306 research outputs found
Trends in prevalence of ultrasound-assessed carotid atherosclerosis in a general population over time. The Tromsø Study 1994-2016
No full textBackground: During the past decades, there has been a shift in risk factor levels in many high-income countries, with decrease in smoking, blood pressure and cholesterol levels, while body mass index, obesity and diabetes increase. The diverging trends may have opposite effects on prevalence of atherosclerosis. We aimed to assess carotid plaque prevalence and the association with risk factor levels in a general population over a period of 22 years.
Methods: Prevalence of plaque, number of plaques and total plaque area in the carotid arteries were assessed in three repeated cross-sectional surveys of the population-based Tromsø Study from 1994 through 2016. The number of participants from the first to the last survey was 6362, 7069 and 3021. All surveys included physical examinations, questionnaires, and blood samples. Multivariable logistic regression analysis models were fitted to assess the relationship between risk factors and carotid plaque.
Results: We found no significant change in plaque burden over a period of 22 years, neither when measured as plaque presence, plaque number or total plaque area. Plaques were more frequent in men (70%) than in women (59.4%) and increased by age. Systolic blood pressure and smoking increased, while BMI and diabetes decreased over time both in participants with and without plaque. Most risk factors remained higher in participants with plaque than in plaque- free participants while cholesterol levels decreased and reached similar levels in both groups. Age, male sex, systolic blood pressure, smoking, diabetes and HDL cholesterol (inverse) were associated with plaque prevalence.
Conclusions: Plaque prevalence remained stable in the observation period. Favorable reductions in systolic blood pressure, cholesterol and smoking may have been partly counteracted by increased diabetes prevalence. Risk factor levels remained higher in participants with plaque than in plaque-free participants, indicating a potential for further improvement in primary prevention of carotid atherosclerosis
sj-docx-1-eso-10.1177_23969873221089800 – Supplemental material for Wake-up stroke and unknown-onset stroke; occurrence and characteristics from the nationwide Norwegian Stroke Register
No full textSupplemental material, sj-docx-1-eso-10.1177_23969873221089800 for Wake-up stroke and unknown-onset stroke; occurrence and characteristics from the nationwide Norwegian Stroke Register by Mary-Helen Søyland, Arnstein Tveiten, Agnethe Eltoft, Halvor Øygarden, Torunn Varmdal, Bent Indredavik and Ellisiv B Mathiesen in European Stroke Journal</p
Utredning med tanke på kardial embolikilde hos pasienter med hjerneinfarkt
No full textBakgrunn:
Kardial emboli er en viktig årsak til hjerneinfarkt. Hensikten med denne studien var å kartlegge omfanget av kardial utredning hos sykehusinnlagte pasienter med førstegangs hjerneinfarkt.
Metode og materiale:
Aktuelle for inklusjon i denne studien var 245 personer som deltok i den 5. Tromsøundersøkelsen i 2001-2002 og som fikk førstegangs hjerneinfarkt i oppfølgingsperioden fram til 31.12.2007. Informasjon om utredning med EKG, ekkokardiografi og samlet vurdering av utredning med tanke på kardial embolikilde var basert på journalopplysninger.
Resultater:
Andelen som ble utredet med EKG var høy hos både kvinner og menn (96%). Andelen som fikk utført ekkokardiografi falt signifikant med økende alder (69,2% av pasientene <55 år, 48,9% i alderen 55-74 år og 14,1% i aldersgruppen ≥75 år, p < 0,001) og var lavere hos kvinner enn hos menn (28,4% vs 41,9%, p=0,04). Kardial utredning ble vurdert som tilstrekkelig hos 72,1% av mennene og 75,2% av kvinnene. En fjerdedel av pasientene ble vurdert som utilstrekkelig utredet med tanke på koronar embolikilde. Kjønn, alder og bevissthetsgrad var ikke signifikant assosiert med samlet vurdering av tilstrekkelig koronarutredning.
Konklusjon:
Resultatene indikerer at utredning for å avdekke eventuell kardial embolikilde hos sykehusutredete pasienter med førstegangs hjerneinfarkt ikke er optimal
Hjerterytmeregistrering hos pasienter med akutt hjerneinfarkt innlagt i perioden 2012-2019 ved Universitetssykehuset Nord-Norge, Tromsø.
No full textBakgrunn: Atrieflimmer (AF) er en potent risikofaktor for hjerneslag og regnes å være årsaken til 20-30% av hjerneslag. Antikoagulasjonsbehandling har veldokumentert beskyttende effekt mot hjerneslag hos AF pasienter sammenlignet med platehemming. Tilstrekkelig hjerterytmeregistrering er derfor sentralt for valg av sekundærforebygging hos hjerneslagpasientene. Omfanget av hjerterytmemonitorering hos hjerneinfarktpasientene ved Universitetssykehuset Nord-Norge (UNN) er ikke kjent. Erfaringen blant leger og sykepleiere ved UNN er at telemetri kun er tilgjengelig i begrenset omfang.
Formål: Kartlegge omfanget av hjerterytmemonitorering hos pasienter innlagt med akutt hjerneinfarkt ved UNN i perioden 2012-2019. Undersøke hvilke faktorer som hadde betydning for prioritering av pasienter til hjerterytmemonitorering i samme periode.
Metode: Oppgaven er basert på registerdata over pasienter med diagnosen I63 hjerneinfarkt fra Norsk hjerneslagregister (NHR). Pasientene ble fordelt på to grupper basert på om de mottok kontinuerlig hjerterytmemonitorering i tråd med nasjonale retningslinjer. 1714 pasienter ble inkludert i studien, 927 i utredningsgruppen og 787 i ikke-utredningsgruppen.
Resultat: 54,1% av pasienten i studien mottok kontinuerlig hjerterytmemonitorering. Ikke-utredningsgruppen var i gjennomsnitt 2 år eldre enn utredningsgruppen og andelen kvinner og enslige/enker/enkemenn var høyere. Det var høyere andel av røykere og flere med tidligere hjerneinfarkt i ikke-utredningsgruppen. Det var signifikant høyere andel som mottok annen utredning i form av bildediagnostikk av hjernen og ekstrakranielle kar, samt ekkokardiografi i utredningsgruppen. 32% av pasientene i utredningsgruppen og 6,7% i ikke-utredningsgruppen fikk trombolyse.
Konklusjon: I perioden 2012-2019 mottok 54,1% av pasientene kontinuerlig hjerterytme-monitorering. Ettersom nasjonale retningslinjer anbefaler at hjerterytmemonitorering gjøres hos alle slagpasienter må dette regnes som et relativt lavt tall. Det var generelt mindre forskjell mellom utredningsgruppen og ikke-utredningsgruppen enn forventet. Dette kan bety at tilbudet om kontinuerlig hjerterytmemonitorering påvirkes av om det er tilgjengelig ved behov
Ischemic stroke in a general population: Time trends in incidence, case fatality and the impact of risk factors.
No full textAbout 80-85% of all strokes are due to reduced blood flow to the brain (ischemic strokes). Lack of knowledge regarding time trends in incidence and case fatality of ischemic stroke in Norway represented a main motivation for this study. Data from the Tromsø Study, following >40,000 attendees from six surveys through 2012, provided an excellent opportunity to reveal time trends of ischemic stroke and assess the potential mechanisms behind these trends in a general population.
We found that the overall age- and sex adjusted incidence of ischemic stroke declined with 27% from 1995–2012 in persons aged ≥30 years. The time trends differed by age, with increasing incidence in women aged 30-49 years, a non-significant rising trend among men 30–49 years, and declining incidence in women aged 50–74 and men aged 65–74 years. In men 50–64 and among those ≥75 years, the ischemic stroke incidence in 2012 did not differ from the incidence two decades earlier. The age-adjusted 30-days case fatality decreased in men aged 30-84 years but not in women or in attendees ≥85 years.
Overall, the combined changes in seven cardiovascular risk factors (systolic blood pressure, total cholesterol, HDL, daily smoking, physical activity, diabetes and body mass index) accounted for 57% (95% CI: 28–100) of the decrease in ischemic stroke incidence from 1995–2012, with decrease in average blood pressure and decline in smoking prevalence as the most important contributors. The increasing diabetes prevalence contributed negatively to the decline in ischemic stroke risk.
Using the parametric g-formula, we could hypothetically apply joint interventions and assess the subsequent stroke risk. We found that a feasible joint hypothetical intervention on systolic blood pressure, total cholesterol, weight, physical activity, smoking and alcohol intake would reduce the 18-year stroke risk in our population by 19% (1995–2012). A combination of more intensive interventions would reduce the estimated 18-years stroke risk by 55%. Blood pressure reduction and quitting smoking significantly reduced the risk when applied separately
Retinal vascular calibres: Risk factors and methodological aspects of retinal vascular imaging. The Tromsø Eye Study – a part of the Tromsø Study.
No full textCardiovascular disease is a major cause of death and morbidity in developed countries. The eye offers a unique window to the study of the microvasculature in vivo, which has been less investigated than the macrovasculature. We wanted to investigate the relationship between the traditional cardiovascular risk factors and retinal vascular calibres. Further, iron is a proposed cardiovascular risk factor and we wanted to investigate whether measures of iron stores and hemoglobin are related to retinal vascular calibre.
The two first papers in this thesis are based on data from the Tromsø Study. We have measured the diameter of the retinal arterioles and venules on retinal images from 6353 participants of the sixth survey of the Tromsø Study (Tromsø 6, 2007-2008). We found that blood pressure and smoking were the factors with the most pronounced effect on the retinal vascular calibre. Blood pressure and age were associated with narrower retinal vessels and mainly affecting arteriolar calibre. Smoking, overweight (body mass index) and unfavourable lipid-profile were associated with wider retinal vessels, mainly affecting venular calibre. The effect of low HDL cholesterol and high BMI with venular widening was significantly stronger in men than in women.
Further, 2993 participants with retinal vascular calibre measurements in Tromsø 6 also participated in the fifth survey (Tromsø 5, 2001-2002) when measurements of iron stores (serum ferritin and transferring saturation) and hemoglobin were performed. Men have higher levels of both iron stores and hemoglobin. We found that serum ferritin was associated with wider retinal venules in men. Hemoglobin was associated with wider retinal venules in both men and women.
Cameras used for retinal photography commonly use light in the visual spectrum for the imaging technique and include several exposures with flash illumination to capture different fields of the retina. We examined 32 healthy volunteers and found that retinal venular calibre increased during an image sequence of 6 images and that the venular calibre was wider after light exposure compared to dark exposure before imaging
Får hjerneinfarktspasienter i Tromsø adekvat utredning for å avdekke karotisstenose og hvordan påvirkes utredningen av alder, kjønn og slagets alvorlighetsgrad?
No full textBakgrunn: Vi vet i dag lite om hva slags utredning som blir gjort blant hjerneslagspasienter i Tromsø. I henhold til nasjonale faglige retningslinjer bør man som hovedregel gjøre utredning med tanke på karotisstenose hos alle pasienter med hjerneinfarkt. I denne studien kartlegges utredningsfrekvensen for karotisstenose blant hjerneinfarktpasienter som deltok i den 5. tromsøundersøkelsen i 2001-02 (Tromsø 5) og hvorvidt alder, kjønn og slagets alvorlighetsgrad påvirker denne.
Materiale og metode: I alt 7852 deltakere i Tromsø 5 uten tidligere hjerneinfarkt ble fulgt opp med registrering av førstegangs hjerneinfarkt t.o.m. 2007. Av disse fikk 268 personer førstegangs hjerneinfarkt i oppfølgingsperioden og ble inkludert i studien. Adekvat stenoseutredning ble definert som ultralydsundersøkelse og/eller angiografisk (CT, MR eller konvensjonell angiografi) framstilling av det precerebrale forløp av karotisarteriene.
Resultater: Totalt var det 62 % som gjennomgikk adekvat stenoseutredning. Færre ble utredet i de eldste aldersgruppene (p<0,0001), blant dem med registrert demensdiagnose (p=0,06) og de som hadde svekket bevissthet ved innkomst (p=0,01). Det var ingen forskjell i utredning mellom kjønnene. Med 10 års økning i alder ble sjansen for stenoseutredning redusert med 76 % (OR 0,24, KI 0,14 – 0,39). Svekket bevissthet reduserte sjansen for utredning med 72 % (OR 0,27, KI 0,11 – 0,53).
Diskusjon: En høy andel av hjerneinfarktpasientene ble ikke utredet for å avdekke eventuell karotisstenose. Selv når man tar hensyn til forhold som bevissthetssvekkelse som uttrykk for slagets alvorlighetsgrad og komorbiditiet i form av demens, synes utredningsfrekvensen å være lavere enn det som er anbefalt i gjeldende nasjonale anbefalinger
Effects of alteplase on survival after ischaemic stroke (IST-3): 3 year follow-up of a randomised, controlled, open-label trial
No full textThe effect of alteplase on patient survival after ischaemic stroke is the subject of debate. We report the effect of intravenous alteplase on long-term survival after ischaemic stroke of participants in the Third International Stroke Trial (IST-3).In IST-3, done at 156 hospitals in 12 countries (Australia, Europe, and the UK), participants (aged >18 years) were randomly assigned with a telephone voice-activated or web-based system in a 1:1 ratio to treatment with intravenous 0·9 mg/kg alteplase plus standard care or standard care alone within 6 h of ischaemic stroke. We followed up participants in the UK and Scandinavia (Sweden and Norway) for survival up to 3 years after randomisation using data from national registries and compared survival in the two groups with proportional hazards survival analysis, adjusting for key prognostic variables. IST-3 is registered with the ISRCTN registry, number ISRCTN25765518.Between May 5, 2000, and July 27, 2011, 3035 participants were enrolled in IST-3. Of these, 1948 (64%) of 3035 participants were scheduled for analysis of 3 year survival, and 1946 (>99%) of these were included in the analysis (967 [50%] in the alteplase plus standard care group and 979 [50%] in the standard care alone group). By 3 years after randomisation, 453 (47%) of 967 participants in the alteplase plus standard care group and 494 (50%) of 979 in the standard care alone group had died (risk difference 3·6% [95% CI -0·8 to 8·1]). Participants allocated to alteplase had a significantly higher hazard of death during the first 7 days (99 [10%] of 967 died in the alteplase plus standard care group vs 65 [7%] of 979 in the standard care alone group; hazard ratio 1·52 [95% CI 1·11-2·08]; p=0·004) and a significantly lower hazard of death between 8 days and 3 years (354 [41%] of 868 vs 429 [47%] of 914; 0·78 [0·68-0·90]; p=0·007).Alteplase treatment within 6 h after ischaemic stroke was associated with a small, non-significant reduction in risk of death at 3 years, but among individuals who survived the acute phase, treatment was associated with a significant increase in long-term survival. These results are reassuring for clinicians who have expressed concerns about the effect of alteplase on survival.Heart and Stroke Scotland, UK Medical Research Council, Health Foundation UK, Stroke Association UK, Research Council of Norway, AFA Insurance, Swedish Heart Lung Fund, Foundation of Marianne and Marcus Wallenberg, Polish Ministry of Science and Education, Australian Heart Foundation, Australian National Health and Medical Research Council, Swiss National Research Foundation, Swiss Heart Foundation, Assessorato alla Sanita (Regione dell'Umbria), and Danube University
The stenotic carotid artery plaque : prevalence, risk factors and relations to clinical disease : the Tromsø study
No full textStroke is the second leading cause of death
in the world and is responsible for a high
percentage of major disability, requiring
substantial resources spent on care and
rehabilitation. Atherosclerosis due to lipid
accumulation in the vessel wall with
formation of stenotic atheromatous plaques
in the carotid bifurcation and/or the internal
carotid artery is an important cause of
stroke. In 1991, two large, multi-center
trials reported that carotid endarterectomy
was of benefit to patients with a degree of
stenosis above 70%, and thus showed that
the degree of stenosis was a major risk
factor for ipsilateral stroke. However, it
is well known that many high-grade
stenoses remain stable and never cause
cerebrovascular events, while others
develop rapidly and produce serious,
potentially life-threatening disease. While
the majority of patients presenting with
transient ischemic attack (TIA) and stroke
has an ipsilateral carotid lesion, only about
half of them have a hemodynamically
significant carotid stenosis. Only 5-15%
of strokes are heralded by a TIA. This has
led to a search for additional risk factors
which might help identify the individuals
with a high risk for stroke
Response to Letter by Romanens Regarding Article, “Carotid Plaque Area and Intima-Media Thickness in Prediction of First-Ever Ischemic Stroke: A 10-Year Follow-Up of 6584 Men and Women: The Tromsø Study”
No full text- …
