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Introduction: There is limited knowledge about the use of invasive treatment and mortality after acute myocardial infarction (AMI) in prostate cancer (PCa) patients. We therefore wanted to compare rates of invasive treatment and 30-day mortality between AMIs in patients with PCa and AMIs in the general Norwegian male population. Methods: Norwegian population-based registry data from 2013 to 2019 were used in this cohort study to identify AMIs in patients with a preceding PCa diagnosis. We compared invasive treatment rates and 30-day mortality in AMI patients with PCa to the same outcomes in all male AMI patients in Norway. Invasive treatment was defined as performed angiography with or without percutaneous coronary intervention or coronary artery bypass graft surgery. Standardized mortality (SMR) and incidence ratios, and logistic regression were used to evaluate the association between PCa risk groups and invasive treatment. Results: In 1,018 patients with PCa of all risk groups, the total rates of invasive treatment for AMIs were similar to the rates in the general AMI population. In patients with ST-segment elevation AMIs, rates were lower in metastatic PCa compared to localized PCa (OR 0.15, 95% CI: 0.04–0.49). For non-ST-segment elevation AMIs, there were no differences between PCa risk groups. The 30-day mortality after AMI was lower in PCa patients than in the total population of similarly aged AMI patients (SMR 0.77, 95% CI: 0.61–0.97). Conclusion: Except for patients with metastatic PCa experiencing an ST-segment elevation AMI, PCa patients were treated as frequent with invasive treatment for their AMI as the general AMI population. 30-day all-cause mortality was lower after AMI in PCa patients compared to the general AMI population. [ABSTRACT FROM AUTHOR]

Background: Drug-eluting stents (DES) reduce target lesion revascularization (TLR) with no effect on mortality or myocardial infarction (MI) compared to bare-metal stents (BMS) in native vessels. Randomized stent studies in saphenous vein grafts (SVG) are few and the reported effects are ambiguous. The Norwegian Coronary Stent Trial study is the first to randomize lesions to percutaneous coronary intervention in native vessels and SVG. Aims: The aim of this study was to compare the rate of mortality, MI, and TLR across stent and vessel types. Methods: In this substudy, 6,087 patients with a single lesion in native vessels and 164 in SVG were followed for 5 years. Results: MI was more frequent in SVG (subdistributional hazard ratio [SHR] 4.95 (3.75–6.54, p < 0.001), but not affected by stent type. In the first 500 days, DES reduced TLR in native vessels (SHR 0.21 (0.15–0.30) p < 0.001) and SVG (SHR 0.18 (0.04–0.80) p = 0.02). Thereafter, DES and BMS were equivalent in native vessels, but DES had a higher TLR rate than BMS in SVG (SHR 3.31 (1.23–8.94) p = 0.02). After 5 years, the TLR rate was still significantly lower for DES in native vessels (3.2% vs. 7.8%, p < 0.001) but not in SVG (21.4% vs. 18. 4%). Conclusion: In SVG, no difference in TLR between DES and BMS was observed after 5 years in contrast to persistent benefit in native vessels. The high rate of TLR and MI in SVG makes treatment of native vessels a preference whenever feasible and better treatment options for SVG are warranted. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether acute myocardial infarction (MI) diagnoses in national health registers are sufficiently correct and complete to replace manual collection of endpoint data for a population-based, epidemiological study. Patients and Methods: Using the Tromsø Study Cardiovascular Disease Register for 2013– 2014 as gold standard, we calculated correctness (defined as positive predictive value (PPV)) and completeness (defined as sensitivity) of MI cases in the Norwegian Myocardial Infarction Register and the Norwegian Patient Register separately and in combination. We calculated the sensitivity and PPV with 95% confidence intervals using the Clopper-Pearson Exact test. Results: We identified 153 MI cases in the gold standard. In the Norwegian Myocardial Infarction Register, we found a PPV of 97.1% (95% confidence interval (CI) 92.8– 99.2) and a sensitivity of 88.2% (95% CI 82.0– 92.9). In the Norwegian Patient Register, the PPV was 96.3% (95% CI 91.6– 98.8) and the sensitivity was 85.6% (95% CI 79.0– 90.8). The combined dataset of the Norwegian Myocardial Infarction Register and the Norwegian Patient Register had a PPV of 96.6% (95% CI 92.1– 98.9) and a sensitivity of 91.5% (95% CI 85.9– 95.4). Conclusion: MI diagnoses in both the Norwegian Myocardial Infarction Register and the Norwegian Patient Register were highly correct and complete, and each of the registers could be considered as endpoint sources for the Tromsø Study. A combination of the two national registers seemed, however, to represent the most comprehensive data source overall. The benefits of using data from national registers as endpoints in epidemiological studies include faster, less resource-intensive access to nationwide data and considerably lower loss to follow-up, compared to manual data collection in a limited geographical area. [ABSTRACT FROM AUTHOR]

Introduction: Bleeding is a concern after percutaneous coronary intervention (PCI) and subsequent dual antiplatelet therapy (DAPT). We herein report the incidence and risk factors for major bleeding in the Norwegian Coronary Stent Trial (NORSTENT). Materials and methods: NORSTENT was a randomized, double blind, pragmatic trial among patients with acute coronary syndrome or stable coronary disease undergoing PCI during 2008–11. The patients (N = 9,013) were randomized to receive either a drug-eluting stent or a bare-metal stent, and were treated with at least nine months of DAPT. The patients were followed for a median of five years, with Bleeding Academic Research Consortium (BARC) 3–5 major bleeding as one of the safety endpoints. We estimated cumulative incidence of major bleeding by a competing risks model and risk factors through cause-specific Cox models. Results: The 12-month cumulative incidence of major bleeding was 2.3%. Independent risk factors for major bleeding were chronic kidney disease, low bodyweight (< 60 kilograms), diabetes mellitus, and advanced age (> 80 years). A myocardial infarction (MI) or PCI during follow-up increased the risk of major bleeding (HR = 1.67, 95% CI 1-29-2.15). Conclusions: The 12-month cumulative incidence of major bleeding in NORSTENT was higher than reported in previous, explanatory trials. This analysis strengthens the role of chronic kidney disease, advanced age, and low bodyweight as risk factors for major bleeding among patients receiving DAPT after PCI. The presence of diabetes mellitus or recurrent MI among patients is furthermore a signal of increased bleeding risk. Clinical trial registration: Unique identifier NCT00811772; http://www.clinicaltrial.gov. [ABSTRACT FROM AUTHOR]

Background: Disease-specific registers may be used for measuring and improving healthcare and patient outcomes, and for disease surveillance and research, provided they contain valid and reliable data. The aim of this study was to assess the interrater reliability of all variables in a national myocardial infarction register. Methods: We randomly selected 280 patients who had been enrolled from 14 hospitals to the Norwegian Myocardial Infarction Register during the year 2013. Experienced audit nurses, who were blinded to the data about the 280 patients already in the register, completed the Norwegian Myocardial Infarction paper forms for 240 patients by review of medical records. We then extracted all registered data on the same patients from the Norwegian Myocardial Infarction Register. To compare the interrater reliability between the register and the audit nurses, we calculated intraclass correlations coefficient for continuous variables, Cohen's kappa and Gwet's first agreement coefficient (AC1) for nominal variables, and quadratic weighted Cohen's kappa and Gwet's second AC for ordinal variables. Results: We found excellent (AC1 >0.80) or good (AC1 0.61-0.80) agreement for most variables, including date and time variables, medical history, investigations and treatments during hospitalization, medication at discharge, and ST-segment elevation or non-ST-segment elevation acute myocardial infarction. However, only moderate agreement (AC1 0.41-0.60) was found for family history of coronary heart disease, diagnostic electrocardiography, and complications during hospitalization, whereas fair agreement (AC1 0.21-0.40) was found for acute myocardial infarction location. A high percentage of missing data was found for symptom onset, family history, body mass index, infarction location, and new Q-wave. Conclusion: Most variables in Norwegian Myocardial Infarction Register had excellent or good reliability. However, some important variables had lower reliability than expected or had missing data. Precise definitions of data elements and proper training of data abstractors are necessary to ensure that clinical registries contain valid and reliable data. [ABSTRACT FROM AUTHOR]

High blood pressure is a modifiable risk factor for cardiovascular disease. Previous studies showing a blood pressure decline in recent decades lack data to follow individuals born in different decades from early and middle adulthood to older age. We investigated changes in age-specific blood pressure by repeated measurements in 37 973 women and men born 1905 to 1977 (aged 20–89 years) examined ≤5× between 1979 and 2008 in the population-based Tromsø Study. Mixed models were used to estimate time trends. Mean systolic and diastolic blood pressure decreased from 1979 to 2008 in both genders in the age groups 30 to 89 years. The decrease was similar in the 80th percentile and the 20th percentile of the population blood pressure distribution. The decrease in systolic blood pressure in age group 40 to 49 years was 10.6 mm Hg in women and 4.5 mm Hg in men. Systolic blood pressure increased with age in women and men born 1920 to 1949, whereas a decrease or flattening of curve was observed in the younger birth cohorts. Thus, we found both time periodic and cohort effects, and trends were more pronounced in women than in men. The findings suggest changes in blood pressure in the population rather than an effect of treatment of high-risk individuals. [ABSTRACT FROM AUTHOR]

The article discusses a research which examines the association of multiple protein biomarkers with the 10-year risk of incident first-ever myocardial infarction (MI) and identifies a clinically significant risk model in samples from a longitudinal study of men and women in Tromsø, Norway. The study found several clinically significant biomarkers adjusted for traditional risk factors including apolipoprotein B/apolipoprotein A1 ratio, kallikrein, and matrix metalloproteinase 9.

The article focuses on comparison of comparing contemporary bare-metal stents (BMS) and second-generation drug-eluting stents (DES) inpatients with stable or unstable coronary artery disease, done by Norwegian Coronary Stent Trial (NORSTENT). Topics discussed are test conducted on the basis of factors such as sex, age and medical history, European guidelines for safety outcomes, and growing evidence of stent thrombosis in DES stents compared to BMS stents.

The article presents a study on the relationship between blood levels of folate, vitamin B12, homocysteine and vitamin B12 transport proteins, and prostate cancer risk. The case-control study was done by investigating prostate-specific antigen-detected prostate cancer of the Prostate Testing for Cancer and Treatment in Great Britain, which measured 1,461 cases and 1,507 controls. The authors found that increased risk for prostate cancer can be attributed to vitamin B12 and folate based on the cohort studies in Great Britain.

The article offers information on a study which investigated the effects of treatment with B vitamins on cancer outcomes and all-cause mortality. A total of 6837 patients were recruited to participate in two randomized, double-blind, placebo-controlled clinical trials conducted in Norway between 1998 and 2005, and followed up through December 31, 2007. Treatment interventions included oral treatment with folic acid combined with vitamin B12 and vitamin 6, folic acid combined with vitamin B12, vitamin 6 alone and placebo. Presented in details are the research findings.

The article offers information on a study which investigated the effects of treatment with B vitamins on cancer outcomes and all-cause mortality. A total of 6837 patients were recruited to participate in two randomized, double-blind, placebo-controlled clinical trials conducted in Norway between 1998 and 2005, and followed up through December 31, 2007. Treatment interventions included oral treatment with folic acid combined with vitamin B12 and vitamin 6, folic acid combined with vitamin B12, vitamin 6 alone and placebo. Presented in details are the research findings.

Presents a meta-analysis comparing coronary stents with balloon angioplasty for interventional cardiology. Efficacy of stents in reducing angiographic restenosis and the need for repeat revascularizations; Failure of stents to show any significant effect on either mortality or the occurrence of acute myocardial infarction; Widespread acceptance of stenting despite the limited evidence of long-term clinical benefit.

Introduction: Diabetes is associated with increased risk of coronary heart disease (CHD). The relative risk has been found to be higher in women than men, and the more pronounced adverse effect has even been claimed to eliminate the female advantage in risk. However, few previous studies have quantified the difference in risk between men and women among individuals with diabetes. Aims: To evaluate interaction between gender and diabetes in relation to the risk of incident myocardial infarction (MI). Methods: Population-based prospective study of 33,859 individuals (51% women) in Tromsø, Norway. Median follow-up time at ages 35-94 years was 17.6 years; 2,746 individuals (854 women) were diagnosed with MI during follow-up. At their last visit, a total of 1063 individuals (3.1%) reported they had diabetes (530 men, 533 women); 170 (74 women) were later diagnosed with MI. Incidence rate ratios (IRR) were calculated as estimates of relative risk in Poisson regression analysis of person-years at risk. Interaction terms were included in the model to evaluate heterogeneity in risk estimates across subgroups. Results: Adjusted for age, gender and established CHD risk factors, diabetes was associated with a doubling in risk of MI (IRR=2.18, 95% CI=1.86-2.55). The adverse effect was slightly more pronounced for women than men (IRR of 2.55 vs. 1.96, p=0.11, test for interaction). Accordingly, the gender contrast in risk was less pronounced among individuals with diabetes (IRR of 1.63 vs 2.11), but the elevated risk in men remained significant. Considering combined categories of interacting factors, women with diabetes had a risk level close to men without diabetes, but men with diabetes had a risk about four times as high as women without diabetes. Some heterogeneity across age groups was seen, but risk estimates were imprecise. These results are preliminary. Gender heterogeneity in associations with adjustment factors may influence risk estimates. Analyses based on data with 5 year extended follow-up are planned. Conclusions: In terms of relative risk, the association between diabetes and risk of MI was more pronounced for women than men, but the female advantage in risk of MI was not erased in persons with diabetes. [ABSTRACT FROM AUTHOR]