Kardiovaskulära händelser i MKC

Malmö Diet and Cancer Study
incl. CV-cohort

Cardiovascular Endpoints

End of follow-up: 31 December 2016
Report: 4 April 2018

By 
Anders Dahlin (data manager)
Bo Hedblad (coronary events and stroke)
Gunnar Engström (heart failure)
Olle Melander (atrial fibrillation and flutter)
Gustav Smith (CABG, PCI, MACE, aortic stenosis)
 

General information

All cardiovascular disease groups, except atrial fibrillation and flutter events, can have both prevalent and incident outcomes at the individual level.

Prevalent: date of diagnosis ≤ date of entry
Incident: date of diagnosis > date of entry

Abbreviations:
CABG = Coronary Artery Bypass Graft surgery
MACE = Major Adverse Coronary Events
PCI = Percutaneous Coronary artery Intervention

Amendments and implementation of new procedures

Year* Description

2017
- Added the variables cgdat_ep, fucg, pcdat_ep, fupc
- Included all secondary diagnoses (currently max 31) in the Patient Register and added two more groups of the source-variables for the disease groups CABG, atrial fibrillation/flutter, aortic stenosis (both "as" and "ay")
- Removed events which have occurred after the date of emigration (if available)
2015
- Validation of stroke events by means of the Stroma register started in 1989 and ceased in year 2013, the latest year with complete validated data was 2010. New non-validated stroke events from hospitals in Malmö were included as endpoints, but only events after 2010.
- Atrial fibrillation and flutter events from the Hospital-based outpatient care (Öppenvårdsregistret) were included as endpoints. Previously only data from the Hospital Discharge Register (Slutenvårdsregistret) and the Cause-of-Death Register were included.
- As a consequence of the amendments above the coding of the source variables pr_stso, stso and afso was changed. The coding of the variable pr_st was also modified.
2014
- Introduced a separate last follow-up date for stroke.
2012
- The original value for the recidive date in the Recidive Registry (part of the Stroma Registry) is composed of year and month (i.e. YYYYMM; day is missing). By default the day has been set to 15 in previous endpoint updates. Nevertheless, a few individuals have died a few days before day 15, which was not taken into account previously. However, in the new update the recidive date has been changed for such cases to date of death.
2011
- Five new endpoints were added to the cardiovascular endpoint update: CABG surgery event, PCI event, MACE event (coronary event, CABG or PCI), Aortic stenosis event (based on ICD code), and Aortic stenosis event (based on surgery code).
- In order to relate the cardiovascular events to the date at rescreening (2007-2012), a new file was created, parallell to the ordinary file with baseline screening date (1991-1996).
- Information of reused (återanvända) Personal Identity Numbers (PIN) was taken into account, diagnoses appearing after the date of death of an MDC participating individual were removed.
- For individuals with changed PINs, data with the new PIN (death, emigration) were included in the endpoint update.
- Date of death as given by SCB has been used (previously dates from SoS were used)
- One individual in the MDC cohort (not in CV cohort) was identified with two different PINs, the latest PIN was removed. The new MDC cohort number is 30 446.

^{* The year when the endpoint update was made, usually the year after last follow-up year.}

1. Cohorts

Baseline 1991-1996
Background population: 74 137
Men: 31 513
Women: 42 624

Malmö Diet and Cancer Study (MDC) cohort
Individuals qualify to the MDC cohort if they participated in at least one part of the Malmö Diet and Cancer Study.
Total: 30 446
Men: 12 120
Women: 18 326

Cardiovascular (CV) cohort
Every other individual in the MDC cohort screened between 1991 to 1994 was invited to a CV project which included a B-mode carotid ultrasound examination for determination of carotid intima-media thickness and plaques. Out of 6 103 individuals which accepted the invitation about 5 500 further participated in an extended examination, including laboratory analyses.
Total: 6 103
Men: 2 572
Women: 3 531

CV-rescreening 2007-2012 (CV-AUS)
All individuals in the CV-cohort, alive, not emigrated, and living in southern Sweden, were invited to rescreening during 2007-2012. In total 3 734 individuals participated in the study out of the original number 6 103.
Total: 3 734
Men: 1 522
Women: 2 212
 

2. Time of follow-up

Number of person-years from date of entry to death, lost to follow-up or to 31 December 2016

^{* Six individuals (3 males, 3 females) out of 30 446 lack follow-up time due to missing screening date.
** One individual (male) out of 6 103 lack follow-up time due to missing screening date}

3. Summary of prevalent and incident events by disease group

Number of individuals with first prevalent and/or first incident cardiovascular disease until 31 December 2016 by cohort and disease group

REFERENCE TIME POINT AT BASELINE (tables 4-13)

4. Incident cardiovascular events by year of diagnosis – Part 1

Number of individuals with first incident coronary, stroke, heart failure and/or atrial fibrillation/flutter events until 31 December 2016 in the MDC and CV cohorts by year of diagnosis

^{* Incident heart failure events were splitted into following groups:
  Pre MI = heart failure at least one day before a possible acute myocardial infarction
  Post MI = heart failure on the same day or after a non-fatal acute myocardial infarction (incl. possible prevalent MI)
  Acute myocardial infarction were identified through ICD8/9=410 and ICD10=I21 in the Hospital Discharge Register
** No incident atrial fibrillation/flutter event is recorded if the individual has a prevalent event}

5. Incident cardiovascular events by year of diagnosis – Part 2

Number of individuals with first incident CABG, PCI, MACE, aortic stenosis (ICD and surgery) events until 31 December 2016 in the MDC and CV cohorts by year of diagnosis

6. Coronary events by diagnosis

Number of individuals with first prevalent and/or first incident coronary events until 31 December 2016 in the MDC and CV cohorts by diagnosis group

7. Incident coronary events by diagnosis and source

Number of individuals with first incident coronary event until 31 December 2016 in the MDC cohort by diagnosis group and source of information

8. Stroke events by diagnosis

Number of individuals with first prevalent and/or first incident stroke events until 31 December 2016 in the MDC and CV cohorts by diagnosis group

9. Incident stroke events by diagnosis and source

Number of individuals with first incident stroke event until 31 December 2016 in the MDC cohort by diagnosis group and source of information

10. Heart failure events by diagnosis

Number of individuals with first prevalent and/or first incident heart failure events until 31 December 2016 in the MDC and CV cohorts by diagnosis group

^{* Prevalent and incident heart failure events were splitted into following groups:
  Pre MI = heart failure at least one day before a possible acute myocardial infarction
  Post MI = heart failure on the same day or after a non-fatal acute myocardial infarction (incl. possible prevalent MI)
  Acute myocardial infarction were identified through ICD8/9=410 and ICD10=I21 in the Hospital Discharge Register}

11. Incident heart failure events by diagnosis and source

Number of individuals with first incident heart failure event until 31 December 2016 in the MDC cohort by diagnosis group and source of information

_{^{* Incident heart failure events were splitted into following groups:
  Pre MI = heart failure at least one day before a possible acute myocardial infarction
  Post MI = heart failure on the same day or after a non-fatal acute myocardial infarction (incl. possible prevalent MI)
  Acute myocardial infarction were identified through ICD8/9=410 and ICD10=I21 in the Hospital Discharge Register}}

12. Atrial fibrillation and flutter events by diagnosis

Number of individuals with first prevalent or first incident atrial fibrillation and flutter events until 31 December 2016 in the MDC and CV cohorts. Only the first event of an individual is recorded, thus no incident event is recorded if the individual has a prevalent event

13. Incident atrial fibrillation and flutter events by diagnosis and source

Number of individuals with first incident atrial fibrillation and flutter event until 31 December 2016 in the MDC cohort by diagnosis group and source of information. Only the first event of an individual is recorded, thus no incident event is recorded if the individual has a prevalent event

^{* Corresponding code in the Cause-of-death Register is 4273}