Creatine kinase is associated with glycated haemoglobin in a nondiabetic population. The Tromsø study

Background Creatine kinase (CK) has been associated with insulin resistance and identified as a risk marker of cardiovascular disease largely by its relationship with hypertension and increased body mass index. This study determined whether CK is a predictor of glycated haemoglobin (HbA1C) in a nondiabetic general population. Methods Associations between CK and the outcome variable HbA1C (%) were performed by variance and multivariate analyses in 11662 nondiabetic subjects defined as HbA1C (%) <6.5 who participated in the population based Tromsø study (Tromsø 6) in Norway. Results Abnormal elevated CK was detected in 543/11662 participants (4.66%). Mean HbA1C (%) in the “high CK” group was 5.62 (SD = 0.33) compared to 5.52 (SD = 0.36) in the “normal CK” group, P 1C (%) quartiles in women (P <0.001) and non-linearly in men (P <0.001). In a multivariate analysis, CK was independently associated with HbA1C (%) after adjusting for age, sex, body mass index, blood pressure, glucose, lipids, C-reactive protein, creatinine, alanine transaminase and aspartate aminotransferase. A 1-unit increase in log CK was associated with a 0.17-unit increase in HbA1C (%). Conclusion These data demonstrate a positive and independent association between CK and glycated haemoglobin in a nondiabetic general population

Serum alanine aminotransferase activity and risk factors for cardiovascular disease in a Caucasian population: the Tromsø study

Background - High and low levels of serum alanine aminotransferase (ALT) are both associated with cardiovascular diseases (CVD) risks especially in elderly, but the mechanisms are less known. This study investigated associations between ALT and CVD risk factors including effects of sex and age in a Caucasian population. Methods - Cross-sectional data were analysed sex-stratified in 2555 men (mean age 60.4 years) and 2858 women (mean age 60.0 years) from the population study Tromsø 6. Associations were assessed by variance analysis and multivariable logistic regression of odds to have abnormal ALT. Risk factors included body mass index (BMI), waist-to-hip-ratio, blood pressure, lipids, glucose, glycated haemoglobin and high-sensitive C-reactive protein (CRP). Results - Abnormal elevated ALT was detected in 113 men (4.4%) and 188 women (6.6%). Most CVD risk factors associated positively with ALT in both sexes except systolic blood pressure and CRP (women only), while ALT was positively associated with age in men when adjusted for CVD risk factors, P  Conclusion - This study confirms a positive relationship between ALT and CVD risk factors, particularly BMI. Age is not a major confounder in the ALT-CVD relationship, but separate sex-analyses is recommended in such studies

Video consultations in medication overuse headache. A randomized controlled trial

Objective - To test the hypothesis that the effect of video consultations is noninferior to traditional consultations in managing patients with overuse headache (MOH). Materials and Methods - Patients were recruited from referrals to a neurological clinic. In a randomized controlled trial (RCT), headache burden measured by headache impact test (HIT‐6) and frequency of headache days n = 51) and traditional consultations (n = 51) in a post hoc analysis. Results - The overall response rate was 74.5%. HIT‐6 changed from 66.3 (SD = 4.7) to 60.0 (SD = 9.1) from baseline to 12 months in participants randomized to video consultations and from 65.8 (SD = 3.7) to 58.4 (SD = 8.3) in the group consulted traditionally (95% CI −2.3 to 6.5, p = 0.44). Frequency of headache days p = 0.60. In the video group, VAS improved by 2.3 points compared to 2.4 in the traditional group from baseline to 12 months (95% CI −1.2 to 1.2, p = 0.76). Analyses of repeated measurements comparing HIT‐6 and VAS over two points of time in the two groups were insignificant. Conclusion - The effect of video consultations is noninferior to traditional consultations in managing MOH patients. Using video may be a good alternative in consulting patients with MOH

Leisure physical exercise and creatine kinase activity. The Tromsø study

Creatine kinase (CK) is an enzyme catalyzing energy reaction in muscle cells and has proven to modify cardiovascular risks. The influence of skeletal muscle activity on CK concentrations is a potential study confounder but is mainly reported in connection with sport activities. This study investigated the association between leisure physical exercise and CK and estimated the effect of physical exercise on the CK values. CK and leisure physical exercise defined as intensity, frequency, and duration subsets were measured in the population‐based Tromsø study. Comparisons of CK at different exercise levels, multivariate analyses, and relative differences in CK between “never exercise” and “heavy exercise” (moderate or hard exercise ≥2 hours per week) subgroups were analyzed age‐ and sex‐stratified in 12 796 men and women. CK increased significantly with higher levels of physical exercise intensity and frequency in both sexes analyzed by ANOVA. In a multivariate analysis, CK was independently associated with heavy exercise after adjusting for age, BMI, and blood pressure; OR 9.38 (95% CI 5.32‐16.53), P P < .0001 in women. The differences in CK between physically inactive and participants performing heavy exercise varied between 3.1% (women) and 6.4% (men) and was also larger in participants ≥50 years. In conclusion, CK was positively and independently associated with increasing leisure physical exercise in a general population. CK values associated with exercise were approximately twice as high in men than women, but exercise altered CK only modestly

One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial

Background: Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective: The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods: Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results: From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions: One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice

Alanine aminotransferase and body composition in obese men and women

There is a known relationship between serum alanine aminotransferase (ALT) and obesity in humans, but the mechanism(s) are not clarified. This study investigated the associations between serum ALT and body composition in an overweight and obese population. The results are based on data from a previous randomized controlled trial treating obesity with vitamin D3. A sample of 448 overweight and obese individuals underwent dual-energy X-ray absorptiometry (DEXA) and measured serum ALT along with supplementary blood samples at study baseline. Body fat mass and lean mass indexes were calculated by dividing total body fat/lean weight (kg) by body height squared (kg/m2 ). ALT correlated with body mass index (BMI) in men but not women (r = 0.33, P r = 0.06, P = 0.29). In men, serum ALT correlated positively with fat mass index (r = 0.23, P = 0.004) and lean mass index (r = 0.32, P r = 0.13, P = 0.031) but not fat mass index (r = 0.003, P = 0.96). In a multivariate model adjusted for age and fat mass index, a 1-unit increase in lean mass index associated with a 0.37 U/L higher ALT in the male subgroup (95% CI 0.024 to 0.040, P < 0.0001). In conclusion, serum ALT was associated with body fat mass index in men and with lean mass index in men and women in an overweight and obese population. The findings also demonstrate a gender difference in the role of fat

Creatine kinase is associated with reduced inflammation in a general population: The Tromsø study

Background: Creatine kinase (CK) has been associated with reduced inflammation in obesity while inflammation is associated with obesity-related cardiovascular diseases. We investigated the relationship between CK and high sensitive C-reactive protein (hs-CRP) in a general population. Methods: CK and hs-CRP were measured in the population-based Tromsø study that included entire birth cohorts and random samples of citizens between 30–87 years of age. The analyses were performed sex-stratified in 5969 men and 6827 women. Results: CK correlated negatively with hs-CRP in men (r = -0.08, P Conclusion: CK were inversely and independently associated with hs-CRP in a general population. These data provide evidence that CK might have anti-inflammatory properties, but the mechanism and clinical implications are unclarified.</p

A randomized trial of telemedicine efficacy and safety for nonacute headaches

Source at https://doi.org/10.1212/WNL.0000000000004085.Objective: To evaluate long-term treatment efficacy and safety of one-time telemedicine consultations for nonacute headaches. Methods: We randomized, allocated, and consulted nonacute headache patients via telemedicine (n = 200) or in a traditional manner (n = 202) in a noninferiority trial. Efficacy endpoints, assessed by questionnaires at 3 and 12 months, included change from baseline in Headache Impact Test–6 (HIT-6) (primary endpoint) and pain intensity (visual analogue scale [VAS]) (secondary endpoint). The primary safety endpoint, assessed via patient records, was presence of secondary headache within 12 months after consultation. Results: We found no differences between telemedicine and traditional consultations in HIT-6 (p = 0.84) or VAS (p = 0.64) over 3 periods. The absolute difference in HIT-6 from baseline was 0.3 (95% confidence interval [CI] −1.26 to 1.82, p = 0.72) at 3 months and 0.2 (95% CI −1.98 to 1.58, p = 0.83) at 12 months. The absolute change in VAS was 0.4 (95% CI −0.93 to 0.22, p = 0.23) after 3 months and 0.3 (95% CI −0.94 to 0.29, p = 0.30) at 12 months. We found one secondary headache in each group at 12 months. The estimated number of consultations needed to miss one secondary headache with the use of telemedicine was 20,200. Conclusion: Telemedicine consultation for nonacute headache is as efficient and safe as a traditional consultation