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Coronary heart disease and its risk factors in the Tromsø Study


Image caption Picture: Lumination/mostphotos.com

Coronary heart disease (CHD) is a major cause of morbidity and mortality worldwide. It is a complex disease that is influenced by various genetic, environmental, and lifestyle factors. Coronary heart disease and its risk factors in the Tromsø Study is a large-scale research project comprising several sub-projects aimed at investigating various aspects of CHD in the general population.

Project period: 2012 - present.

The study aims to provide a comprehensive understanding of CHD and its risk factors in the general population, which can help in developing effective prevention and treatment strategies. CHD is a major public health concern, and understanding its risk factors and mechanisms is crucial for reducing its burden on individuals and society.

The project has a special focus on sex differences and aims to present sex specific results. Also, the study assessed whether the gender contrast in risk of myocardial infarction (MI) could be explained by differences in established CHD risk factors, and whether the postmenopausal risk increase eliminate the sex difference.

The specific research aims include assessing the effect of environmental factors on the morbidity and mortality of MI, evaluating the association between a proposed cardiovascular health metric score and incident MI, and assessing multiple protein biomarkers for association with the 10-year risk of incident MI.

Other research aims include investigating how CVD risk factors and medication use change over time among individuals with high risk of CVD, investigating European guideline treatment target achievement in cardiovascular risk factors, medication use, and lifestyle, after MI or ischemic stroke, and exploring the hypothesis of an adverse effect of long-term exposure to unfavorable lipid levels.

Overall, this comprehensive research project aims to provide valuable insights into the various aspects of CHD and its risk factors in the general population. The study's findings can help in developing effective prevention and treatment strategies for CHD, which can ultimately improve the health and well-being of individuals and society.

Specific aims (with reference to publication list below)

  • To consider the effect of temperature, wind, atmospheric pressure, humidity, and snowfall on MI morbidity and/or mortality, as well as the effect of season on systolic and diastolic blood pressure, heart rate, body weight, cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, C-reactive protein (CRP) and fibrinogen (1,2).
  • To assess the association between a proposed cardiovascular health metric score and incident MI and to estimate the generalized impact fraction (3).
  • To assess multiple protein biomarkers for association with the 10-year risk of incident MI and identify a clinically significant risk model that adds information to current common risk models (4).
  • To assess secular and longitudinal trends of blood pressure, and the impact of hypertension treatment in a general population and changes in these parameters after first-ever MI (5,12).
  • To estimate the longitudinal trend in rates of out-of-hospital sudden cardiac death (SCD), incidence, treatment, and outcome of STEMI and NSTEMI as well as an analysis of the impact of changes in coronary risk factors on first CHD event from 1995-2010 (6).
  • To quantify the sex difference in risk of incident MI and to examine interaction effects between gender and CHD risk factors in relation to the risk of incident MI (7,8,9).
  • To assess secular and longitudinal trends of total serum cholesterol, and the impact of lipid-lowering drug use on cholesterol levels in a general population, as well as the change in total and low-density lipoprotein (LDL) cholesterol levels and LLD use after first-ever MI (10, 11).
  • To assess the implementation and clinical results of the pharmaco-invasive strategy for STEMI patients in rural sub-arctic north Norway during 11 years following the introduction of community-based prehospital thrombolytic therapy (13).
  • To assess the secular and longitudinal trends in cardiovascular risk profile using the risk assessment tool NORRISK 2 score in a general population, as well as comparing the results of NORRISK 2 and the 2017 guidelines to the NORRISK and 2009 guidelines regarding population proportion at high risk of CVD (14,16).
  • To use the parametric g-formula to estimate the 19-year risk of MI under hypothetical interventions on six cardiovascular risk factors (15).
  • Among individuals with a high risk of CVD, to what extent do CVD risk factors and medication use change over time (17)? To investigate European guideline treatment target achievement in cardiovascular risk factors, medication use, and lifestyle, after MI or ischemic stroke, in women and men living in Norway (18).
  • To explore the hypothesis of an adverse effect of long‐term exposure to unfavorable lipid levels by performing a direct comparison of mean lipid levels at different ages during adulthood between individuals with and without a subsequent diagnosis of incident MI.
  • To describe secular and longitudinal changes in body mass index, waist circumference, body composition, and the prevalence of obesity using the Tromsø Study (19,20,21,23,25,26)
  • To develop reference values and threshold values for visceral adipose tissue (VAT) in an adult population and investigate the associations of VAT parameters with cardiometabolic risk factors, as well as assess whether anthropometric measures (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio) are satisfactory substitutes for VAT regarding the association with cardiometabolic risk (22,24)

Members

Tom Wilsgaard (PI in sub-project)
Laila Arnesdatter Hopstock (PI in sub-project)
Kaare Harald Bønaa (PI in sub-project)
Maja-Lisa Løchen
Sameline Grimsgaard
Anne Elise Eggen
Grethe Albrektsen
Inger Njølstad
Bjarne Koster Jacobsen
Ola Løvsletten
Marie Wasmuth Lundblad
Jan Mannsverk
Amalie Nilsen

 

Publications
  1. Hopstock LA, Fors AS, Bønaa KH, Mannsverk J, Njølstad I, Wilsgaard T. The effect of daily weather conditions on myocardial infarction incidence in a subarctic population: the Tromsø Study 1974-2004. J Epidemiol Community Health 2012;66:815-820.
  2. Hopstock LA, Barnett AG, Bønaa KH, Mannsverk J, Njølstad I, Wilsgaard T. Seasonal variation in cardiovascular disease risk factors in a subarctic population: the Tromsø Study 1979–2008. J Epidemiol Community Health 2013;67:113-118.
  3. Wilsgaard T, Loehr LR, Mathiesen EB, Løchen ML, Bønaa KH, Njølstad I, Heiss G. Cardiovascular health and the modifiable burden of incident myocardial infarction: the Tromsø Study. BMC Public Health. 2015;15:221.
  4. Wilsgaard T, Mathiesen EB, Patwardhan A, Rowe MW, Schirmer H, Løchen ML, Sudduth-Klinger J, Hamren S, Bønaa KH, Njølstad I. Clinically significant novel biomarkers for prediction of first ever myocardial infarction: the Tromsø Study. Circ Cardiovasc Genet. 2015;8:363-71. 
  5. Hopstock LA, Bønaa KH, Eggen AE, Grimsgaard S, Jacobsen BK, Løchen ML, Mathiesen EB, Njølstad I, Wilsgaard T. Longitudinal and Secular Trends in Blood Pressure Among Women and Men in Birth Cohorts Born Between 1905 and 1977: The Tromsø Study 1979 to 2008. Hypertension. 2015;66:496-501. 
  6. Mannsverk J, Wilsgaard T, Mathiesen EB, Løchen ML, Rasmussen K, Thelle DS, Njølstad, I. Hopstock LA, Bønaa, KH. Trends in modifiable risk factors are associated with declining incidence of hospitalized and nonhospitalized acute coronary heart disease in a population. Circulation. 2016; 133:74–81.
  7. Albrektsen G, Heuch I, Løchen ML, Thelle DS, Wilsgaard T, Njølstad I, Bønaa KH. Lifelong Gender Gap in Risk of Incident Myocardial Infarction: The Tromsø Study. JAMA Intern Med. 2016;176):1673-1679. 
  8. Albrektsen G, Heuch I, Løchen ML, Thelle DS, Wilsgaard T, Njølstad I, Bønaa KH. Data on gender contrasts in the risk of incident myocardial infarction by age. The Tromsø Study 1979-2012. Data Brief. 2017;13:779-784. 
  9. Albrektsen G, Heuch I, Løchen ML, Thelle DS, Wilsgaard T, Njølstad I, Bønaa KH. Risk of incident myocardial infarction by gender: Interactions with serum lipids, blood pressure and smoking. The Tromsø Study 1979-2012. Atherosclerosis. 2017;261:52-59. 
  10. Hopstock LA, Bønaa KH, Eggen AE, Grimsgaard S, Jacobsen BK, Løchen ML, Mathiesen EB, Njølstad I, Wilsgaard T. Longitudinal and secular trends in total cholesterol levels and impact of lipid-lowering drug use among Norwegian women and men born in 1905-1977 in the population-based Tromsø Study 1979-2016. BMJ Open. 2017;7:e015001.
  11. Hopstock LA, Eggen AE, Løchen ML, Mathiesen EB, Njølstad I, Wilsgaard T. Secondary prevention care and effect: Total and low-density lipoprotein cholesterol levels and lipid-lowering drug use in women and men after incident myocardial infarction - The Tromsø Study 1994-2016. Eur J Cardiovasc Nurs. 2018;17:563-570. 
  12. Hopstock LA, Eggen AE, Løchen ML, Mathiesen EB, Nilsen A, Njølstad I, Wilsgaard T. Blood pressure target achievement and antihypertensive medication use in women and men after first-ever myocardial infarction: the Tromsø Study 1994-2016. Open Heart. 2018;5(1):e000746. 
  13. Mannsverk J, Steigen T, Wang H, Tande PM, Dahle BM, Nedrejord ML, Hokland IO, Gilbert M. Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for STelevation myocardial infarction in rural sub-arctic Norway. Eur Heart J Acute Cardiovasc Care. 2019; 1: 8-14.
  14. Nilsen A, Hansen TA, Lappegård KT, Eggen AE, Løchen ML, Njølstad I, Wilsgaard T, Hopstock LA. Secular and longitudinal trends in cardiovascular risk in a general population using a national risk model: The Tromsø Study. Eur J Prev Cardiol. 2019;26(17):1852-1861. 
  15. Wilsgaard T, Vangen-Lønne AM, Mathiesen E, Løchen ML, Njølstad I, Heiss G, Danaei G. Hypothetical interventions and risk of myocardial infarction in a general population: application of the parametric g-formula in a longitudinal cohort study-the Tromsø Study. BMJ Open. 2020;10(5):e035584. 
  16. Nilsen A, Hansen TA, Lappegård KT, Eggen AE, Løchen ML, Selmer RM, Njølstad I, Wilsgaard T, Hopstock LA. Change in cardiovascular risk assessment tool and updated Norwegian guidelines for cardiovascular disease in primary prevention increase the population proportion at risk: The Tromsø Study 2015-2016. OpenHeart. 2021;8:e001777.
  17. Hagen NA, Ariansen I, Hanssen TA, Lappegård KT, Eggen AE, Løchen ML, Njølstad I, Wilsgaard T, Hopstock LA. Achievements of primary prevention targets in individuals with high risk of cardiovascular disease. An 8-year follow-up of the Tromsø Study. European Heart Journal Open. 2022;2:oeac061.
  18. Hopstock LA, Morseth B, Cook S, Eggen AE, Grimsgaard S, Lundblad MW, Løchen ML, Mathiesen E, Nilsen A, Njølstad I. Treatment target achievement after myocardial infarction and ischaemic stroke: cardiovascular risk factors, medication use, and lifestyle: the Tromsø Study 2015-16. Eur J Prev Cardiol. 2022;29(2):362-370. 
  19. Jacobsen BK, Aars NA. Changes in body mass index and the prevalence of obesity during 1994-2008- repeated cross-sectional surveys and longitudinal analyses: The Tromsø Study. BMJ Open 2015;5:e007859
  20. Jacobsen BK, Aars NA. Changes in waist circumference and the prevalence of abdominal obesity during 1994-2008 – cross-sectional and longitudinal results from two surveys: the Tromsø Study. BMC Obesity 2016; 3; 41
  21. Løvsletten O, Jacobsen BK, Grimsgaard S, Njølstad I, Wilsgaard T, Løchen ML, Eggen AE, Hopstock LA. Prevalence of general and abdominal obesity in 2015-16 and 8-year longitudinal weight and waist circumference changes in adults and elderly: the Tromsø Study. BMJ Open 2020;10: e038465.
  22. Lundblad MW, Jacobsen BK, Johansson J, Rolfe E, Grimsgaard S, Hopstock LA. Reference values for DXA derived visceral adipose tissue in adults 40 years and older from a European population: The Tromsø Study 2015-2016. J Obesity 2021; 2021:6634536.
  23. Lundblad MW, Johansson J, Jacobsen BK, Grimsgaard S, Frost-Andersen L, Wilsgaard T, Hopstock LA. Secular and longitudinal trends in body composition: The Tromsø Study, 2001 to 2016. Obesity 2021; 29: 1939-1949
  24. Lundblad MW, Jacobsen BK, Johansson J, Grimsgaard S, Andersen LF, Hopstock LA. Anthropometric measures are satisfactory substitutes for the DXA-derived visceral adipose tissue in the association with cardiometabolic risk – The Tromsø Study 2015-2016. Obes Sci Pract 2021;7:525–534.
  25. Løvsletten O, Njølstad I, Wilsgaard T, Hopstock LA, Jacobsen BK, Bønaa KH, Eggen AE, Løchen ML. Is the ongoing obesity epidemic partly explained by concurrent decline in cigarette smoking? Insights from a longitudinal population study. The Tromsø Study 1994-2016. Prev Med 2021; 147: 106533. doi: 10.1016/j.ypmed.2021.106533 
  26. Aars NA, Jacobsen BK. Longitudinal changes in desired body weight compared to changes in body weight: evidence of adaptation to weight gain? BMC Obesity 2016; 3:40