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252. A framework for quantifying net benefits of alternative prognostic models

Author

Rapsomaniki, E., White, I. R., Wood, A. M., Thompson, S. G., Tipping, R. W., Ford, C. E., Simpson, L. M., Folsom, A. R., Chambless, L. E., Panagiotakos, D. B., Pitsavos, C., Chrysohoou, C., Stefanadis, C., Knuiman, M., Whincup, P. H., Wannamethee, S. G., Morris, R. W., Kiechl, S., Willeit, J., Oberhollenzer, F., Mayr, A., Wald, N., Lawlor, D. A., Yarnell, J. W., Gallacher, J., Casiglia, E., Tikhonoff, V., Nietert, P. J., Sutherland, S. E., Bachman, D. L., Keil, J. E., Cushman, M., Tracy, R., Tybjaerg-Hansen, A., Nordestgaard, B. G., Frikke-Schmidt, R., Giampaoli, S., Palmieri, L., Panico, S., Vanuzzo, D., Pilotto, L., Gomez de la Camara, A., Gomez Gerique, J. A., Simons, L., Mccallum, J., Friedlander, Y., Lee, A. J., Taylor, J., Guralnik, J. M., Wallace, R., Blazer, D. G., Khaw, K. -T., Schottker, B., Muller, H., Rothenbacher, D., Jansson, J. -H., Wennberg, P., Nissinen, A., Donfrancesco, C., Salomaa, V., Harald, K., Jousilahti, P., Vartiainen, E., Woodward, M., D'Agostino Sr, R. B., Wolf, P. A., Vasan, R. S., Pencina, M. J., Bladbjerg, E. -M., Jorgensen, T., Moller, L., Jespersen, J., Dankner, R., Chetrit, A., Lubin, F., Rosengren, A., Lappas, G., Eriksson, H., Bjorkelund, C., Lissner, L., Bengtsson, C., Nagel, D., Kiyohara, Y., Arima, H., Doi, Y., Ninomiya, T., Rodriguez, B., Dekker, J. M., Nijpels, G., Stehouwer, C. D. A., Iso, H., Kitamura, A., Yamagishi, K., Noda, H., Goldbourt, U., Kauhanen, J., Salonen, J. T., Cooper, J. A., Verschuren, W. M. M., Blokstra, A., Shea, S., Doring, A., Meisinger, C., Bueno-de-Mesquita, H. B., Kuller, L. H., Grandits, G., Gillum, R. F., Mussolino, M., Bauer, K. A., Kirkland, S., Shaffer, J., Korin, M. R., Sato, S., Amouyel, P., Arveiler, D., Evans, A., Ferrieres, J., Schulte, H., Assmann, G., Westendorp, R. G., Buckley, B. M., Packard, C. J., Sattar, N., Cantin, B., Despres, J. -P., Dagenais, G. R., Barrett-Connor, E., Wingard, D. L., Bettencourt, R., Gudnason, V., Aspelund, T., Sigurdsson, G., Thorsson, B., Witteman, J., Kardys, I., Tiemeier, H., Hofman, A., Tunstall-Pedoe, H., Tavendale, R., Lowe, G. D. O., Howard, B. V., Zhang, Y., Best, L., Umans, J., Ben-Shlomo, Y., Davey-Smith, G., Njolstad, I., Wilsgaard, T., Ingelsson, E., Lind, L., Giedraitis, V., Lannfelt, L., Gaziano, J. M., Stampfer, M., Ridker, P., Wassertheil-Smoller, S., Manson, J. E., Marmot, M., Clarke, R., Fletcher, A., Brunner, E., Shipley, M., Buring, J., Shepherd, J., Cobbe, S. M., Ford, I., Robertson, M., Marin Ibanez, A., Feskens, E. J. M., Kromhout, D., Interne Geneeskunde, and RS: CARIM School for Cardiovascular Diseases

Subjects
Nutrition and Disease, Epidemiology, Cost effectiveness, Cost-Benefit Analysis, cardiovascular-disease, Kaplan-Meier Estimate, 01 natural sciences, Health informatics, 010104 statistics & probability, 0302 clinical medicine, cardiovascular disease, Voeding en Ziekte, Econometrics, Medicine, 030212 general & internal medicine, Research Articles, competing risks, validation, Framingham Risk Score, Cost–benefit analysis, coronary heart-disease, Discriminant Analysis, cohort, Prognosis, 3. Good health, Cardiovascular Diseases, Meta-analysis, Risk assessment, metaanalysis, Statistics and Probability, reclassification, Context (language use), risk score, Risk Assessment, screening strategies, statins, 03 medical and health sciences, Meta-Analysis as Topic, Humans, 0101 mathematics, cost-effectiveness, Proportional Hazards Models, VLAG, business.industry, Proportional hazards model, Cardiovascular disease, Competing risks, Cost-effectiveness, Net benefit, Screening strategies, Epidemiologic Research Design, predictive ability, R1, meta-analysis, roc curve, business, net benefit
Abstract

New prognostic models are traditionally evaluated using measures of discrimination and risk reclassification, but these do not take full account of the clinical and health economic context. We propose a framework for comparing prognostic models by quantifying the public health impact (net benefit) of the treatment decisions they support, assuming a set of predetermined clinical treatment guidelines. The change in net benefit is more clinically interpretable than changes in traditional measures and can be used in full health economic evaluations of prognostic models used for screening and allocating risk reduction interventions. We extend previous work in this area by quantifying net benefits in life years, thus linking prognostic performance to health economic measures; by taking full account of the occurrence of events over time; and by considering estimation and cross-validation in a multiple-study setting. The method is illustrated in the context of cardiovascular disease risk prediction using an individual participant data meta-analysis. We estimate the number of cardiovascular-disease-free life years gained when statin treatment is allocated based on a risk prediction model with five established risk factors instead of a model with just age, gender and region. We explore methodological issues associated with the multistudy design and show that cost-effectiveness comparisons based on the proposed methodology are robust against a range of modelling assumptions, including adjusting for competing risks. Copyright © 2011 John Wiley & Sons, Ltd.

Published
2012
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253. Independent Associations of Glucose Status and Arterial Stiffness With Left Ventricular Diastolic Dysfunction An 8-year follow-up of the Hoorn Study

Author

van den Hurk, K., Alssema, M., Kamp, O., Henry, R. M., Stehouwer, C. D., Smulders, Y. M., Nijpels, G., Paulus, W. J., Dekker, J. M., Epidemiology and Data Science, Cardiology, Internal medicine, General practice, Physiology, ICaR - Heartfailure and pulmonary arterial hypertension, and EMGO - Lifestyle, overweight and diabetes

Published
2012
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254. Lower verbal intelligence is associated with diabetic complications and slower walking speed in people with Type 2 diabetes: the Maastricht Study

Author

Spauwen, P. J. J., primary, Martens, R. J. H., additional, Stehouwer, C. D. A., additional, Verhey, F. R. J., additional, Schram, M. T., additional, Sep, S. J. S., additional, van der Kallen, C. J. H., additional, Dagnelie, P. C., additional, Henry, R. M. A., additional, Schaper, N. C., additional, and van Boxtel, M. P. J., additional

Published
2016
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255. 6-Year Changes in Glucose Tolerance, Assessed by Duplicate Oral Glucose Tolerance Tests. The Hoorn Study

Author

NIJPELS, G., DEKKER, J. M., STEHOUWER, C. D. A., BOUTER, L. M., and HEINE, R. J.

Subjects
Diagnosis, Analysis, Prevalence studies (Epidemiology) -- Analysis, Glucose tolerance test -- Analysis, Type 2 diabetes -- Diagnosis, Glucose tolerance tests -- Analysis
Abstract

The aims of the present study were to investigate the six-year changes in glucose tolerance, assessed by duplicate oral glucose tolerance tests (OGTT) in the general population and to identify [...]

Published
2000

256. Plasma levels of matrix metalloproteinase-2, -3, -10, and tissue inhibitor of metalloproteinase-1 are associated with vascular complications in patients with type 1 diabetes: The EURODIAB Prospective Complications Study

Author

Peeters, S. A., Engelen, L., Buijs, J., Chaturvedi, N., Fuller, J. H., Schalkwijk, C. G., Stehouwer, C. D., Karamanos, B., Kofinis, A., Petrou, K., Giorgino, F., Picca, G., Angarano, A., De, Pergola. G., Laviola, L., Giorgino, R., Ionescu-Tirgoviste, C., Coszma, A., Guja, C., Songini, M., Casu, A., Pedron, M., Pintus, S., Fossarello, M., Ferriss, J. B., Grealy, G., O'Keefe, D., Toeller, M., Arden, C., Rottiers, R., Tuyttens, C., Priem, H., Ebeling, P., Kylliainen, M., Koivisto, V. A., Idzior-Walus, B., Sieradzki, J., Cyganek, K., Solnica, B., Lemkes, H. H. P. J., Lemkes-Stuffken, J. C., Nunes-Correa, J., Rogado, M. C., Gardete-Correia, L., Cardoso, M. C., Silva, A., Boavida, J., Machado Sa Marques, M., Michel, G., Wirion, R., Cardillo, S., Pozza, G., Mangili, R., Asnaghi, V., Standl, E., Schaffler, B., Brand, H., Harms, A., Ben Soussan, M., Verier-Mine, O., Fallas, P., Fallas, M. C., Holloway, J., Asbury, L., Betteridge, D. J., Cathelineau, G., Bouallouche, A., Villatte Cathelineau, B., Santeusanio, F., Rosi, G., D'Alessandro, V., Cagini, C., Bottini, P., Reboldi, G. P., Navalesi, R., Penno, G., Bandinelli, S., Miccoli, R., Nannipieri, M., Ghirlanda, G., Saponara, C., Cotroneo, P., Manto, Andrea, Minnella, Angelo Maria, Ward, J. D., Tesfaye, S., Eaton, S., Mody, C., Borra, M., Cavallo Perin, P., Giunti, S., Grassi, G., Pagano, G. F., Porta, M., Sivieri, R., Vitelli, F., Veglio, M., Papazoglou, N., Manes, G., Muggeo, M., Iagulli, M., Cacciatori, V., Cattedra di Malattie del Metabolismo, V., Irsigler, K., Abrahamian, H., Walford, S., Sinclair, J., Hughes, S., Mclelland, V., Ward, J., Roglic, G., Metelko, Z., Pepeonik, Z. R., Manto A., Minnella A. (ORCID:0000-0001-5896-5313), Peeters, S. A., Engelen, L., Buijs, J., Chaturvedi, N., Fuller, J. H., Schalkwijk, C. G., Stehouwer, C. D., Karamanos, B., Kofinis, A., Petrou, K., Giorgino, F., Picca, G., Angarano, A., De, Pergola. G., Laviola, L., Giorgino, R., Ionescu-Tirgoviste, C., Coszma, A., Guja, C., Songini, M., Casu, A., Pedron, M., Pintus, S., Fossarello, M., Ferriss, J. B., Grealy, G., O'Keefe, D., Toeller, M., Arden, C., Rottiers, R., Tuyttens, C., Priem, H., Ebeling, P., Kylliainen, M., Koivisto, V. A., Idzior-Walus, B., Sieradzki, J., Cyganek, K., Solnica, B., Lemkes, H. H. P. J., Lemkes-Stuffken, J. C., Nunes-Correa, J., Rogado, M. C., Gardete-Correia, L., Cardoso, M. C., Silva, A., Boavida, J., Machado Sa Marques, M., Michel, G., Wirion, R., Cardillo, S., Pozza, G., Mangili, R., Asnaghi, V., Standl, E., Schaffler, B., Brand, H., Harms, A., Ben Soussan, M., Verier-Mine, O., Fallas, P., Fallas, M. C., Holloway, J., Asbury, L., Betteridge, D. J., Cathelineau, G., Bouallouche, A., Villatte Cathelineau, B., Santeusanio, F., Rosi, G., D'Alessandro, V., Cagini, C., Bottini, P., Reboldi, G. P., Navalesi, R., Penno, G., Bandinelli, S., Miccoli, R., Nannipieri, M., Ghirlanda, G., Saponara, C., Cotroneo, P., Manto, Andrea, Minnella, Angelo Maria, Ward, J. D., Tesfaye, S., Eaton, S., Mody, C., Borra, M., Cavallo Perin, P., Giunti, S., Grassi, G., Pagano, G. F., Porta, M., Sivieri, R., Vitelli, F., Veglio, M., Papazoglou, N., Manes, G., Muggeo, M., Iagulli, M., Cacciatori, V., Cattedra di Malattie del Metabolismo, V., Irsigler, K., Abrahamian, H., Walford, S., Sinclair, J., Hughes, S., Mclelland, V., Ward, J., Roglic, G., Metelko, Z., Pepeonik, Z. R., Manto A., and Minnella A. (ORCID:0000-0001-5896-5313)

Published
2015

257. Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity in Europeans

Author

Song, X., Jousilahti, P., Stehouwer, C. D. A., Söderberg, Stefan, Onat, A., Laatikainen, T., Yudkin, J. S., Dankner, R., Morris, R., Tuomilehto, J., Qiao, Q., Song, X., Jousilahti, P., Stehouwer, C. D. A., Söderberg, Stefan, Onat, A., Laatikainen, T., Yudkin, J. S., Dankner, R., Morris, R., Tuomilehto, J., and Qiao, Q.

Abstract

Background and aims: Cardiovascular and all-cause mortality in relation to various anthropometric measures of obesity is still controversial. Methods and results: Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR) were measured at baseline in a cohort of 46,651 European men and women aged 24-99 years. The relationship between anthropometric measures of obesity and mortality was evaluated by the Cox proportional hazards model with age as a time-scale and with threshold detected by a piecewise regression model. Over a median follow-up of 7.9 years, 2381 men and 1055 women died, 1071 men (45.0%) and 339 women (32.1%) from cardiovascular disease (CVD). BMI had a J-shaped relationship with CVD mortality, whereas anthropometric measures of abdominal obesity had positive linear relationships. BMI, WC and WHtR showed J-shaped associations with all-cause mortality, whereas WHR, ABSI and WHHR demonstrated positive linear relationships. Accordingly, a threshold value was detected at 29.29 and 30.98 kg/m(2) for BMI, 96.4 and 93.3 cm for WC, 0.57 and 0.60 for WHtR, 0.0848 and 0.0813 m(11/6) kg(-2/3) for ABSI with CVD mortality in men and women, respectively; 29.88 and 29.50 kg/m(2) for BMI, 104.3 and 105.6 for WC, 0.61 and 0.67 for WHtR, 0.95 and 0.86 for WHR, 0.0807 and 0.0765 for ABSI in men and women, respectively, and 0.52 for WHHR in women with all-cause mortality. Conclusion: All anthropometric measures of abdominal obesity had positive linear associations with CVD mortality, whereas some showed linear and the others J-shaped relationships with all-cause mortality. BMI had a J-shaped relationship with either CVD or all-cause mortality. Thresholds detected based on mortality may help with clinical definition of obesity in relation to mortality.

Published
2015
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258. Covariate-adjusted measures of discrimination for survival data

Author

White, Ian R., Rapsomaniki, Eleni, Wannamethee, S. G., Morris, R. W., Willeit, J., Willeit, P., Santer, P., Kiechl, S., Wald, N., Ebrahim, S., Lawlor, D. A., Gallacher, J., Yarnell, J. W G, Ben-Shlomo, Y., Casiglia, E., Tikhonoff, V., Sutherland, S. E., Nietert, P. J., Keil, J. E., Bachman, D. L., Psaty, B. M., Cushman, M., Nordestgaard, B. G., Tybjærg-Hansen, A., Frikke-Schmidt, R., Giampaoli, S., Palmieri, L., Panico, S., Pilotto, L., Vanuzzo, D., Simons, L. A., Friedlander, Y., McCallum, J., Price, J. F., McLachlan, S., Taylor, J. O., Guralnik, J. M., Wallace, R. B., Kohout, F. J., Cornoni-Huntley, J. C., Blazer, D. G., Phillips, C. L., Wareham, N. J., Khaw, K. T., Brenner, H., Schöttker, B., Müller, H. T., Rothenbacher, D., Nissinen, A., Donfrancesco, C., Harald, K., Jousilahti, P. R., Vartiainen, E., Salomaa, V., D'Agostino, R. B., Wolf, P. A., Vasan, R. S., Daimon, M., Oizumi, T., Kayama, T., Kato, T., Chetrit, A., Dankner, R., Lubin, F., Welin, L., Svärdsudd, K., Eriksson, H., Lappas, G., Lissner, L., Mehlig, K., Björkelund, C., Nagel, D., Kiyohara, Y., Arima, H., Ninomiya, T., Hata, J., Rodriguez, B., Dekker, J. M., Nijpels, G., Stehouwer, C. D A, Iso, H., Kitamura, A., Yamagishi, K., Noda, H., Goldbourt, U., Kauhanen, J., Salonen, J. T., Tuomainen, T. P., Meade, T. W., DeStavola, B. L., Blokstra, A., Verschuren, W. M M, de Boer, I. H., Folsom, A. R., Koenig, W., Meisinger, C., Peters, A., Bueno-de-Mesquita, H. B., Rosengren, A., Wilhelmsen, L., Kuller, L. H., Grandits, G., Cooper, J. A., Bauer, K. A., Davidson, K. W., Kirkland, S., Shaffer, J. A., Shimbo, D., Sato, S., Dullaart, R. P F, Bakker, S. J L, Gansevoort, R. T., Ducimetiere, P., Amouyel, P., Arveiler, D., Evans, A., Ferrières, J., Schulte, H., Assmann, G., Jukema, J. W., Westendorp, R. G J, Sattar, N., Cantin, B., Lamarche, B., Després, J. P., E.Barrett-Connor, Wingard, D. L., Daniels, L. B., Gudnason, V., Aspelund, T., Trevisan, M., Hofman, A., Franco, O. H., Tunstall-Pedoe, H., Tavendale, R., Lowe, G. D O, Woodward, M., Howard, W. J., Howard, B. V., Zhang, Y., Best, L. G., Umans, J., Davey-Smith, G., Onat, A., Nakagawa, H., Sakurai, M., Nakamura, K., Morikawa, Y., Njølstad, I., Mathiesen, E. B., Wilsgaard, T., Sundström, J., Gaziano, J. M., Ridker, P. M., Marmot, M., Clarke, R., Collins, R., Fletcher, A., Brunner, E., Shipley, M., Kivimaki, M., Buring, J., Rifai, N., Cook, N., Ford, I., Robertson, M., Marín Ibañez, A., Feskens, E. J M, Geleijnse, J. M., White, Ian R., Rapsomaniki, Eleni, Wannamethee, S. G., Morris, R. W., Willeit, J., Willeit, P., Santer, P., Kiechl, S., Wald, N., Ebrahim, S., Lawlor, D. A., Gallacher, J., Yarnell, J. W G, Ben-Shlomo, Y., Casiglia, E., Tikhonoff, V., Sutherland, S. E., Nietert, P. J., Keil, J. E., Bachman, D. L., Psaty, B. M., Cushman, M., Nordestgaard, B. G., Tybjærg-Hansen, A., Frikke-Schmidt, R., Giampaoli, S., Palmieri, L., Panico, S., Pilotto, L., Vanuzzo, D., Simons, L. A., Friedlander, Y., McCallum, J., Price, J. F., McLachlan, S., Taylor, J. O., Guralnik, J. M., Wallace, R. B., Kohout, F. J., Cornoni-Huntley, J. C., Blazer, D. G., Phillips, C. L., Wareham, N. J., Khaw, K. T., Brenner, H., Schöttker, B., Müller, H. T., Rothenbacher, D., Nissinen, A., Donfrancesco, C., Harald, K., Jousilahti, P. R., Vartiainen, E., Salomaa, V., D'Agostino, R. B., Wolf, P. A., Vasan, R. S., Daimon, M., Oizumi, T., Kayama, T., Kato, T., Chetrit, A., Dankner, R., Lubin, F., Welin, L., Svärdsudd, K., Eriksson, H., Lappas, G., Lissner, L., Mehlig, K., Björkelund, C., Nagel, D., Kiyohara, Y., Arima, H., Ninomiya, T., Hata, J., Rodriguez, B., Dekker, J. M., Nijpels, G., Stehouwer, C. D A, Iso, H., Kitamura, A., Yamagishi, K., Noda, H., Goldbourt, U., Kauhanen, J., Salonen, J. T., Tuomainen, T. P., Meade, T. W., DeStavola, B. L., Blokstra, A., Verschuren, W. M M, de Boer, I. H., Folsom, A. R., Koenig, W., Meisinger, C., Peters, A., Bueno-de-Mesquita, H. B., Rosengren, A., Wilhelmsen, L., Kuller, L. H., Grandits, G., Cooper, J. A., Bauer, K. A., Davidson, K. W., Kirkland, S., Shaffer, J. A., Shimbo, D., Sato, S., Dullaart, R. P F, Bakker, S. J L, Gansevoort, R. T., Ducimetiere, P., Amouyel, P., Arveiler, D., Evans, A., Ferrières, J., Schulte, H., Assmann, G., Jukema, J. W., Westendorp, R. G J, Sattar, N., Cantin, B., Lamarche, B., Després, J. P., E.Barrett-Connor, Wingard, D. L., Daniels, L. B., Gudnason, V., Aspelund, T., Trevisan, M., Hofman, A., Franco, O. H., Tunstall-Pedoe, H., Tavendale, R., Lowe, G. D O, Woodward, M., Howard, W. J., Howard, B. V., Zhang, Y., Best, L. G., Umans, J., Davey-Smith, G., Onat, A., Nakagawa, H., Sakurai, M., Nakamura, K., Morikawa, Y., Njølstad, I., Mathiesen, E. B., Wilsgaard, T., Sundström, J., Gaziano, J. M., Ridker, P. M., Marmot, M., Clarke, R., Collins, R., Fletcher, A., Brunner, E., Shipley, M., Kivimaki, M., Buring, J., Rifai, N., Cook, N., Ford, I., Robertson, M., Marín Ibañez, A., Feskens, E. J M, and Geleijnse, J. M.

Published
2015

259. Covariate-adjusted measures of discrimination for survival data

Author

AIOS Psychiatrie, Public Health Epidemiologie, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS MDL 1, Cancer, Affectieve & Psychotische Med., White, Ian R., Rapsomaniki, Eleni, Wannamethee, S. G., Morris, R. W., Willeit, J., Willeit, P., Santer, P., Kiechl, S., Wald, N., Ebrahim, S., Lawlor, D. A., Gallacher, J., Yarnell, J. W G, Ben-Shlomo, Y., Casiglia, E., Tikhonoff, V., Sutherland, S. E., Nietert, P. J., Keil, J. E., Bachman, D. L., Psaty, B. M., Cushman, M., Nordestgaard, B. G., Tybjærg-Hansen, A., Frikke-Schmidt, R., Giampaoli, S., Palmieri, L., Panico, S., Pilotto, L., Vanuzzo, D., Simons, L. A., Friedlander, Y., McCallum, J., Price, J. F., McLachlan, S., Taylor, J. O., Guralnik, J. M., Wallace, R. B., Kohout, F. J., Cornoni-Huntley, J. C., Blazer, D. G., Phillips, C. L., Wareham, N. J., Khaw, K. T., Brenner, H., Schöttker, B., Müller, H. T., Rothenbacher, D., Nissinen, A., Donfrancesco, C., Harald, K., Jousilahti, P. R., Vartiainen, E., Salomaa, V., D'Agostino, R. B., Wolf, P. A., Vasan, R. S., Daimon, M., Oizumi, T., Kayama, T., Kato, T., Chetrit, A., Dankner, R., Lubin, F., Welin, L., Svärdsudd, K., Eriksson, H., Lappas, G., Lissner, L., Mehlig, K., Björkelund, C., Nagel, D., Kiyohara, Y., Arima, H., Ninomiya, T., Hata, J., Rodriguez, B., Dekker, J. M., Nijpels, G., Stehouwer, C. D A, Iso, H., Kitamura, A., Yamagishi, K., Noda, H., Goldbourt, U., Kauhanen, J., Salonen, J. T., Tuomainen, T. P., Meade, T. W., DeStavola, B. L., Blokstra, A., Verschuren, W. M M, de Boer, I. H., Folsom, A. R., Koenig, W., Meisinger, C., Peters, A., Bueno-de-Mesquita, H. B., Rosengren, A., Wilhelmsen, L., Kuller, L. H., Grandits, G., Cooper, J. A., Bauer, K. A., Davidson, K. W., Kirkland, S., Shaffer, J. A., Shimbo, D., Sato, S., Dullaart, R. P F, Bakker, S. J L, Gansevoort, R. T., Ducimetiere, P., Amouyel, P., Arveiler, D., Evans, A., Ferrières, J., Schulte, H., Assmann, G., Jukema, J. W., Westendorp, R. G J, Sattar, N., Cantin, B., Lamarche, B., Després, J. P., E.Barrett-Connor, Wingard, D. L., Daniels, L. B., Gudnason, V., Aspelund, T., Trevisan, M., Hofman, A., Franco, O. H., Tunstall-Pedoe, H., Tavendale, R., Lowe, G. D O, Woodward, M., Howard, W. J., Howard, B. V., Zhang, Y., Best, L. G., Umans, J., Davey-Smith, G., Onat, A., Nakagawa, H., Sakurai, M., Nakamura, K., Morikawa, Y., Njølstad, I., Mathiesen, E. B., Wilsgaard, T., Sundström, J., Gaziano, J. M., Ridker, P. M., Marmot, M., Clarke, R., Collins, R., Fletcher, A., Brunner, E., Shipley, M., Kivimaki, M., Buring, J., Rifai, N., Cook, N., Ford, I., Robertson, M., Marín Ibañez, A., Feskens, E. J M, Geleijnse, J. M., AIOS Psychiatrie, Public Health Epidemiologie, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS MDL 1, Cancer, Affectieve & Psychotische Med., White, Ian R., Rapsomaniki, Eleni, Wannamethee, S. G., Morris, R. W., Willeit, J., Willeit, P., Santer, P., Kiechl, S., Wald, N., Ebrahim, S., Lawlor, D. A., Gallacher, J., Yarnell, J. W G, Ben-Shlomo, Y., Casiglia, E., Tikhonoff, V., Sutherland, S. E., Nietert, P. J., Keil, J. E., Bachman, D. L., Psaty, B. M., Cushman, M., Nordestgaard, B. G., Tybjærg-Hansen, A., Frikke-Schmidt, R., Giampaoli, S., Palmieri, L., Panico, S., Pilotto, L., Vanuzzo, D., Simons, L. A., Friedlander, Y., McCallum, J., Price, J. F., McLachlan, S., Taylor, J. O., Guralnik, J. M., Wallace, R. B., Kohout, F. J., Cornoni-Huntley, J. C., Blazer, D. G., Phillips, C. L., Wareham, N. J., Khaw, K. T., Brenner, H., Schöttker, B., Müller, H. T., Rothenbacher, D., Nissinen, A., Donfrancesco, C., Harald, K., Jousilahti, P. R., Vartiainen, E., Salomaa, V., D'Agostino, R. B., Wolf, P. A., Vasan, R. S., Daimon, M., Oizumi, T., Kayama, T., Kato, T., Chetrit, A., Dankner, R., Lubin, F., Welin, L., Svärdsudd, K., Eriksson, H., Lappas, G., Lissner, L., Mehlig, K., Björkelund, C., Nagel, D., Kiyohara, Y., Arima, H., Ninomiya, T., Hata, J., Rodriguez, B., Dekker, J. M., Nijpels, G., Stehouwer, C. D A, Iso, H., Kitamura, A., Yamagishi, K., Noda, H., Goldbourt, U., Kauhanen, J., Salonen, J. T., Tuomainen, T. P., Meade, T. W., DeStavola, B. L., Blokstra, A., Verschuren, W. M M, de Boer, I. H., Folsom, A. R., Koenig, W., Meisinger, C., Peters, A., Bueno-de-Mesquita, H. B., Rosengren, A., Wilhelmsen, L., Kuller, L. H., Grandits, G., Cooper, J. A., Bauer, K. A., Davidson, K. W., Kirkland, S., Shaffer, J. A., Shimbo, D., Sato, S., Dullaart, R. P F, Bakker, S. J L, Gansevoort, R. T., Ducimetiere, P., Amouyel, P., Arveiler, D., Evans, A., Ferrières, J., Schulte, H., Assmann, G., Jukema, J. W., Westendorp, R. G J, Sattar, N., Cantin, B., Lamarche, B., Després, J. P., E.Barrett-Connor, Wingard, D. L., Daniels, L. B., Gudnason, V., Aspelund, T., Trevisan, M., Hofman, A., Franco, O. H., Tunstall-Pedoe, H., Tavendale, R., Lowe, G. D O, Woodward, M., Howard, W. J., Howard, B. V., Zhang, Y., Best, L. G., Umans, J., Davey-Smith, G., Onat, A., Nakagawa, H., Sakurai, M., Nakamura, K., Morikawa, Y., Njølstad, I., Mathiesen, E. B., Wilsgaard, T., Sundström, J., Gaziano, J. M., Ridker, P. M., Marmot, M., Clarke, R., Collins, R., Fletcher, A., Brunner, E., Shipley, M., Kivimaki, M., Buring, J., Rifai, N., Cook, N., Ford, I., Robertson, M., Marín Ibañez, A., Feskens, E. J M, and Geleijnse, J. M.

Published
2015

260. Should patients prescribed long-term low-dose aspirin receive proton pump inhibitors? A systematic review and meta-analysis

Author

Epidemiology & Health Economics, Julius Centrum, Brain, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Circulatory Health, Tran-Duy, A., Vanmolkot, F. H., Joore, M. A., Hoes, A. W., Stehouwer, C. D. A., Epidemiology & Health Economics, Julius Centrum, Brain, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Circulatory Health, Tran-Duy, A., Vanmolkot, F. H., Joore, M. A., Hoes, A. W., and Stehouwer, C. D. A.

Published
2015

262. 4D.01

Author

Londono, F., primary, Bossuyt, J., additional, Engelen, L., additional, Stehouwer, C., additional, Ferreira, I., additional, Laurent, S., additional, Boutouyrie, P., additional, Segers, P., additional, and Van Bortel, L., additional

Published
2015
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263. Hemato-oncologie (hfdstk 9)

Author

Huijgens, P. C., Zweegman, S., Hagenbeek, A., Stehouwer, C. D. A., Koopmans, R. P., Meer, J., Cancer Center Amsterdam, and Clinical Haematology

Published
2010

264. Reumatische ziekten

Author

van de Laar, M. A. F. J., Vonkeman, Harald E., Tak, P. P., Stehouwer, C. D. A., Koopmans, R. P., Meer, J., Amsterdam institute for Infection and Immunity, and Clinical Immunology and Rheumatology

Published
2010

265. Research update for articles published in EJCI in 2008

Author

Anderwald, C., Ankersmit, H. J., Badaoui, A., Beneduce, L., Buko, V. U., Calo, L. A., Carrero, J. J., Chang, C. Y., Chang, K. C., Chen, Y. J., Cnotliwy, M., Costelli, Paola, Crujeiras, A. B., Cuocolo, A., Davis, P. A., de Boer, O. J., Ebenbichler, C. F., Erridge, C., Fassina, G., Felix, S. B., García Gómez, M. C., Guerrero Romero, F., Haider, D. G., Heinemann, A., Herda, L. R., Hoogeveen, E. K., Hörl, W. H., Iglseder, B., Huang, K. C., Kaser, S., Kastrati, A., Kuzniatsova, N., Latella, G., Lichtenauer, M., Lin, Y. K., Lip, G. Y., N. H., Lu, Lukivskaya, O., Luschnig, P., Maniscalco, M., Martinez, J. A., Müller Krebs, S., Ndrepepa, G., Nicolaou, G., Peck Radosavljevic, M., Penna, Fabio, Pintó, X., Reiberger, T., Rodriguez Moran, M., Schmidt, A., Schwenger, V., Spinelli, L., Starkel, P., Stehouwer, C. D., Stenvinkel, P., Strasser, P., Suzuki, H., Tschoner, A., van der Wal, A. C., Vesely, D. L., Wen, C. J., Wiernicki, I., Zanninelli, G., Zhu, Y., Interne Geneeskunde, MUMC+: MA Interne Geneeskunde (3), RS: CARIM School for Cardiovascular Diseases, Anderwald, C, Ankersmit, Hj, Badaoui, A, Beneduce, L, Buko, Vu, Calo, La, Carrero, Jj, Chang, C, Chang, K, Chen, Y, Cnotliwy, M, Costelli, P, Crujeiras, Ab, Cuocolo, Alberto, Davis, Pa, De Boer, Oj, Ebenbichler, Cf, Erridge, C, Fassina, G, Felix, Sb, García Gómez, Mc, Guerrero Romero, F, Haider, Dg, Heinemann, A, Herda, Lr, Hoogeveen, Ek, Hörl, Wh, Iglseder, B, Huang, K, Kaser, S, Kastrati, A, Kuzniatsova, N, Latella, G, Lichtenauer, M, Lin, Y, Lip, Gyh, Lu, N, Lukivskaya, O, Luschnig, P, Maniscalco, M, Martinez, Ja, Müller Krebs, S, Ndrepepa, G, Nicolaou, G, Peck Radosavljevic, M, Penna, F, Pintó, X, Reiberger, T, Rodriguez Moran, M, Schmidt, A, Schwenger, V, Spinelli, Letizia, Starkel, P, Stehouwer, Cda, Stenvinkel, P, Strasser, P, Suzuki, H, Tschoner, A, Van Der Wal, Ac, Vesely, Dl, Wen, C, Wiernicki, I, Zanninelli, G, and Zhu, Y.

Abstract

Eur J Clin Invest 2010; 40 (9): 770-789.

Published
2010

266. Hematologie (hoofdstuk 8)

Author

Oers, Marinus H. J. van, Stehouwer, C. D. A., Koopmans, R. P., Meer, J., Amsterdam institute for Infection and Immunity, Cancer Center Amsterdam, and Clinical Haematology

Published
2010

268. Deteriorating glucose tolerance status is associated with left ventricular dysfunction - the Hoorn Study

Author

Henry, R. M. A., Paulus, W. J., Kamp, O., Kostense, P. J., Spijkerman, A. M. W., Dekker, J. M., Nijpels, G., Heine, R. J., Lex Bouter, Stehouwer, C. D. A., Epidemiology and Data Science, Physiology, Cardiology, Internal medicine, ICaR - Heartfailure and pulmonary arterial hypertension, EMGO - Lifestyle, overweight and diabetes, and Executive board Vrije Universiteit

Subjects
SDG 3 - Good Health and Well-being, Echocardiography, Diabetes, Cardiovascular disease
Abstract

Background: Type 2 diabetes (DM2) is associated with a greater risk of heart failure. The mechanisms underlying this association remain controversial and include diabetes-associated hypertension and obesity, impaired small and large artery function, and a distinct metabolic cardiomyopathy related to hyperglycaemia/hyperinsulinaemia. The proximate causes of heart failure are left ventricular (LV) systolic dysfunction (SDF) and diastolic dysfunction (DDF). We investigated, in a population-based cohort (n=746), the association between glucose tolerance status and SDF and DDF. Methods and results: The study population consisted of 274 individuals with normal glucose metabolism (NGM), 174 with impaired glucose metabolism (IGM) and 298 with DM2 (mean age 68.5 years). All participants underwent an LV echocardiogram. SDF was defined as ejection fraction pv and Amv duration (≥41 ms), and left atrial volume (≥57 ml), where cut-off values were based upon the 90th percentile in NGM. In addition, we analysed the ratio of early to late diastolic filling (E/A ratio) on a continuous scale using linear regression analyses. The age- and sex-standardised prevalences in NGM, IGM and DM2 were 13, 14 and 30% for SDF, and 26, 36 and 47% for DDF (P(trend) for both

Published
2008

271. Is higher dairy consumption associated with lower weight and less metabolic disturbances?

Author

Snijder, M. B., Heijden, A. A. W. A., Dam, R. M., Stehouwer, C. D. A., Hiddink, G. J., Nijpels, M. G. A. A. M., Heine, R. J., Lex Bouter, Dekker, J. M., Nutrition and Health, Sociology and Social Gerontology, EMGO+ - Lifestyle, Overweight and Diabetes, EMGO+ - Quality of Care, and EMGO+ - Mental Health

Subjects
SDG 3 - Good Health and Well-being
Published
2007

273. Individual and partner's level of occupation and the association with HbA1c levels in people with Type 2 diabetes mellitus: the Dutch Diabetes Pearl cohort.

Author

Rutte, A., Rauh, S. P., Schram, M. T., Nijpels, G., DeVries, J. H., Holleman, F., Pijl, H., Dekkers, O. M., Özcan, B., Sijbrands, E. J. G., Tack, C. J., Abbink, E. J., Valk, H. W., Silvius, B., Wolffenbuttel, B. H. R., Stehouwer, C. D. A., Schaper, N. C., Dekker, J. M., Beulens, J. W., and Elders, P. J. M.

Subjects
EMPLOYMENT, GLYCOSYLATED hemoglobin, LONGITUDINAL method, TYPE 2 diabetes, REGRESSION analysis, SOCIOECONOMIC factors, CROSS-sectional method
Abstract

Aims Individual indicators of socio-economic status have been associated with glycaemic control in people with Type 2 diabetes, but little is known about the association between partner's socio-economic status and HbA1c levels. We therefore examined the cross-sectional association between individual and partner's level of occupation on HbA1c levels in people with Type 2 diabetes in the Netherlands. Methods We included people with Type 2 diabetes with a partner who were treated in primary, secondary and tertiary care in the Diabetes Pearl cohort. Occupational level was classified according to International Standard Classification of Occupations ( ISCO)-08 skill levels. Linear regression analyses were performed stratified for sex, and corrected for age, recruitment centre and diabetes medication. Results In total, 3257 participants (59.8% men, mean 62.2±9.4 years) were included. For men, having a partner with an intermediate level of occupation was associated with lower HbA1c levels [e.g. ISCO level 3: -2 mmol/mol (95% CI -4;-1) or -0.2% (95% CI -0.4;-0.1)], compared with having a partner of the highest occupational level ( ISCO level 4). In women, having an unemployed partner was associated with higher HbA1c levels [14 mmol/mol (95% CI 6; 22) or 1.3% (95% CI 0.6; 2.0)], compared with having a partner of the highest occupational level. Conclusions Partner's occupational status provided additional information on the association between socio-economic status and HbA1c levels in people with Type 2 diabetes. Women seemed to benefit from a partner with a higher occupational status, while men seemed to benefit from a partner with a lower status. Because of the cross-sectional nature of the present study, more research is necessary to explore this association. [ABSTRACT FROM AUTHOR]

Published
2017
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274. Low vitamin D levels are not a contributing factor to higher prevalence of depressive symptoms in people with Type 2 diabetes mellitus: the Hoorn study.

Author

Westra, S., Simsek, S., Rutters, F., Krul‐Poel, Y. M. H., Stehouwer, C. D. A., Dekker, J. M., and Pouwer, F.

Subjects
MENTAL depression risk factors, COHORT analysis, CONFIDENCE intervals, GLUCOSE tolerance tests, MULTIVARIATE analysis, TYPE 2 diabetes, RESEARCH funding, SELF-evaluation, VITAMIN D, COMORBIDITY, LOGISTIC regression analysis, CROSS-sectional method, GLUCOSE intolerance, DATA analysis software, ODDS ratio
Abstract

Aim To test whether a low serum 25-hydroxyvitamin D level explains the greater prevalence of depression among people with Type 2 diabetes. Methods We performed a cross-sectional analysis of 527 people, aged 60-87 years, who participated in a population-based cohort study. Type 2 diabetes, impaired glucose tolerance, impaired fasting glucose and normal glucose tolerance were defined according to the 2006 WHO criteria. The Centre for Epidemiologic Studies Depression questionnaire was administered, using a cut-off score of ≥ 16 to determine clinically relevant depressive symptoms. Results Logistic regression analysis confirmed that women with impaired glucose tolerance/impaired fasting glucose and people with Type 2 diabetes did have a higher risk of depressive symptoms [unadjusted odds ratios 3.66 (95% CI 1.59 to 8.43) and 3.04 (95% CI 1.57 to 5.88), respectively], compared with people with normal glucose tolerance. Serum 25-hydroxyvitamin D level was not a mediating factor in the association between impaired glucose tolerance/impaired fasting glucose or Type 2 diabetes and depressive symptoms [unstandardized indirect effect 0.001 (95% CI −0.063 to 0.079) and 0.004 (95% CI −0.025 to 0.094), respectively]. Conclusions The study found no evidence that low vitamin D levels are a contributing factor to higher depression scores in people with Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Published
2017
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275. Global clinical performance rating, reliability and validity in an undergraduate clerkship

Author

Daelmans, H. E.M., van der Hem-Stokroos, H. H., Hoogenboom, R. J.I., Scherpbier, A. J.J.A., Stehouwer, C. D.A., van der Vleuten, C. P.M., and IOO

Subjects
education
Abstract

Background: Global performance rating is frequently used in clinical training despite its known psychometric drawbacks. Inter-rater reliability is low in undergraduate training but better in residency training, possibly because residency offers more opportunities for supervision. The low or moderate predictive validity of global performance ratings in undergraduate and residency training may be due to low or unknown reliability of both global performance ratings and criterion measures. In an undergraduate clerkship, we investigated whether reliability improves when raters are more familiar with students' work and whether validity improves with increased reliability of the predictor and criterion instrument. Methods: Inter-rater reliability was determined in a clerkship with more student-rater contacts than usual. The in-training assessment programme of the clerkship that immediately followed was used as the criterion measure to determine predictive validity. Results: With four ratings, inter-rater reliability was 0.41 and predictive validity was 0.32. Reliability was lower and validity slightly higher than similar results published for residency training. Conclusion: Even with increased student-rater interaction, the reliability and validity of global performance ratings were too low to warrant the usage of global performance ratings as individual assessment format. However, combined with other assessment measures, global performance ratings may lead to improved integral assessment.

Published
2005

277. Immunopathologie

Author

Hack, C. E., Hamann-Wenzlau, D., ten Berge, R. J. M., van der Meer, J., Stehouwer, C. D. A., Landsteiner Laboratory, Amsterdam institute for Infection and Immunity, Nephrology, and Clinical Immunology and Rheumatology

Published
2005

278. Oude en nieuwe scoresystemen voor het schatten van cardiovasculaire risico's:Beperkingen in de validiteit, de precisie en de homogeniteit van de risicocategorieën

Author

Smulders, Y. M., Spijkerman, A. M.W., Kostense, P. J., Bouter, L. M., and Stehouwer, C. D.A.

Subjects
SDG 3 - Good Health and Well-being
Abstract

Scoring systems for cardiovascular-risk assessment are increasingly being used to identify patients suitable for primary prevention measures. However, the quality of risk-score systems is threatened by (a) external invalidity, which can be partly compensated for by calibration of the score, (b) risk-score model imprecision, reflected by wide confidence intervals for the risk estimate, and (c) risk-category heterogeneity resulting from the random spread of known and unknown risk factors that are unaccounted for in the scoring system. The commonly used Framingham risk score is limited by imprecision and marked risk-category heterogeneity. The recently published SCORE risk model is probably more precise, but lacks homogenous risk categories. To prevent large scale undertreatment of patients at high cardiovascular risk, the commonly used risk threshold for initiating primary preventative treatment should be lowered.

Published
2004

279. No effect of folic acid on markers of endothelial dysfunction or inflammation in patients with type 2 diabetes mellitus and mild hyperhomocysteinaemia

Author

Spoelstra-de, Man A M E, Brouwer, C B, Terheggen, F, Bollen, J M, Stehouwer, C D A, Smulders, Y M, and Internal medicine

Abstract

BACKGROUND: Mild hyperhomocysteinaemia is a cardiovascular risk factor in patients with type 2 diabetes mellitus. Homocysteine may exert its detrimental effects through induction of endothelial dysfunction and/or chronic inflammation. In this study, we examined the effects of homocysteine-lowering therapy with folic acid on biochemical markers of endothelial dysfunction and low-grade inflammation in patients with type 2 diabetes mellitus and mild hyperhomocysteinaemia (> or = 14 micromol/l).METHODS: In a randomised, double-blind, controlled trial, patients were treated with folic acid 5 mg or placebo for six months. At 0 and 6 months, albuminuria, von Willebrand factor, soluble cellular adhesion molecules, C-reactive protein, interleukin-6 and tumour necrosis factor-alpha were determined.RESULTS: Forty-one patients completed the study (folic acid 23, placebo 18). Baseline hyperhomocysteinaemia (median 17 micromol/l, range 14 to 30 micromol/l) was reduced by 29% in the folic-acid-treated group, and remained unchanged in patients receiving placebo. On average, folic acid treatment did not significantly affect any of the endothelial (e.g. von Willebrand factor: difference folic acid minus placebo +1%, confidence interval -3 to +16%) or inflammation (e.g. C-reactive protein: difference folic acid minus placebo +13%, confidence interval -42 to +52%) markers studied. Multiple regression analyses without and with adjustment for baseline differences in cardiovascular disease and ethnicity confirmed these results. An apparent beneficial effect of folic acid on albuminuria in crude analysis was attenuated by multiple adjustment (difference folic acid minus placebo -35%, confidence interval -178 to +32%, p=0.08, adjusted 0.26).CONCLUSION: The data indicate that, in this group of patients with type 2 diabetes mellitus and mild hyperhomocysteinaemia, lowering homocysteine with folic acid for six months does not improve biochemical markers of endothelial dysfunction or low-grade inflammation.

Published
2004

280. Erratum

Author

Becker, A., Henry, R. M.A., Kostense, P. J., Jakobs, C., Teerlink, T., Zweegman, A., Dekker, J. M., Nijpels, G., Heine, R. J., Bouter, L. M., Smulders, Y. M., Stehouwer, C. D.A., and EMGO+

Published
2004
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281. Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events

Author

Fowkes, F. G. R., Murray, G. D., Butcher, I., Folsom, A. R., Hirsch, A. T., Couper, D. J., DeBacker, G., Kornitzer, M., Newman, A. B., Sutton-Tyrrell, K. C., Cushman, M., Lee, A. J., Price, J. F., D'Agostino, R. B., Sr., Murabito, J. M., Norman, P. E., Masaki, K. H., Bouter, L. M., Heine, R. J., Stehouwer, C. D. A., McDermott, M. M., Stoffers, H. E. J. H., Knottnerus, J. A., Ögren, Mats, Hedblad, B., Koenig, W., Meisinger, C., Cauley, J. A., Franco, O. H., Hunink, M. G. M., Hofman, A., Witteman, J. C., Criqui, M. H., Langer, R. D., Hiatt, W. R., Hamman, R. F., Fowkes, F. G. R., Murray, G. D., Butcher, I., Folsom, A. R., Hirsch, A. T., Couper, D. J., DeBacker, G., Kornitzer, M., Newman, A. B., Sutton-Tyrrell, K. C., Cushman, M., Lee, A. J., Price, J. F., D'Agostino, R. B., Sr., Murabito, J. M., Norman, P. E., Masaki, K. H., Bouter, L. M., Heine, R. J., Stehouwer, C. D. A., McDermott, M. M., Stoffers, H. E. J. H., Knottnerus, J. A., Ögren, Mats, Hedblad, B., Koenig, W., Meisinger, C., Cauley, J. A., Franco, O. H., Hunink, M. G. M., Hofman, A., Witteman, J. C., Criqui, M. H., Langer, R. D., Hiatt, W. R., and Hamman, R. F.

Published
2014
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283. Microvascular dysfunction as a link between obesity, insulin resistance and hypertension

Author

Karaca, U., Karaca, U., Schram, M. T., Houben, A. J. H. M., Muris, D. M. J., Stehouwer, C. D. A., Karaca, U., Karaca, U., Schram, M. T., Houben, A. J. H. M., Muris, D. M. J., and Stehouwer, C. D. A.

Abstract

Impaired microvascular dilatation from any cause and impaired insulin-mediated capillary recruitment in particular result in suboptimal delivery of glucose and insulin to skeletal muscle, and subsequently impairment of glucose disposal (insulin resistance). In addition, microvascular dysfunction, through functional and/or structural arteriolar and capillary drop-out, and arteriolar constriction, increases peripheral resistance and thus blood pressure. Microvascular dysfunction may thus constitute a pathway that links insulin resistance and hypertension. Overweight and obesity may be an important cause of microvascular dysfunction. Mechanisms linking overweight and obesity to microvascular dysfunction include changes in the secretion of adipokines leading to increased levels of free fatty acids and inflammatory mediators, and decreased levels of adiponectin all of which may impair endothelial insulin signaling. Microvascular dysfunction may thus constitute a new treatment target in the prevention of type 2 diabetes mellitus and hypertension.

Published
2014

284. Association Between Arterial Stiffness and Skin Microvascular Function: The SUVIMAX2 Study and The Maastricht Study

Author

van Sloten, T. T., primary, Czernichow, S., additional, Houben, A. J., additional, Protogerou, A. D., additional, Henry, R. M., additional, Muris, D. M., additional, Schram, M. T., additional, Sep, S. J., additional, Dagnelie, P. C., additional, van der Kallen, C. J., additional, Schaper, N. C., additional, Blacher, J., additional, Hercberg, S., additional, Levy, B. I., additional, and Stehouwer, C. D., additional

Published
2014
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286. Improvement of glycaemic control in type 2 diabetes:Favourable changes in blood pressure, total cholesterol and triglycerides, but not in HDL cholesterol, fibrinogen, von Willebrand factor and (pro)insulin

Author

Becker, A., van der Does, F. E.E., van Hinsbergh, V. W.M., Heine, R. J., Bouter, L. M., and Stehouwer, C. D.A.

Abstract

Background: Diabetes mellitus causes a substantial increase in cardiovascular risk, which can only partly be reduced by antihyperglycaemic treatment. We were interested in whether improvement in glycaemic control is associated with improvement of other cardiovascular risk factors. Therefore, we studied among type 2 diabetic patients the association between on the one hand changes in glycaemic control and on the other hand within-subject changes of both classic cardiovascular risk factors and less conventional cardiovascular risk indicators that are typically associated with type 2 diabetes (proinsulin, insulin, fibrinogen, von Willebrand factor and the urinary albumin-creatinine ratio). Methods: The 214 type 2 diabetic patients were randomly assigned to either a strict fasting capillary glucose target level (IC. Results: Individuals in whom HbAIC decreased had significant favourable concurrent changes in triglycerides, total cholesterol, blood pressure, and in the albumin-creatinine ratio in those who were normoalbuminuric at baseline. In contrast, these individuals had unfavourable, although not statistically significant, changes in HDL cholesterol, proinsulin, insulin, fibrinogen and von Willebrand factor. In the whole group, fibrinogen increased more than could be expected on the basis of the relationship between fibrinogen and age, namely from 3.5 ± 0.8 to 3.9 ± 0.9 g/l (p value

Published
2003

287. Improvement of glycaemic control in type 2 diabetes: favourable changes in blood pressure, total cholesterol and triglycerides, but not in HDL cholesterol, fibrinogen, von Willebrand factor and (pro)insulin

Author

Becker, A., Does, F. E. E., Hinsbergh, V. W. M., Heine, R. J., Lex Bouter, Stehouwer, C. D. A., EMGO+ - Musculoskeletal Health, EMGO+ - Lifestyle, Overweight and Diabetes, EMGO+ - Mental Health, Pulmonary medicine, AII - Cancer immunology, CCA - Cancer biology and immunology, CCA - Cancer Treatment and quality of life, Physiology, Internal medicine, and Epidemiology and Data Science

Subjects
SDG 3 - Good Health and Well-being
Abstract

Background: Diabetes mellitus causes a substantial increase in cardiovascular risk, which can only partly be reduced by antihyperglycaemic treatment. We were interested in whether improvement in glycaemic control is associated with improvement of other cardiovascular risk factors. Therefore, we studied among type 2 diabetic patients the association between on the one hand changes in glycaemic control and on the other hand within-subject changes of both classic cardiovascular risk factors and less conventional cardiovascular risk indicators that are typically associated with type 2 diabetes (proinsulin, insulin, fibrinogen, von Willebrand factor and the urinary albumin-creatinine ratio). Methods: The 214 type 2 diabetic patients were randomly assigned to either a strict fasting capillary glucose target level (

Published
2003

290. Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations

Author

Song, X., Jousilahti, P., Stehouwer, C. D. A., Söderberg, Stefan, Onat, A., Laatikainen, T., Yudkin, J. S., Dankner, R., Morris, R., Tuomilehto, J., Qiao, Q., Song, X., Jousilahti, P., Stehouwer, C. D. A., Söderberg, Stefan, Onat, A., Laatikainen, T., Yudkin, J. S., Dankner, R., Morris, R., Tuomilehto, J., and Qiao, Q.

Abstract

BACKGROUND/OBJECTIVES: Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general obesity, while abdominal obesity indicators have been proposed to be more informative in risk prediction. SUBJECT/METHODS: A prospective cohort study consisting of 46 651 Europeans aged 24-99 years was conducted to investigate the relationship between CVD mortality and different obesity indicators including BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR). Hazard ratio (HR) was estimated by the Cox proportional hazards model using age as timescale, and compared using paired homogeneity test. RESULTS: During a median follow-up of 7.9 years, 3435 participants died, 1409 from CVD. All obesity indicators were positively associated with increased risk of CVD mortality, with HRs (95% confidence intervals) per standard deviation increase of 1.19 (1.12-1.27) for BMI, 1.29 (1.21-1.37) for WC, 1.28 (1.20-1.36) for WHR, 1.35 (1.27-1.44) for WSR, 1.34 (1.26-1.44) for ABSI and 1.34 (1.25-1.42) for WHHR in men and 1.37 (1.24-1.51), 1.49 (1.34-1.65), 1.45 (1.31-1.60), 1.52 (1.37-1.69), 1.32 (1.18-1.48) and 1.45 (1.31-1.61) in women, respectively. The prediction was stronger with abdominal obesity indicators than with BMI or ABSI (P<0.05 for all paired homogeneity tests). WSR appeared to be the strongest predictor among all the indicators, with a linear relationship with CVD mortality in both men and women. CONCLUSIONS: Abdominal obesity indicators such as WC, WHR, WSR and WHHR, are stronger predictors for CVD mortality than general obesity indicator of BMI.

Published
2013
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292. Semi-automatic assessment of skin capillary density: Proof of principle and validation

Author

Gronenschild, E. H. B. M., Gronenschild, E. H. B. M., Muris, D. M. J., Schram, M. T., Karaca, U., Stehouwer, C. D. A., Houben, A. J. H. M., Gronenschild, E. H. B. M., Gronenschild, E. H. B. M., Muris, D. M. J., Schram, M. T., Karaca, U., Stehouwer, C. D. A., and Houben, A. J. H. M.

Abstract

Background: Skin capillary density and recruitment have been proven to be relevant measures of microvascular function. Unfortunately, the assessment of skin capillary density from movie files is very time-consuming, since this is done manually. This impedes the use of this technique in large-scale studies. We aimed to develop a (semi-) automated assessment of skin capillary density. Methods: CapiAna (Capillary Analysis) is a newly developed semi-automatic image analysis application. The technique involves four steps: 1) movement correction, 2) selection of the frame range and positioning of the region of interest (ROI), 3) automatic detection of capillaries, and 4) manual correction of detected capillaries. To gain insight into the performance of the technique, skin capillary density was measured in twenty participants (ten women; mean age 562 [42-72] years). To investigate the agreement between CapiAna and the classic manual counting procedure, we used weighted Deming regression and Bland-Altman analyses. In addition, intra-and inter-observer coefficients of variation (CVs), and differences in analysis time were assessed. Results: We found a good agreement between CapiAna and the classic manual method, with a Pearson's correlation coefficient (r) of 0.95 (P <0.001) and a Deming regression coefficient of 1.01 (95%CI: 0.91; 1.10). In addition, we found no significant differences between the two methods, with an intercept of the Deming regression of 1.75 (-6.04; 9.54), while the Bland-Altman analysis showed a mean difference (bias) of 2.0 (-13.5; 18.4) capillaries/mm(2). The intra- and inter-observer CVs of CapiAna were 2.5% and 5.6% respectively, while for the classic manual counting procedure these were 3.2% and 7.2%, respectively. Finally, the analysis time for CapiAna ranged between 25 and 35 min versus 80 and 95 min for the manual counting procedure. Conclusion: We have developed a semi-automatic image analysis application (CapiAna) for the assessment of skin

Published
2013

293. Reference intervals for common carotid intima-medi thickness measured with echotracking: Relation with risk factors

Author

Giannattasio, C, Engelen, L, Ferreira, I, Stehouwer, C, Boutouyrie, P, Laurent, S, GIANNATTASIO, CRISTINA, Stehouwer, CD, Laurent, S., Giannattasio, C, Engelen, L, Ferreira, I, Stehouwer, C, Boutouyrie, P, Laurent, S, GIANNATTASIO, CRISTINA, Stehouwer, CD, and Laurent, S.

Abstract

Aims Common carotid artery intima-media thickness (CCIMT) is widely used as a surrogate marker of atherosclerosis, given its predictive association with cardiovascular disease (CVD). The interpretation of CCIMT values has been hampered by the absence of reference values, however. We therefore aimed to establish reference intervals of CCIMT, obtained using the probably most accurate method at present (i.e. echotracking), to help interpretation of these measures. Methods and results We combined CCIMT data obtained by echotracking on 24 871 individuals (53% men; age range 15-101 years) from 24 research centres worldwide. Individuals without CVD, cardiovascular risk factors (CV-RFs), and BP-, lipid-, and/or glucose-lowering medication constituted a healthy sub-population (n 1/4 4234) used to establish sex-specific equations for percentiles of CCIMT across age. With these equations, we generated CCIMT Z-scores in different reference subpopulations, thereby allowing for a standardized comparison between observed and predicted ('normal') values from individuals of the same age and sex. In the sub-population without CVD and treatment (n 1/4 14 609), and in men and women, respectively, CCIMT Z-scores were independently associated with systolic blood pressure [standardized bs 0.19 (95% CI: 0.16-0.22) and 0.18 (0.15-0.21)], smoking [0.25 (0.19-0.31) and 0.11 (0.04-0.18)], diabetes [0.19 (0.05-0.33) and 0.19 (0.02-0.36)], total-to-HDL cholesterol ratio [0.07 (0.04-0.10) and 0.05 (0.02-0.09)], and body mass index [0.14 (0.12-0.17) and 0.07 (0.04-0.10)]. Conclusion We estimated age- and sex-specific percentiles of CCIMT in a healthy population and assessed the association of CVRFs with CCIMT Z-scores, which enables comparison of IMT values for (patient) groups with different cardiovascular risk profiles, helping interpretation of such measures obtained both in research and clinical settings. © 2012 The Author All rights reserved.

Published
2013

294. Rapid progression of albumin excretion is an independent predictor of cardiovascular mortality in patients with type 2 diabetes and microalbuminuria

Author

Spoelstra-de Man, A M, Brouwer, C B, Stehouwer, C D, Smulders, Y M, Intensive care medicine, ACS - Atherosclerosis & ischemic syndromes, Internal medicine, ACS - Diabetes & metabolism, AII - Infectious diseases, and AII - Inflammatory diseases

Subjects
endocrine system diseases, nutritional and metabolic diseases, urologic and male genital diseases
Abstract

OBJECTIVE: In patients with type 2 diabetes, microalbuminuria is associated with an increase in predominantly cardiovascular mortality. Considerable interindividual variability in the rate of progression of microalbuminuria exists. The prognostic significance of rate of progression of microalbuminuria with regard to cardiovascular and renal clinical end points is, however, unknown. The purpose of this study was to determine the prognostic significance of rate of progression of microalbuminuria for cardiovascular end points and renal function.RESEARCH DESIGN AND METHODS: In a previous prospective cohort study, progression of microalbuminuria (expressed as mean yearly change in albumin-to-creatinine ratio) was assessed in 58 patients with type 2 diabetes. During a median follow-up of 7 years after progression of microalbuminuria was determined, we registered all-cause mortality and coronary heart disease mortality as primary end points and coronary heart disease (fatal or nonfatal), peripheral vascular disease, ischemic stroke, retinopathy, macroalbuminuria, and change in serum creatinine as secondary end points.RESULTS: Seven subjects died during the study; five of these subjects died of coronary heart disease. Cox's regression analysis identified progression of microalbuminuria as a significant predictor of all-cause mortality (hazard ratio 1.46 per point increase in albumin-to-creatinine ratio per year, P < 0.001), coronary heart disease mortality (hazard ratio 2.32, P = 0.006), and macroalbuminuria (hazard ratio 1.79, P < 0.001). Adjustment for multiple cardiovascular risk factors did not affect these results. Identical analyses for baseline level of microalbuminuria instead of progression rate of microalbuminuria did not show significant hazard ratios. In addition, progression of microalbuminuria significantly predicted an increase in serum creatinine (r = 0.29, P = 0.04).CONCLUSIONS: In patients with type 2 diabetes and microalbuminuria, the rate of progression of albumin excretion seems to be a powerful independent predictor of mortality caused mainly by coronary heart disease.

Published
2001

295. Decreased smooth muscle cell/extracellular matrix ratio of media of femoral artery in patients with atherosclerosis and hyperhomocysteinemia

Author

Vermeulen, E G, Niessen, H W, Bogels, M, Stehouwer, C D, Rauwerda, J A, van Hinsbergh, V W, Surgery, Pathology, Cardio-thoracic surgery, ACS - Heart failure & arrhythmias, AGEM - Digestive immunity, Amsterdam Neuroscience - Cellular & Molecular Mechanisms, CCA - Target Discovery & Preclinial Therapy Development, AII - Inflammatory diseases, and Physiology

Abstract

The aim of this study was to determine whether the morphology of the muscular femoral artery in patients with atherosclerosis and hyperhomocysteinemia differs from that of atherosclerotic vessels from patients with normal homocysteine levels. Whole-vessel biopsies of the superficial femoral artery were taken from patients with symptomatic atherosclerotic disease with and without hyperhomocysteinemia and from patients without atherosclerosis from traumatic amputations. The morphology of these specimens was studied qualitatively by light and electron microscopy and quantitatively by light microscopy in combination with a video overlay system. Atherosclerotic lesions in patients with hyperhomocysteinemia were morphologically similar to those in patients with normal homocysteine levels, except for a significantly decreased smooth muscle cell/extracellular matrix ratio of the media in hyperhomocysteinemic patients (P=0.02 versus normohomocysteinemic atherosclerotic group and P=0.001 versus group without a history of cardiovascular disease). Hyperhomocysteinemia is associated with a significant decrease of the smooth muscle cell/extracellular matrix ratio of the media of muscular femoral arteries without significant changes in medial thickness. Further investigations should concentrate on the cause of this newly discovered phenomenon and its impact on vascular compliance.

Published
2001

296. Genetic polymorphisms of the renin-angiotensin system and complications of insulin-dependent diabetes mellitus

Author

van Ittersum, F J, Thijssen, S, de Knijff, P, Slagboom, E, Smulders, Y, Tarnow, L, Donker, A J, Bilo, H J, Stehouwer, C D, Spoelstra-de Man, AME, Nephrology, ACS - Atherosclerosis & ischemic syndromes, Internal medicine, ACS - Diabetes & metabolism, AII - Infectious diseases, AII - Inflammatory diseases, and Intensive care medicine

Abstract

OBJECTIVE: Patients with insulin-dependent diabetes mellitus (IDDM) have a high risk of developing diabetic nephropathy, retinopathy and cardiovascular diseases. The contribution of gene polymorphisms of the renin angiotensin system to these complications is controversial and may differ among populations.METHODS: In 257 Dutch IDDM patients (188 with urinary albumin excretion (UAE) RESULTS: The T-allele of the AGT-M235T polymorphism was associated with an increased risk of an elevated UAE (odds ratio (OR) 3.03; 95% confidence interval (CI) 1.06-8.61), but only when interaction with the D-allele of the ACE-ID polymorphism was considered. A previously described positive interaction between the T-allele of the AGT-M235T polymorphism and the D-allele of the ACE-ID polymorphism could not be confirmed. The T-allele was also associated with an increased risk of retinopathy (OR 3.89, 95% CI 1.79-8.47). The CC-genotype of the AT1-A1166C polymorphism was associated with hypertension (OR 3.58; 95% CI 1. 23-10.37).CONCLUSIONS: In a Dutch IDDM population, including 69 patients with (incipient) diabetic nephropathy, the T-allele of the AGT-M235T polymorphism is associated with an elevated UAE and diabetic retinopathy and the CC-genotype of the AT1-A1166C polymorphism is associated with hypertension. A previously described interaction between the AGT-M235T and the ACE-ID polymorphisms could not be confirmed. Since the number of nephropathic patients in this study is small, these conclusions must be interpreted with caution.

Published
2000

297. Risk scores for predicting type 2 diabetes : using the optimal tool

Author

Alssema, M, Vistisen, D, Heymans, M W, Nijpels, G, Glümer, C, Zimmet, P Z, Shaw, J E, Eliasson, Mats, Stehouwer, C D A, Tabák, A G, Colagiuri, S, Borch-Johnsen, K, Dekker, J M, Alssema, M, Vistisen, D, Heymans, M W, Nijpels, G, Glümer, C, Zimmet, P Z, Shaw, J E, Eliasson, Mats, Stehouwer, C D A, Tabák, A G, Colagiuri, S, Borch-Johnsen, K, and Dekker, J M

Abstract

Letter

Published
2011
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298. Klinisch denken en beslissen in de praktijk. Een patiënt met een trombosebeen

Author

Gans, R O and Stehouwer, C D

Subjects
Male, Anemia, Macrocytic/etiology, Leukemia-Lymphoma, Adult T-Cell/complications, Treatment Outcome, hemic and lymphatic diseases, Leukocytosis/etiology, Anemia, Pernicious/complications, Humans, Antineoplastic Combined Chemotherapy Protocols/therapeutic use, Diagnostic Errors, Middle Aged, Stomach Neoplasms/complications, Thrombophlebitis/etiology
Abstract

A 55-year-old man presented with deep venous thrombosis of his left leg. Laboratory evaluation disclosed macrocytic anaemia and leukocytosis. In the clinical decision process it was not verified whether all symptoms fitted in with the presumptive diagnosis of pernicious anaemia and stomach carcinoma. The ultimate diagnosis was acute lymphocytic leukaemia. A proper evaluation of a peripheral blood smear would have led to this diagnosis earlier.

Published
1999

299. Klinisch denken en beslissen in de praktijk. Een patiënte met aanvallen van flushing

Author

Stehouwer, C D and Gans, R O

Subjects
Flushing/etiology, Time Factors, Biopsy, Immunoglobulin E/blood, Urticaria/etiology, Mastocytosis/complications, Diagnosis, Differential, Bone Marrow/pathology, Chronic Disease, Splenomegaly, Humans, Female, skin and connective tissue diseases, Aged, Pheochromocytoma/diagnosis
Abstract

A 74-year-old woman had an 8-year history of spells consisting of facial flushing and swelling, itching and erythema of the hands, rhinorrhoea and gastrointestinal complaints. The ultimate diagnosis was systemic mastocytosis without urticaria pigmentosa. In the clinical decision process the treating physicians used clinical axioms to try to establish a diagnosis, but these axioms were sometimes used inappropriately. In particular, spells accompanied by flushing inappropriately elicited a possible diagnosis of phenochromocytoma. Generalised mastocytosis can occur in the absence of urticaria pigmentosa and is probably an underestimated cause of spell-like complaints.

Published
1999

300. Diabetes, prediabetes and cancer mortality

Author

Zhou, X. H., Qiao, Q., Zethelius, Björn, Pyörälä, K., Söderberg, S., Pajak, A., Stehouwer, C. D. A., Heine, R. J., Jousilahti, P., Ruotolo, G., Nilsson, P. M., Calori, G., Tuomilehto, J., Zhou, X. H., Qiao, Q., Zethelius, Björn, Pyörälä, K., Söderberg, S., Pajak, A., Stehouwer, C. D. A., Heine, R. J., Jousilahti, P., Ruotolo, G., Nilsson, P. M., Calori, G., and Tuomilehto, J.

Abstract

Aims/hypothesis We aimed to investigate the risk of cancer mortality in relation to the glucose tolerance status classified according to the 2 h OGTT. Methods Data from 17 European population-based or occupational cohorts involved in the DECODE study comprising 26,460 men and 18,195 women aged 25-90 years were collaboratively analysed. The cohorts were recruited between 1966 and 2004 and followed for 5.9 to 36.8 years. Cox proportional hazards analysis with adjustment for cohort, age, BMI, total cholesterol, blood pressure and smoking status was used to estimate HRs for cancer mortality. Results Compared with people in the normal glucose category, multivariable adjusted HRs (95% CI) for cancer mortality were 1.13 (1.00, 1.28), 1.27 (1.02, 1.57) and 1.71 (1.35, 2.17) in men with prediabetes, previously undiagnosed diabetes and known diabetes, respectively; in women they were 1.11 (0.94, 1.30), 1.31 (1.00, 1.70) and 1.43 (1.01, 2.02), respectively. Significant increases in deaths from cancer of the stomach, colon-rectum and liver in men with prediabetes and diabetes, and deaths from cancers of the liver and pancreas in women with diabetes were also observed. In individuals without known diabetes, the HR (95% CI) for cancer mortality corresponding to a one standard deviation increase in fasting plasma glucose was 1.06 (1.02, 1.09) and in 2 h plasma glucose was 1.07 (1.03, 1.11). Conclusions/interpretation Diabetes and prediabetes were associated with an increased risk of cancer death, particularly death from liver cancer. Mortality from all cancers rose linearly with increasing glucose concentrations.

Published
2010
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