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Ambulatory cardiac arrhythmias in relation to mild hypokalaemia and prognosis in community dwelling middle-aged and elderly subjects.

https://arctichealth.org/en/permalink/ahliterature281049
Source
Europace. 2016 Apr;18(4):585-91
Publication Type
Article
Date
Apr-2016
Author
Nick Mattsson
Golnaz Sadjadieh
Preman Kumarathurai
Olav Wendelboe Nielsen
Lars Køber
Ahmad Sajadieh
Source
Europace. 2016 Apr;18(4):585-91
Date
Apr-2016
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Atrial Premature Complexes - etiology - mortality - physiopathology
Biomarkers - blood
Denmark
Disease-Free Survival
Diuretics - therapeutic use
Electrocardiography, Ambulatory
Female
Humans
Hypokalemia - blood - complications - diagnosis - drug therapy - mortality
Independent living
Kaplan-Meier Estimate
Linear Models
Logistic Models
Male
Middle Aged
Multivariate Analysis
Potassium - blood
Predictive value of tests
Proportional Hazards Models
Risk factors
Severity of Illness Index
Tachycardia, Supraventricular - etiology - mortality - physiopathology
Time Factors
Ventricular Premature Complexes - diagnosis - etiology - mortality - physiopathology
Abstract
Severe hypokalaemia can aggravate arrhythmia tendency and prognosis, but less is known about risk of mild hypokalaemia, which is a frequent finding. We examined the associations between mild hypokalaemia and ambulatory cardiac arrhythmias and their prognosis.
Subjects from the cohort of the 'Copenhagen Holter Study' (n = 671), with no history of manifest cardiovascular (CV) disease or stroke, were studied. All had laboratory tests and 48-h ambulatory electrocardiogram (ECG) recording. The median follow-up was 6.3 years. p-Potassium was inversely associated with frequency of premature ventricular complexes (PVCs) especially in combination with diuretic treatment (r = -0.22, P = 0.015). Hypokalaemia was not associated with supraventricular arrhythmias. Subjects at lowest quintile of p-potassium (mean 3.42, range 2.7-3.6 mmol/L) were defined as hypokalaemic. Cardiovascular mortality was higher in the hypokalaemic group (hazard ratio and 95% confidence intervals: 2.62 (1.11-6.18) after relevant adjustments). Hypokalaemia in combination with excessive PVC worsened the prognosis synergistically; event rates: 83 per 1000 patient-year in subjects with both abnormalities, 10 and 15 per 1000 patient-year in those with one abnormality, and 3 per 1000 patient-year in subjects with no abnormality. One variable combining hypokalaemia with excessive supraventricular arrhythmias gave similar results in univariate analysis, but not after multivariate adjustments.
In middle-aged and elderly subjects with no manifest heart disease, mild hypokalaemia is associated with increased rate of ventricular but not supraventricular arrhythmias. Hypokalaemia interacts synergistically with increased ventricular ectopy to increase the risk of adverse events.
PubMed ID
26293625 View in PubMed
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Excessive Atrial Ectopy and Short Atrial Runs Increase the Risk of Stroke Beyond Incident Atrial Fibrillation.

https://arctichealth.org/en/permalink/ahliterature266627
Source
J Am Coll Cardiol. 2015 Jul 21;66(3):232-41
Publication Type
Article
Date
Jul-21-2015
Author
Bjørn Strøier Larsen
Preman Kumarathurai
Julie Falkenberg
Olav W Nielsen
Ahmad Sajadieh
Source
J Am Coll Cardiol. 2015 Jul 21;66(3):232-41
Date
Jul-21-2015
Language
English
Publication Type
Article
Keywords
Aged
Arrhythmias, Cardiac - diagnosis
Atrial Fibrillation - complications - diagnosis - epidemiology - physiopathology
Atrial Premature Complexes - diagnosis - epidemiology
Cohort Studies
Comorbidity
Denmark - epidemiology
Electrocardiography, Ambulatory - methods - statistics & numerical data
Female
Follow-Up Studies
Heart Atria - physiopathology
Heart Conduction System - abnormalities
Humans
Incidence
Ischemic Attack, Transient - epidemiology - etiology - physiopathology
Male
Middle Aged
Risk assessment
Risk factors
Stroke - epidemiology - etiology - physiopathology
Abstract
Approximately 30% of ischemic strokes have an unknown cause. Increased atrial ectopy (AE) increases the risk of atrial fibrillation (AF), but the risk of stroke in patients with increased AE is unknown.
This study aimed to examine whether increased AE and short atrial runs increase the risk of stroke beyond incident AF.
Data were collected during a 15-year follow-up of the Copenhagen Holter Study cohort with 678 men and women between 55 and 75 years of age, with no earlier history of cardiovascular disease, stroke, or AF. Study subjects underwent 48-h ambulatory electrocardiography, fasting blood tests, and clinical examination. Excessive supraventricular ectopic activity (ESVEA) was defined as the presence of either =30 premature atrial contractions (PACs)/hour daily or any runs of =20 PACs.
Ninety-nine subjects (15%) demonstrated ESVEA. After adjusting for baseline risk factors, ESVEA was associated with ischemic stroke when censoring subjects at time of AF (hazard ratio [HR]: 1.96; 95% confidence interval [CI]: 1.10 to 3.49) or when modeling AF as a time-varying exposure (HR: 2.00; 95% CI: 1.16 to 3.45). Among subjects with ESVEA who developed a stroke, 14.3% had diagnosed AF before their stroke. The incidence of stroke in subjects with ESVEA and a CHA2DS2-VASc (congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) score of =2 was 2.4% per year, comparable to the risk observed in AF. In day-to-day analysis, ESVEA was a consistent finding.
ESVEA was associated with an increased risk of ischemic stroke beyond manifest AF in this middle-aged and older population. Stroke was more often the first clinical presentation, rather than AF, in these study subjects.
PubMed ID
26184616 View in PubMed
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Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects.

https://arctichealth.org/en/permalink/ahliterature283189
Source
Stroke. 2017 Mar;48(3):537-543
Publication Type
Article
Date
Mar-2017
Author
Nick Mattsson
Preman Kumarathurai
Bjørn Strøier Larsen
Olav Wendelboe Nielsen
Ahmad Sajadieh
Source
Stroke. 2017 Mar;48(3):537-543
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Aged
Atrial Premature Complexes - complications - epidemiology
Denmark - epidemiology
Electrocardiography, Ambulatory
Female
Humans
Hypokalemia - complications - epidemiology
Incidence
Independent living
Male
Middle Aged
Risk
Stroke - epidemiology - etiology
Abstract
Stroke is independently associated with the common conditions of hypokalemia and supraventricular ectopy, and we hypothesize that the combination of excessive supraventricular ectopic activity and hypokalemia has a synergistic impact on the prognosis in terms of stroke in the general population.
Subjects (55-75 years old) from the Copenhagen Holter Study cohort (N=671) with no history of atrial fibrillation or stroke were studied-including baseline values of potassium and ambulatory 48-hour Holter monitoring. Excessive supraventricular ectopic activity is defined as =30 premature atrial complexes per hour or any episodes of runs of =20. Hypokalemia was defined as plasma-potassium =3.6 mmol/L. The primary end point was ischemic stroke. Cox models were used.
Hypokalemia was mild (mean, 3.4 mmol/L; range, 2.7-3.6). Hypokalemic subjects were older (67.0±6.94 versus 64.0±6.66 years; P
PubMed ID
28174323 View in PubMed
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Soluble urokinase plasminogen activator receptor, C-reactive protein and triglyceride are associated with heart rate variability in non-diabetic Danes.

https://arctichealth.org/en/permalink/ahliterature115351
Source
Eur J Clin Invest. 2013 May;43(5):457-68
Publication Type
Article
Date
May-2013
Author
Theodoros Intzilakis
Gro Hartmann
Mette R Mouridsen
Jesper Eugen-Olsen
Preman Kumarathurai
Sten Madsbad
Thomas P Almdal
Steen B Haugaard
Ahmed Sajadieh
Author Affiliation
Department of Internal Medicine, Copenhagen University Hospital, Italiensvej 1, 2300 Amager, Denmark. theodoros@lavabit.com
Source
Eur J Clin Invest. 2013 May;43(5):457-68
Date
May-2013
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
C-Reactive Protein - metabolism
Cardiovascular Diseases - blood - physiopathology
Denmark
Diabetes Mellitus, Type 2 - blood - physiopathology
Electrocardiography
European Continental Ancestry Group
Female
Heart Rate - physiology
Humans
Male
Middle Aged
Receptors, Urokinase Plasminogen Activator - blood
Risk factors
Triglycerides - blood
Abstract
Heart rate variability (HRV) is associated with an increased risk of cardiovascular morbidity and mortality. HRV is in part a function of the activity of the autonomic nervous system and has been associated with low-grade inflammation. In patients with type 2 diabetes, HRV is decreased and is a predictor of poor outcome. As HRV and its determinants in non-diabetic individuals have not been studied properly, the aim of this observational study was to evaluate possible associations between HRV vs. impaired fasting glucose, insulin resistance, lipidaemia and markers of inflammation and immune activation in these individuals.
Healthy individuals (n = 596, 55-75 years) from the community were evaluated with ambulant 48-h continuous electrocardiogram monitoring and fasting markers of lipidaemia, inflammation and immune activation, respectively. Insulin resistance was estimated by HOMA-IR. Time domain components of HRV were calculated.
Heart rate and HRV were not associated with glucose metabolic parameters but were inversely associated with soluble urokinase plasminogen activator receptor (suPAR), high-sensitive CRP and leucocyte number (P
PubMed ID
23517378 View in PubMed
Less detail