Department of Medical Sciences

Cardiovascular epidemiology

Senior members of the group:

  • Lars Lind, MD, professor
  • Andreas Terént, MD, professor
  • Anders Holmlund, PhD
  • Signild Åsberg, MD, PhD
     

Cardiovascular epidemiology

Lars Lind, Research group leader

Sweden is a country with unique opportunities for epidemiological research, and has long been one of the world leaders in this field. The prospective cohort study – where a defined, prospectively examined group of people is followed over time based on personal ID number for register linkages – is the most valuable observational study design. Sweden has a large number of carefully collected population-based cohorts that have been followed for decades. We have ongoing recruitment into several world-leading cohorts. We have a variety of high quality national socio-demographic and medical registries, covering the whole population since many decades. We also have a large number of world-leading epidemiological researchers in the country, of which the combined knowledge spans most current research fields. In addition, we have two strategic research areas in epidemiology funded by the Swedish government via the Swedish Research Council; our research group is leading one of them. A common theme in the research group is the ambition to unravel the pathophysiology behind atherosclerotic disorders such as myocardial infarction and stroke, for improved risk classification in the population and improved treatment strategies.

Ongoing projects

Projects-Cardiovascular epidemiology

CARDIOVASCULAR EPIDEMIOLOGY

Sweden is a country with unique opportunities for epidemiological research, and has long been one of the world leaders in this field. The prospective cohort study – where a defined, prospectively examined group of people is followed over time based on personal ID number for register linkages – is the most valuable observational study design. Sweden has a large number of carefully collected population-based cohorts that have been followed for decades. We have ongoing recruitment into several world-leading cohorts. We have a variety of high quality national socio-demographic and medical registries, covering the whole population since many decades. We also have a large number of world-leading epidemiological researchers in the country, of which the combined knowledge spans most current research fields. In addition, we have two strategic research areas in epidemiology funded by the Swedish government via the Swedish Research Council; our research group is leading one of them. A common theme in the research group is the ambition to unravel the pathophysiology behind atherosclerotic disorders such as myocardial infarction and stroke, for improved risk classification in the population and improved treatment strategies.

Below follows a description of the cohort studies presently used by the research group:

The Epidemiology for Health (EpiHealth) study

Lars Lind, PI

In the EpiHealth study, the plan is to enrol 300,000 Swedes in the age-groups 45 to 75 years to study the interplay between genes and life-style factors on the development of common disorders seen in the elderly, such as myocardial infarction, stroke, bone fractures, dementia, chronic obstructive pulmonary disease, cancer, and arthrosis. Data on life-style exposures are collected using a web-based questionnaire and serum/plasma/DNA is biobanked at a visit to a test centre where also physiological measures, such as blood pressure, lung function, cognitive function, anthropometry and ECG are recorded. A test centre in Uppsala was started up in April 2011 and in Malmö in Jan 2012. The Uppsala site was closed in 2015. By the end of 2016, abount 23,000 individuals had been enrolled in the study. The cohort is now open for research.

The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study

Lars Lind, PI

The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study is a population-based longitudinal cohort study, started in 2001, of men and women aged 70. A number of cardiovascular characteristics have been collected, e.g. measurements of intima-media thickness, three different tests of endothelial function, MRI of the large arteries, myocardium and adipose tissue, and a large number of biochemical biomarkers, including genomics, proteomics and metabolomics.  A reinvestigation of the cohort at age 75 was performed between March 2006 and Sep 2009, and a reinvestigation at age 80 was performed 5 years later. Apart from analyses of classical risk factors, ultrasound of the carotid arteries and the heart will be performed together with 2 cognitive function tests and MRI of the brain.

The Uppsala Longitudinal Study of Adult Men (ULSAM)

Martin Ingelsson (@pubcare.uu.se) PI

The ULSAM study was started in 1970, when 2 322 men at the age of 50 participated in a health survey. The men have thereafter been investigated again at ages 60, 70, 77, 82 and 88 years, respectively. The focusi n the ULSAM cohort is on cardiovascular disease and metabolic links, but several other research areas have also been explored, such as nutrition, osteoporosis, and dementia. The follow-up time for morbidity and mortality through national registers is now >40 years. The major research aims in the ULSAM study are: to investigate the impact of life-time exposures of risk factors using updated covariates on the major CV diseases MI, Stroke and heart failure, to explore new risk factors, and to evaluate the risk associated with different genotypes on CV outcomes.

The Prospective investigation of Obesity, Energy production and Metabolism (POEM) longitudinal study

Lars Lind, PI

A randomized sample of 500 individuals selected from the inhabitants of the Uppsala County aged 50 have been invited for the baseline examination. The subjects were recruited from 2010 to 2016. The subjects underwent a very detailed examination regarding cardiovascular status and metabolism, including vascular tests, echocardiography, an exercise test with gas exchange, indirect calorimetry, OGTT and sleep apnea recordings.

Management and outcome of stroke using Riks-Stroke

Anders Terent/Signild Åsberg, PI

Stroke is the most common clinical manifestation of vascular disease in the brain. The onset of symptoms is sudden and the consequences long-lasting. Hemorrhage/bleeding (15%) or ischemia/infarction (85%) in the brain parenchyma causes stroke. In Sweden about 25 000 individuals are hospitalized due to an acute strokes every year, and approximately 10 000 face a transient ischemic attack (TIA) every year. We performed a cohort study of >200 000 stroke patients, registered in Riksstroke (the Swedish Stroke Register) during 2001 through 2009, and a separate cohort study also including TIA-patients for the years 2011 through 2014. Cross-linking with the National Patient Register, the Prescribed Drug Register and Cause of Death Registers has been done to achieve data on previous hospitalizations, drug therapy, death dates, and causes of death. The objectives were to assess co-morbidity, functionality and drug treatment in stroke patients before and after the stroke/TIA. Of particular interest is the use of anti-thrombotic treatment before and after the stroke/TIA. In addition, and in cooperation with Gothenburg University, we have analyzed epilepsy before and after stroke. 

In collaboration with Uppsala Clinical Research Center, with founding from the Swedish Research Council, we are planning the world’s first randomized clinical trial within a national stroke register (R-RCT). This R-RCT will compare early vs. delayed start of oral anticoagulation in patients with acute ischemic stroke and atrial fibrillation. Half of the study population will also be included in a sub study analyzing biomarkers as risk markers for stroke in patients with atrial fibrillation.