| 1. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study
- 2016
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Ingår i: Bmj-British Medical Journal. - : BMJ. - 1756-1833. ; 354
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES To compare the risk associated with systolic blood pressure that meets current recommendations (that is, below 140 mm Hg) with the risk associated with lower levels in patients who have type 2 diabetes and no previous cardiovascular disease. Population based cohort study with nationwide clinical registries, 2006-12. The mean follow-up was 5.0 years. 187 106 patients registered in the Swedish national diabetes register who had had type 2 diabetes for at least a year, age 75 or younger, and with no previous cardiovascular or other major disease. Clinical events were obtained from the hospital discharge and death registers with respect to acute myocardial infarction, stroke, a composite of acute myocardial infarction and stroke (cardiovascular disease), coronary heart disease, heart failure, and total mortality. Hazard ratios were estimated for different levels of baseline systolic blood pressure with clinical characteristics and drug prescription data as covariates. The group with the lowest systolic blood pressure (110-119 mm Hg) had a significantly lower risk of non-fatal acute myocardial infarction (adjusted hazard ratio 0.76, 95% confidence interval 0.64 to 0.91; P=0.003), total acute myocardial infarction (0.85, 0.72 to 0.99; P=0.04), non-fatal cardiovascular disease (0.82, 0.72 to 0.93; P=0.002), total cardiovascular disease (0.88, 0.79 to 0.99; P=0.04), and non-fatal coronary heart disease (0.88, 0.78 to 0.99; P=0.03) compared with the reference group (130-139 mm Hg). There was no indication of a J shaped relation between systolic blood pressure and the endpoints, with the exception of heart failure and total mortality. Lower systolic blood pressure than currently recommended is associated with significantly lower risk of cardiovascular events in patients with type 2 diabetes. The association between low blood pressure and increased mortality could be due to concomitant disease rather than antihypertensive treatment.
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| 2. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Carotid intima-media thickness is associated with incidence of hospitalized atrial fibrillation.
- 2014
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Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 233:2, s. 673-678
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Tidskriftsartikel (refereegranskat)abstract
- Carotid intima-media thickness (IMT) is a measure of arterial thickening and a risk predictor for myocardial infarction and stroke. It is unclear whether IMT also predicts atrial fibrillation (AF). We explored the association between IMT and incidence of first AF hospitalization in a population-based cohort.
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| 3. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Ceruloplasmin and atrial fibrillation: evidence of causality from a population-based Mendelian randomization study.
- 2014
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Ingår i: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 275:2, s. 164-171
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Tidskriftsartikel (refereegranskat)abstract
- Inflammatory diseases and inflammatory markers secreted by the liver, including C-reactive protein (CRP) and ceruloplasmin, have been associated with incident atrial fibrillation (AF). Genetic studies have not supported a causal relationship between CRP and AF, but the relationship between ceruloplasmin and AF has not been studied. The purpose of this Mendelian randomization study was to explore whether genetic polymorphisms in the gene encoding ceruloplasmin are associated with elevated ceruloplasmin levels, and whether such genetic polymorphisms are also associated with the incidence of AF.
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| 4. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Incidence of Coronary Events and Case Fatality Rate in Relation to Blood Lymphocyte and Neutrophil Counts.
- 2012
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Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - 1524-4636. ; 32, s. 533-837
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Elevated levels of blood leukocytes have been associated with acute coronary events (CEs), but data on leukocyte subclasses are limited. This study aimed to explore whether blood lymphocyte and neutrophil counts are associated with incidence of CEs and with fatal outcome in subjects who subsequently experienced a first CE. METHODS AND RESULTS: Neutrophil and lymphocyte counts were measured in 27 419 subjects from the general population without a history of CEs, heart failure, or atrial fibrillation. Incidence of CEs was studied in relation to leukocyte counts during a mean follow-up of 13.6 years. Neutrophil but not lymphocyte counts were significantly associated with incidence of CEs. After adjustments for confounding factors, the hazard ratios (95% confidence interval) were 1.00 (reference), 1.07 (0.94-1.23), 1.09 (0.95-1.25), and 1.39 (1.22-1.59) for subjects with neutrophils in the first, second, third, and fourth (highest) sex-specific quartiles, respectively (P for trend <0.001). Of the 1965 subject who had a CE, 471 subjects died on the first day of the CE, in- or outside hospital. The proportions of subjects who died the first day were 19%, 21%, 25%, and 28%, respectively in the first, second, third, and fourth quartiles (P for trend <0.001). CONCLUSIONS: Increased neutrophil counts are associated with incidence of CEs and increased case-fatality rate after a CE.
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| 5. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Inflammation-sensitive proteins and risk of atrial fibrillation: a population-based cohort study.
- 2011
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 1573-7284 .- 0393-2990. ; 26, s. 449-455
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Tidskriftsartikel (refereegranskat)abstract
- Low-grade inflammation has been repeatedly associated with cardiovascular diseases but the relationship with incidence of atrial fibrillation (AF) remains unclear. We explored the association between elevated plasma levels of inflammation-sensitive proteins (ISPs) and incidence of AF in a population-based cohort. Plasma levels of five ISPs (fibrinogen, haptoglobin, ceruloplasmin, α(1)-antitrypsin and orosomucoid) and two complement factors (C3 and C4) were measured in 6,031 men (mean age 46.8 years) without history of myocardial infarction, heart failure, stroke or cancer. Incidence of hospitalizations due to AF during a mean follow-up of 25 years was studied both in relation to individual inflammatory proteins and the number of elevated ISPs. During follow-up, 667 patients were hospitalized with a diagnosis of AF. After adjustment for potential confounding factors, the hazard ratios (HR) for AF were 1.00 (reference), 1.08 (95% CI: 0.88-1.31), 1.07 (CI: 0.84-1.36), and 1.40 (CI: 1.12-1.74), respectively, in men with none, one, two and three or more ISPs in the 4th quartile (P for trend = 0.007). Ceruloplasmin was the only individual ISP significantly associated with incidence of AF after adjustment for confounding factors (HR 1.17 per standard deviation, 95% CI: 1.08-1.26). In conclusion, a score of five ISPs was associated with long-term incidence of hospitalizations due to AF in middle-aged men. Of the individual ISPs, a significant association was observed for ceruloplasmin, a protein previously associated with copper metabolism and oxidative stress.
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| 6. |
- Adamsson Eryd, Samuel
(författare)
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Novel risk factors for atrial fibrillation in an urban population
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, and a major cause of morbidity and mortality. Low-grade inflammation, erythrocyte volume variation, and subclinical atherosclerosis have repeatedly been associated with cardiovascular disease, but it remains unclear whether these risk factors are also associated with incident AF. This thesis is based on four epidemiological papers. Paper I-II included subjects from the Malmö Preventive Project (n=22 444, aged 26-61 years), followed during a mean follow-up time of 25 years. Paper III-IV included subjects from the Malmö Diet and Cancer Study (n=30 477, aged 44-74 years), followed during mean follow-up of 13.6 and 15.3 years respectively. Cases of incident AF were retrieved by linkage with the Swedish Hospital Discharge Register and the Swedish Cause of Death Register. Participants in Paper I-II underwent measurements of inflammation-sensitive proteins (ISPs) and genotyping of polymorphisms in the ceruloplasmin gene (CP). Red blood cells distribution width (RDW) was measured in participants of Paper III. Carotid intima-media thickness (IMT) was measured in participants of Paper IV. All subjects were without history of AF, myocardial infarction and heart failure at study entry. A score of five ISPs (ceruloplasmin, fibrinogen, haptoglobin, orosomucoid and α1-antitrypsin) were significantly associated with incidence of AF. Plasma levels of ceruloplasmin were associated with incidence of AF. Genetic polymorphisms in the promoter of the ceruloplasmin gene were associated with elevated plasma levels of ceruloplasmin. One of these polymorphisms was also associated with incidence of AF, suggesting a causal relationship between ceruloplasmin and AF. RDW and carotid IMT were both independently associated with incidence of AF. In conclusion, this thesis shows that ceruloplasmin, RDW and carotid IMT are all factors that may predict future events of AF in the general population. Further studies are needed to elucidate the causal pathway between ceruloplasmin and AF.
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| 7. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Red blood cell distribution width is associated with incidence of atrial fibrillation.
- 2014
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Ingår i: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 275:1, s. 84-92
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Tidskriftsartikel (refereegranskat)abstract
- Red blood cell distribution width (RDW), a measure of variation in erythrocyte volume, has been associated with several cardiovascular disorders, but the relationship with atrial fibrillation (AF) remains unclear. We investigated the association between RDW and incidence of first hospitalization due to AF in a population-based cohort.
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| 8. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Response to Letter to the Editor 'Red cell distribution width in patients with atrial fibrillation'
- 2014
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Ingår i: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 275:5, s. 544-544
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- RDW is a new and easily available risk marker for adverse cardiovascular outcomes and we agree that this may encourage a wider use in clinical practice. As pointed out by Balta et al [2], the underlying causal links are unclear. The causal links could hypothetically involve some of the factors mentioned by Balta et al [2], but also properties of the red cells per se. This article is protected by copyright. All rights reserved.
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| 9. |
- Adamsson Eryd, Samuel, et al.
(författare)
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Risk of future microvascular and macrovascular disease in people with Type 1 diabetes of very long duration : A national study with 10-year follow-up
- 2017
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071. ; 34:3, s. 411-418
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To describe factors associated with prevalence or absence of microvascular and macrovascular complications in people with Type 1 diabetes of very long duration and to investigate the risk factors associated with the incidence of such complications. Methods: We included individuals with Type 1 diabetes who had been entered in the Swedish National Diabetes Register between 2002 and 2004 (n = 18 450). First, risk factor distribution in people with diabetes duration of ≥ 50 years was compared between people with and without complications. Second, the incidence of complications during a 10-year follow-up period was studied in all individuals who had no complications at baseline. Results: Among people with a diabetes duration of ≥ 50 years (n = 1023), 453 (44%) had macrovascular disease, 534 (52%) had microvascular disease and 319 (31%) did not have either of the diagnoses. Factors that differed significantly between people with and without macrovascular disease were gender, age, HbA1c, BMI, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, albuminuria, antihypertensive medication and lipid-lowering medication. The same factors differed significantly between people with and without microvascular disease, with the exception of gender and HDL cholesterol. During the follow-up period, 6.1% of the study cohort were diagnosed with macrovascular disease and 19.6% with microvascular disease. Incidence of macrovascular disease was significantly associated with HbA1c levels. Hazard ratios decreased with longer diabetes duration. Conclusions: People with Type 1 diabetes who have survived ≥ 50 years without complications are significantly younger, and have significantly lower HbA1c levels, BMI and triglyceride levels than survivors with complications. HbA1c level is a predictor of macrovascular disease, independently of diabetes duration.
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| 10. |
- Bager, Johan-Emil, et al.
(författare)
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Treatment of hypertension in old patients without previous cardiovascular disease.
- 2019
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Ingår i: Journal of hypertension. - 1473-5598. ; 37:11, s. 2269-2279
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare the risk of cardiovascular disease (CVD) - nonfatal acute myocardial infarction (AMI) or stroke - at blood pressure levels that meet current recommendations with risk at lower levels, particularly in older patients.We identified patients with hypertension aged 40-90 years from a primary care register. Patients with a history of cancer, diabetes mellitus or CVD were excluded. Patients were divided into age groups (40-75 and 76-90), and four groups of SBP 110-129, 130-139 (reference), 140-149 and ≥150mmHg. We used the Kaplan-Meier estimator to study incidence of AMI, stroke and a composite of the two. Cox proportional-hazards regression was used to estimate hazard ratios for outcomes.We included 31704 patients: 26663 were 40-75 years old and 5041 were 76-90 years old. Mean follow-up was 2 years. Although no significant differences in risk of any outcome were found in the younger group, low blood pressure was associated with the lowest risk in the older group. Older patients in the 110-129mmHg group had a lower incidence of CVD (15.9/1000 vs. 25.3/1000 person-years) than the reference group. After adjustment for covariates, the hazard ratio of CVD in older patients in the 110-129mmHg group compared with the reference group was 0.60 (95% confidence interval 0.40-0.92).Blood pressure levels lower than those currently recommended are not harmful among older patients. The association between lower SBP and lesser risk of CVD may instead suggest a beneficial effect of lower SBP.
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| 11. |
- Manhem, Karin, 1954, et al.
(författare)
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Meta-analyses and blood pressure goals
- 2018
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 20:8, s. 1149-1152
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 12. |
- Mourtzinis, Georgios, 1974, et al.
(författare)
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Primary aldosteronism and thyroid disorders in atrial fibrillation: A Swedish nationwide case-control study
- 2018
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 25:7, s. 694-701
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Tidskriftsartikel (refereegranskat)abstract
- Background Atrial fibrillation is associated with hyperthyroidism. Patients with primary aldosteronism have an increased prevalence of atrial fibrillation. However, the prevalence of primary aldosteronism in the atrial fibrillation population is unknown. Aim This nationwide case-control study aimed to compare the prevalence of primary aldosteronism and thyroid disorders in patients with atrial fibrillation with that of age- and sex-matched controls. Methods We identified all atrial fibrillation cases in Sweden between 1987 and 2013 (n=713,569) by using the Swedish National Patient Register. A control cohort without atrial fibrillation was randomly selected from the Swedish Total Population Register with a case to control ratio of 1:2. This control cohort was matched for age, sex and place of birth (n=1,393,953). Results The prevalence of primary aldosteronism in December 2013 was 0.056% in the atrial fibrillation cohort and 0.024% in controls. At the same time, the prevalence of hypothyroidism was 5.9% in the atrial fibrillation cohort and 3.7% in controls. The prevalence of hyperthyroidism was 2.3% in the atrial fibrillation cohort and 0.8% in controls. Conclusion This study shows, for the first time, a doubled prevalence of primary aldosteronism in a large cohort of patients with atrial fibrillation compared with the general population. There is also an increased prevalence of hypo- and hyper-thyroidism in patients with atrial fibrillation compared with the general population.
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| 13. |
- Norby, Faye L, et al.
(författare)
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Association of Lipid-Related Genetic Variants with the Incidence of Atrial Fibrillation : The AFGen Consortium
- 2016
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Several studies have shown associations between blood lipid levels and the risk of atrial fibrillation (AF). To test the potential effect of blood lipids with AF risk, we assessed whether previously developed lipid gene scores, used as instrumental variables, are associated with the incidence of AF in 7 large cohorts.METHODS: We analyzed 64,901 individuals of European ancestry without previous AF at baseline and with lipid gene scores. Lipid-specific gene scores, based on loci significantly associated with lipid levels, were calculated. Additionally, non-pleiotropic gene scores for high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc) were calculated using SNPs that were only associated with the specific lipid fraction. Cox models were used to estimate the hazard ratio (HR) and 95% confidence intervals (CI) of AF per 1-standard deviation (SD) increase of each lipid gene score.RESULTS: During a mean follow-up of 12.0 years, 5434 (8.4%) incident AF cases were identified. After meta-analysis, the HDLc, LDLc, total cholesterol, and triglyceride gene scores were not associated with incidence of AF. Multivariable-adjusted HR (95% CI) were 1.01 (0.98-1.03); 0.98 (0.96-1.01); 0.98 (0.95-1.02); 0.99 (0.97-1.02), respectively. Similarly, non-pleiotropic HDLc and LDLc gene scores showed no association with incident AF: HR (95% CI) = 1.00 (0.97-1.03); 1.01 (0.99-1.04).CONCLUSIONS: In this large cohort study of individuals of European ancestry, gene scores for lipid fractions were not associated with incident AF.
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| 14. |
- Tangri, Navdeep, et al.
(författare)
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Mortality, Health Care Burden, and Treatment of CKD : A Multinational, Observational Study (OPTIMISE-CKD)
- 2024
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Ingår i: KIDNEY360. - : Wolters Kluwer. - 2641-7650. ; 5:3, s. 352-362
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Tidskriftsartikel (refereegranskat)abstract
- Background Kidney-protective treatments (renin-angiotensin system inhibitors and sodium-glucose cotransporter-2 inhibitors [SGLT-2is]) can delay CKD progression, cardiovascular events, and death. Methods This observational cohort study used electronic health records and claims data from Japan, Sweden, and the United States to assess 1-year mortality/hospitalization event rates per 100 patient-years (PYs), cumulative hospital health care costs per patient, and kidney-protective treatment use before/after SGLT-2i (dapagliflozin) approval for CKD (2021) for patients with CKD stage 3-4 with/without type 2 diabetes (T2D). Results Among 449,232 patients (across-country median age range 74-81 years), 79% did not have T2D. Prevalence ranges for atherosclerotic cardiovascular disease and heart failure were 20%-36% and 17%-31%, respectively. Baseline kidney-protective treatment (renin-angiotensin system inhibitor and/or SGLT-2i) use was limited, especially among patients without T2D. Event rates were high for CKD (11.4-44.4/100 PYs) and heart failure (7.4-22.3/100 PYs). Up to 14.6% of patients had died within 1 year. Hospital costs were higher for CKD and heart failure than for atherosclerotic cardiovascular disease. After incident CKD, kidney-protective treatment initiation was low (8%-20%) and discontinuation was high (16%-27%), especially among patients without T2D. Conclusions Incident CKD was associated with substantial morbidity, mortality, costs, and undertreatment, especially in patients without T2D, who represented the majority of patients. This highlights an urgent need for early CKD detection and better kidney-protective treatment use in moderate CKD.
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| 15. |
- Ödesjö, Helena, et al.
(författare)
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Adherence to lipid-lowering guidelines for secondary prevention and potential reduction in CVD events in Swedish primary care: a cross-sectional study
- 2020
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Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 10:10
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The protective effect of lipid-lowering treatment for secondary prevention after coronary heart disease (CHD) has been well documented. Current guidelines recommend a target level for low-density lipoprotein cholesterol (LDL-C) of <= 1.8 mmol/L. The aim was to describe lipid-lowering treatment patterns and to provide an estimate of the potential reductions in cardiovascular disease (CVD) events with improved adherence to guidelines. Design Cross-sectional. Setting Primary care in a large Swedish region. Participants 37 120 patients with CHD in a Swedish regional primary care quality register (QregPV), by 31 December 2015. Primary and secondary outcome measures Proportion of patients on statin treatment and proportion of patients achieving LDL-C <= 1.8 mmol/L. Estimated number of CVD events calculated for (1) current treatment, (2) improved treatment and (3) lowered LDL-C, based on applying rate reductions from meta-analyses of randomised trials to the potentially undertreated population. Risk estimation modelling was based on 52 042 patients in the same register on January 2011 followed for 5 years. Results Of 37 120 patients, 18% reached LDL-C <= 1.8 mmol/L and 32% were not on statin treatment. Based on individual risks, the estimated number of CVD events in the study group over 5 years was 9209/37 120. If all patients without a statin or with less potent statin treatment were given atorvastatin 80 mg, an estimated reduction of CVD events by 14% (7901 vs 9209) was seen. If all patients achieved LDL-C <= 1.8 mmol/L, the number of events was estimated to be reduced by 18% (7577 vs 9209). Conclusion One-third of patients with CHD in primary care were not on lipid-lowering treatment. Based on the assumption that included patients would react to statin therapy the same way as the patients in randomised trials, improved adherence to treatment guidelines could lead to a substantial reduction in new CVD events.
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| 16. |
- Ödesjö, Helena, et al.
(författare)
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Visit patterns at primary care centres and individual blood pressure level - a cross-sectional study
- 2019
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 37:1, s. 53-59
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Hypertension is a major cause of cardiovascular disease. Nevertheless, blood pressure (BP) is often inadequately treated. We studied visit patterns at primary health care centres (PHCCs) and their relation to individual BP control. Design and setting: Cross-sectional register-based study on all patients with hypertension who visited 188 PHCCs in a Swedish region. Patients: A total of 88,945 patients with uncomplicated hypertension age 40-79. Main outcome measures: Odds ratio (OR) for the individual patient to achieve the BP target of <= 140/90 mmHg. Results: Overall, 63% of patients had BP <= 140/90 mmHg (48% BP < 140/90). The PHCC that the patient was enrolled at and, as part of that, more nurse visits at PHCC level was associated with BP control, adjusted OR 1,10 (95% CI 1.01 to 1.21). Patients visiting PHCCs with the highest proportion of visits with nurses had an even higher chance of achieving the BP target, OR 1.19 (95% CI 1.07 to 1.32). Conclusions: In a Swedish population of patients with hypertension, about half do not achieve recommended treatment goals. Organisation of PHCC and team care are known as factors influencing BP control. Our results suggests that a larger focus on PHCC organisation including nurse based care could improve hypertension care.
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