Background

heart_002Globally, cardiovascular disease is the most common cause of death. Nearly 20% of the healthcare costs in the developed world are represented by cardiovascular diseases. In most cases, atherosclerosis is the basic mechanism behind these disease conditions. Intervention and treatment of traditional risk factors (such as high blood pressure, diabetes, smoking, high blood lipids, and obesity) have had an important impact in preventing diseases related to atherosclerosis. However, at least half of patients afflicted by cardiovascular disease do not have any or only have one of the traditional risk factors, indicating other important mechanisms at play. There is a need to improve the traditional risk assessment of individual subjects to increase cost-effectiveness in the preventive strategies and thereby reduce both first-time cardiovascular events and relapses.

The SAVa project (Study of Atherosclerosis in Vastmanland) covers two research studies: the VaMIS (Vastmanland Myocardial Infarction Study) and the PADVa (Peripheral Arterial Disease in Vastmanland). In these projects, patients (n = 1460) with various manifestations of cardiovascular disease, specifically acute myocardial infarction (VaMIS) and peripheral arterial disease (PADVa), were included between November 2005 and May 2011. In addition, control subjects (n = 855) were randomly included from the general population matched to the VaMIS patients on age, sex, and municipality.

 

Study populations

VaMIS (Vastmanland Myocardial Infarction Study)

In the VaMIS cohort, consecutive patients admitted to the Department of Cardiology at the Västmanland County Hospital, Västerås, Sweden, were included if they fulfilled the following criteria:

  1. acute myocardial infarction diagnose
  2. living in the catchment area of the Västmanland County Hospital, Västerås, Sweden.

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PADVa (Peripheral Artery Disease in Vastmanland)

In the PADVa cohort, consecutive patients referred to the Vascular Ultrasound Laboratory of the Department of Vascular Surgery at the Västmanland County Hospital, Västerås, Sweden, were included if they fulfilled at least one of the following criteria:

  1. symptoms of claudication and an ankle-brachial-index of ≤ 0,9 in the ipsilateral lower extremity
  2. symptoms of claudication combined with ultrasonographic evidence of occlusive arterial disease in the ipsilateral lower extremity
  3. stenosis or occlusion in the internal carotid artery.

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Control subjects from the general population

For every patient included in the VaMIS cohort, a person from the community was invited to participate as a control subjects in the study. This person was randomly chosen from the Swedish National Population Register among the citizens of the same sex, age, and municipality as the VaMIS patient. If the invited person had a history of previous myocardial infarction, a second individual was invited (to be a control subject in the VaMIS study). However, not only the second but also the first control subject was examined according to the study protocol.

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