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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]

Aims: Atrial fibrillation (AF) is becoming increasingly common. Traditional cardiovascular risk factors (CVRF) do not explain all AF cases. Blood‐based biomarkers reflecting cardiac injury such as high‐sensitivity troponin I (hsTnI) may help close this gap. Methods: We investigated the predictive ability of hsTnI for incident AF in 45,298 participants (median age 51.4 years, 45.0% men) across European community cohorts in comparison to CVRF and established biomarkers (C‐reactive protein, N‐terminal pro B‐type natriuretic peptide). Results: During a median follow‐up of 7.7 years, 1734 (3.8%) participants developed AF. Those in the highest hsTnI quarter (≥4.2 ng/L) had a 3.91‐fold (95% confidence interval (CI) 3.30, 4.63; p <.01) risk for developing AF compared to the lowest quarter (<1.4 ng/L). In multivariable‐adjusted Cox proportional hazards models a statistically significant association was seen between hsTnI and AF (hazard ratio (HR) per 1 standard deviation (SD) increase in log10(hsTnI) 1.08; 95% CI 1.01, 1.16; p =.03). Inclusion of hsTnI did improve model discrimination (C‐index CVRF 0.811 vs. C‐index CVRF and hsTnI 0.813; p <.01). Higher hsTnI concentrations were associated with heart failure (HR per SD 1.37; 95% CI 1.12, 1.68; p <.01) and overall mortality (HR per SD 1.24; 95% CI 1.09, 1.41; p <.01). Conclusion: hsTnI as a biomarker of myocardial injury does not improve prediction of AF incidence beyond classical CVRF and NT‐proBNP. However, it is associated with the AF‐related disease heart failure and mortality likely reflecting underlying subclinical cardiovascular impairment. [ABSTRACT FROM AUTHOR]

Aims: To (i) define the characteristics of snus users compared with non‐users and smokers and (ii) define the relationship between snus use and self‐reported anxiety and depression and compare it with the relation between smoking and anxiety and depression. Design, setting and participants: A cross‐sectional study based on data from the Norwegian population‐based survey, the Tromsø Study (2015–16). A total of 32 591 people aged 40 years and older in the municipality of Tromsø were invited to attend. There were 21 083 respondents, giving a 65% attendance rate. Measurements: Tobacco use was assessed by current and previous use of snus or cigarettes. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Findings Snus users were more often male, were younger and had higher income and higher alcohol consumption than smokers and non‐users of snus. In a linear regression analysis, we found no significant association between current snus use and anxiety and depression after adjusting for background variables. However, there was a positive association between previous snus use and anxiety among males [adjusted beta = 0.258; 99% confidence interval (CI) = 0.023–0.492]. Regarding anxiety, the adjusted beta‐coefficients for current smoking were 0.425 (99% CI = 0.184–0.666) for females and 0.303 (99% CI = 0.084–0.522) for males. Concerning depression, the adjusted beta coefficients for current smoking were 0.569 (99% CI = 0.358–0.780) for females and 0.281 (99% CI = 0.060–0.503) for males. Conclusions: In Norway, current snus users differ from current smokers by having a higher socio‐economic status and no detectable association with anxiety and depression. This suggests that the relationship between tobacco use and anxiety and depression is associated with the administration method. [ABSTRACT FROM AUTHOR]

Aims: To examine the associations between diastolic dysfunction indices and long‐term risk of all‐cause mortality in adults over 23‐year follow‐up. Methods and results: Participants (n = 2734) of the population‐based Tromsø Study of Norway had echocardiography in 1994–1995. Of these 67% were repeated in 2001 and/or 2007–2008. Mortality between 1994 and 2016 was determined by linkage to the national death registry. Cox regression was used to model the hazard of all‐cause mortality in relation to left atrial parameters (treated as time‐dependent using repeated measurements) adjusted for traditional risk factors and cardiovascular disease. During the follow‐up, 1399 participants died. Indexed left atrial diameter, mitral peak E deceleration time, and mitral peak E to peak A ratio showed an U‐shaped association with all‐cause mortality. Combining left atrial diameter with mitral peak E deceleration time increased the prognostic accuracy for all‐cause mortality whereas adding mitral peak E to peak A ratio did not increase prognostic value. We estimated new optimal cutoff values of left atrial diameter, mitral peak E deceleration time, and mitral peak E to peak A ratio for all‐cause mortality outcome. E/e′ had a cubic relation to mortality. Conclusion: Both enlarged and small left atrial diameters were associated with increased all‐cause mortality risk. A combination of Doppler‐based left ventricle filling parameters had an incremental effect on all‐cause mortality risk. The cutoff values of diastolic dysfunction indices we determined had similar all‐cause mortality prediction ability as those recommended by American Association of Echocardiography and European Association of Cardiovascular Imaging. [ABSTRACT FROM AUTHOR]

Objective To investigate the validity of self-reported information about hypertensive disorders in previous pregnancies among women participating in the fourth survey of the Tromsø Study. Design Retrospective cohort study with case-control design. Population Parous women participating in the fourth survey of the Tromsø Study. Methods Medical records including partograms of 200 randomly selected women who had answered positively to whether they had hypertension and/or proteinuria during one or more of their previous pregnancies (cases) and 200 women who had answered negatively (controls) were studied. The cases and controls were matched for age. The investigators were blinded to the allocation of cases and controls until data collection was finished. Main outcome measures Self-reported and actual prevalence of hypertensive pregnancy disorders and predictive value of self-reported hypertension and/or proteinuria in previous pregnancies. Results Clinical data were missing for 23.5% (94/400) of the participants (50 cases and 44 controls). A total of 80% (120/150) of cases and 57.1% (89/156) of controls had answered the question on whether or not they had high blood pressure and/or proteinuria during their pregnancies correctly (positive predictive value 0.800; negative predictive value 0.571). The proportion of false-positive cases declined with increasing age while the proportion of false-negative controls increased until 55 years of age. Conclusions We found good concordance between self-reported hypertension and/or proteinuria during previous pregnancies and actual clinical findings among the cases. However, there was a tendency towards under-reporting among controls. [ABSTRACT FROM AUTHOR]

QT Interval and the Risk of Myocardial Infarction and All-Cause Death. Introduction: The relationship between QT interval and cardiovascular disease is controversial. Methods: All male residents aged 20-61 years and female residents aged 20-56 years were invited to the Tromsø Study in 1986-1987. A total of 15,558 participants free of heart disease were prospectively followed over 20 years for myocardial infarction and death. QT interval at baseline was measured on lead I of the electrocardiogram. Hazard ratios (HRs) with 95% confidence intervals (CIs) per standard deviation change in QT interval were calculated using a Cox regression model. Results: We identified 756 cases of myocardial infarction and 1,183 all-cause deaths. Prolonged QT interval was present in 792 (5%) participants. QT interval was not associated with increased risk of myocardial infarction (HR: 0.95, 95% CI: 0.84-1.07, after adjustment for potential confounders). Heart-rate-corrected QT interval was a significant predictor for all-cause death in men (HR: 1.15, 95% CI: 1.03-1.29), but not in women (HR: 1.04, 95% CI: 0.91-1.18), after adjustment for potential confounders. Conclusions: The findings suggest that the previously observed relationship between QT interval and increased risk of cardiovascular death is not mediated by increased risk of myocardial infarction. The clinical utility of the QT interval to identify individuals at high risk for coronary events is limited in a general population without prior heart disease. (J Cardiovasc Electrophysiol, Vol. 23, pp. 846-852, August 2012) [ABSTRACT FROM AUTHOR]

Skjelbakken T, Langbakk B, Dahl IMS, Løchen M-L. Haemoglobin and anaemia in a gender perspective: The Tromsø Study.Eur J Haematol 2005: 74: 381–388.© Blackwell Munksgaard 2005.Objectives: To examine the gender-specific distribution of haemoglobin (Hb) and the World Health Organization (WHO) criteria for anaemia compared with the 2.5 percentile for Hb.Methods: A population-based study from Tromsø, Northern Norway. All inhabitants above 24 yr were invited. In total, 26 530 (75%) had their Hb analysed.Results: The 2.5–97.5 percentile of Hb was 129–166 and 114–152 g/L for all men and women, respectively. In men, mean Hb decreased from 148 to 137 g/L between 55–64 and 85+ yr. In women, mean Hb increased from 132 to 137 g/L between 35–44 and 65–74 yr and then decreased to 131 g/L among the oldest. Using the WHO criteria for anaemia (Hb:<130 and<120 g/L, men and women respectively), the prevalence of anaemia in men increased with age from 0.6% aged 25–34 to 29.6% aged 85+. For women, the prevalence of anaemia varied from 9.1%, 2.2% and 16.5% in the age groups of 35–44, 55–64 and 85+ yr, respectively. The WHO criteria gave a two to three times higher prevalence of anaemia compared with the 2.5 percentile of Hb in women, but the difference was small in men. Poor self-rated health was not associated with low values of Hb in women. In men, there was an association in some age groups.Conclusion: The WHO criteria for anaemia and the 2.5 percentile for Hb corresponded well for men, but not for women. The WHO criteria of anaemia may result in medicalization of healthy women. [ABSTRACT FROM AUTHOR]