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Pekka Jousilahti

Publications and source records attributed to Pekka Jousilahti.

At least 19 recordsLinked to original sources
PubMed2007

Trends in lifestyle factors affecting blood pressure in hypertensive and normotensive Finns during 1982-2002.

OBJECTIVE: To assess the trends in blood pressure (BP) affecting lifestyle factors in hypertensive and normotensive Finns from 1982 to 2002. DESIGN AND SETTING: Five independent cross-sectional population surveys conducted in 1982, 1987, 1992, 1997 and 2002 in the provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland. PARTICIPANTS: Stratified random samples of men and women aged 25-64 years were drawn from the national population register. The participants (n = 28 235) were classified into four groups according to their BP level and treatment status: normotensive, unaware hypertensive, aware but untreated hypertensive, and treated hypertensive subjects. MAIN OUTCOME MEASURES: Alcohol intake, body mass index (BMI), 24-h urinary sodium and potassium excretion (a subsample of 5849 subjects) and the proportion of subjects with leisure-time physical activity (LTPA) at least three times a week. RESULTS: Mean BMI increased significantly in all groups except in untreated hypertensive women. Alcohol intake increased in all men but especially in hypertensive women (P < 0.001). The 24-h urinary sodium excretion decreased significantly in all BP groups. The proportion of subjects with a recommended level of LTPA increased significantly and similarly in all BP groups (P < 0.001). CONCLUSIONS: The unfavourable trends observed in mean BMI and alcohol intake in the entire population should be reversed in order to decrease the frequency of hypertension in Finland. The health behaviours of hypertensive subjects should be carefully monitored and modified in a more systematic and efficient way than at present.

Adult↗
PubMed2006

Serum antibody response to periodontal pathogens and herpes simplex virus in relation to classic risk factors of cardiovascular disease.

BACKGROUND: Increasing evidence links chronic infections, especially burden of several infections, with increased risk for cardiovascular diseases (CVD). We studied joint immune response against two major periodontal pathogens and herpes simplex virus (HSV) in relation to established risk factors of CVD. METHODS: Serum antibody levels to HSV, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis were determined by ELISA. The study included 1107 subjects, 734 from Finland and 373 from Russia. RESULTS: Combined antibody response to periodontal pathogens was associated inversely (OR, 95% CI) with high-density lipoprotein (HDL) cholesterol concentration (beta = 0.35; 0.20, 0.60; P < 0.001) and directly with HSV antibody quartiles: compared with the first quartile, ORs (95% CI) for quartiles 2-4 were 1.43 (0.88-2.32), 1.74 (1.07-2.82), and 1.89 (1.18-3.02), respectively (P for trend <0.001), after adjusting for age, gender, area, education, smoking, BMI, alcohol, triglycerides, and number of teeth. In linear regression analysis, the 3-pathogen antibody score (comprising antibody levels against periodontal pathogens and HSV) was inversely associated with HDL cholesterol concentration (beta = -0.067/1 mmol/l; -0.235, -0.018; P < 0.05). CONCLUSIONS: HSV infection may promote infection by periodontal pathogens. Furthermore, the infectious burden comprising HSV and periodontitis may increase the risk for CVD by clearly decreasing HDL cholesterol concentrations.

Adult↗
PubMed2006

Occupational, commuting and leisure-time physical activity in relation to coronary heart disease among middle-aged Finnish men and women.

OBJECTIVE: To examine the association of different levels of occupational, commuting, and leisure-time physical activity with the risk of coronary heart disease (CHD) events. METHODS AND RESULTS: The study comprised 47,840 Finnish participants aged 25-64 years without history of CHD and stroke at baseline. During a mean follow-up of 18.9 years, 4660 new CHD events were documented. The multivariable-adjusted (age, body mass index, systolic blood pressure, total cholesterol, education, alcohol consumption, smoking, history of diabetes, and other two types of physical activity) hazard ratios (HRs) of CHD events associated with low, moderate, and high occupational activity were 1.00, 0.87, and 0.90 (P(trend)=0.019) for men, and 1.00, 0.75, and 0.80 (P(trend)<0.001) for women, respectively. The multivariable-adjusted HRs of CHD events associated with low, moderate, and high leisure-time physical activity were 1.00, 0.95, and 0.84 (P(trend)=0.026) for men, and 1.00, 0.85, and 0.77 (P(trend)=0.003) for women, respectively. Active commuting had a significant inverse association with the risk of CHD events in women but not in men. CONCLUSION: Moderate or high levels of occupational or leisure-time physical activity are associated with a reduced risk of CHD. Daily walking or cycling to and from work is associated with a decreased risk of CHD among women.

Adult↗
PubMed2006

Systemic exposure to Porphyromonas gingivalis predicts incident stroke.

Periodontitis has been associated with an increased risk for atherosclerosis. Prospective data concerning its association with risk of stroke, especially those measuring systemic exposure to periodontal pathogens, are scarce. We analyzed if serum antibody levels to two major periodontopathogens predict stroke. The cases and the controls were nested in a random population-based sample of 8911 subjects aged 30-59 years at baseline, who participated in a cardiovascular disease (CVD) risk factor survey in Eastern Finland in 1977 and were followed for 15 years. CVD-free controls (n=516) were matched for sex and 5-year age group with stroke cases (n=470). In subjects free from CVD at baseline (n=893), systemic exposure to Porphyromonas gingivalis increased the risk of stroke: compared to seronegative subjects, men IgA-seropositive and women IgG-seropositive for P. gingivalis had a multivariate odds ratio (OR) (95% CI) of 1.63 (1.06-2.50) and 2.30 (1.39-3.78) for stroke, respectively. Higher OR was observed in males, who had never smoked: compared to seronegative men, P. gingivalis IgA-seropositive men had a multivariate OR of 3.31 (1.31-8.40, p=0.012) for stroke. No association between antibody levels to Actinobacillus actinomycetemcomitans and stroke was found. The results suggest that the systemic exposure to P. gingivalis may predispose to incident stroke.

Adult↗
PubMed2006

Serum gamma-glutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28,838 middle-aged men and women.

AIMS: Serum gamma-glutamyltransferase (GGT) concentration may be involved in atherosclerosis. This study examined if serum GGT predicted coronary heart disease (CHD), especially differentiating non-fatal myocardial infarction (MI) and fatal CHD event, among the general population or participants with type-2 diabetes. METHODS AND RESULTS: A prospective study of 28,838 Finnish men and women aged 25-74 years was performed (1467 incident CHD cases; a median follow-up time of 11.9 years). Serum GGT cutpoints were the 25th, 50th, 75th, and 90th sex-specific percentiles. After adjustment for known cardiovascular risk factors, compared with the lowest GGT category, hazard ratios (HR) were 1.15, 1.25, 1.27, and 1.57 among men and 1.03, 1.22, 1.32, and 1.44 among women in other four GGT categories (P for trend <0.01, respectively). However, stronger associations were observed among subjects aged <60 and among alcohol drinkers. The strength of association was similar for non-fatal MI and for fatal CHD. Among subjects with type-2 diabetes, the corresponding adjusted HRs were 1.29, 1.57, 1.88, and 1.78 (P trend=0.03, men and women combined). CONCLUSION: This study suggests an independent mechanism linking serum GGT to CHD among general population. Even though the strength of association appeared to be modest among all subjects, stronger associations were observed among subjects aged <60 and among alcohol drinkers. Especially, measurement of serum GGT among type-2 diabetics may be helpful to predict the future risk of CHD.

Adult↗
PubMed2006

Infectious burden as a determinant of atopy-- a comparison between adults in Finnish and Russian Karelia.

BACKGROUND: Evidence of the influence of pathogen exposure on the development of atopy and atopic disease is not unequivocal. We investigated the association between markers of infections and occurrence of atopy among adults in eastern Finland and western Russia, two adjacent areas with profound differences in living conditions and lifestyles. METHODS: Randomly selected adults aged 25-54 years from Finland (n = 790) and from Russia (n = 387) participated in the study. Skin prick tests were performed to 11 common airborne allergens, and at least one positive prick reaction was considered to indicate atopy. Antibodies to different pathogens including hepatitis A virus (HAV), Helicobacter pylori, Toxoplasma gondii, herpes simplex virus (HSV), Chlamydia pneumoniae and the periodontal pathogens Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans were measured. RESULTS: In Finland 34.3% and in Russia 23.3% of the study population was atopic (p < 0.001). Seroprevalences to all these pathogens were significantly higher among the Russians. In multivariate logistic regression analysis, only H. pylori was inversely associated with atopy in Russia. A further stepwise analysis revealed that H. pylori alone can explain 32% of the difference in atopy between the countries, and T. gondii, A. actinomycetemcomitans, HSV and C. pneumoniae had a slightly additive effect, whereas, unexpectedly, seropositivity to HAV and, to a lesser extent, P. gingivalis had an opposite effect. The net result of the stepwise analysis showed that 44% of the difference in atopy between the countries could be explained by seropositivity to these seven pathogens. CONCLUSIONS: Seropositivity to select pathogens, particularly to H. pylori, could explain a substantial part of the difference in atopy prevalence between Finland and Russia. Exposure to HAV was not associated with protection against atopy in this adult population.

Adult↗
PubMed2006

Modifiable risk factors have an impact on socio-economic differences in coronary heart disease events.

OBJECTIVES: To investigate the association of socio-economic status, defined by occupational class, income and education, with coronary heart disease (CHD) morbidity and mortality, and further to analyse to which extent modifiable risk factors may explain socio-economic differences in CHD risk. DESIGN: A population-based prospective cohort study including 9,061 men and 10,211 women aged 35-64 at baseline who participated in a cardiovascular risk factor survey in 1982, 1987, 1992 or 1997 in Finland. The subjects were followed for CHD events up till the end of 2001. Cox's proportional hazards model was used in the analysis. RESULTS: Male manual workers had a double risk of CHD death compared with upper-level employees (HR=2.00, 95% CI 1.35-2.97). This excess risk was reduced by 31% when adjusted for traditional cardiovascular risk factors and most of this reduction was due to smoking. CONCLUSIONS: Modifiable risk factors explained about a third of the excess CHD mortality between manual workers and upper-level employees in men. Among women the differences between socio-economic groups were not statistically significant.

Adult↗
PubMed2006

C-reactive protein, interleukin-6 and tumor necrosis factor alpha as predictors of incident coronary and cardiovascular events and total mortality. A population-based, prospective study.

Previous studies have shown an association between serum C-reactive protein (CRP) and cardiovascular disease (CVD) risk. The roles of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFalpha) are less well established. The aim of the present study was to analyze the associations of CRP, IL-6 and TNFalpha with incident coronary heart disease (CHD) events, CVD events, and total mortality. A random population sample, including men and women aged 25-64 years was examined in Finland in 1992. The sample size was 7,927 and 6,051 (76%) participated. The cohort was followed up until the end of 2001. During the follow-up, 151 incident CHD events, 205 CVD events and 183 deaths from any cause were observed. A stratified random subsample (n=313) was used as the comparison group. After adjustment for conventional CVD risk factors, CRP showed a significant association with CHD risk in men (HR=2.39, 1.08-5.28, comparing fourth quartile to the first quartile). This association remained significant after further adjustment for TNFalpha. TNFalpha also was a significant predictor of CHD among men, but the association was nonlinear (HR=2.21, 1.18-4.14 comparing the three upper quartiles to the first quartile). Further adjustment for CRP did not change this association substantially. Both CRP and TNFalpha predicted also all CVD events and total mortality among men. Among women the findings were nonsignificant. In conclusion, CRP and TNFalpha were significant, independent predictors of CHD and CVD events and total mortality among men. These findings provide further support to the important role of inflammation in the pathogenesis of CVD.

Adult↗
PubMed2006

Evaluation of lipid-lowering therapy and cholesterol goal attainment in Finland: the National FINRISK Study.

BACKGROUND: European and US study findings show that patients in primary care and specialty care are not adequately treated for cholesterol reduction. OBJECTIVE: To evaluate lipid-lowering treatment in Finland, estimate the proportions of subjects who are achieving cholesterol goals, and assess the influence of determinants on goal attainment. METHODS: Subgroup analysis of the FINRISK study, a national study of cardiovascular disease risk factors in Finland. Study participants, the subgroup of patients on lipid-lowering therapy from FINRISK, completed a postal self-administered questionnaire on health/health behavioral factors. Serum total cholesterol (TC) and other clinical variables were measured using a standardized protocol. Ten-year coronary risk was computed using Framingham risk equations. The influence of certain factors on goal attainment was determined by logistic regression analysis. The main outcome measure was the proportion of subjects who were receiving lipid-lowering therapy and achieved a TC goal of <5 mmol/L (<194 mg/dL). RESULTS: Among 9581 respondents, 622 subjects were on lipid-lowering therapy. Of these, 68 subjects were excluded because of missing data on TC and/or the type/dose of therapy. Among the 554 subjects included, 210 (38%) were secondary-prevention patients and 51% had 10-year coronary risk >/=20%. Approximately two-thirds of subjects were prescribed simvastatin (42%) or atorvastatin (26%), and about half (51%) were prescribed low-equipotency HMG-CoA reductase inhibitors (statins). There was no difference in equipotent doses of statins prescribed for primary and secondary prevention. About half (54%) of subjects did not attain their cholesterol goal (TC <5.0 mmol/L [194 mg/dL]). Subjects with coronary heart disease (odds ratio [OR] 3.00; 95% CI 2.07, 4.35) and patients prescribed medium-to-high equipotent statins (OR 1.93; 95% CI 1.35, 2.76) were more likely to achieve cholesterol goals, whereas postmenopausal women (OR 0.61; 95% CI 0.42, 0.88) were less likely than men to achieve cholesterol goals. CONCLUSION: Most (92%) patients receiving lipid-lowering therapy in a Finnish population were managed on statin monotherapy and approximately half of the patients did not achieve their recommended cholesterol goals. More effective and safe therapies are needed to enhance cholesterol goal attainment. These treatments might include regimens that act on two or more pharmacologic pathways.

Aged↗
PubMed2006

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Journal Article↗
PubMed2005

The impact of history of hypertension and type 2 diabetes at baseline on the incidence of stroke and stroke mortality.

BACKGROUND AND PURPOSE: Both hypertension and diabetes are strong predictors of stroke, but very few studies have assessed their joint effect on stroke risk. We evaluated prospectively the joint association of history of hypertension and type 2 diabetes on the incidence of stroke and stroke mortality. METHODS: We prospectively followed 49,582 Finnish subjects aged 25 to 74 years without a history of stroke and coronary heart disease at baseline. Hazards ratios (HRs) for stroke risk were estimated by the hypertension and diabetes status. RESULTS: During a mean follow-up of 19.1 years, 2978 incident stroke events were recorded, of which 924 were fatal. Age-, sex-, and study year-adjusted HRs of stroke incidence were 1.35 (95% CI, 1.21 to 1.51), 1.98 (95% CI, 1.79 to 2.19), 2.54 (95% CI, 1.61 to 4.01), 3.51 (95% CI, 2.40 to 5.14), and 4.50 (95% CI, 3.60 to 5.61), respectively, among subjects with hypertension I (blood pressure 140 to 159/90 to 94 mm Hg) only, with hypertension II (blood pressure > or =160/95 mm Hg, or using antihypertensive drugs) only, with diabetes only, with both hypertension I and diabetes, and with both hypertension II and diabetes compared with the subjects without either of the diseases. The corresponding HRs of stroke mortality were 1.47, 2.62, 3.06, 5.59, and 9.27, respectively. Additional adjustments for body mass index, cholesterol, education, smoking, alcohol consumption, and physical activity did not appreciably change these risk estimates. Blood pressure affected the risk of stroke similarly in diabetic and nondiabetic subjects. CONCLUSIONS: Hypertension and type 2 diabetes increase stroke risk independently, and their combination increases the risk drastically. A significant proportion of the risk of stroke assumed to be related to hypertension may be attributable to concomitant diabetes.

Adult↗
PubMed2005

Growing disparities in atopy between the Finns and the Russians: a comparison of 2 generations.

BACKGROUND AND OBJECTIVE: Western lifestyle has consistently been associated with the current asthma and atopy epidemics. We examined the occurrence and risk factors of atopy among schoolchildren and their mothers in 2 geographically adjacent areas with fundamental differences in living conditions and lifestyles. METHODS: A population-based study of 2 generations was carried out in eastern Finland and in western Russia. Randomly selected schoolchildren aged 7 to 16 years (367 in Finland and 446 in Russia) and their mothers (365 and 437, respectively) were enrolled. Data were obtained by using a modified International Study of Asthma and Allergies in Childhood questionnaire and by performing skin prick tests against 14 common airborne and food allergens. RESULTS: In children a 4-fold higher risk for atopy (> or =1 positive prick test result) was found in Finland compared with Russia. Sensitization rates in Finland were generally higher among children compared with those of their mothers, whereas in Russia the opposite trends emerged. Parental farming in early life (<1 year) in Finland (odds ratio [OR], 0.53; 95% CI, 0.28-0.99) and in Russia (OR, 0.47; 95% CI, 0.22-1.03) and currently in Finland (OR, 0.45; 95% CI, 0.22-0.91) conferred protection against atopy. Having pets, dogs in Finland (OR, 0.57; 95% CI, 0.35-0.95) and cats in Russia (OR, 0.43; 95% CI, 0.24-0.80), in early life was also inversely associated with atopy. CONCLUSION: Atopy was several-fold more common in Finland compared with in Russia, and disparities in sensitization rates between the countries have further increased during these generations. The similarity of explanatory variables of atopy in both countries suggests that determinants of atopy are shared, at least in similar geoclimatic conditions.

Adolescent↗
PubMed2005

Leisure time, occupational, and commuting physical activity and the risk of stroke.

BACKGROUND AND PURPOSE: The role of physical activity, especially that of occupational and commuting physical activity, in the prediction of stroke risk is not properly established. We assessed the relationship of different types of physical activity with total and type-specific stroke risk. METHODS: We prospectively followed 47 721 Finnish subjects 25 to 64 years of age without a history of coronary heart disease, stroke, or cancer at baseline. Hazard ratios (HRs) for incident stroke were estimated for different levels of leisure time, occupational, and commuting physical activity. RESULTS: During a mean follow-up of 19.0 years, 2863 incident stroke events were ascertained. The multivariate-adjusted (age, sex, area, study year, body mass index, systolic blood pressure, cholesterol, education, smoking, alcohol consumption, diabetes, and other 2 types of physical activity) HRs associated with low, moderate, and high leisure time physical activity were 1.00, 0.86, and 0.74 (Ptrend<0.001) for total stroke, 1.00, 0.87, and 0.46 (Ptrend=0.011) for subarachnoid hemorrhage, 1.00, 0.77, and 0.63 (Ptrend=0.024) for intracerebral hemorrhage, and 1.00, 0.87, and 0.80 (Ptrend=0.001) for ischemic stroke, respectively. The multivariate-adjusted HRs associated with none, 1 to 29, and > or =30 minutes of active commuting were 1.00, 0.92, and 0.89 (Ptrend=0.043) for total stroke, and 1.00, 0.93, and 0.86 (Ptrend=0.028) for ischemic stroke, respectively. Occupational activity had a modest association with ischemic stroke in the multivariate analysis (Ptrend=0.046). CONCLUSIONS: A high level of leisure time physical activity reduces the risk of all subtypes of stroke. Daily active commuting also reduces the risk of ischemic stroke.

Adult↗
PubMed2005

Associations of leisure time physical activity, self-rated physical fitness, and estimated aerobic fitness with serum C-reactive protein among 3,803 adults.

OBJECTIVE: Serum C-reactive protein (CRP), a marker of systemic inflammation, is a risk factor for cardiovascular disease. Obesity and physical activity are associated with CRP, though population studies are sparse. METHODS AND RESULTS: We assessed the cross-sectional relationship of physical activity, self-rated fitness and estimated aerobic fitness with serum CRP among a population-based random sample of 3,803 Finnish adults aged 25-74 years. Conditioning, commuting and non-conditioning physical activity was measured by a recall and self-rated physical fitness by a questionnaire. A non-exercise test was used to estimate aerobic fitness. The combined association of aerobic fitness and waist-to-hip ratio (WHR) on CRP was also assessed. Self-rated fitness and aerobic fitness had inverse associations with CRP (adjusted for age, WHR, smoking, anti-hypertensive drugs, aspirin, diabetes, hypercholesterolemia, hormone replacement therapy and menopausal status) in both sexes (p < 0.001). An inverse age-adjusted association of conditioning and non-conditioning physical activity with CRP was found in both sexes. After further adjustments, associations remained significant in women for conditioning and non-conditioning activity (p < 0.001 and p = 0.010, respectively) and borderline significant in men (p = 0.074 and p = 0.070, respectively). Commuting physical activity was inversely associated with CRP among women only (p = 0.012). CONCLUSIONS: Physical activity and fitness may have an anti-inflammatory effect, which is independent of obesity.

Adult↗
PubMed2005

The gender-specific impact of diabetes and myocardial infarction at baseline and during follow-up on mortality from all causes and coronary heart disease.

OBJECTIVES: The goal of this study is to compare the magnitude of diabetes and myocardial infarction (MI) at baseline and during follow-up on cause-specific and all-cause mortality. BACKGROUND: History of both MI and diabetes are strong predictors of coronary heart disease (CHD) death. However, gender-specific data on the joint effect of diabetes and MI, and particularly on the effect of incident diabetes and MI developed during the follow-up, on CHD mortality are scarce. METHODS: The baseline cohort study included 2,416 patients with prior diabetes or MI at baseline; the follow-up cohort study included 4,315 patients with incident diabetes or MI diagnosed during the follow-up. RESULTS: In the baseline cohort study, men with prior MI had a 20% to 80% increased risk of CHD or total mortality, but women with prior MI had a 43% to 45% decreased risk of CHD or total mortality in comparison with men and women with prior diabetes. In the follow-up cohort study, men and women with incident MI had a higher risk of CHD mortality (hazard ratio [HR] 2.15 in men and 1.65 in women), and an almost similar risk of total mortality (HR 0.95 in men and 1.02 in women) in comparison with men and women with incident diabetes. CONCLUSIONS: In men, MI at baseline or during follow-up confers a greater risk on CHD mortality than diabetes does. In women, prior MI at baseline confers a lower risk on CHD mortality than prior diabetes does, but incident MI during follow-up confers a greater risk than incident diabetes does. In both men and women, total mortality is similar for incident MI and diabetes.

Cohort Studies↗