Body size in adolescence and future risk of Aortic disease: a nationwide cohort study of Swedish men

Background

To improve cardiovascular disease prevention, knowledge of early key risk factors for aortic disease (AD), especially those that are modifiable such as overweight and obesity, is essential. Therefore, we aimed to determine whether measures of body size, including body mass index (BMI), body surface area (BSA) and body height in adolescent men is associated to AD later in life.

Methods

Register-based cohort study of conscripts (n=1,575,909; mean age at baseline, 18.3 years) who enlisted during 1968–2005 in Sweden. Follow-up was done through linkage to the nationwide Swedish inpatient- and cause of death registries. Risk of AD (hospitalization for Aortic aneurysm or aortic dissection) during follow-up (5–48 years) was calculated with cox proportional hazard models.

Results

During follow-up there were 8185 cases of AD. Incidence rates (per 100000 person years) increased with increasing body size measures; BSA 14.19 (95% CI, 13.6–14.8) for Q1 vs 19.36 (18.6–20.2) for Q4; BMI 15.89 (15.2–16.6) for Q1 vs. 16.89 (16.2–17.6) for Q4; and body height 13.45 (95% CI, 12.9–14.1) for Q1 vs 19.93 (95% CI, 19.1–20.8) for Q4. Compared to the lowest, the highest quartile of BSA and body height was associated with increased risk of AD (adjusted HR (aHR) 1.95 (95% confidence interval 1.83–2.08) and 1.72 (1.62–1.83) respectively). For BMI, the corresponding aHR was 1.40 (1.31–1.49, Figure 1).

Conclusion

Large body size in early adulthood is associated with risk for aortic disease later in life. The pathophysiological mechanisms remain uncertain and warrants further investigation.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Swedish state under the agreement concerning research and education of doctors [grant number ALFGBG-427301]; the Swedish Society for Physicians, the Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, Sweden, and the Swedish Heart and Lung Foundation [grant number 2015-0438]; the Swedish Research Council [grant numbers 2013-5187 (SIMSAM), 2013-4236]; and the Swedish Council for Health, Working Life and Welfare (FORTE) [grant numbers 2013-0325]

Engineered mesoporous silica reduces long-term blood glucose, HbA1c, and improves metabolic parameters in prediabetics

Aim: To investigate the effect of oral consumption of engineered mesoporous silica particles, SiPore15^®, on long-term blood glucose levels and other metabolic parameters in individuals with prediabetes and newly diagnosed Type 2 diabetes. Method: An open-label, single-arm, multicenter trial was conducted in which SiPore15 was consumed three times daily for 12 weeks. Hemoglobin A1c (HbA1c, primary end point) and an array of metabolic parameters were measured at baseline and throughout the trial. Result: SiPore15 treatment significantly reduced HbA1c by a clinically meaningful degree and improved several disease-associated parameters with minimal side effects. Conclusion: The results from this study demonstrate the potential use of SiPore15 as a treatment for prediabetes that may also delay or prevent the onset of Type 2 diabetes.

Decreasing time on sick leave for patients with heart failure in Sweden during two decades

Background

Heart failure (HF) is increasing in people of working age in Sweden (1). Given high morbidity and reduced quality of life among HF patients (2, 3), working capacity could be greatly affected, however, studies are scarce.

Purpose

To determine trends in sick leave rates following a first hospitalization for HF in Sweden 1995–2015 compared to controls matched by age and sex.

Methods

In Sweden, people who cannot work receive sickness benefit. Sickness benefit pay days are registered by Statistics Sweden. We identified all patients aged 18–60 years with a first hospitalization for HF in Sweden 1995–2012 in the National Patient Register (NPR). For each case we selected 2 controls matched for age and sex. Cases and controls were split into age groups, <45 years and 45–60 years. Age, sex and comorbidities were recorded. Paid sickness benefit days were recorded during the index year and the two subsequent years.

Results

A total of 24,677 cases and 65,923 controls were included, mean age for the younger and older age group 36.6 and 54.5 years, and proportion of women 35.3% and 23.8%, respectively. In 1995, the proportion of time on sickness benefit in patients <45 years was on average 28%, decreasing to 15% in 2012, with corresponding estimates for patients 45–60 29% and 17%, shown by index year for cases and controls for patients <45 years in Figure 1 and for patients 45–60 years in Figure 2.

Conclusion

Patients had a longer time on sick leave than controls over the study period. Time on sickness benefit initially declined over the course of the study period for both patients and controls, but the last years of the study period this decline stalled for both patients and controls.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Swedish state under an agreement between the Swedish government and the County Councils Concerning Economic Support of Research and Education of Doctors [ALFGBG-717211, ALFGBG-433211, ALFGBG-725081]; the Swedish Heart and Lung Foundation [2013-0307, 2018-0419, 2018-0589]. Figure 1Figure 2

Post-discharge major bleeding, myocardial infarction and mortality risk after coronary artery bypass grafting: a nationwide cohort study from the SWEDEHEART registry

Background

Platelet inhibition and occasionally oral anticoagulants are used after coronary artery bypass grafting (CABG) to reduce ischaemic events but may increase bleeding risk. The impact of post-discharge major bleeding and myocardial infarction on mortality risk in CABG patients is unknown.

Methods

All patients who underwent first-time isolated CABG in Sweden 2006–2017 and survived 14 days after discharge were included. Individual patient data from five mandatory national registries (SWEDEHEART, National Patient Register, Swedish Prescribed Drug Register, Cause of Death Register and The Swedish Population Register) were merged. Post-discharge major bleeding and myocardial infarction were defined as hospitalization with a bleeding or myocardial infarction diagnosis as main diagnosis respectively. A Cox proportional piecewise hazard model for the effect of time-updated bleeding and myocardial infarction as first post-discharge event on subsequent mortality risk was developed. The model was adjusted for age, sex, year of surgery, comorbidities at baseline and time-updated use of platelet inhibitors, oral anticoagulants and other secondary prevention medications. To estimate the time-dependent risk on mortality after an event, hazard ratios were calculated for <30 days, 30–365 days and >365 days after first incidence of major bleeding and myocardial infarction.

Results

In total 36 633 patients were included and median follow-up was 6.0 years (25th-75th percentile 3.0–9.0 years). During follow-up, 2265 (6.2%) patients suffered a major bleeding and 2108 (5.8%) patients a myocardial infarction as a first post-discharge event. In total 6683 (18.2%) died during follow-up. Both major bleeding and myocardial infarction were significantly associated with increased mortality risk compared to patients without any major bleeding or myocardial infarction. The adjusted hazard ratios for mortality <30 days after major bleeding were 21.45 (95% CI 18.27–25.20) and 22.00 (95% CI 18.29–26.45) after myocardial infarction, 4.04 (95% CI 3.57–4.56) and 4.54 (95% CI 3.88–5.31) 30–365 days after the event and 1.57 (95% CI 1.43–1.72) and 2.07 (95% CI 1.86–2.30) >365 days after the event, all compared to patients without major bleeding or myocardial infarction.

Conclusion

Major bleeding and myocardial infarction as first post-discharge event after CABG had similar incidence and were associated with a significant and comparable increase in mortality risk. The risk was highest during the first 30 days after the event. Strategies to prevent myocardial infarction and major bleeding events after CABG are of great importance to improve survival.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Swedish Heart-Lung FoundationSparbanken Sjuhärads stiftelse för forskning vid Södra Älvsborgs Sjukhus Forest plot

Diverging trends for onset of acute myocardial infarction, heart failure, stroke and mortality in young males: role of changes in obesity and fitness

BACKGROUND

As opposed to the decreasing overall rates of coronary heart disease (CHD) incidence and overall cardiovascular disease (CVD) mortality, heart failure (HF) and stroke incidence are increasing in young people, potentially due to rising rates of obesity and reduced cardiorespiratory fitness (CRF).

OBJECTIVES

We investigated trends in early major CVD outcomes in a large cohort of young men.

METHODS

Successive cohorts of Swedish military conscripts from 1971 to 1995 (N = 1,258,432; mean age, 18.3 years) were followed, using data from the National Inpatient and Cause of Death registries. Cox proportional hazard models were used to analyse changes in 21-year CVD event rates.

RESULTS

21-year CVD and all-cause mortality and incidence of acute myocardial infarction (AMI) decreased progressively. Compared with the cohort conscripted in 1971-1975 (reference), the hazard ratios (HRs) for the last 1991-1995 cohort were 0.50 [95% confidence interval (CI) 0.42-0.59] for CVD mortality; 0.57 (95% CI 0.54-0.60) for all-cause mortality; and 0.63 (95% CI 0.53-0.75) for AMI. In contrast, the incidence of ischaemic stroke, intracerebral haemorrhage and HF increased with HRs of 1.43 (95% CI 1.17-1.75), 1.30 (95% CI 1.01-1.68) and 1.84 (95% CI 1.47-2.30), respectively. During the period, rates of obesity increased from 1.04% to 2.61%, whilst CRF scores decreased slightly. Adjustment for these factors influenced these secular trends only moderately.

CONCLUSION

Secular trends of young-onset CVD events demonstrated a marked shift from AMI and CVD mortality to HF and stroke incidence. Trends were significantly, though moderately, influenced by changing baseline BMI and CRF.

Predicting one-year outcomes in first-episode psychosis

The outcome of first-episode psychosis (FEP) varies and may be predicted by several baseline measures. In the Helsinki Early Psychosis Study, young adults with FEP (n=97) from the Helsinki area in Finland were broadly assessed as soon as possible after first psychiatric contact for psychosis. Age- and gender-matched population controls were also assessed (n=62). The participants were followed up via appointments and medical records. We present both published and unpublished results on predictors of 12-month clinical, functional, and metabolic outcomes. More severe cognitive deficits at the beginning of treatment predicted several outcomes such as occupational status and functional level – beyond baseline positive and affective symptom levels, but not when negative symptoms were accounted for. More severe baseline obsessive-compulsive symptoms were predictive of a lower rate of remission, whereas a higher level of anxiety symptoms predicted better functional outcome, when the severity of positive symptoms was adjusted for. Adverse childhood experiences measuring cumulating psychosocial stress did not predict occupational status or functional level when positive and negative symptoms and neurocognition were controlled for, whereas in controls having experienced school bullying was associated with lower functioning. Insulin resistance in early psychosis appeared as an early marker of increased vulnerability to weight gain and abdominal obesity in young adults with FEP. Further, increased waist circumference predicted worsening low-grade inflammation, increasing further the cardiovascular risk. In sum, we have found different types of prognostic markers in FEP. Identifying the individuals at risk of less favorable outcomes could affect treatment choices in FEP.

Younger patients have an increased risk for dementia after coronary artery bypass grafting, a population-based cohort study from the SWEDEHEART registry

Background

Previous studies investigating the association between coronary artery bypass grafting (CABG) and risk for dementia show conflicting results.

Purpose

To compare the long-term risk for dementia in CABG patients to matched individuals in the general population, and to identify independent predictors for developing dementia after CABG.

Methods

Data from the SWEDEHEART registry and three other mandatory national registries were merged to compare all patients who underwent isolated CABG in Sweden from 1992 to 2015 (n=111.335) with an age- and sex-matched control individuals from the general population (n=222.396). Cumulative incidence adjusted for the competing risk for death and Cox regression models with Hazard Ratio (HR) and 95% confidence interval (CI) adjusted for age, gender, co-morbidity and socioeconomic variables, were used to calculate the risk of dementia. Median follow-up was 10.1 years (IQR 2.5–14.7) among CABG patients and 10.7 years (5.6–15.7) among the controls. Identified interactions of the excess risk for dementia with sex and age categories (<65, 65-<75, ≥75 years) resulted in analyses being stratified on those sub-cohorts.

Results

The overall cumulative incidence at 20 years follow up of all-cause dementia was 9.6% (95% CI 9.4–9.9) among CABG patients and 9.0 (8.8–9.2) among individuals in the general population. The adjusted relative risk for all-cause dementia was increased among CABG patients <65 years and 65–75 years, (HR 1.29 (95% CI 1.17–1.41) and HR 1.06 (1.01–1.11), respectively (fig 1). The risk for all-cause dementia was higher in CABG women than in CABG men (HR 1.62 (1.30–2.03) vs HR 1.22 (1.10–1.35)). In the oldest age group (75 years and older) the risk for all cause dementia, vascular dementia and Alzheimer's disease was lower for CABG patients compared to controls (HR 0.73 (0.69–0.78). Female CABG patients <65 years had an increased risk for Alzheimer's disease (HR 1.83 (1.06–3.15). Hypertension, diabetes, preoperative stroke, renal failure, heart failure, atrial fibrillation, depression and low income were independent predictors for all-cause dementia in CABG patients.

Conclusion

CABG patients younger than 75 years at the time of surgery have an increased risk of all-cause dementia compared to an age- and sex-matched population. Women younger than 65 years that underwent CABG had also a markedly higher risk for Alzheimer disease. Increased awareness of the higher risk for dementia in younger CABG patients is warranted to avoid delay of diagnosis and treatment.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swedish Heart and Lung Foundation, Swedish State

High prevalence of alcohol- and substance abuse among young heart failure patients in Sweden

Background

Heart failure in the young is increasing. Increasing prevalence of overweight and obesity may be of importance. While alcohol and drugs are known to have cardiotoxic effects, few studies have investigated the prevalence of alcohol- or substance abuse among young patients with HF.

Aim

To investigate the prevalence of alcohol- and substance abuse in a cohort of young patients with heart failure.

Methods

All patients that received a diagnosis of heart failure at Sahlgrenska University Hosital (Sweden) between 1997 and 2016, ages 18–54, with a previously documented transthoracic echocardiogram were included. A systematic evaluation of participants electronic health records was performed, where predefined details about the use of alcohol, narcotic drugs and anabolic steroids, as well as echocardiographic findings were recorded.

Result

A total of 1363 patients were included (1001 men and 366 women, mean age 45 years), 190 (14%) of which were <34 years, 304 (22%) 35–44, and 869 (64%) 45–54 years. In total, a record of either alcohol- or substance abuse was found in 28% of men and 9% of women, respectively. The prevalence of Anabolic steroids was found to be 2% among men. For substance abuse, the prevalence was found to be 12% in men and 5% in women. Alcohol abuse was found in 24% of men and 5% of women. Both alcohol- and drug abuse was most common in the highest age group.

Conclusion

There was a high prevalence of alcohol- and/or drug-abuse among young adults with heart failure, especially in male patients.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swedish state under the agreement concerning research and education of doctors [grant number ALFGBG-427301]; The Swedish Society for Physicians, the Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, Sweden, and the Swedish Heart and Lung Foundation [grant number 2015-0438]

Increasing home-time for patients with heart failure in Sweden 1992–2008

Background

Heart failure (HF) reduces survival and is one of the most common causes of hospitalizations in the elderly, imposing a major economic burden on the health care system, with frequency of rehospitalizations often used in interventional and observational studies in patients with HF. Home-time is a novel end-point measuring time spent alive and out of hospital and is easier for both clinicians and patients to relate to. Given the advances in treatment of HF over the last decades we postulated that an increase in home-time would follow.

Purpose

To investigate whether home-time for patients with HF has changed over the last decades in Sweden and if home-time differs between patients of working age and those retired, or between men and women.

Methods

Patients aged 18–84 years with a first hospitalization for HF in Sweden between 1992 and 2008 were identified using the National Inpatient Register which was linked to the Swedish Cause of Death Register. Information on rehospitalizations and mortality was collected and followed over a time period of 4 years. The patients were divided into two age groups: (i) <65 years and (ii) >65 years. The cut off 65 years was chosen being the official age of retirement over the study period in Sweden.

Results

A total of 324,907 patients were included in this study, mean age 73.5 years (standard deviation 9.3). Only 15.6% were <65 and 45.1% were women. In total, average home-time was 70.1% of the total follow up time, 2.1% of time was spent in hospital while, during a mean of 27.9% of the 4 year-period, patients were no longer alive. A small increase in home-time was observed over the study period. The older age group spent 67.7% at home compared with 83% in the younger group. After taking differences in mortality into account, the difference in home-time was no longer significant, with 92.7 and 95.8% home-time for the older and younger age groups, respectively. Over the entire study period older men had less home-time compared with older women. Since 1998 the reverse was true in younger men and women, where younger men had more home-time than younger women. Home-time increased for all subgroups over the study period with the most pronounced increase for younger men (see figure 1).

Conclusion

Home-time for patients in Sweden increased over the study period and the increase was more marked for younger patients, where men spent more time at home than women.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swedish state (ALF), The Swedish Heart and Lung Foundation, Västra Götaland Region, The Göteborg Medical Society

Entrapping Digestive Enzymes with Engineered Mesoporous Silica Particles Reduces Metabolic Risk Factors in Humans

Engineered mesoporous silica particles (MSP) are thermally and chemically stable porous materials composed of pure silica and have attracted attention for their potential biomedical applications. Oral intake of engineered MSP is shown to reduce body weight and adipose tissue in mice. Here, clinical data from a first-in-humans study in ten healthy individuals with obesity are reported, demonstrating a reduction in glycated hemoglobin (HbA1c) and low-density lipoprotein cholesterol, which are well-established metabolic and cardiovascular risk factors. In vitro investigations demonstrate sequestration of pancreatic  α-amylase and lipase in an MSP pore-size dependent manner. Subsequent ex vivo experiments in conditions mimicking intestinal conditions and in vivo experiments in mice show a decrease in enzyme activity upon exposure to the engineered MSP, presumably by the same mechanism. Therefore, it is suggested that tailored MSP act by lowering the digestive enzyme availability in the small intestine, resulting in decreased digestion of macronutrient and leading to reduced caloric uptake. This novel MSP based mechanism-of-action, combined with its excellent safety in man, makes it a promising future agent for prevention and treatment of metabolic diseases.

Obesity in adolescent men increases the risk of venous thromboembolism in adult life

BACKGROUND

As the population of obese and severely obese young adults grows, it is becoming increasingly important to recognize the long-term risks associated with adolescent obesity.

OBJECTIVES

This study aimed to determine the association between body mass index (BMI) in young men at enlistment for military service and later risk of venous thromboembolism (VTE).

METHODS

Nationwide register-based prospective cohort study of men enlisting 1969 to 2005, followed through the Swedish National Patient and Cause of Death registries. We identified 1 639 838 men (mean age, 18.3 years) free of prior venous thromboembolism, of whom 29 342 were obese (BMI 30 to <35 kg m^-2 ) and 7236 severely obese (BMI ≥ 35 kg m^-2 ). The participants were followed until a first registered diagnosis of VTE.

RESULTS

During a median follow-up of 28 years (interquartile interval, 20 to 36 years), 11 395 cases of deep vein thrombosis and 7270 cases of pulmonary embolism were recorded. Compared with men with a BMI of 18.5 to <20 kg m^-2 , men with higher BMI in young adulthood showed an incrementally increasing risk of VTE that was moderately but significantly increased already at normal BMI levels. Adolescent obese men with a BMI of 30 to 35 kg m^-2 had an adjusted hazard ratio of 2.93 (95% confidence interval, 2.65 to 3.24) for VTE. Severely obese men with a BMI of ≥35 kg m^-2 had a hazard ratio of 4.95 (95% confidence interval, 4.16 to 5.90).

CONCLUSIONS

Men who were obese or severely obese in young adulthood had a marked increase in risk of VTE.

Mesoporous silica with precisely controlled pores reduces food efficiency and suppresses weight gain in mice

Aim: Obesity is a risk factor for cardiovascular disease and diabetes. We aimed to elucidate the effects of distinct mesoporous silica particles (MSPs) supplemented in food on metabolic parameters in obesity. Materials & methods: MSPs with precisely controlled pore size were synthesized, characterized and compared with a control in a C57Bl/6 mouse diet-induced obesity model, studying weight, adiposity, metabolic regulation and food efficiency. Results: The most effective MSPs reduced adipose tissue formation to 6.5 ± 0.5 g compared with 9.4 ± 1.2 g, leptin levels nearly halved from 32.8 ± 7.4 to 16.9 ± 1.9 ng/ml and a 33% reduction of food efficiency. Control MSP showed no effects. Conclusion: Results demonstrate potential of distinct MSPs to improve metabolic risk factors. Further studies investigating mechanism of action and confirming human safety are needed.

P3821Resting heart rate in late adolescence and long term risk of cardiomyopathy - A nationwide study of one million Swedish men

Background/Introduction

Elevated resting heart rate (RHR) is a known risk factor for HF. Whether elevated RHR is also associated with cardiomyopathy (CM), a common cause of heart failure in the young, is unknown.

Purpose

To investigate the association of resting heart rate (RHR) measured in late adolescence with long term risk of various subtypes of CM with special attention to cardiorespiratory fitness (CRF), an important predictor of RHR and myocardial dysfunction.

Methods

We followed a cohort of Swedish men enrolled for conscription in 1968–2005 (n=1,008,485; mean age=18.3 years) until December 2014. Outcomes of CM were collected from the national inpatient- (IPR), outpatient- (OPR) and cause of death registries and were divided into categories: 1) dilated, 2) hypertrophic, 3) alcohol/drug-induced, and 4) other. Cox proportional hazard models were used to analyze the longitudinal association between RHR and outcomes while adjusting for potential confounders, including body mass index (BMI), arterial blood pressure and cardiorespiratory fitness (CRF). CRF was measured by maximum capacity ergometer testing as part of the enlistment protocol.

Results

During a mean follow up of 34 years, there were 3500 cases of a first hospitalization for CM (mean age at diagnosis, 50.1 years). Comparing the highest with the lowest quintile of the RHR distribution, we found a positive association between RHR and dilated CM (hazard ratio (HR) = 1.58 [confidence interval (CI) = 1.37–1.82]) after adjustment for BMI, age at conscription, conscription year, test center, and baseline comorbidities (diabetes, hypertension, congenital heart disease). There no significant association with alcohol/drug-induced (HR=1.32 [CI=0.94–1.85]) or other categories of CM.

Conclusion

Adolescent RHR is associated with future risk CM, independently of blood pressure, BMI and CRF. The association was driven by dilated CM. These findings are suggestive of a causal pathway between elevated heart rate and adverse cardiac remodeling that warrants further investigation.

Acknowledgement/Funding

The Swedish Heart and Lung Foundation, the Swedish Research Council, the Swedish Council for Health, Working Life and Welfare

P2495Poor cardiorespiratory fitness in adolescence predicts cardiomyopathy risk in mid-life

Background

Cardiorespiratory fitness and physical activity have well–known cardio–protective effects. Along with reports on declining levels of physical activity globally, heart failure caused by cardiomyopathy is increasing among young people. Still, it is unknown whether poor fitness in adolescence can be associated with cardiomyopathy in adulthood.

Purpose

To study a possible link between cardiorespiratory fitness in adolescence and being diagnosed with cardiomyopathy in adulthood.

Methods

A nationwide register-based prospective cohort study of 1,668,893 young men (mean age 18.3 years, SD 0.7), enlisting for compulsory military service 1969–2005. Body mass index (BMI) and blood pressure were registered at baseline, along with test results for fitness. Values were trichotomized and about 13.5% were classified as having poor cardiorespiratory fitness. Cardiomyopathy diagnoses were identified from the National Hospital Register and Cause of Death Register, during an up to 46-year follow-up, and divided into categories: 1) dilated, 2) hypertrophic, 3) alcohol/drug-induced, and 4) other. Hazard ratios (HR) were calculated with Cox proportional hazards models.

Results

During follow-up (median 27 years; interquartile interval 19–35 years), 4,477 cases of cardiomyopathy were registered, of which 2,631 (59%) were dilated, 673 (15%) were hypertrophic, and 480 (11%) were alcohol/drug-induced. Poor cardiorespiratory fitness was strongly associated with elevated risk of both dilated (HR 1.59, 95% confidence interval (CI) 1.38–1.83) and alcohol/drug–induced cardiomyopathy (HR 2.32, 95% CI 1.68–3.20), adjusted for BMI, age at conscription, conscription year, test center, and baseline comorbidities (diabetes, hypertension, congenital heart disease).

Conclusion

The present study shows that poor cardiorespiratory fitness in adolescence may be associated with both dilated and alcohol/drug–induced cardiomyopathy in adulthood. This strengthens the evidence of fitness as a cardio–protective factor, and brings further support to the importance of interventions promoting physical activity already in childhood.

Acknowledgement/Funding

The Swedish Research Council, The Swedish Heart and Lung Foundation

4949Diverging secular trends in cardiovascular disease 21-year incidence in Swedish men born in 1950–1978

Background

Cardiovascular disease (CVD) mortality is decreasing in Western countries, including Sweden. However, there are reports of increases in incidence in young people with respect to heart failure (HF) and atrial fibrillation (AF). The magnitude and causes of these changes are only partly known.

Aims

We investigated secular trends in incidence in CVD outcomes and their attenuation by changes in body mass index (BMI). The outcomes were risk of acute myocardial infarction (AMI), heart failure (HF) and atrial fibrillation (AF) as well as cardiovascular and all-cause death in a population of Swedish adolescents.

Methods

We followed a cohort of Swedish men enrolled for military service conscription in 1969–1996 (n=1,326,082; mean age=18.3) until December 2016, collected from the national inpatient (IPR) and outpatient registries (OPR). Cox-proportional hazard models were used to analyse the longitudinal change in incidence by with respect to early (0–21 years) of follow-up for subgroups with conscription 1968–1971, 1971–1976, 1976–1981, 1981–1986, 1986–1991, 1991–1996 (with the group born 1971–1976 as reference). Adjustments for potential confounders including BMI were performed.

Results

We found that CVD and all-cause mortality and MI decreased progressively during the follow-up with hazard ratios (HR) of 0.51, 95% confidence interval (CI) 0.43–0.62, HR 0.51 CI 0.57–0.62, and 0.60 CI 0.50–0.72, respectively. In contrast, we found increases in the incidence of HF (HR 1.86, CI 1.48–2.33], and AF (HR 8.26, CI 6.87–9.92). Adjustments for changes in BMI partly attenuated the changes in secular trends. Cubic spline models showed where the changes in secular trends were most prominent.

Conclusion

The incidences of cardiovascular outcomes show diverging secular changes. While MI and cardiovascular mortality are continually decreasing, there is an increase in HF and AF. The associations appear to be partly explained by changes in index BMI over time.

Acknowledgement/Funding

grants from the Swedish Government and the county councils, the ALF–GBG-719761, ALFGBG-751111, Swedish Stroke Association, Göteborg Medical Society

The lack of association between herpes simplex virus 1 or Toxoplasma gondii infection and cognitive decline in the general population: An 11-year follow-up study

BACKGROUND

Inflammation has been suggested to be one, possibly treatable, cause of cognitive decline and dementia. The purpose of the present article was to investigate whether the herpes simplex virus 1 (HSV-1) or Toxoplasma gondii (T. gondii) infections are related to cognitive decline or dementia.

METHOD

The Health 2000 survey, conducted 2000-2001, is a population-representative sample of people over 30 years old that involved 7112 participants. The sample was followed up in the year 2011, in the Health 2011 study. At both time points, cognitive performance was assessed with two tests from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) assessing verbal fluency and verbal learning. In addition, the abbreviated Mini-Mental State Examination was administered to people aged over 55. In addition, tests assessing reaction and movement time were performed at baseline. Dementia diagnoses from nationwide health care registers were followed up until the end of year 2013. The presence of HSV-1 and T. gondii immunoglobulin G (IgG) was determined by solid-phase immunoassay at baseline.

RESULTS

HSV-1 or T. gondii seropositivity, or IgG antibody levels, were not associated with cognitive decline when investigated as infection × time interactions. In addition, the infections were not associated with the risk of dementia.

CONCLUSIONS

In a large sample of participants that is representative of the whole country and with a long follow-up, the results suggest that latent HSV-1 or T. gondii infections are not related to either decline in cognitive performance or dementia risk.

Anti-neuronal anti-bodies in patients with early psychosis

It may be challenging to distinguish autoimmune encephalitis associated with anti-neuronal autoantibodies from primary psychiatric disorders. Here, serum was drawn from patients with a first-episode psychosis (n=70) or a clinical high-risk for psychosis (n=6) and controls (n=34). We investigated the serum prevalence of 24 anti-neuronal autoantibodies: IgG antibodies for anti-N-methyl-d-aspartate-type glutamate receptor (anti-NMDAR), glutamate and γ-aminobutyric acid alpha and beta receptors (GABA-a, GABA-b), alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA), glycine receptor (GlyR), metabotropic glutamate receptor 1 and 5 (mGluR1, mGluR5), anti-Tr/Delta/notch-like epidermal growth factor-related receptor (DNER), contactin-associated protein-like 2 (CASPR2), myelin oligodendrocyte glycoprotein (MOG), glutamic acid decarboxylase-65 (GAD65), collapsin response mediator protein 5/crossveinless-2 (CV2), aquaporin-4 (AQP4), anti-dipeptidyl-peptidase-like protein-6 (DPPX), type 1 anti-neuronal nuclear antibody (ANNA-1, Hu), Ri, Yo, IgLON5, Ma2, zinc finger protein 4 (ZIC4), Rho GTPase-activating protein 26, amphiphysin, and recoverin, as well as IgA and IgM for dopamine-2-receptor (DRD2). Anti-NMDA IgG antibodies were positive with serum titer 1:320 in one patient with a clinical high risk for psychosis. He did not receive a diagnosis of encephalitis after comprehensive neurological evaluation. All other antineuronal autoantibodies were negative and there were no additional findings with immunohistochemistry of brain issues.

Inhibition of merozoite invasion and transient de-sequestration by sevuparin in humans with Plasmodium falciparum malaria

SEVERE MALARIA

Even with the best available treatment, the mortality from severe Plasmodium falciparum malaria remains high. Typical features at death are high parasite loads and obstructed micro- vasculature. Infected erythrocytes (IE) containing mature parasites bind to the host receptor heparan sulfate, which is also an important receptor for merozoite invasion. To block merozoite invasion has not previously been proposed as an adjunctive therapeutic approach but it may preclude the early expansion of an infection that else leads to exacerbated sequestration and death.

SEVUPARIN IN PHASE I STUDY

The drug sevuparin was developed from heparin because heparan sulfate and heparin are nearly identical, so the rationale was that sevuparin would act as a decoy receptor during malaria infection. A phase I study was performed in healthy male volunteers and sevuparin was found safe and well tolerated.

SEVUPARIN IN PHASE I/II CLINICAL STUDY

A phase I/II clinical study was performed in which sevuparin was administered via short intravenous infusions to malaria patients with uncomplicated malaria who were also receiving atovaquone/proguanil treatment. This was a Phase I/II, randomized, open label, active control, parallel assignment study. Sevuparin was safe and well tolerated in the malaria patients. The mean relative numbers of ring-stage IEs decreased after a single sevuparin infusion and mature parasite IEs appeared transiently in the circulation. The effects observed on numbers of merozoites and throphozoites in the circulation, were detected already one hour after the first sevuparin injection. Here we report the development of a candidate drug named sevuparin that both blocks merozoite invasion and transiently de-sequesters IE in humans with P. falciparum malaria.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01442168.

Sevuparin binds to multiple adhesive ligands and reduces sickle red blood cell-induced vaso-occlusion

Sevuparin is a novel drug candidate in phase II development as a treatment for vaso-occlusive crises (VOC) in patients with sickle cell disease (SCD). As a heparin-derived polysaccharide, sevuparin has been designed to retain anti-adhesive properties, while the antithrombin-binding domains have been eliminated, substantially diminishing its anticoagulant activity. Here, we demonstrate that sevuparin inhibits the adhesion of human sickle red blood cells (SS-RBCs) to stimulated cultured endothelial cells in vitro. Importantly, sevuparin prevents vaso-occlusion and normalizes blood flow in an in vivo mouse model of SCD vaso-occlusion. Analyses by surface plasmon resonance (SPR) and fluorescence correlation spectroscopy (FCS) demonstrate that sevuparin binds to P- and L-selectins, thrombospondin, fibronectin and von Willebrand factor, all of which are thought to contribute to vaso-occlusion in SCD. Despite low anticoagulation activity, sevuparin has anti-adhesive efficacy similar to the low molecular weight heparin tinzaparin both in vitro and in vivo. These results suggest that the anti-adhesive properties rather than the anticoagulant effects of heparinoids are critical for the treatment of vaso-occlusion in SCD. Therefore, sevuparin is now being evaluated in SCD patients hospitalized for treatment of VOC.

Fe(III) distribution varies substantially within and between atherosclerotic plaques

PURPOSE

Vulnerable atherosclerotic plaques are structurally weak and prone to rupture, presumably due to local oxidative stress. Redox active iron is linked to oxidative stress and the aim of this study was to investigate the distribution of Fe(III) in carotid plaques and its relation to vulnerability for rupture.

METHODS

Atherosclerotic plaques from 10 patients (three asymptomatic and seven symptomatic) were investigated. Plaque vulnerability was classified using ultrasound and immunohistochemistry and correlated to Fe(III) measured by electron paramagnetic resonance spectroscopy.

RESULTS

Large intra-plaque Fe(III) variations were found. Plaques from symptomatic patients had a higher Fe(III) concentration as compared with asymptomatic plaques (0.36 ± 0.21 vs. 0.06 ± 0.04 nmol Fe(III)/mg tissue, P < 0.05, in sections adjoining narrowest part of the plaques). All but one plaque from symptomatic patients showed signs of cap rupture. No plaque from asymptomatic patients showed signs of cap rupture. There was a significant increase in cap macrophages in plaques from symptomatic patients compared with asymptomatic patients (31 ± 11% vs. 2.3 ± 2.3%, P < 0.01).

CONCLUSION

Fe(III) distribution varies substantially within atherosclerotic plaques. Plaques from symptomatic patients had significantly higher concentrations of Fe(III), signs of cap rupture and increased cap macrophage activity.

Sensory-specific anomic aphasia following left occipital lesions: data from free oral descriptions of concrete word meanings

The present study investigated hierarchical lexical semantic structure in oral descriptions of concrete word meanings produced by a subject (ZZ) diagnosed with anomic aphasia due to left occipital lesions. The focus of the analysis was production of a) nouns at different levels of semantic specificity (e.g., "robin"-"bird"-"animal") and b) words describing sensory or motor experiences (e.g., "blue," "soft," "fly"). Results show that in contrast to healthy and aphasic controls, who produced words at all levels of specificity and mainly vision-related sensory information, ZZ produced almost exclusively nouns at the most non-specific levels and words associated with sound and movement.

Solid solubility of rare earth elements (Nd, Eu, Tb) in In2−xSnxO3 – effect on electrical conductivity and optical properties

Wide band-gap semiconductors doped with luminescent rare earth elements (REEs) have attracted recent interest due to their unique optical properties.

Effects of aerobic conditioning on cardiovascular sympathetic response to and recovery from challenge

Exercise has widely documented cardioprotective effects, but the mechanisms behind these effects are still poorly understood. Here, we test the hypothesis that aerobic training lowers cardiovascular sympathetic responses to and speeds recovery from challenge. We conducted a randomized, controlled trial contrasting aerobic versus strength training on indices of cardiac (pre-ejection period, PEP) and vascular (low-frequency blood pressure variability, LF-BPV) sympathetic responses to and recovery from psychological and orthostatic challenge in 149 young, healthy, sedentary adults. Aerobic and strength training did not alter PEP or LF-BPV reactivity to or recovery from challenge. These findings, from a large randomized, controlled trial using an intent-to-treat design, show that moderate aerobic exercise training has no effect on PEP and LF-BPV reactivity to or recovery from psychological or orthostatic challenge. In healthy young adults, the cardioprotective effects of exercise training are unlikely to be mediated by changes in sympathetic activity.

Search for a two-Higgs-boson doublet using a simplified model in pp collisions at sqrt[s] = 1.96 TeV

We present a search for new particles in an extension to the standard model that includes a heavy Higgs boson (H(0)), a lighter charged Higgs boson (H(±)), and an even lighter Higgs boson h(0), with decays leading to a W-boson pair and a bottom-antibottom quark pair in the final state. We use events with exactly one lepton, missing transverse momentum, and at least four jets in data corresponding to an integrated luminosity of 8.7 fb(-1) collected by the CDF II detector in proton-antiproton collisions at sqrt[s]= 1.96 TeV. We find the data to be consistent with standard model predictions and report the results in terms of a simplified Higgs-cascade-decay model, setting 95% confidence level upper limits on the product of cross section and branching fraction from 1.3 pb to 15 fb as a function of H(0) and H(±) masses for m(h)(0) = 126 GeV/c(2).

Measurements of the top-quark mass and the tt cross section in the hadronic τ+jets decay channel at sqrt[s] = 1.96 TeV

We present the first direct measurement of the top-quark mass using tt events decaying in the hadronic τ+jets decay channel. Using data corresponding to an integrated luminosity of 2.2 fb(-1) collected by the CDF II detector in pp collisions at sqrt[s] = 1.96 TeV at the Fermilab Tevatron, we measure the tt cross section, σ(tt), and the top-quark mass, M(top). We extract M(top) from a likelihood based on per-event probabilities calculated with leading-order signal and background matrix elements. We measure σ(tt) = 8.8 ± 3.3(stat) ± 2.2(syst) pb and M(top) = 172.7 ± 9.3(stat) ± 3.7(syst) GeV/c(2).

Search for the standard model Higgs Boson produced in association with top quarks using the full CDF data set

A search is presented for the standard model Higgs boson produced in association with top quarks using the full Run II proton-antiproton collision data set, corresponding to 9.45 fb(-1), collected by the Collider Detector at Fermilab. No significant excess over the expected background is observed, and 95% credibility-level upper bounds are placed on the cross section σ(ttH → lepton + missing transverse energy+jets). For a Higgs boson mass of 125 GeV/c(2), we expect to set a limit of 12.6 and observe a limit of 20.5 times the standard model rate. This represents the most sensitive search for a standard model Higgs boson in this channel to date.

Measurement of the bottom-strange meson mixing phase in the full CDF data set

We report a measurement of the bottom-strange meson mixing phase β(s) using the time evolution of B(s)(0)→J/ψ(→μ(+)μ(-))φ(→K(+)K(-)) decays in which the quark-flavor content of the bottom-strange meson is identified at production. This measurement uses the full data set of proton-antiproton collisions at √s=1.96 TeV collected by the Collider Detector experiment at the Fermilab Tevatron, corresponding to 9.6 fb(-1) of integrated luminosity. We report confidence regions in the two-dimensional space of β(s) and the B(s)(0) decay-width difference ΔΓ(s) and measure β(s)∈[-π/2,-1.51]∪[-0.06,0.30]∪[1.26,π/2] at the 68% confidence level, in agreement with the standard model expectation. Assuming the standard model value of β(s), we also determine ΔΓ(s)=0.068±0.026(stat)±0.009(syst) ps(-1) and the mean B(s)(0) lifetime τ(s)=1.528±0.019(stat)±0.009(syst) ps, which are consistent and competitive with determinations by other experiments.

Precision top-quark mass measurement at CDF

We present a precision measurement of the top-quark mass using the full sample of Tevatron √s = 1.96 TeV proton-antiproton collisions collected by the CDF II detector, corresponding to an integrated luminosity of 8.7 fb(-1). Using a sample of tt¯ candidate events decaying into the lepton+jets channel, we obtain distributions of the top-quark masses and the invariant mass of two jets from the W boson decays from data. We then compare these distributions to templates derived from signal and background samples to extract the top-quark mass and the energy scale of the calorimeter jets with in situ calibration. The likelihood fit of the templates from signal and background events to the data yields the single most-precise measurement of the top-quark mass, M(top)=172.85±0.71(stat)±0.85(syst) GeV/c(2).

Search for the standard model Higgs boson decaying to a bb pair in events with one charged lepton and large missing transverse energy using the full CDF data set

We present a search for the standard model Higgs boson produced in association with a W boson in sqrt[s]=1.96  TeV pp collision data collected with the CDF II detector at the Tevatron corresponding to an integrated luminosity of 9.45  fb(-1). In events consistent with the decay of the Higgs boson to a bottom-quark pair and the W boson to an electron or muon and a neutrino, we set 95% credibility level upper limits on the WH production cross section times the H→bb branching ratio as a function of Higgs boson mass. At a Higgs boson mass of 125  GeV/c(2), we observe (expect) a limit of 4.9 (2.8) times the standard model value.