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1. Risk of sudden cardiac death associated with QRS, QTc, and JTc intervals in the general population

Author

Tikkanen, J. T. (Jani T.), Kenttä, T. (Tuomas), Porthan, K. (Kimmo), Anttonen, O. (Olli), Eranti, A. (Antti), Aro, A. L. (Aapo L.), Kerola, T. (Tuomas), Rissanen, H. A. (Harri A.), Knekt, P. (Paul), Heliövaara, M. (Markku), Holkeri, A. (Arttu), Haukilahti, A. (Anette), Niiranen, T. (Teemu), Hernesniemi, J. (Jussi), Jula, A. (Antti), Nieminen, M. S. (Markku S.), Myerburg, R. J. (Robert J.), Albert, C. M. (Christine M.), Salomaa, V. (Veikko), Huikuri, H. V. (Heikki V.), Junttila, M. J. (M. Juhani), Tikkanen, J. T. (Jani T.), Kenttä, T. (Tuomas), Porthan, K. (Kimmo), Anttonen, O. (Olli), Eranti, A. (Antti), Aro, A. L. (Aapo L.), Kerola, T. (Tuomas), Rissanen, H. A. (Harri A.), Knekt, P. (Paul), Heliövaara, M. (Markku), Holkeri, A. (Arttu), Haukilahti, A. (Anette), Niiranen, T. (Teemu), Hernesniemi, J. (Jussi), Jula, A. (Antti), Nieminen, M. S. (Markku S.), Myerburg, R. J. (Robert J.), Albert, C. M. (Christine M.), Salomaa, V. (Veikko), Huikuri, H. V. (Heikki V.), and Junttila, M. J. (M. Juhani)

Abstract

Background: QRS duration and corrected QT (QTc) interval have been associated with sudden cardiac death (SCD), but no data are available on the significance of repolarization component (JTc interval) of the QTc interval as an independent risk marker in the general population. Objective: In this study, we sought to quantify the risk of SCD associated with QRS, QTc, and JTc intervals. Methods: This study was conducted using data from 3 population cohorts from different eras, comprising a total of 20,058 individuals. The follow-up period was limited to 10 years and age at baseline to 30–61 years. QRS duration and QT interval (Bazett’s) were measured from standard 12-lead electrocardiograms at baseline. JTc interval was defined as QTc interval — QRS duration. Cox proportional hazards models that controlled for confounding clinical factors identified at baseline were used to estimate the relative risk of SCD. Results: During a mean period of 9.7 years, 207 SCDs occurred (1.1 per 1000 person-years). QRS duration was associated with a significantly increased risk of SCD in each cohort (pooled hazard ratio [HR] 1.030 per 1-ms increase; 95% confidence interval [CI] 1.017–1.043). The QTc interval had borderline to significant associations with SCD and varied among cohorts (pooled HR 1.007; 95% CI 1.001–1.012). JTc interval as a continuous variable was not associated with SCD (pooled HR 1.001; 95% CI 0.996–1.007). Conclusions: Prolonged QRS durations and QTc intervals are associated with an increased risk of SCD. However, when the QTc interval is deconstructed into QRS and JTc intervals, the repolarization component (JTc) appears to have no independent prognostic value.

Published
2022

2. Poor R-wave progression as a predictor of sudden cardiac death in the general population and subjects with coronary artery disease

Author

Schröder, L. C. (Linda C.), Holkeri, A. (Arttu), Eranti, A. (Antti), Haukilahti, M. A. (M. Anette E.), Kerola, T. (Tuomas), Kenttä, T. V. (Tuomas V.), Noponen, K. (Kai), Seppänen, T. (Tapio), Rissanen, H. (Harri), Heliövaara, M. (Markku), Knekt, P. (Paul), Junttila, M. J. (M. Juhani), Huikuri, H. V. (Heikki V.), and Aro, A. L. (Aapo L.)

Subjects
Electrocardiography, Sudden cardiac death, Epidemiology, R-wave, Coronary artery disease
Abstract

Background: Poor R-wave progression (PRWP) is a common clinical finding on the standard 12-lead electrocardiogram (ECG), but its prognostic significance is unclear. Objective: The purpose of this study was to examine the prognosis associated with PRWP in terms of sudden cardiac death (SCD), cardiac death, and all-cause mortality in general population subjects with and without coronary artery disease (CAD). Methods: Data and 12-lead ECGs were collected from a Finnish general population health examination survey conducted during 1978–1980 with follow-up until 2011. The study population consisted of 6854 subjects. Main end points were SCD, cardiac death, and all-cause mortality. PRWP was defined as R-wave amplitude ≤ 0.3 mV in lead V₃ and R-wave amplitude in lead V₂ ≤ R-wave amplitude in lead V₃. Results: PRWP occurred in 213 subjects (3.1%). During the follow-up period of 24.3 ± 10.4 years, 3723 subjects (54.3%) died. PRWP was associated with older age, higher prevalence of heart failure and CAD, and β-blocker medication. In multivariate analyses, PRWP was associated with SCD (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.34–3.39), cardiac death (HR 1.75; 95% CI 1.35–2.15), and all-cause mortality (HR 1.29; 95% CI 1.08–1.54). In the subgroup with CAD, PRWP had a stronger association with cardiac mortality (HR 1.71; 95% CI 1.19–2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38–4.98). Conclusions: PRWP was associated with adverse prognosis in the general population and with SCD in subjects with CAD.

Published
2022

3. Prognostic significance of flat T-waves in the lateral leads in general population

Author

Holkeri, A. (Arttu), Eranti, A. (Antti), Haukilahti, M. A. (M. Anette E.), Kerola, T. (Tuomas), Kenttä, T. V. (Tuomas V.), Noponen, K. (Kai), Seppänen, T. (Tapio), Rissanen, H. (Harri), Heliövaara, M. (Markku), Knekt, P. (Paul), Junttila, M. J. (M. Juhani), Huikuri, H. V. (Heikki V.), Aro, A. L. (Aapo L.), Holkeri, A. (Arttu), Eranti, A. (Antti), Haukilahti, M. A. (M. Anette E.), Kerola, T. (Tuomas), Kenttä, T. V. (Tuomas V.), Noponen, K. (Kai), Seppänen, T. (Tapio), Rissanen, H. (Harri), Heliövaara, M. (Markku), Knekt, P. (Paul), Junttila, M. J. (M. Juhani), Huikuri, H. V. (Heikki V.), and Aro, A. L. (Aapo L.)

Abstract

Background: Negative T-waves are associated with sudden cardiac death (SCD) risk in the general population. Whether flat T-waves also predict SCD is not known. The aim of the study was to examine the clinical characteristics and risk of SCD in general population subjects with flat T-waves. Methods: We examined the electrocardiograms of 6750 Finnish general population adults aged ≥30 years and classified the subjects into 3 groups: 1) negative T-waves with an amplitude ≥0.1 mV in ≥2 of the leads I, II, aVL, V4–V6, 2) negative or positive low amplitude T-waves with an amplitude <0.1 mV and the ratio of T-wave and R-wave <10% in ≥2 of the leads I, II, aVL, V4–V6, and 3) normal positive T-waves (not meeting the aforesaid criteria). The association between T-wave classification and SCD was assessed during a 10-year follow-up. Results: A total of 215 (3.2%) subjects had negative T-waves, 856 (12.7%) flat T-waves, and 5679 (84.1%) normal T-waves. Flat T-wave subjects were older and had more often cardiovascular morbidities compared to normal T-wave subjects, while negative T-wave subjects were the oldest and had most often cardiovascular morbidities. After adjusting for multiple factors, both flat T-waves (hazard ratio [HR] 1.81; 95% confidence interval [CI] 1.13–2.91) and negative T-waves (HR 3.27; 95% CI 1.85–5.78) associated with SCD. Conclusions: Cardiovascular risk factors and disease are common among subjects with flat T-waves, but these minor T-wave abnormalities are also independently associated with increased SCD risk.

Published
2021

4. Impact of age and sex on the long-term prognosis associated with early repolarization in the general population

Author

Holkeri, A. (Arttu), Eranti, A. (Antti), Haukilahti, M. A. (M. Anette E.), Kerola, T. (Tuomas), Kenttä, T. V. (Tuomas V.), Tikkanen, J. T. (Jani T.), Rissanen, H. (Harri), Heliövaara, M. (Markku), Knekt, P. (Paul), Junttila, M. J. (M. Juhani), Aro, A. L. (Aapo L.), and Huikuri, H. V. (Heikki V.)

Subjects
Electrocardiography, Sudden cardiac death, Early repolarization, Epidemiology, Age groups
Abstract

Background: Early repolarization (ER) has been linked to the risk of sudden cardiac death (SCD) in the general population, although controversy remains regarding risks across various subgroups. Objective: The purpose of this study was to investigate whether age and sex influence the prognostic significance of ER. Methods: We evaluated the 12-lead electrocardiograms of 6631 Finnish general population subjects age ≥30 years (mean age 50.1 ± 13.9 years; 44.5% men) for the presence of ER (J-point elevation ≥0.1 mV in ≥2 inferior/lateral leads) and followed them for 24.4 ± 10.3 years. We analyzed the association between ER and the risk of SCD, cardiac death, and all-cause mortality in subgroups according to age (

Published
2020

5. Electrocardiographic risk markers for heart failure in women versus men

Author

Haukilahti, M. A. (Mira Anette E.), Kenttä, T. V. (Tuomas V.), Tikkanen, J. T. (Jani T.), Anttonen, O. (Olli), Aro, A. L. (Aapo L.), Kerola, T. (Tuomas), Rissanen, H. (Harri), Knekt, P. (Paul), Junttila, M. J. (M. Juhani), and Huikuri, H. V. (Heikki V.)

Subjects
cardiovascular diseases
Abstract

Heart failure (HF) is one of the leading causes of hospitalization in the Western world. Women have a lower HF hospitalization rate and mortality compared with men. The role of electrocardiography as a risk marker of future HF in women is not well known. We studied association of electrocardiographic (ECG) risk factors for HF hospitalization in women from a large middle-aged general population with a long-term follow-up and compared the risk profile to men. Standard 12-lead ECG markers were analyzed from 10,864 subjects (49% women), and their predictive value for HF hospitalization was analyzed. During the follow-up (30 ± 11 years), a total of 1,743 subjects had HF hospitalization; of these, 861 were women (49%). Several baseline characteristics, such as age, body mass index, blood pressure, and history of previous cardiac disease predicted the occurrence of HF both in women and men (p

Published
2020

6. Gender differences in prevalence and prognostic value of fragmented QRS complex

Author

Haukilahti, M. A. (M. Anette E.), Holmström, L. (Lauri), Vähätalo, J. (Juha), Tikkanen, J. T. (Jani T.), Terho, H. K. (Henri K.), Kiviniemi, A. M. (Antti M.), Lepojärvi, E. S. (E. Samuli), Tulppo, M. (Mikko), Perkiömäki, J. S. (Juha S.), Ukkola, O. H. (Olavi H.), Anttonen, O. (Olli), Aro, A. L. (Aapo L.), Kerola, T. (Tuomas), Rissanen, H. (Harri), Knekt, P. (Paul), Junttila, M. J. (M. Juhani), Huikuri, H. V. (Heikki V.), Kenttä, T. V. (Tuomas V.), Haukilahti, M. A. (M. Anette E.), Holmström, L. (Lauri), Vähätalo, J. (Juha), Tikkanen, J. T. (Jani T.), Terho, H. K. (Henri K.), Kiviniemi, A. M. (Antti M.), Lepojärvi, E. S. (E. Samuli), Tulppo, M. (Mikko), Perkiömäki, J. S. (Juha S.), Ukkola, O. H. (Olavi H.), Anttonen, O. (Olli), Aro, A. L. (Aapo L.), Kerola, T. (Tuomas), Rissanen, H. (Harri), Knekt, P. (Paul), Junttila, M. J. (M. Juhani), Huikuri, H. V. (Heikki V.), and Kenttä, T. V. (Tuomas V.)

Abstract

Background: Fragmented QRS (fQRS) on 12-lead electrocardiogram (ECG) is associated with scarred myocardium and adverse outcome. However, the data on gender differences in terms of its prevalence and prognostic value is sparse. The aim of this study was to evaluate whether gender differences in fQRS exist among subjects drawn from populations with different risk profiles. Methods: We analyzed fQRS from 12-lead ECG in 953 autopsy-confirmed victims of sudden cardiac death (SCD) (78% men; 67.0 ± 11.4 yrs), 1900 coronary artery disease (CAD) patients with angiographically confirmed stenosis of ≥50% (70% men; 66.6 ± 9.0 yrs, 43% with previous myocardial infarction [MI]), and in 10,904 adults drawn from the Finnish adult general population (52% men; 44.0 ± 8.5 yrs). Results: Prevalence of fQRS was associated with older age, male sex and the history and severity of prior cardiac disease of subjects. Among the general population fQRS was more commonly found among men in comparison to women (20.5% vs. 14.8%, p < 0.001). The prevalence of fQRS rose gradually along with the severity of prior cardiac disease in both genders, yet remained significantly higher in the male population: subjects with suspected or known cardiac disease (25.4% vs. 15.8% p < 0.001), CAD patients without prior MI (39.9% vs. 26.4%, p < 0.001), CAD patients with prior MI (42.9% vs. 31.2%, p < 0.001), and victims of SCD (56.4% vs. 44.4%, p < 0.001). Conclusions: The prevalence of QRS fragmentation varies in different populations. The fragmentation is clearly related to the underlying cardiac disease in both genders, however women seem to have significantly lower prevalence of fQRS in each patient population in comparison to men.

Published
2020

7. Prevalence and prognostic significance of negative U-waves in a 12-lead electrocardiogram in the general population

Author

Holkeri, A. (Arttu), Eranti, A. (Antti), Haukilahti, M. A. (M. Anette), Kerola, T. (Tuomas), Kenttä, T. V. (Tuomas V.), Noponen, K. (Kai), Seppänen, T. (Tapio), Rissanen, H. (Harri), Heliövaara, M. (Markku), Knekt, P. (Paul), Junttila, M. J. (M. Juhani), Huikuri, H. V. (Heikki V.), Aro, A. L. (Aapo L.), Holkeri, A. (Arttu), Eranti, A. (Antti), Haukilahti, M. A. (M. Anette), Kerola, T. (Tuomas), Kenttä, T. V. (Tuomas V.), Noponen, K. (Kai), Seppänen, T. (Tapio), Rissanen, H. (Harri), Heliövaara, M. (Markku), Knekt, P. (Paul), Junttila, M. J. (M. Juhani), Huikuri, H. V. (Heikki V.), and Aro, A. L. (Aapo L.)

Abstract

Negative U-waves are a relatively rare finding in an electrocardiogram (ECG), but are often associated with cardiac disease. The prognostic significance of negative U-waves in the general population is unknown. We evaluated 12-lead ECGs of 6,518 adults (45% male, mean age 50.9 ± 13.8 years) for the presence of U-waves, and followed the subjects for 24.5 ± 10.3 years. Primary end points were all-cause mortality, cardiac mortality, and sudden cardiac death; secondary end point was hospitalization due to cardiac causes. Negative U-waves (amplitude ≥0.05 mV) were present in 231 subjects (3.5%), minor negative (amplitude <0.05 mV) or discordant U-waves in 1,004 subjects (15.4%), normal positive U-waves in 3,950 (60.6%) subjects, and no U-waves were observed in 603 subjects (9.3%). In 730 subjects (11.2%), U-waves were unassessable. When adjusted for age and gender, negative U-waves were associated with all end points (p <0.01). In an analysis adjusted for multiple demographic and clinical factors, in men, negative U-waves were associated with increased risk of all-cause mortality (hazard ratio [HR] 1.60; 95% confidence interval [CI] 1.26 to 2.03; p <0.001), cardiac mortality (HR 1.74; 95% CI 1.26 to 2.39; p = 0.001), and cardiac hospitalization (HR 1.67; 95% CI 1.27 to 2.18; p <0.001), but not with sudden cardiac death, whereas women did not show a significant association to any of the end points (p >0.30). In conclusion, negative U-waves are associated with adverse events in the general population. In men, this association is independent of cardiovascular risk factors.

Published
2019

8. Experiences in digitizing and digitally measuring a paper-based ECG archive

Author

Holkeri, A. (Arttu), Eranti, A. (Antti), Kenttä, T. V. (Tuomas V.), Noponen, K. (Kai), Haukilahti, M. A. (M. Anette E.), Seppänen, T. (Tapio), Junttila, M. J. (M. Juhani), Kerola, T. (Tuomas), Rissanen, H. (Harri), Heliövaara, M. (Markku), Knekt, P. (Paul), Aro, A. L. (Aapo L.), Huikuri, H. V. (Heikki V.), Holkeri, A. (Arttu), Eranti, A. (Antti), Kenttä, T. V. (Tuomas V.), Noponen, K. (Kai), Haukilahti, M. A. (M. Anette E.), Seppänen, T. (Tapio), Junttila, M. J. (M. Juhani), Kerola, T. (Tuomas), Rissanen, H. (Harri), Heliövaara, M. (Markku), Knekt, P. (Paul), Aro, A. L. (Aapo L.), and Huikuri, H. V. (Heikki V.)

Abstract

Background: No established method for digitizing and digital measuring of paper electrocardiograms (ECG) exists. We describe a paper ECG digitizing and digital measuring process, and report comparability to manual measurements. Methods: A paper ECG was recorded from 7203 health survey participants in 1978–1980. With specific software, the ECGs were digitized (ECG Trace Tool), and measured digitally (EASE). A sub-sample of 100 ECGs was selected for manual measurements. Results: The measurement methods showed good agreement. The mean global (EASE)-(manual) differences were 1.4 ms (95% CI 0.5–2.2) for PR interval, −1.0 ms (95% CI −1.5–[−0.5]) for QRS duration, and 11.6 ms (95% CI 10.5–12.7) for QT interval. The mean inter-method amplitude differences of RampV5, RampV6, SampV1, TampII and TampV5 ranged from −0.03 mV to 0.01 mV. Conclusions: The presented paper-to-digital conversion and digital measurement process is an accurate and reliable method, enabling efficient storing and analysis of paper ECGs.

Published
2018

9. Associations of tissue transglutaminase antibody seropositivity with coronary heart disease: Findings from a prospective cohort study

Author

Heikkilä, K, Rissanen, H, Heliövaara, M, Knekt, P, Mäki, M, and Kaukinen, K

Subjects
cardiovascular diseases
Abstract

BACKGROUND AND AIMS: Clinical experience and observational studies suggest that individuals with coeliac disease are at increased risk of coronary heart disease (CHD), but the precise mechanism for this is unclear. Laboratory studies suggest that it may relate to tissue transglutaminase antibodies (tTGAs). Our aim was to examine whether seropositivity for tTGA and endomysial antibodies (EMAs) are associated with incident CHD in humans. METHODS AND RESULTS: We used data from Mini-Finland Health Survey, a prospective cohort study of Finnish men and women aged 35-80 at study baseline 1978-80. TTGA and EMA seropositivities were ascertained from baseline blood samples and incident CHD events were identified from national hospitalisation and death registers. Cox regression was used to examine the associations between antibody seropositivity and incident CHD. Of 6887 men and women, 562 were seropositive for tTGAs and 72 for EMAs. During a median follow-up of 26 years, 2367 individuals experienced a CHD event. We found no clear evidence for an association between tTGA positivity (hazard ratio, HR: 1.04, 95% confidence interval, CI: 0.83, 1.30) or EMA positivity (HR: 1.16, 95% CI: 0.77, 1.74) and incident CHD, once pre-existing CVD and known CHD risk factors had been adjusted for. CONCLUSION: We found no clear evidence for an association of tTGA or EMA seropositivity with incident CHD outcomes, suggesting that tTG autoimmunity is unlikely to be the biological link between coeliac disease and CHD.

Published
2017

10. Poor R-wave progression as a predictor of sudden cardiac death in the general population and subjects with coronary artery disease.

Author

Schröder LC, Holkeri A, Eranti A, Haukilahti MAE, Kerola T, Kenttä TV, Noponen K, Seppänen T, Rissanen H, Heliövaara M, Knekt P, Junttila MJ, Huikuri HV, and Aro AL

Subjects
Death, Sudden, Cardiac epidemiology, Death, Sudden, Cardiac etiology, Electrocardiography, Humans, Prognosis, Proportional Hazards Models, Risk Factors, Coronary Artery Disease complications, Coronary Artery Disease diagnosis
Abstract

Background: Poor R-wave progression (PRWP) is a common clinical finding on the standard 12-lead electrocardiogram (ECG), but its prognostic significance is unclear., Objective: The purpose of this study was to examine the prognosis associated with PRWP in terms of sudden cardiac death (SCD), cardiac death, and all-cause mortality in general population subjects with and without coronary artery disease (CAD)., Methods: Data and 12-lead ECGs were collected from a Finnish general population health examination survey conducted during 1978-1980 with follow-up until 2011. The study population consisted of 6854 subjects. Main end points were SCD, cardiac death, and all-cause mortality. PRWP was defined as R-wave amplitude ≤ 0.3 mV in lead V 3 and R-wave amplitude in lead V 2 ≤ R-wave amplitude in lead V 3 ., Results: PRWP occurred in 213 subjects (3.1%). During the follow-up period of 24.3 ± 10.4 years, 3723 subjects (54.3%) died. PRWP was associated with older age, higher prevalence of heart failure and CAD, and β-blocker medication. In multivariate analyses, PRWP was associated with SCD (hazard ratio [HR] 2.13; 95% confidence interval [CI] 1.34-3.39), cardiac death (HR 1.75; 95% CI 1.35-2.15), and all-cause mortality (HR 1.29; 95% CI 1.08-1.54). In the subgroup with CAD, PRWP had a stronger association with cardiac mortality (HR 1.71; 95% CI 1.19-2.46) than in the subgroup without CAD, while the association with SCD was significant only in the subgroup with CAD (HR 2.62; 95% CI 1.38-4.98)., Conclusion: PRWP was associated with adverse prognosis in the general population and with SCD in subjects with CAD., (Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Published
2022
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11. Impact of age and sex on the long-term prognosis associated with early repolarization in the general population.

Author

Holkeri A, Eranti A, Haukilahti MAE, Kerola T, Kenttä TV, Tikkanen JT, Rissanen H, Heliövaara M, Knekt P, Junttila MJ, Aro AL, and Huikuri HV

Subjects
Adult, Age Factors, Death, Sudden, Cardiac etiology, Female, Finland epidemiology, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Sex Factors, Survival Rate trends, Time Factors, Ventricular Fibrillation complications, Ventricular Fibrillation physiopathology, Death, Sudden, Cardiac epidemiology, Electrocardiography, Heart Conduction System physiopathology, Heart Rate physiology, Population Surveillance methods, Risk Assessment methods, Ventricular Fibrillation epidemiology
Abstract

Background: Early repolarization (ER) has been linked to the risk of sudden cardiac death (SCD) in the general population, although controversy remains regarding risks across various subgroups., Objective: The purpose of this study was to investigate whether age and sex influence the prognostic significance of ER., Methods: We evaluated the 12-lead electrocardiograms of 6631 Finnish general population subjects age ≥30 years (mean age 50.1 ± 13.9 years; 44.5% men) for the presence of ER (J-point elevation ≥0.1 mV in ≥2 inferior/lateral leads) and followed them for 24.4 ± 10.3 years. We analyzed the association between ER and the risk of SCD, cardiac death, and all-cause mortality in subgroups according to age (<50 or ≥50 years) and sex., Results: ER was present in 367 of the 3305 subjects age <50 years and in 426 of 3326 subjects ≥50 years. ER was not associated with any of the endpoints in the entire study population. After adjusting for clinical factors, ER was associated with SCD (hazard ratio [HR] 1.88; 95% confidence interval [CI] 1.16-3.07) in subjects <50 but not in older subjects (interaction between ER and age group, P = .048). In the younger subgroup, women with ER had a high risk of SCD (HR 4.11; 95% CI 1.41-12.03), whereas among men ER was not associated with SCD. Finally, ER was not associated with cardiac mortality or all-cause mortality in either age group., Conclusion: ER is associated with SCD in subjects younger than 50 years, particularly in women, but not in subjects 50 years and older., (Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Published
2020
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12. Population-based Borrelia burgdorferi sensu lato seroprevalence and associated risk factors in Finland.

Author

van Beek J, Sajanti E, Helve O, Ollgren J, Virtanen MJ, Rissanen H, Lyytikäinen O, Hytönen J, and Sane J

Subjects
Adult, Aged, Aged, 80 and over, Antibodies, Bacterial blood, Cross-Sectional Studies, Enzyme-Linked Immunosorbent Assay, Female, Finland epidemiology, Humans, Immunoglobulin G blood, Lyme Disease microbiology, Male, Middle Aged, Prevalence, Risk Factors, Seroepidemiologic Studies, Sex Factors, Young Adult, Borrelia burgdorferi Group isolation & purification, Lyme Disease epidemiology
Abstract

Lyme borreliosis (LB) is caused by Borrelia burgdorferi sensu lato (Bb-sl) and is the most common vector-borne disease in Europe. The objectives of this study were to determine the Bb-sl seroprevalence among the general Finnish adult population and to identify risk factors associated with Bb-sl-seropositive status. Two thousand sera from a nationwide health survey from 2011 were tested by whole-cell sonicate IgG ELISA, C6 peptide ELISA, and recomBead IgG 2.0 and test results were linked to a general health questionnaire. A multivariable logistic regression model was used to identify risk factors. The median age of the study population was 56 years (range 29-97) and the Bb-sl weighted seroprevalence was 3.9% (95% confidence interval (CI) 3.03-5.08). The weighted seroprevalence was significantly higher among males than females (adjusted odds ratio 1.91, 95%CI 1.21-3.04). The seroprevalence was highest in Southern, Central, and Eastern regions. The first Bb-sl seroprevalence study in Finland showed a seroprevalence of 3.9% (regional range 0.87%-6.12%). The results of this study can be used, together with previous data on LB incidence and spatial tick distribution, to target public health communication about preventive measures., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

Published
2018
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13. Associations of tissue transglutaminase antibody seropositivity with coronary heart disease: Findings from a prospective cohort study.

Author

Heikkilä K, Rissanen H, Heliövaara M, Knekt P, Mäki M, and Kaukinen K

Subjects
Adult, Aged, Aged, 80 and over, Biomarkers blood, Celiac Disease diagnosis, Celiac Disease epidemiology, Celiac Disease immunology, Coronary Disease diagnosis, Coronary Disease epidemiology, Coronary Disease immunology, Female, Finland epidemiology, Health Surveys, Humans, Incidence, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Prospective Studies, Protein Glutamine gamma Glutamyltransferase 2, Risk Factors, Serologic Tests, Autoantibodies blood, Celiac Disease blood, Coronary Disease blood, GTP-Binding Proteins immunology, Transglutaminases immunology
Abstract

Background and Aims: Clinical experience and observational studies suggest that individuals with coeliac disease are at increased risk of coronary heart disease (CHD), but the precise mechanism for this is unclear. Laboratory studies suggest that it may relate to tissue transglutaminase antibodies (tTGAs). Our aim was to examine whether seropositivity for tTGA and endomysial antibodies (EMAs) are associated with incident CHD in humans., Methods and Results: We used data from Mini-Finland Health Survey, a prospective cohort study of Finnish men and women aged 35-80 at study baseline 1978-80. TTGA and EMA seropositivities were ascertained from baseline blood samples and incident CHD events were identified from national hospitalisation and death registers. Cox regression was used to examine the associations between antibody seropositivity and incident CHD. Of 6887 men and women, 562 were seropositive for tTGAs and 72 for EMAs. During a median follow-up of 26 years, 2367 individuals experienced a CHD event. We found no clear evidence for an association between tTGA positivity (hazard ratio, HR: 1.04, 95% confidence interval, CI: 0.83, 1.30) or EMA positivity (HR: 1.16, 95% CI: 0.77, 1.74) and incident CHD, once pre-existing CVD and known CHD risk factors had been adjusted for., Conclusion: We found no clear evidence for an association of tTGA or EMA seropositivity with incident CHD outcomes, suggesting that tTG autoimmunity is unlikely to be the biological link between coeliac disease and CHD., (Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Published
2017
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14. Carotenoids, retinol, tocopherols, and prostate cancer risk: pooled analysis of 15 studies.

Author

Key TJ, Appleby PN, Travis RC, Albanes D, Alberg AJ, Barricarte A, Black A, Boeing H, Bueno-de-Mesquita HB, Chan JM, Chen C, Cook MB, Donovan JL, Galan P, Gilbert R, Giles GG, Giovannucci E, Goodman GE, Goodman PJ, Gunter MJ, Hamdy FC, Heliövaara M, Helzlsouer KJ, Henderson BE, Hercberg S, Hoffman-Bolton J, Hoover RN, Johansson M, Khaw KT, King IB, Knekt P, Kolonel LN, Le Marchand L, Männistö S, Martin RM, Meyer HE, Mondul AM, Moy KA, Neal DE, Neuhouser ML, Palli D, Platz EA, Pouchieu C, Rissanen H, Schenk JM, Severi G, Stampfer MJ, Tjønneland A, Touvier M, Trichopoulou A, Weinstein SJ, Ziegler RG, Zhou CK, and Allen NE

Subjects
Adult, Biomarkers blood, Case-Control Studies, Cohort Studies, Cross-Sectional Studies, Humans, Lycopene, Male, Meta-Analysis as Topic, Middle Aged, Neoplasm Grading, Neoplasm Staging, Observational Studies as Topic, Prospective Studies, Prostate pathology, Prostatic Neoplasms epidemiology, Prostatic Neoplasms pathology, Risk Factors, Carotenoids blood, Prostatic Neoplasms blood, Vitamin A blood, alpha-Tocopherol blood
Abstract

Background: Individual studies have suggested that circulating carotenoids, retinol, or tocopherols may be associated with prostate cancer risk, but the studies have not been large enough to provide precise estimates of associations, particularly by stage and grade of disease., Objective: The objective of this study was to conduct a pooled analysis of the associations of the concentrations of 7 carotenoids, retinol, α-tocopherol, and γ-tocopherol with risk of prostate cancer and to describe whether any associations differ by stage or grade of the disease or other factors., Design: Principal investigators of prospective studies provided individual participant data for prostate cancer cases and controls. Risk by study-specific fifths of each biomarker was estimated by using multivariable-adjusted conditional logistic regression in matched case-control sets., Results: Data were available for up to 11,239 cases (including 1654 advanced stage and 1741 aggressive) and 18,541 controls from 15 studies. Lycopene was not associated with overall risk of prostate cancer, but there was statistically significant heterogeneity by stage of disease, and the OR for aggressive disease for the highest compared with the lowest fifth of lycopene was 0.65 (95% CI: 0.46, 0.91; P-trend = 0.032). No other carotenoid was significantly associated with overall risk of prostate cancer or with risk of advanced-stage or aggressive disease. For retinol, the OR for the highest compared with the lowest fifth was 1.13 (95% CI: 1.04, 1.22; P-trend = 0.015). For α-tocopherol, the OR for the highest compared with the lowest fifth was 0.86 (95% CI: 0.78, 0.94; P-trend < 0.001), with significant heterogeneity by stage of disease; the OR for aggressive prostate cancer was 0.74 (95% CI: 0.59, 0.92; P-trend = 0.001). γ-Tocopherol was not associated with risk., Conclusions: Overall prostate cancer risk was positively associated with retinol and inversely associated with α-tocopherol, and risk of aggressive prostate cancer was inversely associated with lycopene and α-tocopherol. Whether these associations reflect causal relations is unclear., (© 2015 American Society for Nutrition.)

Published
2015
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15. Association between all-cause and cause-specific mortality and the GOLD stages 1-4: A 30-year follow-up among Finnish adults.

Author

Mattila T, Vasankari T, Kanervisto M, Laitinen T, Impivaara O, Rissanen H, Knekt P, Jousilahti P, Saarelainen S, Puukka P, and Heliövaara M

Subjects
Adult, Cause of Death trends, Female, Finland epidemiology, Follow-Up Studies, Forced Expiratory Volume, Humans, Male, Proportional Hazards Models, Pulmonary Disease, Chronic Obstructive physiopathology, Retrospective Studies, Risk Factors, Severity of Illness Index, Survival Rate trends, Vital Capacity, Forecasting, Population Surveillance methods, Pulmonary Disease, Chronic Obstructive mortality, Risk Assessment methods
Abstract

Background: Mortality correlates with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria of airway obstruction. Yet, little data exist concerning the long-term survival of patients presenting with different levels of obstruction., Methods: We studied the association between all-cause and cause-specific mortality and GOLD stages 1-4 in a 30-year follow-up among 6636 Finnish men and women aged 30 or older participating in the Mini-Finland Health Study between 1978 and 1980., Results: After adjusting for age, sex, and smoking history, the GOLD stage of the subject showed a strong direct relationship with all-cause mortality, mortality from cardiovascular and respiratory diseases, and cancer. The adjusted hazard ratios of death were 1.27 (95% confidence interval (CI) 1.06-1.51), 1.40 (1.21-1.63), 1.55 (1.21-1.97) and 2.85 (1.65-4.94) for GOLD stages 1-4, respectively, with FEV1/FVC ≥70% as the reference. The association between GOLD stages 2-4 and mortality was strongest among subjects under 50 years of age at the baseline measurement. Cardiovascular mortality increased consistently for all GOLD stages., Conclusions: Airway obstruction indicates an increased risk for all-cause mortality according to the severity of the GOLD stage. We found that even stage 1 carries a risk for cardiovascular death independently of smoking history and other known risk factors., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Published
2015
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16. Mortality in the presence of a vertebral fracture, scoliosis, or Scheuermann's disease in the thoracic spine.

Author

Puisto V, Rissanen H, Heliövaara M, Knekt P, and Helenius I

Subjects
Adult, Aged, Aged, 80 and over, Cardiovascular Diseases mortality, Female, Finland epidemiology, Follow-Up Studies, Humans, Logistic Models, Male, Middle Aged, Neoplasms mortality, Proportional Hazards Models, Radiography, Thoracic, Respiratory Tract Diseases mortality, Scheuermann Disease diagnostic imaging, Scoliosis diagnostic imaging, Sex Distribution, Spinal Fractures diagnostic imaging, Scheuermann Disease mortality, Scoliosis mortality, Spinal Fractures mortality
Abstract

Purpose: Vertebral fractures and scoliosis, unlike Scheuermann's disease, have been associated with increased mortality. Total and cause-specific mortalities of these spinal deformities were studied to produce epidemiologic knowledge., Methods: A population of 16,010 Finnish men and women 20 to 92 years of age participated in a health examination from 1973-1976. Their spinal deformities were assessed from chest radiographs by two radiologists. Logistic regression and Cox's model were used to estimate risk ratios and to control confounding. The follow-up period was 30 years., Results: Vertebral fracture significantly predicted total mortality, and this increase in mortality was due to an excess of cancer and respiratory deaths. The increased risk of cancer death persisted even when those subjects with a history of cancer and the first 5 years of follow-up were excluded to avoid the effect of metastatic fractures, and when confounding was controlled. In this analysis the relative risk of cancer death in subjects with a baseline vertebral fracture was 2.02 (95% confidence interval: 1.23-3.31)., Conclusion: Vertebral fracture significantly predicted increased mortality from cancer. To clarify the mechanism, the fractures should be studied further for their associations with defined and site-specific cancer types.

Published
2008
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17. Flavonoid intake and risk of chronic diseases.

Author

Knekt P, Kumpulainen J, Järvinen R, Rissanen H, Heliövaara M, Reunanen A, Hakulinen T, and Aromaa A

Subjects
Adult, Arthritis, Rheumatoid epidemiology, Asthma epidemiology, Cataract epidemiology, Cerebrovascular Disorders epidemiology, Diabetes Mellitus, Type 2 epidemiology, Female, Humans, Lung Neoplasms epidemiology, Male, Middle Aged, Mortality, Myocardial Ischemia mortality, Neoplasms epidemiology, Prostatic Neoplasms epidemiology, Quercetin administration & dosage, Risk, Risk Factors, Surveys and Questionnaires, Chronic Disease epidemiology, Diet, Flavanones, Flavonoids administration & dosage, Hesperidin, Kaempferols, Quercetin analogs & derivatives
Abstract

Background: Flavonoids are effective antioxidants and may protect against several chronic diseases., Objective: The association between flavonoid intake and risk of several chronic diseases was studied., Design: The total dietary intakes of 10 054 men and women during the year preceding the baseline examination were determined with a dietary history method. Flavonoid intakes were estimated, mainly on the basis of the flavonoid concentrations in Finnish foods. The incident cases of the diseases considered were identified from different national public health registers., Results: Persons with higher quercetin intakes had lower mortality from ischemic heart disease. The relative risk (RR) between the highest and lowest quartiles was 0.79 (95% CI: 0.63, 0.99: P for trend = 0.02). The incidence of cerebrovascular disease was lower at higher kaempferol (0.70; 0.56, 0.86; P = 0.003), naringenin (0.79; 0.64, 0.98; P = 0.06), and hesperetin (0.80; 0.64, 0.99; P = 0.008) intakes. Men with higher quercetin intakes had a lower lung cancer incidence (0.42; 0.25, 0.72; P = 0.001), and men with higher myricetin intakes had a lower prostate cancer risk (0.43; 0.22, 0.86; P = 0.002). Asthma incidence was lower at higher quercetin (0.76; 0.56, 1.01; P = 0.005), naringenin (0.69; 0.50, 0.94; P = 0.06), and hesperetin (0.64; 0.46, 0.88; P = 0.03) intakes. A trend toward a reduction in risk of type 2 diabetes was associated with higher quercetin (0.81; 0.64, 1.02; P = 0.07) and myricetin (0.79; 0.62, 1.00; P = 0.07) intakes., Conclusion: The risk of some chronic diseases may be lower at higher dietary flavonoid intakes.

Published
2002
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