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Antihypertensive control and new-onset atrial fibrillation: Results from the Swedish Primary Care Cardiovascular Database (SPCCD).

https://arctichealth.org/en/permalink/ahliterature291189
Source
Eur J Prev Cardiol. 2017 07; 24(11):1206-1211
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
07-2017
Author
Georgios Mourtzinis
Linus Schiöler
Thomas Kahan
Kristina Bengtsson Boström
Per Hjerpe
Jan Hasselström
Karin Manhem
Author Affiliation
1 Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden.
Source
Eur J Prev Cardiol. 2017 07; 24(11):1206-1211
Date
07-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Antihypertensive Agents - therapeutic use
Atrial Fibrillation - epidemiology - etiology - prevention & control
Blood Pressure - drug effects
Databases, Factual
Female
Follow-Up Studies
Heart Rate - physiology
Humans
Hypertension - complications - drug therapy - physiopathology
Incidence
Male
Middle Aged
Primary Health Care - statistics & numerical data
Retrospective Studies
Risk Assessment - methods
Risk factors
Survival Rate - trends
Sweden - epidemiology
Time Factors
Abstract
Background Atrial fibrillation is associated with increased cardiovascular morbidity and mortality. Hypertension is an important risk factor for the development of atrial fibrillation. Aim This study assessed the relationship between blood pressure control and new-onset atrial fibrillation in hypertensive patients. Methods and results We followed 45,530 hypertensive patients with no previously documented atrial fibrillation, attending primary healthcare in Sweden during 2001-2008. After a mean follow-up of 3.5 years 2057 patients (4.5%) developed atrial fibrillation. Compared to patients with no atrial fibrillation, the new-onset atrial fibrillation group (after adjustment for age, sex, diabetes mellitus, heart failure, ischaemic heart disease, cerebrovascular disease and number of visits) had higher mean in-treatment systolic blood pressure (SBP) and diastolic blood pressure of 3.8?mmHg (95% confidence interval (CI) 3.0-4.6; P?
PubMed ID
28470087 View in PubMed
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Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation.

https://arctichealth.org/en/permalink/ahliterature300413
Source
JAMA Cardiol. 2017 02 01; 2(2):146-152
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
02-01-2017
Author
Sara Själander
Fredrik Holmqvist
J Gustav Smith
Pyotr G Platonov
Milos Kesek
Peter J Svensson
Carina Blomström-Lundqvist
Fariborz Tabrizi
Jari Tapanainen
Dritan Poci
Anders Jönsson
Anders Själander
Author Affiliation
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Source
JAMA Cardiol. 2017 02 01; 2(2):146-152
Date
02-01-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Administration, Oral
Age Factors
Anticoagulants - administration & dosage
Atrial Fibrillation - complications - drug therapy - surgery
Brain Ischemia - epidemiology - etiology - prevention & control
Catheter Ablation - methods
Cause of Death - trends
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Prognosis
Pulmonary Veins - surgery
Retrospective Studies
Risk Assessment - methods
Risk factors
Survival Rate - trends
Sweden - epidemiology
Time Factors
Warfarin - administration & dosage
Withholding Treatment
Abstract
Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke.
To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA2DS2-VASc (congestive heart failure, hypertension, age =75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment.
A retrospective cohort study was conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016.
Warfarin treatment.
Ischemic stroke, intracranial hemorrhage, and death.
In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA2DS2-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA2DS2-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P?=?.046). Patients with a CHA2DS2-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P?=?.02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P?=?.007, respectively).
These findings indicate that discontinuation of warfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.
Notes
CommentIn: JAMA Cardiol. 2017 Feb 1;2(2):152-154 PMID 27893050
PubMed ID
27893055 View in PubMed
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Coronary artery disease severity and long-term cardiovascular risk in patients with myocardial infarction: a Danish nationwide register-based cohort study.

https://arctichealth.org/en/permalink/ahliterature298150
Source
Eur Heart J Cardiovasc Pharmacother. 2018 01 01; 4(1):25-35
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
01-01-2018
Author
Cengiz Özcan
Anna Deleskog
Anne-Marie Schjerning Olsen
Helene Nordahl Christensen
Morten Lock Hansen
Gunnar Hilmar Gislason
Author Affiliation
Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegårdsvej 28, 2900 Hellerup, Denmark.
Source
Eur Heart J Cardiovasc Pharmacother. 2018 01 01; 4(1):25-35
Date
01-01-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Coronary Artery Disease - complications - diagnosis - epidemiology
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Morbidity - trends
Myocardial Infarction - diagnosis - epidemiology - etiology
Prognosis
Registries
Retrospective Studies
Risk Assessment - methods
Risk factors
Severity of Illness Index
Survival Rate - trends
Time Factors
Abstract
Long-term prognostic impact of coronary artery disease (CAD) severity in stable post-myocardial infarction (MI) patients is not well known. We examined the impact of CAD severity and co-morbidity on the long-term (1 year and beyond) risk of cardiovascular events post-MI.
From nationwide administrative and clinical registers, we identified 55?747?MI patients, during 2004-2010, who had not experienced subsequent MI, stroke, or death within 7 days post-discharge. The risk for primary composite endpoint (MI, stroke, or cardiovascular death) was estimated for the first 365 days after MI (index MI) and from day 366 to study completion (stable post-MI population), corresponding to a mean follow-up of 3.6 (2.2) years. Risk was assessed using cumulative incidence, multivariable adjusted logistic regression and Cox proportional-hazards models. The 1-year cumulative incidence for primary endpoint was 20.0% [95% confidence interval (CI), (19.6-20.3)]. Correspondingly, the 4-year cumulative incidence for primary endpoint was 21.0% (95% CI, 20.6-21.4) in patients without events on the first year. In multivariable models with no significant stenosis as reference, CAD severity was the most important risk factor for cardiovascular events the first 365 days [left main stenosis (LMS): odds ratio and 95% CI, 4.37, 3.69-5.17; 3-vessel disease (VD), 4.18, 3.66-4.77; 2-VD, 3.23, 2.81-3.72; 1-VD, 2.12,-1.85-2.43] and remained from day 366 to study completion [LMS: hazard ratio and 95% CI, 1.91, 1.64-2.22; 3-VD, 1.85,1.65-2.07; 2-VD, 1.55, 1.38-1.74; 1-VD, 1.30, 1.16-1.45].
Despite contemporary treatment at baseline, stable post-MI patients' 4-year outcome was similar to 1-year outcome after MI, and CAD severity remained a critical risk factor the first year and thereafter.
PubMed ID
28444162 View in PubMed
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Editor's Choice - The National Norwegian Carotid Study: Time from Symptom Onset to Surgery is too Long, Resulting in Additional Neurological Events.

https://arctichealth.org/en/permalink/ahliterature289239
Source
Eur J Vasc Endovasc Surg. 2017 Oct; 54(4):415-422
Publication Type
Journal Article
Multicenter Study
Observational Study
Date
Oct-2017
Author
K E Kjørstad
S T Baksaas
D Bundgaard
E Halbakken
T Hasselgård
T Jonung
G T Jørgensen
J J Jørgensen
A H Krog
K Krohg-Sørensen
E Laxdal
S R Mathisen
G V Oskarsson
S Seljeskog
I Settemsdal
M Vetrhus
B A Viddal
J Wesche
F Aasgaard
E Mattsson
Author Affiliation
University Hospital of North Norway, Tromsø, Norway. Electronic address: knutek@unn.no.
Source
Eur J Vasc Endovasc Surg. 2017 Oct; 54(4):415-422
Date
Oct-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Observational Study
Keywords
Aged
Carotid Stenosis - complications - diagnosis - epidemiology - physiopathology
Endarterectomy, Carotid - methods - statistics & numerical data
Humans
Ischemic Attack, Transient - epidemiology - etiology - prevention & control
Male
Middle Aged
Needs Assessment
Norway - epidemiology
Platelet Aggregation Inhibitors - therapeutic use
Prospective Studies
Risk Assessment - methods
Severity of Illness Index
Stroke - epidemiology - etiology - prevention & control
Symptom Assessment - statistics & numerical data
Time-to-Treatment - standards - statistics & numerical data
Abstract
The objective was to observe for 1 year all patients in Norway operated on for symptomatic carotid stenosis with respect to (i) the time from the index event to surgery and neurological events during this time; (ii) the level in the healthcare system causing delay of surgical treatment; and (iii) the possible relationship between peri-operative use of platelet inhibitors and neurological events while awaiting surgery.
This was a prospective national multicentre study of a consecutive series of symptomatic patients. Patients were eligible for inclusion when referred for surgery. An index event was defined as the neurological event prompting contact with the healthcare system. All 15 departments in Norway performing carotid endarterectomy (CEA) participated.
Three hundred and seventy one patients were eligible for inclusion between 1 April 2014 and 31 March 2015, and 368 patients (99.2%) were included. Fifty-four percent of the patients contacted their general practitioner on the day of the index event. Primary healthcare referred 84.2% of the patients to hospital on the same day as examined. In hospital median time from admission to referral for vascular surgery was 3 days. Median time between referral to the operating unit and actual CEA was 5 days. Overall, 61.7% of the patients were operated on within 2 weeks of the index event. Twelve patients (3.3%) suffered a new neurological event while awaiting surgery. The percentage of patients on dual antiplatelet therapy was lower (25.0%) in this group than among the other patients (62.6%) (p = .008). The combined 30 day mortality and stroke rate was 3.8%.
This national study with almost complete inclusion and follow-up shows that the delays occur mainly at patient level and in hospital. The delay is associated with new neurological events. Dual antiplatelet therapy is associated with reduced risk of having a new neurological event before surgery.
Notes
CommentIn: Eur J Vasc Endovasc Surg. 2017 Oct;54(4):413-414 PMID 28888385
PubMed ID
28844552 View in PubMed
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Gout in immigrant groups: a cohort study in Sweden.

https://arctichealth.org/en/permalink/ahliterature289265
Source
Clin Rheumatol. 2017 May; 36(5):1091-1102
Publication Type
Journal Article
Multicenter Study
Date
May-2017
Author
Per Wändell
Axel C Carlsson
Xinjun Li
Danijela Gasevic
Johan Ärnlöv
Martin J Holzmann
Jan Sundquist
Kristina Sundquist
Author Affiliation
Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83, Huddinge, Sweden. per.wandell@ki.se.
Source
Clin Rheumatol. 2017 May; 36(5):1091-1102
Date
May-2017
Language
English
Publication Type
Journal Article
Multicenter Study
Keywords
Adult
Aged
Aged, 80 and over
Cohort Studies
Emigrants and Immigrants
Ethnic Groups
Female
Gout - ethnology
Humans
Incidence
Male
Middle Aged
Population Surveillance
Registries
Risk Assessment - methods
Risk factors
Sweden - epidemiology
Abstract
Our aim was to study the association between country of birth and incidence of gout in different immigrant groups in Sweden. The study population included the whole population of Sweden. Gout was defined as having at least one registered diagnosis in the National Patient Register. The association between incidence of gout and country of birth was assessed by Cox regression, with hazard ratios (HRs) and 95% confidence intervals (95% CI), using Swedish-born individuals as referents. All models were conducted in both men and women, and the full model was adjusted for age, place of residence in Sweden, educational level, marital status, neighbourhood socio-economic status and co-morbidities. The risk of gout varied by country of origin, with highest estimates, compared to Swedish born, in fully adjusted models among men from Iraq (HR 1.82, 95% CI 1.54-2.16), and Russia (HR 1.69, 95% CI 1.26-2.27), and also high among men from Austria, Poland, Africa and Asian countries outside the Middle East; and among women from Africa (HR 2.23, 95% CI 1.50-3.31), Hungary (HR 1.98, 95% CI 1.45-2.71), Iraq (HR 1.76, 95% CI 1.13-2.74) and Austria (HR 1.70, 95% CI 1.07-2.70), and also high among women from Poland. The risk of gout was lower among men from Greece, Spain, Nordic countries (except Finland) and Latin America and among women from Southern Europe, compared to their Swedish counterparts. The increased risk of gout among several immigrant groups is likely explained by a high cardio-metabolic risk factor pattern needing attention.
Notes
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PubMed ID
28091806 View in PubMed
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Metabolic syndrome and some of its components in relation to risk of cataract extraction. A prospective cohort study of men.

https://arctichealth.org/en/permalink/ahliterature299855
Source
Acta Ophthalmol. 2019 Jun; 97(4):409-414
Publication Type
Journal Article
Multicenter Study
Date
Jun-2019
Author
Birgitta Ejdervik Lindblad
Niclas Håkansson
Alicja Wolk
Author Affiliation
Department of Ophthalmology, School of Medical Sciences, Örebro University, Örebro, Sweden.
Source
Acta Ophthalmol. 2019 Jun; 97(4):409-414
Date
Jun-2019
Language
English
Publication Type
Journal Article
Multicenter Study
Keywords
Age Distribution
Age Factors
Aged
Cataract - epidemiology - etiology
Cataract Extraction - statistics & numerical data
Follow-Up Studies
Humans
Incidence
Life Style
Male
Metabolic Syndrome - complications - epidemiology
Middle Aged
Postoperative Complications - epidemiology
Prognosis
Prospective Studies
Risk Assessment - methods
Risk factors
Surveys and Questionnaires
Sweden - epidemiology
Abstract
To evaluate the relationship between metabolic syndrome and some of its components with the incidence of cataract extraction.
A population-based prospective cohort with a total of 45 049 men, aged 45-79 years, from the Cohort of Swedish Men completed in 1997 a self-administered questionnaire concerning anthropometric measurements and lifestyle factors. The men were followed from 1 January 1998 through 31 December 2012, and the cohort was matched with registers of cataract extraction. The main outcome measure was incident cases of age-related cataract extraction.
Over the 15-years of follow-up, 7573 incident cases of cataract extraction were identified. After controlling for potential confounders, the association between single components of metabolic syndrome, abdominal adiposity, diabetes and hypertension and risk of cataract extraction was rate ratio (RR): 1.04; 95% confidence interval (CI): 0.99-1.10, RR: 1.77; 95% CI: 1.64-1.92 and RR: 1.06; 95% CI 1.00-1.13, respectively. The risk of cataract extraction increased with increasing numbers of metabolic syndrome components (p 
PubMed ID
30353683 View in PubMed
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Persistent Organochlorine Pollutants in Plasma, Blood Pressure, and Hypertension in a Longitudinal Study.

https://arctichealth.org/en/permalink/ahliterature298471
Source
Hypertension. 2018 06; 71(6):1258-1268
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
06-2018
Author
Carolina Donat-Vargas
Agneta Åkesson
Andreas Tornevi
Maria Wennberg
Johan Sommar
Hannu Kiviranta
Panu Rantakokko
Ingvar A Bergdahl
Author Affiliation
From the Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (C.D.-V., A.A.).
Source
Hypertension. 2018 06; 71(6):1258-1268
Date
06-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Adult
Air Pollutants - adverse effects
Biomarkers - blood
Blood Pressure - physiology
Body mass index
Environmental Exposure - adverse effects
Female
Follow-Up Studies
Humans
Hydrocarbons, Chlorinated - adverse effects - blood
Hypertension - blood - epidemiology - physiopathology
Incidence
Male
Middle Aged
Odds Ratio
Retrospective Studies
Risk Assessment - methods
Sweden - epidemiology
Abstract
Persistent organochlorine pollutants (POPs) have shown to be involved in the atherosclerotic process and to cause endothelial cell dysfunction. To assess longitudinally whether plasma concentrations of different POPs were associated with blood pressure and risk of hypertension in middle-aged women and men. Study subjects were 850 participants in the VIP (Västerbotten Intervention Programme) with 2 blood samples and blood pressure measurements, 10 years apart, during 1990 to 2003 (baseline) and during 2000 to 2013 (follow-up). Dioxin-like and nondioxin-like polychlorinated biphenyls (DL-PCBs, NDL-PCBs) and p,p'-dichlorodiphenyldichloroethylene (DDE) were measured. Associations were assessed using generalized estimating equations. At baseline sampling 49% and at follow-up 64% had hypertension. DL-PCBs and DDE, but not NDL-PCBs or hexachlorobenzene, were associated with hypertension. Only the association for DL-PCBs remained statistically significant after lipid-standardization and adjustment for body mass index and total serum lipids. The multivariable-adjusted odds ratio of hypertension based on repeated measurements were 1.52 (95% confidence interval, 1.08-2.13) for DL-PCBs (third versus first tertile of lipid-standardized POPs). In stratified adjusted analyses, odds ratio for those born after 1950 increased to 3.99 (95% confidence interval, 2.15-7.43), whereas no association was observed among those born earlier. Based on repeated measurements, the accumulated exposure to DL-PCBs and DDE, although less clear for the latter, may disrupt the normal blood pressure levels and increase the odds of hypertension. Moreover, individuals experiencing early-life POP exposure may be at elevated risk of vascular POP effects.
PubMed ID
29712742 View in PubMed
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Repolarization Heterogeneity Measured With T-Wave Area Dispersion in Standard 12-Lead ECG Predicts Sudden Cardiac Death in General Population.

https://arctichealth.org/en/permalink/ahliterature301178
Source
Circ Arrhythm Electrophysiol. 2018 02; 11(2):e005762
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
02-2018
Author
Tuomas V Kenttä
Moritz F Sinner
Bruce D Nearing
Rebecca Freudling
Kimmo Porthan
Jani T Tikkanen
Martina Müller-Nurasyid
Katharina Schramm
Matti Viitasalo
Antti Jula
Markku S Nieminen
Annette Peters
Veikko Salomaa
Lasse Oikarinen
Richard L Verrier
Stefan Kääb
M Juhani Junttila
Heikki V Huikuri
Author Affiliation
From the Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland (T.V.K., J.T.T., M.J.J., H.V.H.); Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, Germany (M.F.S., R.F., K.S., S.K.); German Cardiovascular Research Centre, Partner Site: Munich Heart Alliance (M.F.S., M.M.-N., A.P., S.K.); Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (B.D.N., R.L.V.); Institute of Genetic Epidemiology (R.F., M.M.-N., K.S.) and Institute of Epidemiology II (A.P.), Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg; Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Finland (K.P., M.V., A.J., M.S.N., L.O.); Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (J.T.T.); and National Institute for Health and Welfare, Helsinki, Finland (V.S.). tuomas.kentta@oulu.fi.
Source
Circ Arrhythm Electrophysiol. 2018 02; 11(2):e005762
Date
02-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Adult
Aged
Cause of Death - trends
Coronary Disease - complications - mortality - physiopathology
Cross-Sectional Studies
Death, Sudden, Cardiac - epidemiology - etiology - prevention & control
Electrocardiography - methods
Female
Finland - epidemiology
Follow-Up Studies
Health Surveys - methods
Heart Rate - physiology
Humans
Incidence
Male
Middle Aged
Retrospective Studies
Risk Assessment - methods
Risk factors
Survival Rate - trends
Time Factors
Abstract
We developed a novel electrocardiographic marker, T-wave area dispersion (TW-Ad), which measures repolarization heterogeneity by assessing interlead T-wave areas during a single cardiac cycle and tested whether it can identify patients at risk for sudden cardiac death (SCD) in the general population.
TW-Ad was measured from standard digital 12-lead ECG in 5618 adults (46% men; age, 50.9±12.5 years) participating in the Health 2000 Study-an epidemiological survey representative of the Finnish adult population. Independent replication was performed in 3831 participants of the KORA S4 Study (Cooperative Health Research in the Region of Augsburg; 49% men; age, 48.7±13.7 years; mean follow-up, 8.8±1.1 years). During follow-up (7.7±1.4 years), 72 SCDs occurred in the Health 2000 Survey. Lower TW-Ad was univariately associated with SCD (0.32±0.36 versus 0.60±0.19; P
PubMed ID
29440187 View in PubMed
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Risk Factors for Discontinuation of Treatment for Neovascular Age-Related Macular Degeneration.

https://arctichealth.org/en/permalink/ahliterature298646
Source
Ophthalmic Epidemiol. 2018 04; 25(2):176-182
Publication Type
Journal Article
Multicenter Study
Date
04-2018
Author
Inger Westborg
Aldana Rosso
Author Affiliation
a Department of Clinical Sciences/Ophthalmology , Umeå University , Umeå , Sweden.
Source
Ophthalmic Epidemiol. 2018 04; 25(2):176-182
Date
04-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Keywords
Angiogenesis Inhibitors - administration & dosage - therapeutic use
Comorbidity
Disease Progression
Follow-Up Studies
Humans
Intravitreal Injections
Ranibizumab - administration & dosage
Receptors, Vascular Endothelial Growth Factor - administration & dosage
Recombinant Fusion Proteins - administration & dosage
Registries
Risk Assessment - methods
Risk factors
Sweden - epidemiology
Time Factors
Tomography, Optical Coherence
Visual Acuity - drug effects
Wet Macular Degeneration - diagnosis - drug therapy
Withholding Treatment
Abstract
To investigate risk factors for treatment discontinuation for neovascular age-related macular degeneration (nAMD).
Data from the Swedish Macula Register and the Skåne Healthcare Register are reported on the treatment received by 932 nAMD patients diagnosed 2013-2015. Treatment discontinuation is defined as having a termination visit or lacking a control or treatment visit during the period of 10-14 months after the diagnostic visit. The risk of treatment discontinuation during the first year is estimated using a Poisson model and a classification tree.
503 eyes (50.9%) discontinued the treatment within the first year. Patients with visual acuity below 60 ETDRS letters (20/60 Snellen) at baseline, serious comorbidities, or treated at the university hospital have a 42% (95% CI 25-61%, P 
PubMed ID
29131696 View in PubMed
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Survival and incidence of cardiovascular diseases in participants in a long-distance ski race (Vasaloppet, Sweden) compared with the background population.

https://arctichealth.org/en/permalink/ahliterature297525
Source
Eur Heart J Qual Care Clin Outcomes. 2018 04 01; 4(2):91-97
Publication Type
Journal Article
Multicenter Study
Date
04-01-2018
Author
Ulf Hållmarker
Johan Lindbäck
Karl Michaëlsson
Johan Ärnlöv
Signild Åsberg
Per Wester
Dan Hellberg
Bo Lagerqvist
Stefan James
Author Affiliation
Depatment of Internal Medicine, Mora hospital, 792 85 Mora, Sweden.
Source
Eur Heart J Qual Care Clin Outcomes. 2018 04 01; 4(2):91-97
Date
04-01-2018
Language
English
Publication Type
Journal Article
Multicenter Study
Keywords
Adult
Cardiovascular Diseases - epidemiology - physiopathology - prevention & control
Exercise - physiology
Female
Humans
Incidence
Life Style
Male
Risk Assessment - methods
Skiing
Survival Rate - trends
Sweden - epidemiology
Time Factors
Abstract
We studied the relationship between taking part in a long-distance ski race and incidence of cardiovascular diseases (CVDs) to address the hypothesis that lifestyle lowers the incidence.
A cohort of 399 630 subjects in Sweden, half were skiers in the world's largest ski race, and half were non-skiers. Non-skiers were frequency matched for sex, age, and year of race. Individuals with severe diseases were excluded. The endpoints were death, myocardial infarction, or stroke. The subjects were followed up for a maximum of 21.8 years and median of 9.8 years. We identified 9399 death, myocardial infarction, or stroke events among non-skiers and 4784 among the Vasaloppet skiers. The adjusted hazard ratios (HRs) comparing skiers and non-skiers were 0.52 [95% confidence interval (CI) 0.49-0.54] for all-cause mortality, 0.56 (95% CI 0.52-0.60) for myocardial infarction and 0.63 (95% CI 0.58-0.67) for stroke and for all three outcomes 0.56 (95% CI 0.54-0.58). The results were consistent across subgroups: age, sex, family status, education, and race year. For skiers, a doubling of race time was associated with a higher age-adjusted risk of 19%, and male skiers had a doubled risk than female skiers, with a HR 2.06 (95% CI 1.89-2.41). The outcome analyses revealed no differences in risk of atrial fibrillation between skiers and non-skiers.
This large cohort study provides additional support for the hypothesis that individuals with high level of physical activity representing a healthy lifestyle, as evident by their participation in a long-distance ski race, have a lower risk of CVD or death.
Notes
CommentIn: Eur Heart J Qual Care Clin Outcomes. 2018 Apr 1;4(2):71-72 PMID 29506022
PubMed ID
29390055 View in PubMed
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