Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case-control study using European electronic health records

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• dc.contributor.author Perera, Gayan
• dc.contributor.author Rijnbeek, Peter
• dc.contributor.author Alexander, Myriam
• dc.contributor.author Ansel, David
• dc.contributor.author Avillach, Paul
• dc.contributor.author Duarte Salles, Talita, 1985-
• dc.contributor.author Gordon, Mark F.
• dc.contributor.author Lapi, Francesco
• dc.contributor.author Mayer, Miguel Ángel, 1960-
• dc.contributor.author Pasqua, Alessandro
• dc.contributor.author Pedersen, Lars
• dc.contributor.author van der Lei, Johan
• dc.contributor.author Visser, Pieter Jelle
• dc.contributor.author Stewart, Robert
• dc.date.accessioned 2021-06-02T07:31:34Z
• dc.date.available 2021-06-02T07:31:34Z
• dc.date.issued 2020
• dc.description.abstract 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.
• dc.description.sponsorship The research leading to these results has received support from the Innovative Medicines Initiative (IMI) Joint Undertaking under EMIF grant agreement n° 115372, resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and EFPIA companies’ in kind contribution. RS and GP are part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre and Dementia Biomedical Research Unit at South London and Maudsley NHS Foundation Trust and King's College London.
• dc.format.mimetype application/pdf
• dc.identifier.citation Perera G, Rijnbeek PR, Alexander M, Ansell D, Avillach P, Duarte-Salles T, et al. Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case-control study using European electronic health records. BMJ Open. 2020 Nov 14; 10(11): e038753. DOI: 10.1136/bmjopen-2020-038753
• dc.identifier.doi http://dx.doi.org/10.1136/bmjopen-2020-038753
• dc.identifier.issn 2044-6055
• dc.identifier.uri http://hdl.handle.net/10230/47713
• dc.language.iso eng
• dc.publisher BMJ Publishing Group
• dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/115372
• dc.rights Copyright © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Dementia
• dc.subject.keyword Epidemiology
• dc.subject.keyword Health informatics
• dc.subject.keyword Hypertension
• dc.subject.keyword Mental health
• dc.subject.keyword Physiology
• dc.title Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case-control study using European electronic health records
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion