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Schiffer TA, Carvalho LRRA, Guimaraes D, Boeder A, Wikström P, Carlström M. Specific NOX4 Inhibition Preserves Mitochondrial Function and Dampens Kidney Dysfunction Following Ischemia-Reperfusion-Induced Kidney Injury. Antioxidants (Basel) 2024; 13:489. [PMID: 38671936 DOI: 10.3390/antiox13040489] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Acute kidney injury (AKI) is a sudden episode of kidney failure which is frequently observed at intensive care units and related to high morbidity/mortality. Although AKI can have many different causes, ischemia-reperfusion (IR) injury is the main cause of AKI. Mechanistically, NADPH oxidases (NOXs) are involved in the pathophysiology contributing to oxidative stress following IR. Previous reports have indicated that knockout of NOX4 may offer protection in cardiac and brain IR, but there is currently less knowledge about how this could be exploited therapeutically and whether this could have significant protection in IR-induced AKI. Aim: To investigate the hypothesis that a novel and specific NOX4 inhibitor (GLX7013114) may have therapeutic potential on kidney and mitochondrial function in a mouse model of IR-induced AKI. Methods: Kidneys of male C57BL/6J mice were clamped for 20 min, and the NOX4 inhibitor (GLX7013114) was administered via osmotic minipump during reperfusion. Following 3 days of reperfusion, kidney function (i.e., glomerular filtration rate, GFR) was calculated from FITC-inulin clearance and mitochondrial function was assessed by high-resolution respirometry. Renal histopathological evaluations (i.e., hematoxylin-eosin) and TUNEL staining were performed for apoptotic evaluation. Results: NOX4 inhibition during reperfusion significantly improved kidney function, as evidenced by a better-maintained GFR (p < 0.05) and lower levels of blood urea nitrogen (p < 0.05) compared to untreated IR animals. Moreover, IR caused significant tubular injuries that were attenuated by simultaneous NOX4 inhibition (p < 0.01). In addition, the level of renal apoptosis was significantly reduced in IR animals with NOX4 inhibition (p < 0.05). These favorable effects of the NOX4 inhibitor were accompanied by enhanced Nrf2 Ser40 phosphorylation and conserved mitochondrial function, as evidenced by the better-preserved activity of all mitochondrial complexes. Conclusion: Specific NOX4 inhibition, at the time of reperfusion, significantly preserves mitochondrial and kidney function. These novel findings may have clinical implications for future treatments aimed at preventing AKI and related adverse events, especially in high-risk hospitalized patients.
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Affiliation(s)
- Tomas A Schiffer
- Department of Physiology and Pharmacology, Karolinska Institutet, 17165 Solna, Sweden
| | | | - Drielle Guimaraes
- Department of Physiology and Pharmacology, Karolinska Institutet, 17165 Solna, Sweden
| | - Ariela Boeder
- Department of Physiology and Pharmacology, Karolinska Institutet, 17165 Solna, Sweden
- Department of Pharmacology, Federal University of Santa Catarina, Florianópolis 88040-900, Brazil
| | - Per Wikström
- Department of Physiology and Pharmacology, Karolinska Institutet, 17165 Solna, Sweden
- Glucox Biotech AB, 17997 Färentuna, Sweden
| | - Mattias Carlström
- Department of Physiology and Pharmacology, Karolinska Institutet, 17165 Solna, Sweden
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Karazisi C, Dellborg M, Mellgren K, Giang KW, Skoglund K, Eriksson P, Mandalenakis Z. Outcomes after cancer diagnosis in children and adult patients with congenital heart disease in Sweden: a registry-based cohort study. BMJ Open 2024; 14:e083237. [PMID: 38631823 PMCID: PMC11029300 DOI: 10.1136/bmjopen-2023-083237] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE Patients with congenital heart disease (CHD) have an increased cancer risk. The aim of this study was to determine cancer-related mortality in CHD patients compared with non-CHD controls, compare ages at cancer diagnosis and death, and explore the most fatal cancer diagnoses. DESIGN Registry-based cohort study. SETTING AND PARTICIPANTS CHD patients born between 1970 and 2017 were identified using Swedish Health Registers. Each was matched by birth year and sex with 10 non-CHD controls. Included were those born in Sweden with a cancer diagnosis. RESULTS Cancer developed in 758 out of 67814 CHD patients (1.1%), with 139 deaths (18.3%)-of which 41 deaths occurred in patients with genetic syndromes. Cancer was the cause of death in 71.9% of cases. Across all CHD patients, cancer accounted for 1.8% of deaths. Excluding patients with genetic syndromes and transplant recipients, mortality risk between CHD patients with cancer and controls showed no significant difference (adjusted HR 1.17; 95% CI 0.93 to 1.49). CHD patients had a lower median age at cancer diagnosis-13.0 years (IQR 2.9-30.0) in CHD versus 24.6 years (IQR 8.6-35.1) in controls. Median age at death was 15.1 years (IQR 3.6-30.7) in CHD patients versus 18.5 years (IQR 6.1-32.7) in controls. The top three fatal cancer diagnoses were ill-defined, secondary and unspecified, eye and central nervous system tumours and haematological malignancies. CONCLUSIONS Cancer-related deaths constituted 1.8% of all mortalities across all CHD patients. Among CHD patients with cancer, 18.3% died, with cancer being the cause in 71.9% of cases. Although CHD patients have an increased cancer risk, their mortality risk post-diagnosis does not significantly differ from non-CHD patients after adjustements and exclusion of patients with genetic syndromes and transplant recipients. However, CHD patients with genetic syndromes and concurrent cancer appear to be a vulnerable group.
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Affiliation(s)
- Christina Karazisi
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Mellgren
- Department of Pediatric Oncology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Kok Wai Giang
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Kristofer Skoglund
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
| | - Peter Eriksson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Goteborg, Sweden
- Adult Congenital Heart Disease Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
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Mellbin LG, Bhatt DL, David JP, Ekström K, Petrie MC, Rasmussen S, Vilsbøll T. Semaglutide and cardiovascular outcomes by baseline HbA1c in diabetes: the SUSTAIN 6 and PIONEER 6 trials. Eur Heart J 2024; 45:1371-1374. [PMID: 38416593 PMCID: PMC11015952 DOI: 10.1093/eurheartj/ehae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 03/01/2024] Open
Affiliation(s)
- Linda G Mellbin
- Department of Medicine Solna, Karolinska Institutet, Eugeniavägen 27, 171 64 Solna, Stockholm, Sweden
- Heart Vascular and Neuro Theme, Karolinska University Hospital, K2 Medicin, K2 Kardio Pernow J, 171 77 Solna, Stockholm, Sweden
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | | | - Tina Vilsbøll
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
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4
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Kataria B, Woisetschläger M, Nilsson Althén J, Sandborg M, Smedby Ö. Image quality in CT thorax: effect of altering reconstruction algorithm and tube load. Radiat Prot Dosimetry 2024; 200:504-514. [PMID: 38369635 PMCID: PMC10997858 DOI: 10.1093/rpd/ncae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/03/2023] [Accepted: 01/09/2024] [Indexed: 02/20/2024]
Abstract
Non-linear properties of iterative reconstruction (IR) algorithms can alter image texture. We evaluated the effect of a model-based IR algorithm (advanced modelled iterative reconstruction; ADMIRE) and dose on computed tomography thorax image quality. Dual-source scanner data were acquired at 20, 45 and 65 reference mAs in 20 patients. Images reconstructed with filtered back projection (FBP) and ADMIRE Strengths 3-5 were assessed independently by six radiologists and analysed using an ordinal logistic regression model. For all image criteria studied, the effects of tube load 20 mAs and all ADMIRE strengths were significant (p < 0.001) when compared to reference categories 65 mAs and FBP. Increase in tube load from 45 to 65 mAs showed image quality improvement in three of six criteria. Replacing FBP with ADMIRE significantly improves perceived image quality for all criteria studied, potentially permitting a dose reduction of almost 70% without loss in image quality.
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Affiliation(s)
- Bharti Kataria
- Department of Radiology, Linköping University, SE-581 85, Linköping, Sweden
- Department of Health, Medicine & Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Center for Medical Image Science & Visualisation (CMIV), Linköping University, SE-581 83 Linköping, Sweden
| | - Mischa Woisetschläger
- Department of Radiology, Linköping University, SE-581 85, Linköping, Sweden
- Department of Health, Medicine & Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Center for Medical Image Science & Visualisation (CMIV), Linköping University, SE-581 83 Linköping, Sweden
| | - Jonas Nilsson Althén
- Department of Health, Medicine & Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Department of Medical Physics, Linköping University, SE-581 85 Linköping, Sweden
| | - Michael Sandborg
- Department of Health, Medicine & Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Center for Medical Image Science & Visualisation (CMIV), Linköping University, SE-581 83 Linköping, Sweden
- Department of Medical Physics, Linköping University, SE-581 85 Linköping, Sweden
| | - Örjan Smedby
- Department of Biomedical Engineering and Health Systems (MTH), KTH Royal Institute of Technology, SE-141 57 Stockholm, Sweden
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Mulholland M, Depuydt MAC, Jakobsson G, Ljungcrantz I, Grentzmann A, To F, Bengtsson E, Jaensson Gyllenbäck E, Grönberg C, Rattik S, Liberg D, Schiopu A, Björkbacka H, Kuiper J, Bot I, Slütter B, Engelbertsen D. Interleukin-1 receptor accessory protein blockade limits the development of atherosclerosis and reduces plaque inflammation. Cardiovasc Res 2024:cvae046. [PMID: 38563353 DOI: 10.1093/cvr/cvae046] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 01/12/2024] [Accepted: 02/01/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS The interleukin-1 receptor accessory protein (IL1RAP) is a co-receptor required for signalling through the IL-1, IL-33, and IL-36 receptors. Using a novel anti-IL1RAP-blocking antibody, we investigated the role of IL1RAP in atherosclerosis. METHODS AND RESULTS Single-cell RNA sequencing data from human atherosclerotic plaques revealed the expression of IL1RAP and several IL1RAP-related cytokines and receptors, including IL1B and IL33. Histological analysis showed the presence of IL1RAP in both the plaque and adventitia, and flow cytometry of murine atherosclerotic aortas revealed IL1RAP expression on plaque leucocytes, including neutrophils and macrophages. High-cholesterol diet fed apolipoprotein E-deficient (Apoe-/-) mice were treated with a novel non-depleting IL1RAP-blocking antibody or isotype control for the last 6 weeks of diet. IL1RAP blockade in mice resulted in a 20% reduction in subvalvular plaque size and limited the accumulation of neutrophils and monocytes/macrophages in plaques and of T cells in adventitia, compared with control mice. Indicative of reduced plaque inflammation, the expression of several genes related to leucocyte recruitment, including Cxcl1 and Cxcl2, was reduced in brachiocephalic arteries of anti-IL1RAP-treated mice, and the expression of these chemokines in human plaques was mainly restricted to CD68+ myeloid cells. Furthermore, in vitro studies demonstrated that IL-1, IL-33, and IL-36 induced CXCL1 release from both macrophages and fibroblasts, which could be mitigated by IL1RAP blockade. CONCLUSION Limiting IL1RAP-dependent cytokine signalling pathways in atherosclerotic mice reduces plaque burden and plaque inflammation, potentially by limiting plaque chemokine production.
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Affiliation(s)
- Megan Mulholland
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
| | - Marie A C Depuydt
- Leiden Academic Centre for Drug Research, Division of Biotherapeutics, Leiden University, Leiden, The Netherlands
| | - Gabriel Jakobsson
- Department of Translational Medicine, Cardiac Inflammation, Lund University, Malmö, Sweden
| | - Irena Ljungcrantz
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
| | - Andrietta Grentzmann
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
| | - Fong To
- Department of Clinical Sciences, Cardiovascular Research-Matrix and Inflammation in Atherosclerosis, Lund University, Malmö, Sweden
| | - Eva Bengtsson
- Department of Clinical Sciences, Cardiovascular Research-Matrix and Inflammation in Atherosclerosis, Lund University, Malmö, Sweden
- Department of Biomedical Science, Malmö University, Malmö, Sweden
- Biofilms-Research Center for Biointerfaces, Malmö University, Malmö, Sweden
| | | | | | - Sara Rattik
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
- Cantargia AB, Lund, Sweden
| | | | - Alexandru Schiopu
- Department of Translational Medicine, Cardiac Inflammation, Lund University, Malmö, Sweden
| | - Harry Björkbacka
- Department of Clinical Sciences, Cardiovascular Research-Cellular Metabolism and Inflammation, Lund University, Malmö, Sweden
| | - Johan Kuiper
- Leiden Academic Centre for Drug Research, Division of Biotherapeutics, Leiden University, Leiden, The Netherlands
| | - Ilze Bot
- Leiden Academic Centre for Drug Research, Division of Biotherapeutics, Leiden University, Leiden, The Netherlands
| | - Bram Slütter
- Leiden Academic Centre for Drug Research, Division of Biotherapeutics, Leiden University, Leiden, The Netherlands
| | - Daniel Engelbertsen
- Department of Clinical Sciences, Cardiovascular Research-Immune Regulation, Lund University, Malmö, Sweden
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Sundling C, Yman V, Mousavian Z, Angenendt S, Foroogh F, von Horn E, Lautenbach MJ, Grunewald J, Färnert A, Sondén K. Disease-specific plasma protein profiles in patients with fever after traveling to tropical areas. Eur J Immunol 2024; 54:e2350784. [PMID: 38308504 DOI: 10.1002/eji.202350784] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/04/2024]
Abstract
Fever is common among individuals seeking healthcare after traveling to tropical regions. Despite the association with potentially severe disease, the etiology is often not determined. Plasma protein patterns can be informative to understand the host response to infection and can potentially indicate the pathogen causing the disease. In this study, we measured 49 proteins in the plasma of 124 patients with fever after travel to tropical or subtropical regions. The patients had confirmed diagnoses of either malaria, dengue fever, influenza, bacterial respiratory tract infection, or bacterial gastroenteritis, representing the most common etiologies. We used multivariate and machine learning methods to identify combinations of proteins that contributed to distinguishing infected patients from healthy controls, and each other. Malaria displayed the most unique protein signature, indicating a strong immunoregulatory response with high levels of IL10, sTNFRI and II, and sCD25 but low levels of sCD40L. In contrast, bacterial gastroenteritis had high levels of sCD40L, APRIL, and IFN-γ, while dengue was the only infection with elevated IFN-α2. These results suggest that characterization of the inflammatory profile of individuals with fever can help to identify disease-specific host responses, which in turn can be used to guide future research on diagnostic strategies and therapeutic interventions.
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Affiliation(s)
- Christopher Sundling
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Victor Yman
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Stockholm South Hospital, Stockholm, Sweden
| | - Zaynab Mousavian
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sina Angenendt
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Fariba Foroogh
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ellen von Horn
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maximilian Julius Lautenbach
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Johan Grunewald
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Respiratory Medicine Unit, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Anna Färnert
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Klara Sondén
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Sachs E, Jackson V, Al-Ameri M, Sartipy U. Uniportal video-assisted thoracic surgery: segmentectomy versus lobectomy-early outcomes. Eur J Cardiothorac Surg 2024; 65:ezae127. [PMID: 38547393 PMCID: PMC11009028 DOI: 10.1093/ejcts/ezae127] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES To assess the feasibility and safety of uniportal video-assisted thoracoscopic pulmonary segmentectomy compared with lobectomy by studying early postoperative outcomes. METHODS We included all patients who underwent uniportal segmentectomy and lobectomy between 2017 and 2022 at Karolinska University Hospital. Early clinical outcomes were compared between the uniportal segmentectomy and lobectomy groups. Differences in baseline characteristics were addressed using inverse probability of treatment weighting. RESULTS A total of 833 patients (232 segmentectomy, 601 lobectomy) were included. The number of uniportal operations increased during the study period. Patients in the segmentectomy and lobectomy groups, respectively, had stage I lung cancer in 65% and 43% of the cases; 97% and 94% had no postoperative complications, the median number of lymph node stations sampled was 4 vs 5, and non-radical microscopic resection occurred in 1.7% vs 1.8%. The drains were removed on postoperative day 1 in 75% vs 72% of the patients following segmentectomy and lobectomy, respectively, and 90% vs 89% were discharged directly home. CONCLUSIONS Uniportal video-assisted segmentectomy was performed with similar early postoperative clinical results compared with uniportal lobectomy in patients with benign, metastatic or early-stage lung cancer.
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Affiliation(s)
- Erik Sachs
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Veronica Jackson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mamdoh Al-Ameri
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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Stattin K, Eriksson M, Frithiof R, Kawati R, Hultström M, Lipcsey M. Physical activity is associated with a lower risk of contracting and dying in infection and sepsis: a Swedish population-based cohort study. Crit Care 2024; 28:98. [PMID: 38523312 PMCID: PMC10962192 DOI: 10.1186/s13054-024-04881-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Sepsis is a condition where the immune response to infection becomes dysregulated and life-threatening. It is not known whether lifestyle factors influence the risk of sepsis. The aim of the present study is to investigate the association between physical activity and the risk of acquiring and dying in infection or sepsis. METHODS The population-based Swedish Mammography Cohort and Cohort of Swedish Men sent participants lifestyle questionnaires in 1997 and have subsequently followed participants in national Swedish registers, including the National Patient Register, the Swedish Intensive Care Registry and the Cause of Death Register. The risk of contracting infection and sepsis, the risk of intensive care unit admission and the risk of death were estimated using multivariable Cox regression. RESULTS Among 64,850 cohort participants, 26,124 individuals suffered at least one episode of infection or sepsis and 4708 individuals died of infection or sepsis during the study period. In adjusted analyses, compared to exercising less than one hour per week, stated exercise one hour per week was associated with lower risk of contracting infection or sepsis, hazard ratio (HR) 0.93 (95% confidence interval (CI) 0.90-0.97), and lower risk of dying in infection or sepsis, HR 0.87 (95% CI 0.80-0.96). Further exercise was associated with even lower risk, and similar patterns were observed for walking. The population-attributable risks of contracting and dying in infection or sepsis for not exercising were 2.6% and 4.5%, respectively. CONCLUSIONS Exercise and walking demonstrate inverse dose-response associations with both the risk of contracting and dying in infection and sepsis, presenting possible preventative interventions for this critical condition.
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Affiliation(s)
- Karl Stattin
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Akademiska Sjukhuset, Ingång 70, 75 185, Uppsala, Sweden.
| | - Mikael Eriksson
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Akademiska Sjukhuset, Ingång 70, 75 185, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Akademiska Sjukhuset, Ingång 70, 75 185, Uppsala, Sweden
| | - Rafael Kawati
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Akademiska Sjukhuset, Ingång 70, 75 185, Uppsala, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Akademiska Sjukhuset, Ingång 70, 75 185, Uppsala, Sweden
- Department of Medical Cell Biology, Unit for Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Akademiska Sjukhuset, Ingång 70, 75 185, Uppsala, Sweden
- Hedenstierna Laboratory, Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
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Björklund E, Enström P, Nielsen SJ, Tygesen H, Martinsson A, Hansson EC, Lindgren M, Malm CJ, Pivodic A, Jeppsson A. Postdischarge major bleeding, myocardial infarction, and mortality risk after coronary artery bypass grafting. Heart 2024; 110:569-577. [PMID: 38148160 PMCID: PMC10982629 DOI: 10.1136/heartjnl-2023-323394] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE To investigate the incidence and mortality risk associated with postdischarge major bleeding after coronary artery bypass grafting (CABG), and relate this to the incidence of, and mortality risk from, postdischarge myocardial infarction. METHODS All patients undergoing first-time isolated CABG in Sweden in 2006-2017 and surviving 14 days after hospital discharge were included in a cohort study. Individual patient data from the SWEDEHEART Registry and five other mandatory nationwide registries were merged. Piecewise Cox proportional hazards models were used to investigate associations between major bleeding, defined as hospitalisation for bleeding, with subsequent mortality risk. Similar Cox proportional hazards models were used to investigate the association between postdischarge myocardial infarction and mortality risk. RESULTS Among 36 633 patients, 2429 (6.6%) had a major bleeding event and 2231 (6.1%) had a myocardial infarction. Median follow-up was 6.0 (range 0-11) years. Major bleeding was associated with higher mortality risk <30 days (adjusted HR (aHR)=20.2 (95% CI 17.3 to 23.5)), 30-365 days (aHR=3.8 (95% CI 3.4 to 4.3)) and >365 days (aHR=1.8 (95% CI 1.7 to 2.0)) after the event. Myocardial infarction was associated with higher mortality risk <30 days (aHR=20.0 (95% CI 16.7 to 23.8)), 30-365 days (aHR=4.1 (95% CI 3.6 to 4.8)) and >365 days (aHR=1.8 (95% CI 1.7 to 2.0)) after the event. CONCLUSIONS The increase in mortality risk associated with a postdischarge major bleeding after CABG is substantial and is similar to the mortality risk associated with a postdischarge myocardial infarction.
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Affiliation(s)
- Erik Björklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Southern Älvsborg Hospital, Borås, Sweden
| | - Philip Enström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Tygesen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Southern Älvsborg Hospital, Borås, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Lindgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl-Johan Malm
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Aldina Pivodic
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
- APNC Sweden, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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10
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De Vincentis A, Tavaglione F, Namba S, Kanai M, Okada Y, Kamatani Y, Maurotti S, Pedone C, Antonelli Incalzi R, Valenti L, Romeo S, Vespasiani-Gentilucci U. Poor accuracy and sustainability of the first-step FIB4 EASL pathway for stratifying steatotic liver disease risk in the general population. Aliment Pharmacol Ther 2024. [PMID: 38497224 DOI: 10.1111/apt.17953] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/15/2023] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND AIMS The European Association for the Study of the Liver introduced a clinical pathway (EASL CP) for screening significant/advanced fibrosis in people at risk of steatotic liver disease (SLD). We assessed the performance of the first-step FIB4 EASL CP in the general population across different SLD risk groups (MASLD, Met-ALD and ALD) and various age classes. METHODS We analysed a total of 3372 individuals at risk of SLD from the 2017-2018 National Health and Nutrition Examination Survey (NHANES17-18), projected to 152.3 million U.S. adults, 300,329 from the UK Biobank (UKBB) and 57,644 from the Biobank Japan (BBJ). We assessed liver stiffness measurement (LSM) ≥8 kPa and liver-related events occurring within 3 and 10 years (3/10 year-LREs) as outcomes. We defined MASLD, MetALD, and ALD according to recent international recommendations. RESULTS FIB4 sensitivity for LSM ≥ 8 kPa was low (27.7%), but it ranged approximately 80%-90% for 3-year LREs. Using FIB4, 22%-57% of subjects across the three cohorts were identified as candidates for vibration-controlled transient elastography (VCTE), which was mostly avoidable (positive predictive value of FIB4 ≥ 1.3 for LSM ≥ 8 kPa ranging 9.5%-13% across different SLD categories). Sensitivity for LSM ≥ 8 kPa and LREs increased with increasing alcohol intake (ALD>MetALD>MASLD) and age classes. For individuals aged ≥65 years, using the recommended age-adjusted FIB4 cut-off (≥2) substantially reduced sensitivity for LSM ≥ 8 kPa and LREs. CONCLUSIONS The first-step FIB4 EASL CP is poorly accurate and feasible for individuals at risk of SLD in the general population. It is crucial to enhance the screening strategy with a first-step approach able to reduce unnecessary VCTEs and optimise their yield.
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Affiliation(s)
- Antonio De Vincentis
- Internal Medicine Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University, Rome, Italy
| | - Federica Tavaglione
- Clinical Medicine and Hepatology Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University, Rome, Italy
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Shinichi Namba
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masahiro Kanai
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Genome Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Japan
| | - Yoichiro Kamatani
- Laboratory of Complex Trait Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Samantha Maurotti
- Clinical Nutrition Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Claudio Pedone
- Unit of Geriatrics, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University, Rome, Italy
| | - Raffaele Antonelli Incalzi
- Internal Medicine Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University, Rome, Italy
| | - Luca Valenti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
- Translational Medicine, Biological Resource Center, Department of Transfusion Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Stefano Romeo
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinical Nutrition Unit, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Umberto Vespasiani-Gentilucci
- Clinical Medicine and Hepatology Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University, Rome, Italy
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11
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Einarsdottir MJ, Kibiwott Kirui B, Li H, Olsson D, Johannsson G, Nyberg F, Ragnarsson O. Impact of chronic oral glucocorticoid treatment on mortality in patients with COVID-19: analysis of a population-based cohort. BMJ Open 2024; 14:e080640. [PMID: 38490654 PMCID: PMC10946357 DOI: 10.1136/bmjopen-2023-080640] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES While glucocorticoid (GC) treatment initiated for COVID-19 reduces mortality, it is unclear whether GC treatment prior to COVID-19 affects mortality. Long-term GC use raises infection and thromboembolic risks. We investigated if patients with oral GC use prior to COVID-19 had increased mortality overall and by selected causes. DESIGN Population-based observational cohort study. SETTINGS Population-based register data in Sweden. PARTICIPANTS All patients infected with COVID-19 in Sweden from January 2020 to November 2021 (n=1 200 153). OUTCOME MEASURES Any prior oral GC use was defined as ≥1 GC prescription during 12 months before index. High exposure was defined as ≥2 GC prescriptions with a cumulative prednisolone dose ≥750 mg or equivalent during 6 months before index. GC users were compared with COVID-19 patients who had not received GCs within 12 months before index. We used Cox proportional hazard models and 1:2 propensity score matching to estimate HRs and 95% CIs, controlling for the same confounders in all analyses. RESULTS 3378 deaths occurred in subjects with any prior GC exposure (n=48 806; 6.9%) and 14 850 among non-exposed (n=1 151 347; 1.3%). Both high (HR 1.98, 95% CI 1.87 to 2.09) and any exposure (1.58, 1.52 to 1.65) to GCs were associated with overall death. Deaths from pulmonary embolism, sepsis and COVID-19 were associated with high GC exposure and, similarly but weaker, with any exposure. High exposure to GCs was associated with increased deaths caused by stroke and myocardial infarction. CONCLUSION Patients on oral GC treatment prior to COVID-19 have increased mortality, particularly from pulmonary embolism, sepsis and COVID-19.
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Affiliation(s)
- Margret J Einarsdottir
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Goteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Brian Kibiwott Kirui
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Daniel Olsson
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Goteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Goteborg, Sweden
- Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Goteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Goteborg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Goteborg, Sweden
- Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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12
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Griffin F, Ekblom-Bak E, Arvidsson D, Paulsson S, Börjesson M. Maintaining or increasing cardiorespiratory fitness is associated with reduced hospital admission rate. Eur J Prev Cardiol 2024; 31:436-444. [PMID: 38019572 DOI: 10.1093/eurjpc/zwad367] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/21/2023] [Accepted: 11/26/2023] [Indexed: 11/30/2023]
Abstract
AIMS The aim of this study was to investigate the association between change in cardiorespiratory fitness (CRF) and cardiovascular disease (CVD)-related and all-cause hospital admission and explore if the association varies dependently on prior admission, baseline CRF, sex, and age. METHODS AND RESULTS A total of 91 140 adult participants (41.5% women) with two examinations from occupational health profile assessments between 1986 and 2019 were included (mean of 3.2 years between examinations). Cardiorespiratory fitness was assessed as maximal oxygen consumption and estimated through a submaximal cycle test. Cardiorespiratory fitness change was defined as annual percentage change in relative CRF (mL/min/kg) and further divided into 'decliners' (≤1%), 'maintainers' (-1% to 1%), and 'increasers' (>1%). Hospital admissions were followed over a mean of 7 years. Natural cubic splines and Cox proportional hazards model were applied. Additionally, prevented fraction for the population was calculated. Increase in CRF was associated with a lower risk of CVD [hazard ratio (HR) = 0.99] and all-cause hospital admission (HR = 0.99), after multilevel adjustment for confounders and change in smoking, diet, and stress. Compared with a decline, maintenance of CRF was associated with 9% and 7% lower risk of CVD and all-cause admission, respectively. Increase in CRF reduced the risk by 13% and 11% and, for individuals with prior admission, by 20% and 14%. The burden of CVD and all-cause admission was 6% and 5% lower than if the whole cohort had declined CRF, with large potential cost savings. CONCLUSION Efforts to maintain or improve CRF should be included in disease-preventive strategies, regardless of change in other lifestyle-related risk factors. Preventing the age-associated decline in CRF can lessen healthcare utilization and costs.
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Affiliation(s)
- Frida Griffin
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
| | - Elin Ekblom-Bak
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Daniel Arvidsson
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Sofia Paulsson
- Research Department, HPI Health Profile Institute, Stockholm, Sweden
| | - Mats Börjesson
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 11, 416 50 Gothenburg, Sweden
- Centre for Lifestyle Intervention, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Broberg O, Weismann CG, Øra I, Wiebe T, Laaksonen R, Liuba P. Ceramides: a potential cardiovascular biomarker in young adult childhood cancer survivors? Eur Heart J Open 2024; 4:oeae026. [PMID: 38659666 PMCID: PMC11042783 DOI: 10.1093/ehjopen/oeae026] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/09/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024]
Abstract
Aims The aim of this study was to investigate circulating ceramides involved in cardiovascular disease (CVD) in young adult childhood cancer survivors (CCS) and their correlations to previously reported adverse cardiovascular changes in this cohort. Methods and results Fifty-seven CCS and 53 healthy controls (age 20-30 years) were studied. Plasma long-chain ceramides, known to be cardiotoxic (C16:0, C18:0, C24:0, and C24:1), were analysed by mass spectrometry. The coronary event risk test 2 (CERT2) score was calculated from the ceramide data. Cardiac and carotid artery ultrasound data and lipid data available from previous studies of this cohort were used to study partial correlations with ceramide and CERT2 score data. All four analysed ceramides were elevated in CCS compared with controls (P ≤ 0.012). The greatest difference was noted for C18:0, which was 33% higher in CCS compared with controls adjusted for sex, age, and body mass index (BMI) (P < 0.001). The CERT2 score was higher in CCS compared with controls (P < 0.001). In the CCS group, 35% had a high to very high CERT2 score (7-12) when compared with 9% in the control group (P < 0.001). The CCS subgroup with a CERT2 score ≥ 7 had higher heart rate, systolic blood pressure, and higher levels of apolipoprotein B compared with CCS with a CERT2 score < 6 (P ≤ 0.011). When adjusted for age, sex, and BMI, CERT2 score was significantly correlated with arterial stiffness, growth hormone, and cranial radiotherapy (P < 0.044). Conclusion Ceramides could be important biomarkers in understanding the pathophysiology of CVD and in predicting CVD disease risk in young adult CCS.
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Affiliation(s)
- Olof Broberg
- Department of Pediatric Cardiology, Skåne University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
| | - Constance G Weismann
- Department of Pediatric Cardiology, Skåne University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian University, Klinikum Grosshadern, Marchioninistr. 15, DE-81377 Munich, Germany
| | - Ingrid Øra
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
- Department of Pediatric Oncology, Skane University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
| | - Thomas Wiebe
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
- Department of Pediatric Oncology, Skane University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
| | - Reijo Laaksonen
- Finnish Cardiovascular Research Center, Tampere University, Arvo Ylpön Katu 34, P.O. Box 100, FI-33014, Finland
- Zora Biosciences, Biologinkuja 1, FI-02150 Espoo, Finland
| | - Petru Liuba
- Department of Pediatric Cardiology, Skåne University Hospital, Lasarettgatan 48, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, Lasarettgatan 40, SE-221 45 Lund, Sweden
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14
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Falk A, Sartipy U, Stenman M. Self-reported preoperative depressive symptoms and survival after cardiac surgery. Eur J Cardiothorac Surg 2024; 65:ezae076. [PMID: 38485689 DOI: 10.1093/ejcts/ezae076] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/01/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Depression has been associated with increased cardiovascular morbidity and mortality. This study aimed to determine whether self-reported preoperative depressive symptoms were associated with worse long-term survival in patients undergoing cardiac surgery. METHODS This population-based, observational cohort study included patients who had undergone cardiac surgery at Karolinska University Hospital between 2013 and 2016. Self-reported data about depressive symptoms were collected using the Patient Health Questionnaire (PHQ-9) and other patient data were collected from the institutional surgical database and medical charts. Depression was defined as a PHQ-9 score ≥10. Weighted flexible parametric survival models were used to estimate the association between self-reported preoperative depressive symptoms and all-cause mortality and to quantify absolute survival differences. RESULTS Of the 1120 study patients, 162 (14.5%) had depressive symptoms before cardiac surgery. During a mean follow-up of 7.2 years (maximum, 9.2 years), there were 36 deaths in 1129 person-years (PYs) in the depressed group, compared to 160 deaths in 6889 PYs in the non-depressed group. In the adjusted analysis, self-reported depressive symptoms were associated with worse long-term survival (hazard ratio 1.66; 95% confidence interval 1.09-2.54) compared with no reported depressive symptoms. The absolute survival differences (% and 95% confidence interval) between the non-depressed and the depressed patients were -1.9 (-3.9 to 0.19), -5.7 (-11 to -0.01) and -9.7 (-19 to -0.4) after 1, 5 and 8 years, respectively. CONCLUSIONS Self-reported preoperative depressive symptoms were associated with worse long-term survival following cardiac surgery and should be regarded as important as other classical risk factors.
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Affiliation(s)
- Anna Falk
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
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15
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Vercalsteren E, Karampatsi D, Buizza C, Nyström T, Klein T, Paul G, Patrone C, Darsalia V. The SGLT2 inhibitor Empagliflozin promotes post-stroke functional recovery in diabetic mice. Cardiovasc Diabetol 2024; 23:88. [PMID: 38424560 PMCID: PMC10905950 DOI: 10.1186/s12933-024-02174-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024] Open
Abstract
Type-2 diabetes (T2D) worsens stroke recovery, amplifying post-stroke disabilities. Currently, there are no therapies targeting this important clinical problem. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are potent anti-diabetic drugs that also efficiently reduce cardiovascular death and heart failure. In addition, SGLT2i facilitate several processes implicated in stroke recovery. However, the potential efficacy of SGLT2i to improve stroke recovery in T2D has not been investigated. Therefore, we determined whether a post-stroke intervention with the SGLT2i Empagliflozin could improve stroke recovery in T2D mice. T2D was induced in C57BL6J mice by 8 months of high-fat diet feeding. Hereafter, animals were subjected to transient middle cerebral artery occlusion and treated with vehicle or the SGLTi Empagliflozin (10 mg/kg/day) starting from 3 days after stroke. A similar study in non diabetic mice was also conducted. Stroke recovery was assessed using the forepaw grip strength test. To identify potential mechanisms involved in the Empagliflozin-mediated effects, several metabolic parameters were assessed. Additionally, neuronal survival, neuroinflammation, neurogenesis and cerebral vascularization were analyzed using immunohistochemistry/quantitative microscopy. Empagliflozin significantly improved stroke recovery in T2D but not in non-diabetic mice. Improvement of functional recovery was associated with lowered glycemia, increased serum levels of fibroblast growth factor-21 (FGF-21), and the normalization of T2D-induced aberration of parenchymal pericyte density. The global T2D-epidemic and the fact that T2D is a major risk factor for stroke are drastically increasing the number of people in need of efficacious therapies to improve stroke recovery. Our data provide a strong incentive for the potential use of SGLT2i for the treatment of post-stroke sequelae in T2D.
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Affiliation(s)
- Ellen Vercalsteren
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden.
| | - Dimitra Karampatsi
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden
| | - Carolina Buizza
- Translational Neurology Group, Department of Clinical Science, Wallenberg Neuroscience Center and Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Thomas Nyström
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden
| | - Thomas Klein
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Gesine Paul
- Translational Neurology Group, Department of Clinical Science, Wallenberg Neuroscience Center and Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Cesare Patrone
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden.
| | - Vladimer Darsalia
- NeuroCardioMetabol Group, Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden.
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16
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Gong T, Brew BK, Lundholm C, Smew AI, Harder A, Kuja-Halkola R, Ludvigsson JF, Lu Y, Almqvist C. Comorbidity Between Inflammatory Bowel Disease and Asthma and Allergic Diseases: A Genetically Informed Study. Inflamm Bowel Dis 2024:izae027. [PMID: 38412344 DOI: 10.1093/ibd/izae027] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Little is known about shared origins between inflammatory bowel disease (IBD) and allergic diseases (asthma, allergic rhinitis, and eczema). We aimed to expand current knowledge on the etiological sources of comorbidities between these disorders using a range of genetically informed methods. METHODS Within-individual and familial co-aggregation analysis was applied to 2 873 445 individuals born in Sweden from 1987 to 2014 and their first- and second-degree relatives. Quantitative genetic modeling was applied to 38 723 twin pairs to decompose the genetic and environmental sources for comorbidity. Polygenic risk score analysis between IBD and allergic diseases was conducted in 48 186 genotyped twins, and linkage disequilibrium score regression was applied using publicly available data to explore the genetic overlap. RESULTS IBD was associated with asthma (adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 1.30 to 1.40), allergic rhinitis (aOR, 1.27; 95% CI, 1.20 to 1.34), and eczema (aOR, 1.47; 95% CI, 1.38 to 1.56), with similar estimates for ulcerative colitis or Crohn's disease. The ORs for familial co-aggregation decreased with decreasing genetic relatedness. Quantitative genetic modeling revealed little evidence of common genetic factors between IBD and allergic diseases (eg, IBD and allergic rhinitis; genetic correlation ra = 0.06; 95% CI, -0.03 to 0.15) but did reveal some evidence of unique environmental factors between IBD and eczema (re = 0.16; 95% CI, 0.00 to 0.32). Molecular genetic analyses were similarly null for IBD and allergic diseases, except for a slight association between Crohn's disease polygenic risk score and eczema (OR, 1.09; 95% CI, 1.06 to 1.12). CONCLUSIONS We found little evidence to support a shared origin between IBD and any allergic disease but weak evidence for shared genetic and unique environmental components for IBD and eczema.
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Affiliation(s)
- Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Big Data Research in Health and School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Awad I Smew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Harder
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Orebro University Hospital, Orebro, Sweden
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Shahim B, Xu H, Haugaa K, Zetterberg H, Jurga J, Religa D, Eriksdotter M. Cholinesterase inhibitors are associated with reduced mortality in patients with Alzheimer's disease and previous myocardial infarction. Eur Heart J Cardiovasc Pharmacother 2024; 10:128-136. [PMID: 38224338 DOI: 10.1093/ehjcvp/pvad102] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/13/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Cholinesterase inhibitors (ChEIs) are the first-line symptomatic pharmacologic treatment for patients with mild-to-moderate Alzheimer's disease (AD). Although the target organ for this group of drugs is the brain, inhibition of the enzyme may affect cardiac function through vagotonic and anti-inflammatory effects. OBJECTIVE To assess the impact of ChEIs on outcomes in patients with AD who have experienced myocardial infarction (MI) prior to the AD diagnosis. METHODS Patients who had experienced MI before they were diagnosed with AD or Alzheimer's mixed dementia between 2008 and 2018 were identified from the Swedish Dementia Registry (SveDem, www.svedem.se), which was linked to the National Patient Registry to obtain data on MI and mortality. Cox proportional hazards regression model among a propensity score-matched dataset was performed to assess the association between ChEI treatment and clinical outcomes. RESULTS Of 3198 patients with previous MI and a diagnosis of AD or mixed dementia, 1705 (53%) were on treatment with ChEIs. Patients treated with ChEIs were more likely to be younger and have a better overall cardiovascular (CV) risk profile. The incidence rate of all-cause death (per 1000 patient-years) in the propensity-matched cohort of 1016 ChEI users and 1016 non-users was 168.6 in patients on treatment with ChEIs compared with 190.7 in patients not on treatment with ChEIs. In this propensity-matched cohort, treatment with ChEIs was associated with a significantly lower risk of all-cause death (adjusted hazard ratio 0.81, 95% confidence interval 0.71-0.92) and a greater reduction with higher doses of ChEIs. While in the unadjusted analysis, ChEIs were associated with a lower risk of both CV and non-CV death, only the association with non-CV death remained significant after accounting for baseline differences. CONCLUSION Treatment with ChEIs was associated with a significantly reduced risk of all-cause death, driven by lower rates of non-CV death in a nationwide cohort of patients with previous MI and a diagnosis of AD or mixed dementia. These associations were greater with higher ChEI doses. CONDENSED ABSTRACT We assessed the association between cholinesterase inhibitors (ChEIs) and clinical outcomes in a nationwide cohort of patients with previous myocardial infarction (MI) and a diagnosis of Alzheimer's disease (AD) or mixed dementi. In propensity-matched analysis, treatment with ChEIs was associated with a 19% reduction in all-cause death driven by non-cardiovascular death. The reduction in all-cause death was greater with the higher doses of ChEIs.
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Affiliation(s)
- Bahira Shahim
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Hong Xu
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Kristina Haugaa
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, 41345 Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 41345 Mölndal, Sweden
- UK Dementia Research Institute at UCL, London, UK
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong SAR, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Juliane Jurga
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, 17177 Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, 17177 Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
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Caputo M, Andersson E, Xia Y, Hou W, Cansby E, Erikson M, Lind DE, Hallberg B, Amrutkar M, Mahlapuu M. Genetic Ablation of STE20-Type Kinase MST4 Does Not Alleviate Diet-Induced MASLD Susceptibility in Mice. Int J Mol Sci 2024; 25:2446. [PMID: 38397122 PMCID: PMC10888586 DOI: 10.3390/ijms25042446] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) and its advanced subtype, metabolic dysfunction-associated steatohepatitis (MASH), have emerged as the most common chronic liver disease worldwide, yet there is no targeted pharmacotherapy presently available. This study aimed to investigate the possible in vivo function of STE20-type protein kinase MST4, which was earlier implicated in the regulation of hepatocellular lipotoxic milieu in vitro, in the control of the diet-induced impairment of systemic glucose and insulin homeostasis as well as MASLD susceptibility. Whole-body and liver-specific Mst4 knockout mice were generated by crossbreeding conditional Mst4fl/fl mice with mice expressing Cre recombinase under the Sox2 or Alb promoters, respectively. To replicate the environment in high-risk subjects, Mst4-/- mice and their wild-type littermates were fed a high-fat or a methionine-choline-deficient (MCD) diet. Different in vivo tests were conducted in obese mice to describe the whole-body metabolism. MASLD progression in the liver and lipotoxic damage to adipose tissue, kidney, and skeletal muscle were analyzed by histological and immunofluorescence analysis, biochemical assays, and protein and gene expression profiling. In parallel, intracellular fat storage and oxidative stress were assessed in primary mouse hepatocytes, where MST4 was silenced by small interfering RNA. We found that global MST4 depletion had no effect on body weight or composition, locomotor activity, whole-body glucose tolerance or insulin sensitivity in obese mice. Furthermore, we observed no alterations in lipotoxic injuries to the liver, adipose, kidney, or skeletal muscle tissue in high-fat diet-fed whole-body Mst4-/- vs. wild-type mice. Liver-specific Mst4-/- mice and wild-type littermates displayed a similar severity of MASLD when subjected to an MCD diet, as evidenced by equal levels of steatosis, inflammation, hepatic stellate cell activation, fibrosis, oxidative/ER stress, and apoptosis in the liver. In contrast, the in vitro silencing of MST4 effectively protected primary mouse hepatocytes against ectopic lipid accumulation and oxidative cell injury triggered by exposure to fatty acids. In summary, these results suggest that the genetic ablation of MST4 in mice does not mitigate the initiation or progression of MASLD and has no effect on systemic glucose or insulin homeostasis in the context of nutritional stress. The functional compensation for the genetic loss of MST4 by yet undefined mechanisms may contribute to the apparent discrepancy between in vivo and in vitro phenotypic consequences of MST4 silencing.
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Affiliation(s)
- Mara Caputo
- Department of Chemistry and Molecular Biology, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Emma Andersson
- Department of Chemistry and Molecular Biology, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Ying Xia
- Department of Chemistry and Molecular Biology, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Wei Hou
- Department of Chemistry and Molecular Biology, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Emmelie Cansby
- Department of Chemistry and Molecular Biology, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Max Erikson
- Department of Chemistry and Molecular Biology, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Dan Emil Lind
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Bengt Hallberg
- Department of Medical Biochemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Manoj Amrutkar
- Department of Pathology, Oslo University Hospital Rikshospitalet, 0372 Oslo, Norway
| | - Margit Mahlapuu
- Department of Chemistry and Molecular Biology, University of Gothenburg and Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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Cinato M, Andersson L, Miljanovic A, Laudette M, Kunduzova O, Borén J, Levin MC. Role of Perilipins in Oxidative Stress-Implications for Cardiovascular Disease. Antioxidants (Basel) 2024; 13:209. [PMID: 38397807 PMCID: PMC10886189 DOI: 10.3390/antiox13020209] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/12/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Oxidative stress is the imbalance between the production of reactive oxygen species (ROS) and antioxidants in a cell. In the heart, oxidative stress may deteriorate calcium handling, cause arrhythmia, and enhance maladaptive cardiac remodeling by the induction of hypertrophic and apoptotic signaling pathways. Consequently, dysregulated ROS production and oxidative stress have been implicated in numerous cardiac diseases, including heart failure, cardiac ischemia-reperfusion injury, cardiac hypertrophy, and diabetic cardiomyopathy. Lipid droplets (LDs) are conserved intracellular organelles that enable the safe and stable storage of neutral lipids within the cytosol. LDs are coated with proteins, perilipins (Plins) being one of the most abundant. In this review, we will discuss the interplay between oxidative stress and Plins. Indeed, LDs and Plins are increasingly being recognized for playing a critical role beyond energy metabolism and lipid handling. Numerous reports suggest that an essential purpose of LD biogenesis is to alleviate cellular stress, such as oxidative stress. Given the yet unmet suitability of ROS as targets for the intervention of cardiovascular disease, the endogenous antioxidant capacity of Plins may be beneficial.
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Affiliation(s)
- Mathieu Cinato
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (M.C.); (L.A.); (A.M.); (M.L.); (J.B.)
| | - Linda Andersson
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (M.C.); (L.A.); (A.M.); (M.L.); (J.B.)
| | - Azra Miljanovic
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (M.C.); (L.A.); (A.M.); (M.L.); (J.B.)
| | - Marion Laudette
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (M.C.); (L.A.); (A.M.); (M.L.); (J.B.)
| | - Oksana Kunduzova
- Institute of Metabolic and Cardiovascular Diseases (I2MC), National Institute of Health and Medical Research (INSERM) 1297, Toulouse III University—Paul Sabatier, 31432 Toulouse, France;
| | - Jan Borén
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (M.C.); (L.A.); (A.M.); (M.L.); (J.B.)
| | - Malin C. Levin
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (M.C.); (L.A.); (A.M.); (M.L.); (J.B.)
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Pan E, Nielsen SJ, Landenhed-Smith M, Törngren C, Björklund E, Hansson EC, Jeppsson A, Martinsson A. Statin treatment after surgical aortic valve replacement for aortic stenosis is associated with better long-term outcome. Eur J Cardiothorac Surg 2024; 65:ezae007. [PMID: 38273669 DOI: 10.1093/ejcts/ezae007] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the association between statin use after surgical aortic valve replacement for aortic stenosis and long-term risk for major adverse cardiovascular events (MACEs) in a large population-based, nationwide cohort. METHODS All patients who underwent isolated surgical aortic valve replacement due to aortic stenosis in Sweden 2006-2020 and survived 6 months after discharge were included. Individual patient data from 5 nationwide registries were merged. Primary outcome is MACE (defined as all-cause mortality, myocardial infarction or stroke). Multivariable Cox regression model adjusted for age, sex, comorbidities, valve type, operation year and secondary prevention medications is used to evaluate the association between time-updated dispense of statins and long-term outcome in the entire study population and in subgroups based on age, sex and comorbidities. RESULTS A total of 11 894 patients were included. Statins were dispensed to 49.8% (5918/11894) of patients at baseline, and 51.0% (874/1713) after 10 years. At baseline, 3.6% of patients were dispensed low dose, 69.4% medium dose and 27.0% high-dose statins. After adjustments, ongoing statin treatment was associated with a reduced risk for MACE [adjusted hazard ratio 0.77 (95% confidence interval 0.71-0.83). P < 0.001], mainly driven by a reduction in all-cause mortality [adjusted hazard ratio, 0.70 (0.64-0.76)], P < 0.001. The results were consistent in all subgroups. CONCLUSIONS The results suggest that statin therapy might be beneficial for patients undergoing surgical aortic valve replacement for aortic stenosis. Randomized controlled trials are warranted to establish causality between statin treatment and improved outcome.
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Affiliation(s)
- Emily Pan
- University of Turku, Turku, Finland
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maya Landenhed-Smith
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotta Törngren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Björklund
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Southern Älvborg Hospital, Borås, Sweden
| | - Emma C Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Brew BK, Gong T, Ohlin E, Hedman AM, Larsson H, Curman P, Lundholm C, Almqvist C. Maternal mental health disorders and offspring asthma and allergic diseases: The role of child mental health. Pediatr Allergy Immunol 2024; 35:e14085. [PMID: 38366746 DOI: 10.1111/pai.14085] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Maternal psychological stress during pregnancy and postnatally has been shown to be associated with offspring atopic diseases (asthma, atopic dermatitis and allergic rhinitis). The aim of this study was to assess whether this association may be attributable to the child's own mental health disorders. METHOD The study population included 15,092 twin children born 2002-2010 in Sweden. Questionnaire data at age 9 years was linked to national patient- and prescription registers. Maternal mental health during pregnancy and 3 years postnatally were identified from diagnosis and medication data (depression, anxiety and stress disorders). Atopic diseases in children were identified from questionnaires, diagnosis and medication data. Child mental health status (depression and anxiety) was identified from questionnaires. Three-way decomposition methods tested for mediation or interaction by child mental health disorders. RESULTS Maternal mental health disorders were associated with most child atopic diseases including asthma aRR1.36 (95% CI 1.12, 1.60), and child mental health disorders, aRR1.73 (95% CI 1.56, 1.92). Children with mental health disorders were comorbid for atopic diseases with only asthma reaching statistical significance, aRR1.29 (95% CI 1.14, 1.47). Three-way decomposition found that mediation or interaction by child mental health disorders did not account for the mother mental health and child atopy associations except in parent-report asthma, where child mental health disorders mediated 13.4% (95% CI 2.1, 24.7) of the effect, but not for objectively defined (diagnosis and medication) asthma. CONCLUSION The associations between maternal mental health and child asthma and allergic diseases do not appear to be attributable to child mental health disorders.
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Affiliation(s)
- Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Big Data Research in Health and School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emma Ohlin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Surgical Unit, Mora Hospital, Mora, Sweden
| | - Anna M Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Philip Curman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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22
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Fortin E, Campi B, Ferrannini E, Mari A, Mellbin LG, Norhammar A, Näsman P, Rydén L, Saba A, Ferrannini G. High Mannose Correlates With Surrogate Indexes of Insulin Resistance and Is Associated With an Increased Risk of Cardiovascular Events Independently of Glycemic Status and Traditional Risk Factors. Diabetes Care 2024; 47:246-251. [PMID: 38055929 DOI: 10.2337/dc23-0870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/15/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To explore the associations among mannose, indexes of insulin resistance (IR) and secretion, and long-term cardiovascular outcomes. RESEARCH DESIGN AND METHODS Fasting mannose was assayed in 1,403 participants, one-half of which had a first myocardial infarction (MI) with either normal glucose tolerance (n = 1,045) or newly detected dysglycemia (i.e., impaired glucose tolerance or type 2 diabetes; n = 358). Regression models were used to explore mannose associations with surrogate indexes of IR/insulin secretion. Multivariate Cox models were used to investigate the independent association between high (higher quartile) versus low (lower three quartiles) mannose and major adverse cardiac events (MACE) (n = 163) during the 10-year follow-up. RESULTS Mannose was independently associated with IR indexes (all P ≤ 0.001). High versus low mannose was independently associated with MACE (hazard ratio 1.54, 95% CI 1.07-2.20) in the overall population. CONCLUSIONS Mannose might represent a new biomarker able to track early, potentially detrimental glucometabolic alterations independently of glycemic state.
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Affiliation(s)
- Elena Fortin
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Beatrice Campi
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Ele Ferrannini
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Andrea Mari
- National Research Council Institute of Neuroscience, Padova, Italy
| | - Linda G Mellbin
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norhammar
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
- Capio St. Görans Hospital, Stockholm, Sweden
| | - Per Näsman
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
- Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Alessandro Saba
- Mass Spectrometry Laboratory, Department of Pathology, University of Pisa, Pisa, Italy
- Clinical Pathology Laboratory, Santa Chiara University Hospital, Pisa, Italy
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Erhardsson M, Faxén UL, Venkateshvaran A, Hage C, Pironti G, Thorvaldsen T, Webb D, Hellström PM, Andersson DC, Ståhlberg M, Lund LH. Acyl ghrelin increases cardiac output while preserving right ventricular-pulmonary arterial coupling in heart failure. ESC Heart Fail 2024; 11:601-605. [PMID: 38030138 PMCID: PMC10804189 DOI: 10.1002/ehf2.14580] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/03/2023] [Accepted: 10/29/2023] [Indexed: 12/01/2023] Open
Abstract
AIM Acyl ghrelin increases cardiac output (CO) in heart failure with reduced ejection fraction (HFrEF). This could impair the right ventricular-pulmonary arterial coupling (RVPAC), both through an increased venous return and right ventricular afterload. We aim to investigate if acyl ghrelin increases CO with or without worsening the right-sided haemodynamics in HFrEF assessed by RVPAC. METHODS AND RESULTS The Karolinska Acyl ghrelin Trial was a randomized double-blind placebo-controlled trial of acyl ghrelin versus placebo (120-min intravenous infusion) in HFrEF. RVPAC was assessed echocardiographically at baseline and 120 min. ANOVA was used for difference in change between acyl ghrelin versus placebo, adjusted for baseline values. Of the 30 randomized patients, 22 had available RVPAC (acyl ghrelin n = 12, placebo n = 10). Despite a 15% increase in CO in the acyl ghrelin group (from 4.0 (3.5-4.6) to 4.6 (3.9-6.1) L/min, P = 0.003), RVPAC remained unchanged; 5.9 (5.3-7.6) to 6.3 (4.8-7.5) mm·(m/s)-1 , P = 0.372, while RVPAC was reduced in the placebo group, 5.2 (4.3-6.4) to 4.8 (4.2-5.8) mm·(m/s)-1 , P = 0.035. Comparing change between groups, CO increased in the acyl ghrelin group versus placebo (P = 0.036) while RVPAC and the right ventricular pressure gradient remained unchanged. CONCLUSION Treatment with acyl ghrelin increases CO while preserving or even improving RVPAC in HFrEF, possibly due to increased contractility, reduced PVR and/or reduced left sided filling pressures. These potential effects strengthen the role of acyl ghrelin therapy in HFrEF with right ventricular failure.
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Affiliation(s)
- Mikael Erhardsson
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
| | - Ulrika L. Faxén
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
- Department of Perioperative Medicine and Intensive CareKarolinska University HospitalStockholmSweden
| | - Ashwin Venkateshvaran
- Department of Clinical Physiology, Department of Clinical SciencesLund UniversityStockholmSweden
- Skåne University HospitalLundSweden
| | - Camilla Hage
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
- Department of Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
| | - Gianluigi Pironti
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - Tonje Thorvaldsen
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
- Department of Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
| | - Dominic‐Luc Webb
- Department of Medical Sciences, Gastroenterology and HepatologyUppsala UniversityUppsalaSweden
| | - Per M. Hellström
- Department of Medical Sciences, Gastroenterology and HepatologyUppsala UniversityUppsalaSweden
| | - Daniel C. Andersson
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
- Department of Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - Marcus Ståhlberg
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
- Department of Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
| | - Lars H. Lund
- Department of Medicine, Unit of CardiologyKarolinska InstitutetStockholmSweden
- Department of Heart and Vascular ThemeKarolinska University HospitalStockholmSweden
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Walles J, Winqvist N, Hansson SR, Sturegård E, Baqir H, Westman A, Kjerstadius T, Schön T, Björkman P. Pregnancy Outcomes in Women Screened for Tuberculosis Infection in Swedish Antenatal Care. Clin Infect Dis 2024; 78:125-132. [PMID: 37572363 PMCID: PMC10810708 DOI: 10.1093/cid/ciad465] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/23/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) disease has been associated with pregnancy complications. However, the potential impact of TB infection (TBI) on pregnancy outcome is unknown. To investigate this, we conducted a register-based study in immigrant women screened with QuantiFERON assays for TBI in antenatal care in Sweden. METHODS Women with history of immigration from TB-endemic countries were eligible for inclusion if national identification numbers and available QuantiFERON results obtained during pregnancy from 2014 to 2018 were available. QuantiFERON results were linked to data on maternal characteristics and pregnancy outcomes from the national Pregnancy and Patient Registers. TBI was defined as nil-corrected QuantiFERON result ≥0.35 IU/mL, in the absence of TB disease. Pregnancies in women with TB disease or human immunodeficiency virus were excluded, as were multiplex pregnancies, pregnancies resulting in miscarriage, and pregnancies occurring >10 years after immigration. Odds of defined adverse pregnancy outcomes were compared by maternal TBI status using mixed effects logistic regression with adjustment for maternal age and region of origin. RESULTS In total, 7408 women with 12 443 pregnancies were included. In multivariable analysis, stillbirth (adjusted odds ratio [AOR], 1.90; 95% confidence interval [CI], 1.13-3.21; P = .016), severe preeclampsia (AOR, 1.62; 95% CI, 1.03-2.56; P = .036), low birthweight (<2500 g; AOR, 1.38; 95% CI, 1.01-1.88; P = .041), and emergency cesarean section (AOR, 1.28; 95% CI, 1.02-1.63; P = .033) were significantly associated with TBI. CONCLUSIONS Among immigrant women seeking antenatal care in Sweden, TBI was independently associated with adverse pregnancy outcomes. Further studies are needed to corroborate these findings and to explore mechanisms involved.
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Affiliation(s)
- John Walles
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Central Hospital, Kristianstad, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Skåne University Hospital Lund, Lund, Sweden
| | - Niclas Winqvist
- Skåne Regional Office for Infectious Disease Control and Prevention, Malmö, Sweden
| | - Stefan R Hansson
- Division of Obstetrics and Gynaecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Erik Sturegård
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Skåne University Hospital Lund, Lund, Sweden
| | - Haitham Baqir
- Department of Clinical Microbiology, Linköping University Hospital, Linköping, Sweden
| | - Anna Westman
- Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska University Hospital Laboratory, Stockholm, Sweden
| | | | - Thomas Schön
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Infectious Diseases, Kalmar County Hospital, Linköping University, Kalmar, Sweden
- Department of Infectious Diseases, Linköping University, Linköping, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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25
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Af Klinteberg M, Winberg A, Andersson M, Rönmark E, Hedman L. Decreasing prevalence of atopic dermatitis in Swedish schoolchildren: three repeated population-based surveys. Br J Dermatol 2024; 190:191-198. [PMID: 37776301 DOI: 10.1093/bjd/ljad370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND The prevalence of atopic dermatitis (AD) has increased over several decades and now affects about one-fifth of all children in high-income countries (HICs). While the increase continues in lower-income countries, the prevalence of AD might have reached a plateau in HICs. OBJECTIVES To investigate trends in the prevalence of AD and atopic comorbidity in schoolchildren in Sweden. METHODS The study population consisted of three cohorts of children (median age 8 years) in Norrbotten, Sweden, for 1996 (n = 3430), 2006 (n = 2585) and 2017 (n = 2785). An identical questionnaire that included questions from the International Study of Asthma and Allergies in Childhood (ISAAC) protocol was used in all three cohorts. Trends in AD prevalence were estimated, as well as trends in atopic comorbidity. AD prevalence was estimated both according to the ISAAC definition of AD and by adding the reported diagnosis by a physician (D-AD). RESULTS The prevalence of AD decreased in the last decade, from 22.8% (1996) and 21.3% (2006) to 16.3% (2017; P < 0.001). The prevalence of D-AD was lower, but the same pattern of decrease was seen, from 9.3% (1996) and 9.4% (2006) to 5.7% (2017; P < 0.001). In all three cohorts, AD was more common among girls than boys (18.9% vs. 13.8% in 2017; P < 0.001). Children from the mountain inlands had a higher prevalence of AD than children from coastal cities (22.0% vs. 15.1% in 2017; P < 0.001). In comparing D-AD, there were no significant differences between the sexes or between inland or coastal living. Concomitant asthma increased over the years from 12.2% (1996) to 15.8% (2006) to 23.0% (2017; P < 0.001). Concomitant allergic rhinitis and allergic sensitization increased from 1996 (15.0% and 27.5%) to 2006 (24.7% and 49.5%) but then levelled off until 2017 (21.0% and 46.7%). CONCLUSIONS The prevalence of AD among schoolchildren in Sweden decreased over the study period, whereas atopic comorbidity among children with AD increased. Although a decrease was seen, AD is still common and the increase in atopic comorbidity among children with AD, especially the increase in asthma, is concerning.
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Affiliation(s)
- Maja Af Klinteberg
- Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Umeå, Sweden
| | - Anna Winberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University, Umeå, Sweden
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Okuyama K, Johansson SE, Sundquist K. Neighbourhood socioeconomic status and pain among older adults-A cross-sectional study. Eur J Pain 2024. [PMID: 38214141 DOI: 10.1002/ejp.2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 10/27/2023] [Accepted: 12/09/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Pain is associated with falls, disability and a poor quality of life among older adults. It is highly prevalent in many societies, and studies have shown that pain could be preventable or managed more effectively at the population level. However, few studies have investigated who is at higher risk of pain in the general population, which is important for development of effective interventions. The purpose of this study was to investigate, by using nationally representative samples in Sweden, whether neighbourhood socioeconomic status (SES) is associated with pain among older adults after considering other important risk factors. METHODS The study used the Statistics on Income and Living Conditions (EU-SILC), which is a nationwide annual survey of the living conditions of residents in Sweden. We used the data of individuals who were over 65 years of age between 2008 and 2013. Multivariable logistic regression was conducted to investigate the association between neighbourhood SES and severe pain. RESULTS Those who resided in low SES neighbourhoods had a 30% higher odds of having severe pain than those who resided in high SES neighbourhoods after controlling for individual risk factors, such as the sex, age, individual SES, smoking, exercise habits and body mass index. Exercise was protective against severe pain. CONCLUSION Given the high prevalence of pain across populations, interventions targeting geographic areas (such as those in the current study) in combination with individual risk factors could be effective to reduce the burden of pain at the population level. SIGNIFICANCE Those who reside in neighbourhoods with low SES may have higher risks of pain due to a lack of health-promoting resources as well as psychological stress. Further studies identifying the specific mechanisms behind the association between neighbourhood SES and pain would be useful in order to develop effective interventions.
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Affiliation(s)
- Kenta Okuyama
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo-shi, Shimane, Japan
| | - Sven-Erik Johansson
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Izumo-shi, Shimane, Japan
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Martinsson A, Törngren C, Nielsen SJ, Pan E, Hansson EC, Taha A, Jeppsson A. Renin-angiotensin system inhibition after surgical aortic valve replacement for aortic stenosis. Heart 2024; 110:202-208. [PMID: 37460192 PMCID: PMC10850732 DOI: 10.1136/heartjnl-2023-322922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/28/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE The optimal medical therapy after surgical aortic valve replacement (SAVR) for aortic stenosis remains unknown. Renin-angiotensin system (RAS) inhibitors could potentially improve cardiac remodelling and clinical outcomes after SAVR. METHODS All patients undergoing SAVR due to aortic stenosis in Sweden 2006-2020 and surviving 6 months after surgery were included. The primary outcome was major adverse cardiovascular events (MACEs; all-cause mortality, stroke or myocardial infarction). Secondary endpoints included the individual components of MACE and cardiovascular mortality. Time-updated adjusted Cox regression models were used to compare patients with and without RAS inhibitors. Subgroup analyses were performed, as well as a comparison between angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). RESULTS A total of 11 894 patients (mean age, 69.5 years, 40.4% women) were included. Median follow-up time was 5.4 (2.7-8.5) years. At baseline, 53.6% of patients were dispensed RAS inhibitors, this proportion remained stable during follow-up. RAS inhibition was associated with a lower risk of MACE (adjusted hazard ratio (aHR) 0.87 (95% CI 0.81 to 0.93), p<0.001), mainly driven by a lower risk of all-cause death (aHR 0.79 (0.73 to 0.86), p<0.001). The lower MACE risk was consistent in all subgroups except for those with mechanical prostheses (aHR 1.07 (0.84 to 1.37), p for interaction=0.040). Both treatment with ACE inhibitors (aHR 0.89 (95% CI 0.82 to 0.97)) and ARBs (0.87 (0.81 to 0.93)) were associated with lower risk of MACE. CONCLUSION The results of this study suggest that medical therapy with an RAS inhibitor after SAVR is associated with a 13% lower risk of MACE and a 21% lower risk of all-cause death.
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Affiliation(s)
- Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Charlotta Törngren
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Emily Pan
- Department of Cardiovascular Medicine, Harvard Medical School, Boston, Massachusetts, USA
- University of Turku, Turku, Finland
| | - Emma C Hansson
- Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Amar Taha
- Department of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
- Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Vats S, Sundquist K, Sundquist J, Zhang N, Wang X, Acosta S, Gottsäter A, Memon AA. Oxidative stress-related genetic variation and antioxidant vitamin intake in intact and ruptured abdominal aortic aneurysm: a Swedish population-based retrospective cohort study. Eur J Prev Cardiol 2024; 31:61-74. [PMID: 37665957 DOI: 10.1093/eurjpc/zwad271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023]
Abstract
AIMS The aim of this study is to investigate how genetic variations in genes related to oxidative stress, intake of antioxidant vitamins, and any potential interactions between these factors affect the incidence of intact abdominal aortic aneurysm (AAA) and its rupture (rAAA), accounting for sex differences where possible. METHODS AND RESULTS The present retrospective cohort study (n = 25 252) uses baseline single-nucleotide polymorphisms (SNPs) and total antioxidant vitamin intake data from the large population-based, Malmö Diet and Cancer Study. Cumulative incidence of intact AAA was 1.6% and of rAAA 0.3% after a median follow-up of 24.3 years. A variant in NOX3 (rs3749930) was associated with higher rAAA risk in males [adjusted hazard ratio (aHR): 2.49; 95% confidence interval (CI): 1.36-4.35] and the overall population (aHR: 1.88; 95% CI: 1.05-3.37). Higher intakes of antioxidant vitamins, riboflavin, and folate were associated with 20% and 19% reduced intact AAA incidence, respectively. Interestingly, the inverse associations between riboflavin and vitamin D intake with intact AAA incidence were stronger in the individuals carrying the NOX3 variant as compared with the wild-type recessive genotype, i.e. by 60% and 66%, respectively (P for interaction < 0.05). Higher riboflavin intake was associated with a 33% male-specific intact AAA risk reduction, while higher intake of vitamin B12 intake was associated with 55% female-specific intact AAA risk increase; both these associations were significantly modified by sex (P for interaction < 0.05). CONCLUSIONS Our findings highlight the role of oxidative stress genetic variations and antioxidant vitamin intake in AAA. Although a low AAA/rAAA sample size limited some analyses, especially in females, our findings highlight the need for future randomized controlled trials and mechanistic studies, to explore the potential benefits of antioxidant vitamins while accounting for genetic and sex differences.
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Affiliation(s)
- Sakshi Vats
- Center for Primary Health Care Research, Wallenberg Laboratory, 5th floor, Inga Marie Nilsson's gata 53, 214 28, Malmö, Sweden
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Naiqi Zhang
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Xiao Wang
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund University, Malmö, S-205 02, Sweden
| | - Anders Gottsäter
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund University, Malmö, S-205 02, Sweden
| | - Ashfaque A Memon
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
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Talvitie M, Jonsson M, Roy J, Hultgren R. Association of women-specific size threshold and mortality in elective abdominal aortic aneurysm repair. Br J Surg 2024; 111:znad376. [PMID: 37963191 PMCID: PMC10776526 DOI: 10.1093/bjs/znad376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/17/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND It is unclear whether women derive mortality benefit from early repair of abdominal aortic aneurysms (AAA). The aim of this study was to compare short- and mid-term mortality for women treated at small versus large diameters. METHOD Women receiving elective repair of AAA at small (49-54 mm) and large (≥55 mm) diameters from 2008 to 2022 were extracted from the Swedish National Registry for Vascular Surgery (n = 1642 women). The effect of diameter on 90-day, 1- and 3-year mortality was studied in logistic regression and propensity score models. Age, co-morbidities, smoking and repair modality were considered as confounders. Men (n = 9047) were analysed in parallel. RESULTS Some 1642 women were analysed, of whom 34% underwent repair at small diameters (versus 52% of men). Women with small (versus large) AAAs were younger (73 versus 75 years, P < 0.001), and 63% of women in both size groups had endovascular repairs (P = 0.120). Mortality was 3.5% (90 days), 7.1% (1 year) and 15.8% (3 years), with no differences between the size strata. There was no consistent association between AAA size and mortality in multivariable models. Sex differences in mortality were almost entirely due to mortality in younger-than-average women versus men (3-year mortality: small AAAs 11.1% versus 7.3%, P < 0.030, or large 14.4% versus 10.7%, P < 0.038). CONCLUSION Mortality in women is high and unaffected by AAA size at repair. The optimal threshold for women remains undefined. The higher rupture risk in women should not automatically translate into a lower, women-specific threshold.
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Affiliation(s)
- Mareia Talvitie
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Jonsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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30
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Fattahi N, Linné A, Roy J, Stenman M, Svensjö S, Nilsson O, Hultgren R. Prevalence of abdominal aortic aneurysm (AAA) in first-degree relatives: detecting AAA in adult offspring of AAA patients. BJS Open 2024; 8:zrad163. [PMID: 38195162 PMCID: PMC10776345 DOI: 10.1093/bjsopen/zrad163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND First-degree relatives of patients with abdominal aortic aneurysm (AAA) may have an increased risk of developing the disease. The primary aim was to report the prevalence of AAA in adult male and female offspring of patients with AAA. The secondary aim was to explore the efficiency of a registry-based detection route, and the third aim was to report contemporary prevalence in the population. METHODS Adult offspring of individuals with AAA and matched controls were identified through national registries. The examination included questionnaires and ultrasound examinations of the infrarenal aorta. Aortic pathology was defined as an aortic diameter ≥25 mm, AAA ≥30 mm. RESULTS The participation rate among male and female adult offspring was 64% (350/543) and 69% (402/583), respectively. A lower participation rate was found in male and female controls (51% and 52%). No difference in prevalence of AAA was observed between male adult offspring and controls (0.9%, c.i. 0.2 to 2.3%) or in the female population (prevalence of 0.2% in adult offspring and controls). Aortic pathology and previously diagnosed AAA were detected in 5.3% (c.i. 3.3 to 8.0%) of male adult offspring and 2.3% (c.i. 1.1 to 4.2%) in controls. Aortic pathology was more prevalent among adult offspring of females with AAA. CONCLUSION The prevalence of AAA in the general population is low, but aortic pathology is notably higher among male first-degree relatives. Increased awareness should be directed towards individuals with a possible hereditary predisposition, particularly offspring of females with AAA and older smokers. Risk factor-based targeted screening of adult offspring of patients with AAA after registry-based detection should be further explored. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT4623268.
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Affiliation(s)
- Nina Fattahi
- Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
- Section of Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Anneli Linné
- Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden
- Section of Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Joy Roy
- Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Malin Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
| | - Sverker Svensjö
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, Falun County Hospital, Falun, Sweden
| | - Olga Nilsson
- Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Vascular Surgery, Karolinska University Hospital Stockholm, Stockholm, Sweden
- Stockholm Aneurysm Research Group, STAR, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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31
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Attelind S, Eriksson N, Sundström A, Wadelius M, Hallberg P. Identification of risk factors for adverse drug reactions in a pharmacovigilance database. Pharmacoepidemiol Drug Saf 2024; 33:e5753. [PMID: 38169128 DOI: 10.1002/pds.5753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Affiliation(s)
- S Attelind
- Department of Medical Sciences, Clinical Pharmacogenomics, Uppsala University, Uppsala, Sweden
- Department of Drug Safety, Swedish Medical Products Agency, Uppsala, Sweden
| | - N Eriksson
- Department of Medical Sciences, Clinical Pharmacogenomics, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
| | - A Sundström
- Department of Drug Safety, Swedish Medical Products Agency, Uppsala, Sweden
| | - M Wadelius
- Department of Medical Sciences, Clinical Pharmacogenomics, Uppsala University, Uppsala, Sweden
| | - P Hallberg
- Department of Medical Sciences, Clinical Pharmacogenomics, Uppsala University, Uppsala, Sweden
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32
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Arvidsson D, Fridolfsson J, Ekblom-Bak E, Ekblom Ö, Bergström G, Börjesson M. Fundament for a methodological standard to process hip accelerometer data to a measure of physical activity intensity in middle-aged individuals. Scand J Med Sci Sports 2024; 34:e14541. [PMID: 37985378 DOI: 10.1111/sms.14541] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/12/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND There is a lack of a methodological standard to process accelerometer data to measures of physical activity, which impairs data quality and comparability. This study investigated the effect of different combinations of settings of multiple processing components, on the measure of physical activity and the association with measures of cardiometabolic health in an unselected population of middle-aged individuals. METHODS Free-living hip accelerometer data, aerobic fitness, body mass index, HDL:total cholesterol ratio, blood glucose, and systolic blood pressure were achieved from 4391 participants 50-64 years old included in The Swedish CArdioPulmonary bioImage Study (SCAPIS) baseline measurement (cross-sectional). Lab data were also included for calibration of accelerometers to provide comparable measure of physical activity intensity and time spent in different intensity categories, as well as to enhance understanding. The accelerometer data processing components were hardware recalibration, frequency filtering, number of accelerometer axes, epoch length, wear time criterium, time composition (min/24 h vs. % of wear time). Partial least regression and ordinary least regression were used for the association analyses. RESULTS The setting of frequency filter had the strongest effect on the physical activity intensity measure and time distribution in different intensity categories followed by epoch length and number of accelerometer axes. Wear time criterium and recalibration of accelerometer data were less important. The setting of frequency filter and epoch length also showed consistent important effect on the associations with the different measures of cardiometabolic health, while the effect of recalibration, number of accelerometer axes, wear time criterium and expression of time composition was less consistent and less important. There was a large range in explained variance of the measures of cardiometabolic health depending on the combination of processing settings, for example, 12.1%-20.8% for aerobic fitness and 5.8%-14.0% for body mass index. CONCLUSIONS There was a large variation in the physical activity intensity measure and the association with different measures of cardiometabolic health depending on the combination of settings of accelerometer data processing components. The results provide a fundament for a standard to process hip accelerometer data to assess the physical activity in middle-aged populations.
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Affiliation(s)
- Daniel Arvidsson
- Center for Health and Performance, Department of Food and Nutrition, and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
| | - J Fridolfsson
- Center for Health and Performance, Department of Food and Nutrition, and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
| | - E Ekblom-Bak
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Ö Ekblom
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - G Bergström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Region Västra Götaland, Gothenburg, Sweden
| | - M Börjesson
- Center for Health and Performance, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Vestergaard AEF, Jensen SK, Heide-Jørgensen U, Adelborg K, Birn H, Carrero JJ, Christiansen CF. Oral anticoagulant treatment and risk of kidney disease-a nationwide, population-based cohort study. Clin Kidney J 2024; 17:sfad252. [PMID: 38186872 PMCID: PMC10768770 DOI: 10.1093/ckj/sfad252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 04/29/2023] [Indexed: 01/09/2024] Open
Abstract
Background Direct oral anticoagulants (DOACs) are recommended as first-line treatment of atrial fibrillation. Whether DOAC use is associated with lower risks of kidney complications compared with vitamin K antagonists (VKAs) remains unclear. We examined this association in a nationwide, population-based cohort study. Methods We conducted a cohort study including patients initiating oral anticoagulant treatment within 3 months after an atrial fibrillation diagnosis in Denmark during 2012-18. Using routinely collected creatinine measurements from laboratory databases, we followed patients in an intention-to-treat approach for acute kidney injury (AKI) and chronic kidney disease (CKD) progression. We used propensity-score weighting to balance baseline confounders, computed weighted risks and weighted hazard ratios (HRs) with 95% confidence intervals (CIs) comparing DOACs with VKAs. We performed several subgroup analyses and a per-protocol analysis. Results We included 32 781 persons with atrial fibrillation initiating oral anticoagulation (77% initiating DOACs). The median age was 75 years, 25% had a baseline estimated glomerular filtration rate <60 mL/min/1.73 m2, and median follow-up was 2.3 (interquartile range 1.1-3.9) years. The weighted 1-year risks of AKI were 13.6% in DOAC users and 15.0% in VKA users (HR 0.86, 95% CI 0.82; 0.91). The weighted 5-year risks of CKD progression were 13.9% in DOAC users and 15.4% in VKA users (HR 0.85, 95% CI 0.79; 0.92). Results were similar across subgroups and in the per-protocol analysis. Conclusions Initiation of DOACs was associated with a decreased risk of AKI and CKD progression compared with VKAs. Despite the potential limitations of observational studies, our findings support the need for increased clinical awareness to prevent kidney complications among patients who initiate oral anticoagulants.
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Affiliation(s)
- Ane Emilie Friis Vestergaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Simon Kok Jensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Biochemistry, Gødstrup Regional Hospital, Gødstrup, Denmark
| | - Henrik Birn
- Departments of Biomedicine and Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatisctics, Karolinska Institutet, Stockholm, Sweden
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Venkatakrishnan V, Thomsson KA, Padra M, Andersson A, Brundin B, Christenson K, Bylund J, Karlsson NG, Lindén A, Lindén SK. Protein N-glycosylation in the bronchoalveolar space differs between never-smokers and long-term smokers with and without COPD. Glycobiology 2023; 33:1128-1138. [PMID: 37656214 PMCID: PMC10876041 DOI: 10.1093/glycob/cwad071] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) kills millions of people annually and patients suffering from exacerbations of this disorder display high morbidity and mortality. The clinical course of COPD is associated with dysbiosis and infections, but the underlying mechanisms are poorly understood. Glycosylation of proteins play roles in regulating interactions between microbes and immune cells, and knowledge on airway glycans therefore contribute to the understanding of infections. Furthermore, glycans have biomarker potential for identifying smokers with enhanced risk for developing COPD as well as COPD subgroups. Here, we characterized the N-glycosylation in the lower airways of healthy never-smokers (HNS, n = 5) and long-term smokers (LTS) with (LTS+, n = 4) and without COPD (LTS-, n = 8). Using mass spectrometry, we identified 57 highly confident N-glycan structures whereof 38 oligomannose, complex, and paucimannose type glycans were common to BAL samples from HNS, LTS- and LTS+ groups. Hybrid type N-glycans were identified only in the LTS+ group. Qualitatively and quantitatively, HNS had lower inter-individual variation between samples compared to LTS- or LTS+. Cluster analysis of BAL N-glycosylation distinguished LTS from HNS. Correlation analysis with clinical parameters revealed that complex N-glycans were associated with health and absence of smoking whereas oligomannose N-glycans were associated with smoking and disease. The N-glycan profile from monocyte-derived macrophages differed from the BAL N-glycan profiles. In conclusion, long-term smokers display substantial alterations of N-glycosylation in the bronchoalveolar space, and the hybrid N-glycans identified only in long-term smokers with COPD deserve to be further studied as potential biomarkers.
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Affiliation(s)
- Vignesh Venkatakrishnan
- Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 9C, 41390, Gothenburg, Sweden
| | - Kristina A Thomsson
- Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 9C, 41390, Gothenburg, Sweden
| | - Médea Padra
- Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 9C, 41390, Gothenburg, Sweden
| | - Anders Andersson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3, 41390, Gothenburg, Sweden
| | - Bettina Brundin
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 17177, Stockholm, Sweden
| | - Karin Christenson
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 12F, 41390, Gothenburg, Sweden
| | - Johan Bylund
- Department of Oral Microbiology and Immunology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 12F, 41390, Gothenburg, Sweden
| | - Niclas G Karlsson
- Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 9C, 41390, Gothenburg, Sweden
| | - Anders Lindén
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 17177, Stockholm, Sweden
- Department Respiratory Medicine and Allergy, Karolinska Severe COPD Center, Karolinska University Hospital, Solna, Eugeniavägen 3, 171 76 Stockholm, Sweden
| | - Sara K Lindén
- Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 9C, 41390, Gothenburg, Sweden
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Waagaard L, Herraiz-Adillo Á, Ahlqvist VH, Higueras-Fresnillo S, Berglind D, Wennberg P, Daka B, Lenander C, Sundström J, Östgren CJ, Rådholm K, Henriksson P. Body mass index and weight gain in pregnancy and cardiovascular health in middle age: A cohort study. BJOG 2023. [PMID: 38149523 DOI: 10.1111/1471-0528.17740] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 11/23/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE To examine associations between body mass index (BMI) in early pregnancy and gestational weight gain (GWG) with cardiovascular health in middle age using the 'Life's Essential 8' (LE8) concept of the American Heart Association (AHA). DESIGN Population-based cohort study. SETTING Swedish CardioPulmonary bioImage Study (SCAPIS). POPULATION A total of 8871 women from SCAPIS were included. METHODS Information on cardiovascular health in middle age was collected from SCAPIS and linked to pregnancy weight data obtained from the Swedish Medical Birth Register, with an average follow-up time of 24.5 years. An LE8 score between 0 and 100 was determined, where a score under 60 points was defined as poor cardiovascular health. Binary logistic regression and restricted cubic splines were used. MAIN OUTCOME MEASURES Cardiovascular health according to LE8 in middle age. RESULTS The odds of having poor cardiovascular health in middle age were significantly higher in women who had overweight (adjusted odds ratio, aOR 3.30, 95% CI 2.82-3.88) or obesity (aOR 7.63, 95% CI 5.86-9.94), compared with women classified as being of normal weight in pregnancy. Higher odds were also found for excessive GWG (aOR 1.31, 95% CI 1.09-1.57), compared with women who gained weight within the recommendations. CONCLUSIONS A high BMI in early pregnancy and excessive GWG were associated with greater odds of poor cardiovascular health in middle age. Although further studies are needed, our results highlight pregnancy as an important period to support long-term cardiovascular health.
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Affiliation(s)
- Lovisa Waagaard
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ángel Herraiz-Adillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Viktor H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sara Higueras-Fresnillo
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department Physical Education, Sport and Human Motricity, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Center for Wellbeing, Welfare and Happiness, Stockholm School of Economics, Stockholm, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Bledar Daka
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Lenander
- Department for Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Lund, Sweden
| | - Johan Sundström
- Clinical Epidemiology Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Carl Johan Östgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Karin Rådholm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Gatti P, Linde C, Benson L, Thorvaldsen T, Normand C, Savarese G, Dahlström U, Maggioni AP, Dickstein K, Lund LH. What determines who gets cardiac resynchronization therapy in Europe? A comparison between ESC-HF-LT registry, SwedeHF registry, and ESC-CRT Survey II. Eur Heart J Qual Care Clin Outcomes 2023; 9:741-748. [PMID: 37076773 PMCID: PMC10745247 DOI: 10.1093/ehjqcco/qcad024] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/01/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
AIMS Cardiac resynchronization therapy (CRT) is effective in heart failure with reduced ejection fraction (HFrEF) and dyssynchrony but is underutilized. In a cohort study, we identified clinical, organizational, and level of care factors linked to CRT implantation. METHODS AND RESULTS We included HFrEF patients fulfilling study criteria in the ESC-HF-Long Term Registry (ESC-HF-LT, n = 1031), the Swedish Heart Failure Registry (SwedeHF) (n = 5008), and the ESC-CRT Survey II (n = 11 088). In ESC-HF-LT, 36% had a CRT indication of which 47% had CRT, 53% had indication but no CRT, and the remaining 54% had no indication and no CRT. In SwedeHF, these percentages were 30, 25, 75, and 70%. Median age of patients with CRT indication and CRT present vs. absent was 68 vs. 65 years with 24% vs. 22% women in ESC-HF-LT, 76 vs. 74 years with 26% vs. 26% women in SwedeHF, and 70 years with 24% women in CRT Survey II (all had CRT). For ESC-HF-LT, independent predictors of having CRT were guideline-directed medical therapy (GDMT), atrial fibrillation (AF), prior HF hospitalization, and NYHA class. For SwedeHF, they were GDMT, age, AF, previous myocardial infarction, lower NYHA class, enrolment at university hospital, and follow-up at HF centre/Hospital. In SwedeHF, above median income and higher education level were also independently associated with having CRT. In the ESC-CRT Survey II (n = 11 088), all patients received CRT but with differences in the clinical characteristics between countries. CONCLUSION CRT was used in a minority of eligible patients and more used in ESC-HF-LT than in SwedeHF.
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Affiliation(s)
- Paolo Gatti
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Linde
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Lina Benson
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tonje Thorvaldsen
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Camilla Normand
- Cardiology Division, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, Stavanger University, Stavanger, Norway
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Kenneth Dickstein
- Cardiology Division, Stavanger University Hospital, Stavanger, Norway
- Stavanger University Hospital, University of Bergen, Stavanger, Norway
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska Universitetssjukhuset, Stockholm, Sweden
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Garcia-Ryde M, van der Burg NMD, Larsson CE, Larsson-Callerfelt AK, Westergren-Thorsson G, Bjermer L, Tufvesson E. Lung Fibroblasts from Chronic Obstructive Pulmonary Disease Subjects Have a Deficient Gene Expression Response to Cigarette Smoke Extract Compared to Healthy. Int J Chron Obstruct Pulmon Dis 2023; 18:2999-3014. [PMID: 38143920 PMCID: PMC10742772 DOI: 10.2147/copd.s422508] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/16/2023] [Indexed: 12/26/2023] Open
Abstract
Background and aim Cigarette smoking is the most common cause of chronic obstructive pulmonary disease (COPD) but more mechanistic studies are needed. Cigarette smoke extract (CSE) can elicit a strong response in many COPD-related cell types, but no studies have been performed in lung fibroblasts. Therefore, we aimed to investigate the effect of CSE on gene expression in lung fibroblasts from healthy and COPD subjects. Patients and methods Primary lung fibroblasts, derived from six healthy and six COPD subjects (all current or ex-smokers), were either unstimulated (baseline) or stimulated with 30% CSE for 4 h prior to RNA isolation. The mRNA expression levels were measured using the NanoString nCounter Human Fibrosis V2 panel (760 genes). Pathway enrichment was assessed for unique gene ontology terms of healthy and COPD. Results At baseline, a difference in the expression of 17 genes was found in healthy and COPD subjects. Differential expression of genes after CSE stimulation resulted in significantly less changes in COPD lung fibroblasts (70 genes) than in healthy (207 genes), with 51 genes changed in both. COPD maintained low NOTCH signaling throughout and upregulated JUN >80%, indicating an increase in apoptosis. Healthy downregulated the Mitogen-activated protein kinase (MAPK) signaling cascade, including a ≥50% reduction in FGF2, CRK, TGFBR1 and MEF2A. Healthy also downregulated KAT6A and genes related to cell proliferation, all together indicating possible cell senescence signaling. Conclusion Overall, COPD lung fibroblasts responded to CSE stimulation with a very different and deficient expression profile compared to healthy. Highlighting that stimulated healthy cells are not an appropriate substitute for COPD cells which is important when investigating the mechanisms of COPD.
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Affiliation(s)
- Martin Garcia-Ryde
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Nicole M D van der Burg
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Carin E Larsson
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | | | | | - Leif Bjermer
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Ellen Tufvesson
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
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Larsson SC, Butterworth AS, Burgess S. Mendelian randomization for cardiovascular diseases: principles and applications. Eur Heart J 2023; 44:4913-4924. [PMID: 37935836 PMCID: PMC10719501 DOI: 10.1093/eurheartj/ehad736] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023] Open
Abstract
Large-scale genome-wide association studies conducted over the last decade have uncovered numerous genetic variants associated with cardiometabolic traits and risk factors. These discoveries have enabled the Mendelian randomization (MR) design, which uses genetic variation as a natural experiment to improve causal inferences from observational data. By analogy with the random assignment of treatment in randomized controlled trials, the random segregation of genetic alleles when DNA is transmitted from parents to offspring at gamete formation is expected to reduce confounding in genetic associations. Mendelian randomization analyses make a set of assumptions that must hold for valid results. Provided that the assumptions are well justified for the genetic variants that are employed as instrumental variables, MR studies can inform on whether a putative risk factor likely has a causal effect on the disease or not. Mendelian randomization has been increasingly applied over recent years to predict the efficacy and safety of existing and novel drugs targeting cardiovascular risk factors and to explore the repurposing potential of available drugs. This review article describes the principles of the MR design and some applications in cardiovascular epidemiology.
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Affiliation(s)
- Susanna C Larsson
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Papworth Road, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
- Health Data Research UK, Wellcome Genome Campus and University of Cambridge, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Stephen Burgess
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Papworth Road, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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Kurt Z, Cheng J, Barrere-Cain R, McQuillen CN, Saleem Z, Hsu N, Jiang N, Pan C, Franzén O, Koplev S, Wang S, Björkegren J, Lusis AJ, Blencowe M, Yang X. Shared and distinct pathways and networks genetically linked to coronary artery disease between human and mouse. eLife 2023; 12:RP88266. [PMID: 38060277 PMCID: PMC10703441 DOI: 10.7554/elife.88266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Mouse models have been used extensively to study human coronary artery disease (CAD) or atherosclerosis and to test therapeutic targets. However, whether mouse and human share similar genetic factors and pathogenic mechanisms of atherosclerosis has not been thoroughly investigated in a data-driven manner. We conducted a cross-species comparison study to better understand atherosclerosis pathogenesis between species by leveraging multiomics data. Specifically, we compared genetically driven and thus CAD-causal gene networks and pathways, by using human GWAS of CAD from the CARDIoGRAMplusC4D consortium and mouse GWAS of atherosclerosis from the Hybrid Mouse Diversity Panel (HMDP) followed by integration with functional multiomics human (STARNET and GTEx) and mouse (HMDP) databases. We found that mouse and human shared >75% of CAD causal pathways. Based on network topology, we then predicted key regulatory genes for both the shared pathways and species-specific pathways, which were further validated through the use of single cell data and the latest CAD GWAS. In sum, our results should serve as a much-needed guidance for which human CAD-causal pathways can or cannot be further evaluated for novel CAD therapies using mouse models.
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Affiliation(s)
- Zeyneb Kurt
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
- The Information School at the University of SheffieldSheffieldUnited Kingdom
| | - Jenny Cheng
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
- Interdepartmental Program of Molecular, Cellular and Integrative Physiology, University of California, Los AngelesLos AngelesUnited States
| | - Rio Barrere-Cain
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
| | - Caden N McQuillen
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
| | - Zara Saleem
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
| | - Neil Hsu
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
| | - Nuoya Jiang
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
| | - Calvin Pan
- Department of Medicine, Division of Cardiology, University of California, Los AngelesLos AngelesUnited States
| | - Oscar Franzén
- Department of Genetics & Genomic Sciences, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Simon Koplev
- Department of Genetics & Genomic Sciences, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount SinaiNew YorkUnited States
| | - Susanna Wang
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
| | - Johan Björkegren
- Department of Genetics & Genomic Sciences, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount SinaiNew YorkUnited States
- Department of Medicine, (Huddinge), Karolinska InstitutetHuddingeSweden
| | - Aldons J Lusis
- Department of Medicine, Division of Cardiology, University of California, Los AngelesLos AngelesUnited States
- Departments of Human Genetics & Microbiology, Immunology, and Molecular Genetics, UCLALos AngelesUnited States
- Cardiovascular Research Laboratory, David Geffen School of Medicine, UCLALos AngelesUnited States
| | - Montgomery Blencowe
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
- Interdepartmental Program of Molecular, Cellular and Integrative Physiology, University of California, Los AngelesLos AngelesUnited States
| | - Xia Yang
- Department of Integrative Biology and Physiology, University of California, Los AngelesLos AngelesUnited States
- Interdepartmental Program of Molecular, Cellular and Integrative Physiology, University of California, Los AngelesLos AngelesUnited States
- Interdepartmental Program of Bioinformatics, University of California, Los AngelesLos AngelesUnited States
- Department of Molecular and Medical Pharmacology, University of California, Los AngelesLos AngelesUnited States
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Attelind S, Eriksson N, Sundström A, Wadelius M, Hallberg P. Identification of risk factors for adverse drug reactions in a pharmacovigilance database. Pharmacoepidemiol Drug Saf 2023; 32:1431-1438. [PMID: 37580910 DOI: 10.1002/pds.5679] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/11/2023] [Accepted: 08/02/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION In addition to identifying new safety signals, pharmacovigilance databases could be used to identify potential risk factors for adverse drug reactions (ADRs). OBJECTIVE To evaluate whether data mining in a pharmacovigilance database can be used to identify known and possible novel risk factors for ADRs, for use in pharmacovigilance practice. METHOD Exploratory data mining was performed within the Swedish national database of spontaneously reported ADRs. Bleeding associated with direct oral anticoagulants (DOACs)-rivaroxaban, apixaban, edoxaban, and dabigatran-was used as a test model. We compared demographics, drug treatment, and clinical features between cases with bleeding (N = 965) and controls who had experienced other serious ADRs to DOACs (N = 511). Statistical analysis was performed by unadjusted and age adjusted logistic regression models, and the random forest based machine-learning method Boruta. RESULTS In the logistic regression, 13 factors were significantly more common among cases of bleeding compared with controls. Eleven were labelled or previously proposed risk factors. Cardiac arrhythmia (e.g., atrial fibrillation), hypertension, mental impairment disorders (e.g., dementia), renal and urinary tract procedures, gastrointestinal ulceration and perforation, and interacting drugs remained significant after adjustment for age. In the Boruta analysis, high age, arrhythmia, hypertension, cardiac failure, thromboembolism, and pharmacodynamically interacting drugs had a larger than random association with the outcome. High age, cardiac arrhythmia, hypertension, cardiac failure, and pharmacodynamically interacting drugs had odds ratios for bleeding above one, while thromboembolism had an odds ratio below one. CONCLUSIONS We demonstrated that data mining within a pharmacovigilance database identifies known risk factors for DOAC bleeding, and potential risk factors such as dementia and atrial fibrillation. We propose that the method could be used in pharmacovigilance for identification of potential ADR risk factors that merit further evaluation.
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Affiliation(s)
- Sofia Attelind
- Department of Medical Sciences, Clinical Pharmacogenomics, Uppsala University, Uppsala, Sweden
- Department of Drug Safety, Swedish Medical Products Agency, Uppsala, Sweden
| | - Niclas Eriksson
- Department of Medical Sciences, Clinical Pharmacogenomics, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
| | - Anders Sundström
- Department of Drug Safety, Swedish Medical Products Agency, Uppsala, Sweden
| | - Mia Wadelius
- Department of Medical Sciences, Clinical Pharmacogenomics, Uppsala University, Uppsala, Sweden
| | - Pär Hallberg
- Department of Medical Sciences, Clinical Pharmacogenomics, Uppsala University, Uppsala, Sweden
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Theorell-Haglöw J, Zhou X, Wittert G, Adams R, Appleton S, Reynolds A, Ljunggren M, Marshall N. Does obstructive sleep apnea increase the risk of cancer and cancer mortality in combined community-based cohorts? J Sleep Res 2023:e14089. [PMID: 37990480 DOI: 10.1111/jsr.14089] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 11/23/2023]
Abstract
Obstructive sleep apnea (OSA) has been linked to cancer in several clinical and community-based cohorts. The effect in community-based studies free of clinical referral bias needs to be replicated. In this observational prospective cohort study, we pooled data from three community-based prospective cohorts (Uppsala Sleep and Health in Men cohort [UMEN]; Sleep and health in women [SHE]; Men Androgen Inflammation Lifestyle Environment and Stress Cohort [MAILES]; nTotal = 1467). All cohorts had objective data on obstructive sleep apnea and registry linkage data on cancer and cancer mortality. Analyses for different obstructive sleep apnea measures (apnea-hypopnea index [AHI], oxygen desaturation index [ODI], and minimal saturation) as risk factors for cancer incidence (all cancers) were performed using Cox proportional hazards models (follow-up 5-16 years). We did not find an overall increased risk of cancer after adjustment for age, sex, and BMI (HRAHI [95% CI] = 1.00 [0.98; 1.01] and HRODI [95% CI] = 0.99 [0.97; 1.01]). Stratifying by daytime sleepiness did not influence the association. Cancer mortality was not significantly associated with obstructive sleep apnea. Taken together, we did not observe an overall increased risk of cancer or cancer mortality in relation to obstructive sleep apnea, however, our confidence limits remain wide for important diagnostic categories of sleep apnea severity. The relationship between obstructive sleep apnea and cancer needs further investigation in a comprehensive multi-cohort approach with greater statistical precision. For future studies we may need to find and then combine every community-based cohort study that can provide a definitive answer to the question on the risk of cancer from obstructive sleep apnea in the general population.
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Affiliation(s)
- Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Xingwu Zhou
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Gary Wittert
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert Adams
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sarah Appleton
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Amy Reynolds
- Flinders Health and Medical Research Institute - Sleep Health (Adelaide Institute for Sleep Health), College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Nathaniel Marshall
- Centre for Research and Understanding of Sleep (CIRUS), Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
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Ohlsson C, Nethander M, Norlén AK, Poutanen M, Gudmundsson EF, Aspelund T, Sigurdsson S, Ryberg H, Gudnason V, Tivesten Å. Serum DHEA and Testosterone Levels Associate Inversely With Coronary Artery Calcification in Elderly Men. J Clin Endocrinol Metab 2023; 108:3272-3279. [PMID: 37391895 PMCID: PMC10655543 DOI: 10.1210/clinem/dgad351] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 07/02/2023]
Abstract
CONTEXT Epidemiological and preclinical data support cardiovascular, mainly protective, effects of sex steroids in men, but the mechanisms underlying the cardiovascular actions of sex steroids are poorly understood. Vascular calcification parallels the development of atherosclerosis, but is increasingly recognized as a diversified, highly regulated process, which itself may have pathophysiological importance for clinical cardiovascular events. OBJECTIVE To investigate the association between serum sex steroids and coronary artery calcification (CAC) in elderly men. METHODS We used gas chromatography tandem mass spectrometry to analyze a comprehensive sex steroid profile, including levels of dehydroepiandrosterone (DHEA), androstenedione, estrone, testosterone, estradiol, and dihydrotestosterone, in men from the population-based AGES-Reykjavik study (n = 1287, mean 76 years). Further, sex hormone-binding globulin (SHBG) was assayed and bioavailable hormone levels calculated. CAC score was determined by computed tomography. The main outcome measures were cross-sectional associations between dehydroepiandrosterone, androstenedione, estrone, testosterone, dihydrotestosterone, and estradiol and quintiles of CAC. RESULTS Serum levels of DHEA, androstenedione, testosterone, dihydrotestosterone, and bioavailable testosterone showed significant inverse associations with CAC, while estrone, estradiol, bioavailable estradiol, and SHBG did not. DHEA, testosterone, and bioavailable testosterone remained associated with CAC after adjustment for traditional cardiovascular risk factors. In addition, our results support partially independent associations between adrenal-derived DHEA and testes-derived testosterone and CAC. CONCLUSION Serum levels of DHEA and testosterone are inversely associated with CAC in elderly men, partially independently from each other. These results raise the question whether androgens from both the adrenals and the testes may contribute to male cardiovascular health.
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Affiliation(s)
- Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, SE-413 45 Gothenburg, Sweden
| | - Maria Nethander
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Bioinformatics and Data Centre, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden
| | - Anna-Karin Norlén
- Department of Clinical Chemistry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Matti Poutanen
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, FI-20520 Turku, Finland
| | | | - Thor Aspelund
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | | | - Henrik Ryberg
- Department of Clinical Chemistry, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
| | - Vilmundur Gudnason
- Icelandic Heart Association, 201 Kopavogur, Iceland
- Faculty of Medicine, University of Iceland, 101 Reykjavik, Iceland
| | - Åsa Tivesten
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden
- Department of Endocrinology, Sahlgrenska University Hospital, Region Västra Götaland, SE-413 45 Gothenburg, Sweden
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Sandberg A, Nordanstig J, Cider Å, Jivegård L, Hagströmer M, Bäck M. The Impact of Nordic Pole Walk Advice Alone or in Combination With Exercise Strategies on Daily Physical Activity in Patients With Intermittent Claudication: A Randomized Clinical Trial. Phys Ther 2023; 103:pzad086. [PMID: 37459237 PMCID: PMC10630612 DOI: 10.1093/ptj/pzad086] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/21/2023] [Accepted: 05/22/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE The impact of exercise interventions on physical activity (PA) remains undetermined in intermittent claudication, which is why it is important to include objectively measured PA as an additional endpoint. The aim of this prespecified secondary analysis of a randomized clinical trial was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) on PA in patients with intermittent claudication. METHODS In total, 166 patients with intermittent claudication (mean age = 72 [SD = 7.4] y; 41% women) were randomized to 3 intermittent claudication-treatment strategies: WA, WA + SEP, or WA + HSEP. All patients received Nordic poles and standardized WA (≥30 min, 3 times weekly). Patients randomized to HSEP and SEP accepted participation in an additional 6-months exercise program. PA was measured with an accelerometer-based activPAL3 monitor for 7 days at baseline and at 3, 6, and 12 months. PA outcomes were steps per day, time spent within a stepping cadence ≥100 steps per minute, time spent upright, number of body transitions from sitting to standing, and number of sitting bouts of >30 minutes and >60 minutes. RESULTS At 1 year, no intergroup differences were observed in any of the PA variables, whereas significant intergroup differences were observed at 3 months regarding time spent within a stepping time cadence ≥100 steps per minute. The mean change for HSEP (2.47 [SD = 10.85] min) was significantly different from the mean change for WA (-3.20 [SD = 6.24] min). At 6 months, the number of sitting bouts (>60 min) for SEP was significantly different from WA (mean change = 0.24 [SD = 0.69] vs -0.23 [SD = 0.81]). CONCLUSION This study indicates that the addition of 6 months of HSEP or SEP does not improve PA at 1 year, as compared to unsupervised WA alone. Factors of importance for increasing PA in patients with intermittent claudication require further investigation. IMPACT At the 1-year follow-up, the addition of intermittent claudication-tailored additional exercise strategies did not improve daily PA in patients with intermittent claudication compared with unsupervised Nordic pole WA alone. Future studies may explore the role of behavior change techniques to increase PA in this patient group.
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Affiliation(s)
- Anna Sandberg
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Nordanstig
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Cider
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jivegård
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Health Technology Assessment Centre Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Hagströmer
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Academic Primary Care Centre, Region Stockholm, Stockholm, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Svedjeholm R, Ferrari G, Vanky F, Friberg Ö, Holm J. Glutamate infusion associated with reduced rises of p-Copeptin after coronary surgery: Substudy of GLUTAMICS II. Acta Anaesthesiol Scand 2023; 67:1373-1382. [PMID: 37365871 DOI: 10.1111/aas.14303] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Glutamate plays a key role for post-ischaemic recovery of myocardial metabolism. According to post hoc analyses of the two GLUTAMICS trials, patients without diabetes benefit from glutamate with less myocardial dysfunction after coronary artery bypass surgery (CABG). Copeptin reflects activation of the Arginine Vasopressin system and is a reliable marker of heart failure but available studies in cardiac surgery are limited. We investigated whether glutamate infusion is associated with reduced postoperative rises of plasma Copeptin (p-Copeptin) after CABG. METHODS A prespecified randomised double-blind substudy of GLUTAMICS II. Patients had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0 and underwent CABG ± valve procedure. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h was commenced 10-20 min before the release of the aortic cross-clamp and then continued for another 150 min P-Copeptin was measured preoperatively and postoperatively on day one (POD1) and day three. The primary endpoint was an increase in p-Copeptin from the preoperative level to POD1. Postoperative stroke ≤24 h and mortality ≤30 days were safety outcomes. RESULTS We included 181 patients of whom 48% had diabetes. The incidence of postoperative mortality ≤30 days (0% vs. 2.1%; p = .50) and stroke ≤24 h (0% vs. 3.2%; p = .25) did not differ between the glutamate group and controls. P-Copeptin increased postoperatively with the highest values recorded on POD1 without significant inter-group differences. Among patients without diabetes, p-Copeptin did not differ preoperatively but postoperative rise from preoperative level to POD1 was significantly reduced in the glutamate group (73 ± 66 vs. 115 ± 102 pmol/L; p = .02). P-Copeptin was significantly lower in the Glutamate group on POD1 (p = .02) and POD 3 (p = .02). CONCLUSIONS Glutamate did not reduce rises of p-Copeptin significantly after moderate to high-risk CABG. However, glutamate was associated with reduced rises of p-Copeptin among patients without diabetes. These results agree with previous observations suggesting that glutamate mitigates myocardial dysfunction after CABG in patients without diabetes. Given the exploratory nature of these findings, they need to be confirmed in future studies.
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Affiliation(s)
- Rolf Svedjeholm
- Department of Thoracic and Vascular Surgery, Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Gabriele Ferrari
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Farkas Vanky
- Department of Thoracic and Vascular Surgery, Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Jonas Holm
- Department of Thoracic and Vascular Surgery, Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Linköping University, Linköping, Sweden
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Bos MF, Ermund A, Hansson GC, de Graaf J. Goblet cell interactions reorient bundled mucus strands for efficient airway clearance. PNAS Nexus 2023; 2:pgad388. [PMID: 38024407 PMCID: PMC10661087 DOI: 10.1093/pnasnexus/pgad388] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
The respiratory tract of larger animals is cleared by sweeping bundled strands along the airway surface. These bundled strands can be millimetric in length and consist of MUC5B mucin. They are produced by submucosal glands, and upon emerging from these glands, the long axis of the bundled strands is oriented along the cilia-mediated flow toward the oral cavity. However, after release, the bundled strands are found to have turned orthogonal to the flow, which maximizes their clearance potential. How this unexpected reorientation is accomplished is presently not well understood. Recent experiments suggest that the reorientation process involves bundled strands sticking to MUC5AC mucus threads, which are tethered to the goblet cells. Such goblet cells are present in small numbers throughout the airway epithelium. Here, we develop a minimal model for reorientation of bundled mucus strands through adhesive interactions with surface goblet cells. Our simulations reveal that goblet cell interactions can reorient the bundled strands within 10 mm of release-making reorientation on the length scale of the tracheal tube feasible-and can stabilize the orthogonal orientation. Our model also reproduces other experimental observations such as strong velocity fluctuations and significant slow-down of the bundled strand with respect to the cilia-mediated flow. We further provide insight into the strand turning mechanism by examining the effect of strand shape on the impulse exerted by a single goblet cell. We conclude that goblet cell-mediated reorientation is a viable route for bundled strand reorientation, which should be further validated in future experiment.
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Affiliation(s)
- Meike F Bos
- Institute for Theoretical Physics, Center for Extreme Matter and Emergent Phenomena, Utrecht University, Princetonplein 5, 3584 CC, Utrecht, The Netherlands
| | - Anna Ermund
- Department of Medical Biochemistry and Cell Biology, University of Gothenburg, PO Box 440, 405 30, Gothenburg, Sweden
| | - Gunnar C Hansson
- Department of Medical Biochemistry and Cell Biology, University of Gothenburg, PO Box 440, 405 30, Gothenburg, Sweden
| | - Joost de Graaf
- Institute for Theoretical Physics, Center for Extreme Matter and Emergent Phenomena, Utrecht University, Princetonplein 5, 3584 CC, Utrecht, The Netherlands
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Wuopio J, Orho-Melander M, Engström G, Ärnlöv J. 'No research without perfect methods': a problematic approach in epidemiology. Eur Heart J Open 2023; 3:oead093. [PMID: 37953823 PMCID: PMC10634624 DOI: 10.1093/ehjopen/oead093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/14/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Jonas Wuopio
- Department of Neurobiology, Care Sciences and Society (NVS), Family Medicine and Primary Care Unit, Karolinska Institute, Alfred Nobels allé 23, 141 52 Huddinge, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Lasarettsvägen 10, 79182 Falun, Sweden
| | | | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society (NVS), Family Medicine and Primary Care Unit, Karolinska Institute, Alfred Nobels allé 23, 141 52 Huddinge, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Lasarettsvägen 10, 79182 Falun, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
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Lindow T, Maanja M, Schelbert EB, Ribeiro AH, Ribeiro ALP, Schlegel TT, Ugander M. Heart age gap estimated by explainable advanced electrocardiography is associated with cardiovascular risk factors and survival. Eur Heart J Digit Health 2023; 4:384-392. [PMID: 37794867 PMCID: PMC10545529 DOI: 10.1093/ehjdh/ztad045] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/05/2023] [Indexed: 10/06/2023]
Abstract
Aims Deep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age. Methods and results Both A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using logistic regression. The association between Heart Age Gaps and death or heart failure (HF) hospitalization was evaluated using Cox regression adjusted for clinical covariates/comorbidities. Among patients [n = 731, 103 (14.1%) deaths, 52 (7.1%) HF hospitalizations, median (interquartile range) follow-up 5.7 (4.7-6.7) years], A-ECG Heart Age Gap was associated with risk factors and outcomes [unadjusted hazard ratio (HR) (95% confidence interval) (5 year increments): 1.23 (1.13-1.34) and adjusted HR 1.11 (1.01-1.22)]. DNN-AI Heart Age Gap was associated with risk factors and outcomes after adjustments [HR (5 year increments): 1.11 (1.01-1.21)], but not in unadjusted analyses [HR 1.00 (0.93-1.08)], making it less easily applicable in clinical practice. Conclusion A-ECG Heart Age Gap is associated with cardiovascular risk factors and HF hospitalization or death. Explainable A-ECG Heart Age Gap has the potential for improving clinical adoption and prognostic performance compared with existing DNN-AI-type methods.
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Affiliation(s)
- Thomas Lindow
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia
- Department of Clinical Physiology, Research and Development, Växjö Central Hospital, Region Kronoberg, Sweden
- Clinical Physiology, Clinical Sciences, Lund University, Sweden
| | - Maren Maanja
- Department of Clinical Physiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | - Antônio H Ribeiro
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Antonio Luiz P Ribeiro
- Telehealth Center, Hospital das Clínicas, and Internal Medicine Department, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Todd T Schlegel
- Department of Clinical Physiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
- Nicollier-Schlegel SARL, Trélex, Switzerland
| | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, Australia
- Department of Clinical Physiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Stattin K, Hultström M, Frithiof R, Lipcsey M, Kawati R. Prior physical illness predicts death better than acute physiological derangement on intensive care unit admission in COVID-19: A Swedish registry study. PLoS One 2023; 18:e0292186. [PMID: 37756328 PMCID: PMC10529545 DOI: 10.1371/journal.pone.0292186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
COVID-19 is associated with prolonged intensive care unit (ICU) stay and considerable mortality. The onset of persistent critical illness, defined as when prior illness predicts death better than acute physiological derangement, has not been studied in COVID-19. This national cohort study based on the Swedish Intensive Care Registry (SIR) included all patients admitted to a Swedish ICU due to COVID-19 from 6 March 2020 to 9 November 2021. Simplified Acute Physiology Score-3 (SAPS3) Box 1 was used as a measure of prior illness and Box 3 as a measure of acute derangement to evaluate the onset and importance of persistent critical illness in COVID-19. To compare predictive capacity, the area under receiver operating characteristic (AUC) of SAPS3 and its constituent Box 1 and 3 was calculated for 30-day mortality. In 7 969 patients, of which 1 878 (23.6%) died within 30 days of ICU admission, the complete SAPS3 score had acceptable discrimination: AUC 0.75 (95% CI 0.74 to 0.76) but showed under prediction in low-risk patients and over prediction in high-risk patients. SAPS3 Box 1 showed markedly better discrimination than Box 3 (AUC 0.74 vs 0.65, P<0,0001). Using custom logistic models, the difference in predictive performance of prior and acute illness was validated, AUC 0.76 vs AUC 0.69, p<0.0001. Prior physical illness predicts death in COVID-19 better than acute physiological derangement during ICU stay, and the whole SAPS3 score is not significantly better than just prior illness. The results suggests that COVID-19 may exhibit similarities to persistent critical illness immediately from ICU admission, potentially because of long median ICU length-of-stay. Alternatively, the variables in the acute physiological derangement model may not adequately capture the severity of illness in COVID-19.
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Affiliation(s)
- Karl Stattin
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Lady Davis Institute of Medical Research, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Robert Frithiof
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rafael Kawati
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
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Wärme J, Sundqvist MO, Hjort M, Agewall S, Collste O, Ekenbäck C, Frick M, Henareh L, Hofman-Bang C, Spaak J, Sörensson P, Y-Hassan S, Svensson P, Lindahl B, Hofmann R, Tornvall P. Helicobacter pylori and Pro-Inflammatory Protein Biomarkers in Myocardial Infarction with and without Obstructive Coronary Artery Disease. Int J Mol Sci 2023; 24:14143. [PMID: 37762446 PMCID: PMC10531769 DOI: 10.3390/ijms241814143] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Myocardial infarction (MI) with obstructive coronary artery disease (MI-CAD) and MI in the absence of obstructive coronary artery disease (MINOCA) affect different populations and may have separate pathophysiological mechanisms, with greater inflammatory activity in MINOCA compared to MI-CAD. Helicobacter pylori (Hp) can cause systemic inflammation and has been associated with cardiovascular disease (CVD). We aimed to investigate whether Hp infection is associated with concentrations of protein biomarkers of inflammation and CVD. In a case-control study, patients with MINOCA (n = 99) in Sweden were included, complemented by matched subjects with MI-CAD (n = 99) and controls (n = 100). Protein biomarkers were measured with a proximity extension assay in plasma samples collected 3 months after MI. The seroprevalence of Hp and cytotoxin-associated gene A (CagA) was determined using ELISA. The associations between protein levels and Hp status were studied with linear regression. The prevalence of Hp was 20.2%, 19.2%, and 16.0% for MINOCA, MI-CAD, and controls, respectively (p = 0.73). Seven proteins were associated with Hp in an adjusted model: tissue plasminogen activator (tPA), interleukin-6 (IL-6), myeloperoxidase (MPO), TNF-related activation-induced cytokine (TRANCE), pappalysin-1 (PAPPA), soluble urokinase plasminogen activator receptor (suPAR), and P-selectin glycoprotein ligand 1 (PSGL-1). Hp infection was present in one in five patients with MI, irrespective of the presence of obstructive CAD. Inflammatory proteins were elevated in Hp-positive subjects, thus not ruling out that Hp may promote an inflammatory response and potentially contribute to the development of CVD.
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Affiliation(s)
- Jonatan Wärme
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Martin O. Sundqvist
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Marcus Hjort
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Stefan Agewall
- Division of Medicine, Institute of Clinical Medicine, University of Oslo, NO-0318 Oslo, Norway
- Department of Cardiology, Oslo University Hospital, NO-0450 Oslo, Norway
| | - Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Christina Ekenbäck
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Loghman Henareh
- Department of Medicine Huddinge, Karolinska Institute, SE-141 86 Huddinge, Sweden
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Claes Hofman-Bang
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden
| | - Peder Sörensson
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Shams Y-Hassan
- Department of Medicine Huddinge, Karolinska Institute, SE-141 86 Huddinge, Sweden
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Per Svensson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, SE-118 83 Stockholm, Sweden
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Taha A, Hjärpe A, Martinsson A, Nielsen SJ, Barbu M, Pivodic A, Lannemyr L, Bergfeldt L, Jeppsson A. Cardiopulmonary bypass management and risk of new-onset atrial fibrillation after cardiac surgery. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad153. [PMID: 37713475 PMCID: PMC10533753 DOI: 10.1093/icvts/ivad153] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES Cardiopulmonary bypass (CPB) management may potentially play a role in the development of new-onset atrial fibrillation (AF) after cardiac surgery. The aim of this study was to explore this potential association. METHODS Patients who underwent coronary artery bypass grafting and/or valvular surgery during 2016-2020 were included in an observational single-centre study. Data collected from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies registry and a local CPB database were merged. Associations between individual CPB variables (CPB and aortic clamp times, arterial and central venous pressure, mixed venous oxygen saturation, blood flow index, bladder temperature and haematocrit) and new-onset AF were analysed using multivariable logistic regression models adjusted for patient characteristics, comorbidities and surgical procedure. RESULTS Out of 1999 patients, 758 (37.9%) developed new-onset AF. Patients with new-onset postoperative AF were older, had a higher incidence of previous stroke, worse renal function and higher EuroSCORE II and CHA2DS2-VASc scores and more often underwent valve surgery. Longer CPB time [adjusted odds ratio 1.05 per 10 min (95% confidence interval 1.01-1.08); P = 0.008] and higher flow index [adjusted odds ratio 1.21 per 0.2 l/m2 (95% confidence interval 1.02-1.42); P = 0.026] were associated with an increased risk for new-onset AF, while the other variables were not. A sensitivity analysis only including patients with isolated coronary artery bypass grafting supported the primary analyses. CONCLUSIONS CPB management following current guideline recommendations appears to have minor or no influence on the risk of developing new-onset AF after cardiac surgery.
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Affiliation(s)
- Amar Taha
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Hjärpe
- Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Martinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Barbu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Blekinge Hospital, Karlskrona, Sweden
| | - Aldina Pivodic
- APNC Sweden, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lukas Lannemyr
- Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Anaesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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