| 1. |
- Maddock, Jane, et al.
(författare)
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Vitamin D and cognitive function : A Mendelian randomisation study.
- 2017
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- The causal nature of the association between hypovitaminosis D and poor cognitive function in mid- to later-life is uncertain. Using a Mendelian randomisation(MR) approach, we examined the causal relationship between 25(OH)D and cognitive function. Data came from 172,349 participants from 17 cohorts. DHCR7(rs12785878), CYP2R1 rs12794714) and their combined synthesis score were chosen to proxy 25(OH)D. Cognitive tests were standardised into global and memory scores. Analyses were stratified by 25(OH)D tertiles, sex and age. Random effects meta-analyses assessed associations between 25(OH)D and cognitive function. Associations of serum 25(OH)D with global and memory-related cognitive function were non-linear (lower cognitive scores for both low and high 25(OH)D, p curvature ≤ 0.006), with much of the curvature attributed to a single study. DHCR7, CYP2R1, and the synthesis score were associated with small reductions in 25(OH)D per vitamin D-decreasing allele. However, coefficients for associations with global or memory-related cognitive function were non-significant and in opposing directions for DHCR7 and CYP2R1, with no overall association observed for the synthesis score. Coefficients for the synthesis score and global and memory cognition were similar when stratified by 25(OH)D tertiles, sex and age. We found no evidence for serum 25(OH)D concentration as a causal factor for cognitive performance in mid- to later life.
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| 2. |
- Nilsson, Konrad, 1992-
(författare)
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Clinical Outcomes of Transcatheter Aortic Valve Implantation (TAVI)
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aortic stenosis (AS) is the most common valvular heart disease and most prevalent in the elderly. In the latest decades, a new method for replacement of the aortic valve: transcatheter aortic valve implantation (TAVI) has been introduced. This has enabled treatment of patients who were earlier not candidates for surgery, and has also led to a shift towards TAVI from open surgery for many patients with symptomatic AS. The aims of this thesis were to examine clinical outcomes after TAVI since its implementation in Sweden.In Study I we analysed the burden of disease after TAVI with focus on causes of hospitalisation, hospitalisation patterns and predictors of repeated hospitalisation. We identified that hospitalisations are common and from various indications. Heart failure was the most prevalent diagnosis and efforts should be made to reduce the burden of heart failure hospitalisations.In Study II we performed an external validation of an existing prediction model of risk for short-term hospitalisations after TAVI. The model underperformed in a Swedish setting and it is therefore not recommended for clinical use in its current state. The findings highlight the challenges of developing reliable models that are valid after transportation into a new setting.In Study III we investigated regional differences in availability to TAVI in Sweden with focus on regional procedure rates, short-term mortality and waiting times. The findings indicated no major regional differences. Hence, despite that Sweden is a geographically large and sparsely populated country the current system with a few specialised TAVI centres seems sufficient for providing national coverage of TAVI procedures.In Study IV we examined the need for and indications for coronary interventions after TAVI. We concluded that most patients do not need interventions after TAVI and in case an intervention is needed, the outcome is in a majority of cases successful, even though the success rates are lower than in patients without prior aortic valve replacement. The most common indication for intervention was non-ST elevation acute myocardial infarction and only a minority of patients underwent angiography at the time of a myocardial infarction post TAVI.
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| 3. |
- Rydén, Lars, et al.
(författare)
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ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 34:39, s. 3035-3087
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Tidskriftsartikel (refereegranskat)abstract
- This is the second iteration of the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) joining forces to write guidelines on the management of diabetes mellitus (DM), pre-diabetes, and cardiovascular disease (CVD), designed to assist clinicians and other healthcare workers to make evidence-based management decisions. The growing awareness of the strong biological relationship between DM and CVD rightly prompted these two large organizations to collaborate to generate guidelines relevant to their joint interests, the first of which were published in 2007. Some assert that too many guidelines are being produced but, in this burgeoning field, five years in the development of both basic and clinical science is a long time and major trials have reported in this period, making it necessary to update the previous Guidelines.
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| 4. |
- Strand, Bjorn Heine, et al.
(författare)
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Spousal bereavement and its effects on later life physical and cognitive capability : the Tromsø study
- 2024
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Ingår i: Geroscience. - 2509-2715.
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Tidskriftsartikel (refereegranskat)abstract
- Spousal bereavement is associated with health declines and increased mortality risk, but its specific impact on physical and cognitive capabilities is less studied. A historical cohort study design was applied including married Tromso study participants (N=5739) aged 50-70 years with baseline self-reported overall health and health-related factors and measured capability (grip strength, finger tapping, digit symbol coding, and short-term recall) at follow-up. Participants had data from Tromso4 (1994-1995) and Tromso5 (2001), or Tromso6 (2007-2008) and Tromso7 (2015-2016). Propensity score matching, adjusted for baseline confounders (and baseline capability in a subset), was used to investigate whether spousal bereavement was associated with poorer subsequent capability. Spousal bereavement occurred for 6.2% on average 3.7 years (SD 2.0) before the capability assessment. There were no significant bereavement effects on subsequent grip strength, immediate recall, or finger-tapping speed. Without adjustment for baseline digit symbol coding test performance, there was a negative significant effect on the digit symbol coding test (ATT -1.33; 95% confidence interval -2.57, -0.10), but when baseline digit symbol coding test performance was taken into account in a smaller subsample, using the same set of matching confounders, there was no longer any association (in the subsample ATT changed from -1.29 (95% CI -3.38, 0.80) to -0.04 (95% CI -1.83, 1.75). The results in our study suggest that spousal bereavement does not have long-term effects on the intrinsic capacity components physical or cognition capability to a notable degree.
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| 5. |
- Tiwari, Sweta, et al.
(författare)
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Lifestyle factors as mediators of area-level socioeconomic differentials in mental health and cognitive function: The Tromsø Study
- 2024
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Ingår i: Journal of Epidemiology and Community Health. - 0143-005X .- 1470-2738. ; 78:2, s. 88-97
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Low socioeconomic status (SES) is associated with poor mental health and cognitive function. Individual-level SES and area-level SES (ASES) may affect mental health and cognitive function through lifestyle. We aimed to quantify the associations of ASES with mental health and cognitive function and examine the mediating role of lifestyle behaviours independent of individual-level SES in a Norwegian population. Methods: In this cross-sectional study, we included 7211 participants (54% women) from the seventh survey of the Tromsø Study (2015-2016) (Tromsø7). The exposure variable ASES was created by aggregating individual-level SES variables (education, income, housing ownership) from Statistics Norway at the geographical subdivision level. Tromsø7 data were used as mediators (smoking, snuff, alcohol, physical activity, diet) and outcomes (cognitive function, anxiety, depression, insomnia). Mediation and mediated moderation analysis were performed with age as a moderator, stratified by sex. Results: Higher ASES was associated with better cognitive function and fewer depression and insomnia symptoms, independent of individual-level SES. These associations were mediated by smoking and physical activity. Alcohol was a mediator for depression and cognitive function in women. Age was a significant moderator of the association between ASES and global cognitive function in women. The largest total indirect effect of ASES was found for depression, with the joint effect of the mediators accounting for 36% of the total effect. Conclusions: People living in areas with lower ASES are at higher risk of poor mental health, such as depression and insomnia, and have lower cognitive function possibly due to unhealthy lifestyle (smoking, alcohol and physical inactivity).
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