The aim of this study was to investigate factors associated with alexithymia in patients (n=153) with coronary heart disease (CHD) verified by coronary angiography.
Self-rated depression was assessed using 21-item Beck Depression Inventory (BDI) and other psychiatric symptoms with Symptom Check List-90 (SCL-90). Life satisfaction was assessed using a separate scale. The Structured Clinical Interview (SCID I and II) for DSM-III-R was used to identify mental disorders. Assessments took place 1 day before angiography.
Twenty-one percent of CHD patients (n=32) were assessed as being alexithymic according to the Toronto Alexithymia Scale (TAS-20). Alexithymics were more often blue-collar workers, incapable of working, dissatisfied with life, and depressed than the other CHD patients. Occurrences of mental disorders were not associated with alexithymia. Logistic regression analysis revealed that factors independently associated with alexithymia were currently or previously being a blue-collar worker (adjusted odds ratio, AOR: 4.8), self-rated depression (AOR: 3.2), and dissatisfaction with life (AOR: 2.9).
In CHD patients alexithymia was unrelated to cardiovascular risk factors or exercise capacity but was related to self-rated depression and decreased life satisfaction. Alexithymia is associated with the enhanced psychosocial burden of suffering CHD. This patient group may need more individual support and attention than other CHD patients.
Apolipoprotein E (apo E) is a normal constituent of very-low-density lipoproteins and it participates in the metabolism of both low-density lipoproteins (LDL) and apo E-containing lipoproteins. In the present study, the aim was to examine to what extent apo E phenotypes modify central obesity-induced changes in serum lipids, insulin, and blood pressure in obese women. Altogether, 143 middle-aged obese women with a body mass index (in kg/m2) of 28.0-43.0 were examined. Twelve had apo E 3,2 phenotype, 93 had apo E 3,3 phenotype, and 38 had either apo E 4,3 or 4,4 (4,3 + 4,4 group) phenotype. Serum total and LDL cholesterol were lower in the apo E 3,2 group than in other groups, but no significant differences were observed in other lipid variables in this regard. Both systolic and diastolic blood pressure measures tended to be lowest in subjects with apo E 3,2 phenotype and highest in those with apo E 4,3 or 4,4 phenotype (P = 0.08-0.15 for trend). When serum lipids, blood pressure, and insulin were analyzed by waist circumference and apo E phenotype group, it became evident that women who had central obesity and the apo E 4 allele had the highest blood pressures, insulin-glucose ratios, and insulin concentrations. These results suggest that apo E phenotype significantly modifies the central obesity-induced changes in metabolic and hemodynamic variables characteristic of insulin resistance.
The aim of the study was to examine the social and economic variables associated with mental health by means of telephone interviews of a randomly chosen population sample (n = 1557) in Finland in 1993. Mental health was evaluated by means of a 12-item General Health Questionnaire. A mental disorder, indicated by the GHQ score, was detected in 18.3% of the interviewees. Mental disorders were more common in women than in men. Other factors associated with a mental disorder were unemployment, financial difficulties and insufficient social support from other people. Mental disorders, indicated by the GHQ score, were common in the long-term unemployed, users of hypnotics and sedatives, and in those who were uncertain about their future. In stepwise logistic regression analyses the statistically independent associates with impaired mental health were suicidal thoughts, receiving of housing allowance and female sex. On the other hand, being on salary was a protective factor.
To explore the relationship between several indicators of depression and metabolic syndrome (MetS).
A population-based sample with high (HMS group) or low (LMS group) levels of mental symptoms, including those of depression, in three follow-ups participated in a clinical examination in 2005 (n = 223). MetS was determined according to the NCEP criteria.
The prevalence of MetS was 49% in men and 21% in women. Men with MetS had higher rates of major depressive disorder than other men. They also displayed higher Hamilton Rating Scale for Depression (HDRS) scores and more often signs of suicidality. In logistic regression analyses, higher HDRS scores (OR 1.31, 95% CI 1.04-1.64) and belonging to the HMS group (OR 10.1, 95% CI 1.98-51.3) were independent associates for MetS but only in men.
The results highlight that there is an association between long-term depressive symptoms and the emergence of MetS, especially in men.
The effects of postmenopausal hormone replacement therapy (HRT) and vitamin D on the serum concentrations of three bone biochemical markers and their associations with bone mineral density (BMD) were studied in a population-based 1-yr follow-up study. A total of 72 healthy postmenopausal women were randomized into 4 treatment groups: HRT group (sequential combination of 2 mg estradiol valerate and 1 mg cyproterone acetate), D group (vitamin D3, 300 IU/day), HRT+D group (both of the above), and placebo group (calcium lactate, 500 mg/day). Serum concentrations of osteocalcin (OC) and bone-specific alkaline phosphatase (BAP) were measured as biochemical markers of bone formation, and serum type I collagen carboxy-terminal telopeptide was measured as a marker of bone resorption at baseline and after 6 and 12 months of treatment. To investigate the associations of these markers with BMD, lumbar (L2-L4) and femoral neck BMDs were determined by dual x-ray absorptiometry at baseline and after 2.5 yr of treatment. In both hormone groups, the serum concentrations of the three bone metabolic markers had decreased after 12 months. Those of OC decreased by 29.2% (P = 0.017) in the HRT group and by 37.3% (P = 0.004) in the HRT+D group, and BAP concentrations decreased by 34.4% (P
To assess the association between the body fat distribution and axial bone mineral density (BMD) in postmenopausal women with or without hormone replacement therapy (HRT).
Cross-sectional population-based study.
University of Eastern Finland, Bone and Cartilage Research Unit, Kuopio, Finland.
198 postmenopausal women, mean age 67.5 (1.9 SD), mean BMI 27.1 (3.9 SD).
Regional body composition and BMD assessed by dual X-ray absorptiometry (DXA, Prodigy).
Spinal and Femoral BMD.
Out of the body composition parameters, FM was the main determinant of postmenopausal bone mass. Only the lumbar spine (L2-L4) BMD, not the femoral neck BMD, was positively associated with the trunk FM. Positive trends for association were revealed between the spinal BMD and the trunk FM regardless of the use of HRT. Adjustments did not change the results.
Higher trunk fat mass was associated with the spinal BMD, but not with the hip BMD in postmenopausal women, irrespective of the HRT use. In addition to biological factors, uncertainties related to DXA measurements in patients with varying body mass may contribute to this phenomenon.
The Captopril Prevention Project (CAPPP) is an ongoing intervention study conducted in 11,019 hypertensive patients in Sweden and Finland. Patients have been randomized to receive either conventional antihypertensive therapy (diuretics and/or beta-blockers) or captopril-based treatment. A prospective, randomized, open, blinded-endpoint evaluation (PROBE) study design is used to compare these two therapeutic regimens as regards cardiovascular morbidity and mortality. The rationale for the CAPPP Study are the many observations of beneficial effects of ACE inhibition, as compared to diuretics and beta-blockers, on intermediary endpoints such as insulin sensitivity, serum lipoproteins, left ventricular hypertrophy and renal function. Captopril has also been shown to be markedly effective in the treatment of left ventricular dysfunction as well as congestive heart failure. The hypothesis is that these differences might result in improved risk reduction when ACE inhibitors are used in the treatment of hypertension. The present paper describes the baseline data and the changes in blood pressure during the first year in the total cohort. During the first year the average blood pressure was reduced by 11/8 mm Hg. A number of substudies have been conducted in the CAPPP Study. In one of these insulin sensitivity was compared in a subgroup of the patients using the euglycemic insulin clamp technique. In another substudy the ACE gene was sequenced and some new polymorphisms were discovered. Several other substudies are in progress or in the planning phase. The main results of the CAPPP Study should be available by mid-1998. Some of the intended anayses of the final results as well as other planned substudies are briefly described here.
We assessed the determinants of onset of hypertension in a large, prospective population-based study of perimenopausal women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study. The data collection started in 1989, when a baseline postal inquiry was sent to all women aged 47-56 years (n=14 220) residing in the Kuopio Province in Eastern Finland. Names, social security numbers and addresses were obtained from the Population Register Centre of Finland. A total of 11 798 women responded at baseline and at 5-year follow-up in 1994. After the exclusion of 1777 women with prevalent hypertension at baseline and women with missing height or weight information, the study population consisted of 9485 without established hypertension at baseline. New cases of established hypertension during the follow-up (n=908) were ascertained with the Registry of Specially Refunded Drugs of the Finnish Social Insurance Institution (SII). According to the National Health Insurance, the SII granted 90% reimbursement for drug costs in defined chronic illnesses necessitating continuous medication, like arterial hypertension. Weight and weight gain both raised the risk by 5% per kg (P
The aim of this study was to examine the sociodemographic and clinical variables associated with life satisfaction in psychiatric patients. The study population consisted of out-patients and in-patients (n = 1204) treated at the Department of Psychiatry of Kuopio University Hospital in North Savo, Finland, during May 1993. Sociodemographic, psychosocial and clinical correlates of life satisfaction were examined by means of two different questionnaires, one directed at patients and the other directed at the staff. Life satisfaction was assessed by means of a separate scale based on four questions. Patients with schizophrenia were less dissatisfied than patients with other disorders. The strongest correlates of dissatisfaction were depression and poor social support. Other factors relating to dissatisfaction in multiple regression analysis were self-rated health and poor financial circumstances. A psychosomatic reaction tendency or degree of psychosocial functioning at the time of the study was not independently related to life satisfaction. Psychiatric patients who are dissatisfied should be evaluated both for depression and for effectiveness of their social network.
Low-grade inflammation has been implicated in the development of Type 2 diabetes and cardiovascular disease, but its role in the pathogenesis of the metabolic syndrome is unclear. We investigated the association between C-reactive protein (CRP) levels and the development of the metabolic syndrome and diabetes in men.
Serum CRP concentrations and factors related to insulin resistance were determined in middle-aged Finnish men who participated in a population-based cohort study and were free of diabetes at baseline.
At the 11-year follow-up, 143 of 680 men had developed the metabolic syndrome as defined by the National Cholesterol Education Program (NCEP) and 103 of 598 men had developed the metabolic syndrome as defined by the World Health Organization (WHO). Our analyses excluded men with the metabolic syndrome by the respective definition at baseline. In all, 78 of 762 men developed diabetes over the same period. Men with CRP concentrations > or =3 mg/l had a several-fold higher age-adjusted risk of developing the metabolic syndrome (NCEP definition: odds ratio [OR]=3.2, 95% CI 1.9-5.5; WHO definition: OR=3.4, 95% CI 2.0-6.1) or diabetes (OR=4.1, 95% CI 2.1-8.0) than men whose CRP levels were or =3 mg/l, but the association with the metabolic syndrome was no longer significant.
Low-grade inflammation may increase the risk of the metabolic syndrome and diabetes in middle-aged men, but some of the risk is mediated through obesity and factors related to insulin resistance.