Carl Johan Östgren Professor, distriktsläkare 2017-05-08 TILLSAMMANS RÄDDAR VI LIV
Vad är SCAPIS? SCAPIS är Sveriges största satsning någonsin inom hjärt-, kärl och lungforskning. Genom att göra omfattande undersökningar på 30 000 svenskar i åldern 50-64 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.
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
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.
Other large imaging studies MESA Dallas Heart Study BioImaging SCAPIS Start Completion 2000 2002 2002 2004 2008 2009 2014 2018 Age group (years) 45-84 30-65 M >55-80 W >60-80 50-64 Sample size N=6814 (F 53%) N=3072 (F 55%) N=6104 (F 55%) N=30 000 (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) 6814-6104 30 000 Carotid plaque (MRI) - - 525 3000 Calcified coronaries (CACS) 6814 2971 6104 30 000 Coronary plaque (CTA) - - - 30 000 Pumonary imaging (CT) - - - 30 000 Metabolic imaging (liver) 6814 2971-30 000 Metabolic imaging (fat) 6814 2971-30 000 Publications (March 2012) N=443 N=110 N=2 -
SCAPIS time line 2007 First idea 2012 Pilot SCAPIS (Gothenburg, n=1111) 2014 SCAPIS 2012 n 17.000 n > 250 subjects/week (Gothenburg, Malmö) 2015 2013 2018-2019 SCAPIS (Stockholm, Linköping, Uppsala, Umeå) Cross sectional data 2020-2024 Prospective data
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
Computer tomography (CT) Development Time-resolution Radiation Dual-energy SCAPIS 6 Siemens SOMATOM Definition Flash All scanners locked during the study
Radiology - Overview Cardiac Calcium score Coronary angiography 3mSv Pulmonary High resolution CT Inhalation, exhalation Metabolic - DECT Epicardial fat Subcutaneous/visceral fat Liver fat Thighs
Normala kranskärl
Plaque förträngning
Fynd: noduli
Noduli
Fynd: myxom
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
Vilka är guldäggen i SCAPIS? CT angio Ektopiskt fett Accelerometerdata
Ectopic fat accumulation and cardiovascular disease Paracrine Systemic(?) Epicardial Myocardial Infarction H eart failure Subcutaneous/visceral Systemic Subclinical disease Liver Diabetes Dyslipidemia Hypertension
Stor-SCAPIS Samma studieprotokoll på 6 univ.sjukhus Gemensam finansiering T illäggsundersökningar Genomförs och finansieras lokalt
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)
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)
Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person) No Data <10% 10% 14%
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%
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%
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 http://www.cdc.gov/diabetes/data