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5. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

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Phelps, Nowell H, Singleton, Rosie K, Zhou, Bin, Heap, Rachel A, Mishra, Anu, Bennett, James E, Paciorek, Christopher J, Lhoste, Victor PF, Carrillo-Larco, Rodrigo M, Stevens, Gretchen A, Rodriguez-Martinez, Andrea, Bixby, Honor, Bentham, James, Di Cesare, Mariachiara, Danaei, Goodarz, Rayner, Archie W, Barradas-Pires, Ana, Cowan, Melanie J, Savin, Stefan, Riley, Leanne M, Aguilar-Salinas, Carlos A, Baker, Jennifer L, Barkat, Amina, Bhutta, Zulfiqar A, Branca, Francesco, Caixeta, Roberta B, Cuschieri, Sarah, Farzadfar, Farshad, Ganapathy, Shubash, Ikeda, Nayu, Iotova, Violeta, Kengne, Andre P, Khang, Young-Ho, Laxmaiah, Avula, Lin, Hsien-Ho, Ma, Jun, Mbanya, Jean Claude N, Miranda, J Jaime, Pradeepa, Rajendra, Rodríguez-Artalejo, Fernando, Sorić, Maroje, Turley, Maria, Wang, Limin, Webster-Kerr, Karen, Aarestrup, Julie, Abarca-Gómez, Leandra, Abbasi-Kangevari, Mohsen, Abdeen, Ziad A, Abdrakhmanova, Shynar, Abdul Ghaffar, Suhaila, Abdul Rahim, Hanan F, Abdurrahmonova, Zulfiya, Abu-Rmeileh, Niveen M, Abubakar Garba, Jamila, Acosta-Cazares, Benjamin, Adam, Ishag, Adamczyk, Marzena, Adams, Robert J, Adu-Afarwuah, Seth, Aekplakorn, Wichai, Afsana, Kaosar, Afzal, Shoaib, Agbor, Valirie N, Agdeppa, Imelda A, Aghazadeh-Attari, Javad, Ågren, Åsa, Aguenaou, Hassan, Agyemang, Charles, Ahmad, Mohamad Hasnan, Ahmad, Noor Ani, Ahmadi, Ali, Ahmadi, Naser, Ahmadi, Nastaran, Ahmed, Imran, Ahmed, Soheir H, Ahrens, Wolfgang, Aitmurzaeva, Gulmira, Ajlouni, Kamel, Al-Hazzaa, Hazzaa M, Al-Hinai, Halima, Al-Lahou, Badreya, Al-Lawati, Jawad A, Al-Raddadi, Rajaa, Al Asfoor, Deena, Al Hourani, Huda M, Al Qaoud, Nawal M, Alarouj, Monira, AlBuhairan, Fadia, AlDhukair, Shahla, Aldwairji, Maryam A, Alexius, Sylvia, Ali, Mohamed M, Alieva, Anna V, Alkandari, Abdullah, Alkerwi, Ala'a, Alkhatib, Buthaina M, Allin, Kristine, Alomary, Shaker A, Alomirah, Husam F, Alshangiti, Arwa M, Alvarez-Pedrerol, Mar, Aly, Eman, Amarapurkar, Deepak N, Amiano Etxezarreta, Pilar, Amoah, John, Amougou, Norbert, Amouyel, Philippe, Andersen, Lars Bo, Anderssen, Sigmund A, Androutsos, Odysseas, Ängquist, Lars, Anjana, Ranjit Mohan, Ansari-Moghaddam, Alireza, Anufrieva, Elena, Aounallah-Skhiri, Hajer, Araújo, Joana, Ariansen, Inger, Aris, Tahir, Arku, Raphael E, Arlappa, Nimmathota, Aryal, Krishna K, Assefa, Nega, Aspelund, Thor, Assah, Felix K, Assembekov, Batyrbek, Assunção, Maria Cecília F, Aung, May Soe, Aurélio de Valois, Correia Júnior Marco, Auvinen, Juha, Avdičová, Mária, Avi, Shina, Azad, Kishwar, Azevedo, Ana, Azimi-Nezhad, Mohsen, Azizi, Fereidoun, Babu, Bontha V, Bacopoulou, Flora, Bæksgaard Jørgensen, Maja, Baharudin, Azli, Bahijri, Suhad, Bajramovic, Izet, Bakacs, Marta, Balakrishna, Nagalla, Balanova, Yulia, Bamoshmoosh, Mohamed, Banach, Maciej, Banegas, José R, Baran, Joanna, Baran, Rafał, Barbagallo, Carlo M, Barbosa Filho, Valter, Barceló, Alberto, Baretić, Maja, Barnoya, Joaquin, Barrera, Lena, Barreto, Marta, Barros, Aluisio JD, Barros, Mauro Virgílio Gomes, Bartosiewicz, Anna, Basit, Abdul, Bastos, Joao Luiz, Bata, Iqbal, Batieha, Anwar M, Batista, Aline P, Batista, Rosangela L, Battakova, Zhamilya, Baur, Louise A, Bayauli, Pascal M, Beaglehole, Robert, Bel-Serrat, Silvia, Belavendra, Antonisamy, Ben Romdhane, Habiba, Benedek, Theodora, Benedics, Judith, Benet, Mikhail, Benitez Rolandi, Gilda Estela, Benzeval, Michaela, Bere, Elling, Berger, Nicolas, Bergh, Ingunn Holden, Berhane, Yemane, Berkinbayev, Salim, Bernabe-Ortiz, Antonio, Bernotiene, Gailute, Berrios Carrasola, Ximena, Bettiol, Heloísa, Beutel, Manfred E, Beybey, Augustin F, Bezerra, Jorge, Bhagyalaxmi, Aroor, Bharadwaj, Sumit, Bhargava, Santosh K, Bi, Hongsheng, Bi, Yufang, Bia, Daniel, Biasch, Katia, Bika Lele, Elysée Claude, Bikbov, Mukharram M, Bista, Bihungum, Bjelica, Dusko J, Bjerregaard, Anne A, Bjerregaard, Peter, Bjertness, Espen, Bjertness, Marius B, Björkelund, Cecilia, Bloch, Katia V, Blokstra, Anneke, Blychfeld Magnazu, Moran, Bo, Simona, Bobak, Martin, Boddy, Lynne M, Boehm, Bernhard O, Boer, Jolanda MA, Boggia, Jose G, Bogova, Elena, Boissonnet, Carlos P, Bojesen, Stig E, Bonaccio, Marialaura, Bongard, Vanina, Bonilla-Vargas, Alice, Bopp, Matthias, Borghs, Herman, Botomba, Steve, Bourne, Rupert RA, Bovet, Pascal, Boymatova, Khadichamo, Braeckevelt, Lien, Braeckman, Lutgart, Bragt, Marjolijn CE, Braithwaite, Tasanee, Brajkovich, Imperia, Breckenkamp, Juergen, Breda, João, Brenner, Hermann, Brewster, Lizzy M, Brian, Garry R, Briceño, Yajaira, Brinduse, Lacramioara, Bringolf-Isler, Bettina, Brito, Miguel, Brophy, Sinead, Brug, Johannes, Bruno, Graziella, Bugge, Anna, Buoncristiano, Marta, Burazeri, Genc, Burns, Con, Cabrera de León, Antonio, Cacciottolo, Joseph, Cai, Hui, Cama, Tilema, Cameron, Christine, Camolas, José, Can, Günay, Cândido, Ana Paula c, Cañete, Felicia, Capanzana, Mario V, Čapková, Naděžda, Capuano, Eduardo, Capuano, Rocco, Capuano, Vincenzo, Cardol, Marloes, Cardoso, Viviane C, Carlsson, Axel C, Carmuega, Esteban, Carvalho, Joana, Casajús, José A, Casanueva, Felipe F, Casas, Maribel, Celikcan, Ertugrul, Censi, Laura, Cervantes-Loaiza, Marvin, Cesar, Juraci A, Chamnan, Parinya, Chamukuttan, Snehalatha, Chan, Angelique, Chan, Queenie, Charchar, Fadi J, Charles, Marie-Aline, Chaturvedi, Himanshu K, Chaturvedi, Nish, Che Abdul Rahim, Norsyamlina, Chee, Miao Li, Chen, Chien-Jen, Chen, Fangfang, Chen, Huashuai, Chen, Long-Sheng, Chen, Shuohua, Chen, Zhengming, Cheng, Ching-Yu, Cheng, Yiling J, Cheraghian, Bahman, Chetrit, Angela, Chikova-Iscener, Ekaterina, Chinapaw, Mai JM, Chinnock, Anne, Chiolero, Arnaud, Chiou, Shu-Ti, Chirita-Emandi, Adela, Chirlaque, María-Dolores, Cho, Belong, Christensen, Kaare, Christofaro, Diego G, Chudek, Jerzy, Cifkova, Renata, Cilia, Michelle, Cinteza, Eliza, Cirillo, Massimo, Claessens, Frank, Clare, Philip, Clarke, Janine, Clays, Els, Cohen, Emmanuel, Cojocaru, Cosmin R, Colorado-Yohar, Sandra, Compañ-Gabucio, Laura-María, Concin, Hans, Confortin, Susana C, Cooper, Cyrus, Coppinger, Tara C, Corpeleijn, Eva, Cortés, Lilia Yadira, Costanzo, Simona, Cottel, Dominique, Cowell, Chris, Craig, Cora L, Crampin, Amelia C, Cross, Amanda J, Crujeiras, Ana B, Cruz, Juan J, Csányi, Tamás, Csilla, Semánová, Cucu, Alexandra M, Cui, Liufu, Cureau, Felipe V, Czenczek-Lewandowska, Ewelina, D'Arrigo, Graziella, d'Orsi, Eleonora, da Silva, Alanna G, Dacica, Liliana, Dahm, Christina C, Dallongeville, Jean, Damasceno, Albertino, Damsgaard, Camilla T, Dankner, Rachel, Dantoft, Thomas M, Dasgupta, Parasmani, Dastgiri, Saeed, Dauchet, Luc, Davletov, Kairat, de Assis Guedes de Vasconcelos, Francisco, de Assis, Maria Alice Altenburg, De Backer, Guy, De Bacquer, Dirk, De Bacquer, Jaco, de Bont, Jeroen, De Curtis, Amalia, de Fragas Hinnig, Patrícia, de Gaetano, Giovanni, De Henauw, Stefaan, De Miguel-Etayo, Pilar, De Neve, Jan-Walter, Duarte de Oliveira, Paula, De Ridder, David, De Ridder, Karin, de Rooij, Susanne R, de Sá, Ana Carolina MGN, De Smedt, Delphine, Deepa, Mohan, Deev, Alexander D, DeGennaro, Vincent Jr, Delisle, Hélène, Delpeuch, Francis, Demarest, Stefaan, Dennison, Elaine, Dereń, Katarzyna, Deschamps, Valérie, Devrishov, Ruslan D, Dhimal, Meghnath, Di Castelnuovo, Augusto, Dias-da-Costa, Juvenal Soares, Díaz-Sánchez, María Elena, Diaz, Alejandro, Díaz Fernández, Pedro, Díez Ripollés, María Pilar, Dika, Zivka, Djalalinia, Shirin, Djordjic, Visnja, Do, Ha TP, Dobson, Annette J, Dominguez, Liria, Donati, Maria Benedetta, Donfrancesco, Chiara, Dong, Guanghui, Dong, Yanhui, Donoso, Silvana P, Döring, Angela, Dorobantu, Maria, Dorosty, Ahmad Reza, Dörr, Marcus, Doua, Kouamelan, Dragano, Nico, Drygas, Wojciech, Du, Shufa, Duan, Jia Li, Duante, Charmaine A, Duboz, Priscilla, Duleva, Vesselka L, Dulskiene, Virginija, Dumith, Samuel C, Dushpanova, Anar, Dwyer, Terence, Dyussupova, Azhar, Dzerve, Vilnis, Dziankowska-Zaborszczyk, Elzbieta, Ebrahimi, Narges, Echeverría, Guadalupe, Eddie, Ricky, Eftekhar, Ebrahim, Efthymiou, Vasiliki, Egbagbe, Eruke E, Eggertsen, Robert, Eghtesad, Sareh, Eiben, Gabriele, Ekelund, Ulf, El-Khateeb, Mohammad, El Ammari, Laila, El Ati, Jalila, Eldemire-Shearer, Denise, Elliott, Paul, Enang, Ofem, Endevelt, Ronit, Engle-Stone, Reina, Erasmus, Rajiv T, Erem, Cihangir, Ergor, Gul, Eriksen, Louise, Eriksson, Johan G, Escobedo-de la Peña, Jorge, Eslami, Saeid, Esmaeili, Ali, Evans, Alun, Evans, Roger G, Faeh, David, Fagherazzi, Guy, Fakhradiyev, Ildar, Fakhretdinova, Albina A, Fall, Caroline H, Faramarzi, Elnaz, Farjam, Mojtaba, Farrugia Sant'Angelo, Victoria, Farzi, Yosef, Fattahi, Mohammad Reza, Fawwad, Asher, Fawzi, Wafaie W, Felix-Redondo, Francisco J, Ferguson, Trevor S, Fernandes, Romulo A, Fernández-Bergés, Daniel, Ferrante, Daniel, Ferrao, Thomas, Ferrari, Gerson, Ferrari, Marika, Ferrario, Marco M, Ferreccio, Catterina, Ferreira, Haroldo S, Ferrer, Eldridge, Ferrieres, Jean, Figueiró, Thamara Hubler, Fijalkowska, Anna, Fink, Günther, Fisberg, Mauro, Fischer, Krista, Foo, Leng Huat, Forsner, Maria, Fottrell, Edward F, Fouad, Heba M, Francis, Damian K, Franco, Maria do Carmo, Fras, Zlatko, Fraser, Brooklyn, Frontera, Guillermo, Fuchs, Flavio D, Fuchs, Sandra C, Fujiati, Isti I, Fujita, Yuki, Fumihiko, Matsuda, Furdela, Viktoriya, Furusawa, Takuro, Gabriela, Stefan Adela, Gaciong, Zbigniew, Gafencu, Mihai, Galán Cuesta, Manuel, Galbarczyk, Andrzej, Galcheva, Sonya V, Galenkamp, Henrike, Galeone, Daniela, Galfo, Myriam, Galvano, Fabio, Gao, Jingli, Gao, Pei, Garcia-de-la-Hera, Manoli, García Mérida, María José, García Solano, Marta, Gareta, Dickman, Garnett, Sarah P, Gaspoz, Jean-Michel, Gasull, Magda, Gaya, Adroaldo Cesar Araujo, Gaya, Anelise Reis, Gazzinelli, Andrea, Gehring, Ulrike, Geiger, Harald, Geleijnse, Johanna M, George, Ronnie, Gerdts, Eva, Ghaderi, Ebrahim, Ghamari, Seyyed-Hadi, Ghanbari, Ali, Ghasemi, Erfan, Gheorghe-Fronea, Oana-Florentina, Gialluisi, Alessandro, Giampaoli, Simona, Gianfagna, Francesco, Gieger, Christian, Gill, Tiffany K, Giovannelli, Jonathan, Gironella, Glen, Giwercman, Aleksander, Gkiouras, Konstantinos, Glushkova, Natalya, Godara, Ramesh, Godos, Justyna, Gogen, Sibel, Goldberg, Marcel, Goltzman, David, Gómez, Georgina, Gómez Gómez, Jesús Humberto, Gomez, Luis F, Gómez, Santiago F, Gomula, Aleksandra, Gonçalves Cordeiro da Silva, Bruna, Gonçalves, Helen, Gonçalves, Mauer, González-Alvarez, Ana D, Gonzalez-Chica, David A, González-Gil, Esther M, Gonzalez-Gross, Marcela, González-Leon, Margot, González-Rivas, Juan P, González-Villalpando, Clicerio, González-Villalpando, María-Elena, Gonzalez, Angel R, Gottrand, Frederic, Graça, Antonio Pedro, Grafnetter, Dušan, Grajda, Aneta, Grammatikopoulou, Maria G, Gregg, Edward W, Gregor, Ronald D, Gregório, Maria João, Grøholt, Else Karin, Grøntved, Anders, Grosso, Giuseppe, Gruden, Gabriella, Gu, Dongfeng, Guajardo, Viviana, Gualdi-Russo, Emanuela, Guallar-Castillón, Pilar, Gualtieri, Andrea, Gudmundsson, Elias F, Gudnason, Vilmundur, Guerchet, Maëlenn, Guerrero, Ramiro, Guessous, Idris, Guimaraes, Andre L, Gujral, Unjali P, Gulliford, Martin C, Gunnlaugsdottir, Johanna, Gunter, Marc J, Guo, Xiu-Hua, Guo, Yin, Gupta, Prakash C, Gupta, Rajeev, Gureje, Oye, Gurinović, Mirjana A, Gutiérrez González, Enrique, Gutierrez, Laura, Gutzwiller, Felix, Gwee, Xinyi, Ha, Seongjun, Hadaegh, Farzad, Hadjigeorgiou, Charalambos A, Haghshenas, Rosa, Hakimi, Hamid, Halkjær, Jytte, Hambleton, Ian R, Hamzeh, Behrooz, Hanekom, Willem A, Hange, Dominique, Hanif, Abu AM, Hantunen, Sari, Hao, Jie, Hardman, Carla Menêses, Hardy, Louise, Hari Kumar, Rachakulla, Harmer Lassen, Tina, Harooni, Javad, Hashemi-Shahri, Seyed Mohammad, Hassapidou, Maria, Hata, Jun, Haugsgjerd, Teresa, Hayes, Alison J, He, Jiang, He, Yuan, He, Yuna, Heidinger-Felső, Regina, Heier, Margit, Heinen, Mirjam, Hejgaard, Tatjana, Hendriks, Marleen Elisabeth, Henrique, Rafael dos Santos, Henriques, Ana, Hernandez Cadena, Leticia, Herrala, Sauli, Herrera-Cuenca, Marianella, Herrera, Victor M, Herter-Aeberli, Isabelle, Herzig, Karl-Heinz, Heshmat, Ramin, Heude, Barbara, Hill, Allan G, Ho, Sai Yin, Ho, Suzanne C, Hobbs, Michael, Höfelmann, Doroteia A, Holdsworth, Michelle, Homayounfar, Reza, Homs, Clara, Hoogendijk, Emiel, Hopman, Wilma M, Horimoto, Andrea RVR, Hormiga, Claudia M, Horta, Bernardo L, Houti, Leila, Howitt, Christina, Htay, Thein Thein, Htet, Aung Soe, Htike, Maung Maung Than, Hu, Yonghua, Huerta, José María, Huhtaniemi, Ilpo Tapani, Huiart, Laetitia, Huidumac Petrescu, Constanta, Husseini, Abdullatif, Huu, Chinh Nguyen, Huybrechts, Inge, Hwalla, Nahla, Hyska, Jolanda, Iacoviello, Licia, Iakupova, Ellina M, Ibarluzea, Jesús, Ibrahim, Mohsen M, Ibrahim Wong, Norazizah, Igland, Jannicke, Ijoma, Chinwuba, Ikram, M Arfan, Iñiguez, Carmen, Irazola, Vilma E, Ishida, Takafumi, Isiguzo, Godsent C, Islam, Muhammad, Islam, Sheikh Mohammed Shariful, Islek, Duygu, Ittermann, Till, Ivanova-Pandourska, Ivaila Y, Iwasaki, Masanori, Jääskeläinen, Tuija, Jackson, Rod T, Jacobs, Jeremy M, Jadoul, Michel, Jafar, Tazeen, Jallow, Bakary, James, Kenneth, Jamil, Kazi M, Jamrozik, Konrad, Jan, Nataša, Jansson, Anna, Janszky, Imre, Janus, Edward, Jarani, Juel, Jarnig, Gerald, Jarvelin, Marjo-Riitta, Jasienska, Grazyna, Jelaković, Ana, Jelaković, Bojan, Jennings, Garry, Jiang, Chao Qiang, Jimenez, Ramon O, Jöckel, Karl-Heinz, Joffres, Michel, Jokelainen, Jari J, Jonas, Jost B, Jonnagaddala, Jitendra, Jøran Kjerpeseth, Lars, Jørgensen, Torben, Joshi, Pradeep, Joshi, Rohina, Josipović, Josipa, Joukar, Farahnaz, Jóźwiak, Jacek J, Judge, Debra S, Juolevi, Anne, Jurak, Gregor, Jurca Simina, Iulia, Juresa, Vesna, Kaaks, Rudolf, Kaducu, Felix O, Kadvan, Agnes L, Kafatos, Anthony, Kaj, Mónika, Kajantie, Eero O, Kakutia, Natia, Kállayová, Daniela, Kalmatayeva, Zhanna, Kalter-Leibovici, Ofra, Kameli, Yves, Kanala, Kodanda R, Kannan, Srinivasan, Kapantais, Efthymios, Karaglani, Eva, Karakosta, Argyro, Kårhus, Line L, Karki, Khem B, Karlsson, Omat, Kassi Anicet, Adoubi, Katchunga, Philippe B, Katibeh, Marzieh, Katz, Joanne, Katzmarzyk, Peter T, Kauhanen, Jussi, Kaur, Prabhdeep, Kavousi, Maryam, Kazakbaeva, Gyulli M, Kaze, François F, Kazembe, Benson M, Ke, Calvin, Keil, Ulrich, Keinan Boker, Lital, Keinänen-Kiukaanniemi, Sirkka, Kelishadi, Roya, Kelleher, Cecily, Kemper, Han CG, Keramati, Maryam, Kerimkulova, Alina, Kersting, Mathilde, Key, Timothy, Khader, Yousef Saleh, Khaledifar, Arsalan, Khalili, Davood, Kheiri, Bahareh, Kheradmand, Motahareh, Khosravi, Alireza, Khouw, Ilse MSL, Kiechl-Kohlendorfer, Ursula, Kiechl, Sophia J, Kiechl, Stefan, Killewo, Japhet, Kim, Hyeon Chang, Kim, Jeongseon, Kindblom, Jenny M, Kingston, Andrew, Klakk, Heidi, Klanarong, Suntara, Klanova, Jana, Klimek, Magdalena, Klimont, Jeannette, Klumbiene, Jurate, Knoflach, Michael, Kobel, Susanne, Koirala, Bhawesh, Kolle, Elin, Kolo, Sanda M, Kolsteren, Patrick, König, Jürgen, Korpelainen, Raija, Korrovits, Paul, Korzycka, Magdalena, Kos, Jelena, Koskinen, Seppo, Kouda, Katsuyasu, Koussoh Simone, Malik, Kovács, Éva, Kovacs, Viktoria Anna, Kovalskys, Irina, Kowlessur, Sudhir, Koziel, Slawomir, Kratenova, Jana, Kratzer, Wolfgang, Kriaucioniene, Vilma, Kriemler, Susi, Kristensen, Peter Lund, Krizan, Helena, Kroker-Lobos, Maria F, Krokstad, Steinar, Kromhout, Daan, Kruger, Herculina S, Kruger, Ruan, Kryst, Łukasz, Kubinova, Ruzena, Kuciene, Renata, Kujala, Urho M, Kujundzic, Enisa, Kulaga, Zbigniew, Kulimbet, Mukhtar, Kulothungan, Vaitheeswaran, Kumar, R Krishna, Kumari, Meena, Kunešová, Marie, Kurjata, Pawel, Kusuma, Yadlapalli S, Kutsenko, Vladimir, Kuulasmaa, Kari, Kyobutungi, Catherine, La, Quang Ngoc, Laamiri, Fatima Zahra, Laatikainen, Tiina, Labadarios, Demetre, Lachat, Carl, Lackner, Karl J, Lai, Daphne, Laid, Youcef, Lall, Lachmie, Lam, Tai Hing, Landaeta Jimenez, Maritza, Landais, Edwige, Lankila, Tiina, Lanska, Vera, Lappas, Georg, Larijani, Bagher, Larissa, Simo Pone, Lateva, Mina P, Latt, Tint Swe, Laurenzi, Martino, Lauria, Laura, Lazo-Porras, Maria, Le Coroller, Gwenaëlle, Le Nguyen Bao, Khanh, Le Port, Agnès, Le, Tuyen D, Lee, Jeannette, Lee, Jeonghee, Lee, Paul H, Lehtimäki, Terho, Lemogoum, Daniel, Leong, Elvynna, Leskošek, Branimir, Leszczak, Justyna, Leth-Møller, Katja B, Leung, Gabriel M, Levitt, Naomi S, Li, Yanping, Liivak, Merike, Lilly, Christa L, Lim, Charlie, Lim, Wei-Yen, Lima-Costa, M Fernanda, Lin, Xu, Lind, Lars, Lingam, Vijaya, Linkohr, Birgit, Linneberg, Allan, Lissner, Lauren, Litwin, Mieczyslaw, Liu, Jing, Liu, Lijuan, Liu, Liping, Liu, Xiaotian, Lo, Wei-Cheng, Loit, Helle-Mai, Long, Khuong Quynh, Longo Abril, Guadalupe, Lopes, Luis, Lopes, Marcus SS, Lopes, Oscar, Lopez-Garcia, Esther, Lopez, Tania, Lotufo, Paulo A, Lozano, José Eugenio, Lukrafka, Janice L, Luksiene, Dalia, Lundqvist, Annamari, Lunet, Nuno, Lunogelo, Charles, Lustigová, Michala, Łuszczki, Edyta, M'Buyamba-Kabangu, Jean-René, Ma, Guansheng, Ma, Xu, Machado-Coelho, George LL, Machado-Rodrigues, Aristides M, Macia, Enguerran, Macieira, Luisa M, Madar, Ahmed A, Madraisau, Sherilynn, Madsen, Anja L, Maestre, Gladys E, Maggi, Stefania, Magliano, Dianna J, Magnacca, Sara, Magriplis, Emmanuella, Mahasampath, Gowri, Maire, Bernard, Majer, Marjeta, Makdisse, Marcia, Mäki, Päivi, Malekpour, Mohammad-Reza, Malekzadeh, Fatemeh, Malekzadeh, Reza, Malhotra, Rahul, Mallikharjuna Rao, Kodavanti, Malta, Deborah C, Malyutina, Sofia K, Maniego, Lynell V, Manios, Yannis, Mann, Jim I, Mannix, Masimango Imani, Mansour-Ghanaei, Fariborz, Manyanga, Taru, Manzato, Enzo, Mapatano, Mala Ali, Marcil, Anie, Margozzini, Paula, Maria-Magdalena, Rosu, Mariño, Joany, Markaki, Anastasia, Markey, Oonagh, Markidou Ioannidou, Eliza, Marques-Vidal, Pedro, Marques, Larissa Pruner, Marrugat, Jaume, Martin-Prevel, Yves, Martin, Rosemarie, Martorell, Reynaldo, Martos, Eva, Maruf, Fatai A, Maruszczak, Katharina, Marventano, Stefano, Masala, Giovanna, Mascarenhas, Luis P, Masinaei, Masoud, Masoodi, Shariq R, Mathiesen, Ellisiv B, Mathur, Prashant, Matijasevich, Alicia, Matłosz, Piotr, Matsha, Tandi E, Matsudo, Victor, Matteo, Giletta, Maulik, Pallab K, Mavrogianni, Christina, Mazur, Artur, McFarlane, Shelly R, McGarvey, Stephen T, McKee, Martin, McLean, Rachael M, McLean, Scott B, McNairy, Margaret L, McNulty, Breige A, Mediene Benchekor, Sounnia, Medzioniene, Jurate, Mehlig, Kirsten, Mehrparvar, Amir Houshang, Meirhaeghe, Aline, Meisfjord, Jørgen, Meisinger, Christa, Melgarejo, Jesus D, Melkumova, Marina, Mello, Júlio, Méndez, Fabián, Mendivil, Carlos O, Menezes, Ana Maria B, Menon, Geetha R, Mensink, Gert BM, Menzano, Maria Teresa, Meshram, Indrapal I, Meto, Diane T, Meyer, Haakon E, Mi, Jie, Michaelsen, Kim F, Michels, Nathalie, Mikkel, Kairit, Miłkowska, Karolina, Miller, Jody C, Milushkina, Olga, Minderico, Cláudia S, Mini, GK, Miquel, Juan Francisco, Mirjalili, Mohammad Reza, Mirkopoulou, Daphne, Mirrakhimov, Erkin, Mišigoj-Duraković, Marjeta, Mistretta, Antonio, Mocanu, Veronica, Modesti, Pietro A, Moghaddam, Sahar Saeedi, Mohamed, Shukri F, Mohammad, 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Schröder, Helmut, Schultsz, Constance, Schultz, Gry, Schulze, Matthias B, Schutte, Aletta E, Sebert, Sylvain, Sedaghattalab, Moslem, Selamat, Rusidah, Sember, Vedrana, Sen, Abhijit, Senbanjo, Idowu O, Sepanlou, Sadaf G, Sequera, Guillermo, Serra-Majem, Luis, Servais, Jennifer, Ševčíková, Ľudmila, Sewpaul, Ronel, Shalnova, Svetlana, Shamah-Levy, Teresa, Shamshirgaran, Seyed Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K, Sharman, Almaz, Shaw, Jonathan E, Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shengelia, Lela, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shimony, Tal, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M, Sidossis, Labros S, Silitrari, Natalia, Silva, Antonio M, Silva, Caroline Ramos de Moura, Silva, Diego Augusto Santos, Silva, Kelly Samara, Sim, Xueling, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skoblina, Elena V, Skoblina, Natalia A, 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Suárez-Medina, Ramón, Suarez-Ortegón, Milton F, Suebsamran, Phalakorn, Sugiyama, Mindy, Suka, Machi, Sulo, Gerhard, Sun, Chien-An, Sun, Liang, Sund, Malin, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Sweis, Nabil William G, Swinburn, Boyd A, Sy, Rody G, Sylva, René Charles, Szponar, Lucjan, Tabone, Lorraine, Tai, E Shyong, Takuro, Furusawa, Tambalis, Konstantinos D, Tammesoo, Mari-Liis, Tamosiunas, Abdonas, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Taxová Braunerová, Radka, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Te Velde, Saskia, Tebar, William R, Tell, Grethe S, Tello, Tania, Tessema, Masresha, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thomas, Nihal, Thorand, Barbara, Thrift, Amanda G, Tichá, Ľubica, Timmermans, Erik J, Tjandrarini, Dwi Hapsari, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Tomaszewski, Maciej, Topbas, Murat, Topór-Mądry, Roman, Torheim, Liv Elin, Tornaritis, Michael J, Torrent, Maties, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Tremblay, Mark S, Triantafyllou, Areti, Trichopoulos, Dimitrios, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsintavis, Panagiotis, Tsugane, Shoichiro, Tuitele, John, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Twig, Gilad, Tynelius, Per, Tzala, Evangelia, Tzotzas, Themistoklis, Tzourio, Christophe, Udoji, Nwannedimma, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, van den Born, Bert-Jan, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Lippevelde, Wendy, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Vargas, Luz Nayibe, Varona-Pérez, Patricia, Vasan, Senthil K, Vasques, Daniel G, Vatasescu, Radu, Vega, Tomas, Veidebaum, Toomas, Velasquez-Melendez, Gustavo, Velika, Biruta, Verloigne, Maïté, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Vik, Frøydis N, Vilar, Monica, Villalpando, Salvador, Vioque, Jesus, Viriyautsahakul, Napaphan, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Vourli, Georgia, Voutilainen, Ari, Vrijheid, Martine, Vrijkotte, Tanja GM, Vuletić, Silvije, Wade, Alisha N, Waldhör, Thomas, Walton, Janette, Wambiya, Elvis OA, Wan Bebakar, Wan Mohamad, Wan Mohamud, Wan Nazaimoon, Wanderley Júnior, Rildo de Souza, Wang, Chongjian, Wang, Huijun, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nicholas, Wartha, Olivia, Weber, Adelheid, Wedderkopp, Niels, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Westbury, Leo D, Whincup, Peter H, Wichstrøm, Lars, Wickramasinghe, Kremlin, Widhalm, Kurt, Widyahening, Indah S, Więcek, Andrzej, Wild, Philipp S, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wirth, James P, Wojtyniak, Bogdan, Woldeyohannes, Meseret, Wolf, Kathrin, Wong-McClure, Roy A, Wong, Andrew, Wong, Emily B, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Hon-Yen, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Wyszyńska, Justyna, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Li, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yasuharu, Tabara, Yépez García, Martha, Yiallouros, Panayiotis K, Yngve, Agneta, Yoosefi, Moein, Yoshihara, Akihiro, Yotov, Yoto, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Yu, Yu-Ling, Yu, Yunjiang, Yusof, Safiah Md, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassilis, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antonis, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Zaw, Ko Ko, Zayed, Ayman A, Zdrojewski, Tomasz, Żegleń, Magdalena, Zejglicova, Kristyna, Zeljkovic Vrkic, Tajana, Zeng, Yi, Zentai, Andrea, Zhang, Bing, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhecheva, Yanitsa V, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zimmet, Paul, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Zoghlami, Nada, Zuñiga Cisneros, Julio, Zuziak, Monika, and Ezzati, Majid

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2024
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6. Should workers be physically active after work? Associations of leisure-time physical activity with cardiovascular and all-cause mortality across occupational physical activity levels—An individual participant data meta-analysis

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Cillekens, Bart, Coenen, Pieter, Huysmans, Maaike A., Holtermann, Andreas, Troiano, Richard P., Mork, Paul Jarle, Krokstad, Steinar, Clays, Els, De Bacquer, Dirk, Aadahl, Mette, Kårhus, Line Lund, Sjøl, Anette, Bo Andersen, Lars, Kauhanen, Jussi, Voutilainen, Ari, Pulsford, Richard, Stamatakis, Emmanuel, Goldbourt, Uri, Peters, Annette, Thorand, Barbara, Rosengren, Annika, Björck, Lena, Sprow, Kyle, Franzon, Kristin, Rodriguez-Barranco, Miguel, Luján-Barroso, Leila, Alfredsson, Lars, Bahls, Martin, Ittermann, Till, Wanner, Miriam, Bopp, Matthias, Marott, Jacob Louis, Schnohr, Peter, Nordestgaarda, Børge G., Dalene, Knut Eirik, Ekelund, Ulf, Clausen, Johan, Jensen, Magnus T., Petersen, Christina Bjørk, Krause, Niklas, Twisk, Jos, van Mechelen, Willem, and van der Beek, Allard J.

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2024
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7. Worldwide trends in underweight and obesity from 1990 to 2022:a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

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Phelps, Nowell H., Singleton, Rosie K., Zhou, Bin, Heap, Rachel A., Mishra, Anu, Bennett, James E., Paciorek, Christopher J., Lhoste, Victor PF, Carrillo-Larco, Rodrigo M., Stevens, Gretchen A., Rodriguez-Martinez, Andrea, Bixby, Honor, Baker, Jennifer L., Aarestrup, Julie, Afzal, Shoaib, Allin, Kristine, Andersen, Lars Bo, Ängquist, Lars, Bjerregaard, Peter, Bojesen, Stig E., Christensen, Kaare, Damsgaard, Camilla T., Dantoft, Thomas M., Eriksen, Louise, Giwercman, Aleksander, Halkjær, Jytte, Jørgensen, Torben, Kristensen, Peter Lund, Lind, Lars, Linneberg, Allan, Liu, Jing, Liu, Liping, Madsen, Anja L., Michaelsen, Kim F., Møllehave, Line T., Mortensen, Erik Lykke, Nordestgaard, Børge G., Osler, Merete, Overvad, Kim, Schmidt, Ida Maria, Schnohr, Peter, Schramm, Stine, Sobngwi, Eugène, Sodemann, Morten, Sørensen, Thorkild IA, Tjonneland, Anne, Tolstrup, Janne S., Wang, Qian, Wang, Ying Wei, Yang, Yang, Phelps, Nowell H., Singleton, Rosie K., Zhou, Bin, Heap, Rachel A., Mishra, Anu, Bennett, James E., Paciorek, Christopher J., Lhoste, Victor PF, Carrillo-Larco, Rodrigo M., Stevens, Gretchen A., Rodriguez-Martinez, Andrea, Bixby, Honor, Baker, Jennifer L., Aarestrup, Julie, Afzal, Shoaib, Allin, Kristine, Andersen, Lars Bo, Ängquist, Lars, Bjerregaard, Peter, Bojesen, Stig E., Christensen, Kaare, Damsgaard, Camilla T., Dantoft, Thomas M., Eriksen, Louise, Giwercman, Aleksander, Halkjær, Jytte, Jørgensen, Torben, Kristensen, Peter Lund, Lind, Lars, Linneberg, Allan, Liu, Jing, Liu, Liping, Madsen, Anja L., Michaelsen, Kim F., Møllehave, Line T., Mortensen, Erik Lykke, Nordestgaard, Børge G., Osler, Merete, Overvad, Kim, Schmidt, Ida Maria, Schnohr, Peter, Schramm, Stine, Sobngwi, Eugène, Sodemann, Morten, Sørensen, Thorkild IA, Tjonneland, Anne, Tolstrup, Janne S., Wang, Qian, Wang, Ying Wei, and Yang, Yang

Abstract

Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and a

Published
2024

8. Aortic Root Dimension Using Transthoracic Echocardiography:Results from the Copenhagen City Heart Study

Author

Pedersen, Maria W., Duch, Kirsten, Lindgren, Filip L., Lundgren, Nils L.O., Tayal, Bhupendar, Hagendorff, Andreas, Jensen, Gorm B., Biering-Sørensen, Tor, Schnohr, Peter, Møgelvang, Rasmus, Høst, Nis, Kragholm, Kristian, Andersen, Niels H., Søgaard, Peter, Pedersen, Maria W., Duch, Kirsten, Lindgren, Filip L., Lundgren, Nils L.O., Tayal, Bhupendar, Hagendorff, Andreas, Jensen, Gorm B., Biering-Sørensen, Tor, Schnohr, Peter, Møgelvang, Rasmus, Høst, Nis, Kragholm, Kristian, Andersen, Niels H., and Søgaard, Peter

Abstract

Findings regarding the relation between aortic size and risk factors are heterogeneous. This study aimed to generate new insights from a population-based adult cohort on aortic root dimensions and their association with age, anthropometric measures, and cardiac risk factors and evaluate the incidence of acute aortic events. Participants from the fifth examination round of the Copenhagen City Heart study (aged 20 to 98 years) with applicable echocardiograms and no history of aortic disease or valve surgery were included. Aorta diameter was assessed at the annulus, sinus of Valsalva, sinotubular junction, and the tubular part of the ascending aorta. The study population comprised 1,796 men and 2,316 women; mean age: 56.4 ± 17.0 and 56.9 ± 18.1 years, respectively. Men had larger aortic root diameters than women regardless of height indexing (p <0.01). Age, height, weight, systolic and diastolic blood pressure, mean arterial pressure, pulse pressure, hypertension, diabetes, ischemic heart disease, and smoking were positively correlated with aortic sinus diameter in the crude and gender-adjusted analyses. However, after full adjustment, only height, weight, and diastolic blood pressure remained significantly positively correlated with aortic sinus diameter (p <0.001). For systolic blood pressure and pulse pressure, the correlation was inverse (p <0.001). During follow-up (median 5.4 [quartile 1 to quartile 3 4.5 to 6.3] years), the incidence rate of first-time acute aortic events was 13.6 (confidence interval 4.4 to 42.2) per 100,000 person-years. In conclusion, beyond anthropometric measures, age, and gender, diastolic blood pressure was the only cardiac risk factor that was independently correlated with aortic root dimensions. The number of aortic events during follow-up was low.

Published
2024

9. Normal Values for Left Atrial Strain, Volume and Function Derived from Three-Dimensional Echocardiography:the Copenhagen City Heart Study

Author

Yafasov, Marat, Olsen, Flemming Javier, Skaarup, Kristoffer Grundtvig, Lassen, Mats Christian Højbjerg, Johansen, Niklas Dyrby, Lindgren, Filip Lyng, Jensen, Gorm Boje, Schnohr, Peter, Møgelvang, Rasmus, Søgaard, Peter, Biering-Sørensen, Tor, Yafasov, Marat, Olsen, Flemming Javier, Skaarup, Kristoffer Grundtvig, Lassen, Mats Christian Højbjerg, Johansen, Niklas Dyrby, Lindgren, Filip Lyng, Jensen, Gorm Boje, Schnohr, Peter, Møgelvang, Rasmus, Søgaard, Peter, and Biering-Sørensen, Tor

Abstract

Aims 3D echocardiographic (3DE) assessment of the left atrium (LA) is a new modality of potential clinical value. Age- and sex-based normative values are needed to benchmark these parameters for clinical use. Methods and results Of 4466 participants in the 5th Copenhagen City Heart Study, a prospective longitudinal cohort study on the general population, 2082 participants underwent 3DE of the LA. Healthy participants were included to establish normative values for LA strain, volume, and function by 3DE. The effects of age and sex were also evaluated. After excluding participants with comorbidities, 979 healthy participants (median age 44 years, 39.6% males) remained. The median and limits of normality (2.5th and 97.5th percentiles) for functional and volumetric measures were as follows: LA reservoir strain (LASr) 30.8% (18.4–44.2%), LA conduit strain (LAScd) 19.1% (6.8–32.0%), LA contractile strain 11.7% (4.3–22.2%), total LA emptying fraction (LAEF) 61.4% (47.8–71.0%), passive LAEF 37.7% (17.4–53.9%), active LAEF 37.4% (22.2–52.5%), LA minimum volume index (LAVimin) 10.2 (5.9–18.5) mL/m2, and LA maximum volume index (LAVimax) 26.8 (16.5–40.1) mL/m2. All parameters changed significantly with increasing age (P value for all <0.001). Significant sex-specific differences were observed for all parameters except active LAEF and LAVimax. Sex significantly modified the association between age and LASr (P for interaction < 0.001), LAScd (P for interaction < 0.001), LAVimin (P for interaction = 0.037), and total LAEF (P for interaction = 0.034) such that these parameters deteriorated faster with age in females than males. Conclusion We present age- and sex-specific reference material including limits of normality for LA strain, volume, and function by 3DE., BACKGROUND: Three-dimensional echocardiographic (3DE) assessment of the left atrium (LA) is a new modality of potential clinical value. Age- and sex-based normative values are needed to benchmark these parameters for clinical use.METHODS AND RESULTS: Of 4466 participants in the 5th Copenhagen City Heart Study, a prospective longitudinal cohort study on the general population, 2,082 participants underwent 3DE of the LA. Healthy participants were included to establish normative values for LA strain, volume, and function by 3DE. The effects of age and sex were also evaluated. After excluding participants with comorbidities, 979 healthy participants (median age 44 years, 39.6% males) remained. The median and limits of normality (2.5th and 97.5th percentiles) for functional and volumetric measures were: LA reservoir strain (LASr) 30.8% (18.4-44.2%), LA conduit strain (LAScd) 19.1% (6.8-32.0%), LA contractile strain (LASct) 11.7% (4.3-22.2%) total LA emptying fraction (LAEF) 61.4% (47.8-71.0%), passive LAEF 37.7% (17.4-53.9%), active LAEF 37.4% (22.2-52.5%), LA minimum volume index (LAVimin) 10.2 (5.9-18.5) ml/m2, LA maximum volume index (LAVimax) 26.8 (16.5-40.1) ml/m2. All parameters changed significantly with increasing age (p value for all <0.001). Significant sex-specific differences were observed for all parameters except active LAEF and LAVimax. Sex significantly modified the association between age and LASr (p for interaction < 0.001), LAScd (p for interaction < 0.001), LAVimin (p for interaction = 0.037) and total LAEF (p for interaction = 0.034) such that these parameters deteriorated faster with age in females than males.CONCLUSION: We present age- and sex specific reference material including limits of normality for LA strain, volume, and function by 3DE.

Published
2024

10. Even mild mitral regurgitation is associated with incident atrial fibrillation in the general population

Author

Yafasov, Marat, Olsen, Flemming Javier, Shabib, Ali, Skaarup, Kristoffer Grundtvig, Lassen, Mats Christian Højbjerg, Johansen, Niklas Dyrby, Jensen, Magnus T, Jensen, Gorm Boje, Schnohr, Peter, Møgelvang, Rasmus, Biering-Sørensen, Tor, Yafasov, Marat, Olsen, Flemming Javier, Shabib, Ali, Skaarup, Kristoffer Grundtvig, Lassen, Mats Christian Højbjerg, Johansen, Niklas Dyrby, Jensen, Magnus T, Jensen, Gorm Boje, Schnohr, Peter, Møgelvang, Rasmus, and Biering-Sørensen, Tor

Abstract

Aims Mitral regurgitation (MR) can be difficult to quantify. We sought to investigate whether the MR jet area to left atrial (LA) area ratio (MR/LA ratio) method for quantifying MRs can be used to predict incident atrial fibrillation (AF) in the general population. Methods and results The study included 4466 participants from the 5th Copenhagen City Heart Study, a prospective general population study, who underwent transthoracic echocardiography. MR jet area was measured and indexed to LA area. The endpoint was incident AF. MR was quantified in 4042 participants (mean age: 57 years, 43% men). Of these, 198 (4.9%) developed AF during a median follow-up period of 5.3 years (interquartile range: 4.4–6.1 years). MR was present in 1938 participants (48%) including 1593 (39%) trace/mild MRs (MR/LA ratio ≤ 20% and ≤4 cm2). In unadjusted analysis, MR/LA ratio was associated with incident AF [HR: 1.06 (1.00–1.13), P = 0.042 per 5% increase] but not after adjusting for CHARGE-AF score. However, the association was modified by age (P for interaction = 0.034), such that MR/LA ratio was associated with AF only in participants ≤ 73 years. In these participants, MR/LA ratio ‘was’ independently associated with AF after adjusting for CHARGE-AF score [HR: 1.14 (1.06–1.24), P = 0.001, per 5% increase]. This finding persisted when restricting the analysis to participants without moderate or severe MR and normal LA size [HR: 1.35 (1.09–1.68), P = 0.005, per 5% increase]. Conclusion MR, including even trace regurgitations quantified by MR/LA ratio, is independently associated with incident AF in individuals ≤ 73 years of age., Aims Mitral regurgitation (MR) can be difficult to quantify. We sought to investigate whether the MR jet area to left atrial (LA) area ratio (MR/LA ratio) method for quantifying MRs can be used to predict incident atrial fibrillation (AF) in the general population. Methods and results The study included 4466 participants from the 5th Copenhagen City Heart Study, a prospective general population study, who underwent transthoracic echocardiography. MR jet area was measured and indexed to LA area. The endpoint was incident AF. MR was quantified in 4042 participants (mean age: 57 years, 43% men). Of these, 198 (4.9%) developed AF during a median follow-up period of 5.3 years (interquartile range: 4.4–6.1 years). MR was present in 1938 participants (48%) including 1593 (39%) trace/mild MRs (MR/LA ratio ≤ 20% and ≤4 cm2). In unadjusted analysis, MR/LA ratio was associated with incident AF [HR: 1.06 (1.00–1.13), P = 0.042 per 5% increase] but not after adjusting for CHARGE-AF score. However, the association was modified by age (P for interaction = 0.034), such that MR/LA ratio was associated with AF only in participants ≤ 73 years. In these participants, MR/LA ratio ‘was’ independently associated with AF after adjusting for CHARGE-AF score [HR: 1.14 (1.06–1.24), P = 0.001, per 5% increase]. This finding persisted when restricting the analysis to participants without moderate or severe MR and normal LA size [HR: 1.35 (1.09–1.68), P = 0.005, per 5% increase]. Conclusion MR, including even trace regurgitations quantified by MR/LA ratio, is independently associated with incident AF in individuals ≤ 73 years of ag

Published
2024

11. Right ventricular free wall and four-chamber longitudinal strain in relation to incident heart failure in the general population

Author

Espersen, Caroline, Skaarup, Kristoffer Grundtvig, Lassen, Mats Christian Højbjerg, Johansen, Niklas Dyrby, Hauser, Raphael, Jensen, Gorm Boje, Schnohr, Peter, Møgelvang, Rasmus, Biering-Sørensen, Tor, Espersen, Caroline, Skaarup, Kristoffer Grundtvig, Lassen, Mats Christian Højbjerg, Johansen, Niklas Dyrby, Hauser, Raphael, Jensen, Gorm Boje, Schnohr, Peter, Møgelvang, Rasmus, and Biering-Sørensen, Tor

Abstract

Aims Right ventricular free wall (RVFWLS) and four-chamber longitudinal strain (RV4CLS) are associated with adverse events in various patient populations including patients with heart failure (HF). We sought to investigate the prognostic value of RVFWLS and RV4CLS for the development of incident HF in participants from the general population. Methods Participants from the 5th Copenhagen City Heart Study (2011–2015) without known chronic ischaemic heart disease or HF and results at baseline were included. RVFWLS and RV4CLS were obtained using two-dimensional speckle-tracking echocardiography from the right ventricular (RV)-focused apical four-chamber view. The primary endpoint was incident HF. Among 2740 participants (mean age 54 ± 17 years, 42% male), 43 (1.6%) developed HF during a median follow-up of 5.5 years (IQR 4.5–6.3). Both RVFWLS and RV4CLS were associated with an increased risk of incident HF during follow-up independent of age, sex, hypertension, diabetes, body mass index and tricuspid annular plane systolic excursion (TAPSE), (HR 1.06, 95%CI 1.00–1.11, P = 0.034, per 1% absolute decrease and HR 1.14, 95%CI 1.05–1.23, P = 0.001, per 1% absolute decrease, respectively). Left ventricular ejection fraction (LVEF) modified the association between RV4CLS and incident HF (P for interaction = 0.016) such that RV4CLS was only of prognostic importance among those with LVEF < 55% (HR 1.21, 95%CI 1.11–1.33, P < 0.001 vs. HR 0.94, 95%CI 0.80–1.10, P = 0.43 in patients with LVEF ≥ 55%). Conclusion In participants from the general population, both RVFWLS and RV4CLS were associated with a greater risk of incident HF independent of important baseline characteristics and TAPSE, and LVEF modified the relationship between RV4CLS and incident HF.

Published
2024

12. Association between myocardial work indices and cardiovascular events according to hypertension in the general population

Author

Olsen, Flemming Javier, Skaarup, Kristoffer Grundtvig, Lassen, Mats Christian Højbjerg, Johansen, Niklas Dyrby, Jensen, Gorm Boje, Schnohr, Peter, Marott, Jacob Louis, Søgaard, Peter, Gislason, Gunnar, Svendsen, Jesper Hastrup, Møgelvang, Rasmus, Aalen, John Moene, Smiseth, Otto Armin, Remme, Espen Wattenberg, Biering-Sørensen, Tor, Olsen, Flemming Javier, Skaarup, Kristoffer Grundtvig, Lassen, Mats Christian Højbjerg, Johansen, Niklas Dyrby, Jensen, Gorm Boje, Schnohr, Peter, Marott, Jacob Louis, Søgaard, Peter, Gislason, Gunnar, Svendsen, Jesper Hastrup, Møgelvang, Rasmus, Aalen, John Moene, Smiseth, Otto Armin, Remme, Espen Wattenberg, and Biering-Sørensen, Tor

Abstract

Aims Pressure-strain loop (PSL) analysis is a novel echocardiographic tool capable of assessing myocardial work non-invasively. In this study, we aim to evaluate the prognostic value of myocardial work indices in the general population. Methods and results This was a prospective community-based cohort study (n = 4466). PSL analyses were performed to acquire global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency (GWE). The endpoint was a composite of heart failure or cardiovascular death (HF/CVD). Survival analysis was applied. A total of 3932 participants were included in this analysis (median age: 58 years, 43% men). Of these, 124 (3%) experienced the outcome during a median follow-up period of 3.5 years [interquartile range (IQR): 2.6–4.4 years]. Hypertension significantly modified the association between all work indices and outcome (P for interaction < 0.05), such that work indices posed a higher risk of outcome in non-hypertensive than in hypertensive participants. After adjusting for Atherosclerosis Risk in Communities (ARIC)-HF risk variables, all work indices predicted outcome in non-hypertensive participants, but only GWI, GCW, and GWE predicted outcome in hypertensive participants [GWI: hazard ratio (HR) = 1.12 (1.07–1.16), per 100 mmHg% decrease; GCW: HR = 1.12 (1.08–1.17), per 100 mmHg% decrease; GWE: HR = 1.08 (1.04–1.12), per 1% decrease]. Only GWE significantly increased C-statistics when added to ARIC-HF risk variables in hypertensive participants (C-stat 0.865 vs. 0.877, P for increment = 0.003). Conclusion Hypertension modifies the association between myocardial work indices and HF/CVD in the general population. All work indices are associated with outcome in normotensive participants. GWI, GCW, and GWE are independently associated with outcome in hypertension, but only GWE improves risk prediction., AIMS: Pressure-strain loop (PSL) analysis is a novel echocardiographic tool capable of assessing myocardial work non-invasively. In this study, we aim to evaluate the prognostic value of myocardial work indices in the general population.METHODS AND RESULTS: This was a prospective community-based cohort study (n = 4466). PSL analyses were performed to acquire global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency (GWE). The endpoint was a composite of heart failure or cardiovascular death (HF/CVD). Survival analysis was applied. A total of 3932 participants were included in this analysis (median age: 58 years, 43% men). Of these, 124 (3%) experienced the outcome during a median follow-up period of 3.5 years [interquartile range (IQR): 2.6-4.4 years]. Hypertension significantly modified the association between all work indices and outcome (P for interaction < 0.05), such that work indices posed a higher risk of outcome in non-hypertensive than in hypertensive participants. After adjusting for Atherosclerosis Risk in Communities (ARIC)-HF risk variables, all work indices predicted outcome in non-hypertensive participants, but only GWI, GCW, and GWE predicted outcome in hypertensive participants [GWI: hazard ratio (HR) = 1.12 (1.07-1.16), per 100 mmHg% decrease; GCW: HR = 1.12 (1.08-1.17), per 100 mmHg% decrease; GWE: HR = 1.08 (1.04-1.12), per 1% decrease]. Only GWE significantly increased C-statistics when added to ARIC-HF risk variables in hypertensive participants (C-stat 0.865 vs. 0.877, P for increment = 0.003).CONCLUSION: Hypertension modifies the association between myocardial work indices and HF/CVD in the general population. All work indices are associated with outcome in normotensive participants. GWI, GCW, and GWE are independently associated with outcome in hypertension, but only GWE improves risk prediction.

Published
2024

13. Normal values for left atrial strain, volume, and function derived from 3D echocardiography: the Copenhagen City Heart Study.

Author

Yafasov, Marat, Olsen, Flemming Javier, Skaarup, Kristoffer Grundtvig, Lassen, Mats Christian Højbjerg, Johansen, Niklas Dyrby, Lindgren, Filip Lyng, Jensen, Gorm Boje, Schnohr, Peter, Møgelvang, Rasmus, Søgaard, Peter, and Biering-Sørensen, Tor

Subjects
REFERENCE values, PEARSON correlation (Statistics), LEFT heart atrium, RESEARCH funding, BENCHMARKING (Management), SEX distribution, KRUSKAL-Wallis Test, AGE distribution, CHI-squared test, MULTIVARIATE analysis, DESCRIPTIVE statistics, LONGITUDINAL method, DISEASES, DATA analysis software, ECHOCARDIOGRAPHY, REGRESSION analysis
Abstract

Aims 3D echocardiographic (3DE) assessment of the left atrium (LA) is a new modality of potential clinical value. Age- and sex-based normative values are needed to benchmark these parameters for clinical use. Methods and results Of 4466 participants in the 5th Copenhagen City Heart Study, a prospective longitudinal cohort study on the general population, 2082 participants underwent 3DE of the LA. Healthy participants were included to establish normative values for LA strain, volume, and function by 3DE. The effects of age and sex were also evaluated. After excluding participants with comorbidities, 979 healthy participants (median age 44 years, 39.6% males) remained. The median and limits of normality (2.5th and 97.5th percentiles) for functional and volumetric measures were as follows: LA reservoir strain (LASr) 30.8% (18.4–44.2%), LA conduit strain (LAScd) 19.1% (6.8–32.0%), LA contractile strain 11.7% (4.3–22.2%), total LA emptying fraction (LAEF) 61.4% (47.8–71.0%), passive LAEF 37.7% (17.4–53.9%), active LAEF 37.4% (22.2–52.5%), LA minimum volume index (LAVimin) 10.2 (5.9–18.5) mL/m2, and LA maximum volume index (LAVimax) 26.8 (16.5–40.1) mL/m2. All parameters changed significantly with increasing age (P value for all <0.001). Significant sex-specific differences were observed for all parameters except active LAEF and LAVimax. Sex significantly modified the association between age and LASr (P for interaction < 0.001), LAScd (P for interaction < 0.001), LAVimin (P for interaction = 0.037), and total LAEF (P for interaction = 0.034) such that these parameters deteriorated faster with age in females than males. Conclusion We present age- and sex-specific reference material including limits of normality for LA strain, volume, and function by 3DE. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Non-adherence to established dietary guidelines associated with increased mortality: the Copenhagen General Population Study

Author

Ewers, Bettina, Marott, Jacob L, Schnohr, Peter, Nordestgaard, Børge G, and Marckmann, Peter

Abstract

Aims The relevance of adherence to established dietary guidelines is repeatedly challenged. We hypothesised that non-adherence to established dietary guidelines is associated with an excess risk of cardiovascular, non-cardiovascular and all-cause mortality.Methods We studied 100,191 white adult Danes aged 20–100 years recruited in 2003–2015 and followed up until December 2018. During follow-up equalling 865,600 person-years, 9273 individuals died. Participants’ diets were assessed at baseline by a food frequency questionnaire focusing on key foods defining a healthy diet according to Danish dietary guidelines. Individuals were divided into five categories ranging from very high to very low adherence to dietary guidelines and studied with Cox and Fine–Gray regression models. At study inclusion, we collected demographic and lifestyle characteristics by questionnaire, made a physical examination and took a blood sample.Results Cardiovascular, non-cardiovascular and all-cause mortality increased gradually with increasing non-adherence to dietary guidelines. Cardiovascular mortality was 30% higher (95% confidence interval 7–57%), non-cardiovascular mortality 54% higher (32–79%) and all-cause mortality 43% higher (29–59%) in individuals with very low adherence to dietary guidelines compared with those with very high adherence after adjustments for age, sex, education, income, smoking, leisure time physical activity and alcohol intake. Mortality risk estimates were similar in all strata of adjusted variables.Conclusion Non-adherence to Danish food-based dietary guidelines is associated with up to 43% increased all-cause mortality in a dose–response manner. The mortality excess was seen for both cardiovascular and non-cardiovascular causes. The public has good reasons to have confidence in and to adhere to established dietary guidelines.

Published
2024
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18. Associations of occupational and leisure-time physical activity with all-cause mortality: an individual participant data meta-analysis.

Author

Coenen P, Huysmans MA, Holtermann A, Troiano RP, Mork PJ, Krokstad S, Clays E, Cillekens B, De Bacquer D, Aadahl M, Kårhus LL, Sjøl A, Andersen LB, Kauhanen J, Voutilainen A, Pulsford RM, Stamatakis E, Goldbourt U, Peters A, Thorand B, Rosengren A, Björck L, Sprow K, Franzon K, Rodriguez-Barranco M, Luján-Barroso L, Knutsson A, Alfredsson L, Bahls M, Ittermann T, Kluttig A, Hassan L, Wanner M, Bopp M, Marott JL, Schnohr P, Nordestgaard BG, Dalene KE, Ekelund U, Clausen J, Jensen MT, Petersen CB, Krause N, Twisk J, Mechelen WV, and van der Beek AJ

Abstract

Objective: Health effects of different physical activity domains (ie, during leisure time, work and transport) are generally considered positive. Using Active Worker consortium data, we assessed independent associations of occupational and leisure-time physical activity (OPA and LTPA) with all-cause mortality., Design: Two-stage individual participant data meta-analysis., Data Source: Published and unpublished cohort study data., Eligibility Criteria: Working participants aged 18-65 years., Methods: After data harmonisation, we assessed associations of OPA and LTPA with all-cause mortality. In stage 1, we analysed data from each study separately using Cox survival regression, and in stage 2, we pooled individual study findings with random-effects modelling., Results: In 22 studies with up to 590 497 participants from 11 countries, during a mean follow-up of 23.1 (SD: 6.8) years, 99 743 (16%) participants died. Adjusted for LTPA, body mass index, age, smoking and education level, summary (ie, stage 2) hazard ration (HRs) and 95% confidence interval (95% CI) for low, moderate and high OPA among men (n=2 96 134) were 1.01 (0.99 to 1.03), 1.05 (1.01 to 1.10) and 1.12 (1.03 to 1.23), respectively. For women (n=2 94 364), HRs (95% CI) were 0.98 (0.92 to 1.04), 0.96 (0.92 to 1.00) and 0.97 (0.86 to 1.10), respectively. In contrast, higher levels of LTPA were inversely associated with mortality for both genders. For example, for women HR for low, moderate and high compared with sedentary LTPA were 0.85 (0.81 to 0.89), 0.78 (0.74 to 0.81) and 0.75 (0.65 to 0.88), respectively. Effects were attenuated when adjusting for income (although data on income were available from only 9 and 6 studies, for men and women, respectively)., Conclusion: Our findings indicate that OPA may not result in the same beneficial health effects as LTPA., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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19. Normal values for left atrial strain, volume, and function derived from 3D echocardiography: the Copenhagen City Heart Study.

Author

Yafasov M, Olsen FJ, Skaarup KG, Lassen MCH, Johansen ND, Lindgren FL, Jensen GB, Schnohr P, Møgelvang R, Søgaard P, and Biering-Sørensen T

Subjects
Humans, Male, Female, Reference Values, Adult, Middle Aged, Prospective Studies, Denmark, Aged, Longitudinal Studies, Cohort Studies, Sex Factors, Age Factors, Healthy Volunteers, Echocardiography, Three-Dimensional methods, Heart Atria diagnostic imaging, Atrial Function, Left physiology
Abstract

Aims: 3D echocardiographic (3DE) assessment of the left atrium (LA) is a new modality of potential clinical value. Age- and sex-based normative values are needed to benchmark these parameters for clinical use., Methods and Results: Of 4466 participants in the 5th Copenhagen City Heart Study, a prospective longitudinal cohort study on the general population, 2082 participants underwent 3DE of the LA. Healthy participants were included to establish normative values for LA strain, volume, and function by 3DE. The effects of age and sex were also evaluated. After excluding participants with comorbidities, 979 healthy participants (median age 44 years, 39.6% males) remained. The median and limits of normality (2.5th and 97.5th percentiles) for functional and volumetric measures were as follows: LA reservoir strain (LASr) 30.8% (18.4-44.2%), LA conduit strain (LAScd) 19.1% (6.8-32.0%), LA contractile strain 11.7% (4.3-22.2%), total LA emptying fraction (LAEF) 61.4% (47.8-71.0%), passive LAEF 37.7% (17.4-53.9%), active LAEF 37.4% (22.2-52.5%), LA minimum volume index (LAVimin) 10.2 (5.9-18.5) mL/m2, and LA maximum volume index (LAVimax) 26.8 (16.5-40.1) mL/m2. All parameters changed significantly with increasing age (P value for all <0.001). Significant sex-specific differences were observed for all parameters except active LAEF and LAVimax. Sex significantly modified the association between age and LASr (P for interaction < 0.001), LAScd (P for interaction < 0.001), LAVimin (P for interaction = 0.037), and total LAEF (P for interaction = 0.034) such that these parameters deteriorated faster with age in females than males., Conclusion: We present age- and sex-specific reference material including limits of normality for LA strain, volume, and function by 3DE., Competing Interests: Conflict of interest: M.Y.: none; F.J.O.: none; K.G.S.: advisory board: Sanofi Pasteur; M.C.H.L.: none; N.D.J.: none; F.L.L.: none; G.B.J.: none; P.Sc.: none; R.M.: none; P.Sø.: advisory board: Biotronik; and T.B.-S.: Steering Committee member of the Amgen-financed GALACTIC-HF trial; Steering Committee member of the Boehringer Ingelheim–financed SHARP3 trial; chief investigator of the Sanofi Pasteur–financed ‘NUDGE-FLU’ trial; chief investigator of the Sanofi Pasteur–financed ‘DANFLU-1’ trial; chief investigator of the Sanofi Pasteur–financed ‘DANFLU-2’ trial; Steering Committee member of ‘LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific’s Investigational ICM System’ trial; advisory board: Sanofi Pasteur, Amgen, and GSK; speaker honorarium: Bayer, Novartis, Sanofi Pasteur, and GSK; and research grants: GE Healthcare, AstraZeneca, Novo Nordisk, and Sanofi Pasteur., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2024
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20. Even mild mitral regurgitation is associated with incident atrial fibrillation in the general population.

Author

Yafasov M, Olsen FJ, Shabib A, Skaarup KG, Lassen MCH, Johansen ND, Jensen MT, Jensen GB, Schnohr P, Møgelvang R, and Biering-Sørensen T

Subjects
Humans, Female, Male, Middle Aged, Prospective Studies, Incidence, Aged, Denmark epidemiology, Risk Assessment, Severity of Illness Index, Cohort Studies, Atrial Fibrillation diagnostic imaging, Mitral Valve Insufficiency diagnostic imaging, Echocardiography methods
Abstract

Aims: Mitral regurgitation (MR) can be difficult to quantify. We sought to investigate whether the MR jet area to left atrial (LA) area ratio (MR/LA ratio) method for quantifying MRs can be used to predict incident atrial fibrillation (AF) in the general population., Methods and Results: The study included 4466 participants from the 5th Copenhagen City Heart Study, a prospective general population study, who underwent transthoracic echocardiography. MR jet area was measured and indexed to LA area. The endpoint was incident AF. MR was quantified in 4042 participants (mean age: 57 years, 43% men). Of these, 198 (4.9%) developed AF during a median follow-up period of 5.3 years (interquartile range: 4.4-6.1 years). MR was present in 1938 participants (48%) including 1593 (39%) trace/mild MRs (MR/LA ratio ≤ 20% and ≤4 cm2). In unadjusted analysis, MR/LA ratio was associated with incident AF [HR: 1.06 (1.00-1.13), P = 0.042 per 5% increase] but not after adjusting for CHARGE-AF score. However, the association was modified by age (P for interaction = 0.034), such that MR/LA ratio was associated with AF only in participants ≤ 73 years. In these participants, MR/LA ratio 'was' independently associated with AF after adjusting for CHARGE-AF score [HR: 1.14 (1.06-1.24), P = 0.001, per 5% increase]. This finding persisted when restricting the analysis to participants without moderate or severe MR and normal LA size [HR: 1.35 (1.09-1.68), P = 0.005, per 5% increase]., Conclusion: MR, including even trace regurgitations quantified by MR/LA ratio, is independently associated with incident AF in individuals ≤ 73 years of age., Competing Interests: Conflict of interest: M.Y.: none. F.J.O.: none. A.S.: none. K.G.S.: advisory board: Sanofi Pasteur. M.C.H.L.: none. N.D.J.: none. M.T.J.: none. G.B.J.: none. P.S.: none. R.M.: none. T.B.-S.: Steering Committee member of the Amgen financed GALACTIC-HF trial. Chief investigator of the Sanofi Pasteur financed ‘NUDGE-FLU’ trial. Chief investigator of the Sanofi Pasteur financed ‘DANFLU-1’ trial. Chief investigator of the Sanofi Pasteur financed ‘DANFLU-2’ trial. Steering Committee member of ‘LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific’s Investigational ICM System’ trial. Advisory board: Sanofi Pasteur, Amgen, and GSK. Speaker honorarium: Bayer, Novartis, Sanofi Pasteur, and GSK. Research grants: GE Healthcare, Sanofi Pasteur, Novo Nordisk, and AstraZeneca., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2024
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21. Association between myocardial work indices and cardiovascular events according to hypertension in the general population.

Author

Olsen FJ, Skaarup KG, Lassen MCH, Johansen ND, Jensen GB, Schnohr P, Marott JL, Søgaard P, Gislason G, Svendsen JH, Møgelvang R, Aalen JM, Smiseth OA, Remme EW, and Biering-Sørensen T

Subjects
Male, Humans, Middle Aged, Female, Cohort Studies, Prospective Studies, Myocardium, Ventricular Function, Left, Stroke Volume, Hypertension epidemiology, Heart Failure diagnostic imaging, Heart Failure epidemiology, Atherosclerosis
Abstract

Aims: Pressure-strain loop (PSL) analysis is a novel echocardiographic tool capable of assessing myocardial work non-invasively. In this study, we aim to evaluate the prognostic value of myocardial work indices in the general population., Methods and Results: This was a prospective community-based cohort study (n = 4466). PSL analyses were performed to acquire global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency (GWE). The endpoint was a composite of heart failure or cardiovascular death (HF/CVD). Survival analysis was applied. A total of 3932 participants were included in this analysis (median age: 58 years, 43% men). Of these, 124 (3%) experienced the outcome during a median follow-up period of 3.5 years [interquartile range (IQR): 2.6-4.4 years]. Hypertension significantly modified the association between all work indices and outcome (P for interaction < 0.05), such that work indices posed a higher risk of outcome in non-hypertensive than in hypertensive participants. After adjusting for Atherosclerosis Risk in Communities (ARIC)-HF risk variables, all work indices predicted outcome in non-hypertensive participants, but only GWI, GCW, and GWE predicted outcome in hypertensive participants [GWI: hazard ratio (HR) = 1.12 (1.07-1.16), per 100 mmHg% decrease; GCW: HR = 1.12 (1.08-1.17), per 100 mmHg% decrease; GWE: HR = 1.08 (1.04-1.12), per 1% decrease]. Only GWE significantly increased C-statistics when added to ARIC-HF risk variables in hypertensive participants (C-stat 0.865 vs. 0.877, P for increment = 0.003)., Conclusion: Hypertension modifies the association between myocardial work indices and HF/CVD in the general population. All work indices are associated with outcome in normotensive participants. GWI, GCW, and GWE are independently associated with outcome in hypertension, but only GWE improves risk prediction., Competing Interests: Conflict of interest: T.B.-S.: Steering Committee member of the Amgen financed GALACTIC-HF trial; Steering Committee of the Boston Scientific financed LUX-Dx TRENDS trial; Advisory Board: Sanofi Pasteur. Advisory Board: Amgen; Speaker Honorarium: Novartis; Speaker Honorarium: Sanofi Pasteur; Research grant: GE Healthcare; Research grant: Sanofi Pasteur. O.A.S.: co-inventor of ‘Method for myocardial segment work analysis’, which was used to calculate myocardial work indices. J.H.S.: advisory board member for Medtronic and unrestricted research grants from Medtronic outside this work. The organizations had no role in any aspect of the study. The remaining authors do not have any potential conflicts of interest to disclose., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2024
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22. Right ventricular free wall and four-chamber longitudinal strain in relation to incident heart failure in the general population.

Author

Espersen C, Skaarup KG, Lassen MCH, Johansen ND, Hauser R, Jensen GB, Schnohr P, Møgelvang R, and Biering-Sørensen T

Subjects
Humans, Male, Adult, Middle Aged, Aged, Female, Stroke Volume, Ventricular Function, Left, Echocardiography adverse effects, Prognosis, Ventricular Function, Right, Heart Failure diagnostic imaging, Heart Failure epidemiology, Heart Failure etiology, Ventricular Dysfunction, Right diagnostic imaging, Ventricular Dysfunction, Right epidemiology, Ventricular Dysfunction, Right complications
Abstract

Aims: Right ventricular free wall (RVFWLS) and four-chamber longitudinal strain (RV4CLS) are associated with adverse events in various patient populations including patients with heart failure (HF). We sought to investigate the prognostic value of RVFWLS and RV4CLS for the development of incident HF in participants from the general population., Methods and Results: Participants from the 5th Copenhagen City Heart Study (2011-2015) without known chronic ischaemic heart disease or HF at baseline were included. RVFWLS and RV4CLS were obtained using two-dimensional speckle-tracking echocardiography from the right ventricular (RV)-focused apical four-chamber view. The primary endpoint was incident HF. Among 2740 participants (mean age 54 ± 17 years, 42% male), 43 (1.6%) developed HF during a median follow-up of 5.5 years (IQR 4.5-6.3). Both RVFWLS and RV4CLS were associated with an increased risk of incident HF during follow-up independent of age, sex, hypertension, diabetes, body mass index and tricuspid annular plane systolic excursion (TAPSE), (HR 1.06, 95%CI 1.00-1.11, P = 0.034, per 1% absolute decrease and HR 1.14, 95%CI 1.05-1.23, P = 0.001, per 1% absolute decrease, respectively). Left ventricular ejection fraction (LVEF) modified the association between RV4CLS and incident HF (P for interaction = 0.016) such that RV4CLS was only of prognostic importance among those with LVEF < 55% (HR 1.21, 95%CI 1.11-1.33, P < 0.001 vs. HR 0.94, 95%CI 0.80-1.10, P = 0.43 in patients with LVEF ≥ 55%)., Conclusion: In participants from the general population, both RVFWLS and RV4CLS were associated with a greater risk of incident HF independent of important baseline characteristics and TAPSE, and LVEF modified the relationship between RV4CLS and incident HF., Competing Interests: Conflict of interest: T.B.S.: Steering Committee member of the Amgen financed GALACTIC-HF trial, the Boehringer Ingelheim financed EASi-KIDNEY trial, and the ‘LUX-Dx TRENDS Evaluates Diagnostics Sensors in Heart Failure Patients Receiving Boston Scientific’s Investigational ICM System’ trial. Chief investigator of the Sanofi Pasteur financed ‘NUDGE-FLU’ trial, the Sanofi Pasteur financed ‘DANFLU-1’ trial, and the Sanofi Pasteur financed ‘DANFLU-2’ trial, and the Boston Scientific financed “DANLOGIC-HF” trial., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2024
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