Browsing by Subject "INTIMA-MEDIA THICKNESS"

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  • Pulkkinen, Mari-Anne; Tuomaala, Anna-Kaisa; Hero, Matti; Gordin, Daniel; Sarkola, Taisto (2020)
    Introduction We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. Research design and methods 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size. Results 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI -0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI -0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI -0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9-10.0 mmol/L) and crPWV (r=-0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found. Conclusion There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk.
  • Kivimaki, Mika; Vahtera, Jussi; Tabak, Adam G.; Halonen, Jaana I.; Vineis, Paolo; Pentti, Jaana; Pahkala, Katja; Rovio, Suvi; Viikari, Jorma; Kahonen, Mika; Juonala, Markus; Ferrie, Jane E.; Stringhini, Silvia; Raitakari, Olli T. (2018)
    Background Neighbourhood socioeconomic disadvantage has been linked to increased diabetes risk, but little is known about differences in risk factors in childhood and adulthood in those with high and low neighbourhood socioeconomic disadvantage, or about the association between long-term neighbourhood socioeconomic disadvantage and incidence of diabetes in adulthood. We used data from the prospective, population-based Young Finns Study to address these questions. Methods We did a nationwide population-based cohort study in Finland using data from The Young Finns Study, which included 3467 participants aged 6-18 years followed up for over 30 years via eight repeated biomedical examinations and linkage to electronic health records. Participants were also linked to national grid data on neighbourhood disadvantage via their residential address from age 6-48 years. We used these data to examine differences in ten risk factors (dietary habits, physical activity, daily smoking, body-mass index, systolic blood pressure, fasting HDL cholesterol, fasting triglycerides, fasting plasma glucose, fasting serum insulin, and homoeostasis model assessment insulin sensitivity) from childhood (6-21 years) to adulthood (22-48 years) among individuals with high (>= 0.5 SD above the national mean) and low (0.5 SD below the national mean) neighbourhood socioeconomic disadvantage, and the association of cumulative neighbourhood socioeconomic disadvantage with six cardiometabolic risk factors (obesity, high waist circumference, fatty liver, hypertension, carotid plaque, and left ventricle mass index) and diabetes by middle age (22-48 years). We used logistic and linear regression analyses to assess the effects of neighbourhood disadvantage on cardiometabolic and diabetes risk, controlling for potential confounders (age, sex, and individual socioeconomic disadvantage). Findings We included data for 3002 individuals with risk factor assessment in childhood and adulthood. Of whom, 2048 underwent a clinical examination during the last follow-up at age 33-48 years. Differences in risk factors by neighbourhood socioeconomic disadvantage at the beginning of follow-up were small, but large differences emerged over the follow-up. High neighbourhood socioeconomic disadvantage was characterised by decreased fruit and vegetable intake as early as age 6 years, decreased physical activity, and increased prevalence of daily smoking from adolescence (12 years) onwards, and decreased homoeostasis model assessment insulin sensitivity and increased fasting glucose and insulin concentration from early adulthood (27 years; all p Interpretation Living in socioeconomically disadvantaged areas can shape health in childhood and adulthood. Neighbourhood socioeconomic disadvantage is associated with differences in health risks across the life course, including detrimental lifestyle factors from childhood and adolescence onwards and worse glucose metabolism from early adulthood. By middle age, cumulative neighbourhood socioeconomic disadvantage is associated with increased cardiometabolic risk factors and increased incidence of diabetes. Copyright (C) The Author(s). Published by Elsevier Ltd.
  • Palanca, Ana; Castelblanco, Esmeralda; Perpinan, Hector; Betriu, Angels; Soldevila, Berta; Manuel Valdivielso, Jose; Bermudez, Marcelino; Duran, Xavier; Fernandez, Elvira; Puig-Domingo, Manel; Groop, Per-Henrik; Alonso, Nuria; Mauricio, Didac (2018)
    Background and aims: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) and diabetes. Traditional cardiovascular risk factors fail to fully account for the increase in cardiovascular risk in these patients. This study aims to analyse the prevalence and progression of subclinical atherosclerosis in CKD patients with and without diabetes. Methods: We included data from CKD patients with and without diabetes free from previous cardiovascular events from the NEFRONA cohort. Patients underwent baseline and 24-month follow-up carotid and femoral ultrasound examinations. Multivariable models were used to assess the contribution of diabetes to the presence and plaque progression. Results: A total of 419 patients with diabetes and 1129 without diabetes were included. Diabetic patients were older, had higher BMIs, more hypertension and dyslipidaemia. At baseline, the proportion of patients with plaque was higher among diabetic patients (81.4% vs. 64.1%, p <0.001). Diabetic patients more frequently had more than two vascular territories with plaque (64.4% vs. 48.4%, p <0.001). Multivariable analysis indicated that plaque at baseline was significantly associated with age, gender, smoking and renal replacement therapy (RRT) in the non-diabetic patients, but only with age and male gender in diabetic patients. Plaque progression was significantly associated with age, number of territories with basal plaque, smoking and RRT in both groups. Conclusions: Subclinical atherosclerosis is more prevalent, carries a higher plaque burden and is more rapidly progressive in renal patients with diabetes. In these patients, diabetes outweighs other described risk factors associated with the presence of subclinical atherosclerosis. (c) 2018 Elsevier B.V. All rights reserved.
  • Palanca, Ana; Castelblanco, Esmeralda; Betriu, Angels; Perpinan, Hector; Soldevila, Berta; Manuel Valdivielso, Jose; Bermudez-Lopez, Marcelino; Puig-Jove, Carlos; Puig-Domingo, Manel; Groop, Per-Henrik; Fernandez, Elvira; Alonso, Nuria; Mauricio, Didac (2019)
    Background: Individuals with diabetes have remarkably high rates of cardiovascular morbidity and mortality. However, the incremental cardiovascular risk in diabetes is heterogeneous and has often been related to renal involvement. The purpose of this study was to analyse the prognostic value of subclinical atherosclerosis in determining the incidence of first cardiovascular events (CVEs) in individuals with diabetes and chronic kidney disease (CKD) compared to CKD individuals without diabetes. Methods: We included data from individuals with CKD with and without diabetes, free from pre-existing cardiovascular disease, from the NEFRONA cohort. Participants underwent baseline carotid and femoral ultrasound and were followed up for 4 years. All CVEs during follow-up were registered. Bivariate analysis and Fine-Gray competing risk models were used to perform the statistical analysis. Results: During the mean follow-up time of 48 months, a total of 203 CVE was registered. 107 CVE occurred among participants without diabetes (19.58 per 1000 person-years) and 96 CVE occurred among participants with diabetes (44.44 per 1000 person-years). Following the competing risk analysis, the variables predicting CVEs in CKD individuals without diabetes were the number of territories with plaque at baseline (HR 1.862, 95% CI [1.432;2.240]), age (HR 1.026, 95% CI [1.003;1.049]) and serum concentrations of 25-OH vitamin D (HR 0.963, 95% CI [0.933;0.094]). The only variable predicting CVEs among CKD participants with diabetes was the number of territories with plaque at baseline (HR 1.782, 95% CI [1.393, 2.278]). For both models, concordance (C) index yielded was over 0.7. Conclusions: The burden of subclinical atherosclerosis is the strongest predictor of future CVEs in diabetic individuals with CKD. Early detection of subclinical atherosclerotic burden by multiterritorial vascular ultrasound could improve CVE prediction in this population.
  • Elovainio, Marko; Vahtera, Jussi; Pentti, Jaana; Hakulinen, Christian; Pulkki-Råback, Laura; Lipsanen, Jari; Virtanen, Marianna; Keltikangas-Järvinen, Liisa; Kivimäki, Mika; Kähönen, Mika; Viikari, Jorma; Lehtimäki, Terho; Raitakari, Olli (2020)
    The association between socioeconomic disadvantage and increased risk of depressive symptoms in adulthood is well established. We tested 1) the contribution of early exposure to neighborhood socioeconomic disadvantage to later depressive symptoms throughout life, 2) the persistence of the potential association between early exposure and depressive symptoms, and 3) the contributions of other known risk factors to the association. Data were collected from the Young Finns Study, a prospective, population-based 32-year follow-up study that included participants aged 3-18 years at baseline in 1980. Participants were followed up with repeated measurements of depressive symptoms between 1992 and 2012 (n = 2,788) and linked to national grid data on neighborhood disadvantage via residential addresses. We examined the associations in mixed models separately for the 5-, 10-, 15-, and 20-year follow-ups. Living in a disadvantaged neighborhood during childhood and adolescence was associated with a higher level of depressive symptoms in adulthood during all follow-up periods (beta = 0.07, P = 0.001) than living in a nondisadvantaged area. Individual adulthood socioeconomic status mediated the associations. These findings suggest that living in a socioeconomically disadvantaged area during childhood and adolescence has a long-lasting negative association with mental health irrespective of family-related risks, partially due to socioeconomic adversity later in life.
  • Fromm, Annette; Thomassen, Lars; Naess, Halvor; Meijer, Rudy; Eide, Geir Egil; Krakenes, Jostein; Vedeler, Christian A.; Gerdts, Eva; Larsen, Terje H.; Kuiper, Karel K-J; Laxdal, Elin; Russell, David; Tatlisumak, Turgut; Waje-Andreassen, Ulrike (2013)