fabiola
    Mekonnen, Wubegzier
    Melaku, Yohannes A
    Meltzer, Michele
    Memish, Ziad A
    Mendoza, Walter
    Mensah, George A
    Meretoja, Atte
    Mhimbira, Francis Apolinary
    Micha, Renata
    Miller, Ted R
    Mills, Edward J
    Misganaw, Awoke
    Mishra, Santosh
    Ibrahim, Norlinah Mohamed
    Mohammad, Karzan A
    Mokdad, Ali H
    Mola, Glen L
    Monasta, Lorenzo
    Hernandez, Julio C Montañez
    Montico, Marcella
    Moore, Ami R
    Morawska, Lidia
    Mori, Rintaro
    Moschandreas, Joanna
    Moturi, Wilkister N
    Mozaffarian, Dariush
    Mueller, Ulrich O
    Mukaigawara, Mitsuru
    Mullany, Erin C
    Murthy, Kinnari S
    Naghavi, Mohsen
    Nahas, Ziad
    Naheed, Aliya
    Naidoo, Kovin S
    Naldi, Luigi
    Nand, Devina
    Nangia, Vinay
    Narayan, Km Venkat
    Nash, Denis
    Neal, Bruce
    Nejjari, Chakib
    Neupane, Sudan P
    Newton, Charles R
    Ngalesoni, Frida N
    de Dieu Ngirabega, Jean
    Nguyen, Grant
    Nguyen, Nhung T
    Nieuwenhuijsen, Mark J
    Nisar, Muhammad I
    Nogueira, José R
    Nolla, Joan M
    Nolte, Sandra
    Norheim, Ole F
    Norman, Rosana E
    Norrving, Bo
    Nyakarahuka, Luke
    Oh, In-Hwan
    Ohkubo, Takayoshi
    Olusanya, Bolajoko O
    Omer, Saad B
    Opio, John Nelson
    Orozco, Ricardo
    Pagcatipunan, Rodolfo S
    Pain, Amanda W
    Pandian, Jeyaraj D
    Panelo, Carlo Irwin A
    Papachristou, Christina
    Park, Eun-Kee
    Parry, Charles D
    Caicedo, Angel J Paternina
    Patten, Scott B
    Paul, Vinod K
    Pavlin, Boris I
    Pearce, Neil
    Pedraza, Lilia S
    Pedroza, Andrea
    Stokic, Ljiljana Pejin
    Pekericli, Ayfer
    Pereira, David M
    Perez-Padilla, Rogelio
    Perez-Ruiz, Fernando
    Perico, Norberto
    Perry, Samuel A L
    Pervaiz, Aslam
    Pesudovs, Konrad
    Peterson, Carrie B
    Petzold, Max
    Phillips, Michael R
    Phua, Hwee Pin
    Plass, Dietrich
    Poenaru, Dan
    Polanczyk, Guilherme V
    Polinder, Suzanne
    Pond, Constance D
    Pope, C Arden
    Pope, Daniel
    Popova, Svetlana
    Pourmalek, Farshad
    Powles, John
    Prabhakaran, Dorairaj
    Prasad, Noela M
    Qato, Dima M
    Quezada, Amado D
    Quistberg, D Alex A
    Racapé, Lionel
    Rafay, Anwar
    Rahimi, Kazem
    Rahimi-Movaghar, Vafa
    Rahman, Sajjad Ur
    Raju, Murugesan
    Rakovac, Ivo
    Rana, Saleem M
    Rao, Mayuree
    Razavi, Homie
    Reddy, K Srinath
    Refaat, Amany H
    Rehm, Jürgen
    Remuzzi, Giuseppe
    Ribeiro, Antonio L
    Riccio, Patricia M
    Richardson, Lee
    Riederer, Anne
    Robinson, Margaret
    Roca, Anna
    Rodriguez, Alina
    Rojas-Rueda, David
    Romieu, Isabelle
    Ronfani, Luca
    Room, Robin
    Roy, Nobhojit
    Ruhago, George M
    Rushton, Lesley
    Sabin, Nsanzimana
    Sacco, Ralph L
    Saha, Sukanta
    Sahathevan, Ramesh
    Sahraian, Mohammad Ali
    Salomon, Joshua A
    Salvo, Deborah
    Sampson, Uchechukwu K
    Sanabria, Juan R
    Sanchez, Luz Maria
    Sánchez-Pimienta, Tania G
    Sanchez-Riera, Lidia
    Sandar, Logan
    Santos, Itamar S
    Sapkota, Amir
    Satpathy, Maheswar
    Saunders, James E
    Sawhney, Monika
    Saylan, Mete I
    Scarborough, Peter
    Schmidt, Jürgen C
    Schneider, Ione J C
    Schöttker, Ben
    Schwebel, David C
    Scott, James G
    Seedat, Soraya
    Sepanlou, Sadaf G
    Serdar, Berrin
    Servan-Mori, Edson E
    Shaddick, Gavin
    Shahraz, Saeid
    Levy, Teresa Shamah
    Shangguan, Siyi
    She, Jun
    Sheikhbahaei, Sara
    Shibuya, Kenji
    Shin, Hwashin H
    Shinohara, Yukito
    Shiri, Rahman
    Shishani, Kawkab
    Shiue, Ivy
    Sigfusdottir, Inga D
    Silberberg, Donald H
    Simard, Edgar P
    Sindi, Shireen
    Singh, Abhishek
    Singh, Gitanjali M
    Singh, Jasvinder A
    Skirbekk, Vegard
    Sliwa, Karen
    Soljak, Michael
    Soneji, Samir
    Søreide, Kjetil
    Soshnikov, Sergey
    Sposato, Luciano A
    Sreeramareddy, Chandrashekhar T
    Stapelberg, Nicolas J C
    Stathopoulou, Vasiliki
    Steckling, Nadine
    Stein, Dan J
    Stein, Murray B
    Stephens, Natalie
    Stöckl, Heidi
    Straif, Kurt
    Stroumpoulis, Konstantinos
    Sturua, Lela
    Sunguya, Bruno F
    Swaminathan, Soumya
    Swaroop, Mamta
    Sykes, Bryan L
    Tabb, Karen M
    Takahashi, Ken
    Talongwa, Roberto T
    Tandon, Nikhil
    Tanne, David
    Tanner, Marcel
    Tavakkoli, Mohammad
    Te Ao, Braden J
    Teixeira, Carolina M
    Téllez Rojo, Martha M
    Terkawi, Abdullah S
    Texcalac-Sangrador, José Luis
    Thackway, Sarah V
    Thomson, Blake
    Thorne-Lyman, Andrew L
    Thrift, Amanda G
    Thurston, George D
    Tillmann, Taavi
    Tobollik, Myriam
    Tonelli, Marcello
    Topouzis, Fotis
    Towbin, Jeffrey A
    Toyoshima, Hideaki
    Traebert, Jefferson
    Tran, Bach X
    Trasande, Leonardo
    Trillini, Matias
    Trujillo, Ulises
    Dimbuene, Zacharie Tsala
    Tsilimbaris, Miltiadis
    Tuzcu, Emin Murat
    Uchendu, Uche S
    Ukwaja, Kingsley N
    Uzun, Selen B
    van de Vijver, Steven
    Van Dingenen, Rita
    van Gool, Coen H
    van Os, Jim
    Varakin, Yuri Y
    Vasankari, Tommi J
    Vasconcelos, Ana Maria N
    Vavilala, Monica S
    Veerman, Lennert J
    Velasquez-Melendez, Gustavo
    Venketasubramanian, N
    Vijayakumar, Lakshmi
    Villalpando, Salvador
    Violante, Francesco S
    Vlassov, Vasiliy Victorovich
    Vollset, Stein Emil
    Wagner, Gregory R
    Waller, Stephen G
    Wallin, Mitchell T
    Wan, Xia
    Wang, Haidong
    Wang, JianLi
    Wang, Linhong
    Wang, Wenzhi
    Wang, Yanping
    Warouw, Tati S
    Watts, Charlotte H
    Weichenthal, Scott
    Weiderpass, Elisabete
    Weintraub, Robert G
    Werdecker, Andrea
    Wessells, K Ryan
    Westerman, Ronny
    Whiteford, Harvey A
    Wilkinson, James D
    Williams, Hywel C
    Williams, Thomas N
    Woldeyohannes, Solomon M
    Wolfe, Charles D A
    Wong, John Q
    Woolf, Anthony D
    Wright, Jonathan L
    Wurtz, Brittany
    Xu, Gelin
    Yan, Lijing L
    Yang, Gonghuan
    Yano, Yuichiro
    Ye, Pengpeng
    Yenesew, Muluken
    Yentür, Gökalp K
    Yip, Paul
    Yonemoto, Naohiro
    Yoon, Seok-Jun
    Younis, Mustafa Z
    Younoussi, Zourkaleini
    Yu, Chuanhua
    Zaki, Maysaa E
    Zhao, Yong
    Zheng, Yingfeng
    Zhou, Maigeng
    Zhu, Jun
    Zhu, Shankuan
    Zou, Xiaonong
    Zunt, Joseph R
    Lopez, Alan D
    Vos, Theo
    Murray, Christopher J
    Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 386, no 10010, p. 2287-2323Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.

    METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.

    FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.

    INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

  • 40.
    Ganna, Andrea
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Salihovic, Samira
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Broeckling, Corey D
    Proteomics and Metabolomics Facility, Colorado State University, Fort Collins, Colorado, United States of America.
    Hedman, Åsa K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Magnusson, Patrik K E
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Siegbahn, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Coagulation and inflammation science.
    Zilmer, Mihkel
    Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia.
    Prenni, Jessica
    Proteomics and Metabolomics Facility, Colorado State University, Fort Collins, Colorado, United States of America.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Fall, Tove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Large-scale Metabolomic Profiling Identifies Novel Biomarkers for Incident Coronary Heart Disease2014In: PLOS Genetics, ISSN 1553-7390, E-ISSN 1553-7404, Vol. 10, no 12, p. e1004801-Article in journal (Refereed)
    Abstract [en]

    Analyses of circulating metabolites in large prospective epidemiological studies could lead to improved prediction and better biological understanding of coronary heart disease (CHD). We performed a mass spectrometry-based non-targeted metabolomics study for association with incident CHD events in 1,028 individuals (131 events; 10 y. median follow-up) with validation in 1,670 individuals (282 events; 3.9 y. median follow-up). Four metabolites were replicated and independent of main cardiovascular risk factors [lysophosphatidylcholine 18∶1 (hazard ratio [HR] per standard deviation [SD] increment = 0.77, P-value<0.001), lysophosphatidylcholine 18∶2 (HR = 0.81, P-value<0.001), monoglyceride 18∶2 (MG 18∶2; HR = 1.18, P-value = 0.011) and sphingomyelin 28∶1 (HR = 0.85, P-value = 0.015)]. Together they contributed to moderate improvements in discrimination and re-classification in addition to traditional risk factors (C-statistic: 0.76 vs. 0.75; NRI: 9.2%). MG 18∶2 was associated with CHD independently of triglycerides. Lysophosphatidylcholines were negatively associated with body mass index, C-reactive protein and with less evidence of subclinical cardiovascular disease in additional 970 participants; a reverse pattern was observed for MG 18∶2. MG 18∶2 showed an enrichment (P-value = 0.002) of significant associations with CHD-associated SNPs (P-value = 1.2×10-7 for association with rs964184 in the ZNF259/APOA5 region) and a weak, but positive causal effect (odds ratio = 1.05 per SD increment in MG 18∶2, P-value = 0.05) on CHD, as suggested by Mendelian randomization analysis. In conclusion, we identified four lipid-related metabolites with evidence for clinical utility, as well as a causal role in CHD development.

  • 41.
    Gasparini, Alessandro
    et al.
    Karolinska Inst, Dept Clin Sci Technol & Intervent, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Evans, Marie
    Karolinska Inst, Dept Clin Sci Technol & Intervent, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Coresh, Josef
    Johns Hopkins Univ, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA..
    Grams, Morgan E.
    Johns Hopkins Univ, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD USA.;Johns Hopkins Univ, Dept Med, Div Nephrol, Baltimore, MD USA..
    Norin, Olof
    Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Stockholm, Sweden..
    Qureshi, Abdul R.
    Karolinska Inst, Dept Clin Sci Technol & Intervent, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Runesson, Bjorn
    Karolinska Inst, Dept Clin Sci Technol & Intervent, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Barany, Peter
    Karolinska Inst, Dept Clin Sci Technol & Intervent, Div Renal Med & Baxter Novum, Stockholm, Sweden..
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden.
    Jernberg, Tomas
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Cardiol, Stockholm, Sweden..
    Wettermark, Bjorn
    Stockholm Cty Council, Publ Healthcare Serv Comm, Stockholm, Sweden.;Karolinska Inst, Dept Med, Ctr Pharmacoepidemiol, Stockholm, Sweden..
    Elinder, Carl G.
    Karolinska Inst, Dept Clin Sci Technol & Intervent, Div Renal Med & Baxter Novum, Stockholm, Sweden.;Stockholm Cty Council, Publ Healthcare Serv Comm, Stockholm, Sweden..
    Carrero, Juan-Jesus
    Karolinska Inst, Dept Clin Sci Technol & Intervent, Div Renal Med & Baxter Novum, Stockholm, Sweden.;Karolinska Inst, Ctr Mol Med, Stockholm, Sweden..
    Prevalence and recognition of chronic kidney disease in Stockholm healthcare2016In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 31, no 12, p. 2086-2094Article in journal (Refereed)
    Abstract [en]

    Background. Chronic kidney disease (CKD) is common, but the frequency of albuminuria testing and referral to nephrology care has been difficult to measure. We here characterize CKD prevalence and recognition in a complete healthcare utilization cohort of the Stockholm region, in Sweden. Methods. We included all adult individuals (n = 1 128 058) with at least one outpatient measurement of IDMS-calibrated serum creatinine during 2006-11. Estimated glomerular filtration rate (eGFR) was calculated via the CKD-EPI equation and CKD was solely defined as eGFR <60 mL/min/1.73 m(2). We also assessed the performance of diagnostic testing (albuminuria), nephrology consultations, and utilization of ICD-10 diagnoses. Results. A total of 68 894 individuals had CKD, with a crude CKD prevalence of 6.11% [95% confidence interval (CI): 6.07-6.16%] and a prevalence standardized to the European population of 5.38% (5.33-5.42%). CKD was more prevalent among the elderly (28% prevalence >75 years old), women (6.85 versus 5.24% in men), and individuals with diabetes (17%), hypertension (17%) or cardiovascular disease (31%). The frequency of albuminuria monitoring was low, with 38% of diabetics and 27% of CKD individuals undergoing albuminuria testing over 2 years. Twenty-three per cent of the 16 383 individuals satisfying selected KDIGO criteria for nephrology referral visited a nephrologist. Twelve per cent of CKD patients carried an ICD-10 diagnostic code of CKD. Conclusions. An estimated 6% of the adult Stockholm population accessing healthcare has CKD, but the frequency of albuminuria testing, nephrology consultations and registration of CKD diagnoses was suboptimal despite universal care. Improving provider awareness and treatment of CKD could have a significant public health impact.

  • 42.
    Gasparini, Alessandro
    et al.
    Karolinska Inst, Div Renal Med, Stockholm, Sweden.;Baxter Novum, CLINTEC, Stockholm, Sweden..
    Evans, Marie
    Karolinska Inst, Div Renal Med, Stockholm, Sweden.;Baxter Novum, CLINTEC, Stockholm, Sweden..
    Qureshi, Abdul Rashid
    Karolinska Inst, Div Renal Med, Stockholm, Sweden.;Baxter Novum, CLINTEC, Stockholm, Sweden..
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Barany, Peter
    Karolinska Inst, Div Renal Med, Stockholm, Sweden.;Baxter Novum, CLINTEC, Stockholm, Sweden..
    Coresh, Josef
    Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA..
    Wettermark, Bjorn
    Stockholm Cty Council, Publ Healthcare Serv Comm, Stockholm, Sweden.;Karolinska Inst, Dept Med, Ctr Pharmacoepidemiol, Stockholm, Sweden..
    Elinder, Carl-Gustaf
    Karolinska Inst, Div Renal Med, Stockholm, Sweden.;Baxter Novum, CLINTEC, Stockholm, Sweden.;Stockholm Cty Council, Publ Healthcare Serv Comm, Stockholm, Sweden..
    Carrero, Juan-Jesus
    Karolinska Inst, Div Renal Med, Stockholm, Sweden.;Baxter Novum, CLINTEC, Stockholm, Sweden..
    Prevalence, Diagnosis And Nephrology Care Of CKD In The Region Of Stockholm2016In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 31, p. 191-192Article in journal (Other academic)
  • 43. Grams, Morgan E
    et al.
    Sang, Yingying
    Ballew, Shoshana H
    Gansevoort, Ron T
    Kimm, Heejin
    Kovesdy, Csaba P
    Naimark, David
    Oien, Cecilia
    Smith, David H
    Coresh, Josef
    Sarnak, Mark J
    Stengel, Benedicte
    Tonelli, Marcello
    A Meta-analysis of the Association of Estimated GFR, Albuminuria, Age, Race, and Sex With Acute Kidney Injury2015In: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 66, no 4, p. 591-601Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Acute kidney injury (AKI) is a serious global public health problem. We aimed to quantify the risk of AKI associated with estimated glomerular filtration rate (eGFR), albuminuria (albumin-creatinine ratio [ACR]), age, sex, and race (African American and white).

    STUDY DESIGN: Collaborative meta-analysis.

    SETTING & POPULATION: 8 general-population cohorts (1,285,049 participants) and 5 chronic kidney disease (CKD) cohorts (79,519 participants).

    SELECTION CRITERIA FOR STUDIES: Available eGFR, ACR, and 50 or more AKI events.

    PREDICTORS: Age, sex, race, eGFR, urine ACR, and interactions.

    OUTCOME: Hospitalized with or for AKI, using Cox proportional hazards models to estimate HRs of AKI and random-effects meta-analysis to pool results.

    RESULTS: 16,480 (1.3%) general-population cohort participants had AKI over a mean follow-up of 4 years; 2,087 (2.6%) CKD participants had AKI over a mean follow-up of 1 year. Lower eGFR and higher ACR were strongly associated with AKI. Compared with eGFR of 80mL/min/1.73m(2), the adjusted HR of AKI at eGFR of 45mL/min/1.73m(2) was 3.35 (95% CI, 2.75-4.07). Compared with ACR of 5mg/g, the risk of AKI at ACR of 300mg/g was 2.73 (95% CI, 2.18-3.43). Older age was associated with higher risk of AKI, but this effect was attenuated with lower eGFR or higher ACR. Male sex was associated with higher risk of AKI, with a slight attenuation in lower eGFR but not in higher ACR. African Americans had higher AKI risk at higher levels of eGFR and most levels of ACR.

    LIMITATIONS: Only 2 general-population cohorts could contribute to analyses by race; AKI identified by diagnostic code.

    CONCLUSIONS: Reduced eGFR and increased ACR are consistent strong risk factors for AKI, whereas associations of AKI with age, sex, and race may be weaker in more advanced stages of CKD.

  • 44. Griswold, MG
    et al.
    Fullman, N
    Hawley, C
    Arian, N
    Zimsen, SRM,
    Tymeson, HD
    Venkateswaran, V
    Tapp, AD
    Forouzanfar, MH
    Salama, JS
    Ärnlöv, Johan
    Karolinska Inst, Dept Neurobiol, Stockholm, Sweden; Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Carrero, JJ
    Carvalho, F
    Yotebieng, M
    Younis, MZ
    Zachariah, G
    Zaidi, Z
    Zamani, M
    Zhang, X
    Zodpey, S
    Mokdad, AH
    Naghavi, M
    Murray, CJL
    Gakidou, E
    Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 20162018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10152, p. 1015-1035Article in journal (Refereed)
    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.

  • 45.
    Hagström, Emil
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Ahlström, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Hellman, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Parathyroid hormone and calcium are independently associated with subclinical vascular disease in a community-based cohort2015In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 238, no 2, p. 420-426Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    Diseases with abnormal levels of parathyroid hormone (PTH) and calcium, such as primary and secondary hyperparathyroidism, are associated with an increased risk of cardiovascular morbidity and mortality. However, there is paucity on the association between calcium, PTH and abnormalities in the vascular system in the general population.

    METHODS:

    In the PIVUS study (Prospective Investigation of the Vasculature in Uppsala Seniors), a community based cohort of 70-year old men and women (n = 1016), the associations between s-calcium, p-PTH and endothelial function, arterial stiffness and blood pressures were investigated, adjusting for cardiovascular risk factors and mineral metabolism.

    RESULTS:

    In multivariable linear regression models 1 SD increase in calcium was associated with 1.1 units decrease in the stroke volume/pulse pressure ratio and 0.06 decrease in common carotid artery distensibility (p < 0.001) indicative of increased arterial stiffness. Further, calcium was associated with increasing calculated central pulse pressure with 1.3 mmHg elevation per 1 SD increase in calcium (p < 0.05). 1 SD increase in PTH was associated with 1.9 and 1.0 mmHg increase in intra-arterially measured brachial artery systolic and diastolic blood pressures, respectively (p < 0.01), as well as 1.6 and 0.9 mmHg increase in calculated central systolic and diastolic blood pressures (p < 0.05). PTH was not associated with arterial stiffness, endothelial function or pulse pressure.

    CONCLUSION:

    In a large community-based sample of elderly, calcium was independently associated with increased arterial stiffness, and PTH independently to intra-arterial peripheral and calculated central blood pressures. The findings indicate a possible link between the vasculature and mineral metabolism.

  • 46.
    Hagström, Emil
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Kilander, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Nylander, Ruta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Johansson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Arnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Plasma Parathyroid Hormone Is Associated with Vascular Dementia and Cerebral Hyperintensities in Two Community-Based Cohorts2014In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 99, no 11, p. 4181-4189Article in journal (Refereed)
    Abstract [en]

    Context:

    In diseases with increased PTH such as hyperparathyroidism and chronic renal failure, dementia is common. Little is known of PTH and dementia in the community.

    Objective:

    We sought to investigate relations between PTH, clinical dementia and cerebral micro-vascular disease.

    Setting and Design:

    The Uppsala Longitudinal Study Of Adult Men (ULSAM) was prospective, baseline, 1991-1995; followup, 15.8 years. The Prospective Investigation Of The Vasculature In Uppsala Seniors (PIVUS) was cross-sectional, baseline, 2001. Both settings were community based.

    Participants and Main Outcome Measure:

    In the ULSAM study of 998 men (age 71) the association between PTH and dementia was investigated. In the PIVUS study of 406 men and women (age 70) the relation between PTH and magnetic resonance imaging signs of cerebral small vascular disease was investigated.

    Results:

    During followup, 56 individuals were diagnosed with vascular, 91 with Alzheimer's, and 59 with other dementias. In Cox-regression analyses, higher PTH was associated with vascular dementia (hazard ratio per 1 SD increase of PTH, 1.41; P < .01), but not with other dementias. The top tertile of PTH accounted for 18.5% of the population-attributable risk for vascular dementia, exceeding all other risk factors. In linear regression analysis in PIVUS, PTH was associated with increasing white matter hyperintensities (WMHI), reflecting increasing burden of cerebral small vessel disease (1 SD PTH increase, 0.31 higher category of WMHI; P = .016). All models were adjusted for vascular risk factors and mineral metabolism.

    Conclusions:

    In two community-based samples, PTH predicted clinically diagnosed and neuroimaging indices of vascular dementia and cerebral small vessel disease. Our data suggest a role for PTH in the development of vascular dementia.

  • 47.
    Hagström, Emil
    et al.
    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.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Hansen, Tomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Johansson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
    Ingelsson, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Sundström, Johan
    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.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Arnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Plasma-Parathyroid Hormone Is Associated With Subclinical and Clinical Atherosclerotic Disease in 2 Community-Based Cohorts2014In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 34, no 7, p. 1567-73Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Cardiovascular risk factors have different impact on different arterial territories. Diseases with elevated circulating parathyroid hormone (PTH) such as primary hyperparathyroidism and chronic renal failure have been shown to be associated with an increased risk of cardiovascular disease, predominantly heart or cerebrovascular diseases. However, data on the associations between circulating PTH and peripheral atherosclerosis are limited.

    APPROACH AND RESULTS: Two prospective, community-based studies were used. In 306 men and women, who were 70 years old, from the Prospective investigation of the vasculature in Uppsala seniors (PIVUS) study, cross-sectional relations between PTH and atherosclerotic burden assessed by whole-body magnetic resonance angiography were investigated. In 998 men, who were 71 years old, from the Uppsala longitudinal study of adult men (ULSAM) study, the association between PTH concentration and risk of subsequent nonfatal atherosclerotic disease (excluding coronary or cerebrovascular disease) was investigated. Adjusting for established vascular risk factors, PTH was associated with burden of atherosclerosis (increase in total atherosclerotic score per SD PTH increase: 0.04, 0.003-0.08; P=0.03) in the PIVUS study. During follow-up in the ULSAM study (median 16.7 years), 89 men were diagnosed with nonfatal atherosclerotic disease. In Cox-regression analyses adjusting for established vascular risk factors and mineral metabolism, higher PTH was associated with an increased risk of nonfatal atherosclerotic disease (hazard ratio for 1 SD increase of PTH: 1.55, 1.33-1.88; P<0.0001). Results were similar when including fatal atherosclerotic disease in the outcome.

    CONCLUSIONS: In 2 independent community-based cohorts, PTH was associated to the degree of atherosclerosis and risk of clinically overt atherosclerotic disease, respectively. Our data confirm and extend previous studies supporting a role for PTH in the development of atherosclerotic disease.

  • 48.
    Hagström, Emil
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Kilander, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Plasma parathyroid hormone and the risk of cerebrovascular diseases in the community2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no Suppl 1, p. 236-236Article in journal (Other academic)
  • 49. Hallmarker, Ulf
    et al.
    Michaëlsson, Karl
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lagerqvist, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lindbäck, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Outcome After Myocardial Infarction In A Cohort Study Of Cross Country Skiers In Sweden2014In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 63, no 12, p. A1345-A1345Article in journal (Refereed)
  • 50. Hay, SI
    et al.
    Abajobir, AA
    Abate, KH
    Abbafati, C
    Abbas, KM
    Abd-Allah, F
    Abdulkader, RS
    Abdulle, AM
    Abebo, TA
    Abera, SF
    Aboyans, V
    Abu-Raddad, LJ
    Ärnlöv, Johan
    Karolinska institute, Dept Neurobiol, Div Family Med & Primary Care, Care Sci & Soc, Stockholm, Sweden; Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden .
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Zaki, MES
    Zegeye, EA
    Zenebe, ZM
    Zhang, X
    Zheng, Y
    Zhou, M
    Zipkin, B
    Zodpey, S
    Zoeckler, L
    Zuhlke, LJ
    Murray, CJL
    Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10100, p. 1260-1344, article id S0140-6736(17)32130-XArticle in journal (Refereed)
    Abstract [en]

    BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).

    METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.

    FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.

    INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.

    FUNDING: Bill & Melinda Gates Foundation.

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