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4. Clinical Synthetic Data Generation to Predict and Identify Risk Factors for Cardiovascular Diseases

Author

García-Vicente, Clara, Chushig-Muzo, David, Mora-Jiménez, Inmaculada, Fabelo, Himar, Gram, Inger Torhild, Løchen, Maja-Lisa, Granja, Conceição, Soguero-Ruiz, Cristina, Goos, Gerhard, Founding Editor, Hartmanis, Juris, Founding Editor, Bertino, Elisa, Editorial Board Member, Gao, Wen, Editorial Board Member, Steffen, Bernhard, Editorial Board Member, Yung, Moti, Editorial Board Member, Rezig, El Kindi, editor, Gadepally, Vijay, editor, Mattson, Timothy, editor, Stonebraker, Michael, editor, Kraska, Tim, editor, Kong, Jun, editor, Luo, Gang, editor, Teng, Dejun, editor, and Wang, Fusheng, editor

Published
2022
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10. Lifestyle factors as mediators of area-level socioeconomic differentials in mental health and cognitive function: the Tromsø Study

Author

Tiwari, Sweta, primary, Cerin, Ester, additional, Wilsgaard, Tom, additional, Løvsletten, Ola, additional, Grimsgaard, Sameline, additional, Hopstock, Laila Arnesdatter, additional, Schirmer, Henrik, additional, Rosengren, Annika, additional, Kristoffersen, Kathrine, additional, and Løchen, Maja-Lisa, additional

Published
2023
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11. Occupational physical activity and risk of mortality in women and men: the Tromsø Study 1986–2021

Author

Sagelv, Edvard H, primary, Dalene, Knut Eirik, additional, Eggen, Anne Elise, additional, Ekelund, Ulf, additional, Fimland, Marius Steiro, additional, Heitmann, Kim Arne, additional, Holtermann, Andreas, additional, Johansen, Kristoffer Robin, additional, Løchen, Maja-Lisa, additional, Morseth, Bente, additional, and Wilsgaard, Tom, additional

Published
2023
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13. Lifestyle factors as mediators of area-level socioeconomic differentials in mental health and cognitive function: the Tromsø Study.

Author

Tiwari, Sweta, Cerin, Ester, Wilsgaard, Tom, Løvsletten, Ola, Grimsgaard, Sameline, Hopstock, Laila Arnesdatter, Schirmer, Henrik, Rosengren, Annika, Kristoffersen, Kathrine, and Løchen, Maja-Lisa

Subjects
LIFESTYLES, CROSS-sectional method, MENTAL health, COGNITION, SOCIOECONOMIC status, PHYSICAL activity, SOCIAL classes, FACTOR analysis, DESCRIPTIVE statistics, RESEARCH funding, SMOKING
Published
2024
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14. No decline in drug overdose deaths in Norway: An ecological approach to understanding at-risk groups and the impact of interventions.

Author

Amundsen, Ellen J, Melsom, Anne-Karine M, Eriksen, Bjørn O, and Løchen, Maja-Lisa

Subjects
DRUG overdose, HARM reduction, DRUG abusers, PUBLISHED articles, OPIOIDS
Abstract

Aim: This Norwegian case study examines groups at risk of drug overdose deaths, evidence-based harm reduction interventions, low-threshold services and treatment implemented, as well as trends in drug overdose deaths between 2010 and 2021. We aimed to explore the relevance of interventions for at-risk groups and discuss their potential impact on drug overdose trends. Method/data: Using an ecological approach, we analysed the following: (1) groups identified through latent profile analysis (LPA) among a sample of 413 high-risk drug users collected in 2010–2012, supplemented with other relevant studies up to 2021; (2) published information on harm-reduction interventions, low-threshold services and treatment in Norway; and (3) nationwide drug overdose mortality figures supplemented with published articles on the topic. Results: High-risk drug users in 2010–2012 commonly engaged in frequent illegal drug use, injecting and poly-drug use (including pharmaceutical opioids), which continued into following decade. The interventions implemented between 2010 and 2021 were relevant for at-risk groups identified in the surveys. However, there was no decrease in the trend of drug overdose deaths up to 2021. While relevant interventions may have mitigated a theoretical increase in mortality, new at-risk groups may have contributed to fatal outcomes associated with pharmaceutical opioids. Conclusion: The interventions were relevant to the risk groups identified among high-risk drug users and potentially effective in preventing an increase in drug overdose trends. However, tailored interventions are needed for individuals at risk of death from prescribed opioids. Comprehensive studies encompassing all at-risk populations, including both legal and non-medical users of prescription opioids, are needed. [ABSTRACT FROM AUTHOR]

Published
2024
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18. Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group

Author

Hanssen, Henner, primary, Moholdt, Trine, additional, Bahls, Martin, additional, Biffi, Alessandro, additional, Siegrist, Monika, additional, Lewandowski, Adam J, additional, Biondi-Zoccai, Giuseppe, additional, Cavarretta, Elena, additional, Kokkvoll, Ane, additional, Løchen, Maja-Lisa, additional, Maestrini, Viviana, additional, Pinto, Rita Salvador, additional, Palermi, Stefano, additional, Thivel, David, additional, Wojcik, Malgorzata, additional, Hansen, Dominique, additional, Van Craenenbroeck, Emeline M, additional, Weghuber, Daniel, additional, Kraenkel, Nicolle, additional, and Tiberi, Monica, additional

Published
2023
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23. PCSK9-hemmere på blå resept for hvem?

Author

Semb, Anne Grete, primary, Vesterbekkmo, Elisabeth Kleivhaug, primary, Retterstøl, Kjetil, primary, Atar, Dan, primary, Solberg, Erik E., primary, Schirmer, Henrik, primary, Løchen, Maja-Lisa, primary, Kask, Anne, primary, Grimsmo, Jostein, primary, Ingul, Charlotte Björk, primary, and Munkhaugen, John, primary

Published
2023
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24. Data from national health registers as endpoints for the Tromsø Study: Correctness and completeness of stroke diagnoses.

Author

Varmdal, Torunn, Løchen, Maja-Lisa, Wilsgaard, Tom, Njølstad, Inger, Nyrnes, Audhild, Grimsgaard, Sameline, and Mathiesen, Ellisiv B.

Subjects
*STROKE diagnosis, *REPORTING of diseases, *DATA quality, *PREDICTIVE tests, *CONFIDENCE intervals, *CARDIOVASCULAR diseases, *DESCRIPTIVE statistics, *SENSITIVITY & specificity (Statistics), *DIAGNOSTIC errors, *EPIDEMIOLOGICAL research
Abstract

Aim: To assess whether stroke diagnoses in national health registers are sufficiently correct and complete to replace manual collection of endpoint data for the Tromsø Study, a population-based epidemiological study. Method: Using the Tromsø Study Cardiovascular Disease Register for 2013–2014 as the gold standard, we calculated correctness (defined as positive predictive value, PPV) and completeness (defined as sensitivity) of stroke cases in four different data subsets derived from the Norwegian Patient Register and the Norwegian Stroke Register. We calculated the sensitivity and PPV with 95% confidence intervals (CIs) assuming a normal approximation of the binomial distribution. Results: In the Norwegian Stroke Register we found a sensitivity of 79.8% (95% CI 74.2–85.4) and a PPV of 97.5% (95% CI 95.1–99.9). In the Norwegian Patient Register the sensitivity was 86.4% (95% CI 81.6–91.1) and the PPV was 84.2% (95% CI 79.2–89.2). The overall highest levels were found in a subset based on a linkage between the Norwegian Stroke Register and the Norwegian Patient Register, with a sensitivity of 88.9% (95% CI 84.5–93.3), and a PPV of 89.3% (95% CI 85.0–93.6). Conclusions: Data from the Norwegian Patient Register and from the linked data set between the Norwegian Patient Register and the Norwegian Stroke Register had acceptable levels of correctness and completeness to be considered as endpoint sources for the Tromsø Study Cardiovascular Disease Register. The benefits of using data from national registers as endpoints in epidemiological studies must be weighed against the impact of potentially decreased data quality. [ABSTRACT FROM AUTHOR]

Published
2023
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28. Risk prediction of atrial fibrillation and its complications in the community using hs troponin I

Author

Börschel, Christin S., primary, Geelhoed, Bastiaan, additional, Niiranen, Teemu, additional, Camen, Stephan, additional, Donati, Maria Benedetta, additional, Havulinna, Aki S., additional, Gianfagna, Francesco, additional, Palosaari, Tarja, additional, Jousilahti, Pekka, additional, Kontto, Jukka, additional, Vartiainen, Erkki, additional, Ojeda, Francisco M., additional, den Ruijter, Hester M., additional, Costanzo, Simona, additional, de Gaetano, Giovanni, additional, Di Castelnuovo, Augusto, additional, Linneberg, Allan, additional, Vishram‐Nielsen, Julie K., additional, Løchen, Maja‐Lisa, additional, Koenig, Wolfgang, additional, Jørgensen, Torben, additional, Kuulasmaa, Kari, additional, Blankenberg, Stefan, additional, Iacoviello, Licia, additional, Zeller, Tanja, additional, Söderberg, Stefan, additional, Salomaa, Veikko, additional, and Schnabel, Renate B., additional

Published
2023
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29. Exploring the incremental utility of circulating biomarkers for robust risk prediction of incident atrial fibrillation in European cohorts using regressions and modern machine learning methods

Author

Toprak, Betül, primary, Brandt, Stephanie, additional, Brederecke, Jan, additional, Gianfagna, Francesco, additional, Vishram-Nielsen, Julie K K, additional, Ojeda, Francisco M, additional, Costanzo, Simona, additional, Börschel, Christin S, additional, Söderberg, Stefan, additional, Katsoularis, Ioannis, additional, Camen, Stephan, additional, Vartiainen, Erkki, additional, Donati, Maria Benedetta, additional, Kontto, Jukka, additional, Bobak, Martin, additional, Mathiesen, Ellisiv B, additional, Linneberg, Allan, additional, Koenig, Wolfgang, additional, Løchen, Maja-Lisa, additional, Di Castelnuovo, Augusto, additional, Blankenberg, Stefan, additional, de Gaetano, Giovanni, additional, Kuulasmaa, Kari, additional, Salomaa, Veikko, additional, Iacoviello, Licia, additional, Niiranen, Teemu, additional, Zeller, Tanja, additional, and Schnabel, Renate B, additional

Published
2023
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31. Ten‐year mortality among older male recreational endurance athletes in the Birkebeiner Aging Study in comparison with older men from the Tromsø Study.

Author

Johansen, Kristoffer R., Ranhoff, Anette Hylen, Sørensen, Eivind, Nes, Bjarne M., Bucher‐Sandbakk, Silvana, Wilsgaard, Tom, Løchen, Maja‐Lisa, Thelle, Dag S., Morseth, Bente, Myrstad, Marius, Loennechen, Jan Pål, Tveit, Arnljot, Apelland, Turid, Folkenborg, Kristine, Johnson, Kristin Espolin, Letnes, Jon Magne, Malmo, Vegard, Sellevold, Andreas Berg, Byrkjeland, Rune, and Enger, Steve

Subjects
MORTALITY prevention, MORTALITY risk factors, ENDURANCE sports training, CONFIDENCE intervals, TIME, RECREATION, REGRESSION analysis, COMPARATIVE studies, PHYSICAL activity, ENDURANCE sports, RESEARCH funding, SKIING, EXTREME sports, PROPORTIONAL hazards models, DOSE-response relationship in biochemistry, OLD age
Abstract

Background: Physical activity (PA) is associated with reduced mortality. However, whether there is an added benefit of long‐term endurance training is unclear. Thus, we aimed to examine 10‐year mortality in older male endurance athletes compared with an older male general population. Method: Male athletes (n = 503) participating in an annual long‐distance ski race (median years of participation: 14, range: 1–53) from the Norwegian Birkebeiner Aging study (BiAS), and non‐athletic men (n = 1867) attending the sixth Tromsø Study (Tromsø6) aged ≥65 years were included. Associations with endurance sport practice and joint exposures of endurance sport practice and self‐reported leisure‐time PA with all‐cause mortality were examined. We analyzed the data with Cox proportional hazard models and regression standardization. Results: After 10 years (median: 10.4, range: 0.5–11.1) the mortality rate was lower in athletes (hazard ratio (HR) 0.34, 95% confidence interval (CI): 0.24–0.49) compared with non‐athletes, corresponding to a 15% (95% CI: 12–19%) absolute risk reduction associated with endurance sport practice. In joint analyses categorized according to PA and endurance sport practice, we observed an inverse dose–response relationship with mortality (p < 0.001). Compared to inactive non‐athletes, PA was associated with lower mortality in both active non‐athletes and athletes. However, the observed benefit among participants reporting moderate‐to‐vigorous PA was larger in athletes (HR: 0.21, 95% CI: 0.14–0.32) than non‐athletes (HR: 0.43, 95% CI: 0.31–0.59) (p < 0.01). Conclusion: Endurance sport practice was associated with reduced 10‐year mortality, beyond the effect of PA in older men. This study suggests that long‐term endurance sport practice maintained into older adulthood promotes longevity. [ABSTRACT FROM AUTHOR]

Published
2023
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33. Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice: a 10-year follow-up. The Birkebeiner Ageing Study and the Tromsø Study

Author

Johansen, Kristoffer Robin, primary, Ranhoff, Anette Hylen, additional, Sørensen, Eivind, additional, Nes, Bjarne M, additional, Heitmann, Kim Arne, additional, Apelland, Turid, additional, Bucher Sandbakk, Silvana, additional, Wilsgaard, Tom, additional, Løchen, Maja-Lisa, additional, Thelle, Dag S, additional, Morseth, Bente, additional, and Myrstad, Marius, additional

Published
2022
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35. Sex-specific time trends in incident atrial fibrillation and the contribution of risk factors: the Tromsø Study 1994–2016

Author

Sharashova, Ekaterina, primary, Gerdts, Eva, additional, Ball, Jocasta, additional, Espnes, Hilde, additional, Jacobsen, Bjarne K, additional, Kildal, Simon, additional, Mathiesen, Ellisiv B, additional, Njølstad, Inger, additional, Rosengren, Annika, additional, Schirmer, Henrik, additional, Wilsgaard, Tom, additional, and Løchen, Maja-Lisa, additional

Published
2022
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36. Outcomes after coronary angiography for unstable angina compared to stable angina, myocardial infarction and an asymptomatic general population

Author

Fladseth, Kristina, primary, Wilsgaard, Tom, additional, Lindekleiv, Haakon, additional, Kristensen, Andreas, additional, Mannsverk, Jan, additional, Løchen, Maja-Lisa, additional, Njølstad, Inger, additional, Mathiesen, Ellisiv B, additional, Trovik, Thor, additional, Rotevatn, Svein, additional, Forsdahl, Signe, additional, and Schirmer, Henrik, additional

Published
2022
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37. Sex differences in arterial hypertension A scientific statement from the ESC Council on Hypertension, the European Association of Preventive Cardiology, Association of Cardiovascular Nursing and Allied Professions, the ESC Council for Cardiology Practice, and the ESC Working Group on Cardiovascular Pharmacotherapy

Author

Gerdts, Eva, Sudano, Isabella, Brouwers, Sofie, Borghi, Claudio, Bruno, Rosa Maria, Ceconi, Claudio, Cornelissen, Veronique, Diévart, François, Ferrini, Marc, Kahan, Thomas, Løchen, Maja Lisa, Maas, Angela H E M, Mahfoud, Felix, Mihailidou, Anastasia S, Moholdt, Trine, Parati, Gianfranco, de Simone, Giovanni, Faculty of Medicine and Pharmacy, Brussels Heritage Lab, Pharmaceutical and Pharmacological Sciences, and Experimental Pharmacology

Subjects
hypertension, Cardiac & Cardiovascular Systems, CONSENSUS DOCUMENT, BLOOD-PRESSURE, END-POINT REDUCTION, Hypertension-mediated organ damage, ANTIHYPERTENSIVE TREATMENT, LOSARTAN INTERVENTION, sex hormones, pharmacological treatment, LEFT-VENTRICULAR HYPERTROPHY, Internal Medicine, Blood Pressure regulators, Sex hormones, GENDER-DIFFERENCES, Science & Technology, LEFT ATRIAL SIZE, Cardiovascular disease, adverse events, PULSE-WAVE VELOCITY, Adverse events, Hypertension, Cardiovascular System & Cardiology, RISK-FACTORS, Sex, pharmacology, Cardiology and Cardiovascular Medicine, Life Sciences & Biomedicine, Pharmacological treatment
Abstract

There is strong evidence that sex chromosomes and sex hormones influence blood pressure (BP) regulation, distribution of cardiovascular (CV) risk factors and co-morbidities differentially in females and males with essential arterial hypertension. The risk for CV disease increases at a lower BP level in females than in males, suggesting that sex-specific thresholds for diagnosis of hypertension may be reasonable. However, due to paucity of data, in particularly from specifically designed clinical trials, it is not yet known whether hypertension should be differently managed in females and males, including treatment goals and choice and dosages of antihypertensive drugs. Accordingly, this consensus document was conceived to provide a comprehensive overview of current knowledge on sex differences in essential hypertension including BP development over the life course, development of hypertension, pathophysiologic mechanisms regulating BP, interaction of BP with CV risk factors and co-morbidities, hypertension-mediated organ damage in the heart and the arteries, impact on incident CV disease, and differences in the effect of antihypertensive treatment. The consensus document also highlights areas where focused research is needed to advance sex-specific prevention and management of hypertension. ispartof: EUROPEAN HEART JOURNAL vol:43 issue:46 pages:4777-4788 ispartof: location:England status: published

Published
2022

39. Sex differences in arterial hypertension

Author

Gerdts, Eva, primary, Sudano, Isabella, additional, Brouwers, Sofie, additional, Borghi, Claudio, additional, Bruno, Rosa Maria, additional, Ceconi, Claudio, additional, Cornelissen, Véronique, additional, Diévart, François, additional, Ferrini, Marc, additional, Kahan, Thomas, additional, Løchen, Maja-Lisa, additional, Maas, Angela H E M, additional, Mahfoud, Felix, additional, Mihailidou, Anastasia S, additional, Moholdt, Trine, additional, Parati, Gianfranco, additional, and de Simone, Giovanni, additional

Published
2022
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42. Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation: the 8th AFNET/EHRA consensus conference

Author

Schnabel, Renate B, primary, Marinelli, Elena Andreassi, additional, Arbelo, Elena, additional, Boriani, Giuseppe, additional, Boveda, Serge, additional, Buckley, Claire M, additional, Camm, A John, additional, Casadei, Barbara, additional, Chua, Winnie, additional, Dagres, Nikolaos, additional, de Melis, Mirko, additional, Desteghe, Lien, additional, Diederichsen, Søren Zöga, additional, Duncker, David, additional, Eckardt, Lars, additional, Eisert, Christoph, additional, Engler, Daniel, additional, Fabritz, Larissa, additional, Freedman, Ben, additional, Gillet, Ludovic, additional, Goette, Andreas, additional, Guasch, Eduard, additional, Svendsen, Jesper Hastrup, additional, Hatem, Stéphane N, additional, Haeusler, Karl Georg, additional, Healey, Jeff S, additional, Heidbuchel, Hein, additional, Hindricks, Gerhard, additional, Hobbs, F D Richard, additional, Hübner, Thomas, additional, Kotecha, Dipak, additional, Krekler, Michael, additional, Leclercq, Christophe, additional, Lewalter, Thorsten, additional, Lin, Honghuang, additional, Linz, Dominik, additional, Lip, Gregory Y H, additional, Løchen, Maja Lisa, additional, Lucassen, Wim, additional, Malaczynska-Rajpold, Katarzyna, additional, Massberg, Steffen, additional, Merino, Jose L, additional, Meyer, Ralf, additional, Mont, Lluıs, additional, Myers, Michael C, additional, Neubeck, Lis, additional, Niiranen, Teemu, additional, Oeff, Michael, additional, Oldgren, Jonas, additional, Potpara, Tatjana S, additional, Psaroudakis, George, additional, Pürerfellner, Helmut, additional, Ravens, Ursula, additional, Rienstra, Michiel, additional, Rivard, Lena, additional, Scherr, Daniel, additional, Schotten, Ulrich, additional, Shah, Dipen, additional, Sinner, Moritz F, additional, Smolnik, Rüdiger, additional, Steinbeck, Gerhard, additional, Steven, Daniel, additional, Svennberg, Emma, additional, Thomas, Dierk, additional, True Hills, Mellanie, additional, van Gelder, Isabelle C, additional, Vardar, Burcu, additional, Palà, Elena, additional, Wakili, Reza, additional, Wegscheider, Karl, additional, Wieloch, Mattias, additional, Willems, Stephan, additional, Witt, Henning, additional, Ziegler, André, additional, Daniel Zink, Matthias, additional, and Kirchhof, Paulus, additional

Published
2022
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45. Risk Factors, Subsequent Disease Onset, and Prognostic Impact of Myocardial Infarction and Atrial Fibrillation

Author

Camen, Stephan, primary, Csengeri, Dora, additional, Geelhoed, Bastiaan, additional, Niiranen, Teemu, additional, Gianfagna, Francesco, additional, Vishram‐Nielsen, Julie K., additional, Costanzo, Simona, additional, Söderberg, Stefan, additional, Vartiainen, Erkki, additional, Börschel, Christin S., additional, Donati, Maria Benedetta, additional, Løchen, Maja‐Lisa, additional, Ojeda, Francisco M., additional, Kontto, Jukka, additional, Mathiesen, Ellisiv B., additional, Jensen, Steen, additional, Koenig, Wolfgang, additional, Kee, Frank, additional, de Gaetano, Giovanni, additional, Zeller, Tanja, additional, Jørgensen, Torben, additional, Tunstall‐Pedoe, Hugh, additional, Blankenberg, Stefan, additional, Kuulasmaa, Kari, additional, Linneberg, Allan, additional, Salomaa, Veikko, additional, Iacoviello, Licia, additional, and Schnabel, Renate B., additional

Published
2022
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48. Obesity Does Not Protect From Subarachnoid Hemorrhage: Pooled Analyses of 3 Large Prospective Nordic Cohorts

Author

Rautalin, Ilari, primary, Kaprio, Jaakko, additional, Ingebrigtsen, Tor, additional, Jousilahti, Pekka, additional, Løchen, Maja-Lisa, additional, Romundstad, Pål Richard, additional, Salomaa, Veikko, additional, Vik, Anne, additional, Wilsgaard, Tom, additional, Mathiesen, Ellisiv B., additional, Sandvei, Marie, additional, and Korja, Miikka, additional

Published
2022
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49. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Author

Zeppenfeld, Katja, Tfelt-Hansen, Jacob, de Riva, Marta, Winkel, Bo Gregers, Behr, Elijah R, Blom, Nico A, Charron, Philippe, Corrado, Domenico, Dagres, Nikolaos, de Chillou, Christian, Eckardt, Lars, Friede, Tim, Haugaa, Kristina H, Hocini, Mélèze, Lambiase, Pier D, Marijon, Eloi, Merino, Jose L, Peichl, Petr, Priori, Silvia G, Reichlin, Tobias, Schulz-Menger, Jeanette, Sticherling, Christian, Tzeis, Stylianos, Verstrael, Axel, Volterrani, Maurizio, Cikes, Maja, Kirchhof, Paulus, Abdelhamid, Magdy, Aboyans, Victor, Arbelo, Elena, Arribas, Fernando, Asteggiano, Riccardo, Basso, Cristina, Bauer, Axel, Bertaglia, Emanuele, Biering-Sørensen, Tor, Blomström-Lundqvist, Carina, Borger, Michael A, Čelutkienė, Jelena, Cosyns, Bernard, Falk, Volkmar, Fauchier, Laurent, Gorenek, Bulent, Halvorsen, Sigrun, Hatala, Robert, Heidbuchel, Hein, Kaab, Stefan, Konradi, Aleksandra, Koskinas, Konstantinos C, Kotecha, Dipak, Landmesser, Ulf, Lewis, Basil S, Linhart, Ales, Løchen, Maja-Lisa, Lund, Lars H, Metzner, Andreas, Mindham, Richard, Nielsen, Jens Cosedis, Norekvål, Tone M, Patten, Monica, Prescott, Eva, Rakisheva, Amina, Remme, Carol Ann, Roca-Luque, Ivo, Sarkozy, Andrea, Scherr, Daniel, Sitges, Marta, Touyz, Rhian M, Van Mieghem, Nicolas, Velagic, Vedran, Viskin, Sami, Volders, Paul G A, Pediatrics, Physiology, ACS - Heart failure & arrhythmias, Paediatric Cardiology, Cardiology, and APH - Methodology

Subjects
Genetic testing, Cardiac magnetic resonance, Sudden death, Arrhythmias, Cardiac, Ventricular tachycardia, Primary electrical disease, Guidelines, Recommendations, Chronic coronary artery disease, Risk calculator, Sudden cardiac death, Death, Sudden, Cardiac, Implantable cardioverter defibrillator, Ventricular arrhythmia, Humans, Catheter ablation, Anti-arrhythmic drugs, Ventricular fibrillation, Cardiology and Cardiovascular Medicine, 610 Medicine & health, Cardiomyopathies, Premature ventricular complex, Risk stratification
Published
2022

50. Sex and Gender-based Analyses in Norwegian Treatment Studies: a Scoping Review

Author

Østbø, Nora Mork, Vist, Gunn Elisabeth, and Løchen, Maja-Lisa

Subjects
Oversiktsverk som emne, Review Literature as Topic, Norway, Female, Sex, Therapeutics, Behandlinger, Norge
Abstract

Innledning Biologisk kjønn har betydning for kliniske utfall i behandling av en rekke sykdommer. Kunnskap om kjønnsforskjeller i effekt av behandling bidra til sikrere og mer tilpasset behandling for pasienter. For å sikre tilstrekkelig kunnskap på tvers av kjønn er det viktig at kjønn som variabel anvendes i helseforskning ved å være oppmerksom på kjønnsfordelingen i studieutvalget og ved å foreta kjønnsstratifiserte analyser og vurdere resultatene ut fra relevant eksisterende kunnskap. Det finnes imidlertid ingen standardisert måte å anvende kjønn i helseforskning på, og det er begrenset med dokumentasjon på i hvilken grad kjønnsperspektivet blir ivaretatt i norske forskningsprosjekter. Til nå har ingen systematiske studier eller rapporter kartlagt hvorvidt norsk helseforskning utfører og rapporterer funn fra kjønnsstratifiserte analyser, eller om studier er representative for populasjonen med hensyn til kjønnsfordeling i studieutvalget. Hensikt Hensikten med denne kartleggingsoversikten var å undersøke bruken av kjønnsstratifiserte analyser i studier på effekt av behandling i en norsk sammenheng. Rapportens formål var å kartlegge hvorvidt: • Kjønnsstratifiserte analyser blir foretatt i forskning utført i Norge på utvalgte sykdomsgrupper, og hvordan eventuelle funn er anvendt i diskusjon og konklusjon. • Studier har en kjønnsfordeling blant studiedeltakere som gjenspeiler kjønnsfordelingen for sykdomsforekomst. • Det er forskjell på observasjonsstudier og randomiserte studier i de to ovennevnte forskningsspørsmålene. • Inkluderte studier konkluderer med at kjønn medfører forskjell i behandlingsresultat. Metode Vi kartla enkeltstudier om behandlingsutfall i en norsk sammenheng fra 2017 - 2022. Inkluderte studier hadde minst én forfatter med norsk institusjonstilhørighet, og hadde rekruttert pasienter fra Norge. Vi inkluderte studier med minst 50 studiedeltakere i alle aldre. Studien måtte omhandle minst én sykdom fra 62 forhåndsbestemte sykdommer. Søket ble utført i juli og august 2022, og omfattet søk i følgende databaser: MEDLINE, PsycINFO, og Cochrane Central Register of Controlled Trials (CENTRAL). Det ble søkt etter 62 utvalgte sykdommer, og emneord knyttet til kvinner og kjønn. Søket var avgrenset til Norge ved bruk av søkeordet «Norway». Gjennomgang og datauthenting ble gjort i det digitale verktøyet EPPI Reviewer. Resultater Søket gav 3233 unike treff som ble gjennomgått i tittel og sammendrag, og 427 studier ble lest i fulltekst. Vi fant 133 studier med minst 50 pasienter fra Norge i perioden 2017 – 2022 om effekten av behandling for minst én av 62 forhåndsdefinerte sykdommer og der det var utført en kjønnsstratifisert analyse. Av 62 forhåndsbestemte sykdommer var det flest studier om kreftsykdommer (n = 47), etterfulgt av muskel- og skjelettlidelser (n = 28), og hjerte- og karsykdommer (n = 25). Det var 21 av de forhåndsspesifiserte sykdommene som ikke var representert i de norske studiene med kjønnsstratifisert analyse i denne tidsperioden, og 19 sykdommer representert med én studie. Det var flere (n = 178 studier) som ikke hadde en kjønnsstratifisert analyse på behandlingsutfall/effekt av behandling enn studier som rapporterte en kjønnsstratifisert analyse (n = 133 studier). Det var 36 og 33 studier som viste statistisk signifikante funn til fordel for henholdsvis kvinner og menn. Av disse var det fem studier som viste blandede resultater, hvor kvinner og menn skåret bedre på ulike utfallsmål. Det var 67 studier som fant kun ikke-signifikante funn, og i tillegg 19 studier hvor det var både signifikante og ikke-signifikante funn. En av tre studier hadde trukket funnene om kjønn inn i diskusjonen, og ca. én av fire hadde nevnt kjønn i konklusjonen. Det var ikke betydelige forskjeller mellom studiedesigntypene og bruk av analyseresultater i diskusjon eller konklusjon. Mindre enn halvparten av studiene hadde en jevn kjønnsfordeling i studieutvalget. Det var 21 (15 %) studier med spesielt lav andel kvinner (11 % - 30 %), hvorav alle studiene omhandlet hjerte- og karsykdommer eller kreftsykdommer. Det var få studier som hadde en kjønnsstratifisert analyse på effekt av behandling som involverte barn og unge under 18 år (n = 6 (4,5 %)). Blant studier som ikke hadde en kjønnsstratifisert analyse var det også få studier representert for barn 0 – 12 år (n = 7, 4 %) og ungdom 13-17 år (n = 6, 3 %). Diskusjon Denne systematiske kartleggingsoversikten viser et situasjonsbilde av hvorvidt kjønnsperspektiv er innlemmet i behandlingsstudier de siste fem årene for et bredt utvalg sykdommer som kan ramme både menn og kvinner. Det var et mindretall av studier som hadde utført separate analyser for kvinner og menn, og enda færre som hadde analysert effekten av kjønn på behandlingsresultat ved bruk av en interaksjonstest. Forskere bør være klar over at relevant informasjon om kjønnsforskjeller i behandlingsutfall kan utebli om slike analyser ikke utføres. Av studier som hadde inkludert en analyse basert på kjønn var det et mindretall som hadde omtalt resultatene i diskusjonen og vurdert resultatene i forhold til eksisterende kunnskap om betydningen av kjønn på forskningsområdet. For at resultatene skal kunne anvendes og følges opp i videre forskning er det nødvendig at kunnskapen som utarbeides blir satt i sammenheng med eksisterende kunnskap, og at resultatenes betydning for praksis blir drøftet. Konklusjon Vi fant betydelige forskjeller i behandlingsstudier på i hvilken grad kjønnsdimensjonen innlemmes i forskningen, og det er vår vurdering at effekt av kjønn på behandlingsutfall og effekt av behandling ikke rapporteres på en systematisk måte. Det var store forskjeller i studier på hvorvidt funnene var anvendt i diskusjon og konklusjon, og dette var gjort i et mindretall av studier. Når kjønnsstratifiserte analyser utføres bør dette komme tydelig frem i metode, resultat, og diskusjon. Vi fant at det var svært få studier som rapporterte en interaksjonstest av kjønn og behandlingsresultat, og et mindretall som analyserte behandlingsutfall separat for kvinner og menn. Det er gjennom slike analyser vi utarbeider best mulig kunnskap om hvordan menn og kvinner responderer på behandling, og vi skulle gjerne sett flere studier ta i bruk slike analysemetoder.

Published
2022

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