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5. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis.

Author

Kovesdy, Csaba P, Matsushita, Kunihiro, Sang, Yingying, Brunskill, Nigel J, Carrero, Juan J, Chodick, Gabriel, Hasegawa, Takeshi, Heerspink, Hiddo L, Hirayama, Atsushi, Landman, Gijs WD, Levin, Adeera, Nitsch, Dorothea, Wheeler, David C, Coresh, Josef, Hallan, Stein I, Shalev, Varda, Grams, Morgan E, Astor, Brad, Appel, Larry, Greene, Tom, Chen, Teresa, Chalmers, John, Woodward, Mark, Arima, Hisatomi, Perkovic, Vlado, Djurdjev, Ognjenka, Zhang, Luxia, Liu, Lisheng, Zhao, Minghui, Wang, Fang, Wang, Jinwei, Tang, Mila, Iso, Hiroyasu, Yamagishi, Kazumasa, Umesawa, Mitsumasa, Muraki, Isao, Fukagawa, Masafumi, Maruyama, Shoichi, Hamano, Takayuki, Fujii, Naohiko, Wheeler, David, Emberson, John, Townend, John, Landray, Martin, Green, Jamie, Kirchner, H Lester, Chang, Alex R, Cirillo, Massimo, Jee, Sun Ha, Kimm, Heejin, Mok, Yejin, Wetzels, Jack FM, Blankestijn, Peter J, van Zuilen, Arjan D, Bots, M, Sarnak, Mark, Inker, Lesley, Roderick, Paul, Fletcher, Astrid, Bottinger, Erwin, Nadkarni, Girish N, Ellis, Stephen B, Nadukuru, Rajiv, Brunskill, Nigel, Major, Rupert, Shepherd, David, Medcalf, James, Gansevoort, Ron T, Bakker, Stephan JL, Heerspink, Hiddo J Lambers, Jassal, Simerjot K, Bergstrom, Jaclyn, Ix, Joachim H, Barrett-Connor, Elizabeth, Kovesdy, Csaba, Kalantar-Zadeh, Kamyar, de Zeeuw, Dick, Brenner, Barry, Gasparini, Alessandro, Elinder, Carl-Gustaf, Barany, Peter, Evans, Marie, Segelmark, Mårten, Stendahl, Maria, Schön, Staffan, Tangri, Navdeep, Sud, Maneesh, Naimark, David, Wen, Chi-Pang, and Tsao, Chwen-Keng

Subjects
Kidney Disease, Prevention, Clinical Research, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Renal and urogenital, Cardiovascular, Good Health and Well Being, Adult, Aged, Albuminuria, Cardiovascular Diseases, Cause of Death, Comorbidity, Glomerular Filtration Rate, Humans, Hyperkalemia, Hypokalemia, Kidney Failure, Chronic, Middle Aged, Prognosis, Renal Insufficiency, Chronic, Risk Factors, Potassium, Estimated glomerular filtration rate, End-stage renal disease, Mortality, CKD Prognosis Consortium, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Cardiovascular System & Hematology
Abstract

AimsBoth hypo- and hyperkalaemia can have immediate deleterious physiological effects, and less is known about long-term risks. The objective was to determine the risks of all-cause mortality, cardiovascular mortality, and end-stage renal disease associated with potassium levels across the range of kidney function and evaluate for consistency across cohorts in a global consortium.Methods and resultsWe performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high cardiovascular risk, and 10 chronic kidney disease (CKD)] in the CKD Prognosis Consortium. We used Cox regression followed by random-effects meta-analysis to assess the relationship between baseline potassium and adverse outcomes, adjusted for demographic and clinical characteristics, overall and across strata of estimated glomerular filtration rate (eGFR) and albuminuria. We included 1 217 986 participants followed up for a mean of 6.9 years. The average age was 55 ± 16 years, average eGFR was 83 ± 23 mL/min/1.73 m2, and 17% had moderate- to-severe increased albuminuria levels. The mean baseline potassium was 4.2 ± 0.4 mmol/L. The risk of serum potassium of >5.5 mmol/L was related to lower eGFR and higher albuminuria. The risk relationship between potassium levels and adverse outcomes was U-shaped, with the lowest risk at serum potassium of 4-4.5 mmol/L. Compared with a reference of 4.2 mmol/L, the adjusted hazard ratio for all-cause mortality was 1.22 [95% confidence interval (CI) 1.15-1.29] at 5.5 mmol/L and 1.49 (95% CI 1.26-1.76) at 3.0 mmol/L. Risks were similar by eGFR, albuminuria, renin-angiotensin-aldosterone system inhibitor use, and across cohorts.ConclusionsOutpatient potassium levels both above and below the normal range are consistently associated with adverse outcomes, with similar risk relationships across eGFR and albuminuria.

Published
2018

6. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data

Author

Matsushita, Kunihiro, Ballew, Shoshana H, Coresh, Josef, Arima, Hisatomi, Ärnlöv, Johan, Cirillo, Massimo, Ebert, Natalie, Hiramoto, Jade S, Kimm, Heejin, Shlipak, Michael G, Visseren, Frank LJ, Gansevoort, Ron T, Kovesdy, Csaba P, Shalev, Varda, Woodward, Mark, Kronenberg, Florian, Chalmers, John, Perkovic, Vlado, Grams, Morgan E, Sang, Yingying, Schaeffner, Elke, Martus, Peter, Levin, Adeera, Djurdjev, Ognjenka, Tang, Mila, Heine, Gunnar, Seiler, Sarah, Zawada, Adam, Emrich, Insa, Sarnak, Mark, Katz, Ronit, Brenner, Hermann, Schöttker, Ben, Rothenbacher, Dietrich, Saum, Kai-Uwe, Köttgen, Anna, Schneider, Markus, Eckardt, Kai-Uwe, Green, Jamie, Kirchner, H Lester, Chang, Alex R, Black, Corri, Marks, Angharad, Prescott, Gordon, Clark, Laura, Fluck, Nick, Jee, Sun Ha, Mok, Yejin, Chodick, Gabriel, Wetzels, Jack FM, Blankestijn, Peter J, van Zuilen, Arjan D, Bots, M, Peralta, Carmen, Hiromoto, Jade, Bottinger, Erwin, Nadkarni, Girish N, Ellis, Stephen B, Nadukuru, Rajiv, Kenealy, Timothy, Elley, C Raina, Collins, John F, Drury, Paul L, Bakker, Stephan JL, Heerspink, Hiddo J Lambers, Jassal, Simerjot K, Bergstrom, Jaclyn, Ix, Joachim H, Barrett-Connor, Elizabeth, Kalantar-Zadeh, Kamyar, Carrero, Juan J, Gasparini, Alessandro, Qureshi, Abdul Rashid, Barany, Peter, Algra, Ale, van der Graaf, Yolanda, Evans, Marie, Segelmark, Mårten, Stendahl, Maria, Schön, Staffan, Tangri, Navdeep, Sud, Maneesh, Naimark, David, Lannfelt, Lars, Larsson, Anders, Hallan, Stein, Levey, Andrew S, Chen, Jingsha, and Kwak, Lucia

Subjects
Clinical Research, Kidney Disease, Prevention, Renal and urogenital, Good Health and Well Being, Adult, Aged, Albuminuria, Creatinine, Databases, Factual, Female, Glomerular Filtration Rate, Humans, Incidence, Male, Middle Aged, Peripheral Arterial Disease, Renal Insufficiency, Chronic, Risk Factors, Chronic Kidney Disease Prognosis Consortium, Medical Biochemistry and Metabolomics, Clinical Sciences, Public Health and Health Services
Abstract

BackgroundSome evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease.MethodsIn this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics.FindingsWe analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7-8·9], range 2·0-15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m2, adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14-1·30) at an eGFR of 45 mL/min per 1·73 m2 and 2·06 (1·70-2·48) at an eGFR of 15 mL/min per 1·73 m2. Compared with an ACR of 5 mg/g, the adjusted HR for incident study-specific peripheral artery disease was 1·50 (1·41-1·59) at an ACR of 30 mg/g and 2·28 (2·12-2·44) at an ACR of 300 mg/g. The adjusted HR at an ACR of 300 mg/g versus 5 mg/g was 3·68 (95% CI 3·00-4·52) for leg amputation. eGFR and albuminuria contributed multiplicatively (eg, adjusted HR 5·76 [4·90-6·77] for incident peripheral artery disease and 10·61 [5·70-19·77] for amputation in eGFR

Published
2017

7. Dietary habits and compliance with dietary guidelines in patients with established cardiovascular disease.

Author

Bonekamp, Nadia E., Geleijnse, Johanna M., van der Schouw, Yvonne T., Dorresteijn, Jannick A. N., van der Meer, Manon G., Ruigrok, Ynte M., Teraa, Martin, Visseren, Frank L. J., Koopal, Charlotte, Cramer, M. J., Nathoe, H. M., van de Meer, M. G., de Borst, G. J., Teraa, M., Bots, M. L., van Smeden, M., Emmelot-Vonk, M. H., de Jong, P. A., Lely, A. T., and van der Kaaij, N. P.

Subjects
CARDIOVASCULAR disease prevention, PATIENT compliance, NUTRITION policy, MYOCARDIAL infarction, RESEARCH funding, FOOD consumption, QUESTIONNAIRES, DAIRY products, CARDIOVASCULAR diseases risk factors, RETROSPECTIVE studies, DESCRIPTIVE statistics, FISHES, MEAT, LONGITUDINAL method, FOOD habits, MEDICAL records, ACQUISITION of data, DISEASE relapse, CONFIDENCE intervals, DIET, PROPORTIONAL hazards models, LEGUMES
Abstract

Background: Unhealthy dietary habits are an important risk factor for cardiovascular disease (CVD) and adopting a healthy diet is a central recommendation in CVD prevention. This study assessed the dietary habits of patients with established CVD, their compliance to dietary guidelines, and the relationship between guideline-compliance and recurrent cardiovascular event risk. Methods: 2656 patients with established CVD from the Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease (UCC-SMART) prospective cohort study, were included between 1996 and 2022. Data on dietary intake was retrospectively collected for all participants in December 2022 using a 160-item food frequency questionnaire. Compliance with dietary guidelines was quantified using an amended version of the Dutch Healthy Diet 2015 (DHD-15) index (range: 0–135). Cox proportional hazard models were used to quantify the relationship with cardiovascular events (stroke and myocardial infarction). Results: Among 2656 CVD patients (77% male, mean age 59 ± 9 years), median energy intake was 1922 [IQR: 1536–2351] kcal/day. The median DHD-15 index was 81.7 [IQR 71.2–92.0], with high compliance scores for recommendations on legumes and fish, and low scores for recommendations on whole grains, red meat, processed meat, and dairy. A higher DHD-15 score was associated with lower stroke risk (HR 0.78, 95% CI 0.66–0.92 per 10-point increase) but not with myocardial infarction. Conclusion: Compliance with dietary guidelines was suboptimal in patients with established CVD. High compliance was associated with a clinically significant reduction in stroke risk in patients with established CVD, emphasizing the importance of dietary counseling. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Sex differences in modifiable risk factors for stroke incidence and recurrence: the UCC-SMART study.

Author

Rissanen, Ina, Basten, Maartje, Exalto, Lieza G., Peters, Sanne A. E., Visseren, Frank L. J., Geerlings, Mirjam I., For the UCC-SMART-Study Group, Cramer, M. J., van der Meer, M. G., Nathoe, H. M., de Borst, G. J., Bots, M. L., Geerlings, M. I., Emmelot-Vonk, M. H., de Jong, P. A., Lely, A. T., van der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y. M., and Verhaar, M. C.

Subjects
SEX factors in disease, DISEASE risk factors, DYSLIPIDEMIA, HEMORRHAGIC stroke, PROPORTIONAL hazards models, STROKE
Abstract

Background and purpose: Risk factors for stroke differ between women and men in general populations. However, little is known about sex differences in secondary prevention. We investigated if sex interacted with modifiable risk factors for stroke in a large arterial disease cohort. Methods: Within the prospective UCC-SMART study, 13,898 patients (35% women) with atherosclerotic disease or high-risk factor profile were followed up to 23 years for stroke incidence or recurrence. Hypertension, smoking, diabetes, overweight, dyslipidemia, high alcohol use, and physical inactivity were studied as risk factors. Association between these factors and ischemic and hemorrhagic stroke incidence or recurrence was studied in women and men using Cox proportional hazard models and Poisson regression models. Women-to-men relative hazard ratios (RHR) and rate differences (RD) were estimated for each risk factor. Left-truncated age was used as timescale. Results: The age-adjusted stroke incidence rate was lower in women than men (3.9 vs 4.4 per 1000 person-years), as was the age-adjusted stroke recurrence rate (10.0 vs 11.7). Hypertension and smoking were associated with stroke risk in both sexes. HDL cholesterol was associated with lower stroke incidence in women but not in men (RHR 0.49; CI 0.27–0.88; and RD 1.39; CI − 1.31 to 4.10). Overweight was associated with a lower stroke recurrence in women but not in men (RHR 0.42; CI 0.23–0.80; and RD 9.05; CI 2.78–15.32). Conclusions: In high-risk population, sex modifies the association of HDL cholesterol on stroke incidence, and the association of overweight on stroke recurrence. Our findings highlight the importance of sex-specific secondary prevention. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Early mitral valve repair surgery versus active surveillance in patients with asymptomatic severe primary mitral regurgitation; insights from the Dutch AMR registry

Author

El Mathari, S, primary, Hart, E, additional, Jansen, R, additional, Wind, A, additional, Schaap, J, additional, Cramer, M J, additional, Bots, M L, additional, Streukens, S A J, additional, Wagenaar, L, additional, Boekholdt, S M, additional, Kluin, J, additional, and Chamuleau, S A J, additional

Published
2023
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17. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data

Author

Chalmers, John, Arima, Hisatomi, Perkovic, Vlado, Grams, Morgan E., Sang, Yingying, Schaeffner, Elke, Martus, Peter, Levin, Adeera, Djurdjev, Ognjenka, Tang, Mila, Heine, Gunnar, Seiler, Sarah, Zawada, Adam, Emrich, Insa, Sarnak, Mark, Katz, Ronit, Brenner, Hermann, Schöttker, Ben, Rothenbacher, Dietrich, Saum, Kai-Uwe, Köttgen, Anna, Schneider, Markus, Eckardt, Kai-Uwe, Green, Jamie, Kirchner, H Lester, Chang, Alex R, Black, Corri, Marks, Angharad, Prescott, Gordon, Clark, Laura, Fluck, Nick, Jee, Sun Ha, Mok, Yejin, Chodick, Gabriel, Shalev, Varda, Wetzels, Jack F.M., Blankestijn, Peter J, van Zuilen, Arjan D, Bots, M, Peralta, Carmen, Hiromoto, Jade, Bottinger, Erwin, Nadkarni, Girish N, Ellis, Stephen B, Nadukuru, Rajiv, Kenealy, Timothy, Elley, C Raina, Collins, John F, Drury, Paul L, Bakker, Stephan JL, Heerspink, Hiddo J Lambers, Jassal, Simerjot K, Bergstrom, Jaclyn, Ix, Joachim H, Barrett-Connor, Elizabeth, Kalantar-Zadeh, Kamyar, Carrero, Juan J, Gasparini, Alessandro, Qureshi, Abdul Rashid, Barany, Peter, Algra, Ale, van der Graaf, Yolanda, Evans, Marie, Segelmark, Mårten, Stendahl, Maria, Schön, Staffan, Tangri, Navdeep, Sud, Maneesh, Naimark, David, Lannfelt, Lars, Larsson, Anders, Hallan, Stein, Levey, Andrew S, Chen, Jingsha, Kwak, Lucia, Matsushita, Kunihiro, Ballew, Shoshana H, Coresh, Josef, Ärnlöv, Johan, Cirillo, Massimo, Ebert, Natalie, Hiramoto, Jade S, Kimm, Heejin, Shlipak, Michael G, Visseren, Frank L J, Gansevoort, Ron T, Kovesdy, Csaba P, Woodward, Mark, and Kronenberg, Florian

Published
2017
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18. Cardiovascular and metabolic effects of metformin in patients with type 1 diabetes (REMOVAL): a double-blind, randomised, placebo-controlled trial

Author

Nickerson, H, Lou, O, Dutta, S, Haw, J, Anderson, C, Kean, S, Thomson, E, Gillespie, L, Gibb, J, Greenlaw, N, Keech, A, Jenkins, A, March, K, Williams, S, Coady, E, Bots, M, Dreyer, J, Jan, T, Sheffy, K, Lusky, R, Peleg, S, Shore, A, Carty, D, Donnan, P, Witham, M, Adler, A, Lonn, E, Rauchhaus, P, Lindsay, R, Brouwers, M, Van-Melckebeke, J, Hamill, T, Cuthbertson, L, Murray, A, Jolly, L, Miller, E, Hair, J, Bell, A, Carmichael, S, Douglas, E, Surtees, P, Dinnett, E, Allan, J, Watson, C, McLaughlin, M, Brindley, G, Smillie, E, Motherwell, D, MacDonald, S, Ellis, P, Stuart, D, Travers, M, Brearley, S, Greig, L, Colman, P, Nankervis, A, Forulanos, S, West, D, Vaughan, S, Bjorasen, M, Donlan, J, Vrazas, J, O'Neal, D, Horsburgh, J, Pater, H, Kent, S, Twigg, S, Fulcher, G, Denner, R, Piotrowicz, A, Januszewski, A, Coy, A, Paul, T, McDonald, C, Tereschyn, S, Schmidt, N, Weingert, M, Heard, H, Burke, S, Ooi, TC, Lochnan, H, Sorisky, A, Keely, E, Malcolm, J, Maranger, J, Favreau, C, Petherick, S, Boles, K, Rossing, P, Hansen, TW, Lund, S, Hemmingsen, B, Thorogood, N, Green, K, Robinson, T, Abouglilia, K, Nayman, D, Miller, C, Warren, R, Aizawa, K, Balasubramani, M, Toth, S, Harvey, K, Birch, G, Atkin, S, Sathyapalan, T, James, A, Javed, Z, Wilding, J, Martin, B, Birch, S, Wilcox, A, Watson, N, Oliver, N, Jugnee, N, Rutter, M, Turgut, T, Shaju, A, Yau, S, Subin, S, Walker, M, Wake, D, Millward, A, Chong, P, Hibbert, M, George, J, Schaper, N, Pinxt, J, op het Roodt, J, Phillips, Sam, Murray, L, Sleigh, L, Collier, A, Sit, LE, Allan, K, Cook, J, Campbell, K, Hodge, L, Leese, G, Reekie, G, Jaap, A, Sudworth, A, White, A, McKnight, J, Steven, L, McKay, G, Llano, A, Currie, G, Lennon, E, Johnstone, J, Shields, K, Petrie, John R, Chaturvedi, Nishi, Ford, Ian, Brouwers, Martijn C G J, Greenlaw, Nicola, Tillin, Therese, Hramiak, Irene, Hughes, Alun D, Jenkins, Alicia J, Klein, Barbara E K, Klein, Ronald, Ooi, Teik C, Rossing, Peter, Stehouwer, Coen D A, Sattar, Naveed, and Colhoun, Helen M

Published
2017
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20. Estimation of recurrent atherosclerotic cardiovascular event risk in patients with established cardiovascular disease

Author

Hageman, Steven H. J., McKay, Ailsa J., Ueda, Peter, Gunn, Laura H., Jernberg, Tomas, Hagström, Emil, Bhatt, Deepak L., Steg, Ph. Gabriel, Läll, Kristi, Mägi, Reedik, Gynnild, Mari Nordbø, Ellekjær, Hanne, Saltvedt, Ingvild, Tuñón, José, Mahíllo, Ignacio, Aceña, Álvaro, Kaminski, Karol, Chlabicz, Malgorzata, Sawicka, Emilia, Tillman, Taavi, McEvoy, John W., di Angelantonio, Emanuele, Graham, Ian, de Bacquer, Dirk, Ray, Kausik K., Dorresteijn, Jannick A. N., Visseren, Frank L. J., Asselbergs, F. W., Nathoe, H. M., de Borst, G. J., Bots, M. L., Geerlings, M. I., Emmelot, M. H., de Jong, P. A., Leiner, T., Lely, A. T., van der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y. M., Verhaar, M. C., Visseren, F. L. J., Westerink, J., Halle, Martin, Timmis, Adam D., Lettino, Maddalena, Vardas, Panos E., McEvoy, John William, Graham, Ian M., and Academic Medical Center

Subjects
Cardiac & Cardiovascular Systems, PREDICTION, Myocardial Infarction, Residual risk, Risk Assessment, ARTERIAL-DISEASE, Recurrent risk, Risk Factors, Medicine and Health Sciences, Humans, Cardiac and Cardiovascular Systems, 1102 Cardiorespiratory Medicine and Haematology, METAANALYSIS, Science & Technology, Kardiologi, Secondary prevention, 1103 Clinical Sciences, ASSOCIATION, Atherosclerosis, Established ASCVD, COMPETING RISKS, PREVENTION, Risk prediction, Stroke, ASPIRIN, Cardiovascular System & Hematology, Cardiovascular Diseases, CLINICAL-PRACTICE, Personalized treatment, Cardiovascular System & Cardiology, Cardiology and Cardiovascular Medicine, OUTPATIENTS, Life Sciences & Biomedicine, Algorithms, Biomarkers, TASK-FORCE
Abstract

Aims The 10-year risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events in patients with established ASCVD can be estimated with the Secondary Manifestations of ARTerial disease (SMART) risk score, and may help refine clinical management. To broaden generalizability across regions, we updated the existing tool (SMART2 risk score) and recalibrated it with regional incidence rates and assessed its performance in external populations. Methods and results Individuals with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysms were included from the Utrecht Cardiovascular Cohort-SMART cohort [n = 8355; 1706 ASCVD events during a median follow-up of 8.2 years (interquartile range 4.2-12.5)] to derive a 10-year risk prediction model for recurrent ASCVD events (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular mortality) using a Fine and Gray competing risk-adjusted model. The model was recalibrated to four regions across Europe, and to Asia (excluding Japan), Japan, Australia, North America, and Latin America using contemporary cohort data from each target region. External validation used data from seven cohorts [Clinical Practice Research Datalink, SWEDEHEART, the international REduction of Atherothrombosis for Continued Health (REACH) Registry, Estonian Biobank, Spanish Biomarkers in Acute Coronary Syndrome and Biomarkers in Acute Myocardial Infarction (BACS/BAMI), the Norwegian COgnitive Impairment After STroke, and Bialystok PLUS/Polaspire] and included 369 044 individuals with established ASCVD of whom 62 807 experienced an ASCVD event. C-statistics ranged from 0.605 [95% confidence interval (CI) 0.547-0.664] in BACS/BAMI to 0.772 (95% CI 0.659-0.886) in REACH Europe high-risk region. The clinical utility of the model was demonstrated across a range of clinically relevant treatment thresholds for intensified treatment options. Conclusion The SMART2 risk score provides an updated, validated tool for the prediction of recurrent ASCVD events in patients with established ASCVD across European and non-European populations. The use of this tool could allow for a more personalized approach to secondary prevention based upon quantitative rather than qualitative estimates of residual risk. Key objective To improve upon prediction of 10-year residual atherosclerotic cardiovascular disease (ASCVD) event risk in individuals with established ASCVD, by taking into account competing risks and geographical differences in ASCVD incidence. Key findings Derivation in 8355 individuals with established ASCVD from the Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease (SMART) cohort. C-statistics ranged from 0.605 [95% confidence interval (CI) 0.547-0.664] to 0.772 (95% CI 0.659-0.886). Clinical utility was demonstrated across a range of treatment thresholds relevant to therapy intensification. Take-home messages The SMART2 risk score can be used to estimate 10-year residual risk of fatal and non-fatal ASCVD in individuals with established ASCVD. Adapted to the CVD incidence in several global regions. Facilitates shared decision-making on Step 2 prevention goals as recommended by the 2021 ESC Guidelines on cardiovascular prevention.

Published
2022
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22. Rationale and design of the iCORONARY trial:improving the cost-effectiveness of coronary artery disease diagnosis

Author

Peper, J., Becker, L. M., Bruning, T. A., Budde, R. P.J., van Dockum, W. G., Frederix, G. W.J., Habets, J., Henriques, J. P.S., Houthuizen, P., Mohamed Hoesein, F. A.A., Planken, R. N., Voskuil, M., Bots, M. L., Leiner, T., Swaans, M. J., Peper, J., Becker, L. M., Bruning, T. A., Budde, R. P.J., van Dockum, W. G., Frederix, G. W.J., Habets, J., Henriques, J. P.S., Houthuizen, P., Mohamed Hoesein, F. A.A., Planken, R. N., Voskuil, M., Bots, M. L., Leiner, T., and Swaans, M. J.

Abstract

Background: In patients with stable coronary artery disease (CAD), revascularisation decisions are based mainly on the visual grading of the severity of coronary stenosis on invasive coronary angiography (ICA). However, invasive fractional flow reserve (FFR) is the current standard to determine the haemodynamic significance of coronary stenosis. Non-invasive and less-invasive imaging techniques such as computed-tomography-derived FFR (FFR-CT) and angiography-derived FFR (QFR) combine both anatomical and functional information in complex algorithms to calculate FFR. Trial design: The iCORONARY trial is a prospective, multicentre, non-inferiority randomised controlled trial (RCT) with a blinded endpoint evaluation. It investigates the costs, effects and outcomes of different diagnostic strategies to evaluate the presence of CAD and the need for revascularisation in patients with stable angina pectoris who undergo coronary computed tomography angiography. Those with a Coronary Artery Disease—Reporting and Data System (CAD-RADS) score between 0–2 and 5 will be included in a prospective registry, whereas patients with CAD-RADS 3 or 4A will be enrolled in the RCT. The RCT consists of three randomised groups: (1) FFR-CT-guided strategy, (2) QFR-guided strategy or (3) standard of care including ICA and invasive pressure measurements for all intermediate stenoses. The primary endpoint will be the occurrence of major adverse cardiac events (death, myocardial infarction and repeat revascularisation) at 1 year. Clinicaltrials.gov-identifier: NCT04939207. Conclusion: The iCORONARY trial will assess whether a strategy of FFR-CT or QFR is non-inferior to invasive angiography to guide the need for revascularisation in patients with stable CAD. Non-inferiority to the standard of care implies that these techniques are attractive, less-invasive alternatives to current diagnostic pathways.

Published
2023

23. High-Target Hemodiafiltration Convective Dose Achieved in Most Patients in a 6-Month Intermediary Analysis of the CONVINCE Randomized Controlled Trial

Author

MS Nefrologie, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, Circulatory Health, JC onderzoeksprogramma Cardiovascular Health, Nefro Vasculaire Geneeskunde, Vernooij, Robin W.M., Hockham, C., Barth, C., Canaud, B., Cromm, K., Davenport, A., Hegbrant, J., Rose, M., Strippoli, G. F.M., Török, M., Woodward, M., Bots, M. L., Blankestijn, P. J., MS Nefrologie, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, Circulatory Health, JC onderzoeksprogramma Cardiovascular Health, Nefro Vasculaire Geneeskunde, Vernooij, Robin W.M., Hockham, C., Barth, C., Canaud, B., Cromm, K., Davenport, A., Hegbrant, J., Rose, M., Strippoli, G. F.M., Török, M., Woodward, M., Bots, M. L., and Blankestijn, P. J.

Published
2023

24. Rationale and design of the iCORONARY trial: improving the cost-effectiveness of coronary artery disease diagnosis

Author

Cardiologie, Researchgr. Cardiovasculaire Radiologie, Cancer, Onderwijs Public Health, HEE, Child Health, JC onderzoeksprogramma Methodologie, MS Radiologie, Team Medisch, Circulatory Health, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Peper, J., Becker, L. M., Bruning, T. A., Budde, R. P.J., van Dockum, W. G., Frederix, G. W.J., Habets, J., Henriques, J. P.S., Houthuizen, P., Mohamed Hoesein, F. A.A., Planken, R. N., Voskuil, M., Bots, M. L., Leiner, T., Swaans, M. J., Cardiologie, Researchgr. Cardiovasculaire Radiologie, Cancer, Onderwijs Public Health, HEE, Child Health, JC onderzoeksprogramma Methodologie, MS Radiologie, Team Medisch, Circulatory Health, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Peper, J., Becker, L. M., Bruning, T. A., Budde, R. P.J., van Dockum, W. G., Frederix, G. W.J., Habets, J., Henriques, J. P.S., Houthuizen, P., Mohamed Hoesein, F. A.A., Planken, R. N., Voskuil, M., Bots, M. L., Leiner, T., and Swaans, M. J.

Published
2023

26. Analyzing student-teacher interactions in Challenge-based Learning

Author

Doulougeri, K. I., Vermunt, J. D., Bombaerts, G., Bots, M., Järvinen, Hannu-Matti, Silvestre, Santiago, Llorens, Ariadna, Nagy, Balàzs, Group Vermunt, Philosophy & Ethics, and EIRES

Subjects
Challenge-based learning, Self-regulated learning, Portfolio, Aprenentatge autodirigit, Active learning, Aprenentatge actiu, self-regulated learning, Ensenyament i aprenentatge::Innovació i Investigació educativa [Àrees temàtiques de la UPC], Portfolios in education, Self-managed learning, Portafolis en educació, challenge-based learning, portfolio
Abstract

Challenge-based learning (CBL) exposes students to the complexities of openended and real-life challenges and encourages them to be in the lead of their learning. The role of teachers remains important but shifts from being the expert to the role of a coach who gradually scaffolds students into becoming independent learners. Accordingly, the interplay between teachers' and students' regulation of teaching and learning can result in friction and influence students' learning experience. This study explores incidents of constructive or destructive friction between student and teacher regulation during a 9-week CBL course for first-year engineering students. Thematic analysis is employed to identify critical incidents of friction during students' learning via analyzing students' weekly learning portfolios. Results suggest that students' experience in CBL is not linear, and there is a constant interplay between students' ability to regulate their learning and teachers' scaffolding. Initial exposure to CBL was characterized by friction in student and teacher interactions. Several students increased their self-regulated learning skills by resolving the initial friction by adopting a more proactive approach to their learning by actively asking questions and feedback from their teachers. The findings of this study are particularly relevant for CBL, where much attention is paid to students' autonomy, self-directedness, and collaboration. Building on the insights of this research, we make recommendations for further research and educational practice.

Published
2022
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27. Cardiac dysfunction in relation to vascular brain injury, cognitive impairment and depressive symptoms; The Heart-Brain Connection Study

Author

Amier, R P, primary, Marcks, N, additional, Leeuwis, A E, additional, Nijveldt, R, additional, Biessels, G J, additional, Kappelle, L J, additional, Van Oostenbrugge, R J, additional, Van Der Geest, R J, additional, Bots, M L, additional, Niessen, W J, additional, De Bresser, J, additional, Mooijaart, S P, additional, Van Der Flier, W M, additional, Brunner-La Rocca, H P, additional, and Van Rossum, A C, additional

Published
2022
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28. Microinfarcts in the Deep Gray Matter on 7T MRI: Risk Factors, MRI Correlates, and Relation to Cognitive Functioning-The SMART-MR Study

Author

Ghaznawi, R., Zwartbol, M. H. T., de Bresser, J., Kuijf, H. J., Vincken, K. L., Rissanen, I., Hendrikse, J., Geerlings, Mirjam I., Asselbergs, F. W., Nathoe, H. M., de Borst, G. J., Bots, M. L., Geerlings, M. I., Emmelot, M. H., de Jong, P. A., Leiner, T., Lely, A. T., van der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y., Verhaar, M. C., Visseren, F. L. J., Westerink, J., General practice, APH - Aging & Later Life, APH - Personalized Medicine, Amsterdam Neuroscience - Mood, Anxiety, Psychosis, Stress & Sleep, Amsterdam Neuroscience - Neurodegeneration, and ACS - Heart failure & arrhythmias

Subjects
Cognition, Risk Factors, Adult Brain, Humans, Radiology, Nuclear Medicine and imaging, Neurology (clinical), Gray Matter, Carotid Intima-Media Thickness, Magnetic Resonance Imaging, Biomarkers, Aged
Abstract

BACKGROUND AND PURPOSE: The clinical relevance of cortical microinfarcts has recently been established; however, studies on microinfarcts in the deep gray matter are lacking. We examined the risk factors and MR imaging correlates of microinfarcts in the deep gray matter on 7T MR imaging and their relation to cognitive functioning.\MATERIALS AND METHODS: Within the Second Manifestations of ARTerial disease?Magnetic Resonance (SMART-MR) study, 213 patients (mean age, 68 [SD, 8]?years) had a risk-factor assessment, 7T and 1.5T brain MR imaging, and a cognitive examination. Microinfarcts on 7T MR imaging were defined as lesions of < 5 mm. Regression models were used to examine the age-adjusted associations among risk factors, MR imaging markers, and microinfarcts. Cognitive function was summarized as composite and domain-specific z scores. RESULTS: A total of 47 microinfarcts were found in 28 patients (13%), most commonly in the thalamus. Older age, history of stroke, hypertension, and intima-media thickness were associated with microinfarcts. On 1.5T MR imaging, cerebellar infarcts (relative risk = 2.75; 95% CI, 1.4?5.33) and lacunes in the white (relative risk = 3.28; 95% CI, 3.28?6.04) and deep gray matter (relative risk?= 3.06; 95% CI, 1.75?5.35) were associated with microinfarcts, and on 7T MR imaging cortical microinfarcts (relative risk = 2.33; 95% CI, 1.32?4.13). Microinfarcts were also associated with poorer global cognitive functioning (mean difference in the global z score between patients with multiple microinfarcts versus none = ?0.97; 95% CI, ?1.66 to ?0.28, P = .006) and across all cognitive domains. CONCLUSIONS: Microinfarcts in the deep gray matter on 7T MR imaging were associated with worse cognitive functioning and risk factors and MR imaging markers of small-vessel and large-vessel disease. Our findings suggest that microinfarcts in the deep gray matter may represent a novel imaging marker of vascular brain injury.

Published
2022

33. Patients with diffuse idiopathic skeletal hyperostosis have an increased burden of thoracic aortic calcifications

Author

MS Interne Geneeskunde, Circulatory Health, MS Radiologie, Arts-assistenten Radiologie, Beeldverwerking ISI, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Cancer, Researchgr. Systems Radiology, Infection & Immunity, Team Medisch, Zorgeenheid Vaatchirurgie Medisch, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 7a, Brain, MS Geriatrie, MS Verloskunde, Child Health, CTC, Neurologen, Nefro Vasculaire Geneeskunde, Interne Geneeskunde Vasculaire, Harlianto, Netanja I., Westerink, Jan, Hol, Marjolein E., Wittenberg, Rianne, Foppen, Wouter, Van Der Veen, Pieternella H., Van Ginneken, Bram, Verlaan, Jorrit Jan, De Jong, P. A., Mohamed Hoesein, Firdaus A.A., Asselbergs, F. W., Nathoe, H. M., De Borst, G. J., Bots, M. L., Geerlings, M. I., Emmelot, M. H., Leiner, T., Lely, A. T., Van Der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y. M., Verhaar, M. C., Visseren, F. L.J., MS Interne Geneeskunde, Circulatory Health, MS Radiologie, Arts-assistenten Radiologie, Beeldverwerking ISI, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Cancer, Researchgr. Systems Radiology, Infection & Immunity, Team Medisch, Zorgeenheid Vaatchirurgie Medisch, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 7a, Brain, MS Geriatrie, MS Verloskunde, Child Health, CTC, Neurologen, Nefro Vasculaire Geneeskunde, Interne Geneeskunde Vasculaire, Harlianto, Netanja I., Westerink, Jan, Hol, Marjolein E., Wittenberg, Rianne, Foppen, Wouter, Van Der Veen, Pieternella H., Van Ginneken, Bram, Verlaan, Jorrit Jan, De Jong, P. A., Mohamed Hoesein, Firdaus A.A., Asselbergs, F. W., Nathoe, H. M., De Borst, G. J., Bots, M. L., Geerlings, M. I., Emmelot, M. H., Leiner, T., Lely, A. T., Van Der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y. M., Verhaar, M. C., and Visseren, F. L.J.

Published
2022

34. Missing data is poorly handled and reported in prediction model studies using machine learning: a literature review

Author

Epi Methoden Team 2, Epi Methoden Team 1, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiologie, Team Medisch, Epi Methoden, Cancer, JC onderzoeksprogramma Methodologie, Nijman, S. W.J., Leeuwenberg, A. M., Beekers, I., Verkouter, I., Jacobs, J.J.L., Bots, M. L., Asselbergs, F. W., Moons, K. G.M., Debray, T. P.A., Epi Methoden Team 2, Epi Methoden Team 1, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiologie, Team Medisch, Epi Methoden, Cancer, JC onderzoeksprogramma Methodologie, Nijman, S. W.J., Leeuwenberg, A. M., Beekers, I., Verkouter, I., Jacobs, J.J.L., Bots, M. L., Asselbergs, F. W., Moons, K. G.M., and Debray, T. P.A.

Published
2022

35. Atrial fibrillation: trends in prevalence and antithrombotic prescriptions in the community

Author

HAG Trombose, Epi Infectieziekten Team 1, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Directie Raad van Bestuur, Circulatory Health, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, HAG Hart- Vaatziekten, Joosten, L. P.T., de Boer, A. R., van Eerde, E. J.B., van Doorn, S., Hoes, A. W., Bots, M. L., Rutten, F. H., Geersing, G. J., HAG Trombose, Epi Infectieziekten Team 1, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Directie Raad van Bestuur, Circulatory Health, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, HAG Hart- Vaatziekten, Joosten, L. P.T., de Boer, A. R., van Eerde, E. J.B., van Doorn, S., Hoes, A. W., Bots, M. L., Rutten, F. H., and Geersing, G. J.

Published
2022

38. Patients with diffuse idiopathic skeletal hyperostosis have an increased burden of thoracic aortic calcifications

Author

Harlianto, Netanja I., Westerink, Jan, Hol, Marjolein E., Wittenberg, Rianne, Foppen, Wouter, van der Veen, Pieternella H., van Ginneken, Bram, Verlaan, Jorrit-Jan, de Jong, Pim A., Mohamed Hoesein, Firdaus A. A., Asselbergs, F. W., Nathoe, H. M., de Borst, G. J., Bots, M. L., Geerlings, M. I., Emmelot, M. H., de Jong, P. A., Leiner, T., Lely, A. T., van der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y. M., Verhaar, M. C., Visseren, F. L. J., General practice, APH - Personalized Medicine, Amsterdam Neuroscience - Mood, Anxiety, Psychosis, Stress & Sleep, Amsterdam Neuroscience - Neurodegeneration, and APH - Aging & Later Life

Subjects
calcification, All institutes and research themes of the Radboud University Medical Center, Rheumatology, thoracic aortic calcification, atherosclerosis, diffuse idiopathic skeletal hyperostosis, Rare cancers Radboud Institute for Health Sciences [Radboudumc 9], bone formation
Abstract

Objectives. DISH has been associated with increased coronary artery calcifications and incident ischaemic stroke. The formation of bone along the spine may share pathways with calcium deposition in the aorta. We hypothesized that patients with DISH have increased vascular calcifications. Therefore we aimed to investigate the presence and extent of DISH in relation to thoracic aortic calcification (TAC) severity. Methods. This cross-sectional study included 4703 patients from the Second Manifestation of ARTerial disease cohort, consisting of patients with cardiovascular events or risk factors for cardiovascular disease. Chest radiographs were scored for DISH using the Resnick criteria. Different severities of TAC were scored arbitrarily from no TAC to mild, moderate or severe TAC. Using multivariate logistic regression, the associations between DISH and TAC were analysed with adjustments for age, sex, BMI, diabetes, smoking status, non-high-density lipoprotein cholesterol, cholesterol lowering drug usage, renal function and blood pressure. Results. A total of 442 patients (9.4%) had evidence of DISH and 1789 (38%) patients had TAC. The prevalence of DISH increased from 6.6% in the no TAC group to 10.8% in the mild, 14.3% in the moderate and 17.1% in the severe TAC group. After adjustments, DISH was significantly associated with the presence of TAC [odds ratio (OR) 1.46 [95% CI 1.17, 1.82)]. In multinomial analyses, DISH was associated with moderate TAC [OR 1.43 (95% CI 1.06, 1.93)] and severe TAC [OR 1.67 (95% CI 1.19, 2.36)]. Conclusions. Subjects with DISH have increased TACs, providing further evidence that patients with DISH have an increased burden of vascular calcifications.

Published
2022
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