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- Acosta, Stefan, et al.
(författare)
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Lp-PLA2 activity and mass for prediction of incident abdominal aortic aneurysms : A prospective longitudinal cohort study
- 2017
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Ingår i: Atherosclerosis. - : Elsevier BV. - 0021-9150. ; 262, s. 14-18
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims The pathogenesis of abdominal aortic aneurysm (AAA) shares several common pathways with atherosclerosis. Prospective clinical plasma biomarker studies in AAA have been hampered by the need for very large cohorts and long follow-up time. Methods We analyzed a prospective longitudinal cohort of middle-aged individuals from the cardiovascular cohort of the Malmö Diet and Cancer study (n = 5551; 1991-94). The plasma biomarkers lipoprotein-associated phospholipase A2 (Lp-PLA2 activity and mass), proneurotensin and C-reactive protein, and conventional risk factors at baseline were measured in patients with incident AAA during follow-up, and compared to individuals without a diagnosis of AAA. Subjects were followed until December 31st, 2013. Multivariable analyses were expressed in terms of hazard ratios (HR) per 1 standard deviation increment of each respective log-transformed plasma biomarker in the Cox proportional hazard models. Results Cumulative incidence of AAA was 1.5% (men 2.9%, women 0.5%) during a median follow-up period of 20.7 years. Overall, 84 individuals had an incident AAA, of whom 22 (26.2%) were operated on and 16 (19.0%) had ruptured. Mean age of individuals with incident AAA was 59.7 years at study entry and AAA was diagnosed on average 14 years later. When adjusting for age, gender, smoking, body mass index, hypertension, and diabetes mellitus, Lp-PLA2 activity (HR 1.40; 95% CI 1.15–1.72) and Lp-PLA2 mass (HR 1.23; 95% CI 1.00–1.51) were independently associated with incident AAA. Conclusions The plasma biomarkers Lp-PLA2 activity and mass were markers of AAA risk and this implies that AAA is an athero-thrombotic related disease.
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| 2. |
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| 3. |
- Taimour, Soumia, et al.
(författare)
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Aortic diameter at age 65 in men with newly diagnosed type 2 diabetes
- 2017
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 51:4, s. 202-206
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Type 2 diabetes mellitus has been linked to a decreased risk for abdominal aortic aneurysm (aortic diameter 30mm, AAA) development in men. The aim of this study was to evaluate if such an effect is detectable already around the time of diabetes diagnosis. Design. We cross-sectionally compared aortic diameter at ultrasound screening for AAA in 691 men aged 65 years with incipient or newly diagnosed type 2 diabetes (group A) with 18,262 65-year old control men without diabetes (group B). Results. Aortic diameter did not differ between groups (18.8[17.4-20.8] vs. 19.0[17.5-28.7] mm; p=0.43). AAA prevalence was 2.5% in group A and 1.5% in group B (p=.010). In logistic regression taking group differences in body mass index (BMI), smoking, presence of atherosclerotic disease and hypertension into account, the difference in AAA prevalence was no longer significant (p=.15). Among men in group A, C-peptide (r=.093; p=.034), but not HbA1c (r=.060; p=.24) correlated with aortic diameter. Conclusion. Among 65 year old men aortic diameter and AAA prevalence do not differ between those with newly diagnosed type 2 diabetes and those without diabetes. Putative protective effects of type 2 diabetes mellitus against aortic dilatation and AAA development therefore probably occur later after diagnosis of diabetes.
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| 4. |
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| 5. |
- Taimour, Soumia, et al.
(författare)
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Nationwide comparison of long-term survival and cardiovascular morbidity after acute aortic aneurysm repair in patients with and without type 2 diabetes
- 2020
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214. ; 71:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Epidemiologic data indicate decreased risk for development, growth, and rupture of abdominal aortic aneurysm (AAA) among patients with type 2 diabetes mellitus (DM). We therefore evaluated mortality and cardiovascular morbidity after acute repair of AAA in diabetic and nondiabetic patients. Methods: In this nationwide observational cohort study of patients registered in the Swedish Vascular Registry and the Swedish National Diabetes Register, we compared mortality and morbidity after acute open (n = 1357 [61%]) or endovascular (n = 860 [39%]) repair of ruptured (n = 1469 [66%]) or otherwise symptomatic (n = 748 [34%]) AAAs in 363 patients with and 1854 patients without DM with propensity score-adjusted analysis. Results: Follow-up was 3.91 years for patients with DM and 3.18 years for those without. In propensity-adjusted analysis, diabetic patients showed lower total mortality (relative risk [RR], 0.75; 95% confidence interval [CI], 0.59-0.95; P = .016) and cardiovascular mortality (RR, 0.17; 95% CI, 0.06-0.50; P = .01) than those without DM, whereas there were no differences in rates of major adverse cardiovascular events (RR, 1.10; 95% CI, 0.87-1.42; P = .42), acute myocardial infarction (RR, 1.36; 95% CI, 0.70-2.63; P = .37), or stroke (RR, 1.31; 95% CI, 0.84-2.03; P = .23). Conclusions: Patients with type 2 DM had lower rates of both total and cardiovascular mortality after acute AAA repair than those without DM, whereas rates of cardiovascular events, acute myocardial infarction, and stroke did not differ between groups. This might be explained by putative protective effects of DM on the aortic wall.
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| 6. |
- Taimour, Soumia, et al.
(författare)
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No relation between biomarkers at age 47-49 and aortic diameter after 14-19 years of follow-up - a population-based study
- 2017
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Ingår i: Vasa - European Journal of Vascular Medicine. - : Hogrefe Publishing Group. - 0301-1526. ; 46:4, s. 291-295
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Biomarkers reflecting diverse pathophysiological pathways may play an important role in the pathogenesis of abdominal aortic aneurysm (aortic diameter ≥30 mm, AAA), levels of many biomarkers are elevated and correlated to aortic diameter among 65-year-old men undergoing ultrasound (US) screening for AAA.PROBANDS AND METHODS: To evaluate potential relationships between biomarkers and aortic dilatation after long-term follow-up, levels of C-reactive protein (CRP), proneurotensin (PNT), copeptin (CPT), lipoprotein-associated phospholipase 2 (Lp-PLA2), cystatin C (Cyst C), midregional proatrial natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM) were measured in 117 subjects (114 [97 %] men) aged 47-49 in a prospective population-based cohort study, and related to aortic diameter at US examination of the aorta after 14-19 years of follow-up.RESULTS: Biomarker levels at baseline did not correlate with aortic diameter after 14-19 years of follow up (CRP [r = 0.153], PNT [r = 0.070], CPT [r = -.156], Lp-PLA2 [r = .024], Cyst C [r = -.015], MR-proANP [r = 0.014], MR-proADM [r = -.117]). Adjusting for age and smoking at baseline in a linear regression model did not reveal any significant correlations.CONCLUSIONS: Tested biomarker levels at age 47-49 were not associated with aortic diameter at ultrasound examination after 14-19 years of follow-up. If there are relationships between these biomarkers and aortic dilatation, they are not relevant until closer to AAA diagnosis.
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| 7. |
- Taimour, Soumia
(författare)
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Stiffness and aneurysm of the aorta. Relations to vascular aging, hyperglycemia, and inflammation.
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A well-functioning arterial system for the transport of oxygen to the cells is essential for human health. The aorta has a key role for the provision of this physiological effect. Disturbances to aortic function can lead to majorsymptoms and even death due to ruptured abdominal aortic aneurysm (AAA). Multiple diseases may exacerbate, or alleviate the symptoms of aortic conditions.This thesis examines the following features potentially affecting aortic function:Aortic stiffness; the wall of the aorta loses its elasticity and blood travels with excessive speed Horizontal/radial expansion of the abdominal aorta, referred to as AAA Diabetes mellitus (DM), excessive concentration of glucose in the blood streamThe above relationships are complex and the pathways not yet fully clarified by contemporary medical research.Research has implied a positive link between type 2 DM (DM2) and stiffening but a negative link between typeDM2 and AAA, indicating a need for more studies about details in these correlations. The purpose of this thesishas been to investigate relationships between:DM2 and aortic stiffnessBiomarkers and AAADM2 and AAAThe research has used data obtained from a number of primary sources:The cardiovascular arm of the Malmö Diet Cancer Study, and the Malmö Offspring StudyNational and regional diabetes registriesThe Swedish Vascular Register, SwedvascThe ultrasound screening program for AAA in MalmöStatistical calculations have been used with the concept of significance as the pivotal measure of whether anassociation could be proven or not. This has yielded a total of five papers, all published in scientific journals withvarious co-authors. The main conclusions are:DM2 is related to aortic stiffness, primarily in older individuals.None of six evaluated plasma biomarkers predicted aortic diameter 15 – 20 years laterThe reported protective effect of DM2 on AAA could not be detected in the early stages of DM2During follow-up after elective endovascular AAA repair, DM2 was associated with lower need of re-interventionDuring follow-up after acute AAA repair, DM2 was associated with lower rates of cardiovascular diseases andmortalityPlausible explanatory theories for the above mechanisms are discussed, and further research is needed to identify which of these that are most clinically relevant.
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| 8. |
- Taimour, Soumia, et al.
(författare)
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Survival, cardiovascular morbidity, and reinterventions after elective endovascular aortic aneurysm repair in patients with and without diabetes : A nationwide propensity-adjusted analysis
- 2019
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Ingår i: Vascular Medicine (United Kingdom). - 1358-863X. ; 24:6, s. 539-546
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Tidskriftsartikel (refereegranskat)abstract
- Epidemiological data indicate decreased risk for development and growth of abdominal aortic aneurysm (AAA) among patients with diabetes mellitus (DM). On the other hand, DM adds to increased cardiovascular (CV) morbidity and mortality. In a nationwide observational cohort study of patients registered in the Swedish Vascular Register and the Swedish National Diabetes Register, we evaluated potential effects of DM on total mortality, CV morbidity, and the need for reintervention after elective endovascular aneurysm repair (EVAR) for AAA. We compared 748 patients with and 2630 without DM with propensity score-adjusted analysis, during a median 4.22 years of follow-up for patients with DM, and 4.05 years for those without. In adjusted analysis, diabetic patients showed higher rates of acute myocardial infarction (AMI) during follow-up (relative risk (RR) 1.44, 95% CI 1.06–1.95; p = 0.02), but lower need for reintervention (RR 0.12, CI 0.02–0.91; p = 0.04). There were no differences in total (RR 0.88, CI 0.74–1.05; p = 0.15) or CV (RR 1.58, CI 0.87–2.86; p = 0.13) mortality, or stroke (RR 0.95, CI 0.68–1.32; p = 0.75) during follow-up. In conclusion, patients with DM had higher rates of AMI and lower need for reintervention after elective EVAR than those without DM, whereas neither total nor CV mortality differed between groups. The putative protective effects of DM towards further AAA enlargement and late sac rupture may help explain the lower need for reintervention and absence of excess mortality.
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