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  • 1.
    Angerås, Oskar
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Haraldsson, Inger
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Redfors, Björn
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Petursson, Petur
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Albertsson, Per
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ioanes, Dan
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Odenstedt, Jacob
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Olsson, Hans
    Department of Cardiology, Karlstad Hospital, Karlstad, Sweden.
    Witt, Nils
    Department of Cardiology, South Hospital Stockholm, Stockholm, Sweden.
    Rück, Andreas
    Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Millgård, Jonas
    Department of Cardiology, Sunderby Hospital, Sunderbyn, Sweden.
    Nilsson, Johan
    Department of Cardiology, Heart Centre, Umeå University Hospital, Umeå, Sweden.
    Persson, Jonas
    Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
    Söderbom, Måns
    Department of Economics, University of Gothenburg, Gothenburg, Sweden.
    Wedel, Hans
    Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Erlinge, David
    Department of Cardiology, Lund University, Lund, Sweden.
    James, Stefan
    Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Ramunddal, Truls
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Omerovic, Elmir
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Impact of Thrombus Aspiration on Mortality, Stent Thrombosis, and Stroke in Patients With ST-Segment-Elevation Myocardial Infarction: A Report From the Swedish Coronary Angiography and Angioplasty Registry2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 7, no 1, article id e007680Article in journal (Refereed)
    Abstract [en]

    Background: Thrombus aspiration is still being used in a substantial number of patients despite 2 large randomized clinical trials showing no favorable effect of routine thrombus aspiration during primary percutaneous coronary intervention in patients with STsegment- elevation myocardial infarction. The aim of this observational study was to evaluate the impact of thrombus aspiration on mortality, stent thrombosis, and stroke using all available data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).

    Methods and Results: We identified 42 829 consecutive patients registered in SCAAR between January 2005 and September 2014 who underwent percutaneous coronary intervention for ST-segment-elevation myocardial infarction. Thrombus aspiration was used in 25% of the procedures. We used instrumental variable analysis with administrative healthcare region as the treatmentpreference instrumental variable to evaluate the effect of thrombus aspiration on mortality, stent thrombosis, and stroke. Thrombus aspiration was not associated with mortality at 30 days (risk reduction: -1.2; 95% confidence interval [CI], -5.4 to 3.0; P=0.57) and 1 year (risk reduction: -2.4; 95% CI, -7.6 to 3.0; P=0.37). Thrombus aspiration was associated with a lower risk of stent thrombosis both at 30 days (risk reduction: -2.7; 95% CI, -4.1 to -1.4; P<0.001) and 1 year (risk reduction: -3.5; 95% CI, -5.3 to -1.7; P<0.001). In-hospital stroke and neurologic complications did not differ between groups (risk reduction: 0.1; 95% CI, -0.8 to 1.1; P=0.76).

    Conclusions: Mortality was not different between the groups. Thrombus aspiration was associated with decreased risk of stent thrombosis. Our study provides important evidence for the external validity of previous randomized studies regarding mortality.

  • 2.
    Ban, Lu
    et al.
    Division of Epidemiology & Public Health, University of Nottingham, Nottingham, United Kingdom; Division of Rheumatology, Orthopaedics and Dermatology, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom.
    Sprigg, Nikola
    Stroke, Division of Neuroscience, University of Nottingham, Nottingham, United Kingdom.
    Abdul Sultan, Alyshah
    Division of Epidemiology & Public Health, University of Nottingham, Nottingham, United Kingdom; Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, United Kingdom.
    Nelson-Piercy, Catherine
    Women's Health Academic Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
    Bath, Philip M
    Women's Health Academic Centre, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
    Ludvigsson, Jonas F.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Stephansson, Olof
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Tata, Laila J
    Division of Epidemiology & Public Health, University of Nottingham, Nottingham, United Kingdom.
    Incidence of First Stroke in Pregnant and Nonpregnant Women of Childbearing Age: A Population-Based Cohort Study From England2017In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 6, no 4, article id e004601Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pregnant women may have an increased risk of stroke compared with nonpregnant women of similar age, but the magnitude and the timing of such risk are unclear. We examined the risk of a first stroke event in women of childbearing age and compared the risk during pregnancy and in the early postpartum period with the background risk outside these periods.

    METHODS AND RESULTS: We conducted an open cohort study of 2 046 048 women aged 15 to 49 years between April 1, 1997, and March 31, 2014, using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care records in England. Risk of first stroke was assessed by calculating the incidence rate of stroke in antepartum, peripartum (2 days before until 1 day after delivery), and early (first 6 weeks) and late (second 6 weeks) postpartum periods compared with nonpregnant time using a Poisson regression model with adjustment for maternal age, socioeconomic group, and calendar time. A total of 2511 women had a first stroke. The incidence rate of stroke was 25.0 per 100 000 person-years (95% CI 24.0-26.0) in nonpregnant time. The rate was lower antepartum (10.7 per 100 000 person-years, 95% CI 7.6-15.1) but 9-fold higher peripartum (161.1 per 100 000 person-years, 95% CI 80.6-322.1) and 3-fold higher early postpartum (47.1 per 100 000 person-years, 95% CI 31.3-70.9). Rates of ischemic and hemorrhagic stroke both increased peripartum and early postpartum.

    CONCLUSIONS: Although the absolute risk of first stroke is low in women of childbearing age, healthcare professionals should be aware of a considerable increase in relative risk during the peripartum and early postpartum periods.

  • 3.
    Bergman, Sofia
    et al.
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Mohammad, Moman A.
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    James, Stefan K.
    Uppsala University, Uppsala, Sweden.
    Angerås, Oskar
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Wagner, Henrik
    Helsingborg Lasarett, Helsingborg, Sweden.
    Jensen, Jens
    Södersjukhuset, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; Capio, S:t Görans Hospital AB, Stockholm, Sweden.
    Scherstén, Fredrik
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Koul, Sasha
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Erlinge, David
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors: a VALIDATE-SWEDEHEART Substudy2021In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 10, no 18, article id e022984Article in journal (Refereed)
    Abstract [en]

    Background: The clinical importance of intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention in the contemporary era of potent oral P2Y12 inhibitors is not established. The aim of this study was to assess IPST and its association with clinical outcome in patients with myocardial infarction undergoing percutaneous coronary intervention with contemporary antithromboticmedications.

    Methods and Results: The VALIDATE-SWEDEHEART study (Bivalirudin Versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial) included 6006 patients with myocardial infarction, treated with potent P2Y12 inhibitors during percutaneous coronary intervention. IPST, defined as a new or worsening thrombus related to a stent deployed during the procedure, was reported by the interventional cardiologist in 55 patients (0.9%) and was significantly associated with ST-segment elevation myocardial infarction presentation, longer stents, bailout glycoprotein IIb/IIIa inhibitors, and final Thrombolysis in Myocardial Infarction flow <3. The primary composite end point included cardiovascular death, myocardial infarction, out-of-laboratory definite stent thrombosis and target vessel revascularization within 30 days. Secondary end points were major bleeding and the individual components of the primary composite end point. Patients with versus without IPST had significantly higher rates of the primary composite end point (20.0% versus 4.4%), including higher rates of cardiovascular death, target vessel revascularization, and definite stent thrombosis, but not myocardial infarction or major bleeding. By multivariable analysis, IPST was independently associated with the primary composite end point (hazard ratio, 3.82; 95% CI, 2.05-7.12; P<0.001).

    Conclusions: IPST is a rare but dangerous complication during percutaneous coronary intervention, independently associated with poor prognosis, even in the current era of potent antiplatelet agents. Future treatment studies are needed to reduce the rate of IPST and to improve the poor outcome among these patients. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02311231. 

  • 4.
    Björkenheim, Anna
    et al.
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Brandes, Axel
    Department of Cardiology, Odense University Hospital, Odense, Denmark.
    Magnuson, Anders
    Chemnitz, Alexander
    Department of Cardiology, Odense University Hospital, Odense, Denmark.
    Edvardsson, Nils
    Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.
    Poçi, Dritan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Patient-Reported Outcomes in Relation to Continuously Monitored Rhythm Before and During 2 Years After Atrial Fibrillation Ablation Using a Disease-Specific and a Generic Instrument2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 7, no 5, article id e008362Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Atrial fibrillation (AF) ablation improves patient-reported outcomes, irrespective of mode of intermittent rhythm monitoring. We evaluated the use of an AF-specific and a generic patient-reported outcomes instrument during continuous rhythm monitoring 2 years after AF ablation.

    METHODS AND RESULTS: Fifty-four patients completed the generic 36-Item Short-Form Health Survey and the AF-specific AF6 questionnaires before and 6, 12, and 24 months after AF ablation. All patients underwent continuous ECG monitoring via an implantable loop recorder. The generic patient-reported outcomes scores were compared with those of a Swedish age- and sex-matched population. After ablation, both summary scores reached normative levels at 24 months, while role-physical and vitality remained lower than norms. Responders to ablation (AF burden <0.5%) reached the norms in all individual 36-Item Short-Form Health Survey domains, while nonresponders (AF burden >0.5%) reached norms only in social functioning and mental component summary. All AF6 items and the sum score showed moderate to large improvement in both responders and nonresponders, although responders showed significantly greater improvement in all items except item 1 from before to 24 months after ablation. Higher AF burden was independently associated with poorer physical component summary and AF6 sum score.

    CONCLUSIONS: The AF-specific AF6 questionnaire was more sensitive to changes related to AF burden than the generic 36-Item Short-Form Health Survey. Patients improved as documented by both instruments, but a higher AF burden after ablation was associated with poorer AF-specific patient-reported outcomes and poorer generic physical but not mental health. Our results support the use of an AF-specific instrument, alone or in combination with a generic instrument, to assess the effect of ablation.

    CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00697359.

  • 5.
    Djekic, Demir
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden; Cardiology unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Lindgren, Martin
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden; Cardiology unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Åberg, N. David
    Department of Internal Medicine Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Acute Medicine and Geriatrics (SU/Sahlgrenska), Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Åberg, Maria
    School of Public Health and Community, Medicine/Primary Health Care Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland Regionhälsan, Gothenburg, Sweden.
    Fengsrud, Espen
    Örebro University, School of Medical Sciences. Department of Cardiology, Örebro University, Örebro, Sweden.
    Poci, Dritan
    Department of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospita,l Gothenburg, Sweden.
    Adiels, Martin
    Cardiology unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Rosengren, Annika
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg Sweden; Cardiology unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
    Body Mass Index in Adolescence and Long-Term Risk of Early Incident Atrial Fibrillation and Subsequent Mortality, Heart Failure, and Ischemic Stroke2022In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 11, no 21, article id e025984Article in journal (Refereed)
    Abstract [en]

    Background: We sought to determine the role of obesity in adolescent men on development of atrial fibrillation (AF) and subsequent associated clinical outcomes in subjects diagnosed with AF.

    Methods and Results: We conducted a nationwide, register-based, cohort study of 1 704 467 men (mean age, 18.3±0.75 years) enrolled in compulsory military service in Sweden from 1969 through 2005. Height and weight, blood pressure, fitness, muscle strength, intelligence quotient, and medical disorders were recorded at baseline. Records obtained from the National Inpatient Registry and the Cause of Death Register were used to determine incidence and clinical outcomes of AF. During a median follow-up of 32 years (interquartile range, 24-41 years), 36 693 cases (mean age at diagnosis, 52.4±10.6 years) of AF were recorded. The multivariable-adjusted hazard ratio (HR) for AF increased from 1.06 (95% CI, 1.03-1.10) in individuals with body mass index (BMI) of 20.0 to <22.5 kg/m2 to 3.72 (95% CI, 2.44-5.66) among men with BMI of 40.0 to 50.0 kg/m2, compared with those with BMI of 18.5 to <20.0 kg/m2. During a median follow-up of ≈6 years in patients diagnosed with AF, we identified 3767 deaths, 3251 cases of incident heart failure, and 921 cases of ischemic stroke. The multivariable-adjusted HRs for all-cause mortality, incident heart failure, and ischemic stroke in AF-diagnosed men with baseline BMI >30 kg/m2 compared with those with BMI <20 kg/m2 were 2.86 (95% CI, 2.30-3.56), 3.42 (95% CI, 2.50-4.68), and 2.34 (95% CI, 1.52-3.61), respectively.

    Conclusions: Increasing BMI in adolescent men is strongly associated with early AF, and with subsequent worse clinical outcomes in those diagnosed with AF with respect to all-cause mortality, incident heart failure, and ischemic stroke.

  • 6.
    Djekic, Demir
    et al.
    Department of Cardiology, Faculty of Health, Örebro University Hospital, Örebro, Sweden.
    Shi, Lin
    Engineering and Nutritional Science, Shaanxi Normal University, Xi'an China; Chalmers University of Technology, Gothenburg, Sweden.
    Brolin, Harald
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Carlsson, Frida
    Chalmers University of Technology, Gothenburg, Sweden.
    Särnqvist, Charlotte
    Department of Cardiology, Faculty of Health, Örebro University Hospital, Örebro, Sweden.
    Savolainen, Otto
    Chalmers University of Technology, Gothenburg, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Bäckhed, Fredrik
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; Novo Nordisk Foundation, Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Tremaroli, Valentina
    The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Landberg, Rikard
    Chalmers University of Technology, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Health, Örebro University Hospital, Örebro, Sweden.
    Effects of a Vegetarian Diet on Cardiometabolic Risk Factors, Gut Microbiota, and Plasma Metabolome in Subjects With Ischemic Heart Disease: A Randomized, Crossover Study2020In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 9, no 18, article id e016518Article in journal (Refereed)
    Abstract [en]

    Background: A vegetarian diet (VD) may reduce future cardiovascular risk in patients with ischemic heart disease.

    Methods and Results: A randomized crossover study was conducted in subjects with ischemic heart disease, assigned to 4-week intervention periods of isocaloric VD and meat diet (MD) with individually designed diet plans, separated by a 4-week washout period. The primary outcome was difference in oxidized low-density lipoprotein cholesterol (LDL-C) between diets. Secondary outcomes were differences in cardiometabolic risk factors, quality of life, gut microbiota, fecal short-chain and branched-chain fatty acids, and plasma metabolome. Of 150 eligible patients, 31 (21%) agreed to participate, and 27 (87%) participants completed the study. Mean oxidized LDL-C (-2.73 U/L), total cholesterol (-5.03 mg/dL), LDL-C (-3.87 mg/dL), and body weight (-0.67 kg) were significantly lower with the VD than with the MD. Differences between VD and MD were observed in the relative abundance of several microbe genera within the families Ruminococcaceae, Lachnospiraceae, and Akkermansiaceae. Plasma metabolites, including l-carnitine, acylcarnitine metabolites, and phospholipids, differed in subjects consuming VD and MD. The effect on oxidized LDL-C in response to the VD was associated with a baseline gut microbiota composition dominated by several genera of Ruminococcaceae.

    Conclusions: The VD in conjunction with optimal medical therapy reduced levels of oxidized LDL-C, improved cardiometabolic risk factors, and altered the relative abundance of gut microbes and plasma metabolites in patients with ischemic heart disease. Our results suggest that composition of the gut microbiota at baseline may be related to the reduction of oxidized LDL-C observed with the VD.

    Registration: URL: https://www.clini​caltr​ials.gov; Unique identifier: NCT02942628.

  • 7.
    Eggers, Kai M.
    et al.
    Department of Medical Sciences and Uppsala Clinical Research Center Uppsala University Uppsala Sweden.
    Baron, Tomasz
    Department of Medical Sciences and Uppsala Clinical Research Center Uppsala University Uppsala Sweden.
    Hjort, Marcus
    Department of Medical Sciences and Uppsala Clinical Research Center Uppsala University Uppsala Sweden.
    Nordenskjöld, Anna M.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology .
    Tornvall, Per
    Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
    Lindahl, Bertil
    Uppsala University, Uppsala, Sweden.
    GRACE 2.0 Score for Risk Prediction in Myocardial Infarction With Nonobstructive Coronary Arteries2021In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 10, no 17, article id e021374Article in journal (Refereed)
  • 8.
    Emilsson, Louise
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Vårdcentralen Värmlands Nysäter, Värmland County, Sweden; Department of Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Andersson, Bert
    Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Elfström, Peter
    Department of Neonatology, Astrid Lindgren Children's Hospital Danderyd, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Green, Peter H. R.
    Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Ludvigsson, Jonas F.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; the Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Solna, Sweden; Karolinska Institutet, Stockholm, Sweden.
    Risk of idiopathic dilated cardiomyopathy in 29 000 patients with celiac disease2012In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 1, no 3, article id e001594Article in journal (Refereed)
    Abstract [en]

    Background: Dilated cardiomyopathy (DCM) is a rare disease of largely unknown origin. Previous studies have suggested an increased prevalence of celiac disease (CD) in patients with DCM. These studies, however, were based on a maximum of 5 patients with both CD and DCM. In the present large Swedish population-based cohort study, we examined the risk of idiopathic DCM in patients with CD determined by small-intestinal histopathology.

    Methods and Results: From 2006 to 2008, we collected duodenal/jejunal biopsy data on CD (equal to villous atrophy, Marsh stage 3, n=29 071 unique individuals) from (all) 28 pathology departments in Sweden. These individuals were compared with 144 429 reference individuals matched for age, sex, calendar year, and county. Data on DCM were obtained through the National Patient Register and confirmed by patient charts and echocardiography data. During follow-up, 17 patients with CD and 52 reference individuals developed idiopathic DCM. Thus, patients with CD were at an increased risk of idiopathic DCM (hazard ratio, 1.73; 95% confidence interval, 1.00 to 3.00), although the risk estimate failed to attain statistical significance (P=0.052).

    Conclusion: This nationwide study found a moderately but not statistically significantly increased risk of idiopathic DCM in patients with biopsy-verified CD.

  • 9.
    Eriksson, Marie
    et al.
    Department of Statistics, USBE, Umeå University, Umeå, Sweden.
    Grundberg, Anton
    Department of Statistics, USBE, Umeå University, Umeå, Sweden.
    Inge, Erik
    Department of Statistics, USBE, Umeå University, Umeå, Sweden.
    von Euler, Mia
    Örebro University, School of Medical Sciences. Department of Neurology and Rehabilitation, Faculty of Medicine and Health Örebro University Örebro Sweden.
    Stroke Recurrence Following 28 Days After First Stroke in Men and Women 2012 to 2020: Observations From the Swedish Stroke Register2023In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 12, no 3, article id e028222Article in journal (Refereed)
    Abstract [en]

    Background: Stroke incidence, care, and survival show continuous improvements in Sweden, including no or decreasing disparities between men and women. In this study, we aimed to estimate and compare the risk of stroke recurrence in men and women over time, accounting for the competing risk of death.

    Methods and Results: We included adult patients with first-time stroke (ischemic or intracerebral hemorrhage) registered in Riksstroke (the Swedish Stroke Register), 2012 to 2020, and followed until December 2020. Stroke recurrences included new events registered in Riksstroke from 28 days after stroke. To account for the competing risk of death, we used the cumulative incidence function to estimate crude incidences, and multivariable Cox regression to estimate cause-specific hazard ratios (HRs) adjusting for differences in patients' risk factor profiles. The study included 72 148 (53.5%) men and 62 689 (46.5%) women. We observed 10 925 stroke recurrences and 81 811 deaths following the initial 28 days after the first stroke. The cumulative incidence of stroke recurrence was 3.7% (95% CI, 3.6-3.8) after 1 year, 7.0 (95% CI, 6.8-7.1) after 3 years, and 9.1% (95% CI, 8.9-9.3) after 5 years. The incidence decreased substantially during the study period (HR, 2019-2020 versus 2012, 0.824 [95% CI, 0.759-0.894]). Overall, men had a lower risk of stroke recurrence. After adjustments for differences in patient characteristics, men had a slightly higher risk of recurrence (of any type) after an ischemic stroke (HR, 1.090 [95% CI, 1.045-1.138]) and a lower risk after hemorrhagic stroke (HR, 0.880 [95% CI, 0.781-0.991]) compared with women.

    Conclusions: The risk of stroke recurrence has decreased in both men and women. Women's higher age and other differences in risk factors partly explain their higher risk of stroke recurrence compared with men.

  • 10.
    Fröbert, Ole
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Calais, Fredrik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    James, Stefan K.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Lagerqvist, Bo
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    ST-Elevation Myocardial Infarction, Thrombus Aspiration, and Different Invasive Strategies: A TASTE Trial Substudy2015In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 4, no 6, article id e001755Article in journal (Refereed)
    Abstract [en]

    Background: The clinical effect of thrombus aspiration in ST-elevation myocardial infarction may depend on the type of aspiration catheter and stenting technique.

    Methods and Results: The multicenter, prospective, randomized, open-label trial Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia (TASTE) did not demonstrate a clinical benefit of thrombus aspiration compared to percutaneous coronary intervention alone. We assessed the effect of type of aspiration device, stent type, direct stenting, and postdilatation on outcomes at 1 year. There was no difference in all-cause mortality, between the 3 most frequently used aspiration catheters (Eliminate [Terumo] 5.4%, Export [Medtronic] 5.0%, Pronto [Vascular Solutions] 4.5%) in patients randomized to thrombus aspiration. There was no difference in mortality between directly stented patients randomized to thrombus aspiration compared to patients randomized to percutaneous coronary intervention only (risk ratio 1.08, 95% CI 0.70 to 1.67, P=0.73). Similarly, there was no difference in mortality between the 2 randomized groups for patients receiving drug-eluting stents (risk ratio 0.89, 95% CI 0.63 to 1.26, P=0.50) or for those treated with postdilation (risk ratio 0.72, 95% CI 0.49 to 1.07, P=0.11). Furthermore, there was no difference in rehospitalization for myocardial infarction or stent thrombosis between the randomized arms in any of the subgroups.

    Conclusions: In patients with ST-elevation myocardial infarction randomized to thrombus aspiration, the type of aspiration catheter did not affect outcome. Stent type, direct stenting, or postdilation did not affect outcome irrespective of treatment with thrombus aspiration and percutaneous coronary intervention or percutaneous coronary intervention alone.

  • 11.
    Han, Hedong
    et al.
    Department of Health Statistics, Second Military Medical University, Shanghai, China.
    Wei, Xin
    Mount Sinai St. Luke's and West Medical Center, New York, NY, USA.
    He, Qian
    Department of Health Statistics, Second Military Medical University, Shanghai, China.
    Yu, Yamei
    Department of Cardiology, Shanghai Changning District Central Hospital, Shanghai, China.
    Ruan, Yiming
    Department of Health Statistics, Second Military Medical University, Shanghai, China.
    Wu, Cheng
    Department of Health Statistics, Second Military Medical University, Shanghai, China.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Herzog, Eyal
    Mount Sinai St. Luke's and West Medical Center, New York, NY, USA.
    He, Jia
    Department of Health Statistics, Second Military Medical University, Shanghai, China; Tongji University School of Medicine, Shanghai, China.
    Comparison of In-Hospital Mortality and Length of Stay in Acute ST-Segment-Elevation Myocardial Infarction Among Urban Teaching Hospitals in China and the United States2019In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 8, no 22, article id e012054Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the study is to compare in-hospital outcomes of acute ST-segment–elevation myocardial infarction (STEMI) between China and the United States.

    Methods and Results: Urban teaching hospitals were queried for adult patients with a primary diagnosis of acute STEMI during 2007–2010. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay. Multivariable analyses adjusting for potential confounders were conducted for comparison between countries. Subgroup analysis was performed in acute STEMI patients receiving revascularization. In total, 32 228 patients in China and 76 117 patients in the United States were included. Overall in-hospital mortality was 8.23% in China and 7.96% in the United States (P<0.001). Multivariable analyses revealed that the 2 countries had similar overall in-hospital mortality (odds ratio, 0.97; 95% CI, 0.87–1.09; P=0.59), whereas China had lower 3-day mortality (odds ratio, 0.78; 95% CI, 0.70–0.89; P<0.001). In patients receiving primary percutaneous coronary interventions, Chinese hospitals had significant higher overall mortality (odds ratio, 2.39; 95% CI, 1.85–3.07; P<0.001) and 3-day mortality (odds ratio, 2.39; 95% CI, 1.78–3.20; P<0.001). For total acute STEMI patients, acute STEMI patients receiving percutaneous coronary intervention and coronary artery bypass grafting, median length of stay in China and the United States were 10 versus 3, 9 versus 3, and 25 versus 9 days, respectively (all P<0.001).

    Conclusions: Overall in-hospital mortality in acute STEMI patients was comparable among urban teaching hospitals between China and the United States during 2007-2010. In addition, 3-day mortality was lower in China. However, worse outcomes in patients undergoing early revascularization and longer length of stay in China need to be given more attention.

  • 12.
    Höskuldsdóttir, Gudrún
    et al.
    Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sattar, Naveed
    The Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom.
    Miftaraj, Mervete
    Centre of Registers National Diabetes Register, Gothenburg, Sweden.
    Näslund, Ingmar
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ottosson, Johan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
    Franzén, Stefan
    Centre of Registers National Diabetes Register, Gothenburg, Sweden; Health Metrics Unit Sahlgrenska AcademyUniversity of Gothenburg, Gothenburg, Sweden.
    Svensson, Ann-Marie
    Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden; Centre of Registers National Diabetes Register, Gothenburg, Sweden.
    Eliasson, Björn
    Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Potential Effects of Bariatric Surgery on the Incidence of Heart Failure and Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus and Obesity and on Mortality in Patients With Preexisting Heart Failure: A Nationwide, Matched, Observational Cohort Study2021In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 10, no 7, article id e019323Article in journal (Refereed)
    Abstract [en]

    Background: Obesity and diabetes mellitus are strongly associated with heart failure (HF) and atrial fibrillation (AF). The benefits of bariatric surgery on cardiovascular outcomes are known in people with or without diabetes mellitus. Surgical treatment of obesity might also reduce the incidence of HF and AF in individuals with obesity and type 2 diabetes mellitus (T2DM).

    Methods and Results: In this register-based nationwide cohort study we compared individuals with T2DM and obesity who underwent Roux-en-Y gastric bypass surgery with matched individuals not treated with surgery. The main outcome measures were hospitalization for HF and/or AF and mortality in patients with preexisting HF. We identified 5321 individuals with T2DM and obesity who had undergone Roux-en-Y gastric bypass surgery between January 2007 and December 2013 and 5321 matched controls. The individuals included were 18 to 65 years old and had a body mass index >27.5 kg/m2. The follow-up time for hospitalization was until the end of 2015 (mean 4.5 years) and the end of 2016 for death. Our results show a 73% lower risk for HF (hazard ratio [HR], 0.27; CI, 0.19-0.38), 41% for AF (HR, 0.59; CI, 0.44-0.78), and 77% for concomitant AF and HF (HR, 0.23; CI, 0.12-0.46) in the surgically treated group. In patients with preexisting HF we observed significantly lower mortality in the group who underwent surgery (HR, 0.23; 95% CI, 0.12-0.43).

    Conclusion:s Bariatric surgery may reduce risk for HF and AF in patients with T2DM and obesity, speculatively via positive cardiovascular and renal effects. Obesity treatment with surgery may also be a valuable alternative in selected patients with T2DM and HF. 

  • 13.
    Lind, Lars
    et al.
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Salihovic, Samira
    Örebro University, School of Medical Sciences. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Sundström, Johan
    Medical Sciences, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Broeckling, Corey D.
    Proteomics and Metabolomics Facility, Colorado State University, Fort Collins, CO, USA.
    Magnusson, Patrik K.
    Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden.
    Prenni, Jessica
    Department of Horticulture and Landscape Architecture, Colorado State University, Fort Collins, CO, USA.
    Fall, Tove
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Ärnlöv, Johan
    Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; School of Health and Social Sciences, Dalarna University, Falun, Sweden.
    Multicohort Metabolomics Analysis Discloses 9-Decenoylcarnitine to Be Associated With Incident Atrial Fibrillation2021In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 10, no 2, article id e017579Article in journal (Refereed)
    Abstract [en]

    Background: The molecular mechanisms involved in atrial fibrillation are not well known. We used plasma metabolomics to investigate if we could identify novel biomarkers and pathophysiological pathways of incident atrial fibrillation.

    Methods and Results: We identified 200 endogenous metabolites in plasma/serum by nontargeted ultra‐performance liquid chromatography coupled to time‐of‐flight mass spectrometry in 3 independent population‐based samples (TwinGene, n=1935, mean age 68, 43% females; PIVUS [Prospective Investigation of the Vasculature in Uppsala Seniors], n=897, mean age 70, 51% females; and ULSAM [Uppsala Longitudinal Study of Adult Men], n=1118, mean age 71, all males), with available data on incident atrial fibrillation during 10 to 12 years of follow‐up. A meta‐analysis of ULSAM and PIVUS was used as a discovery sample and TwinGene was used for validation. In PIVUS, we also investigated associations between metabolites of interest and echocardiographic indices of myocardial geometry and function. Genome‐wide association studies were performed in all 3 cohorts for metabolites of interest. In the meta‐analysis of PIVUS and ULSAM with 430 incident cases, 4 metabolites were associated with incident atrial fibrillation at a false discovery rate <5%. Of those, only 9‐decenoylcarnitine was associated with incident atrial fibrillation and replicated in the TwinGene sample (288 cases) following adjustment for traditional risk factors (hazard ratio, 1.24 per unit; 95% CI, 1.06–1.45, P=0.0061). A meta‐analysis of all 3 cohorts disclosed another 4 significant metabolites. In PIVUS, 9‐decenoylcarnitine was related to left atrium size and left ventricular mass. A Mendelian randomization analysis did not suggest a causal role of 9‐decenoylcarnitine in atrial fibrillation.

    Conclusions: A nontargeted metabolomics analysis disclosed 1 novel replicated biomarker for atrial fibrillation, 9‐Decenoylcarnitine, but this acetylcarnitine is likely not causally related to atrial fibrillation.

  • 14.
    Mohammad, Moman A.
    et al.
    Department of Cardiology Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
    Stone, Gregg W.
    The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Cardiovascular Research Foundation, New York City, NY, USA.
    Koul, Sasha
    Department of Cardiology Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
    Olivecrona, Göran K.
    Department of Cardiology Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
    Bergman, Sofia
    Department of Cardiology Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
    Persson, Jonas
    Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden.
    Engstrøm, Thomas
    The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden; Department of Clinical Medicine, Aarhus University Health, Aarhus, Denmark.
    Jernberg, Tomas
    Department of Clinical Medicine, Aarhus University Health, Aarhus, Denmark; Division of Cardiovascular Medicine, Department of Clinical Sciences Danderyd, University Hospital, Karolinska Institute, Stockholm, Sweden.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital, Institute of Medicine, Lund, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    James, Stefan
    Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Bergström, Göran
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Erlinge, David
    Department of Cardiology Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
    On the Natural History of Coronary Artery Disease: A Longitudinal Nationwide Serial Angiography Study2022In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 11, no 21, article id e026396Article in journal (Refereed)
    Abstract [en]

    Background: The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events.

    Methods and Results: All coronary artery segments with <50% luminal stenosis in patients with a first-time coronary angiogram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The stenosis progression and incidence rates were 2.6% and 1.45 (95% CI, 1.43-1.46) per 1000 segment-years, respectively. The greatest progression rate occurred in the proximal and middle segments of the left anterior descending artery. Male sex and diabetes were associated with a 2-fold increase in risk, and nearly 70% of new stenoses occurred in patients with baseline single-vessel disease (hazard ratio, 3.86 [95% CI, 3.69-4.04]). Coronary artery segments in patients with no baseline risk factors had a progression rate of 0.6% and incidence rate of 0.36 (95% CI, 0.34-0.39), increasing to 8.1% and 4.01 (95% CI, 3.89-4.14) per 1000 segment-years, respectively, in patients with ≥4 risk factors. The prognostic impact of risk factors on stenosis progression was greatest in younger patients and women.

    Conclusions: Coronary atherosclerosis progressed slowly but more frequently in the left coronary artery in men and in the presence of traditional risk factors. Coronary artery segments in patients without risk factors had little or no risk of stenosis progression, and the relative impact of risk factors appears to be of greater importance in younger patients and women. These findings help in the understanding the long-term course of coronary atherosclerosis.

  • 15.
    Paramel Varghese, Geena
    et al.
    Örebro University, School of Medical Sciences.
    Folkersen, Lasse
    Department of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Strawbridge, Rona J.
    Department of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Halvorsen, Bente
    Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Yndestad, Arne
    Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway.
    Ranheim, Trine
    Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Krohg-Sørensen, Kirsten
    Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway.
    Skjelland, Mona
    Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
    Espevik, Terje
    Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway.
    Aukrust, Pål
    Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway.
    Lengquist, Mariette
    Department of Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Hedin, Ulf
    Department of Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Jansson, Jan-Håkan
    Department of Internal Medicine, Umeå University Hospital, Umeå, Sweden; Department of Internal Medicine, Skellefteå Hospital, Skellefteå, Sweden.
    Fransén, Karin
    Örebro University, School of Medical Sciences.
    Hansson, Göran K.
    Department of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Per
    Department of Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Sirsjö, Allan
    Örebro University, School of Medical Sciences.
    NLRP3 Inflammasome Expression and Activation in Human Atherosclerosis2016In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 5, no 5, article id e003031Article in journal (Refereed)
    Abstract [en]

    Background: The NLR family, pyrin domain containing 3 (NLRP3) inflammasome is an interleukin (IL)-1β and IL-18 cytokine processing complex that is activated in inflammatory conditions. The role of the NLRP3 inflammasome in the pathogenesis of atherosclerosis and myocardial infarction is not fully understood.

    Methods and Results: Atherosclerotic plaques were analyzed for transcripts of the NLRP3 inflammasome, and for IL-1β release. The Swedish First-ever myocardial Infarction study in Ac-county (FIA) cohort consisting of DNA from 555 myocardial infarction patients and 1016 healthy individuals was used to determine the frequency of 4 single nucleotide polymorphisms (SNPs) from the downstream regulatory region of NLRP3. Expression of NLRP3, Apoptosis-associated speck-like protein containing a CARD (ASC), caspase-1 (CASP1), IL1B, and IL18 mRNA was significantly increased in atherosclerotic plaques compared to normal arteries. The expression of NLRP3 mRNA was significantly higher in plaques of symptomatic patients when compared to asymptomatic ones. CD68-positive macrophages were observed in the same areas of atherosclerotic lesions as NLRP3 and ASC expression. Occasionally, expression of NLRP3 and ASC was also present in smooth muscle cells. Cholesterol crystals and ATP induced IL-1β release from lipopolysaccharide-primed human atherosclerotic lesion plaques. The minor alleles of the variants rs4266924, rs6672995, and rs10733113 were associated with NLRP3 mRNA levels in peripheral blood mononuclear cells but not with the risk of myocardial infarction.

    Conclusions: Our results indicate a possible role of the NLRP3 inflammasome and its genetic variants in the pathogenesis of atherosclerosis.

  • 16.
    Redfors, Björn
    et al.
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jha, Sandeep
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Thorleifsson, Sigurdur
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jernberg, Tomas
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Angerås, Oskar
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. The Department of Cardiology.
    Petursson, Petur
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Tornvall, Per
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
    Sarno, Giovanna
    The Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Ekenbäck, Christina
    Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ravn-Fisher, Annika
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Y-Hassan, Shams
    The Department of Medicine, Karolinska University, Hospital Huddinge, Stockholm, Sweden.
    Lyon, Alexander R.
    NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
    James, Stefan
    The Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Erlinge, David
    The Department of Cardiology, Skåne University Hospital, Lund, Sweden.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Short- and Long-Term Clinical Outcomes for Patients With Takotsubo Syndrome and Patients With Myocardial Infarction: A Report From the Swedish Coronary Angiography and Angioplasty Registry2021In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 10, no 17, article id e017290Article in journal (Refereed)
    Abstract [en]

    Background: Takotsubo syndrome (TS) is a potentially life-threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, management, and outcome remain incompletely understood. Our aim was to assess the relative short-term mortality risk of TS, ST-segment-elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) and to identify predictors of in-hospital complications and poor prognosis in patients with TS.

    Methods and Results: This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898 [2.5%]), STEMI (N=48 493 [41.2%]), or NSTEMI (N=66 329 [56.3%]) between January 2009 and February 2018. We compared patients with TS to those with NSTEMI or STEMI. The primary end point was all-cause mortality at 30 days. Secondary outcomes were acute heart failure (Killip Class ≥2) and cardiogenic shock (Killip Class 4) at the time of angiography. Patients with TS were more often women compared with patients with STEMI or NSTEMI. TS was associated with unadjusted and adjusted 30-day mortality risks lower than STEMI (adjusted hazard ratio [adjHR], 0.60; 95% CI, 0.48-0.76; P<0.001), but higher than NSTEMI (adjHR, 2.70; 95% CI, 2.14-3.41; P<0.001). Compared with STEMI, TS was associated with a similar risk of acute heart failure (adjHR, 1.26; 95% CI, 0.91-1.76; P=0.16) but a lower risk of cardiogenic shock (adjHR, 0.55; 95% CI, 0.34-0.89; P=0.02). The relative 30-day mortality risk for TS versus STEMI and NSTEMI was higher for smokers than nonsmokers (adjusted P interaction STEMI=0.01 and P interaction NSTEMI=0.01).

    Conclusions: The 30-day mortality rate in TS was higher than in NSTEMI but lower than STEMI despite a similar risk of acute heart failure in TS and STEMI. Among patients with TS, smoking was an independent predictor of mortality. 

  • 17.
    Simard, Trevor
    et al.
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada.
    Hibbert, Benjamin
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada.
    Natarajan, Madhu K.
    Division of Cardiology, Hamilton Health Sciences, Hamilton ON, Canada.
    Mercuri, Mathew
    Division of Cardiology, Hamilton Health Sciences, Hamilton ON, Canada; Division of Cardiology, Department of Medicine, Columbia University, New York NY, USA.
    Hetherington, Simon L.
    Kettering General Hospital, Kettering, United Kingdom.
    Wright, Robert
    James Cook University Hospital, Middlesbrough, United Kingdom.
    Delewi, Ronak
    Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
    Piek, Jan J.
    Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
    Lehmann, Ralf
    Johann Wolfgang Goethe-University, Frankfurt, Germany.
    Ruzsa, Zoltán
    Cardiac and Vascular Center, Semmelweis University, Budapest, Hungary.
    Lange, Helmut W.
    Kardiologisch-Angiologische Praxis Herzzentrum, Bremen, Germany.
    Geijer, Håkan
    Örebro University, School of Medical Sciences. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Sandborg, Michael
    Radiation Physics, Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
    Kansal, Vinay
    Faculty of Undergraduate Medicine, University of Ottawa, Ottawa ON, Canada.
    Bernick, Jordan
    Cardiovascular Research Methods Center, Ottawa ON, Canada.
    Di Santo, Pietro
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada.
    Pourdjabbar, Ali
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada.
    Ramirez, F. Daniel
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada.
    Chow, Benjamin J. W.
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada.
    Chong, Aun Yeong
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada.
    Labinaz, Marino
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada.
    Le May, Michel R.
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada.
    O'Brien, Edward R.
    Libin Cardiovascular Institute of Alberta, Calgary AB, Canada.
    Wells, George A.
    Cardiovascular Research Methods Center, Ottawa ON, Canada.
    So, Derek
    Division of Cardiology, University of Ottawa Heart Institute, Ottawa ON, Canada .
    Impact of Center Experience on Patient Radiation Exposure During Transradial Coronary Angiography and Percutaneous Intervention: A Patient-Level, International, Collaborative, Multi-Center Analysis2016In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 5, no 6, article id e003333Article in journal (Refereed)
    Abstract [en]

    Background: The adoption of the transradial (TR) approach over the traditional transfemoral (TF) approach has been hampered by concerns of increased radiation exposure-a subject of considerable debate within the field. We performed a patient-level, multi-center analysis to definitively address the impact of TR access on radiation exposure.

    Methods and Results: Overall, 10 centers were included from 6 countries-Canada (2 centers), United Kingdom (2), Germany (2), Sweden (2), Hungary (1), and The Netherlands (1). We compared the radiation exposure of TR versus TF access using measured dose-area product (DAP). To account for local variations in equipment and exposure, standardized TR:TF DAP ratios were constructed per center with procedures separated by coronary angiography (CA) and percutaneous coronary intervention (PCI). Among 57 326 procedures, we demonstrated increased radiation exposure with the TR versus TF approach, particularly in the CA cohort across all centers (weighted-average ratios: CA, 1.15; PCI, 1.05). However, this was mitigated by increasing TR experience in the PCI cohort across all centers (r=-0.8; P=0.005). Over time, as a center transitioned to increasing TR experience (r=0.9; P=0.001), a concomitant decrease in radiation exposure occurred (r=-0.8; P=0.006). Ultimately, when a center's balance of TR to TF procedures approaches 50%, the resultant radiation exposure was equivalent.

    Conclusions: The TR approach is associated with a modest increase in patient radiation exposure. However, this increase is eliminated when the TR and TF approaches are used with equal frequency-a guiding principle for centers adopting the TR approach.

  • 18.
    Szarek, Michael
    et al.
    CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA; SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
    Hess, Connie
    CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA.
    Patel, Manesh R.
    Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
    Jones, W. Schuyler
    Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
    Berger, Jeffrey S.
    New York University School of Medicine, New York, NY, USA.
    Baumgartner, Iris
    Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland; University of Bern, Bern, Switzerland.
    Katona, Brian
    AstraZeneca Gaithersburg, Gaithersburg, MD, USA.
    Mahaffey, Kenneth W.
    Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, USA.
    Norgren, Lars
    Örebro University, School of Medical Sciences.
    Blomster, Juuso
    Turku University Hospital, Turku, Finland.
    Rockhold, Frank W.
    Duke Clinical Research Institute, Durham, NC, USA.
    Hsia, Judith
    CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA.
    Fowkes, F. Gerry R.
    Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
    Bonaca, Marc P
    CPC Clinical Research, Aurora, CO, USA; Department of Medicine, University of Colorado, Aurora, CO, USA.
    Total Cardiovascular and Limb Events and the Impact of Polyvascular Disease in Chronic Symptomatic Peripheral Artery Disease2022In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 11, no 11, article id e025504Article in journal (Refereed)
    Abstract [en]

    Background: Peripheral artery disease (PAD) is associated with heightened risk for major adverse cardiovascular and limb events, but data on the burden of risk for total (first and potentially subsequent) events, and the association with polyvascular disease, are limited. This post hoc analysis of the EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) trial evaluated total cardiovascular and limb events among patients with symptomatic PAD, overall and by number of symptomatic vascular territories.

    Methods and Results: In the EUCLID trial, patients with symptomatic PAD (lower extremity revascularization >30 days before randomization or ankle-brachial index ≤0.80) were randomized to treatment with ticagrelor or clopidogrel. Relative effects on total events (cardiovascular death; nonfatal myocardial infarction and ischemic stroke; acute limb ischemia, unstable angina, and transient ischemic attack requiring hospitalization; coronary, carotid, and peripheral revascularization procedures; and amputation for symptomatic PAD) were summarized by hazard ratios (HRs), whereas absolute risks were estimated by incidence rates and mean cumulative functions. Among 13 885 randomized patients, 7600 total cardiovascular and limb events occurred during a median 2.7 years of follow-up, translating to 60.0 and 62.5 events per 100 patients through 3 years for the ticagrelor and clopidogrel groups, respectively (HR, 0.96; 95% CI, 0.89-1.03; P=0.27). Among 1393 patients with disease in 3 vascular territories, event accrual rates through 3 years for the ticagrelor and clopidogrel groups were 87.3 and 97.7 events per 100 patients, respectively. Absolute risk reductions for ticagrelor relative to clopidogrel at 3 years were -0.2, 6.7, and 10.3 events per 100 patients for 1, 2, and 3 affected vascular territories, respectively (Pinteraction=0.09).

    Conclusions: Patients with symptomatic PAD have nearly double the number of total events than first events, with rates reflecting the number of affected vascular territories. These findings highlight the clinical relevance of quantifying disease burden in terms of total events and the need for long-term preventive treatments in high-risk patient populations. Registration URL: https://clinicaltrials.gov/; Unique identifier: NCT01732822.

  • 19.
    Tallroth, Mattias
    et al.
    Örebro University, School of Medical Sciences. Department of Neurology and Rehabilitation, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Clinical Epidemiology and Biostatistics.
    Büki, Andras
    Örebro University, School of Medical Sciences. Department of Neurosurgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    von Euler, Mia
    Örebro University, School of Medical Sciences. Department of Neurology and Rehabilitation, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Antithrombotic Treatment and Clinical Outcomes After Intracerebral Hemorrhage: A Retrospective Cohort Study from the Swedish Stroke Register2024In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, E-ISSN 2047-9980, Vol. 13, no 10, article id e034716Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A rapid shift has occurred from vitamin K antagonists toward direct oral anticoagulants, which have a lower risk of intracerebral hemorrhage (ICH). However, effects on clinical outcomes after ICH are understudied. We aimed to describe the prevalence of antithrombotic drugs and to study the prognosis among prestroke functionally independent Swedish patients with ICH.

    METHODS AND RESULTS: We identified all patients diagnosed with nontraumatic ICH in 2017 to 2021 from the Swedish Stroke Register (n=13 155) and assessed death and functional outcome at 3 months after ICH in prestroke functionally independent patients (n=10 014). Functional outcome was estimated among 3-month survivors on the basis of self-reported activities of daily living scores. Risks of outcomes were estimated using Poisson regression. In 13 155 patients, 14.5% used direct oral anticoagulant, 10.1% vitamin K antagonists, and 21.6% antiplatelets at ICH onset. Among 10 014 pre-stroke activities of daily living-independent patients, oral anticoagulants and antiplatelets were associated with increased mortality risk (adjusted risk ratio, 1.27 [95% CI, 1.13-1.43]; P<0.001; and adjusted risk ratio, 1.23 [95% CI, 1.13-1.34]; P<0.001 respectively). Mortality risk did not statistically differ between antiplatelets and oral anticoagulants nor between direct oral anticoagulant and vitamin K antagonists. Among 5126 patients with nonmissing functional outcome (69.1% of survivors), antiplatelets (adjusted risk ratio, 1.06 [95% CI, 0.99-1.13]; P=0.100) and oral anticoagulants (adjusted risk ratio, 1.01 [95% CI, 0.92-1.12]; P=0.768) were not statistically significantly associated with functional dependence.

    CONCLUSIONS: There was no statistically significant difference in mortality risk between direct oral anticoagulant and vitamin K antagonists in prestroke functionally independent patients (unadjusted for oral anticoagulant class indication). Furthermore, mortality risk in antiplatelet and oral anticoagulant users might differ less than previously suggested.

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