Cumulative incidence and risk factors of myocardial infarction during 20 years of follow-up: comparing two cohorts of middle-aged men born 30 years apart

OBJECTIVE

To study cumulative incidence and predictors of myocardial infarction (MI) in two random general population samples consisting of middle-aged Swedish men born 30 years apart.

METHOD

Results from the "Study of Men Born In 1913" and the "Study of Men Born In 1943", two longitudinal cohort studies performed in the same geographic area and using the same methodology were compared. Both cohorts were followed prospectively from 50 to 70 years of age. MI was defined as first myocardial infarction, fatal or non-fatal.

RESULTS

Men born in 1943 had a 34% lower cumulative risk of first MI [HR 0.66 (0.50-0.88), p = 0.0051] during follow-up as compared to men born in 1913. Interaction analysis showed that hypertension had a significantly higher impact on risk of MI in cohort 1943 than in cohort 1913 [HR 2.33 (95% CI 1.41-3.83)] and [HR 1.10 (0.74-1.62)], p = 0.0009 respectively. The population attributable risk for hypertension was 2.5-fold higher in the cohort of men born in 1943 as compared to men born in 1913, and diabetes mellitus and sedentary lifestyle attributed more to MI risk in cohort 1943 than in cohort 1913. On the contrary, smoking and total cholesterol have less attributable risk to MI in cohort 1943 than in cohort 1913.

CONCLUSION

Despite declining incident MI and improved cardiovascular prevention in general, hypertension remains an increasingly important attributable risk factor to MI together with diabetes mellitus and sedentary lifestyle over time.

Multi-modality biomarkers in the early prediction of ischaemic heart disease in middle-aged men during a 21-year follow-up

Background

Ischaemic heart disease (IHD) often develops after decades of preceding subclinical coronary atherosclerosis. Biomarkers are useful prognostic predictors of IHD, but their long-term predictive value in a general population has not been adequately studied.

Purpose

To investigate the early predictive value of multi-modality biomarkers in addition to clinical risk factors in incident IHD in a random male general population sample followed from 50 to 71 years of age.

Method

“The Study of Men Born in 1943” is a longitudinal cohort study during follow-up. All the men underwent a baseline examination in 1993, where a panel of biomarkers were analysed and incident IHD was registered during 21-year follow-ups.

Results

Of 739 participants, 97 men (13.1%) developed an IHD event. For time to first occurrence of IHD, univariable analyses showed that elevated levels of high sensitivity troponin T (hs-TNT), high sensitivity-C reactive protein (hs-CRP) and interleukin-6 (IL-6) were significant predictors of IHD. In addition, a high number of biomarkers with elevated levels (hs-TNT > 10 ng/L, hs-CRP > 1 mg/L, IL-6 > 8 ng/L and N-terminal pro b-type natriuretic peptide (NT-proBNP) > 100 pg/mL) increased predictive ability. In univariable and multivariable analysis high-density lipoprotein-cholesterol (HDL-C) had the highest predictive ability. Hs-TNT provided better predictive ability than smoking, body mass index and glucose, and was an independent significant predictor when adjusted for HDL-C, total cholesterol and hypertension. Addition of biomarkers on top of clinical risk factors provided significantly better prediction as tested by likelihood ratio test (p = 0.033), but did not significantly enhance the model’s discriminative ability However, it appeared contributing to higher sensitivity in the late phase of follow-up.

Conclusion

In this random, middle-aged male population sample, the addition of biomarker hs-TNT was an independent significant predictor of IHD and significantly improved prediction, indicating the probability of a better prediction of long-term risk of IHD in a low-risk population.

Trial registration: The study is registered at Clinical Trials.gov Identifier number: NCT03138122

Determinants of suboptimal long-term secondary prevention of acute myocardial infarction: the structural interview method and physical examinations

Background

Secondary prevention after an acute myocardial infarction (AMI) reduces morbidity and mortality, but suboptimal secondary prevention of cardiovascular disease is common. Therefore, the present study aimed to identify potential underlying factors for suboptimal secondary prevention 2 years after an AMI event.

Methods

Patients aged 18–85 years at the time of their index AMI and hospitalized between July 2010 and December 2011, were identified retrospectively and consecutively from hospital discharge records. All patients who agreed to participate underwent a structured interview, physical examinations and laboratory analysis 2 years after their index AMI. The secondary preventive goals included are; blood pressure < 140/90 mmHg, LDL < 1.8 mmol/L, HbA1c < 48 mmol/mol, regular physical activity that causes sweating at least twice a week, non-smoking and BMI < 25 kg/m². Multivariable and univariable logistic regression models were applied to identify independent predictors of different secondary prevention achievements.

Results

Of the 200 patients (mean age 63.3 ± 9.7 years) included in the study, 159 (80%) were men. No common determinants were found in patients who failed to achieve at least six secondary prevention guideline-directed goals. For individual secondary prevention goals, several determinants were defined. Patients born in Sweden were less likely to achieve optimal lipid control [odds ratio (OR) 0.28 (95% confidence interval, CI 0.12–0.63)]. Younger (≤ 65 years) [OR 0.24 (95% CI 0.07–0.74)] and unemployed patients [OR 0.23 (95% CI 0.06–0.82)] were less likely to be non-smokers. Patients with diabetes mellitus [OR 0.21 (95% CI 0.04–0.98)] or with a walking aid [OR 0.23 (95% CI 0.07–0.71)] were less likely to achieve an optimal body mass index (BMI < 25). Living alone was an independent predictor of achieving regular physical activity [OR 1.94 (95% CI 1.02–3.69)].

Conclusion

Long-term secondary prevention remained suboptimal 2 years after an AMI. Causes are likely multifactorial, with no single determinant for all six guideline-recommended preventive goals. Therefore a tailored comprehensive assessment should be requested and updated and treatment of risk factors should be applied.

P4155Multiple modality biomarkers predict ischemic heart disease in middle-aged men from the general population during a 21-year follow-up

Background

Ischemic heart disease (IHD) often develops after decades of preceding subclinical coronary atherosclerosis. An early prediction of risk for IHD in a general population would be helpful for preventive decision-making. It is well known that biomarkers including troponine, natriuretic peptides and inflammatory biomarkers are useful prognostic predictors for IHD, their long-term predictive values in a general population for incident IHD have not been studied.

Purpose

The aim of the study was to investigate the predictive value of multi-modality biomarkers on the incident IHD in a random male sample from the general population followed from the age of 50 to 71 years.

Method

“The study of Men Born in 1943” is a longitudinal cohort study of men living in the city of Gothenburg in Sweden. All patients underwent a baseline examination in 1993, which included physical examination, questionnaires and blood samples. Because of multifactorial nature of atherosclerosis, a panel of biomarkers representing multiple mechanisms such as high-sensitivity troponine (hs-TNT), interleukin-6 (IL-6), cystatin C, high-sensitivity C-reactive protein (hs-CRP), urat, ferritin, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were analyzed from blood samples collected at 50 years of age. Incident IHD was defined as new-onset one of following (myocardial infarction, hospitalized unstable angina and intervention with either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) during 1993–2014. The impact of biomarkers on incident IHD was studied using univariable, followed by stepwise and multivariable Cox proportional hazards models.

Results

Among the, 753 patients in the study, 105 patients (13,9%) developed IHD during 21 years of follow up with an event rate per 1000 person years 7.49 and a 95% confidence interval (CI) of 6.19 - 9.07. In Cox proportional hazards model for time to first occurrence of IHD, univariable analyses showed that multi-modality biomarker (CRP >1 mg/ml, NT-proBNP >100 pg/mL, troponin >10 ng/L, IL-6 >8 ng/L) provide most powerful prediction, followed by total cholesterol and fasting plasma glucose. In multivariable Cox proportional hazards model for time to first of IHD, above four-biomarker combination modality remains a most powerful predictor with risk increased by one additional biomarker [Hazard Ratio (95% CI): 1.69 (1.26 - 2.26), p=0.0004], followed by total cholesterol (mmol/L) with risk increased by one [Hazard Ratio (95% CI: 1.31 (1.09 - 1.56), p=0.0031], and fasting plasma glucose (mmol/L) with risk increased by one unit [Hazard Ratio (95% CI): 1.11 (1.01 - 1.22), p=0.038].

Conclusion

A multi-modality biomarker strategy can be used to predict increased risk of developing IHD during the following two decades after 50 years, enabling us to identify individuals who might benefit from early intensive risk modification to prevent the development of IHD.

Study of patients’ dehumanization in a hospital setting

This study aims to explore and compare the extent and the forms of patients’ dehumanization among Greek health professionals, mental health professionals and the general population.

Preference for non-cooperative economic strategies is associated with lower perceived self-efficacy, fewer positive emotions, and less optimism

The goal was to investigate the association of economic opportunism with self-efficacy, optimism, and positive emotion. It was hypothesized that economic opportunists should experience lower self-efficacy, less positive thinking, and less optimism. Study 1 (N = 206) showed that economic opportunism was negatively correlated with self-efficacy, optimism, and positive affect, and positively correlated with negative affect. Study 2 (N = 128) indicated that individuals reporting higher self-efficacy were less likely to defect on their counterparts in a game situation. These findings show the negative association of opportunistic propensity with self-efficacy and positive emotions. Implications for experimental research on economic opportunism and positive emotions are discussed.

Social embeddedness and economic opportunism: a game situation

According to Evolutionary Game Theory, multiple exchanges with partners are necessary to foster cooperation. Multiple exchanges with partners tend to enhance the good experience of the partners and the predictability of their behaviour and should therefore increase cooperativeness. This study explored whether social embeddedness, or the preference for close and stable social relationships, a variable which tends to increase multiple exchanges, is associated with more cooperative attitudes; and whether social embeddedness increases cooperative behavior towards unknown partners in a game situation. The first study, with 169 undergraduates, indicated that social embeddedness (preference for close and durable social relations) was negatively associated with opportunistic attitudes. The second study had a sample of 60 undergraduates playing a Trust Game with unknown partners and showed that self-reported social embeddedness was positively correlated with scores for cooperative economic behavior towards the partners. These results highlight the relationships of social embeddedness with cooperative attitudes and behaviour.

Opportunistic Propensity Hinders Commitment to Acts in Conditions of Forced Compliance and Compliance without Pressure

The psychosocial literature contains empirical evidence of the effects of personality variables on commitment to acts. The association of economic opportunism was explored with respect to postexperimental attitude change, intentions, and intrinsic motivation of individuals ( N = 132) toward acts with either forced compliance or compliance without pressure. In conditions of commitment and compliance without pressure, both intention and intrinsic motivation decreased as economic opportunism increased, while in conditions of commitment and forced compliance, intention increased as economic opportunism increased. Attitude change and economic opportunism did not appear to be associated in any experimental condition. These findings suggest that tendency to noncooperativeness predisposes to reduced concern for consistency and compliance with performed acts.

Valuing and representing information: the paradox of undervaluing information and overvaluing information producers

Information's increasing importance in contemporary societies raises questions concerning laymen's valuation of information and of professionals producing information. The main hypotheses were: (a) potential sellers will underestimate information's value compared to that of material goods; (b) when potential buyers' involvement is high (that is high investment and high risk), sellers will demand even lower prices for information; (c) some important current functions and meanings of information are not assimilated in social representations of information; (d) by contrast, participants must overvalue the remuneration of professionals producing pure information (invention) compared to those who apply this information to produce material goods. An experimental study confirmed hypotheses (a) and (b). A second study to investigate the structure of information's social representations showed that the representation's central core is mainly composed of categories referring to traditional media, functions and technologies; contemporary functions and technologies are less frequent or absent. A third experimental study confirmed hypothesis (d).

How much is information worth? Willingness to pay for expert and non-expert informational goods compared to material goods in lay economic thinking

Economists consider information a paradoxical good of uncertain value. This experimental study compares the valuation of economic information to the valuation of material goods when subjects possess perfect information so that uncertainty about the outcome of the transaction is eliminated. It also aims to study the participants' justifications of their valuations, in order to examine the underlying cognitive processes. The main hypotheses were that: (a) even if subjects deal with perfect information they will underestimate its value compared to the value of material goods; (b) underestimation of the value of information will be greater in conditions of high involvement, that is when expected payoff and therefore investment and risk are high; and (c) expert information will be valued more highly than non-expert information, since it should be regarded as more reliable. In the main study, two groups of students in the same university were asked to value and justify their valuation of material goods, under conditions of certain low (1000) and high (100,000) payoffs, respectively. Two other groups were asked to value and to justify their valuation of non-expert information under the same conditions of profit. Finally, two more groups of students were asked to value and justify their valuation of expert information, again under conditions of low or high expected profit. The findings of the study show that under all conditions subjects underestimate the value of information both absolutely and relatively in comparison to material goods, especially under conditions of high involvement. The participants' justifications of their own valuations are heuristics which seem to take into account the uncertain character of informational goods.