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Sökning: L773:1874 1754 > Stockholms universitet

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1.
  • Dalin, Martin, 1982, et al. (författare)
  • Massive parallel sequencing questions the pathogenic role of missense variants in dilated cardiomyopathy
  • 2017
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 228, s. 742-748
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Germline genetic variants are an important cause of dilated cardiomyopathy (DCM). However, recent sequencing studies have revealed rare variants in DCM-associated genes also in individuals without known heart disease. In this study, we investigate variant prevalence and genotype-phenotype correlations in Swedish DCM patients, and compare their genetic variants to those detected in reference cohorts. Methods and results: We sequenced the coding regions of 41 DCM-associated genes in 176 unrelated patients with idiopathic DCM and found 102 protein-altering variants with an allele frequency of <0.04% in reference cohorts; the majority were missense variants not previously described in DCM. Fifty-five (31%) patients had one variant, and 24 (14%) patients had two or more variants in the analysed genes. Detection of genetic variants in any gene, and in LMNA, MYII7 or TTN alone, was associated with early onset disease and reduced transplant-free survival. As expected, nonsense and frameshift variants were more common in DCM patients than in healthy individuals of the reference cohort 1000 Genomes Europeans. Surprisingly however, the prevalence, conservation and pathogenicity scores, and localization of missense variants were similar in DCM patients and healthy reference individuals. Conclusion: To our knowledge, this is the first study to identify correlations between genotype and prognosis when sequencing a large number of genes in unselected DCM patients. The similar distribution of missense variants in DCM patients and healthy reference individuals questions the pathogenic role of many variants, and suggests that results from genetic testing of DCM patients should be interpreted with caution.
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2.
  • Ding, Mozhu, et al. (författare)
  • Atrial fibrillation and use of antithrombotic medications in older people : A population-based study
  • 2017
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 249, s. 173-178
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Trends in the use of antithrombotic drugs in elderly patients with atrial fibrillation (AF) are largely unknown. We estimated the prevalence of AF in an older population, and examined whether use of anticoagulant and antiplatelet drugs in older AF patients has changed over time. Methods: Data from the population-based Swedish National study on Aging and Care in Kungsholmen (n = 3363, age = 60 years, 64.9% women) were used (2001-2004 and 2007-2010). AF cases were identified through 12-lead electrocardiogram, physician examinations, and patient register records (ICD-10 code I48). We used the CHADS(2) and CHA(2)DS(2)-VASc scores to estimate stroke risk, and an incomplete HAS-BLED score to estimate bleeding risk. Results: At baseline (2001-2004), 328 persons (9.8%) were ascertained to have AF. The prevalence of AF increased significantly with age from 2.8% in people aged 60-66 years to 21.2% in those = 90 years, and was more common in men than in women (11.2% vs. 9.0%). Among AF patients with CHADS2 score = 2 at baseline, 25% were taking anticoagulant drugs and 54% were taking antiplatelet drugs. High bleeding risk was significantly associated with not using anticoagulant drugs in AF patients (multi-adjusted OR = 2.50, p = 0.015). Between 2001-2004 and 2007-2010, use of anticoagulant drugs increased significantly, especially in AF patients with CHA2DS2-VASc score >= 2 (23% vs. 33%, p = 0.008) and in those with HAS-BLED score <3 (32% vs. 53%, p = 0.004). Conclusion: AF is common among old people. The use of anticoagulant drugs increased over time in AF patients, yet still two-thirds of those with high stroke risk remained untreated.
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  • Liang, Yajun, et al. (författare)
  • Effects of biological age on the associations of blood pressure with cardiovascular and non-cardiovascular mortality in old age : A population-based study
  • 2016
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 220, s. 508-513
  • Tidskriftsartikel (refereegranskat)abstract
    • Background/objectives: Whether chronological or biological age may play a role in the association between blood pressure and cause-specific mortality in old age is unclear. We seek to investigate the associations of blood pressure with all-cause, cardiovascular, and non-cardiovascular mortality among older people and to explore whether chronological age and biological age may modify the associations. Methods: This cohort study included 3014 participants (age >= 60 years, 64.0% women) fromthe Swedish National study on Aging and Care in Kungsholmen, Stockholm. In 2001-2004, data were collected through interviews, clinical examinations, and inpatient register. Survival status and causes of deaths till 2011 for all participants were ascertained from Swedish death register. Data were analyzed with Cox proportional hazard models for all-cause mortality, and Fine-Gray competing risks models for cause-specific mortality. Results: During 23,788 person-years of follow-up (median per person, 8.4 years), 933 (31.0%) participants died. Systolic blood pressure < 130mmHg (vs. 130-139mmHg) was significantly associated with decreased all-cause mortality (hazard ratio = 0.59, 95% confidence interval = 0.40-0.87) and non-cardiovascular mortality (0.59, 0.36-0.98) in biologically young people (persons with neither cognitive impairment nor mobility limitation), but with increased all-cause mortality (1.63, 1.22-2.16) and non-cardiovascular mortality (2.18, 1.27-3.75) in biologically old people (persons with either cognitive impairment or mobility limitation). The hazard ratio of cardiovascular mortality was increased with increasing levels of systolic blood pressure (p(trend) = 0.009) and diastolic blood pressure (p(trend) = 0.008) in biologically young people. Conclusions: Biological age plays a pivotal role in the associations of blood pressure with cardiovascular and non-cardiovascular mortality in old age.
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6.
  • Liang, Yajun, et al. (författare)
  • Trends in incidence of hypertension in Chinese adults, 1991-2009 : The China Health and Nutrition Survey
  • 2014
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 175:1, s. 96-101
  • Tidskriftsartikel (refereegranskat)abstract
    • Background/objectives: Previous studies have shown an upward trend in the prevalence of hypertension, but data on trend of incidence of hypertension are lacking. We seek to investigate the trends in incidence of hypertension and control of incident hypertension among Chinese adults during 1991-1997 and 2004-2009. Methods: Within the China Health and Nutrition Survey (1991-2009), we identified five cohorts of adults (age >= 18 years) who were free of hypertension at baseline of each cohort: cohorts 1991-1997 (n = 4107), 1993-2000 (n = 4068), 1997-2004 (n = 4141), 2000-2006 (n = 4695), and 2004-2009 (n = 4523). Data on demographics, smoking, alcohol intake, physical activity, body mass index (BMI), and blood pressure were collected through interviews and clinical examination. Hypertension was defined as blood pressure >= 140/90 mmHg or currently using antihypertensive drugs. Multiple generalized estimation equations and Coxregression models were used to test the trends in blood pressure, incidence of hypertension, use of antihypertensive drugs, and control status of incident hypertension. Results: After controlling for potential confounders, incidence of hypertension (per 100 person-years) significantly increased from 2.9 in 1991-1997 to 5.3 in 2004-2009 (p(trend) = 0.024); the linear trend was statistically or marginally significant in the age group of 18-39 years, in women, in rural residents, and in adults with normal BMI. The overall rates of antihypertensive treatment and control of incident hypertension increased significantly from 5.7% and 1.7% in 1991-1997 to 19.9% and 7.6% in 2004-2009, respectively (p(trend) < 0.001). Conclusions: The incidence of hypertension has increased in Chinese adults since early 1990s. The treatment and control status of incident hypertension, while improved, remain very poor.
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7.
  • Ljung Faxen, Ulrika, et al. (författare)
  • HFpEF and HFrEF exhibit different phenotypes as assessed by leptin and adiponectin
  • 2017
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 228, s. 709-716
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Heart failure with reduced ejection fraction (HFrEF) exhibits a reverse metabolic profile. Whether this profile exists in HF with preserved ejection fraction (HFpEF) is unknown. We tested the hypothesis that HFpEF and HFrEF are similar regarding concentrations of and prognostic impact of leptin and adiponectin.Methods: In patients with HFpEF(n = 79), HFrEF(n = 84), and controls(n = 71), we analyzed serum leptin and adiponectin concentrations, their correlations, and associations with outcome.Results: Leptin levels in HFpEF and HFrEF were increased (p < 0.05) compared to controls; with the highest levels in HFpEF, median (IQR), 23.1 (10.2-51.0), vs. HFrEF 15.0 (6.2-33.2), and vs. controls 10.8 (5.4-18.9) ng/mL. There was no difference between HFpEF and HFrEF p=0.125 (adjusted for gender, BMI and age). Leptin was inversely associated with NT-proBNP (r = -0.364 p = 0.001) and associated with better outcome in HFrEF (HR per ln increase of leptin 0.76, 95% CI 0.58-0.99, p = 0.044) but not in HFpEF.Crude levels of adiponectin were similar in HFpEF: 11.8 (7.9-20.1), HFrEF: 13.7 (7.0-21.1), and controls: 10.5 (7.4-15.1) mu g/L. In men, adjusted similarly as leptin, there was no difference between HFpEF and HFrEF, p = 0.310 but, compared to controls, higher levels in HFpEF (p - 0.044) and HFrEF (p - 0.001). Adiponectin correlated positively with NT-proBNP; r = 0.396 p < 0.001 and higher levels were associated with adverse outcome only in HFrEF (HR per ln increase 2.88 (95% CI 1.02-8.14, p = 0.045).Conclusion: HFpEF and HFrEF share elevated levels of leptin and adiponectin. However, the concept of reverse metabolic profile could not be confirmed in HFpEF, suggesting that HFpEF might have a conventional metabolic profile, rather than a distinct HF syndrome.
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8.
  • Marengoni, Alessandra, et al. (författare)
  • Heart failure, frailty, and pre-frailty : A systematic review and meta-analysis of observational studies
  • 2020
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 316, s. 161-171
  • Forskningsöversikt (refereegranskat)abstract
    • Frailty is a syndrome characterized by reduced physiological reserves, increased vulnerability to stressors and adverse health outcomes. Frailty can change the prognosis and treatment approach of several chronic diseases, including heart failure (HF). The aim of this study was to conduct a systematic review and meta-analysis assessing the association of HF with frailty and pre-frailty. We employed PRISMA guidelines for reporting the results. We searched PubMed, Web of Science, and Embase from 01/01/2002 to 29/11/2019.The quality of the studies was evaluated with the Newcastle Ottawa Scale. Pooled estimates were obtained through random-effect models and Mantel-Haenszel weighting. Homogeneity (I2) and publication bias were assessed. We selected 54 studies (52 cross-sectional, one longitudinal, and one with both designs). The pooled prevalence of pre-frailty in individuals with HF was 46% (95% CI = 38–53; I2 = 93.1%) and 40% (95% CI = 31–48; I2 = 97%) for frailty. The proportion of pre-frail individuals with HF was 20% (95%CI = 15–25; I2 = 99.2%) and the proportion of frail individuals with HF was 31% (95% CI = 17–45; I2 = 98.7%). Two studies using the same frailty definition reported estimates for the association between frailty and HF (pooled OR = 3.44; 95% CI = 0.75–15.73; I2 = 95.8%). In conclusion, frailty and pre-frailty are frequent in people with HF. Persons with HF have 3.4-fold increased odds of frailty. Longitudinal studies examining bidirectional pathophysiological pathways between HF and frailty are needed to further clarify this relationship and to assess if specific treatment for HF may prevent or delay the onset of frailty and vice versa.
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9.
  • Ottosson, Filip, et al. (författare)
  • A plasma lipid signature predicts incident coronary artery disease
  • 2021
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 331, s. 249-254
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Dyslipidemia is a hallmark of cardiovascular disease but is characterized by crude measurements of triglycerides, HDL- and LDL cholesterol. Lipidomics enables more detailed measurements of plasma lipids, which may help improve risk stratification and understand the pathophysiology of cardiovascular disease.Methods: Lipidomics was used to measure 184 lipids in plasma samples from the Malmö Diet and Cancer – Cardiovascular Cohort (N = 3865), taken at baseline examination. During an average follow-up time of 20.3 years, 536 participants developed coronary artery disease (CAD). Least absolute shrinkage and selection operator (LASSO) were applied to Cox proportional hazards models in order to identify plasma lipids that predict CAD.Results: Eight plasma lipids improved prediction of future CAD on top of traditional cardiovascular risk factors. Principal component analysis of CAD-associated lipids revealed one principal component (PC2) that was associated with risk of future CAD (HR per SD increment =1.46, C·I = 1.35–1.48, P < 0.001). The risk increase for being in the highest quartile of PC2 (HR = 2.33, P < 0.001) was higher than being in the top quartile of systolic blood pressure. Addition of PC2 to traditional risk factors achieved an improvement (2%) in the area under the ROC-curve for CAD events occurring within 10 (P = 0.03), 15 (P = 0.003) and 20 (P = 0.001) years of follow-up respectively.Conclusions: A lipid pattern improve CAD prediction above traditional risk factors, highlighting that conventional lipid-measures insufficiently describe dyslipidemia that is present years before CAD. Identifying this hidden dyslipidemia may help motivate lifestyle and pharmacological interventions early enough to reach a substantial reduction in absolute risk.
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10.
  • Wang, Rui, et al. (författare)
  • The age-related blood pressure trajectories from young-old adults to centenarians : A cohort study
  • 2019
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 296, s. 141-148
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Blood pressure (BP) trajectories among older adults, especially among the oldest-old, are still poorly characterized. Objective: To investigate the longitudinal trajectories of four BP components with age and their potential influential factors. Methods: This population-based prospective cohort study included 3315 participants (age 60-105 years, 64.6% women) who were regularly examined from 2001 to 2004 through 2013-2016. The longitudinal trajectories of systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP) with age were estimated using linear mixed-effects models. Results: Overall, SBP and PP increased with age until similar to 80 years and then declined, whereas DBP and MAP decreased constantly after 60 years of age. The age-related BP trajectories varied by survival time, birth cohort, use of antihypertensive drugs, and heart disease. Specifically, people who survived < 2 years after the last visit showed higher levels of BP components before similar to 80 years, followed by steeper declines in SBP and PP. At the same age, people who were born earlier showed higher BP than those who were born later. People who used antihypertensive drugs had higher BP than those who did not until similar to 80-90 years old, thereafter BP showed no significant difference. After similar to 80 years old, people with heart disease showed steeper declines in SBP and PP than those without. Conclusions: The late-life longitudinal BP trajectories with age vary with demographics, clinical conditions, and contextual factors. These findings may help better understand the age-dependent relationship of BP with health outcomes as well as help achieve optimal BP control in older people. Perspectives: Competency in medical knowledge: Understanding the age-related blood pressure trajectories and potential influential factors may help improve blood pressure management in older people. Translational outlook 1: Blood pressure trajectories with age in older adults vary by birth cohort, survival time, antihypertensive therapy, and heart disease. The age-related blood pressure trajectories by birth cohorts are featured with lower blood pressure levels at the same age in more recent birth cohorts, which may partially reflect the improvement of blood pressure control over time. Translational outlook 2: The age-related blood pressure trajectories in the oldest old (e.g., age similar to 85 years) are characterized by steeper and faster blood pressure declines associated with heart disease and short survival (e.g., < 2 years). This may have implications for the optimal management of blood pressure as well as for the interpretation of the relationships between blood pressure and health outcomes (e.g., death) among the oldest old. 
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