Heart-healthy diets including phytostanol ester consumption to reduce the risk of atherosclerotic cardiovascular diseases. A clinical review.

The risk of atherosclerotic cardiovascular diseases (ASCVDs) can be reduced by lowering low-density lipoprotein cholesterol (LDL-C) concentrations. Nevertheless, ASCVDs still cause most deaths worldwide. Here, we discuss the prevention of ASCVD and the event risk with a focus on heart-healthy diets, i.e., low intakes of saturated and trans-fatty acids and cholesterol, and high intakes of unsaturated fatty acids, viscous fibre, and dietary phytostanols as fatty acid esters, according to international dyslipidaemia treatment guidelines. Calculations based on both FINRISK and Cholesterol Treatment Trialists' Collaborators regression equations indicate that heart-healthy diets combined with phytostanol ester reduce LDL-C concentrations to such an extent that the 10-year estimated reduction in the incidence of coronary artery disease would be 23%. This information can be used, in particular, to prevent the development of subclinical atherosclerosis in healthy middle-aged populations and the progression of atherosclerosis to ASCVD. The outcome of simple and feasible dietary changes, and, when needed, combined with statins, can be significant: reduced mortality, an increased number of healthy life-years, and reduced healthcare costs.

Risk prediction of atrial fibrillation and its complications in the community using hs troponin I.

AIMS: Atrial fibrillation (AF) is becoming increasingly common. Traditional cardiovascular risk factors (CVRF) do not explain all AF cases. Blood-based biomarkers reflecting cardiac injury such as high-sensitivity troponin I (hsTnI) may help close this gap. METHODS: We investigated the predictive ability of hsTnI for incident AF in 45,298 participants (median age 51.4 years, 45.0% men) across European community cohorts in comparison to CVRF and established biomarkers (C-reactive protein, N-terminal pro B-type natriuretic peptide). RESULTS: During a median follow-up of 7.7 years, 1734 (3.8%) participants developed AF. Those in the highest hsTnI quarter (≥4.2 ng/L) had a 3.91-fold (95% confidence interval (CI) 3.30, 4.63; p < .01) risk for developing AF compared to the lowest quarter (<1.4 ng/L). In multivariable-adjusted Cox proportional hazards models a statistically significant association was seen between hsTnI and AF (hazard ratio (HR) per 1 standard deviation (SD) increase in log10(hsTnI) 1.08; 95% CI 1.01, 1.16; p = .03). Inclusion of hsTnI did improve model discrimination (C-index CVRF 0.811 vs. C-index CVRF and hsTnI 0.813; p < .01). Higher hsTnI concentrations were associated with heart failure (HR per SD 1.37; 95% CI 1.12, 1.68; p < .01) and overall mortality (HR per SD 1.24; 95% CI 1.09, 1.41; p < .01). CONCLUSION: hsTnI as a biomarker of myocardial injury does not improve prediction of AF incidence beyond classical CVRF and NT-proBNP. However, it is associated with the AF-related disease heart failure and mortality likely reflecting underlying subclinical cardiovascular impairment.

Exploring the incremental utility of circulating biomarkers for robust risk prediction of incident atrial fibrillation in European cohorts using regressions and modern machine learning methods.

AIMS: To identify robust circulating predictors for incident atrial fibrillation (AF) using classical regressions and machine learning (ML) techniques within a broad spectrum of candidate variables. METHODS AND RESULTS: In pooled European community cohorts (n = 42 280 individuals), 14 routinely available biomarkers mirroring distinct pathophysiological pathways including lipids, inflammation, renal, and myocardium-specific markers (N-terminal pro B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin I [hsTnI]) were examined in relation to incident AF using Cox regressions and distinct ML methods. Of 42 280 individuals (21 843 women [51.7%]; median [interquartile range, IQR] age, 52.2 [42.7, 62.0] years), 1496 (3.5%) developed AF during a median follow-up time of 5.7 years. In multivariable-adjusted Cox-regression analysis, NT-proBNP was the strongest circulating predictor of incident AF [hazard ratio (HR) per standard deviation (SD), 1.93 (95% CI, 1.82-2.04); P < 0.001]. Further, hsTnI [HR per SD, 1.18 (95% CI, 1.13-1.22); P < 0.001], cystatin C [HR per SD, 1.16 (95% CI, 1.10-1.23); P < 0.001], and C-reactive protein [HR per SD, 1.08 (95% CI, 1.02-1.14); P = 0.012] correlated positively with incident AF. Applying various ML techniques, a high inter-method consistency of selected candidate variables was observed. NT-proBNP was identified as the blood-based marker with the highest predictive value for incident AF. Relevant clinical predictors were age, the use of antihypertensive medication, and body mass index. CONCLUSION: Using different variable selection procedures including ML methods, NT-proBNP consistently remained the strongest blood-based predictor of incident AF and ranked before classical cardiovascular risk factors. The clinical benefit of these findings for identifying at-risk individuals for targeted AF screening needs to be elucidated and tested prospectively.

Contribution of smoking change to 45-year trend in prevalence of chronic bronchitis in Finland.

AIMS: Tobacco smoking has been identified as the most important risk factor of chronic bronchitis. The aim of this study was to assess the contribution of smoking to the trends in prevalence of chronic bronchitis among men and women in Finland. METHODS: For this purpose, we analysed questionnaires included in national FINRISK and FinHealth studies conducted between 1972 and 2017 in 5-year intervals. A total of 26,475 men and 28,684 women aged 30-59 years were included in the analysis. In addition to smoking, age and socioeconomic status were used as risk factors in the logistic regression model. RESULTS: Smoking in Finland has declined from 51% to 23% in men between 1972 and 2017. In women, it increased from 11% in 1972 to 23% in 2002, with a following decrease to 16% in 2017. The prevalence of chronic bronchitis has generally followed the trend of smoking. The population attributable risk was 60% in men and 49% in women. A decrease in chronic bronchitis was observed in male never-smokers. CONCLUSIONS: Smoking is currently declining in Finland in both men and women. As result, the prevalence of chronic bronchitis is declining and it is approaching baseline independent of smoking. The decrease in never-smokers has yet to be explained.

Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes.

AIMS: There is inconsistent evidence on the relation of alcohol intake with incident atrial fibrillation (AF), in particular at lower doses. We assessed the association between alcohol consumption, biomarkers, and incident AF across the spectrum of alcohol intake in European cohorts. METHODS AND RESULTS: In a community-based pooled cohort, we followed 107 845 individuals for the association between alcohol consumption, including types of alcohol and drinking patterns, and incident AF. We collected information on classical cardiovascular risk factors and incident heart failure (HF) and measured the biomarkers N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin I. The median age of individuals was 47.8 years, 48.3% were men. The median alcohol consumption was 3 g/day. N = 5854 individuals developed AF (median follow-up time: 13.9 years). In a sex- and cohort-stratified Cox regression analysis alcohol consumption was non-linearly and positively associated with incident AF. The hazard ratio for one drink (12 g) per day was 1.16, 95% CI 1.11-1.22, P < 0.001. Associations were similar across types of alcohol. In contrast, alcohol consumption at lower doses was associated with reduced risk of incident HF. The association between alcohol consumption and incident AF was neither fully explained by cardiac biomarker concentrations nor by the occurrence of HF. CONCLUSIONS: In contrast to other cardiovascular diseases such as HF, even modest habitual alcohol intake of 1.2 drinks/day was associated with an increased risk of AF, which needs to be considered in AF prevention.

Cardiac Troponin I and Incident Stroke in European Cohorts: Insights From the BiomarCaRE Project.

BACKGROUND AND PURPOSE: Stroke is a common cause of death and a leading cause of disability and morbidity. Stroke risk assessment remains a challenge, but circulating biomarkers may improve risk prediction. Controversial evidence is available on the predictive ability of troponin concentrations and the risk of stroke in the community. Furthermore, reports on the predictive value of troponin concentrations for different stroke subtypes are scarce. METHODS: High-sensitivity cardiac troponin I (hsTnI) concentrations were assessed in 82 881 individuals (median age, 50.7 years; 49.7% men) free of stroke or myocardial infarction at baseline from 9 prospective European community cohorts. We used Cox proportional hazards regression to determine relative risks, followed by measures of discrimination and reclassification using 10-fold cross-validation to control for overoptimism. Follow-up was based upon linkage with national hospitalization registries and causes of death registries. RESULTS: Over a median follow-up of 12.7 years, 3033 individuals were diagnosed with incident nonfatal or fatal stroke (n=1654 ischemic strokes, n=612 hemorrhagic strokes, and n=767 indeterminate strokes). In multivariable regression models, hsTnI concentrations were associated with overall stroke (hazard ratio per 1-SD increase, 1.15 [95% CI, 1.10-1.21]), ischemic stroke (hazard ratio, 1.14 [95% CI, 1.09-1.21]), and hemorrhagic stroke (hazard ratio, 1.10 [95% CI, 1.01-1.20]). Adding hsTnI concentrations to classical cardiovascular risk factors (C indices, 0.809, 0.840, and 0.736 for overall, ischemic, and hemorrhagic stroke, respectively) increased the C index significantly but modestly. In individuals with an intermediate 10-year risk (5%-20%), the net reclassification improvement for overall stroke was 0.038 (P=0.021). CONCLUSIONS: Elevated hsTnI concentrations are associated with an increased risk of incident stroke in the community, irrespective of stroke subtype. Adding hsTnI concentrations to classical risk factors only modestly improved estimation of 10-year risk of stroke in the overall cohort but might be of some value in individuals at an intermediate risk.

Immune-microbiota interaction in Finnish and Russian Karelia young people with high and low allergy prevalence.

BACKGROUND: After the Second World War, the population living in the Karelian region was strictly divided by the "iron curtain" between Finland and Russia. This resulted in different lifestyle, standard of living, and exposure to the environment. Allergic manifestations and sensitization to common allergens have been much more common on the Finnish compared to the Russian side. OBJECTIVE: The remarkable allergy disparity in the Finnish and Russian Karelia calls for immunological explanations. METHODS: Young people, aged 15-20 years, in the Finnish (n = 69) and Russian (n = 75) Karelia were studied. The impact of genetic variation on the phenotype was studied by a genome-wide association analysis. Differences in gene expression (transcriptome) were explored from the blood mononuclear cells (PBMC) and related to skin and nasal epithelium microbiota and sensitization. RESULTS: The genotype differences between the Finnish and Russian populations did not explain the allergy gap. The network of gene expression and skin and nasal microbiota was richer and more diverse in the Russian subjects. When the function of 261 differentially expressed genes was explored, innate immunity pathways were suppressed among Russians compared to Finns. Differences in the gene expression paralleled the microbiota disparity. High Acinetobacter abundance in Russians correlated with suppression of innate immune response. High-total IgE was associated with enhanced anti-viral response in the Finnish but not in the Russian subjects. CONCLUSIONS AND CLINICAL RELEVANCE: Young populations living in the Finnish and Russian Karelia show marked differences in genome-wide gene expression and host contrasting skin and nasal epithelium microbiota. The rich gene-microbe network in Russians seems to result in a better-balanced innate immunity and associates with low allergy prevalence.

Temporal relations between atrial fibrillation and ischaemic stroke and their prognostic impact on mortality.

AIMS: Limited evidence is available on the temporal relationship between atrial fibrillation (AF) and ischaemic stroke and their impact on mortality in the community. We sought to understand the temporal relationship of AF and ischaemic stroke and to determine the sequence of disease onset in relation to mortality. METHODS AND RESULTS: Across five prospective community cohorts of the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project we assessed baseline cardiovascular risk factors in 100 132 individuals, median age 46.1 (25th-75th percentile 35.8-57.5) years, 48.4% men. We followed them for incident ischaemic stroke and AF and determined the relation of subsequent disease diagnosis with overall mortality. Over a median follow-up of 16.1 years, N = 4555 individuals were diagnosed solely with AF, N = 2269 had an ischaemic stroke but no AF diagnosed, and N = 898 developed both, ischaemic stroke and AF. Temporal relationships showed a clustering of diagnosis of both diseases within the years around the diagnosis of the other disease. In multivariable-adjusted Cox regression analyses with time-dependent covariates subsequent diagnosis of AF after ischaemic stroke was associated with increased mortality [hazard ratio (HR) 4.05, 95% confidence interval (CI) 2.17-7.54; P < 0.001] which was also apparent when ischaemic stroke followed after the diagnosis of AF (HR 3.08, 95% CI 1.90-5.00; P < 0.001). CONCLUSION: The temporal relations of ischaemic stroke and AF appear to be bidirectional. Ischaemic stroke may precede detection of AF by years. The subsequent diagnosis of both diseases significantly increases mortality risk. Future research needs to investigate the common underlying systemic disease processes.

Sex Differences and Similarities in Atrial Fibrillation Epidemiology, Risk Factors, and Mortality in Community Cohorts: Results From the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe).

BACKGROUND: Atrial fibrillation (AF) is a common cardiac disease in aging populations with high comorbidity and mortality. Sex differences in AF epidemiology are insufficiently understood. METHODS: In N=79 793 individuals without AF diagnosis at baseline (median age, 49.6 years; age range, 24.1-97.6 years; 51.7% women) from 4 community-based European studies (FINRISK, DanMONICA, Moli-sani Northern Sweden) of the BiomarCaRE consortium (Biomarker for Cardiovascular Risk Assessment in Europe), we examined AF incidence, its association with mortality, common risk factors, biomarkers, and prevalent cardiovascular disease, and their attributable risk by sex. Median follow-up time was 12.6 (to a maximum of 28.2) years. RESULTS: Fewer AF cases were observed in women (N=1796; 4.4%), than in men (N=2465; 6.4%). Cardiovascular risk factor distribution and lipid profile at baseline were less beneficial in men than in women, and cardiovascular disease was more prevalent in men. Cumulative incidence increased markedly after the age of 50 years in men and after 60 years in women. The lifetime risk was similar (>30%) for both sexes. Subjects with incident AF had a 3.5-fold risk of death in comparison with those without AF. Multivariable-adjusted models showed sex differences for the association of body mass index and AF (hazard ratio per standard deviation increase, 1.18; 95% confidence interval [CI], 1.12-1.23 in women versus 1.31; 95% CI 1.25-1.38 in men; interaction P value of 0.001). Total cholesterol was inversely associated with incident AF with a greater risk reduction in women (hazard ratio per SD, 0.86; 95% CI, 0.81-0.90 versus 0.92; 95% CI, 0.88-0.97 in men; interaction P value of 0.023). No sex differences were seen for C-reactive protein and N-terminal pro B-type natriuretic peptide. The population-attributable risk of all risk factors combined was 41.9% in women and 46.0% in men. About 20% of the risk was observed for body mass index. CONCLUSIONS: Lifetime risk of AF was high, and AF was strongly associated with increased mortality both in women and men. Body mass index explained the largest proportion of AF risk. Observed sex differences in the association of body mass index and total cholesterol with AF need to be evaluated for underlying pathophysiology and relevance to sex-specific prevention strategies.

Language as a determinant of participation rates in Finnish health examination surveys.

AIM: A high participation rate is considered as a prerequisite for representative survey results, especially when it is known that non-participation is selective. In many countries migration is increasing and the proportion of people speaking other language(s) than the official language(s) of the country is also increasing. How does this affect survey participation rates? METHODS: Data from four cross-sectional health examination surveys (the FINRISK Study) were used to evaluate the effect of the registered mother tongue to participation in the survey. RESULTS: Finland has two official languages (Finnish and Swedish). Between 1997 and 2012, the proportion of the population with some other language as their registered mother tongue has increased significantly. Participation rates in the health surveys have been highest among the Finnish language group (68% in men in 1997 and 76% in women in 1997), while lowest among the foreign language group (43% in men in 1997 and 57% in women in 1997). In 2012, the participation rates had declined in all language groups: for men, 58%, 62% and 41% for Finnish, Swedish and foreign groups respectively, and for women 68%, 75% and 56%. CONCLUSIONS: The participation rate for the foreign language group was significantly lower than for the Finnish and Swedish groups. In future surveys it will be important to include actions to promote participation, e.g. providing survey material in several languages. These actions will increase costs but will be essential to ensure high participation rates and reliable results for the total population.

Differences in participation rates between urban and rural areas are diminishing in Finland.

Increasing within-country migration from rural to urban areas is setting new challenges for survey organization. For example, the educational level of population in urban and rural areas differ, resulting in differences in health behaviours and health outcomes between areas. Data from the national cross-sectional surveys of the FINRISK Study conducted in Finland in 1997-2012 among the adult population were used. Women living in the capital region were more likely to be survey non-participants than women living in rural areas. The differences between rural and urban areas have diminished over time among men, but not among women. Even though participation rates between different levels of urbanizations are becoming similar, observed differences in population profiles - that is, educational level - between areas may bias survey results unless results are adequately adjusted.

Participation rates by educational levels have diverged during 25 years in Finnish health examination surveys.

Background: Declining participation rates in health examination surveys may impair the representativeness of surveys and introduce bias into the comparison of results between population groups if participation rates differ between them. Changes in the characteristics of non-participants over time may also limit comparability with earlier surveys. Methods: We studied the association of socio-economic position with participation, and its changes over the past 25 years. Occupational class and educational level are used as indicators of socio-economic position. Data from six cross-sectional FINRISK surveys conducted between 1987 and 2012 in Finland were linked to national administrative registers, which allowed investigation of the differences between survey participants and non-participants. Results: Our results show that individuals with low occupational class or low level of education were less likely to participate than individuals with high occupational class or high level of education. Participation rates decreased in all subgroups of the population but the decline was fastest among those with low level of education. Conclusions: The differences in participation rates must be taken into account to avoid biased estimates because socio-economic position has also been shown to be strongly related to health, health behaviour and biological risk factors. Particular attention should be paid to the recruitment of the less-educated population groups.

Successful nutrition policy: improvement of vitamin D intake and status in Finnish adults over the last decade.

Background: Due to vitamin D intake below recommendation (10 µg/day) and low (<50 nmol/l) serum 25-hydroxycholecalciferol (25(OH)D) concentration in Finnish population, the fortification of liquid dairy products with 0.5 µg vitamin D/100 g and fat spreads with 10 µg/100 g started in Finland in December 2002. In 2010, the fortification recommendation was doubled. The aim of this study was to investigate whether the vitamin D intake and status have improved among Finnish adults as a consequence of these nutrition policy actions. A further aim was to study the impact of vitamin supplement use to the total vitamin D intake. Methods: A cross-sectional survey was conducted every 5 years. The National FINDIET Survey was conducted in Finland as part of the National FINRISK health monitoring study. Dietary data were collected by using a computer-assisted 48-h dietary recall. In 2002, dietary data comprised 2007, in 2007, 1575 and 2012, 1295 working aged (25-64 years) Finns. Results: The mean D-vitamin intake increased from 5 µg/day to 17 µg/day in men and from 3 µg/day to 18 µg/day in women from 2002 to 2012. The most important food sources of vitamin D were milk products, fat spreads and fish dishes. The share of milk products was 39% among younger men and 38% among younger women, and 29% among older men and 28% among older women. Fat spreads covered on average 28% of vitamin D intake, except for younger men for which it covered 23%. Fish dishes provided 28% of vitamin D intake for older men and women, and approximately 18% for younger ones. In January-April 2012, the average serum 25-hydroxycholecalciferol (25(OH)D) concentration for men was 63 nmol/l for men and for women 67 nmol/l for women. Conclusions: The fortification of commonly used foods with vitamin D and vitamin D supplementation seems to be an efficient way to increase the vitamin D intake and the vitamin D status in the adult population.

Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium.

AIMS: Our aims were to evaluate the distribution of troponin I concentrations in population cohorts across Europe, to characterize the association with cardiovascular outcomes, to determine the predictive value beyond the variables used in the ESC SCORE, to test a potentially clinically relevant cut-off value, and to evaluate the improved eligibility for statin therapy based on elevated troponin I concentrations retrospectively. METHODS AND RESULTS: Based on the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project, we analysed individual level data from 10 prospective population-based studies including 74 738 participants. We investigated the value of adding troponin I levels to conventional risk factors for prediction of cardiovascular disease by calculating measures of discrimination (C-index) and net reclassification improvement (NRI). We further tested the clinical implication of statin therapy based on troponin concentration in 12 956 individuals free of cardiovascular disease in the JUPITER study. Troponin I remained an independent predictor with a hazard ratio of 1.37 for cardiovascular mortality, 1.23 for cardiovascular disease, and 1.24 for total mortality. The addition of troponin I information to a prognostic model for cardiovascular death constructed of ESC SCORE variables increased the C-index discrimination measure by 0.007 and yielded an NRI of 0.048, whereas the addition to prognostic models for cardiovascular disease and total mortality led to lesser C-index discrimination and NRI increment. In individuals above 6 ng/L of troponin I, a concentration near the upper quintile in BiomarCaRE (5.9 ng/L) and JUPITER (5.8 ng/L), rosuvastatin therapy resulted in higher absolute risk reduction compared with individuals <6 ng/L of troponin I, whereas the relative risk reduction was similar. CONCLUSION: In individuals free of cardiovascular disease, the addition of troponin I to variables of established risk score improves prediction of cardiovascular death and cardiovascular disease.

" Nature step" to prevent noncommunicable inflammatory disease.

The prevention of many diseases has significantly improved by intervening in known risk factors. However, the causes of the increase in allergy and type 1 diabetes are unknown. These diseases are often associated with a low-grade inflammation and immunological imbalance. The lifestyle and environment of urbanized populations have changed causing imbalance in the human normal flora and affecting immune regulation. We discuss everyday factors affecting immune regulation, using allergy as an example. Health may be promoted through the "nature step", by supporting the connection between humans and nature.

Cardiovascular risk factors among Russian, Somali and Kurdish migrants in comparison with the general Finnish population.

BACKGROUND: There is limited information on cardiovascular risk among migrants. We compared cardiovascular risk factors among three major migrant groups in Finland with the general population. METHODS: Cross-sectional data from 30- to 64-year-old health examination participants (n = 921) of the Migrant Health and Wellbeing Study (2010-12) were used. Data for comparison with the general Finnish population were obtained from the Health 2011 Study (n = 892). RESULTS: Russian men had a similar risk profile to that of the reference group. Kurdish men had lower prevalence of hypertension [prevalence ratio (PR) 0.55, 95% confidence interval (CI) 0.39-0.79] but higher prevalence of dyslipidaemia (PR: 1.12, 95% CI: 1.02-1.24) and hyperglycaemia (PR: 2.61, 95% CI: 1.88-3.64) compared with the reference group. Somali men had lower prevalence of smoking (PR: 0.18, 95% CI: 0.08-0.44), hypertension (PR: 0.55, 95% CI: 0.32-0.97)) and obesity (PR: 0.35, 95% CI: 0.17-0.71) but higher prevalence of hyperglycaemia (PR: 2.59, 95% CI: 1.73-3.86) compared with the reference group. Similar patterns were observed for women, except for higher prevalence of hyperglycaemia among Russian women (PR: 1.95, 95% CI: 1.26-3.01) and obesity among Kurdish and Somali women (PR: 1.41, 95% CI: 1.15-1.72 and PR: 1.68, 95% CI: 1.40-2.03, respectively) compared with the reference group. All migrant women had significantly lower prevalence of smoking than the reference group. CONCLUSIONS: There were significant variations in cardiovascular risk profiles of Kurdish and Somali migrants compared with the general population. Differences in cardiovascular risk factors by migrant group need to be taken into account in planning and implementing health promotion strategies.

Perceived health-related self-efficacy associated with BMI in adults in a population-based survey.

BACKGROUND: The concept of ability to control personal behaviour in various environmental temptations is called self-efficacy. The high prevalence of obesity and overweight in Finland is the reason for studying the determinants of weight. The aim of the present study was to clarify the associations between body mass index and health-related self-efficacy (HSE), including food patterns, health behaviour and education. METHODS: A random sample of adults was invited to the cross-sectional FINRISK 2002 Study in six regions in Finland. Participants (n=7784) gave information on education, health behaviour, HSE and food consumption. Height and weight were measured in a health examination. The response rate was 60% for men and 71% for women. Six food patterns were identified by principal component analysis on the basis of food consumption. The scores from seven-item HSE was calculated and categorized into tertiles for the analysis. The associations of BMI with self-efficacy and exploratory variables were tested using general linear modelling in total population and by gender. RESULTS: A weak HSE was associated with a higher BMI after adjusting for age, education, food patterns and health behaviour. In addition, low education, infrequent PA and non-smoking were associated with the higher BMI, but the association of HSE and BMI remained in multivariate model. The associations of food patterns and BMI were small. The adverse association with BMI was observed for patterns with sweet and butter. CONCLUSION: The study supports the importance of self-control in weight management, which needs to be considered as an empowerment tool in health education.

Trends and educational differences in non-communicable disease risk factors in Pitkäranta, Russia, from 1992 to 2007.

AIM: Mortality and morbidity from non-communicable diseases (NCDs) is a major public health problem in Russia. The aim of the study was to examine trends and educational differences from 1992 to 2007 in NCD risk factors in Pitkäranta in the Republic of Karelia, Russia. METHODS: Four cross-sectional population health surveys were carried out in the Pitkäranta region, Republic of Karelia, Russia, in 1992, 1997, 2002, and 2007. An independent random sample of 1000 persons from the general population aged 25-64 years was studied in each survey round. The total number of respondents in the four surveys was 2672. The surveys included a questionnaire, physical measurements, and blood sampling, and they were carried out following standard protocols. RESULTS: The NCD risk factor trends generally increased in Pitkäranta during the study period with the exception of systolic blood pressure and smoking among men. Especially significant increases were observed in alcohol consumption among both sexes and in smoking among women. Educational differences and differences in trends were relatively small with the exception of a significant increase in smoking in the lowest female educational category. CONCLUSIONS: Trends showing an increase in some major NCD risk factors and signs of emerging socio-economic differences call for stronger attention to effective health promotion and preventive policies in Russia.

Can the accuracy of health behaviour surveys be improved by non-response follow-ups?

BACKGROUND: Prevalence estimates may be biased if the characteristics of respondents differ from those of non-respondents in surveys. In this study, we used a follow-up telephone interview of initial non-respondents to examine the differences--in terms of self-rated health and health behaviours--to initial postal respondents and to assess improvements in prevalence estimates. METHODS: Following a postal questionnaire survey using a random sample (n = 5000) of the Finnish working-age population with a response rate of 57% (n = 2826), a follow-up telephone survey was performed based on 1261 non-respondents (response rate 56%, n = 708) in 2010. Prevalence of smoking, alcohol use, body mass index, physical activity, self-rated fitness, dietary habits and self-rated health were calculated for the survey population with and without a telephone interview. Logistic regression models were used to examine differences in health behaviours and health between the initial postal questionnaire respondents and follow-up telephone interview respondents. RESULTS: The total response rate increased from 57% to 71% when the telephone respondents were included. The telephone survey indicated that both male and female telephone respondents were more often smokers, and female telephone respondents were more often heavy episodic drinkers and less often reported poor self-rated fitness than postal respondents. Nonetheless, the prevalence rates of outcome variables did not change significantly when telephone respondents were included. CONCLUSION: The response rate of surveys can be increased by using a telephone survey in follow-up contacts with non-respondents. As non-respondents differ from respondents, this contributes to an improvement--although small--in internal validity.

Forty-year trends in cardiovascular risk factors in Finland.

BACKGROUND: Finland has experienced remarkable changes in population levels of coronary heart disease risk factors and mortality over the past decades. The National FINRISK studies have monitored risk factors in major non-communicable diseases from 1972 to 2012. The 40-year changes in those risk factors are presented. METHODS: Study population included participants aged 30-59 years in the series on independent random population samples. Data were collected in 5-year intervals in 1972-2012. FINRISK studies so far comprised 53 589 men and women who participated in a health examination, gave a venous blood sample and filled in questionnaires. Serum total cholesterol, systolic and diastolic blood pressure, and body mass index (BMI) were measured using standardized protocol, and smoking status was recorded. RESULTS: Total serum cholesterol decreased remarkably until 2007, but after that has increased. Systolic blood pressure has continued to decline over time since 1972, while decrease in diastolic blood pressure has levelled off during the last 10 years. Smoking prevalence has markedly decreased. BMI has increased in the population, but most significantly in the earlier survey years, not the past 10 years. CONCLUSIONS: After three decades of favourable development, the population risk factor levels showed some increase in total cholesterol and diastolic blood pressure. This emphasizes the need for continued efforts towards national disease prevention and health promotion.