| 1. |
- Mohammadi, Hanieh, et al.
(författare)
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Abdominal obesity and the risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction
- 2020
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 27:18, s. 1944-1952
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The association between abdominal obesity and recurrent atherosclerotic cardiovascular disease after myocardial infarction remains unknown.OBJECTIVE: The purpose of this study was to investigate the prevalence of abdominal obesity and its association with recurrent atherosclerotic cardiovascular disease in patients after a first myocardial infarction.DESIGN AND METHODS: In this register-based observational cohort, 22,882 patients were identified from the national Swedish Web-system for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) registry at a clinical revisit 4-10 weeks after their first myocardial infarction 2005-2014. Patients were followed for recurrent atherosclerotic cardiovascular disease defined as non-fatal myocardial infarction, coronary heart disease death, non-fatal or fatal ischaemic stroke. Univariate and multivariable-adjusted Cox regression models were used to calculate hazard ratios and 95% confidence intervals in quintiles of waist circumference as well as three categories of body mass index including normal weight, overweight and obesity.RESULTS: The majority of patients had abdominal obesity. During a median follow-up time of 3.8 years, 1232 men (7.3%) and 469 women (7.9%) experienced a recurrent atherosclerotic cardiovascular disease event. In the univariate analysis, risk was elevated in the fifth quintile (hazard ratio 1.22, 95% confidence interval 1.07-1.39) compared with the first. In the multivariable-adjusted analysis, risk was elevated in the fourth and fifth quintiles (hazard ratio 1.21, confidence interval 1.03-1.43 and hazard ratio 1.25, confidence interval 1.04-1.50), respectively. Gender-stratified analyses showed similar associations in men, while U-shaped associations were observed in women and the body mass index analyses.CONCLUSIONS: Abdominal obesity was common in post-myocardial infarction patients and larger waist circumference was independently associated with recurrent atherosclerotic cardiovascular disease, particularly in men. We recommend utilising waist circumference to identify patients at increased risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction.
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| 2. |
- Ohm, Joel, et al.
(författare)
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Association of Socioeconomic Status With Risk Factor Target Achievements and Use of Secondary Prevention After Myocardial Infarction
- 2021
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 4:3
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Low socioeconomic status (SES) is associated with poor long-term prognosis after myocardial infarction (MI). Plausible underlying mechanisms have received limited study. OBJECTIVE To assess whether SES is associated with risk factor target achievements or with riskmodifying activities, including cardiac rehabilitation programs, monitoring, and drug therapies, during the first year after MI. DESIGN, SETTING, AND PARTICIPANTS This cohort study included a population-based consecutive sample of 30 191 one-year survivors of first-ever MI who were 18 to 76 years of age, resided in the general community in Sweden, were followed up until their routine 11- to 15-month revisit, and were registered in the national registry SwedishWeb-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) from 2006 through 2013. Data analyses were performed from January to August 2020. EXPOSURE Individual-level SES by proxy disposable income quintile. Secondary exposures were educational level and marital status. MAIN OUTCOMES AND MEASURES Odds ratios (ORs) with 95% CIs for achieved risk factor targets at the 1-year revisit and for use of guideline-recommended secondary prevention activities. RESULTS The study comprised 30 191 participants ( 72.9% men) with a mean (SD) age of 63.0 (8.6) years. Overall, higher SESwas associated with better target achievements and use of most secondary prevention. The highest (vs lowest) income quintilewas associated with achieved smoking cessation (OR, 2.05; 95% CI, 1.78-2.35), target blood pressure levels (OR, 1.17; 95% CI, 1.07-1.27), and glycated hemoglobin levels (OR, 1.57; 95% CI, 1.19-2.06). The highest-income quintile was associated not only with participation in physical training programs (OR, 2.28; 95% CI, 2.11-2.46) and patient educational sessions (OR, 2.29; 95% CI, 2.12-2.47) in cardiac rehabilitation but also with more monitoring of lipid profiles (OR, 1.20; 95% CI, 1.08-1.33) and intensification of statin therapy (OR, 1.22; 95% CI, 1.11-1.35) during the first year after MI. One year after MI, the highest-income quintile was associated with persistent use of statins (OR, 1.26; 95% CI, 1.10-1.45), high-intensity statins (OR, 1.10; 95% CI, 1.00-1.21), and renin-angiotensin-aldosterone system inhibitors (OR, 1.27; 95% CI, 1.08-1.49). CONCLUSIONS AND RELEVANCE Findings indicated that, in a publicly financed health care system, higher SES was associated with better achievement of most risk factor targets, programs aimed at lifestyle change, and evidence-based drug therapies after MI. Observed differences in secondary prevention activity may be a factor in higher long-term risk of recurrent disease among individuals with low SES.
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| 3. |
- Ohm, Joel, et al.
(författare)
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Lipid levels achieved after a first myocardial infarction and the prediction of recurrent atherosclerotic cardiovascular disease
- 2019
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Ingår i: International Journal of Cardiology. - : ELSEVIER IRELAND LTD. - 0167-5273 .- 1874-1754. ; 296, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low density lipoprotein cholesterol (LDL-C) goals post-myocardial infarction (MI) are debated, and the significance of achieved blood lipid levels for predicting a first recurrent atherosclerotic cardiovascular disease (rASCVD) event post-MI is unclear.Methods: This was a cohort study on first-ever MI survivors aged <= 76 years attending 4-14 week revisits throughout Sweden 2005-2013. Personal-level data was collected from SWEDEHEART and linked national registries. Exposures were quintiles of LDL-C, high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TGs) at the revisit. Group level associations with rASCVD (nonfatal MI or coronary heart disease death or fatal or nonfatal ischemic stroke) were estimated in Cox regression models. Predictive capacity was estimated by differences in C-statistic, integrated discriminatory improvement, and net reclassification improvement when adding each blood lipid to a validated risk prediction model.Results: 25,643 patients, 96.9% on statin therapy, were followed during a mean of 4.1 years. rASCVD occurred in 2173 patients (8.5%). For LDL-C and TC, moderate associations with rASCVD were observed only in the 5th vs. the lowest (referent) quintiles. For TGs and HDL-C increased risks were observed in quintiles 3-5 vs. the lowest. Minor predictive improvements were observed when lipid fractions were added to the risk model but the discrimination overall was poor (C-statistics < 0.6).Conclusions: Our data question the importance of LDL-C levels achieved at first revisit post-MI for decisions on continued treatment intensity considering the weak association with rASCVD observed in this post-MI cohort.
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| 4. |
- Ohm, Joel, et al.
(författare)
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Socioeconomic Disparities and Mediators for Recurrent Atherosclerotic Cardiovascular Disease Events After a First Myocardial Infarction
- 2023
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Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539. ; 148:3, s. 256-267
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Low socioeconomic status is associated with worse secondary prevention use and prognosis after myocardial infarction (MI). Actions for health equity improvements warrant identification of risk mediators. Therefore, we assessed mediators of the association between socioeconomic status and first recurrent atherosclerotic cardiovascular disease event (rASCVD) after MI.METHODS:In this cohort study on 1-year survivors of first-ever MI with Swedish universal health coverage ages 18 to 76 years, individual-level data from SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and linked national registries was collected from 2006 through 2020. Exposure was socioeconomic status by disposable income quintile (principal proxy), educational level, and marital status. The primary outcome was rASCVD and secondary outcomes were cardiovascular and all-cause mortality. We initially assessed the incremental attenuation of hazard ratios with 95% CIs in sequential multivariable models adding groups of potential mediators (ie, previous risk factors, acute presentation and infarct severity, initial therapies, and secondary prevention). Thereafter, the proportion of excess rASCVD associated with a low income mediated through nonparticipation in cardiac rehabilitation, suboptimal statin management, a cardiometabolic risk profile, persistent smoking, and blood pressure above target after MI were calculated using causal mediation analysis.RESULTS:Among 68 775 participants (73.8% men), 7064 rASCVD occurred during a mean 5.7-year follow-up. Income, adjusted for age, sex, and calendar year, was associated with rASCVD (hazard ratio, 1.63 [95% CI, 1.51-1.76] in the lowest versus highest income quintile). Risk attenuated most by adjustment for previous risk factors and by adding secondary prevention variables for a final model (hazard ratio, 1.38 [95% CI, 1.26-1.51]) in the lowest versus highest income quintile. The proportions of the excess 15-year rASCVD risk in the lowest income quintile mediated through nonparticipation in cardiac rehabilitation, cardiometabolic risk profile, persistent smoking, and poor blood pressure control were 3.3% (95% CI 2.1-4.8), 3.9% (95% CI, 2.9-5.5), 15.2% (95% 9.1-25.7), and 1.0% (95% CI 0.6-1.5), respectively. Risk mediation through optimal statin management was negligible.CONCLUSIONS:Nonparticipation in cardiac rehabilitation, a cardiometabolic risk profile, and persistent smoking mediate income-dependent prognosis after MI. In the absence of randomized trials, this causal inference approach may guide decisions to improve health equity.
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| 5. |
- Ohm, Joel
(författare)
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Socioeconomic status and myocardial infarction : influence on secondary prevention and prognosis
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and Aims: In the wealth of research undertaken on myocardial infarctions (MIs), secondary prevention is less well studied. Incidence and death from MI have declined substantially in the past decades due to the identification of cardiovascular (CV) risk factors, methods to assess risk in the general population, development of efficient therapies that modify risk factor levels, and the introduction of revascularization therapies used in the acute phase of a MI. Meanwhile, secondary prevention in the large population of MI survivors performs poorly with suboptimal management and low achievement rates of the treatment targets recommended in major prevention guidelines. There is room for improvement. Links between socioeconomic status (SES) and CV risk factors, and first-ever MI have been reported for almost 100 years. Circumstances of contemporary secondary prevention after MI suggest that SES may be an important risk factor. With this thesis, aims were to improve knowledge on SES in secondary prevention care after MI and with regards to prognosis. Material and Methods: This thesis was based a large nationwide cohort of men and women who attended routine revisits in the year after hospitalization for acute MI between 2005 and 2013 and were registered in the Swedish National Quality Registry for cardiac care. Clinical data collected on study participants was linked with data from national registries manged by government agencies on individual-level indicators of SES (disposable income quintiles, educational level, and marital status), claimed drug prescriptions, and recurrent atherosclerotic CV disease events (ASCVD; coronary heart disease death, nonfatal MI, fatal or nonfatal ischemic stroke) during long-term follow-up. Multivariable Cox regression models were used to estimate the association between SES and recurrent ASCVD and between on-treatment blood lipid levels (total cholesterol, low and high density lipoprotein cholesterol [LDL-C and HDL-C], and triglycerides) and recurrent ASCVD. The incremental predictive value of each blood lipid fraction was assessed by addition to a secondary prevention risk score for estimates of differences in C-index and measures of reclassification. The associations between SES and most secondary prevention activities and risk factor treatment targets recommended in major guidelines on secondary prevention were assessed in logistic regression models. Differences in sociodemographic, clinical, and therapeutic characteristics of participants and non-participants in clinical trials after MI were estimated in Poisson regression models and the association between clinical trial participation and recurrent ASCVD was estimated in Cox regression models. Mediation in the association between SES and recurrent ASCVD was assessed using sequential Cox regression models and a method for mathematically consistent estimates of causal mediating effects. Results: Risk for recurrent ASCVD was lower among study participants with higher income, higher educational level, and in marriage. The strongest association with recurrent ASCVD was observed for income and the association was independent of differences in CV risk factor profile. With 97% in the cohort on statin therapy at the 2-month revisit, recurrent ASCVD was weakly associated with achieved levels of LDL-C and strongly associated with levels of triglycerides. The adopted secondary prevention risk score discriminated poorly in the study cohort (C-index <0.6) and measures of incremental predictive power were inconsistent. Rates of achieved risk factor targets 1 year after MI were overall low and worse in low SES groups. SES was associated with achieving smoking cessation and target levels of blood pressure levels and glycated hemoglobin, but not LDL-C. Correspondingly, rates of participation in programs within comprehensive cardiac rehabilitation were also low overall, and strongly associated with SES. Higher SES was also associated with more lipid profile measurements and intensification of statin therapy during the first year post-MI. Use of risk-modifying drug therapy was high overall. At discharge from initial care, higher SES was associated with receiving dual antiplatelet therapy. One year post-MI, high SES was associated with persistent use of statins, high statin intensity, and renin-angiotensin-aldosterone system inhibitors. The 10% of this cohort who participated in a clinical trial during the first year after MI (compared to those who did not) were more likely to be men, married, have an income in the highest quintile, a post-secondary education, a better risk profile, and their risk for recurrent ASCVD was lower. In the association between SES and recurrent ASCVD, risk attenuated in sequential analysis models, primarily from adjustment for risk factor profile and secondary prevention activities but a 37% higher risk remained in the lowest vs. highest income quintile after full extensive adjustments for plausible risk mediators. Estimated proportions of the excess risk for recurrent ASCVD in the lowest income quintile mediated through risk profile, physical training and patient education within cardiac rehabilitation were significant but small whereas optimal statin therapy was not a mediator of this risk. Conclusions: SES, by proxy disposable income level, may be a better measure than ontreatment lipid levels in the assessment of risk for recurrent ASCVD within the post-MI population. More study is needed to improve secondary prevention risk prediction, for riskbased intensified treatment to those who would likely benefit most. Secondary prevention after MI performs poorly, especially among low-income groups. Observed SES disparities regarding participation in programs within cardiac rehabilitation were mediators for higher long-term risk of recurrent ASCVD events. Hence, interventions for improved cardiac rehabilitation participation in low-income groups may improve health equity. However, the mediating proportions were small and plausible effectiveness of interventions warrant evaluation of efficacy in clinical trials. Awareness of under-representation of low SES individuals among trial participants within the post-MI population must be taken into account in designing such confirmatory trials. Further study on pathways through which low SES is associated with secondary prevention achievements and higher risk for recurrent ASCVD is needed. Adherence to therapies and dietary habits may be important areas to study.
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| 6. |
- Ohm, Joel, et al.
(författare)
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Socioeconomic status predicts second cardiovascular event in 29,226 survivors of a first myocardial infarction
- 2018
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Ingår i: European Journal of Preventive Cardiology. - : SAGE PUBLICATIONS LTD. - 2047-4873 .- 2047-4881. ; 25:9, s. 985-993
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Tidskriftsartikel (refereegranskat)abstract
- Background Risk assessment post-myocardial infarction needs improvement, and risk factors derived from general populations apply differently in secondary prevention. The prediction of subsequent cardiovascular events post-myocardial infarction by socioeconomic status has previously been poorly studied. Design Swedish nationwide cohort study. Methods A total of 29,226 men and women (27%), 40-76 years of age, registered at the standardised one year revisit after a first myocardial infarction in the secondary prevention quality registry of SWEDEHEART 2006-2014. Personal-level data on socioeconomic status measured by disposable income and educational level, marital status, and the primary endpoint, first recurrent event of atherosclerotic cardiovascular disease, defined as non-fatal myocardial infarction or coronary heart disease death or fatal or non-fatal stroke were obtained from linked national registries. Results During the mean 4.1-year follow-up, 2284 (7.8%) first recurrent manifestations of atherosclerotic cardiovascular disease occurred. Both socioeconomic status indicators and marital status were associated with the primary endpoint in multivariable Cox regression models. In a comprehensively adjusted model, including secondary preventive treatment, the hazard ratio for the highest versus lowest quintile of disposable income was 0.73 (95% confidence interval 0.62-0.83). The association between disposable income and first recurrent manifestation of atherosclerotic cardiovascular disease was stronger in men as was the risk associated with being unmarried (tests for interaction P<0.05). Conclusions Among one year survivors of a first myocardial infarction, first recurrent manifestation of atherosclerotic cardiovascular disease was predicted by disposable income, level of education and marital status. The association between disposable income and first recurrent manifestation of atherosclerotic cardiovascular disease was independent of secondary preventive treatment but further study on causal pathways is needed.
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