Showing papers by "Jaap W. Deckers published in 2014"

Sex differences in lifetime risk and first manifestation of cardiovascular disease: prospective population based cohort study

Abstract: Objective To evaluate differences in first manifestations of cardiovascular disease between men and women in a competing risks framework. Design Prospective population based cohort study. Setting People living in the community in Rotterdam, the Netherlands. Participants 8419 participants (60.9% women) aged ≥55 and free from cardiovascular disease at baseline. Main outcome measures First diagnosis of coronary heart disease (myocardial infarction, revascularisation, and coronary death), cerebrovascular disease (stroke, transient ischaemic attack, and carotid revascularisation), heart failure, or other cardiovascular death; or death from non-cardiovascular causes. Data were used to calculate lifetime risks of cardiovascular disease and its first incident manifestations adjusted for competing non-cardiovascular death. Results During follow-up of up to 20.1 years, 2888 participants developed cardiovascular disease (826 coronary heart disease, 1198 cerebrovascular disease, 762 heart failure, and 102 other cardiovascular death). At age 55, overall lifetime risks of cardiovascular disease were 67.1% (95% confidence interval 64.7% to 69.5%) for men and 66.4% (64.2% to 68.7%) for women. Lifetime risks of first incident manifestations of cardiovascular disease in men were 27.2% (24.1% to 30.3%) for coronary heart disease, 22.8% (20.4% to 25.1%) for cerebrovascular disease, 14.9% (13.3% to 16.6%) for heart failure, and 2.3% (1.6% to 2.9%) for other deaths from cardiovascular disease. For women the figures were 16.9% (13.5% to 20.4%), 29.8% (27.7% to 31.9%), 17.5% (15.9% to 19.2%), and 2.1% (1.6% to 2.7%), respectively. Differences in the number of events that developed over the lifespan in women compared with men (per 1000) were −7 for any cardiovascular disease, −102 for coronary heart disease, 70 for cerebrovascular disease, 26 for heart failure, and −1 for other cardiovascular death; all outcomes manifested at a higher age in women. Patterns were similar when analyses were restricted to hard atherosclerotic cardiovascular disease outcomes, but absolute risk differences between men and women were attenuated for both coronary heart disease and stroke. Conclusions At age 55, though men and women have similar lifetime risks of cardiovascular disease, there are considerable differences in the first manifestation. Men are more likely to develop coronary heart disease as a first event, while women are more likely to have cerebrovascular disease or heart failure as their first event, although these manifestations appear most often at older ages.

Heart disease in the Netherlands: a quantitative update

Abstract: In this review we discuss cardiovascular mortality, incidence and prevalence of heart disease, and cardiac interventions and surgery in the Netherlands. We combined most recently available data from various Dutch cardiovascular registries, Dutch Hospital Data (LMR), Statistics Netherlands (CBS), and population-based cohort studies, to provide a broad quantitative update. The absolute number of people dying from cardiovascular diseases is declining and cardiovascular conditions are no longer the leading cause of death in the Netherlands. However, a substantial burden of morbidity persists with 400,000 hospitalisations for cardiovascular disease involving over 80,000 cardiac interventions annually. In the Netherlands alone, an estimated 730,000 persons are currently diagnosed with coronary heart disease, 120,000 with heart failure, and 260,000 with atrial fibrillation. These numbers emphasise the continuous need for dedicated research on prevention, diagnosis, and treatment of heart disease in our country.

Healthy volunteer effect and cardiovascular risk.

Abstract: REFERENCES 1. Murray CJ, Kulkarni SC, Michaud C, et al. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med. 2006;3:e260. 2. National Center for Health Statistics. Health, United States, 2012. 2013. Available at: http:// www.cdc.gov/nchs/hus.htm. Accessed 24 December 2013. 3. Gawande A. The hot spotters. New Yorker. 2011;86:41. 4. US Department of Health and Human Services. Healthy People 2020: General Health Status Topics and Objectives. Washington, DC: US Department of Health and Human Services; 2011. 5. Howard-Pitney B, Winkleby MA. Chewing tobacco: who uses and who quits? Findings from NHANES III, 1988–1994. Am J Public Health. 2002;92:250–256. 6. Lewis RJ. An introduction to classification and regression tree (CART) analysis. In: Annual Meeting of the Society for Academic Emergency Medicine. San Francisco, CA: Citeseer; 2000:1–14. 7. Breiman L. Random forests. Mach Learn. 2001;45:5–32. 8. Garge NR, Bobashev G, Eggleston B. Random forest methodology for model-based recursive partitioning: the mobForest package for R. BMC Bioinformatics. 2013;14:125. in such studies because relatively good health status is required for a person to agree to undergo the examinations. This implies that persons enrolled in a study requiring active participation are healthier than those who declined to participate. It is thus unclear whether the cardiovascular risk distributions among study participants adequately reflect the risk distribution of the source population. We aimed to quantify the consequences of this “healthy volunteer effect.” Within the Rotterdam Study,1 a prospective population-based cohort, we investigated the association between participation in the third examination (1997–1999), all-cause mortality,2 and coronary risk (Framingham point score; assessed at enrollment 1990–1993)3 (see eAppendix, http://links.lww.com/ EDE/A779 for details). Of 5423 eligible invitees (mean age 73.5 years; 39% men), 87% participated, of whom 76% visited the research center (eTable 1, http://links.lww.com/EDE/A779). Nonparticipants had lost interest (50%), had physical complaints (34%), or considered themselves too old to participate (12%; mean age 86.9 years). Persons who were elderly, women, less educated, and with higher levels of specific cardiovascular risk factors were less likely to participate (eTable 1). Nonparticipation was strongly associated with mortality (hazard ratio [HR] = 1.71 [95% confidence interval (CI) = 1.56–1.88]). This was most pronounced shortly after invitation (0–3 months, HR = 4.85 [2.43–9.71]), with a diminishing healthy volunteer effect during follow-up (test for trend, P < 0.001) (Table). Every percentagepoint increase in coronary risk yielded an approximately 3% lower probability of participating (eTable 2, http:// links.lww.com/EDE/A779). Those categorized as “high risk” were least likely to participate (odds ratio = 0.56 [95% CI = 0.45–0.71]; eTable 2). There was a slightly lower proportion of highrisk persons among the examined participants compared with all invitees

Comparison of prognosis in unrecognized versus recognized myocardial infarction in men versus women >55 years of age (from the Rotterdam Study).

Abstract: Unrecognized myocardial infarction (MI) is frequent in the general population. Its prognosis is reported to be at least as unpropitious as that of recognized MI, particularly in men. However, contemporary data with long follow-up are lacking. The aims of this study were to investigate the long-term prognosis of unrecognized MI with respect to all-cause and cause-specific mortality and to investigate possible differences in prognosis by gender. In the population-based Rotterdam Study (2,672 men and 3,862 women), the presence of unrecognized MI and recognized MI was determined at baseline (1990 to 1993). The cohort was followed for nearly 2 decades for all-cause and cause-specific mortality. During 82,268 patient-years of follow-up (median 15.6 years) 3,412 patients died (1,300 from cardiovascular causes). Men and women with recognized and unrecognized MIs had increased total mortality rates compared with those without MIs. Hazard ratios (HRs) for men and women were 1.57 (95% confidence interval [CI] 1.36 to 1.81) and 1.89 (95% CI 1.56 to 2.30) for recognized MI and 1.72 (95% CI 1.43 to 2.07) and 1.36 (95% CI 1.14 to 1.61) for unrecognized MI. Unrecognized MI was associated with increased risks for cardiovascular mortality (men: HR 2.19, 95% CI 1.66 to 2.91; women: HR 1.36, 95% CI 1.03 to 1.81) and noncardiovascular mortality (men: HR 1.47, 95% CI 1.14 to 1.89; women: HR 1.39, 95% CI 1.10 to 1.75). In conclusion, the long-term prognosis of patients with unrecognized MIs is worse compared with those without MIs and applies not only to cardiovascular mortality but also to noncardiovascular mortality. In men, the prognosis is as unfavorable as that of patients with recognized MIs.

Risk factors for coronary heart disease and survival after myocardial infarction

Abstract: Objectives:Several risk factors for coronary heart disease (CHD) have been associated with improved in-hospital survival after myocardial infarction (MI). We aimed to confirm this paradox and asses...

Erratum to: Heart disease in the Netherlands: a quantitative update

Abstract: Erratum to: Neth Heart J (2013) 22:3–10 DOI 10.1007/s12471-013-0504-x Figures 1, ​,2,2, ​,3,3, and ​and44 in the article were incorrect and should have appeared as presented in this erratum. The authors apologise for this oversight and any confusion this may have caused. Fig. 1 Standardised cardiovascular mortality per 100,000 inhabitants in the Netherlands from 1950 through 2011 [1] Fig. 2 Coronary heart disease incidence per 1000 inhabitants in the Netherlands in 2007 (Source: general practice registry) [1] Fig. 3 Number of surgical procedures and percutaneous coronary interventions in the Netherlands from 1983 through 2012 (Source: Supervisory Committee for Cardiac Interventions in the Netherlands (BHN)) [2] Fig. 4 Number of deaths attributed to myocardial infarction or heart failure as the primary cause of death in the Netherlands from 1980 through 2012 (Source: Statistics Netherlands (CBS))

Abstract 12068: Sex Differences in Lifetime Risk and First Manifestation of Cardiovascular Disease: An Evidence Gap in Preventive Cardiology

Abstract: Introduction: Knowledge on the first manifestation of cardiovascular disease (CVD) is relevant for primary prevention and data on sex differences of first manifestations of CVD are scarce. Hypothesis: We sought to evaluate differences in first CVD manifestations between men and women in a competing risks framework. Methods: We used data from 8419 participants (60.9% women), aged 55 years and older, of the prospective population-based Rotterdam Study cohorts to estimate lifetime risks of CVD and its first-incident fatal or nonfatal manifestations (coronary heart disease [CHD], cerebrovascular disease, heart failure, and other CVD death) at various ages. Competing risks among the different first CVD manifestations and non-cardiovascular death were taken into account in all analyses. Regression models were adjusted for cardiovascular risk factors. Results: During a follow-up of up to 20.1 years, 2888 participants developed CVD. Lifetime risk of CVD at age 55 was similar for both sexes with 67.1% (95% CI 64.7-69.5) for men and 66.4% (95% CI 64.2-68.7) for women (P=0.34 for difference between sexes). Lifetime risks of first CVD manifestations coronary heart disease, cerebrovascular disease, heart failure, and other CVD death were 27.2% (95% CI 24.1-30.3), 22.8% (95% CI 20.4-25.1), 14.9% (95% CI 13.3-16.6), and 2.3% (95% CI 1.6-2.9) for men, and 16.9% (95% CI 13.5-20.4)(P Conclusions: At age 55, men and women have similar lifetime risks of CVD. However, sex differences in the first manifestation of CVD are large with coronary heart disease being the most common initial manifestation of CVD in men, whereas in women CVD unveils itself most frequently with cerebrovascular disease followed by heart failure. Our results underscore the importance of adequate risk factor control for stroke and heart failure in women.