Dyspnea after pulmonary embolism: a nation-wide population-based case–control study

Dyspnea is common after a pulmonary embolism. Often, but not always, the dyspnea can be explained by pre-existing comorbidities, and only rarely by chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is probably the extreme manifestation of a far more common condition, called the post-pulmonary embolism syndrome. The purpose of this retrospective study was to investigate the prevalence and predictors of dyspnea among Swedish patients that survived a pulmonary embolism, compared to the general population. All Swedish patients diagnosed with an acute pulmonary embolism in 2005 (n = 5793) were identified via the Swedish National Patient Registry. Patients that lived until 2007 (n = 3510) were invited to participate. Of these, 2105 patients responded to a questionnaire about dyspnea and comorbidities. Data from the general population (n = 1905) were acquired from the multinational MONItoring of trends and determinants in CArdiovascular disease health survey, conducted in 2004. Patients with pulmonary embolism had substantially higher prevalences of both exertional dyspnea (53.0% vs. 17.3%, odds ratio (OR): 5.40, 95% confidence intervals (CI): 4.61–6.32) and wake-up dyspnea (12.0% vs. 1.7%, OR: 7.7, 95% CI: 5.28–11.23) compared to control subjects. These differences remained after adjustments and were most pronounced among younger patients. The increased risk for exertional dyspnea and wake-up dyspnea remained after propensity score matching (OR (95% CI): 4.11 (3.14–5.38) and 3.44 (1.95–6.06), respectively). This population-based, nation-wide study demonstrated that self-reported dyspnea was common among patients with previous pulmonary embolism. This finding suggested that a post-pulmonary embolism syndrome might be present, which merits further investigation.

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Population-based study of amyotrophic lateral sclerosis and occupational lead exposure in Denmark

Occupational and Environmental Medicine ◽

10.1136/oemed-2018-105469 ◽

2019 ◽

pp. oemed-2018-105469 ◽

Cited By ~ 4

Author(s):

Aisha S Dickerson ◽

Johnni Hansen ◽

Aaron J Specht ◽

Ole Gredal ◽

Marc G Weisskopf

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Conditional Logistic Regression ◽

Population Based ◽

Population Based Study ◽

Employment History ◽

National Patient Registry ◽

Increased Risk ◽

National Patient ◽

Pb Exposure ◽

Lateral Sclerosis

ObjectivesPrevious research has indicated links between lead (Pb) exposure and increased risk of neurodegenerative disorders, including amyotrophic lateral sclerosis (ALS). In this study, we evaluated the association between occupational Pb exposures and ALS.MethodsALS cases were ascertained through the Danish National Patient Registry from 1982 to 2013 and age and sex-matched to 100 controls. Using complete employment history since 1964 from the Danish Pension Fund, cumulative Pb exposure was estimated for each subject via a Danish job exposure matrix. Associations were evaluated using conditional logistic regression analyses and stratified by sex.ResultsFor men with >50% probability of exposure, there was an increase in odds of ALS for exposures in the 60th percentile or higher during any time 5 years prior to diagnosis (aOR: 1.35; 95% CI 1.04 to 1.76) and 10 years prior to diagnosis (aOR: 1.33; 95% CI 1.03 to 1.72). No significant associations were observed in women, and there were no linear trends seen for Pb exposures for either sex.ConclusionsOur study indicates an association between consistently higher occupational Pb exposures and ALS. These findings support those of previously reported associations between ALS and specific occupations that commonly experience Pb exposure.

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The Risk of Deep Venous Thrombosis and Pulmonary Embolism in Primary Sjögren Syndrome: A General Population-based Study

The Journal of Rheumatology ◽

10.3899/jrheum.160185 ◽

2017 ◽

Vol 44 (8) ◽

pp. 1184-1189 ◽

Cited By ~ 13

Author(s):

J. Antonio Aviña-Zubieta ◽

Michael Jansz ◽

Eric C. Sayre ◽

Hyon K. Choi

Keyword(s):

Pulmonary Embolism ◽

General Population ◽

Population Based ◽

Sjögren Syndrome ◽

First Year ◽

Study Cohort ◽

Sjogren Syndrome ◽

Primary Sjögren Syndrome ◽

Entry Time ◽

Increased Risk

Objective.To estimate the future risk and time trends of venous thromboembolism (VTE) in individuals with newly diagnosed primary Sjögren syndrome (pSS) in the general population.Methods.Using a population database that includes all residents of British Columbia, Canada, we created a study cohort of all patients with incident SS and up to 10 controls from the general population matched for age, sex, and entry time. We compared incidence rates (IR) of pulmonary embolism (PE), deep vein thrombosis (DVT), and VTE between the 2 groups according to SS disease duration. We calculated HR, adjusting for confounders.Results.Among 1175 incident pSS cases (mean age 56.7 yrs, 87.6% women), the IR of PE, DVT, and VTE were 3.9, 2.8, and 5.2 per 1000 person-years (PY), respectively; the corresponding rates in the comparison cohort were 0.9, 0.8, and 1.4 per 1000 PY. Compared with non-SS individuals, the multivariable HR for PE, DVT, and VTE among SS cases were 4.07 (95% CI 2.04–8.09), 2.80 (95% CI 1.27–6.17), and 2.92 (95% CI 1.66–5.16), respectively. The HR matched for age, sex, and entry time for VTE, PE, and DVT were highest during the first year after SS diagnosis (8.29, 95% CI 2.57–26.77; 4.72, 95% CI 1.13–19.73; and 7.34, 95% CI 2.80–19.25, respectively).Conclusion.These findings provide population-based evidence that patients with pSS have a substantially increased risk of VTE, especially within the first year after SS diagnosis. Further research into the involvement of monitoring and prevention of VTE in SS may be warranted.

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Medical conditions increasing the risk of chronic thromboembolic pulmonary hypertension

Thrombosis and Haemostasis ◽

10.1160/th04-10-0657 ◽

2005 ◽

Vol 93 (03) ◽

pp. 512-516 ◽

Cited By ~ 144

Author(s):

Diana Bonderman ◽

Johannes Jakowitsch ◽

Christopher Adlbrecht ◽

Michael Schemper ◽

Paul Kyrle ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Hypertension ◽

Odds Ratio ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Medical Conditions ◽

Symptomatic Pulmonary Embolism ◽

Increased Risk ◽

Lung Scan ◽

Thromboembolic Pulmonary Hypertension ◽

Inflammatory Bowel

SummaryChronic thromboembolic pulmonary hypertension (CTEPH) is characterized by organized thromboemboli that obstruct the pulmonary vascular bed. Although CTEPH is a serious complication of acute symptomatic pulmonary embolism in 4% of cases, signs, symptoms and classical risk factors for venous thromboembolism are lacking. The aim of the present study was to identify medical conditions conferring an increased risk of CTEPH. We performed a case-control-study comparing 109 consecutive CTEPH patients to 187 patients with acute pulmonary embolism that was confirmed by a high probability lung scan. Splenectomy (odds ratio=13, 95% CI 2.7–127), ventriculoatrial (VA-) shunt for the treatment of hydrocephalus (odds ratio=13, 95% CI 2.5–129) and chronic inflammatory disorders, such as osteomyelitis and inflammatory bowel disease (IBD, odds ratio=67, 95% CI 7.9–8832) were associated with an increased risk of CTEPH.

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The risk and trend of pulmonary embolism and deep vein thrombosis in rheumatoid arthritis: a general population-based study

Rheumatology ◽

10.1093/rheumatology/keaa262 ◽

2020 ◽

Vol 60 (1) ◽

pp. 188-195

Author(s):

Lingyi Li ◽

Na Lu ◽

Ana Michelle Avina-Galindo ◽

Yufei Zheng ◽

Diane Lacaille ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

General Population ◽

Population Based ◽

Case Definition ◽

Population Based Study ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein

Abstract Objectives To estimate the overall risk of venous thromboembolism (VTE), pulmonary embolism (PE) and deep vein thrombosis (DVT) among patients newly diagnosed with RA compared with the general population without RA; and to estimate the risk trends of VTE, PE and DVT after RA diagnosis up to 5 years compared with the general population. Methods Using previously validated RA case definition, we conducted a matched cohort study using the population-based administrative health database from the province of British Columbia, Canada. We calculated incidence rates (IRs) and fully adjusted hazard ratios (HRs) for the risk of VTE, DVT and PE after RA index date. Results Among 39 142 incident RA patients (66% female, mean age 60), 1432, 543 and 1068 developed VTE, PE and DVT, respectively. IRs for the RA cohort were 3.79, 1.43 and 2.82 per 1000 person-years vs 2.70, 1.03 and 1.94 per 1000 person-years for the non-RA cohort. After adjusting for VTE risk factors, the HRs (95% CI) were 1.28 (1.20, 1.36), 1.25 (1.13, 1.39) and 1.30 (1.21, 1.40) for VTE, PE and DVT, respectively. The fully adjusted HRs for VTE during the first five years after RA diagnosis were 1.60, 1.47, 1.40, 1.30 and 1.28, respectively. A similar trend was shown in PE. Conclusion This population-based study demonstrates that RA patients have an increased risk of VTE, PE and DVT after diagnosis compared with the general population. This risk is independent of traditional VTE risk factors and is highest during the first year after RA diagnosis, then progressively declined.

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Sarcoidosis mortality in Sweden: a population-based cohort study

European Respiratory Journal ◽

10.1183/13993003.01815-2017 ◽

2018 ◽

Vol 51 (2) ◽

pp. 1701815 ◽

Cited By ~ 23

Author(s):

Marios Rossides ◽

Susanna Kullberg ◽

Johan Askling ◽

Anders Eklund ◽

Johan Grunewald ◽

...

Keyword(s):

General Population ◽

Large Population ◽

Population Based ◽

Disease Heterogeneity ◽

International Classification Of Disease ◽

Risk Of Death ◽

Drug Register ◽

Hazard Ratios ◽

Increased Risk ◽

National Patient

We aimed to investigate sarcoidosis mortality in a large, population-based cohort, taking into account disease heterogeneity.Individuals with incident sarcoidosis (n=8207) were identified from the Swedish National Patient Register using International Classification of Disease codes (2003‒2013). In a subset, cases receiving treatment ±3 months from diagnosis were identified from the Prescribed Drug Register. Nonsarcoidosis comparators from the general population were matched to cases 10:1 on birth year, sex and county. Individuals were followed for all-cause death in the Cause of Death Register. Adjusted mortality rates, rate differences and hazard ratios (HRs) were estimated, stratifying by age, sex and treatment status.The mortality rate was 11.0 per 1000 person-years in sarcoidosis versus 6.7 in comparators (rate difference 2.7 per 1000 person-years). The HR for death was 1.61 (95% CI 1.47‒1.76), with no large variation by age or sex. For cases not receiving treatment within the first 3 months, the HR was 1.13 (95% CI 0.94‒1.35). The HR was 2.34 (95% CI 1.99‒2.75) for those receiving treatment.Individuals with sarcoidosis are at a higher risk of death compared to the general population. For the majority, the increased risk is small. However, patients whose disease leads to treatment around diagnosis have a two-fold increased risk of death. Future interventions should focus on this vulnerable group.

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Follow-up after acute Pulmonary Embolism

Hämostaseologie ◽

10.5482/hamo-17-06-0020 ◽

2018 ◽

Vol 38 (01) ◽

pp. 22-32 ◽

Cited By ~ 12

Author(s):

Stefano Barco ◽

Frederikus Klok

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Functional Limitations ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Increased Risk ◽

Recurrent Venous Thromboembolism ◽

Thromboembolic Pulmonary Hypertension ◽

Potential Benefits ◽

Definition Of

SummaryIn addition to among others major bleeding from anticoagulant therapy and recurrent venous thromboembolism (VTE), patients who survived acute pulmonary embolism (PE) face an increased risk of chronic functional limitations and decreased quality of life. In recent years, this latter complications have been better framed within the evolving definition of “post-PE syndrome” of which chronic thromboembolic pulmonary hypertension (CTEPH) represents the most extreme presentation. The post-PE syndrome in all its aspects is a frequent and clinically relevant long-term complication of PE but -except for CTEPH- has been largely understudied. There is great need to better define and understand the natural course of acute PE, to predict the development of the post-PE syndrome and to evaluate the potential benefits evolving treatments such as cardiopulmonary rehabilitation.

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Potential Involvement of Osteopontin in Inflammatory and Fibrotic Processes in Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension

Thrombosis and Haemostasis ◽

10.1055/s-0039-1692174 ◽

2019 ◽

Vol 119 (08) ◽

pp. 1332-1346 ◽

Cited By ~ 1

Author(s):

Sebastian Kölmel ◽

Lukas Hobohm ◽

Anja Käberich ◽

Valentin J. Krieg ◽

Magdalena L. Bochenek ◽

...

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Hypertension ◽

Plasma Concentrations ◽

Vena Cava ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Translational Study ◽

Increased Risk ◽

Immuno Histochemistry ◽

Thromboembolic Pulmonary Hypertension ◽

Tissue Material

Background Inflammation and incomplete thrombus resolution leading to obstructive fibrotic remodelling are considered critical mechanisms for the development of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE). Osteopontin (OPN) is involved in a variety of biological processes including inflammation and tissue fibrosis. Methods OPN plasma concentrations were measured in 70 CTEPH and 119 PE patients. Tissue material from 6 CTEPH patients removed during pulmonary endarterectomy and murine venous thrombi induced by subtotal ligation of the inferior vena cava in C57BL/6 mice were analysed by (immuno)histochemistry. Results CTEPH patients had higher OPN plasma concentrations (median, 106.9 [interquartile range, 75.6–155.9]) compared to PE patients (90.4 [53.3–123.9] ng/mL, p = 0.001). OPN- and matrix metalloproteinase (MMP)-9-positive cells were predominantly present in myofibroblast-rich and profibrotic areas of CTEPH tissue material. Early stages of murine thrombus resolution were characterised by high numbers of OPN- and MMP-2-positive cells while OPN was almost absent in fresh thrombi of CTEPH tissue material. PE patients with OPN plasma concentrations of < 55 ng/mL had a 15.2-fold (95% confidence interval, 1.7–135.5, p = 0.015) increased risk for a diagnosis of CTEPH during follow-up. Conclusion The results of the present observational translational study point to a possible involvement of OPN in the pathogenesis of CTEPH by affecting early inflammatory and late fibrotic processes.

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The risk of pulmonary embolism and deep vein thrombosis in rheumatoid arthritis: a UK population-based outpatient cohort study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2012-201669 ◽

2012 ◽

Vol 72 (7) ◽

pp. 1182-1187 ◽

Cited By ~ 60

Author(s):

Hyon K Choi ◽

Young-Hee Rho ◽

Yanyan Zhu ◽

Lucia Cea-Soriano ◽

Juan Antonio Aviña-Zubieta ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Pulmonary Embolism ◽

Cohort Study ◽

Deep Vein Thrombosis ◽

General Population ◽

Population Based ◽

Incidence Rates ◽

Vein Thrombosis ◽

Increased Risk ◽

Deep Vein

BackgroundRecent hospital-based studies have suggested a sixfold increased risk of pulmonary embolism (PE) in rheumatoid arthritis (RA) in the year following admission. We evaluated the risk of PE and deep vein thrombosis (DVT) and associated time trend among RA patients (84.5% without a history of hospitalisation during the past year) derived from the general population.MethodsWe conducted a cohort study using an electronic medical records database representative of the UK general population, collected from 1986 to 2010. Primary definitions of the RA cohort (exposure) and PE/DVT outcomes required physician diagnoses followed by corresponding treatments. We estimated relative risks (RRs) of PE and DVT compared with a matched non-RA comparison cohort, adjusting for age, sex, smoking, body mass index, comorbidities and hospitalisations.ResultsAmong 9589 individuals with RA (69% female, mean age of 58 years), 82 developed PE and 110 developed DVT (incidence rates, 1.5 and 2.1 per 1000 person-years). Compared with non-RA individuals (N=95 776), the age-, sex- and entry-time-matched RRs were 2.23 (95% CI 1.75 to 2.86) for PE and 2.20 (CI 1.78 to 2.71) for DVT. Adjusting for other covariates, the corresponding RRs were 2.16 (CI 1.68 to 2.79) and 2.16 (CI 1.74 to 2.69). The time-specific RRs for PE were 3.27, 1.88 and 2.35 for follow-up times of <1 year, 1–4.9 years, and ≥5 years, and corresponding RRs for DVT were 3.16, 1.82 and 2.32.ConclusionsThis population-based study indicates an increased risk of PE and DVT in RA, supporting increased monitoring of venous-thromboembolic complications and risk factors in RA, regardless of hospitalisation.

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Incidence and risk factors of chronic thromboembolic pulmonary hypertension following venous thromboembolism, a population-based cohort study in England

Pulmonary Circulation ◽

10.1177/2045894018791358 ◽

2018 ◽

Vol 8 (3) ◽

pp. 204589401879135 ◽

Cited By ~ 13

Author(s):

C. Martinez ◽

C. Wallenhorst ◽

S. Teal ◽

A.T. Cohen ◽

A.J. Peacock

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Pulmonary Hypertension ◽

Cohort Study ◽

Venous Thromboembolism ◽

Conditional Logistic Regression ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Population Based ◽

Thromboembolic Pulmonary Hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of unresolved organised pulmonary emboli/thrombi obstructing the major pulmonary arteries. The aim of this study was to estimate the incidence and risk factors of CTEPH in a cohort with first venous thromboembolism (VTE). This was a population-based cohort study of patients with first VTE and no active cancer in England between 2001 and 2012. CTEPH was assessed using a rigorous case-ascertainment algorithm. Risk factors for CTEPH were studied using a nested case-control approach by matching CTEPH cases to VTE patients without CTEPH. Adjusted odds ratios (OR) of comorbidities were estimated from conditional logistic regression. During 81,413 person-years of follow-up among 23,329 patients with first VTE (mean follow-up 3.5 years; maximum 11.0 years) 283 patients were diagnosed with CTEPH (incidence rate 3.5 per 1000 person-years); cumulative incidence was 1.3% and 3.3% at 2 and 10 years after pulmonary embolism, and 0.3% and 1.3% following deep vein thrombosis (DVT), respectively. Risk factors for CTEPH included age over 70, OR 2.04 (95% CI 1.23 to 3.38), female gender, 1.44 (1.06 to 1.94), pulmonary embolism at first VTE, 3.11 (2.23 to 4.35), subsequent pulmonary embolism and DVT, 3.17 (2.02 to 4.96) and 2.46 (1.34 to 4.51) respectively, chronic obstructive pulmonary disease 3.17 (2.13 to 4.73), heart failure 2.52 (1.76 to 3.63) and atrial fibrillation, 2.42 (1.71 to 3.42). CTEPH develops most commonly after pulmonary embolism and less frequently after DVT. Awareness of risk factors may increase referrals to specialised centres for confirmation of CTEPH and initiation of specific treatment.

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Incidence of Benign and Malignant Tumors in Patients with Acromegaly is Increased: a Nationwide Population-Based Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab560 ◽

2021 ◽

Author(s):

Daniela Esposito ◽

Oskar Ragnarsson ◽

Gudmundur Johannsson ◽

Daniel S Olsson

Keyword(s):

General Population ◽

Anal Cancer ◽

Malignant Tumors ◽

Population Based ◽

Benign Tumors ◽

Medical Surveillance ◽

Population Based Study ◽

Increased Risk ◽

National Patient ◽

Standardized Mortality Ratios

Abstract Context Whether cancer risk in acromegaly is increased remains controversial. Also, the risk of benign tumors has been little studied. Objective To investigate the incidence of benign and malignant tumors in acromegaly in a nationwide population-based study. Design Adult patients diagnosed with acromegaly between 1987 and 2017 were identified in the Swedish National Patient Registry. The diagnoses of benign and malignant tumors were recorded. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for neoplasms with 95% confidence intervals (CIs) were calculated using the Swedish general population as reference. Results The study included 1296 patients (52% women). Mean (SD) age at diagnosis was 51.6 (14.7) years. Median (range) follow-up time was 11.7 (0-31) years. Overall, 186 malignancies were identified in acromegalic patients compared to 144 expected in the general population (SIR 1.3; 95% CI, 1.1-1.5). The incidence of colorectal and anal cancer (SIR 1.5; 95% CI, 1.0-2.2), and renal and ureteral cancer (SIR 4.0; 95% CI, 2.3-6.5) was increased, whereas the incidence of malignancies of the respiratory system, brain, prostate, and breast was not. Only three cases of thyroid cancer were recorded. Mortality due to malignancies was not increased (SMR 1.1; 95% CI, 0.9-1.4). Incidence of benign tumors was increased more than 2-fold (SIR 2.4; 95% CI, 2.1-2.7). Conclusions Patients with acromegaly had an increased risk of both benign and malignant tumors including colorectal and anal cancer, and renal and ureteral cancer. Whether this is associated with acromegaly itself or due to more intensive medical surveillance remains to be shown.

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