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Nylund O, Johansson L, Lind MM, Johansson M. The association between self-rated health, health-related quality of life, and risk of venous thromboembolism. Prev Med Rep 2023; 36:102434. [PMID: 37766725 PMCID: PMC10520937 DOI: 10.1016/j.pmedr.2023.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Poor self-rated health (SRH) is associated with various adverse health outcomes, including cardiovascular disease. Little is known about SRH and health-related quality of life (HRQoL) as predictors of first-time venous thromboembolism (VTE). Our aim was to investigate the association between SRH, HRQoL, and risk of VTE in a whole cohort, as well as in women and men separately. A total of 108,025 middle-aged inhabitants (51 % women) of Västerbotten, Sweden, participated in a health examination between 1985 and 2014. Data on SRH, HRQoL, and potential confounders were collected by questionnaire. Participants were followed as a cohort and validated first-time VTE events were registered. The mean follow-up time was 13.9 years, during which 2054 participants experienced a first-time VTE. Overall, 27 % of participants reported their health as very good, 46 % as good, 20 % as average, 5 % as somewhat bad, and 1 % as bad. In a multivariable analysis, compared with participants who self-rated as having very good SRH, hazard ratios (95 % confidence intervals) for VTE were 1.17 (1.02-1.33) with good SRH, 1.27 (1.09-1.47) with average SRH, and 1.48 (1.00-2.18) with bad SRH. The risk of VTE increased with lower SRH for both men (p for trend 0.02) and women (p for trend 0.04). In a fully adjusted model, we also found significant associations between four aspects of HRQoL (general health, bodily pain, vitality, emotional well-being) and VTE risk. In conclusion, lower perceived health is associated with an increased risk of VTE in both men and women.
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Affiliation(s)
- Otto Nylund
- Umeå University, Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Sweden
| | - Lars Johansson
- Umeå University, Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Sweden
| | - Marcus M Lind
- Umeå University, Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Sweden
| | - Magdalena Johansson
- Umeå University, Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Sweden
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Johansson C, Örtendahl L, Lind MM, Andersson J, Johansson L, Brunström M. Diabetes, prediabetes, and atrial fibrillation-A population-based cohort study based on national and regional registers. J Intern Med 2023; 294:605-615. [PMID: 37387643 DOI: 10.1111/joim.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 07/01/2023]
Abstract
BACKGROUND Previous studies have shown an increased risk for atrial fibrillation and atrial flutter (AF) in people with type 2 diabetes and prediabetes. It is unclear whether this increase in AF risk is independent of other risk factors for AF. OBJECTIVE To investigate the association between diabetes and different prediabetic states, as independent risk factors for the onset of AF. METHODS We performed a population-based cohort study in Northern Sweden, including data on fasting plasma glucose, oral glucose tolerance test, major cardiovascular risk factors, medical history, and lifestyle factors. Participants were divided into six groups depending on glycemic status and followed through national registers for AF diagnosis. Cox proportional hazard model was used to assess the association between glycemic status and AF, using normoglycemia as reference. RESULTS The cohort consisted of 88,889 participants who underwent a total of 139,661 health examinations. In the model adjusted for age and sex, there was a significant association between glycemic status and development of AF in all groups except the impaired glucose tolerance group, with the strongest association for the group with known diabetes (p-value <0.001). In a model adjusted for sex, age, systolic blood pressure, body mass index, antihypertensive drugs, cholesterol, alcohol, smoking, education level, marital status, and physical activity, there was no significant association between glycemic status and AF. CONCLUSIONS/INTERPRETATION The association between glycemic status and AF disappears upon adjustment for potential confounders. Diabetes and prediabetes do not appear to be independent risk factors for AF.
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Affiliation(s)
- Cecilia Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lina Örtendahl
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Marcus M Lind
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Lind MM, Johansson M, Själander A, Johansson L. Incidence and risk factors of venous thromboembolism in men and women. Thromb Res 2022; 214:82-86. [DOI: 10.1016/j.thromres.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
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Johansson K, Johansson L, Nilsson TK, Lind MM. Factor XII Concentrations and Risk of Intracerebral Haemorrhage. A Prospective Case-Referent Study. J Stroke Cerebrovasc Dis 2021; 30:105565. [PMID: 33412399 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In a previous pilot study, we found an association between high factor XII levels and risk of haemorrhagic stroke suggesting that factor XII is a risk marker for intracerebral haemorrhage (ICH). The aim of this study was to further investigate the association between factor XII and risk of ICH in a larger population. MATERIALS AND METHODS This study was conducted as a prospective nested case-referent study. All participants underwent a health examination and blood sampling for factor XII analysis at baseline. Cases were defined as participants who were diagnosed with a first-ever ICH between 1985 and 2000. Two referents were matched to each case. RESULTS We identified 70 individuals with first-ever ICH and 137 matched referents who had undergone a health examination and donated blood samples before the ICH event. The mean age was 54 years, and 33% were women. The median time-to-event was 3.5 years (range 0.04 to 10.2 years). Conditional logistic regression showed no association between factor XII and risk of ICH, (odds ratio 1.06 per SD; [95% confidence interval: 0.57-1.97] in a multivariable model). CONCLUSIONS A previous finding of an association between high concentration of factor XII and risk of ICH could not be replicated in this larger study.
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Affiliation(s)
- Kristina Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, SE-901 81 Umeå, Sweden.
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, SE-901 81 Umeå, Sweden.
| | - Torbjörn K Nilsson
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, SE-901 81 Umeå, Sweden.
| | - Marcus M Lind
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, SE-901 81 Umeå, Sweden.
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Johansson C, Lind MM, Eriksson M, Johansson L. Weight, height, weight change, and risk of incident atrial fibrillation in middle-aged men and women. J Arrhythm 2020; 36:974-981. [PMID: 33335612 PMCID: PMC7733566 DOI: 10.1002/joa3.12409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Anthropometric factors are reported to be risk factors for atrial fibrillation (AF), but it is unclear whether weight change in mid-life is associated with AF. We aimed to study the possible associations of weight, height, and weight change with the risk of incident AF in men and women. METHODS Our study cohort included 108 417 persons (51% women) who participated in a population-based health examination in northern Sweden at 30, 40, 50, or 60 years of age. The health examination included weight and height measurement and collection of data regarding cardiovascular risk factors. Within this cohort, 40 275 participants underwent two health examinations with a 10-year interval. We identified cases with a first-ever diagnosis of AF through the Swedish National Patient Registry. RESULTS During a total follow-up of 1 469 820 person-years, 5154 participants developed incident AF. The mean age at inclusion was 46.3 years, and mean age at AF diagnosis was 66.6 years. After adjustment for potential confounders, height, weight, body mass index (BMI), and body surface area (BSA) were positively associated with risk of incident AF in both men and women. Among participants who underwent two health examinations 10 years apart, 1142 persons developed AF. The mean weight change from baseline was a gain of 4.8%. Weight gain or weight loss was not significantly associated with risk of incident AF. CONCLUSIONS Height, weight, BMI, and BSA showed positive associations with risk of incident AF in both men and women. Midlife weight change was not significantly associated with AF risk.
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Affiliation(s)
- Cecilia Johansson
- Skellefteå Research UnitDepartment of Public Health and Clinical MedicineUmeå UniversitySkellefteåSweden
| | - Marcus M. Lind
- Skellefteå Research UnitDepartment of Public Health and Clinical MedicineUmeå UniversitySkellefteåSweden
| | | | - Lars Johansson
- Skellefteå Research UnitDepartment of Public Health and Clinical MedicineUmeå UniversitySkellefteåSweden
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Johansson K, Jansson JH, Johansson L, Ekblom K, Lind MM. Von Willebrand factor, ABO blood group, and risk of first-ever intracerebral hemorrhage: A prospective nested case-control study. Thromb Res 2020; 195:77-80. [DOI: 10.1016/j.thromres.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/14/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
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Johansson K, Johansson L, Pennlert J, Söderberg S, Jansson JH, Lind MM. Phosphatidylethanol Levels, As a Marker of Alcohol Consumption, Are Associated With Risk of Intracerebral Hemorrhage. Stroke 2020; 51:2148-2152. [PMID: 32543974 DOI: 10.1161/strokeaha.120.029630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Previous observational studies have shown a moderately increased risk of intracerebral hemorrhage (ICH) with high self-reported alcohol consumption. However, self-reported data tend to underestimate alcohol consumption. Phosphatidylethanol is a specific biomarker reflecting alcohol intake during the last month and correlates with the amount of alcohol consumed. The present study aimed to investigate the association between phosphatidylethanol levels and the risk of future ICH. METHODS This population-based nested case-referent study was conducted within the Northern Sweden Health and Disease Cohort. At baseline, all participants underwent a health examination, including a questionnaire with questions about alcohol consumption. A blood sample was collected and stored at -80°C, and phosphatidylethanol 16:0/18:1 levels were measured in packed erythrocytes. Cases (n=97) were diagnosed with a first-ever ICH between 1985 and 2007. Two referents (n=180) were matched to each case. RESULTS The mean age at baseline was 55 years, 39% of participants were women, and the mean time from blood sampling to ICH was 7.3 years. Only phosphatidylethanol and hypertension remained independently associated with ICH in a multivariable model. Participants with phosphatidylethanol >0.30 μmol/L had an increased risk of ICH compared with those with phosphatidylethanol <0.01 μmol/L (odds ratio, 4.64 [95% CI, 1.49-14.40]). CONCLUSIONS High blood concentrations of phosphatidylethanol were associated with an increased risk of future ICH. This association was independent of hypertension and other risk factors for ICH. Our findings suggest that phosphatidylethanol, as a marker of alcohol consumption, may be used as a risk marker of future ICH.
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Affiliation(s)
- Kristina Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit (K.J., L.J., J.-H.J., M.M.L.), Umeå University, Sweden
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit (K.J., L.J., J.-H.J., M.M.L.), Umeå University, Sweden
| | - Johanna Pennlert
- Department of Public Health and Clinical Medicine (J.P., S.S.), Umeå University, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine (J.P., S.S.), Umeå University, Sweden
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit (K.J., L.J., J.-H.J., M.M.L.), Umeå University, Sweden
| | - Marcus M Lind
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit (K.J., L.J., J.-H.J., M.M.L.), Umeå University, Sweden
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Johansson C, Lind MM, Eriksson M, Wennberg M, Andersson J, Johansson L. Alcohol consumption and risk of incident atrial fibrillation: A population-based cohort study. Eur J Intern Med 2020; 76:50-57. [PMID: 32147331 DOI: 10.1016/j.ejim.2020.02.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 12/17/2019] [Revised: 02/01/2020] [Accepted: 02/18/2020] [Indexed: 02/06/2023]
Abstract
AIMS Atrial fibrillation (AF) is a common tachyarrhythmia. High alcohol consumption is associated with increased AF risk. It remains unclear whether lower levels of alcohol consumption are also associated with AF risk, and whether the association differs between men and women. In this study, we investigated the association between low to moderate levels of alcohol consumption and AF risk in men and women. METHODS We performed a population-based cohort study of 109,230 health examination participants in northern Sweden. Data regarding alcohol intake were obtained using a questionnaire administered at the health examination. Incident AF cases were identified from the Swedish National Patient Registry. RESULTS AF was diagnosed in 5,230 individuals during a total follow-up of 1,484,547 person-years. Among men, AF risk increased over quartiles of weekly alcohol consumption (P for trend 0.001). Men with alcohol consumption in the highest quartile (≥4.83 standard drinks [each drink containing 12 gs of ethanol] per week; SDW) had a HR of 1.21 (95% CI 1.09-1.34) for AF compared to men in the lowest quartile (<0.90 SDW). In men, problem drinking was also associated with an increased AF risk (HR: 1.24; 95% CI: 1.10-1.39). Among women, AF risk was not significantly associated with alcohol consumption (P for trend 0.09 for decreasing risk of AF over quartiles of weekly alcohol consumption) or problem drinking (HR: 1.00; 95% CI 0.70-1.42). CONCLUSION Self-reported alcohol consumption and problem drinking were associated with an increased risk of AF among men, but not in women.
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Affiliation(s)
- Cecilia Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden.
| | - Marcus M Lind
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden
| | | | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Section of Sustainable Health and Nutritional Research, Umeå University, Sweden
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden
| | - Lars Johansson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, 931 86 Skellefteå, Sweden
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