Investigations, findings, and follow-up in patients with chest pain and elevated high-sensitivity cardiac troponin T levels but no myocardial infarction.

BACKGROUND: Elevated troponin levels, in patients without myocardial infarction (MI), are associated with increased mortality. In an observational cohort study we aimed to assess how patients with elevated high-sensitivity cardiac troponin T (hs-cTnT) levels, and no MI are investigated and followed up, compared to patients with MI. METHODS: During January 1, 2011 to December 31, 2012, all patients >25years of age, with chest pain and elevated hs-cTnT levels or MI, at the Karolinska University Hospital were included. We calculated risk ratios (RR) with 95% confidence intervals (CI) for echocardiographies, stress tests, and follow-up, and compared medication in patients with and without MI. RESULTS: 1848 patients with elevated hs-cTnT levels but no MI, of whom 871 (47%) had no prior heart disease, and 667 patients with MI were included. Echocardiography was performed in 609 patients (33%) without MI and 580 (87%) with MI (adjusted RR 0.42; 95% CI, 0.37-0.48). Follow-up was planned for 856 (46%) patients without MI and 611 (92%) with MI (adjusted RR 0.54; 95% CI, 0.48-0.60). Among patients without MI and no heart disease who underwent echocardiography 46 (14%) had a left ventricular ejection fraction of ≤40%, and on stress tests 27 (37%) had findings associated with ischemia. Platelet inhibitors and statins were started in 266 (25%) and 199 (17%) patients without MI, respectively, compared with 424 (93%), and 416 (86%) patients with MI. CONCLUSIONS: Patients with elevated hs-cTnT levels and no MI are rarely investigated for detection of cardiac disease or followed up, or started on cardiovascular medication that potentially could prevent future cardiovascular events and death.

Neonatal vitamin D status and risk of multiple sclerosis.

OBJECTIVE: Low vitamin D status at birth may be associated with risk of adult onset multiple sclerosis, but this link has not been studied directly. We assessed the relation between neonatal vitamin D concentrations, measured in stored blood samples, and risk of multiple sclerosis. METHODS: This was a population-based case-control study in Sweden including 459 incident cases of multiple sclerosis and 663 controls, randomly drawn from a national population registry and frequency matched on sex, age, and residential area. RESULTS: There was no association between neonatal 25-hydroxyvitamin D quintile and risk of multiple sclerosis (crude odds ratio = 1.0, 95% confidence interval = 0.68-1.44, for the highest quintile compared to the lowest). Adjusting for a number of potential confounding factors in early life (month of birth, latitude of birth, breastfeeding) and in adult life (25-hydroxyvitamin D, sun exposure, vitamin D intake from dairy products, fatty fish consumption, smoking, body mass index at 20 years of age) as well as ancestry, multiple sclerosis heredity, and socioeconomic group did not considerably affect the result. INTERPRETATION: At a broad population level, 25-hydroxyvitamin D at birth was not associated with risk of multiple sclerosis.