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  • 51. Nystrom, Petter K.
    et al.
    Carlsson, Axel C.
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Leander, Karin
    de Faire, Ulf
    Hellenius, Mai-Lis
    Gigante, Bruna
    Obesity, Metabolic Syndrome and Risk of Atrial Fibrillation: A Swedish, Prospective Cohort Study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0127111Article in journal (Refereed)
    Abstract [en]

    Aim We aimed to investigate whether different measures of obesity could similarly predict atrial fibrillation, and whether the atrial fibrillation risk associated with obesity is dependent on presence of metabolic syndrome. Material and Methods We performed our study in a population-based longitudinal cardiovascular study, comprising 1 924 men and 2 097 women, aged 60 years, from Stockholm. Body mass index, waist circumference, sagittal abdominal diameter and components of metabolic syndrome (systolic- and diastolic blood pressure, fasting glucose, triglycerides, high-density lipoprotein-cholesterol) were recorded at baseline. Participants were classified by their body mass index (normal weight, overweight or obese), waist circumference (normal, semi-elevated or elevated), and according to presence of metabolic syndrome. Atrial fibrillation risk was estimated by Cox proportional hazards regression models, adjusted for common atrial fibrillation risk factors, expressed as HR and 95% CI. Results During a mean follow-up of 13.6 years, 285 incident atrial fibrillation cases were recorded. One standard deviation increment of each obesity measure was associated with increased atrial fibrillation risk as: bodymass index 1.25 (1.12 - 1.40), waist circumference 1.35 (1.19 - 1.54) and sagittal abdominal diameter 1.28 (1.14 - 1.44). Compared to normal weight subjects without metabolic syndrome, increased atrial fibrillation risk was noted for overweight subjects with metabolic syndrome, 1.67 (1.16 - 2.41), obese subjects without metabolic syndrome, 1.75 (1.11 - 2.74) and obese subjects withmetabolic syndrome, 1.92 (1.34 - 2.74). Compared to subjects with normal waist circumference without metabolic syndrome, subjects with elevated waist circumference and metabolic syndrome suffered increased atrial fibrillation risk, 2.03 (1.44 - 2.87). Conclusions Body mass index, waist circumference and sagittal abdominal diameter could similarly predict atrial fibrillation. Obesity was associated with an increased atrial fibrillation risk regardless of metabolic syndrome, whereas overweight and elevated waist circumference was associated with increased atrial fibrillation risk only if metabolic syndrome was present.

  • 52.
    Rajan, Gita
    et al.
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Stockholm Cty Council, Acad Primary Healthcare Ctr, Stockholm, Sweden..
    Ljunggren, Gunnar
    Stockholm Cty Council, Publ Healthcare Serv Comm Adm, Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Stockholm, Sweden..
    Wändell, Per
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Stockholm Cty Council, Acad Primary Healthcare Ctr, Stockholm, Sweden..
    Wahlström, Lars
    Karolinska Inst, Ctr Psychiat Res, Stockholm, Sweden..
    Svedin, Carl-Göran
    Linkoping Univ, Fac Med, Dept Clin & Expt Med, Barnafrid Child & Adolescent Psychiat, Linkoping, Sweden..
    Carlsson, Axel C
    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 .
    Diagnoses of sexual abuse and their common registered comorbidities in the total population of Stockholm2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 6, p. 592-598Article in journal (Refereed)
    Abstract [en]

    Background: Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions.

    Methods: Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013-2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated.

    Results: Girls at the ages 13-17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5-12 years (0.11%), and girls 0-4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008-0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5-12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 017 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0-17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18-) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic disorders; 15.3 (8.0 to 29.4). For men (18-) the highest ORs of comorbidities were: alcohol abuse; 25.8 (15.2 to 43.9), anxiety disorders; 14.3 (8.5 to 24.2) stress disorder; 12.9 (7.5 to 22.1) and drug abuse; 12.9 (6.9 to 24.1).

    Conclusions: Diagnoses of drug and alcohol abuse, psychotic, bipolar, stress anxiety disorders, depression and somatic pain are more common among individuals with a diagnosis of sexual abuse than among individuals without a diagnosis of sexual abuse.

  • 53.
    Roos, Andreas
    et al.
    Karolinska Inst, Dept Med, Stockholm, Sweden;Karolinska Univ Hosp, Dept Emergency Med, C1 63, S-14186 Stockholm, Sweden.
    Hellgren, Anton
    Karolinska Inst, Dept Med, Stockholm, Sweden;Karolinska Univ Hosp, Dept Emergency Med, C1 63, S-14186 Stockholm, Sweden.
    Rafatnia, Farshid
    Karolinska Inst, Dept Med, Stockholm, Sweden;NYU Lutheran Med Ctr, Dept Internal Med, Brooklyn, NY USA.
    Hammarsten, Ola
    Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Clin Chem & Transfus Med, Gothenburg, Sweden.
    Ljung, Rickard
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Huddinge, Sweden.
    Holzmann, Martin J.
    Karolinska Inst, Dept Med, Stockholm, Sweden;Karolinska Univ Hosp, Dept Emergency Med, C1 63, S-14186 Stockholm, Sweden.
    Investigations, findings, and follow-up in patients with chest pain and elevated high-sensitivity cardiac troponin T levels but no myocardial infarction2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 232, p. 111-116Article in journal (Refereed)
    Abstract [en]

    Background: Elevated troponin levels, in patients without myocardial infarction (MI), are associated with increased mortality. In an observational cohort study we aimed to assess how patients with elevated high-sensitivity cardiac troponin T (hs-cTnT) levels, and no MI are investigated and followed up, compared to patients with MI.

    Methods: During January 1, 2011 to December 31, 2012, all patients > 25 years of age, with chest pain and elevated hs-cTnT levels or MI, at the Karolinska University Hospital were included. We calculated risk ratios (RR) with 95% confidence intervals (CI) for echocardiographies, stress tests, and follow-up, and compared medication in patients with and without MI.

    Results: 1848 patients with elevated hs-cTnT levels but no MI, of whom 871 (47%) had no prior heart disease, and 667 patients with MI were included. Echocardiography was performed in 609 patients (33%) without MI and 580 (87%) with MI (adjusted RR 0.42; 95% CI, 0.37-0.48). Follow-up was planned for 856 (46%) patients without MI and 611 (92%) with MI (adjusted RR 0.54; 95% CI, 0.48-0.60). Among patients without MI and no heart disease who underwent echocardiography 46 (14%) had a left ventricular ejection fraction of <= 40%, and on stress tests 27 (37%) had findings associated with ischemia. Platelet inhibitors and statins were started in 266 (25%) and 199 (17%) patients without MI, respectively, compared with 424 (93%), and 416 (86%) patients with MI.

    Conclusions: Patients with elevated hs-cTnT levels and no MI are rarely investigated for detection of cardiac disease or followed up, or started on cardiovascular medication that potentially could prevent future cardiovascular events and death.

  • 54.
    Ruge, Toralph
    et al.
    Karolinska Inst, Dept Med, Stockholm, Sweden; Karolinska Inst, Dept 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 & Primary Care, Huddinge, Sweden.
    Ingelsson, Erik
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Stanford Univ, Sch Med, Div Cardiovasc Med, Stanford, CA USA.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Sundström, Johan
    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 Public Health and Caring Sciences.
    Larsson, Anders
    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.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    Circulating endostatin and the incidence of heart failure.2018In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 5, p. 244-249Article in journal (Refereed)
    Abstract [en]

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

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

    Results: Higher serum endostatin was associated with an increased risk for heart failure in both cohorts after adjustment for established heart failure risk factors, glomerular filtration rate and N-terminal pro-brain natriuretic peptide (NT-proBNP) (PIVUS: multivariable hazard ratio (HR) per 1-standard deviation (SD) increase, HR 1.46 (95%CI, 1.17-1.82, p < .001); ULSAM: HR 1.29 (95%CI, 1.00-1.68, p < .05). In cross-sectional analyses at baseline, higher endostatin was significantly associated with both worsened left ventricular systolic and diastolic function in both cohorts.

    Conclusion: Higher serum endostatin was associated with left ventricular dysfunction and an increased heart failure risk in two community-based cohorts of elderly. Our findings encourage further experimental studies that investigate the role of endostatin in the development of heart failure.

  • 55. Ruge, Toralph
    et al.
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska institutet, Stockholm, Sweden.
    Jansson, Jan-Håkan
    Söderberg, Stefan
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ärnlöv, Johan
    The association between circulating endostatin levels and incident myocardial infarction2018In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 52, no 6, p. 315-319Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Increased levels of circulating endostatin have been observed in patients with prevalent ischemic heart disease. However, the association between circulating endostatin, and incident myocardial infarction (MI) is less studied. Our main aim was to study the association between circulating endostatin and incident MI in the community adjusted for established cardiovascular risk factors in men and women.

    DESIGN: Circulating endostatin was measured in a nested case control study based on three large community-based Swedish cohorts, including 533 MI cases, and 1003 age-, sex- and cohort-matched controls. Odds ratios (OR) with 95% confidence intervals (CI) were calculated with adjustments for established cardiovascular risk factors.

    RESULTS: Higher endostatin was associated with a higher incidence of MI independently of established cardiovascular risk factors (OR 1.19, 95 % CI 1.03-1.37, p = 0.02), but this association was abolished after additional adjustment for C-reactive protein. Sex-stratified analyses suggest that the association was substantially stronger in women as compared to men Conclusions: In our community based sample, higher endostatin predicted incident myocardial infarction predominantly in women but not independently of CRP. Thus, our findings do not support a broad utility of endostatin measurements for the prediction of incident myocardial infarction in clinical practice.

  • 56.
    Ruge, Toralph
    et al.
    Department of Emergency Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden..
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Kjøller, Erik
    Department of Cardiology, Herlev Hospital, Copenhagen University Hospital, Copenhagen, Denmark..
    Hilden, Jørgen
    Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark..
    Kolmos, Hans Jørn
    Department of Clinical Microbiology, Odense University Hospital, Denmark..
    Sajadieh, Ahmad
    Copenhagen University Hospital of Bispebjerg & Frederiksberg, Denmark..
    Kastrup, Jens
    Rigshospitalet of Copenhagen University, Denmark..
    Jensen, Gorm Boje
    Copenhagen University Hospital Hvidovre, Denmark..
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Nowak, Christoph
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden..
    Jakobsen, Janus Christian
    Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Holbæk Hospital, Holbæk, Denmark..
    Winkel, Per
    Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark..
    Gluud, Christian
    Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark..
    Ärnlöv, Johan
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden.
    Circulating endostatin as a risk factor for cardiovascular events in patients with stable coronary heart disease: A CLARICOR trial sub-study2019In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 284, p. 202-208Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Raised levels of serum endostatin, a biologically active fragment of collagen XVIII, have been observed in patients with ischemic heart disease but association with incident cardiovascular events in patients with stable coronary heart disease is uncertain.

    METHODS: The CLARICOR-trial is a randomized, placebo-controlled trial of stable coronary heart disease patients evaluating 14-day treatment with clarithromycin. The primary outcome was a composite of acute myocardial infarction, unstable angina pectoris, cerebrovascular disease or all-cause mortality. In the present sub-study using 10-year follow-up data, we investigated associations between serum endostatin at entry (randomization) and the composite outcome and its components during follow-up. The placebo group was used as discovery sample (1204 events, n = 1998) and the clarithromycin-treated group as replication sample (1220 events, n = 1979).

    RESULTS: In Cox regression models adjusting for cardiovascular risk factors, glomerular filtration rate, and current pharmacological treatment, higher serum endostatin was associated with an increased risk of the composite outcome in the discovery sample (hazard ratio per standard deviation increase 1.11, 95% CI 1.03-1.19, p = 0.004), but slightly weaker and not statistically significant in the replication sample (hazard ratio 1.06, 95% CI 1.00-1.14, p = 0.06). In contrast, strong and consistent associations were found between endostatin and cardiovascular and all-cause mortality in all multivariable models and sub-samples. Addition of endostatin to a model with established cardiovascular risk factors provided no substantial improvement of risk prediction (<1%).

    CONCLUSIONS: Raised levels of serum endostatin might be associated with cardiovascular events in patients with stable coronary heart disease. The clinical utility of endostatin measurements remains to be established.

  • 57. Ruge, Toralph
    et al.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemical endocrinology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Ärnlöv, Johan
    Endostatin: a promising biomarker in the cardiovascular continuum?2017In: Biomarkers in Medicine, ISSN 1752-0363, E-ISSN 1752-0371, Vol. 11, no 10, p. 905-916Article, review/survey (Refereed)
    Abstract [en]

    The current review article aims to provide an up-to-date summary of previous studies in humans that have reported the association between circulating endostatin levels and different cardiovascular phenotypes. We also aim to provide suggestions for future directions of future research evaluating endostatin as a clinically relevant cardiovascular biomarker. With a few exceptions, higher circulating levels of endostatin seem to reflect vascular and myocardial damage, and a worsened prognosis for cardiovascular events or mortality in individuals with hypertension, diabetes, kidney disease, cardiovascular disease, as well as in the general population. Circulating endostatin seems to be a promising biomarker for cardiovascular pathology, but there is not enough evidence to date to support the use of endostatin measurements in clinical practice.

  • 58. Ruge, Toralph
    et al.
    Carlsson, Axel C
    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
    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.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Endostatin Level is Associated with Kidney Injury in the Elderly: Findings from Two Community-Based Cohorts2014In: American Journal of Nephrology, ISSN 0250-8095, E-ISSN 1421-9670, Vol. 40, no 5, p. 417-424Article in journal (Refereed)
    Abstract [en]

    Background: We aimed to investigate the associations between circulating endostatin and the different aspects of renal dysfunction, namely, estimated (cystatin C) glomerular filtration rate (GFR) and urine albumin-creatinine ratio (ACR).

    Methods: Two independent longitudinal community-based cohorts of elderly. ULSAM, n = 786 men; age 78 years; median GFR 74 ml/min/1.73 m(2); median ACR 0.80 mg/mmol); and PIVUS, n = 815; age 75 years; 51% women; median GFR; 67 ml/min/1.73 m(2); median ACR 1.39 mg/mmol. Cross-sectional associations between the endostatin levels and GFR as well as ACR, and longitudinal association between endostatin at baseline and incident CKD (defined as GFR <60 ml/min/1.73 m(2)) were assessed.

    Results: In cross-sectional regression analyses adjusting for age, gender, inflammation, and cardiovascular risk factors, serum endostatin was negatively associated with GFR (ULSAM: B-coefficient per SD increase -0.51, 95% CI (-0.57, -0.45), p < 0.001; PIVUS -0.47, 95% CI (-0.54, -0.41), p < 0.001) and positively associated with ACR (ULSAM: B-coefficient per SD increase 0.24, 95% CI (0.15, 0.32), p < 0.001; PIVUS 0.13, 95% CI (0.06-0.20), p < 0.001) in both cohorts. Moreover, in longitudinal multivariable analyses, higher endostatin levels were associated with increased risk for incident CKD defined as GFR <60 ml/min/1.73 m(2) at re-investigations in both ULSAM (odds ratio per SD increase of endostatin 1.39 (95% CI 1.01-1.90) and PIVUS 1.68 (95% CI 1.36-2.07)).

    Conclusions: Higher circulating endostatin is associated with lower GFR and higher albuminuria and independently predicts incident CKD in elderly subjects. Further studies are warranted to investigate the underlying mechanisms linking endostatin to kidney pathology, and to evaluate the clinical relevance of our findings.

  • 59.
    Rydell, Andreas
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden;Norslund Svardsjo Primary Hlth Care Ctr, Dalarna Cty Council, Falun, Sweden.
    Janson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Ställberg, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Nowak, Christoph
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    Feldreich, Tobias
    Dalarna Univ, Sch Hlth & Social Sci, Falun, Sweden.
    Iggman, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Norslund Svardsjo Primary Hlth Care Ctr, Dalarna Cty Council, Falun, Sweden.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Arnlov, Johan
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden;Dalarna Univ, Sch Hlth & Social Sci, Falun, Sweden;Norslund Svardsjo Primary Hlth Care Ctr, Dalarna Cty Council, Falun, Sweden.
    Endothelial dysfunction is associated with impaired lung function in two independent community cohorts2018In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 143, p. 123-128Article in journal (Refereed)
    Abstract [en]

    Background: Prior studies investigating the association between endothelial dysfunction and impaired lung function have been small and inconsistent. The primary aim was to investigate the association between endothelial function and lung function in two community-based cohorts. Methods: We used a discovery/replication approach to study the association between endothelial function and lung function in the Prospective investigation of Obesity, Energy and Metabolism (POEM, discovery cohort, n = 490, mean age 50.3 +/- 0.2 years) and the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS, replication cohort, n = 892, mean age 70.2 +/- 0.15 years). Spirometry and three different measures of endothelial function were performed including both the invasive forearm technique (endothelium-dependent and endothelium-independent vasodilation [EDV and EIDV, respectively] and noninvasive flow mediated dilation [FMD]). Results: An age and sex adjusted association between lower EDV and lower FEV1 was found in POEM and replicated in PIVUS. After merging the two cohorts, 1 standard deviation decrease in EDV was associated with 1.57% lower FEV1 after additional adjustment for smoking status, body mass index, exercise level, and C-reactive protein (95% confidence intervals 0.63-2.51, p = 0.001). The association was slightly lower albeit still statistically significant after excluding participants without cardiovascular disease and chronic respiratory disease and appeared stronger among previous/current smokers vs. non-smokers and in men vs. women (p for interaction = 0.2 and 0.02 respectively). Conclusions: Our findings suggest that even individuals with sub-clinical impairments of lung function in the community have concomitant endothelial dysfunction.

  • 60.
    Sandström, Ylva Kristoferson
    et al.
    Karolinska Inst, Dept Neurobiol, Div Family Med, Care Sci & Soc, S-14183 Huddinge, Sweden..
    Ljunggren, Gunnar
    Stockholm Cty Council, Publ Healthcare Serv Comm Adm, Stockholm, Sweden.;Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Wandell, Per
    Karolinska Inst, Dept Neurobiol, Div Family Med, Care Sci & Soc, S-14183 Huddinge, Sweden..
    Wahlstrom, Lars
    Karolinska Inst, Ctr Psychiat Res, Stockholm, Sweden..
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol, Div Family Med, Care Sci & Soc, S-14183 Huddinge, Sweden..
    Psychiatric comorbidities in patients with hypertension: a study of registered diagnoses 2009-2013 in the total population in Stockholm County, Sweden2016In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 34, no 3, p. 414-420Article in journal (Refereed)
    Abstract [en]

    Objective:The objective of this study was to investigate the prevalence of concomitant hypertension and psychiatric disorders in the general population, using administrative healthcare data in Stockholm County.Design and method:The study population, included all living persons who resided in Stockholm County 1 January 2011 (N=2058408). Individuals with a diagnosis of hypertension were identified with data from all consultations in primary care, specialized outpatient care, and inpatient care 2009-2013. As outcome, data were obtained on all consultations because of certain psychiatric diagnoses between 2011 and 2013, including specifically depression, anxiety disorders, bipolar disorder, and schizophrenia. Age-adjusted odd ratios (ORs) with 95% confidence intervals (95% CI) were calculated for men and women with and without hypertension, with individuals without hypertension as referents.Results:The age-adjusted ORs for depression in persons with hypertension were 1.293 (95% CI 1.256-1.331,) for men and 1.036 (95% CI 1.013-1.058) for women. The age-adjusted ORs for anxiety in persons with hypertension were 1.279 (95% CI 1.238-1.322) for men and 1.050 (95% CI 1.024-1.076) for women. The OR for bipolar disease were 0.904 (95% CI 0.826-0.990) for men and 0.709 (95% CI 0.656-0.767) for women. For schizophrenia, the ORs were 0.568 (95% CI 0.511-0.632) for men and 0.537 (95% CI 0.478-0.603) for women.Conclusion:Increased awareness of the risk of depression and anxiety among hypertensive patients is needed to combat hypertension, its complications, and psychiatric suffering in the population. Hypertension is probably underdiagnosed and neglected in individuals with severe psychiatric disorders. We warrant efforts to integrate psychiatric and hypertensive care.

  • 61.
    Steubl, Dominik
    et al.
    Tech Univ Munich, Klinikum Rechts Isar, Nephrol Abt, Munich, Germany.
    Kumar, Santhosh V
    Klinikum Univ Munchen, Div Renal, Med Klin & Poliklin 4, Campus Innenstadt, Munich, Germany.
    Tato, Maia
    Klinikum Univ Munchen, Div Renal, Med Klin & Poliklin 4, Campus Innenstadt, Munich, Germany.
    Mulay, Shrikant R
    Klinikum Univ Munchen, Div Renal, Med Klin & Poliklin 4, Campus Innenstadt, Munich, Germany.
    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.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Renders, Lutz
    Tech Univ Munich, Klinikum Rechts Isar, Nephrol Abt, Munich, Germany.
    Heemann, Uwe
    Tech Univ Munich, Klinikum Rechts Isar, Nephrol Abt, Munich, Germany.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Huddinge, 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.
    Anders, Hans-Joachim
    Klinikum Univ Munchen, Div Renal, Med Klin & Poliklin 4, Campus Innenstadt, Munich, Germany.
    Circulating cathepsin-S levels correlate with GFR decline and sTNFR1 and sTNFR2 levels in mice and humans2017In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, article id 43538Article in journal (Refereed)
    Abstract [en]

    Cardiovascular complications determine morbidity/mortality in chronic kidney disease (CKD). We hypothesized that progressive CKD drives the release of cathepsin-S (Cat-S), a cysteine protease that promotes endothelial dysfunction and cardiovascular complications. Therefore, Cat-S, soluble tumor-necrosis-factor receptor (sTNFR) 1/2 and glomerular filtration rate (GFR) were measured in a CKD mouse model, a German CKD-cohort (MCKD, n = 421) and two Swedish community-based cohorts (ULSAM, n = 764 and PIVUS, n = 804). Association between Cat-S and sTNFR1/2/GFR was assessed using multivariable linear regression. In the mouse model, Cat-S and sTNFR1/2 concentrations were increased following the progressive decline of GFR, showing a strong correlation between Cat-S and GFR (r = -0.746, p < 0.001) and Cat-S and sTNFR1/sTNFR2 (r = 0.837/0.916, p < 0.001, respectively). In the human cohorts, an increase of one standard deviation of estimated GFR was associated with a decrease of 1.008 ng/ml (95%-confidence interval (95%-CI) -1.576-(-0.439), p < 0.001) in Cat-S levels in MCKD; in ULSAM and PIVUS, results were similar. In all three cohorts, Cat-S and sTNFR1/sTNFR2 levels were associated in multivariable linear regression (p < 0.001). In conclusion, as GFR declines Cat-S and markers of inflammation-related endothelial dysfunction increase. The present data indicating that Cat-S activity increases with CKD progression suggest that Cat-S might be a therapeutic target to prevent cardiovascular complications in CKD.

  • 62.
    Waendell, Per E.
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    de Waard, Anne-Karien M.
    Univ Med Ctr, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Funct Area Emergency Med, Stockholm, Sweden;Karolinska Inst, Dept Internal Med, Stockholm, Sweden.
    Gornitzki, Carl
    Karolinska Inst, Univ Lib, Stockholm, Sweden.
    Lionis, Christos
    Univ Crete, Sch Med, Clin Social & Family Med, Iraklion, Greece.
    de Wit, Niek
    Univ Med Ctr, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands.
    Sondergaard, Jens
    Univ Southern, Inst Publ Hlth, Res Unit Gen Practice, Odense, Denmark.
    Sonderlund, Anders L.
    Charles Univ Prague, Fac Med 1, Dept Gen Practice, Prague, Czech Republic.
    Kral, Norbert
    NIVEL Netherlands Inst Hlth Serv Res, Utrecht, Netherlands.
    Seifert, Bohumil
    NIVEL Netherlands Inst Hlth Serv Res, Utrecht, Netherlands.
    Korevaar, Joke C.
    Vrije Univ Amsterdam Med Ctr, Amsterdam Publ Hlth Res Inst, Dept Gen Practice & Elderly Care Med, Amsterdam, Netherlands.
    Schellevis, Francois G.
    Vrije Univ Amsterdam Med Ctr, Amsterdam Publ Hlth Res Inst, Dept Gen Practice & Elderly Care Med, Amsterdam, Netherlands.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review2018In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 35, no 4, p. 383-398Article, review/survey (Refereed)
    Abstract [en]

    The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention). We identified several frequently reported barriers and facilitators for prevention of CMD, which may be used in designing future implementation and intervention studies.

  • 63. Waikar, Sushrut S
    et al.
    Sabbisetti, Venkata
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Coresh, Josef
    Feldman, Harold I
    Foster, Meredith C
    Fufaa, Gudeta D
    Helmersson-Karlqvist, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Hsu, Chi-Yuan
    Kimmel, Paul L
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Liu, Yumin
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Liu, Kathleen D
    Mifflin, Theodore E
    Nelson, Robert G
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Vasan, Ramachandran S
    Xie, Dawei
    Zhang, Xiaoming
    Bonventre, Joseph V
    Relationship of proximal tubular injury to chronic kidney disease as assessed by urinary kidney injury molecule-1 in five cohort studies2016In: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 31, no 9, p. 1460-1470Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The primary biomarkers used to define CKD are serum creatinine and albuminuria. These biomarkers have directed focus on the filtration and barrier functions of the kidney glomerulus even though albuminuria results from tubule dysfunction as well. Given that proximal tubules make up ∼90% of kidney cortical mass, we evaluated whether a sensitive and specific marker of proximal tubule injury, urinary kidney injury molecule-1 (KIM-1), is elevated in individuals with CKD or with risk factors for CKD.

    METHODS: We measured urinary KIM-1 in participants of five cohort studies from the USA and Sweden. Participants had a wide range of kidney function and were racially and ethnically diverse. Multivariable linear regression models were used to test the association of urinary KIM-1 with demographic, clinical and laboratory values.

    RESULTS: In pooled, multivariable-adjusted analyses, log-transformed, creatinine-normalized urinary KIM-1 levels were higher in those with lower eGFR {β = -0.03 per 10 mL/min/1.73 m(2) [95% confidence interval (CI) -0.05 to -0.02]} and greater albuminuria [β = 0.16 per unit of log albumin:creatinine ratio (95% CI 0.15-0.17)]. Urinary KIM-1 levels were higher in current smokers, lower in blacks than nonblacks and lower in users versus nonusers of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.

    CONCLUSION: Proximal tubule injury appears to be an integral and measurable element of multiple stages of CKD.

  • 64.
    Wallen, E. Flygare
    et al.
    Stockholm Cty Council, Acad Primary Hlth Care Ctr, Solnavagen 1e, S-11365 Stockholm, Sweden.;Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Ljunggren, G.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Stockholm Cty Council, Publ Hlth Care Serv Comm Adm, Stockholm, Sweden..
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Pettersson, D.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Wändell, P.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    High prevalence of diabetes mellitus, hypertension and obesity among persons with a recorded diagnosis of intellectual disability or autism spectrum disorder2018In: Journal of Intellectual Disability Research, ISSN 0964-2633, E-ISSN 1365-2788, Vol. 62, no 4, p. 269-280Article in journal (Refereed)
    Abstract [en]

    Background: Obesity and lack of physical activity are frequently reported in persons with intellectual disability (ID) or autism spectrum disorder (ASD). We hypothesised a higher prevalence of diabetes and hypertension in this population.

    Method: We used administrative data for all primary and specialist outpatient and inpatient healthcare consultations for people with at least one recorded diagnosis of diabetes mellitus, hypertension or obesity from 1998 to 2015. Data were drawn from the central administrative database for Stockholm County, Sweden. It was not possible to separate data for type 1 and type 2 diabetes. We stratified 26988 individuals with IDs or ASD into three groups, with Down syndrome treated separately, and compared these groups with 1996140 people from the general population.

    Results: Compared with the general population, men and women with ID/ASD had 1.6-3.4-fold higher age-adjusted odds of having a registered diagnosis of obesity or diabetes mellitus, with the exception of diabetes among men with Down syndrome. A registered diagnosis of hypertension was only more common among men with ID/ASD than in the general population.

    Conclusions: Diabetes and blood pressure health screening, along with efforts to prevent development of obesity already in childhood, are necessary for individuals with IDs and ASD. We believe that there is a need for adapted community-based health promotion programmes to ensure more equitable health for these populations.

  • 65.
    Wandell, Per
    et al.
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, S-14183 Huddinge, Sweden.;Stockholm Cty Council, Acad Primary Healthcare Ctr, Huddinge, Sweden..
    Carlsson, Axel C.
    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, S-14183 Huddinge, Sweden..
    Gasevic, Danijela
    Univ Edinburgh, Coll Med & Vet Med, Ctr Populat Hlth Sci, Edinburgh, Midlothian, Scotland..
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Neighbourhood socio-economic status and all-cause mortality in adults with atrial fibrillation: A cohort study of patients treated in primary care in Sweden2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 202, p. 776-781Article in journal (Refereed)
    Abstract [en]

    Objective: Our aim was to study the potential impact of neighbourhood socio-economic status (SES) on all-cause mortality in patients with atrial fibrillation (AF) treated in primary care. Methods: Study population included adults (n = 12,283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. Association between neighbourhood SES and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs), and by Laplace regression where years to death (95% CI) of the first 10% of the participants were used as an outcome. All models were conducted in both men and women and adjusted for age, educational level, marital status, change of neighbourhood status, cardiovascular co-morbidities, anticoagulant treatment and statin treatment. High-and low neighbourhood SES were compared with middle SES as reference group. Results: After adjustments for potential confounders, higher relative risk of all-cause mortality (HR 1.49, 95% CI 1.13-1.96) was observed in men living in low SES neighbourhoods compared to those from middle SES neighbourhoods. The results were confirmed using Laplace regression; the time until the first 10% of the men in low SES neighbourhoods died was 1.45 (95% CI 0.48-2.42) years shorter than for the men in middle SES neighbourhoods. Conclusions: Increased rates of heart disease and subsequent mortality among adults in deprived neighbourhoods raise important clinical and public health concerns. These findings could serve as an aid to policy-makers when allocating resources in primary health care settings as well as to clinicians who encounter patients in deprived neighbourhoods.

  • 66.
    Wandell, Per
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Family Med, S-14183 Huddinge, Sweden.;Stockholm Cty Council, Acad Primary Care Ctr, Huddinge, Sweden..
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Family Med, S-14183 Huddinge, Sweden.;Stockholm Cty Council, Acad Primary Care Ctr, Huddinge, Sweden..
    Gasevic, Danijela
    Univ Edinburgh, Coll Med & Vet Med, Ctr Populat Hlth Sci, Edinburgh, Midlothian, Scotland..
    Wahlström, Lars
    Karolinska Inst, Ctr Psychiat Res, Stockholm, Sweden..
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden.;Stanford Univ, Sch Med, Stanford Prevent Res Ctr, Palo Alto, CA 94304 USA..
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden.;Stanford Univ, Sch Med, Stanford Prevent Res Ctr, Palo Alto, CA 94304 USA..
    Depression or anxiety and all-cause mortality in adults with atrial fibrillation: A cohort study in Swedish primary care2016In: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 48, no 1-2, p. 59-66Article in journal (Refereed)
    Abstract [en]

    Objective Our aim was to study depression and anxiety in atrial fibrillation (AF) patients as risk factors for all-cause mortality in a primary care setting.Methods The study population included adults (n=12283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. The association between depression or anxiety and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses were conducted in men and women, adjusted for age, educational level, marital status, neighborhood socio-economic status (SES), change of neighborhood status and anxiety or depression, respectively, and cardiovascular co-morbidities. As a secondary analysis, background factors and their association with depression or anxiety were explored.Results The risk of all-cause mortality was higher among men with depression compared to their counterparts without depression even after full adjustment (HR=1.28, 95% CI 1.08-1.53). For anxiety among men and anxiety or depression among women with AF, no associations were found. Cerebrovascular disease was more common among depressed AF patients.Conclusions Increased awareness of the higher mortality among men with AF and subsequent depression is called for. We suggest a tight follow-up and treatment of both ailments in clinical practice.

  • 67.
    Wandell, Per
    et al.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Funct Area Emergency Med, Stockholm, Sweden;Karolinska Inst, Dept Internal Med, Stockholm, Sweden.
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden; Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden.
    Sundquist, Jan
    Lund Univ, Ctr Primacy Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Dept Family Med & Community Hlth, New York, NY 10029 USA.
    Sundquist, Kristina
    Lund Univ, Ctr Primacy Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Dept Family Med & Community Hlth, New York, NY 10029 USA.
    The association between relevant co-morbidities and prevalent as well as incident heart failure in patients with atrial fibrillation2018In: Journal of Cardiology, ISSN 0914-5087, E-ISSN 1876-4738, Vol. 72, no 1-2, p. 26-32Article in journal (Refereed)
    Abstract [en]

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

  • 68.
    Wandell, Per
    et al.
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Alfred Nobels Alle 12, S-14183 Huddinge, Sweden..
    Carlsson, Axel C.
    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, Alfred Nobels Alle 12, S-14183 Huddinge, Sweden..
    Holzmann, Martin
    Karolinska Univ Hosp, Dept Emergency Med, Stockholm, Sweden.;Karolinska Inst, Dept Internal Med, Stockholm, 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..
    Johansson, Sven-Erik
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation-a cohort study in primary care2017In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 73, no 2, p. 215-221Article in journal (Refereed)
    Abstract [en]

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

  • 69.
    Wandell, Per
    et al.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc NVS, Huddinge, Sweden..
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Huddinge, Sweden.
    Li, Xinjun
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Gasevic, Danijela
    Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Coll Med & Vet Med, Edinburgh, Midlothian, Scotland..
    Arnlov, Johan
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc NVS, Huddinge, Sweden.;Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
    Holzmann, Martin J.
    Karolinska Univ Hosp, Funct Area Emergency Med, Stockholm, Sweden.;Karolinska Inst, Dept Internal Med Solna, Stockholm, Sweden..
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden.;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA..
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden.;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA..
    Atrial fibrillation in immigrant groups: a cohort study of all adults 45 years of age and older in Sweden2017In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 32, no 9, p. 785-796Article in journal (Refereed)
    Abstract [en]

    To study the association between country of birth and incident atrial fibrillation (AF) in several immigrant groups in Sweden. The study population included all adults (n = 3,226,752) aged 45 years and older in Sweden. AF was defined as having at least one registered diagnosis of AF in the National Patient Register. The incidence of AF in different immigrant groups, using Swedish-born as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence intervals (CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, and neighbourhood socioeconomic status. Compared to their Swedish-born counterparts, higher incidence of AF [HR (95% CI)] was observed among men from Bosnia 1.74 (1.56-1.94) and Latvia 1.29 (1.09-1.54), and among women from Iraq 1.96 (1.67-2.31), Bosnia 1.88 (1.61-1.94), Finland 1.14 (1.11-1.17), Estonia 1.14 (1.05-1.24) and Germany 1.08 (1.03-1.14). Lower incidence of AF was noted among men (HRs > 0.60) from Iceland, Southern Europe (especially Greece, Italy and Spain), Latin America (especially Chile), Africa, Asia (including Iraq, Turkey, Lebanon and Iran), and among women from Nordic countries (except Finland), Southern Europe, Western Europe (except Germany), Africa, North America, Latin America, Iran, Lebanon and other Asian countries (except Turkey and Iraq). In conclusion, we observed substantial differences in incidence of AF between immigrant groups and the Swedish-born population. A greater awareness of the increased risk of AF development in some immigrant groups may enable for a timely diagnosis, treatment and prevention of its debilitating complications, such as stroke.

  • 70.
    Wandell, Per
    et al.
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Alfred Nobels Alle 23, SE-14183 Huddinge, Sweden..
    Carlsson, Axel C
    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, Alfred Nobels Alle 23, SE-14183 Huddinge, Sweden..
    Li, Xinjun
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Gasevic, Danijela
    Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Coll Med & Vet Med, Edinburgh, Midlothian, Scotland..
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Dept Emergency Med, Huddinge, Sweden.;Karolinska Inst, Dept Internal Med Solna, Stockholm, Sweden..
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Gout in immigrant groups: a cohort study in Sweden2017In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 36, no 5, p. 1091-1102Article in journal (Refereed)
    Abstract [en]

    Our aim was to study the association between country of birth and incidence of gout in different immigrant groups in Sweden. The study population included the whole population of Sweden. Gout was defined as having at least one registered diagnosis in the National Patient Register. The association between incidence of gout and country of birth was assessed by Cox regression, with hazard ratios (HRs) and 95% confidence intervals (95% CI), using Swedish-born individuals as referents. All models were conducted in both men and women, and the full model was adjusted for age, place of residence in Sweden, educational level, marital status, neighbourhood socio-economic status and co-morbidities. The risk of gout varied by country of origin, with highest estimates, compared to Swedish born, in fully adjusted models among men from Iraq (HR 1.82, 95% CI 1.54-2.16), and Russia (HR 1.69, 95% CI 1.26-2.27), and also high among men from Austria, Poland, Africa and Asian countries outside the Middle East; and among women from Africa (HR 2.23, 95% CI 1.50-3.31), Hungary (HR 1.98, 95% CI 1.45-2.71), Iraq (HR 1.76, 95% CI 1.13-2.74) and Austria (HR 1.70, 95% CI 1.07-2.70), and also high among women from Poland. The risk of gout was lower among men from Greece, Spain, Nordic countries (except Finland) and Latin America and among women from Southern Europe, compared to their Swedish counterparts. The increased risk of gout among several immigrant groups is likely explained by a high cardio-metabolic risk factor pattern needing attention.

  • 71.
    Wandell, Per
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, S-14183 Huddinge, Sweden.;Stockholm Cty Council, Acad Primary Healthcare Ctr, Huddinge, Sweden..
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, S-14183 Huddinge, Sweden..
    Ljunggren, Gunnar
    Stockholm Cty Council, Publ Healthcare Serv Comm Adm, SE-10239 Stockholm, Sweden.;Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, SE-17177 Stockholm, Sweden..
    Gout and its comorbidities in the total population of Stockholm2015In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 81, p. 387-391Article in journal (Refereed)
    Abstract [en]

    Objective. Study of prevalence of gout with concomitant diseases. Methods. Study population included all living persons in Stockholm County, Sweden, on January 1st 2013 (N = 2,124,959). A diagnosis of gout was identified during 2013-2014, with information of diabetes mellitus and insulin resistance, hypertension, chronic heart failure, chronic kidney disease, alcohol abuse, and malignancies. Age-adjusted odds ratios (ORs) with 95% confidence intervals (95% CI) for women and men with gout, using individuals without gout as referents, were calculated. Results. Age-adjusted odds of co-morbidities among individuals with gout vs. those without goutwere: diabetes mellitus and insulin resistance 3.97 (95% CI 3.65-4.31) in women and 1.88 (95% CI 1.78-1.99) in men; hypertension 4.02 (95% CI 3.69-4.37) inwomen and 3.21 (95% CI 3.06-3.37) in men; chronic heart failure 4.72 (95% CI 4.31-5.19) in women and 2.84 (95% CI 2.66-3.04) inmen; chronic kidney disease 2.08 (95% CI 1.50-2.87) in women and 2.39 (95% CI 2.15-2.66) in men; alcohol abuse 8.98 (95% CI 8.15-9.80) in women and 4.38 (95% CI 4.10-4.69) in men; and malignancies 1.32 (95% CI 1.17-1.48) in women and 1.13 (95% CI 1.06-1.21) men. Conclusion. Gout is a warning sign for concomitant diseases, e.g. alcoholism, diabetes, cardiovascular diseases, and cancer. Key messages. 1. A diagnosis of gout was present in 0.3% among women and 0.8% among men in Stockholm County. 2. Among individuals with gout, hypertension, being the most common concomitant disease, was present in 68% among women and 54% among men. 3. Alcohol abuse was the most overrepresented disorder compared to individuals without gout, with odds ratio of 9 among women and 5 among men.

  • 72. Wandell, Per
    et al.
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Sundquist, Jan
    Johansson, Sven-Erik
    Bottai, Matteo
    Sundquist, Kristina
    Effect of cardiovascular drugs on mortality in atrial fibrillation and chronic heart failure2014In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, no 5, p. 291-298Article in journal (Refereed)
    Abstract [en]

    Objectives. To study mortality rates among men and women with atrial fibrillation (AF) and concomitant chronic heart failure (CHF) prescribed different classes of cardiovascular drugs in primary health care. Design. A cohort of men (n = 1159) and women (n = 1155) aged 45 years or above and diagnosed with both AF and CHF from patient records from 75 primary care centers in Sweden were included in the study. Regression models with mortality as the outcome were used, with adjustment for a propensity score comprising age, cardiovascular co-morbidities, education, marital status, and pharmacotherapy. We analysed using Cox regression with hazard ratio (HR), and Laplace regression with years until 10% of the patients had died, with 95% confi dence intervals (95% CI). Independent variables were prescribed cardiovascular drugs. Results. Individuals prescribed anticoagulants versus no treatment gained 1.95 years (95% CI 0.47-3.43), anticoagulants versus antiplatelets 1.26 years (95% CI 0.42-2.10), calcium channel blockers 1.17 years (95% CI 0.21-2.14), and statins 1.49 years (95% CI 0.39-2.59). Among patients 80 years or above no significant effect by anticoagulants was seen, HR 0.73 (95% CI 0.43-1.23). Conclusions. Our findings suggest that life may be prolonged in patients with AF and concomitant CHF in primary care prescribed anticoagulants, calcium channel blockers, and statins.

  • 73.
    Wandell, Per
    et al.
    Karolinska Inst, Div Family Med, NVS Dept, Alfred Nobels Alle 23, S-14183 Huddinge, Sweden;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. UpKarolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    Sundquist, Jan
    Shimane Univ, Sch Med, Dept Funct Pathol, Ctr Community Based Healthcare Res & Educ CoHRE, Matsue, Shimane, Japan;Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Dept Family Med & Community Hlth, New York, NY 10029 USA.
    Sundquist, Kristina
    Shimane Univ, Sch Med, Dept Funct Pathol, Ctr Community Based Healthcare Res & Educ CoHRE, Matsue, Shimane, Japan;Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Dept Family Med & Community Hlth, New York, NY 10029 USA.
    The association between relevant comorbidities and dementia in patients with atrial fibrillation2018In: GEROSCIENCE, ISSN 2509-2715, Vol. 40, no 3, p. 317-324Article in journal (Refereed)
    Abstract [en]

    Risk of dementia is increased in patients with atrial fibrillation (AF). We aimed to study associations between relevant comorbidities and prevalent as well as incident dementia in AF patients. Study population included all adults (n = 12,283) >= 45 years diagnosed with AF at 75 primary care centers in Sweden 2001-2007. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (95% CI) for associations between comorbidities and prevalent dementia. In a subsample (n = 12,096), (excluding patients with dementia diagnosed before AF onset), Cox regression was used to estimate hazard ratios (HR) with 95% CIs for association between comorbidities, and incident dementia, after adjustment for age, socioeconomic factors and anticoagulant treatment. Totally 937 patients (7.6%), 388 men (5.8%) and 549 women (9.7%), were diagnosed with dementia. After adjustments, prevalent dementia was more common in (ORs, 95% CI) men with congestive heart failure (CHF), stroke, and depression; in women with CHF and depression, and among women > 75 years with stroke, but less common in women with hypertension. During a 5.6-year follow-up (standard deviation 2.5), 750 patients (6.2%; 322 men, 4.9%, and 428 women, 7.8%) were diagnosed with incident dementia. An increased risk of incident dementia was found among men with diabetes and depression; a decreased risk among men and women with CHF, and among women with hypertension, myocardial infarction cerebrovascular diseases. The findings regarding incident dementia need to be interpreted with great caution, as they may have been subject to survival bias.

  • 74. Wandell, Per E.
    et al.
    Carlsson, Axel C.
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Gender differences and time trends in incidence and prevalence of type 2 diabetes in Sweden: A model explaining the diabetes epidemic worldwide today?2014In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 106, no 3, p. E90-E92Article in journal (Refereed)
    Abstract [en]

    Gender differences in type 2 diabetes in Sweden were studied based on a literature search. The male predominance in 1940s (male/female ratio 1.2-1.4 in the ages 10-55 years) increased over time especially in the age 45-64 years with a male/female ratio up to 2.

  • 75. Wandell, Per Erik
    et al.
    Carlsson, Axel Carl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Sundquist, Jan
    Johansson, Sven-Erik
    Bottai, Matteo
    Sundquist, Kristina
    Pharmacotherapy and mortality in atrial fibrillation: a cohort of men and women 75 years or older in Sweden2015In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 2, p. 232-238Article in journal (Refereed)
    Abstract [en]

    Background: atrial fibrillation (AF) is a common cardiovascular morbidity, not least among elderly people, and is treated with different classes of cardiovascular pharmacotherapies. Hypothesis: cardiovascular drugs may have a different impact on survival in elderly patients with AF in primary health care. Methods: a cohort of 3,020 men and 3,749 women aged a parts per thousand yen75 and diagnosed with AF were selected from 75 primary care centres in Sweden. Laplace regression was used with years to death of the first 10% of the participants as the outcome. Independent variables were prescribed cardiovascular drugs. Regression models were adjusted for a propensity score comprising age, cardiovascular co-morbidities, socio-economic factors and other cardiovascular pharmacotherapies. Results: overall, mortality was 18.2%. The main finding of this study was survival increases associated with anticoagulants versus no treatment and versus antiplatelets of 1.95 years (95% confidence interval (CI) 1.43-2.48) and 0.78 years (95% CI 0.38-1.18), respectively, and survival increases associated with thiazides and calcium channel blockers of 0.81 years (95% CI 0.43-1.18) and 0.83 years (95% CI 0.47-1.18), respectively, in men and women together (results from sex-adjusted models). Conclusion: our findings suggest that anticoagulants, thiazides and calcium channel blockers may lead to longer survival in elderly patients with AF.

  • 76. Wandell, Per
    et al.
    Ljunggren, Gunnar
    Wahlstrom, Lars
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Diabetes and psychiatric illness in the total population of Stockholm2014In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 77, no 3, p. 169-173Article in journal (Refereed)
    Abstract [en]

    Objective: Concomitant psychiatric disorders in people with diabetes affect morbidity and mortality. We aimed to study psychiatric morbidity in people with diabetes and the general population using administrative health care data in Stockholm County. Methods: The study population included all living persons who resided in Stockholm County, Sweden, on January 1, 2011 (N = 2,058,408). Subjects with a diagnosis of diabetes were identified with data from all consultations in primary health care, specialist outpatient care and inpatient care during the time span 2009-2013. As outcome, information was obtained on all consultations due to any psychiatric diagnosis as well as, specifically, schizophrenia, bipolar disorders, depression, and anxiety disorders, in 2011-2013. Analyses were performed by age group and gender. Age-adjusted odds ratios (ORs) with 95% confidence intervals (95% Cl) for women and men with diabetes, using individuals without diabetes as referents, were calculated. Results: Age-adjusted OR for all psychiatric diagnoses among people with diabetes was 1.296 (95% Cl 1.267-1.326) for women and 1.399 (95% Cl 1.368-1.432) for men. The greatest excess risk was found for schizophrenia, with OR 3.439 (95% Cl 3.057-3.868) in women and 2.787 (95% Cl 2.514-3.089) in men, with ORs between 1276 (95% Cl 1227-1327) and 1.714 (95% Cl 1.540-1.905) for the remaining diagnoses. Conclusion: The prevalence of psychiatric disorders is elevated in people with diabetes, which calls for preventive action to be taken to minimize suffering and costs to society.

  • 77. Wierup, Ia
    et al.
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Wandell, 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.
    Ärnlov, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Borne, Yan
    Low anthropometric measures and mortality-results from the Malmo Diet and Cancer Study2015In: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 47, no 4, p. 325-331Article in journal (Refereed)
    Abstract [en]

    Aim. To study the association between anthropometric measures: body mass index (BMI), percent body fat, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-hip-to-height ratio (WHHR), and A Body Shape Index (ABSI); to see if individuals in the lowest 5 percentiles for these measures have an increased risk of mortality. Methods. A population-based prospective cohort study ( 10,304 men and 16,549 women), the Malmo Diet and Cancer study (MDC), aged 45-73 years. Results. During a mean follow-up of 14 +/- 3 years, 2,224 men and 1,983 women died. There was a significant increased mortality risk after adjustments for potential confounders in the group with the 5% lowest BMI ( referent 25%-75%); hazard ratios (HR) with 95% confidence intervals were 1.33 (1.10-1.61) for women and 1.27 (1.07-1.52) for men. A similar significant increased mortality risk was seen with the 5% lowest percent body fat, HR 1.31 (1.07-1.60) for women and 1.25 (1.04-1.50) for men. Women with an ABSI in the lowest 5 percentiles had a lower mortality risk HR 0.64 (0.48-0.85). Conclusion. These results imply that BMI or percent body fat could be used to identify lean individuals at increased mortality risk.

  • 78.
    Wuopio, Jonas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Hilden, Jørgen
    Bring, Carl
    Kastrup, Jens
    Sajadieh, Ahmad
    Jensen, Gorm Boje
    Kjøller, Erik
    Kolmos, Hans Jørn
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Jakobsen, Janus Christian
    Winkel, Per
    Gluud, Christian
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Ärnlöv, Johan
    Cathepsin B and S as markers for cardiovascular risk and all-cause mortality in patients with stable coronary heart disease during 10 years: a CLARICOR trial sub-study.2018In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 278, p. 97-102Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 79.
    Wändell, Per
    et al.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Gasevic, Danijela
    Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Coll Med & Vet Med, Edinburgh, Midlothian, Scotland;Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Funct Area Emergency Med, Stockholm, Sweden;Karolinska Inst, Dept Internal Med, Stockholm, Sweden.
    Ärnlöv, Johan
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden;Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden.
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA;Shimane Univ, Sch Med, Ctr Community Based Healthcare Res & Educ CoHRE, Dept Funct Pathol, Matsue, Shimane, Japan.
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA;Shimane Univ, Sch Med, Ctr Community Based Healthcare Res & Educ CoHRE, Dept Funct Pathol, Matsue, Shimane, Japan.
    Socioeconomic factors and mortality in patients with atrial fibrillation: a cohort study in Swedish primary care2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 6, p. 1103-1109Article in journal (Refereed)
    Abstract [en]

    Background: Preventing ischaemic stroke attracts significant focus in atrial fibrillation (OAF) cases. Less is known on the association between socioeconomic factors and mortality and cardiovascular outcomes in patients with AF. Methods: Our study population included adults (On=12 283) >= 45 years diagnosed with AF at 75 primary care centres in Sweden 2001-07. Cox regression was used to calculate hazard ratios (OHRs) with 95% confidence intervals (OCIs) for the association between the exposures educational level, marital status, neighbourhood socioeconomic status and the outcomes all-cause mortality, after adjustment for age, and comorbid cardiovascular conditions. Results: During a mean of 5.8 years (OSD 2.4) of follow-up, 3954 (O32.3%) patients had died; 1971 were women (O35.0%) and 1983 were men (O29.8%). Higher educational level was associated with a reduced mortality in fully adjusted models: HR 0.85 (O95% CI 0.77-0.96) for secondary school in men, HR 0.73 (O95% CI 0.60-0.88) for college/university in women, and HR 0.82 (O95% CI 0.71-0.94) for college/university in men, compared to primary school. Unmarried men and divorced men had an increased risk of death, compared with married men: HR 1.25 (O95% CI 1.05-1.50), and HR 1.23 (O95% CI 1.07-1.42), respectively. College/university education level was also associated with lower risk of myocardial infarction in men and women, and lower risk of congestive heart failure in women. Conclusion: More attention could be paid to individuals of lower levels of formal education, and unmarried men, in order to provide timely management for AF and prevent its debilitating complications.

  • 80.
    Wändell, Per
    et al.
    Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Stockholm Cty Council, Acad Primary Healthcare Ctr, Huddinge, Sweden..
    Carlsson, Axel C.
    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.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Dept Emergency Med, Stockholm, Sweden.;Karolinska Inst, Dept Internal Med, Stockholm, 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..
    Johansson, Sven-Erik
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Warfarin treatment and risk of stroke among primary care patients with atrial fibrillation2016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 5-6, p. 311-316Article in journal (Refereed)
    Abstract [en]

    Objective. Our aim was to study the risk of a first ischaemic stroke (IS) in patients with atrial fibrillation (AF) treated in primary healthcare.

    Design. The study population included all adults (n=11,517), 45 years and older diagnosed with AF, from 75 primary care centres in Sweden between 2001 and 2007. IS was defined as a hospital care event of stroke between 2001 and 2010. Association between incident stroke and warfarin treatment was explored using Cox regression analysis, with hazard ratios (HRs), and 95% confidence intervals (95%CIs). Adjustment was made for age, socioeconomic factors and co-morbidity.

    Results. Persistent treatment with warfarin was present among 33.7% of women and 40.0% among men. Persistent warfarin treatment, compared to no persistent treatment, was associated with a stroke preventing effect with fully adjusted HRs of 0.25 (95%CI 0.18-0.36) in women, and 0.25 (95%CI 0.19-0.32) in men. A CHA(2)DS(2)-VASc score of at least two among women, and three among men, was associated with a stroke risk exceeding 18% during a mean follow-up of 5.4 years. Risk of haemorrhagic stroke was not increased.

    Conclusions. Warfarin is effective in preventing stroke in AF patients in primary healthcare.

  • 81.
    Wändell, Per
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden;Uppsala Univ, Dept Med Sci, Cardiovasc Epidemiol, Uppsala, Sweden.
    Holzmann, Martin J.
    Karolinska Inst, Dept Internal Med, Stockholm, Sweden;Karolinska Univ Hosp, Funct Area Emergency Med, Stockholm, Sweden.
    Ärnlöv, Johan
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden;Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden.
    Sundquist, Jan
    Shimane Univ, Sch Med, Dept Funct Pathol, Ctr Community Based Healthcare Res & Educ CoHRE, Matsue, Shimane, Japan;Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Dept Family Med & Community Hlth, New York, NY 10029 USA.
    Sundquist, Kristina
    Shimane Univ, Sch Med, Dept Funct Pathol, Ctr Community Based Healthcare Res & Educ CoHRE, Matsue, Shimane, Japan;Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Dept Family Med & Community Hlth, New York, NY 10029 USA.
    Associations between relevant cardiovascular pharmacotherapies and incident heart failure in patients with atrial fibrillation: a cohort study in primary care2018In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 36, no 9, p. 1929-1935Article in journal (Refereed)
    Abstract [en]

    Objective: To study association between relevant cardiovascular pharmacotherapy and incident congestive heart failure (CHF) in patients with atrial fibrillation treated in primary health care.

    Methods: Study population included all adults (n=7975) aged 45 years and older diagnosed with atrial fibrillation at 75 primary care centers in Sweden between 2001 and 2007. Outcome was defined as a first diagnosis of CHF post-atrial fibrillation diagnosis. Association between CHF and treatment with relevant cardiovascular pharmacotherapies (beta blockers, calcium blockers, digitalis, diuretics, RAS blockers, and statins) was explored using Cox regression analysis with hazard ratios and 95% CIs. Adjustments were made for age, sociodemographic variables, and comorbid conditions (with or without cardiovascular disorders).

    Results: During a mean of 5.7 years (SD 2.3) of follow-up, totally 1552 patients (19.5%; 803 women and 749 men) had a recorded CHF diagnosis. Thiazides (hazard ratio 0.74, 95% CI 0.65-0.84), vessel-active calcium channel blockers (hazard ratio 0.76, 95% CI 0.67-0.86), and nonselective beta blockers (hazard ratio 0.84, 95% CI 0.72-0.98), with specifically sotalol representing 80% of nonselective beta blockers (hazard ratio 0.81, 95% CI 0.69-0.97), were associated with lower CHF risk in fully adjusted models. Loop diuretics (hazard ratio 1.41, 95% CI 1.25-1.57) were associated with a higher risk. Findings for thiazides and vessel-active channel blockers were consistent in the tested subgroups.

    Conclusion: In this clinical setting, we found that thiazides, vessel-active calcium channel blockers, and nonselective beta blockers (specifically sotalol) were associated with a lower risk of incident CHF among patients with atrial fibrillation. The findings of the present study need to be confirmed in other settings.

  • 82.
    Wändell, Per
    et al.
    Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Funct Area Emergency Med, Stockholm, Sweden.;Solna Karolinska Inst, Dept Internal Med, Stockholm, Sweden..
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Div Family Med & Primary Care, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden.;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, New York, NY 10029 USA.;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA..
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden.;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, New York, NY 10029 USA.;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA..
    Comparison of Mortality and Nonfatal Cardiovascular Events in Adults With Atrial Fibrillation With Versus Without Levothyroxine Treatment2017In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 120, no 11, p. 1974-1979Article in journal (Refereed)
    Abstract [en]

    Levothyroxine has been suggested to be cardiotoxic, but previous studies on the risk of cardiovascular events associated with levothyroxine treatment have been inconclusive. We aimed to study the association between levothyroxine treatment and all-cause mortality as well as cardiovascular events. Study population included all adults (n = 12,283) >= 45 years diagnosed with atrial fibrillation (AF) at 75 primary care centers in Sweden in 2001 to 2007, with (n = 1,189; 283 men and 906 women) or without (n = 11,094) levothyroxine treatment. Outcome was defined as all-cause mortality and cardiovascular events, that is, myocardial infarction, ischemic stroke, and congestive heart failure until December 31, 2010. During a mean 5.8 years (standard deviation 2.4 years) of follow-up, a total of 3,954 patients died (32.2%), among whom 92 men (32.5%) and 266 women (29.4%) were treated with levothyroxine. In fully adjusted Cox regression models (age, co-morbidity, socioeconomic factors, and warfarin treatment), a significant association between levothyroxine treatment and lower mortality was found among women (hazard ratio 0.78, 95% confidence interval 0.68 to 0.91), but not among men (hazard ratio 0.87, 95% confidence interval 0.69 to 1.10). In the secondary analysis, levothyroxine treatment was not associated with the risk of myocardial infarction, ischemic stroke, or congestive heart failure (p > 0.05). In conclusion, in a large representative cohort, we found that levothyroxine treatment decreased the mortality risk in women with AF, which suggests that such treatment could be of benefit in this setting.

  • 83.
    Wändell, Per
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden..
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Funct Area Emergency Med, Stockholm, Sweden.;Karolinska Inst, Dept Internal Med Solna, Stockholm, Sweden..
    Ärnlöv, Johan
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.;Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden.;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Dept Family Med & Community Hlth, New York, NY 10029 USA..
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden.;Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Dept Family Med & Community Hlth, New York, NY 10029 USA..
    Mortality in patients with atrial fibrillation and common co-morbidities - a cohort study in primary care2018In: Annals of Medicine, ISSN 0785-3890, E-ISSN 1365-2060, Vol. 50, no 2, p. 156-163Article in journal (Refereed)
    Abstract [en]

    Objective: To study the association between cardiovascular co-morbidities and mortality risk in primary care patients with atrial fibrillation.

    Methods: The study population included all adults (n=12,283) >= 45 years diagnosed with AF at 75 primary care centres in Sweden between 2001 and 2007. The outcome was mortality (until 2010) and data were explored for co-morbidities using Cox regression with hazard ratios (HRs). Analyses were performed stratified by sex and by age-group (45-64, 65-74 and >= 75 years of age) with adjustment for age, socio-economic factors and relevant co-morbidities.

    Results: During a mean of 5.8 years (standard deviation 2.4) of follow-up, 3954 (32%) patients died (1971 (35%) women, and 1983 (30%) men). High HRs were found for congestive heart disease (CHF) and cerebrovascular diseases for all age-groups among men and women (except for the 45-64 year old women); for coronary heart disease among the oldest men; for diabetes among the 65-74 year old men and the 45-64 year old women. Low HRs were found for hypertension among women >= 75 years of age.

    Conclusions: In this clinical setting, CHF and cerebrovascular diseases were consistently associated with mortality in all age-groups. The possible protective effect by hypertension among elderly women should be interpreted with caution.

  • 84. Wändell, Per
    et al.
    Carlsson, Axel C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Sundquist, Jan
    Johansson, Sven-Erik
    Bottai, Matteo
    Sundquist, Kristina
    Effects of prescribed antithrombotics and other cardiovascular pharmacotherapies on all-cause mortality in patients with diabetes and atrial fibrillation - a cohort study from Sweden using propensity score analyses2014In: Diabetology and Metabolic Syndrome, ISSN 1758-5996, E-ISSN 1758-5996, Vol. 6, p. 2-Article in journal (Refereed)
    Abstract [en]

    Aims

    To study mortality rates among patients with diabetes and concomitant atrial fibrillation (AF), prescribed different cardiovascular drugs in primary health care.

    Methods

    Study population consisted of men (n = 1319) and women (n = 1094) aged = >= 45 years from a database including 75 primary care centres in Sweden. Cox regression analysis, with hazard ratios (HRs), 95% confidence interval (95% CIs) and mortality (years to death) as outcome, and Laplace regression, with difference in time to first 10% mortality (with 95% CI), were performed. Independent variables were prescribed cardiovascular drugs. Regression models were adjusted for a propensity score calculated separately for each prescribed drug class (comprising age, cardiovascular co-morbidities, education, marital status and pharmacotherapy).

    Results

    Overall mortality was lower in the whole sample for anticoagulants vs no treatment (HR 0.45; 95% CI 0.26-0.77); and among patients < 80 years for anticoagulants vs. antiplatelets (HR 0.44; 95% CI 0.25-0.78); while among individuals aged >= 80 years, antiplatelets (HR 0.47; 95% CI 0.26-0.87) and anticoagulants (HR 0.49; 95% CI 0.24-1.00) vs. no treatment were equally effective. Statins were associated with lower mortality among those < 80 years (HR 0.45; 95% CI 0.29-0.71). Laplace regression models in the whole sample, with years to first 10% of total mortality as outcome, were significant for: among patients < 80 years anticoagulants vs. no treatment 2.70 years (95% CI 0.04-5.37), anticoagulants vs. antiplatelets 2.31 years (95% CI 0.84-3.79), and those >= 80 antiplatelets vs. no treatment 1.78 years (95% CI 1.04-2.52).

    Conclusions

    Our findings suggest that antiplatelets could exert a beneficial effect among those above 80 years.

  • 85.
    Wändell, Per
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Alfred Nobels Alle 23, S-14183 Huddinge, Sweden.
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Alfred Nobels Alle 23, S-14183 Huddinge, Sweden.
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA;Shimane Univ, Sch Med, Dept Funct Pathol, Ctr Community Based Healthcare Res & Educ CoHRE, Matsue, Shimane, Japan.
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden;Icahn Sch Med Mt Sinai, Dept Family Med & Community Hlth, Dept Populat Hlth Sci & Policy, New York, NY 10029 USA;Shimane Univ, Sch Med, Dept Funct Pathol, Ctr Community Based Healthcare Res & Educ CoHRE, Matsue, Shimane, Japan.
    Antihypertensive drugs and relevant cardiovascular pharmacotherapies and the risk of incident dementia in patients with atrial fibrillation2018In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 272, p. 149-154Article in journal (Refereed)
    Abstract [en]

    Background: Atrial fibrillation (AF) and dementia arc predominant among the elderly; patients with AF have an increased dementia risk. We aimed to study if prescribed antihypertensive drugs and cardiovascular pharmacotherapies are associated with a lower relative risk of dementia.

    Methods: All included patients were >= 45 years and diagnosed with AF in primary care; 12,096 (6580 men and 5516 women) in Sweden. We excluded patients with a dementia diagnosis before onset of AF. Cox regression was used (hazard ratios, HRs, and 95% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities.

    Results: Incident dementia occurred in 750 patients (6.2%) during an average of 5.6 years of follow-up (a total of 69,214 person-years). Patients prescribed thiazides HR 0.81 (95% CI 0.66-0.99) and warfarin HR 0.78 (95% CI 0.66-0.92) had a lower risk of dementia than patients without these drugs. The use of 1-4 of the different antihypertensive drug classes ( thiazides, beta blocker, vessel active calcium channel blockers or renin angiotensin aldosterone (RAAS) blockers) were associated with a reduction of incident dementia; HR 0.80 (95% CI 0.64-1.00) for one to two drugs, and HR 0.63 (95% CI 0.46-0.84) for three or four drugs, versus having no prescribed anlihy-pertensive drugs. The combination of a RAAS-blocker and a thiazide was significant, HR 0.70 (95% CI 0.53-0.92), versus not having that particular combination prescribed, while RAAS-blockers or thiazides separately were not significant.

    Conclusion: Prescribed antihypertensive drugs, including thiazide/RAAS-blocker combination therapy and use of warfarin, were associated with a decreased incidence of dementia.

12 51 - 85 of 85
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