Carl Johan Östgren Professor, distriktsläkare

Transkript

1 Carl Johan Östgren Professor, distriktsläkare TILLSAMMANS RÄDDAR VI LIV

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3 Vad är SCAPIS? SCAPIS är Sveriges största satsning någonsin inom hjärt-, kärl och lungforskning. Genom att göra omfattande undersökningar på svenskar i åldern år, byggs världens djupaste medicinska kunskapsbank. Målet är att kunna förutsäga vem som riskerar att drabbas av hjärt- eller lungsjukdom och hindra sjukdomen innan den uppstår.

4 The rationale for a new population study Technical advances in: Genetics, proteomics, lipidomics, metabolomics New imaging allows direct visualization of disease Low dose of radiation from CT Image analysis

5 SCAPIS outline Identification of vulnerable plaques CTA Ultrasound (carotid artery) MRI (carotid artery) Visceral adipose tissue, epicardial and liver fat CT Structural changes in lung tissue CT Baseline survey includes: Blood tests Anthropometry Blood pressure, ankle-arm index Activity measurement Lung function tests (spirometry and CT) ECG Detailed questionnaire - Environmental and socioeconomic factors, diet Local and central biobank for blood and urine analyses Follow-up via national registries Morbidity Mortality 30,000 men and women aged 50 to 64 years Bergstrom et al. The Swedish CArdioPulmonary BioImage Study: objectives and design. J Intern Med 2015.

6 Other large imaging studies MESA Dallas Heart Study BioImaging SCAPIS Start Completion Age group (years) M >55-80 W > Sample size N=6814 (F 53%) N=3072 (F 55%) N=6104 (F 55%) N= (F 50%) Exclusion criteria Known CVD, cancer. NA Claims for CVD, cancer etc None Population Stratified for ethnicity Probability sampling (postal addresses) Stratified for ethnicity Members of Humana Health Plan, Stratified for ethnicity Random population sample Participation rate (%) 7% 40% NA 50% Carotid plaque (US) Carotid plaque (MRI) Calcified coronaries (CACS) Coronary plaque (CTA) Pumonary imaging (CT) Metabolic imaging (liver) Metabolic imaging (fat) Publications (March 2012) N=443 N=110 N=2 -

7 SCAPIS time line 2007 First idea 2012 Pilot SCAPIS (Gothenburg, n=1111) 2014 SCAPIS 2012 n n > 250 subjects/week (Gothenburg, Malmö) SCAPIS (Stockholm, Linköping, Uppsala, Umeå) Cross sectional data Prospective data

8 Imaging in cardiopulmonary disease development Obesity Emphysema Dyslipidemia Diabetes Hypertension Atherosclerosis MI Stroke COPD Visceral obesity (CT) Liver steatosis (CT) Coronary atherosclerosis (CTA) Pericardial fat Carotid plaques >2,7 mm (6-7%) Carotid atherosclerosis (US) Emphysema Carotid plaque morphology (MRI), n=3.000) 8

9 Computer tomography (CT) Development Time-resolution Radiation Dual-energy SCAPIS 6 Siemens SOMATOM Definition Flash All scanners locked during the study

10 Radiology - Overview Cardiac Calcium score Coronary angiography 3mSv Pulmonary High resolution CT Inhalation, exhalation Metabolic - DECT Epicardial fat Subcutaneous/visceral fat Liver fat Thighs

11 Normala kranskärl

12 Plaque förträngning

13 Fynd: noduli

14 Noduli

15 Fynd: myxom

16 Magnetic Resonance Imaging (MRI) of large carotid plaques (6-7%) Cap thickness Lipid rich necrotic core Intra plaque hemorrhage (IPH) Calcifications Dedicated carotid coil Philips Achieva 3.0T Water content Magnetic field RF-signals Water permeability Contrast

17 Vilka är guldäggen i SCAPIS? CT angio Ektopiskt fett Accelerometerdata

18 Ectopic fat accumulation and cardiovascular disease Paracrine Systemic(?) Epicardial Myocardial Infarction H eart failure Subcutaneous/visceral Systemic Subclinical disease Liver Diabetes Dyslipidemia Hypertension

19 Stor-SCAPIS Samma studieprotokoll på 6 univ.sjukhus Gemensam finansiering T illäggsundersökningar Genomförs och finansieras lokalt

20 Flödesschema SCAPIS-Linköping Dag 1 (4-5 timmar) Dag 2 (1,5 timme) Dag 3 (2 timmar) Incheckning Incheckning Incheckning Samtycke, medical history Återlämna: Actigraph, hemblodtryck Tonometri Provtagning, hårklippn. Kolla enkätsvar Hjärt-EKO Antropometri Formulär CT Mikrocirkulation Ultraljud halskärl EKG, blodtryck, ankelbt. Frukost Kostenkät + övrig enkät Lämna: Actigraph, hemblodtyck, betablockad, Modifast Spirometri + elektr. näsa Omkontroll blodglukos om >7.0 mmol/l dag 1 CT-undersökning (CMIV)

21 Some of the challenges Health care related Tumors, nodules, severe atherosclerosis, aneurysms etc Burden on health care Unspecific findings (anxiety) Ethics Project related Coordination Quality control Storage of data Personal Identification Numbers Privacy / Integrity Availability of data (open access)

22 Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%

23 Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24%

24 Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

25 Age-Adjusted Prevalence of Diagnosed Diabetes Among US Adults 2010 Missing data <4.5% 4.5% 5.9% 6.0% 7.4% 7.5% 8.9% 9.0% CDC s Division of Diabetes Translation. United States Surveillance System available at

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