Browsing by Subject "ISCHEMIC-HEART-DISEASE"

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  • Wehkalampi, Karoliina; Muurinen, Mari; Wirta, Sara Bruce; Hannula-Jouppi, Katariina; Hovi, Petteri; Järvenpää, Anna-Liisa; Eriksson, Johan G.; Andersson, Sture; Kere, Juha; Kajantie, Eero (2013)
  • Tuohinen, Suvi Sirkku; Rankinen, Jani; Skyttä, Tanja; Huhtala, Heini; Virtanen, Vesa; Kellokumpu-Lehtinen, Pirkko-Liisa; Raatikainen, Pekka; Nikus, Kjell (2018)
    Background: ST segment depression (STD) and T wave inversion (TWI) are typical electrocardiographic (ECG) findings in non-ST elevation myocardial infarction (NSTEMI). In ST elevation myocardial infarction, ST changes represent transmural ischemia. The pathophysiological mechanisms of the ECG changes in NSTEMI are unclear. Purpose: We studied the associations between ECG and the echocardiographic findings in NSTEMI patients. Methods: Twenty patients with acute NSTEMI were recruited during their hospital stay. A comprehensive echocardiography study was performed. The findings were compared with blinded ECG analyses. Results: Nine (45%) patients had STD, and 16 (85%) patients had TWI. In multivariable analysis, STD was independently associated with a lower global early diastolic strain rate (beta=-5.061, p=0.033). TWI was independently associated with lower circumferential strain (beta=0.132, p =0.032). Conclusions: The typical ECG changes in NSTEMI patients were associated with subtle echocardiographic changes. STD was related to changes in diastolic function, and TWI was associated with systolic deterioration. (C) 2017 Elsevier Inc. All rights reserved.
  • Fischer, Krista; Kettunen, Johannes; Wurtz, Peter; Haller, Toomas; Havulinna, Aki S.; Kangas, Antti J.; Soininen, Pasi; Esko, Tonu; Tammesoo, Mari-Liis; Maegi, Reedik; Smit, Steven; Palotie, Aarno; Ripatti, Samuli; Salomaa, Veikko; Ala-Korpela, Mika; Perola, Markus; Metspalu, Andres (2014)
  • Bonamy, Anna-Karin Edstedt; Mohlkert, Lilly-Ann; Hallberg, Jenny; Liuba, Petru; Fellman, Vineta; Domellof, Magnus; Norman, Mikael (2017)
    Background-Advances in perinatal medicine have increased infant survival after very preterm birth. Although this progress is welcome, there is increasing concern that preterm birth is an emerging risk factor for hypertension at young age, with implications for the lifetime risk of cardiovascular disease. Methods and Results-We measured casual blood pressures (BPs) in a population-based cohort of 6-year-old survivors of extremely preterm birth (<27 gestational weeks; n=171) and in age-and sex-matched controls born at term (n=172). Measured BP did not differ, but sex, age-, and height-adjusted median z scores were 0.14 SD higher (P=0.02) for systolic BP and 0.10 SD higher (P=0.01) for diastolic BP in children born extremely preterm than in controls. Among children born extremely preterm, shorter gestation, higher body mass index, and higher heart rate at follow-up were all independently associated with higher BP at 6 years of age, whereas preeclampsia, smoking in pregnancy, neonatal morbidity, and perinatal corticosteroid therapy were not. In multivariate regression analyses, systolic BP decreased by 0.10 SD (P=0.08) and diastolic BP by 0.09 SD (P=0.02) for each week-longer gestation. Conclusions-Six-year-old children born extremely preterm have normal but slightly higher BP than their peers born at term. Although this finding is reassuring for children born preterm and their families, follow-up at older age is warranted.
  • Forouzanfar, Mohammad H.; Afshin, Ashkan; Alexander, Lily T.; Anderson, H. Ross; Bhutta, Zulficiar A.; Biryukov, Stan; Brauer, Michael; Burnett, Richard; Cercy, Kelly; Charlson, Fiona J.; Cohen, Aaron J.; Dandona, Lalit; Estep, Kara; Ferrari, Alize J.; Frostad, Joseph J.; Fullman, Nancy; Gething, Peter W.; Godwin, William W.; Griswold, Max; Kinfu, Yohannes; Kyu, Hmwe H.; Larson, Heidi J.; Liang, Xiaofeng; Lim, Stephen S.; Liu, Patrick Y.; Lopez, Alan D.; Lozano, Rafael; Marczak, Laurie; Mensah, George A.; Mokdad, Ali H.; Moradi-Lakeh, Maziar; Naghavi, Mohsen; Neal, Bruce; Reitsma, Marissa B.; Roth, Gregory A.; Salomon, Joshua A.; Sur, Patrick J.; Vos, Theo; Wagner, Joseph A.; Wang, Haidong; Zhao, Yi; Zhou, Maigeng; Aasvang, Gunn Marit; Amanuel,; Abajobir, Alemu; Abate, Kalkidan Hassen; Lallukka, Tea; Meretoja, Atte; Meretoja, Tuomo J.; Weiderpass, Elisabete; GBD 2015 Risk Factors (2016)
    Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd.
  • Perälä, Mia-Maria; Valsta, Liisa M.; Kajantie, Eero; Leiviskä, Jaana; Eriksson, Johan G. (2011)
  • Virtanen, Marianna; Elovainio, Marko (2018)
    Modern work life is characterized by constant change, reorganizations, and requirements of efficiency, which make the distribution of resources and obligations, as well as justice in decisionmaking, highly important. In the work life context, it is a question not only of distributing resources and obligations, but also of the procedures and rules that guide the decisionmaking in the organization. Studies of these rules and procedures have provided the basis for a new line of research that evaluates leadership and social relationships in working communities; that is, distributive, procedural, and relational justice. This review follows the development of research on organizational justice from its origins in early social and motivational psychological theories to its establishment as a major line of research in modern work and organizational psychology. The adverse consequences of injustice include poor team climate, reduced productivity and well-being, and work-related illnesses.
  • Ervasti, Jenni; Pietiläinen, Olli; Rahkonen, Ossi; Lahelma, Eero; Kouvonen, Anne; Lallukka, Tea; Mänty, Minna (2019)
    PurposeWe developed a job exposure matrix (JEM) to study the association between long-term exposure to heavy physical effort or heavy lifting and carrying at work with disability pension due to musculoskeletal disorders and premature all-cause mortality.MethodsExposure to heavy physical effort at work during 1996-2005 was estimated with JEM developed for this study population, where the exposure was based on occupational titles of the participants. We included all employees of the City of Helsinki, Finland, who had annual data of exposure for 8-10years (1996-2005, n=18387). The outcome variables were register-based, and the follow-up was from 2006 until 2015. The risk estimates were evaluated using competing risk survival analysis.ResultsThere were 530 (3%) disability pension events due to musculoskeletal disorders during the 10-year follow-up. After adjustment for sex, age, education and chronic diseases, employees in the second (SHR=1.46, 95% CI 1.05-2.05), third (SHR=2.73, 95% CI 2.00-2.29), and the highest exposure quartile (SHR=2.56, 95% CI 1.88-3.50) had a higher risk of musculoskeletal disability pension than employees in the lowest quartile. A total of 110 (4%) men and 266 (2%) women died during the follow-up. Men in the third quartile (SHR=2.29, 95% CI 1.23-4.24), and women in the highest exposure quartile (SHR=1.54, 95% CI 0.99-2.41) had a higher risk of premature mortality than those in the lowest quartile.ConclusionsEight to ten years of exposure to heavy physical effort at work is strongly associated with disability pension due to musculoskeletal disorders. This exposure also increases the risk of premature mortality, particularly among men.
  • Wickberg, Asa; Liljegren, Goran; Killander, Fredrika; Lindman, Henrik; Bjöhle, Judith; Carlberg, Michael; Blomqvist, Carl; Ahlgren, Johan; Villman, Kenneth (2018)
    Purpose: The aim of this study was to verify if radiotherapy (RT) safely can be omitted in older women treated for estrogen-receptor positive early breast cancer with breast-conserving surgery (BCS) and endocrine therapy (ET). Patients and Methods: Eligibility criteria were: consecutive patients with age >= 65 years, BCS + sentinel node biopsy, clear margins, unifocal T1N0M0 breast cancer tumor, Elston-Ellis histological grade 1 or 2 and estrogen receptor-positive tumor. After informed consent, adjuvant ET for 5 years was prescribed. Primary endpoint was ipsilateral breast tumor recurrence (IBTR). Secondary endpoints were contralateral breast cancer and overall survival. Results: Between 2006 and 2012, 603 women were included from 14 Swedish centers. Median age was 71.1 years (range 65-90). After a median follow-up of 68 months 16 IBTR (cumulative incidence at five-year follow-up; 1.2%, 95% CI, 0.6% to 2.5%), 6 regional recurrences (one combined with IBTR), 2 distant recurrences (both without IBTR or regional recurrence) and 13 contralateral breast cancers were observed. There were 48 deaths. One death (2.1%) was due to breast cancer and 13 (27.1%) were due to other cancers (2 endometrial cancers). Five-year overall survival was 93.0% (95% CI, 90.5% to 94.9%). Conclusion: BCS and ET without RT seem to be a safe treatment option in women >= 65 years with early breast cancer and favorable histopathology. The risk of IBTR is comparable to the risk of contralateral breast cancer. Moreover, concurrent morbidity dominates over breast cancer as leading cause of death in this cohort with low-risk breast tumors. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
  • Di Girolamo, Chiara; Nusselder, Wilma J.; Bopp, Matthias; Bronnum-Hansen, Henrik; Costa, Giuseppe; Kovacs, Katalin; Leinsalu, Mall; Martikainen, Pekka; Pacelli, Barbara; Valverde, Jose Rubio; Mackenbach, Johan P. (2020)
    Objective To assess whether recent declines in cardiovascular mortality have benefited all socioeconomic groups equally and whether these declines have narrowed or widened inequalities in cardiovascular mortality in Europe. Methods In this prospective registry-based study, we determined changes in cardiovascular mortality between the 1990s and the early 2010s in 12 European populations by gender, educational level and occupational class. In order to quantify changes in the magnitude of differences in mortality, we calculated both ratio measures of relative inequalities and difference measures of absolute inequalities. Results Cardiovascular mortality has declined rapidly among lower and higher socioeconomic groups. Relative declines (%) were faster among higher socioeconomic groups; absolute declines (deaths per 100 000 person-years) were almost uniformly larger among lower socioeconomic groups. Therefore, although relative inequalities increased over time, absolute inequalities often declined substantially on all measures used. Similar trends were seen for ischaemic heart disease and cerebrovascular disease mortality separately. Best performer was England and Wales, which combined large declines in cardiovascular mortality with large reductions in absolute inequalities and stability in relative inequalities in both genders. In the early 2010s, inequalities in cardiovascular mortality were smallest in Southern Europe, of intermediate magnitude in Northern and Western Europe and largest in Central-Eastern European and Baltic countries. Conclusions Lower socioeconomic groups have experienced remarkable declines in cardiovascular mortality rates over the last 25 years, and trends in inequalities can be qualified as favourable overall. Nevertheless, further reducing inequalities remains an important challenge for European health systems and policies.
  • Hendricks, Audrey E.; Bochukova, Elena G.; Marenne, Gaelle; Keogh, Julia M.; Atanassova, Neli; Bounds, Rebecca; Wheeler, Eleanor; Mistry, Vanisha; Henning, Elana; Koerner, Antje; Muddyman, Dawn; McCarthy, Shane; Hinney, Anke; Hebebrand, Johannes; Scott, Robert A.; Langenberg, Claudia; Wareham, Nick J.; Surendran, Praveen; Howson, Joanna M.; Butterworth, Adam S.; Danesh, John; Nordestgaard, Borge G.; Nielsen, Sune F.; Afzal, Shoaib; Papadia, Sofia; Ashford, Sofie; Garg, Sumedha; Millhauser, Glenn L.; Palomino, Rafael I.; Kwasniewska, Alexandra; Tachmazidou, Ioanna; O'Rahilly, Stephen; Zeggini, Eleftheria; Barroso, Ines; Farooqi, I. Sadaf; Understanding Soc Sci Grp; EPIC-CVD Consortium; UK10K Consortium; Palotie, Aarno (2017)
    Obesity is a genetically heterogeneous disorder. Using targeted and whole-exome sequencing, we studied 32 human and 87 rodent obesity genes in 2,548 severely obese children and 1,117 controls. We identified 52 variants contributing to obesity in 2% of cases including multiple novel variants in GNAS, which were sometimes found with accelerated growth rather than short stature as described previously. Nominally significant associations were found for rare functional variants in BBS1, BBS9, GNAS, MKKS, CLOCK and ANGPTL6. The p.S284X variant in ANGPTL6 drives the association signal (rs201622589, MAF similar to 0.1%, odds ratio = 10.13, p-value = 0.042) and results in complete loss of secretion in cells. Further analysis including additional case-control studies and population controls (N = 260,642) did not support association of this variant with obesity (odds ratio = 2.34, p-value = 2.59 x 10(-3)), highlighting the challenges of testing rare variant associations and the need for very large sample sizes. Further validation in cohorts with severe obesity and engineering the variants in model organisms will be needed to explore whether human variants in ANGPTL6 and other genes that lead to obesity when deleted in mice, do contribute to obesity. Such studies may yield druggable targets for weight loss therapies.
  • Sipola-Leppänen, Marika; Hovi, Petteri; Andersson, Sture; Wehkalampi, Karoliina; Vääräsmäki, Marja; Strang-Karlsson, Sonja; Järvenpää, Anna-Liisa; Mäkitie, Outi; Eriksson, Johan G.; Kajantie, Eero (2011)
  • Mujahid, Mahasin S.; James, Sherman A.; Kaplan, George A.; Salonen, Jukka (2017)
    Previous cross-sectional studies examining whether John Henryism (JH), or high-effort coping with socioeconomic adversity, potentiates the inverse association between socioeconomic position (SEP) and cardiovascular health have focused mainly on hypertension in African Americans. We conducted the first longitudinal test of this hypothesis on incident acute myocardial infarction (AMI) using data from the Kuopio Ischemic Heart Disease Risk Factor Study in Finland (N = 1405 men, 42-60 years). We hypothesized that the expected inverse gradient between SEP and AMI risk would be stronger for men scoring high on JH than for those scoring low. John Henryism was measured by a Finnish version of the JH Scale for Active Coping. Four different measures of SEP were used: childhood SEP, education, income, and occupation. AMI hazard ratios (HR) by SEP and JH were estimated using COX proportional hazard models, before and after adjustment for study covariates. 205 cases of AMI occurred over a median of 14.9 years. Men employed in lower rank (farmer, blue-collar) occupations who scored high on JH had significantly higher age-adjusted risks of AMI than men in higher rank (white-collar) occupations (HR = 3.14, 95% CI: 1.65-5.98 for blue collar; HR = 2.33, 95% Cl: 1.04-5.22 for farmers) who also scored high on JH. No socioeconomic differences in AMI were observed for men who scored low on JH (HR = 136, 95% CI: 0.74 2.47 for blue collar; HR = 0.93, 95% CI: 0.59-1.48 for farmers; p = 0.002 for the SEP x JH interaction). These findings persisted after adjustment for sociodemographic, behavioral, and biological factors. Results for other SEP measures were in the same direction, but did not reach statistical significance. Repetitive high-effort coping with adversity (John Henryism) was independently associated with increased risk for AMI in Finnish men, underscoring the potential relevance of the John Henryism hypothesis to CVD outcomes other than hypertension and to populations other than African Americans. (C) 2016 Published by Elsevier Ltd.
  • Mujahid, Mahasin S.; James, Sherman A.; Kaplan, George A.; Salonen, Jukka (2017)
    Previous cross-sectional studies examining whether John Henryism (JH), or high-effort coping with socioeconomic adversity, potentiates the inverse association between socioeconomic position (SEP) and cardiovascular health have focused mainly on hypertension in African Americans. We conducted the first longitudinal test of this hypothesis on incident acute myocardial infarction (AMI) using data from the Kuopio Ischemic Heart Disease Risk Factor Study in Finland (N = 1405 men, 42-60 years). We hypothesized that the expected inverse gradient between SEP and AMI risk would be stronger for men scoring high on JH than for those scoring low. John Henryism was measured by a Finnish version of the JH Scale for Active Coping. Four different measures of SEP were used: childhood SEP, education, income, and occupation. AMI hazard ratios (HR) by SEP and JH were estimated using COX proportional hazard models, before and after adjustment for study covariates. 205 cases of AMI occurred over a median of 14.9 years. Men employed in lower rank (farmer, blue-collar) occupations who scored high on JH had significantly higher age-adjusted risks of AMI than men in higher rank (white-collar) occupations (HR = 3.14, 95% CI: 1.65-5.98 for blue collar; HR = 2.33, 95% Cl: 1.04-5.22 for farmers) who also scored high on JH. No socioeconomic differences in AMI were observed for men who scored low on JH (HR = 136, 95% CI: 0.74 2.47 for blue collar; HR = 0.93, 95% CI: 0.59-1.48 for farmers; p = 0.002 for the SEP x JH interaction). These findings persisted after adjustment for sociodemographic, behavioral, and biological factors. Results for other SEP measures were in the same direction, but did not reach statistical significance. Repetitive high-effort coping with adversity (John Henryism) was independently associated with increased risk for AMI in Finnish men, underscoring the potential relevance of the John Henryism hypothesis to CVD outcomes other than hypertension and to populations other than African Americans. (C) 2016 Published by Elsevier Ltd.
  • Fruchart, Jean-Charles; Santos, Raul D.; Aguilar-Salinas, Carlos; Aikawa, Masanori; Al Rasadi, Khalid; Amarenco, Pierre; Barter, Philip J.; Ceska, Richard; Corsini, Alberto; Despres, Jean-Pierre; Duriez, Patrick; Eckel, Robert H.; Ezhov, Marat V.; Farnier, Michel; Ginsberg, Henry N.; Hermans, Michel P.; Ishibashi, Shun; Karpe, Fredrik; Kodama, Tatsuhiko; Koenig, Wolfgang; Krempf, Michel; Lim, Soo; Lorenzatti, Alberto J.; McPherson, Ruth; Millan Nunez-Cortes, Jesus; Nordestgaard, Borge G.; Ogawa, Hisao; Packard, Chris J.; Plutzky, Jorge; Ponte-Negretti, Carlos I.; Pradhan, Aruna; Ray, Kausik K.; Reiner, Zeljko; Ridker, Paul M.; Ruscica, Massimiliano; Sadikot, Shaukat; Shimano, Hitoshi; Sritara, Piyamitr; Stock, Jane K.; Su, Ta-Chen; Susekov, Andrey V.; Tartar, Andre; Taskinen, Marja-Riitta; Tenenbaum, Alexander; Tokgozoglu, Lale S.; Tomlinson, Brian; Tybjaerg-Hansen, Anne; Valensi, Paul; Vrablik, Michal; Wahli, Walter; Watts, Gerald F.; Yamashita, Shizuya; Yokote, Koutaro; Zambon, Alberto; Libby, Peter (2019)
    In the era of precision medicine, treatments that target specific modifiable characteristics of high-risk patients have the potential to lower further the residual risk of atherosclerotic cardiovascular events. Correction of atherogenic dyslipidemia, however, remains a major unmet clinical need. Elevated plasma triglycerides, with or without low levels of high-density lipoprotein cholesterol (HDL-C), offer a key modifiable component of this common dyslipidemia, especially in insulin resistant conditions such as type 2 diabetes mellitus. The development of selective peroxisome proliferator-activated receptor alpha modulators (SPPARM) offers an approach to address this treatment gap. This Joint Consensus Panel appraised evidence for the first SPPARM agonist and concluded that this agent represents a novel therapeutic class, distinct from fibrates, based on pharmacological activity, and, importantly, a safe hepatic and renal profile. The ongoing PROMINENT cardiovascular outcomes trial is testing in 10,000 patients with type 2 diabetes mellitus, elevated triglycerides, and low levels of HDL-C whether treatment with this SPPARM agonist safely reduces residual cardiovascular risk.