| 1. |
- Andell, Pontus, et al.
(författare)
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Neighborhood socioeconomic status and aortic stenosis : A Swedish study based on nationwide registries and an echocardiographic screening cohort
- 2020
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 318, s. 153-159
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Tidskriftsartikel (refereegranskat)abstract
- Background: Aortic stenosis (AS) is the most common valvular heart disease in developed countries, confers high mortality in advanced cases, but can effectively be reversed using endovascular or open-heart surgery. We evaluated the association between AS and neighborhood socioeconomic status (NSES). Methods: We used Swedish population-based nationwide registers and an echocardiography screening cohort during the study period 1997–2014. NSES was determined by an established neighborhood deprivation index composed of education, income, unemployment, and receipt of social welfare. Multilevel adjusted logistic regression models determined the association between NSES and incident AS (according to ICD-10 diagnostic codes). Results: The study population of men and women (n=6,641,905) was divided into individuals living in high (n = 1,608,815 [24%]), moderate (n = 3,857,367 [58%]) and low (n = 1,175,723 [18%]) SES neighborhoods. There were 63,227 AS cases in total. Low NSES (versus high) was associated with a slightly increased risk of AS (OR 1.06 [95% CI 1.03–1.08]) in the nationwide study population. In the echocardiography screening cohort (n = 1586), the association between low NSES and AS was markedly stronger (OR: 2.73 [1.05–7.12]). There were more previously undiagnosed AS cases in low compared to high SES neighborhoods (3.1% versus 1.0%). Conclusions: In this nationwide Swedish register study, low NSES was associated with a slightly increased risk of incident AS. However, the association was markedly stronger in the echocardiography screening cohort, which revealed an almost three-fold increase of AS among individuals living in low SES neighborhoods, possibly indicating an underdiagnosis of AS among these individuals.
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| 2. |
- Carlsson, Axel C., et al.
(författare)
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Neighborhood deprivation and warfarin, aspirin and statin prescription - A cohort study of men and women treated for atrial fibrillation in Swedish primary care
- 2015
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 187, s. 547-552
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Tidskriftsartikel (refereegranskat)abstract
- Background: Weaimed to study differences in the prescribing of warfarin, aspirin and statins to patients with atrial fibrillation (AF) in socio-economically diverse neighborhoods. We also aimed to explore the effects of neighborhood deprivation on the relationship between CHADS2 risk score and warfarin prescription. Methods: Data were obtained from primary health care records that contained individual clinical data that were linked to national data on neighborhood of residence and a deprivation index for different neighborhoods. Logistic regression was used to estimate the potential neighborhood differences in prescribed warfarin, aspirin and statins, and the association between the CHADS2 score and prescribed warfarin treatment, in neighborhoods with high, middle (referent) and low socio-economic (SES). Results: After adjustment for age, socio-economic factors, co-morbidities and moves to neighborhoods with different SES during follow-up, adults with AF living in high SES neighborhoods were more often prescribed warfarin (men odds ratio (OR) (95% confidence interval (CI): 1.44 (1.27-1.62); and women OR (95% CI): 1.19 (1.05-1.36)) and statins (men OR (95% CI): 1.23 (1.07-1.41); women OR (95% CI): 1.23 (1.05-1.44)) compared to their counterparts residing in middle SES. Prescription of aspirin was lower in men from high SES neighborhoods (OR (95% CI): 0.75 (0.65-0.86)) than in those from middle SES neighborhoods. Higher CHADS2 risk scores were associated with higher warfarin prescription which remained after adjustment for neighborhood SES. Conclusions: The apparent inequalities in pharmacotherapy seen in the present study call for resource allocation to primary care in neighborhoods with low and middle socio-economic status.
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| 3. |
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| 4. |
- Wandell, Per, et al.
(författare)
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Neighbourhood socio-economic status and all-cause mortality in adults with atrial fibrillation : A cohort study of patients treated in primary care in Sweden
- 2016
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 202, s. 776-781
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 5. |
- Wändell, Per, et al.
(författare)
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Antihypertensive drugs and relevant cardiovascular pharmacotherapies and the risk of incident dementia in patients with atrial fibrillation
- 2018
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 272, s. 149-154
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Tidskriftsartikel (refereegranskat)abstract
- Background: Atrial fibrillation (AF) and dementia are 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 antihypertensive 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.
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| 6. |
- Wändell, Per, et al.
(författare)
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Effects of cardiovascular pharmacotherapies on incident dementia in patients with atrial fibrillation : A cohort study of all patients above 45 years diagnosed with AF in hospitals in Sweden
- 2019
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 297, s. 55-60
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with atrial fibrillation (AF) have an increased dementia risk dementia. We aimed to study the effect of antihypertensive drugs on dementia in AF patients. Methods: Included patients were ≥45 years diagnosed with AF in Swedish National Patient Register (n = 160,251; 89,723 men and 70,528 women) and alive on January 1, 2007. We excluded patients with dementia before onset of AF. Cox regression was used (hazard ratios, HRs, and 99% confidence interval, CI) with adjustments for sex, age, socioeconomic factors and co-morbidities, using incident dementia diagnosis until December 31, 2015 as outcome. Cardiovascular pharmacotherapies were obtained from the Swedish Prescribed Drug Register. Results: Incident dementia occurred in 9532 patients (5.9%), 4669 men (5.2%) and 4863 women (6.9%). ARBs were associated with lower risk for all patients (HR 0.87, 99% CI 0.78–0.98), especially in the ages 65–84 years of age (HR 0.87, 99% CI 0.76–0.99). Loop-diuretics were associated with higher risk for all dementia among patients 65–84 years of age (HR 1.16, 99% CI 1.00–1.35), and in the sub-group of other causes of dementia than Alzheimer Disease (AD) and vascular dementia (VaD) (HR 1.14, 99% CI 1.00–1.30), but with a lower risk in the sub-group of AD and VaD (HR 0.81, 99% CI 0.68–0.95). Conclusion: ARBs were associated with a decreased incidence of dementia, and loop diuretics with a higher risk in general but lower risk in the AD and VaD sub-group. ARBs could have specific advantages in prevention of dementia, but the results need confirmation in further studies.
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| 7. |
- Wändell, Per, et al.
(författare)
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Warfarin treatment and risk of myocardial infarction — A cohort study of patients with atrial fibrillation treated in primary health care
- 2016
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 221, s. 789-793
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Tidskriftsartikel (refereegranskat)abstract
- Objective To study the risk of myocardial infarction (MI) in patients with atrial fibrillation (AF) treated in primary health care with warfarin or acetylsalicylic acid (ASA, aspirin). Methods The study population included subjects (n = 12,283) 45 years or older diagnosed with AF who were treated in 75 primary care centres in Sweden between 2001 and 2007. MI was defined as a hospital stay for MI during 2001 through 2010 registered in the Swedish Patient Register. Associations between warfarin or ASA treatment and incident MI were explored using Cox regression analysis, by estimating hazard ratios (HRs) and 95% confidence intervals (95% CIs). Adjustment was made for age, socio-economic factors and cardio-vascular co-morbidity. Results Persistent treatment (“per protocol” treatment) with warfarin alone was present among 32.4% of women and 37.4% of men, and with ASA alone among 30.0% of women and 28.1% of men. The fully adjusted HRs for MI, compared to those with no antithrombotic treatment, with warfarin treatment for women were 0.26 (95% CI 0.16–0.41) and for men 0.28 (95% CI 0.20–0.39); and the corresponding HRs for those treated with ASA were for women 0.57 (95% CI 0.37–0.87), and for men 0.44 95% CI (0.31–0.63). The fully adjusted HR for MI when comparing patients with warfarin treatment to those with ASA treatment was for women 0.46 (95% CI 0.27–0.80), and for men 0.58 (95% CI 0.38–0.89). Conclusions Warfarin seems to prevent MI among AF patients in a primary healthcare setting, which emphasizes the importance of persistent anticoagulant treatment in those patients.
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| 8. |
- Calling, Susanna, et al.
(författare)
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Shared and non-shared familial susceptibility of coronary heart disease, ischemic stroke, peripheral artery disease and aortic disease.
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 168:3, s. 2844-2850
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Little is known about whether the four main manifestations of arterial vascular disease (coronary heart disease=CHD, ischemic stroke, peripheral artery disease=PAD, and aortic (i.e. atherosclerosis/aneurysm) disease=AD) share familial susceptibility. The aim of this nationwide study was to determine the familial risks of concordant (same disease in proband and exposed relative) and discordant (different disease in proband and exposed relative) cardiovascular disease (CVD). METHODS: Data from the Swedish Multigeneration Register on individuals aged 0-76years were linked to Swedish Hospital Discharge Register data for the period 1964-2008. Standardized incidence ratios (SIRs) for CHD (n=140,708 cases), ischemic stroke (n=73,771), PAD (n=18,982) and AD (n=7879) were calculated for siblings of individuals hospitalized due to CHD, stroke, PAD or AD compared to those of unaffected siblings. The procedure was repeated for parent-offspring and spouses. RESULTS: All concordant and discordant sibling risks were increased for both males and females. Concordant risks were generally higher than discordant risks. The highest sibling risks were observed for premature concordant disease (<55years for males and <65years for females): SIR for CHD=1.93 (95% CI: 1.90-1.96), SIR for ischemic stroke=1.45 (1.39-1.50), SIR for PAD=2.76 (2.54-3.00), and SIR for AD=6.36 (5.28-7.59). Premature parent-offspring transmission followed the same pattern. The disease risk was modestly increased in spouses, highest for AD (SIR=1.48 (1.28-1.69)) and PAD (SIR=1.27 (1.21-1.32)). CONCLUSIONS: The four main manifestations of CVD share familial susceptibility, but unique site-specific familial factors may exist.
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| 9. |
- Lindgren, Magnus P., et al.
(författare)
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Mortality risks associated with sibling heart failure
- 2020
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 307, s. 114-118
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Tidskriftsartikel (refereegranskat)abstract
- Background The mortality in individuals with a family history of heart failure (HF) has not been determined. This nationwide sib-pair study aimed to determine mortality in individuals with a sibling affected with HF. Methods Sib-pairs were linked using the Swedish Multi-Generation Register, the Hospital Discharge Register and the Cause of Death Register for the period 1987–2012. Families with cardiomyopathy or congenital heart disease were excluded. Mortality hazard ratios (HRs) were calculated for siblings of individuals who had been diagnosed with HF compared with siblings of individuals unaffected by HF as the reference group. Similar analyses were made for spouses. HRs were determined for overall mortality, cardiovascular mortality, and death of unknown cause. Results Among siblings, the adjusted HR for overall mortality was 1.21 (95% CI 1.18–1.25). This risk remained (HR = 1.19, 95% CI 1.15–1.23) also among subjects without HF themselves. The adjusted HRs for cardiovascular mortality and death of unknown cause were 1.39 (95% CI 1.32–1.45) and 1.58 (95% CI 1.29–1.95), respectively. The mortality risk associations with spousal HF were all minimal, with an overall mortality HR of 1.02 (1.01–1.02). Early sibling age of onset of HF
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| 10. |
- Lindgren, Magnus P., et al.
(författare)
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Sibling risk of hospitalization for heart failure – A nationwide study
- 2016
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 223, s. 379-384
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Tidskriftsartikel (refereegranskat)abstract
- Background The familial risks of heart failure (HF) remain largely undetermined. This nationwide follow-up study aimed at determining risk of hospitalization for HF conferred by affected siblings. Methods and results Swedish Multi-generation Register data, with records of at least one full sibling available at start of follow-up, were linked to the Hospital Discharge Register data for 1987–2010. The oldest participants were aged 78 years in 2010. Relative risks, standardized incidence ratios (SIRs), of HF hospitalization were calculated for individuals with siblings hospitalized with HF compared with those whose siblings were not. Adjustments were made for common HF comorbidities, age, time period, socioeconomic status and region. During the 24 year follow-up (1987–2010) 23,212 individuals (7155 females), were hospitalized because of HF. From this total, 1121 had at least one full sibling hospitalized for HF. Sibling risks were generally similar for males and females. The SIR of HF hospitalization was 1.62 (95% confidence interval 1.54–1.70) for individuals with one affected sibling and 15.46 (12.82–18.50) for individuals with two affected siblings. The SIR conferred by one or more affected siblings was 2.67 (2.24–3.16) below the age of 50 years, 1.92 (1.75–2.10) between 50 and 59 years of age, 1.63 (1.52–1.76) between 60 and 69 years of age, and 1.54 (1.38–1.71) between 70 and 78 years of age. Spouses had low familial risks: SIR = 1.04 (1.03–1.06). Conclusions Familial factors are important risk factors in HF, with particularly high risks among individuals with two or more affected siblings and in early onset of HF.
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