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Exome-sequencing studies have generally been underpowered to identify deleterious alleles with a large effect on complex traits as such alleles are mostly rare. Because the population of northern and eastern Finland has expanded considerably and in isolation following a series of bottlenecks, individuals of these populations have numerous deleterious alleles at a relatively high frequency. Here, using exome sequencing of nearly 20,000 individuals from these regions, we investigate the role of rare coding variants in clinically relevant quantitative cardiometabolic traits. Exome-wide association studies for 64 quantitative traits identified 26 newly associated deleterious alleles. Of these 26 alleles, 19 are either unique to or more than 20 times more frequent in Finnish individuals than in other Europeans and show geographical clustering comparable to Mendelian disease mutations that are characteristic of the Finnish population. We estimate that sequencing studies of populations without this unique history would require hundreds of thousands to millions of participants to achieve comparable association power.
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Secuenciación del Exoma , Estudios de Asociación Genética/métodos , Predisposición Genética a la Enfermedad/genética , Variación Genética/genética , Sitios de Carácter Cuantitativo/genética , Alelos , HDL-Colesterol/genética , Análisis por Conglomerados , Determinación de Punto Final , Finlandia , Mapeo Geográfico , Humanos , Herencia Multifactorial/genética , Reproducibilidad de los ResultadosRESUMEN
An Amendment to this paper has been published and can be accessed via a link at the top of the paper.
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AIMS: The effects of COVID-19 containment measures on health-related lifestyle have been both favourable and unfavourable for health. Factors predisposing to unfavourable changes are still poorly known. In this short communication, we aimed to examine which socioeconomic and health-related factors predicted unfavourable lifestyle changes based on data from the same individuals before (2017) the pandemic and during the second wave (2020) of the pandemic in Finland. METHODS: This individual-level follow-up study was based on a nationally representative, two-stage stratified cluster sample of Finnish adults from the FinHealth 2017 Study, conducted in Spring 2017, and its follow-up survey, conducted in Autumn 2020. A total of 3834 men and women aged 25-69 years at baseline had information of selected lifestyle factors (vegetable consumption, leisure-time physical activity, sleeping problems and nightmares) available at both time points. Odds ratios and 95% confidence intervals for unfavourable lifestyle changes (yes/no) according to socioeconomic and health-related factors were calculated using logistic regression models taking into account the sampling design and non-response. RESULTS: We found that those having poor health (i.e. psychological distress, poor self-rated health or chronic diseases) or disadvantaged socioeconomic background before the pandemic were prone to unfavourable lifestyle changes during the follow-up. CONCLUSIONS: Observed unfavourable lifestyle changes in vulnerable population groups may accelerate health inequalities. Targeted health promotion actions are needed to prevent this unfavourable development.
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COVID-19 , Pandemias , Adulto , Masculino , Humanos , Femenino , Estudios de Seguimiento , COVID-19/epidemiología , Estilo de Vida , Estado de SaludRESUMEN
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.
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Válvula Aórtica/cirugía , Bioprótesis/tendencias , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/tendencias , Prótesis Valvulares Cardíacas/tendencias , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Pautas de la Práctica en Medicina/tendencias , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Toma de Decisiones Clínicas , Comorbilidad , Femenino , Finlandia , Disparidades en Atención de Salud/tendencias , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del TratamientoRESUMEN
Background: Contemporary validation studies of register-based heart failure diagnoses based on current guidelines and complete clinical data are lacking in Finland and internationally. Our objective was to assess the positive and negative predictive values of heart failure diagnoses in a nationwide hospital discharge register. Methods: Using Finnish Hospital Discharge Register data from 2013-2015, we obtained the medical records for 120 patients with a register-based diagnosis for heart failure (cases) and for 120 patients with a predisposing condition for heart failure, but without a heart failure diagnosis (controls). The medical records of all patients were assessed by a physician who categorized each individual as having heart failure (with reduced or preserved ejection fraction) or no heart failure, based on the definition of current European Society of Cardiology heart failure guidelines. Unclear cases were assessed by a panel of three physicians. This classification was considered as the clinical gold standard, against which the registers were assessed. Results: Register-based heart failure diagnoses had a positive predictive value of 0.85 (95% CI 0.77-0.91) and a negative predictive value of 0.83 (95% CI 0.75-0.90). The positive predictive value decreased when we classified patients with transient heart failure (duration <6 months), dialysis/lung disease or heart failure with preserved ejection fraction as not having heart failure. Conclusions: Heart failure diagnoses of the Finnish Hospital Discharge Register have good positive predictive value and negative predictive value, even when patients with pre-existing heart conditions are used as healthy controls. Our results suggest that heart failure diagnoses based on register data can be reliably used for research purposes.
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Insuficiencia Cardíaca/diagnóstico , Alta del Paciente , Sistema de Registros , Anciano , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Hypertension is a well-known risk factor for intracerebral hemorrhage (ICH). On many of the other potential risk factors, such as smoking, diabetes, and alcohol intake, results are conflicting. We assessed risk factors of ICH, taking also into account prior depression and fatigue. METHODS: This is a population-based case-control study of 250 primary ICH patients, conducted in Helsinki University Hospital, Finland. The controls (nâ¯=â¯750) were participants of the FINRISK study, a large Finnish population survey on risk factors of chronic noncommunicable diseases, matched with cases by sex and age. Ages were matched in 5-year age bands. However, as the oldest FINRISK participants were 74-year-olds, controls for the age group 75-84 were selected from the age group of 70-74 years. Patients aged greater than or equal to 85 years were excluded. Patients and controls were compared in univariate analyses. The age categories less than 70, and greater than or equal to 70 years were also analyzed separately. Binary logistic regression analysis was performed for variables with P less than .1 in univariate analysis. RESULTS: Analyzing all cases and controls, the cases had more hypertension, history of heart attack, lipid-lowering medication, and reported more frequently fatigue prior to ICH. In persons aged less than 70 years, hypertension and fatigue were more common among cases. In persons aged greater than or equal to 70 years, factors associated with risk of ICH were fatigue prior to ICH, use of lipid-lowering medication, and overweight. CONCLUSIONS: Hypertension was associated with risk of ICH among all patients and in the group of patients under 70 years. Fatigue prior to ICH was more common among all ICH cases.
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Hemorragia Cerebral/etiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Presión Sanguínea , Estudios de Casos y Controles , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/fisiopatología , Depresión/complicaciones , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Fatiga/complicaciones , Femenino , Finlandia , Estado de Salud , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Hipolipemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Medición de Riesgo , Factores de RiesgoRESUMEN
OBJECTIVE: Interleukin (IL)-1ß represents a key cytokine in the development of cardiovascular disease (CVD). IL-1ß is counter-regulated by IL-1 receptor antagonist (IL-1RA), an endogenous inhibitor. This study aimed to identify population-based studies on circulating IL-1RA and incident CVD in a systematic review, estimate the association between IL-1RA and incident CVD in a meta-analysis, and to test whether the association between IL-1RA and incident CVD is explained by other inflammation-related biomarkers in the MONICA/KORA Augsburg case-cohort study (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease/Cooperative Health Research in the Region of Augsburg). APPROACH AND RESULTS: We performed a systematic literature search and identified 5 cohort studies on IL-1RA and incident CVD in addition to the MONICA/KORA Augsburg case-cohort study for a meta-analysis based on a total of 1855 CVD cases and 18 745 noncases with follow-up times between 5 and 16 years. The pooled standardized hazard ratio (95% confidence interval) for incident CVD was 1.11 (1.06-1.17) after adjustment for age, sex, anthropometric, metabolic, and lifestyle factors (P<0.0001). There was no heterogeneity in effect sizes (I2=0%; P=0.88). More detailed analyses in the MONICA/KORA study showed that the excess risk for CVD was attenuated by ≥10% after additional separate adjustment for serum levels of high-sensitivity C-reactive protein, IL-6, myeloperoxidase, soluble E-selectin, or soluble intercellular adhesion molecule-1. CONCLUSIONS: Serum IL-1RA levels were positively associated with risk of CVD after adjustment for multiple confounders in a meta-analysis of 6 population-based cohorts. This association may at least partially reflect a response to triggers inducing subclinical inflammation, oxidative stress, and endothelial activation.
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Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Proteína Antagonista del Receptor de Interleucina 1/sangre , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Humanos , Oportunidad Relativa , Pronóstico , Medición de Riesgo , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVES: Diabetic patients have two-fold excess risk of cardiovascular complications (CVCs). To compare the treatment quality of diabetic patients we compared the incidence of CVCs between the five university hospital districts (UHDs) in Finland. DESIGN: The study population comprised all persons with diabetes in Finland since 1964. They were followed up for the incidence of first acute coronary syndrome (ACS) and first ischemic stroke (IS) using the National Hospital Discharge Register and the National Causes of Death Register data between the years 2000 and 2011. Incidence differences among diabetic patients were also compared with corresponding results in the total population. The main analysis tool was Poisson regression adjusted for age, sex and study year. The UHD of Helsinki was used as the reference category. RESULTS: In the diabetic population the risk for ACS exceeded the reference significantly in three UHDs ranging from 1.03 (95% CI 0.89-1.19) to 1.70 (1.46-1.97). The incidence of IS exceeded the reference in two UHDs ranging from 1.01 (0.89-1.15) to 1.36 (1.18-1.56). These differences were similar to the corresponding figures in the total population. Differences between the UHDs remained stable over time. CONCLUSIONS: We found major and stable differences in the incidence of ACS and IS between the UHDs among patients with diabetes. The differences result from several factors influencing the risk of these complications, including the treatment. These differences tended to be larger than the corresponding differences in the total population, which suggests that there is potential to prevent CVCs by improving diabetes care.
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Síndrome Coronario Agudo/epidemiología , Isquemia Encefálica/epidemiología , Diabetes Mellitus/terapia , Indicadores de Calidad de la Atención de Salud , Accidente Cerebrovascular/epidemiología , Síndrome Coronario Agudo/diagnóstico , Adulto , Distribución por Edad , Anciano , Isquemia Encefálica/diagnóstico , Bases de Datos Factuales , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Finlandia/epidemiología , Disparidades en Atención de Salud , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Sistema de Registros , Factores de Riesgo , Distribución por Sexo , Accidente Cerebrovascular/diagnóstico , Factores de TiempoRESUMEN
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.
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Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/tendencias , Anuloplastia de la Válvula Mitral/tendencias , Válvula Mitral/cirugía , Pautas de la Práctica en Medicina/tendencias , Factores de Edad , Anciano , Bioprótesis/tendencias , Toma de Decisiones Clínicas , Comorbilidad , Femenino , Finlandia , Disparidades en Atención de Salud/tendencias , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/fisiopatología , Prótesis Valvulares Cardíacas/tendencias , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/fisiopatología , Anuloplastia de la Válvula Mitral/efectos adversos , Anuloplastia de la Válvula Mitral/instrumentación , Anuloplastia de la Válvula Mitral/mortalidad , Análisis Multivariante , Selección de Paciente , Modelos de Riesgos Proporcionales , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIMS: To assess the prognosis of patients with coronary heart disease (CHD) after first myocardial revascularisation procedure in real-world practice and to compare the differences in outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) among diabetic and non-diabetic patients. METHODS AND RESULTS: A database was compiled from the national hospital discharge register to collect data on all cardiac revascularisations performed in Finland in 2000-2015. The outcomes (all-cause deaths, cardiovascular (CV) deaths, major CV events and need for repeat revascularisation) after the first revascularisation were identified from the national registers at 28 day, 1 year, and 3 year time points.A total of 139 242 first-time revascularisations (89 493 PCI and 49 749 CABG) were performed during the study period. Of all the revascularised patients, 24% had diabetes, and 76% were non-diabetic patients. At day 28, the risk of fatal outcomes was lower after PCI than after CABG among non-diabetic patients, whereas no difference was seen among diabetic patients. In long-term follow-up the situation was reversed with PCI showing higher risk compared with CABG for most of the outcomes. In particular, at 3 year follow-up the risk of all-cause deaths was elevated among diabetic patients [HR 1.30 (95% CI 1.22-1.38) comparing PCI with CABG] more than among non-diabetic patients [HR 1.09 (1.04-1.15)]. The same was true for CV deaths [HR 1.29 (1.20-1.38) among diabetic patients, and HR 1.03 (0.98-1.08) among non-diabetic patients]. CONCLUSION: Although PCI was associated with better 28 day prognosis, CABG seemed to produce better long-term prognosis especially among diabetic patients.
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Enfermedad de la Arteria Coronaria , Diabetes Mellitus , Intervención Coronaria Percutánea , Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/cirugía , Diabetes Mellitus/epidemiología , Humanos , Intervención Coronaria Percutánea/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Data on non-drug related risk-factors for gastrointestinal bleeding (GIB) in the general population are limited, especially for life-style factors, clinical measurements and laboratory parameters. AIM: To identify and investigate non-drug risk factors for major GIB in the general population of Finland. METHODS: We performed a retrospective cohort study using data from the FINRISK health examination surveys, which have been conducted every 5 years across Finland from 1987 to 2007. Participants were adults aged 25 years to 74 years, excluding those with a previous hospitalization for GIB. Follow-up from enrollment was performed through linkage to national electronic health registers and ended at an event of GIB that led to hospitalization/death, death due to any other cause, or after 10 years. Covariates included demographics, socioeconomic and lifestyle factors, clinical measurements, laboratory parameters and comorbidities. Variable selection was undertaken using Least Absolute Shrinkage and Selection Operator (LASSO) and factors associated with GIB were identified using Cox regression. RESULTS: Among 33,508 participants, 403 (1.2%) experienced GIB [256 men (63.5%); mean age, 56.0 years (standard deviation (SD) ± 12.1)] and 33105 who did not experience GIB [15768 men (47.6%); mean age, 46.8 (SD ± 13) years], within 10 years of follow-up. Factors associated with a significantly increased risk of GIB were baseline age [per 10-year increase; hazard ratio (HR) 1.62, 95% confidence interval (CI): 1.42-1.86], unemployment (HR: 1.70, 95%CI: 1.11-2.59), body mass index (BMI) (HR: 1.15, 95%CI: 1.01-1.32), gamma-glutamyl transferase (GGT) (HR: 1.05, 95%CI: 1.02-1.09), precursors of GIB (HR: 1.90, 95%CI: 1.37-2.63), cancer (HR: 1.47, 95%CI: 1.10-1.97), psychiatric disorders (HR: 1.32, 95%CI: 1.01-1.71), heart failure (HR: 1.46, 95%CI: 1.04-2.05), and liver disorders (HR: 3.20, 95%CI: 2.06-4.97). Factors associated with a significantly decreased risk of GIB were systolic blood pressure (SBP) (HR: 0.78, 95%CI: 0.64-0.96), 6-10 cups of coffee a day (HR: 0.67, 95%CI: 0.46-0.99), or > 10 cups (HR: 0.43, 95%CI: 0.23-0.81). CONCLUSION: Our study confirms established risk-factors for GIB and identifies potential risk-factors not previously reported such as unemployment, BMI, GGT, SBP and coffee consumption.
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Café , Hemorragia Gastrointestinal , Adulto , Finlandia/epidemiología , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
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.
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AIMS: To evaluate risk factors for major adverse cardiac event (MACE) after the first acute coronary syndrome (ACS) and to examine the prevalence of risk factors in post-ACS patients. METHODS: We used Finnish population-based myocardial infarction register, FINAMI, data from years 1993-2011 to identify survivors of first ACS (n = 12686), who were then followed up for recurrent events and all-cause mortality for three years. Finnish FINRISK risk factor surveys were used to determine the prevalence of risk factors (smoking, hyperlipidaemia, diabetes and blood pressure) in post-ACS patients (n = 199). RESULTS: Of the first ACS survivors, 48.4% had MACE within three years of their primary event, 17.0% were fatal. Diabetes (p = 4.4 × 10-7), heart failure (HF) during the first ACS attack hospitalization (p = 6.8 × 10-15), higher Charlson index (p = 1.56 × 10-19) and older age (p = .026) were associated with elevated risk for MACE in the three-year follow-up, and revascularization (p = .0036) was associated with reduced risk. Risk factor analyses showed that 23% of ACS survivors continued smoking and cholesterol levels were still high (>5mmol/l) in 24% although 86% of the patients were taking lipid lowering medication. CONCLUSION: Diabetes, higher Charlson index and HF are the most important risk factors of MACE after the first ACS. Cardiovascular risk factor levels were still high among survivors of first ACS.
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Síndrome Coronario Agudo , Diabetes Mellitus , Insuficiencia Cardíaca , Infarto del Miocardio , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/etiología , Anciano , Diabetes Mellitus/epidemiología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Humanos , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Medición de Riesgo , Factores de RiesgoRESUMEN
Importance: Epidemiological data on lower gastrointestinal bleeding (GIB) in the general population are sparse. Objective: To describe the incidence, recurrence, mortality, and case fatality rates of major upper GIB and lower GIB in the general population of Finland between 1987 and 2016. Design, Setting, and Participants: This prospective cohort study used data from the 1987 to the 2012 cycles of the National FINRISK Study, a health examination survey that was conducted every 5 years in Finland. Survey participants were adults aged 25 to 74 years who were recruited from a population register by random sampling; those with a history of hospitalization for GIB were excluded. Participants were followed up from survey enrollment to onset of GIB that led to hospitalization, death from any cause, or study end (December 31, 2016). Follow-up was performed through linkage with national electronic health registers. Data were analyzed from February 1, 2019, to January 31, 2020. Main Outcomes and Measures: Incidence, recurrence, mortality, and case fatality rates for all, upper, lower, and unspecified GIB. Outcome measures were stratified by sex and age group. Results: Among the 39â¯054 participants included in the study, 494 (1.3%) experienced upper GIB (321 men [65.0%]; mean [SD] age, 52.8 [12.1] years) and 645 (1.7%) had lower GIB (371 men [57.5%]; mean [SD] age, 54.0 [11.7] years). The age-standardized incidence rate was 0.94 per 1000 person-years (95% CI, 0.85-1.04) for upper GIB and 1.26 per 1000 person-years (95% CI, 1.15-1.38) for lower GIB; the incidence was higher in men than in women. Between 1987 and 2016 the incidence rate of upper GIB remained mostly stable, ranging from 0.40 to 0.66 per 1000 person-years, whereas constant increases occurred in the incidence of lower GIB until the rate stabilized. The proportion of recurrent GIB events showed an increasing trend from 1987 to 2016. The upper GIB-specific mortality was higher (0.07 per 1000 person-years; 95% CI, 0.04-0.09) than the lower GIB-specific mortality (0.01 per 1000 person-years; 95% CI, 0.001-0.03). Case fatality was high for those with upper GIB (7.0%; 95% CI, 4.7-10.1) compared with those with lower GIB (0.4%; 95% CI, 0.1-1.3). Case fatality remained stable over the years but was higher in men (between 5% and 10%) than women (<2%) with GIB. Conclusions and Relevance: This study found that the overall incidence rate of upper GIB was lower than the incidence of lower GIB, but the recurrence, mortality, and 28-day case fatality were higher in participants with upper GIB. These data can serve as a reference when putting into context the rates of drug-associated GIB and can inform efforts to improve GIB care and outcome and to prevent rebleeding or death for patients with major GIB.
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Hemorragia Gastrointestinal/mortalidad , Hemorragia Gastrointestinal/patología , Índice de Severidad de la Enfermedad , Adulto , Distribución por Edad , Anciano , Várices Esofágicas y Gástricas/mortalidad , Várices Esofágicas y Gástricas/patología , Femenino , Finlandia , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Recurrencia , Medición de Riesgo , Distribución por SexoRESUMEN
Aims: To compare diabetic patients with coronary heart disease (CHD) needing revascularization to corresponding non-diabetic patients in terms of revascularization methods, comorbidities and urgency of procedure. We also examined the impact of patient characteristics and comorbidities on the revascularization method.Methods: We identified all diabetic (n = 33,018) and non-diabetic (n = 106,224) patients with first-ever, percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) from electronic health records in Finland between 2000 and 2015.Results: Overall, PCI was the most common revascularization method. PCI outnumbered CABG in women and men both in diabetic and non-diabetic patients. However, diabetic patients were more likely to undergo CABG than PCI (OR 1.30; 95% CI 1.27-1.34, adjusted for age, gender, region of residence and procedure year). Moreover, 26.9% of diabetic patients' urgent procedures were CABG compared to 21.6% in non-diabetic patients (p<.001). Among diabetic patients, prior myocardial infarction was associated with increased odds of CABG, whereas female gender, atrial fibrillation, congestive heart failure, hypertension and later procedure year were associated with lower odds of CABG.Conclusions: CABG has been performed more frequently in diabetic than in non-diabetic CHD patients. Nevertheless, PCI was the dominant revascularization method over CABG both in diabetic and non-diabetic patients. KEY MESSAGESPCI was the dominant revascularization method in both diabetic and non-diabetic patients. Diabetic patients were more likely to undergo CABG than PCI when compared to non-diabetic patients (OR: 1.30; CI 1.27-1.34).Diabetic patients underwent urgent CABG procedures more often than non-diabetic patients and had more comorbidities compared to non-diabetic patients.
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Enfermedad Coronaria/epidemiología , Diabetes Mellitus/epidemiología , Revascularización Miocárdica/métodos , Anciano , Estudios de Casos y Controles , Puente de Arteria Coronaria/estadística & datos numéricos , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/cirugía , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/cirugía , Femenino , Finlandia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/estadística & datos numéricos , Sistema de RegistrosRESUMEN
Aims: To quantify the incidence and prevalence of heart failure (HF) in persons with type 2 diabetes (T2DM) and to examine the 1-year survival after the diagnosis of HF. Materials and methods: All cases of HF (n = 295,990) and T2DM in Finland were identified from national electronic health care registers for the period 1996-2012. The annual incidence and prevalence rates of HF and 1-year survival after the first diagnosis of HF were calculated for persons with T2DM and without diabetes using Poisson regression for the event rates. Results: The age-adjusted rate ratio for incident HF among men with T2DM in the age group 35-74 years declined from 3.73 (95% CI, 3.46-4.02) in 1996 to 2.17 (2.04-2.31) in 2012 and among women from 3.90 (3.61-4.22) to 2.36 (2.16-2.58). The multivariate-adjusted hazard ratio of 1-year death after the diagnosis of HF declined from 1.15 (1.11-1.21) to 1.07 (1.05-1.10) from the first to the second half of the study period. Conclusions: Individuals aged <75 years with T2DM had a considerably higher incidence of HF than individuals without diabetes. The prognosis of HF was worse in individuals with T2DM than in individuals without diabetes. However, the gap between the groups had narrowed over time. Key messages The incidence of heart failure is 2-3 times higher among patients under 75 years of age with type 2 diabetes than among individuals without diabetes. The prognosis of heart failure patients is worse among patients with type 2 diabetes than it is among patients without diabetes although it is improving.
Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Insuficiencia Cardíaca/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Sistema de Registros , Distribución por SexoRESUMEN
Assessing movement over 24 hours increases our understanding of the total physical activity level and its patterns. In the FinHealth 2017 Survey, a population-based health examination study, 940 participants between 25 and 93 years were instructed to wear an accelerometer (Actigraph GT9X Link) on their non-dominant wrist for 24 hours on 7 consecutive days. Physical activity information was extracted from 100-Hz triaxial 60-second epoch data as average vector magnitude counts per minute (VM cpm). Results were analyzed by gender, 10-year age-groups, employment status, and education. Hourly means were plotted and compared. Analyses included 915 participants (44% men) who wore the device at least 10 hours on 4 or more days, with mean wear time being 149.5 hours (standard deviation of 615.2 minutes).Women had higher average VM cpm than men (p < 0.001), with significant gender differences in all age-groups until 65 years and older. Total physical activity was lower with age, unemployment, and retirement, where the hourly patterns mirrored the findings. Our findings agree with previous large-scale wrist-accelerometry data, but extend current knowledge by providing data on gender and socioeconomic variation in physical activity across 24 hours in a population-based adult sample representing a broad age range.
Asunto(s)
Acelerometría/instrumentación , Ejercicio Físico/fisiología , Factores Socioeconómicos , Encuestas y Cuestionarios , Muñeca/fisiología , Adulto , Anciano , Empleo , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Background Recent studies have shown an increasing prevalence of vascular risk factors in young adults with ischemic stroke ( IS ). However, the strength of the association between all vascular risk factors and early-onset IS has not been fully established. Methods and Results We compared 961 patients with a first-ever IS at 25 to 49 years to 1403 frequency-matched stroke-free controls from a population-based cohort study ( FINRISK ). Assessed risk factors included an active malignancy, atrial fibrillation, cardiovascular disease, current smoking status, a family history of stroke, high low-density lipoprotein cholesterol, high triglycerides, low high-density lipoprotein cholesterol, hypertension, and type 1 and type 2 diabetes mellitus. We performed subgroup analyses based on age, sex, and IS etiology. In a fully adjusted multivariable logistic regression analysis, significant risk factors for IS consisted of atrial fibrillation (odds ratio [OR], 10.43; 95% confidence interval [ CI ], 2.33-46.77], cardiovascular disease (OR, 8.01; 95% CI , 3.09-20.78), type 1 diabetes mellitus (OR, 6.72; 95% CI , 3.15-14.33), type 2 diabetes mellitus (OR, 2.31; 95% CI , 1.35-3.95), low high-density lipoprotein cholesterol (OR, 1.81; 95% CI , 1.37-2.40), current smoking status (OR, 1.81; 95% CI , 1.50-2.17), hypertension (OR, 1.43; 95% CI , 1.17-1.75), and a family history of stroke (OR, 1.37; 95% CI , 1.04-1.82). High low-density lipoprotein cholesterol exhibited an inverse association with IS . In the subgroup analyses, the most consistent associations appeared for current smoking status and type 1 diabetes mellitus. Conclusions Our study establishes the associations between 11 vascular risk factors and early-onset IS , among which atrial fibrillation, cardiovascular disease, and both type 1 and 2 diabetes mellitus in particular showed strong associations.
Asunto(s)
Isquemia Encefálica/epidemiología , Accidente Cerebrovascular/epidemiología , Adulto , Edad de Inicio , Isquemia Encefálica/complicaciones , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiologíaRESUMEN
During the last 40 years, Finland has experienced a remarkable decline in coronary heart disease and stroke mortality. The latest coronary heart disease mortality figures in the working-age population are <20% of the top figures in the early 1970s. Equal declines can be seen in men and in women, and the improvement extends to elderly populations as well. However, due to the very high historic levels, Finland still continues to have clearly higher cardiovascular mortality than, for example, the Mediterranean countries. Parallel to the decline in cardiovascular mortality, the life expectancy of Finns has increased by 11.6 years in men and by 9.2 years in women. The probability for a 30-year-old man to die of cardiovascular disease has dropped from about 30% in 1970 to 7% in 2013, and for a 30-year-old woman, the corresponding probability has dropped from 13% to about 2%.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Esperanza de Vida/tendencias , Finlandia/epidemiología , Humanos , Incidencia , Factores de Riesgo , Tasa de Supervivencia/tendenciasRESUMEN
In the 1960s and early 1970s, coronary heart disease (CHD) mortality in Finland was the highest in the world, and within Finland, mortality was particularly high in the eastern part of the country. The North Karelia Project, the first large community-based cardiovascular diseases prevention program was established in 1972 to reduce the extremely high CHD mortality through behavioral change and reduction of the main cardiovascular disease risk factors among the whole population of North Karelia, the easternmost province of Finland. During the 40-year period from 1972 to 2012, smoking prevalence, serum total cholesterol, and systolic blood pressure declined markedly, except a small increase in serum cholesterol levels between 2007 and 2012. From the early 1970s to 2012, CHD mortality decreased by 82% (from 643 to 118 per 100,000) among working-age (35 to 64 years) men. Among working-age women, the decline was 84% (from 114 to 17 per 100,000). During the first 10 years, changes in these 3 target risk factors explained nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than the predicted reduction. In the early 1970s, premature CHD mortality (35 to 74 years) was about 37% higher among Eastern Finnish men and 23% higher among Eastern Finnish women, compared with men and women in Southwestern Finland. During the last 40 years, premature CHD mortality declined markedly in both areas, but the decline was larger in Eastern Finland and the mortality gap between the two areas nearly disappeared.