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  • 1.
    Mohammad, Moman A.
    et al.
    Lund Univ, Sweden.
    Koul, Sasha
    Lund Univ, Sweden.
    Rylance, Rebecca
    Lund Univ, Sweden.
    Frobert, Ole
    Orebro Univ, Sweden.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Sahlen, Anders
    Karolinska Inst, Sweden; Natl Heart Ctr Singapore, Singapore.
    Witt, Nils
    Soder Sjukhuset, Sweden.
    Jernberg, Tomas
    Karolinska Inst, Sweden.
    Muller, James
    Brigham and Womens Hosp, MA 02115 USA.
    Erlinge, David
    Lund Univ, Sweden.
    Association of Weather With Day-to-Day Incidence of Myocardial Infarction A SWEDEHEART Nationwide Observational Study2018In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 3, no 11, p. 1081-1089Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Whether certain weather conditions modulate the onset of myocardial infarction (MI) is of great interest to clinicians because it could be used to prevent MIs as well as guide allocation of health care resources. OBJECTIVE To determine if weather is associated with day-to-day incidence of MI. DESIGN, SETTING, AND PARTICIPANTS In this prospective, population-based and nationwide setting, daily weather data from the Swedish Meteorological and Hydrological Institute were extracted for all MIs reported to the Swedish nationwide coronary care unit registry, Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART), during 1998 to 2013 and then merged with each MI on date of symptom onset and coronary care unit. All patients admitted to any coronary care unit in Sweden owing to MI were included, A total of 280 873 patients were included, of whom 92 044 were diagnosed as having ST-elevation MI. Weather data were available for 274 029 patients (97.6%), which composed the final study population. Data were analyzed between February 2017 and April 2018. EXPOSURES The nationwide daily mean air temperature, minimum air temperature, maximum air temperature, wind velocity, sunshine duration, atmospheric air pressure, air humidity, snow precipitation, rain precipitation, and change in air temperature. MAIN OUTCOMES AND MEASURES The nationwide daily counts of MI as outcome. RESULTS In 274 029 patients, mean (SD) age was 71.7 (12) years. Incidence of MI increased with lower air temperature, lower atmospheric air pressure, higher wind velocity, and shorter sunshine duration. The most pronounced association was observed for air temperature, where a 1-SD increase in air temperature (7.4 degrees C) was associated with a 2.8% reduction in risk of MI (unadjusted incidence ratio, 0.972; 95% CI, 0.967-0.977; P amp;lt;.001). Results were consistent for non-ST-elevation MI as well as ST-elevation MI and across a large range of subgroups and health care regions. CONCLUSIONS AND RELEVANCE In this large, nationwide study, low air temperature, low atmospheric air pressure, high wind velocity, and shorter sunshine duration were associated with risk of MI with the most evident association observed for air temperature.

  • 2.
    Schwartz, Gregory G.
    et al.
    Vet Affairs Med Ctr, CO 80220 USA; Univ Colorado, CO USA.
    Ballantyne, Christie M.
    Baylor Coll Med, TX 77030 USA.
    Barter, Philip J.
    Univ New South Wales, Australia.
    Kallend, David
    Medicines Co, Switzerland.
    Leiter, Lawrence A.
    Univ Toronto, Canada.
    Leitersdorf, Eran
    Hadassah Hebrew Univ, Israel.
    McMurray, John J. V.
    Univ Glasgow, Scotland.
    Nicholls, Stephen J.
    Univ Adelaide, Australia.
    Olsson, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Shah, Prediman K.
    Cedars Sinai Heart Inst, CA USA.
    Tardif, Jean-Claude
    Univ Montreal, Canada.
    Kittelson, John
    Univ Colorado, CO USA.
    Association of Lipoprotein(a) With Risk of Recurrent Ischemic Events Following Acute Coronary Syndrome Analysis of the dal-Outcomes Randomized Clinical Trial2018In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 3, no 2, p. 164-168Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE It is uncertain whether lipoprotein(a) [Lp(a)], which is associated with incident cardiovascular disease, is an independent risk factor for recurrent cardiovascular events after acute coronary syndrome (ACS). OBJECTIVE To determine the association of Lp(a) concentration measured after ACS with the subsequent risk of ischemic cardiovascular events. DESIGN, SETTING, AND PARTICIPANTS This nested case-cohort analysis was performed as an ad hoc analysis of the dal-Outcomes randomized clinical trial. This trial compared dalcetrapib, the cholesteryl ester transfer protein inhibitor, with placebo in patients with recent ACS and was performed between April 2008 and September 2012 at 935 sites in 27 countries. There were 969 case patients who experienced a primary cardiovascular outcome, and there were 3170 control patients who were event free at the time of a case event and had the same type of index ACS (unstable angina ormyocardial infarction) as that of the respective case patients. Concentration of Lp(a) was measured by immunoturbidimetric assay. Data analysis for this present study was conducted from June 8, 2016, to April 21, 2017. INTERVENTIONS Patients were randomly assigned to receive treatment with dalcetrapib, 600 mg daily, or matching placebo, beginning 4 to 12 weeks after ACS. MAIN OUTCOMES AND MEASURES Death due to coronary heart disease, a major nonfatal coronary event (myocardial infarction, hospitalization for unstable angina, or resuscitated cardiac arrest), or fatal or nonfatal ischemic stroke. RESULTS The mean (SD) age was 63 (10) years for the 969 case patients and 60 (9) years for the 3170 control patients, and both cohorts were composed of predominantly male (770 case patients [79%] and 2558 control patients [81%]; P = .40) and white patients (858 case patients [89%] and 2825 control patients [89%]; P = .62). At baseline, the median (interquartile range) Lp(a) level was 12.3 (4.7-50.9) mg/dL. There was broad application of evidence-based secondary prevention strategies after ACS, including use of statins in 4030 patients (97%). The cumulative distribution of baseline Lp(a) levels did not differ between cases and controls at P = .16. Case-cohort regression analysis showed no association of baseline Lp(a) level with risk of cardiovascular events. For a doubling of Lp(a) concentration, the hazard ratio (case to control) was 1.01 (95% CI, 0.96-1.06; P = .66) after adjustment for 16 baseline variables, including assigned study treatment. CONCLUSIONS AND RELEVANCE For patients with recent ACS who are treated with statins, Lp(a) concentration was not associated with adverse cardiovascular outcomes. These findings call into question whether treatment specifically targeted to reduce Lp(a) levels would thereby lower the risk for ischemic cardiovascular events after ACS.

  • 3.
    Själander, Sara
    et al.
    Umeå University, Sweden.
    Holmqvist, Fredrik
    Skåne University Hospital, Sweden; Lund University, Sweden.
    Gustav Smith, J.
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Platonov, Pyotr G.
    Skåne University Hospital, Sweden; Lund University, Sweden.
    Kesek, Milos
    Umeå University, Sweden.
    Svensson, Peter J.
    Lund University, Sweden.
    Blomstrom-Lundqvist, Carina
    Uppsala University, Sweden.
    Tabrizi, Fariborz
    Karolinska Institute, Sweden; Arrhythmia Centre Stockholm, Sweden; Arrhythmia Centre Stockholm, Sweden.
    Tapanainen, Jari
    Karolinska University Hospital, Sweden.
    Poci, Dritan
    Örebro University, Sweden.
    Jonsson, Anders
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Själander, Anders
    Umeå University, Sweden.
    Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation2017In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591, Vol. 2, no 2, p. 146-152Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke. OBJECTIVES To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age amp;gt;= 75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort studywas conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016. EXPOSURES Warfarin treatment. MAIN OUTCOMES AND MEASURES Ischemic stroke, intracranial hemorrhage, and death. RESULTS In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA(2)DS(2)-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA(2)DS(2)-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P = .046). Patients with a CHA(2)DS(2)-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P = .02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P = .007, respectively). CONCLUSIONS AND RELEVANCE These findings indicate that discontinuation ofwarfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.

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