HUNT Study Research Articles

159 LV volumes, EF, MAPSE, myocardial mass and systolic compression and relation to ageing. Results from the HUNT study

Abstract Background Myocardial mass increase with age, but the impact of recently discovered length reduction by age has not been taken into account. Long axis shortening is considered the main contributor to LV stroke volume. There is still disagreement about the relative contributions of cross sectional vs long axis shortening. Long axis shortening decrease with age, but EF do not. It has been postulated that this is due to increased transverse function, but this has not been demonstrated. Also, the degree of systolic myocardial compression is unresolved. Methods The HUNT study examined 1266 subjects without evidence of heart disease from a mixed urban/rural population of North Trøndelag county, Norway. Linear dimensions of diastolic left ventricular annulus to apex distance, systolic and diastolic wall thicknesses (WT), chamber diameter (LVID), and mitral annular plane displacement (MAPSE) were measured. Measurements were applied to a half-ellipsoid model of the left ventricle with assumption of 50% thinner apex than midway thickness, for calculations of left ventricular length (LVL), LV cavity volume (LVEDV), stroke volume (SV) and EF as shown in fig. 1. Results Dimensions and volumes are given in table 1. LV internal diameter was unchanged by age, and so was fractional shortening (FS). Wall thickness increased by age (p < 0.001), corresponding to an increase in external diameter, but LVL decreased (p < 0.001), so increase in myocardial volume (MyoV) although significant (p < 0.001), was less. Wall thickening decreased from 59 to 52% by age group (p < 0.001). MAPSE decreased by age (p < 0.001). Similarly systolic external diameter reduction (from 13.6 to 11.9%), and SV also decreased by age, while EF was unchanged. MAPSE contributed 74% to stroke volume, external diameter reduction to 26% These relative contributions did not change by age. Systolic myocardial compression was 2.5%, at all ages. Conclusion LVEDV decreases with age due to LV shortening, not wall thickening. EF is maintained by a simultaneous reduction in SV and EDV. MAPSE decreases by age, and so does transverse function. Thus, both are decreasing in proportion, and the reduction in SV is due to both, not to any increase in transverse function. Table 1 Age (years) WT (mm) LVL (mm) LVID (mm) LVEDV (ml) MyoV (ml) MAPSE (mm) SV (ml) EF (%) <40 8.1 (1.3) 94.2 (7.5) 50.9 (4.9) 124.0 (30.0) 101.4 (27.9) 17.3 (2.0) 83.7 (21.4) 67 (6) 40 - 60 8.9 (1.4) 92.9 (8.1) 50.9 (5.4) 122.5 (31.0) 111.2 (29.2) 15.8 (2.3) 82.4 (22.8) 67 (6) >60 9.5 (1.4) 89.0 (7.9) 50.3 (6.1) 113.8 (31.7) 113.9 (31.7) 14.0 (2.2) 76.0 (24.1) 66 (9) 8.8 (1.4) 92.4 (8.1) 50.8 (5.4) 121.1 (31.1) 109.2 (29.1) 15.8 (2.5) 81.4 (22.9) 67 (8) Diastolic dimensions volumes and functional measures by age. Abstract 159 Figure 1

P1740 Normal values for TAPSE in the HUNT study of subjects without evidence of heart disease

Abstract Background TAPSE is a simple and robust measure of RV function, but only in the absence of regional dysfunction and translational effects from the LV. Normal values from large normal studies are scarce, however. The aim of this study was to present normal values from the HUNT 3 study. Methods The HUNT study examined 1266 subjects without evidence of heart disease, from a mixed urban / rural population of North Tøndelag county in Norway. TAPSE was measured by reconstructed M-mode through the lateral tricuspid ring of the RV, in apical four-chamber view as shown in figure 1. Results Age and gender related values are given in table 1. TAPSE was normally distributes with a skewness of 0.42. Mean TAPSE was 2.8 cm (SD = 0.5), TAPSE declined with increasing age (p < 0.001), but the correlation with age was moderate (R=-0.15, p < 0.001). There was only a small gender difference (p < 0.001), and a moderate correlation with BSA (R = 0.24, p < 0.005). In linear regression with BSA and gender, only BSA was significant. Conclusions As all long axis measures, it declines with age, but this is moderate, so the relevance of age-specific measures can be discussed. TAPSE is near gender independent, and gender differences are only due to body size. Age and gender related values for TAPSE Age (years): <40 40-60 >60 All Women TAPSE(cm) 2.9 (0.5) 2.7 (0.5) 2.5 (0.5) 2.8 (0.5) Men TAPSE(cm) 3.0 (0.6) 2.9 (0.6) 2.8 (0.6) 2.9 (0.6) All TAPSE(cm) 2.9 (0.5) 2.8 (0.5) 2.7 (0.5) 2.8 (0.5) Abstract P1740 Figure. Fig. 1

The phenomenon of magical treasure hunting as an example for the definition of religious norms in the 18th century

The phenomenon of magical treasure hunting experienced a phase of high popularity in the Holy Roman Empire of German Nation in the early modern period. The applied magical practices were just one part of the wide magical spectrum of that time. In fact, many of them were closely connected to Catholic liturgy. This article will, based on a case study from Bamberg, examine whether or how Catholic doctrine was distinguished from those magical practices and by whom. Furthermore, it will analyse the attitude of clergy and secular people towards magic in order to gain hidden treasure. The study of magical treasure hunting illustrates exemplarily the fight against popular piety and superstition in the XVIIIth century.

P1744 Motion and velocity of the different parts of the AV plane. Relation to site and wall length

Abstract Background Displacement (MAPSE) and peak systolic velocity (S") of the various parts of the mitral annulus differ. Also, both indices are higher in the right ventricular free wall. We aimed to investigate the relations between wall motion, wall lengths and sites in the left ventricle, as well as comparing to the right ventricle to assess the influence on systolic deformation of the AV-plane. Methods The HUNT study examined 1266 subjects without evidence of heart disease from a mixed urban/rural population of North Trøndelag county, S", linear diastolic left ventricular annulus to apex distance (WL) and MAPSE was measured in the septal, anterior, lateral and inferior points of the mitral annulus. Intra individual variance and relative variance (variance / mean) of S" and MAPSE was calculated and compared to the same variance of the values normalised for wall length (S"/WL and MAPSE/WL). Results Wall lengths, velocities and MAPSE are shown in figure 1. Wall lengths were associated with both MAPSE and S". Both wall lengths and motion were greatest in the free walls of the LV, but smallest in the septal parts of the AVplane. Variances are shown in table 1. Even if intra-individual variances are larger for S" than MAPSE, relative variance for both decreased by 80 - 90% when normalised for wall length. Conclusion There is an intra-individual variability of MAPSE and S" of the LV, corresponding to WL, when the values normalised for WL most of the variability disappears. Intra individual variability of strain and strain rate per wall is less than MAPSE and S" as shown earlier. As the apex is located centrally, walls corresponding to the free walls are longer than those closest to the septum, thus motion and wall length are both greatest corresponding to the LV free walls. Motion of the right ventricular free wall was higher than the LV free wall; TAPSE 2.8 cm, and S" 12.6 cm/s as shown previously. The relation of TAPSE and S" of the right ventricle to wall length will be different, as the afterload in the RV is far less. But as both lateral parts of the AV plane move more than the centre, givinga systolic bending of the AV-planealso as the central part of the AV-plane is centrally anchored to the large arteries as shown in fig. 1. Table 1 WL (cm) MAPSE (cm) MAPSE / WL (% points) S" (cm/s) S" / WL (/s) Mean of 4 walls 9.5 1.6 0.16 8.4 0.87 Variance 0.04 0.04 0.0004 1.2 0.01 Relative variance (%) 2.8 2.7 0.25 12.1 1.4 Wall lengths (WL), displacement(MAPSE), Systolic velocity (S") and mAPSE and S" normalised for WL. Means and intra individual variances. Abstract P1744 Figure. Fig. 1

1025 Global strain rate do not reduce biological variability compared to S", and do not normalize for body size

Abstract Background As the Left ventricular (LV) apex is stationary, and maximum velocities are in the mitral plane, peak systolic annular velocity (S") normalized for wall length (WL) is a measure of peak systolic strain rate (Fig. 1), as is strain rate measured by tissue Doppler. As the normalization presumably corrects for the size of the heart (and thus body), this should reduce biological variability, but this assumption has previously been shown to be faulty for annular displacement (MAPSE) vs global longitudinal strain. Methods The HUNT study examined 1266 subjects without evidence of heart disease, from a mixed urban / rural population of North Tøndelag county in Norway. Annular systolic velocity was measured by pulsed-wave Tissue Doppler in the septal, lateral, anterior and inferior points, and averaged. Wall lengths was measured in a straight line in the same points, and S" was normalized (S"/WL) and averaged. Segmental systolic strain rate was also measured by combined speckle tracking / Tissue Doppler and averaged to a global value (GLSR). Results are given in table 1. All three measures declined with increasing age (R was -0.23, -0.29 and -0.29, respectively, all p < 0.001) The over-all relative standard deviations were similar for S", normalized S" and global strain rate. Both S"/WL and GLSR correlated negatively with BSA, R was - 0.22 and 0.17, respectively (p < 0.001), while S" showed a modest positive correlation; R = 0.13, (p < 0.001) Conclusion Normalizing peak systolic mitral annular velocity for length do not reduce biological variability, and introduces a systematic error in the body size relation, due to the one-dimensional nature of the normalisation, and the three-dimensional nature of LV deformation. This is in accordance with what has previously been shown for global longitudinal strain vs. annular plane displacement. Table 1 Age (years) S" (cm/s) S"/WL (/s) GLSR (/s) < 40 9.1 (1.2) 0.93 (0.13) 1.08 (0.12) 40 - 60 8.3 (1.3) 0.86 (0.13) 1.03 (0.12) > 60 7.7 (1.3) 0.81 (0.14) 0.98 (0.14) All 8.4 (1.4) 0.87 (0.14) 1.03 (0.13) Relative SD (%) 16.7 16.1 12.6 Mitral annular velocity (S"), normalised velocity (S"/WL) and Global strain by age groups. (Standard deviations in parentheses) Abstract 1025 Figure. Fig. 1

Asthma, asthma control and risk of ischemic stroke: The HUNT study

BackgroundAsthma, a chronic inflammatory airway disease, shares common pathophysiological mechanisms with ischemic stroke. The aim of the study is to assess the association between asthma, levels of asthma control and ischemic stroke risk in men and women and by smoking habits. MethodsThis prospective population-based cohort study utilized data on 58 712 adults from HUNT Study in Norway free from stroke. Self-reported asthma was categorized as ever asthma, non-active asthma and active asthma (i.e., being on asthma medication within 12 months of the baseline). Asthma control was defined according to the Global Initiative for Asthma questionnaire and was categorized into controlled and not controlled asthma. Stroke was ascertained by linking HUNT data with Nord-Trøndelag hospital records and the Norwegian Patient Registry. ResultsDuring a mean follow-up of 17.3 ± 5.3 years, 2619 participants (4.5%) had a first stroke. Not controlled asthma was associated with a modest increased risk of stroke (adjusted HR 1.34, 95%CI 1.03–1.73). Subgroup analyses revealed that the respective association was stronger among those with history of smoking (HR 1.48, 95%CI 1.10–2.00) and males (HR 1.55, 95%CI 1.12–2.16) while absent in non-smokers (HR 1.02, 95%CI 0.61–1.70) and females (HR 1.05, 95%CI 0.69–1.60). Likewise, active asthma was associated with similar increased stroke risk among smokers and males and absent in non-smokers and females. ConclusionsSymptomatic and active asthma was associated with a modest increased relative risk for ischemic stroke in smokers and males. Future studies should clarify the difference in risks and mechanisms between different phenotypes of asthma.

Intake of Boiled Potato in Relation to Cardiovascular Disease Risk Factors in a Large Norwegian Cohort: The HUNT Study.

Overall potato consumption is positively associated with cardiovascular disease (CVD) risk factors, such as measures of adiposity. However, few studies have explicitly stated the preparation method of potatoes, which may impact these associations. We examined cross-sectional associations between self-reported dietary intake of boiled potatoes and levels of body mass index, waist circumference, blood pressure, and blood lipids among 43,683 participants in the HUNT Study, Norway in 2006–2008. All estimated associations were adjusted for possible imbalance in age, sex, physical activity, smoking, intake of other foods and alcohol between categories of boiled potato consumption. Overall, there were no large differences in mean levels of CVD risk factors between categories of boiled potato consumption. Compared to the reference group of individuals who consumed boiled potatoes less than once/week, those who reported eating boiled potatoes every day had slightly higher prevalence of high waist circumference (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05–1.29), high triglycerides levels (OR 1.20, 95% CI 1.07–1.34), and metabolic syndrome (OR 1.17, 95% CI 1.03–1.33). In summary, consumption of boiled potatoes showed weak and small associations with the CVD risk factors under study, but the cross-sectional design prevents us from drawing any firm conclusions.

Risk Factors and Risk Profiles for Persistent Neck Pain in Young Adults: Results From the HUNT Study

Risk Factors and Risk Profiles for Persistent Neck Pain in Young Adults: Results From the HUNT Study

Subjective memory impairment, instrumental activities of daily living and longitudinal effect on mortality among older adults in a population-based cohort study: The HUNT Study

Background: Subjective impairment in memory and instrumental activities in daily living (IADL) are associated with future cognitive decline and poorer mental health in older adults, but their association with mortality is uncertain. Our aim was to examine the associations between subjective memory and IADL impairments and all-cause mortality, as well as the mortality risk for reporting both memory and IADL impairments. Methods: Data from the 70-year-old and older cohort in the third survey of a population-based study, the Nord-Trøndelag Health Study (HUNT3), were linked to the Norwegian Causes of Death Registry. A total of 5802 older adults had complete data from HUNT3 (70.8% of the 70+ cohort). The mean follow-up time was 8.0 years, and 1870 respondents had died. Associations between subjective memory and ADL impairments with mortality were analysed in Cox regression models adjusted for covariates with attained age as the timescale. Analyses were performed separately for two age groups - 70-79 and 80+ years - to fulfil the proportional hazards assumption. Results: Subjective impairments in short-term memory and IADL were significantly associated with mortality both separately and combined. These associations were strongest in the 70- to 79-year-old group, where reporting impairment on one short-term memory item increased the mortality risk by 51% (hazard ratio=1.51; 95% confidence interval 1.20-1.91). Long-term memory impairments were not associated with mortality in the adjusted models. Conclusions: Subjective short-term memory impairments and IADL impairments are associated with increased mortality risk. Neither of these symptoms should be regarded as benign aspects of ageing, and concerns should be properly addressed.

Influence of sleep problems and co-occurring musculoskeletal pain on long-term prognosis of chronic low back pain: the HUNT Study

BackgroundWe investigated the influence of sleeplessness and number of insomnia symptoms on the probability of recovery from chronic low back pain (LBP), and the possible interplay between sleeplessness and co-occurring...

Impact of Sex Hormones, Postmenopausal Hormone Therapy and Risk Factors on Development of Abdominal Aortic Aneurysm in Women: A Population-based Prospective Study in Norway: A Hunt Study

Introduction - Women develop abdominal aortic aneurysms (AAA) five to ten years later than men (1,2). The delay in AAA development may be secondary to a protection from estrogens (3,4). The aim of the present study was to evaluate the impact of risk factors associated with AAA development in women, including postmenopausal hormone therapy. This has previously been investigated in small cohorts with limited information. Methods - In a total cohort of 106,000 individuals from the Norwegian Nord-Trøndelag Health Study (HUNT), 20,024 postmenopausal women were identified, of which 201 developed AAAs during a median follow-up of 18 years (1995-2014, i.e. 295,554 person-years). The data is based on questionnaires, physical measurements, medical records and blood samples. A multivariable Cox regression model was constructed, where the final adjusted model included the following variables: smoking (current, past, never), body mass index, coronary heart disease, diabetes, hypertension and postmenopausal hormone therapy. Multiple imputation was performed for missing data (n=50 data sets). Serum estradiol concentrations were compared between women who later did or did not develop AAAs. Median time from blood sample collection to AAA diagnosis was seven years. Results - Mean age at AAA diagnosis was 77 (59 -100) years. 28% of the cohort reported ever use of postmenopausal hormone therapy. In the multivariable analysis, a notable Hazard ratio (HR) of 0.58 was observed for current use of hormone therapy, but the result was not statistically significant (95% CI 0.29-1.16, p=0.12). Women who reported current smoking had a more than ten-fold risk for developing AAA during follow-up (HR 10.9 (7.4-16.1)). Positive associations were also found for hypertension (HR 2.0 (1.4-3.0)) and coronary heart disease (HR 2.2 (1.6-3.2)). There was no substantial difference in estradiol concentrations between women with and without AAA (p=0.06). Conclusion - Postmenopausal hormone therapy is of less clinical importance compared to the strong associations observed between smoking, hypertension coronary heart disease and AAA development in women. These findings were supported by measured estradiol concentrations.

Increased Risk of Abdominal Aortic Aneurysms in Individuals with Depressive Symptoms: A Population-based Prospective Study in Norway: A Hunt Study

Introduction - Depression has been associated with earlier onset of cardiovascular disease and increased cardiovascular morbidity and mortality [1-3]. Individuals with a Hospital Anxiety Depression Score (HADS) ≥ 8 have been found to more often present with depressive symptoms, such as feelings of hopelessness and fatigue [5]. The aim of this study was to investigate if a HADS score ≥8 is associated with development of abdominal aortic aneurysm (AAA), which recently has been stated as a possibility [4]. Methods - The study population comprised 50,930 participants who had complete HADS-data on at least one follow-up. They were part of the prospective, population-based Nord-Trøndelag health study (HUNT) in Norway. The Chi-square test was used for comparing incidence proportions of AAA between individuals with and without depressive symptoms, as measured by a HADS ≥8, and < 8 respectively. The hazard of AAA was assessed in unadjusted and adjusted Cox regression models. Attained age was defined as the time scale (entry at age ≥50), whereas HADS (<8 vs. ≥8), gender, smoking, coronary heart disease, hypertension, body mass index and diabetes were included in the model as categorical risk factors. Results - A total of 6203 individuals (12%) had a HADS ≥8, and 735 individuals (201 women) developed an AAA during a median follow-up of 16.5 years (age 50-100 years). The incidence proportion of AAA was significantly higher in individuals with a HADS ≥8 (18% vs. 12%, p<0.001). In the unadjusted Cox regression model, individuals with a HADS ≥8 had approximately 50% higher risk of AAA than individuals with a HADS <8 (hazard ratio (HR) 1.51; 95% CI 1.24-1.84). The association remained significant in the adjusted analyses (HR 1.36 (1.1-1.7)). Current smoking (HR 8.4 (6.3-11.3)), past smoking (HR 3.6 (2.6-4.8)), male gender (HR 2.2 (1.9-2.7)), coronary heart disease (HR 2.3 (1.9-2.8)) and hypertension (HR 1.45 (1.2-1.8)) were also significantly associated with development of AAA. Conclusion - Individuals with elevated HADS as a sign of depressive symptoms have an increased risk of AAA development.

Effect of Depression on Mortality In Individuals With Abdominal Aortic Aneurysm Compared to a General Population – A Prospective Cohort Study: A Hunt Study

Effect of Depression on Mortality In Individuals With Abdominal Aortic Aneurysm Compared to a General Population – A Prospective Cohort Study: A Hunt Study

Symptoms of Depression and Risk of Abdominal Aortic Aneurysm: A HUNT Study.

Symptoms of Depression and Risk of Abdominal Aortic Aneurysm: A HUNT Study.

Time trends (1995\u20132008) in dietary habits among adolescents in relation to the Norwegian school fruit scheme: the HUNT study

IntroductionThe importance of healthy eating in adolescence is well established. The present study examined possible effects of the free Norwegian School Fruit Scheme (NSFS), changes in dietary habits between 1995 and 2008, and whether secular changes in dietary habits differed among schools who implemented the NSFS during September 2007.MethodWe used data from the Young-HUNT1 survey conducted from 1995 to 1997 and the Young-HUNT3 survey conducted from 2006 to 2008, which are part of the Nord-Trøndelag Health Study (HUNT), a longitudinal population health study. To evaluate the NSFS, the date Young-HUNT3 participants answered the questionnaire was used to identify affiliation to the intervention group (post-September 2007, n = 1892) or control group (pre-September 2007, n = 2855). To explore dietary habits over time, adolescents attending the same schools in Young-HUNT1 (n = 4137) and Young-HUNT3 (n = 4113) were included. Further, we investigated secular changes in dietary habits according to school type (intervention schools vs control schools). In all analysis, we explored possible differential effects according to socioeconomic status (SES) and gender. A questionnaire measured adolescents’ consumption of fruit, vegetables, candy, potato chips, sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB). Educational intention was used as a proxy for SES. Multilevel logistic regression was used.ResultsWithin Young-HUNT3, the intervention group showed increased odds of daily consumption of fruit (aOR 1.7, 95% CI = 1.3–2.4) compared to the control group. Over time, adolescents were more likely to consume fruit (aOR = 1.48, 95% CI = 1.28–1.71), vegetables (OR = 1.41, 95% CI = 1.28–1.53), potato chips (aOR = 1.60, 95% CI = 1.26–2.04) and SSB (OR = 2.02, 95% CI = 1.66–2.45). Secular changes for fruit differed by school type: adolescents in intervention schools had higher odds of daily consumption (aOR = 1.82, 95% CI = 1.38–2.38) than those in control schools (aOR 1.26, 95% CI = 1.07–1.47).ConclusionThe results indicated that the NSFS increased adolescents’ fruit consumption. In the period assessed, the study identified positive and negative changes in adolescents’ dietary habits.

Proton pump inhibitors and fracture risk. The HUNT study, Norway.

Proton pump inhibitors (PPIs) are widely prescribed and have been linked to increased risk of fracture. We used data from the Nord-Trøndelag Health Study (HUNT3), The Fracture registry in Nord-Trøndelag, and the Norwegian Prescription Database, including 15,017 women and 13,241 men aged 50-85 years. The study population was followed from the date of participating in HUNT3 (2006-2008) until the date of first fracture (forearm or hip), death, or end of study (31 December 2012). The Cox proportional hazards model with time-dependent exposure to PPIs was applied, and each individual was considered as unexposed until the first prescriptions was filled. To be included, the prescription of PPIs should minimum be equivalent to 90 defined daily doses (DDD) in the period. Individuals were defined as exposed until 6 months after end of drug supply. The proportion of women and men using PPIs was 17.9% and 15.5%, respectively. During a median of 5.2 years follow-up, 266 women and 134 men had a first hip fracture and 662 women and 127 men, a first forearm fracture. The combined rate/1000 patient-years for forearm and hip fractures in women was 49.2 for users of PPIs compared with 64.1 among non-users; for men 18.6 and 19.8, respectively. The hazard ratios with 95% confidence interval for the first forearm or hip fracture among users of PPIs in the age-adjusted analysis were 0.82 (0.67-1.01) for women and 1.05 (0.72-1.52) for men. Adjusting for age, use of anti-osteoporotic drugs, and FRAX, the HR declined to 0.80 (0.65-0.98) in women and 1.00 (0.69-1.45) in men. Use of PPIs was not associated with an increased risk of fractures.

Symptoms of anxiety and depression and risk of atrial fibrillation—The HUNT study

BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Anxiety and depression may activate the autonomic nervous system which is likely to play an important role in the etiology of AF. However, little is known about the association between symptoms of anxiety and depression and risk of AF. ObjectiveThis study aimed to assess the association between symptoms of anxiety and depression and risk of AF. MethodsIn a population-based study, 37,402 adult residents were followed for incident AF from 2006 to 2008 until 2015. Participants were classified according to data on anxiety and depression symptoms. Cox proportional regression models were used to adjust for common AF risk factors. ResultsDuring a median follow-up of 8.1 years, 1433 (3.8%) participants developed AF. In comparisons with no anxiety symptoms, the multivariable-adjusted hazard ratios (HRs) were 1.1 (95% CI: 0.9–1.5) for mild to moderate anxiety symptoms and 1.0 (95% CI: 0.8–1.4) for severe anxiety symptoms. In comparisons with no depression symptoms, the multivariable-adjusted HRs were 1.5 (95% CI: 1.2–1.8) for mild to moderate depression symptoms and 0.9 (95% CI: 0.6–1.3) for severe depression symptoms. Recurrent anxiety/depression symptoms were not associated with increased AF risk. ConclusionsIn this large, population-based study, we found no evidence of an association between symptoms of anxiety or severe depression and AF risk, even for recurrent anxiety or depression symptoms. An unexpected association of symptoms of mild to moderate depression with increased AF risk requires confirmation in other studies. Our findings add to the sparse literature on symptoms of anxiety and depression and risk of AF.

Genetic polymorphisms associated with sleep-related phenotypes; relationships with individual nocturnal symptoms of insomnia in the HUNT study

BackgroundIn recent years, several GWAS (genome wide association studies) of sleep-related traits have identified a number of SNPs (single nucleotides polymorphism) but their relationships with symptoms of insomnia are not known. The aim of this study was to investigate whether SNPs, previously reported in association with sleep-related phenotypes, are associated with individual symptoms of insomnia.MethodsWe selected participants from the HUNT study (Norway) who reported at least one symptom of insomnia consisting of sleep onset, maintenance or early morning awakening difficulties, (cases, N = 2563) compared to participants who presented no symptoms at all (controls, N = 3665). Cases were further divided in seven subgroups according to different combinations of these three symptoms. We used multinomial logistic regressions to test the association among different patterns of symptoms and 59 SNPs identified in past GWAS studies.ResultsAlthough 16 SNPS were significantly associated (p < 0.05) with at least one symptom subgroup, none of the investigated SNPs remained significant after correction for multiple testing using the false discovery rate (FDR) method.ConclusionsSNPs associated with sleep-related traits do not replicate on any pattern of insomnia symptoms after multiple tests correction. However, correction in this case may be overly conservative.

Changes in General Practitioners' consultation frequency over time for patients with hypertension or anxiety/depression symptoms: a 10-year follow-up of the Norwegian HUNT study.

General Practitioners' (GPs') workload has been suggested to increase in many countries; how does this impact patient follow-up? To investigate trends in GP consultation patterns for adults according to baseline hypertension and anxiety/depression symptoms and attribution of the GP to trend differences. Prospective cohort study, linking survey data and clinical measurements from the Norwegian HUNT3 study (2006-08) with national administrative data on GP list assignment and consultations with GP services. We grouped participants aged 40-59 years according to sex and their baseline status regarding hypertension and anxiety/depression symptoms. We registered GP consultations in 2007-16 and used general estimation equation models to estimate the level of GP consultations per month per year during follow-up. We used multilevel models with participants nested in their assigned regular GP to calculate GP-level intra-class correlation coefficients, reflecting to what extent patients' consultation patterns could be attributed to the individual GP. In total, 47 550 HUNT3 participants were registered with 102 different GPs in Nord-Trøndelag County, Norway, in 2007. Adjusted for age, we observed an overall increase in GP consultations in 2007-16, particularly in those with a better health status at baseline. About 2% of the variance of patient consultations could be attributed to differences between GPs and 10% to the use of lengthy consultations. Out-of-hours consultations did not change much in the study period 2007-16. Increased use of GP consultations, mainly among the healthiest participants, encourage further research into whether these patients displace patients with heavier and more complex needs.

The Association of Bone Mineral Density with Mortality in a COPD Cohort. The HUNT Study, Norway

In individuals with chronic obstructive pulmonary disease (COPD), the presence of comorbidities is associated with increased mortality risk. We wanted to study the association between bone mineral density (BMD) and mortality among individuals with COPD in a population-based cohort study. Participants were recruited from the second (1995–1997) and third (2006–2008) surveys of the HUNT Study and followed until February 2019. Hip and forearm BMD were included as continuous T-scores or categorized according to WHO criteria (normal, osteopenia, and osteoporosis). Hazard ratios with 95% confidence intervals were estimated by multivariable Cox regression models. In total, 2076 and 3239 participants were identified as having COPD by FEV1/FVC below lower limit of normal (LLN) or <0.70, respectively, according to Global Lung Initiative (GLI) and Global Initiative for Chronic Obstructive Lung Disease (GOLD). The prevalence of osteoporosis was 15.7% vs. 16.6% in the GLI-COPD vs. GOLD-COPD cohorts. Mean follow-up was 12.7 and 11.9 years. Lower T-scores were associated with a 5% (95% confidence interval (CI) 1.01–1.09) increased mortality in the GLI-COPD and GOLD-COPD cohorts, respectively. However, the presence of osteoporosis (T < –2.5), compared to normal BMD, was not associated with mortality in neither GLI-COPD (HR 1.13, 95% CI 0.91–1.41) nor GOLD-COPD cohorts (HR 1.22, 95% CI 0.99–1.51). Thus, a small positive association was found between decreasing BMD T-score and mortality in both GLI-COPD and GOLD-COPD. However, osteoporosis as defined by WHO was not associated with mortality, probably due to loss of power upon categorization.