1,721,172 research outputs found
Trends in prevalence of ultrasound-assessed carotid atherosclerosis in a general population over time. The Tromsø Study 1994-2016
Full text linkBackground: 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
Effects of alteplase on survival after ischaemic stroke (IST-3): 3 year follow-up of a randomised, controlled, open-label trial
Full text linkThe 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
Prediction of progression of ultrasound assessed carotid artery athersclerosis
Full text linkAtherosclerosis is an important underlying cause of cardiovascular disease and death.
According to the World Health Organization’s Global Burden of Disease Study, ischemic heart disease and stroke combined killed 12.9 million people in 2010, or one in four deaths worldwide. Ultrasound of the carotid arteries can be used to assess the burden of atherosclerosis by measurements of intima-media thickness (IMT) and total plaque area (TPA). Age, male gender, serum cholesterol, blood pressure and smoking are well known risk factors for atherosclerosis, while factors that may influence the progression of atherosclerosis have been less extensively studied. In the longitudinal population-based Tromsø Study, ultrasound assessment of carotid atherosclerosis was performed at in 1994-5 and repeated in 2007-8. We found that age, male sex, total cholesterol, systolic blood pressure and smoking measured at baseline (1994-5) were associated with progression of TPA, whereas male sex, total cholesterol and systolic blood pressure (inverse) were predictors of progression of IMT.
The metabolic syndrome, a cluster of metabolic and non-metabolic cardiovascular risk factors
including impaired glucose tolerance, visceral adiposity, dyslipidemia, and hypertension, was
not associated with progression of IMT or TPA in the total study population. Use of lipidlowering
drugs had a protective effect against progression of carotid atherosclerosis, most pronounced in subjects who had used LLD for 5 years or more
Utredning med tanke på kardial embolikilde hos pasienter med hjerneinfarkt
Full text linkBakgrunn:
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
Carotid atherosclerosis, vascular risk factors and relation to cognitive test results : the Tromsø study 1994-2008.
Full text linkThe prevalence of dementia and cognitive impairment is rising worldwide as the number of elderly people increases in most countries. Vascular risk factors and carotid artery atherosclerosis have in some epidemiological studies been associated with increased risk of cognitive decline. The carotid artery is essential for blood supply to the brain, but is also vulnerable to atherosclerosis. The degree of atherosclerosis in the carotid artery can easily be measured by ultrasonography.
The population-based Tromsø study, with repeated screening surveys of the Tromsø population, has made it possible to follow participants prospectively. Repeated carotid ultrasound scanning and cognitive test assessments have provided a unique opportunity for assessing change in atherosclerosis and change in cognitive test scores. In this study we assessed the impact of different vascular risk factors on scores in three cognitive tests after 7 years of follow-up, and studied if carotid atherosclerosis and progression of atherosclerosis were independent risk factors for lower cognitive test scores and cognitive decline in a middle–aged stroke-free population.
We found that diabetes, smoking and systolic blood pressure were consistent and independent risk factors for lower cognitive test results after 7 years follow-up in both genders. Physical inactivity was associated with lower scores in women. Carotid atherosclerosis measured as total plaque area and number of plaques predicted lower scores on the verbal memory test 7 years later, whereas the average of plaque scores, measured at baseline and at follow-up, was associated with lower scores on all the cognitive tests in this study. Progression of carotid plaques over 7 years was associated with lower scores on the digit symbol coding test and the tapping test. We found no association between plaque scores and cognitive decline from 7 to 13 years of follow-up
Temporal trends in intracerebral hemorrhage in a general population. Incidence, risk factors, case fatality and long-term mortality. The Tromsø Study
Full text linkIntracerebral hemorrhage (ICH) is the second most common subtype of stroke. The prognosis is poor. However, it is to a large degree a preventable disease. The aim of our study was to analyse the association between cardiovascular risk factors and risk of ICH, and to assess the impact of changes in risk factor levels over time on incidence rates of ICH. In addition, we aimed to analyse short- and long-term mortality after ICH. The Tromsø study is an ongoing, longitudinal population-based study with repeated health surveys, with >45,000 attendees, providing an unique opportunity to assess longitudinal data on ICH epidemiology in a general population in a well-defined geographical area. Age, male sex, systolic and diastolic blood pressure were significantly associated with increased risk of ICH. Incidence rates were stable in the overall population in the period 1995-2013. In women incidence rates decreased, whereas incidence rates in men were stable. Lower blood pressure levels, and a steeper decrease in blood pressure in women may have contributed to the difference in trends. Despite an increase in treatment of hypertension, less than half of attendees of the last survey who had hypertension were on blood pressure-lowering drugs. Of these, two-thirds had uncontrolled hypertension. One-month case fatality and 5-year mortality rates remained stable. Participants who survived the first 30 days after ICH had a more than 60% increased 5-year risk of death compared with controls matched by birth-year and sex. The main cause of death was cardiovascular disease. Smoking, serum cholesterol and use of anticoagulant drugs at time of ICH were associated with increased risk of 5-year mortality after ICH.
Our results indicate that there is a need for improved primary prevention of ICH. The stable short- and long-term mortality rates probably reflect the limited treatment possibilities of ICH and emphasize the urge for improved treatment strategies in the acute phase and a need for better knowledge on secondary prevention after ICH
Hjerterytmeregistrering hos pasienter med akutt hjerneinfarkt innlagt i perioden 2012-2019 ved Universitetssykehuset Nord-Norge, Tromsø.
Full text linkBakgrunn: 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.
Full text linkAbout 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?
Full text linkBakgrunn: 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
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