Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case–control study using European electronic health records
Objective The objective of the study is to compare body mass index (BMI), systolic/diastolic blood pressure (SBP/DBP) and serum total cholesterol levels between dementia cases and controls at multiple time intervals prior to dementia onset, and to test time interval as a modifying factor for these a...
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BMJ Publishing Group
2020-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/11/e038753.full |
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| author | Johan van Der Lei Robert Stewart Pieter Jelle Visser Talita Duarte-Salles Myriam Alexander David Ansell Alessandro Pasqua Francesco Lapi Paul Avillach Lars Pedersen Gayan Perera Mark Forrest Gordon Miguel Angel Mayer |
| author_facet | Johan van Der Lei Robert Stewart Pieter Jelle Visser Talita Duarte-Salles Myriam Alexander David Ansell Alessandro Pasqua Francesco Lapi Paul Avillach Lars Pedersen Gayan Perera Mark Forrest Gordon Miguel Angel Mayer |
| author_sort | Johan van Der Lei |
| collection | DOAJ |
| description | Objective The objective of the study is to compare body mass index (BMI), systolic/diastolic blood pressure (SBP/DBP) and serum total cholesterol levels between dementia cases and controls at multiple time intervals prior to dementia onset, and to test time interval as a modifying factor for these associations.Design Case–control study.Setting Six European electronic health records databases.Participants 291 780 cases at the date of first-recorded dementia diagnosis, compared with 29 170 549 controls randomly selected from the same databases, age matched and sex matched at this index date.Exposure The following measures were extracted whenever recorded within each dataset: BMI (kg/m2), SBP and DBP (mm Hg) and serum total cholesterol (mmol/L). Levels for each of these variables were defined within six 2-year time intervals over the 12 years prior to the index date.Main outcomes Case–control differences in exposures of interest were modelled for each time period and adjusted for demographic and clinical factors (ischaemic/unspecified stroke, type 2 diabetes mellitus, acute myocardial infarction, hypertension diagnosis, antihypertensive medication, cholesterol-lowering medication). Coefficients and interactions with time period were meta-analysed across the six databases.Results Mean BMI (coefficient −1.16 kg/m2; 95% CI –1.38 to 0.93) and SBP (−2.83 mm Hg; 95% CI –4.49 to –1.16) were lower in cases at diagnosis, and case–control differences were greater in more recent time periods, as indicated by significant case-x-time interaction and case-x-time-squared interaction terms. Time variations in coefficients for cholesterol levels were less consistent between databases and those for DBP were largely not significant.Conclusion Routine clinical data show emerging divergence in levels of BMI and SBP prior to the diagnosis of dementia but less evidence for DBP or total cholesterol levels. These divergences should receive at least some consideration in routine dementia risk screening, although underlying mechanisms still require further investigation. |
| format | Article |
| id | doaj-art-d525cdb72ae44ebeb238b2e714648dbc |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d525cdb72ae44ebeb238b2e714648dbc2025-08-20T02:48:09ZengBMJ Publishing GroupBMJ Open2044-60552020-11-01101110.1136/bmjopen-2020-038753Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case–control study using European electronic health recordsJohan van Der Lei0Robert Stewart1Pieter Jelle Visser2Talita Duarte-Salles3Myriam Alexander4David Ansell5Alessandro Pasqua6Francesco Lapi7Paul Avillach8Lars Pedersen9Gayan Perera10Mark Forrest Gordon11Miguel Angel Mayer12Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands1 Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK1 Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, Amsterdam, The NetherlandsFundació Institut Universitari per a la Recerca a l`Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, SpainOPEN Health Communications LLP London, London, UK1RUSH University Medical CenterHealth Search, Italian College of General Practitioners and Primary Care, Florence, ItalyHealth Search, Italian College of General Practitioners and Primary Care, Florence, ItalyDepartment of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA2 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, DenmarkPsychological Medicine, King’s College London Institute of Psychiatry, Psychology and Neuroscience, London, UKSpecialty Clinical Development, Neurology and Psychiatry, Teva Pharmaceuticals USA Inc, North Wales, Pennsylvania, USAHospital del Mar Institute for Medical Research, Barcelona, SpainObjective The objective of the study is to compare body mass index (BMI), systolic/diastolic blood pressure (SBP/DBP) and serum total cholesterol levels between dementia cases and controls at multiple time intervals prior to dementia onset, and to test time interval as a modifying factor for these associations.Design Case–control study.Setting Six European electronic health records databases.Participants 291 780 cases at the date of first-recorded dementia diagnosis, compared with 29 170 549 controls randomly selected from the same databases, age matched and sex matched at this index date.Exposure The following measures were extracted whenever recorded within each dataset: BMI (kg/m2), SBP and DBP (mm Hg) and serum total cholesterol (mmol/L). Levels for each of these variables were defined within six 2-year time intervals over the 12 years prior to the index date.Main outcomes Case–control differences in exposures of interest were modelled for each time period and adjusted for demographic and clinical factors (ischaemic/unspecified stroke, type 2 diabetes mellitus, acute myocardial infarction, hypertension diagnosis, antihypertensive medication, cholesterol-lowering medication). Coefficients and interactions with time period were meta-analysed across the six databases.Results Mean BMI (coefficient −1.16 kg/m2; 95% CI –1.38 to 0.93) and SBP (−2.83 mm Hg; 95% CI –4.49 to –1.16) were lower in cases at diagnosis, and case–control differences were greater in more recent time periods, as indicated by significant case-x-time interaction and case-x-time-squared interaction terms. Time variations in coefficients for cholesterol levels were less consistent between databases and those for DBP were largely not significant.Conclusion Routine clinical data show emerging divergence in levels of BMI and SBP prior to the diagnosis of dementia but less evidence for DBP or total cholesterol levels. These divergences should receive at least some consideration in routine dementia risk screening, although underlying mechanisms still require further investigation.https://bmjopen.bmj.com/content/10/11/e038753.full |
| spellingShingle | Johan van Der Lei Robert Stewart Pieter Jelle Visser Talita Duarte-Salles Myriam Alexander David Ansell Alessandro Pasqua Francesco Lapi Paul Avillach Lars Pedersen Gayan Perera Mark Forrest Gordon Miguel Angel Mayer Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case–control study using European electronic health records BMJ Open |
| title | Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case–control study using European electronic health records |
| title_full | Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case–control study using European electronic health records |
| title_fullStr | Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case–control study using European electronic health records |
| title_full_unstemmed | Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case–control study using European electronic health records |
| title_short | Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case–control study using European electronic health records |
| title_sort | vascular and metabolic risk factor differences prior to dementia diagnosis a multidatabase case control study using european electronic health records |
| url | https://bmjopen.bmj.com/content/10/11/e038753.full |
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