Population trends in aortic valve surgery in Finland between 2001 and 2016.

Objectives. To investigate nationwide changes in procedure rates, patient selection, and prognosis after all surgical aortic valve replacements. Design. Patients undergoing primary surgical aortic valve replacement between 2001 and 2016 were identified from three nationwide registers with compulsory reporting to examine trends in aortic valve surgery over four four-year time periods. Results. A total of 12,139 surgical aortic valve replacement procedures (mean age 61.9 ± 11.8 years, 39.1% women) were performed. The total number of biological valves increased from 1001 (42.9%) to 2526 (75.5%) from 2001-2004 to 2013-2016 (p < .001). During the first and last time periods the comorbidity burden increased; share of patients with hypertension increased from 37.5% to 46.9% (p < .001), diabetes from 14% to 16.5% (p = .01) and previous stroke from 5.2% to 7.2% (p = .01). The proportion of women undergoing surgery decreased from 40% to 36.1% from 2001-2004 to 2013-2016, respectively (p = .01). Overall 28-day mortality was 3.5%. In patients with biologic valve the multivariable-adjusted risk of short-term mortality decreased steadily in every four-year period from 2001-2004 to 2005-2008 (HR, 0.66; 95% CI 0.47-9.92), 2009-2012 (HR, 0.54; 95% CI, 0.39-0.75) and 2013-2016 (HR, 0.41; 95% CI, 0.29-0.58), whereas short-term mortality remained similar in patients with mechanical valve. The risk of four-year postoperative mortality after all surgical aortic valve replacements stayed constant. Conclusions. The use of biologic aortic valve prosthesis has increased from 2001 to 2016. The proportion of women has declined markedly. The short-term mortality has decreased and the long-term mortality has stayed constant despite increasing comorbidity burden.

Population trends in mitral valve surgery in Finland between 1997 and 2014: the finnish CVD register.

OBJECTIVES: Contemporary, nationwide data on trends in mitral valve surgery are scarce. Our aim was to investigate changes in procedure rates, patient selection, and post-procedural prognosis of open-heart mitral valve surgery in Finland. DESIGN: We combined data from three nationwide administrative registers with compulsory reporting. We identified patients who had undergone first-ever open-heart mitral valve surgery between 1997 and 2014 and followed them for adverse events. We examined trends in mitral valve surgery over three six-year time periods (1997-2002, 2003-2008, and 2009-2014). RESULTS: 3684 mitral valve procedures (mean age: 67.0 ± 10.9 years, 42.6% women) were performed in 1997-2014 in Finland. During this period, mitral valve repair operations became more common than replacements and we observed an increasing trend in the use of bioprosthetic valves. Between 1997-2002 and 2009-2014, the mean age of patients undergoing mitral valve surgery and the proportion of urgent surgeries increased (p < .001 for both). The proportion of women undergoing surgery decreased while the share of patients with hypertension (p = .023) or diabetes (p = .026) increased. The multivariable-adjusted risk of 28-day (hazard ratio, 0.55; 95% confidence interval, 0.37-0.83) and 6-year (hazard ratio, 0.80; 95% confidence interval, 0.67-0.97) post-operative mortality was lower in the last six-year period than in 1994-1998. CONCLUSIONS: Short- and long-term mortality of mitral valve surgery patients in Finland has decreased from 1997 to 2014 despite the patients being older and having more comorbidities. Understanding the changing characteristics and prognosis of these patients is important for the interpretation of previous and future cohort studies and trials.

Clinical and laboratory characteristics of active and healthy aging (AHA) in octogenarian men.

OBJECTIVES: To investigate clinical and laboratory variables associated with good subjective and objective health ("active and healthy aging", AHA) in a cohort of octogenarian men. DESIGN: Cross-sectional analyses of a longitudinal study. SETTING: The Helsinki Businessmen Study in Finland. PARTICIPANTS: A socioeconomically homogenous cohort of men (baseline n = 3293), born in 1919-1934, has been followed up from the 1960s. From 2000, the men have been regularly sent mailed questionnaires and mortality has been retrieved from national registers. MEASUREMENTS: In 2010 survey, AHA was defined as independently responding to the mailed survey, feeling happy without cognitive or functional impairments and without major diseases. In 2010/11, a random subgroup men was clinically investigated and survivors with healthy and nonhealthy aging were compared. RESULTS: By 2010, 1788 men of the baseline cohort had died, and 894 men responded to the mailed survey. 154 (17.2 %) of those fulfilled the present AHA criteria. Increasing number of criteria were negatively (P < 0.001) related to short-term mortality. In 2011, a random sample of 458 men were clinically investigated, 90 of them with AHA. Men with AHA had higher serum LDL cholesterol and diastolic blood pressure (partially explained by less frequent drug use) but no significant difference was observed in other risk factors. Men with AHA had significantly faster walking speed (P < 0.001), stronger handgrip (P = 0.017), better self-rated health and less phenotypic frailty (P = 0.02). CONCLUSION: Less than 5 % enjoyed active and healthy aging over their life course, which was significantly related to markers of frailty but not to the traditional vascular risk factors.

The "obesity paradox," frailty, disability, and mortality in older men: a prospective, longitudinal cohort study.

An inverse relationship between overweight and mortality (the "obesity paradox") is well documented, but there are scarce data on how body weight during the life course affects this relationship. In the Helsinki Businessmen Study, we examined the effect of weight trajectories on incident disability, frailty, and mortality by stratifying 1,114 men (mean age of 47 years in 1974) into the following 4 groups based on body mass index (weight (kg)/height (m)(2)) values measured twice, in 1974 and 2000: 1) constantly normal weight (n = 340, reference group); 2) constantly overweight (n = 495); 3) weight gain (n = 136); and 4) weight loss (n = 143). Twelve-year mortality rates (from 2000 to 2012) and frailty and mobility-related disability in late life were determined. Compared with constantly normal weight, weight loss was associated with disability (odds ratio (OR) = 2.4, 95% confidence interval (CI): 1.1, 4.9) and frailty (OR = 3.7, 95% CI: 1.3, 10.5) in late life. Constant overweight was associated with increased disability (OR = 1.9, 95% CI: 1.1, 3.2). Men with constantly normal weight had the fewest comorbidities in late life (P < 0.001). Higher 12-year mortality rates were observed both with weight loss (hazard ratio = 1.8, 95% CI: 1.3, 2.3) and with constant overweight (hazard ratio = 1.3, 95% CI: 1.03, 1.7). Those with constantly normal weight or weight gain had similar outcomes. We observed no obesity paradox in late life when earlier weight trajectories were taken into account.

Anticoagulation Therapy After Biologic Aortic Valve Replacement.

Objectives: Thromboembolism prophylaxis after biologic aortic valve replacement (BAVR) is recommended for 3 months postoperatively. We examined the continuation of oral anticoagulation (OAC) treatment and its effect on the long-term prognosis after BAVR. Methods: We used nation-wide register data from 4,079 individuals who underwent BAVR. We examined the association between warfarin and the non-vitamin K antagonist oral anticoagulant use with death, stroke and major bleeding in 2010 - 2016. Results: The risk of stroke was higher (HR 2.39, 95% CI 1.62 - 3.53, p < 0.001) and the risk of death was lower (HR 0.79, 95% CI 0.65 - 0.96, p = 0.016) in OAC-users compared to individuals without OAC. We observed no significant associations between OAC use and bleeding risk. Conclusion: OAC use after BAVR was associated with increased risk of stroke and decreased risk of death. These observational findings warrant validation in randomized controlled trials before any clinical conclusions can be drawn.

Associations of healthy food choices with gut microbiota profiles.

BACKGROUND: Diet has a major influence on the human gut microbiota, which has been linked to health and disease. However, epidemiological studies on associations of a healthy diet with the microbiota utilizing a whole-diet approach are still scant. OBJECTIVES: To assess associations between healthy food choices and human gut microbiota composition, and to determine the strength of association with functional potential. METHODS: This population-based study sample consisted of 4930 participants (ages 25-74; 53% women) in the FINRISK 2002 study. Intakes of recommended foods were assessed using a food propensity questionnaire, and responses were transformed into healthy food choices (HFC) scores. Microbial diversity (alpha diversity) and compositional differences (beta diversity) and their associations with the HFC score and its components were assessed using linear regression. Multiple permutational multivariate ANOVAs were run from whole-metagenome shallow shotgun-sequenced samples. Associations between specific taxa and HFC were analyzed using linear regression. Functional associations were derived from Kyoto Encyclopedia of Genes and Genomes orthologies with linear regression models. RESULTS: Both microbial alpha diversity (ß/SD, 0.044; SE, 6.18 × 10-5; P = 2.21 × 10-3) and beta diversity (R2, 0.12; P ≤ 1.00 × 10-3) were associated with the HFC score. For alpha diversity, the strongest associations were observed for fiber-rich breads, poultry, fruits, and low-fat cheeses (all positive). For beta diversity, the most prominent associations were observed for vegetables, followed by berries and fruits. Genera with fiber-degrading and SCFA-producing capacities were positively associated with the HFC score. The HFC score was associated positively with functions such as SCFA metabolism and synthesis, and inversely with functions such as fatty acid biosynthesis and the sulfur relay system. CONCLUSIONS: Our results from a large, population-based survey confirm and extend findings of other, smaller-scale studies that plant- and fiber-rich dietary choices are associated with a more diverse and compositionally distinct microbiota, and with a greater potential to produce SCFAs.

Leisure-time physical activity, cardiovascular risk factors and mortality during a 34-year follow-up in men.

UNLABELLED: The inverse relationship between physical activity and mortality may be confounded by socioeconomic factors, cardiovascular risk factors and inverse causality. We investigated long-term association between self-reported regular physical activity and mortality in a socioeconomically homogeneous, initially healthy middle-aged (mean age 47) male cohort (the Helsinki Businessmen Study). In 1974, the men were assessed with questionnaires, clinical and laboratory examinations. Cardiovascular disease (CVD) risk factors (including body mass index [BMI], age, cholesterol, glucose, systolic blood pressure and smoking) and details of physical activity of 782 men were available. Leisure time physical activity was collapsed into 3 categories: low (n = 148), moderate (n = 398) and high activity (n = 236). Physical activity was also briefly assessed in questionnaire surveys in 1985-1986 and in 2000. Total mortality up to 2007 was retrieved from the Central Population Register. Altogether 295 men (37.7%) died during the 34-year follow-up, and leisure-time physical activity was significantly related to mortality in a step-wise manner: 45.9% (n = 68), 37.7% (n = 150), and 32.6% (n = 77) died in the low, moderate, and high activity groups, respectively (P < 0.001). With high activity group as referent and adjusted for midlife CVD risk, perceived health and fitness at baseline, hazard ratio for total mortality was 1.21 (95% confidence interval: 0.90, 1.62), and 1.61 (95% confidence interval: 1.13, 2.30) in the moderate and low activity groups, respectively. CONCLUSION: During the 34-year follow-up, leisure-time physical activity in initially healthy middle-aged men had a graded association with reduced mortality that was independent of CVD risk, glucose and BMI.

Explaining the obesity paradox: cardiovascular risk, weight change, and mortality during long-term follow-up in men.

AIMS: To examine life-long weight trajectories behind the 'obesity paradox', and whether cardiovascular disease (CVD) risk contributes. METHODS AND RESULTS: Cardiovascular disease risk and body mass index (BMI) at mean ages of 25, 47 (year 1974), and 73 years (year 2000) were available of a socioeconomically homogenous sample of 1114 men, without chronic diseases and diabetes in 1974. Overweight was defined as BMI > 25 kg/m(2), and 7-year mortality (2000-06) from the mean age of 73 years determined (188 deaths). Between 1974 and 2000, 44.3% (n = 494) were constantly overweight, 31.0% (n = 345) constantly normal weight, 12.2% (n = 136) moved from normal to overweight, and 12.5% (n = 139) moved from overweight to normal. The last group had highest CVD risk in midlife, and in late life more co-morbidities and greatest total mortality (P < 0.001). Adjusted mortality hazard ratio was 2.0 (95% confidence interval, CI 1.3-3.0; constantly normal weight group as referent). The hazard ratio remained similar (1.9, 95% CI 1.2-3.0) after adjustment for prevalent diseases in 2000. CONCLUSION: In old age, both normal weight and overweight men are a mixture of individuals with different weight trajectories during their life course. Overweight and high-CVD risk in midlife with subsequent weight decrease predict the worst prognosis in late life.

Unsupervised hierarchical clustering identifies a metabolically challenged subgroup of hypertensive individuals.

The current classification of hypertension does not reflect the heterogeneity in characteristics or cardiovascular outcomes of hypertensive individuals. Our objective was to identify distinct phenotypes of hypertensive individuals with potentially different cardiovascular risk profiles using data-driven cluster analysis. We performed clustering, a procedure that identifies groups with similar characteristics, in 3726 individuals (mean age 59.4 years, 49% women) with grade 2 hypertension (blood pressure ≥160/100 mmHg or antihypertensive medication) selected from FINRISK 1997, 2002, and 2007 cohorts. We computed clusters based on eight factors associated with hypertension: mean arterial pressure, pulse pressure, non-high-density lipoprotein cholesterol, blood glucose, BMI, C-reactive protein, estimated glomerular filtration rate, and alcohol. After that, we used Cox regression models adjusted for age and sex to assess the relative risk of cardiovascular disease (CVD) outcomes between the clusters and a reference group of 11 020 individuals. We observed two comparable clusters in both men and women. The Metabolically Challenged (MC) cluster was characterized by high blood glucose (Z-score 4.4 ± 1.1 vs 0.2 ± 0.8, men; 3.5 ± 1.1 vs 0.0 ± 0.6, women) and elevated BMI (30.4 ± 4.1 vs 28.9 ± 4.3, men; 32.7 ± 4.9 vs 29.3 ± 5.5, women). Over a 10-year follow-up (1034 CVD events), MC had 1.6-fold (95% CI 1.1-2.4) CVD risk compared to non-MC and 2.5-fold (95% CI 1.7-3.7) CVD risk compared to the reference group (P ≤ .009 for both). Using unsupervised hierarchical clustering, we found two phenotypically distinct hypertension subgroups with different risks of CVD complications. This substratification could be used to design studies that explore the differential effects of antihypertensive therapies among subgroups of hypertensive individuals.

Alcoholic beverage preference, 29-year mortality, and quality of life in men in old age.

BACKGROUND: Harms of excessive alcohol consumption are obvious, but moderate wine consumption is frequently advocated for prevention of cardiovascular diseases. We compared 29-year mortality and quality of life in old age by alcoholic beverage preference (beer, wine, or spirits) in a cohort of men whose socioeconomic status was similar in their adult life. METHODS: In 1974, cardiovascular risk factors and beverage preference were assessed in 2468 businessmen and executives aged 40-55 years. Of them, 131 did not use alcohol, 455 did not report a single preference, and 694, 251, and 937 preferred beer, wine, and spirits, respectively. Quality of life with a RAND-36 Short Form (SF)-36 instrument was surveyed in 2000 in survivors. Mortality was retrieved from registers during the 29-year follow-up. RESULTS: Alcoholic beverage preference tracked well during the follow-up. Total alcohol consumption was not significantly different between preference groups. Men with wine preference had the lowest total mortality due to lower cardiovascular mortality. With the spirits group as the reference category and age, cardiovascular risk factors, and total alcohol consumption as covariates, wine drinkers had a 34% lower total mortality (relative risk 0.66; 95% confidence interval, 0.45-0.98); relative risk for beer preferers was 0.91 (95% confidence interval, 0.68-1.14). In 2000, wine preferers had the highest scores in all RAND-36 scales; general health (p =.007) and mental health (p =.01) were also significantly different. CONCLUSION: In this male cohort from the highest social class, wine preference was associated with lower mortality and better quality of life in old age. Mortality advantage was independent of overall alcohol consumption and cardiovascular risk factors, but contributing personal characteristics or early life differences cannot be excluded.

Cardiovascular risk in midlife and psychological well-being among older men.

BACKGROUND: Negative and positive affects influence the prognosis in the elderly, but underlying mechanisms are obscure. We investigated whether cardiovascular disease risk in midlife is related to psychological well-being in older men (aged 69-84 years old). METHODS: A socioeconomically homogeneous volunteer sample of men, born from 1919 through 1934, was followed up for 29 years. At baseline in 1974, they were healthy but considered to be at low (n = 593) or high (n = 610) risk of cardiovascular diseases (repeatedly 1 or more of classic cardiovascular risk factors). From November 1, 2002, through March 31, 2003, a mailed questionnaire was used to assess psychological well-being in older survivors. Mortality up to December 31, 2002, was retrieved from national registers. RESULTS: During the entire follow-up, 303 men died, 127 (21.4%) and 176 (28.9%) in the low- and high-risk groups, respectively (hazard ratio, 1.54; 95% confidence interval, 1.19-2.00; P = .001). From 2002 through 2003, the response rates were 73.7% (336/456) and 71.4% (297/416) in the low- and high-risk groups, respectively (P = .45), and the mean age was 76 years. The variables related to psychological well-being were consistently better in the low-risk than in the high-risk group as they became older. The differences were observed especially in life satisfaction (P = .02), feeling of happiness (P = .001), positive life orientation as a whole (P = .04), and the Zung depression score (P = .007). The difference in the feeling of happiness between the groups prevailed (P = .01) after adjustments, including the feeling of depression. CONCLUSION: Low cardiovascular risk in midlife was associated not only with better survival but also with better psychological well-being in the elderly.

Trends in hypertension care in eastern and south-western Finland during 1982-2002.

OBJECTIVE: To assess the trends in blood pressure (BP) levels and the control of hypertension in eastern and south-western Finland during 1982-2002. DESIGN: Five independent cross-sectional population surveys conducted in 1982, 1987, 1992, 1997 and 2002. SETTING: The provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in south-western Finland. PARTICIPANTS: Stratified random samples of men and women aged 25-64 years were selected from the national population register. The total number of participants was 29 127. MAIN OUTCOME MEASURES: Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP), the prevalence and control of hypertension. The distribution of all subjects with no antihypertensive drug treatment in 2002 according to the modified risk stratification scheme introduced in 2003 European Society of Hypertension-European Society of Cardiology guidelines. RESULTS: Mean SBP and DBP and the prevalence of hypertension decreased significantly in all areas. The proportion of treated hypertensive subjects with adequately controlled BP (SBP < 140 mmHg and DBP < 90 mmHg) increased from 13.7 to 33.3% in men (P < 0.001) and from 11.4 to 32.0% in women (P < 0.001). The unsatisfactory treatment of hypertension was mainly a result of the lack of control of high SBP. According to the 2003 guidelines, 35.9% of the entire population currently not on antihypertensive drug treatment should have been prescribed such treatment within a year. CONCLUSIONS: Hypertension care has improved significantly in Finland during 1982-2002. However, the difference between the actual situation at the population level and the treatment goals presented by the hypertension guidelines remains vast.

Trends in rates, patient selection and prognosis of coronary revascularisations in Finland between 1994 and 2013: the CVDR.

AIMS: The aim of the study was to investigate the 20-year trends in rates, patient selection and prognosis of coronary revascularisations in Finland. METHODS AND RESULTS: We identified patients from nationwide registers who had undergone first-ever percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) between 1994 and 2013. We examined changes in procedure rates, patient characteristics and estimated hazard ratios (HR) and 95% confidence intervals for cardiovascular events during this period. Between 1994 and 2013, 85,482 PCIs and 74,338 CABGs were performed. During this period, PCI rates more than quadrupled while CABG rates declined by two thirds. Between 1994-1998 and 2009-2013, the proportion of urgent procedures and mean patient age increased while the proportion of women remained stable. Although unadjusted mortality rose, the multivariable-adjusted HRs for 28-day mortality (PCI: 0.62 [0.49-0.79]; CABG: 0.62 [0.54-0.72]) and five-year incidence of cardiovascular death (PCI: 0.72 [0.66-0.80]; CABG: 0.77 [0.72-0.83]), myocardial infarction (PCI: 0.47 [0.44-0.50]; CABG: 0.31 [0.29-0.32]) and stroke (PCI: 0.37 [0.34-0.40]; CABG: 0.36 [0.33-0.38]) were lower in the last five-year period than in the period 1994-1998. CONCLUSIONS: Although revascularisation patients are older than before, post-procedural prognosis has improved drastically in recent years. Understanding the changing characteristics and prognosis of these patients is important for the interpretation of previous and future studies.

Alcohol consumption, 29-y total mortality, and quality of life in men in old age.

BACKGROUND: The negative effects of excessive alcohol consumption are well known, but moderate alcohol consumption is advocated for health reasons. OBJECTIVE: We compared 29-y total mortality and quality of life in old age by alcohol consumption in midlife. DESIGN: Cardiovascular disease risk factors and alcohol consumption were assessed in 1974 in 1808 men (aged 40-55 y) of high socioeconomic status. At baseline, the men were without signs of chronic diseases. Baseline alcohol consumption was divided as zero (n = 116), moderate (1-349 g/wk; n = 1519), and high (>349 g/wk; n = 173). Quality of life was surveyed in 2000 with the RAND-36 (SF-36) health survey (n = 1216). Mortality was retrieved from registers during the 29-y follow-up. RESULTS: Median alcohol consumption in 1974 and in 2000 was 123 (interquartile range: 56-238) and 84 (28-168) g/wk, respectively, and was significantly correlated. Values of cardiovascular disease risk factors measured in 1974 increased with increasing alcohol consumption. During the 29-y follow-up, 499 men (27.6%) died; mortality was significantly higher among men with the highest alcohol consumption (37.6%) than in abstainers (25.0%) or in men with moderate (26.7%) consumption. Quality of life was not significantly associated with baseline alcohol consumption in responding survivors but was worst in men with high consumption when deaths during follow-up were accounted for. CONCLUSIONS: In this male cohort of high socioeconomic status, only the highest alcohol consumption (>3 drinks/d) affected mortality, and it was associated with worse quality of life in old age. Moderate alcohol consumption in middle age offered no special benefits compared with abstinence over the long term.

Isolated diastolic hypertension, pulse pressure, and mean arterial pressure as predictors of mortality during a follow-up of up to 32 years.

OBJECTIVE: To compare mortality associated with various blood pressure components in middle-aged men during up to 32 years of follow-up. DESIGN: A prospective cohort study. SETTING: Helsinki, Finland. PARTICIPANTS: We studied 3267 initially healthy men, aged 30-45 years, who participated in health check-ups from 1964 onwards. MAIN OUTCOME MEASURES: Cox regression was used to relate baseline blood pressure components to all-cause (n = 701) and cardiovascular disease (CVD) mortality (n = 325). RESULTS: Systolic (SBP) and diastolic (DBP) blood pressures, pulse pressure and mean arterial pressure singly predicted CVD mortality. With SBP 160 mmHg and DBP 90 mmHg as cut-off values, four blood pressure subgroups were identified: normotension (n = 1919), isolated systolic hypertension (ISH, n = 17), isolated diastolic hypertension (IDH, n = 1013), and combined systolic and diastolic hypertension (SDH, n = 318). IDH was subdivided into IDH-1 with SBP 140-159 mmHg (n = 667) and IDH-2 with SBP less than 140 mmHg (n = 346). With normotension as reference, only SDH and IDH-1 predicted CVD mortality [relative risk (RR) 2.71, 95% confidence interval (CI) 2.00 to 3.66, and RR 1.39, 95% CI 1.04 to 1.87, respectively]. Risk with IDH-2 (RR 1.14, 95% CI 0.77 to 1.69) was not statistically significant. SDH and IDH-1, but not IDH-2, were also associated with increased all-cause mortality risk. Use of antihypertensive medication did not explain the results. CONCLUSION: These results demonstrate the often neglected role of SBP in predicting long-term CVD risk in middle-aged men. When SBP is less than 140 mmHg, IDH is not associated with significantly increased risk of mortality. Administrative guidelines, which affect population health, should also take due note of SBP.

Non-pharmacological treatment of hypertension in primary health care: a 2-year open randomized controlled trial of lifestyle intervention against hypertension in eastern Finland.

OBJECTIVE: To assess whether lifestyle counselling is effective in non-pharmacological treatment of hypertension in primary health care. DESIGN: Open randomized controlled trial. SETTING: Ten municipal primary health care centres in eastern Finland. PATIENTS: Seven hundred and fifteen subjects aged 25-74 years with systolic blood pressure 140-179 mmHg and/or diastolic blood pressure 90-109 mmHg or antihypertensive drug treatment. INTERVENTIONS: Systematic health counselling given by local public health nurses for 2 years. MAIN OUTCOME MEASURES: Blood pressure, lipids and lifestyle data were collected annually. RESULTS: Among participants with no antihypertensive drug treatment, the net reductions after 1 year both in systolic blood pressure [-2.6 mmHg; 95% confidence interval (CI), -4.7 to -0.5 mmHg] and in diastolic blood pressure (-2.7 mmHg; 95% CI, -4.0 to -1.4 mmHg) were significant in favour of the intervention group. This difference in blood pressure change was maintained during the second year. In participants with antihypertensive drug treatment, no significant difference in blood pressure reduction was seen between the groups during the study. CONCLUSIONS: A relatively modest, but systematic counselling in primary health care can, at least among untreated hypertensive subjects, produce reductions in blood pressure levels that are modest for the individual, but very important from the public health point of view.

A follow-up study found that cardiovascular risk in middle age predicted mortality and quality of life in old age.

OBJECTIVE: Cardiovascular risk reduction, while saving lives, may prolong the time with disability and impair the quality of life in survivors. We compared the consequences of middle age cardiovascular risk in old age. STUDY DESIGN AND SETTING: In 1974, risk was low in 593 (low-risk group) and high in 610 men (high-risk group). At baseline, all were healthy with similar age and socioeconomic status. Lifestyle and clinical factors, including quality of life (RAND-36), were surveyed with a questionnaire in 2000, and mortality was determined up to 2002. RESULTS: During the follow-up, 303 men died, with mortality 54% higher in the high-risk group (P=.001). In the 2000 survey, high-risk men still had significantly greater BMI, higher blood glucose, higher prevalence of smoking, and more sedentary lifestyle, and they reported more both cardiovascular and noncardiovascular diseases. All the RAND-36 scales were worse in the high-risk group; of the two component summary scores, physical (PCS), but not mental (MCS) score, was significantly lower in the high-risk group. CONCLUSION: Low cardiovascular risk in middle age was associated with lower mortality, morbidity, and better quality of life in old age 26 years later. The results may support the theory of compression of morbidity.

Low midlife blood pressure, survival, comorbidity, and health-related quality of life in old age: the Helsinki Businessmen Study.

OBJECTIVE: The aim of the present study was to examine the long-term impact of midlife blood pressure (BP) on mortality, comorbidity, and health-related quality of life (HRQoL) in old age. METHODS: These are longitudinal analyses of the Helsinki Businessmen Study, a cohort of business executives, born in 1919-1934, whose BP was measured between 1964 and 1973 (n = 3267). Comorbidity and HRQoL with RAND-36 [Short Form (SF)-36] were assessed from questionnaires in 2000; mortality up to 31 July 2012 was ascertained from national registers. Baseline BP was categorized as normal, less than 120  mmHg systolic and less than 80  mmHg diastolic (n = 121); prehypertension, 120-139  mmHg systolic or 80-89  mmHg diastolic (n = 2131); stage 1 hypertension, 140-159 mmHg systolic or 90-99  mmHg diastolic (n = 757); and stage 2 hypertension, more than 160  mmHg systolic or more than 100  mmHg diastolic (n = 258). Main outcome measures were long-term mortality, comorbidity, and HRQoL in old age. RESULTS: During the 48-year follow-up, 2013 men (61.6%) died. There was a graded relationship between BP and total mortality (P < 0.001). The men with normal BP had the lowest mortality; the age-adjusted difference in mean survival was 7.5 years between the normal and stage 2 baseline BP groups, and 11.2 months between normal and prehypertension groups. Lower BP in midlife was associated with better scores in the physical functioning (P-linear trend <0.001) and general health (P = 0.01) scales of RAND-36 in old age. RAND-36 scales associated with mental health were not affected by midlife BP. CONCLUSION: Lower BP in midlife is associated with longer life and better physical HRQoL in old age.

Leisure-time physical activity in midlife is related to old age frailty.

BACKGROUND: There are scarce studies of the long-term associations between leisure-time physical activity (LTPA) in midlife and phenotypic frailty in old age. METHODS: We studied healthy Caucasian men of high socioeconomic status (N = 514), who had participated in health checkups during the 1960s (the Helsinki Businessmen Study, Finland). In 1974, they were examined with questionnaires and clinical examinations, and LTPA was collapsed into three categories: low (n = 87), moderate (n = 256), and high (n = 171). In 2000, at mean age of 74, survivors were assessed for physical activity and frailty phenotype using the modified Fried criteria validated in our cohort. Four criteria were used: (a) weight loss > 5% from midlife or current body mass index < 21kg/m(2), (b) physical inactivity, (c) low vitality, and (d) physical weakness. Responders with 3-4, 1-2, and zero criteria were classified as frail, prefrail, and nonfrail, respectively. RESULTS: The prevalence of frailty was 16.1%, 10.2%, and 4.7% in the low, moderate, and high LTPA groups, respectively. Higher midlife LTPA was significantly related to lower prevalence of both frailty and prefrailty in old age. After adjusting for baseline age, smoking, body mass index, blood pressure, and alcohol, the risk of frailty was 80% lower in the high LTPA group compared with the low LTPA group (odds ratio = 0.20; 95% confidence interval 0.07-0.55). This finding was supported by the relationships between the change of physical activity and frailty in old age. CONCLUSIONS: In this socioeconomically homogenous male cohort, higher physical activity since midlife was strongly associated with less frailty in old age.