Browsing by Subject "PRIMARY PREVENTION"

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  • Lavikainen, Piia; Korhonen, Maarit Jaana; Huupponen, Risto; Helin-Salmivaara, Arja (2015)
  • Wardlaw, Joanna M; Debette, Stephanie; Jokinen, Hanna; De Leeuw, Frank-Erik; Pantoni, Leonardo; Chabriat, Hugues; Staals, Julie; Doubal, Fergus; Rudilosso, Salvatore; Eppinger, Sebastian; Schilling, Sabrina; Ornello, Raffaele; Enzinger, Christian; Cordonnier, Charlotte; Taylor-Rowan, Martin; Lindgren, Arne G. (2021)
    'Covert' cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke, cognitive impairment, dependency, and death. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist with clinical decisions about management of ccSVD, specifically white matter hyperintensities and lacunes, to prevent adverse clinical outcomes. The guidelines were developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We prioritised the clinical outcomes of stroke, cognitive decline or dementia, dependency, death, mobility and mood disorders, and interventions of blood pressure lowering, antiplatelet drugs, lipid lowering, lifestyle modifications, glucose lowering and conventional treatments for dementia. We systematically reviewed the literature, assessed the evidence, formulated evidence-based recommendations where feasible, and expert consensus statements. We found little direct evidence, mostly of low quality. We recommend patients with ccSVD and hypertension to have their blood pressure well controlled; lower blood pressure targets may reduce ccSVD progression. We do not recommend antiplatelet drugs such as aspirin in ccSVD. We found little evidence on lipid lowering in ccSVD. Smoking cessation is a health priority. We recommend regular exercise which may benefit cognition, and a healthy diet, good sleep habits, avoiding obesity and stress for general health reasons. In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments. Randomised controlled trials with clinical endpoints are a priority for ccSVD.
  • GBD 2016 Stroke Collaborators; Johnson, Catherine Owens; Minh Nguyen,; Roth, Gregory A.; Kivimäki, Mika; Meretoja, Atte; Meretoja, Tuomo J.; Weiderpass, Elisabete (2019)
    Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016. Methods We report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles. Findings In 2016, there were 5.5 million (95% UI 5.3 to 5.7) deaths and 116.4 million (111.4 to 121.4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36.2% (-39.3 to -33.6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34.2% (-37.2 to -31.5), also with decreases in all SDI quintiles. There were 13.7 million (12.7 to 14.7) new stroke cases in 2016. Global age-standardised incidence declined by 8.1% (-10.7 to -5.5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80.1 million (74.1 to 86.3) prevalent cases of stroke globally in 2016; 41.1 million (38.0 to 44.3) in women and 39.0 million (36.1 to 42.1) in men. Interpretation Although age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
  • Strandberg, Timo E.; Räikkönen, K.; Salomaa, V.; Strandberg, A.; Kautiainen, H.; Kivimäki, M.; Pitkälä, K.; Huttunen, J. (2018)
    Objectives: In a 5-year multifactorial risk reduction intervention for healthy men with at least one cardiovascular disease (CVD) risk factor, mortality was unexpectedly higher in the intervention than the control group during the first 15-year follow-up. In order to find explanations for the adverse outcome, we have extended mortality follow-up and examined in greater detail baseline characteristics that contributed to total mortality. Design: Long-term follow-up of a controlled intervention trial. Setting: The Helsinki Businessmen Study Intervention Trial. Participants and Intervention: The prevention trial between 1974-1980 included 1,222 initially healthy men (born 1919-1934) at high CVD risk, who were randomly allocated into intervention (n=612) and control groups (n=610). The 5-year multifactorial intervention consisted of personal health education and contemporary drug treatments for dyslipidemia and hypertension. In the present analysis we used previously unpublished data on baseline risk factors and lifestyle characteristics. Main outcome measures: 40-year total and cause-specific mortality through linkage to nation-wide death registers. Results: The study groups were practically identical at baseline in 1974, and the 5-year intervention significantly improved risk factors (body mass index, blood pressure, serum lipids and glucose), and total CVD risk by 46% in the intervention group. Despite this, total mortality has been consistently higher up to 25 years post-trial in the intervention group than the control group, and converging thereafter. Increased mortality risk was driven by CVD and accidental deaths. Of the newly-analysed baseline factors, there was a significant interaction for mortality between intervention group and yearly vacation time (P=0.027): shorter vacation was associated with excess 30-year mortality in the intervention (hazard ratio 1.37, 95% CI 1.03-1.83, P=0.03), but not in the control group (P=0.5). This finding was robust to multivariable adjustments. Conclusion: After a multifactorial intervention for healthy men with at least one CVD risk factor, there has been an unexpectedly increased mortality in the intervention group. This increase was especially observed in a subgroup characterised by shorter vacation time at baseline. Although this adverse response to personal preventive measures in vulnerable individuals may be characteristic to men of high social status with subclinical CVD, it clearly deserves further investigation.
  • Nylund, Lotta; Satokari, Reetta; Nikkila, Janne; Rajilic-Stojanovic, Mirjana; Kalliomaki, Marko; Isolauri, Erika; Salminen, Seppo; de Vos, Willem M. (2013)
  • Chasman, Daniel I.; Anttila, Verneri; Buring, Julie E.; Ridker, Paul M.; Schuerks, Markus; Kurth, Tobias; Int Headache Genetics Consortium (2014)
  • Komulainen, Kaisla; Mittleman, Murray A.; Jokela, Markus; Laitinen, Tomi T.; Pahkala, Katja; Elovainio, Marko; Juonala, Markus; Tammelin, Tuija; Kähönen, Mika; Raitakari, Olli; Keltikangas-Jarvinent, Liisa; Pulkid-Raback, Laura (2019)
    Background Promoting ideal cardiovascular health behaviors is an objective of the American Heart Association 2020 goals. We hypothesized that ideal health behaviors of parents are associated with health behaviors of their adult offspring, and that higher socioeconomic position in either generation enhances intergenerational associations of ideal health behaviors. Design Prospective cohort study. Methods We included 1856 Young Finns Study participants who had repeated measurements of socioeconomic position (education, income, occupation), smoking status, body mass index, physical activity and diet from 2001, 2007 and 2011, and data on parental socioeconomic position and health behaviors from 1980. We calculated the total number of ideal behaviors in both generations using American Heart Association definitions. Intergenerational associations were examined using ordinal and linear multilevel regression with random intercepts, in which each participant contributed one, two or three measurements of adult health behaviors (2001, 2007, 2011). All analyses were adjusted for offspring sex, birth year, age, parental education and single parenthood. Results Overall, parental ideal health behaviors were associated with ideal behaviors among offspring (odds ratio (OR) 1.28, 95% confidence interval 1.17, 1.39). Furthermore, ORs for these intergenerational associations were greater among offspring whose parents or who themselves had higher educational attainment (OR 1.56 for high vs. OR 1.19 for low parental education; P = 0.01 for interaction, OR 1.32 for high vs. OR 1.04 for low offspring education; P = 0.02 for interaction). Similar trends were seen with parental income and offspring occupation. Results from linear regression analyses were similar. Conclusions These prospective data suggest higher socioeconomic position in parents or in their adult offspring strengthens the intergenerational continuum of ideal cardiovascular health behaviors.
  • Lavikainen, Piia; Helin-Salmivaara, Arja; Eerola, Mervi; Fang, Gang; Hartikainen, Juha; Huupponen, Risto; Korhonen, Maarit Jaana (2016)
    Objectives Previous studies on the effect of statin adherence on cardiovascular events in the primary prevention of cardiovascular disease have adjusted for time-dependent confounding, but potentially introduced bias into their estimates as adherence and confounders were measured simultaneously. We aimed to evaluate the effect when accounting for time-dependent confounding affected by previous adherence as well as time sequence between factors. Design Retrospective cohort study. Setting Finnish healthcare registers. Participants Women aged 45-64years initiating statin use for primary prevention of cardiovascular disease in 2001-2004 (n=42807). Outcomes Acute cardiovascular event defined as a composite of acute coronary syndrome and acute ischaemic stroke was our primary outcome. Low-energy fractures were used as a negative control outcome to evaluate the healthy-adherer effect. Results During the 3-year follow-up, 474 women experienced the primary outcome event and 557 suffered a low-energy fracture. The causal HR estimated with marginal structural model for acute cardiovascular events for all the women who remained adherent (proportion of days covered 80%) to statin therapy during the previous adherence assessment year was 0.78 (95% CI: 0.65 to 0.94) when compared with everybody remaining non-adherent (proportion of days covered Conclusions Our study, which took into account the time dependence of adherence and confounders, as well as temporal order between these factors, is support for the concept that adherence to statins in women in primary prevention decreases the risk of acute cardiovascular events by about one-fifth in comparison to non-adherence. However, part of the observed effect of statin adherence on acute cardiovascular events may be due to the healthy-adherer effect.
  • Strandberg, Timo E.; Urtamo, Annele; Kähärä, Juuso; Strandberg, Arto Y.; Pitkälä, Kaisu H.; Kautiainen, Hannu (2018)
    Background: Statin treatment is common among 80+ people, but little is known about statin effects on health-related quality of life (HRQoL) in this oldest age group. Methods: In the Helsinki Businessmen Study (HBS), men born from 1919 to 1934 (original n = 3,490), have been followed-up since the 1960s. In 2015, a questionnaire about lifestyle, diseases, and medications, and including RAND-36/SF-36 HRQoL instrument was mailed to survivors. About 612 men (72.6%) responded, 530 of them reporting their medications (98% community-living). Propensity score analysis was used to compare statin users and nonusers for HRQoL. Results: We compared 229 current statin users (median age 85 years, interquartile range 84-88 years) with 301 nonusers (86; 84-89 years). Current statin users had had significantly higher serum cholesterol level in midlife (p <.001), but current lifestyle-related characteristics were similar in users and nonusers. Statin users reported more hypertension (61.1%, p <.001), diabetes (23.6%, p Conclusions: Our study suggests that statin treatment has no significant effect on health-related quality of life among octogenarian, community-dwelling men. The results contradict concerns about statin treatment in the oldest-old, and may caution against deprescribing of statins due to old age alone.
  • Luotola, Kari; Jyväkorpi, Satu; Urtamo, Annele; Pitkälä, Kaisu H.; Kivimäki, Mika; Strandberg, Timo E. (2020)
    BACKGROUND: statin treatment has increased also among people aged 80 years and over, but adverse effects potentially promoting frailty and loss of resilience are frequent concerns. METHODS: in the Helsinki Businessmen Study, men born in 1919-34 (original n = 3,490) have been followed up since the 1960s. In 2011, a random subcohort of home-living survivors (n = 525) was assessed using questionnaires and clinical (including identification of phenotypic frailty) and laboratory examinations. A 7-year mortality follow-up ensued. RESULTS: we compared 259 current statin users (median age 82 years, interquartile range 80-85 years) with 266 non-users (83; 80-86 years). Statin users had significantly more multimorbidity than non-users (prevalencies 72.1% and 50.4%, respectively, P < 0.0001) and worse glucose status than non-users (prevalencies of diabetes 19.0% and 9.4%, respectively, P = 0.0008). However, there was no difference in phenotypic frailty (10.7% versus 11.2%, P = 0.27), and statin users had higher plasma prealbumin level than non-users (mean levels 257.9 and 246.3 mg/L, respectively, P = 0.034 adjusted for age, body mass index and C-reactive protein) implying better nutritional status. Despite morbidity difference, age-adjusted 7-year mortality was not different between the two groups (98 and 103 men among users and non-users of statins, respectively, hazard ratio 0.96, 95% confidence interval 0.72-1.30). CONCLUSIONS: our study suggests that male octogenarian statin users preserved resilience and survival despite multimorbidity, and this may be associated with better nutritional status among statin users.
  • Aro, Aapo L.; Rusinaru, Carmen; Uy-Evanado, Audrey; Reinier, Kyndaron; Phan, Derek; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S. (2017)
    Background: Syncope has been associated with increased risk of sudden cardiac arrest (SCA) in specific patient populations, such as hypertrophic cardiomyopathy, heart failure, and long QT syndrome, but data are lacking on the risk of SCA associated with syncope among patients with coronary artery disease (CAD), the most common cause of SCA. We investigated this association among CAD patients in the community. Methods: All cases of SCA due to CAD were prospectively identified in Portland, Oregon (population approximately 1 million) as part of the Oregon Sudden Unexpected Death Study 2002-2015, and compared to geographical controls. Detailed clinical information including history of syncope and cardiac investigations was obtained from medical records. Results: 2119 SCA cases (68.4 +/- 13.8 years, 66.9% male) and 746 controls (66.7 +/- 11.7 years, 67.0% male) were included in the analysis. 143 (6.8%) of cases had documented syncope prior to the SCA. SCA cases with syncope were > 5 years older and had more comorbidities than other SCA cases. After adjusting for clinical factors and left ventricular ejection fraction (LVEF), syncope was associated with increased risk of SCA (OR 2.8; 95%CI 1.68-4.85). When analysis was restricted to subjects with LVEF >= 50%, the risk of SCA associated with syncope remained significantly elevated (adjusted OR 3.1; 95%CI 1.68-5.79). Conclusions: Syncope was associated with increased risk of SCA in CAD patients even with preserved LV function. These findings suggest a role for this clinical marker among patients with CAD and normal LVEF, a large subgroup without any current means of SCA risk stratification. (C) 2016 Published by Elsevier Ireland Ltd.
  • Preiss, David; Campbell, Ross T.; Murray, Heather M.; Ford, Ian; Packard, Chris J.; Sattar, Naveed; Rahimi, Kazem; Colhoun, Helen M.; Waters, David D.; LaRosa, John C.; Amarenco, Pierre; Pedersen, Terje R.; Tikkanen, Matti J.; Koren, Michael J.; Poulter, Neil R.; Sever, Peter S.; Ridker, Paul M.; MacFadyen, Jean G.; Solomon, Scott D.; Davis, Barry R.; Simpson, Lara M.; Nakamura, Haruo; Mizuno, Kyoichi; Marfisi, Rosa M.; Marchioli, Roberto; Tognoni, Gianni; Athyros, Vasilios G.; Ray, Kausik K.; Gotto, Antonio M.; Clearfield, Michael B.; Downs, John R.; McMurray, John J. (2015)
    Aims The effect of statins on risk of heart failure (HF) hospitalization and HF death remains uncertain. We aimed to establish whether statins reduce major HF events. Methods and results We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for randomized controlled endpoint statin trials from 1994 to 2014. Collaborating trialists provided unpublished data from adverse event reports. We included primary- and secondary-prevention statin trials with >1000 participants followed for >1 year. Outcomes consisted of first on-fatal HF hospitalization, HF death and a composite of first non-fatal HF hospitalization or HF death. HF events occurring Conclusion In primary- and secondary-prevention trials, statins modestly reduced the risks of non-fatal HF hospitalization and a composite of non-fatal HF hospitalization and HF death with no demonstrable difference in risk reduction between those who suffered an MI or not.