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Modin D, Claggett B, Jørgensen ME, Køber L, Benfield T, Schou M, Jensen JUS, Solomon SD, Trebbien R, Fralick M, Vardeny O, Pfeffer MA, Torp-Pedersen C, Gislason G, Biering-Sørensen T. Flu Vaccine and Mortality in Hypertension: A Nationwide Cohort Study. J Am Heart Assoc 2022; 11:e021715. [PMID: 35132866 PMCID: PMC9075279 DOI: 10.1161/jaha.121.021715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/15/2022]
Abstract
Background Influenza infection may increase the risk of stroke and acute myocardial infarction (AMI). Whether influenza vaccination may reduce mortality in patients with hypertension is currently unknown. Methods and Results We performed a nationwide cohort study including all patients with hypertension in Denmark during 9 consecutive influenza seasons in the period 2007 to 2016 who were prescribed at least 2 different classes of antihypertensive medication (renin‐angiotensin system inhibitors, diuretics, calcium antagonists, or beta‐blockers). We excluded patients who were aged <18 years, >100 years, had ischemic heart disease, heart failure, chronic obstructive lung disease, cancer, or cerebrovascular disease. The exposure to influenza vaccination was assessed before each influenza season. The end points were defined as death from all‐causes, from cardiovascular causes, or from stroke or AMI. For each influenza season, patients were followed from December 1 until April 1 the next year. We included a total of 608 452 patients. The median follow‐up was 5 seasons (interquartile range, 2–8 seasons) resulting in a total follow‐up time of 975 902 person‐years. Vaccine coverage ranged from 26% to 36% during the study seasons. During follow‐up 21 571 patients died of all‐causes (3.5%), 12 270 patients died of cardiovascular causes (2.0%), and 3846 patients died of AMI/stroke (0.6%). After adjusting for confounders, vaccination was significantly associated with reduced risks of all‐cause death (HR, 0.82; P<0.001), cardiovascular death (HR, 0.84; P<0.001), and death from AMI/stroke (HR, 0.90; P=0.017). Conclusions Influenza vaccination was significantly associated with reduced risks of death from all‐causes, cardiovascular causes, and AMI/stroke in patients with hypertension. Influenza vaccination might improve outcome in hypertension.
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Affiliation(s)
- Daniel Modin
- Department of Cardiology Herlev & Gentofte Hospital University of Copenhagen Denmark
| | - Brian Claggett
- Department of Medicine Cardiovascular Medicine Division Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Mads Emil Jørgensen
- Department of Cardiology Herlev & Gentofte Hospital University of Copenhagen Denmark
| | - Lars Køber
- Faculty of Health Sciences Institute of Clinical MedicineUniversity of Copenhagen Denmark.,Department of Cardiology, Rigshospitalet University of Copenhagen Denmark
| | - Thomas Benfield
- Faculty of Health Sciences Institute of Clinical MedicineUniversity of Copenhagen Denmark.,Department of Infectious Diseases Hvidovre HospitalUniversity of Copenhagen Hvidovre Denmark
| | - Morten Schou
- Department of Cardiology Herlev & Gentofte Hospital University of Copenhagen Denmark.,Faculty of Health Sciences Institute of Clinical MedicineUniversity of Copenhagen Denmark
| | - Jens-Ulrik Stæhr Jensen
- Faculty of Health Sciences Institute of Clinical MedicineUniversity of Copenhagen Denmark.,Respiratory Medicine Section Herlev & Gentofte Hospital University of Copenhagen Denmark.,Department of Infectious Diseases PERSIMUNE Rigshospitalet Denmark
| | - Scott D Solomon
- Department of Medicine Cardiovascular Medicine Division Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Ramona Trebbien
- Department of Virus and Microbiological Special Diagnostics National Influenza CenterStatens Serum Institut Copenhagen Denmark
| | - Michael Fralick
- Department of Medicine Eliot Phillipson Clinician Scientist Training ProgramUniversity of Toronto Ontario Canada
| | - Orly Vardeny
- Center for Chronic Disease Outcomes Research Minneapolis VA Health Care System Minneapolis MN.,University of Minnesota Minneapolis MN
| | - Marc A Pfeffer
- Department of Medicine Cardiovascular Medicine Division Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research Nordsjaellands Hospital Hillerød Denmark.,Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - Gunnar Gislason
- Department of Cardiology Herlev & Gentofte Hospital University of Copenhagen Denmark.,Faculty of Health Sciences Institute of Clinical MedicineUniversity of Copenhagen Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology Herlev & Gentofte Hospital University of Copenhagen Denmark.,Department of Biomedical Sciences Faculty of Health and Medical Sciences University of Copenhagen Denmark
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Reinholdt K, Munk C, Thomsen LT, Dehlendorff C, Carstensen B, Jørgensen ME, Kjaer SK. Increased incidence of genital warts among women and men with type 1 diabetes compared with the general population-results from a nationwide registry-based, cohort study. Acta Diabetol 2022; 59:105-112. [PMID: 34499240 DOI: 10.1007/s00592-021-01786-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/29/2021] [Accepted: 08/11/2021] [Indexed: 01/23/2023]
Abstract
AIMS To estimate the incidence rates of genital warts (GWs) in women and men with type 1 diabetes compared to persons without diabetes. METHODS In this nationwide registry-based cohort study, we included the entire population aged 15 to 49 years living in Denmark between 1996 and 2016. From national registries, we retrieved individual level information on diabetes status, diagnoses and treatment of GWs, and potential confounding variables. We used Poisson regression to model sex- and age-specific incidence rates of GWs in persons with type 1 diabetes and persons without diabetes. Based on the models, we computed sex-specific incidence rate ratios (IRRs) of GWs in persons with type 1 diabetes compared to persons without diabetes, overall and according to age. RESULTS The analysis included 3,514,824 persons without type 2 diabetes and no GW diagnoses before baseline. The incidence rate of GWs in persons with type 1 diabetes was higher than in those without diabetes, both among women (IRR = 1.59; 95% CI, 1.42-1.78) and men (IRR = 1.36; 95% CI, 1.25-1.48). The pattern of increased incidence rates of GWs in persons with type 1 diabetes was seen at all ages. CONCLUSIONS Persons with type 1 diabetes have higher incidence rates of GWs than persons without diabetes. This supports the importance of HPV vaccination of young girls and boys with type 1 diabetes.
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Affiliation(s)
- K Reinholdt
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - C Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - C Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - B Carstensen
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - M E Jørgensen
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- University of Southern Denmark, Odense, Denmark
| | - S K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
- Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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Abstract
BACKGROUND Influenza infection is a serious event for patients with heart failure (HF). Little knowledge exists about the association between influenza vaccination and outcome in patients with HF. This study sought to determine whether influenza vaccination is associated with improved long-term survival in patients with newly diagnosed HF. METHODS We performed a nationwide cohort study including all patients who were >18 years of age and diagnosed with HF in Denmark in the period of January 1, 2003, to June 1, 2015 (n=134 048). We collected linked data using nationwide registries. Vaccination status, number, and frequency during follow-up were treated as time-varying covariates in time-dependent Cox regression. RESULTS Follow-up was 99.8% with a median follow-up time of 3.7 years (interquartile range, 1.7-6.8 years). The vaccination coverage of the study cohort ranged from 16% to 54% during the study period. In unadjusted analysis, receiving ≥1 vaccinations during follow-up was associated with a higher risk of death. After adjustment for inclusion date, comorbidities, medications, household income, and education level, receiving ≥1 vaccinations was associated with an 18% reduced risk of death (all-cause: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001; cardiovascular causes: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001). Annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared with intermittent vaccination. CONCLUSIONS In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders. Frequent vaccination and vaccination earlier in the year were associated with larger reductions in the risk of death compared with intermittent and late vaccination.
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Affiliation(s)
- Daniel Modin
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark
| | - Mads Emil Jørgensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark
| | - Lars Køber
- Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet (L.K.), University of Copenhagen, Denmark
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.M.H., S.D.S.)
| | - Sheila M Hegde
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.M.H., S.D.S.)
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.M.H., S.D.S.)
| | - Christian Torp-Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences (G.G., J.S.J., L.K., C.T.-P.), University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., M.E.J., G.G., J.S.J., C.T.-P, T.B.-S.), University of Copenhagen, Denmark
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Andreasen C, Jørgensen ME, Gislason GH, Martinsson A, Sanders RD, Abdulla J, Jensen PF, Torp-Pedersen C, Køber L, Andersson C. Association of Timing of Aortic Valve Replacement Surgery After Stroke With Risk of Recurrent Stroke and Mortality. JAMA Cardiol 2019; 3:506-513. [PMID: 29710128 DOI: 10.1001/jamacardio.2018.0899] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/18/2022]
Abstract
Importance Timing of surgical aortic valve replacement (SAVR) in patients with aortic valve stenosis and previous stroke for the risk of recurrent stroke is insufficiently investigated. Objective To evaluate the association of time elapsed between previous stroke and SAVR with the risk of recurrent perioperative stroke, major adverse cardiovascular events (MACE), and mortality among patients with aortic valve stenosis. Design, Setting, and Participants This cohort study using data from Danish administrative registries included all patients with aortic valve stenosis older than 18 years who underwent SAVR between 1996 and 2014 (n = 14 030). Patients who received simultaneous mitral, tricuspid, or pulmonary valve surgery and patients with endocarditis 1 year prior to surgery were excluded. Data were analyzed from March 2017 to January 2018. Exposures Time elapsed between prior stroke and SAVR (<3 months, 3-<12 months, ≥12 months, and no prior stroke). Main Outcomes and Measures Thirty-day risks of MACE, ischemic stroke, and all-cause mortality reported as absolute events and multivariable adjusted odds ratios with 95% confidence intervals. Restricted cubic spline regression models were additionally applied on the subgroup with prior stroke. Results Of the 14 030 included patients, 616 patients (190 [30.8%] women; mean [SD] age, 72.0 [9.1] years) with prior stroke underwent surgery, and 13 414 (4837 [36.1%] women; mean [SD] age, 69.8 [10.8] years) without prior stroke underwent surgery. The absolute risk of ischemic stroke was significantly increased in patients with stroke less than 3 months prior to surgery compared with patients with no prior stroke (18.4% [37 of 201] vs 1.2% [160 of 13 219]; odds ratio, 14.69; 95% CI, 9.69-22.27). Likewise, compared with patients without stroke, patients with stroke less than 3 months prior surgery were at significantly increased risk of MACE (23.3% [53 of 227] vs 5.7% [768 of 13 414]; odds ratio, 4.57; 95% CI, 3.24-6.44) but not all-cause mortality (6.8% [50 of 730] vs 3.6% [374 of 10 370]; odds ratio, 1.45; 95% CI, 0.83-2.54). Spline analyses supported a declining risk over time, reaching nadir after 2 to 4 months. Conclusions and Relevance Previous stroke is a major risk factor of recurrent ischemic stroke and MACE in patients undergoing SAVR, especially if time elapsed between previous stroke and surgery is less than 3 months.
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Affiliation(s)
- Charlotte Andreasen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark
| | - Mads Emil Jørgensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark.,The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Robert D Sanders
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Jawdat Abdulla
- Division of Cardiology, Department of Medicine, Glostrup University Hospital, Copenhagen, Denmark
| | - Per Føge Jensen
- The Multidisciplinary Pain Center, Department of Anaesthesia, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark
| | - Christian Torp-Pedersen
- Department of Health, Science, and Technology, Aalborg University, Aalborg, Denmark.,The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Andersson
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark
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Faerch K, Quist JS, Hulman A, Witte DR, Tabak AG, Brunner EJ, Kivimäki M, Jørgensen ME, Panda S, Vistisen D. Prospective association between late evening food consumption and risk of prediabetes and diabetes: the Whitehall II cohort study. Diabet Med 2019; 36:1256-1260. [PMID: 30897241 PMCID: PMC6754814 DOI: 10.1111/dme.13951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/18/2019] [Indexed: 12/15/2022]
Abstract
AIMS We examined whether late evening food consumption was prospectively associated with the risk of developing prediabetes or diabetes in a large observational study of individuals with normoglycaemia. METHODS Participants were 2642 men and women with normoglycaemia (HbA1c < 39 mmol/mol; < 5.7%) from the Whitehall II study. Time of last eating episode (TLEE) before the examination day was assessed at baseline. We studied the associations of TLEE with 5-year changes in HbA1c and risk of developing prediabetes or diabetes (HbA1c ≥ 39 mmol/mol; ≥ 5.7%). Potential heterogeneity in the association between TLEE and prediabetes or diabetes was examined using recursive partitioning modelling for time-to-event outcomes. RESULTS There was a tendency of an overall association of TLEE with change in HbA1c but with little effect size [β per 1-h increase in TLEE = 0.2 mmol/mol, 95% CI -0.0 to 0.3 (0.01%, -0.00 to 0.03); P = 0.055] and no association with the risk of developing prediabetes/diabetes (risk ratio per 1-h increase in TLEE = 1.03, 95% CI 0.94 to 1.13; P = 0.511). According to the recursive partitioning modelling, women with HbA1c ≤ 36 mmol/mol and TLEE after 21:00 had a 1.51 times (95% CI 1.16 to 1.93) higher 5-year risk of developing prediabetes or diabetes than those having their TLEE between 16:00 and 21:00 (35.4% vs. 23.5%; P = 0.003). CONCLUSIONS There was no overall association of TLEE with the development of prediabetes or diabetes in the Whitehall II population. However, explorative analyses suggested that eating late in the evening was associated with increased risk of developing prediabetes/diabetes among women with good glycaemic control. Whether restricting late evening food consumption is effective and feasible for the prevention of Type 2 diabetes needs testing in randomized controlled trials.
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Affiliation(s)
- K Faerch
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - J S Quist
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A Hulman
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - D R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - A G Tabak
- 1st Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - E J Brunner
- Department of Epidemiology & Public Health, University College London, London, UK
| | - M Kivimäki
- Department of Epidemiology & Public Health, University College London, London, UK
| | - M E Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark
| | - S Panda
- Salk Institute for Biological Studies, La Jolla, CA, USA
| | - D Vistisen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Venkatesan S, Jørgensen ME, Manning HJ, Andersson C, Mozid AM, Coburn M, Moonesinghe SR, Foex P, Mythen M, Grocott MPW, Hardman JG, Myles PR, Sanders RD. Preoperative chronic beta-blocker prescription in elderly patients as a risk factor for postoperative mortality stratified by preoperative blood pressure: a cohort study. Br J Anaesth 2019; 123:118-125. [PMID: 31101323 DOI: 10.1016/j.bja.2019.03.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 03/01/2019] [Accepted: 03/21/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Recent data suggest that beta blockers are associated with increased perioperative risk in hypertensive patients. We investigated whether beta blockers were associated with an increased risk in elderly patients with raised preoperative arterial blood pressure. METHODS We conducted a propensity-score-matched cohort study of primary care data from the UK Clinical Practice Research Datalink (2004-13), including 84 633 patients aged 65 yr or over. Conditional logistic regression models, including factors that were significantly associated with the outcome, were constructed for 30-day mortality after elective noncardiac surgery. The effects of beta blockers (primary outcome), renin-angiotensin system (RAS) inhibitors, calcium-channel blockers, thiazides, loop diuretics, and statins were investigated at systolic and diastolic arterial pressure thresholds. RESULTS Beta blockers were associated with increased odds of postoperative 30-day mortality in patients with systolic hypertension (defined as systolic BP >140 mm Hg; adjusted odds ratio [aOR]: 1.92; 95% confidence interval [CI]: 1.05-3.51). After excluding patients for whom prior data suggest benefit from perioperative beta blockade (patients with prior myocardial infarction or heart failure), rather than adjusting for them, the point estimate shifted slightly (aOR: 2.06; 95% CI: 1.09-3.89). Compared with no use, statins (aOR: 0.35; 95% CI: 0.17-0.75) and thiazides (aOR: 0.28; 95% CI: 0.10-0.78) were associated with lower mortality in patients with systolic hypertension. CONCLUSIONS These data suggest that the safety of perioperative beta blockers may be influenced by preoperative blood pressure thresholds. A randomised controlled trial of beta-blocker withdrawal, in select populations, is required to identify a causal relationship.
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Affiliation(s)
- Sudhir Venkatesan
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mads Emil Jørgensen
- Department of Internal Medicine, Division of Cardiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helen J Manning
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Charlotte Andersson
- The Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Abdul M Mozid
- Department of Cardiology, Bristol Heart Institute, Bristol, UK
| | - Mark Coburn
- Department of Anaesthesia, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - S Ramani Moonesinghe
- University College London Hospitals & National Institute of Health Biomedical Research Centre, London, UK
| | - Pierre Foex
- Nuffield Division of Anaesthetics, Oxford University Hospital, Oxford, UK
| | - Monty Mythen
- University College London Hospitals & National Institute of Health Biomedical Research Centre, London, UK
| | - Michael P W Grocott
- Integrative Physiology and Critical Illness, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, UK
| | | | - Puja R Myles
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Robert D Sanders
- Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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7
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Venkatesan S, Myles PR, Manning HJ, Mozid AM, Andersson C, Jørgensen ME, Hardman JG, Moonesinghe SR, Foex P, Mythen M, Grocott MPW, Sanders RD. Cohort study of preoperative blood pressure and risk of 30-day mortality after elective non-cardiac surgery. Br J Anaesth 2018. [PMID: 28633374 DOI: 10.1093/bja/aex056] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 01/08/2023] Open
Abstract
Background Preoperative blood pressure (BP) thresholds associated with increased postoperative mortality remain unclear. We investigated the relationship between preoperative BP and 30-day mortality after elective non-cardiac surgery. Methods We performed a cohort study of primary care data from the UK Clinical Practice Research Datalink (2004-13). Parsimonious and fully adjusted multivariable logistic regression models, including restricted cubic splines for numerical systolic and diastolic BP, for 30-day mortality were constructed. The full model included 29 perioperative risk factors, including age, sex, comorbidities, medications, and surgical risk scale. Sensitivity analyses were conducted for age (>65 vs <65 years old) and the timing of BP measurement. Results A total of 251 567 adults were included, with 589 (0.23%) deaths within 30 days of surgery. After adjustment for all risk factors, preoperative low BP was consistently associated with statistically significant increases in the odds ratio (OR) of postoperative mortality. Statistically significant risk thresholds started at a preoperative systolic pressure of 119 mm Hg (adjusted OR 1.02 [95% confidence interval (CI) 1.01-1.02]) compared with the reference (120 mm Hg) and diastolic pressure of 63 mm Hg [OR 1.24 (95% CI 1.03-1.49)] compared with the reference (80 mm Hg). As BP decreased, the OR of mortality risk increased. Subgroup analysis demonstrated that the risk associated with low BP was confined to the elderly. Adjusted analyses identified that diastolic hypertension was associated with increased postoperative mortality in the whole cohort. Conclusions In this large observational study we identified a significant dose-dependent association between low preoperative BP values and increased postoperative mortality in the elderly. In the whole population, elevated diastolic, not systolic, BP was associated with increased mortality.
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Affiliation(s)
- S Venkatesan
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - P R Myles
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - H J Manning
- Department of Obstetrics and Gynaecology, University of Wisconsin, Madison, WI, USA
| | - A M Mozid
- Department of Cardiology, Bristol Heart Institute, Bristol, UK
| | - C Andersson
- Division of Cardiology, Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Denmark
| | - M E Jørgensen
- Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J G Hardman
- Department of Anaesthesia, University of Nottingham, Nottingham, UK
| | - S R Moonesinghe
- Department of Anaesthesia, Surgical Outcomes Research Centre, University College London Hospital, London, UK.,National Institute for Academic Anaesthesia's Health Services Research Centre, London, UK
| | - P Foex
- Nuffield Division of Anaesthetics, Oxford University Hospital, Oxford, UK
| | - M Mythen
- Department of Anaesthesia, Surgical Outcomes Research Centre, University College London Hospital, London, UK.,National Institute for Academic Anaesthesia's Health Services Research Centre, London, UK
| | - M P W Grocott
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Obstetrics and Gynaecology, University of Wisconsin, Madison, WI, USA.,Integrative Physiology and Critical Illness, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R D Sanders
- Anesthesiology and Critical Care Trials and Interdisciplinary Outcomes Network (ACTION), Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI 53792-3272, USA
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8
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Abstract
Importance Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events. Objective To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management. Design, Setting, and Participants This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age- and cause-specific mortality, calibrated to rates reported in SPRINT. We also used population-based observational data to model development of heart failure, myocardial infarction, stroke, and subsequent mortality. Costs were based on published sources, Medicare data, and the National Inpatient Sample. Interventions Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management). Main Outcomes and Measures Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. Results Standard management yielded 9.6 QALYs and accrued $155 261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176 584 in costs. Intensive blood pressure management cost $23 777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times more common in the intensive management arm to prefer standard management. Conclusions and Relevance Intensive blood pressure management is cost-effective at typical thresholds for value in health care and remains so even with substantially higher adverse event rates.
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Affiliation(s)
- Ilana B Richman
- Palo Alto VA Health Care System, Palo Alto, California2Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Michael Fairley
- Department of Management Science and Engineering, Stanford University, Stanford, California
| | - Mads Emil Jørgensen
- The Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark5Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Alejandro Schuler
- Center for Biomedical Informatics Research, Stanford University, Stanford, California
| | - Douglas K Owens
- Palo Alto VA Health Care System, Palo Alto, California2Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jeremy D Goldhaber-Fiebert
- Center for Primary Care and Outcomes Research/Center for Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Jørgensen ME, Andersson C, Venkatesan S, Sanders RD. Beta-blockers in noncardiac surgery: Did observational studies put us back on safe ground? Br J Anaesth 2018; 121:16-25. [PMID: 29935568 DOI: 10.1016/j.bja.2018.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/10/2018] [Accepted: 02/07/2018] [Indexed: 01/10/2023] Open
Abstract
Based on landmark trials, international guidelines had for years promoted the use of beta-blockers in the setting of non-cardiac surgery. In 2011, concerns were raised regarding the integrity of some of the landmark trials, as the Dutch Erasmus Medical Center found some of them to be scientifically incorrect. Based on the remaining studies that were to be trusted, investigations showed that, in contrast to prior beliefs, the widespread use of perioperative beta-blockers might be harmful. A call for further investigations into the matter ushered in several observational studies evaluating the safety of perioperative beta-blocker therapy in specific patient subgroups. Within this review, we discuss important aspects for making these decisions, and compare the major observational studies and specific estimates of risk in subgroups of interest. We conclude that patients at high risk with heavy co-morbidities, such as heart failure, may benefit from beta-blocker therapy, whereas low-risk patients, such as patients with uncomplicated hypertension, may be at increased risk with beta-blocker therapy. We provide a critical review of current perioperative guidelines in view of the new observational data, suggesting that the recommended schematics, such as the Revised Cardiac Risk Index, for risk stratification of patients in this setting may be suboptimal. Further, we provide discussions of other aspects, including risk of sepsis, type of beta-blocker, and the potential of perioperative beta-blocker withdrawal, which may be important in guiding future studies. Summarising the current evidence, we argue that, after a precarious decade, we may just now, be back on safe ground.
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Affiliation(s)
- M E Jørgensen
- The Cardiovascular Research Center, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - C Andersson
- The Cardiovascular Research Center, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - S Venkatesan
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - R D Sanders
- Anesthesiology & Critical Care Trials & Interdisciplinary Outcome Network, Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
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10
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Rasmussen A, Almdal T, Anker Nielsen A, Nielsen KE, Jørgensen ME, Hangaard S, Siersma V, Holstein PE. Decreasing incidence of foot ulcer among patients with type 1 and type 2 diabetes in the period 2001-2014. Diabetes Res Clin Pract 2017. [PMID: 28648855 DOI: 10.1016/j.diabres.2017.05.025] [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] [Indexed: 10/19/2022]
Abstract
AIM Diabetic foot ulcer (DFU) is a serious complication to diabetes. The aim was to study the incidence of first DFU among patients with type 1 (T1DM) and type 2 diabetes (T2DM), stratified according to etiology: neuropathic, neuro-ischemic or ischemic, over a period of 14years (2001-2014). METHODS DFU incidence rates were calculated from electronic patient record data from patients with T1DM and complicated T2DM from a large specialized diabetes hospital with a multidisciplinary foot clinic in Denmark. Poisson regression was used to model incidence of first DFU according to calendar year, diabetes type and etiology. RESULTS Among 5640 patients with T1DM 255 developed a DFU, corresponding to an incidence of 5.8 (95% confidence interval (95%CI) 5.1-6.5) per 1000 patient years; this incidence dropped from 8.1 (95%CI 5.4-11.9) per 1000 patient years in 2002 to 2.6 (95%CI 1.3-5.3) in 2014 (p=0.0059). Among 6953 patients with T2DM 310 developed a DFU, corresponding to an incidence of 11.3 (95%CI 10.1-12.6) per 1000 patient years; this incidence dropped from 17.0 (95%CI 12.2-23.8) per 1000 patient years in 2002 to 8.7 (95%CI 5.3-14.1) per 1000 patient year (p=0.0260) in 2014. CONCLUSION The incidence of DFU has decreased substantially in T1DM as well as in T2DM. This change was driven by a decrease in incidence of neuropathic ulcers.
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Affiliation(s)
- A Rasmussen
- Steno Diabetes Center Copenhagen, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - T Almdal
- Steno Diabetes Center Copenhagen, Niels Steensensvej 2, 2820 Gentofte, Denmark; Department of Medical Endocrinology PE, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - A Anker Nielsen
- Steno Diabetes Center Copenhagen, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - K E Nielsen
- Steno Diabetes Center Copenhagen, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - M E Jørgensen
- Steno Diabetes Center Copenhagen, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - S Hangaard
- Steno Diabetes Center Copenhagen, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - V Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - P E Holstein
- Steno Diabetes Center Copenhagen, Niels Steensensvej 2, 2820 Gentofte, Denmark; Department of Dermatology and Copenhagen Woundhealing Center, Copenhagen Wound Healing Center, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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11
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Venkatesan S, Myles PR, Manning HJ, Mozid AM, Andersson C, Jørgensen ME, Hardman JG, Moonesinghe SR, Foex P, Mythen M, Grocott MPW, Sanders RD. Cohort study of preoperative blood pressure and risk of 30-day mortality after elective non-cardiac surgery. Br J Anaesth 2017; 119:174. [PMID: 28974084 DOI: 10.1093/bja/aex223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Venkatesan
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - P R Myles
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - H J Manning
- Department of Obstetrics and Gynaecology, University of Wisconsin, Madison, WI, USA
| | - A M Mozid
- Department of Cardiology, Bristol Heart Institute, Bristol, UK
| | - C Andersson
- Division of Cardiology, Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Denmark
| | - M E Jørgensen
- Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J G Hardman
- Department of Anaesthesia, University of Nottingham, Nottingham, UK
| | - S R Moonesinghe
- Department of Anaesthesia, Surgical Outcomes Research Centre, University College London Hospital, London, UK.,National Institute for Academic Anaesthesia's Health Services Research Centre, London, UK
| | - P Foex
- Nuffield Division of Anaesthetics, Oxford University Hospital, Oxford, UK
| | - M Mythen
- Department of Anaesthesia, Surgical Outcomes Research Centre, University College London Hospital, London, UK.,National Institute for Academic Anaesthesia's Health Services Research Centre, London, UK
| | - M P W Grocott
- Integrative Physiology and Critical Illness, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Southampton NIHR Biomedical Research Centre, Southampton, UK
| | - R D Sanders
- Anesthesiology and Critical Care Trials and Interdisciplinary Outcomes Network (ACTION), Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI 53792-3272, USA
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12
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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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13
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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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14
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Jensen TM, Vistisen D, Fleming T, Nawroth PP, Rossing P, Jørgensen ME, Lauritzen T, Sandbaek A, Witte DR. Methylglyoxal is associated with changes in kidney function among individuals with screen-detected Type 2 diabetes mellitus. Diabet Med 2016; 33:1625-1631. [PMID: 27504739 DOI: 10.1111/dme.13201] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 08/08/2016] [Indexed: 12/26/2022]
Abstract
AIMS The glycolysis-derived metabolite methylglyoxal has been linked to clinical microvascular complications, including diabetic nephropathy. We aimed to further investigate the hypothesis that methylglyoxal is involved in decline in renal function by assessing the associations between measures of renal function during a 6-year follow-up in 1481 people with screen-detected Type 2 diabetes, as part of the Danish arm of the ADDITION-Europe trial (ADDITION-DK). METHODS Biobank serum samples collected at ADDITION-DK baseline (2001-2006) and follow-up (2009-2010) were used in the current analysis of methylglyoxal. We assessed cross-sectional baseline and longitudinal associations between methylglyoxal and urinary albumin-to-creatinine ratio (ACR) or estimated GFR (eGFR), and between methylglyoxal and categories of albuminuria or reduced eGFR. RESULTS Baseline methylglyoxal was positively associated with ACR at baseline (12% higher ACR per doubling in methylglyoxal levels), and change in methylglyoxal during 6 years of follow-up was inversely associated with change in eGFR (-1.6 ml/min/1.73 m2 per doubling in methylglyoxal change), in models adjusted for age, sex, HbA1c , systolic blood pressure, anti-hypertensive treatment, LDL-cholesterol, lipid-lowering treatment, C-reactive protein and smoking. CONCLUSIONS In a population of people with screen-detected Type 2 diabetes, we observed associations between methylglyoxal and markers of renal function: 6-year change in methylglyoxal was inversely associated with 6-year change in eGFR. Also, methylglyoxal at baseline was positively associated with ACR at baseline. Our study lends further support to a role for methylglyoxal in the pathogenesis of diabetic nephropathy.
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Affiliation(s)
- T M Jensen
- Steno Diabetes Center, Gentofte, Denmark
| | - D Vistisen
- Steno Diabetes Center, Gentofte, Denmark
| | - T Fleming
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - P P Nawroth
- Department of Medicine I and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany
| | - P Rossing
- Steno Diabetes Center, Gentofte, Denmark
| | - M E Jørgensen
- Steno Diabetes Center, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Odense, Denmark
| | - T Lauritzen
- Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - A Sandbaek
- Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - D R Witte
- Department of Public Health, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
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15
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Hansen PW, Gislason GH, Jørgensen ME, Køber L, Jensen PF, Torp-Pedersen C, Andersson C. Influence of age on perioperative major adverse cardiovascular events and mortality risks in elective non-cardiac surgery. Eur J Intern Med 2016; 35:55-59. [PMID: 27306404 DOI: 10.1016/j.ejim.2016.05.028] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 05/26/2016] [Accepted: 05/28/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Advanced age increases the risk of perioperative cardiovascular complications and may pose reluctance to subject elderly patients to surgery. We examined the impact of high age on perioperative major adverse cardiovascular events (MACE) and mortality in a nationwide cohort of patients undergoing elective surgery. METHODS All Danish patients aged ≥20years undergoing non-cardiac, elective surgery in 2005-2011 were identified from nationwide administrative registers. Risks of 30-day MACE (non-fatal ischemic stroke, non-fatal myocardial infarction, or cardiovascular death) and all-cause mortality were analyzed by multivariable logistic regression models (adjusted for comorbidities, revised cardiac risk index, cardiovascular pharmacotherapy, body mass index, and surgery type). RESULTS A total of 386,818 procedures on 302,459 patients were included; mean age was 54.8years (min-max 20-104), and 44% were men. A total of 1297 (0.34%) had perioperative MACE and 1449 (0.37%) died. Advanced age was associated with increased risks of MACE (odds ratio [OR], 1.87; 95% CI, 1.78-1.98 per 10-year high) and mortality (OR, 1.87; 95% CI, 1.78-1.96 per 10-year high). A total of 21,511 procedures were performed on patients >80-90years old, and 1662 on patients >90years. The numbers of MACE and crude mortality rates were 331 (1.7%) and 388 (2.0%) among >80-90years old, and 50 (3.0%) and 67 (4.0%) for those aged >90years. CONCLUSION The risk of mortality and major adverse cardiovascular events within 30days after surgery increased with advanced age. However, despite advanced age, the absolute event rates appeared to be relatively modest and around 4% for people aged above 90years.
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Affiliation(s)
- Peter Wæde Hansen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark; The Danish Heart Foundation, Denmark.
| | - Gunnar H Gislason
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark; The Danish Heart Foundation, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Mads Emil Jørgensen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark
| | - Lars Køber
- Department of Clinical Medicine, University of Copenhagen, Denmark; The Heart Center, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Per Føge Jensen
- Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Charlotte Andersson
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark; Department of Internal Medicine, Section of Cardiology, Glostrup Hospital, Denmark
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16
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Kamper-Jørgensen Z, Carstensen B, Norredam M, Bygbjerg IC, Andersen PH, Jørgensen ME. Diabetes-related tuberculosis in Denmark: effect of ethnicity, diabetes duration and year of diagnosis. Int J Tuberc Lung Dis 2016; 19:1169-75. [PMID: 26459528 DOI: 10.5588/ijtld.14.0932] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between diabetes mellitus (DM) and tuberculosis (TB) has been established on the basis of cross-sectional studies; however, only a few longitudinal studies have been conducted, with inconsistent results. OBJECTIVE To study the effect of ethnicity and the presence and duration of DM on the risk of incident TB based on 15 years of follow-up of the entire Danish population. DESIGN AND METHODS Using Poisson regression analysis, we estimated TB incidence in individuals with DM vs. those without DM by linking nationwide DM and TB registers to the National Civil Register at case level. RESULTS The TB rate ratio was 1.9 in individuals with DM compared to non-DM individuals, regardless of country of birth, with the exception of African-born individuals (rate ratio 0.5). The risk decreased drastically within the first 2 years after the diagnosis of DM; no association was found with longer durations of DM. The risk also decreased the later the year of DM diagnosis. CONCLUSIONS The study confirmed DM as a risk factor for TB, except in the case of African-born individuals. Other non-DM risk factors for TB could act as effect-modifiers on the DM-TB association. Implementing earlier DM diagnosis and improving metabolic control may reduce the risk of DM-related TB.
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Affiliation(s)
- Z Kamper-Jørgensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark; Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; Immunology and Microbiology Faculty of Medicine and Health Sciences, Department of International Health, University of Copenhagen, Copenhagen, Denmark
| | - B Carstensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark
| | - M Norredam
- Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases and Department of Immigrant Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - I C Bygbjerg
- Immunology and Microbiology Faculty of Medicine and Health Sciences, Department of International Health, University of Copenhagen, Copenhagen, Denmark
| | - P H Andersen
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - M E Jørgensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark
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17
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Almdal T, Nielsen AA, Nielsen KE, Jørgensen ME, Rasmussen A, Hangaard S, Siersma V, Holstein PE. Increased healing in diabetic toe ulcers in a multidisciplinary foot clinic-An observational cohort study. Diabetes Res Clin Pract 2015; 110:315-21. [PMID: 26515911 DOI: 10.1016/j.diabres.2015.10.003] [Citation(s) in RCA: 14] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/23/2015] [Accepted: 10/01/2015] [Indexed: 11/25/2022]
Abstract
AIM To study toe ulcer healing in patients with diabetic foot ulcers attending a multidisciplinary foot clinic over a 10 years period. METHODS The study was retrospective, consecutive and observational during 2001 through 2011. The patients were treated according to the International Consensus on the Diabetic Foot. During the period the chiropodist staffing in the foot clinic was doubled; new offloading material and orthopedic foot corrections for recalcitrant ulcers were introduced. Healing was investigated in toe ulcers in Cox regression models. RESULTS 2634 patients developed foot ulcers, of which 1461 developed toe ulcers; in 790 patients these were neuropathic, in 551 they were neuro-ischemic and in 120 they were critically ischemic. One-year healing rates increased in the period 2001-2011 from 75% to 91% for neuropathic toe ulcers and from 72% to 80% for neuro-ischemic toe ulcers, while no changes was observed for ischemic toe ulcers. Adjusted for changes in the patient population, the overall rate of healing for neuropathic and neuro-ischemic toe ulcers almost doubled (HR=1.95 [95% CI: 1.36-2.80]). CONCLUSION The results show that the healing of toe ulcers improved. This outcome could not be explained by changes in the patient characteristics, but coincided with a number of improvements in organization and therapy.
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Affiliation(s)
- T Almdal
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
| | - A Anker Nielsen
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - K E Nielsen
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - M E Jørgensen
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - A Rasmussen
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - S Hangaard
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark
| | - V Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - P E Holstein
- Steno Diabetes Center, Niels Steensensvej 2, 2820 Gentofte, Denmark; Department of Dermatology and Copenhagen Woundhealing Center, Copenhagen Wound Healing Center, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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18
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Christiansen CB, Pallisgaard J, Gerds TA, Olesen JB, Jørgensen ME, Numé AK, Carlson N, Kristensen SL, Gislason G, Torp-Pedersen C. Comparison of antiplatelet regimens in secondary stroke prevention: a nationwide cohort study. BMC Neurol 2015; 15:225. [PMID: 26525411 PMCID: PMC4630842 DOI: 10.1186/s12883-015-0480-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 10/22/2015] [Indexed: 01/11/2023] Open
Abstract
Background In patients with ischemic stroke of non-cardioembolic origin, acetylsalicylic acid, clopidogrel, or a combination of acetylsalicylic acid and dipyridamole are recommended for the prevention of a recurrent stroke. The purpose of this study was to examine the risk of bleeding or recurrent stroke associated with these three treatments. Methods Patients who were discharged with first-time ischemic stroke from 2007–2010, with no history of atrial fibrillation were identified from Danish nationwide registries. Hazard ratios (HRs) and 1-year risks of recurrent ischemic stroke and bleeding were calculated for each antiplatelet regimen. Results Among patients discharged after first-time ischemic stroke, 3043 patients were treated with acetylsalicylic acid, 12,295 with a combination of acetylsalicylic acid and dipyridamole, and 3885 with clopidogrel. Adjusted HRs for clopidogrel versus the combination of acetylsalicylic acid and dipyridamole were 1.02 (95 % confidence interval [CI]: 0.89–1.17) for ischemic stroke and 1.06 (95 % CI: 0.83–1.35) for bleeding. Adjusted HRs for acetylsalicylic acid versus the combination of acetylsalicylic acid and dipyridamole were 1.48 (95 % CI: 1.31–1.67) for stroke and 1.47 (95 % CI: 1.18–1.82) for bleeding. Clopidogrel versus acetylsalicylic acid yielded HRs of 0.69 (95 % CI: 0.59–0.81) and 0.72 (95 % CI: 0.55–0.96) for stroke and bleeding, respectively. The 1-year predicted risks associated with acetylsalicylic acid, the combination of acetylsalicylic acid and dipyridamole, and clopidogrel were 11.1 (95 % CI: 10.2–12.2), 7.7 (95 % CI: 7.3–8.3), and 8.0 (95 % CI: 6.9–8.7) for ischemic stroke, respectively; while, the risks for bleeding were 3.4 (95 % CI: 2.8–3.9), 2.4 (95 % CI: 2.1–2.7), and 2.4 (95 % CI: 1.9–2.9), respectively. Conclusion Clopidogrel and the combination of acetylsalicylic acid and dipyridamole were associated with similar risks for recurrent ischemic stroke and bleeding; whereas acetylsalicylic acid was associated with higher risks for both ischemic stroke and bleeding. The latter finding may partially be explained by selection bias.
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Affiliation(s)
- Christine Benn Christiansen
- Aalborg University Hospital, Forskningens Hus, Sdr. Skovvej 15, 9000, Aalborg, Denmark. .,Department of Cardiology, Gentofte Hospital, Gentofte, Denmark.
| | | | - Thomas Alexander Gerds
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Anna Karin Numé
- Department of Cardiology, Gentofte Hospital, Gentofte, Denmark
| | | | | | - Gunnar Gislason
- Department of Cardiology, Gentofte Hospital, Gentofte, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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19
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Eliraqi GM, Vistisen D, Lauritzen T, Sandbaek A, Jørgensen ME, Faerch K. Intensive multifactorial treatment modifies the effect of family history of diabetes on glycaemic control in people with Type 2 diabetes: a post hoc analysis of the ADDITION-Denmark randomized controlled trial. Diabet Med 2015; 32:1085-9. [PMID: 25819139 DOI: 10.1111/dme.12764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/24/2015] [Indexed: 11/27/2022]
Abstract
AIM To investigate whether intensive multifactorial treatment can reverse the predisposed adverse phenotype of people with Type 2 diabetes who have a family history of diabetes. METHODS Data from the randomized controlled trial ADDITION-Denmark were used. A total of 1441 newly diagnosed patients with diabetes (598 with family history of diabetes) were randomized to intensive treatment or routine care. Family history of diabetes was defined as having one parent and/or sibling with diabetes. Linear mixed-effects models were used to assess the changes in risk factors (BMI, waist circumference, blood pressure, lipids and HbA1c ) after 5 years of follow-up in participants with and without a family history of diabetes. An interaction term between family history of diabetes and treatment group was included in the models to test for a modifying effect of the intervention. All analyses were adjusted for age, sex, baseline value of the risk factor and general practice (random effect). RESULTS At baseline, participants with a family history of diabetes were younger and had a 1.1 mmol/mol (0.1%) higher HbA1c concentration at the time of diagnosis than those without a family history of diabetes. Family history of diabetes modified the effect of the intervention on changes in HbA1c levels. In the group receiving routine care, participants with a family history of diabetes experienced an improvement in HbA1c concentration that was 3.3 mmol/mol (0.3%) lower than the improvement found in those without a family history of diabetes after 5 years of follow-up. In the intensive treatment group, however, there was no difference in HbA1c concentrations between participants with and without a family history of diabetes after 5 years of treatment. CONCLUSIONS Intensive treatment of diabetes may partly remove the adverse effects of family history of diabetes on glycaemic control. The effect of this improvement on long-term diabetic complications warrants further investigation.
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Affiliation(s)
- G M Eliraqi
- Steno Diabetes Center, Gentofte, Denmark
- Faculty of Medicine, Lund University, Malmö, Sweden
| | - D Vistisen
- Steno Diabetes Center, Gentofte, Denmark
| | - T Lauritzen
- Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - A Sandbaek
- Institute of Public Health, Aarhus University, Aarhus, Denmark
| | | | - K Faerch
- Steno Diabetes Center, Gentofte, Denmark
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Hansen CS, Jensen TM, Jensen JS, Nawroth P, Fleming T, Witte DR, Lauritzen T, Sandbaek A, Charles M, Fleischer J, Vistisen D, Jørgensen ME. The role of serum methylglyoxal on diabetic peripheral and cardiovascular autonomic neuropathy: the ADDITION Denmark study. Diabet Med 2015; 32:778-85. [PMID: 25761542 DOI: 10.1111/dme.12753] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 03/10/2015] [Indexed: 12/18/2022]
Abstract
AIMS Cardiovascular autonomic neuropathy and diabetic peripheral neuropathy are common diabetic complications and independent predictors of cardiovascular disease. The glucose metabolite methylglyoxal has been suggested to play a causal role in the pathogeneses of diabetic peripheral neuropathy and possibly diabetic cardiovascular autonomic neuropathy. The aim of this study was to investigate the cross-sectional association between serum methylglyoxal and diabetic peripheral neuropathy and cardiovascular autonomic neuropathy in a subset of patients in the ADDITION-Denmark study with short-term screen-detected Type 2 diabetes (duration ~ 5.8 years). METHODS The patients were well controlled with regard to HbA(1c), lipids and blood pressure. Cardiovascular autonomic neuropathy was assessed by measures of resting heart rate variability and cardiovascular autonomic reflex tests. Diabetic peripheral neuropathy was assessed by vibration detection threshold (n = 319), 10 g monofilament (n = 543) and the Michigan Neuropathy Screening Instrument questionnaire (n = 966). Painful diabetic neuropathy was assessed using the Brief Pain Inventory short form (n = 882). RESULTS No associations between methylglyoxal and cardiovascular autonomic reflex tests or any measures of diabetic peripheral neuropathy or painful diabetic neuropathy were observed. However, a positive association between methylglyoxal and several heart rate variability indices was observed, although these associations were not statistically significant when corrected for multiple testing. CONCLUSION Serum methylglyoxal is not associated with cardiovascular autonomic neuropathy, diabetic peripheral neuropathy or painful diabetic neuropathy in this cohort of well-treated patients with short-term diabetes.
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Affiliation(s)
- C S Hansen
- Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte, Denmark
| | - T M Jensen
- Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte, Denmark
| | - J S Jensen
- Department of Cardiology, Gentofte Hospital, Denmark
| | - P Nawroth
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Germany
| | - T Fleming
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Germany
| | - D R Witte
- Centre for Health Studies, CRP-Santé, Strassen, Luxembourg
| | - T Lauritzen
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - A Sandbaek
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - M Charles
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - J Fleischer
- Medical Research Laboratories, Clinical Institute of Medicine, Aarhus University, Aarhus, Denmark
| | - D Vistisen
- Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte, Denmark
| | - M E Jørgensen
- Department of Clinical Epidemiology, Steno Diabetes Centre A/S, Gentofte, Denmark
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21
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Oya J, Vistisen D, Christensen DL, Faurholt-Jepsen D, Mohan V, Ramachandran A, Chew SKH, Shaw JE, Jørgensen ME. Geographic differences in the associations between impaired glucose regulation and cardiovascular risk factors among young adults. Diabet Med 2015; 32:497-504. [PMID: 25523878 DOI: 10.1111/dme.12674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 12/11/2014] [Indexed: 01/26/2023]
Abstract
AIMS To assess geographic differences in the association between BMI, blood pressure and lipid levels with impaired glucose regulation among young adults from various geographical regions. METHODS This was a cross-sectional study including data from 6987 participants aged ≤ 30 years from India, Singapore, Australia, Greenland, Kenya and Tanzania. Impaired glucose regulation was determined by the 75-g oral glucose tolerance test. For each geographical region, BMI, blood pressure and lipids were examined and compared between participants with normal glucose tolerance and those with impaired glucose regulation. Multiple logistic regression models were used to assess the association between risk factors and impaired glucose regulation. RESULTS Indian and East African people had a higher prevalence of impaired glucose regulation compared with participants from other regions, despite their lower BMI. Compared with the other regions, blood pressure was lower among Indian and Singaporean people but higher in those from Greenland. Greenlanders had the highest, while Indian and East-African people, had the lowest level of HDL cholesterol. BMI was positively associated with impaired glucose regulation in all regions, and there were no statistically significant geographic differences. In the Indian, Singaporean and Australian participants, there was a positive association between blood pressure and impaired glucose regulation. Triglycerides were positively associated with and HDL cholesterol had no association with impaired glucose regulation in all geographical regions. CONCLUSIONS Higher BMI and triglyceride levels were positively associated with prevalent impaired glucose regulation in all geographical regions. There were geographic differences in the association between impaired glucose regulation and blood pressure and lipids, probably reflecting environmental and genetic factors.
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Affiliation(s)
- J Oya
- Steno Diabetes Center, Gentofte, Denmark
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Affiliation(s)
- R D Sanders
- Department of Anesthesiology, University of Wisconsin, Madison, USA
| | - M E Jørgensen
- The Cardiovascular Research Center, Gentofte Hospital, University of Copenhagen, Denmark
| | - G A Mashour
- Department of Anesthesiology, University of Michigan, Ann Arbor, USA
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Andersson C, Wissenberg M, Jørgensen ME, Hlatky MA, Mérie C, Jensen PF, Gislason GH, Køber L, Torp-Pedersen C. Age-Specific Performance of the Revised Cardiac Risk Index for Predicting Cardiovascular Risk in Elective Noncardiac Surgery. Circ Cardiovasc Qual Outcomes 2015; 8:103-8. [DOI: 10.1161/circoutcomes.114.001298] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 01/22/2023]
Affiliation(s)
- Charlotte Andersson
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet,
| | - Mads Wissenberg
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet,
| | - Mads Emil Jørgensen
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet,
| | - Mark A. Hlatky
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet,
| | - Charlotte Mérie
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet,
| | - Per Føge Jensen
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet,
| | - Gunnar H. Gislason
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet,
| | - Lars Køber
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet,
| | - Christian Torp-Pedersen
- From the Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (C.A., M.W., M.E.J., C.M., G.H.G.); Department of Health Research and Policy, Stanford University, CA (M.A.H.); Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (P.F.J.); The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark (G.H.G.); The Heart Center, Copenhagen University Hospital, Rigshospitalet,
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Andersson C, Jørgensen ME, Martinsson A, Hansen PW, Gustav Smith J, Jensen PF, Gislason GH, Køber L, Torp-Pedersen C. Noncardiac surgery in patients with aortic stenosis: a contemporary study on outcomes in a matched sample from the Danish health care system. Clin Cardiol 2014; 37:680-6. [PMID: 25224044 DOI: 10.1002/clc.22324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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] [Received: 05/22/2014] [Accepted: 07/15/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Past research has identified aortic stenosis (AS) as a major risk factor for adverse outcomes in noncardiac surgery; however, more contemporary studies have questioned the grave prognosis. To further our understanding of this, the risks of a 30-day major adverse cardiovascular event (MACE) and all-cause mortality were investigated in a contemporary Danish cohort. HYPOTHESIS AS is not an independent risk factor for adverse outcomes in noncardiac surgery. METHODS All patients with and without diagnosed AS who underwent noncardiac surgery in 2005 to 2011 were identified through nationwide administrative registers. AS patients (n = 2823; mean age, 75.5 years, 53% female) were matched with patients without AS (n = 2823) on propensity score for AS and surgery type. RESULTS In elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death) occurred in 66/1772 (3.7%) of patients with AS and 52/1772 (2.9%) of controls (P = 0.19), whereas mortality occurred in 67/1772 (3.8%) AS patients and 51/1772 (2.9%) controls (P = 0.13). In emergency surgery, 163/1051 (15.5%) AS patients and 120/1051 (11.4%) controls had a MACE (P = 0.006), whereas 225/1051 (21.4%) vs 179/1051 (17.0%) AS patients and controls died, respectively (P = 0.01). Event rates were higher for those with symptoms (defined as use of nitrates, congestive heart failure, or use of loop diuretics), compared with those without symptoms (P < 0.0001). CONCLUSIONS AS is associated with high perioperative rates of MACE and mortality, but perhaps prognosis is, in practice, not much worse for patients with AS than for matched controls. Symptomatic patients and patients undergoing emergency surgery are at considerable risks of a MACE and mortality.
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Affiliation(s)
- Charlotte Andersson
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Hellerup, Denmark
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25
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Jørgensen ME, Torp-Pedersen C, Finer N, Caterson I, James WPT, Legler UF, Andersson C. Association between serum bilirubin and cardiovascular disease in an overweight high risk population from the SCOUT trial. Nutr Metab Cardiovasc Dis 2014; 24:656-662. [PMID: 24534073 DOI: 10.1016/j.numecd.2013.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [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: 08/28/2013] [Revised: 11/18/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS An inverse relationship between (serum) total bilirubin and risk of cardiovascular disease has been reported previously, but longitudinal data on overweight and obese patients are lacking. We have investigated the relationship between total bilirubin and cardiovascular adverse events in a large group of patients with risk factors for cardiovascular disease who were enrolled in a large weight loss trial. METHODS AND RESULTS Data from the Sibutramine Cardiovascular Outcomes (SCOUT) trial, including almost 10.000 overweight/obese high cardiovascular risk patients, were used. The relationship between total bilirubin level at screening and the primary outcome (i.e. non-fatal myocardial infarction, non-fatal stroke, resuscitated cardiac arrest or cardiovascular death) for the entire study period was investigated using Cox proportional hazards models. The population was divided into four groups based on total bilirubin levels (normal range 5-25 μmol/L). Time-dependent Cox analyses were also performed to adjust for weight loss over time. Initial analyses adjusted for sex, age and treatment allocation showed significantly reduced hazard ratios of 0.80 (95% confidence interval 0.68-0.94), 0.73 (0.62-0.86) and 0.77 (0.65-0.91), for the three higher total bilirubin groups: >8 and ≤10 μmol/L, >10 and ≤13 μmol/L and >13 μmol/L (5-95 interpercentile range for total bilirubin at screening; 6-19 μmol/L), compared to the lowest total bilirubin group ≤8 μmol/L. When adjusting for classical cardiovascular risk factors, estimates increased towards unity. Additional adjustment for indicators of liver function did not alter the results. A time-dependent Cox model, adjusted for weight loss, demonstrated a similar trend. CONCLUSION Bilirubin was not a risk-factor independent from other traditional cardiovascular risk-factors in our population.
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Affiliation(s)
- M E Jørgensen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark.
| | - C Torp-Pedersen
- Department of Health Science and Technology, Aalborg University, Denmark
| | - N Finer
- Centre for Cardiovascular Prevention & Outcomes, UCL Institute of Cardiovascular Sciences, London, UK
| | - I Caterson
- Boden Institute, University of Sydney, NSW, Australia
| | - W P T James
- London School of Hygiene and Tropical Medicine, London, UK
| | - U F Legler
- Special Vocational College for handicapped Persons, Mainz, Germany
| | - C Andersson
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Denmark
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Jørgensen ME, Almdal TP, Faerch K. Reduced incidence of lower-extremity amputations in a Danish diabetes population from 2000 to 2011. Diabet Med 2014; 31:443-7. [PMID: 24111834 DOI: 10.1111/dme.12320] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 04/24/2013] [Revised: 08/21/2013] [Accepted: 09/18/2013] [Indexed: 01/03/2023]
Abstract
AIMS Diabetic foot disease and amputations severely reduce quality of life and have major economic consequences. The aim of this study was to estimate time trends in the incidence of lower-extremity amputations in Danish people with diabetes. METHODS We studied major and minor lower-extremity amputations from 2000 to 2011 among 11,332 people with diabetes from the Steno Diabetes Center. Amputations were identified by linkage of the electronic medical system with the National Patient Registry. Sex-specific incidence rates of amputations by age, diabetes duration, calendar time and diabetes type were modelled by Poisson regression. RESULTS From 2000 to 2011, 384 incident lower-extremity amputations (205 major, 179 minor) occurred during 100,495 years of patient follow-up. From 2000 to 2011, the incidence of all lower-extremity amputations decreased by 87.5% among men and 47.4% among women with type 1 diabetes and by 83.3% among men and 79.1% among women with type 2 diabetes (P < 0.001). In particular, there was a decline in major lower-extremity amputations. In 2011, the incidence rates of major lower-extremity amputations were 0.25 (95% CI 0.07-0.82) among men and 0.21 (95% CI 0.06-0.71) among women per 1000 patient-years at age 50 years and 0.56 (95% CI 0.18-1.89) among men and 0.41 (95% CI 0.16-1.09) among women per 1000 patient-years at age 70 years. No significant change in incidence of minor amputations was observed. CONCLUSION The incidence of major lower-extremity amputations reduced significantly from 2000 to 2011 in Danish people with diabetes followed at a diabetes specialist centre.
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Philipsen A, Carstensen B, Sandbaek A, Almdal TP, Johansen NB, Jørgensen ME, Witte DR. Reproducibility of ultrasonography for assessing abdominal fat distribution in a population at high risk of diabetes. Nutr Diabetes 2013; 3:e82. [PMID: 23917154 PMCID: PMC3730221 DOI: 10.1038/nutd.2013.23] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/16/2013] [Accepted: 06/18/2013] [Indexed: 12/05/2022] Open
Abstract
Background: Visceral fat plays an important role in the development of metabolic disease independently of the effect of overall abdominal fat. Ultrasonography is an accessible method of accurately assessing abdominal fat distribution in epidemiological studies, but few details about the reproducibility of this method have been published. Objective: The aim of this study was to investigate the reproducibility of ultrasonography in the assessment of abdominal fat distribution in a population at high risk of type 2 diabetes. Design and Methods: Ultrasonography was used to estimate visceral and subcutaneous abdominal fat. Intra- and interobserver variation, short-term variation and variation between estimates in the fasting and non-fasting state were examined in three samples of 30, 33 and 23 participants from the ADDITION-PRO study. A variance components model was used to calculate intra- and interobserver variation, and Bland–Altman plots were drawn for all three substudies. Results: Coefficients of variation for intra- and interobserver variation were in the range 3.4–6.1%, except for interobserver variation for subcutaneous fat (9.5%). Short-term variation over a median of 35 days had a coefficient of variation of 15%. The effect of a meal was primarily on the visceral estimates and did not extend beyond the first postprandial hour. Non-fasting visceral estimates were larger than fasting estimates. Conclusion: Both visceral and subcutaneous fat can be estimated with ultrasonography with adequate intra- and interobserver reproducibility by clinical researchers with limited training, making it a feasible method of assessing abdominal fat distribution in epidemiological studies.
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Affiliation(s)
- A Philipsen
- Steno Diabetes Center A/S, Gentofte, Denmark
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Abstract
BACKGROUND AND AIM Most studies show that diabetes increases with migration and urbanization. Previous studies from Greenland have shown inconsistent associations between cardiovascular risk and urbanization. Thus, the aim was to study the association between diabetes and urbanization among Greenland Inuit. METHODS A total of 3089 adult Inuit aged 18 years and older participated in a geographically representative, population-based study 'Inuit Health in Transition Study'. The examination included a 75 g oral glucose tolerance test and anthropometric measurements. Information on socio-demographic characteristic and health behaviour was obtained by interview or questionnaire. The participants were categorized according to degree of urbanization into three groups based on current place of residence: (1) participants living in towns (> 2000 inhabitants), (2) participants living in small towns (< 2000 inhabitants) and (3) participants living in villages (< 500 inhabitants). RESULTS The total prevalence of diabetes was 9% of which 79% were previously unknown. Nine per cent had impaired glucose tolerance and 19% had impaired fasting glycaemia (IFG). Compared with towns, odds rations (ORs) for diabetes and impaired fasting glycaemia were higher in small towns [OR(diabetes) = 1.5 (1.0-2.3), OR(IFG) = 1.9 (1.2-2.3)] and villages [OR(diabetes) = 1.2 (0.8-1.9), OR(IFG) = 1.3 (0.9-2.0)], whereas no association was seen for impaired glucose tolerance. The inverse association between urbanization and diabetes and impaired fasting glycaemia persisted after adjustment for relevant confounders. CONCLUSION Diabetes and impaired fasting glycaemia decreased with urbanization contrary to the results of most studies. It appears that Greenland Inuit follow the pattern usually observed in industrialized countries with the highest risk of diabetes in the lower socio-economic groups.
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Jørgensen ME, Sørensen MR, Ekholm O, Rasmussen NK. Importance of questionnaire context for a physical activity question. Scand J Med Sci Sports 2012; 23:651-6. [PMID: 22260444 DOI: 10.1111/j.1600-0838.2011.01433.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2011] [Indexed: 11/29/2022]
Abstract
Adequate information about physical activity habits is essential for surveillance, implementing, and evaluating public health initiatives in this area. Previous studies have shown that question order and differences in wording result in systematic differences in people's responses to questionnaires; however, this has never been shown for physical activity questions. The aim was to study the influence of different formulations and question order on self-report physical activity in a population-based health interview survey. Four samples of each 1000 adults were drawn at random from the National Person Register. A new question about physical activity was included with minor differences in formulations in samples 1-3. Furthermore, the question in sample 2 was included in sample 4 but was placed in the end of the questionnaire. The mean time spent on moderate physical activity varied between the four samples from 57 to 100 min/day. Question order was associated with the reported number of minutes spent on moderate-intensity physical activity and with prevalence of meeting the recommendation, whereas physical inactivity was associated with the differences in formulation of the question. Questionnaire context influences the way people respond to questions about physical activity significantly and should be tested systematically in validation studies of physical activity questionnaires.
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Affiliation(s)
- M E Jørgensen
- Department of Epidemiology, Steno Diabetes Center, Gentofte, Denmark
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Jørgensen ME, Borch-Johnsen K, Bjerregaard P. A cross-sectional study of the association between persistent organic pollutants and glucose intolerance among Greenland Inuit. Diabetologia 2008; 51:1416-22. [PMID: 18560802 DOI: 10.1007/s00125-008-1066-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [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: 12/27/2007] [Accepted: 05/08/2008] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS Some evidence supports the hypothesis that persistent organic pollutants (POPs) may increase the risk of type 2 diabetes. The Inuit population in Greenland, which is highly exposed to POPs due to a high intake of marine mammals, has experienced a rapid increase in diabetes prevalence over the last 30 years. Thus the aim was to study the association between POPs and glucose intolerance and markers of insulin resistance and insulin secretion using a population-based design. METHODS From 1999 to 2002 the Greenland population study was carried out among adult Inuit living in Greenland. The examination included a 75 g OGTT, anthropometric measurements, a structured interview, and blood tests. Plasma glucose and serum insulin were analysed, and three defined subclasses of POPs were analysed in a subgroup. Associations were adjusted for age, sex, waist circumference, Inuit heritage, cigarette smoking, alcohol consumption and educational level. RESULTS Data on POPs were available on 692 individuals, 305 men (mean age 50 years) and 387 women (mean age 49 years). The prevalence of diabetes was 10.3%, and 10.5% had impaired glucose tolerance. The concentrations of several POPs were exceptionally high. While no associations were found between POPs and stages of glucose intolerance or markers of insulin resistance, POPs were significantly inversely associated with stimulated insulin concentrations and homeostasis model assessment of beta cell function. CONCLUSIONS/INTERPRETATION The study indicates that POPs may affect insulin secretion rather than being involved in the pathogenesis of insulin resistance. No association was seen between POPs and glucose intolerance or markers of insulin resistance.
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Jørgensen ME, Bjerregaard P, Gyntelberg F, Borch-Johnsen K. Prevalence of the metabolic syndrome among the Inuit in Greenland. A comparison between two proposed definitions. Diabet Med 2004; 21:1237-42. [PMID: 15498091 DOI: 10.1111/j.1464-5491.2004.01294.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [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] [Indexed: 11/29/2022]
Abstract
AIMS To estimate the prevalence of the metabolic syndrome among Greenland Inuit according to the World Health Organization (WHO) definition and the definition suggested by the National Cholesterol Education Program (NCEP). METHODS From 1999 to 2001, 917 adult Inuit participated in a health survey in Greenland. The examination included a 75-g oral glucose tolerance test (OGTT). Body mass index (BMI), waist circumference, waist-to-hip ratio and blood pressure were measured. Plasma glucose, serum insulin, lipids and urine albumin/creatinine ratio were measured. The metabolic syndrome was diagnosed according to the WHO criteria 1999 and to the working definition suggested by the NCEP 2001. RESULTS Using the WHO and the NCEP criteria, 20.7% and 17.9% of the participants had the metabolic syndrome, respectively. There was a moderate agreement between the two definitions, kappa = 0.56 (95% CI 0.51-0.61). Of those with the WHO metabolic syndrome, 37.9% did not have the NCEP syndrome, and 28.5% of those with the NCEP syndrome were not classified with the metabolic syndrome under the WHO criteria. Compared with the WHO syndrome, men with the NCEP syndrome had higher mean values of waist circumference, BMI and triglycerides, and lower mean values of high-density lipoprotein (HDL) cholesterol; among women, triglycerides were higher with the NCEP syndrome. CONCLUSION The metabolic syndrome is common among Inuit using either the WHO definition or the proposed NCEP definition. The classification disagreement is considerable and a universally accepted definition is needed.
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Affiliation(s)
- M E Jørgensen
- Steno Diabetes Centre, Niels Steensensvej 2, 2820 Gentofte, Denmark.
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Bjerregaard P, Jørgensen ME, Borch-Johnsen K. Serum lipids of Greenland Inuit in relation to Inuit genetic heritage, westernisation and migration. Atherosclerosis 2004; 174:391-8. [PMID: 15136072 DOI: 10.1016/j.atherosclerosis.2004.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [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: 12/03/2003] [Revised: 02/12/2004] [Accepted: 02/27/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND The reputed low prevalence of cardiovascular disease among the Inuit has recently been challenged. Studies have shown total cholesterol among the Inuit to differ little from that of western populations and the association between cholesterol and atherosclerosis to be inconsistent. METHODS We studied serum lipids in a population survey among 2114 Inuit living in Denmark or in West Greenland. Blood tests were supplemented by structured interviews, anthropometry and measurements of blood pressure. FINDINGS Compared with the general population of Denmark, total cholesterol was higher among Inuit women, while HDL-cholesterol was higher among Inuit men. Triglyceride was lower among Inuit of both sexes. Cholesterol and triglyceride varied according to westernisation, diet, alcohol consumption and smoking. In a multivariate analysis, serum lipids also differed significantly between pure and genetically mixed Inuit: HDL-cholesterol was higher among the genetically pure Inuit, while among men triglyceride was lower and among women total and LDL-cholesterol were higher. INTERPRETATION Among the Inuit, serum lipids are significantly associated with westernisation and genetic heritage. The effect of westernisation is to some extent due to dietary changes. From a cardiovascular health point of view, westernisation within Greenland is associated with unfavourable lipid changes while migration to Denmark is associated with favourable lipid changes.
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Affiliation(s)
- P Bjerregaard
- Division for Research in Greenland, National Institute of Public Health, Svanemøllevej 25, DK-2100 Copenhagen, Denmark.
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Rejnmark L, Jørgensen ME, Pedersen MB, Hansen JC, Heickendorff L, Lauridsen AL, Mulvad G, Siggaard C, Skjoldborg H, Sørensen TB, Pedersen EB, Mosekilde L. Vitamin D insufficiency in Greenlanders on a westernized fare: ethnic differences in calcitropic hormones between Greenlanders and Danes. Calcif Tissue Int 2004; 74:255-63. [PMID: 14708040 DOI: 10.1007/s00223-003-0110-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [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: 05/12/2003] [Accepted: 07/25/2003] [Indexed: 10/26/2022]
Abstract
We studied the influence of age, gender, latitude, season, diet and ethnicity on plasma 25-hydroxyvitamin D 25 OHD, PTH, 1,25-dihydroxyvitamin D, vitamin D-binding protein, bone-specific alkaline phosphatase, and osteocalcin levels in 46 Greenlanders living in Nuuk (64 degrees N) on a traditional fare (group A), 45 Greenlanders living in Nuuk on a westernized fare (group B), 54 Greenlanders (group C), and 43 Danes (Group D) living in Denmark (55 degrees N) on a westernized fare. Blood specimens were drawn both summer and winter. Vitamin D insufficiency (plasma 25 OHD <40 nmol/l) was common in all four study groups during summer (23-74%) and winter (42-81%). Compared to groups A and D, vitamin D insufficiency was significantly more frequent in groups B and C. In all groups, summer levels of 25 OHD were above winter levels. Multiple regression analysis revealed a significant effect of ethnicity. Compared to Danes, Greenlanders had higher 1,25-dihydroxyvitamin D levels, but lower 25 OHD and PTH levels despite relatively low plasma calcium concentrations. In addition to ethnicity, 25(OH)D levels were influenced by age, season (summer > winter), and diet (a traditional Inuit diet>westernized diet). Ethnic differences exist between Greenlanders and Danes. Our results suggest that Greenlanders may have an inherent lower "set-point" for calcium-regulated PTH release or an enhanced renal 1,25(OH)(2)D production. In addition to ethnicity, age, season, and diet were important determinants of vitamin D status. Changes from a traditional to a westernized fare are associated with a reduced vitamin D status in Greenlanders. Vitamin D supplementation should be considered.
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Affiliation(s)
- L Rejnmark
- Department of Endocrinology and Metabolism C, Aarhus Amtssygehus, Aarhus University Hospital, Aarhus, Denmark.
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Jørgensen ME, Pedersen MB, Siggaard C, Sørensen TB, Mulvad G, Hansen JC, Skjoldborg H, Pedersen EB. Twenty-four-hour blood pressure among Greenlanders and Danes: relationship to diet and lifestyle. Scand J Clin Lab Invest 2003; 62:413-22. [PMID: 12469896 DOI: 10.1080/00365510260389967] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Greenlanders have a lower rate of cardiovascular mortality and morbidity than Danes, possibly due to lower blood pressure. However, 24-h blood pressure has never been measured in Greenlanders. The aim of this study was to compare the 24-h blood pressure of Greenlanders and Danes, and to analyse the influence of Arctic food and lifestyle on blood pressure. METHODS Four groups of healthy subjects were recruited for the study. Group I: Danes in Denmark consuming European food; group II: Greenlanders in Denmark consuming European food; group III: Greenlanders in Greenland consuming mainly European food; and group IV: Greenlanders in Greenland consuming mainly traditional Greenlandic food. All subjects underwent a physical examination, laboratory screening of blood and urine samples, and completed a questionnaire on diet, physical activity, smoking status, intake of alcohol, liquorices, vitamins and minerals. Twenty-four-hour blood pressure was measured. RESULTS It was found that 24-h diastolic blood pressure was lower in Greenlanders than in Danes for the whole 24-h period and during both day and night-time, whereas systolic blood pressure was the same (mean 24-h blood pressure with 95% CI: Danes 123/75 mmHg (120/73-127/77), Greenlanders 122/ 69 (119/68-124/70)). Among Greenlanders, blood pressure increased with age and male gender, and systolic blood pressure increased with body mass index (BMI). No association with diet was found. The difference between the two populations persisted after controlling for age, gender, BMI, outdoor temperature, and lifestyle factors. CONCLUSION Greenlanders have a lower 24-h diastolic blood pressure than Danes, and it is suggested that genetic factors are mainly responsible for the lower blood pressure level among Greenlanders.
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Affiliation(s)
- M E Jørgensen
- Department of Medicine, Queen Ingrid's Hospital, Nuuk, Greenland.
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Jørgensen ME, Glümer C, Bjerregaard P, Gyntelberg F, Jørgensen T, Borch-Johnsen K. Obesity and central fat pattern among Greenland Inuit and a general population of Denmark (Inter99): Relationship to metabolic risk factors. Int J Obes (Lond) 2003; 27:1507-15. [PMID: 14634682 DOI: 10.1038/sj.ijo.0802434] [Citation(s) in RCA: 56] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate whether the obesity observed among the Inuit of Greenland and in a general Danish population was associated with the same degree of metabolic disturbances. DESIGN Comparison of data from two population-based cross-sectional surveys conducted in 1999-2001. SUBJECTS A total of 7892 individuals aged 30-60 y, 1108 Inuit participants from the Greenland Population study, and 6784 Danish participants in the Danish Inter99 study. MEASUREMENTS Height, weight, waist and hip circumference were measured, and BMI and waist-to-hip ratio were calculated. The participants received a standard 75 g OGTT. s-Triglyceride, s-HDL cholesterol, fasting and 2 h p-glucose and s-insulin were analysed. Blood pressure was measured. Information on lifestyle factors was obtained by a questionnaire and interview. RESULTS The Inuit had lower levels of 2-h glucose and insulin, blood pressure, triglyceride, and higher levels of HDL cholesterol than the Danish participants at any given level of obesity. Fasting glucose and fasting insulin levels within obesity categories were not different in the two populations. Adjustment for physical activity, smoking, school education, and alcohol consumption did not change these findings. CONCLUSION The trends in the association between obesity and metabolic effects among the Inuit and a Northern European population were the same, but the levels of the risk factors were significantly different. This may be due to genetic factors and differences in body composition.
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Bjerregaard P, Jørgensen ME, Andersen S, Mulvad G, Borch-Johnsen K. Decreasing overweight and central fat patterning with Westernization among the Inuit in Greenland and Inuit migrants. Int J Obes (Lond) 2002; 26:1503-10. [PMID: 12439653 DOI: 10.1038/sj.ijo.0802082] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [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: 02/07/2002] [Revised: 05/03/2002] [Accepted: 05/07/2002] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To analyse overweight, obesity and central fat patterning among the Inuit of Greenland and Inuit migrants in Denmark and their relation to Westernization. DESIGN Cross-sectional, population-based epidemiological study. SUBJECTS A total of 2046 adult Greenlanders (Inuit), 61% of those invited to participate, living in three areas of Greenland and in Denmark. MEASUREMENTS Height, weight, waist and hip circumferences were measured and body mass index (BMI in kg/m(2)) and waist-hip ratio calculated. Sociocultural information was obtained by questionnaire and interview. Westernization was estimated by language and place of residence. RESULTS The prevalence of obesity (>or=30 kg/m(2)) was 16 and 22% among men and women in Greenland (P=0.004), and 12 and 11%, respectively, in Denmark (NS). Westernization was accompanied by a decrease in the proportion of obese people, in particular among women. Adjusted for BMI, age and Inuit heritage waist circumference decreased with Westernization (among women), while hip circumference did not change. The differences were particularly pronounced for migrants compared with residents of Greenland. CONCLUSION BMI and central fat patterning decrease with Westernization among Greenland Inuit women contrary to most studies of migrants. The changes were less prominent among men. This suggests a reduced cardiovascular risk profile with Westernization among Greenland Inuit.
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Affiliation(s)
- P Bjerregaard
- National Institute of Public Health, Copenhagen, Denmark.
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Bjerregaard P, Jørgensen ME, Lumholt P, Mosgaard L, Borch-Johnsen K. Higher blood pressure among Inuit migrants in Denmark than among the Inuit in Greenland. J Epidemiol Community Health 2002; 56:279-84. [PMID: 11896135 PMCID: PMC1732127 DOI: 10.1136/jech.56.4.279] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE Previous studies of blood pressure among the Inuit have given inconsistent results and studies comparing Inuit migrants with those living in traditional Inuit areas are absent. The purpose of the study was to compare the blood pressure of the Inuit in Greenland with that of Inuit migrants in Denmark. DESIGN Questionnaire, interview, and clinical examination in a cross sectional random population sample. SETTING A population based survey among Inuit in Greenland and Inuit migrants in Denmark. PARTICIPANTS 2046 Inuit aged >/or =18, 61% of the sample. MAIN RESULTS Age and gender adjusted blood pressures were 117/72 mm Hg in Greenland and 127/81 mm Hg among the migrants (p<0.001). In both populations, blood pressure increased with age and body mass index, and was higher among men and non-smokers. In Greenland, blood pressure increased with the level of school education. The associations with Inuit heritage, alcohol, diet, and physical activity were not significant. The difference between the two populations persisted after adjusting for age, gender, body mass index, education, and smoking. Among those who had completed high school, there was no difference between the systolic blood pressure of the two populations while the difference for diastolic blood pressure was much less than for those with less education. CONCLUSIONS Blood pressure was lower among the Inuit in Greenland than among the Inuit migrants in Denmark but the difference was absent (systolic pressure) or reduced (diastolic pressure) among the better educated. The results suggest that the blood pressure of the Inuit, especially Inuit men, may be responsive to factors related to the modern Western way of life.
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Affiliation(s)
- P Bjerregaard
- National Institute of Public Health, Division for Research in Greenland, Svanemøllevej 25, DK-2100 Copenhagen Ø, Denmark.
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