Publications by authors named "Thor Aspelund"

252 Publications

Cross-sectional study of early postpartum pelvic floor dysfunction and related bother in primiparous women 6-10 weeks postpartum.

Int Urogynecol J 2021 May 3. Epub 2021 May 3.

Faculty of Medicine, School of Health Sciences, University of Iceland, Vatnsmýrarvegi 16, 101, Reykjavík, Iceland.

Introduction And Hypothesis: To study the prevalence of pelvic floor dysfunction and related bother in primiparous women 6-10 weeks postpartum, comparing vaginal and cesarean delivery.

Methods: Cross-sectional study of 721 mothers with singleton births in Reykjavik, Iceland, 2015 to 2017, using an electronic questionnaire. Information on urinary and anal incontinence, pelvic organ prolapse and sexual dysfunction with related bother (trouble, nuisance, worry, annoyance) was collected. Main outcome measures were prevalence of pelvic floor dysfunction and related bother.

Results: The overall prevalence of urinary and anal incontinence was 48% and 60%, respectively. Bother regarding urinary symptoms was experienced by 27% and for anal symptoms by 56%. Pelvic organ prolapse was noted by 29%, with less than half finding this bothersome. Fifty-five percent were sexually active, of whom 66% reported coital pain. Of all the women, 48% considered sexual issues bothersome. Urinary incontinence and pelvic organ prolapse were more prevalent in women who delivered vaginally compared to cesarean section, but no differences were observed for anal incontinence and coital pain. Compared to women with BMI < 25, obesity was a predictor for urinary incontinence after vaginal delivery (OR 1.94; 95% CI 1.20-3.14). Birthweight > 50th percentile was predictive for urgency incontinence after vaginal delivery (OR 1.53; 95% CI 1.05-2.21). Episiotomy predicted more anal incontinence (OR 2.19; 95% CI 1.30-3.67). No associations between maternal and delivery characteristics were found for pelvic floor dysfunction after cesarean section.

Conclusions: Bothersome pelvic floor dysfunction symptoms are prevalent among first-time mothers in the immediate postpartum period.
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http://dx.doi.org/10.1007/s00192-021-04813-yDOI Listing
May 2021

[Prevalence and incidence of type 2 diabetes in Iceland 2005-2018].

Laeknabladid 2021 May;107(5):227-233

Icelandic Heart Association, University of Iceland.

Introduction: The number of people with type 2 diabetes has increased in Iceland in the last few decades. We utilized the national database on prescribed medication from the Directorate of Health to estimate the prevalence and incidence of type 2 diabetes in Iceland and made prediction on the prevalence of type 2 diabetes in Iceland in 10 and 20 years.

Material And Methods: Prevalence and incidence of type 2 diabetes for the period 2005-2018 was estimated based on prescriptions of diabetes medication in the national prescription database containing all prescriptions in Iceland during the period. The result was compared to the result from the REFINE-Reykjavik study (prospective, population-based cohort study) from 2004 to 2011 and published data from the USA from 1980 to 2016.

Results: The prevalence of type 2 diabetes more than doubled in near all age groups in both men and women in the period 2005-2018. The incidence increased by 2.8% annually (in 18-79 years old). The number of people in Iceland with type 2 diabetes was 10600 in 2018 and had increased from 4200 in the year 2005. Comparison with the results of the REFINE-Reykjavik study showed an underestimation (29% in men and women) of the prevalence of type 2 diabetes. If the increase in type 2 diabetes continues at a similar rate as in the years 2005-2018 the number of people with diabetes in Iceland could be near 24000 in the year 2040.

Conclusion: Linear increase was seen in incidence and prevalence of people with type 2 diabetes in the years 2005-2018. Similar evolution was seen in USA from 1984. In order to counteract the increase of type 2 diabetes following the same path as has been seen in the USA, targeted measures are needed.
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http://dx.doi.org/10.17992/lbl.2021.05.634DOI Listing
May 2021

Exploratory assessment of pineal gland volume, composition, and urinary 6-sulfatoxymelatonin levels on prostate cancer risk.

Prostate 2021 Jun 16;81(8):487-496. Epub 2021 Apr 16.

Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, USA.

Introduction: Melatonin levels are partially driven by the parenchyma volume of the pineal gland. Low urinary levels of 6-sulfatoxymelatonin have been associated with increased risk of advanced prostate cancer, but the relationship between pineal gland volume and composition and prostate cancer risk has not been examined.

Materials And Methods: We utilized data from 864 men from the AGES-Reykjavik Study with complete pineal gland volumes and urinary 6-sulfatoxymelatonin measurements. Pineal parenchyma, calcification, and cyst volumes were calculated from brain magnetic resonance imaging. Levels of 6-sulfatoxymelatonin were assayed from prediagnostic urine samples. We calculated Pearson correlation coefficients between parenchyma volume and urinary 6-sulfatoxymelatonin levels. We used Cox proportional hazards regression to calculate multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) comparing prostate cancer risk across parenchyma volume tertiles and across categories factoring in parenchyma volume, gland composition, and urinary 6-sulfatoxymelatonin level.

Results: Parenchyma volume was moderately correlated with urinary 6-sulfatoxymelatonin level (r = .24; p < .01). There was no statistically significant association between parenchyma volume tertile and prostate cancer risk. Men with high parenchyma volume, pineal cysts and calcifications, and low urinary 6-sulfatoxymelatonin levels had almost twice the risk of total prostate cancer as men with low parenchyma volume, no pineal calcifications or cysts, and low urinary 6-sulfatoxymelatonin levels (HR: 1.98; 95% CI: 1.02, 3.84; p: .04).

Conclusions: Although parenchyma volume is not associated with prostate cancer risk, pineal gland composition and other circadian dynamics may influence risk for prostate cancer. Additional studies are needed to examine the interplay of pineal gland volume, composition, and melatonin levels on prostate cancer risk.
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http://dx.doi.org/10.1002/pros.24130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194005PMC
June 2021

Increased respiratory morbidity associated with exposure to a mature volcanic plume from a large Icelandic fissure eruption.

Nat Commun 2021 04 12;12(1):2161. Epub 2021 Apr 12.

Chief Epidemiologist, Directorate of Health, Centre for Health Threats and Communicable Diseases, Reykjavík, Iceland.

The 2014-15 Holuhraun eruption in Iceland was the largest fissure eruption in over 200 years, emitting prodigious amounts of gas and particulate matter into the troposphere. Reykjavík, the capital area of Iceland (250 km from eruption site) was exposed to air pollution events from advection of (i) a relatively young and chemically primitive volcanic plume with a high sulphur dioxide gas (SO) to sulphate PM (SO) ratio, and (ii) an older and chemically mature volcanic plume with a low SO/SO ratio. Whereas the advection and air pollution caused by the primitive plume were successfully forecast and forewarned in public advisories, the mature plume was not. Here, we show that exposure to the mature plume is associated with an increase in register-measured health care utilisation for respiratory disease by 23% (95% CI 19.7-27.4%) and for asthma medication dispensing by 19.3% (95% CI 9.6-29.1%). Absence of public advisories is associated with increases in visits to primary care medical doctors and to the hospital emergency department. We recommend that operational response to volcanic air pollution considers both primitive and mature types of plumes.
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http://dx.doi.org/10.1038/s41467-021-22432-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042009PMC
April 2021

Serum levels of ACE2 are higher in patients with obesity and diabetes.

Obes Sci Pract 2021 Apr 16;7(2):239-243. Epub 2020 Dec 16.

Icelandic Heart Association Kopavogur Iceland.

Objective: As severity of outcome in COVID-19 is disproportionately higher among individuals with obesity, smokers, patients with hypertension, kidney disease, chronic pulmonary disease, coronary heart disease (CHD), and/or type 2 diabetes (T2D), serum levels of ACE2, the cellular entry point for the coronavirus SARS-CoV-2, were examined in these high-risk groups.

Methods: Associations of ACE2 levels to smokers and patients with hypertension, T2D, obesity, CHD, or COPD were investigated in a single center population-based study of 5457 Icelanders from the Age, Gene/Environment Susceptibility Reykjavík Study (AGES-RS) of the elderly (mean age 75 ± 6 years), using multiple linear regression analysis.

Results: Serum levels of ACE2 were higher in smokers and individuals with T2D and/or obesity while they were unaffected in the other patient groups.

Conclusion: ACE2 levels are higher in some patient groups with comorbidities linked to COVID-19 including obesity and T2D and as such may have an emerging role as a circulating biomarker for severity of outcome in the disease.
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http://dx.doi.org/10.1002/osp4.472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019273PMC
April 2021

Untangling fracture risk in monoclonal gammopathy of undetermined significance: A population-based cohort study.

Eur J Haematol 2021 Jul 28;107(1):137-144. Epub 2021 Apr 28.

Faculty of Medicine, University of Iceland, Reykjavík, Iceland.

Objective: Monoclonal gammopathy of undetermined significance (MGUS) is the asymptomatic precursor of multiple myeloma (MM). Lytic bone lesions and fractures are hallmarks of MM and although there are no lytic lesions in MGUS, it has also been associated with fractures. The causes of fractures in MGUS are currently unclear but potential causes include inherent MGUS bone disease, undiagnosed MM, and peripheral neuropathy (PN). We therefore conducted a large population-based study including 8395 individuals with MGUS and 30 851 matched controls from Sweden.

Methods: Data on fractures, PN, and confounders were acquired from high-quality registers in Sweden.

Results: Monoclonal gammopathy of undetermined significance and PN were independently associated with fractures (hazard ratio [HR]: 1.29; 95% confidence interval [95% CI]: 1.21-1.37; P < .001 and HR: 1.34; 95% CI: 1.16-1.55; P < .001). Imminent MGUS progression increased the risk of fractures (odds ratio: 1.66; 95% CI: 1.27-2.16; P < .001). Fractures were not associated with long-term risk of MGUS progression (HR: 1.08; 95% CI: 0.77-1.53; P = .64).

Discussion: Based on these findings, we speculate that MGUS leads to fractures through at least 3 independent mechanisms: undetected MGUS progression to MM, MGUS inherent bone disease, and PN through falls. These findings highlight the need for further study of MGUS inherent bone disease and can inform further research into fracture prevention in MGUS.
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http://dx.doi.org/10.1111/ejh.13633DOI Listing
July 2021

Accelerated decline in quadriceps area and Timed Up and Go test performance are associated with hip fracture risk in older adults with impaired kidney function.

Exp Gerontol 2021 07 16;149:111314. Epub 2021 Mar 16.

National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA.

Objective: This study aimed to examine whether an accelerated decline in quadriceps cross-sectional area (CSA), attenuation (a surrogate of quality), and strength, as well as lower limb muscular function, are associated with hip fractures in older adults with impaired kidney function.

Design: Prospective population-based study.

Setting: Community-dwelling old population in Reykjavik, Iceland.

Subjects: A total of 875 older adults (mean baseline age 76 years) from the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study with impaired kidney function.

Methods: Quadriceps CSA and density were determined using computed tomography (CT), knee extension strength was measured with an isometric dynamometer chair, and muscular function was assessed using the Timed Up and Go (TUG) test. All muscle-related measurements were assessed twice over a mean follow-up of 5.2 years. Data on hip fracture incidence was obtained from medical records during a maximum of 8.4 years of follow-up time.

Results: Fully adjusted cox-proportional hazard regression models showed that a faster decline in quadriceps CSA and TUG test performance were significantly associated with increased hip fracture risk (HR = 1.55, 95% CI = 1.02-2.36, and HR = 1.80, 95% CI = 1.19-2.72, respectively). A faster decrease in quadriceps density and isometric knee extension strength were not associated with fracture risk.

Conclusions: Accelerated decline in CT-derived quadriceps CSA and muscular function, as measured by the TUG test's performance, are predictive of hip fracture risk in older adults with impaired kidney function. TUG test is a simple measure and easily included in routine medical examinations, compared to CT scans, which seems to be useful for identifying a subgroup of individuals with high risk of fracture.
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http://dx.doi.org/10.1016/j.exger.2021.111314DOI Listing
July 2021

Randomized Trial for Weight Loss Using a Digital Therapeutic Application.

J Diabetes Sci Technol 2021 Mar 19:19322968211000815. Epub 2021 Mar 19.

Faculty of Medicine, University of Iceland and Children's Medical Centre, Landspitali University Hospital, Reykjavik, Iceland.

Background: Smartphones present a near-ubiquitous channel through which structured lifestyle change can reduce risk or progression of the most common noncommunicable diseases. We explored whether a digital structured lifestyle program enhances weight loss.

Methods: We randomized overweight and obese participants attending a four-month lifestyle change program to either standard weekly coaching sessions (controls), or standard treatment supplemented with a digital therapeutic mobile application (intervention). Changes in body mass index after four months were the main outcome measure. Odds ratios of achieving 5% weight loss were estimated with unconditional logistic regression.

Results: Of 234 eligible persons, 146 (62%) agreed to participate, were block-randomized, showed up for the baseline measures, and constituted the intention-to-treat (ITT) sample ( = 95 intervention group,  = 51 control group). In the intervention group, 70 (74%) downloaded the mobile application and completed the program (intervention per-protocol). Significant weight loss and BMI reduction were observed for both the intention-to-treat intervention group ( < 0.05,  = 0.01) and the per-protocol intervention group ( < 0.0001,  < 0.0001). For the intervention per-protocol group, the odds ratio of achieving 5% weight loss, compared to not treated per-protocol, was 3.3 (95% CI 1.3-8.2), adjusting for age and weight at baseline.Attendance to weekly coaching sessions decreased by 18% during the program in the control group while it increased by 3% amongst the per-protocol group ( = 0.004).

Conclusions: These preliminary findings support the benefit of a digital therapeutic to enhance weight reduction and attendance in a structured lifestyle change program. Larger trials of longer duration are needed to confirm these findings.
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http://dx.doi.org/10.1177/19322968211000815DOI Listing
March 2021

Computed tomography-based skeletal muscle and adipose tissue attenuation: Variations by age, sex, and muscle.

Exp Gerontol 2021 07 10;149:111306. Epub 2021 Mar 10.

Laboratory of Epidemiology and Population Science, Intramural Research Program, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA.

Objective: This study aimed to investigate how skeletal muscle attenuation and adipose tissue (AT) attenuation of the quadriceps, hamstrings, paraspinal muscle groups and the psoas muscle vary according to the targeted muscles, sex, and age.

Design: Population-based cross-sectional study.

Setting: Community-dwelling old population in Reykjavik, Iceland.

Subjects: A total of 5331 older adults (42.8% women), aged 66-96 years from the Age, Gene/Environment Susceptibility (AGES)- Reykjavik Study, who participated in the baseline visit (between 2002 and 2006) and had valid thigh and abdominal computed tomography (CT) scans were studied.

Methods: Muscle attenuation and AT attenuation of the quadriceps, hamstrings, paraspinal muscle groups and the psoas muscle were determined using CT. Linear mixed model analysis of variance was performed for each sex, with skeletal muscle or AT attenuation as the dependent variable.

Results: Muscle attenuation decreased, and AT attenuation increased with age in both sexes, and these differences were specific for each muscle, although not in all age groups. Age-related differences in muscle and AT attenuation varied with specific muscle. In general, for both sexes, skeletal muscle attenuation of the hamstrings declined more than average with age. Men and women displayed a different pattern in the age differences in AT attenuation for each muscle.

Conclusions: Our data support the hypotheses that skeletal muscle attenuation decreases, and AT attenuation increases with aging. In addition, our data add new evidence, supporting that age-related differences in skeletal muscle and AT attenuation vary between muscles.
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http://dx.doi.org/10.1016/j.exger.2021.111306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096682PMC
July 2021

Severe volcanic SO exposure and respiratory morbidity in the Icelandic population - a register study.

Environ Health 2021 Feb 27;20(1):23. Epub 2021 Feb 27.

Chief Epidemiologist, Directorate of Health, Centre for Health Threats and Communicable Diseases, Barónsstigur 57, 101, Reykjavík, Iceland.

Background: The Holuhraun volcanic eruption September 2014 to February 2015 emitted large amounts of sulfur dioxide (SO). The aim of this study was to determine the association between volcanic SO gases on general population respiratory health some 250 km from the eruption site, in the Icelandic capital area.

Methods: Respiratory health outcomes were: asthma medication dispensing (AMD) from the Icelandic Medicines Register, medical doctor consultations in primary care (PCMD) and hospital emergency department visits (HED) in Reykjavík (population: 215000) for respiratory disease from 1 January 2010 to 31 December 2014. The associations between daily counts of health events and daily mean SO concentration and high SO levels (24-h mean SO > 125 μg/m3) were analysed using generalized additive models.

Results: After the eruption began, AMD was higher than before (129.4 vs. 158.4 individuals per day, p < 0.05). For PCMD and HED, there were no significant differences between the number of daily events before and after the eruption (142.2 vs 144.8 and 18.3 vs 17.5, respectively). In regression analysis adjusted for other pollutants, SO was associated with estimated increases in AMD by 0.99% (95% CI 0.39-1.58%) per 10 μg/m at lag 0-2, in PCMD for respiratory causes 1.26% (95% CI 0.72-1.80%) per 10 μg/m SO at lag 0-2, and in HED by 1.02% (95% CI 0.02-2.03%) per 10 μg/m SO at lag 0-2. For days over the health limit, the estimated increases were 10.9% (95% CI 2.1-19.6%), 17.2% (95% CI 10.0-24.4%) for AMD and PCMD. Dispensing of short-acting medication increased significantly by 1.09% (95% CI 0.49-1.70%), and PCMD for respiratory infections and asthma and COPD diagnoses and increased significantly by 1.12% (95% CI 0.54-1.71%) and 2.08% (1.13-3.04%).

Conclusion: High levels of volcanic SO are associated with increases in dispensing of AMD, and health care utilization in primary and tertiary care. Individuals with prevalent respiratory disease may be particularly susceptible.
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http://dx.doi.org/10.1186/s12940-021-00698-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916308PMC
February 2021

Comorbidities in multiple myeloma and implications on survival: A population-based study.

Eur J Haematol 2021 Jun 11;106(6):774-782. Epub 2021 Mar 11.

Faculty of Medicine, University of Iceland, Reykjavík, Iceland.

High proportion of patients with multiple myeloma suffer from comorbidities which may alter clinical management. Therefore, our aims were to evaluate the prevalence of comorbidities and their impact on survival. We included patients diagnosed with multiple myeloma 1990-2013 in Sweden and all diagnoses from each patient from 1985. A total of 13 656 patients with multiple myeloma were included in the study, thereof 7404 (54%) had comorbidity at diagnosis. The risk of death was increased for those with one comorbidity at diagnosis compared to those without any comorbidity (hazard ratio = 1.19; 95% confidence interval:1.14-1.25); this risk was higher for those with two (1.38; 1.30-1.47) and three or more comorbidities (1.72; 1.62-1.83). Furthermore, the risk of death was increased in patients with prior history of cancer, arrhythmia, heart failure, diabetes mellitus, cerebrovascular disease, chronic lung disease, psychological disease, peptic ulcer, neurological disease, peripheral vascular disease, chronic kidney disease, dementia, and inflammatory bowel disease. This large study shows that over 50% of multiple myeloma patients have a comorbidity at diagnosis and survival decreased with increasing numbers of comorbidities. This emphasizes the importance of comorbidities when evaluating patients and deciding on treatment strategies for individuals with multiple myeloma.
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http://dx.doi.org/10.1111/ejh.13597DOI Listing
June 2021

A nationwide study on inpatient opportunistic infections in patients with chronic lymphocytic leukemia in the pre-ibrutinib era.

Eur J Haematol 2021 Mar 3;106(3):346-353. Epub 2020 Dec 3.

Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

Objective: Opportunistic infections in chronic lymphocytic leukemia (CLL) have been described in clinical trials, single-center studies, and case reports. We performed a nationwide study to estimate the incidence and impact of inpatient opportunistic infections.

Methods: The incidence rate (IR) and incidence rate ratio (IRR) for Swedish CLL patients diagnosed 1994-2013, and matched controls were calculated, as well as the case-fatality ratio (CFR).

Results: Among 8989 CLL patients, a total of 829 opportunistic infections were registered (IR 16.6 per 1000 person-years) compared with 252 opportunistic infections in 34 283 matched controls (IR 0.99). The highest incidence in the CLL cohort was for Pneumocystis pneumonia (200 infections, IR 4.03); Herpes zoster (146 infections, IR 2.94), and Pseudomonas (83 infections, IR 1.66) infections. The highest risk relative to matched controls was observed for Pneumocystis pneumonia (IRR 114, 95% confidence interval 58.7-252). The 60-day CFR for CLL patients with opportunistic infections was 23% (188/821), highest for progressive multifocal encephalopathy (5/7, 71%) and aspergillosis (25/60, 42%).

Conclusion: We have uniquely depicted the incidence of rare and serious infections in CLL patients and found a relatively high incidence of Pneumocystis pneumonia. Of the most common opportunistic infections, CLL patients with aspergillosis had the poorest prognosis.
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http://dx.doi.org/10.1111/ejh.13553DOI Listing
March 2021

[What I talk about when I talk about COVID-19].

Authors:
Thor Aspelund

Laeknabladid 2020 09;106(9):395

PhD Statistician University of Iceland - Centre of Public Health Sciences Icelandic Heart Association.

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http://dx.doi.org/10.17992/lbl.2020.09.594DOI Listing
September 2020

The associations of interstitial lung abnormalities with cancer diagnoses and mortality.

Eur Respir J 2020 12 17;56(6). Epub 2020 Dec 17.

Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

An increased incidence of lung cancer is well known among patients with idiopathic pulmonary fibrosis. It is not known whether interstitial lung abnormalities, early fibrotic changes of the lung, are a risk factor for lung cancer in the general population.The study's objective was to assess whether interstitial lung abnormalities were associated with diagnoses of, and mortality from, lung cancer and other cancers. Data from the AGES-Reykjavik study, a cohort of 5764 older Icelandic adults, were used. Outcome data were ascertained from electronic medical records. Gray's tests, Cox proportional hazards models and proportional subdistribution hazards models were used to analyse associations of interstitial lung abnormalities with lung cancer diagnoses and lung cancer mortality as well as diagnoses and mortality from all cancers.There was a greater cumulative incidence of lung cancer diagnoses (p<0.001) and lung cancer mortality (p<0.001) in participants with interstitial lung abnormalities than in others. Interstitial lung abnormalities were associated with an increased hazard of lung cancer diagnosis (hazard ratio 2.77) and lung cancer mortality (hazard ratio 2.89) in adjusted Cox models. Associations of interstitial lung abnormalities with all cancers were found in models including lung cancers but not in models excluding lung cancers.People with interstitial lung abnormalities are at increased risk of lung cancer and lung cancer mortality, but not of other cancers. This implies that an association between fibrotic and neoplastic diseases of the lung exists from the early stages of lung fibrosis and suggests that interstitial lung abnormalities could be considered as a risk factor in lung cancer screening efforts.
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http://dx.doi.org/10.1183/13993003.02154-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876778PMC
December 2020

Association between lung function decline and obstructive sleep apnoea: the ALEC study.

Sleep Breath 2021 Jun 6;25(2):587-596. Epub 2020 Jul 6.

Department of Sleep Medicine, Landspitali, Reykjavik, Iceland.

Purpose: To study changes in lung function among individuals with a risk of obstructive sleep apnoea (OSA), and if asthma affected this relationship.

Methods: We used data from the European Community Respiratory Health Survey II and III, a multicentre general population study. Participants answered questionnaires and performed spirometry at baseline and 10-year follow-up (n = 4,329 attended both visits). Subjects with high risk for OSA were identified from the multivariable apnoea prediction (MAP) index, calculated from BMI, age, gender, and OSA symptoms at follow-up. Asthma was defined as having doctor's diagnosed asthma at follow-up. Primary outcomes were changes in forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) from baseline to follow-up.

Results: Among 5108 participants at follow-up, 991 (19%) had a high risk of OSA based on the MAP index. Participants with high OSA risk more often had wheeze, cough, chest tightness, and breathlessness at follow-up than those with low OSA risk. Lung function declined more rapidly in subjects with high OSA risk (low vs high OSA risk [mean ± SD]: FEV1 = - 41.3 ± 24.3 ml/year vs - 50.8 ± 30.1 ml/year; FVC = - 30.5 ± 31.2 ml/year vs - 45.2 ± 36.3 ml/year). Lung function decline was primarily associated with higher BMI and OSA symptoms. OSA symptoms had a stronger association with lung function decline among asthmatics, compared to non-asthmatics.

Conclusion: In the general population, a high probability of obstructive sleep apnoea was related to faster lung function decline in the previous decade. This was driven by a higher BMI and more OSA symptoms among these subjects. The association between OSA symptoms and lung function decline was stronger among asthmatics.
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http://dx.doi.org/10.1007/s11325-020-02086-1DOI Listing
June 2021

A population-based study on serious inpatient bacterial infections in patients with chronic lymphocytic leukemia and their impact on survival.

Eur J Haematol 2020 Nov 13;105(5):547-554. Epub 2020 Jul 13.

Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

Objective: Infections in chronic lymphocytic leukemia (CLL) have been thoroughly investigated in the setting of clinical trials and single-center studies. However, large cohort studies on real-world data and studies on temporal trends are lacking. We performed a nationwide study on serious bacterial infections in CLL.

Methods: Using high-quality Swedish government-based registries, 13 009 CLL patients diagnosed in 1982-2013 and their 49 380 matched controls were included.

Results: Overall, CLL patients had an increased risk of serious inpatient bacterial infections with a hazard ratio (HR) 5.32 and 95% confidence interval (95% CI) 5.11-5.53, and the highest risk was observed for septicemia (HR 6.91, 95% CI 6.46-7.39) and lung infections (5.91, 5.64-6.18). The risk of serious inpatient bacterial infections decreased overtime with HR 0.87 (0.81-0.94) and HR 0.76 (0.70-0.82) in 1993-2002 and 2003-2013, respectively, compared to 1982-1992. CLL patients had an increased risk of death following a serious inpatient bacterial infection compared to matched CLL patients, and the risk was highest in the first 12 months after the infection (HR 5.48, 95% CI 5.11-5.90).

Conclusion: We have, in this nationwide study, characterized the risk of serious bacterial infections in CLL patients and, importantly, depicted that the risk has decreased overtime.
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http://dx.doi.org/10.1111/ejh.13477DOI Listing
November 2020

ACE2 levels are altered in comorbidities linked to severe outcome in COVID-19.

medRxiv 2020 Jun 5. Epub 2020 Jun 5.

Aims: Severity of outcome in COVID-19 is disproportionately higher among the obese, males, smokers, those suffering from hypertension, kidney disease, coronary heart disease (CHD) and/or type 2 diabetes (T2D). We examined if serum levels of ACE2, the cellular entry point for the coronavirus SARS-CoV-2, were altered in these high-risk groups.

Methods: Associations of serum ACE2 levels to hypertension, T2D, obesity, CHD, smokers and males in a single center population-based study of 5457 Icelanders from the Age, Gene/Environment Susceptibility Reykjavik Study (AGES-RS) of the elderly (mean age 75+/-6 years).

Results: Smokers, males, and individuals with T2D or obesity have altered serum levels of ACE2 that may influence productive infection of SARS-CoV-2 in these high-risk groups.

Conclusion: ACE2 levels are upregulated in some patient groups with comorbidities linked to COVID-19 and as such may have an emerging role as a circulating biomarker for severity of outcome in COVID-19.
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http://dx.doi.org/10.1101/2020.06.04.20122044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276056PMC
June 2020

Antihypertensive medication uses and serum ACE2 levels: ACEIs/ARBs treatment does not raise serum levels of ACE2.

medRxiv 2020 May 25. Epub 2020 May 25.

Icelandic Heart Association, Holtasmari 1, IS-201 Kopavogur, Iceland.

Importance: Recent reports have shown that hypertension is the most common comorbidity associated with mortality in the current coronavirus disease 2019 (COVID-19). This has been related to the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) as animal studies indicate that these medications increase levels of ACE2, the cellular entry point for the coronavirus SARS-CoV-2. This has prompted clinicians to recommend discontinuing ACEIs and ARBs.

Objective: To examine the effect of ACEIs or ARBs treatment on serum levels of ACE2 and other key enzymes in the renin-angiotensin system (RAS).

Design Setting And Participants: A single center population-based study of 5457 Icelanders from the Age, Gene/Environment Susceptibility Reykjavik Study (AGES-RS) of the elderly (mean age 75±6 years) stratified by ACEIs (N = 699) or ARBs (N = 753) treatment.

Main Outcomes And Measures: The AGES-RS study population was stratified by ACEIs and ARBs medication use and compared for age, body mass index (BMI) (kg/m), hypertension and type 2 diabetes (T2D) as well as serum levels of renin, ACE and ACE2.

Results: While renin and ACE levels were significantly raised in serum of individuals on ACEIs or ARBs treatments, the ACE2 levels remained unaffected.

Conclusions And Relevance: Treatment with ACEIs or ARBs does not raise ACE2 levels in serum. Therefore, the present study does not support the proposed discontinuation of these medications among patients affected with COVID-19.
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http://dx.doi.org/10.1101/2020.05.21.20108738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265694PMC
May 2020

Circulating Protein Signatures and Causal Candidates for Type 2 Diabetes.

Diabetes 2020 08 8;69(8):1843-1853. Epub 2020 May 8.

Faculty of Medicine, University of Iceland, Reykjavik, Iceland

The increasing prevalence of type 2 diabetes poses a major challenge to societies worldwide. Blood-based factors like serum proteins are in contact with every organ in the body to mediate global homeostasis and may thus directly regulate complex processes such as aging and the development of common chronic diseases. We applied a data-driven proteomics approach, measuring serum levels of 4,137 proteins in 5,438 elderly Icelanders, and identified 536 proteins associated with prevalent and/or incident type 2 diabetes. We validated a subset of the observed associations in an independent case-control study of type 2 diabetes. These protein associations provide novel biological insights into the molecular mechanisms that are dysregulated prior to and following the onset of type 2 diabetes and can be detected in serum. A bidirectional two-sample Mendelian randomization analysis indicated that serum changes of at least 23 proteins are downstream of the disease or its genetic liability, while 15 proteins were supported as having a causal role in type 2 diabetes.
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http://dx.doi.org/10.2337/db19-1070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372075PMC
August 2020

Diabetic eye screening with variable screening intervals based on individual risk factors is safe and effective in ophthalmic practice.

Acta Ophthalmol 2020 Jun 25;98(4):343-346. Epub 2020 Mar 25.

Risk ehf, Reykjavík, Iceland.

Purpose: To test in a 'real world' diabetic eye-screening programme, a computer-based personal risk evaluation for progression to sight-threatening diabetic retinopathy. Screening intervals were individualized, and clinical outcomes, safety and cost-effectiveness documented.

Methods: The RETINARISK algorithm was used in an ophthalmology clinic in Norway. The diabetes cohort was divided on voluntary basis into two groups: one with variable screening intervals based on their personal risk profile and the other group with conventional fixed interval diabetic eye screening. Compliance, clinical outcomes, safety and health economics were evaluated. A total of 843 diabetic patients participated in the program 2014-2019. A total of 63 had type 1 and 780 type 2 diabetes. A total of 671 patients had no diabetic retinopathy at baseline and 171 had retinopathy.

Results: A total of 444 (53%) diabetic patients were included in the personal risk profile program and 399 in the fixed interval group. The RETINARISK algorithm calculated 563 screening intervals for the variable interval group, which was 23 ± 16 months (mean ± SD), compared to 14 ± 5 months for the group with fixed screening intervals. Due to selection bias, the two groups could not be directly compared. We did not experience any delay in detecting diabetic retinal changes when using the personal risk profile program.

Conclusion: The RETINARISK algorithm was safe and effective in a diabetic screening program in an ophthalmology clinic over 5 years. The use of the program reduces the mean frequency of screening visits and liberates valuable time in ophthalmic practice to be used on high-risk diabetic patients or other patient groups.
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http://dx.doi.org/10.1111/aos.14425DOI Listing
June 2020

A pooled-analysis of age and sex based coronary artery calcium scores percentiles.

J Cardiovasc Comput Tomogr 2020 Sep - Oct;14(5):414-420. Epub 2020 Jan 27.

Department of Vascular Medicine, Amsterdam University Medical Center, Academic Medical Centre, Meibergdreef 5, 1105, AZ, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Center, Location Academic Medical Centre, Meibergdreef 5, 1105, AZ, Amsterdam, the Netherlands. Electronic address:

Background: Age and sex based coronary artery calcium score (CAC) percentiles have been used to improve coronary artery disease (CAD) risk prediction. However, the main limitation of the CACs percentiles currently in use is that they are often based on single studies. We performed a pooled analysis of all available studies that reported on CAC percentiles, in order to develop more generalizable age and sex nomograms.

Methods: PubMed/Medline and Embase were searched for studies that reported nomograms of age and sex-based CACs percentiles. Studies were included if they reported data collected among asymptomatic individuals without a history of cardiovascular disease. Absolute CACs for each specific percentile stratum were pooled and new percentiles were generated taking into account the sample size of the study.

Results: We found 831 studies, of which 12 met the inclusion criteria. Data on CACs percentiles of 134,336 Western and 33,488 Asians were pooled separately, rendering a weighted CACs percentile nomogram available at https://www.calciumscorecalculator.com. Our weighted percentiles differed by up to 24% from the nomograms in use today.

Conclusions: Our pooled age and sex based CACs percentiles based on over 155,000 individuals should provide a measure of risk that is more applicable to a wider population than the ones currently in use and hopefully will lead to better risk assessment and treatment decisions.
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http://dx.doi.org/10.1016/j.jcct.2020.01.006DOI Listing
October 2020

Improved brain perfusion after electrical cardioversion of atrial fibrillation.

Europace 2020 04;22(4):530-537

Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.

Aims: Atrial fibrillation (AF) has been associated with reduced brain volume, cognitive impairment, and reduced cerebral blood flow. The causes of reduced cerebral blood flow in AF are unknown, but no reduction was seen in individuals without the arrhythmia in a previous study. The aim of this study was to test the hypothesis that brain perfusion, measured with magnetic resonance imaging (MRI), improves after cardioversion of AF to sinus rhythm (SR).

Methods And Results: All patients undergoing elective cardioversion at our institution were invited to participate. A total of 44 individuals were included. Magnetic resonance imaging studies were done before and after cardioversion with both brain perfusion and cerebral blood flow measurements. However, 17 did not complete the second MRI as they had a recurrence of AF during the observation period (recurrent AF group), leaving 17 in the SR group and 10 in the AF group to complete both measurements. Brain perfusion increased after cardioversion to SR by 4.9 mL/100 g/min in the whole brain (P < 0.001) and by 5.6 mL/100 g/min in grey matter (P < 0.001). Cerebral blood flow increased by 58.6 mL/min (P < 0.05). Both brain perfusion and cerebral blood flow remained unchanged when cardioversion was unsuccessful.

Conclusion: In this study of individuals undergoing elective cardioversion for AF, restoration, and maintenance of SR for at least 10 weeks after was associated with an improvement of brain perfusion and cerebral blood flow measured by both arterial spin labelling and phase contrast MRI. In those individuals where cardioversion was unsuccessful, there was no change in perfusion or blood flow.
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http://dx.doi.org/10.1093/europace/euz336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132536PMC
April 2020

The effect of the 2008 recession on well-being and employment status of people with and without mental health problems.

Eur J Public Health 2020 08;30(4):761-766

Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

Background: The world was hit hard by the 2008 recession which led to increased unemployment and financial strain. However, how the recession affected people with pre-existing mental health problems has been understudied. This study investigates the effect of the 2008 recession in Iceland on stress, well-being and employment status of people with regard to whether they are suffering from mental health problems.

Methods: The study cohort included participants (18-69 years old) of the 'Health and Wellbeing of Icelanders', a 3-wave survey conducted before (in 2007) and after (in 2009 and 2012) the recession in 2008. Self-assessed well-being was measured with the Short Warwick-Edinburgh Mental Well-being Scale and the 4-item Perceived Stress Scale. Logistic regression was used to assess the effect of the 2008 recession on self-assessed well-being and employment status in 2009 and 2012, using 2007 as a reference year.

Results: Participants with no pre-recession mental health problems were at increased risk of both poor well-being, (with adjusted odds ratio at 1.66, in 2009 and 1.64 in 2012) and higher perceived stress, (with adjusted odds ratio at 1.48 in 2009 and 1.53 in 2012), after the recession. Interestingly, no significant change in well-being and perceived stress was observed among participants suffering from pre-recession mental health problems. Both groups had increased risk of unemployment after the recession.

Conclusion: Results indicate that after recessions, the risk of stress and poor well-being increases only among those who do not suffer from pre-recession mental health problems.
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http://dx.doi.org/10.1093/eurpub/ckz192DOI Listing
August 2020

Fractures and survival in multiple myeloma: results from a population-based study.

Haematologica 2020 04 2;105(4):1067-1073. Epub 2019 Dec 2.

Department of Internal Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.

Multiple myeloma causes lytic bone lesions and fractures. The impact of fractures on multiple myeloma (MM) survival is unclear. The aim of this study was to evaluate the effect of fractures on survival in MM using data from MM patients diagnosed in Sweden in the years 1990-2013, identified from the Swedish Cancer Registry. Information on date of birth, MM diagnosis, fractures, and death was collected from central registries. A Cox regression model was used to compare survival in patients with and without a fracture at MM diagnosis and another Cox model was used with fracture as a time-dependent variable to assess the effect of fracture on survival after MM diagnosis. Results were adjusted for age, sex, year of diagnosis, and previous fractures. A total of 14,013 patients were diagnosed with MM during the study, of whom 1,213 (8.7%) were diagnosed with a fracture at MM diagnosis, and 3,235 (23.1%) after diagnosis. Patients with a fracture at diagnosis were at a significantly increased risk of death (hazard ratio=1.28; 95% confidence interval: 1.19-1.37). The risk of death was significantly increased in patients with a fracture after MM diagnosis (2.00; 1.90-2.10). The impact of fractures on survival did not change significantly between the two calendar periods 1990-1999 and 2000-2013 (0.98; 0.89-1.08). Our large study shows that MM patients with fractures are at a significantly increased risk of dying compared to those without fractures, which stresses the importance of preventing bone disease in MM.
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http://dx.doi.org/10.3324/haematol.2019.230011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7109735PMC
April 2020

Preterm births in Iceland 1997-2016: Preterm birth rates by gestational age groups and type of preterm birth.

Birth 2020 03 19;47(1):105-114. Epub 2019 Nov 19.

Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

Background: The frequency of preterm births has been increasing globally, mainly due to a rise in iatrogenic late preterm births. The aim of this study was to assess the prevalence of preterm births in Iceland during 1997-2016 by type of preterm birth.

Methods: This study included all live births in Iceland during 1997-2016 identified from the Icelandic Medical Birth Registry. Risk of preterm birth by time period was assessed with Poisson regression models adjusted for demographic variables and indications for iatrogenic births.

Results: The study population included 87 076 infants, of which 4986 (5.7%) were preterm. The preterm birth rate increased from 5.3% to 6.1% (adjusted rate ratio [ARR] = 1.16, confidence interval [CI] = 1.07-1.26) between 1997-2001 and 2012-2016 overall. The increase was only evident in multiples (ARR 1.41, 95% CI 1.21-1.65), not singletons (1.07, 0.97-1.19). The rate of late preterm births (34-36 weeks) increased significantly (1.24, 1.14-1.40), and the rate of iatrogenic preterm births more than doubled during this period even after adjustment for identified medical indications (2.40, 2.00-2.88). The rate of spontaneous preterm births decreased during the study period (0.63, 0.55-0.73), and the rate of PPROM increased (1.31, 1.09-1.57). The most common contributing indications for iatrogenic births were fetal distress (26.2%), hypertensive disorders (18.2%), and severe preeclampsia (16.9%).

Conclusions: Preterm birth rates increased in multiples in Iceland between 1997 and 2016, and late and iatrogenic preterm births increased overall. The increase in iatrogenic preterm births remained significant after adjusting for medical indications, suggesting that other factors might be affecting the rise.
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http://dx.doi.org/10.1111/birt.12467DOI Listing
March 2020

[Effects of cardiac rehabilitation on the physical capacity of individuals with heart failure].

Laeknabladid 2019 Nov;105(11):491-497

Janus Health Promotion.

Purpose: Limited information is available on the effects of cardiac rehabilitation (CR) on individuals with heart failure (HF) in Iceland. The aim of this study was to analyze whether CR yielded increased physical capacity (PC) (w/kg) as measured by maximum exercise test at the end of the training period.

Materials And Methods: This is a retrospective data study from January 2010 to June 2018. Participants were patients with HF and also patients with ejection fraction (EF) 45% or less. Age and other diagnoses did not limit participation. Information about EF and exercise test at the beginning and end of the training period had to be recorded. Relative change in PC on these tests was evaluated by general linear models for repeated measurements. During the study period, 112 participants were enrolled, 27 did not finish the training period and 9 had incomplete data. Data from 76 participants aged 36-83 were analyzed.

Results: Participants' PC increased on average by 16% (p<0.001; confidence interval 13-18%). On average, those who attended training more than twice a week improved their PC by 18% which is -significantly more than those who trained twice or less who improved by 6%. The age group 65-83 improved by 19%, which is significantly more compared to the age group 36-64, which added 12%. No significant difference was in improvement between groups with EF under 40% or 40% and more.

Conclusion: Focused CR for individuals with HF and individuals with impaired EF resulted in increased PC.
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http://dx.doi.org/10.17992/lbl.2019.11.256DOI Listing
November 2019

Can postpartum pelvic floor muscle training reduce urinary and anal incontinence?: An assessor-blinded randomized controlled trial.

Am J Obstet Gynecol 2020 03 14;222(3):247.e1-247.e8. Epub 2019 Sep 14.

Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway; Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway.

Background: Pelvic floor dysfunction, including urinary and anal incontinence, is a common postpartum complaint and likely to reduce quality of life.

Objective: To study the effects of individualized physical therapist-guided pelvic floor muscle training in the early postpartum period on urinary and anal incontinence and related bother, as well as pelvic floor muscle strength and endurance.

Materials And Methods: This was an assessor-blinded, parallel-group, randomized controlled trial evaluating effects of pelvic floor muscle training by a physical therapist on the rate of urinary and/or anal leakage (primary outcomes); related bother and muscle strength and endurance in the pelvic floor were secondary outcomes. Between 2016 and 2017, primiparous women giving birth at Landspitali University Hospital in Reykjavik, Iceland, were screened for eligibilty 6-10 weeks after childbirth. Of those identified as urinary incontinent, 95 were invited to participate, of whom 84 agreed. The intervention, starting at ∼9 weeks postpartum consisted of 12 weekly sessions with a physical therapist, after which the main outcomes were assessed (endpoint, ∼6 months postpartum). Additional follow-up was conducted at ∼12 months postpartum. The control group received no instructions after the initial assessment. The Fisher exact test was used to test differences in the proportion of women with urinary and anal incontinence between the intervention and control groups, and independent-sample t tests were used for mean differences in muscle strength and endurance. Significance levels were set as α = 0.05.

Results: A total of 41 and 43 women were randomized to the intervention and control groups, respectively. Three participants and 1 participant withdrew from these respective groups. Measurement variables and main delivery outcomes were not different at recruitment. At the endpoint, urinary incontinence was less frequent in the intervention group, with 21 participants (57%) still symptomatic, compared to 31 controls (82%) (P = .03), as was bladder-related bother with 10 participants (27%) in the intervention vs 23 (60%) in the control group (P = .005). Anal incontinence was not influenced by pelvic floor muscle training (P = .33), nor was bowel-related bother (P = .82). The mean differences between groups in measured pelvic floor muscle strength changes at endpoint was 5 hPa (95% confidence interval, 2-8; P = .003), and for pelvic floor muscle endurance changes, 50 hPa/s (95% confidence interval, 23-77; P = .001), both in favor of the intervention group. The mean between-group differences for anal sphincter strength changes was 10 hPa (95% confidence interval, 2-18; P = .01) and for anal sphincter endurance changes 95 hPa/s (95% confidence interval, 16-173; P = .02), both in favor of the intervention. At the follow-up visit 12 months postpartum, no differences were observed between the groups regarding rates of urinary and anal incontinence and related bother. Pelvic floor- and anal muscle strength and endurance favoring the intervention group were maintained.

Conclusion: Postpartum pelvic floor mucle training decreased the rate of urinary incontinence and related bother 6 months postpartum and increased muscle strength and endurance.
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http://dx.doi.org/10.1016/j.ajog.2019.09.011DOI Listing
March 2020

Hyperuricemia is associated with intermittent hand joint pain in a cross sectional study of elderly females: The AGES-Reykjavik Study.

PLoS One 2019 23;14(8):e0221474. Epub 2019 Aug 23.

University of Iceland, Reykjavik, Iceland.

Background: The debate whether "asymptomatic hyperuricemia" should be treated is still ongoing. The objective of this cross-sectional study was to analyze whether hyperuricema in the elderly is associated with joint pain.

Methods And Findings: Participants in the population-based AGES-Reykjavik Study (males 2195, females 2975, mean age 76(6)) answered standardized questions about joint pain. In addition they recorded intermittent hand joint pain by marking a diagram of the hand. In males, no association was found between hyperuricemia and pain. Females however, showed a positive association between hyperuricemia and joint pain at many sites. After adjustment for age, BMI and hand osteoarthritis however, only intermittent hand joint pain (OR 1.30(1.07-1.58), p = 0.008) and intermittent pain in ≥10 hand joints (OR 1.75(1.32-2.31), p<0.001) remained significant. The best model for describing the relationship between serum uric acid levels (SUA) and intermittent hand joint pain in ≥10 joints was non-linear with a cut-off at 372 μmol/L. The attributable surplus number of symptomatic females with SUA ≥372 μmol/L was approximately 2.0% of the study population for those reporting pain in ≥10 hand joints. Next after having severe hand osteoarthritis, SUA ≥372 was an independent predictive factor of intermittent pain in ≥10 hand joints. Intermittent hand joint pain was also an independent risk factor for worse general health description.

Conclusion: Results from this population based study indicate that hyperuricemia in elderly females may be a rather frequent cause of intermittent hand joint pain, often in many joints. The most likely explanation relates to low-grade urate crystal induced inflammation. Our data do not allow for assessment of the severity of symptoms or whether they merit specific treatment, but intermittent hand joint pain was an independent predictor of worse general health. These findings may be an important contribution to the debate on whether hyperuricemia should be treated.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221474PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707588PMC
March 2020

Type 2 diabetes and obesity in midlife and breast cancer risk in the Reykjavik cohort.

Cancer Causes Control 2019 Oct 10;30(10):1057-1065. Epub 2019 Aug 10.

Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

Purpose: As obesity and type 2 diabetes (T2D) have been increasing worldwide, we investigated their association with breast cancer incidence in the Reykjavik Study.

Methods: During 1968-1996, approximately 10,000 women (mean age = 53 ± 9 years) completed questionnaires and donated blood samples. T2D status was classified according to self-report (n = 140) and glucose levels (n  = 154) at cohort entry. A linkage with the Icelandic Cancer Registry provided breast cancer incidence through 2015. Cox regression with age as time metric and adjusted for known confounders was applied to obtain hazard ratios (HR) and 95% confidence intervals (CI).

Results: Of 9,606 participants, 294 (3.1%) were classified as T2D cases at cohort entry while 728 (7.8%) women were diagnosed with breast cancer during 28.4 ± 11.6 years of follow-up. No significant association of T2D (HR 0.95; 95% CI 0.56-1.53) with breast cancer incidence was detected except among the small number of women with advanced breast cancer (HR 3.30; 95% CI 1.13-9.62). Breast cancer incidence was elevated among overweight/obese women without (HR 1.18; 95% CI 1.01-1.37) and with T2D (HR 1.35; 95% CI 0.79-2.31). Height also predicted higher breast cancer incidence (HR 1.03; 95% CI 1.02-1.05). All findings were confirmed in women of the AGES-Reykjavik sub-cohort (n  = 3,103) who returned for an exam during 2002-2006. With a 10% T2D prevalence and 93 incident breast cancer cases, the HR for T2D was 1.18 (95% CI 0.62-2.27).

Conclusions: These findings in a population with low T2D incidence suggest that the presence of T2D does not confer additional breast cancer risk and confirm the importance of height and excess body weight as breast cancer risk factors.
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http://dx.doi.org/10.1007/s10552-019-01213-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736708PMC
October 2019