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Association of Selected Antipsychotic Agents With Major Adverse Cardiovascular Events and Noncardiovascular Mortality in Elderly Persons.

https://arctichealth.org/en/permalink/ahliterature273549
Source
J Am Heart Assoc. 2015 Sep;4(9):e001666
Publication Type
Article
Date
Sep-2015
Author
Marie Sahlberg
Ellen Holm
Gunnar H Gislason
Lars Køber
Christian Torp-Pedersen
Charlotte Andersson
Source
J Am Heart Assoc. 2015 Sep;4(9):e001666
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Antipsychotic Agents - adverse effects
Cardiovascular Diseases - diagnosis - epidemiology - mortality
Cause of Death
Comorbidity
Denmark - epidemiology
Female
Humans
Male
Multivariate Analysis
Odds Ratio
Risk assessment
Risk factors
Time Factors
Abstract
Data from observational studies have raised concerns about the safety of treatment with antipsychotic agents (APs) in elderly patients with dementia, but this area has been insufficiently investigated. We performed a head-to-head comparison of the risk of major adverse cardiovascular events and noncardiovascular mortality associated with individual APs (ziprasidone, olanzapine, risperidone, quetiapine, levomepromazine, chlorprothixen, flupentixol, and haloperidol) in Danish treatment-naïve patients aged =70 years.
We followed all treatment-naïve Danish citizens aged =70 years that initiated treatment with APs for the first time between 1997 and 2011 (n=91 774, mean age 82±7 years, 35 474 [39%] were men). Incidence rate ratios associated with use of different APs were assessed by multivariable time-dependent Poisson regression models. For the first 30 days of treatment, compared with risperidone, incidence rate ratios of major adverse cardiovascular events were higher with use of levomepromazine (3.80, 95% CI 3.43 to 4.21) and haloperidol (1.85, 95% CI 1.67 to 2.05) and lower for treatment with flupentixol (0.54, 95% CI 0.45 to 0.66), ziprasidone (0.31, 95% CI 0.10 to 0.97), chlorprothixen (0.76, 95% CI 0.61 to 0.95), and quetiapine (0.68, 95% CI 0.58 to 0.80). Relationships were generally similar for long-term treatment. The majority of agents were associated with higher risks among patients with cardiovascular disease compared with patients without cardiovascular disease (P for interaction
Notes
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PubMed ID
26330335 View in PubMed
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Cause-specific cardiovascular risk associated with nonsteroidal antiinflammatory drugs among healthy individuals.

https://arctichealth.org/en/permalink/ahliterature143012
Source
Circ Cardiovasc Qual Outcomes. 2010 Jul;3(4):395-405
Publication Type
Article
Date
Jul-2010
Author
Emil Loldrup Fosbøl
Fredrik Folke
Søren Jacobsen
Jeppe N Rasmussen
Rikke Sørensen
Tina Ken Schramm
Søren S Andersen
Søren Rasmussen
Henrik Enghusen Poulsen
Lars Køber
Christian Torp-Pedersen
Gunnar H Gislason
Author Affiliation
Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. ELF@heart.dk
Source
Circ Cardiovasc Qual Outcomes. 2010 Jul;3(4):395-405
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Adult
Anti-Inflammatory Agents, Non-Steroidal - adverse effects - therapeutic use
Cardiovascular Diseases - epidemiology - etiology - mortality - physiopathology
Cause of Death
Cross-Over Studies
Denmark
Female
Humans
Male
Middle Aged
Risk factors
Substance-Related Disorders - epidemiology - etiology - mortality - physiopathology
Survival Analysis
Abstract
Studies have raised concern on the cardiovascular safety of nonsteroidal antiinflammatory drugs (NSAIDs). We studied safety of NSAID therapy in a nationwide cohort of healthy individuals.
With the use of individual-level linkage of nationwide administrative registers, we identified a cohort of individuals without hospitalizations 5 years before first prescription claim of NSAIDs and without claimed drug prescriptions for selected concomitant medication 2 years previously. The risk of cardiovascular death, a composite of coronary death or nonfatal myocardial infarction, and fatal or nonfatal stroke associated with the use of NSAIDs was estimated by case-crossover and Cox proportional hazard analyses. The entire Danish population age 10 years or more consisted of 4,614,807 individuals on January 1, 1997, of which 2,663,706 (57.8%) claimed at least 1 prescription for NSAIDs during 1997 to 2005. Of these; 1,028,437 individuals were included in the study after applying selection criteria regarding comorbidity and concomitant pharmacotherapy. Use of the nonselective NSAID diclofenac and the selective cyclooxygenase-2 inhibitor rofecoxib was associated with an increased risk of cardiovascular death (odds ratio, 1.91; 95% confidence interval, 1.62 to 2.42; and odds ratio, 1.66; 95% confidence interval, 1.06 to 2.59, respectively), with a dose-dependent increase in risk. There was a trend for increased risk of fatal or nonfatal stroke associated with ibuprofen treatment (odds ratio, 1.29; 95% confidence interval, 1.02 to 1.63), but naproxen was not associated with increased cardiovascular risk (odds ratio for cardiovascular death, 0.84; 95% confidence interval, 0.50 to 1.42).
Individual NSAIDs have different degrees of cardiovascular safety, which must be considered when choosing appropriate treatment. In particular, rofecoxib and diclofenac were associated with increased cardiovascular mortality and morbidity and should be used with caution in most individuals, whereas our results suggest that naproxen has a safer cardiovascular risk-profile.
PubMed ID
20530789 View in PubMed
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Coronary artery calcification detected in lung cancer screening predicts cardiovascular death.

https://arctichealth.org/en/permalink/ahliterature270488
Source
Scand Cardiovasc J. 2015 Jun;49(3):159-67
Publication Type
Article
Date
Jun-2015
Author
Thomas Rasmussen
Lars Køber
Jawdat Abdulla
Jesper Holst Pedersen
Mathilde Marie Winkler Wille
Asger Dirksen
Klaus Fuglsang Kofoed
Source
Scand Cardiovasc J. 2015 Jun;49(3):159-67
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Calcinosis - diagnosis
Cause of Death
Coronary Artery Disease - diagnosis - etiology - mortality
Coronary Vessels - pathology
Denmark - epidemiology
Early Detection of Cancer - methods
Female
Humans
Lung Neoplasms - etiology - mortality - radiography
Male
Middle Aged
Outcome Assessment (Health Care)
Prognosis
Proportional Hazards Models
Registries
Smoking - adverse effects - epidemiology
Survival Rate
Tomography, X-Ray Computed
Abstract
It remains unknown whether non-electrocardiogram-gated coronary artery calcium (CAC) score in lung cancer screening provides incremental prognostic value. The aim of this study was to evaluate the prognostic value of CAC in the Danish Lung Cancer Screening Trial (DLCST), in addition to conducting a systematic review and meta-analysis including previously published studies regarding CAC in lung cancer screening.
In DLCST, we measured Agatston CAC scores in 1,945 current and former smokers. Causes of death were extracted from the Danish National Death Registry. We used Cox proportional hazards model to determine hazard ratios (HRs) of CAC scores. A weighted fixed-effects model was used for the meta-analysis.
Median follow-up in DLCST was 7.1 years, and 55% were men. Overall survival rates associated with CAC scores of 0, 1-400, and > 400 were 98%, 96%, and 92% (p 400 was 3.8 (1.0-15) (p
PubMed ID
25919145 View in PubMed
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Electrocardiographic Preexcitation and Risk of Cardiovascular Morbidity and Mortality: Results From the Copenhagen ECG Study.

https://arctichealth.org/en/permalink/ahliterature285049
Source
Circ Arrhythm Electrophysiol. 2017 Jun;10(6)
Publication Type
Article
Date
Jun-2017
Author
Morten W Skov
Peter V Rasmussen
Jonas Ghouse
Steen M Hansen
Claus Graff
Morten S Olesen
Adrian Pietersen
Christian Torp-Pedersen
Stig Haunsø
Lars Køber
Jesper H Svendsen
Anders G Holst
Jonas B Nielsen
Source
Circ Arrhythm Electrophysiol. 2017 Jun;10(6)
Date
Jun-2017
Language
English
Publication Type
Article
Keywords
Accessory Atrioventricular Bundle - physiopathology
Action Potentials
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Atrial Fibrillation - diagnosis - mortality - physiopathology
Cause of Death
Child
Denmark - epidemiology
Electrocardiography
Female
Heart Conduction System - physiopathology
Heart Failure - diagnosis - mortality - physiopathology
Heart rate
Humans
Male
Middle Aged
Pre-Excitation Syndromes - diagnosis - mortality - physiopathology
Predictive value of tests
Prevalence
Primary Health Care
Prognosis
Proportional Hazards Models
Registries
Risk assessment
Risk factors
Sex Factors
Time Factors
Young Adult
Abstract
The majority of available data on the clinical course of patients with ventricular preexcitation in the ECG originates from tertiary centers. We aimed to investigate long-term outcomes in individuals from a primary care population with electrocardiographic preexcitation.
Digital ECGs from 328?638 primary care patients were collected during 2001 to 2011. We identified 310 individuals with preexcitation (age range, 8-85 years). Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. The median follow-up time was 7.4 years (quartiles, 4.6-10.3 years). Compared with the remainder of the population, patients with preexcitation had higher adjusted hazards of atrial fibrillation (hazard ratio [HR], 3.12; 95% confidence interval [CI], 2.07-4.70) and heart failure (HR, 2.11; 95% CI, 1.27-3.50). Subgroup analysis on accessory pathway location revealed a higher adjusted hazard of heart failure for a right anteroseptal accessory pathway (HR, 5.88; 95% CI, 2.63-13.1). There was no evidence of a higher hazard of death among individuals with preexcitation when looking across all age groups (HR, 1.07; 95% CI, 0.68-1.68). However, a statistically significant (P=0.01) interaction analysis (
PubMed ID
28576781 View in PubMed
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Evaluation of the CHADS2 risk score on short- and long-term all-cause and cardiovascular mortality after syncope.

https://arctichealth.org/en/permalink/ahliterature115947
Source
Clin Cardiol. 2013 May;36(5):262-8
Publication Type
Article
Date
May-2013
Author
Martin Huth Ruwald
Anne-Christine Ruwald
Christian Jons
Morten Lamberts
Morten Lock Hansen
Michael Vinther
Lars Køber
Christian Torp-Pedersen
Jim Hansen
Gunnar Hilmar Gislason
Author Affiliation
Department of Cardiology, Gentofte Hospital, Hellerup, Denmark. mruwald@hotmail.com
Source
Clin Cardiol. 2013 May;36(5):262-8
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cardiovascular Diseases - diagnosis - mortality
Cause of Death
Chi-Square Distribution
Denmark - epidemiology
Emergency Service, Hospital
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Patient Discharge
Proportional Hazards Models
Registries
Retrospective Studies
Risk assessment
Risk factors
Syncope - diagnosis - mortality
Time Factors
Abstract
Syncope risk stratification is difficult and has not been implemented clinically.
The CHADS2 score can be applied as a risk stratification tool for predicting mortality after an episode of syncope.
All patients discharged from emergency departments with a first-time diagnosis of syncope from 2001 to 2009 where identified from nationwide registers in Denmark and matched on sex and age with a control population. Risk of all-cause or cardiovascular death was analyzed by multivariable Cox models.
A total of 37,705 patients were included. There were a total of 7761 deaths (21%), of which 52% were cardiovascular vs 27 862 (15%) deaths in the control population. The risk of cardiovascular death was significantly increased with increasing CHADS2 score (CHADS2 score: 1-2, hazard ratio [HR]: 9.11, 95% confidence interval [CI]: 8.25-10.07; CHADS2 score: 3-4, HR: 17.32, 95% CI: 15.42-19.47; CHADS2 score: 5-6, HR: 26.66, 95% CI: 21.40-33.21) relative to CHADS2 score of 0. A CHADS2 score of 0 was associated overall with very low event rates (15.1 deaths per 1000 person-years) but was associated with increased relative risk in the syncope population compared to controls. Syncope predicted 1-week, 1-year, and long-term mortality across CHADS2 scores compared to controls but did not reach significance in CHADS2 scores of 5 to 6.
Increasing CHADS2 score significantly predicts mortality in patients discharged with a diagnosis of syncope, and a CHADS2 score of 0 was associated with a very low absolute mortality. Compared to controls, syncope was associated with increased short- and long-term mortality, particularly in the lower CHADS2 scores.
PubMed ID
23450502 View in PubMed
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Increased short-term risk of thrombo-embolism or death after interruption of warfarin treatment in patients with atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature128494
Source
Eur Heart J. 2012 Aug;33(15):1886-92
Publication Type
Article
Date
Aug-2012
Author
Jakob Raunsø
Christian Selmer
Jonas Bjerring Olesen
Mette Gitz Charlot
Anne-Marie S Olsen
Ditte-Marie Bretler
Jørn Dalsgaard Nielsen
Helena Dominguez
Niels Gadsbøll
Lars Køber
Gunnar H Gislason
Christian Torp-Pedersen
Morten Lock Hansen
Author Affiliation
Department of Cardiology, Copenhagen University Hospital Gentofte, Post 67, Hellerup 2900, Denmark. jrj@heart.dk
Source
Eur Heart J. 2012 Aug;33(15):1886-92
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Atrial Fibrillation - complications - drug therapy - mortality
Cause of Death
Denmark - epidemiology
Female
Hospitalization - statistics & numerical data
Humans
Male
Retrospective Studies
Risk factors
Thromboembolism - etiology - mortality
Warfarin - therapeutic use
Withholding Treatment
Abstract
It is presently unknown whether patients with atrial fibrillation (AF) are at increased risk of thrombo-embolic adverse events after interruption of warfarin treatment. The purpose of this study was to assess the risk and timing of thrombo-embolism after warfarin treatment interruption.
A retrospective, nationwide cohort study of all patients in Denmark treated with warfarin after a first hospitalization with AF in the period 1997-2008. Incidence rate ratios (IRRs) of thrombo-embolic events and all-cause mortality were calculated using the Poisson regression analyses. In total, 48 989 AF patients receiving warfarin treatment were included. Of these, 35 396 patients had at least one episode of warfarin treatment interruption. In all, 8255 deaths or thrombo-embolic events occurred during treatment interruption showing an initial clustering of events with 2717, 835, 500, and 427 events occurring during 0-90, 91-180, 181-270, and 271-360 days after treatment interruption, respectively. Correspondingly, the crude incidence rates were 31.6, 17.7, 12.3, and 11.4 events per 100 patient-years. In a multivariable analysis, the first 90-day interval of treatment interruption was associated with a markedly higher risk of death or thrombo-embolism (IRR 2.5; 95% confidence interval 2.3-2.8) vs. the interval of 271-360 days.
In patients with AF, an interruption of warfarin treatment is associated with a significantly increased short-term risk of death or thrombo-embolic events within the first 90 days of treatment interruption.
Notes
Comment In: Eur Heart J. 2012 Aug;33(15):1864-622368184
PubMed ID
22199117 View in PubMed
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Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature135502
Source
Eur Heart J. 2011 Aug;32(15):1900-8
Publication Type
Article
Date
Aug-2011
Author
Tina Ken Schramm
Gunnar Hilmar Gislason
Allan Vaag
Jeppe Nørgaard Rasmussen
Fredrik Folke
Morten Lock Hansen
Emil Loldrup Fosbøl
Lars Køber
Mette Lykke Norgaard
Mette Madsen
Peter Riis Hansen
Christian Torp-Pedersen
Author Affiliation
Department of Cardiology B, section 2141, Rigshospitalet, The Heart Center, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark. tks@heart.dk
Source
Eur Heart J. 2011 Aug;32(15):1900-8
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cause of Death
Denmark - epidemiology
Diabetes Mellitus, Type 2 - drug therapy - mortality
Diabetic Angiopathies - mortality
Humans
Hypoglycemic agents - therapeutic use
Insulin - analogs & derivatives
Kaplan-Meier Estimate
Metformin - therapeutic use
Middle Aged
Myocardial Infarction - mortality
Risk factors
Stroke - mortality
Treatment Outcome
Young Adult
Abstract
The impact of insulin secretagogues (ISs) on long-term major clinical outcomes in type 2 diabetes remains unclear. We examined mortality and cardiovascular risk associated with all available ISs compared with metformin in a nationwide study.
All Danish residents >20 years, initiating single-agent ISs or metformin between 1997 and 2006 were followed for up to 9 years (median 3.3 years) by individual-level linkage of nationwide registers. All-cause mortality, cardiovascular mortality, and the composite of myocardial infarction (MI), stroke, and cardiovascular mortality associated with individual ISs were investigated in patients with or without previous MI by multivariable Cox proportional-hazard analyses including propensity analyses. A total of 107 806 subjects were included, of whom 9607 had previous MI. Compared with metformin, glimepiride (hazard ratios and 95% confidence intervals): 1.32 (1.24-1.40), glibenclamide: 1.19 (1.11-1.28), glipizide: 1.27 (1.17-1.38), and tolbutamide: 1.28 (1.17-1.39) were associated with increased all-cause mortality in patients without previous MI. The corresponding results for patients with previous MI were as follows: glimepiride: 1.30 (1.11-1.44), glibenclamide: 1.47 (1.22-1.76), glipizide: 1.53 (1.23-1.89), and tolbutamide: 1.47 (1.17-1.84). Results for gliclazide [1.05 (0.94-1.16) and 0.90 (0.68-1.20)] and repaglinide and [0.97 (0.81-1.15) and 1.29 (0.86-1.94)] were not statistically different from metformin in both patients without and with previous MI, respectively. Results were similar for cardiovascular mortality and for the composite endpoint.
Monotherapy with the most used ISs, including glimepiride, glibenclamide, glipizide, and tolbutamide, seems to be associated with increased mortality and cardiovascular risk compared with metformin. Gliclazide and repaglinide appear to be associated with a lower risk than other ISs.
Notes
Comment In: Ann Intern Med. 2012 Jan 17;156(2):JC1-722250169
Comment In: Eur Heart J. 2011 Aug;32(15):1832-421471136
Erratum In: Eur Heart J. 2012 May;33(10):1183
PubMed ID
21471135 View in PubMed
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New-onset atrial fibrillation is associated with cardiovascular events leading to death in a first time myocardial infarction population of 89,703 patients with long-term follow-up: a nationwide study.

https://arctichealth.org/en/permalink/ahliterature105199
Source
J Am Heart Assoc. 2014;3(1):e000382
Publication Type
Article
Date
2014
Author
Casper N Bang
Gunnar H Gislason
Anders M Greve
Christian A Bang
Alexander Lilja
Christian Torp-Pedersen
Per K Andersen
Lars Køber
Richard B Devereux
Kristian Wachtell
Author Affiliation
Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
Source
J Am Heart Assoc. 2014;3(1):e000382
Date
2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - diagnosis - mortality
Cause of Death
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Linear Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - diagnosis - mortality
Prognosis
Propensity Score
Proportional Hazards Models
Recurrence
Registries
Retrospective Studies
Risk factors
Stroke - mortality
Time Factors
Abstract
New-onset atrial fibrillation (AF) is reported to increase the risk of death in myocardial infarction (MI) patients. However, previous studies have reported conflicting results and no data exist to explain the underlying cause of higher death rates in these patients.
All patients with first acute MI between 1997 and 2009 in Denmark, without prior AF, were identified from Danish nationwide administrative registers. The impact of new-onset AF on all-cause mortality, cardiovascular death, fatal/nonfatal stroke, fatal/nonfatal re-infarction and noncardiovascular death, were analyzed by multiple time-dependent Cox models and additionally in propensity score matched analysis. In 89 703 patients with an average follow-up of 5.0 ± 3.5 years event rates were higher in patients developing AF (n=10 708) versus those staying in sinus-rhythm (n=78 992): all-cause mortality 173.9 versus 69.4 per 1000 person-years, cardiovascular death 137.2 versus 50.0 per 1000 person-years, fatal/nonfatal stroke 19.6/19.9 versus 6.2/5.6 per 1000 person-years, fatal/nonfatal re-infarction 29.0/60.7 versus 14.2/37.9 per 1000 person-years. In time-dependent multiple Cox analyses, new-onset AF remained predictive of increased all-cause mortality (HR: 1.9 [95% CI: 1.8 to 2.0]), cardiovascular death (HR: 2.1 [2.0 to 2.2]), fatal/nonfatal stroke (HR: 2.3 [2.1 to 2.6]/HR: 2.5 [2.2 to 2.7]), fatal/nonfatal re-infarction (HR: 1.7 [1.6 to 1.8]/HR: 1.8 [1.7 to 1.9]), and non- cardiovascular death (HR: 1.4 [1.3 to 1.5]) all P
Notes
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PubMed ID
24449803 View in PubMed
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Normal-Weight Central Obesity and Mortality Risk in Older Adults With Coronary Artery Disease.

https://arctichealth.org/en/permalink/ahliterature274587
Source
Mayo Clin Proc. 2016 Mar;91(3):343-51
Publication Type
Article
Date
Mar-2016
Author
Saurabh Sharma
John A Batsis
Thais Coutinho
Virend K Somers
David O Hodge
Rickey E Carter
Ondrej Sochor
Charlotte Kragelund
Alka M Kanaya
Marianne Zeller
Jong-Seon Park
Lars Køber
Christian Torp-Pedersen
Francisco Lopez-Jimenez
Source
Mayo Clin Proc. 2016 Mar;91(3):343-51
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Body mass index
Cause of Death
Cohort Studies
Coronary Artery Disease - epidemiology - mortality
Denmark - epidemiology
Female
France - epidemiology
Humans
Male
Obesity, Abdominal - epidemiology - mortality
Proportional Hazards Models
Risk factors
Sex Factors
United States - epidemiology
Abstract
To study the relationship between body mass index (BMI) and central obesity and mortality in elderly patients with coronary artery disease (CAD).
We identified 7057 patients 65 years or older from 5 cohort studies assessing mortality risk using either waist circumference (WC) or waist-hip ratio (WHR) in patients with CAD from January 1, 1980, to December 31, 2008. Normal weight, overweight, and obesity were defined using standard BMI cutoffs. High WHR was defined as 0.85 or more for women and 0.90 or more for men. High WC was defined as 88 cm or more for women and 102 cm or more for men. Separate models examined WC or WHR in combination with BMI (6 categories each) as the primary predictor (referent = normal BMI and normal WC or WHR). Cox proportional hazards models investigated the relationship between these obesity categories and mortality.
Patients' mean age was 73.0±6.0 years (3741 [53%] women). The median censor time was 7.1 years. A normal BMI with central obesity (high WHR or high WC) demonstrated highest mortality risk (hazard ratio [HR], 1.29; 95% CI, 1.14-1.46; HR, 1.29; 95% CI, 1.12-1.50, respectively). High WHR was also predictive of mortality in the overall (HR, 2.14; 95% CI, 1.93-2.38) as well as in the sex-specific cohort. In the overall cohort, high WC was not predictive of mortality (HR, 1.04; 95% CI, 0.97-1.12); however, it predicted higher risk in men (HR, 1.12; 95% CI, 1.01-1.24).
In older adults with CAD, normal-weight central obesity defined using either WHR or WC is associated with high mortality risk, highlighting a need to combine measures in adiposity-related risk assessment.
PubMed ID
26860580 View in PubMed
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The prevalence and prognostic importance of possible familial hypercholesterolemia in patients with myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature282779
Source
Am Heart J. 2016 Nov;181:35-42
Publication Type
Article
Date
Nov-2016
Author
Sofie Aagaard Rerup
Lia E Bang
Ulrik M Mogensen
Thomas Engstrøm
Erik Jørgensen
Frants Pedersen
Christian Torp-Pedersen
Gunnar Gislason
Stefan James
Emil Hagström
Lars Køber
Emil L Fosbøl
Source
Am Heart J. 2016 Nov;181:35-42
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Anticholesteremic Agents - therapeutic use
Cause of Death
Cholesterol, LDL - blood
Comorbidity
Denmark - epidemiology
Female
Humans
Hyperlipoproteinemia Type II - blood - drug therapy - epidemiology
Male
Middle Aged
Mortality
Myocardial Infarction - epidemiology
Prevalence
Prognosis
Proportional Hazards Models
Recurrence
Registries
Abstract
Familial hypercholesterolemia (FH) is a common genetic disorder causing accelerated atherosclerosis and premature cardiovascular disease. The aim of this study was to examine the prevalence and prognostic significance of possible FH in patients with myocardial infarction (MI).
By individual-level linkage of data from the Eastern Danish Heart Registry and national administrative registries, a study population of patients referred for coronary angiography due to MI was selected. The study population was divided into "unlikely FH" and "possible FH" based on the Dutch Lipid Clinic Network criteria, which included a plasma low-density lipoprotein cholesterol (LDL-C) and age for onset of cardiac disease. A score of =3 points was used as the cutpoint between the 2 groups. Among the study population of 13,174 MI patients, 1,281 (9.7%) had possible FH. These patients were younger (59.1 vs 65.7 years, P = .0001), had similar levels of comorbidities, and were treated more aggressively with cholesterol-lowering drugs compared with patients with unlikely FH. During a median of 3.3 years of follow-up, the unadjusted and adjusted event rates of recurrent MI were higher in patients with possible FH compared with unlikely FH (16% vs 11%, adjusted hazard ratio 1.28, 95% CI 1.09-1.51, P = .003.). Differences in adjusted all-cause mortality were not statistically significant (17% vs 23%, adjusted hazard ratio 0.89 [0.74-1.04], P = .1).
We found that MI patients with possible FH have higher risk of recurrent MI but similar risk of mortality compared with unlikely FH patients. Further studies on secondary prevention are warranted.
PubMed ID
27823691 View in PubMed
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