Archiv der Kategorie: Prävalenzdaten

Ruhe-EKG und Belastungs-EKG zur Risikostratifikation asymptomatischer Personen

Herz Kardiovaskuläre Erkrankungen | July 2007, Volume 32, Issue 5, pp 362-370

– Stefan Möhlenkamp, Heinrich Wieneke, Stefan Sack, Raimund Erbel
Das Ruhe-Elektrokardiogramm (EKG) und das Belastungs- EKG sind in der kardiologischen Routinediagnostik fest etabliert. In Ergänzung zur diagnostischen Bedeutung für strukturelle Herzkrankheiten und Rhythmusstörungen enthält das EKG in Ruhe oder unter Belastung auch prognostisch relevante Informationen…

moehlenkamp_ekg-Herz-tab-1Das Zwölf-Kanal-Ruhe-Elektrokardiogramm (EKG) und das Belastungs-EKG sind als weitverbreitete, einfach durchzuführende, schmerzfreie und gut evaluierte Verfahren im strumentarium der kardiologischen Diagnostik fest etabliert. Das Zwölf-Kanal-Ruhe-EKG ist neben den Herzenzymen der wichtigste Test für einen akuten Myokardinfarkt und bildet die Grundlage zur Identifikation vieler Herzrhythmusstörungen. Im Rahmen der fahrrad- oder laufbandbasierten Belastungsdiagnostik spielt das EKG weiterhin eine wegweisende
Rolle für die adäquate Indikationsstellung zur weiterführenden invasiven Diagnostik bei klinischen Hinweisen für eine stenosierende koronare Herzkrankheit (KHK). Dennoch konnte für Ruhe- und Belastungs-EKG bislang nicht einwandfrei geklärt werden, ob sie als Screeningverfahren bei asymptomatischen Personen einen prognostischen Nutzen unabhängig von den etablierten Risikofaktoren haben.
In einer Vielzahl bevölkerungsbasierter Studien wurde der prädiktive Nutzen von Ruhe-EKG-Variablen im Vergleich zu den konventionellen Risikofaktoren untersucht (Tabelle 1). Eine detaillierte Übersicht liefern Arbeiten von Ashley et al. und der U.S. Preventive Task Force zum Screening einer asymptomatischen KHK.

moehlenkamp_ekg-Herz-tab-2Mehrere EKG-Abnormalitäten wurden im Rahmen des U.S. Pooling Project in Major- und Minor-Kriterien zusammengefasst  (Tabelle 2) und vielfach in epidemiologischen Studien genutzt. In der belgischen BIRNH-Studie waren die Major-Kriterien gemeinsam mit anderen etablierten Risikofaktoren alleinige signifikante unabhängige EKG-basierte Prädiktoren für die kardiovaskuläre (RR = 3,88) und koronare (RR = 2,89) Mortalität. In drei weiteren Studien wurden RRs zwischen 1,4 und 2,2 für die Gesamtmortalität sowie zwischen 1,5 und 2,72 für die koronare Mortalität berichtet. (weiter…)

Body-surface adjusted aortic reference diameters for improved identification of patients with thoracic aortic aneurysms: Results from the population-based Heinz Nixdorf Recall study

IJCA-13519; doi:10.1016/j.ijcard.2011.05.039

-Hagen Kälsch, Nils Lehmann, Stefan Möhlenkamp, Anna Becker, Susanne Moebus, Axel Schmermund, Andreas Stang, Amir A. Mahabadi, Klaus Mann, Karl-Heinz Jöckel, Raimund Erbel, Holger Eggebrecht

Early identification of patients at risk for thoracic aortic aneurysm (TAA) has the potential of improving prognosis. So far, however, “normal” aortic dimensions are not well defined, rendering identification of patientswith enlarged aortas difficult. In the present study we aimed to (1) establish age- and gender-specific distribution of thoracic aortic diameters and (2) to determine the prevalence of asymptomatic TAA in a population-based European cohort.

kaelsch-aorta-diameter-2011-tab1aOf 4814 participants of the HNR study, 4609 (95.7%) ultimately had an EBCT scan performed between December 2000 and August 2003. The remaining were either unable to receive an EBCT (obesity, claustrophobia, etc.) or disclaimed the examination. Of the 4609 subjects with an EBCT scan, 4301 (93.3%) subjects had no history of known CAD. kaelsch-aorta-diameter-2011-tab1bOverall, ATA and DTA diameters were measured in 4129 (96%) of these 4301 individuals. Tables 1a and 1b show the demographics of the study population. The mean age of the participants was 59.4±7.8 years and 47% were males.

kaelsch-aorta-diameter-2011-tab2Overall aortic diameters were greater in ATA than in DTA, and were greater in men than in women. Table 2 shows the measurements of the thoracic aorta diameters in both genders. Aortic diameters were greater in men as compared to women in both the ATA (3.71±0.4 vs. 3.45±0.4 cm, pb0.0001) and DTA (2.82±0.3 vs. 2.54±0.3 cm, pb0.001) (Table 2).

kaelsch-aorta-diameter-2011-tab30.25 cm/m²) for 90th percentile, for 95th percentile (+0.225 vs. 0.25 cm/m²) and for 95th percentile (+0.275 vs. 0.225 cm/m²). Correspondingly, ATA and DTA increased (+0.2 vs. 0.225 cm/m²) for 90th percentile, for 95th percentile (+0.2 vs. 0.225 cm/m²) and for 95th percentile (+0.275 vs. 0.3 cm/m²) in women, respectively. Both genders were found to have an enlargement of ATA of 0.15 cm per 10 years, DTA increased 0.17 cm per 10 years in men and 0.16 cm per 10 years in women (Table 3).

kaelsch-aorta-diameter-2011-tab4Table 4 demonstrates the anthropometric and demographic measurements of participants above and below the 95th percentile for indexed ATA and DTA diameters. Overall, 213 participants revealed thoracic aortic diameters above this cut-off point (111 females/102 males). Mean body-surface adjusted aortic size diameters of males above the 95th percentile were 2.3±0.2 cm/m² for ATA and 2.1±0.3 cm/m² for DTA vs. 2.5±0.2 cm/m² for ATA and 2.3±0.3 cm/m² for DTA in females, respectively. Subjects above the 95th percentile had significantly higher blood pressures but lower indices of body size including body mass index and body-surface area.

kaelsch-aorta-diameter-2011-tab5Early and reliable identification of patients with dilated thoracic aortas before the onset of symptoms or complications has the potential for improving patient’s prognosis by allocation of intensified surveillance and early initiation of medical or elective surgical therapy. Distinguishing dilated from “normal” aortas is, however, difficult in the absence of well-defined reference values for thoracic aorta. Current studies are limited by sample size, non-contemporary imaging methodology used, and study population which may not be representative for the general population as they include stroke patients as well as patients referred for various cardiac and noncardiovascular CT indications [5–9,12–16] (Table 5). (weiter…)

Querschnittsdaten der Ersterhebung

t0-erhebung_tab2 Springer-Verlag: June 2012, Volume 55, Issue 6-7, pp 809-815
Erbel R, Eisele L, Moebus S, Dragano N, Möhlenkamp S, Bauer M, Kälsch H, Jöckel KH.-
Von den 4814 untersuchten Probanden der Ersterhebung waren 50,2% Frauen. Das mittlere Alter lag sowohl für Männer als auch für Frauen bei 59,6 Jahren. Wichtige Befunde und Prävalenzen der kardialen Risikofaktoren sowie von Vorerkrankungen sind in Tab. 2 aufgeführt, sozioökonomische Daten der Probanden in Tab. 3. Die Ultraschalluntersuchung der Halsgefäße zeigte eine Plaquebildung bei 43,2% der Männer und bei 30,7% der Frauen. Eine Bestimmung der Intima-Media-Dicke wurde genutzt, um eine alters-und geschlechtsspezifische Verteilung für unsere Probanden im Alter von 45 bis 75 Jahren aufzustellen. Diese kann im Internet eingesehen werden (http://www.recall-studie.de).t0-erhebung_tab3

Ergebnisse der
Längsschnittbetrachtung

Die bislang wichtigsten Ergebnisse beziehen sich auf die primäre Fragestellung und die Gesamtmortalität. Im Verlauf der ersten fünf Jahre erlitten 93 Probanden einen akuten Herzinfarkt oder verstarben an einem akuten Herztod, davon waren 30% Frauen (Tab. 4). Nach einer medianen Beobachtungszeit von 7,2 Jahren stieg die Zahl an kardialen Ereignissen auf 115 (2,8%). Insgesamt waren 152 (3,6%) zerebrovaskuläre Ereignisse einschließlich Schlaganfälle und koronarer Revaskularisationen (PCI/Bypass-Operation) aufgetreten. Personen mit Ereignissen waren im Mittel älter und wiesen höhere Blutdruckwerte auf. Auffällig war auch ein erhöhter Anteil an Probanden mit Diabetes
mellitus. t0-erhebung_tab4Im Vergleich zu dem aus Risikofaktoren bestimmten Framingham-Score ergab die Analyse der Koronargefäßverkalkung eine deutliche Verbesserung der Risikovorhersage. Verglichen mit Probanden ohne nachweisbare Koronargefäßverkalkung war das adjustierte relative Risiko (RR) bei einem CAC-Score von ≥400 für Männer circa achtfach und für Frauen sechsfach erhöht [adjustiertes RR Männer: 7,92, 95%-Konfidenzintervall (95%-KI) 2,47–25,39; Frauen: 5,99; 95%-KI 2,04–17,64; Adjustierung für National Cholesterol Education Program Adult Treatment Panel III Risikokategorien]. Eine Verdopplung des CAC bedeutete ein um 31% erhöhtes Risiko für Männer beziehungsweise ein um 20% erhöhtes für Frauen. Die Fünf-Jahres-Ereignisrate bei einer Koronargefäßverkalkung unterschied sich zwischen Männern und Frauen nicht und stieg auf >8% bei einem Verkalkungsgrad von >400. (weiter …)

Association of impaired fasting glucose and coronary artery calcification as a marker of subclinical atherosclerosis in a population-based cohort—results of the Heinz Nixdorf Recall Study

Diabetologia (2009) 52:81–89 | DOI 10.1007/s00125-008-1173-y

– S. Moebus; A. Stang; S. Möhlenkamp; N. Dragano; A. Schmermund; U. Slomiany; B. Hoffmann; M. Bauer; M. Broecker-Preuss; K. Mann; J. Siegrist; R. Erbel; K.-H. Jöckel; for the Heinz Nixdorf Recall Study Group

Abstract
moebus-diabetologia-2008-tab1Aims/hypothesis Atherosclerosis and cardiovascular diseases are often present at the time of diagnosis of type 2 diabetes mellitus. Whether subclinical atherosclerosis can be detected in the pre-diabetic (borderline fasting hyperglycemia) state is not clear. This study investigated the association of impaired fasting glucose (IFG) and coronary artery calcification (CAC), a marker of subclinical atherosclerosis, among participants without a history of coronary heart disease or manifest diabetes mellitus.

moebus-diabetologia-2008-tab2Of 2,184 participants 29% (n=633) had IFG. Among men a higher prevalence than in women was observed (37% vs 22%). Characteristics of the study population according to the glucose status are shown in Table 1. Participants with IFG were particularly characterised by a higher mean BMI and waist circumference than those with NFG. Accordingly, more participants with IFG were classified as being obese (BMI ≥30 kg/m2). In addition the participants with IFG were more likely to be older and hypertensive. Dyslipidaemia,
smoking status and use of medications differed between sexes with regard to glucose status.
moebus-diabetologia-2008-fig1For both sexes a positive association between fasting plasma glucose levels and CAC can be shown (ESM Fig. 1). The prevalence of NFG and IFG by CAC risk group and age group is presented in Table 2. A higher proportion of men and women with NFG had no or only small amounts of CAC (<10) compared with those with IFG. On the other hand, participants with IFG were more likely to exhibit high amounts of CAC (≥400). However, in the age group 55–64 years as well as in the CAC risk-groups with values of CAC ≥10 to <100 and ≥10 to <400, this tendency is less pronounced, especially in men. (weiter …)

Daily Siesta, Cardiovascular Risk Factors, and Measures of Subclinical Atherosclerosis: Results of the Heinz Nixdorf Recall Study

SLEEP, Vol. 30, No. 9, 2007

– Andreas Stang; Nico Dragano; Charles Poole; Susanne Moebus; Stefan Möhlenkamp; Axel Schmermund; Johannes Siegrist; Raimund Erbel; Karl-Heinz Jöckel

Background: Several studies have assessed the association between siesta and cardiovascular outcomes. Concern exists that confounding might have distorted these results and contributed to discrepancies among them. This report examines the association between siesta habits and cardiovascular risk factors, including sleep disturbances at night, depressed mood, and measures of subclinical atherosclerosis such as coronary calcium score and ankle brachial index.

stang_2007-Tab1Overall, 325 subjects aged 45-74 years (7%) had a history of CAD. Table 1 presents sleep characteristics of participants without a history of CAD. The median sleep duration at night did not vary by age and sex, but elderly women more often tended to sleep <6 hours per night than elderly men. The prevalence of all nocturnal sleep disturbances was considerably higher among women than among men, regardless of age. The most frequently reported regular sleep disturbance among men and women was difficulty maintaining asleep at night among both. The prevalence of the 3 major types of nocturnal sleep disturbances increased monotonically with age among women. The prevalence of daily siesta was slightly higher among men than women, regardless of age. The median duration of siesta among daily siesta takers was particularly long in older men, among whom siestas contributed appreciably to the total daily sleep duration.

stang_2007-Tab2Table 2 presents the sleep characteristics of the 325 participants with a history of CAD. Because only 68 women had manifest CAD, age-specific estimates of sleep characteristics in that group are not shown. Women with CAD had a considerably higher prevalence of excessively short sleep durations (<6 h) than men with CAD. Difficulty falling asleep and early morning arousal were more prevalent among women than men, whereas the prevalence of difficulty maintaining sleep was about the same in the 2 sexes. Generally, prevalence of siesta and of nocturnal sleep disturbances were higher among participants who had CAD than among those who did not.

stang_2007-Tab3Poor self-perceived health status, depressive mood, difficulties falling asleep, and excessively short nocturnal sleep durations were positively associated with daily long siestas among both men and women. Early morning awakening was negatively associated with regular siesta among men and positively associated with regular siesta among women (Table 3).

stang_2007-Tab4Participants taking short daily siestas showed prevalence of CAD risk factors similar to those of participants who took siestas no more than occasionally (Table 4). Participants taking daily long siestas, however, showed higher prevalence of CAD risk factors, and, especially in men, higher prevalence of subclinical atherosclerosis as measured by ABI and EBT. The overall number of established CAD risk factors was higher among subjects taking daily long siestas compared with subjects taking daily short siestas, irregular siestas, or no siestas.

stang_2007-Tab5In a hypothetical follow-up study of a cohort with the risk factor distributions of the 3 siesta groups in the Heinz Nixdorf Recall Study, the estimated rate ratios for the association between baseline siesta and incident CAD are appreciably confounded upon adjustment for few or no risk factors, among both men and women (Table 5). The adjusted estimates move closer to the hypothetically unconfounded null value upon adjustment for additional numbers of risk factors. (weiter…)

Subclinical coronary atherosclerosis is more pronounced in men and women with lower socio-economic status: associations in a population-based study Coronary atherosclerosis and social status

European Journal of Cardiovascular Prevention and Rehabilitation 2007, 14:568–574

-Nico Dragano, Pablo Emilio Verdea, Susanne Moebus, Andreas Stang,
Axel Schmermund, Ulla Roggenbuck, Stefan Möhlenkamp, Richard Peter,
Karl-Heinz Jöckel, Raimund Erbel, Johannes Siegrist and for the
Heinz Nixdorf Recall Study

Background Social inequalities of manifest coronary heart diseases are well documented in modern societies. Less evidence is available on subclinical atherosclerotic disease despite the opportunity to investigate processes underlying this association. Therefore, we examined the relationship between coronary artery calcification as a sign of subclinical coronary atherosclerosis, socio-economic status and established cardiovascular risk factors in a healthy population.

dragano-EurJCardiovascPrev-2007-Tab1Baseline data on 2264 women and 2037 men are displayed in Table 1. There were marked gender differences in the distribution of the two indicators of social status. Mean
income was higher for men, and men reported more years of formal education. As expected, coronary risk factors were more pronounced in men than in women. The median CAC score for the whole sample was 12.6 with an interquartile range of 117.6 (25%=0; 75%=117.6). On average values were lower in women.

dragano-EurJCardiovascPrev-2007-Tab2A stratification of the CAC score by education and income is presented in Table 2. The median values of the score varied considerably between the social groups in men and women: calcification decreased with increasing education or income. This trend was, however, not consistent across all age groups. It was most pronounced in younger participants aged 45–54 years, but less consistent in the middle and older age groups.

Table 3 displays the results of multivariate analyses, using education as an indicator of SES. For men and women, the crude model confirmed the bivariate findings. As can be seen consecutive adjustment for risk factors diminished substantially the strength of the association between education and CAC. On the basis of the model-fit, cholesterol (men only), diabetes (women only), triglycerides, systolic blood pressure, body mass index and smoking contributed most to the model-fit. Importantly, in both genders the association between education and CAC was no longer statistically significant in the most parsimonious model.
dragano-EurJCardiovascPrev-2007-Tab3-4Analogous findings for income are given in Table 4. The weak relationship between income and CAC for the male study participants was largely explained by age. Further adjustment ruled out any variation of the dependent variable in relation to income. In women associations were more pronounced. In the age-adjusted model (2) women in the lowest quartile had a 50% higher CAC than women in the upper quartile of the income distribution. Again, adjustment for risk factors resulted in a reduction of effects. (weiter…)

Sex related cardiovascular risk stratification based on quantification of atherosclerosis and inflammation

Atherosclerosis 197 (2008) 662–672

Raimund Erbel, Stefan Möhlenkamp, Nils Lehmannb, Axel Schmermund, Susanne Moebus, Andreas Stang, Dietrich Grönemeyer, Rainer Seibel, Klaus Manng, Lothar Volbracht, Nico Dragano, Johannes Siegrist, Karl-Heinz Jöckel, on behalf of the Heinz Nixdorf Recall Study Investigative Group

Background: The National Cholesterol Education Program in Adult Treatment Panel III (NCEP ATP III) suggests using CAC and hs-CRP in individuals at intermediate risk. The effect on risk stratification was not yet tested in the general population.

erbel_atherosclerosis-2008_Tab1Baseline data demonstrate substantial rates of obesity, hypertension, smoking, and hypercholesterolemia in the general population (Tables 1 and 2). Total cholesterol- and
HDL-levels were higher but triglyceride-levels and blood pressures lower in women. Triglyceride levels were higher in those who fasted <6 h compared to those that fasted
>6 h (159±95 mg/dL versus 141±100 mg/dL, p < 0.0001). BMI and hs-CRP-levels were similar in men and women (Tables 1 and 2). CAD participants had higher rates of known hypercholesterolemia but lower levels of total and LDL cholesterol. CAD participants also showed several-fold higher rates of known hypertension, past or active smoking, diabetes, stroke, and PAD compared to subjects without CAD. No male and only 5 (8.1%) of 62 female CAD participants had no CAC.

erbel_atherosclerosis-2008_Tab2The mean FRS was twice as high in men compared to women (Tables 1 and 2). However, one quarter of men but only 1.3% women without CAD were stratified into the high FRSgroup. Subjects withCADhad a higher FRS.Yet, despite a CAD history, almost 20% of men and more than 60% of women were categorized as being at low FRS. (weiter…)

Prevalence of peripheral arterial disease – results of the Heinz Nixdorf Recall Study

European Journal of Epidemiology (2006) 21: 279–285 | DOI 10.1007/s10654-006-0015-9 | © Springer 2006
– Knut Kröger, Andreas Stang, Jana Kondratieva, Susanne Moebus, Eva Beck, Axel Schmermund, Stefan Möhlenkamp, Nico Dragano, Johannes Siegrist, Karl-Heinz Jöckel & Raimund Erbel on behalf of the Heinz Nixdorf Recall Study Group-

kroeger_2006-EurJetEpid-Tab1Background: This report presents population-based estimates of the prevalence of peripheral arterial disease (PAD), chronic critical limb ischemia (CLI), and Moenckeberg’s medial calcinosis (MC) in Germany. Patients and methods: From the year 2000 to 2003, a total of 4,814 subjects aged 45–75 years were included in the study.
From the year 2000 to 2003, a total of 4,814 subjects aged 45–75 years were included in the study. In 30 of these subjects (0.6%), determination of ABI was not possible because of disorders of the leg (edema, pain, ulcers, amputation) or of the arm (lymphedema in a case of mammary carcinoma), leaving 4,735 subjects (99.4%) in the data set who served as the study group for all analyses presented in this paper (Table 1).

kroeger_2006-EurJetEpid-Tab2The overall prevalence of PAD according to the ABI criteria was 6.4% among men and 5.1% among women. After accounting for history of PAD, the prevalence increased to 8.2% among men and 5.5% among women (Table 2).

kroeger_2006-EurJetEpid-Tab3-4Subjects with a history of coronary artery disease had a considerably higher prevalence of PAD than subjects without such a history (Table 3). Due to the differences in distribution of age in these groups, crude estimates of prevalence were confounded by age. The difference in prevalence between subjects with and without CAD became smaller but did not disappear after age-standardization.
Chronic CLI was found only in five older subjects: four men aged 51–72 years (median: 66.5 years) and one woman aged 74 years. Thus, 0.1% of the study population and 2% of the subjects with PAD had CLI.
With use of the criterion of ABI >1.3, about 13.3% of males and 6.9% of females had MC (Table 4). This prevalence is much higher than that of PAD, especially for males. In contrast to PAD, there appears to be a constant percentage of subjects in each age group, which is higher for males than for females. With the criterion of ABI >1.5, only 1.1% and 0.5% of males and females, respectively, had MC. With MC defined by absolute cuff pressure, 30 (0.6%) subjects had MC with incompressible arteries at pressures 260 mmHg and higher (weiter…)