In a large, community-based cardiovascular disease prevention study in Eastern Finland, independent random population samples were surveyed in 1972, 1977 and 1982. The leisure-time physical activity (LTPA), occupational physical activity (OPA), and socioeconomic and lifestyle characteristics were assessed. In men and women aged 30-59, the proportion with high LTPA increased from 1972 to 1982 by approximately one half (p less than 0.001), whereas that of high OPA decreased during the same period (p less than 0.001). In both sexes, high overall physical activity fell from 1972 to 1977 (p less than 0.001), but no more from 1977 to 1982. The proportion of entirely sedentary remained stable. Education, income and younger age showed a positive, body mass index, smoking and OPA a graded, negative association with high LTPA in 1972 and 1982. Significant (p less than 0.001) differences in 10-year trends of changes in LTPA were observed: men and women with low education or income increased LTPA more than those with high education and income. Socioeconomic factors, such as income and education, appear to have lost importance as determinants of population-wide exercise, whereas the clustering of low physical activity with overweight and smoking has increased.
The aim of this study is to describe the 21 year trends in myocardial infarction among middle-aged inhabitants in the city of Turku, in southwestern Finland. Since 1972 the coronary register in Turku has monitored acute coronary events leading to hospital admission or death, first according to the methods of the World Health Organization Heart Attack Register Study, and since 1982 according to the methods of the WHO MONICA. From 1972 to 1992 we registered 7374 events of suspected myocardial infarction, of which 6045 events occurring in inhabitants of Turku aged 35-64 years, fulfilled the criteria for myocardial infarction. Within 28 days, 2266 coronary events proved fatal. During the 21-year period, the incidence of definite myocardial infarction fell by 55% in men and by 62% in women, and coronary mortality fell by 66 and 81%, respectively. From 1972 to 1982, total mortality and coronary mortality decreased in parallel. Later on, the decrease in total mortality levelled off, even though coronary mortality fell still steeper, because mortality from external causes of death increased. The favourable long-term trends reflect favourable changes in total cholesterol and blood pressure in the middle-aged population, and the improvement in the treatment of myocardial infarction. Further efforts are needed to enhance this trend, but also to reduce total mortality among middle-aged people.
Comment In: Eur Heart J. 1996 Oct;17(10):1455-68909894
The purpose of the study was to investigate the associations of abdominal obesity and overall obesity with the risk of acute coronary events.
Body mass index indicating overall obesity and waist-to-hip ratio and waist circumference indicating abdominal obesity were measured for 1346 Finnish men aged 42-60 years who had neither cardiovascular disease nor cancer at baseline. There were 123 acute coronary events during an average follow-up of 10.6 years. In Cox regression analyses adjusted for confounding factors, waist-to-hip ratio (P=0.009), waist circumference (P=0.010) and body mass index (P=0.013) as continuous variables were associated directly with the risk of coronary events. These associations were in part explained by blood pressure, diabetes, fasting serum insulin, serum lipids, plasma fibrinogen, and serum uric acid. Waist-to-hip ratio of > or =0.91 was associated with a nearly threefold risk of coronary events. Waist-to-hip ratio provided additional information beyond body mass index in predicting coronary heart disease, whereas body mass index did not add to the predictive value of waist-to-hip ratio. Abdominal obesity combined with smoking and poor cardiorespiratory fitness increased the risk of coronary events 5.5 and 5.1 times, respectively.
Abdominal obesity is an independent risk factor for coronary heart disease in middle-aged men and even more important than overall obesity. Since the effect of abdominal obesity was strongest in smoking and unfit men, the strategy for lifestyle modification to prevent coronary heart disease should address these issues jointly.
Comment In: Eur Heart J. 2002 May;23(9):687-911977990
In 1977, in the evaluation of the prevention programme for cardiovascular diseases, 11,880 persons in Eastern Finland were asked to report their own weight on a questionnaire. Each participant was weighted during the following clinical examination. The data of the self-reported body weight were analysed according to sex, age, measured weight and body-mass index (BMI). The results showed that older people underestimated their weight to a greater extent than did younger people of both sexes. The error between measured and self-reported weight was greater in heavier subjects than in thinner individuals. In both sexes weight estimate error (measured weight minus self-reported weight) correlated more strongly with high BMI than with measured weight. Associations between weight estimate error and other variables were studied using a multiple regression model. Men whose annual family income was low were more likely to underestimate their weight than the men with a high annual income. In general, women reported their weight more correctly than men did. Older women were more likely to report their weight less than younger women, whereas women who visited their doctor frequently or who had higher annual family incomes were more aware of their actual body weight than those who had few doctor's consultations or whose family income was low. In men 5.2% and in women 8.3% of the variation in the weight estimate error was explained by the regression model.(ABSTRACT TRUNCATED AT 250 WORDS)
The acute myocardial infarction (AMI) register of the FINMONICA study, the Finnish part of the WHO-coordinated multinational MONICA project, operates in the provinces of North Karelia and Kuopio in eastern Finland and in Turku, Loimaa and in communities around Loimaa in southwestern Finland. The AMI register serves as an instrument for the assessment of trends in mortality from coronary heart disease (CHD) and of the incidence and attack rates of AMI among 25-64-year-old residents of the study areas. This report describes the methods used in the FINMONICA AMI register and the findings during the first 3 years of the study, in 1983-1985. The criteria of the multinational WHO MONICA project were used in the classification of fatal events and in the diagnosis of non-fatal definite AMI, but based on the experience within the FINMONICA study, stricter diagnostic criteria than those originally described in the WHO MONICA protocol were used for non-fatal possible AMI. This led to a marked improvement in the comparability of the data from the three study areas with regard to the incidence and attack rates of non-fatal AMI. During the 3-year period the total number of registered events was 6266 among men and 2092 among women. Among men the incidence and attack rates of AMI and mortality from CHD were higher in eastern than in southwestern Finland. Also among women the incidence and attack rates of AMI were higher in eastern than in southwestern Finland, whereas there was no regional difference in mortality from CHD among women. The mortality findings of the FINMONICA AMI Register were in good agreement with the official CHD mortality statistics of Finland.
Analysis of MHC region genetics in Finnish patients with juvenile idiopathic arthritis: evidence for different locus-specific effects in polyarticular vs pauciarticular subsets and a shared DRB1 epitope.
This study used Finnish juvenile idiopathic arthritis (JIA) probands with pauciarticular and rheumatoid factor (RF) negative polyarticular subtypes of JIA to further define the genetic susceptibility to JIA. We examined 16 markers spanning an 18 cM region of chromosome 6 encompassing the MHC and surrounding genomic region in a set of 235 Finnish JIA nuclear families and 639 Finnish control individuals. Analysis by case/control association and transmission disequilibrium test (TDT) methods each demonstrated strong evidence for a susceptibility locus near the D6S2447 microsatellite (P
The deletion/deletion genotype of the insertion (I)/deletion (D) polymorphism of the angiotensin-converting enzyme (ACE) gene has been suggested to be a risk factor for myocardial infarction (MI). The objective of this study was to evaluate whether genotype distributions of the I/D polymorphism of the ACE gene are different between individuals from high-risk and low-risk areas for coronary heart disease in the genetically isolated population of Finland and to assess the impact of this genetic risk factor by comparing individuals with different parental histories of MI. Representative population-based samples of middle-aged men (n = 363) and women (n = 358) from two areas of Finland were used. The area had a borderline significant effect on the prevalence of the genotype DD (beta = 0.35, SE = 0.16, X2 = 470, df = 1, P = 0.03), the DD genotype being more prevalent in eastern Finland (the high-risk area). The II genotype was more prevalent in women with parental history of MI, so we could not replicate the previous findings of the risk-increasing effect of DD genotype in this sample. Although the observed difference in the ACE DD genotype between the high-risk and low-risk areas for coronary heart disease might represent one of the genetic factors contributing to the difference in risk of coronary heart disease between eastern and southwestern Finland, the data emphasize the fact that also other risk factors, including other genes, contribute to this difference and the high incidence of MI in Finland.