Ilonca Vaartjes’s research while affiliated with Utrecht University and other places

Aims This study aimed to evaluate whether lower socioeconomic status (SES) is related to a higher risk of recurrent cardiovascular disease (CVD) events and reduced CVD-free life expectancy in a large cohort of patients with established CVD. Methods and results A total of 9477 patients with established CVD from the Utrecht Cardiovascular Cohort—Secondary Manifestations of ARTerial disease (1996–2022) study were included. SES scores were determined at the neighbourhood level using scores provided by the Netherlands Institute for Social Research, based on income, education, and unemployment. The relationship between SES and recurrent CVD events was analysed using Cox proportional hazard models, adjusted for age, sex, and traditional CVD risk factors. Event-free life expectancy across SES quintiles was assessed using Kaplan–Meier survival estimates, with age as the timescale and accounting for competing risks. Over a median follow-up of 9.0 years [inter-quartile interval (IQI): 4.8–14.1], 2090 recurrent CVD events occurred. Unfavourable CVD risk factors were more prevalent among low SES patients, who less frequently used preventive drug treatment. After adjusting for age and sex, patients in the lowest SES quintile had a higher risk of recurrent events compared with the highest SES quintile [hazard ratio (HR): 1.35; 95% confidence interval (CI): 1.17–1.56]. This relationship persisted after adjusting for CVD risk factors potentially mediating the effect. The median event-free life expectancy was 5.5 years (95% CI: 2.8–8.0) shorter comparing the lowest with highest SES quintile. Conclusion Among patients with established CVD, lower SES is related to a higher risk of recurrent CVD events independent of CVD risk factors and to a shorter CVD-free survival. These findings underscore the need for targeted interventions to reduce health disparities.

Importance Active cancer is a risk factor for cerebral venous thrombosis (CVT), but whether CVT is associated with occult cancer is unknown. Objective To evaluate the incidence of newly diagnosed cancer after CVT. Design, Setting, and Participants This population-based cohort study used data from the Dutch Hospital Discharge Registry from January 1, 1997, to July 1, 2020. Analyses were conducted between June 2023 and April 2024. Patients admitted with a first-ever CVT were included. Patients with a history of cancer or diagnosed with cancer during hospitalization for CVT were excluded. Exposure CVT was identified using International Classification of Diseases, Ninth Revision ( ICD-9 ) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) codes. Main Outcomes and Measures The main outcome was cumulative incidence of cancer after CVT. Standardized incidence ratios (SIRs) were calculated relative to a matched cohort from the general population using the Netherlands Cancer Registry. Results A total of 2649 patients with CVT (median [IQR] age, 44.5 [30.7-56.4] years; 1856 [70.1%] female) were included. Cancer was diagnosed in 119 patients during a median (IQR) follow-up of 4.7 (1.9-8.9) years, of whom 29 (24.4%) had hematologic cancer. The cumulative incidence of cancer was 5.9% (95% CI, 4.8%-7.2%) after 10 years and was highest in men aged 50 years or older (13.5%; 95% CI, 9.1%-18.7%). Patients with CVT had an increased rate of cancer compared with the reference cohort during the entire follow-up, but the difference narrowed over time (SIRs of 3.35 [95% CI, 2.41-4.55] and 1.40 [95% CI, 1.14-1.69] at 1 and 10 years, respectively). The rate was increased both in patients younger than 50 years (SIRs of 6.70 [95% CI, 3.97-10.59] and 1.72 [95% CI, 1.24-2.34] at 1 and 10 years, respectively) and those 50 years or older (SIRs of 2.41 [95% CI, 1.53-3.62] and 1.25 [95% CI, 0.96-1.60] at 1 and 10 years, respectively), as well as in male patients (SIRs of 3.59 [95% CI, 2.16-5.61] and 1.69 [95% CI, 1.25-2.23] at 1 and 10 years, respectively) and female patients (SIRs, 3.17 [95% CI, 1.99-4.80] and 1.22 [95% CI, 0.92-1.58] at 1 and 10 years, respectively). Conclusions and Relevance This cohort study of patients with CVT found an increased risk of cancer during follow-up regardless of age or sex. Men 50 years or older had the highest absolute risk, whereas younger patients had the highest relative risk. Physicians should be vigilant for signs of cancer after CVT, and further research on screening for cancer after CVT is warranted.

Background Air pollution is a major risk factor for cardiovascular diseases and contributes to health disparities, particularly among minority ethnic groups, who often face higher exposure levels. Knowledge on whether the effect of air pollution on cardiovascular diseases differs between ethnic groups is crucial for identifying mechanisms underlying health disparities, ultimately informing targeted public health strategies and interventions. We explored differences in associations between air pollution and ischemic stroke and ischemic heart disease (IHD) for the six largest ethnic groups in the Netherlands. Methods This nationwide analysis (2014–2019), linked residential-address concentrations of NO2 and PM2.5 to individual-level hospital and mortality data. To evaluate incident ischemic stroke, we created a cohort of residents ≥30 years and free of ischemic stroke at baseline and for incident IHD we created a cohort free of IHD. We performed Cox proportional hazard survival analyses in each cohort with 2014 average concentrations of PM2.5 or NO2 as determinants, stratified by ethnicity (Dutch, German, Indonesian, Surinamese, Moroccan, Turkish) and adjusted for age, sex, socioeconomic indicators and region. Results Both cohorts included > 9.5 million people. During follow-up, 127,673 (1.3%) developed ischemic stroke and 156,517 (1.6%) developed IHD. For ischemic stroke, the p-values for the interaction between air pollution and ethnicity were 0.057 for NO2 and 0.055 for PM2.5. The HR of 1 IQR increase (6.42 µg/m³) of NO2 for ischemic stroke was lowest for Moroccans (0.92 [0.84–1.02], p-value = 0.032 difference with Dutch) and highest for Turks (1.09 [1.00-1.18], p-value = 0.157 difference with Dutch). PM2.5 results were similar. For IHD, higher exposure was unexpectedly associated with lower incidence. The p-values for the interaction with ethnicity were 1.75*10− 5 for NO2 and 1.06*10− 3 for PM2.5. The HRs for IHD were lowest for Turks (NO2: 0.88 [0.83–0.92], p-value = 2.0*10− 4 difference with Dutch, PM2.5: 0.86 [0.82–0.91], p-value = 1.3*10− 4 difference with Dutch) and highest for Surinamese (NO2: 1.02 [0.97–1.07], p-value = 0.014 difference with Dutch) and Dutch (PM2.5: 0.96 [0.94–0.98]). Conclusions Associations between air pollutants and ischemic stroke or IHD differ notably between ethnic groups in the Netherlands. Policies to reduce air pollution and prevent ischemic stroke should target populations vulnerable to air pollution with a high cardiovascular disease risk.

Background The use of urban green spaces differs by social characteristics, including gender, ethnicity, and socioeconomic position. We examined motives, means and prerequisites to visit green space of marginalised populations with high cardiometabolic risk in the Netherlands, namely women with a Turkish or South Asian Surinamese background residing in disadvantaged neighbourhoods. Methods We conducted six focus group discussions in two Dutch cities. The study was performed in collaboration with social workers from the local communities with similar ethnic backgrounds as the participants. A thematic analysis was carried out. Results Sixteen Turkish women and 30 South Asian Surinamese women participated. Motives, means and prerequisites that emerged covered four themes: social, personal, environmental characteristics and undertaking activities. Socializing was an important motive to visit green space. Personal motives mainly consisted of positive effects on mental and physical well-being. Activities undertaken in green space were often a means to socialize or improve well-being. Many environmental factors, including safety, aesthetics, and (sanitary) facilities, influenced motivation to visit green space. Except for environmental characteristics, motives, means and prerequisites largely overlapped between ethnic groups. There were notable interactions between the themes. Conclusion Motives, means and prerequisites to visit green space of women with a Turkish or South Asian Surinamese background who live in disadvantaged neighborhoods span multiple interacting themes. Future studies examining the relationship between green space and health should consider interactions between motives, means, prerequisites and ethnicity. The possibility of expanding the multifunctionality of green spaces to provide marginalized populations with more equitable access and activities should be further explored.

Background and objectives: Multiple studies found a higher ischemic stroke incidence in rural areas compared with urbanized areas, often explained by a low socioeconomic status (SES). However, this has rarely been investigated specifically in younger adults. We aimed to investigate the age-specific (15-49 years vs 50+ years) incidence of ischemic stroke in rural and urbanized municipalities within the Netherlands. Methods: Patients with a first-ever ischemic stroke (15 years or older) between 1998 and 2018 were included in this registry-based study through linkage of Dutch national hospital administrative registries. Ischemic stroke was defined through ICD-9 and ICD-10 codes. The urbanization grade of the municipality was defined by the address density in 5 subgroups (from most urban ≥2,500 addresses per km2 to rural <500 addresses per km2). The urbanization grade-specific incidence rate per 100,000 person-years, standardized for age and sex, and incidence rate ratios (IRRs) were calculated. In addition, we performed stratified analyses for young age groups (15-39 and 40-49 years) and neighborhood SES (nSES), which was calculated using welfare, level of education, and recent labor participation. Results: In total, 23,720 patients aged 15-49 years (median age 44.7 years [interquartile range (IQR) 40.6-48.8], 51.6% women) and 369,107 patients aged older than 50 years (median age 76.7 years [IQR 68.8-84.7], 50.8% women) were included. Patients aged 15-49 years living in rural areas showed a 5% higher risk of ischemic stroke (IRR 1.05 [99% CI 0.98-1.13]) compared with patients in urbanized areas, whereas for persons aged 50 years and older, this risk was decreased by 3% (IRR 0.97 [99% CI 0.95-0.98]). For patients aged 15-39 years, this risk was 20% higher (IRR 1.20 [99% CI 1.05-1.37]), and for patients aged 40-49 years, the risk did not differ (IRR 1.01 [99% CI 0.93-1.09]). The rural-urban disparities in all age groups remained similar when stratified for nSES. Discussion: The incidence of ischemic stroke is higher among persons aged 15-49 years living in rural areas compared with urban areas, which was driven by a risk-increase in patients 15-39 years. This was reversed among persons aged 50 years and older. Our findings were not fully explained by differences in nSES. This suggests that different age-specific predictors might play a role in rural-urban disparities in ischemic stroke incidence.

Background Very few studies to date investigated the prospective association of changes in exposure to the food environment with cardiovascular disease (CVD) risk. We aim to explore if time-varying exposure to the food environment was associated with hospitalization and mortality due to total and specific types of CVD in The Netherlands. Methods In this prospective cohort study, 4,641,435 Dutch adults aged 35 + years who did not change residence in 2002–2018 were identified through registry data. Exposure to the food environment was defined as time-varying Food Environment Healthiness Index (FEHI) scores (range: − 5 to 5) and time-varying kernel density of specific food retailers (e.g., fast food outlets, supermarkets) around the home location between 2004 and 2018. The main outcome measures were hospitalization and mortality due to overall CVD, stroke, HF, and CHD occurring between 2004 and 2020, based on hospital and death registries. Results In Cox regression models, each unit increase in the FEHI was associated with a lower hospitalization and mortality of CVD (hospitalization hazard ratio (HRh) = 0.90 (0.89 to 0.91), mortality hazard ratio (HRm) = 0.85 (0.82 to 0.89)), CHD (HRh = 0.88 (0.85 to 0.91), HRm = 0.80 (0.75 to 0.86)), stroke (HRh = 0.89 (0.84 to 0.93)), HRm = 0.89 (0.82 to 0.98)), and HF (HRh = 0.90 (0.84–0.96), HRm = 0.84 (0.76 to 0.92)). Increased density of local food shops, fast food outlets, supermarkets, and convenience stores and decreased density of food delivery outlets and restaurants were associated with a higher risk of CVD, CHD, stroke, and HF hospitalization and mortality. Conclusions In this observational longitudinal study, changes in exposure to a healthier food environment over 14 years were associated with a risk reduction in CVD hospitalization and mortality, in particular in urbanized areas and for younger adults and those with higher incomes.

Objectives: In patients who underwent surgical septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM), additional mitral valve repair may offer additional benefits in terms of further reducing left ventricle outflow tract (LVOT) gradients, systolic anterior motion (SAM) and mitral regurgitation (MR). We performed a systematic review of the literature to evaluate the evidence of surgical myectomy with additional secondary chordal cutting in patients with HOCM. Methods: A systematic literature search in MEDLINE and EMBASE was performed until April 2024. The primary outcome studied was postoperative echocardiographic LVOT-gradient. A random effects meta-analysis of means was performed for the primary outcome. The secondary outcomes studied were postoperative residual MR-grade, 30-day new permanent pacemaker implantation, and in-hospital mortality. Results: From 1911 unique publications, a total of 6 articles fulfilled the inclusion criteria and comprised 471 patients with a pooled mean preoperative resting LVOT gradient of 84 mmHg (95% CI: 76–91). The postoperative pooled mean LVOT-gradient was 11 mmHg (95% CI: 10 – 12) with a low heterogeneity (I2 = 44%). The residual LVOT gradient exceeding 30 mmHg was present in 9 (1%) patients. MR-grade 3 or 4 at hospital discharge was present in 7 (1%) patients. The 30-day new permanent pacemaker implantation rate was 7% and the in-hospital mortality was 0.4%. Conclusion: This systematic review and meta-analysis demonstrate that combining surgical septal myectomy with secondary chordal cutting can be performed safely and effectively eliminate LVOT obstruction in HOCM patients. Further studies are needed to determine the additive effectiveness of additional secondary chordal cuttings