| 1. |
- Djerf, Henrik, et al.
(author)
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Editor's Choice - Cost Effectiveness of Primary Stenting in the Superficial Femoral Artery for Intermittent Claudication: Two Year Results of a Randomised Multicentre Trial
- 2021
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In: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884. ; 62:4, s. 576-582
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Journal article (peer-reviewed)abstract
- Objective: Invasive treatment of intermittent claudication (IC) is commonly performed, despite limited evidence of its cost effectiveness. IC symptoms aremainly caused by atherosclerotic lesions in the superficial femoral artery (SFA), and endovascular treatment is performed frequently. The aimof this studywas to investigate its cost effectiveness vs. noninvasive treatment. Methods: One hundred patients with IC due to lesions in the SFA were randomised to treatment with primary stenting, best medical treatment (BMT) and exercise advice (stent group), or to BMT and exercise advice alone (control group). Patients were recruited at seven hospitals in Sweden. For this analysis of cost effectiveness after 24 months, 84 patients with data on quality adjusted life years (QALY; based on the EuroQol Five Dimensions EQ5D 3L (TM) questionnaire) were analysed. Patient registry and imputed cost data were used for accumulated costs regarding hospitalisation and outpatient visits. Results: The mean cost per patient was (SIC)11 060 in the stent group and (SIC)4 787 in the control group, resulting in a difference of (SIC)6 273 per patient between the groups.The difference in mean QALYs between the groups was 0.26, in favour of the stent group, which resulted in an incremental cost effectiveness ratio (ICER) of (SIC)23 785 per QALY. Conclusion: The costs associated with primary stenting in the SFA for the treatment of IC were higher than for exercise advice and BMT alone. With concurrent improvement in health related quality of life, primary stenting was a cost effective treatment option according to the Swedish national guidelines (ICER < (SIC)50 000 - (SIC)70 000) and approaching the UK's National Institute for Health and Care Excellence threshold for willingness to pay (ICER < 20 pound 000 - 30 pound 000). From a cost effectiveness standpoint, primary stenting of the SFA can, in many countries, be used as an adjunct to exercise training advice, but it must be considered that successful implementation of structured exercise programmes and longer follow up may alter these findings.
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| 2. |
- Fatehali, Abd Al Hakim, et al.
(author)
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Family history of cardiometabolic diseases and its association with arterial stiffness in the Malmö Diet Cancer cohort
- 2017
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In: Journal of Hypertension. - 0263-6352. ; 35:11, s. 2262-2267
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Journal article (peer-reviewed)abstract
- OBJECTIVE:: Arterial stiffening increases with age and is associated with increased cardiovascular risk. Several risk factors have been shown to predict the development of arterial stiffening; however, a positive family history (FH+) of cardiometabolic disease (CMD) and hypertension has not been extensively studied. We hypothesize that FH+ of CMD plays a significant role in the development of arterial stiffening in offspring. METHODS:: We used data from the population-based Malmö Diet Cancer study (n?=?3056) examined in 1992–1996 and again in 2007–2012. Several variables were analysed, including anthropometrics, carotid–femoral pulse wave velocity and FH+. The association between FH+ of CMD and arterial stiffening in the offspring was analysed with analysis of covariance in SPSS. FH+ was subdivided into three categories: family history for cardiovascular events (FH-CVEs), family history for diabetes mellitus type 2 (FH-DM2) and family history for hypertension (FH-HT). The first analysis of covariance-model was adjusted for age, sex, mean arterial pressure and heart rate; the second model additionally adjusted for self-reported medical history in the offspring. RESULTS:: Data indicated that FH-CVE (F?=?14.64, P?
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| 3. |
- Gottsäter, Mikael, et al.
(author)
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A genetic risk score for fasting plasma glucose is independently associatedwith arterial stiffness : A Mendelian randomization study
- 2018
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In: Journal of Hypertension. - 0263-6352. ; 36:4, s. 809-814
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Journal article (peer-reviewed)abstract
- Background: Arterial stiffness is known to be associated with a number of clinical conditions including hypertension, diabetes and dyslipidemia, and may predict cardiovascular events and mortality. However, causal links are hard to establish. Results from genome-wide association studies have identified only a few single nucleotide polymorphisms associated with arterial stiffness, the results have been inconsistent between studies and overlap with other clinical conditions is lacking. Our aim was to investigate a potential shared set of risk single nucleotide polymorphisms between relevant cardiometabolic traits and arterial stiffness. Method: The study population consisted of 2853 individuals (mean age 72 years, 40% men) from the population-based Malmö Diet and Cancer study, Sweden. Carotid-femoral pulse wave velocity, a marker of arterial stiffness, was measured with Sphygmocor. Mendelian randomization analyses were performed using the twostage least square regression and multivariate inversevariance weighted methods. Results: There were positive associations between arterial stiffness and genetic risk scores for type 2 diabetes (β=0.03, P=0.04) and fasting plasma glucose (β=0.03, P=0.03), but not for systolic blood pressure, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol or triglycerides. Multivariate inversevariance weighted methods confirmed the significant positive association for fasting plasma glucose β coefficients (P=0.006), but not for type 2 diabetes β coefficients (P=0.88). Conclusion: Genetically elevated fasting plasma glucose, but not genetically elevated risk of type 2 diabetes, was associated with arterial stiffness suggesting a causal stiffening effect of glycemia on the arterial wall, independently of type 2 diabetes.
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| 4. |
- Gottsäter, Mikael, et al.
(author)
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Adrenomedullin is a marker of carotid plaques and intima-media thickness as well as brachial pulse pressure.
- 2013
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In: Journal of Hypertension. - 1473-5598. ; 31:10, s. 1959-1965
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Journal article (peer-reviewed)abstract
- Adrenomodulin (ADM) is a peptide hormone secreted in response to cellular strain such as ischemia and is believed to have a beneficial effect on the cardiovascular system. However, the epidemiological relationships between ADM and measurements of haemodynamics, arteriosclerosis and atherosclerosis are not well established. The aim of this study was to investigate the association between the mid-regional part of pro-ADM (MR-proADM) and brachial pulse pressure (PP), carotid intima-media thickness (cIMT) and carotid atherosclerosis.
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| 5. |
- Gottsäter, Mikael
(author)
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Epidemiological, mechanistic and genetic aspects of vascular ageing and arterial stiffness in the population
- 2017
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Doctoral thesis (other academic/artistic)abstract
- The core feature of vascular ageing is the age-associated stiffening of the large, elastic arteries, or arteriosclerosis. This results in a diminished volume-buffering function and is therefore central for the increase in systolic blood pressure and pulse pressure seen with advancing age. Since there are considerable individual differences regarding the rate of vascular ageing, the aim was to describe vascular ageing and its relation to hemodynamic, circulating, morphological and genetic markers using cross-sectional and longitudinal data.This thesis is based on epidemiological data from the Malmö Diet and Cancer Study, a population-based cohort from the city of Malmö, Sweden.In Paper 1, adrenomedullin (ADM), a vasoactive peptide mainly produced by endothelial cells, was investigated. The results showed that ADM was positively associated with brachial pulse pressure and both carotid intima-media thickness and atherosclerotic plaques in adjusted models. This suggests a role for ADMin early hemodynamic pathophysiology related to arteriosclerosis and atherosclerosis.In Paper 2 and Paper 3, predictive and cross-sectional assocations between arterial stiffness and cardiovascular risk markers were investigated. In Paper 2, the stiffness of the abdominal aorta was assessed by ultrasound while in Paper 3 carotid-femoral pulse wave velocity (c-f PWV) was used, measuring regionalarterial stiffness along the carotid–aortic–iliac–femoral arterial segment. In Paper 3, markers of impaired glucose metabolism, dyslipidemia (high triglycerides, low high-lipoprotein cholesterol; HDLc), and waist circumference were all independent, non-hemodynamic, long-term predictors of arterial stiffness, following full adjustment in both sexes. Smoking, low density lipoprotein cholesterol (LDLc), and estimated glomerular filtration rate (eGFR) were not associated with arterial stiffness. These results were partly concurrent withresults from Paper 2, the main difference being that insulin resistance and low HDLc were associated with abdominal aortic stiffness among women, but not among men.In Paper 4, Mendelian randomization was used as a method of identifying causal risk factors for arterial stiffness, measured as c-f PWV. Genetic risk scores (GRS) were used as instrumental variables. Arterial stiffness was associated with GRS for fasting plasma glucose (FPG) and type 2 diabetes (T2D). However, ininverse-variance weighted analyzes, significance for FPG β coefficients remained (p=0.006) but the relationship between T2D β coefficients was lost (p=0.88). GRSs for body mass index, systolic blood pressure, LDLc, HDLc and triglycerides were not associated with arterial stiffness. In conclusion, genetically elevatedFPG, but not genetically elevated risk of T2D, was associated with arterial stiffness, suggesting a causal stiffening effect of glycemia on the arterial wall, independently of T2D.To summarize, in a population-based cohort, the risk markers for arteriosclerosis differ from risk markers for atherosclerosis. Results from Mendelian randomization analyses suggest that fasting plasma glucose is acausal risk factor for arteriosclerosis. However, this must be confirmed in future studies including newinterventions on hyperglycaemia to improve arteriosclerosis.
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| 6. |
- Gottsäter, Mikael, et al.
(author)
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Non-hemodynamic predictors of arterial stiffness after 17 years of follow-up: the Malmö Diet and Cancer study.
- 2015
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In: Journal of Hypertension. - 1473-5598. ; 33:5, s. 957-965
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Journal article (peer-reviewed)abstract
- Arterial stiffness plays a fundamental role in the development of hypertension and is a risk factor for both cardiovascular disease and mortality. The stiffening that occurs with increasing age has, in numerous cross-sectional studies, been shown to be associated with several cardiovascular risk factors. This observational study aims to characterize the predictive and cross-sectional markers focusing on the non-hemodynamic component of arterial stiffness.
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| 7. |
- Gottsäter, Mikael, et al.
(author)
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Predictive markers of abdominal aortic stiffness measured by echo-tracking in subjects with varying insulin sensitivity
- 2014
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In: Journal of Human Hypertension. - : Nature Publishing Group. - 0950-9240 .- 1476-5527. ; 28:7, s. 456-460
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Journal article (peer-reviewed)abstract
- Arterial stiffness is influenced by advancing age and vascular disease and is an independent risk factor for cardiovascular events and death. Using ultrasound measurements, arterial stiffness in a specific arterial segment can be assessed. The aim of this observational study was to explore the prospective and cross- sectional associations between arterial stiffness measured by ultrasound locally in the abdominal aorta and cardiovascular risk factors/markers including insulin resistance measured by the homeostatic model assessment- insulin resistance (HOMA- IR), lipids and abdominal obesity. This study includes 335 subjects from Malmo ", Sweden, examined in 1991- 1994 and again at follow- up in 1998- 2000 (mean age 64 years, 42% men). Ultrasound measurement of the abdominal aorta was performed at follow- up investigation. In the female subgroup, there was a positive association between HOMA-IR at baseline and abdominal aortic stiffness at follow-up (beta = 0.18, P 0.03) and a negative association between high-density lipoprotein and aortic stiffness (beta = 0.23, P 0.005), independently of classical cardiovascular risk factors. These associations were not found among men. The results suggest a greater or different role of impaired glucose metabolism in the pathophysiology of arterial stiffness in women than in men.
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| 8. |
- Hartz, Jacob, et al.
(author)
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Lipoprotein Particle Predictors of Arterial Stiffness after 17 Years of Follow Up : The Malmö Diet and Cancer Study
- 2020
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In: International Journal of Vascular Medicine. - : Hindawi Limited. - 2090-2824 .- 2090-2832. ; 2020
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Journal article (peer-reviewed)abstract
- Background. Central arterial stiffness is a surrogate of cardiovascular risk and predicts cardiovascular mortality. Apolipoprotein B lipoproteins are also established cardiovascular risk factors. It is not known whether specific lipoprotein subclasses measured in the Malmö Diet and Cancer Study and previously shown to be associated with coronary heart disease also predict arterial stiffening after a mean period of 17 years. Methods. Lipoprotein particle analysis was performed on 2,505 men and women from Malmö, Sweden, from 1991 to 1994, and arterial stiffness was assessed by carotid-femoral pulse wave velocity (c-fPWV) on this same cohort from 2007 to 2012. Associations between c-fPWV and lipoprotein particles were determined with multiple linear regression, controlling for sex, presence of diabetes, waist-to-hip circumference, and smoking status at baseline, as well as heart rate (measured at the carotid artery), mean arterial pressure, antihypertensive and lipid-lowering medications, C-reactive protein (CRP), and age at the time of c-fPWV measurement. Results. The results confirm that triglycerides (TG) and high-density lipoprotein cholesterol (HDL-c) but not low-density lipoprotein cholesterol (LDL-c) predict c-fPWV. We identify a positive predictive association for very small, small, and medium (high risk), but not large LDL particles. There was a negative association for large HDL particles. The relationships between c-fPWV and high-risk LDL particles were unaffected by adjusting for LDL-c or CRP and were only mildly attenuated by adjusting for the homeostatic model for insulin resistance (HOMA-IR). Due to the collinearity of very small, small, and medium LDL particles and dyslipidemia (elevated TG and decreased HDL-c), the observed relationship between c-fPWV and high-risk LDL particles became insignificant after controlling for the concentration of HDL-c, large cholesterol-rich HDL particles, and TG. Conclusions. The development of central arterial stiffness previously associated with combined dyslipidemia may be mediated in part by LDL particles, particularly the very small-, small-, and medium-sized LDL particles.
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| 9. |
- Muhammad, Iram Faqir, et al.
(author)
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Acute phase proteins as prospective risk markers for arterial stiffness : The Malmö Diet and Cancer cohort
- 2017
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:7
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Journal article (peer-reviewed)abstract
- Background and objectives: Arterial stiffness plays a significant role in the development and progression of adverse cardiovascular events and all-cause mortality. This observational study aims to explore the relationship between six acute phase proteins namely, ceruloplasmin, alpha-1-antitrypsin, orosomucoid, haptoglobin, complement C3 and C-reactive protein (CRP), and carotid-femoral pulse wave velocity (c-f PWV) in a population-based cohort, and to also explore the effect of low-grade inflammation on the relationship between diabetes and c-f PWV. Method: The study consisted of participants from the Malmö Diet and Cancer study with data from baseline examinations (1991–1994) and follow-up examinations (2007–2012). Arterial stiffness was measured at follow-up by determining c-f PWV. After excluding participants with missing data, the total study population included 2338 subjects. General linear models were used to assess the relationship between baseline acute phase proteins and c-f PWV. Results: After adjusting for traditional risk factors the participants in the 4th quartile vs 1st quartile of alpha-1-antitrypsin (geometric mean: 10.32 m/s vs 10.04 m/s) (<0.05), C3 (10.35 m/s vs 10.06 m/s) (p<0.05) and CRP (10.37 m/s vs 9.96 m/s) (<0.001) showed significant association with c-f PWV. Diabetes at follow-up was also associated with high c-f PWV, however, this relationship was independent of low grade inflammation. Conclusion: Alpha-1-antitrypsin, C3 and CRP are associated with arterial stiffness. The results indicate that low grade inflammation is associated with arterial stiffness in addition to established cardiovascular risk factors.
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| 10. |
- Muhammad, Iram Faqir, et al.
(author)
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Arterial stiffness and incidence of diabetes : A population-based cohort study
- 2017
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In: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 40:12, s. 1739-1745
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Journal article (peer-reviewed)abstract
- Objective: Diabetes is known to be associated with increased arterial stiffness. However, the temporal association between increased carotid-femoral pulse wave velocity (c-f PWV) and diabetes is unclear. The aim of this study is to explore the relationship between arterial stiffness, as determined by c-f PWV, and incidence of diabetes. Research Design and Methods: The study population included participants from the Malmö Diet and Cancer cardiovascular cohort, using measurements from the 2007-2012 reexamination as baseline. Arterial stiffness was evaluated by measuring c-f PWV (SphygmoCor). After excluding participants with prevalent diabetes (according to measurements of fasting glucose, oral glucose tolerance tests, and physician's diagnoses), the final study population consisted of 2,450 individuals (mean age = 71.965.6 years). Incidence of diabetes was followed by linkage to local and national diabetes registers. Cox proportional hazards regression was used to assess the incidence of diabetes in relation to the tertiles of c-f PWV, adjusted for potential confounders. Results: During a mean follow-up of 4.43 6 1.40 years, 68 (2.8%) participants developed diabetes. Crude incidence of diabetes (per 1,000 person-years) was 3.5, 5.7, and 9.5, respectively, for subjects in the first, second, and third tertiles of c-f PWV. After adjustment for potential confounders, the hazard ratio of diabetes was 1.00 (reference), 1.83 (95% CI 0.88-3.8), and 3.24 (95% CI 1.51-6.97), respectively, for the tertiles of c-f PWV (P for trend = 0.002). Conclusions: Increased c-fPWV is associated with increased incidence of diabetes, independent of other risk factors. These results suggest that increased arterial stiffness is an early risk marker for developing diabetes.
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