ORCID Profile
0000-0002-8532-6573
Current Organisation
UiT Norges arktiske universitet
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Publisher: Springer Science and Business Media LLC
Date: 10-01-2010
DOI: 10.1038/NG.511
Abstract: Electrocardiographic measures are indicative of the function of the cardiac conduction system. To search for sequence variants that modulate heart rate, PR interval and QRS duration in in iduals of European descent, we performed a genome-wide association study in approximately 10,000 in iduals and followed up the top signals in an additional approximately 10,000 in iduals. We identified several genome-wide significant associations (with P < 1.6 x 10(-7)). We identified one locus for heart rate (MYH6), four for PR interval (TBX5, SCN10A, CAV1 and ARHGAP24) and four for QRS duration (TBX5, SCN10A, 6p21 and 10q21). We tested for association between these loci and subjects with selected arrhythmias in Icelandic and Norwegian case-control s le sets. We observed correlations between TBX5 and CAV1 and atrial fibrillation (P = 4.0 x 10(-5) and P = 0.00032, respectively), between TBX5 and advanced atrioventricular block (P = 0.0067), and between SCN10A and pacemaker implantation (P = 0.0029). We also replicated previously described associations with the QT interval.
Publisher: Wiley
Date: 28-01-2019
DOI: 10.1111/ECHO.14270
Abstract: To examine the associations between diastolic dysfunction indices and long-term risk of all-cause mortality in adults over 23-year follow-up. Participants (n = 2734) of the population-based Tromsø Study of Norway had echocardiography in 1994-1995. Of these 67% were repeated in 2001 and/or 2007-2008. Mortality between 1994 and 2016 was determined by linkage to the national death registry. Cox regression was used to model the hazard of all-cause mortality in relation to left atrial parameters (treated as time-dependent using repeated measurements) adjusted for traditional risk factors and cardiovascular disease. During the follow-up, 1399 participants died. Indexed left atrial diameter, mitral peak E deceleration time, and mitral peak E to peak A ratio showed an U-shaped association with all-cause mortality. Combining left atrial diameter with mitral peak E deceleration time increased the prognostic accuracy for all-cause mortality whereas adding mitral peak E to peak A ratio did not increase prognostic value. We estimated new optimal cutoff values of left atrial diameter, mitral peak E deceleration time, and mitral peak E to peak A ratio for all-cause mortality outcome. E/e' had a cubic relation to mortality. Both enlarged and small left atrial diameters were associated with increased all-cause mortality risk. A combination of Doppler-based left ventricle filling parameters had an incremental effect on all-cause mortality risk. The cutoff values of diastolic dysfunction indices we determined had similar all-cause mortality prediction ability as those recommended by American Association of Echocardiography and European Association of Cardiovascular Imaging.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.YPMED.2018.09.005
Abstract: Physical activity and overweight are associated with myocardial infarction (MI). However, their joint association with MI remains unclear. Our objective was to examine the independent and joint association between leisure-time physical activity (LTPA), body mass index (BMI) and MI. This prospective cohort study included 16,572 men and women (47.5% women) aged 20-54 years who took part in the second Tromsø Study. At baseline in 1979-80 LTPA was assessed by questionnaire. Data on MI was collected and adjudicated through hospital and causes of death registries between 1979 and 2013. Cox proportional hazards models were used to examine the independent and joint associations between LTPA, BMI and MI. The final s le included 16,104 in iduals. During a median follow up of 34 years, 1613 incident cases of MI were recorded. Physical inactivity and elevated BMI were both independently associated with MI (p for trend 0.02 and <0.001). In joint analyses, normal weight, inactive in iduals had a 20% higher risk of MI compared to their active counterparts (hazard ratio (HR) 1.20 (1.02-1.41)). The highest risk of MI was seen in obese, inactive in iduals when compared to normal weight, active in iduals (HR 3.20 (2.30-4.44)). The risk of MI increased with increasing BMI regardless of the activity level. HRs were lower for active compared to inactive in iduals within the same BMI category. The findings suggest that LTPA and BMI are independently associated with risk of MI. LTPA seems to attenuate but not eliminate the risk of MI associated with excess bodyweight.
Publisher: Oxford University Press (OUP)
Date: 06-1992
DOI: 10.1093/OXFORDJOURNALS.EURHEARTJ.A060247
Abstract: A random population s le of 294 men and 312 women aged 20-64 years, all apparently healthy, were examined following a screening to determine the prevalence of silent ischaemia and its relations to coronary risk factors. Based on exercise testing, the prevalence of silent ischaemia was 2.5% in men and 3.4% in women. In men, silent ischaemia was positively related to systolic blood pressure (P less than 0.001). The other risk factors did not show any significant associations with silent ischaemia. However, the men with silent ischaemia had a higher coronary heart disease risk score, and a tendency towards more symptoms and signs suggesting a poorer health status than the other men and the women. In the 21 men classified as 'hypertensives', silent ischaemia was more common than in the normotensive men (14% versus 2%, P less than 0.001). No such difference was observed in women. In conclusion, silent ischaemia may be a sign of hypertension and a generally increased risk of coronary heart disease in men, but probably not in the majority of women. This further supports that exercise electrocardiography has no role in screening asymptomatic persons for coronary heart disease, probably with the exception of middle-aged men with an increased risk.
Publisher: American Medical Association (AMA)
Date: 23-09-2013
DOI: 10.1001/JAMAINTERNMED.2013.8412
Abstract: Identification of structural heart disease in asymptomatic in iduals could allow early disease-modifying treatment. To examine whether echocardiographic screening in the general population improves long-term survival or reduces the risk of cardiovascular disease. We studied 6861 middle-aged participants from the population-based Tromsø Study in Norway. Participants were randomly allocated to an echocardiographic screening group (n = 3272) or a control group (n = 3589). Using the as-treated approach, the data were analyzed for mortality and incidence of fatal and nonfatal myocardial infarction and stroke. During 15 follow-up years, 880 persons (26.9%) in the screening group and 989 persons (27.6%) in the control group died (hazard ratio, 0.97 95% CI, 0.89-1.06). No significant differences between the groups were observed in the secondary outcome measures (sudden death, mortality from any heart disease, or incidence of fatal and nonfatal myocardial infarction and stroke). Echocardiographic screening for structural and valvular heart disease in the general population provided no benefit for mortality or for the risk of myocardial infarction or stroke.
Publisher: Oxford University Press (OUP)
Date: 15-06-2002
Publisher: Elsevier BV
Date: 08-2017
Publisher: Elsevier BV
Date: 03-2011
Publisher: Springer Science and Business Media LLC
Date: 21-07-2009
DOI: 10.1007/S10654-009-9371-6
Abstract: The natural course of Helicobacter pylori (H. pylori) is poorly understood, as most research in the field has been on patient populations. We studied the natural course of H. pylori and its associations to morphological changes of the gastric mucosa, peptic ulcer, and reflux oesophagitis in a prospective cohort study of subjects with and without dyspepsia. A total of 361 adults (201 men/160 women, mean age 41/42 years) in Sørreisa municipality, Norway who in 1987 were subjected to upper endoscopy and assessed for gastrointestinal symptoms and H. pylori status were followed up in 2004. H. pylori was strongly associated with neutrophilic (odds ratio [OR] 23.79 95% confidence interval [CI] 11.64:48.61) and mononuclear infiltration (OR 9.43 CI 5.12:17.36), moderately with atrophy of the antrum (OR 1.98 CI 1.17:3.34), but not with atrophy of the gastric body or intestinal metaplasia. Elimination of H. pylori was associated with regression of gastric inflammation and atrophy, whereas intestinal metaplasia progressed. H. pylori was positively associated with peptic ulcer (OR 2.69 CI 1.2:6.02) but not significantly negatively associated with oesophagitis (OR 0.62 CI 0.35:1.09). This is the first prospective study including endoscopic findings of subjects without dyspepsia, to show that the impact of H. pylori on gastric atrophy is only modest, and that eliminating H. pylori does not cause regression of intestinal metaplasia. However, inflammation of the gastric mucosa regresses after H. pylori elimination. H. pylori is only a moderate risk factor for peptic ulcer, and other explanatory factors deserve more attention.
Publisher: Public Library of Science (PLoS)
Date: 16-09-2016
Publisher: BMJ
Date: 03-06-1995
DOI: 10.1136/BMJ.310.6992.1468B
Abstract: We recently demonstrated that diaryl-naphthopyran photochromic dyes are efficient for sensitization of TiO
Publisher: JMIR Publications Inc.
Date: 25-02-2022
DOI: 10.2196/33636
Abstract: Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the 4 main noncommunicable diseases. These noncommunicable diseases share 4 modifiable risk factors (tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet). Short smartphone surveys have the potential to identify modifiable risk factors for in iduals to monitor trends. We aimed to pilot a smartphone-based information communication technology solution to collect nationally representative data, annually, on 4 modifiable risk factors. We developed an information communication technology solution with functionalities for capturing sensitive data from smartphones, receiving, and handling data in accordance with general data protection regulations. The main survey comprised 26 questions: 8 on socioeconomic factors, 17 on the 4 risk factors, and 1 about current or previous noncommunicable diseases. For answers to the continuous questions, a keyboard was displayed for entering numbers there were preset upper and lower limits for acceptable response values. For categorical questions, pull-down menus with response options were displayed. The second survey comprised 9 yes-or-no questions. For both surveys, we used SMS text messaging. For the main survey, we invited 11,000 in iduals, aged 16 to 69 years, selected randomly from the Norwegian National Population Registry (1000 from each of the 11 counties). For the second survey, we invited a random s le of 100 in iduals from each county who had not responded to the main survey. All data, except county of residence, were self-reported. We calculated the distribution for socioeconomic background, tobacco use, diet, physical activity, and health condition factors overall and by sex. The response rate was 21.9% (2303/11,000 women: 1397/2263 61.7%, men: 866/2263, 38.3% missing: 40/2303, 1.7%). The median age for men was 52 years (IQR 40-61) the median age for women was 48 years (IQR 35-58). The main reported reason for nonparticipation in the main survey was that the sender of the initial SMS was unknown. We successfully developed and piloted a smartphone-based information communication technology solution for collecting data on the 4 modifiable risk factors for the 4 main noncommunicable diseases. Approximately 1 in 5 invitees responded thus, these data may not be nationally representative. The smartphone-based information communication technology solution should be further developed with the long-term goal to reduce premature mortality from the 4 main noncommunicable diseases.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2013
Publisher: Mary Ann Liebert Inc
Date: 02-2014
Abstract: High serum thyrotropin (TSH) levels predict cardiovascular disease (CVD). Recently several single nucleotide polymorphisms (SNPs) associated with TSH levels have been identified, one of them being the rs4704397 SNP in the phosphodiesterase 8B (PDE8B) gene. If the relation between thyroid function and CVD is causal, one could also expect rs4704397 genotypes to predict CVD and possibly health in general. DNA was prepared and genotyping performed for rs4704397 in subjects who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints myocardial infarction (MI), type 2 diabetes (T2DM), cancer, or death, as well as a randomly selected control group. Similarly, genotyping was performed in subjects who had participated in clinical trials where serum TSH, free T4 (fT4), and free T3 (fT3) were measured. From the Tromsø Study, 8938 subjects without thyroid disease or thyroid medication were successfully genotyped for rs4704397. Among these, 2098 were registered with MI, 1025 with T2DM, 2748 with cancer, and 3592 had died. The minor homozygote genotype (A:A) had a median serum TSH level that was 0.29 mIU/L higher than in the major homozygote genotype (G:G). The A:A genotype had a significantly increased risk of MI as compared to the G:G genotype (1.14 [1.00-1.29], hazard ratio [confidence interval], Cox regression with adjustment for age, sex, and body mass index). No significant associations were seen with the other endpoints or CVD risk factors. Furthermore, subjects with the G:G genotype were significantly taller than subjects with the A:A genotype (mean difference 1.5 cm). In 584 subjects with serum TSH, fT4, and fT3 measurements, the subjects with the A:A genotype had significantly higher serum TSH and nonsignificantly lower serum fT3 (mean difference 0.15 pmol/L) levels than subjects with the G:G genotype. rs4704397 is associated with thyroid function, risk of MI, and body height. However, confirmation in other cohorts is needed before firm conclusions can be drawn.
Publisher: Oxford University Press (OUP)
Date: 10-03-2016
Publisher: Oxford University Press (OUP)
Date: 27-09-2013
DOI: 10.1093/NTR/NTS188
Publisher: American Medical Association (AMA)
Date: 10-08-1998
DOI: 10.1001/ARCHINTE.158.15.1633
Abstract: Because physical activity may affect risk of certain chronic diseases, we wanted to examine the effects of leisure time physical activity on the metabolic profiles. In a population-based cohort study, 5220 men and 5869 women, aged 20 to 49 years at entry, took part in 2 surveys (1979-1980 and 1986-1987) with repeated assessments of self-reported leisure time activity. Measurements of body mass index (measured as the weight in kilograms ided by the square of the height in meters [BMI]) and levels of serum triglyceride, total cholesterol (total C), and high-density lipoprotein cholesterol (HDL-C) were studied in relation to 4 levels of physical activity. There was a dose-response relationship between serum lipid levels and BMI, and levels of physical activity in both sexes after adjustments for potential confounders. Differences in BMI and serum lipid levels between sedentary and sustained exercising groups were consistently more pronounced after 7 years than at baseline, especially in the oldest age group. Men reporting sustained very hard exercising compared with sedentary men had lower total C concentrations (5.65 mmol/L vs 6.21 mmol/L [218 mg/dL vs 240 mg/dL]), triglyceride levels (1.34 mmol/L vs 1.85 mmol/L [118 mg/dL vs 164 mg/dL] ), total C/HDL-C ratios by 19.0%, and BMI (23.9 kg/m2 vs 25.7 kg/m2), and higher HDL-C levels (1.52 mmol/L vs 1.36 mmol/L [59 mg/dL vs 52 mg/dL]). The combined sustained hard and very hard exercising group of women compared with sedentary women had lower total C concentrations (5.70 mmol/L vs 5.90 mmol/L [220 mg/ dL vs 228 mg/dL]), triglyceride levels (1.03 mmol/L vs 1.18 mmol/L [91 mg/dL vs 104 mg/dL]), total C/HDL-C ratios by 7.5%, BMI (23.1 kg/m2 vs 23.6 kg/m2), and higher HDL-C levels (1.73 mmol/L vs 1.66 mmol/L [67 mg/dL vs 64 mg/ dL]). An increase in leisure time activity over the 7 years improved metabolic profiles, whereas a decrease worsened them in both sexes. Sustained high levels and change from sedentary to higher levels of physical activity relative to sedentary men and women improved the metabolic risk profiles in both sexes. The differences observed are sufficiently large to have a beneficial effect in the prevention of certain chronic diseases.
Publisher: American Medical Association (AMA)
Date: 22-07-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-10-2016
Abstract: Even though clinical data support a relation between ischemic stroke and venous thromboembolism ( VTE ), the strength and time dependence of the association remain to be settled at the population level. We therefore aimed to investigate the association between ischemic stroke and VTE in a prospective population‐based cohort. Participants (n=30 002) were recruited from 3 surveys of the Tromsø study (conducted in 1994–1995, 2001, and 2007–2008) and followed through 2010. All incident events of ischemic stroke and VTE during follow‐up were recorded. Cox‐regression models with age as time scale and ischemic stroke as a time‐dependent variable were used to calculate hazard ratios ( HR ) of VTE adjusted for cardiovascular risk factors. During a median follow‐up time of 15.7 years, 1360 participants developed ischemic stroke and 722 had a VTE . The risk of VTE was highest the first month ( HR 19.7 95% CI , 10.1–38.5) and from 1 to 3 months after the stroke ( HR 10.6 95% CI 5.0–22.5), but declined rapidly thereafter. The risk estimates were approximately the same for deep vein thrombosis ( HR 19.1 95% CI , 7.8–38.5), and pulmonary embolism ( HR 20.2 95% CI , 7.4–55.1). Stroke was associated with higher risk for provoked ( HR 22.6 95% CI , 12.5–40.9) than unprovoked VTE ( HR 7.4 95% CI , 2.7–20.1) the first 3 months. The risk of VTE increased during the first 3 months after an ischemic stroke. The particularly high risk of provoked VTE suggests that additional predisposing factors, such as immobilization, potentiate the VTE risk in patients with ischemic stroke.
Publisher: Springer Science and Business Media LLC
Date: 07-2013
DOI: 10.1007/S10654-013-9822-Y
Abstract: Serum calcium measured in 27,158 subjects in 1994 and the calcium-sensing receptor polymorphism rs17251221 genotyped in 9,404 subjects were related to cardiovascular risk factors, incident myocardial infarction (MI), type 2 diabetes (T2DM), cancer and death during follow-up until 2008-2010. In a Cox regression model with adjustment for age, gender, smoking and body mass index, subjects with serum calcium 2.50-2.60 mmol/L had a significantly increased risk of incident MI [n = 1,802, hazards ratio (HR) 1.40, 95 % confidence interval (CI) 1.18, 1.66] and T2DM (n = 705, HR 1.49, 95 % CI 1.15, 1.94) and a significantly reduced risk of cancer (n = 2,222, HR 0.73, 95 % CI 0.62, 0.86) as compared to subjects with serum calcium 2.20-2.29 mmol/L. For rs17251221 there was a mean difference in serum calcium of 0.05 mmol/L between major and minor homozygote genotypes. No consistent, significant relation between rs17251221 and risk factors or the major hard endpoints were found. The minor homozygote genotype (high serum calcium) had a significant twofold increased risk (HR 2.32, 95 % CI 1.24, 4.36) for prostate cancer, as compared to the major homozygote. This may be clinically important if confirmed in other cohorts.
Publisher: SAGE Publications
Date: 09-1991
DOI: 10.1177/140349489101900311
Abstract: When the University of Tromsø in northern Norway was founded in 1968, the region suffered from at serious lack of physicians and the health system was not efficient. It was believed that the establishment of a medical school would improve this situation. Half of the places would be reserved for students from northern Norway, and the curriculum would be designed particularly to adapt to the needs of society. The curriculum today aims at obtaining early involvement with patients by using the integrated model for teaching, which means no separation between preclinical and clinical periods and close patient contact throughout the whole curriculum. There is full integration between basic sciences and clinical medicine according to the organ-system model. Emphasis is put on teaching the students a scientific approach involving elective studies and a thesis based on independent study. The expectations of the planners of the medical school have, in the main, been fulfilled. Of the physicians now practising in northern Norway, the proportion who received their education in Tromsø exceeds that of those educated at the other Norwegian medical schools. In addition, there are no serious vacancies in the primary health care service in the region.
Publisher: American Society for Clinical Investigation
Date: 08-03-2018
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/OPENHRT-2022-002086
Abstract: Shift work is associated with myocardial infarction and stroke. We studied if shift work is also associated with incident atrial fibrillation (AF) and if this association differs, depending on sex and age. We studied 22 339 participants (age 37.0±9.8 years, 49% women) with paid work from the third (1986–1987), fourth (1994–1995), fifth (2001) and sixth (2007–2008) surveys of the population-based Tromsø Study, Norway. Participants were followed up for ECG-confirmed AF through 2016. Shift work was assessed by questionnaire at each survey. We used unadjusted and multivariable-adjusted Cox regression models to study the association of shift work with 10-year incident AF and incident AF during extensive follow-up up to 31 years. Interactions with sex and age were tested in the multivariable model. Shift work was reported by 21% of participants at the first attended survey. There was an interaction between shift work and age for 10-year incident AF (p=0.069). When adjusted for AF risk factors, shift work was significantly associated with 10-year incident AF in participants years (HR 2.90, 95% CI 1.12 to 7.49) but not≥40 years of age (HR 0.90, 95% CI 0.53 to 1.51). Shift work was not associated with incident AF during extensive follow-up (HR 1.03, 95% CI 0.89 to 1.20). There was no interaction between shift work and sex. Shift work was associated with 10-year incident AF in in iduals years but not ≥40 years of age. Shift work was not associated with incident AF during extensive follow-up up to 31 years, and there were no sex differences.
Publisher: BMJ
Date: 05-2020
DOI: 10.1136/BMJOPEN-2019-035584
Abstract: The aim of this study was to use the parametric g-formula to estimate the 19-year risk of myocardial infarction (MI) under hypothetical interventions on six cardiovascular risk factors. A populations-based cohort study with repeated measurements, the Tromsø Study. Myocardial infarction. We estimated the relative and absolute risk reduction under feasible and intensive risk reduction strategies for smoking, physical activity, alcohol drinking, body mass index, total serum cholesterol and systolic blood pressure in 14 965 men and women with 19 years of follow-up (1994–2013). The estimated 19-year risk of MI under no intervention was 7.5% in in iduals with baseline mean age 49.3 years (range 25–69). This risk was reduced by 30% (95% CI 19% to 39%) under joint feasible interventions on all risk factors, and 70% (60%, 78%) under a set of more intensive interventions. The most effective interventions were lowering of total cholesterol to 5.18 mmol/L and lowering of systolic blood pressure to 120 mm Hg (33% and 37% lower MI risk, respectively). The absolute risk reductions were significantly larger in men, in older participants, in smokers and in those with low education. Modification of population levels of cardiovascular risk factors could have prevented close to one-third of the cases of MI in the municipality of Tromsø during 19 years of follow-up.
Publisher: American Medical Association (AMA)
Date: 11-2016
DOI: 10.1001/JAMAINTERNMED.2016.5451
Abstract: It is not clear to what extent the higher incidence of coronary heart disease (CHD) in men vs women is explained by differences in risk factor levels because few studies have presented adjusted risk estimates for sex. Moreover, the increase in risk of CHD in postmenopausal women, possibly hormone related, may eventually eliminate the sex contrast in risk, but age-specific risk estimates are scarce. To quantify the difference in risk of incident myocardial infarction (MI) between men and women. Population-based prospective study from Tromsø, Norway, comprising 33 997 in iduals (51% women). Median follow-up time during ages 35 to 102 years was 17.6 years. Incidence rates (IRs) and incidence rate ratios (IRRs, relative risk) of MI were calculated in Poisson regression analysis of person-years at risk. The data analysis was performed in November 2015. Sex, age, birth cohort, serum lipid levels, blood pressure, lifestyle factors, diabetes. Incident MI. A total of 2793 in iduals (886 women) received a diagnosis of MI during follow-up in the period 1979 through 2012. The IR increased with age in both sexes, with lower rates for women until age 95 years. Adjusted for age and birth cohort, the overall IRR for men vs women was 2.72 (95% CI, 2.50-2.96). Adjustment for high-density lipoprotein cholesterol and total cholesterol levels had the strongest impact on the risk estimate for sex, followed by diastolic blood pressure and smoking. However, the sex difference remained substantial even after adjustment for these factors (IRR, 2.07 95% CI, 1.89-2.26). Men had higher risk throughout life, but the IRRs decreased with age (3.64 [95% CI, 2.85-4.65], 2.00 [95% CI, 1.76-2.28], and 1.66 [95% CI, 1.42-1.95] for age groups 35-54, 55-74, and 75-94 years, respectively). Adjustment for systolic blood pressure, diabetes, body mass index, and physical activity had no notable impact. The observed sex contrast in risk of MI cannot be explained by differences in established CHD risk factors. The gender gap persisted throughout life but declined with age as a result of a more pronounced flattening of risk level changes in middle-aged men. The minor changes in IRs when moving from premenopausal to postmenopausal age in women make it unlikely that changes in female hormone levels influence the risk of MI.
Publisher: Oxford University Press (OUP)
Date: 23-07-2012
DOI: 10.1093/IJE/DYS086
Publisher: Wiley
Date: 02-2005
DOI: 10.1111/J.0105-1873.2005.00515.X
Abstract: A survey of occupational skin problems, based on a questionnaire, was carried out among 883 workers in different types of seafood-processing industries in northern Norway. The prevalence of dry skin, itching, rash/eczema, chapped skin and chronic sores was significantly higher among production workers (55.6%) in the white fish-, shrimp- and salmon-processing industries, compared to administrative workers in the same industries (27.5%). Among production workers, there was a significantly higher prevalence of skin symptoms among females (60.2%) compared to males (50.1%). A strong sex ision of work tasks rather than sex itself may explain this. There was no sex difference among administrative workers. Several risk factors for skin symptoms to occur are indicated. The workers are exposed to raw materials and a mixture of water and juice from the fish or shrimp, salt, detergents and disinfectants. Gloves may also cause skin problems. Major risk factors believed to cause skin symptoms were contact with raw materials, fish juice, water and gloves. The results also indicate that skin symptoms are of moderate severity and seldom interfere with working capacity.
Publisher: Oxford University Press (OUP)
Date: 20-05-2019
Abstract: This study examined the association of leisure time physical activity, occupational physical activity, and resting heart rate with all-cause and cardiovascular disease mortality in Sami and non-Sami populations. This was a longitudinal, observational population-based study. The Finnmark 3 study cohort was examined in 1987–1988 and followed for all-cause and cardiovascular disease mortality for 26 years. The cohort included 17,697 men and women with a mean age of 47.2 years at baseline. Leisure time physical activity and occupational physical activity were assessed with a validated questionnaire at baseline, whereas cause of death was obtained from the Norwegian Cause of Death Registry. A total of 1983 women and 3147 men died during follow-up. Leisure time physical activity was linearly and inversely associated with all-cause mortality, but not coronary heart disease mortality. Compared to inactive subjects, all-cause mortality was significantly reduced by 16% in the active leisure time physical activity group (hazard ratio 0.84 95% confidence interval 0.76–0.92). Both for all-cause and cardiovascular disease mortality, we observed a U-shaped relationship with occupational physical activity, as participants in the walking and lifting group had significantly lower mortality than both the mostly sedentary and the heavy manual labour group ( p 0.05). An increase in resting heart rate by one beat per minute was associated with a 1.1% increase in all-cause mortality (hazard ratio 1.011 95% confidence interval 1.009–1.013). The associations were similar in Sami and non-Sami subjects. In this population-based study, leisure time physical activity was inversely associated with all-cause mortality, whereas resting heart rate was positively associated with all-cause and cardiovascular disease mortality. There was a U-shaped association between occupational physical activity and cardiovascular disease and all-cause mortality.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2007
DOI: 10.1161/STROKEAHA.107.487264
Abstract: Background and Purpose— Ultrasound of carotid arteries provides measures of intima media thickness (IMT) and plaque, both widely used as surrogate measures of cardiovascular disease. Although IMT and plaques are highly intercorrelated, the relationship between carotid plaque and IMT and cardiovascular disease has been conflicting. In this prospective, population-based study, we measured carotid IMT, total plaque area, and plaque echogenicity as predictors for first-ever myocardial infarction (MI). Methods— IMT, total plaque area, and plaque echogenicity were measured in 6226 men and women aged 25 to 84 years with no previous MI. The subjects were followed for 6 years and incident MI was registered. Results— During follow-up, MI occurred in 6.6% of men and 3.0% of women. The adjusted relative risk (RR 95% CI) between the highest plaque area tertile versus no plaque was 1.56 (1.04 to 2.36) in men and 3.95 (2.16 to 7.19) in women. In women, there was a significant trend toward a higher MI risk with more echolucent plaque. The adjusted RR (95% CI) in the highest versus lowest IMT quartile was 1.73 (0.98 to 3.06) in men and 2.86 (1.07 to 7.65) in women. When we excluded bulb IMT from analyses, IMT did not predict MI in either sex. Conclusions— In a general population, carotid plaque area was a stronger predictor of first-ever MI than was IMT. Carotid atherosclerosis was a stronger risk factor for MI in women than in men. In women, the risk of MI increased with plaque echolucency.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
DOI: 10.1161/STROKEAHA.116.014377
Abstract: It is proposed that 20% to 40% of the decline in first-ever stroke incidence is attributed to the improvement of risk factor control. We estimated the impact of modifiable cardiovascular risk factors on the changing incidence of ischemic stroke (IS) between 1995 and 2012, using in idual person data from repeated surveys in a general population. The proportion of the IS incidence decline explained by change in each risk factor over time was estimated from 1995 to 2012 by Poisson regression among 26 329 participants who attended the fourth Tromsø survey in 1994 to 1995. Hazard ratios for IS were estimated with Cox proportional hazards regression among 27 936 participants who attended at least 1 of the Tromsø surveys in 1994 to 1995, 2001, or 2007 to 2008. Age- and sex-adjusted means or prevalences of risk factors over time were estimated by generalized estimating equations. There were 1226 first-ever IS during 367 636 person-years of follow-up. Changes in cardiovascular risk factors accounted for 57% of the decrease in IS incidence from 1995 to 2012. The most important contributors were decreasing mean systolic blood pressure and smoking prevalence, accounting for 26% and 17% of the observed decline, respectively. Conversely, increasing diabetes mellitus prevalence contributed negatively to the declining IS incidence. Changes in cardiovascular risk factors explained 57% of the decrease in IS incidence from 1995 to 2012. Reduction in systolic blood pressure and prevalence of smoking were the most important contributors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-11-2011
Publisher: BMJ
Date: 04-2022
DOI: 10.1136/OPENHRT-2021-001946
Abstract: Coffee raises serum cholesterol because of its diterpenes, cafestol and kahweol, and the effect varies by brewing method. Population-based research on espresso coffee’s impact on serum cholesterol is scarce. Our aim was to examine how various brewing methods, in particular espresso, were associated with serum total cholesterol (S-TC). We used cross-sectional population data from the seventh survey of the Tromsø Study in Northern Norway (N=21 083, age ≥40 years). Multivariable linear regression was used to assess the association between S-TC as the dependent variable and each level of coffee consumption using 0 cups as the reference level, adjusting for relevant covariates and testing for sex differences. Consumption of 3–5 cups of espresso daily was significantly associated with increased S-TC (0.09 mmol/L, 95% CI 0.01 to 0.17 for women and 0.16 mmol/L, 95% CI 0.07 to 0.24 for men), compared with participants drinking 0 cups of espresso per day. Consumption of ≥6 cups of boiled lunger coffee daily was also associated with increased S-TC (0.30 mmol/L, 95% CI 0.13 to 0.48 for women and 0.23 mmol/L, 95% CI 0.08 to 0.38 for men), compared with participants drinking 0 cups of boiled lunger coffee. Consumption of ≥6 cups of filtered coffee daily was associated with 0.11 mmol/L (95% CI 0.03 to 0.19) higher S-TC levels for women but not for men. Instant coffee consumption had a significant linear trend but showed no dose–response relationship when excluding participants not drinking instant coffee. There were significant sex differences for all coffee types except boiled lunger coffee. Espresso coffee consumption was associated with increased S-TC with significantly stronger association for men compared with women. Boiled lunger coffee was associated with increased S-TC in both sexes and with similar magnitude as shown in previous research. Filtered coffee was associated with a small increase in S-TC in women. Further research on espresso and S-TC is warranted.
Publisher: Oxford University Press (OUP)
Date: 12-04-2014
DOI: 10.1093/HMG/DDU175
Publisher: Oxford University Press (OUP)
Date: 17-04-2018
Abstract: Atrial fibrillation represents a substantial clinical and public health issue. The definitive impact of body mass index on prognosis of patients with chronic (persistent or permanent) atrial fibrillation remains undetermined. The purpose of this study was to investigate the association of body mass index with health outcomes (mortality and re-hospitalisation) of patients with chronic atrial fibrillation. Using data from the Standard versus Atrial Fibrillation spEcific managemenT strategY (SAFETY) trial (a randomised controlled trial of home-based, atrial fibrillation-specific disease management), we performed post-hoc analyses of mortality and re-hospitalisation outcomes during minimum 24-month follow-up according to baseline body mass index profile. Of 297 participants (mean age 71±11 years, 47% female, mean body mass index 29.6±6.7 kg/m 2 ), 35.0% of participants were overweight (body mass index 25.0–29.9 kg/m 2 ) and 43.1% were obese (body mass index≥30 kg/m 2 ). During follow-up, n=42 died including 16/65 (24.6%) classified as normal body mass index, 16/104 (15.4%) classified as overweight and 10/128 (7.8%) classified as obese. Increasing body mass index was not associated with increased mortality but was associated with re-hospitalisation due to cardiovascular disease with greater length-of-stay (odds ratio 1.05 95% confidence interval 1.00–1.09, p=0.032). Obese in iduals experienced increased unplanned admissions compared to overweight in iduals (incidence rate ratio 0.71 95% confidence interval 0.53–0.96, p=0.028), and increased cardiovascular-related (incidence rate ratio 0.58 95% confidence interval 0.39–0.86, p=0.007) and all-cause admissions (incidence rate ratio 0.63 95% confidence interval 0.45–0.89, p=0.008) compared to those classified as normal body mass index. Overweight and obesity were not associated with survival in patients with chronic atrial fibrillation but were associated with more frequent hospital care and prolonged stay.
Publisher: Oxford University Press (OUP)
Date: 18-07-2018
Publisher: Oxford University Press (OUP)
Date: 09-2022
Abstract: To study change over 8 years in cardiovascular risk, achievement of national guideline-based treatment targets of lipids, blood pressure (BP) and smoking in primary prevention of cardiovascular disease (CVD), medication use, and characteristics associated with target achievement among in iduals with high CVD risk in a general population. We followed 2524 women and men aged 40–79 years with high risk of CVD attending the population-based Tromsø study in 2007–08 (Tromsø6) to their participation in the next survey in 2015–16 (Tromsø7). We used descriptive statistics and regression models to study change in CVD risk and medication use, and characteristics associated with treatment target achievement. In total, 71.4% reported use of BP- and/or lipid-lowering medication at second screening. Overall, CVD risk decreased during follow-up, with a larger decrease among medication users compared with non-users. Treatment target achievement was 31.0% for total cholesterol & mmol/L, 27.3% for LDL cholesterol & mmol/L, 43.4% for BP & /90 (& /85 if diabetes) mmHg, and 85.4% for non-smoking. A total of 9.8% reached all treatment targets combined. Baseline risk factor levels and current medication use had the strongest associations with treatment target achievement. We found an overall improvement in CVD risk factors among high-risk in iduals over 8 years. However, guideline-based treatment target achievement was relatively low for all risk factors except smoking. Medication use was the strongest characteristic associated with achieving treatment targets. This study has demonstrated that primary prevention of CVD continues to remain a major challenge.
Publisher: BMJ
Date: 2022
DOI: 10.1136/OPENHRT-2021-001823
Abstract: Left atrial (LA) enlargement is an independent risk factor for atrial fibrillation (AF). Interestingly, some athletes have increased risk of AF, which may be linked to LA enlargement however, little is known about the relationship between LA enlargement and AF risk at moderate-level physical activity (PA). We aimed to explore the associations between PA, LA size and risk of incident AF, and if PA can attenuate the risk of AF with LA enlargement. This prospective study followed 2479 participants (52.4% female), free from known cardiac pathology, for median 20.2 years. Participants were followed up for hospital-diagnosed AF, confirmed by electrocardiography, from 1994-95 through 2016. At baseline, LA size was evaluated by anteroposterior LA diameter, and PA was self-reported by questionnaire. We observed a U-shaped relationship between PA and AF, and moderately active had 32% lower AF risk than inactive (HR adjusted 0.68, 95% CI 0.50 to 0.93). Participants with LA enlargement had 38% higher AF risk compared with participants with normal LA size (HR adjusted 1.38, 95% CI 1.12 to 1.69). However, the increased AF risk with LA enlargement was attenuated by PA compared with inactive participants with LA enlargement, the AF risk was 45% lower among active with LA enlargement (HR adjusted 0.55, 95% CI 0.39 to 0.79). AF risk in active participants with LA enlargement did not differ from active with normal LA size. These patterns were observed in both men and women, and in participants over/under 65 years. Moderate PA was associated with reduced AF risk, and PA attenuated the increased risk of AF with LA enlargement in both men and women and all age groups.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-04-2022
Abstract: Although myocardial infarction (MI) and atrial fibrillation (AF) are frequent comorbidities and share common cardiovascular risk factors, the direction and strength of the association of the risk factors with disease onset, subsequent disease incidence, and mortality are not completely understood. In pooled multivariable Cox regression analyses, we examined temporal relations of disease onset and identified predictors of MI, AF, and all‐cause mortality in 108 363 in iduals (median age, 46.0 years 48.2% men) free of MI and AF at baseline from 6 European population‐based cohorts. During a maximum follow‐up of 10.0 years, 3558 (3.3%) in iduals were diagnosed exclusively with MI, 1922 (1.8%) with AF but no MI, and 491 (0.5%) in iduals developed both MI and AF. Association of sex, systolic blood pressure, antihypertensive treatment, and diabetes appeared to be stronger with incident MI than with AF, whereas increasing age and body mass index showed a higher risk for incident AF. Total cholesterol and daily smoking were significantly related to incident MI but not AF. Combined population attributable fraction of cardiovascular risk factors was % for incident MI, whereas it was only 27% for AF. Subsequent MI after AF (hazard ratio [HR], 1.68 95% CI, 1.03–2.74) and subsequent AF after MI (HR, 1.75 95% CI, 1.31–2.34) both significantly increased overall mortality risk. We observed different associations of cardiovascular risk factors with both diseases indicating distinct pathophysiological pathways. Subsequent diagnoses of MI and AF significantly increased mortality risk.
Publisher: Springer Science and Business Media LLC
Date: 21-07-2006
DOI: 10.1007/S10654-006-9032-Y
Abstract: Haemoglobin level declines with increasing age in cross sectional studies. Little is known about the longitudinal changes of haemoglobin. Because both high or low haemoglobin levels increase mortality and morbidity we examined how changes in lifestyle factors like body mass index (BMI) and smoking habits influence cohort changes in haemoglobin level. In all, 4159 men aged 20-49 years at baseline were examined in 1974 and 1994-1995 in a longitudinal, population-based study from the municipality of Tromsø, Northern Norway. Mean haemoglobin was 148 g/l. There was no difference in mean haemoglobin after 20 years in any strata of age. Mean BMI increased 2.1 kg/m(2). The prevalence of smokers decreased 20.1 percentage points. In a multiple regression analysis increase in BMI was associated with increased haemoglobin change. Smoking cessation lowered mean haemoglobin 1.6 g/l compared to never smokers. Haemoglobin increased 0.8 g/l in smoking quitters whose BMI increased >2.5 kg/m(2) compared to a decrease of 6.7 g/l in weight reducers. There was a positive dose-response relationship between changes in cigarettes smoked per day and change in haemoglobin among consistent smokers. In conclusion, in contrast to cross sectional studies, mean haemoglobin did not change during 20 years ageing of relatively young men. This could be explained by higher BMI and less smoking. The increase in BMI affected haemoglobin change to such an extent that the reduction in haemoglobin due to smoking cessation was counteracted. Prospective studies are needed to address the health implications.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-01-2014
Abstract: Pulmonary embolism (PE) may trigger atrial fibrillation through increased right atrial pressure and subsequent atrial strain, but the degree of evidence is low. In this study, we wanted to investigate the impact of incident venous thromboembolism ( VTE ) on future risk of atrial fibrillation in a prospective population‐based study. The study included 29 974 subjects recruited from the T romsø study (1994–1995, 2001–2002, 2007–2008). Incident VTE and atrial fibrillation events were registered from date of enrolment to end of follow‐up, December 31, 2010. C ox proportional hazard regression models using age as time‐scale and VTE as a time‐dependent variable were used to estimate crude and multivariable hazard ratios ( HR s) for atrial fibrillation with 95% confidence intervals ( CI s). During 16 years of follow up, 540 (1.8%) subjects had an incident VTE event, and 1662 (5.54%) were diagnosed with atrial fibrillation. Among those with VTE , 50 (9.3%) developed subsequent atrial fibrillation. Patients with VTE had 63% higher risk of atrial fibrillation compared to subjects without VTE (multivariable‐adjusted HR : 1.63, 95% CI : 1.22 to 2.17). The risk of atrial fibrillation was particularly high during the first 6 months after the VTE event ( HR 4.00, 95% CI : 2.21 to 7.25) and among those with PE ( HR 1.78, 95% CI : 1.13 to 2.80). We found that incident VTE was associated with future risk of atrial fibrillation. Our findings support the hypothesis that PE may lead to cardiac dysfunctions that, in turn, could trigger atrial fibrillation.
Publisher: Wiley
Date: 04-1997
DOI: 10.1111/J.1600-0412.1997.TB07996.X
Abstract: To investigate the mortality from cancer of the corpus uteri in relation to parity and age at first and last birth. A cohort of 431,604 married women aged 45-74 years at the Norwegian Census in 1970 was followed over 15 years. A total of 752 deaths from cancer of the corpus uteri were diagnosed during follow-up. All age groups showed significant trends of decreasing mortality rates with increasing number of children. The age-adjusted reduction in mortality was 9.2% (95% CI 5.2-13.0) for each child. Women with 8-11 children had a relative risk of 0.35 (95% CI 0.14-0.85) compared to nulliparous women. For first birth at age > = 35 years versus < = 19 years, the relative risk was 0.53 (95% CI 0.34-0.83). No significant effect of age at last birth was found. This study supports the notion that high parity and postponing the first delivery may reduce the risk of uterine cancer death.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-11-2019
DOI: 10.1161/CIRCULATIONAHA.119.040267
Abstract: Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive rolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non–vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non–vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated.
Publisher: Norwegian Medical Association
Date: 2015
Publisher: S. Karger AG
Date: 13-08-2016
DOI: 10.1159/000447719
Abstract: b i Background: /i /b The aim of this study was to explore temporal trends in incidence and case fatality rates of intracerebral hemorrhage (ICH) over the last two decades in a Norwegian municipality. b i Methods: /i /b Incident cases of primary ICH were registered in the period from 1995 through 2012 in 32,530 participants of the longitudinal population-based Tromsø Study. Poisson regression models were used to obtain incidence rates over time in age- and sex-adjusted and age- and sex-specific models. Case fatality rates were calculated and age- and sex-adjusted trends over time were estimated using logistic regression. b i Results: /i /b A total of 226 ICHs were registered. The age- and sex-adjusted incidence rate [95% confidence interval (CI)] in the overall population was 0.42 (0.37-0.48) per 1,000 person-years. Age-adjusted incidence rates were 0.53 (0.43-0.62) in men and 0.33 (0.26-0.39) in women. In in iduals aged years, the age- and sex-adjusted incidence rate was 0.27 (0.22-0.32) and in in iduals aged ≥75 years, it was 2.42 (1.95-2.89) per 1,000 person-years. There was no significant change in incidence rates over time. The incidence rate ratio (95% CI) in the overall population was 0.73 (0.47-1.12) in 2012 compared with 1995. The overall 30-day case fatality (95% CI) was 23.9% (18.3-29.5) and did not change substantially over time [odds ratio in 2012 vs. 1995 = 0.83 (95% CI 0.27-2.52)]. b i Conclusion: /i /b No significant changes in incidence and case fatality rates of ICH were observed during the last two decades.
Publisher: Wiley
Date: 28-09-2017
DOI: 10.1111/ENE.13445
Abstract: Previous studies have shown associations between atrial fibrillation (AF) and cognitive decline. We investigated this association in a prospective population study, focusing on whether stroke risk factors modulated this association in stroke-free women and men. We included 4983 participants (57% women) from the fifth survey of the Tromsø Study (Tromsø 5, 2001), of whom 2491 also participated in the sixth survey (Tromsø 6, 2007-2008). Information about age, education, blood pressure, body mass index, lipids, smoking, coffee consumption, physical activity, depression, coronary and valvular heart disease, heart failure and diabetes was obtained at baseline. AF status was based on hospital records. The outcome was change in cognitive score from Tromsø 5 to Tromsø 6, measured by the verbal memory test, the digit-symbol coding test and the tapping test. Mean age at baseline was 65.4 years. The mean reduction in the tapping test scores was significantly larger in participants with AF (5.3 taps/10 s 95% CI: 3.9, 6.7) compared with those without AF (3.8 taps/10 s 95% CI: 3.5, 4.1). These estimates were unchanged when adjusted for other risk factors and were similar for both sexes. AF was not associated with change in the digit-symbol coding or the verbal memory tests. Atrial fibrillation in stroke-free participants was independently associated with cognitive decline as measured with the tapping test.
Publisher: BMJ
Date: 13-05-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-02-2018
Abstract: Atrial fibrillation ( AF ) is a well‐established risk factor for ischemic stroke ( IS ). Emerging evidence also indicates an association between AF and pulmonary embolism ( PE ). Because IS may potentially mediate the observed risk of PE in AF , we aimed to assess the impact of AF on the cause‐specific risks of PE and IS in a large cohort recruited from the general population. We observed 29 842 participants from 3 surveys of the Tromsø study (inclusion in 1994–1995, 2001–2002, and 2007–2008) to the end of 2012. Incident events of AF , IS, and PE during follow‐up were recorded, and information on potential confounders was obtained at baseline. Cox regression models, with AF as a time‐dependent variable, were used to calculate cause‐specific hazard ratios ( HR s) with 95% confidence intervals ( CI s) for PE and IS . There were 2067 participants diagnosed as having AF , 296 with PE and 1164 with IS, during a median of 17.6 years of follow‐up. The risks of PE ( HR, 10.88 95% CI , 6.23–18.89) and IS ( HR, 6.16 95% CI , 4.47–8.48) were substantially increased during the first 6 months after AF diagnosis, with crude incidence rates of 18.5 per 1000 person‐years for PE and 52.8 per 1000 person‐years for IS . The risk estimates remained elevated for both PE ( HR , 1.72 95% CI, 1.10–2.71) and IS ( HR, 2.45 95% CI, 2.05–2.92) throughout the study period. AF was associated with increased cause‐specific risks of both PE and IS . Our findings infer that the risk of PE in AF is not explained by intermediate IS .
Publisher: Springer Science and Business Media LLC
Date: 25-06-2002
Abstract: Students aged 13 and 14 y, in a region in northern Norway with high blood cholesterol levels and high mortality from coronary heart disease (CHD) in the adult population, were studied with respect to lifestyle, dietary habits, nutritional intake and blood lipids including fatty acids in serum. The students came from a coastal community with seawater fish as an important part of the traditional diet, and an inland community with meat from reindeer as a major constituent of the diet. To investigate whether the traditional diet was maintained among the adolescents and to evaluate the lifestyle and blood lipids. The study was followed up after 1 y. The adolescents from the coastal region did not maintain the traditional diet. In the inland region the students had a high intake of meat, probably reflecting the traditional food culture. The inland boys had higher mean body mass index (BMI) than the coastal boys, and 12% had BMI>28, as compared to none of the coastal boys. Other findings showed that the students had higher levels of blood cholesterol than in the south of Norway and several other countries (about 25% had total cholesterol >5.2 mmol/l), higher intake of dietary sugar and fat than the national recommendations and little intake of seawater fish with corresponding low levels of n-3 fatty acids. This did not change after 1 y of follow up. Some 10-20% reported daily smoking and 8-13% reported that they rarely or never did physical exercise. About 30% of the students presented no factors negatively related to development of cardiovascular disease. The findings demonstrate, in the majority of students at the age of 13 and 14 y, the appearance of factors contributing to development of cardiovascular disease (CHD). This study was supported by the program 'Medisinsk forskning i Finnmark, University of Tromsø'.
Publisher: MDPI AG
Date: 05-04-2021
DOI: 10.3390/JCM10071514
Abstract: The aim of this study was to explore sex-specific associations between systolic blood pressure (SBP), hypertension, and the risk of incident atrial fibrillation (AF) subtypes, including paroxysmal, persistent, and permanent AF, in a general population. A total of 13,137 women and 11,667 men who participated in the fourth survey of the Tromsø Study (1994–1995) were followed up for incident AF until the end of 2016. Cox proportional hazards regression analysis was conducted using fractional polynomials for SBP to provide sex- and AF-subtype-specific hazard ratios (HRs) for SBP. An SBP of 120 mmHg was used as the reference. Models were adjusted for other cardiovascular risk factors. Over a mean follow-up of 17.6 ± 6.6 years, incident AF occurred in 914 (7.0%) women (501 with paroxysmal ersistent AF and 413 with permanent AF) and 1104 (9.5%) men (606 with paroxysmal ersistent AF and 498 with permanent AF). In women, an SBP of 180 mmHg was associated with an HR of 2.10 (95% confidence interval [CI] 1.60–2.76) for paroxysmal ersistent AF and an HR of 1.80 (95% CI 1.33–2.44) for permanent AF. In men, an SBP of 180 mmHg was associated with an HR of 1.90 (95% CI 1.46–2.46) for paroxysmal ersistent AF, while there was no association with the risk of permanent AF. In conclusion, increasing SBP was associated with an increased risk of both paroxysmal ersistent AF and permanent AF in women, but only paroxysmal ersistent AF in men. Our findings highlight the importance of sex-specific risk stratification and optimizing blood pressure management for the prevention of AF subtypes in clinical practice.
Publisher: MDPI AG
Date: 02-01-2019
DOI: 10.3390/NU11010074
Abstract: The aim of this study was to determine if increased mortality associated with low levels of serum 25-hydroxyvitamin D (25(OH)D) reflects a causal relationship by using a Mendelian randomisation (MR) approach with genetic variants in the vitamin D synthesis pathway. In idual participant data from three European cohorts were harmonized with standardization of 25(OH)D according to the Vitamin D Standardization Program. Most relevant single nucleotide polymorphisms of the genes CYP2R1 (rs12794714, rs10741657) and DHCR7/NADSYN1 (rs12785878, rs11234027), were combined in two allelic scores. Cox proportional hazards regression models were used with the ratio estimator and the delta method for calculating the hazards ratio (HR) and standard error of genetically determined 25(OH)D effect on all-cause mortality. We included 10,501 participants (50.1% females, 67.1±10.1 years) of whom 4003 died during a median follow-up of 10.4 years. The observed adjusted HR for all-cause mortality per decrease in 25(OH)D by 20 nmol/L was 1.20 (95% CI: 1.15–1.25). The HR per 20 nmol/L decrease in genetically determined 25(OH)D was 1.32 (95% CI: 0.80–2.24) and 1.35 (95% CI of 0.81 to 2.37) based on the two scores. In conclusion, the results of this MR study in a combined s le from three European cohort studies provide further support for a causal relationship between vitamin D deficiency and increased all-cause mortality. However, as the current study, even with ~10,000 participants, was underpowered for the study of the effect of the allele score on mortality, larger studies on genetics and mortality are needed to improve the precision.
Publisher: Elsevier BV
Date: 12-2012
DOI: 10.1016/J.GENM.2012.09.001
Abstract: Inflammatory biomarkers are reported as risk factors for atrial fibrillation (AF), but their impact is uncertain. We investigated the associations between inflammatory biomarkers and future AF in a large general cohort. Available markers were white blood cells (WBCs) with subgroups, fibrinogen, high-sensitivity C-reactive protein (hs-CRP), and osteoprotegerin (OPG). A total of 6315 men and women from a population survey in Tromsø, Norway in 1994 to 1995 were followed for a mean of 10.9 years. Mean age at baseline was 60 years. Measurements of height, weight, blood pressure, heart rate, total cholesterol, high-density lipoprotein (HDL) cholesterol, WBC count, and information on diabetes, angina, myocardial infarction, and antihypertensive treatment, were obtained at baseline. Fibrinogen, hs-CRP, and OPG were obtained at a follow-up visit. The outcome measure was first-ever AF, documented on an electrocardiogram. The Cox proportional hazards regression model was used to estimate hazard ratios of AF. In the multivariable analysis, adjusted for traditional cardiovascular risk factors and other inflammatory biomarkers, hs-CRP was associated with AF in men only (hazard ratio = 1.14 for a 1 SD increase 95% CI, 1.02-1.28). There was a significant increase in AF across quartiles of WBCs in men (P = 0.007) and in the total study population (P = 0.004). OPG was associated with AF in patients free of coronary heart disease at baseline. Fibrinogen and subgroups of WBCs showed no significant association with AF. This population-based cohort study showed that hs-CRP was independently associated with AF in men, but apparently not in women, and that patients with WBCs in the upper quartile had increased risk of AF.
Publisher: Oxford University Press (OUP)
Date: 12-02-2019
Abstract: Primary prevention guidelines promote the use of risk assessment tools to estimate total cardiovascular risk. We aimed to study trends in cardiovascular risk and contribution of single risk factors, using the newly developed NORRISK 2 risk score, which estimates 10-year risk of fatal and non-fatal cardiovascular events. Prospective population-based study. We included women and men aged 45–74 years attending the sixth and seventh survey of the Tromsø Study (Tromsø 6, 2007–2008, n = 7284 and Tromsø 7, 2015–2016, n = 14,858) to study secular trends in NORRISK 2 score. To study longitudinal trends, we followed participants born 1941–1962 attending both surveys ( n = 4534). We calculated NORRISK 2 score and used linear regression models to study the relative contribution (% R 2 ) of each single risk factor to the total score. Mean NORRISK 2 score decreased and distribution in risk categories moved from higher to lower risk in both sexes and all age-groups between the first and second surveys ( p 0.001). In birth cohorts, when age was set to baseline in NORRISK 2 calculations, risk score decreased during follow-up. Main contributors to NORRISK 2 were systolic blood pressure, smoking and total cholesterol, with some sex, age and birth cohort differences. We found significant favourable secular and longitudinal trends in total cardiovascular risk and single risk factors during the last decade. Change in systolic blood pressure, smoking and cholesterol were the main contributors to risk score change however, the impact of single risk factors on the total score differed by sex, age and birth cohort.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2018
Abstract: Atrial fibrillation ( AF ) prevalence is increasing, and body mass index ( BMI ) is a risk factor for AF . However, sex differences in the impact of BMI on AF risk have not been fully elucidated. Data from the fourth survey (1994–1995) of the Tromsø Study (Norway) were used to investigate the association of single‐measurement BMI on future AF risk. To analyze the influence of BMI changes on AF risk, data from in iduals who attended the third and fourth study surveys were used. AF diagnosis was derived from record linkage and end point adjudication. Cox regression analysis was conducted using fractional polynomials of BMI and BMI change with models adjusted for age, baseline BMI (change analyses), risk factors, comorbidities, and antihypertensive medications. Data were available for 24 799 in iduals from the fourth survey (mean age, 45.5±14.2 years 52.9% women). Over 15.7±5.5 years, 811 women (6.2%) and 918 men (7.9%) developed AF . In men, lower BMI decreased AF risk and higher BMI increased risk (hazard ratios [95% confidence intervals] for BMI 18 or 40 kg/m 2 compared with 23 kg/m 2 were 0.75 [0.70–0.81] and 4.42 [3.00–6.53], respectively). The same pattern was identified in women. Two surveys were attended by 14 652 in iduals. In men and women, a decrease in BMI over time was associated with decreased AF risk and an increase in BMI was associated with increased AF risk. Within a population cohort, BMI was positively associated with AF risk. Change in BMI over time influenced AF risk in both men and women.
Publisher: MDPI AG
Date: 08-06-2023
Abstract: Background: The study’s purpose was to evaluate the performance of a five-type HPV mRNA test to predict cervical intraepithelial neoplasia grade 3 or worse (CIN3+) during up to 12 years of follow-up. Methods: Overall, 19,153 women were recruited by gynecologists and general practitioners in different parts of Norway between 2003 and 2004. The study population comprised 9582 women of these women, aged 25–69 years with normal cytology and a valid five-type HPV mRNA test at baseline. Follow-up for CIN3+ through 2015 was conducted in the Norwegian Cervical Cancer Screening Programme. Results: The cumulative incidence of CIN3+ by baseline status for HPV mRNA-positive and mRNA-negative women were 20.8% and 1.1%, respectively (p 0.001). Age did not affect the long-term ability of the HPV mRNA test to predict CIN3+ during follow-up. Conclusion: The low long-term risk of CIN3+ among HPV mRNA-negative women and the high long-term risk among HPV mRNA-positive women strengthen the evidence that the five-type HPV mRNA test is an appropriate screening test for women of all ages. Our findings suggest that women with a negative result may extend the screening interval up to 10 years.
Publisher: Oxford University Press (OUP)
Date: 04-11-2016
Publisher: Springer Science and Business Media LLC
Date: 18-09-2007
DOI: 10.1007/S10654-007-9165-7
Abstract: Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.1 million participants from 104 prospective population-based studies, in which subsets have information on lipid and inflammatory markers, other characteristics, as well as major cardiovascular morbidity and cause-specific mortality. Information on repeat measurements on relevant characteristics has been collected in approximately 340,000 participants to enable estimation of and correction for within-person variability. Re-analysis of in idual data will yield up to approximately 69,000 incident fatal or nonfatal first ever major cardiovascular outcomes recorded during about 11.7 million person years at risk. The primary analyses will involve age-specific regression models in people without known baseline cardiovascular disease in relation to fatal or nonfatal first ever coronary heart disease outcomes. This initiative will characterize more precisely and in greater detail than has previously been possible the shape and strength of the age- and sex-specific associations of several lipid and inflammatory markers with incident coronary heart disease outcomes (and, secondarily, with other incident cardiovascular outcomes) under a wide range of circumstances. It will, therefore, help to determine to what extent such associations are independent from possible confounding factors and to what extent such markers (separately and in combination) provide incremental predictive value.
Publisher: Public Library of Science (PLoS)
Date: 23-05-2012
Publisher: Oxford University Press (OUP)
Date: 21-06-2017
Publisher: SAGE Publications
Date: 30-07-2018
Abstract: Studies on the relationship between temporal trends in risk factors and incidence rates of intracerebral hemorrhage are scarce. To analyze temporal trends in risk factors and incidence rates of intracerebral hemorrhage using in idual data from a population-based study. We included 28,167 participants of the Tromsø Study enrolled between 1994 and 2008. First-ever intracerebral hemorrhages were registered through 31 December 2013. Hazard ratios (HRs) for intracerebral hemorrhage were analyzed by Cox proportional hazards models, risk factor levels over time by generalized estimating equations, and incidence rate ratios (IRR) by Poisson regression. We registered 219 intracerebral hemorrhages. Age, male sex, systolic blood pressure (BP), diastolic BP, and hypertension were associated with intracerebral hemorrhage. Hypertension was more strongly associated with non-lobar intracerebral hemorrhage (HR 5.08, 95% CI 2.86–9.01) than lobar intracerebral hemorrhage (HR 1.91, 95% CI 1.12–3.25). In women, incidence decreased significantly (IRR 0.46, 95% CI 0.23–0.90), driven by a decrease in non-lobar intracerebral hemorrhage. Incidence rates in men remained stable (IRR 1.27, 95% CI 0.69–2.31). BP levels were lower and decreased more steeply in women than in men. The majority with hypertension were untreated, and a high proportion of those treated did not reach treatment goals. We observed a significant decrease in intracerebral hemorrhage incidence in women, but not in men. A steeper BP decrease in women may have contributed to the erging trends. The high proportion of untreated and sub-optimally treated hypertension calls for improved strategies for prevention of intracerebral hemorrhage.
Publisher: BMJ
Date: 04-1992
Abstract: The aim was to investigate the associations between physical fitness, leisure physical activity, and coronary risk factors. This was a cross sectional study of a random s le of men and women, following a population survey. The municipality of Tromsø, Norway in 1986-1987. All men born 1925-1966 and all women born 1930-1966 were invited to the survey 21,826 subjects attended (81% of the eligible population): of these, 297 men and 312 women, randomly selected, attended the present study (attendance rates 94% in men and 89% in women). Fitness was tested by bicycle ergometry. Physical activity was reported on a questionnaire. Multiple regression analysis was performed with fitness and leisure activity as dependent variables, and coronary risk factors as independent variables. Fitness and leisure activity were positively related (p less than 0.05). Prominent findings for fitness were negative associations with age and smoking (p less than 0.05), and positive associations with body mass index in both sexes (p less than 0.01). HDL cholesterol and systolic blood pressure were significant predictors of fitness in men (p less than 0.01). Smoking emerged as a strong negative predictor for leisure activity in women (p less than 0.01), and a negative relation between leisure activity and total cholesterol was found in men (p less than 0.01). The study indicates that coronary risk factors are more closely linked to physical fitness than to leisure physical activity.
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1038/KI.2013.470
Abstract: A reduced glomerular filtration rate (GFR) in chronic kidney disease is a risk factor for cardiovascular disease. However, evidence indicates that a high GFR may also be a cardiovascular risk factor. This issue remains unresolved due to a lack of longitudinal studies of manifest cardiovascular disease with precise GFR measurements. Here, we performed a cross-sectional study of the relationship between high GFR measured as iohexol clearance and subclinical cardiovascular disease in the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6), a representative s le of the middle-aged general population. A total of 1521 persons without cardiovascular disease, chronic kidney disease, diabetes, or micro- or macroalbuminuria were examined with carotid ultrasonography and electrocardiography. The GFR in the highest quartile was associated with an increased odds ratio of having total carotid plaque area greater than the median of non-zero values (odds ratio 1.56, 95% confidence interval 1.02-2.39) or electrocardiographic signs of left ventricular hypertrophy (odds ratio 1.62, 95% confidence interval 1.10-2.38) compared to the lowest quartile. The analyses were adjusted for cardiovascular risk factors, urinary albumin excretion, and fasting serum glucose. Thus, high GFR is associated with carotid atherosclerosis and left ventricular hypertrophy and should be investigated as a possible risk factor for manifest cardiovascular disease in longitudinal studies.
Publisher: Oxford University Press (OUP)
Date: 25-07-2023
Abstract: There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.
Publisher: Wiley
Date: 11-06-2022
DOI: 10.1111/ADD.15950
Abstract: To (i) define the characteristics of snus users compared with non-users and smokers and (ii) define the relationship between snus use and self-reported anxiety and depression and compare it with the relation between smoking and anxiety and depression. A cross-sectional study based on data from the Norwegian population-based survey, the Tromsø Study (2015-16). A total of 32 591 people aged 40 years and older in the municipality of Tromsø were invited to attend. There were 21 083 respondents, giving a 65% attendance rate. Tobacco use was assessed by current and previous use of snus or cigarettes. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Snus users were more often male, were younger and had higher income and higher alcohol consumption than smokers and non-users of snus. In a linear regression analysis, we found no significant association between current snus use and anxiety and depression after adjusting for background variables. However, there was a positive association between previous snus use and anxiety among males [adjusted beta = 0.258 99% confidence interval (CI) = 0.023-0.492]. Regarding anxiety, the adjusted beta-coefficients for current smoking were 0.425 (99% CI = 0.184-0.666) for females and 0.303 (99% CI = 0.084-0.522) for males. Concerning depression, the adjusted beta coefficients for current smoking were 0.569 (99% CI = 0.358-0.780) for females and 0.281 (99% CI = 0.060-0.503) for males. In Norway, current snus users differ from current smokers by having a higher socio-economic status and no detectable association with anxiety and depression. This suggests that the relationship between tobacco use and anxiety and depression is associated with the administration method.
Publisher: BMJ
Date: 2018
Publisher: Informa UK Limited
Date: 06-2016
DOI: 10.2147/COPD.S108046
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2011
DOI: 10.1161/STROKEAHA.110.589754
Abstract: Carotid plaque and intima-media thickness (IMT) are recognized as risk factors for ischemic stroke, but their predictive value has been debated and varies between studies. The purpose of this longitudinal population-based study was to assess the risk of ischemic stroke associated with plaque area and IMT in the carotid artery. IMT and total plaque area in the right carotid artery were measured with ultrasound in 3240 men and 3344 women aged 25 to 84 years who participated in a population health study in 1994 to 1995. First-ever ischemic strokes were identified through linkage to hospital and national diagnosis registries, with follow-up until December 31, 2005. Incident ischemic strokes occurred in 7.3% (n=235) of men and 4.8% (n=162) of women. The hazard ratio for 1 SD increase in square-root-transformed plaque area was 1.23 (95% CI, 1.09–1.38 P =0.0009) in men and 1.19 (95% CI, 1.01–1.41 P =0.04) in women when adjusted for other cardiovascular risk factors. The multivariable-adjusted hazard ratio in the highest quartile of plaque area versus no plaque was 1.73 (95% CI, 1.19–2.52 P =0.004) in men and 1.62 (95% CI, 1.04–2.53 P =0.03) in women. The multivariable-adjusted hazard ratio for 1 SD increase in IMT was 1.08 (95% CI, 0.95–1.22 P =0.2) in men and 1.24 (95% CI, 1.05–1.48 P =0.01) in women. There were no differences in stroke risk across quartiles of IMT in multivariable analysis. In the present study, total plaque area appears to be a stronger predictor than IMT for first-ever ischemic stroke.
Publisher: Norwegian Medical Association
Date: 2012
Publisher: Wiley
Date: 05-2005
DOI: 10.1111/J.1600-0609.2004.00392.X
Abstract: To examine the gender-specific distribution of haemoglobin (Hb) and the World Health Organization (WHO) criteria for anaemia compared with the 2.5 percentile for Hb. A population-based study from Tromsø, Northern Norway. All inhabitants above 24 yr were invited. In total, 26 530 (75%) had their Hb analysed. The 2.5-97.5 percentile of Hb was 129-166 and 114-152 g/L for all men and women, respectively. In men, mean Hb decreased from 148 to 137 g/L between 55-64 and 85+ yr. In women, mean Hb increased from 132 to 137 g/L between 35-44 and 65-74 yr and then decreased to 131 g/L among the oldest. Using the WHO criteria for anaemia (Hb: <130 and <120 g/L, men and women respectively), the prevalence of anaemia in men increased with age from 0.6% aged 25-34 to 29.6% aged 85+. For women, the prevalence of anaemia varied from 9.1%, 2.2% and 16.5% in the age groups of 35-44, 55-64 and 85+ yr, respectively. The WHO criteria gave a two to three times higher prevalence of anaemia compared with the 2.5 percentile of Hb in women, but the difference was small in men. Poor self-rated health was not associated with low values of Hb in women. In men, there was an association in some age groups. The WHO criteria for anaemia and the 2.5 percentile for Hb corresponded well for men, but not for women. The WHO criteria of anaemia may result in medicalization of healthy women.
Publisher: Oxford University Press (OUP)
Date: 28-02-2018
Abstract: Background: Secondary prevention guidelines after myocardial infarction (MI) are gender neutral, but underutilisation of treatment in women has been reported. Design: We investigated the change in total and low-density lipoprotein (LDL) cholesterol levels and lipid-lowering drug (LLD) use after first-ever MI in a population-based study. Methods: We followed 10,005 participants (54% women) attending the Tromsø Study 1994–1995 and 8483 participants (55% women) attending the Tromsø Study 2007–2008 for first-ever MI up to their participation in 2007–2008 and 2015–2016, respectively. We used linear and logistic regression models to investigate sex differences in change in lipid levels. Results: A total of 395 (MI cohort I) and 132 participants (MI cohort II) had a first-ever MI during 1994–2008 and 2007–2013, respectively. Mean change in total cholesterol was −2.34 mmol/L (SD 1.15) in MI cohort I, and in LDL cholesterol was −1.63 mmol/L (SD 1.12) in MI cohort II. Men had a larger decrease in lipid levels compared to women: the linear regression coefficient for change was −0.33 (95% confidence interval [CI] −0.51 to −0.14) for total cholesterol and −0.21 (95% CI −0.37 to −0.04) for LDL cholesterol, adjusted for baseline lipid value, age and cohort. Men had 73% higher odds (95% CI 1.15−2.61) of treatment target achievement compared to women, adjusted for baseline lipid value, age and cohort. LLD use was reported in 85% of women and 92% of men in MI cohort I, and 80% in women and 89% in men in MI cohort II. Conclusions: Compared to men, women had significantly less decrease in lipid levels after MI, and a smaller proportion of women achieved the treatment target.
Publisher: Springer Science and Business Media LLC
Date: 03-12-2009
DOI: 10.1007/S00198-009-1131-7
Abstract: In this longitudinal study of 5,286 persons, men with anemia had a 2.15 higher risk of non-vertebral fractures than men with high hemoglobin levels. Women with anemia had no increased fracture risk. Low hemoglobin levels are associated with several risk factors for fractures such as low physical function, impaired cognition, and low bone mass. The aim of this population-based, prospective study was to examine whether anemia predicts non-vertebral fractures. A total of 5,286 inhabitants from the municipality of Tromsø, Norway (2,511 men and 2,775 women), 55-74 years old at baseline, were followed for mean 8.3 years. Measurements of hemoglobin, mean corpuscular volume, height, weight, blood pressure, blood lipids, serum creatinine, and bone mineral density and questionnaire information concerning smoking and drinking habits, physical activity, prevalent diseases, and use of medication was collected before start of follow-up. Non-vertebral fractures were registered during follow-up. A total of 235 men and 641 women sustained a new non-vertebral fracture. One SD lower value of hemoglobin was associated with a 1.27 higher risk of fracture in men (p < 0.001, after multiple adjustments) and 1.08 (p = 0.07) in women. Men with anemia (hemoglobin levels <13 g/dL) had a 2.15 higher risk of non-vertebral fractures than men with high levels (15.2-18.8, g/dL) whereas women with anemia (hemoglobin levels <12 g/dL) had no increased fracture risk. Anemia is associated with non-vertebral fractures in men but not in women.
Publisher: Norwegian Medical Association
Date: 2010
Abstract: In the western world, cardiovascular disease is the leading cause of death for both sexes. These diseases show substantial differences between the sexes with respect to epidemiology, biology and clinical aspects. In recent years, more attention has been directed towards sex differences in pharmacological effects. Although both sexes are included in most pharmacological trials, the proportion of women is often too low to enable sex-specific analyses.
Publisher: Oxford University Press (OUP)
Date: 04-01-2023
Abstract: To identify robust circulating predictors for incident atrial fibrillation (AF) using classical regressions and machine learning (ML) techniques within a broad spectrum of candidate variables. In pooled European community cohorts (n = 42 280 in iduals), 14 routinely available biomarkers mirroring distinct pathophysiological pathways including lipids, inflammation, renal, and myocardium-specific markers (N-terminal pro B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin I [hsTnI]) were examined in relation to incident AF using Cox regressions and distinct ML methods. Of 42 280 in iduals (21 843 women [51.7%] median [interquartile range, IQR] age, 52.2 [42.7, 62.0] years), 1496 (3.5%) developed AF during a median follow-up time of 5.7 years. In multivariable-adjusted Cox-regression analysis, NT-proBNP was the strongest circulating predictor of incident AF [hazard ratio (HR) per standard deviation (SD), 1.93 (95% CI, 1.82–2.04) P & 0.001]. Further, hsTnI [HR per SD, 1.18 (95% CI, 1.13–1.22) P & 0.001], cystatin C [HR per SD, 1.16 (95% CI, 1.10–1.23) P & 0.001], and C-reactive protein [HR per SD, 1.08 (95% CI, 1.02–1.14) P = 0.012] correlated positively with incident AF. Applying various ML techniques, a high inter-method consistency of selected candidate variables was observed. NT-proBNP was identified as the blood-based marker with the highest predictive value for incident AF. Relevant clinical predictors were age, the use of antihypertensive medication, and body mass index. Using different variable selection procedures including ML methods, NT-proBNP consistently remained the strongest blood-based predictor of incident AF and ranked before classical cardiovascular risk factors. The clinical benefit of these findings for identifying at-risk in iduals for targeted AF screening needs to be elucidated and tested prospectively.
Publisher: Informa UK Limited
Date: 07-06-2010
DOI: 10.3109/14017431.2010.483612
Abstract: To develop a cardiovascular risk model simulating different clinical settings using a staged approach. Using data from 27,477 men and women from the Norwegian Tromsø Study in 1986-1987 and 1994-1995, Cox regression models for either myocardial infarction (MI) or stroke combined with a similar model for the competing event a risk model that assess ten-year risk of MI and stroke was developed. Explanatory variables (questions, simple examinations and blood s les) were added gradually. The model was validated using Hosmer-Lemeshow test, the Brier score, c-index, integrated discrimination improvement (IDI) and Net Reclassification Improvement (NRI). In total, 1,298 events of MI and 769 events of stroke were registered. For MI the model showed excellent discrimination in each step with c-index from 0.833 to 0.946. For stroke the c-index ranged between 0.817 and 0.898. IDI showed significant increases in discrimination. The Brier scores and goodness of fit test showed well calibrated models in all steps for all sex- and end-point specific models (p>0.05). Although the predictive and discriminative ability of the models increased with each step, even the simplest model containing only data from questions or blood s les alone yielded valid estimates of cardiovascular risk.
Publisher: American Medical Association (AMA)
Date: 12-02-2001
DOI: 10.1001/ARCHINTE.161.3.466
Abstract: Obesity is a risk factor for a number of chronic diseases. Few longitudinal studies have examined changes in body mass index (BMI [calculated as weight in kilograms ided by the square of the height in meters]). To investigate the changes in mean BMI and the prevalence of obesity in a large cohort examined several times during a 20-year period. Mean BMI, the percentage of subjects with low BMI ( or =30 kg/m(2)) were determined in a large population of men and women who were examined up to 4 times during a 20-year period (1974-1994/1995). In a longitudinal design, we observed 3541 men who attended all 4 screenings (1974-1994/1995) and 4993 women who attended the last 3 screenings (1979/1980-1994/1995). The age- (25-49 years) and sex-adjusted mean BMI increased 1 kg/m(2) in men from 1974 to 1994/1995 and 0.9 kg/m(2)in women from 1979/1980 to 1994/1995. In the last survey, subjects aged 25 to 85 years were included. In most age groups, the mean BMI exceeded 25 kg/m(2) and the prevalence of obesity was 10% or higher in men and women aged 45 years or older. In the longitudinal analysis, the mean BMI in men aged 20 to 49 years increased 2.0 kg/m(2) during 20 years of observation and increased 2.4 kg/m(2)in women aged 20 to 49 years during 15 years of observation. The increase in BMI was larger in younger men than in older men. Body mass index increased in every examined birth cohort (1925-1964) during the 15- to 20-year observation period. Primary prevention of further increased body weight should be a priority.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-07-2023
Abstract: The atherosclerotic effect of an adverse lipid profile is assumed to accumulate throughout life, leading to increased risk of myocardial infarction (MI). Still, little is known about age at onset and duration of unfavorable lipid levels before MI. Longitudinal data on serum lipid levels for 26 130 in iduals (50.5% women, aged 20–89 years) were obtained from 7 population‐based health surveys in Tromsø, Norway. Diagnoses of MI were obtained from national registers. A linear mixed model was applied to compare age‐ and sex‐specific mean values of total cholesterol, high‐density lipoprotein cholesterol (HDL‐C), and triglyceride concentration by MI status (MI versus non‐MI). Already from young adulthood, 20 to 35 years before the incident MI, in iduals with a subsequent incident MI had on average more adverse lipid levels than in iduals of the same age and sex without MI. Analogous to a dose–response relationship, there was a clear trend toward more severe adverse lipid levels the lower the age at incident MI ( P .001, test for trend through ordered categories , 55–74, ≥75 years). This trend was particularly pronounced for high‐density lipoprotein cholesterol in percentage of total cholesterol (both sexes) and for the relative relationship between triglyceride, high‐density lipoprotein cholesterol, and total cholesterol level (women). The difference in mean lipid level by MI status was just as large in women as in men, but the age pattern differed ( P ≤0.05, tests of 3‐way interaction). Compared with general population mean levels, adverse lipid levels were seen 20 to 35 years before the incident MI in both men and women.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2015
DOI: 10.1161/HYPERTENSIONAHA.115.05925
Abstract: High blood pressure is a modifiable risk factor for cardiovascular disease. Previous studies showing a blood pressure decline in recent decades lack data to follow in iduals born in different decades from early and middle adulthood to older age. We investigated changes in age-specific blood pressure by repeated measurements in 37973 women and men born 1905 to 1977 (aged 20–89 years) examined ≤5× between 1979 and 2008 in the population-based Tromsø Study. Mixed models were used to estimate time trends. Mean systolic and diastolic blood pressure decreased from 1979 to 2008 in both genders in the age groups 30 to 89 years. The decrease was similar in the 80th percentile and the 20th percentile of the population blood pressure distribution. The decrease in systolic blood pressure in age group 40 to 49 years was 10.6 mm Hg in women and 4.5 mm Hg in men. Systolic blood pressure increased with age in women and men born 1920 to 1949, whereas a decrease or flattening of curve was observed in the younger birth cohorts. Thus, we found both time periodic and cohort effects, and trends were more pronounced in women than in men. The findings suggest changes in blood pressure in the population rather than an effect of treatment of high-risk in iduals.
Publisher: Informa UK Limited
Date: 10-01-2014
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1111/JTH.15812
Abstract: Myocardial infarction (MI) is associated with an increased risk of venous thromboembolism (VTE). Obesity is a recognized risk factor for both MI and VTE. Whether obesity further increases the risk of VTE in MI patients is scarcely investigated. To study the joint effect of MI and obesity on the risk of VTE. Study participants (n = 29 410) were recruited from three surveys of the Tromsø Study (conducted in 1994-1995, 2001, and 2007-2008) and followed up through 2014. All incident MI and VTE cases during follow-up were recorded. Cox regression models with MI as a time-dependent variable were used to estimate hazard ratios (HRs) of VTE (adjusted for age and sex) by combinations of MI exposure and obesity status. Joint effects were assessed by calculating relative excess risk and attributable proportion (AP) due to interaction. During a median of 19.6 years of follow-up, 2090 study participants experienced an MI and 784 experienced a VTE. Among those with MI, 55 developed a subsequent VTE, yielding an overall incidence rate (IR) of VTE of 5.3 per 1000 person-years (95% confidence interval [CI]: 4.1-6.9). In the combined exposure group (MI+/Obesity+), the IR was 11.3 per 1000 person-years, and the adjusted HR indicated a 3-fold increased risk of VTE (HR 3.16, 95% CI: 1.99-4.99) compared to the reference group (MI-/Obesity-). The corresponding AP was 0.46 (95% CI: 0.17-0.74). The combination of MI and obesity yielded a supra-additive effect on VTE risk of which 46% of the VTE events were attributed to the interaction.
Publisher: Oxford University Press (OUP)
Date: 12-12-2019
Abstract: European guidelines on cardiovascular prevention in clinical practice were first published in 1994 and have been regularly updated, most recently in 2016, by the Sixth European Joint Task Force. Given the amount of new information that has become available since then, components from the task force and experts from the European Association of Preventive Cardiology of the European Society of Cardiology were invited to provide a summary and critical review of the most important new studies and evidence since the latest guidelines were published. The structure of the document follows that of the previous document and has six parts: Introduction (epidemiology and cost effectiveness) Cardiovascular risk How to intervene at the population level How to intervene at the in idual level Disease-specific interventions and Settings: where to intervene? In fact, in keeping with the guidelines, greater emphasis has been put on a population-based approach and on disease-specific interventions, avoiding re-interpretation of information already and previously considered. Finally, the presence of several gaps in the knowledge is highlighted.
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1016/J.ATHEROSCLEROSIS.2017.04.009
Abstract: Overall, men have roughly twice the risk of myocardial infarction (MI) compared to women, but what causes this contrast is unclear. Identification of subgroups where the gender contrast in risk is particularly low or high, may provide new insight. In the search for such subgroups, we focus on gender-specific effects of established coronary heart disease (CHD) risk factors. Heterogeneity across age groups is also explored. Population-based prospective study from Tromsø, Norway, comprising 33,859 in iduals (51% women) 2746 in iduals (854 women) received a diagnosis of MI during follow-up at ages 35-94 years. Incidence rate ratios (IRR) were calculated as estimates of relative risk in Poisson regression analyses. The association between total cholesterol and risk of MI was stronger for men than women, and IRR for men vs. women accordingly increased with increasing cholesterol, but the risk was higher for men in all subgroups (IRR in range 1.63-3.27), except among older people with low cholesterol levels. The adverse effect of increasing blood pressure (BP) was stronger for women, and IRR for gender diminished with increasing systolic (from 3.90 to 1.38) and diastolic BP (from 2.87 to 1.54). The gender contrast in risk was also substantially reduced in smokers ≥75 years. Associations with high-density lipoprotein cholesterol (HDL-C) did not differ between genders. Gender heterogeneity in associations with total cholesterol but not HDL-C indicates gender differences in associations with non-HDL-C. The stronger association with BP in women may relate to more severe hypertension-induced left ventricular hypertrophy.
Publisher: Elsevier BV
Date: 06-2010
Publisher: Oxford University Press (OUP)
Date: 14-10-2022
Abstract: To explore sex-specific time trends in atrial fibrillation (AF) incidence and to estimate the impact of changes in risk factor levels using in idual participant-level data from the population-based Tromsø Study 1994–2016. A total of 14 818 women and 13 225 men aged 25 years or older without AF were enrolled in the Tromsø Study between 1994 and 2008 and followed up for incident AF throughout 2016. Poisson regression was used for statistical analyses. During follow-up, age-adjusted AF incidence rates in women decreased from 1.19 to 0.71 per 1000 person-years. In men, AF incidence increased from 1.18 to 2.82 per 1000 person-years in 2004, and then declined to 1.94 per 1000 person-years in 2016. Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), physical activity, smoking and alcohol consumption together accounted for 10.9% [95% confidence interval (CI): −2.4 to 28.6] of the AF incidence decline in women and for 44.7% (95% CI: 19.2 100.0) of the AF incidence increase in men. Reduction in SBP and DBP had the largest contribution to the decrease in AF incidence in women. Increase in BMI had the largest contribution to the increase in AF incidence in men. In the population-based Tromsø Study 1994–2016, AF incidence decreased in women and increased following a reverse U-shape in men. In idual changes in SBP and DBP in women and in idual changes in BMI in men were the most important risk factors contributing to the AF incidence trends.
Publisher: Oxford University Press (OUP)
Date: 23-05-2016
Publisher: BMJ
Date: 09-2016
Publisher: Oxford University Press (OUP)
Date: 19-10-2018
Abstract: Unrecognized myocardial infarction (MI) is a frequent and intriguing entity associated with a similar risk of death as recognized MI. Previous studies have not fully addressed whether the poor prognosis is explained by traditional cardiovascular risk factors. We investigated whether electrocardiographically detected unrecognized MI was independently associated with cardiovascular events and death and whether it improved prediction for future MI in a general population. Prospective cohort study. We studied 5686 women and men without clinically recognized MI at baseline in 2007–2008. We assessed the risk of future MI, stroke and all-cause mortality in persons with unrecognized MI compared with persons with no MI during 31,051 person-years of follow-up. In the unadjusted analyses, unrecognized MI was associated with increased risk of future recognized MI (hazard ratio 1.84, 95% confidence interval (CI) 1.15–2.96) and all-cause mortality (hazard ratio 1.78, 95% CI 1.21–2.61), but not stroke (hazard ratio 1.09, 95% CI 0.56–2.17). The associations did not remain significant after adjustment for traditional risk factors (hazard ratio 1.25, 95% CI 0.76–2.06 and hazard ratio 1.38, 95% CI 0.93–2.05) for MI and all-cause mortality respectively. Unrecognized MI did not improve risk prediction for future recognized MI using the Framingham Risk Score ( p = 0.96) or the European Systematic COronary Risk Evaluation ( p = 0.65). There was no significant sex interaction regarding any of the endpoints. Electrocardiographic unrecognized MI was not significantly associated with future risk of MI, stroke or all-cause mortality in the general population after adjustment for the traditional cardiovascular risk factors, and it did not improve prediction of future MI.
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/00365510600863895
Abstract: The prognostic value of haemoglobin within normal references is seldom emphasized. The relationship between haemoglobin and mortality has been questioned because of the possible confounding of other risk factors. We investigated whether there was a curve linear relationship between haemoglobin and total mortality, and evaluated the possible modifying effects of smoking, body mass index, total cholesterol and systolic blood pressure. In all, 6541 men aged between 20 and 49 years were examined in 1974 in a prospective, population-based study from the municipality of Tromsø, Northern Norway. During 20 years of follow-up (127 120 person-years), 495 deaths were identified. We found a U-shaped relationship between quintiles of haemoglobin and total mortality. Among the 35-49 years group, the multiple adjusted hazard ratios (95% CI) were 1.83 (1.31-2.57) in quintile 1 and 1.72 (1.23-2.41) in quintile 5, compared to quintile 3 of haemoglobin. Compared to the age-adjusted hazard ratios, the multiple adjustments tended to non-significantly enhance the association in the lowest quintiles and non-significantly attenuate the association in the highest quintiles. The relationship was most pronounced in smokers in a dose-response manner, but also present in non-smokers. High and low haemoglobin levels have an independent prognostic effect on mortality, although a possible effect of residual confounding cannot be ruled out. Smokers in quintile 1 and quintile 5 of haemoglobin were at increased risk of dying.
Publisher: MDPI AG
Date: 07-02-2023
DOI: 10.20944/PREPRINTS202302.0117.V1
Abstract: Machine Learning (ML) methods have become important to enhance the performance of decision-support predictive models. However, class imbalance is one of the main challenges for developing ML models, because it limits the generalization of these models, and biases the learning algorithms. In this paper, we consider overs ling methods for generating synthetic categorical clinical data aiming to improve the predictive performance in ML models, and the identification of risk factors for cardiovascular diseases (CVDs). We performed a comparative study of several categorical synthetic data generation methods, including Generative Adversarial Networks (GANs). Then, we assessed the impact of combining overs ling strategies and linear and nonlinear supervised ML methods. Lastly, we conducted a post-hoc model interpretability based on the importance of the risk factors. Experimental results show the potential of GAN-based models for generating high-quality categorical synthetic data, yielding probability mass functions that are highly close to real data, maintaining relevant insights, and contributing to increase the predictive performance. The GAN-based model and a linear classifier outperforms other overs ling techniques, improving 2\\% the area under the curve. These results demonstrate the capability of synthetic data to help both in determining risk factors and building models for CVD prediction.
Publisher: Oxford University Press (OUP)
Date: 15-05-2013
Abstract: Atrial fibrillation (AF) is a common cardiac arrhythmia which increases morbidity and mortality. Identification of risk factors is therefore important. We examined the impact of palpitations and cardiovascular risk factors in prediction of AF (all types) and lone AF in a large population-based cohort. We carried out a prospective population-based cohort study. A total of 22,815 participants from a population survey in 1994-1995 were followed-up for a mean of 11.1 years. Mean age at baseline was 46 years. Measurements of height, weight, blood pressure, heart rate, total cholesterol and high-density lipoprotein (HDL)-cholesterol, and information on palpitations, diabetes, angina, myocardial infarction, and antihypertensive treatment were obtained at baseline. The outcome measure was first-ever AF, documented on an electrocardiogram. Cox proportional hazards regression model was used to estimate hazard ratios (HRs) for AF. Palpitations were associated with increased risk of AF in both women (HR 1.62, 95% confidence interval [CI] 1.29-2.02) and men (HR 1.91, 95% CI 1.54-2.35). For hypertension the HR for AF was 1.98 (1.46-2.69) in women and 1.40 (1.13-1.74) in men. The HR for 1 SD increase in body mass index (BMI) was 1.16 (1.06-1.27) in women and 1.47 (1.32-1.63) in men. Body height and BMI were associated with increased risk for lone AF in men. Palpitations, hypertension and BMI were predictive of future atrial fibrillation in both sexes.
Publisher: BMJ
Date: 11-2022
DOI: 10.1136/OPENHRT-2022-002154
Abstract: Endurance sport practice is associated with a high prevalence of atrial fibrillation (AF), which increases the risk of stroke in the general population. However, stroke risk in endurance athletes with AF is sparsely investigated. Most studies have been limited by design and are largely restricted to younger and middle-aged populations. Thus, we aimed to investigate AF and stroke risk in older athletes exposed to prolonged endurance training. During a 10-year period, 505 male athletes aged ≥65 years frequently participating in a long-distance ski race were compared with 1867 men of the same age from the general population. The main exposure was endurance sport practice with self-reported AF and stroke as outcomes. Stroke risk was further examined by joint modelling of AF and endurance practice. Statistical analysis was conducted with a modified Poisson model. Athletes (median age: 68, range: 65–90) participated in a long-distance ski race over a median of 14 years (range: 1–53). Prevalence (28.5% vs 17.8%) and adjusted risk of AF (risk ratio (RR): 1.88, 95% CI: 1.49 to 2.37) were higher in athletes compared with non-athletes, whereas the prevalence (5.4% vs 9.7%) and risk of stroke were lower (RR: 0.60, 95% CI: 0.37 to 0.95). Compared with athletes without AF, risk of stroke was twofold in athletes (RR: 2.38, 95% CI: 1.08 to 5.24) and nearly fourfold in non-athletes (RR: 3.87, 95% CI: 1.98 to 7.57) with AF. Although older male endurance athletes experienced an increased risk of AF, the long-term risk of stroke was substantially reduced compared with non-athletes.
Publisher: Oxford University Press (OUP)
Date: 2022
Abstract: The heart failure epidemic is growing and its prevention, in order to reduce associated hospital readmission rates and its clinical and economic burden, is a key issue in modern cardiovascular medicine. The present consensus document aims to provide practical evidence-based information to support the implementation of effective preventive measures. After reviewing the most common risk factors, an overview of the population attributable risks in different continents is presented, to identify potentially effective opportunities for prevention and to inform preventive strategies. Finally, potential interventions that have been proposed and have been shown to be effective in preventing HF are listed.
Publisher: Elsevier BV
Date: 09-2016
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1111/JTH.13329
Abstract: Essentials Registry-based studies indicate a link between arterial- and venous thromboembolism (VTE). We studied this association in a cohort with confounder information and validated outcomes. Myocardial infarction (MI) was associated with a 4.8-fold increased short-term risk of VTE. MI was associated with a transient increased risk of VTE, and pulmonary embolism in particular. Background Recent studies have demonstrated an association between venous thromboembolism (VTE) and arterial thrombotic diseases. Objectives To study the association between incident myocardial infarction (MI) and VTE in a prospective population-based cohort. Methods Study participants (n = 29 506) were recruited from three surveys of the Tromsø Study (conducted in 1994-1995, 2001-2002, and 2007-2008) and followed up to 2010. All incident MI and VTE events during follow-up were recorded. Cox regression models with age as the time scale and MI as a time-dependent variable were used to calculate hazard ratios (HRs) of VTE adjusted for sex, body mass index, blood pressure, diabetes mellitus, HDL cholesterol, smoking, physical activity, and education level. Results During a median follow-up of 15.7 years, 1853 participants experienced an MI and 699 experienced a VTE. MI was associated with a 51% increased risk of VTE (HR 1.51 95% confidence interval [CI] 1.08-2.10) and a 72% increased risk of pulmonary embolism (PE) (HR 1.72 95% CI 1.07-2.75), but not significantly associated with the risk of deep vein thrombosis (DVT) (HR 1.36 95% CI 0.86-2.15). The highest risk estimates for PE were observed during the first 6 months after the MI (HR 8.49 95% CI 4.00-18.77). MI explained 6.2% of the PEs in the population (population attributable risk) and 78.5% of the PE risk in MI patients (attributable risk). Conclusions Our findings indicate that MI is associated with a transient increased VTE risk, independently of traditional atherosclerotic risk factors. The risk estimates were particularly high for PE.
Publisher: BMJ
Date: 04-10-2008
Abstract: To determine the long-term coronary heart disease (CHD) mortality in women and men with symptoms, according to the Rose Angina Questionnaire at a relatively young age. Cohort study with the baseline survey conducted during 1974-8. Information on symptoms was collected by a short, three-item version of the Rose Angina Questionnaire. Participants were re-invited to a similar survey five years later and followed for mortality throughout 2000. Three counties in Norway (the Norwegian Counties Study). 16 616 men and 16 265 women aged 40-49 years and denying CHD in 1974-8. CHD mortality during 23 years. By the end of follow-up 1316 men (7.9%) and 310 women (1.9%) had died from CHD, including 16% (66/406) of men and 4% (24/563) of women with Rose angina in 1974-8. Rose angina implied an elevated mortality from CHD with adjusted hazard ratios 1.50 (95% CI 1.16 to 1.93) in men and 1.98 (95% CI 1.30 to 3.02) in women. According to calculations based on the Cox model these increases in risk are similar to those associated with elevations of total cholesterol by 1.8 mmol/l (men) and 2.5 mmol/l (women) or elevations of systolic blood pressure by 21 mm Hg (men) or 31 mm Hg (women). Angina symptoms in ages as low as 40-49 years were associated with elevated long-term CHD mortality in Norwegian women and men. This indicates that the three-item version of the Rose Angina Questionnaire, although a screening tool rather than a diagnostic test, adds information on undiagnosed CHD in both sexes.
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.ATHEROSCLEROSIS.2008.11.002
Abstract: Increased urinary albumin-excretion is a cardiovascular risk-factor. The cardiovascular risk of the metabolic syndrome (MetS) is debated. The aim of the present prospective, population-based study of non-diabetic in iduals was to examine the association between low-grade urinary albumin-excretion, MetS, and cardiovascular morbidity and all-cause mortality. 5215 non-diabetic, non-proteinuric men and women participating in the Tromsø Study 1994-1995 were included. Urinary albumin-creatinine ratio (ACR) was measured in three urine s les. The participants were categorized into four groups by the presence/absence of MetS (the International Diabetes Federation definition) and ACR in the upper tertile (>or=0.75 mg/mmol). Median follow-up time was 9.6 years for first ever myocardial infarction, 9.7 years for ischemic stroke and 12.4 years for mortality. High ACR (upper tertile)/MetS was associated with increased risk of myocardial infarction (hazard ratio (HR) 1.75 95% confidence interval (CI): 1.30-2.37, p<0.001), stroke (HR 2.48 95% CI: 1.66-3.71, p<0.001), and all-cause mortality (HR 1.63 95% CI: 1.32-2.01, p<0.001) compared to reference (low ACR/no MetS). Similar associations were found for the high ACR/no MetS group. Low ACR/MetS was associated with myocardial infarction only (HR 1.82 95% CI: 1.39-2.37, p or=0.75 mg/mmol was associated with cardiovascular morbidity and all-cause mortality independently of MetS. MetS was not associated with any end-point beyond what was predicted from its components. Thus, low-grade albuminuria, but not MetS, may be used for risk stratification in non-diabetic subjects.
Publisher: SAGE Publications
Date: 06-1996
DOI: 10.1177/140349489602400209
Abstract: On the basis of a questionnaire in a population study in the county of Nordland, Norway, the prevalence of palpitations and its associations to some lifestyle factors, depression and self-rated health were analysed. All the 10,497 residents aged 40 to 42 years were invited to participate, 82% attended, 87% of the attenders returned a questionnaire by mail, and 6436 subjects were included in this report. The prevalence of palpitations was 15% in men and 25% in women. Palpitations were significantly associated with coffee consumption, smoking, alcohol intoxication, physical inactivity, depression and poor self-rated health in the univariate analyses. In a logistic regression analysis, the relations between palpitations and lifestyle were weakened. Significant predictors for palpitations were depression and poor self-rated health in both sexes, in addition to heavy coffee drinking and physical inactivity in men and alcohol intoxication in women. In conclusion, palpitations were more firmly linked to depression and self-evaluated health than to lifestyle.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1111/JTH.14410
Abstract: Essentials Prothrombotic genotypes may agument the risk of venous thromboembolism (VTE) after ischemic stroke. We studied this effect in a case-cohort study using a genetic risk score. In stroke patients, a one-category increase in the genetic risk score was associated with a 50% higher relative risk of VTE. The risk of VTE in stroke patients increased with an increasing number of risk alleles. SUMMARY: Background Patients with ischemic stroke have a transiently increased risk of subsequent venous thromboembolism (VTE). Prothrombotic genotypes may augment VTE risk under conditions of high thrombosis risk related to stroke. Aims To investigate the effect of prothrombotic genotypes in patients with ischemic stroke on the risk of VTE in a population-based case-cohort study. Methods Cases with incident VTE (n = 664) and a randomly selected age-weighted subcohort (n = 1817) were s led from three surveys of the Tromsø Study (1994-2008). Participants were genotyped for ABO (rs8176719), F5 (rs6025), F2 (rs1799963), FGG (rs2066865) and F11 (rs2036914) single-nucleotide polymorphisms (SNPs). Cox regression models were used to calculate hazard ratios (HRs) for incident VTE according to in idual SNPs and categories of risk alleles (5-SNP score 0-1, 2, 3-4 and ≥ 5) in participants with and without ischemic stroke. Results There were 192 patients with incident stroke, of whom 43 developed VTE during a median of 15.2 years of follow-up. The risk alleles of in idual SNPs augmented the elevated VTE risk brought about by ischemic stroke. In stroke patients, a one-category increase in the genetic risk score was associated with a 50% higher relative risk of overall VTE (HR 1.5, 95% confidence interval [CI] 1.3-1.8) and an 80% higher relative risk of provoked VTE (HR 1.8, 95% CI 1.5-2.1). Stroke patients with ≥ 5 risk alleles had a 12-fold (HR 11.7, 95% CI 4.1-33.3) higher relative risk of VTE than stroke-free participants with 0-1 risk alleles. Conclusions Prothrombotic genotypes increased the risk of VTE in stroke patients, and the risk increased with an increasing number of risk alleles.
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.ATHEROSCLEROSIS.2018.08.005
Abstract: Cardiovascular disease is a common cause of morbidity and mortality, with gender differences in pathophysiology. The endothelial glycocalyx maintains vascular integrity, and glycocalyx shedding reflects endothelial dysfunction and early atherosclerosis. Syndecan-1 and -4 are components of the glycocalyx, and increased serum levels indicate glycocalyx damage. We hypothesised that increased serum syndecan-1 and -4 were independently associated with myocardial infarction (MI), ischaemic stroke and all-cause mortality in men and women from a general population. Using a case-cohort design, we included 1495 participants from the Tromsø Study 2001-02. Syndecan-1 and -4 were measured in serum. Baseline variables also included age, gender, cardiovascular risk factors and urinary albumin-creatinine ratio (ACR). Hazard ratios were assessed using multivariable Cox regression models. Between baseline in 2001-02 and December 2007 fatal or non-fatal MI was experienced by 328 and ischaemic stroke by 191 subjects, and 423 participants died. Syndecan-4 was independently associated with MI (hazard ratio per 10 ng/mL increase 1.32 95% confidence interval 1.06-1.63), but not ischaemic stroke and mortality, and the associations were unchanged by adjustment for urinary ACR. Interaction between syndecan-4 and sex was borderline significant, and in gender-specific analysis, syndecan-4 was associated with MI in women only. Syndecan-1 was not associated with any endpoint. Syndecan-4 was associated with incident MI, and the association was stronger in women than in men. This suggests a link between endothelial glycocalyx shedding and coronary heart disease in women. Use of syndecan-4 as a risk marker in clinical setting needs further investigation.
Publisher: Springer Science and Business Media LLC
Date: 07-02-2017
DOI: 10.1007/S10654-017-0231-5
Abstract: The association between myocardial infarction (MI) and future risk of incident cancer is scarcely investigated. Therefore, we aimed to study the risk of cancer after a first time MI in a large cohort recruited from a general population. Participants in a large population-based study without a previous history of MI or cancer (n = 28,763) were included and followed from baseline to date of cancer, death, migration or study end. Crude incidence rates (IRs) and hazard ratios (HRs) for cancer after MI were calculated. During a median follow-up of 15.7 years, 1747 subjects developed incident MI, and of these, 146 suffered from a subsequent cancer. In the multivariable-adjusted model (adjusted for age, sex, BMI, systolic blood pressure, diabetes mellitus, HDL cholesterol, smoking, physical activity and education level), MI patients had 46% (HR 1.46 95% CI: 1.21-1.77) higher hazard ratio of cancer compared to those without MI. The increased cancer incidence was highest during the first 6 months after the MI, with a 2.2-fold higher HR (2.15 95% CI: 1.29-3.58) compared with subjects without MI. After a 2-year period without higher incidence rate, MI patients displayed 60% (HR 1.60 95% CI: 1.27-2.03) higher HR of future cancer more than 3 years after the event. The increased IRs were higher in women than men. Patients with MI had a higher short- and long-term incidence rate of cancer compared to subjects without MI. Our findings suggest that occult cancer and shared risk factors of MI and cancer may partly explain the association.
Publisher: Wiley
Date: 08-03-2011
DOI: 10.1111/J.1365-2893.2010.01290.X
Abstract: Knowledge of the natural course and especially the total and cause-specific mortality of community-acquired chronic HCV infection is limited. The aims of our study were to determine the total and cause-specific mortality in patients infected with chronic hepatitis C in a community-based setting in northern Norway. This prospective cohort study included 1010 HCV-positive patients diagnosed with recombinant immunoblot assay between 1 January 1990 and 1 January 2000, with a median observation time from diagnosis to follow-up of 7 years. Data were collected from medical records in the period between 1 January 2004 and 30 June 2006. Time and cause of death were ascertained from the Norwegian Causes of Death Register. Age-adjusted death rates and standardised mortality ratios (SMRs) were compared with those of the general Norwegian population. In total, 122 deaths were recorded. The Kaplan-Meier estimate of survival was 88% at 14 years. The SMR in the cohort relative to the general population was 6.66. Most of the excess deaths in both genders were because of liver-related causes, those associated with a drug-using lifestyle and suicide. The statistically significant increase in SMRs ranged from 4.2 for death by cancer in women to 64.6 for liver disease in women. There was no statistically significant increase in SMRs from cardiovascular disease in either gender or from cancer in men. In conclusion, our study shows that the death rate in patients infected with hepatitis C is 6.66 times higher than in the general Norwegian population.
Publisher: SAGE Publications
Date: 10-2001
Abstract: We compared the diagnoses made by one dermatologist via telemedicine with those of another dermatologist made in a face-to-face consultation. The patients first underwent a teledermatology consultation and then a face-to-face consultation. A general practitioner was present with the patient in the videoconference studio. Videoconferencing equipment connected at 384 kbit/s was used. The doctor-patient relationship and the satisfaction of the patients and dermatologists in the two settings were assessed, as well as technical conditions during the videoconferences. There were 121 patients, with a mean age of 40 years (range 17-82 years). There was a high degree of concordance between the two sets of diagnoses, with 72% complete agreement and 14% partial agreement between the two dermatologists. A total of 116 patients (96% of those included) completed a questionnaire. Both the patients and the dermatologists were in general satisfied with the videoconferences. Videoconferencing with a participating general practitioner may be useful in dermatology, but the technique should be used only for selected patients.
Publisher: Oxford University Press (OUP)
Date: 14-10-2016
Abstract: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in man, causing substantial morbidity and mortality with a major worldwide public health impact. It is increasingly recognized as a highly heritable condition. This study aimed to determine genetic risk factors for early-onset AF. We sequenced the whole genomes of 8453 Icelanders and imputed genotypes of the 25.5 million sequence variants we discovered into 1799 Icelanders with early-onset AF (diagnosed before 60 years of age) and 337 453 controls. Each sequence variant was tested for association based on multiplicative and recessive inheritance models. We discovered a rare frameshift deletion in the myosin MYL4 gene (c.234delC) that associates with early-onset AF under a recessive mode of inheritance (allelic frequency = 0.58%). We found eight homozygous carriers of the mutation, all of whom had early-onset AF. Six of the homozygotes were diagnosed by the age of 30 and the remaining two in their 50s. Three of the homozygotes had received pacemaker implantations due to sick sinus syndrome, three had suffered an ischemic stroke, and one suffered sudden cardiac death. Through a population approach we found a loss of function mutation in the myosin gene MYL4 that, in the homozygous state, is completely penetrant for early-onset AF. The finding may provide novel mechanistic insight into the pathophysiology of this complex arrhythmia.
Publisher: Elsevier BV
Date: 06-2010
DOI: 10.1016/J.GENM.2010.06.006
Abstract: Body mass index (BMI) and smoking have been positively associated with hemoglobin concentration, and both are risk factors for cardiovascular disease. The aim of this study was to assess whether there were sex differences in how changes in BMI and smoking habits influenced hemoglobin concentration. In 1994-95 and 2001-02, a longitudinal, population-based study was conducted in the municipality of Tromsø, in northern Norway. Inhabitants aged > or =25 years were invited to participate. Participants replied to a questionnaire regarding health, physical activity, coffee and alcohol consumption, and smoking habits. Blood s les were drawn to analyze hemoglobin concentration. All analyses were performed separately for each sex. Differences between 1994-95 and 2001-02 were examined with t or chi(2) (McNemar) tests for paired data. Cross-sectional comparisons were made using 2-s le t tests. Different models of univariate and multiple linear regression analyses were used to investigate the impact of the various variables on hemoglobin change. Data from a total of 2105 men and 2945 women were examined. At baseline, mean age was 58.9 years for men (range, 25-78 years) and 57.8 years for women (range, 25-82 years) mean BMI was 26.1 kg/m(2) for men and 25.8 kg/m(2) for women. In men, hemoglobin decreased with age, on average from 147.5 to 145.1 g/L. In women, hemoglobin decreased from 135.6 to 134.7 g/L, but increased with increasing age up to 54 years, and thereafter decreased gradually. Mean BMI increased 0.8 kg/m(2) in men and 1.2 kg/m(2) in women. In total, 394 of 2057 men (19%) and 499 of 2889 women (17%) stopped smoking or smoked fewer cigarettes per day. In a univariate regression model, an increase of 1 kg/m(2) in BMI was associated with an increase in hemoglobin of 1.1 g/L (95% CI, 0.84 to 1.27) in men and 0.4 g/L (95% CI, 0.30 to 0.56) in women. In another univariate model, smoking cessation was associated with a decrease in hemoglobin of 1.9 g/L (95% CI, -3.32 to -0.56) in men and 1.7 g/L (95% CI, -2.93 to -0.56) in women. In men who smoked less and had a BMI increase of >2.5 kg/m(2), hemoglobin decreased 0.3 g/L. In contrast, hemoglobin decreased 3.4 g/L in men who smoked less and lost weight (P for trend, < 0.001 by changing BMI). Women who smoked less had a decrease in hemoglobin independent of BMI changes. The positive association between an increase in BMI and hemoglobin was stronger in men than in women. The effect of smoking reduction on hemoglobin was attenuated with increasing BMI in men, but not in women.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2016
Publisher: Oxford University Press (OUP)
Date: 22-09-2022
DOI: 10.1093/EURHEARTJ/EHAC470
Abstract: There is strong evidence that sex chromosomes and sex hormones influence blood pressure (BP) regulation, distribution of cardiovascular (CV) risk factors and co-morbidities differentially in females and males with essential arterial hypertension. The risk for CV disease increases at a lower BP level in females than in males, suggesting that sex-specific thresholds for diagnosis of hypertension may be reasonable. However, due to paucity of data, in particularly from specifically designed clinical trials, it is not yet known whether hypertension should be differently managed in females and males, including treatment goals and choice and dosages of antihypertensive drugs. Accordingly, this consensus document was conceived to provide a comprehensive overview of current knowledge on sex differences in essential hypertension including BP development over the life course, development of hypertension, pathophysiologic mechanisms regulating BP, interaction of BP with CV risk factors and co-morbidities, hypertension-mediated organ damage in the heart and the arteries, impact on incident CV disease, and differences in the effect of antihypertensive treatment. The consensus document also highlights areas where focused research is needed to advance sex-specific prevention and management of hypertension.
Publisher: Oxford University Press (OUP)
Date: 21-07-2023
Publisher: Oxford University Press (OUP)
Date: 28-01-2011
Publisher: Elsevier BV
Date: 2010
Publisher: Wiley
Date: 21-11-2013
DOI: 10.1111/SMS.12150
Publisher: Oxford University Press (OUP)
Date: 07-02-2018
Abstract: Although commonly associated with cardiovascular disease or other medical conditions, atrial fibrillation may also occur in in iduals without any known underlying conditions. This manifestation of atrial fibrillation has been linked to extensive and long-term exercise, as prolonged endurance exercise has shown to increase prevalence and risk of atrial fibrillation. In contrast, more modest physical activity is associated with a decreased risk of atrial fibrillation, and current research indicates a J-shaped association between atrial fibrillation and the broad range of physical activity and exercise. This has led to the hypothesis that the mechanisms underlying an increased risk of atrial fibrillation with intensive exercise are different from those underlying a reduced risk with moderate physical activity, possibly linked to distinctive characteristics of the population under study. High volumes of exercise over many years performed by lean, healthy endurance trained athletes may lead to cardiac (patho)physiological alterations involving the autonomic nervous system and remodelling of the heart. The mechanisms underlying a reduced risk of atrial fibrillation with light and moderate physical activity may involve a distinctive pathway, as physical activity can potentially reduce the risk of atrial fibrillation through favourable effects on cardiovascular risk factors.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
DOI: 10.1161/CIRCGENETICS.113.000630
Abstract: Identification of in iduals with high risk for first-ever myocardial infarction (MI) can be improved. The objectives of the study were to survey multiple protein biomarkers for association with the 10-year risk of incident MI and identify a clinically significant risk model that adds information to current common risk models. We used an immunoassay platform that uses a sensitive, s le-efficient molecular counting technology to measure 51 proteins in s les from the fourth survey (1994) in the Tromsø Study, a longitudinal study of men and women in Tromsø, Norway. A case control design was used with 419 first-ever MI cases (169 females/250 males) and 398 controls (244 females/154 males). Of the proteins measured, 17 were predictors of MI when considered in idually after adjustment for traditional risk factors either in men, women, or both. The 6 biomarkers adjusted for traditional risk factors that were selected in a multivariable model (odds ratios [OR] per standard deviation) using a stepwise procedure were apolipoprotein B/apolipoprotein A1 ratio (1.40), kallikrein (0.73), lipoprotein a (1.29), matrix metalloproteinase 9 (1.30), the interaction term IP-10/CXCL10×women (0.69), and the interaction term thrombospondin 4×men (1.38). The composite risk of these biomarkers added significantly to the traditional risk factor model with a net reclassification improvement of 14% ( P =0.0002), whereas the receiver operating characteristic area increased from 0.757 to 0.791, P =0.0004. Novel protein biomarker models improve identification of 10-year MI risk above and beyond traditional risk factors with 14% better allocation to either high or low risk group.
Publisher: MDPI AG
Date: 25-02-2023
Abstract: Background: A specific, cost-effective triage test for minor cytological abnormalities is essential for cervical cancer screening among younger women to reduce overmanagement and unnecessary healthcare utilization. We compared the triage performance of one 13-type human papillomavirus (HPV) DNA test and one 5-type HPV mRNA test. Methods: We included 4115 women aged 25–33 years with a screening result of atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) recorded in the Norwegian Cancer Registry during 2005–2010. According to Norwegian guidelines, these women went to triage (HPV testing and repeat cytology: 2556 were tested with the Hybrid Capture 2 HPV DNA test, which detects the HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68 and 1559 were tested with the PreTect HPV-Proofer HPV mRNA test, which detects HPV types 16, 18, 31, 33, and 45). Women were followed through December 2013. Results: HPV positivity rates at triage were 52.8% and 23.3% among DNA- and mRNA-tested women (p 0.001), respectively. Referral rates for colposcopy and biopsy and repeat testing (HPV + cytology) after triage were significantly higher among DNA-tested (24.9% and 27.9%) compared to mRNA-tested women (18.3% and 5.1%), as were cervical intraepithelial neoplasia grade 3 or worse (CIN3+) detection rates (13.1% vs. 8.3% p 0.001). Ten cancer cases were diagnosed during follow-up eight were in DNA-tested women. Conclusion: We observed significantly higher referral rates and CIN3+ detection rates in young women with ASC-US/LSIL when the HPV DNA test was used at triage. The mRNA test was as functional in cancer prevention, with considerably less healthcare utilization.
Publisher: Wiley
Date: 24-04-1988
DOI: 10.1111/J.0954-6820.1988.TB19621.X
Abstract: Coronary risk factors are described in 288 medically treated hypertensives, 1293 untreated hypertensives and 15,029 normotensives. Cholesterol in untreated men and women was 0.37 mmol/l and 0.35 mmol/l higher than in normotensives (p less than 0.001). Non-significant differences were observed between those untreated and treated. Treated men and women had 0.16 mmol/l and 0.14 mmol/l lower HDL cholesterol than untreated (p less than 0.01). Between untreated and normotensives non-significant differences were found. Triglycerides were 0.27 mmol/l and 0.22 mmol/l higher in treated than in untreated men and women (p less than 0.01). Normotensive men and women had 0.33 mmol/l and 0.10 mmol/l lower triglycerides than untreated (p less than 0.01). The results suggest that the increased cholesterol in hypertensives was present originally, while the decreased HDL cholesterol and elevated triglycerides probably were evoked by drugs. The importance of consideration of the whole constellation of risk factors in order to reduce the mortality from coronary heart disease by antihypertensive drug treatment is emphasized.
Publisher: UiT The Arctic University of Norway
Date: 08-2019
DOI: 10.7557/7.4862
Abstract: Folkehelserapporten gir en oversikt over utvalgte helse- og risikofaktorer fordelt på kjønn, aldersgrupper og geografiske soner i Tromsø kommune med data fra den sjuende Tromsøundersøkelsen (2015-16), og vil inngå i kunnskapsgrunnlaget for kommunens planarbeid og tjenesteutvikling, sammen med blant annet kommunens Levekårsundersøkelser. Det er viktig å legge vekt på at rapporten ikke gir grunnlag for å karakterisere enkelte geografiske områder som spesielt gode eller dårlige å bo i. Det er knyttet begrensninger til data, utvalg og analyser. Viktigst å trekke frem her er at data ikke kan gi et helt presist bilde av helsefaktorer hos enkeltdeltakere, at noen grupper ikke er godt nok representert i utvalget, og at analysene begrenser seg til å vise beskrivende resultater av enkeltfaktorer. Blant alle som deltok i undersøkelsen oppgir 69 % at de har god eller meget god helse. Videre oppgir 4,9 % å ha diabetes, 3,7 % å ha KOLS og 13,3 % å ha eller ha hatt psykiske problemer som de har søkt hjelp for. Totalt oppgir 80 % at de har vært hos fastlege siste år og 13 % at de har vært på legevakten. Blant deltakerne har 68 % overvekt eller fedme, hvorav 24 % har fedme. Totalt 27 % oppgir moderat til høy fysisk aktivitetsnivå i fritid, og 6 % oppgir inntak av fem eller flere porsjoner frukt og grønnsaker per dag. Totalt 8 % oppgir at de er avholdende fra alkohol mens 13 % oppgir at de månedlig eller oftere drikker mer enn 6 alkoholenheter ved en og samme anledning. Videre oppgir 14 % daglig røyking. Totalt 13 % oppgir ukentlig eller daglig bruk av smertestillende medikamenter. Totalt oppgir 11 % at de ikke har nok venner som kan gi hjelp ved behov og 14 % at de ikke har nok venner å snakke fortrolig med. Resultatene viser forskjeller i helse- og risikofaktorer mellom sentrumsnære soner og distriktssoner. Den generelle tendensen er at en del distriktssoner har en høyere andel med fedme og daglig røykere, samt dårligere selvopplevd helse og lavere utdanningsnivå, hos deltakere under 67 år. Resultatene viser også forskjeller mellom de ulike sentrumsnære sonene. Enkelte sentrumsnære soner har en høyere andel med høyere fysisk aktivitetsnivå, bedre selvopplevd helse og høyere utdanning, samt en lavere andel med fedme og daglig røykere hos deltakere under 67 år. Enkelte sentrumsnære soner har en høyere andel med fedme, daglig røykere og dårligere selvopplevd helse, samt lavere fysisk aktivitetsnivå og utdanningsnivå, hos deltakere under 67 år. Den samme tendensen til forskjeller i helse- og risikofaktorer mellom sentrumsnære soner og distriktssoner ser vi også hos deltakere over eller lik 67 år for utdanning og fedme, men ikke for røyking. Oppsummert kan vi slå fast at det er forskjeller i helse- og risikofaktorer i ulike geografiske soner i Tromsø kommune og at disse til dels overlapper med funn fra Levekårsundersøkelsene.
Publisher: S. Karger AG
Date: 2015
DOI: 10.1159/000441092
Abstract: b i Background/Aims: /i /b Estimated glomerular filtration rate (eGFR) is used extensively in epidemiological research. Validations of eGFR have demonstrated acceptable performance, but the dependence of creatinine and cystatin C on non-GFR factors could confound associations with disease. Few studies have investigated this issue in direct comparison with measured GFR (mGFR). We compared the associations between eGFR and mGFR and retinal vasculopathy, a marker of systemic microvasculopathy. b i Methods: /i /b Iohexol clearance and retinal photography were examined in the Renal Iohexol Clearance Survey in Tromsø 6, which consists of a representative s le of middle-aged persons from the general population. A total of 1,553 persons without self-reported kidney disease, cardiovascular disease or diabetes were investigated. Three eGFR equations based on creatinine and/or cystatin C from the Chronic Kidney Disease Epidemiology Collaboration were studied. Differences between eGFR and mGFR were analyzed with seemingly unrelated regression methods. b i Results: /i /b mGFR in the lowest quartile was associated with an increased multivariable-adjusted odds ratio of retinopathy (OR 1.86, 95% CI 1.16-2.97), but not with retinal artery or vein diameters. eGFR based on cystatin C (eGFR sub cys /sub ) was consistently biased relative to mGFR in its associations with retinal vessel diameters across different models. eGFR based on creatinine (eGFR sub crea /sub ) and eGFR based on both creatinine and cystatin C were also biased in several of these models (p 0.05). For retinopathy, the differences between the 3 eGFR and mGFR measurements were not statistically significant. b i Conclusions: /i /b Low mGFR is associated with retinopathy in the general population. eGFR based on creatinine and/or cystatin C are not valid substitutes for mGFR in studies of the relationship between the retina and kidney function in healthy persons.
Publisher: Oxford University Press (OUP)
Date: 30-08-2014
Abstract: Serum uric acid (SUA) has been associated with cardiovascular disease in population studies, but its relation to atrial fibrillation (AF) is largely unknown. The aim of this study was to investigate the association between baseline SUA and future AF in a large population-based cohort. A total of 6308 men and women from a population survey in Tromsø, Norway in 1994-95 were followed-up for 10.8 years. The mean age at baseline was 60 years. Information on angina, myocardial infarction, diabetes, anti-hypertensive and diuretic treatment, physical activity, smoking and alcohol, and measurements of height, weight, blood pressure, SUA, total cholesterol, and high density lipoprotein-cholesterol were obtained at baseline. The outcome measure was first-ever AF, documented on an electrocardiogram. We identified 572 cases of incident AF. In multivariable Cox proportional hazards regression analysis adjusted for cardiovascular risk factors and concomitant diseases, SUA was associated with AF in both sexes. Hazard ratio per 1 SD increase in SUA (91 μmol/L) was 1.40 [95% confidence intervals (CI), 1.14-1.72] in women and 1.17 (95% CI, 1.02-1.36) in men. The upper quartile of SUA conferred a 76% increased risk for AF in women and 49% in men as compared with the lowest quartile. This prospective population-based cohort study showed that baseline SUA was associated with an increased risk for future AF in both sexes.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Elsevier BV
Date: 03-2021
Publisher: Oxford University Press (OUP)
Date: 03-05-2019
Abstract: To explore sex-specific associations between long-term in idual blood pressure (BP) patterns and risk of incident atrial fibrillation (AF) in the general population. Blood pressure was measured in 8376 women and 7670 men who attended at least two of the three population-based Tromsø Study surveys conducted in 1986–87, 1994–95, and 2001. Participants were followed for incident AF throughout 2013. Latent mixed modelling was used to identify long-term trajectories of systolic BP and hypertension. Cox regression was used to estimate associations between the identified trajectories and incident AF. Elevated systolic BP throughout the exposure period (1986–2001) independently and differentially increased risk of AF in women and men. In women, having elevated systolic BP trajectories doubled AF risk compared to having persistently low levels, irrespective of whether systolic BP increased, decreased, or was persistently high over time, with hazard ratios of 1.88 (95% confidence interval 1.37–2.58), 2.32 (1.61–3.35), and 1.94 (1.28–2.94), respectively. In men, those with elevated systolic BP that continued to increase over time had a 50% increased AF risk: 1.51 (1.09–2.10). When compared to those persistently normotensive, women developing hypertension during the exposure period, and women and men with hypertension throughout the exposure period had 1.40 (1.06–1.86), 2.75 (1.99–3.80), and 1.36 (1.10–1.68) times increased risk of AF, respectively. Long-term BP and hypertension trajectories were associated with increased incidence of AF in both women and men, but the associations were stronger in women.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1111/JTH.12762
Abstract: Whether atrial fibrillation is related to risk of venous thromboembolism (VTE) has not been extensively studied. Therefore, we investigated the association between atrial fibrillation and future risk of VTE in a population-based cohort. In total, 29,975 subjects were recruited from three surveys of the Tromsø study and followed from enrollment (1994-1995, 2001-2002 and 2007-2008) up to 2010. Incident events of atrial fibrillation and VTE during follow-up were recorded. Information on potential confounders was obtained at baseline. Cox-regression models with atrial fibrillation as time-dependent variable were used to calculate hazard ratios (HRs) for VTE with 95% confidence intervals (CIs). During 16 years of median follow-up, 1604 subjects were diagnosed with atrial fibrillation and 614 with incident VTE. The risk of VTE was substantially increased during the first 6 months after diagnosis of atrial fibrillation (HR, 8.44 95% CI, 5.61-12.69), and remained increased throughout the study period (HR, 1.43 95% CI, 1.43-1.99) compared with those without atrial fibrillation. Atrial fibrillation displayed higher risk estimates for pulmonary embolism (HR, 11.84 95% CI, 6.80-20.63) than for deep vein thrombosis (HR, 6.20 95% CI, 3.37-11.39) during the first 6 months, and was still associated with pulmonary embolism (HR, 1.96 95% CI, 1.24-3.10) but not with deep vein thrombosis (HR, 1.08 95% CI, 0.66-1.75) more than 6 months after diagnosis. Atrial fibrillation was associated with increased risk of VTE, and pulmonary embolism in particular. Our findings support the concept that isolated pulmonary embolism may originate from right atrial thrombi due to atrial fibrillation.
Publisher: Informa UK Limited
Date: 2009
Publisher: BMJ
Date: 07-2021
DOI: 10.1136/OPENHRT-2021-001624
Abstract: The main aim was to examine age-specific risk factor associations with incident atrial fibrillation (AF) and their attributable fraction in a large European cohort. Additionally, we aimed to examine risk of stroke and mortality in relation to new-onset AF across age. We used in idual-level data (n=66 951, 49.1% men, age range 40–98 years at baseline) from five European cohorts of the MOnica Risk, Genetics, Archiving and Monograph Consortium. The participants were followed for incident AF for up to 10 years and the association with modifiable risk factors from the baseline examinations (body mass index (BMI), hypertension, diabetes, daily smoking, alcohol consumption and history of stroke and myocardial infarction (MI)) was examined. Additionally, the participants were followed up for incident stroke and all-cause mortality after new-onset AF. AF incidence increased from 0.9 per 1000 person-years at baseline age 40–49 years, to 17.7 at baseline age ≥70 years. Multivariable-adjusted Cox models showed that higher BMI, hypertension, high alcohol consumption and a history of stroke or MI were associated with increased risk of AF across age groups (p .05). Between 30% and 40% of the AF risk could be attributed to BMI, hypertension and a history of stroke or MI. New-onset AF was associated with a twofold increase in risk of stroke and death at ages≥70 years (p≤0.001). In this large European cohort aged 40 years and above, risk of AF was largely attributed to BMI, high alcohol consumption and a history MI or stroke from middle age. Thus, preventive measures for AF should target risk factors such as obesity and hypertension from early age and continue throughout life.
Publisher: BMJ
Date: 20-04-2015
DOI: 10.1136/BMJ.H1551
Abstract: To investigate the impact of smoking and smoking cessation on cardiovascular mortality, acute coronary events, and stroke events in people aged 60 and older, and to calculate and report risk advancement periods for cardiovascular mortality in addition to traditional epidemiological relative risk measures. In idual participant meta-analysis using data from 25 cohorts participating in the CHANCES consortium. Data were harmonised, analysed separately employing Cox proportional hazard regression models, and combined by meta-analysis. Overall, 503,905 participants aged 60 and older were included in this study, of whom 37,952 died from cardiovascular disease. Random effects meta-analysis of the association of smoking status with cardiovascular mortality yielded a summary hazard ratio of 2.07 (95% CI 1.82 to 2.36) for current smokers and 1.37 (1.25 to 1.49) for former smokers compared with never smokers. Corresponding summary estimates for risk advancement periods were 5.50 years (4.25 to 6.75) for current smokers and 2.16 years (1.38 to 2.39) for former smokers. The excess risk in smokers increased with cigarette consumption in a dose-response manner, and decreased continuously with time since smoking cessation in former smokers. Relative risk estimates for acute coronary events and for stroke events were somewhat lower than for cardiovascular mortality, but patterns were similar. Our study corroborates and expands evidence from previous studies in showing that smoking is a strong independent risk factor of cardiovascular events and mortality even at older age, advancing cardiovascular mortality by more than five years, and demonstrating that smoking cessation in these age groups is still beneficial in reducing the excess risk.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2005
DOI: 10.1097/01.JOM.0000161732.96555.2B
Abstract: In this study, we explored airway symptoms and exposure to bioaerosols and exhaust gases in seafood industry plants. The study details the results from personal and environmental exposure measurements (17 plants), a questionnaire (n = 984), and clinical examinations (n = 225). The workers were exposed to allergens, endotoxins, molds, and exhaust. The 1-year prevalence of work-related airway symptoms was 42.8% for production workers and 25.9% for administrative workers. Mean levels of forced expiratory volume in 1 second and forced vital capacity were less than the predicted values in all exposed nonsmoker groups. A total of 20.5% had increased levels of total IgE (>/=100 kU/L). Specific IgE-mediated reactions seemed to be relevant only in the shrimp industry. Seafood industry workers showed a high prevalence of work-related airway symptoms. Further research on the relationship between exposure and effects is necessary.
Publisher: BMJ
Date: 12-2017
DOI: 10.1136/BMJOPEN-2017-019107
Abstract: There is a shift in the smoking population from daily smokers to light or occasional smokers. The knowledge about possible adverse health effects of this new smoking pattern is limited. We investigated smoking habits with focus on occasional smoking in relation to total mortality in a follow-up study of a Norwegian general population. A population study in Tromsø, Norway. We collected smoking habits and relevant risk factors in 4020 women and 3033 men aged 30–89 years in the Tromsø Study in 2001. The subjects were followed up regarding total mortality through June 2015. Among the participants, there were 7% occasional smokers. Occasional smokers were younger, more educated and used alcohol more frequently than other participants. A total of 766 women and 882 men died during the follow-up. After the adjustment for confounders, we found that occasional smoking significantly increased mortality by 38% (95% CI 8% to 76%) compared with never smokers. We report a dose–response relationship in the hazards of smoking (daily, occasional, former and never smoking). Occasional smoking is not a safe smoking alternative. There is a need for information to the general public and health workers about the health hazards of occasional smoking. More work should be done to motivate this often well-educated group to quit smoking completely.
Publisher: BMJ
Date: 02-2018
Publisher: Public Library of Science (PLoS)
Date: 30-07-2013
Publisher: Public Library of Science (PLoS)
Date: 23-12-2015
Publisher: BMJ
Date: 08-2017
DOI: 10.1136/BMJOPEN-2016-015001
Abstract: Elevated blood cholesterol is a modifiable risk factor for cardiovascular disease. Cholesterol level surveillance is necessary to study population disease burden, consider priorities for prevention and intervention and understand the effect of diet, lifestyle and treatment. Previous studies show a cholesterol decline in recent decades but lack data to follow in iduals born in different decades throughout life. We investigated changes in age-specific and birth cohort-specific total cholesterol (TC) levels in 43 710 women and men born in 1905–1977 (aged 20–95 years at screening) in the population-based Tromsø Study. Fifty-nine per cent of the participants had more than one and up to six repeated TC measurements during 1979–2016. Linear mixed models were used to test for time trends. Mean TC decreased during 1979–2016 in both women and men and in all age groups. The decrease in TC in age group 40–49 years was 1.2 mmol/L in women and 1.0 mmol/L in men. Both the 80th and the 20th percentile of the population TC distribution decreased in both sexes and all age groups. Longitudinal analysis showed that TC increased with age to a peak around middle age followed by a decrease. At any given age, TC significantly decreased with increase in year born. Lipid-lowering drug use was rare in 1994, increased thereafter, but was low ( % in women and % in men) among those younger than 50 years in all surveys. Between 1994 and 2016, lipid-lowering drug treatment in in iduals 50 years and older explained 21% and 28% of the decrease in TC levels in women and men, respectively. We found a substantial decrease in mean TC levels in the general population between 1979 and 2016 in all age groups. In birth cohorts, TC increased with age to a peak around middle age followed by a decrease.
Publisher: Oxford University Press (OUP)
Date: 2008
Abstract: To investigate the prevalence of musculoskeletal complaints among male and female production workers in different types of seafood industries in North Norway and to analyse associations between musculoskeletal symptoms and some possible risk factors in the seafood industry. A self-administered anonymous questionnaire, covering several aspects concerning occupational environment and health issues, was mailed to employees in seafood-processing plants in North Norway. A total of 1767 employees in 118 seafood-processing plants participated giving a 50% response rate. This included 744 production workers in whitefish, shrimp and salmon industries, and 129 administrative workers in all types of seafood industries. The prevalence of musculoskeletal symptoms was high among seafood production workers. The odds ratio for symptoms from upper limbs was significantly higher for females compared to men. Production workers had the highest relative risk for symptoms from wrist/hands (OR = 4.1-9.4) and elbows (OR = 3.5-5.2) when compared to administrative workers. The main difference between types of seafood industries was the high prevalence of symptoms from wrist/hands among female (82%) and male (64%) production workers in the salmon industry compared to whitefish (62 and 47%, respectively) and shrimp industry (66 and 37%, respectively). Musculoskeletal symptoms were found among the majority of production workers in the whitefish, shrimp and salmon industry, the highest prevalence being among female workers. The main difference between types of seafood industries was the high prevalence of symptoms from wrist/hands among workers in the salmon industry. Cold work was an important risk factor for musculoskeletal symptoms.
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Abstract: The role of serum uric acid as an independent predictor of cardiovascular disease and death is uncertain in the general population. Adjustments for additional cardiovascular risk factors have not been consistent. We examined the association of serum uric acid with all-cause mortality, ischemic stroke and myocardial infarction in a prospective population based study, with several traditional and non-traditional risk factors for cardiovascular disease included in the model. A population-based prospective cohort study was performed among 2696 men and 3004 women. Endpoints were all-cause mortality after 15 years, and fatal or non-fatal myocardial infarction (MI) and ischemic stroke after 12 years. 1433 deaths, 659 MIs and 430 ischemic strokes occurred during follow-up. Fully adjusted Cox regression analyses showed that per 1 SD (87 μmol/L) increase in serum uric acid level, the risk of all-cause mortality increased in both genders (hazard ratios, HR men 1.11, 95% CI 1.02-1.20, women 1.16, 1.05-1.29). HRs and 95% CI for stroke were 1.31, 1.14-1.50 in men, 1.13, 0.94-1.36 in women, and 1.22 (1.09, 1.35) in the overall population. No independent associations were observed with MI. Serum uric acid was associated with all-cause mortality in men and women, even after adjustment for blood pressure, estimated GFR, urinary albumin/creatinine ratio, drug intake and traditional cardiovascular risk factors. After the same adjustments, serum uric acid was associated with 31% increased risk of stroke in men.
Publisher: Wiley
Date: 31-01-2017
DOI: 10.1002/EHF2.12134
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.IJCARD.2017.10.009
Abstract: Unrecognized myocardial infarction (MI) is a frequent condition with unknown underlying reason. We hypothesized the lack of recognition of MI is related to pathophysiology, specifically differences in underlying small and large vessel disease. 6128 participants were examined with retinal photography, ultrasound of the carotid artery and a 12‑lead electrocardiography (ECG). Small vessel disease was defined as narrower retinal arterioles and/or wider retinal venules measured on retinal photographs. Large vessel disease was defined as carotid artery pathology. We defined unrecognized MI as ECG-evidence of MI without a clinically recognized event. We analyzed the cross-sectional relationship between MI recognition and markers of small and large vessel disease, adjusted for age and sex. Unrecognized MI was present in 502 (8.2%) and recognized MI in 326 (5.3%) of the 6128 participants. Compared to recognized MI, unrecognized MI was associated with small vessel disease indicated by narrower retinal arterioles (OR 1.66, 95% CI 1.05-2.62, highest vs. lowest quartile). Unrecognized MI was less associated with wider retinal venules (OR 0.55, 95% CI 0.35-0.87, lowest vs. highest quartile). Compared to recognized MI, unrecognized MI was less associated with large vessel disease indicated by presence of plaque in the carotid artery (OR for presence of carotid artery plaque in unrecognized MI 0.51, 95% CI 0.37-0.69). No significant sex interaction was present. Unrecognized MI was more associated with small vessel disease and less associated with large vessel disease compared to recognized MI. These findings suggest that the pathophysiology behind unrecognized and recognized MI may differ.
Publisher: Oxford University Press (OUP)
Date: 29-12-2012
DOI: 10.1093/NDT/GFR751
Abstract: Glomerular filtration rate 60 mL/min/1.73 m2) and possibly a more sensitive marker for cardiovascular risk and all-cause mortality. We examined the association of cystatin C with cardiovascular morbidity and all-cause mortality in a prospective population-based study. Cystatin C was measured in 2852 men and 3153 women in the Tromsø Study 1994/95. Gender-specific associations during 12 years of follow-up for all-cause mortality and 9.5 years for myocardial infarction (MI) and ischaemic stroke were assessed (Cox proportional hazard ratios, HRs). During follow-up, 591 MIs, 293 ischaemic strokes and 1262 deaths occurred. In women, HR for all-cause mortality was increased in the upper cystatin C quartile (≥0.93 mg/L) compared with the lowest quartile (≤0.73 mg/L) 1.38, 95% confidence interval 1.04-1.84. A significant interaction with gender was observed. One SD (0.17 mg/L) increase in cystatin C was associated with 9% higher risk of death in women, also when persons with a cancer history were excluded. Crude HRs for MI and ischaemic stroke were increased in both genders, but the associations did not persist after multivariable adjustments. No independent associations with end points were observed in non-gender-specific analyses. Cystatin C was not independently associated with fatal and non-fatal MI or ischaemic stroke in the general population. However, cystatin C was a risk factor for all-cause mortality in women.
Publisher: Wiley
Date: 17-10-2014
DOI: 10.1111/AOGS.12514
Abstract: To investigate the validity of self-reported information about hypertensive disorders in previous pregnancies among women participating in the fourth survey of the Tromsø Study. Retrospective cohort study with case-control design. Parous women participating in the fourth survey of the Tromsø Study. Medical records including partograms of 200 randomly selected women who had answered positively to whether they had hypertension and/or proteinuria during one or more of their previous pregnancies (cases) and 200 women who had answered negatively (controls) were studied. The cases and controls were matched for age. The investigators were blinded to the allocation of cases and controls until data collection was finished. Self-reported and actual prevalence of hypertensive pregnancy disorders and predictive value of self-reported hypertension and/or proteinuria in previous pregnancies. Clinical data were missing for 23.5% (94/400) of the participants (50 cases and 44 controls). A total of 80% (120/150) of cases and 57.1% (89/156) of controls had answered the question on whether or not they had high blood pressure and/or proteinuria during their pregnancies correctly (positive predictive value 0.800 negative predictive value 0.571). The proportion of false-positive cases declined with increasing age while the proportion of false-negative controls increased until 55 years of age. We found good concordance between self-reported hypertension and/or proteinuria during previous pregnancies and actual clinical findings among the cases. However, there was a tendency towards under-reporting among controls.
Publisher: Informa UK Limited
Date: 1991
DOI: 10.3109/02813439109018530
Abstract: In a survey, 19222 males and females aged 12-64 answered a question about sudden changes of heart rate or rhythm during the preceding year. The prevalence of reported arrhythmia was 12.4% in males and 17.2% in females. Multiple logistic regression was performed with self-reported arrhythmia as the dependent variable and psychological, lifestyle, and coronary risk factors as independent variables. The highest odds ratio for reported arrhythmia concerned poor compared with excellent health status 3.86 in males and 2.98 in females. The relative risk for reported arrhythmia according to frequency of physician consultations was 2.28 in males and 1.70 in females, and odds ratios in both sexes were significant for psychological problems and smoking. The findings suggest that attention should be paid to the psychological conditions and lifestyle of patients who report irregular heartbeats. Self-reported arrhythmia may be a minor problem from a clinical point of view, but we still do not know its prognostic implications. Further work is necessary to determine the predictive strength of self reported arrhythmia for morbidity and mortality.
Publisher: Oxford University Press (OUP)
Date: 03-1994
DOI: 10.1093/OXFORDJOURNALS.EURHEARTJ.A060501
Abstract: The study looked at palpitations in relation to the prevalence of arrhythmia, as assessed by 24-h ambulatory electrocardiography (ECG) in a population s le. The subjects were randomly drawn from among those involved in a cardiovascular survey. Forty-three of those who answered 'Yes' and 54 of those who answered 'No' (84% of those eligible) to the following question, participated: 'Have you observed sudden changes in your heart rate or heart rhythm during the preceding year?' In both groups mean age was 49 years and 58% were men. There was no relationship between recorded arrhythmia and perceived palpitations during monitoring. The prevalence of at least one arrhythmic episode (ventricular or supraventricular arrhythmia or pauses > = 1.5 s) was significantly higher in those who had perceived palpitations during the previous year (98%) than in those who had not (74%) (P < 0.0014). Through a simple question about palpitations during the preceding year we were able to identify significantly a population with true arrhythmias. However, the question could not be used to define a population entirely without arrhythmia. The high prevalence of arrhythmia in subjects without reported palpitations indicates that it is a normal finding which alone should not demand further clinical investigations.
Publisher: Oxford University Press (OUP)
Date: 18-11-2019
Abstract: Limited evidence is available on the temporal relationship between atrial fibrillation (AF) and ischaemic stroke and their impact on mortality in the community. We sought to understand the temporal relationship of AF and ischaemic stroke and to determine the sequence of disease onset in relation to mortality. Across five prospective community cohorts of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project we assessed baseline cardiovascular risk factors in 100 132 in iduals, median age 46.1 (25th–75th percentile 35.8–57.5) years, 48.4% men. We followed them for incident ischaemic stroke and AF and determined the relation of subsequent disease diagnosis with overall mortality. Over a median follow-up of 16.1 years, N = 4555 in iduals were diagnosed solely with AF, N = 2269 had an ischaemic stroke but no AF diagnosed, and N = 898 developed both, ischaemic stroke and AF. Temporal relationships showed a clustering of diagnosis of both diseases within the years around the diagnosis of the other disease. In multivariable-adjusted Cox regression analyses with time-dependent covariates subsequent diagnosis of AF after ischaemic stroke was associated with increased mortality [hazard ratio (HR) 4.05, 95% confidence interval (CI) 2.17–7.54 P & 0.001] which was also apparent when ischaemic stroke followed after the diagnosis of AF (HR 3.08, 95% CI 1.90–5.00 P & 0.001). The temporal relations of ischaemic stroke and AF appear to be bidirectional. Ischaemic stroke may precede detection of AF by years. The subsequent diagnosis of both diseases significantly increases mortality risk. Future research needs to investigate the common underlying systemic disease processes.
Publisher: E.U. European Publishing
Date: 31-10-2022
DOI: 10.18332/TPC/155287
Publisher: Wiley
Date: 10-12-2014
DOI: 10.1111/J.2047-2927.2013.00174.X
Abstract: Low testosterone levels are associated with metabolic and cardiovascular disease risk factor, and have been shown to predict type 2 diabetes mellitus (T2DM), myocardial infarction (MI) and all-cause mortality. It is not known if these associations are causal or not. Recently, it has been shown that the serum testosterone levels are associated with single-nucleotide polymorphisms (SNPs), and we therefore studied the associations between one of these SNPs, rs1799941 on the Sex Hormone-Binding Globulin (SHBG) gene, and MI, T2DM, cancer and death. DNA was prepared from men who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints MI, T2DM, cancer or death and a randomly selected control group. For mortality, the observation time was set from 1994, and for the other endpoints from birth. The endpoint data were completed up to 2010-2013. Genetic analyses were successfully performed in 5309 men, of whom 1454 were registered with MI, 638 with T2DM, 1534 with cancer and in 2226 who had died. Men with the minor homozygote genotype had significantly higher levels of total testosterone (14.7%) and SHBG (24.7%) compared with men with the major homozygote genotype, whereas free testosterone levels did not differ significantly between the genotypes. The SNP rs1799941 was not significantly associated with MI, T2DM, cancer or mortality. Thus, our result does not support a causal relationship between total testosterone and SHBG and MI, T2DM, cancer or mortality, suggesting that low testosterone more likely is a marker of poor health.
Publisher: Commonwealth Forestry Association
Date: 12-2012
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/OPENHRT-2021-001777
Abstract: To compare the population proportion at high risk of cardiovascular disease (CVD) using the Norwegian NORRISK 1 that predicts 10-year risk of CVD mortality and the Norwegian national guidelines from 2009, with the updated NORRISK 2 that predicts 10-year risk of both fatal and non-fatal risk of CVD and the Norwegian national guidelines from 2017. We included participants from the Norwegian population-based Tromsø Study (2015–2016) aged 40–69 years without a history of CVD (n=16 566). The total proportion eligible for intervention was identified by NORRISK 1 and the 2009 guidelines (serum total cholesterol ≥8 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg) and NORRISK 2 and the 2017 guidelines (serum total cholesterol ≥7 mmol/L, low density lipoprotein (LDL) cholesterol ≥5 mmol/L, systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥100 mm Hg). The total proportion at high risk as defined by a risk score was 12.0% using NORRISK 1 and 9.8% using NORRISK 2. When including single risk factors specified by the guidelines, the total proportion eligible for intervention was 15.5% using NORRISK 1 and the 2009 guidelines and 18.9% using NORRISK 2 and the 2017 guidelines. The lowered threshold for total cholesterol and specified cut-off for LDL cholesterol stand for a large proportion of the increase in population at risk. The population proportion eligible for intervention increased by 3.4 percentage points from 2009 to 2017 using the revised NORRISK 2 score and guidelines.
Publisher: Springer Science and Business Media LLC
Date: 06-03-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 16-11-2021
Abstract: The initial presentation to coronary angiography and extent of coronary artery disease (CAD) vary greatly among patients, from ischemia with no obstructive CAD to myocardial infarction with 3‐vessel disease. Pain tolerance has been suggested as a potential mechanism for the variation in presentation of CAD. We aimed to investigate the association between pain tolerance, coronary angiography, CAD, and death. We identified 9576 participants in the Tromsø Study (2007–2008) who completed the cold‐pressor pain test, and had no prior history of CAD. The median follow‐up time was 10.4 years. We applied Cox‐regression models with age as time‐scale to calculate hazard ratios (HR). More women than men aborted the cold pressor test (39% versus 23%). Participants with low pain tolerance had 19% increased risk of coronary angiography (HR, 1.19 [95% CI, 1.03–1.38]) and 22% increased risk of obstructive CAD (HR, 1.22 [95% CI, 1.01–1.47]) adjusted by age as time‐scale and sex. Among women who underwent coronary angiography, low pain tolerance was associated with 54% increased risk of obstructive CAD (HR, 1.54 [95% CI, 1.09–2.18]) compared with high pain tolerance. There was no association between pain tolerance and nonobstructive CAD or clinical presentation to coronary angiography (ie, stable angina, unstable angina, and myocardial infarction). Participants with low pain tolerance had increased risk of mortality after adjustment for CAD and cardiovascular risk factors (HR, 1.40 [95% CI, 1.19–1.64]). Low cold pressor pain tolerance is associated with a higher risk of coronary angiography and death.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-02-2011
Publisher: Oxford University Press (OUP)
Date: 29-03-2021
Abstract: To investigate European guideline treatment target achievement in cardiovascular risk factors, medication use, and lifestyle, after myocardial infarction (MI) or ischaemic stroke, in women and men living in Norway. In the population-based Tromsø Study 2015–16 (attendance 65%), 904 participants had previous validated MI and/or stroke. Cross-sectionally, we investigated target achievement for blood pressure (& /90 mmHg, & /80 mmHg if diabetes), LDL cholesterol (& .8 mmol/L), HbA1c (& .0% if diabetes), overweight (body mass index (BMI) & kg/m2, waist circumference women & cm, men & cm), smoking (non-smoking), physical activity (self-reported & sedentary, accelerometer-measured moderate-to-vigorous ≥150 min/week), diet (intake of fruits ≥200 g/day, vegetables ≥200 g/day, fish ≥200 g/week, saturated fat & E%, fibre ≥30 g/day, alcohol women ≤10 g/day, men ≤20 g/day), and medication use (antihypertensives, lipid-lowering drugs, antithrombotics, and antidiabetics), using regression models. Proportion of target achievement was for blood pressure 55.2%, LDL cholesterol 9.0%, HbA1c 42.5%, BMI 21.1%, waist circumference 15.7%, non-smoking 86.7%, self-reported physical activity 79%, objectively measured physical activity 11.8%, intake of fruit 64.4%, vegetables 40.7%, fish 96.7%, saturated fat 24.3%, fibre 29.9%, and alcohol 78.5%, use of antidiabetics 83.6%, lipid-lowering drugs 81.0%, antihypertensives 75.9%, and antithrombotics 74.6%. Only 0.7% achieved all cardiovascular risk factor targets combined. Largely, there was little difference between the sexes, and in characteristics, medication use, and lifestyle among target achievers compared to non-achievers. Secondary prevention of cardiovascular disease was suboptimal. A negligible proportion achieved the treatment target for all risk factors. Improvement in follow-up care and treatment after MI and stroke is needed.
Publisher: American Medical Association (AMA)
Date: 26-04-1999
Publisher: Oxford University Press (OUP)
Date: 08-1999
DOI: 10.1177/204748739900600414
Abstract: In epidemiological studies, the electrocardiogram has often been interpreted by means of a categorical classification. Computerized recording offers the possibility of analysing electrocardiographic measurements as continuous variables. To test the hypothesis that duration of QRS complex and T-wave inversion would be independent predictors of myocardial infarction. In a population-based study, we prospectively investigated the risk of developing myocardial infarction according to duration of ORS complex and peak-to-peak T-wave litude measured from lead I of the 12-lead electrocardiogram by computerized electrocardiography. In total 6628 men aged 25-61 years who had not previously suffered a myocardial infarction were followed up for 3.9 years. Eighty-two first myocardial infarctions (55 non-fatal and 24 fatal myocardial infarctions and three sudden deaths) were identified. The risk of myocardial infarction increased with duration of ORS complex and with decreasing T-wave litude. A proportional hazards model with adjustment for possible confounders yielded a relative risk of myocardial infarction of 3.74 (P for linear trend 0.015) for duration of QRS complex > or = 120 ms compared with duration of QRS complex or = 0.35 mV compared with T-wave litude < 0.20 mV was 0.55 (P for linear trend 0.036). When both duration of ORS complex and T-wave litude were included in the multivariate model, T-wave litude retained its predictive power, whereas duration of ORS complex became marginally no longer significant (P=0.067). Peak-to-peak T-wave litude from lead I is an independent predictor of myocardial infarction in men who have not previously suffered a myocardial infarction. Greater duration of ORS complex clearly indicates a higher risk of myocardial infarction. However, when T-wave litude is included as a covariate, the predictive power of duration of QRS complex does not remain significant. Single-lead electrocardiography is a feasible method for improving the assessment of the relative risk of myocardial infarction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-08-2014
Abstract: Red cell distribution width (RDW), a measure of the variability in size of circulating erythrocytes, is associated with mortality and adverse outcome in selected populations with cardiovascular disease. It is scarcely known whether RDW is associated with incident myocardial infarction (MI). We aimed to investigate whether RDW was associated with risk of first‐ever MI in a large cohort study with participants recruited from a general population. Baseline characteristics, including RDW, were collected for 25 612 participants in the Tromsø Study in 1994–1995. Incident MI during follow‐up was registered from inclusion through December 31, 2010. Cox regression models were used to calculate hazard ratios with 95% confidence intervals for MI, adjusted for age, sex, body mass index, smoking, hemoglobin, white blood cells, platelets, and other traditional cardiovascular risk factors. A total of 1779 participants experienced a first‐ever MI during a median follow‐up time of 15.8 years. There was a linear association between RDW and risk of MI, for which a 1% increment in RDW was associated with a 13% increased risk (hazard ratio 1.13 95% CI, 1.07 to 1.19). Participants with RDW above the 95th percentile had 71% higher risk of MI compared with those with RDW in the lowest quintile (hazard ratio 1.71 95% CI, 1.34 to 2.20). All effect estimates were essentially similar after exclusion of participants with anemia (n=1297) from the analyses. RDW is associated with incident MI in a general population independent of anemia and cardiovascular risk factors.
Publisher: Springer Science and Business Media LLC
Date: 14-08-2008
DOI: 10.1007/S10654-008-9275-X
Abstract: Dyspepsia and Helicobacter pylori infection are two important public health issues in the field of gastroenterology, generating high expenditures in diagnosis and treatment. A causal relationship between H. pylori and dyspepsia is still debated. The aim of this study was to address changes in the prevalence of, and association between, dyspepsia and H. pylori infection in a general population. The study took place in the municipality of Sørreisa in Northern Norway. Data were collected in 1987 and 2004. The study included questionnaires on gastrointestinal disorders and risk factors, as well as H. pylori assessment. The prevalence of dyspepsia in 2004 was 31.9% in men and 31.7% in women (compared with 30.7 and 26.3% in 1987). In 2004, the prevalence of H. pylori infection in men with/without dyspepsia was 20.3/26.7% (compared with 47.0/32.7% in 1987), whereas the prevalence of H. pylori infection in women with/without dyspepsia was 31.3/20.8% (compared with 50.0/40.7% in 1987). Since 1987, the prevalence of H. pylori has decreased independently of dyspepsia, most pronounced in the younger age groups, thus indicating a cohort effect. Our findings of a decreasing prevalence of H. pylori, a persistently high prevalence of dyspepsia, and an uneven distribution of H. pylori infection with regard to dyspepsia in men and women, question the understanding of a causal relationship between dyspepsia and H. pylori.
Publisher: BMJ
Date: 31-03-2014
Abstract: The Rose Angina Questionnaire (RAQ) was constructed in the 1960s for assessing the population burden of angina. Studies have found that screening positivity by RAQ conferred an elevated risk of coronary heart disease (CHD). It is, however, not clear to what extent Rose angina represents early CHD in relatively young adults who are free of known CHD. If representing CHD, Rose angina is expected to carry prognostic information in addition to the risk conferred by other risk factors. The Tromsø Study is a population-based cohort study in Northern Norway. All men aged 20-54 years (n=8238) and women aged 20-49 years (n=8001), free of known cardiovascular disease (CVD), who participated in a survey 1979-1980, were followed throughout 2010 for incident myocardial infarction (MI), and for incident MI or stroke used as proxy for incident CVD. HRs were estimated using a Cox proportional hazard regression model. In age-adjusted analyses, Rose angina predicted MI and CVD in both sexes. The excess risk was substantially accounted for by CVD risk factors, leaving no significantly elevated MI risk above the risk explained by these factors (adjusted HR 1.31 95% CI 0.95 to 1.80 in men, HR 1.20 95% CI 0.69 to 2.10 in women). A similar pattern was seen for CVD (adjusted HR 1.16 95% CI 0.87 to 1.55 in men and 1.30 95% CI 0.82 to 2.06 in women). Rose angina predicted MI and CVD in a 29-years' follow-up of a relatively young population. Established CVD risk factors were important mediators.
Publisher: Oxford University Press (OUP)
Date: 22-08-2011
Abstract: Although the mortality of coronary heart disease (CHD) has declined in Western countries during the last decades, studies have suggested that the prevention and treatment of CHD may not have been as effective in women as in men. We examined gender- and age-specific trends in incidence, case fatality and the severity of first myocardial infarction (MI) in a large Norwegian population-based study. Prospective population-based cohort study. A total of 31,323 participants enrolled between 1974 and 2001 were followed throughout 2004 for a total of 400,572 person-years. Suspected coronary events were adjudicated by a review of hospital records and death certificates. A total of 1669 events fulfilled standardized criteria of first-ever fatal or non-fatal MI. In the age group 35-79 years, the age-adjusted incidence of MI declined significantly in men, whereas an increase was observed in women. For men and women ≥ 80 years the incidence rates remained unchanged. The severity of MI and the 28-day and 1-year case fatality rates declined significantly and similarly in men and women. Trends in MI incidence differed by sex and age in the age group 35-79 years a marked decrease was observed among men but an increase was observed among women, while no change was observed among older patients. MI severity and case fatality were clearly reduced for both sexes. These data suggest that the burden of CHD is shifting from middle-aged men toward middle-aged women and elderly patients.
Publisher: MDPI AG
Date: 23-03-2023
DOI: 10.3390/APP13074119
Abstract: Machine Learning (ML) methods have become important for enhancing the performance of decision-support predictive models. However, class imbalance is one of the main challenges for developing ML models, because it may bias the learning process and the model generalization ability. In this paper, we consider overs ling methods for generating synthetic categorical clinical data aiming to improve the predictive performance in ML models, and the identification of risk factors for cardiovascular diseases (CVDs). We performed a comparative study of several categorical synthetic data generation methods, including Synthetic Minority Overs ling Technique Nominal (SMOTEN), Tabular Variational Autoencoder (TVAE) and Conditional Tabular Generative Adversarial Networks (CTGANs). Then, we assessed the impact of combining overs ling strategies and linear and nonlinear supervised ML methods. Lastly, we conducted a post-hoc model interpretability based on the importance of the risk factors. Experimental results show the potential of GAN-based models for generating high-quality categorical synthetic data, yielding probability mass functions that are very close to those provided by real data, maintaining relevant insights, and contributing to increasing the predictive performance. The GAN-based model and a linear classifier outperform other overs ling techniques, improving the area under the curve by 2%. These results demonstrate the capability of synthetic data to help with both determining risk factors and building models for CVD prediction.
Publisher: Oxford University Press (OUP)
Date: 29-07-2020
Abstract: Tobacco use is the single largest preventable risk factor for premature death of non-communicable diseases and the second leading cause of cardiovascular disease. In response to the harmful effects of tobacco smoking, the use of electronic cigarettes (e-cigarettes) has emerged and gained significant popularity over the past 15 years. E-cigarettes are promoted as safe alternatives for traditional tobacco smoking and are often suggested as a way to reduce or quit smoking. However, evidence suggests they are not harmless. The rapid evolution of the e-cigarette market has outpaced the legislator’s regulatory capacity, leading to mixed regulations. The increasing use of e-cigarettes in adolescents and young in iduals is of concern. While the long-term direct cardiovascular effects of e-cigarettes remain largely unknown, the existing evidence suggests that the e-cigarette should not be regarded as a cardiovascular safe product. The contribution of e-cigarette use to reducing conventional cigarette use and smoking cessation is complex, and the impact of e-cigarette use on long-term cessation lacks sufficient evidence. This position paper describes the evidence regarding the prevalence of e-cigarette smoking, uptake of e-cigarettes in the young, related legislations, cardiovascular effects of e-cigarettes and the impact of e-cigarettes on smoking cessation. Knowledge gaps in the field are also highlighted. The recommendations from the population science and public health section of the European Association of Preventive Cardiology are presented.
Publisher: Springer Science and Business Media LLC
Date: 12-06-2018
DOI: 10.1038/S42003-018-0068-9
Abstract: Most sequence variants identified hitherto in genome-wide association studies (GWAS) of atrial fibrillation are common, non-coding variants associated with risk through unknown mechanisms. We performed a meta-analysis of GWAS of atrial fibrillation among 29,502 cases and 767,760 controls from Iceland and the UK Biobank with follow-up in s les from Norway and the US, focusing on low-frequency coding and splice variants aiming to identify causal genes. We observe associations with one missense (OR = 1.20) and one splice-donor variant (OR = 1.50) in RPL3L , the first ribosomal gene implicated in atrial fibrillation to our knowledge. Analysis of 167 RNA s les from the right atrium reveals that the splice-donor variant in RPL3L results in exon skipping. We also observe an association with a missense variant in MYZAP (OR = 1.38), encoding a component of the intercalated discs of cardiomyocytes. Both discoveries emphasize the close relationship between the mechanical and electrical function of the heart.
Publisher: Elsevier BV
Date: 10-2016
Publisher: Oxford University Press (OUP)
Date: 27-06-2016
Publisher: Springer Science and Business Media LLC
Date: 16-03-2014
DOI: 10.1038/NG.2926
Publisher: Wiley
Date: 2022
DOI: 10.1002/EJHF.2351
Abstract: The heart failure epidemic is growing and its prevention, in order to reduce associated hospital readmission rates and its clinical and economic burden, is a key issue in modern cardiovascular medicine. The present position paper aims to provide practical evidence-based information to support the implementation of effective preventive measures. After reviewing the most common risk factors, an overview of the population attributable risks in different continents is presented, to identify potentially effective opportunities for prevention and to inform preventive strategies. Finally, potential interventions that have been proposed and have been shown to be effective in preventing heart failure are listed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
DOI: 10.1161/ATVBAHA.113.302162
Abstract: Recent studies have suggested that arterial and venous thrombosis share common risk factors. Although carotid atherosclerosis is associated with arterial cardiovascular events, its role in venous thromboembolic disease is unclear. We wanted to investigate and compare the effect of carotid atherosclerosis on the risk of myocardial infarction (MI) and venous thromboembolism (VTE) in a general population, taking into account competing risks. Mean intima-media thickness and total plaque area in the right carotid artery were measured with ultrasound in 6257 people aged 25 to 84 years who participated in a population-based health study, the Tromsø Study, from 1994 to 1995. Incident MI and VTE events were registered from date of enrollment to end of follow-up on December 31, 2010. Cox proportional hazards regression models using age as time scale were used to estimate cause-specific hazard ratios with 95% confidence intervals for MI and VTE by increasing levels of intima-media thickness and total plaque area. There were 894 incident MI cases and 256 VTE events during a median of 15.4 years of follow-up. The risk of MI increased significantly across quartiles of mean intima-media thickness ( P for trend .001) and with increasing total plaque area ( P for trend .001), but neither intima-media thickness ( P for trend=0.94) nor total plaque area ( P for trend=0.45) was associated with VTE risk in multivariable-adjusted analysis. In this study, carotid atherosclerosis was strongly associated with future MI but not with VTE. Our findings suggest that carotid atherosclerosis does not represent a link between arterial and venous thrombosis.
Publisher: Springer Science and Business Media LLC
Date: 14-06-2016
Publisher: Oxford University Press (OUP)
Date: 09-2001
Abstract: Tracking of cardiovascular risk factors (blood pressure, body mass index (BMI), and serum lipids) has not been studied much in a general, adult population. No known study has compared tracking of these factors for both sexes. In the present study, 17,710 men and women aged 20-61 years at baseline attended two or three population-based health surveys in Tromsø, Norway, over 16 years (between 1979-1980 and 1994-1995). Tracking coefficients were estimated by using different methods, and possible predictors of tracking were found. There was a high degree of tracking for BMI (overall tracking coefficients: 0.85 for men, 0.80 for women). Relatively high (or moderate) tracking was found for systolic blood pressure (respective sex-specific coefficients: 0.52, 0.54), diastolic blood pressure (0.48, 0.48), high density lipoprotein cholesterol (0.55, 0.64), and total cholesterol (0.77, 0.65). The lowest coefficients were for triglycerides (0.43, 0.39). Analysis of tracking in the upper sextile confirmed these results. Although some baseline predictors were associated with tracking, the effects were relatively weak. When predictors for tracking in the upper sextile were assessed, significant associations were found with relatively strong effects. No major sex differences were observed in tracking. However, women were more likely than men to remain in the upper sextile of systolic and diastolic blood pressures and of BMI.
Publisher: BMJ
Date: 07-03-2016
Abstract: Elevated resting heart rate (RHR) increases risk of death overall, but a comprehensive picture of the associations between RHR, cardiovascular morbidity and mortality events has not yet been presented. We aimed to investigate the effect of RHR on the risk of 5 cardiovascular events: incident myocardial infarction (MI), incident atrial fibrillation (AF), incident ischaemic stroke, total death and cardiovascular death in a general population from Norway. We followed 24 489 men and women from the Tromsø Study 1994-1995, a population-based cohort study, for 18 years, and analysed the association between RHR and the investigated cardiovascular events. Sex-specific Cox regression with time-dependent covariates was applied with the best-fitting fractional polynomials of RHR. Among men, an independent positive relationship was observed for MI and AF (adjusted HR for AF per 20 bpm increase=1.14 95% CI 1.02 to 1.27). In women, the corresponding HR for MI was 1.23 (1.09 to 1.40). A J-shaped association was observed for ischaemic stroke in women when compared with a RHR of 70 bpm (HR for 50 bpm=1.31 0.90 to 1.90 HR for 100 bpm=1.32 1.04 to 1.69). Total and cardiovascular death showed a strong positive association with RHR in men. In women, the pattern for total death was similar. RHR is an independent risk factor for several cardiovascular events. A novel finding is the positive association between RHR and AF in men and the sex difference in association with ischaemic stroke.
Publisher: Wiley
Date: 17-04-2012
DOI: 10.1111/J.1540-8167.2012.02308.X
Abstract: The relationship between QT interval and cardiovascular disease is controversial. All male residents aged 20-61 years and female residents aged 20-56 years were invited to the Tromsø Study in 1986-1987. A total of 15,558 participants free of heart disease were prospectively followed over 20 years for myocardial infarction and death. QT interval at baseline was measured on lead I of the electrocardiogram. Hazard ratios (HRs) with 95% confidence intervals (CIs) per standard deviation change in QT interval were calculated using a Cox regression model. We identified 756 cases of myocardial infarction and 1,183 all-cause deaths. Prolonged QT interval was present in 792 (5%) participants. QT interval was not associated with increased risk of myocardial infarction (HR: 0.95, 95% CI: 0.84-1.07, after adjustment for potential confounders). Heart-rate-corrected QT interval was a significant predictor for all-cause death in men (HR: 1.15, 95% CI: 1.03-1.29), but not in women (HR: 1.04, 95% CI: 0.91-1.18), after adjustment for potential confounders. The findings suggest that the previously observed relationship between QT interval and increased risk of cardiovascular death is not mediated by increased risk of myocardial infarction. The clinical utility of the QT interval to identify in iduals at high risk for coronary events is limited in a general population without prior heart disease.
Publisher: Springer Nature Switzerland
Date: 2022
Publisher: Public Library of Science (PLoS)
Date: 16-02-2017
Publisher: Oxford University Press (OUP)
Date: 19-07-2023
Abstract: To use the parametric g-formula to estimate the long-term risk of atrial fibrillation (AF) by sex and education under hypothetical interventions on six modifiable risk factors. We estimated the risk reduction under hypothetical risk reduction strategies for smoking, physical activity, alcohol intake, body mass index, systolic, and diastolic blood pressure in 14 923 women and men (baseline mean age 45.8 years in women and 47.8 years in men) from the population-based Tromsø Study with a maximum of 22 years of follow-up (1994–2016). The estimated risk of AF under no intervention was 6.15% in women and 13.0% in men. This cumulative risk was reduced by 41% (95% confidence interval 17%, 61%) in women and 14% (−7%, 30%) in men under joint interventions on all risk factors. The most effective intervention was lowering body mass index to ≤ 25 kg/m2, leading to a 16% (4%, 25%) lower risk in women and a 14% (6%, 23%) lower risk in men. We found significant sex-differences in the relative risk reduction by sufficient physical activity, leading to a 7% (-4%, 18%) lower risk in women and an 8% (−2%, −13%) increased risk in men. We found no association between the level of education and differences in risk reduction by any of the interventions. The population burden of AF could be reduced by modifying lifestyle risk factors. Namely, these modifications could have prevented 41% of AF cases in women and 14% of AF cases in men in the municipality of Tromsø, Norway during a maximum 22-year follow-up period.
Publisher: Wiley
Date: 08-2002
DOI: 10.1034/J.1600-0609.2002.01544.X
Abstract: To investigate the prevalence and incidence of haematological malignancies, and to compare the rates found with those reported from the Cancer Registry of Norway. Three sources of information were used: (1) automated blood cell counts from 27 145 persons older than 24 yr (72% of those invited), participating in a population study (the Tromsø Study 1994-95) (2) patient medical records at the University Hospital of Tromsø during 1991-96 (3) the Cancer Registry of Norway. (1) In the population study, 13 new cases of haematological malignancies were diagnosed. For five of these the early detection was probably beneficial. (2) From the hospital records another 59 participants and 36 non-participants to the population study were found to have haematological malignancies. (3) Additionally, six cases were identified from the Cancer Registry. Totally, we thus identified 114 period prevalent cases, of which 86% had been reported to the Cancer Registry. Age-adjusted period prevalence of haematological malignancies was 4.7 per thousand in men and 2.9 per thousand in women. The prevalence increased with age. There were 84 cases with leukaemia, lymphoma, or multiple myeloma diagnosed at any time and still alive at 31 December 1996 (point prevalence 2.2 per thousand). Our estimated incidence of haematological malignancies did not differ significantly from that reported from the Cancer Registry. We found approximately the same rates of haematological malignancies as the Cancer Registry, although an underreporting of 14% to the Cancer Registry was detected. The point prevalence of leukaemia, lymphoma, and multiple myeloma was 2.2%.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-01-2016
DOI: 10.1161/CIRCULATIONAHA.115.016960
Abstract: Few studies have used in idual person data to study whether contemporary trends in the incidence of coronary heart disease are associated with changes in modifiable coronary risk factors. We identified 29 582 healthy men and women ≥25 years of age who participated in 3 population surveys conducted between 1994 and 2008 in Tromsø, Norway. Age- and sex-adjusted incidence rates were calculated for coronary heart disease overall, out-of-hospital sudden death, and hospitalized ST-segment–elevation and non–ST-segment–elevation myocardial infarction. We measured coronary risk factors at each survey and estimated the relationship between changes in risk factors and changes in incidence trends. A total of 1845 participants had an incident acute coronary heart disease event during 375 064 person-years of follow-up from 1994 to 2010. The age- and sex-adjusted incidence of total coronary heart disease decreased by 3% (95% confidence interval, 2.0–4.0 P .001) each year. This decline was driven by decreases in out-of-hospital sudden death and hospitalized ST-segment–elevation myocardial infarction. Changes in coronary risk factors accounted for 66% (95% confidence interval, 48–97 P .001) of the decline in total coronary heart disease. Favorable changes in cholesterol contributed 32% to the decline, whereas blood pressure, smoking, and physical activity each contributed 14%, 13%, and 9%, respectively. We observed a substantial decline in the incidence of coronary heart disease that was driven by reductions in out-of-hospital sudden death and hospitalized ST-segment–elevation myocardial infarction. Changes in modifiable coronary risk factors accounted for 66% of the decline in coronary heart disease events.
Publisher: JMIR Publications Inc.
Date: 08-11-2021
Abstract: ardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the 4 main noncommunicable diseases. These noncommunicable diseases share 4 modifiable risk factors (tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet). Short smartphone surveys have the potential to identify modifiable risk factors for in iduals to monitor trends. e aimed to pilot a smartphone-based information communication technology solution to collect nationally representative data, annually, on 4 modifiable risk factors. e developed an information communication technology solution with functionalities for capturing sensitive data from smartphones, receiving, and handling data in accordance with general data protection regulations. The main survey comprised 26 questions: 8 on socioeconomic factors, 17 on the 4 risk factors, and 1 about current or previous noncommunicable diseases. For answers to the continuous questions, a keyboard was displayed for entering numbers there were preset upper and lower limits for acceptable response values. For categorical questions, pull-down menus with response options were displayed. The second survey comprised 9 yes-or-no questions. For both surveys, we used SMS text messaging. For the main survey, we invited 11,000 in iduals, aged 16 to 69 years, selected randomly from the Norwegian National Population Registry (1000 from each of the 11 counties). For the second survey, we invited a random s le of 100 in iduals from each county who had not responded to the main survey. All data, except county of residence, were self-reported. We calculated the distribution for socioeconomic background, tobacco use, diet, physical activity, and health condition factors overall and by sex. he response rate was 21.9% (2303/11,000 women: 1397/2263 61.7%, men: 866/2263, 38.3% missing: 40/2303, 1.7%). The median age for men was 52 years (IQR 40-61) the median age for women was 48 years (IQR 35-58). The main reported reason for nonparticipation in the main survey was that the sender of the initial SMS was unknown. e successfully developed and piloted a smartphone-based information communication technology solution for collecting data on the 4 modifiable risk factors for the 4 main noncommunicable diseases. Approximately 1 in 5 invitees responded thus, these data may not be nationally representative. The smartphone-based information communication technology solution should be further developed with the long-term goal to reduce premature mortality from the 4 main noncommunicable diseases.
Publisher: Oxford University Press (OUP)
Date: 25-01-2017
Abstract: Background Resting heart rate is an established risk factor for cardiovascular disease, but long-term in idual resting heart rate trajectories and their effect on cardiovascular disease morbidity and mortality have not yet been described. Methods This large population-based longitudinal study included 14,208 men and women aged 20 years or older, not pregnant and not using blood pressure medications, who attended at least two of the three Tromsø Study surveys conducted between 1986-2001. Resting heart rate was measured using an automated Dinamap device. Participants were followed up from 2001 to 2012 with respect to myocardial infarction, atrial fibrillation, ischaemic stroke, cardiovascular disease death and total death. The Proc Traj statistical procedure was used to identify resting heart rate trajectories. Results Five common long-term resting heart rate trajectories were identified: low, moderate, decreasing, increasing and elevated. In men, an elevated resting heart rate trajectory was independently associated with an increased risk of myocardial infarction when low resting heart rate trajectory was used as a reference (hazard ratio 1.83, 95% confidence interval 1.11-3.02). Risk of total death in men was lowest in the low resting heart rate trajectory group and highest in the increasing and elevated resting heart rate trajectory groups. In women, the association between resting heart rate trajectories and myocardial infarction was similar to that in men, but it was not significant. Conclusions Among the five long-term resting heart rate trajectories we identified, increasing and elevated trajectories were associated with an increased risk of myocardial infarction and total death in men. Our results suggest that changes in long-term in idual resting heart rate in the general population may provide additional prognostic information.
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-038465
Abstract: To describe the prevalence of general (body mass index (BMI) ≥30 kg/m 2 ) and abdominal (waist circumference women cm, men cm) obesity in Tromsø 7 (2015–2016), and the secular change from Tromsø 6 (2007–2008). Furthermore, to study longitudinal changes in body weight and waist circumference from Tromsø 6 to Tromsø 7. A population study in Tromsø, Norway. The cross-sectional analyses included 20 855 participants in Tromsø 7 (aged ≥40 years) and 12 868 in Tromsø 6 (aged ≥30 years). The longitudinal analyses included 8592 participants with repeated measurements, aged 35–79 in Tromsø 6. Mean age-specific and sex-specific BMI, waist circumference, prevalence of general and abdominal overweight and obesity, as well as longitudinal changes in body weight and waist circumference according to sex and birth cohort. Over 8 years, the age-adjusted prevalence of general obesity increased (p .0001) from 20.1% to 23.0% in women and from 20.7% to 25.2% in men. The age-adjusted prevalence of abdominal obesity did not increase in women (from 54.7% to 53.4%), and the increase in men was modest (from 36.8% to 38.6%, p=0.003). Longitudinal analyses showed an increase in body weight, by 1.1 kg (95% CI 0.9 to 1.2) in women and 0.7 kg (95% CI 0.6 to 0.9) in men, and also waist circumference, by 1.3 cm (95% CI 1.0 to 1.5) in women and 1.4 cm (95% CI 1.2 to 1.6) in men. There were inverse relationships (p .001) between age at baseline and change in weight and waist circumference. Repeated cross-sectional analyses showed that the prevalence of general obesity increased, whereas the increase in abdominal obesity was less marked. Longitudinal analyses showed increases in both body weight and waist circumference. The youngest age groups have the largest increase.
Publisher: Informa UK Limited
Date: 2004
DOI: 10.1080/00365520410007944
Abstract: Recent availability of tests for Helicobacter pylori antigens in stool s les has provided potentially useful tools for epidemiological studies and clinical settings. The aim of this study was to evaluate a monoclonal antibody-based H. pylori antigen stool test in the primary diagnosis of H. pylori infection, and to study the test performance after patients were treated with lanzoprazole, and after eradication therapy. The study included 122 dyspeptic patients. At gastroscopy, biopsy specimens were obtained for culture and histology. Stool antigen and [14C]-urea breath tests were performed concurrently. Positive culture alone or a positive [14C]-urea breath test in combination with positive histology defined the reference standard. Forty-three Hp +ve patients were treated with lanzoprazole for 2 to 4 weeks, and stool antigen tests were performed on days 1 and 7 post-treatment. After eradication therapy, 32 patients were re-examined for H. pylori infection. Prevalence of H. pylori was 44.3%. Sensitivity and specificity for the stool antigen test in the primary diagnosis of H. pylori infection were 98% and 94%, with positive and negative likelihood ratios of 16.7 and 0.02, respectively. All patients had positive stool tests immediately after lanzoprazole treatment, whereas 2 patients had negative stool tests after 7 days. Triple therapy rendered all patients stool test negative. The monoclonal antibody-based stool antigen test is an accurate tool in the primary diagnosis of H. pylori infection and after eradication therapy. Lanzoprazole treatment does not influence the clinical performance of the test.
Publisher: Public Library of Science (PLoS)
Date: 18-05-2015
Publisher: University of Queensland Library
Date: 2023
DOI: 10.14264/BAB1C57
No related grants have been discovered for Maja-Lisa Løchen.