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Published version, also available at http://dx.doi.org/10.1186/s12882-015-0207-1 Background: The role of uric acid in development of renal dysfunction (RD) remains controversial. Earlier studies have reported inconsistent results, possibly because of their varying ability to adjust for confounding. The impact of longitudinal change in uric acid on renal outcome has not been assessed previously. We aimed to study the impact of change in serum uric acid (SUA) as well as baseline SUA on the development of RD. Methods: In a prospective cohort study, we assessed the associations between change in SUA during follow-up, baseline SUA and RD (defined as albumin-creatinine-ratio (ACR) ≥1.13 mg albumin/mmol creatinine and/or eGFR < 60 ml/min/1.73 m2) in a large cohort from a general population participating in the Tromsø Study (n = 2637). Participants were stratified according to tertiles of change in SUA between baseline (1994/95) and follow-up 13 years later. (upper tertile: SUA increasing group, two lower tertiles: SUA non-increasing group). Logistic regression analysis was applied with RD and each component of RD after 7 and 13 years as the dependent variables. Adjustments were made for baseline eGFR, cardiovascular risk factors, and the use of antihypertensive drugs including diuretics. Results: After excluding participants with RD at baseline, SUA increasers, compared to SUA non-increasers, had a doubled risk of RD after 7 years (odds ratio 2.00, (95 % CI 1.45, 2.75)). Odds ratio for RD in SUA increasers after 13 years was 2.18 (95 % CI 1.71, 2.79). The risk of developing ACR ≥1.13 mg/mmol alone was not significantly increased after 7 years (odds ratio 1.30 (95 % CI 0.90, 1.89), but after 13 years (odds ratio 1.43 (95 % CI 1.09, 1.86)). An increase in baseline SUA of 59 μmol/L (1 mg/dL) gave an odds ratio for RD after 13 years of 1.16 (95 % CI 1.04, 1.29). Conclusion: An increase in SUA during follow-up was associated with an increased risk of developing RD after 7 and 13 years.

Background and Objective In addition to its role as a transport protein, the vitamin D binding protein (DBP) may also affect lipid metabolism, inflammation and carcinogenesis. There are three common variants of the DBP, Gc1s (1s), Gc1f (1f), Gc2 (2) that result in six common phenotypes (1s/1s, 1s/ 1f, 1s/2, 1f/1f, 1f/2, and 2/2). These phenotypes can be identified by genotyping for the two single nucleotide polymorphisms rs7041 and rs4588 in the GC gene. The DBP variants have different binding coefficients for the vitamin D metabolites, and accordingly there may be important relations between DBP phenotypes and health. Methods DNA was prepared from subjects who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints myocardial infarction (MI), type 2 diabetes (T2DM), cancer or death as well as a randomly selected control group. The endpoint registers were complete up to 2010- 2013. Genotyping was performed for rs7041 and rs4588 and serum 25-hydroxyvitamin D (25(OH)D) was measured. Results Genotyping for rs7041 and rs4588 was performed successfully in 11 704 subjects. Among these, 1660 were registered with incident MI, 958 with T2DM, 2410 with cancer and 4318 had died. Subjects with the DBP phenotype 1f/1f had 23 – 26 % reduced risk of incident cancer compared to the 1s/1s and 2/2 phenotypes (P < 0.02, Cox regression with gender as covariate). Differences in serum 25(OH)D levels could not explain the apparent cancer protective effect of the DBP variant 1f. In addition to cancer and 25(OH)D, there were significant associations between DBP phenotype and body height, hip circumference and serum calcium. Conclusion There are important biological differences between the common DBP phenotypes. If the relation between the DBP variant 1f and cancer is confirmed in other studies, determination of DBP phenotype may have clinical importance.

Background:The American Heart Association has proposed an impact goal for the year 2020 to improve cardiovascular health by 20%. The objectives of the study were to assess the association between the proposed cardiovascular health metric score and incident myocardial infarction (MI) and to estimate the generalized impact fraction (GIF). Methods:The health metric score was derived from ideal levels of six cardiovascular risk factors from the population-based Tromsø Study of 22,121 residents of Tromsø, Norway aged 30 to 79 years, examined in 1994–95, 2001, and 2007–08. Incident events of MI were recorded from the date of enrollment in 1994–95 to the end of 2010. Adjudication of hospitalized and out-of hospital events was performed by an independent endpoints committee based on data from hospital and out-of hospital journals, autopsy records and death certificates. Cox proportional hazard regression was used to estimate hazard ratios (HR). GIF was calculated from age stratified analysis using a case-load weighted-sum method. Bootstrapping was used to estimate 95% simulation intervals. Results:A total of 1652 MIs accrued over an average of 14.7 person-years of follow-up. Few men (0.96%) and women (3.6%) had ideal levels in all 6 metrics. 64.7% (men) and 55.7% (women) had ideal levels in 2 or 3 metrics. The age-adjusted HR per point increase in health score was 0.65 (95% confidence interval: 0.61, 0.70) in men and 0.59 (0.54, 0.64) in women. A shift of 30% of subjects from low score levels≤3 to scores≥4 was estimated to prevent 13.7% (11.2, 16.2) of incident MI in men and 15.9% (12.1, 19.4) in women. Conclusions:The association between the health metric score and MI indicate that close to 15% of incident MIs could be prevented by attainable and realistic improvements in the health metrics. Keywords:Coronary heart disease, Cohort studies, Lifestyle, Longitudinal studies, Prevention © Wilsgaard et al.; licensee BioMed Central. 2015. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​4.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.

Background: Red cell distribution width (RDW), a measure of the variability in size of circulating erythrocytes, is associated with mortality and adverse outcome in selected populations with cardiovascular disease. It is scarcely known whether RDW is associated with incident myocardial infarction (MI). We aimed to investigate whether RDW was associated with risk of first-ever MI in a large cohort study with participants recruited from a general population. Methods and Results: Baseline characteristics, including RDW, were collected for 25 612 participants in the Tromsø Study in 1994–1995. Incident MI during follow-up was registered from inclusion through December 31, 2010. Cox regression models were used to calculate hazard ratios with 95% confidence intervals for MI, adjusted for age, sex, body mass index, smoking, hemoglobin, white blood cells, platelets, and other traditional cardiovascular risk factors. A total of 1779 participants experienced a first-ever MI during a median follow-up time of 15.8 years. There was a linear association between RDW and risk of MI, for which a 1% increment in RDW was associated with a 13% increased risk (hazard ratio 1.13; 95% CI, 1.07 to 1.19). Participants with RDW above the 95th percentile had 71% higher risk of MI compared with those with RDW in the lowest quintile (hazard ratio 1.71; 95% CI, 1.34 to 2.20). All effect estimates were essentially similar after exclusion of participants with anemia (n=1297) from the analyses. Conclusion: RDW is associated with incident MI in a general population independent of anemia and cardiovascular risk factors.

Helt siden 1700-tallet har man kjent til at fysisk aktivitet har gunstig effekt på mennesker med koronar hjertesykdom, og i dag anbefales en aktiv livsstil som et ledd i forebygging av hjerte- og karsykdom. Anbefalingene er fundert på en etter hvert stor mengde dokumentasjon som samlet viser at fysisk aktivitet reduserer risikoen for hjerte- og karsykdom og prematur død. I denne artikkelen vil vi kort oppsummere forskningen som ligger til grunn for det man i dag ser på som en etablert sammenheng, med fokus på primærforebygging og harde endepunkter som koronarsykdom og død.

Think tanks are non-governmental institutions – intellectually, organizationally and financially autonomous of government, political parties and organized interests – that are set up with the aim of influencing policy. The Swedish think tank Tobaksfakta, as a nonprofit organization, was formed by Health Professionals against Tobacco in October 2010, and has a number of member organizations. It is a national independent player focusing on measures to reduce tobacco use. The goal is that Tobaksfakta contributes continuously to reducing tobacco use toward a society free of tobacco. A quality evaluation has been conducted by an external panel in five phases: (1) Planning and selection of approach, (2) Collection of data on Tobaksfakta, (3) Self-evaluations, (4) External assessment by a panel of independent experts, and (5) Measures and follow-up. As background to the evaluation, there is a short review of what a think tank is. Then, the scene for tobacco prevention in Sweden is set by giving data on tobacco consumption, an overall Swedish map of tobacco prevention, and a presentation of some controversial issues. The WHO Framework Convention on Tobacco Control sets the global agenda and also the framework for the activities of Tobaksfakta. A SWOT analysis provides an overall assessment of Tobaksfakta. Its strengths include competence, having an effective organization and member organizations, and being a strong provider of information and opinion leaders. Weaknesses include limited economic and human resources, low involvement in activities by member organizations, too broad a focus, and a limited impact on decision-making. Threats include poor economic resources, the perception that tobacco is no longer an issue, and weakness in national tobacco prevention efforts. Among the opportunities available is a new three-year business plan, strengthening of communicative work, networking and extended cooperation, the Tobacco End Game, and new efforts at national and international levels. The evaluation considered organizational structure and resources, goal structure and work processes (monitoring, investigations, knowledge materials, website, press activities, twitter and social media, dissemination of knowledge, and European and international tobacco prevention work). The panel assessed the information and communication work of Tobaksfakta as of high quality, relevant, and timely. The Tobacco Industry Project has functioned as an important vehicle for the overall efforts made by Tobaksfakta The project has performed impressive work in relation to relatively limited economic resources. Although time has run out for the project, the need for its activities will continue for so long as the activities pursued by the tobacco industry continue. Therefore, it is recommended that Tobaksfakta continues to act as a watchdog on the tobacco industry. The Tobacco End Game is a challenging and future-oriented project that has a great potential. Tobaksfakta wants a Swedish government that, after the 2014 elections, reaches a decision on a plan to phase out smoking by 2025. The idea is that such a decision shall be achieved by advocacy at all levels of society. Further development of the Tobacco End Game is recommended as a key developmental effort. Overall assessments and recommendations are: Tobaksfakta is a classic think tank but needs independent financing. It shall continue with intellectual argument not covert lobbying. Tobaksfakta is one of the key actors on the landscape of tobacco prevention. Focusing on structural issues gives added value. The think tank is an efficient and professional organization. Tobaksfakta has an international role to play.

Knowledge of the natural course and especially the total and cause-specific mortality of community-acquired chronic HCV infection is limited. The aims of our study were to determine the total and cause-specific mortality in patients infected with chronic hepatitis C in a community-based setting in northern Norway. This prospective cohort study included 1010 HCV-positive patients diagnosed with recombinant immunoblot assay between 1 January 1990 and 1 January 2000, with a median observation time from diagnosis to follow-up of 7 years. Data were collected from medical records in the period between 1 January 2004 and 30 June 2006. Time and cause of death were ascertained from the Norwegian Causes of Death Register. Age-adjusted death rates and standardised mortality ratios (SMRs) were compared with those of the general Norwegian population. In total, 122 deaths were recorded. The Kaplan–Meier estimate of survival was 88% at 14 years. The SMR in the cohort relative to the general population was 6.66. Most of the excess deaths in both genders were because of liver-related causes, those associated with a drug-using lifestyle and suicide. The statistically significant increase in SMRs ranged from 4.2 for death by cancer in women to 64.6 for liver disease in women. There was no statistically significant increase in SMRs from cardiovascular disease in either gender or from cancer in men. In conclusion, our study shows that the death rate in patients infected with hepatitis C is 6.66 times higher than in the general Norwegian population.