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Eriksson C, Sun J, Bryder M, Bröms G, Everhov ÅH, Forss A, Jernberg T, Ludvigsson JF, Olén O. Impact of inflammatory bowel disease on the risk of acute coronary syndrome: A Swedish Nationwide Cohort Study. Aliment Pharmacol Ther 2024; 59:1122-1133. [PMID: 38425022 DOI: 10.1111/apt.17932] [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: 10/26/2023] [Revised: 11/21/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND There are conflicting data on the risk of acute coronary syndrome (ACS) in patients with inflammatory bowel disease (IBD). Only a few previous reports include patients diagnosed during the last decade. AIM To assess and compare the risk of ACS between patients with IBD and the general population. METHODS In this cohort study, we used nationwide registers to identify patients diagnosed with IBD in Sweden 2003-2021. Every patient was matched by birth year, sex, calendar year and area of residence with up to 10 general population comparators. The primary outcome was incident ACS. We used semi-parametric Cox proportional hazard models to estimate hazard ratios (HRs). RESULTS We identified 76,517 patients with IBD (Crohn's disease [CD], N = 22,732; ulcerative colitis [UC], N = 42,194 and IBD-unclassified, N = 11,591) and 757,141 comparators. During a median follow-up of 8 years, 2546 patients with IBD (37.5/10,000 person-years) were diagnosed with ACS compared with 19,598 (28.0/10,000 person-years) among comparators (HR 1.30; 95% confidence interval 1.24-1.35) after adjustments for confounding factors, and approximately one extra case of ACS in 100 IBD patients followed for 10 years. The highest HRs for ACS were in patients with elderly onset IBD (≥60 years) and among patients with CD or UC with extra-intestinal manifestations. No increased HRs were observed in patients diagnosed with IBD before the age of 40. CONCLUSION In this contemporary cohort of patients with IBD, exposed to modern IBD care, there was an increased risk for ACS compared with individuals from the general population.
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Affiliation(s)
- Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jiangwei Sun
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Matti Bryder
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Gabriella Bröms
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Division of Gastroenterology, Department of Specialist Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Åsa H Everhov
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anders Forss
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology Unit, Department of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Ola Olén
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
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Kvanta H, Bolk J, Strindberg M, Jiménez-Espinoza C, Broström L, Padilla N, Ådén U. Exploring the distribution of grey and white matter brain volumes in extremely preterm children, using magnetic resonance imaging at term age and at 10 years of age. PLoS One 2021; 16:e0259717. [PMID: 34739529 PMCID: PMC8570467 DOI: 10.1371/journal.pone.0259717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To investigate differences in brain volumes between children born extremely preterm and term born controls at term age and at 10 years of age. Study design Children born extremely preterm (EPT), up to 26 weeks and 6 days gestational age, in Stockholm between January 1 2004 to March 31 2007 were included in this population-based cohort study. A total of 45 EPT infants were included at term age and 51 EPT children were included at 10 years of age. There were 27 EPT children included at both time points. Two different control groups were recruited; 15 control infants were included at term age and 38 control children at 10 years of age. The primary outcomes were the grey and white matter volumes. Linear regression, adjusted for intracranial volume and sex, was used. Results At term age, the extremely preterm infants had significantly smaller grey matter volume compared to the control infants with an adjusted mean difference of 5.0 cm3 and a 95% confidence interval of −8.4 to −1.5 (p = 0.004). At 10 years of age the extremely preterm children had significantly smaller white matter volume compared to the control children with an adjusted mean difference of 6.0 cm3 and a 95% confidence interval of −10.9 to −1.0 (p = 0.010). Conclusion Extremely preterm birth was associated with reduced grey matter volume at term age and reduced white matter volume at 10 years of age compared to term born controls.
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Affiliation(s)
- Hedvig Kvanta
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- * E-mail:
| | - Jenny Bolk
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - Marika Strindberg
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Carmen Jiménez-Espinoza
- Faculty of Health Sciences, Department of Basic Medical Sciences, Physiology Section, University of La Laguna, Tenerife, Spain
| | - Lina Broström
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, South General Hospital, Stockholm, Sweden
| | - Nelly Padilla
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Ulrika Ådén
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
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Reepalu A, Balcha TT, Skogmar S, Güner N, Sturegård E, Björkman P. Factors Associated with Early Mortality in HIV-Positive Men and Women Investigated for Tuberculosis at Ethiopian Health Centers. PLoS One 2016; 11:e0156602. [PMID: 27272622 PMCID: PMC4896420 DOI: 10.1371/journal.pone.0156602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/17/2016] [Indexed: 11/19/2022] Open
Abstract
Introduction Despite increasing access to antiretroviral treatment (ART) in low-income countries, HIV-related mortality is high, especially in the first months following ART initiation. We aimed to evaluate the impact of TB coinfection on early mortality and to assess gender-specific predictors of mortality in a cohort of Ethiopian adults subjected to intensified casefinding for active TB before starting ART. Material and Methods Prospectively recruited ART-eligible adults (n = 812, 58.6% female) at five Ethiopian health centers were followed for 6 months. At inclusion sputum culture, Xpert MTB/RIF, and smear microscopy were performed (158/812 [19.5%] had TB). Primary outcome was all-cause mortality. We used multivariate Cox models to identify predictors of mortality. Results In total, 37/812 (4.6%) participants died, 12 (32.4%) of whom had TB. Karnofsky performance score (KPS) and mid-upper arm circumference (MUAC) were associated with mortality in the whole population. However, the associations were different in men and women. In men, only MUAC remained associated with mortality (adjusted hazard ratio [aHR] 0.71 [95% CI 0.57–0.88]). In women, KPS <80% was associated with mortality (aHR 10.95 [95% CI 2.33–51.49]), as well as presence of cough (aHR 3.98 [95% CI 1.10–14.36]). Cough was also associated with mortality for TB cases (aHR 8.30 [95% CI 1.06–65.14]), but not for non-TB cases. Conclusions In HIV-positive Ethiopian adults managed at health centers, mortality was associated with reduced performance score and malnutrition, with different distribution with regard to gender and TB coinfection. These robust variables could be used at clinic registration to identify persons at increased risk of early mortality.
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Affiliation(s)
- Anton Reepalu
- Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- * E-mail:
| | - Taye Tolera Balcha
- Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- Ministry of Health, Addis Ababa, Ethiopia
| | - Sten Skogmar
- Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Nuray Güner
- Region Skåne Competence Center, Skåne University Hospital, Lund, Sweden
| | - Erik Sturegård
- Medical Microbiology, Department of Laboratory Medicine, Malmö, Lund University, Lund, Sweden
| | - Per Björkman
- Infectious Diseases Research Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
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