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J Pekkanen

Publications and source records attributed to J Pekkanen.

At least 73 records · Page 4Linked to original sources
PubMed1998

Association between the clastogenic effect in peripheral lymphocytes and human exposure to arsenic through drinking water.

We describe the association between structural chromosome aberrations (CAs) and parameters of exposure to arsenic among 42 individuals exposed to arsenic through well waters in Finland. The median concentration of arsenic in the wells was 410 microg/l, the total arsenic concentrations in urine (As-tot) was 180 microg/l, and in hair 1.3 microg/g, for current users (n = 32) of contaminated wells. Urinary arsenic species and CAs were also analyzed in eight control individuals from the same village who consumed water which contained arsenic <1.0 microg/l (detection limit). Increased arsenic exposure, indicated best by increased concentrations of arsenic species (inorganic arsenic, methylarsonic acid (MMA), dimethylarsinic acid (DMA)) in urine, was associated with increased frequency of CAs. The increased urinary ratio of MMA/As-tot and the decreased ratio of DMA/As-tot were associated with increased CAs when all aberration types, including gaps, were considered. Associations between CAs and arsenic exposure indicators were stronger among current users than among persons who had stopped using the contaminated well water for 2-4 months before sampling (ex-users, n = 10). Furthermore, there was a positive but not statistically significant association between CAs and arsenic in hair among the current users, but not among the ex-users, who still had relatively high arsenic concentrations in hair. The results suggest that the effect observed in the present study reflects relatively recent arsenic exposure.

Adolescent↗
PubMed1998

Serum eosinophil cationic protein (ECP) and eosinophil protein X (EPX) in childhood asthma: the influence of atopy.

The purpose of this study was to determine the value of serum measurements of eosinophil cationic protein (ECP) and eosinophil protein X (EPX) in diagnosing asthma in children, and to investigate the influence of concomitant allergic diseases and atopic sensitization, assessed by skin prick tests (SPT), on these markers. ECP and EPX were determined in 36 children with asthma, in 33 children with other symptoms from lower airways disease (OSLA), and in 166 control children. Sixteen children with asthma but no anti-inflammatory therapy had significantly higher concentrations of ECP and EPX (ECP: 27.5 microg/L, P < 0.001; EPX: 59.9 microg/L, P < 0.001) than the control children (ECP: 11.2 microg/L; EPX: 26.2 microg/L). In the 20 children on anti-inflammatory therapy, ECP values were similar to those of controls. The children with OSLA (ECP: 13.6 microg/L, P < 0.01; EPX: 47.2 microg/L, P < 0.001) differed significantly from controls. When using the value of 24.7 microg/L (97.5 percentile in the 68 non-atopic controls) as a pathologic upper limit for ECP, 10 (63%) of the 16 asthmatic children on no maintenance medication, two (10%) of the 20 asthmatics on maintenance therapy, and 11 (33%) of the 33 children with OSLA had high ECP; the same figure was only 18 (11%) in the 166 control children. Both ECP and EPX had a significant association with allergic disorders and with SPT reactivity. In multivariate logistic regression analysis, an elevated ECP was significantly associated with asthma (OR 2.3, 95%CI 1.1-4.9) and atopic dermatitis (2.9, 1.2-6.9), and an elevated EPX was significantly associated with asthma (2.61, 1.19-5.74) and allergic rhinoconjunctivitis (5.23, 1.46-18.73). We conclude that serum concentrations of both ECP and EPX are higher in asthmatic than in healthy children. However, other allergic diseases, such as allergic rhinoconjunctivitis, atopic dermatitis, and allergic skin sensitization also raise the concentrations of these markers. This limits their usefulness in the diagnosis of childhood asthma.

Anti-Inflammatory Agents↗
PubMed1998

Urinary excretion of arsenic species after exposure to arsenic present in drinking water.

The water from some drilled wells in southwest Finland contains high arsenic concentrations (min-max: 17-980 microg/L). We analyzed inorganic arsenic (As-i) and organic arsenic (monomethylarsonate [MMA] and dimethylarsinate [DMA]) species in urine and conducted a clinical examination of current users (n = 35) and ex-users (n = 12) of such wells. Ex-users had ceased to use the water from the wells 2-4 months previously. Urinary arsenic species were also analyzed from persons whose drinking water contained less than 1 microg/L of arsenic (controls, n = 9). The geometric means of the concentrations of total arsenic in urine were 58 microg/L for current users, 17 microg/L for ex-users, and 5 microg/L for controls. The excreted arsenic was associated with the calculated arsenic doses, and on average 63% of the ingested arsenic dose was excreted in urine. The ratios of MMA/DMA and As-i/As-tot (As-tot = As-i + MMA + DMA) in urine tended to be lower among the current users and in the higher exposure levels than in controls, suggesting that As-i was better methylated in current users. However, the differences were mainly explained by age; older persons were better methylators of inorganic arsenic than younger individuals. The arsenic content of hair correlated well with the past and chronic arsenic exposure; an increase of 10 microg/L in the arsenic concentration of the drinking water or an increase of 10-20 microg/day of the arsenic exposure corresponded to a 0.1 mg/kg increase in hair arsenic. The individuals were interviewed and complained of muscle cramps, mainly in the legs, and this was associated with elevated arsenic exposure. The present study demonstrates that arsenic methylation has no threshold at these exposure levels.

Adolescent↗
PubMed1998

Prevalence of allergic rhinitis and atopic dermatitis among children in four regions of Finland.

The primary aim of the study was to evaluate the prevalences of allergic rhinitis and atopic dermatitis and their regional differences among Finnish children. The secondary objective was to determine whether the responses to the questions used are affected by the pollen season if asked during such a season. In 1994-5, the self-reported prevalence of allergic symptoms in four regions of Finland was studied among 11,607 schoolchildren aged 13-14 years, as part of the International Study of Asthma and Allergies in Childhood (ISAAC). The prevalence of rhinoconjunctivitis during the preceding year was 16% in eastern Finland (Kuopio County, n=2821), 23% in southern Finland (Helsinki area, n=2771), 15% in southwestern Finland (Turku and Pori County, n=2983), and 16% in northern Finland (Lapland, n=3032). The respective prevalences of flexural dermatitis were 15%, 19%, 16%, and 18%. The surveys were performed in winter, except in the Helsinki area where the survey was carried out mainly in the spring pollen season. Among the children studied in autumn in Helsinki, the prevalence of rhinoconjunctivitis was 19% and that of flexural dermatitis 17%. In multivariate analysis, flexural dermatitis was slightly more common in Lapland than in all other areas. In contrast, no significant differences were found in rhinoconjunctivitis. The prevalences of both disorders were twice as high in girls as in boys. In conclusion, regional differences in the prevalence of allergic rhinitis and atopic dermatitis were small in our country, and the prevalence figures were rather similar to those reported from other European countries. Almost half of the children had suffered from at least one atopic disorder, and over one-third had had symptoms in the past year. A clear season-of-response effect was observed; the prevalence of rhinoconjunctivitis was 25% when studied during the pollen seasons in the Helsinki area.

Adolescent↗
PubMed1998

Do changes in cardiovascular risk factors explain the increasing socioeconomic difference in mortality from ischaemic heart disease in Finland?

STUDY OBJECTIVE: To estimate the extent to which changes in blood pressure, smoking, and serum cholesterol concentration explain the observed increase in socioeconomic differences in mortality from ischaemic heart disease (IHD) in Finland during the past 20 years. DESIGN: Predicted changes in mortality from IHD were calculated using logistic regression models with the risk factor levels assessed by cross sectional population surveys conducted in 1972, 1977, 1982, and 1987. The subjects included white collar and blue collar workers and farmers. The predicted changes were compared with the observed mortality changes in the same socioeconomic groups in the total population of the same geographical area. SETTING: North Karelia and Kuopio provinces, eastern Finland. PARTICIPANTS: 16,741 men and 16,389 women aged 30-59 randomly drawn from the population registers of the study areas. Mortality data were obtained from the total population in the same areas. MAIN RESULTS: In men, the changes in diastolic blood pressure, total serum cholesterol, and smoking predicted a 28% decline in the mortality from IHD among white collar workers, a 30% decline among blue collar workers, and a 33% decline in farmers. Observed declines in the same socioeconomic groups were 61%, 40%, and 37%, respectively. In women, the predicted decline was 41% among white collar workers, 35% among blue collar workers, and 39% among farmers. The respective observed declines were 57%, 43%, and 20%. CONCLUSIONS: Less than half of the decline in IHD mortality among white collar men was explained by the risk factor changes, while they explained 75% of the decline among blue collar men and 89% of the decline among male farmers. Changes in risk factors did not explain the increasing difference in IHD mortality between the socioeconomic groups, especially among men.

Adult↗
PubMed1998

Serum total cholesterol, apolipoprotein E epsilon 4 allele, and Alzheimer's disease.

The epsilon 4 allele of the apolipoprotein E (apoE) is associated with Alzheimer's disease (AD) and also with elevated serum total cholesterol and low-density lipoprotein levels. However, the interrelationships between apoE genotype, plasma cholesterol levels and AD risk have been studied very little. We examined the possible role of serum total cholesterol in the pathogenesis of AD in a population-based sample of 444 men, aged 70-89 years, who were survivors of the Finnish cohorts of the Seven Countries Study. Previous high serum cholesterol level (mean level > or = 6.5 mmol/l) was a significant predictor of the prevalence of AD (odds ratio = 3.1; 95% confidence interval = 1.2, 8.5) after controlling for age and the presence of apoE epsilon 4 allele. In men who subsequently developed AD the cholesterol level decreased before the clinical manifestations of AD. We conclude that high serum total cholesterol may be an independent risk factor for AD and some of the effect of the apoE epsilon 4 allele on risk of AD might be mediated through high serum cholesterol.

Adult↗
PubMed1998

Prevalence of childhood asthma, rhinitis and eczema in Scandinavia and Eastern Europe.

There is evidence that the prevalence of allergies and asthma differs between populations in western and eastern Europe. This study investigated the prevalence of wheezing, rhinitis and eczema among schoolchildren in urban and rural areas of Scandinavia and the formerly socialist countries of Eastern Europe. A total of 79,000 children from two age groups (13-14 yrs and 6-7 yrs) in 18 study centres responded to a questionnaire within the International Study of Asthma and Allergy in Children (ISAAC). The 12 month period prevalence of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema was calculated. The prevalence of wheezing among the 13-14 yr old children was 11.2-19.7% in Finland and Sweden, 7.6-8.5% in Estonia, Latvia and Poland and 2.6-5.9% in Albania, Romania, Russia, Georgia and Uzbekistan (except Samarkand). The prevalence of itching eyes and flexural dermatitis varied in a similar manner between the three regions. The regional differences were less pronounced among the 6-7 yr old children in the seven participating centres. The highest prevalence of rhinitis was recorded in April-July in Scandinavia and during the winter months in the other countries. The prevalence of atopy-related disorders was higher in Scandinavia than in Estonia, Latvia and Poland, which in turn had a higher prevalence than five other countries of eastern Europe with a culture less similar to western Europe. This supports the hypothesis that "Western life style" is associated with a high prevalence of childhood allergy.

Adolescent↗
PubMed1998

Daily variations in air pollution and respiratory health in a multicentre study: the PEACE project. Pollution Effects on Asthmatic Children in Europe.

The Pollution Effects on Asthmatic Children in Europe (PEACE) study is a multicentre study of the acute effects of particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10), black smoke (BS), sulphur dioxide (SO2) and nitrogen dioxide (NO2) on the respiratory health of children with chronic respiratory symptoms. The study was conducted in the winter of 1993/1994 by 14 research centres in Europe. A total of 2,010 children, divided over 28 panels in urban and suburban locations, was followed for at least 2 months. Exposure to air pollution was monitored on a daily basis. Health status was monitored by daily peak expiratory flow (PEF) measurements and a symptom diary. The association between respiratory health and air pollution levels was calculated with time series analysis. Combined effect estimates of air pollution on PEF or the daily prevalence of respiratory symptoms and bronchodilator use were calculated from the panel-specific effect estimates. Fixed effect models were used and, in cases of heterogeneity, random effect models. No clear associations between PM10, BS, SO2 or NO2 and morning PEF, evening PEF, prevalence of respiratory symptoms or bronchodilator use could be detected. Only previous day PM10 was negatively associated with evening PEF, but only in locations where BS was high compared to PM10 concentrations. There were no consistent differences in effect estimates between subgroups based on urban versus suburban, geographical location or mean levels of PM10, BS, SO2 and NO2. The lack of association could not be attributed to a lack of statistical power, low levels of exposure or incorrect trend specifications. In conclusion, the PEACE project did not show effects of particles with a 50% cut-off aerodynamic diameter of 10 microm, black smoke, sulphur dioxide or nitrogen dioxide on morning or evening peak expiratory flow or the daily prevalence of respiratory symptoms and bronchodilator use.

Air Pollution↗
PubMed1998

Role of known risk factors in explaining the difference in the risk of coronary heart disease between eastern and southwestern Finland.

We analysed to what extent cardiovascular risk factors may explain the observed difference in the risk of coronary heart disease (CHD) between two areas with markedly different CHD incidence. The study included 7049 men aged 25-64 years who had participated in a baseline survey in 1982 or in 1987 in the Kuopio and North Karelia provinces of eastern Finland and in the Turku-Loimaa region of southwestern Finland. During the baseline surveys the following factors were determined: smoking, blood pressure, cholesterol, high-density lipoprotein cholesterol, diabetes, height, body mass index, family history of CHD and socioeconomic status. The cohorts were followed for coronary events until the end of 1994. CHD risk was about 40% higher in eastern than in southwestern Finland. The levels of most of the measured risk factors were also higher in eastern Finland. Differences in risk factor levels explained about 40% of the excess CHD risk in eastern Finland. The impact of the classical risk factors, such as smoking, cholesterol and blood pressure, on the regional difference was smaller than expected. Single risk factor measurements in our population surveys, however, may not have correctly reflected the long-term exposure of individuals to these risk factors, particularly because the surveys were carried out within a period during which these risk factors were undergoing favourable changes in the Finnish population. In addition to the classical risk factors, regional differences in body height and socioeconomic status were associated with the regional differences in CHD risk.

Adult↗
PubMed1998

Intra- and interindividual variability of hemostatic factors and traditional cardiovascular risk factors in a three-year follow-up.

Elucidation of the key role of thrombosis in cardiovascular disease events has arisen considerable interest in hemostatic factors and in the repeatability of their determinations. Data on long-term repeatability has, however, remained scanty. We examined twice 208 men and 265 women in North Karelia, eastern Finland. The baseline examination was a part of the FINRISK 1992 Hemostasis Study and the age-range of participants was between 45-64 years. The re-examination took place three years later in 1995. Both surveys followed the same protocol and were carried out during the same season. Spearman rank correlation coefficients between 1992 and 1995 measurements of fibrinogen, factor VII coagulant activity (FVII:C), factor VII antigen (FVII:Ag), and plasminogen were among men 0.72, 0.77, 0.46 and 0.56, respectively. For total cholesterol, HDL-cholesterol, triglycerides and diastolic blood pressure the corresponding coefficients were 0.74, 0.83, 0.66, and 0.54. In women, the coefficient of fibrinogen was lower than in men, 0.62, otherwise the results were similar. Of men belonging to the highest quarter of fibrinogen, FVII:C, FVII:Ag and plasminogen in 1992, 65%, 60%, 53% and 60% belonged to the highest quarter of respective distributions also in 1995. In women, the corresponding proportions were 64%, 65%, 46% and 58%. The modest repeatability of FVII:Ag and plasminogen was mainly due to the high intraindividual variability. However, in comparisons of plasma levels between two groups, relatively small sample sizes seemed to give adequate statistical power to detect possible differences in FVII:Ag and plasminogen. In conclusion, the long-term repeatability of fibrinogen and FVII:C is similar to that of triglycerides and even better than that of diastolic blood pressure, but somewhat lower than the repeatability of total cholesterol. FVII:Ag and plasminogen did not have very good repeatability and more than one measurement of them should be considered if they are used as predictors of cardiovascular disease in prospective studies.

Cardiovascular Diseases↗
PubMed1997

Effects of ultrafine and fine particles in urban air on peak expiratory flow among children with asthmatic symptoms.

It has been suggested that ultrafine particles in urban air may cause the health effects associated with thoracic particles (PM10). We therefore compared the effects of daily variations in particles of different sizes on peak expiratory flow (PEF) during a 57-day follow-up of 39 asthmatic children aged 7-12 years. The main source of particulate air pollution in the area was traffic. In addition to the measurements of PM10 and black smoke (BS) concentrations, an electric aerosol spectrometer was used to measure particle number concentrations in six size classes ranging from 0.01 to 10.0 microns. Daily variations in BS and particle number concentrations in size ranges between 0.032 and 0.32 micron and between 1.0 and 10.0 microns were highly intercorrelated (correlation coefficients about 0.9). Correlations with PM10 were somewhat lower (below 0.7). All these pollutants tended also to be associated with declines in morning PEF. However, the only statistically significant associations were observed with PM10 and BS. Different time lags of PM10 were also most consistently associated with declines in PEF. Therefore, in the present study on asthmatic children, the concentration of ultrafine particles was no more strongly associated with variations in PEF than PM10 or BS, as has earlier been suggested.

Air Pollutants↗
PubMed1997

Childhood asthma in four regions in Scandinavia: risk factors and avoidance effects.

BACKGROUND: The high and increasing prevalence of childhood asthma is a major public health issue. Various risk factors have been proposed in local studies with different designs. METHODS: We have made a questionnaire study of the prevalence of childhood asthma, potential risk factors and their relations in four regions in Scandinavia (Umeå and Malmö in Sweden, Kuopio in eastern Finland and Oslo, Norway). One urban and one less urbanized area were selected in each region, and a study group of 15962 children aged 6-12 years was recruited. RESULTS: The prevalence of symptoms suggestive of asthma varied considerably between different areas (dry cough 8-19%, asthma attacks 4-8%, physician-diagnosed asthma 4-9%), as did the potential risk factors. Urban residency was generally not a risk factor. However, dry cough was common in the most traffic polluted area. Exposure to some of the risk factors. such as smoking indoors and moisture stains or moulds at home during the first 2 years of life, resulted in an increased risk. However, current exposure was associated with odds ratios less than one. CONCLUSIONS: Our findings were probably due to a combination of early impact and later avoidance of these risk factors. The effects of some risk factors were found to differ significantly between regions. No overall pattern between air pollution and asthma was seen, but air pollution differed less than expected between the areas.

Air Pollution↗
PubMed1997

Air pollution and respiratory health among children with asthmatic or cough symptoms.

During the winter of 1994, the association between daily changes in air pollution and in the respiratory health of children 7 to 12 yr of age were studied in Kuopio, Finland. Seventy-four children with asthmatic symptoms and 95 children with cough only, living either in urban or suburban areas, were followed for 3 mo. During the study period, the mean daily concentration of particulate air pollution (PM10) was 18 micrograms/m3 in the urban area and 13 micrograms/m3 in the suburban area. Lagged concentrations of PM10, black smoke, and NO2 were significantly associated with declines in morning peak expiratory flow (PEF) among asthmatic children. The regression coefficient (x10) for a 2-d lag of PM10 was -0.911 (SE, 0.386) in the urban and -1.05 (0.596), in the suburban area. Among children with cough only, PM10, black smoke, and NO2 were not significantly associated with PEF. In the urban area, there was a significant association between SO2 and morning and evening PEF and incidence of upper respiratory symptoms among children who cough only. No other associations between air pollution and evening PEF or respiratory symptoms were observed. This study suggests that particulate air pollution is associated with respiratory health, especially among children with asthmatic symptoms.

Air Pollution↗
PubMed1997

Short-term variations in oscillatory and spirometric lung function indices among school children.

The aim of this study was to compare immediate, daily and weekly variation in respiratory resistance measured by means of the forced oscillation technique (Rrs,FOT) to spirometric indices in 7-12 year old children with chronic respiratory symptoms. The lung function measurements were performed in 19 children on 4 days, i.e. two consecutive days during two consecutive weeks. On each day, the measurements were carried out at the same time of day and always repeated three times. In addition, Rrs,FOT and spirometric lung function indices were compared with an exercise challenge test in 12 children. Intrasubject coefficients of variation (CoVs) for Rrs,FOT were larger than those for spirometric indices. Only in the immediately repeated measurements was the CoV of maximal expiratory flow at 25% vital capacity larger than that of Rrs,FOT (16.6 vs 14.9%). At all time intervals, the smallest CoVs were observed in forced vital capacity (FVC) or in the ratio of forced expiratory volume in one second to FVC (2.0-2.6%). When excluding Rrs,FOT values which were not within 2 SD (0.11 kPa.L-1.s) of the differences between the immediately repeated measurements, the CoV of the immediately repeated measurements of Rrs,FOT was reduced to 9.1%, being smaller than that of maximal mid-expiratory flow (10.1%). However, even then the day-to-day variation in Rrs,FOT was clearly larger (16.0%) than those of the airflow indices at specified lung volumes (7.2-8.3%). This was also true for the weekly variation. In the exercise challenge test, there were larger changes in Rrs,FOT values than in the spirometric indices, but Rrs,FOT was the most sensitive index to detect changes in the respiratory system. In conclusion, the variation in Rrs,FOT values was larger than that of most spirometric indices. When a reliability index was applied, the immediate variation in Rrs,FOT values was comparable to those of the airflow indices at specified lung volumes. Rrs,FOT was also the most sensitive index in the exercise challenge test, and therefore it seems to be suitable for detection of short-term functional changes in the respiratory system. However, the relatively low repeatability of Rrs,FOT over days and weeks may limit its applicability to longer-term follow-ups.

Airway Resistance↗
PubMed1997

Prevalence of asthma symptoms in video and written questionnaires among children in four regions of Finland.

The aim of this study was to determine whether there are regional differences in the prevalence of childhood asthma in Finland. A secondary objective was to assess the concordance between a written and a video questionnaire on asthma symptoms. In 1994-1995, the self-reported prevalence of asthma symptoms in four regions of Finland was studied among 11,607 schoolchildren aged 13-14 yrs, as part of the International Study of Asthma and Allergies in Childhood (ISAAC). The ISAAC written and video (AVQ 3,0) questionnaires were administered in the school setting. The prevalences of any wheezing during the previous 12 months in the ISAAC video questionnaire were 10% in East Finland (Kuopio County, n=2,821), 12% in South Finland (Helsinki area, n=2,771), 12% in Southwest Finland (Turku and Pori County, n=2,983), and 11% in North Finland (Lapland, n=3,032). The prevalences in the ISAAC written questionnaire were 13, 20, 15, and 16%, respectively. The surveys were performed during winter, except in Helsinki where the survey was carried out mainly during the spring pollen season. During autumn, the prevalence in the written questionnaire in Helsinki was 16%. In multivariate analysis, boys had a lower prevalence than girls, and smokers a threefold higher prevalence than nonsmokers. In conclusion, the prevalence of childhood asthma is lower in Finland than in other European countries, and may be even lower in the eastern part of the country. In contrast to the results from some other European countries, prevalences were lower in the video than in the written questionnaire, which suggests that translating the word "wheezing" into other languages, including Finnish, may produce results that cannot be compared. The strong association of smoking with wheeze both in the video and written questionnaires should be considered in further analysis of the ISAAC study.

Adolescent↗
PubMed1997

Long-term outcome of pulmonary function in farmer's lung: a 14 year follow-up with matched controls.

The long-term outcome of pulmonary function was evaluated in farmer's lung (FL) patients compared to representative control farmers. This is, to our knowledge, the first such study which has included a control group. Clinical examinations were conducted in 89 FL patients and 84 control farmers, matched by age, sex, and smoking habits. The mean time after the first diagnosed episode of FL was 14 yrs. The mean transfer factor of the lung for carbon monoxide (TL,CO) was on average 12% lower (p < 0.001) in FL patients compared to control farmers. In spirometry, the mean maximum expiratory flow at 50% of vital capacity (MEF50) was lower (p = 0.08) in FL patients but there were no differences in mean vital capacity (VC) or forced expiratory volume in one second (FEV1) between FL patients and control farmers. However, airway obstruction, defined as an FEV1/VC less than 88% of predicted, was more common in FL patients than in control farmers (33 versus 17%; p = 0.02). Patients who had had recurrent episodes of FL had a significantly lower mean TL,CO compared to those FL patients who had experienced only a single episode. In conclusion, impairment of the pulmonary transfer factor is the most important long-term consequence of farmer's lung. However, farmer's lung may also lead to development of airway obstruction.

Farmer's Lung↗
PubMed1996

Body weight, cardiovascular risk factors, and coronary mortality. 15-year follow-up of middle-aged men and women in eastern Finland.

BACKGROUND: Body weight is closely related to several known cardiovascular risk factors, but it may also have an independent effect on the risk of coronary heart disease (CHD). In this study, we analyzed the association between body mass index (BMI) and smoking, serum cholesterol, and blood pressure at baseline, as well as how BMI and the other risk factors are related to CHD mortality. METHODS AND RESULTS: A total of 16 113 men and women aged 30 to 59 years were examined in eastern Finland in either 1972 or 1977. Serum cholesterol and blood pressure had a positive association and smoking had a negative association with BMI. During the 15-year prospective follow-up, mortality from CHD was positively associated with BMI. The BMI-associated risk ratio of CHD mortality, adjusted for age and study year, estimated from the Cox proportional hazards model was 1.04 (per kg/m2) (P < .001) among men. Inclusion of smoking in the model increased the risk ratio for BMI, whereas inclusion of serum cholesterol and blood pressure decreased it. In the model that included age, study year, and all three major cardiovascular risk factors, the BMI-associated risk ratio was 1.03 (P = .027). Among women, the BMI-associated risk ratio of CHD mortality adjusted for age and study year was 1.05 (P = .023) and the multifactorial adjusted risk ratio was 1.03 (P = .151). CONCLUSIONS: Obesity is an independent risk factor for CHD mortality among men and also contributes to the risk of CHD among women. Part of the BMI-associated risk of CHD mortality is mediated through other known cardiovascular risk factors. By preventing overweight, a substantial part of CHD mortality may be prevented.

Blood Pressure↗