ObjectiveTo investigate the association between echocardiographic measurements with emphasis on diastolic dysfunction and risk of atrial fibrillation (AF) in a population-based cohort study.MethodsWe followed 2406 participants from the Tromsø Study from 1994 to 2010. Left atrial (LA) size and mitral Doppler indices as measured by echocardiography were used for evaluating diastolic dysfunction. Information concerning age, systolic blood pressure, height, heart rate, body mass index, total and high-density lipoprotein cholesterol, self-reported use of alcohol, smoking, coffee, physical activity, antihypertensive treatment, prevalent coronary heart disease, valvular heart disease, heart failure, hypertrophy, diabetes and palpitations were obtained at baseline. The outcome measure was clinical AF, documented by an ECG.ResultsAF was detected in 462 subjects (193 women). Mean age at baseline was 62.6 years. Incidence rate of clinical AF was 12.6 per 1000 person-years. In multivariable Cox proportional hazards regression analysis, moderately enlarged LA was associated with 60% (95% CI 1.2 to 2.0) increased risk of AF. Severely enlarged LA had HR for AF of 4.2 (95% CI 2.7 to 6.5) with p value for linear trend <0.001, and the association was similar in both sexes. Abnormal mitral Doppler flow adjusted for predictor variables did not show a statistically significant association with AF risk. However, when LA size was also adjusted for, the risk of AF increased by 30% (95% CI 1.0 to 1.6).ConclusionsOur findings suggest that enlarged LA as a measure for diastolic dysfunction is a significant risk factor for AF in both sexes, and adding measures of abnormal diastolic flow increased the predictive ability significantly.
An increasing number of children are born with intersex variation (IV; ambiguous genitalia/hermaphrodite, pseudohermaphroditism, etc.). Evidence shows that endocrine-disrupting chemicals (EDCs) in the environment can cause reproductive variation through dysregulation of normal reproductive tissue differentiation, growth, and maturation if the fetus is exposed to EDCs during critical developmental times in utero. Animal studies support fish and reptile embryos exhibited IV and sex reversal when exposed to EDCs. Occupational studies verified higher prevalence of offspring with IV in chemically exposed workers (male and female). Chemicals associated with endocrine-disrupting ability in humans include organochlorine pesticides, poly-chlorinated biphenyls, bisphenol A, phthalates, dioxins, and furans. Intersex individuals may have concurrent physical disorders requiring lifelong medical intervention and experience gender dysphoria. An urgent need exists to determine which chemicals possess the greatest risk for IV and the mechanisms by which these chemicals are capable of interfering with normal physiological development in children.
BackgroundAtrial fibrillation (AF) prevalence is increasing, and body mass index (BMI) is a risk factor for AF. However, sex differences in the impact of BMI on AF risk have not been fully elucidated.Methods and ResultsData from the fourth survey (1994–1995) of the Tromsø Study (Norway) were used to investigate the association of single‐measurement BMI on future AF risk. To analyze the influence of BMI changes on AF risk, data from individuals who attended the third and fourth study surveys were used. AF diagnosis was derived from record linkage and end point adjudication. Cox regression analysis was conducted using fractional polynomials of BMI and BMI change with models adjusted for age, baseline BMI (change analyses), risk factors, comorbidities, and antihypertensive medications.Data were available for 24 799 individuals from the fourth survey (mean age, 45.5±14.2 years; 52.9% women). Over 15.7±5.5 years, 811 women (6.2%) and 918 men (7.9%) developed AF. In men, lower BMI decreased AF risk and higher BMI increased risk (hazard ratios [95% confidence intervals] for BMI 18 or 40 kg/m2 compared with 23 kg/m2 were 0.75 [0.70–0.81] and 4.42 [3.00–6.53], respectively). The same pattern was identified in women. Two surveys were attended by 14 652 individuals. In men and women, a decrease in BMI over time was associated with decreased AF risk and an increase in BMI was associated with increased AF risk.ConclusionsWithin a population cohort, BMI was positively associated with AF risk. Change in BMI over time influenced AF risk in both men and women.
ObjectiveCHA2DS2-VASc score, left atrial (LA) size and atrial fibrillation (AF) have individually been associated with stroke risk. Our aim was to investigate the predictive ability of combinations of these factors for the odds of incident stroke in a population-based cohort study.MethodsWe followed 2844 participants from the Tromsø Study from 1994 to 2012. Information on LA size and CHA2DS2-VASc score (age, sex, congestive heart failure, hypertension, vascular disease, stroke and diabetes) were obtained at baseline. AF status was recorded from medical records. The outcome measure was all strokes. The association between covariates and stroke was investigated by means of multivariate logistic regression analysis.ResultsA total of 325 participants (45% women, mean age at baseline 59.3 years) had a stroke. Incidence rates for stroke were 6.4 in women and 8.4 in men per 1000 person-years. Participants with CHA2DS2-VASc ≥1 and LA size <2.8 had ∼4 times (95% CI 2.6 to 5.3) increased odds of stroke, whereas participants with CHA2DS2-VASc ≥1 and LA size ≥2.8 had ∼9 times (95% CI 5.3 to 16.4) increased odds of stroke, compared with participants with CHA2DS2-VASc score 0, irrespective of AF status. Adjustment for significant covariates had minimal impact on the OR estimates.ConclusionsCombining CHA2DS2-VASc score ≥1 and enlarged LA size identified participants with high odds of stroke regardless of AF status.
Folkehelserapporten gir en oversikt over utvalgte helse- og risikofaktorer fordelt på kjønn, aldersgrupper og geografiske soner i Tromsø kommune med data fra den sjuende Tromsøundersøkelsen (2015-16), og vil inngå i kunnskapsgrunnlaget for kommunens planarbeid og tjenesteutvikling, sammen med blant annet kommunens Levekårsundersøkelser. Det er viktig å legge vekt på at rapporten ikke gir grunnlag for å karakterisere enkelte geografiske områder som spesielt gode eller dårlige å bo i. Det er knyttet begrensninger til data, utvalg og analyser. Viktigst å trekke frem her er at data ikke kan gi et helt presist bilde av helsefaktorer hos enkeltdeltakere, at noen grupper ikke er godt nok representert i utvalget, og at analysene begrenser seg til å vise beskrivende resultater av enkeltfaktorer. Blant alle som deltok i undersøkelsen oppgir 69 % at de har god eller meget god helse. Videre oppgir 4,9 % å ha diabetes, 3,7 % å ha KOLS og 13,3 % å ha eller ha hatt psykiske problemer som de har søkt hjelp for. Totalt oppgir 80 % at de har vært hos fastlege siste år og 13 % at de har vært på legevakten. Blant deltakerne har 68 % overvekt eller fedme, hvorav 24 % har fedme. Totalt 27 % oppgir moderat til høy fysisk aktivitetsnivå i fritid, og 6 % oppgir inntak av fem eller flere porsjoner frukt og grønnsaker per dag. Totalt 8 % oppgir at de er avholdende fra alkohol mens 13 % oppgir at de månedlig eller oftere drikker mer enn 6 alkoholenheter ved en og samme anledning. Videre oppgir 14 % daglig røyking. Totalt 13 % oppgir ukentlig eller daglig bruk av smertestillende medikamenter. Totalt oppgir 11 % at de ikke har nok venner som kan gi hjelp ved behov og 14 % at de ikke har nok venner å snakke fortrolig med. Resultatene viser forskjeller i helse- og risikofaktorer mellom sentrumsnære soner og distriktssoner. Den generelle tendensen er at en del distriktssoner har en høyere andel med fedme og daglig røykere, samt dårligere selvopplevd helse og lavere utdanningsnivå, hos deltakere under 67 år. Resultatene viser også forskjeller mellom de ulike sentrumsnære sonene. Enkelte sentrumsnære soner har en høyere andel med høyere fysisk aktivitetsnivå, bedre selvopplevd helse og høyere utdanning, samt en lavere andel med fedme og daglig røykere hos deltakere under 67 år. Enkelte sentrumsnære soner har en høyere andel med fedme, daglig røykere og dårligere selvopplevd helse, samt lavere fysisk aktivitetsnivå og utdanningsnivå, hos deltakere under 67 år. Den samme tendensen til forskjeller i helse- og risikofaktorer mellom sentrumsnære soner og distriktssoner ser vi også hos deltakere over eller lik 67 år for utdanning og fedme, men ikke for røyking. Oppsummert kan vi slå fast at det er forskjeller i helse- og risikofaktorer i ulike geografiske soner i Tromsø kommune og at disse til dels overlapper med funn fra Levekårsundersøkelsene.
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