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Jensen JS, Cusini M, Gomberg M, Moi H, Wilson J, Unemo M. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2022; 36:641-650. [PMID: 35182080 DOI: 10.1111/jdv.17972] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022]
Abstract
Mycoplasma genitalium infection contributes to 10-35% of non-chlamydial non-gonococcal urethritis in men. In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID) in 10-25%. Transmission of M. genitalium occurs through direct mucosal contact. CLINICAL FEATURES AND DIAGNOSTIC TESTS Asymptomatic infections are frequent. In men, urethritis, dysuria and discharge predominate. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. Symptoms are the main indication for diagnostic testing. Diagnosis is achievable only through nucleic acid amplification testing and must include investigation for macrolide resistance mutations. THERAPY Therapy for M .genitalium is indicated if M. genitalium is detected. Doxycycline has a cure rate of 30-40%, but resistance is not increasing. Azithromycin has a cure rate of 85-95% in macrolide-susceptible infections. An extended course of azithromycin appears to have a higher cure rate, and pre-treatment with doxycycline may decrease organism load and the risk of macrolide resistance selection. Moxifloxacin can be used as second-line therapy but resistance is increasing. RECOMMENDED TREATMENT Uncomplicated M. genitalium infection without macrolide resistance mutations or resistance testing: Azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral). Second-line treatment and treatment for uncomplicated macrolide-resistant M. genitalium infection: Moxifloxacin 400 mg od for 7 days (oral). Third-line treatment for persistent M. genitalium infection after azithromycin and moxifloxacin: Doxycycline or minocycline 100 mg bid for 14 days (oral) may cure 40-70%. Pristinamycin 1 g qid for 10 days (oral) has a cure rate of around 75%. Complicated M. genitalium infection (PID, epididymitis): Moxifloxacin 400 mg od for 14 days. MAIN CHANGES FROM THE 2016 EUROPEAN M. GENITALIUM GUIDELINE Due to increasing antimicrobial resistance and warnings against moxifloxacin use, indications for testing and treatment have been narrowed to primarily involve symptomatic patients. The importance of macrolide resistance-guided therapy is emphasised.
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Affiliation(s)
- J S Jensen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - M Cusini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Gomberg
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - H Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway
| | - J Wilson
- Genitourinary Medicine and HIV, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden
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Tuborgh A, Svendsen SW, Elklit A, Hunter J, Jensen JS, Schröder A, Nielsen JF, Thastum MM, Næss-Schmidt ET, Rask CU. Attachment and symptom reporting in adolescents and young adults after a concussion. J Psychosom Res 2021; 150:110603. [PMID: 34509710 DOI: 10.1016/j.jpsychores.2021.110603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of hospital-treated concussion is 100-300/100,000 person years. Reporting of long-lasting post-concussion symptoms (PCS) is estimated at 5-15%. Attachment insecurity is a potential vulnerability factor for physical illness and poorer disease outcomes in general. This study aimed to explore associations between attachment insecurity and PCS in young people sustaining a concussion. METHODS This cross-sectional study was embedded in a cohort of 15-30-year-old patients (n = 3080) 3 months after sustaining a concussion. Data were obtained from a database and questionnaires. PCS were measured by the Rivermead Post-Concussion Symptoms Questionnaire and attachment dimensions (anxiety and avoidance) by the Experiences in Close Relationships-Relationship Structures Questionnaire. Multiple linear regression models were performed to investigate the association between the attachment dimensions and PCS with adjustment for demographic, injury-related and psychological factors and with additional testing for interaction between the attachment dimensions. RESULTS In the final study sample, comprising 973 patients (31.6%), we found an interaction between the attachment dimensions. Hence, the effect of attachment anxiety on PCS was statistically insignificant at low avoidance (25th percentile) but significant at high avoidance (75th percentile, β = 0.64 (95%CI: 0.02; 1.26)), whereas the effect of attachment avoidance was significant regardless of level of attachment anxiety (25th percentile, β = 1.09 (95%CI: 0.18; 2.01); 75th percentile, β = 2.71 (95%CI: 1.80; 3.61)). CONCLUSION Attachment insecurity, especially characterised by high avoidance in combination with high anxiety, also called fearful attachment, is associated with PCS. Considering the attachment perspective can potentially improve health care for this patient group.
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Affiliation(s)
- A Tuborgh
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - S W Svendsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark; Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark; Department of Public Health, Section of Environmental Health, University of Copenhagen, Denmark
| | - A Elklit
- Department of Psychology, National Centre of Psycho-traumatology, University of Southern Denmark, Denmark
| | - J Hunter
- Department of Psychiatry, Sinai Health System, University of Toronto, Canada
| | - J S Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - A Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - J F Nielsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark
| | - M M Thastum
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark; Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - E T Næss-Schmidt
- Hammel Neurorehabilitation Centre, University Research Clinic, Aarhus University, Denmark
| | - C U Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Lucena Nemirosky J, Espelt R, López Grado E, Sobrino J, Acera A, Pérez J, Jensen JS, Sánchez-Reus F, Prim N. Macrolide resistance in Mycoplasma genitalium in Catalonia, Spain: a 1 year prospective study. J Antimicrob Chemother 2021; 76:2702-2707. [PMID: 34278431 DOI: 10.1093/jac/dkab224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium is an emergent cause of sexually transmitted disease (STD). The first-line treatment is azithromycin, but macrolide resistance is increasing due to mutations in the 23S rRNA gene. OBJECTIVES To determine the rates of M. genitalium infection and macrolide resistance in an area adjacent to Barcelona. METHODS This 1 year prospective study was performed in a heterogenous population that included both low- and high-risk patients. M. genitalium was detected in all specimens sent to our institution for STD detection. Epidemiological and relevant clinical data were collected in the positive cases. Characterization of macrolide-associated resistance was performed by 23S rDNA sequencing. RESULTS Of the 3540 patients included, 132 (3.7%) were positive for M. genitalium. Another sexually transmitted bacteria was detected in 20.4% of the M. genitalium cases, and Chlamydia trachomatis (11%) was the most frequently co-detected microorganism. Only 61.4% of patients received an adequate initial treatment against M. genitalium. The test of cure (TOC) was performed in 42% of patients, and therapeutic failure was detected in 10 cases. The rate of macrolide resistance was 12.6% and the most prevalent mutation was A2058G. There was an association between macrolide resistance and a previous history of M. genitalium detection (P < 0.001). CONCLUSIONS Our results support the contribution of the previous use of macrolides in resistant strains. Given the difficulties in performing TOC in all patients, the inclusion of macrolide resistance in the detection test should be mandatory.
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Affiliation(s)
- J Lucena Nemirosky
- Laboratorio Cerba Internacional SAE, Plaça Ramon Llull, 7, 08203, Sabadell, Barcelona, Spain
| | - R Espelt
- Institut Català de la Salut, Direcció d'Atenció Primaria Metropolitana Nord, Atenció de la Salut Sexual i Reproductiva CAP Sant Fèlix, 08203, Sabadell, Barcelona, Spain
| | - E López Grado
- Institut Català de la Salut, Direcció d'Atenció Primaria Metropolitana Nord, Atenció de la Salut Sexual i Reproductiva CAP Sant Fèlix, 08203, Sabadell, Barcelona, Spain
| | - J Sobrino
- Institut Català de la Salut, Direcció d'Atenció Primaria Metropolitana Nord, Atenció de la Salut Sexual i Reproductiva CAP Sant Fèlix, 08203, Sabadell, Barcelona, Spain
| | - A Acera
- Institut Català de la Salut, Direcció d'Atenció Primaria Metropolitana Nord, Atenció de la Salut Sexual i Reproductiva CAP II Cerdanyola - Ripollet, 08291, Ripollet, Barcelona, Spain
| | - J Pérez
- Catlab (Parc Logistic de Salut), 08232, Viladecavalls, Barcelona, Spain
| | - J S Jensen
- Research Unit for Reproductive Microbiology, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen S, Denmark
| | - F Sánchez-Reus
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain.,Departament de Genètica i Microbiologia, Universitat Autonòma de Barcelona, Bellaterra, Spain
| | - N Prim
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, 08041, Barcelona, Spain.,Laboratori de Referència de Catalunya, 08820, El Prat de Llobregat, Barcelona, Spain
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Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. Background review for the '2020 European guideline for the diagnosis and treatment of gonorrhoea in adults'. Int J STD AIDS 2020; 32:108-126. [PMID: 33323071 DOI: 10.1177/0956462420948739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gonorrhoea is a major public health concern globally. Increasing incidence and sporadic ceftriaxone-resistant cases, including treatment failures, are growing concerns. The 2020 European gonorrhoea guideline provides up-to-date evidence-based guidance regarding the diagnosis and treatment of gonorrhoea. The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests (NAATs) and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1 g plus azithromycin 2 g) OR ceftriaxone 1 g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. This review provides the detailed background, evidence base and discussions, for the 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et al. Int J STD AIDS. 2020).
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Affiliation(s)
- M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jdc Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - A B Serwin
- Department of Dermatology and Venereology, Medical University of Białystok, Białystok, Poland
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
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Unemo M, Ross J, Serwin AB, Gomberg M, Cusini M, Jensen JS. 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults. Int J STD AIDS 2020:956462420949126. [PMID: 33121366 DOI: 10.1177/0956462420949126] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gonorrhoea is a major public health concern globally. Increasing incidence and sporadic ceftriaxone-resistant cases, including treatment failures, are growing concerns. The 2020 European gonorrhoea guideline provides up-to-date evidence-based guidance regarding the diagnosis and treatment of gonorrhoea. The updates and recommendations emphasize significantly increasing gonorrhoea incidence; broad indications for increased testing with validated and quality-assured nucleic acid amplification tests and culture; dual antimicrobial therapy including high-dose ceftriaxone and azithromycin (ceftriaxone 1 g plus azithromycin 2 g) OR ceftriaxone 1 g monotherapy (ONLY in well-controlled settings, see guideline for details) for uncomplicated gonorrhoea when the antimicrobial susceptibility is unknown; recommendation of test of cure (TOC) in all gonorrhoea cases to ensure eradication of infection and identify resistance; and enhanced surveillance of treatment failures when recommended treatment regimens have been used. Improvements in access to appropriate testing, test performance, diagnostics, antimicrobial susceptibility surveillance and treatment, and follow-up of gonorrhoea patients are essential in controlling gonorrhoea and to mitigate the emergence and/or spread of ceftriaxone resistance and multidrug-resistant and extensively drug-resistant gonorrhoea. For detailed background, evidence base and discussions, see the background review for the present 2020 European guideline for the diagnosis and treatment of gonorrhoea in adults (Unemo M, et al. Int J STD AIDS. 2020).
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Affiliation(s)
- M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jdc Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - A B Serwin
- Department of Dermatology and Venereology, Medical University of Białystok, Białystok, Poland
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
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Haahr T, Humaidan P, Jensen JS. Non-transparent and insufficient descriptions of non-validated microbiome methods and related reproductive outcome results should be interpreted with caution. Hum Reprod 2019; 34:2083-2084. [DOI: 10.1093/humrep/dez167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/04/2019] [Accepted: 04/26/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- T Haahr
- The Fertility Clinic, Skive Regional Hospital Resenvej 25, Skive, Denmark
| | - P Humaidan
- The Fertility Clinic, Skive Regional Hospital Resenvej 25, Skive, Denmark
| | - J S Jensen
- Statens Serum Institute, Copenhagen, Denmark
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Mulverstedt S, Klausen IC, Martinsen MH, Kanstrup H, Thomsen KK, Knold J, Henriksen FL, Andersen LJ, Schmidt EB, Theilade J, Clausen J, Yafasov KM, Egstrup K, Jensen JS, Heitmann M. P706Treatment of hypercholesterolaemia with PCSK-9 Inhibitors in Denmark. Assessment of real-life data; safety an extent of adverse effects after the first years of clinical use. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
PCSK9 Inhibitors (PCSK9 I) are a new group of drugs for treatment of hyperlipidaemia. These drugs have been available in Denmark since October 2015. From the two existing major outcome studies (FOURIER and ODYSSEY OUTCOMES) it has been shown that there was no significant difference in the risk of serious adverse events, discontinuation due to adverse events, neurocognitive events, diabetes-related events, muscle-related events, or myalgia in the treatment group, compared with the control group. In FOUIRER 12.5% came of treatment; In ODYSSEY the rate was 10.2–14.8%. Although this highlights the efficacy and safety in patients with cardiovascular disease, we have little knowledge of the use, efficacy and safety with these drugs in real-life populations
Purpose
We aim to describe the demography, the treatment efficacy and the extent of adverse effects among patients treated in Danish lipid clinics.
Methods
Data on all patients treated with PCSK9 I between October 1st, 2015 and May 1st, 2018 were obtained from lipid clinics in Denmark. A database containing information on medications before treatment, adverse effects, plasma lipids (LDL-C, Triglyceride, High density lipoprotein cholesterol (HDL-C)) and supplementary blood tests was created. Levels of plasma lipids and organ markers (Creatinine, Hba1c or Alanine aminotransferase (ALAT)) at baseline and at follow up visits were analysed.
Results
Nationwide, 383 patients were included, an estimated 90% of all patients undergoing treatment with PCSK9 I in Denmark. A large proportion (n=243 - 63.4%) were described as statin intolerant and only 94 patients were receiving statins at baseline. Adverse effects (AE) were reported by 71 patients (18.5%) on PCSK9 I therapy and 50 patients (13.1%) stopped treatment. Most common AE were flu like symptoms and musculoskeletal aches. In two cases an increase in serum creatinine kinase was detected. One case of angioedema and three cases of local reactions to injections had been documented. No case of anaphylaxis was reported. Of the 71 patients with AEs 55 (77.5%) were statin intolerant. Of the 50, who came off treatment, 43 (86.0%) were statin intolerant. When treatment was stopped 15 patients (30.0%) tried the alternative PCSK9 Inhibitor (cross over). Of those, nine patients were able to tolerate the alternative PCSK9 I treatment.
Conclusion
Many patients (18.3%) reported AEs on a wide range of symptoms, but the rate of patients terminating PCSK9 I treatment was the same as found in the outcome studies (13.1% vs. 12.2 and 10.2–14.8%). Most of the patients who stopped treatment were statin intolerant and produced the same symptoms, as they had experienced with statins. Interestingly, nine of the 15 patients that were switched to the alternate PCSK9 I seems to tolerate this treatment.
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Affiliation(s)
| | - I C Klausen
- Regional Hospital Viborg, Department of Cardiology, Viborg, Denmark
| | - M H Martinsen
- Regional Hospital Viborg, Department of Cardiology, Viborg, Denmark
| | - H Kanstrup
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - K K Thomsen
- Sydvestjysk Hospital, Department of Cardiology, Esbjerg, Denmark
| | - J Knold
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - F L Henriksen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - L J Andersen
- Roskilde Hospital, Department of Cardiology, Roskilde, Denmark
| | - E B Schmidt
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J Theilade
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - J Clausen
- Haderslev Hospital, Department of Cardiology, Haderslev, Denmark
| | - K M Yafasov
- Hillerod Hospital, Department of Cardiology, Hillerod, Denmark
| | - K Egstrup
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - J S Jensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Heitmann
- Bispebjerg University Hospital, Copenhagen, Denmark
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Mulverstedt S, Klausen IC, Kanstrup H, Knold J, Andersen LJ, Theilade J, Yafasov KM, Jensen JS, Martinsen MH, Thomsen KK, Henriksen FL, Schmidt EB, Clausen J, Egstrup K, Heitmann M. 2981Treatment of Hypercholesterolaemia with PCSK9 Inhibitors in Denmark. Assessment of real-life data; Extent and Efficacy after the first years of clinical use. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9 I) are a new group of drugs for treatment of hypercholesterolaemia. At present there are two available drugs evolocumab and alirocumab, which lowers low-density lipoprotein cholesterol (LDL-C) by inhibiting the enzyme proprotein convertase subtilisin/kexin type 9. Both evolocumab and alirocumab outcome data (FOURIER and ODYSSEY OUTCOMES respectively) have shown a reduced risk of myocardial infarction, stroke, and coronary revascularization without adverse effects. Patients included in these trials had existing atherosclerotic cardiovascular disease and all patients received maximum-tolerated statin. In the FOURIER trail 100% of the patients received statin and 69% high intensity statin, in the ODYSSEY trial is was 98% and 89%, respectively
Purpose
In collaboration with lipid clinics in Denmark we aimed to describe the clinical characteristics of patients treated, along with the efficacy of LDL-C reduction of such treatment in a real-life population.
Methods
We contacted lipid and cardiological clinics throughout Denmark and obtained clinical data on the majority of patients treated with PCSK9 I in Denmark between October 1st, 2015 and May 1st, 2018. A database containing information on medical history, medications used prior to PCSK9 I initiation, adverse events and plasma lipids including LDL-C was created. Records of baseline LDL-C and at follow up visits were analysed.
Results
From October 1st 2015 to may 1st2018, 383 patients were enrolled; an estimated 90% of all patients in Denmark. The distribution of clinical indications for PCSK9 I initiation is shown in figure 1. A total 243 of these patients (63.4%) were characterised as statin intolerant and 225 (58.7%) had familial hypercholesterolaemia. More than two thirds (69.5%) of the patients were given PCSK9 Inhibitors as secondary prophylaxis. Overall LDL was significantly reduced from 5.11 mmol/L (CI [4.95; 5.28]) to 2.46 mmol/L (CI [2.33–2.68]) after the first month of treatment, corresponding to a 48.9% decrease in LDL-C, which persisted without significant changes throughout the two years of observation. Even with this reduction, only about half of the population of both primary and secondary prevention reached their treatment target. This remained unchanged in patients with familial hypercholesterolaemia an those with statin intolerance (Table 1). A subgroup analysis showed a significantly lower LDL in the first 12 months when PCSK9 I were combined with statins versus PCSK9 I as monotherapy (p<0.05) (results not shown).
Conclusion
Patients treated with PCSK9 I in this real-life do not resemble the populations in the major endpoint studies, as the majority in this real-life population are statin intolerant. Nevertheless, we see an overall reduction of LDL of approx. 50%, even though the number of patients reaching their treatment target remains low (approx. 50% at best).
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Affiliation(s)
| | - I C Klausen
- Regional Hospital Viborg, Department of Cardiology, Viborg, Denmark
| | - H Kanstrup
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J Knold
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - L J Andersen
- Roskilde Hospital, Department of Cardiology, Roskilde, Denmark
| | - J Theilade
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - K M Yafasov
- Hillerod Hospital, Department of Cardiology, Hillerod, Denmark
| | - J S Jensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M H Martinsen
- Regional Hospital Viborg, Department of Cardiology, Viborg, Denmark
| | - K K Thomsen
- Sydvestjysk Hospital, Department of Cardiology, Esbjerg, Denmark
| | - F L Henriksen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - E B Schmidt
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J Clausen
- Haderslev Hospital, Department of Cardiology, Haderslev, Denmark
| | - K Egstrup
- Svendborg Hospital, Department of Cardiology, Svendborg, Denmark
| | - M Heitmann
- Bispebjerg University Hospital, Copenhagen, Denmark
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Frølund Pedersen H, Holsting A, Frostholm L, Rask C, Jensen JS, Høeg MD, Schröder A. "Understand your illness and your needs": Assessment-informed patient education for people with multiple functional somatic syndromes. Patient Educ Couns 2019; 102:1662-1671. [PMID: 31023608 DOI: 10.1016/j.pec.2019.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/10/2019] [Accepted: 04/15/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Patients suffering from multiple functional somatic syndromes (FSS) such as fibromyalgia, chronic fatigue syndrome, or irritable bowel syndrome, often lack both a clear diagnosis and tangible illness explanations, which is a barrier for treatment engagement. We tested a short-term intervention taking the unifying concept of Bodily Distress Syndrome (BDS) as a point of departure. The intervention consisted of a clinical assessment, group-based patient education, and one follow-up consultation. METHODS 174 patients were included and received questionnaires at baseline, after clinical assessment, after patient education, and median 19 weeks after baseline. Data were analyzed using random effects models and simple t-tests. Qualitative data were thematically analyzed. RESULTS We found small reductions in symptom levels, considerable reductions in illness worry, and improvement of illness perceptions and illness-related behaviors. Overall, patients evaluated the intervention positively and expressed high expectations for further treatment. Qualitative results mainly supported these findings. CONCLUSION Targeting illness perceptions through patient education is crucial to obtain patient engagement in self-help management or further treatment. This may lead to improved outcomes. PRACTICAL IMPLICATIONS Physicians in primary and secondary care should strive to give patients with multiple FSS a clear understanding that their various FSS diagnoses are related and provide tangible illness explanations.
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Affiliation(s)
- H Frølund Pedersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark.
| | - A Holsting
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
| | - L Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
| | - C Rask
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juel-Jensens Boulevard 175, Entrance K, 8200 Aarhus N., Denmark
| | - J S Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
| | - M D Høeg
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
| | - A Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C., Denmark
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Damião Gouveia AC, Unemo M, Jensen JS. In vitro activity of zoliflodacin (ETX0914) against macrolide-resistant, fluoroquinolone-resistant and antimicrobial-susceptible Mycoplasma genitalium strains. J Antimicrob Chemother 2019; 73:1291-1294. [PMID: 29444242 DOI: 10.1093/jac/dky022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/03/2018] [Indexed: 01/07/2023] Open
Abstract
Background Mycoplasma genitalium is estimated to be the second most common cause of bacterial sexually transmitted infection in Europe. It is of increasing public health concern due to the rapid development of resistance to different antimicrobial classes, including the preferred first- and second-line treatments azithromycin and moxifloxacin. Thus, new antimicrobial agents are urgently needed, especially for the treatment of MDR strains. Methods The in vitro activity of the new spiropyrimidinetrione zoliflodacin against 47 M. genitalium strains was assessed by growing M. genitalium in Vero cell culture and measuring growth by quantitative PCR. The collection included 34 moxifloxacin-susceptible (MIC <1 mg/L) and 13 moxifloxacin-resistant (MIC ≥1 mg/L) strains. Twenty-three of the strains were azithromycin resistant (MIC ≥16 mg/L) and 12 of these strains were MDR. Results Only one (2.1%) strain with substantially increased MIC (4 mg/L) and potential resistance to zoliflodacin was found. Zoliflodacin was overall more potent than moxifloxacin (P = 0.009) and no cross-resistance was observed between the two drug classes of topoisomerase II inhibitors. Differences in the MICs of zoliflodacin and azithromycin were not statistically significant; however, 23 (48.9%) compared with potentially 1 (2.1%) of the strains were resistant to azithromycin and zoliflodacin, respectively. Conclusions Zoliflodacin is a promising candidate for the treatment of M. genitalium and it is important to further develop and evaluate this drug.
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Affiliation(s)
- A C Damião Gouveia
- Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden
| | - J S Jensen
- Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
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11
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Olsen FJ, Møgelvang R, Jensen GB, Jensen JS, Biering-Sørensen T. Relationship Between Left Atrial Functional Measures and Incident Atrial Fibrillation in the General Population. JACC Cardiovasc Imaging 2019; 12:981-989. [DOI: 10.1016/j.jcmg.2017.12.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/12/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
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12
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Isaksen JL, Graff C, Ellervik C, Jensen JS, Rossing P, Kanters JK, Jensen MT. Cardiac repolarization and depolarization in people with Type 1 diabetes with normal ejection fraction and without known heart disease: a case-control study. Diabet Med 2018; 35:1337-1344. [PMID: 29797352 DOI: 10.1111/dme.13689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
Abstract
AIMS To investigate depolarization and repolarization durations in people with Type 1 diabetes, including the relationship to age. METHODS 855 persons with Type 1 diabetes without known heart disease were included and matched with 1710 participants from a general population study. Clinical examinations, questionnaires and biochemistry were assessed. A 10-second 12-lead ECG was performed and analysed digitally. RESULTS QTc was longer in people with Type 1 diabetes compared to controls (414±16 vs. 411±19 ms, P <0.001), and particularly so in young people with Type 1 diabetes. The fully adjusted increase was 13.8 ms (95% confidence interval (CI): 8.6-19.0 ms, P <0.001) at age 20 years and 3.4 ms (CI: 1.5-5.3 ms, P<0.001) at age 40 years. The rate-corrected QRSc was increased in people with Type 1 diabetes (97±11 vs. 95±11 ms, P <0.001) and was age-independent (P =0.5). JTc was increased in the young people with Type 1 diabetes (10.7 ms (CI: 5.4-16.0 ms, P <0.001) at age 20 years), but not in older people with Type 1 diabetes (interaction age-diabetes, P <0.01). CONCLUSIONS For people with Type 1 diabetes, cardiac depolarization is increased at all ages, whereas repolarization is increased only relatively in young people with Type 1 diabetes. Hence, young people with Type 1 diabetes may be more prone to ventricular arrhythmias. The findings contribute to the understanding of sudden cardiac death in young people with Type 1 diabetes.
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Affiliation(s)
- J L Isaksen
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - C Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - C Ellervik
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J S Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology S, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - P Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Aarhus University, Aarhus, Denmark
| | - J K Kanters
- Laboratory of Experimental Cardiology, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M T Jensen
- Department of Cardiology S, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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13
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Kjøller-Hansen L, Bligaard N, Kelbæk H, Christiansen EH, Thuesen L, Hansen PR, Engstrøm T, Junker A, Abildgaard U, Lassen JF, Jensen JS, Jeppesen JL, Galløe AM. Ten-year clinical outcome of patients treated with a drug-eluting stent in the proximal left anterior descending artery segment compared with patients stented in other non-left main coronary segments. EUROINTERVENTION 2018; 14:764-771. [DOI: 10.4244/eij-d-18-00396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Noringriis I, Modin D, Pedersen SH, Jensen JS, Biering-Sørensen T. Prognostic importance of mechanical dyssynchrony in predicting heart failure development after ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2018; 35:87-97. [PMID: 30143920 DOI: 10.1007/s10554-018-1443-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022]
Abstract
The aim of this study is to assess the prognostic value of mechanical dyssynchrony defined as the standard deviation of the time to peak longitudinal strain (SD T2P LS) in predicting the development of heart failure (HF) after an ST-segment elevation myocardial infarction (STEMI). Three hundred and seventy-three patients were admitted with STEMI and treated with primary percutaneous coronary intervention. Left ventricular (LV) mechanical dyssynchrony was examined through speckle tracking echocardiography and defined as SD T2P LS. The association with the outcome of HF hospitalization was assessed using Cox proportional hazard models. During a median follow-up of 5.12 years, 144 patients (38.6%) were admitted due to HF. Worse dyssynchrony was associated with the outcome in unadjusted and multivariable analysis (multivariable hazard ratio 1.05, 95% confidence interval 1.00-1.10, p-value 0.039, per 10 ms increase), but not after further adjustment for LV ejection fraction (LVEF), E/e' and global longitudinal strain (GLS) (hazard ratio 1.01, 95% confidence interval 1.00-1.07, p-value 0.71, per 10 ms increase), nor in a model only adjusting for GLS (hazard ratio 1.01, 95% confidence interval 1.00-1.06, p-value 0.61, per 10 ms increase). These findings were reproduced in a competing risk analysis treating all-cause mortality as a competing risk. LV mechanical dyssynchrony, as assessed by SD T2P LS is not an independent predictor of post-STEMI HF development and mechanical dyssynchrony does not provide independent prognostic information regarding HF when GLS is known.
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Affiliation(s)
- Inge Noringriis
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
| | - Daniel Modin
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
| | - Sune H Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
| | - Jan S Jensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersensvej 65, Post 835, 2900, Copenhagen, Denmark
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15
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Brainin P, Skaarup K, Iversen A, Godsk P, Platz E, Jensen JS, Biering-Sorensen T. 2235Post-systolic shortening relates to prognosis and degree of stenosis in acute coronary syndrome. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Brainin
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, United States of America
| | - K Skaarup
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - A Iversen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - P Godsk
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - E Platz
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, United States of America
| | - J S Jensen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
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16
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Modin D, Biering-Sorensen SR, Mogelvang R, Alhakak SA, Jensen JS, Biering-Sorensen T. 6173Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Modin
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | | | - R Mogelvang
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - S A Alhakak
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Biering-Sorensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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17
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Hansen GM, Jensen JS, Andersen HU, Rossing P, Jensen MT. P4482Peripheral neuropathy is associated with early myocardial impairment in patients with type 1 diabetes mellitus: results from The Thousand & 1 Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G M Hansen
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | | | - P Rossing
- Steno Diabetes Center, Copenhagen, Denmark
| | - M T Jensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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18
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Dons M, Jensen JS, Olsen FJ, De Knegt MC, Fritz-Hansen T, Mogelvang R, Biering-Sorensen T. P6466Myocardial performance index by tissue doppler echocardiography predicts adverse events in patients with atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Dons
- Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - F J Olsen
- Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - M C De Knegt
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Fritz-Hansen
- Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Biering-Sorensen
- Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
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19
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Joseph G, Marott JL, Sogaard P, Nielsen G, Christensen AE, Biering-Sorensen T, Schnohr P, Jensen JS, Mogelvang R. 4331Dose-response association between level of daily physical activity and mortality in persons with arterial hypertension: a population based cohort study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Joseph
- Vendsyssel Hospital, Department of Cardiology, Hjorring, Denmark
| | - J L Marott
- Frederiksberg University Hospital, Copenhagen City Heart Study, Frederiksberg, Denmark
| | - P Sogaard
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - G Nielsen
- Vendsyssel Hospital, Department of Cardiology, Hjorring, Denmark
| | - A E Christensen
- Aalborg University Hospital, Unit of Epidemiology and Biostatistics, Aalborg, Denmark
| | - T Biering-Sorensen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - P Schnohr
- Frederiksberg University Hospital, Copenhagen City Heart Study, Frederiksberg, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - R Mogelvang
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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20
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Modin D, Jorgensen ME, Gislason G, Jensen JS, Koeber L, Torp-Pedersen C, Biering-Sorensen T. P5349The CHA2DS2-VASc risk score predicts all-cause and cardiovascular mortality following first myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Modin
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M E Jorgensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - G Gislason
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - C Torp-Pedersen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Biering-Sorensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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21
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Hansen KW, Sorensen R, Madsen M, Jensen JS, Mortensen PE, Lange T, Gislason GH, Galatius S. P1230Association between early invasive management, secondary preventive medical therapy and long-term outcomes after acute coronary syndromes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K W Hansen
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R Sorensen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Madsen
- University of Copenhagen - Departmen of Public Health, Copenhagen, Denmark
| | - J S Jensen
- Copenhagen University Hospital Gentofte - Department. of Cardiology, Copenhagen, Denmark
| | - P E Mortensen
- Odense University Hospital, Department of Thoracic Surgery, Odense, Denmark
| | - T Lange
- University of Copenhagen - Departmen of Public Health, Copenhagen, Denmark
| | - G H Gislason
- Copenhagen University Hospital Gentofte - Department. of Cardiology, Copenhagen, Denmark
| | - S Galatius
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
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22
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Pareek M, Jensen LO, Christiansen EH, Aaroe J, Jensen JS, Kristensen SD, Lassen JF, Thuesen L, Madsen M, Boetker HE, Maeng M. 146210-year outcomes from a randomized comparison of zotarolimus-eluting and sirolimus-eluting stents: the SORT OUT III study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Pareek
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - L O Jensen
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - E H Christiansen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J Aaroe
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Gentofte, Denmark
| | - S D Kristensen
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - J F Lassen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - L Thuesen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - M Madsen
- Aarhus University Hospital, Department of Clinical Epidemiology, Aarhus, Denmark
| | - H E Boetker
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - M Maeng
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
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23
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Lundorff IJ, Modin D, Mogelvang R, Jorgensen PG, Jensen JS, Biering-Sorensen TB. 6172Sex-specific echocardiographic predictors of cardiovascular morbidity and mortality in the general population. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- I J Lundorff
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - D Modin
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R Mogelvang
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P G Jorgensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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24
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Modin D, Sengelov M, Jorgensen PG, Olsen FJ, Bruun NE, Fritz-Hansen T, Andersen DM, Jensen JS, Biering-Sorensen T. P5663Prognostic value of left atrial functional measures in heart failure with reduced ejection fraction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Modin
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Sengelov
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P G Jorgensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - F J Olsen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - N E Bruun
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Fritz-Hansen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - D M Andersen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Biering-Sorensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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25
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Brainin P, Biering-Sorensen SR, Mogelvang R, Chantal De Knegt M, Olsen FJ, Galatius S, Jensen JS, Biering-Sorensen T. P3717Post-systolic shortening: normal values and association with validated echocardiographic and invasive measures of cardiac function. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Brainin
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | | | - R Mogelvang
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | | | - F J Olsen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - S Galatius
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - J S Jensen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
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26
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Modin D, Jensen JS, Mogelvang R, Jorgensen PG, Jensen MT, Seferovic JP, Biering-Sorensen T. P2750Left ventricular concentric geometry predicts incident diabetes mellitus independent of established risk factors in the general population: the copenhagen city heart study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Modin
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J S Jensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - R Mogelvang
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - P G Jorgensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M T Jensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J P Seferovic
- Clinical center of Serbia, Diabetes and Metabolic disorders, Belgrade, Serbia
| | - T Biering-Sorensen
- Gentofte University Hospital, Department of Cardiology, Copenhagen, Denmark
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27
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Horner P, Donders G, Cusini M, Gomberg M, Jensen JS, Unemo M. Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? - a position statement from the European STI Guidelines Editorial Board. J Eur Acad Dermatol Venereol 2018; 32:1845-1851. [PMID: 29924422 DOI: 10.1111/jdv.15146] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/12/2018] [Indexed: 12/12/2022]
Abstract
At present, we have no evidence that we are doing more good than harm detecting and subsequently treating Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum colonizations/infections. Consequently, routine testing and treatment of asymptomatic or symptomatic men and women for M. hominis, U. urealyticum and U. parvum are not recommended. Asymptomatic carriage of these bacteria is common, and the majority of individuals do not develop any disease. Although U. urealyticum has been associated with urethritis in men, it is probably not causal unless a high load is present (likely carriage in 40-80% of detected cases). The extensive testing, detection and subsequent antimicrobial treatment of these bacteria performed in some settings may result in the selection of antimicrobial resistance, in these bacteria, 'true' STI agents, as well as in the general microbiota, and substantial economic cost for society and individuals, particularly women. The commercialization of many particularly multiplex PCR assays detecting traditional non-viral STIs together with M. hominis, U. parvum and/or U. urealyticum has worsened this situation. Thus, routine screening of asymptomatic men and women or routine testing of symptomatic individuals for M. hominis, U. urealyticum and U. parvum is not recommended. If testing of men with symptomatic urethritis is undertaken, traditional STI urethritis agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, M. genitalium and, in settings where relevant, Trichomonas vaginalis should be excluded prior to U. urealyticum testing and quantitative species-specific molecular diagnostic tests should be used. Only men with high U. urealyticum load should be considered for treatment; however, appropriate evidence for effective treatment regimens is lacking. In symptomatic women, bacterial vaginosis (BV) should always be tested for and treated if detected.
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Affiliation(s)
- P Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - G Donders
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - M Unemo
- Department of Laboratory Medicine, Microbiology, World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Hagemann CE, Hoffmann S, Olsen FJ, Jørgensen PG, Fritz-Hansen T, Jensen JS, Biering-Sørensen T. Layer-specific global longitudinal strain reveals impaired cardiac function in patients with reversible ischemia. Echocardiography 2018; 35:632-642. [DOI: 10.1111/echo.13830] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Christoffer E. Hagemann
- Department of Cardiology; Herlev & Gentofte Hospital; Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Søren Hoffmann
- Department of Cardiology; Herlev & Gentofte Hospital; Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Flemming J. Olsen
- Department of Cardiology; Herlev & Gentofte Hospital; Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Peter G. Jørgensen
- Department of Cardiology; Herlev & Gentofte Hospital; Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology; Herlev & Gentofte Hospital; Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Jan S. Jensen
- Department of Cardiology; Herlev & Gentofte Hospital; Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology; Herlev & Gentofte Hospital; Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
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Theilade S, Rossing P, Jensen JS, Jensen MT. Arterial-ventricular coupling in type 1 diabetes: arterial stiffness is associated with impaired global longitudinal strain in type 1 diabetes patients-the Thousand & 1 Study. Acta Diabetol 2018; 55:21-29. [PMID: 29038853 DOI: 10.1007/s00592-017-1062-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/27/2017] [Indexed: 01/19/2023]
Abstract
AIMS Diabetes is associated with higher arterial stiffness-an early marker of cardiovascular disease. The coupling between arterial stiffness and myocardial function is still unresolved. We investigate associations between arterial stiffness and early myocardial impairment assessed with advanced echocardiography. METHODS In 305 type 1 diabetes (T1D) patients without known heart disease and with normal left ventricular ejection fraction (LVEF) (biplane LVEF > 45%), we measured arterial stiffness as pulse wave velocity (PWV) and performed conventional and speckle-tracking echocardiography assessing global longitudinal strain (GLS) as a measure of systolic myocardial function. Associations between PWV and myocardial function were reported as standardized beta values from adjusted regression models including age, sex, mean arterial pressure, body mass index, HbA1c, diabetes duration, estimated glomerular filtration rate, degree of albuminuria, total cholesterol, heart rate and smoking. RESULTS Patients were 54 (12) years [mean (SD)], 152 (50%) females, diabetes duration 31 (16) years, HbA1c 65 (12) mmol/mol, LVEF 58 (5) %, GLS -18.2 (2.6) % and PWV 10.2 (3.4) m/s. There was no association between PWV and LVEF (p = 0.93). Conversely, there was a highly significant association between PWV and GLS in crude and multivariable models (standardized β-coefficient 0.25, p < 0.001 and 0.16, p = 0.036, respectively). Also, diastolic function measured as E/e' was highly associated with PWV in crude and multivariable models (standardized β-coefficient 0.43, p < 0.001 and 0.17, p = 0.016, respectively). CONCLUSIONS In T1D patients with normal LVEF and without known heart disease, higher arterial stiffness is independently associated with early systolic and diastolic myocardial impairment detectable by advanced echocardiography. Although unable to demonstrate causality, we display a relationship between diabetic angiopathy and diabetic cardiomyopathy (H-3-2009-139 and PROFIL-H-B-2009-056).
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Affiliation(s)
- Simone Theilade
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 1, 2820, Gentofte, Denmark.
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 1, 2820, Gentofte, Denmark
- Aarhus University, Aarhus, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Jan S Jensen
- University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
| | - Magnus T Jensen
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 1, 2820, Gentofte, Denmark
- Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
- Department of Internal Medicine, Holbaek Sygehus, Holbaek, Denmark
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30
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Alhede C, Lauridsen TK, Johannessen A, Dixen U, Jensen JS, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, Pehrson S, Englund A, Hartikainen J, Hansen PS, Nielsen JC, Jons C. Antiarrhythmic medication is superior to catheter ablation in suppressing supraventricular ectopic complexes in patients with atrial fibrillation. Int J Cardiol 2017; 244:186-191. [DOI: 10.1016/j.ijcard.2017.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
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Jørgensen PG, Jensen MT, Mensberg P, Storgaard H, Nyby S, Jensen JS, Knop FK, Vilsbøll T. Effect of exercise combined with glucagon-like peptide-1 receptor agonist treatment on cardiac function: A randomized double-blind placebo-controlled clinical trial. Diabetes Obes Metab 2017; 19:1040-1044. [PMID: 28188972 DOI: 10.1111/dom.12900] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/05/2017] [Accepted: 02/05/2017] [Indexed: 02/06/2023]
Abstract
In patients with type 2 diabetes, both supervised exercise and treatment with the glucagon-like peptide-1 (GLP-1) receptor agonist (GLP-1RA) liraglutide may improve cardiac function. We evaluated cardiac function before and after 16 weeks of treatment with the GLP-1RA liraglutide or placebo, combined with supervised exercise, in 33 dysregulated patients with type 2 diabetes on diet and/or metformin. Early diastolic myocardial tissue velocity was improved by exercise in the placebo group (mean ± standard deviation [s.d.] -7.1 ± 1.6 to -7.7 ± 1.8 cm/s, P = .01), but not in the liraglutide group (-7.1 ± 1.4 to -7.0 ± 1.4 cm/s, P = .60; between groups, P = .02). Similarly, the mean ± s.d. ratio of early and atrial mitral annular tissue velocities improved in the placebo group (1.0 ± 0.4 to 1.2 ± 0.4, P = .003), but not in the liraglutide group (1.0 ± 0.3 to 1.0 ± 0.3, P = .87; between groups, P = .03). We found no significant differences in heart rate, left ventricular (LV) structure or function within or between the groups. In conclusion, the addition of liraglutide to exercise in sedentary patients with dysregulated type 2 diabetes may blunt the suggested beneficial effect of exercise on LV diastolic function.
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Affiliation(s)
- Peter G Jørgensen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Magnus T Jensen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Pernille Mensberg
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, University of Copenhagen, Copenhagen, Denmark
| | - Heidi Storgaard
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Signe Nyby
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Nutrition, Exercise and Sports, Section of Molecular Physiology, University of Copenhagen, Copenhagen, Denmark
| | - Jan S Jensen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Novo Nordisk Foundation Centre for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hansen CS, Fleischer J, Vistisen D, Ridderstråle M, Jensen JS, Jørgensen ME. Reply to Kurtoglu: Association of heart rate variability with diabetes and vitamin D levels. Diabet Med 2017; 34:590-591. [PMID: 27990687 DOI: 10.1111/dme.13307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C S Hansen
- Department of Clinical Epidemiology, Steno Diabetes Center A/S, Gentofte, Denmark
| | - J Fleischer
- Medical Research Laboratories, Clinical Institute of Medicine, Aarhus University, Aarhus, Denmark
| | - D Vistisen
- Department of Clinical Epidemiology, Steno Diabetes Center A/S, Gentofte, Denmark
| | | | - J S Jensen
- Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
| | - M E Jørgensen
- Department of Clinical Epidemiology, Steno Diabetes Center A/S, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Odense, Denmark
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Hjortebjerg R, Lindberg S, Pedersen S, Mogelvang R, Jensen JS, Oxvig C, Frystyk J, Bjerre M. Insulin-Like Growth Factor Binding Protein 4 Fragments Provide Incremental Prognostic Information on Cardiovascular Events in Patients With ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc 2017; 6:JAHA.116.005358. [PMID: 28314798 PMCID: PMC5524039 DOI: 10.1161/jaha.116.005358] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Fragments of insulin‐like growth factor binding protein 4 (IGFBP‐4) are potential new biomarkers for cardiac risk assessment. The fragments are generated on specific cleavage by pregnancy‐associated plasma protein‐A, which exerts proatherogenic activity. This study investigated the prognostic value of IGFBP‐4 fragments in patients with ST‐segment elevation myocardial infarction. Methods and Results We prospectively included 656 patients with ST‐segment elevation myocardial infarction treated with percutaneous coronary intervention from September 2006 to December 2008. Blood samples were drawn before percutaneous coronary intervention, and levels of intact IGFBP‐4 and N‐terminal and C‐terminal IGFBP‐4 fragments were measured by specific assays. End points were 5‐year all‐cause and cardiovascular mortality and the combined end point of major adverse cardiac events. Prognostic potential was evaluated on top of a clinical model in terms of discrimination, calibration, and reclassification analysis. During follow‐up, 166 patients experienced a major adverse cardiac event and 136 patients died, of whom 69 died from cardiovascular causes. Both IGFBP‐4 fragments were associated with all end points (P<0.001). After multivariable adjustments, both N‐terminal and C‐terminal IGFBP‐4 fragment levels remained associated with all end points, including cardiovascular mortality with hazard ratios per doubling in protein concentration of 2.54 (95% CI 1.59–4.07; P<0.001) and 2.07 (95% CI 1.41–3.04; P<0.001), respectively. Incorporation of IGFBP‐4 fragments into a clinical model with 15 risk factors improved C‐statistics and model calibration and provided incremental prognostic contribution, as assessed by net reclassification improvement and integrated discrimination improvement. Conclusions IGFBP‐4 fragments are associated with increased risk of all‐cause mortality, cardiovascular mortality, and major adverse cardiac events in patients with ST‐segment elevation myocardial infarction.
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Affiliation(s)
- Rikke Hjortebjerg
- Medical Research Laboratory, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark .,The Danish Diabetes Academy, Odense, Denmark
| | - Søren Lindberg
- Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark
| | - Jan S Jensen
- Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Claus Oxvig
- Department of Molecular Biology and Genetics, Faculty of Science and Technology, Aarhus University, Aarhus, Denmark
| | - Jan Frystyk
- Medical Research Laboratory, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Bjerre
- Medical Research Laboratory, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Hansen CS, Fleischer J, Vistisen D, Ridderstråle M, Jensen JS, Jørgensen ME. High and low vitamin D level is associated with cardiovascular autonomic neuropathy in people with Type 1 and Type 2 diabetes. Diabet Med 2017; 34:364-371. [PMID: 27696502 DOI: 10.1111/dme.13269] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 12/18/2022]
Abstract
AIM To investigate the possible association between vitamin D deficiency and cardiovascular autonomic neuropathy in people with diabetes. METHODS A total of 113 people with Type 1 or Type 2 diabetes [mean (interquartile range) diabetes duration 22.0 (12-31) years, mean (sd) age 56.2 (13.0) years, 58% men] underwent vitamin D (D2 and D3) assessment, and were screened for cardiovascular autonomic neuropathy using three cardiovascular reflex tests [heart rate response to deep breathing (E/I ratio), to standing (30/15 ratio) and to the Valsalva manoeuvre] and assessment of 5-min resting heart rate and heart rate variability indices. RESULTS We found an inverse U-shaped association between serum vitamin D level and E/I ratio, 30/15 ratio and three heart rate variability indices (P < 0.05). Vitamin D level was non-linearly associated with cardiovascular autonomic neuropathy diagnosis (P < 0.05 adjusted for age and sex). Linear regression models showed that an increase in vitamin D level from 25 to 50 nmol/l was associated with an increase of 3.9% (95% CI 0.1;7.9) in E/I ratio and 4.8% (95% CI 4.7;9.3) in 30/15 ratio. Conversely, an increase from 125 to 150 nmol/l in vitamin D level was associated with a decrease of 2.6% (95% CI -5.8;0.1) and 4.1% (95% CI -5.8;-0.5) in the respective outcome measures. CONCLUSIONS High and low vitamin D levels were associated with cardiovascular autonomic neuropathy in people with diabetes. Future studies should explore this association and the efficacy of treating dysvitaminosis D to prevent cardiovascular autonomic neuropathy.
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Affiliation(s)
- C S Hansen
- Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte
| | - J Fleischer
- Medical Research Laboratories, Clinical Institute of Medicine, Aarhus University, Aarhus
| | - D Vistisen
- Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte
| | - M Ridderstråle
- Patient Care Centre, Steno Diabetes Centre A/S, Gentofte
| | - J S Jensen
- Department of Cardiology, Gentofte Hospital, Gentofte
| | - M E Jørgensen
- Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte
- National Institute of Public Health, Southern Denmark University, Denmark
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Hansen CS, Jensen JS, Ridderstråle M, Vistisen D, Jørgensen ME, Fleischer J. Vitamin B12 deficiency is associated with cardiovascular autonomic neuropathy in patients with type 2 diabetes. J Diabetes Complications 2017; 31:202-208. [PMID: 27638143 DOI: 10.1016/j.jdiacomp.2016.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/15/2016] [Accepted: 08/27/2016] [Indexed: 12/12/2022]
Abstract
AIMS Vitamin B12 deficiency could be associated with cardiovascular autonomic neuropathy (CAN) in diabetes patients. We aim to investigate the association between serum levels of vitamin B12 and CAN in type 2 diabetes patients. METHODS 469 ambulatory type 2 diabetes patients (mean diabetes duration 10.0years (IQR 5.0;17.0), mean age 59.0years (SD 11.6), 63% men, mean B12 289.0pmol/l (IQR 217;390)) were screened for CAN using three cardiovascular reflex tests, five minute resting heart rate (5min RHR) and heart rate variability indices. RESULTS Serum levels of vitamin B12 were significantly lower in patients treated with metformin and/or proton pump inhibitors (PPIs) compared with patients not treated (p<0.001). A 25pmol/l higher level of vitamin B12 was associated with an odds ratio of the CAN diagnosis of 0.94 (95% CI 0.88; 1.00, p=0.034), an increase in E/I-ratio of 0.21% (95% CI 0.01; 0.43, p=0.038), and a decrease in 5min RHR of 0.25 beats per minute (95% CI -0.47; -0.03, p=0.025). CONCLUSION Vitamin B12 may be inversely associated with CAN in patients with type 2 diabetes. Confirmatory studies investigating a causal role of vitamin B12 for the development of diabetic CAN are warranted.
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Affiliation(s)
- Christian S Hansen
- Department of Clinical Epidemiology, Steno Diabetes Center A/S, Gentofte, Denmark.
| | - Jan S Jensen
- Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
| | | | - Dorte Vistisen
- Department of Clinical Epidemiology, Steno Diabetes Center A/S, Gentofte, Denmark
| | - Marit E Jørgensen
- Department of Clinical Epidemiology, Steno Diabetes Center A/S, Gentofte, Denmark
| | - Jesper Fleischer
- Medical Research Laboratories, Clinical Institute of Medicine, Aarhus University, Aarhus, Denmark
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Alhede C, Johannessen A, Dixen U, Jensen JS, Raatikainen P, Hindricks G, Walfridsson H, Kongstad O, Pehrson S, Englund A, Hartikainen J, Hansen PS, Nielsen JC, Jons C. Higher burden of supraventricular ectopic complexes early after catheter ablation for atrial fibrillation is associated with increased risk of recurrent atrial fibrillation. Europace 2016; 20:50-57. [DOI: 10.1093/europace/euw329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/21/2016] [Indexed: 11/13/2022] Open
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Reid F, Oakeshott P, Kerry SR, Hay PE, Jensen JS. Chlamydia related bacteria (Chlamydiales) in early pregnancy: community-based cohort study. Clin Microbiol Infect 2016; 23:119.e9-119.e14. [PMID: 27773758 PMCID: PMC5317141 DOI: 10.1016/j.cmi.2016.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 11/12/2022]
Abstract
Objectives Serological case–control studies suggest that certain chlamydia-related bacteria (Chlamydiales) which cause cows to abort may do the same in humans. Chlamydiales include Waddlia chondrophila, Chlamydia abortus and Chlamydia trachomatis. Data on prevalence of Chlamydiales in pregnancy are sparse. Using stored urine samples from a carefully characterised cohort of 847 newly pregnant women recruited from 37 general practices in London, UK, we aimed to investigate the prevalence and types of Chlamydiales infections. We also explored possible associations with miscarriage or spontaneous preterm birth. Methods Samples were tested using W. chondrophila and pan-Chlamydiales specific real-time PCRs targeting the 16S rRNA gene. Samples positive on either PCR were subjected to DNA sequencing and C. trachomatis PCR. Results The overall prevalence of Chlamydiales was 4.3% (36/847, 95% CI 3.0% to 5.8%). The prevalence of W. chondrophila was 0.6% (n = 5), C. trachomatis 1.7% (n = 14), and other Chlamydiales species 2.0% (n = 17). Infection with C. trachomatis was more common in women aged <25, of black ethnicity or with bacterial vaginosis, but this did not apply to W. chondrophila or other Chlamydiales. Follow up was 99.9% at 16 weeks gestation and 90% at term. No infection was significantly associated with miscarriage at ≤12 weeks (prevalence 10%, 81/827) or preterm birth <37 weeks (prevalence 4%, 23/628). Of 25 samples sequenced, seven (28%) were positive for Chlamydiales bacterium sequences associated with respiratory tract infections in children. Conclusion In the first study to use the pan-Chlamydiales assay on female urine samples, 4% of pregnant women tested positive for Chlamydiales, including species known to be pathogenic in mothers and neonates.
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Affiliation(s)
- F Reid
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - P Oakeshott
- Population Health Research Institute, St George's, University of London, London, UK.
| | - S R Kerry
- Population Health Research Institute, St George's, University of London, London, UK
| | - P E Hay
- Courtyard Genitourinary Medicine Clinic, St George's NHS Trust, London, UK
| | - J S Jensen
- Statens Serum Institut, Copenhagen, Denmark
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Jørgensen PG, Jensen MT, Mogelvang R, Fritz-Hansen T, Galatius S, Biering-Sørensen T, Storgaard H, Vilsbøll T, Rossing P, Jensen JS. Impact of type 2 diabetes and duration of type 2 diabetes on cardiac structure and function. Int J Cardiol 2016; 221:114-21. [DOI: 10.1016/j.ijcard.2016.07.083] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/31/2016] [Accepted: 07/04/2016] [Indexed: 01/07/2023]
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Lindberg S, Jensen JS, Bjerre M, Frystyk J, Flyvbjerg A, Jeppesen J, Mogelvang R. Low adiponectin levels at baseline and decreasing adiponectin levels over 10 years of follow-up predict risk of the metabolic syndrome. Diabetes Metab 2016; 43:134-139. [PMID: 27639310 DOI: 10.1016/j.diabet.2016.07.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 01/23/2023]
Abstract
AIM Adiponectin is the most abundant adipokine and may play a key role in the interplay between obesity, inflammation, insulin resistance and the metabolic syndrome (MetS). Thus, this large population-based cohort investigated whether adiponectin at baseline and/or a decrease in adiponectin during follow-up is associated prospectively with the risk of incident MetS. METHODS Using a prospective study design, the development of MetS was examined in 1134 healthy participants from the community. Plasma adiponectin was measured at study entry and again after a median follow-up of 9.4 years (IQR: 9.2-9.7). During follow-up, 187 participants developed MetS, and 439 presented with at least two components of MetS. RESULTS During follow-up, adiponectin decreased in participants who developed MetS, whereas adiponectin was increased in those who did not develop MetS (P<0.001). Those with low adiponectin levels (quartile 1) at baseline had an increased risk of developing MetS (OR: 2.92, 2.08-6.97; P<0.001) compared with those with high levels (quartile 4). After adjusting for confounding variables, low adiponectin levels at baseline remained independently associated with MetS (OR: 2.24, 1.11-4.52; P=0.017). Similarly, participants with a decrease in adiponectin during follow-up also had an increased risk of MetS (OR: 2.96, 2.09-4.18; P<0.001). This association persisted after multivariable adjustments, including for baseline adiponectin (OR: 4.37, 2.77-6.97; P<0.001). Finally, adiponectin levels at follow-up were inversely associated with an increase in the number of components of MetS (P<0.001); geometric mean adiponectin levels were 9.5mg/L (95% CI: 9.0-10.0) for participants with no components vs 7.0mg/L (95% CI: 6.3-7.9) for those with four to five components. CONCLUSIONS/INTERPRETATION Low plasma adiponectin levels at baseline and decreasing adiponectin levels during follow-up are both associated with an increased risk of MetS.
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Affiliation(s)
- S Lindberg
- Copenhagen City heart study, Bispebjerg university hospital, Copenhagen, Denmark; Department of cardiology, Gentofte university hospital, 65, Niels Andersens Vej, 2900 Hellerup, Denmark.
| | - J S Jensen
- Copenhagen City heart study, Bispebjerg university hospital, Copenhagen, Denmark; Department of cardiology, Gentofte university hospital, 65, Niels Andersens Vej, 2900 Hellerup, Denmark; Institute of clinical medicine, faculty of health sciences, university of Copenhagen, Copenhagen, Denmark
| | - M Bjerre
- The medical research laboratory, department of clinical medicine, Aarhus university, department of endocrinology and internal medicine, Aarhus university hospital, Aarhus, Denmark
| | - J Frystyk
- The medical research laboratory, department of clinical medicine, Aarhus university, department of endocrinology and internal medicine, Aarhus university hospital, Aarhus, Denmark
| | - A Flyvbjerg
- The medical research laboratory, department of clinical medicine, Aarhus university, department of endocrinology and internal medicine, Aarhus university hospital, Aarhus, Denmark
| | - J Jeppesen
- Institute of clinical medicine, faculty of health sciences, university of Copenhagen, Copenhagen, Denmark; Department of internal medicine, Hvidovre hospital, Glostrup, Denmark
| | - R Mogelvang
- Copenhagen City heart study, Bispebjerg university hospital, Copenhagen, Denmark; Department of cardiology, Rigshospitalet, Copenhagen, Denmark
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Jensen JS, Cusini M, Gomberg M, Moi H. Background review for the 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2016; 30:1686-1693. [PMID: 27605499 DOI: 10.1111/jdv.13850] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/23/2016] [Indexed: 11/29/2022]
Abstract
Mycoplasma genitalium is a cause of 10-35% of non-chlamydial non-gonococcal urethritis in men and in women, and is associated with cervicitis and pelvic inflammatory disease (PID). Transmission of M. genitalium occurs through direct mucosal contact. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. In men, urethritis, dysuria and discharge predominates. Asymptomatic infections are frequent. In this review, we present the evidence base for the recommendations in the 2016 European guideline on M. genitalium infections and describe indications for testing, recommended diagnostic methods, treatment and patient management. The guideline was prepared on behalf of the European branch of The International Union against Sexually Transmitted Infections; the European Academy of Dermatology and Venereology; the European Dermatology Forum; the European Society of Clinical Microbiology and Infectious Diseases; the Union of European Medical Specialists. The European Centre for Disease Prevention and Control and the European Office of the World Health Organisation also contributed to their development.
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Affiliation(s)
- J S Jensen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
| | - M Cusini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Gomberg
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - H Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway
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Jørgensen PG, Jensen MT, Mogelvang R, von Scholten BJ, Bech J, Fritz-Hansen T, Galatius S, Biering-Sørensen T, Andersen HU, Vilsbøll T, Rossing P, Jensen JS. Abnormal echocardiography in patients with type 2 diabetes and relation to symptoms and clinical characteristics. Diab Vasc Dis Res 2016; 13:321-30. [PMID: 27208801 DOI: 10.1177/1479164116645583] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES We aimed to determine the prevalence of echocardiographic abnormalities and their relation to clinical characteristics and cardiac symptoms in a large, contemporary cohort of patients with type 2 diabetes. RESULTS A total of 1030 patients with type 2 diabetes participated. Echocardiographic abnormalities were present in 513 (49.8%) patients, mainly driven by a high prevalence of diastolic dysfunction 178 (19.4%), left ventricular hypertrophy 213 (21.0%) and left atrial enlargement, 200 (19.6%). The prevalence increased markedly with age from 31.1% in the youngest group (<55 years) to 73.9% in the oldest group (>75 years) (p < 0.001) and was equally distributed among the sexes (p = 0.76). In univariate analyses, electrocardiographic abnormalities, age, body mass index, known coronary heart disease, hypertension, albuminuria, diabetes duration and creatinine were associated with abnormal echocardiography along with dyspnoea and characteristic chest pain (p < 0.05 for all). Neither of the cardiac symptoms nor clinical characteristics had sufficient sensitivity and specificity to accurately identify patients with abnormal echocardiography. CONCLUSION Echocardiographic abnormalities are very common in outpatients with type 2 diabetes, but neither cardiac symptoms nor clinical characteristics are effective to identify patients with echocardiographic abnormalities.
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MESH Headings
- Aged
- Denmark/epidemiology
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diastole
- Echocardiography, Doppler
- Electrocardiography
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/epidemiology
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Middle Aged
- Outpatients
- Predictive Value of Tests
- Prevalence
- Risk Factors
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Peter Godsk Jørgensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Magnus T Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Jan Bech
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Søren Galatius
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Tina Vilsbøll
- Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Center for Diabetes Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Peter Rossing
- Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Steno Diabetes Center, Gentofte, Denmark Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Jan S Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Nouhravesh N, Andersen HU, Jensen JS, Rossing P, Jensen MT. Retinopathy is associated with impaired myocardial function assessed by advanced echocardiography in type 1 diabetes patients - The Thousand & 1 Study. Diabetes Res Clin Pract 2016; 116:263-9. [PMID: 27321344 DOI: 10.1016/j.diabres.2016.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/17/2016] [Accepted: 04/16/2016] [Indexed: 10/21/2022]
Abstract
AIMS Retinopathy and heart disease in Type 1 Diabetes Mellitus (Type 1 DM) may be associated; however previous results have been conflicting. Tissue Doppler Imaging (TDI) and speckle-tracking echocardiography (STE) quantify myocardial function not assessable by conventional echocardiography. We investigated the association between severity of retinopathy and early myocardial dysfunction using conventional echocardiography, TDI and STE in Type 1 DM patients. METHODS Type 1 Diabetes Mellitus patients without known heart disease were included from the Steno Diabetes Center. The cross sectional association between retinopathy and myocardial function was analyzed in uni-and multivariable models. Retinopathy was categorized as nil-, simplex- or proliferative retinopathy. RESULTS A total of 1090 Type 1 Diabetes Mellitus patients were included, mean age was 49.6years and 53% were males. Left ventricular ejection fraction did not differ between groups of retinopathy. Global longitudinal strain (GLS) by STE decreased significantly with increasing degrees of retinopathy (nil; -18.6%, simplex; -18.2% (p=0.024), proliferative; -17.7% (p<0.001)), however differences attenuated in multivariable models (p⩾0.05). In univariable models, myocardial tissue velocities differed in relation to retinopathy: s' (nil; 6.9, simplex; 6.5, proliferative; 5.9 (p=0.001), e' (nil; 10.4, simplex; 9.2, proliferative; 7.9, p<0.001), a' (nil; 6.1, simplex; 6.7, proliferative; 7.0, p<0.001) and E/e' (nil; 6.7, simplex; 7.5, proliferative; 9.5, p<0.001). In multivariable models, differences persisted between nil and proliferative retinopathy for s', e' and E/e'. CONCLUSION Proliferative retinopathy is independently associated with decreased myocardial function assessed by Tissue Doppler Imaging in patients with Type 1 Diabetes Mellitus without history of heart disease.
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Affiliation(s)
- Nina Nouhravesh
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaards vej 28, 2900 Hellerup, Denmark.
| | - Henrik U Andersen
- Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark
| | - Jan S Jensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaards vej 28, 2900 Hellerup, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Peter Rossing
- Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Faculty of Health, University of Aarhus, Katrinebergvej 89F, 8200 Aarhus N, Denmark
| | - Magnus T Jensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Kildegaards vej 28, 2900 Hellerup, Denmark; Steno Diabetes Center, Niels Steensens Vej 2, 2820 Gentofte, Denmark; Department of Internal Medicine, Holbaek Hospital, Smedelundsvej 60, 4300 Holbaek, Denmark
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Theilade S, Rossing P, Eugen-Olsen J, Jensen JS, Jensen MT. suPAR level is associated with myocardial impairment assessed with advanced echocardiography in patients with type 1 diabetes with normal ejection fraction and without known heart disease or end-stage renal disease. Eur J Endocrinol 2016; 174:745-53. [PMID: 26951602 DOI: 10.1530/eje-15-0986] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/07/2016] [Indexed: 12/17/2022]
Abstract
AIM Heart disease is a common fatal diabetes-related complication. Early detection of patients at particular risk of heart disease is of prime importance. Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker for development of cardiovascular disease. We investigate if suPAR is associated with early myocardial impairment assessed with advanced echocardiographic methods. METHODS In an observational study on 318 patients with type 1 diabetes without known heart disease and with normal left ventricular ejection fraction (LVEF) (biplane LVEF >45%), we performed conventional, tissue Doppler and speckle tracking echocardiography, and measured plasma suPAR levels. Associations between myocardial function and suPAR levels were studied in adjusted models including significant covariates. RESULTS Patients were 55±12 years (mean±s.d.) and 160 (50%) males. Median (interquartile range) suPAR was 3.4 (1.7) ng/mL and LVEF was 58±5%. suPAR levels were not associated with LVEF (P=0.11). In adjusted models, higher suPAR levels were independently associated with both impaired systolic function assessed with global longitudinal strain (GLS) and tissue velocity s', and with impaired diastolic measures a' and e'/a' (all P=0.034). In multivariable analysis including cardiovascular risk factors and both systolic and diastolic measures (GLS and e'/a'), both remained independently associated with suPAR levels (P=0.012). CONCLUSIONS In patients with type 1 diabetes with normal LVEF and without known heart disease, suPAR is associated with early systolic and diastolic myocardial impairment. Our study implies that both suPAR and advanced echocardiography are useful diagnostic tools for identifying patients with diabetes at risk of future clinical heart disease, suited for intensified medical therapy.
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MESH Headings
- Adult
- Aged
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/diagnostic imaging
- Diabetes Mellitus, Type 1/physiopathology
- Echocardiography
- Female
- Heart/diagnostic imaging
- Heart/physiopathology
- Humans
- Kidney Failure, Chronic/blood
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/diagnostic imaging
- Kidney Failure, Chronic/physiopathology
- Male
- Middle Aged
- Receptors, Urokinase Plasminogen Activator/blood
- Risk Factors
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/physiopathology
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Affiliation(s)
| | - Peter Rossing
- Steno Diabetes CenterGentofte, Denmark Aarhus UniversityAarhus, Denmark University of CopenhagenCopenhagen, Denmark
| | | | - Jan S Jensen
- University of CopenhagenCopenhagen, Denmark Department of CardiologyGentofte Hospital, Gentofte, Denmark
| | - Magnus T Jensen
- Steno Diabetes CenterGentofte, Denmark Department of CardiologyGentofte Hospital, Gentofte, Denmark Department of Internal MedicineHolbaek Sygehus, Holbaek, Denmark
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Lindberg S, Jensen JS, Hoffmann S, Iversen AZ, Pedersen SH, Biering-Sørensen T, Galatius S, Flyvbjerg A, Mogelvang R, Magnusson NE. Plasma Neutrophil Gelatinase-Associated Lipocalin Reflects Both Inflammation and Kidney Function in Patients with Myocardial Infarction. Cardiorenal Med 2016; 6:180-90. [PMID: 27275154 DOI: 10.1159/000443846] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/02/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND/AIMS Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a marker for acute kidney injury and cardiovascular outcome. However, the relative importance of inflammation versus kidney function on plasma NGAL levels is uncertain, making the interpretation of plasma NGAL unclear. Accordingly, we investigated the relationship between plasma NGAL, inflammation and kidney function in patients with myocardial infarction (MI). METHODS We prospectively included 584 patients with acute ST-segment elevation MI (STEMI) treated with primary percutaneous coronary intervention (PCI) from 2006 to 2008. Blood samples were drawn immediately before PCI. Additionally, we included 42 patients who had 4 blood samples drawn before and after PCI. Plasma NGAL was measured using a time-resolved immunofluorometric assay. Cross-sectional analyses were performed in these two single-center, prospective study cohorts. RESULTS Estimated glomerular filtration rate (eGFR) was associated significantly more strongly with plasma NGAL when eGFR was abnormal compared to normal eGFR: a decrease in eGFR of 10 ml/min was associated with an increase in NGAL of 27% (18-36%) versus 4% (1-7%), respectively (p < 0.001). Leukocyte count and C-reactive protein were the main determinants of plasma NGAL in patients with normal eGFR, whereas eGFR was the main determinant at reduced kidney function. CONCLUSIONS eGFR determines the association of NGAL with either inflammation or kidney function; in patients with normal eGFR, plasma NGAL reflects inflammation but when eGFR is reduced, plasma NGAL reflects kidney function, highlighting the dual perception of plasma NGAL. From a clinical perspective, eGFR may be used to guide the interpretation of elevated NGAL levels in patients with STEMI.
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Affiliation(s)
- Søren Lindberg
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Jan S Jensen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Hoffmann
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Allan Z Iversen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Sune H Pedersen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Allan Flyvbjerg
- The Medical Research Laboratories, Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Nils E Magnusson
- The Medical Research Laboratories, Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Abstract
BACKGROUND Severe health anxiety is frequent and costly, yet rarely diagnosed or treated. Earlier treatment studies show problems with recruitment, dropout and recovery. In the current study, the authors aimed to test the effect of acceptance and commitment group therapy (ACT-G) compared to waitlist in patients with severe health anxiety. METHOD During March 2010 to April 2012, 126 consecutively referred patients meeting research criteria for severe health anxiety were block-randomized (1:1) to ACT-G or a 10 months' waitlist (Clinicaltrials.gov, no. NCT01158430). Patients allocated to ACT-G were treated in seven groups of nine patients between December 2010 and October 2012 and received nine weekly 3-h group sessions and a booster session consisting of ACT techniques. The primary outcome was decided a priori as the mean change in self-reported illness worry on the Whiteley-7 Index (WI) from baseline to 10 months' follow-up. Secondary outcomes were improvement in emotional distress and health-related quality of life at 10 months' follow-up. RESULTS Intention-to-treat analysis showed a statistically significant mean difference of 20.5 points [95% confidence interval (CI) 11.7-29.4, p < 0.001] on the WI between the groups at 10 months, and the between-group effect sizes were large (Cohen's d = 0.89, 95% CI 0.50-1.29). The number needed to treat was 2.4 (95% CI 1.4-3.4, p < 0.001). Diagnosis and treatment were well accepted by the patients. CONCLUSIONS ACT-G seems feasible, acceptable and effective in treating severe health anxiety.
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Affiliation(s)
- T Eilenberg
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Aarhus,Denmark
| | - P Fink
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Aarhus,Denmark
| | - J S Jensen
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Aarhus,Denmark
| | - W Rief
- Department of Clinical Psychology and Psychotherapy,University of Marburg,Marburg,Germany
| | - L Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics,Aarhus University Hospital,Aarhus,Denmark
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Jørgensen PG, Jensen JS, Appleyard M, Jensen GB, Mogelvang R. Plasma pro-brain natriuretic peptide and electrocardiographic changes in combination improve risk prediction in persons without known heart disease. Int J Cardiol 2015; 201:104-9. [DOI: 10.1016/j.ijcard.2015.07.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 06/25/2015] [Accepted: 07/29/2015] [Indexed: 12/17/2022]
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Lindberg S, Jensen JS, Hoffmann S, Pedersen SH, Iversen AZ, Galatius S, Frystyk J, Flyvbjerg A, Goetze JP, Bjerre M, Mogelvang R. Interplay Between Adiponectin and Pro-Atrial Natriuretic Peptide and Prognosis in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2015; 116:1340-5. [PMID: 26361828 DOI: 10.1016/j.amjcard.2015.07.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 12/13/2022]
Abstract
Natriuretic peptides (NPs) may regulate adipocyte metabolism including adiponectin. Infusion of atrial natriuretic peptide (ANP) increases plasma adiponectin in patients with heart failure. However, this relation has not been examined in a clinical setting or in myocardial infarction (MI). Accordingly, we investigated the interplay between proANP and adiponectin and the prognostic implications in patients with MI. We prospectively included 680 patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention from September 2006 to December 2008. Blood samples were drawn immediately before percutaneous coronary intervention. Additionally, we included 40 patients with 4 obtained blood samples during STEMI. Adiponectin and proANP were measured in all plasma samples. All patients were followed for 5 years. End points were all-cause mortality (n = 137) and the combined end point (n = 170) of major adverse cardiovascular events (MACEs). Plasma adiponectin and proANP were strongly associated at admission (r = 0.34, p <0.001). In patients with increasing proANP during STEMI, adiponectin also increased (0.5 ± 0.3 vs -0.1 ± 0.1 mg/L, p = 0.026). During follow-up, patients with higher adiponectin at admission had increased risk of all-cause mortality and MACE (both, p <0.001). After adjustment for confounding risk factors by Cox regression analysis, adiponectin remained an independent predictor of all-cause mortality and MACE: hazard ratio 1.31 (95% confidence interval 1.07 to 1.60; p = 0.009) and 1.31 (95% confidence interval 1.09 to 1.57; p = 0.004), respectively, for each SD increase. However, the association vanished when proANP was included in the analysis. In conclusion, adiponectin is associated with an increased risk of all-cause mortality and MACE. However, concomitantly elevated proANP levels appear to confound the association between adiponectin and worsened outcome.
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Niemela MJ, Holm NR, Kervinen K, Erglis A, Maeng M, Kumsars I, Jegere S, Steigen T, Eskola MJ, Makikallio TH, Aaberge L, Jensen LO, Airaksinen J, Pietila M, Frobert O, Ravkilde J, Jensen SE, Jensen JS, Helqvist S, James S, Miettinen H, Lassen JF, Thuesen L, Christiansen EH. TCT-25 Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting. Five Year Clinical Outcome in The Nordic-Baltic Bifurcation Study III. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Turner KME, Frølund M, Davies B, Benfield T, Rasmussen S, Ward H, May MT, Westh H, Andersen BS, Bangsborg J, Christiansen CB, Dessau RBC, Hoffman S, Kjaeldgaard P, Jensen JS, Jensen TG, Lomborg S, Møller JK, Jensen TE, Nørskov-Lauritsen N, Panum I, Dzajic E, Rasmussen B. P08.37 Epidemiological trends in chlamydia testing in denmark 1991 to 2011 and formation of a retrospective, population-based cohort: the danish chlamydia study. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hansen KW, Soerensen R, Madsen M, Madsen JK, Jensen JS, von Kappelgaard LM, Mortensen PE, Galatius S. Developments in the invasive diagnostic-therapeutic cascade of women and men with acute coronary syndromes from 2005 to 2011: a nationwide cohort study. BMJ Open 2015; 5:e007785. [PMID: 26063568 PMCID: PMC4466619 DOI: 10.1136/bmjopen-2015-007785] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To investigate for trends in sex-related differences in the invasive diagnostic-therapeutic cascade in a population of patients with acute coronary syndromes (ACS). DESIGN A nationwide cohort study. SETTING Administrative and clinical registries covering all hospitalisations, invasive cardiac procedures and deaths in the Danish population of 5.6 million inhabitants. PARTICIPANTS We included 52,565 patients aged 30-90 years who were hospitalised with a first ACS from January 2005 to November 2011. Follow-up was 60 days from the day of index admission. MAIN OUTCOME MEASURES Diagnostic coronary angiography, percutaneous coronary intervention or coronary artery bypass within 60 days of index admission. RESULTS Women constituted 36%, were older, had more comorbidity and were less likely to be admitted to a hospital with cardiac catheterisation facilities than men. Mortality rates were similar for both sexes. Diagnostic coronary angiography was performed less frequently on women compared with men, both within 1 day (31% vs 42%; p<0.001) and within 60 days (67% vs 80%; p<0.001), yielding adjusted female-male HRs of 0.83 (0.79-0.87) and 0.86 (0.84-0.89), respectively.Among the 39,677 patients undergoing coronary angiography, non-obstructive coronary artery disease was more frequent among women than men (22% vs 9%; p<0.001). Women were less likely to undergo percutaneous coronary intervention (58% vs 72%; p<0.001) and coronary artery bypass (6% vs 11%, p<0.001) within 60 days than men, yielding adjusted HRs of 0.96 (0.92-0.99) and 0.81 (0.74-0.89), respectively. The sex-related differences were not attenuated over time for any of the invasive cardiac procedures (p values for trend >0.05). CONCLUSIONS In this nationwide study, men were more likely to undergo an invasive approach than women when hospitalised with a first ACS--a difference persisting from 2005 to 2011. Future studies should focus on the potential mechanisms behind this differential treatment.
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Affiliation(s)
- Kim Wadt Hansen
- Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark
| | - R Soerensen
- Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark
| | - M Madsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J K Madsen
- Emergency Department, Holbaek University Hospital, Holbaek, Denmark
| | - J S Jensen
- Department of Cardiology, University Hospital Gentofte, Hellerup, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L M von Kappelgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Danish Heart Registry, Denmark
| | - P E Mortensen
- The Danish Heart Registry, Denmark
- Department of Thoracic Surgery, Odense University Hospital, Denmark
| | - S Galatius
- Department of Cardiology, University Hospital Bispebjerg, Bispebjerg, Denmark
- The Danish Heart Registry, Denmark
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