Biomedical subjects

S Punsar

Publications and source records attributed to S Punsar.

At least 19 recordsLinked to original sources

PubMed1992

Short- and long-term association of serum cholesterol with mortality. The 25-year follow-up of the Finnish cohorts of the seven countries study.

The association of serum cholesterol with cause-specific and all-cause mortality was assessed in a cohort of 1,426 men aged 40-59 years who were free of clinically evident heart disease at baseline (1959). A total of 748 deaths (53 percent of the participants) occurred during the 25-year follow-up period. Men with high serum cholesterol levels at baseline had high mortality due to coronary heart disease during both the early and later parts of the follow-up period. In contrast, the association of serum cholesterol with mortality due to causes other than coronary heart disease changed during follow-up (interaction of cholesterol with follow-up period: p = 0.004). During the first 10 years of follow-up, despite their high coronary mortality, men with high cholesterol levels had lower all-cause mortality (age-adjusted relative risk = 0.71 for serum cholesterol above 5.79 mmol/liter vs. below 5.80 mmol/liter; p = 0.03) because of their low cancer mortality (relative risk = 0.55, p = 0.03) and residual mortality (relative risk = 0.49, p less than 0.01). During the last 15 years of follow-up, cholesterol at baseline was no longer associated with mortality due to causes other than coronary heart disease, and consequently, because of their high coronary mortality, men with high cholesterol levels also had higher all-cause mortality (relative risk = 1.22, p = 0.05). The results suggest that to fully analyze the association of serum cholesterol with all-cause mortality, the follow-up period should be sufficiently long--possibly more than 10 years--and the possibility of a change in the direction of the association studied should always be considered.

Adult↗

PubMed1991

All cause mortality and its determinants in middle aged men in Finland, The Netherlands, and Italy in a 25 year follow up.

STUDY OBJECTIVE: The aims were (1) to compare all cause mortality in population samples of different cultures; and (2) to cross predict fatal event by risk functions involving risk factors usually measured in cardiovascular epidemiology. DESIGN: The study was a 25 year prospective cohort study. The prediction of all cause mortality was made using the multiple logistic equation as a function of 12 risk factors; the prediction of months lived after entry examination was made by the multiple linear regression using the same factors. POPULATION SAMPLES: There were five cohorts of men aged 40-59 years, from Finland (two cohorts, 1677 men), from The Netherlands (one cohort, 878 men), and from Italy (two cohorts, 1712 men). SETTING: The Finnish cohorts came from geographically defined rural areas, the Dutch cohort from a small town in central Holland, and the Italian cohorts from rural villages in northern and central Italy. MEASUREMENTS AND MAIN RESULTS: All cause mortality was highest in Finland (557 per 1000), and lower in The Netherlands (477) and in Italy (475). The solutions of the multiple logistic function showed the significant and almost universal predictive role of certain factors, with rare exceptions. These were age, blood pressure, cigarette smoking, and arm circumference (the latter with a negative relationship). Similar results were obtained when solving a multiple linear regression equation predicting the number of months lived after entry examination as a function of the same factors. The prediction of fatal events in each country, using the risk functions of the others, produced limited errors, the smallest one being -2% and the largest +11%. When solving the logistic model in the pool of all the cohorts with the addition of dummy variables for the identification of nationality, it also appeared that only a small part of the mortality differences between countries is not explained by 12 available risk factors. CONCLUSIONS: A small set of risk factors seems to explain the intercohort differences of 25 year all cause mortality in population samples of three rather different cultures.

Adult↗

PubMed1991

Blood pressure changes as predictors of future mortality in the seven countries study.

Twelve cohorts of men aged 40-59 at entry, enrolled in six countries (Finland, The Netherlands, Italy, Yugoslavia, Greece and Japan), giving a total of 8,287 subjects, were examined for the measurement of cardiovascular risk factors and then followed-up for 20 years. Changes of systolic blood pressure (SBP) occurred over the first 10 years in 6,767 men and these values, computed by an integral-like procedure (Delta-SBP), were used as possible predictors of fatal events recorded in the second 10 years of follow-up. Men who had a relative increase of SBP in the first 10 years showed an excess risk of death as compared with those who had a relative decrease of SBP, after adjustment for age and entry levels of SBP. Such relative risks were greater than 1 in the cohorts pooled within each of the six countries, ranging from 1.07 to 1.79 for all causes of death and from 1.12 to 2.15 for atherosclerotic cardiovascular disease deaths (coronary, stroke and peripheral atherosclerotic disease). The Cox model was solved using the same two end-points as dependent variables and, as coviariates, six risk factors measured at entry examination (age, cigarettes smoked per day, body mass index, serum cholesterol, physical activity at work and systolic blood pressure). By adding Delta-SBP the predictive power of the models was significantly improved and the coefficients of Delta-SBP proved to be statistically significant.

Adult↗

PubMed1990

Predictors of high functional capacity and mortality in elderly Finnish men.

Factors predicting high functional capacity in old age and 25-year mortality were studied in 1711 men aged 40 to 59 years. The study population was that of the East-West Study, i.e. the Finnish part of the Seven Countries Study. After the 25-year follow-up (in 1984) 766 men were still alive. Nonsmoking and good pulmonary function in earlier middle-age and the absence of coronary heart disease, cerebrovascular disease or emphysema in later middle-age predicted high functional capacity in old age. High systolic blood pressure, low forced vital capacity, smoking, and the presence of coronary heart disease predicted mortality in the next 10 to 25 years. Although mortality rates were higher in eastern Finland, the predictors were similar in both the eastern and the southwestern parts of the country.

Aged↗

PubMed1990

Twenty-five-year mortality from coronary heart disease and its prediction in five cohorts of middle-aged men in Finland, The Netherlands, and Italy.

Five cohorts of men ages 40-59 (Finland: 2 cohorts of 1,677 men; Netherlands: 1 cohort of 878 men; Italy: 2 cohorts of 1,712 men) were examined and evaluated for cardiovascular risk factors in 1959-1960 and subsequently followed-up for mortality over the next 25 years. Age-adjusted death rates from coronary heart disease were highest in Finland (244 per 1,000), intermediate in The Netherlands (195 per 1,000), and lowest in Italy (122 per 1,000) with a twofold range between the extremes. The Cox proportional hazards model was used for single cohorts and for the pools of national cohorts with coronary heart disease deaths as endpoints and 12 risk factors as covariates. It showed the significant and almost universal predictive value of these factors (with some rare exceptions). The most highly predictive values were age, blood pressure, total serum cholesterol, cigarette smoking, and physical activity (negative relationship). The prediction of events within each country using the risk function of the others produced errors ranging from -19% to +51%. The largest errors were those involving the Italian cohorts whose experience tended to underpredict coronary heart disease mortality elsewhere and to be overpredicted by the risk functions of the other countries. Solving a Cox model which included all the cohorts, and adding dummy variables for the identification of nationality, it appears that the relative risk, everything else being equal, is 1.49 and 1.34 for a Finnish man, compared with Italian and Dutch men, respectively.

Adult↗

PubMed1989

Risk factors and 25 year risk of coronary heart disease in a male population with a high incidence of the disease: the Finnish cohorts of the seven countries study.

OBJECTIVE: To assess the efficacy of high serum cholesterol concentration, raised blood pressure, and smoking as predictors of coronary heart disease. DESIGN: Prospective cohort study of middle aged men conducted over 25 years. SETTING: Finish components of an ongoing international study (seven countries study). PARTICIPANTS: 1520 Men who at age 40-59 in 1959 were free of clinically evident heart disease. INTERVENTIONS: At each follow up visit a detailed medical examination including resting electrocardiography was performed, blood pressure and serum total cholesterol concentration were measured, and smoking was assessed. MEASUREMENTS AND MAIN RESULTS: 825 Deaths (54% of participants) occurred during follow up, of which 335 were due to coronary heart disease. The hazard ratio for death from coronary heart disease with respect to risk factors at entry were: for serum cholesterol concentrations above 8.4 mmol/l v below 5.2 mmol/l, 2.68 (95% confidence interval 1.62 to 4.42); for systolic blood pressure in the highest quintile v that in the lowest quintile, 2.46 (1.72 to 3.50); and for smoking 10 or more cigarettes daily v never smoking, 1.95 (1.36 to 2.79). The hazard ratios with respect to cholesterol concentrations and blood pressure remained constant during follow up but the ratio with respect to smoking diminished, mainly owing to men giving up the habit. The estimated conditional probability of a 50 year old man dying of coronary heart disease in the next 25 years ranged from 12% among those with the most favourable risk factor profile to 75% among those with the least favourable profile. CONCLUSIONS: High risk factor levels (as determined in this study) in middle aged men may greatly increase the absolute probability of death from coronary heart disease when the period of study is relevant to the human life span.

Blood Pressure↗

PubMed1989

Alcohol consumption and mortality in aging or aged Finnish men.

The association between alcohol consumption and 10-year mortality by death cause was studied in 1112 men aged 55-74 years and living either in eastern or south-western Finland. After adjustment for age, blood pressure, smoking, serum cholesterol, and other variables, the relative odds ratio of 10-year total mortality associated with consuming 1-273 g of absolute alcohol per month was 0.9 (95% confidence interval of 0.6-1.2) and with consuming more than 273 g per month due to violence was small, 15, but relative odds of violent death associated with consuming 1-273 and 274 or more grams of alcohol per month were 3.4 and 16.2, respectively (95% confidence intervals of 0.4-31.9 and 1.9-141.2).

Aged↗

PubMed1989

Predictors of disability in elderly Finnish men--a longitudinal study.

Factors predicting disability in late life were studied in 716 men from eastern or southwestern Finland in connection with the 25-year follow-up of the East-West Study, which is part of the Seven Countries Study, in 1984. In middle-aged men, low forced vital capacity, occurrence of diabetes, presence of intermittent claudication, high diastolic blood pressure, higher age and lower educational level showed the greatest predicting power for future disability 15-25 years later. In later middle age, low forced vital capacity, presence of intermittent claudication, cerebrovascular disease or coronary heart disease and higher age were the most powerful predictors for disability 10 years later. In order to lower disability in old age, it is important to prevent deterioration of ventilatory function and cardiovascular diseases in middle-aged populations and to treat chronic diseases adequately.

Aged↗

PubMed1989

Association of physical activity with coronary risk factors and physical ability: twenty-year follow-up of a cohort of Finnish men.

The association of physical activity with coronary risk factors and self-reported physical ability was studied in a cohort of 331 healthy Finnish men aged 45-64 years at entry, representing the survivors of a 20-year longitudinal study from 1964 to 1984. Baseline physical activity was not significantly related to levels of coronary risk factors at subsequent 5-year, 10-year or 20-year follow-up examinations. The 72 who increased their physical activity during the study period smoked less at 20-year follow-up than those who remained sedentary (p = 0.03). No other significant associations between 20-year changes of physical activity and coronary risk factors were seen. Although baseline physical activity was not, physical activity and exercise at 20-year follow-up were positively related to indices of functional capacity assessed at the end of the study period, when the subjects had reached a mean age of 73 years. It is concluded from this long-term study that a relative increase of physical activity between middle and old age is associated with both less smoking and a maintained high level of physical ability.

Aged↗

PubMed1989

Mental disability among elderly men in Finland: prevalence, predictors and correlates.

Mental disability, variables associated with it and predictors of mental disability in late life were studied in 716 men from eastern and southwestern Finland in connection with the 25-year follow-up of the east-west study, which formed the Finnish part of the seven-countries study. The examinations were carried out in autumn 1984, when the men were 65-84 years of age. According to a 10-item mental status questionnaire, 95% of the men had normal mental capacities. There were no differences between the 2 areas. Old age, low educational level, low functional capacity, low body mass index, low serum cholesterol, low diastolic blood pressure, low alcohol or coffee consumption, low hemoglobin, low serum calcium, low serum triiodothyronine, high scores on the Zung Self-rating Depression Scale, and presence of transient ischemia or stroke were associated with mental disability in 1984. In the prospective analysis, low forced vital capacity, low forced expiratory volume in 0.75 s and high blood pressure in middle age predicted mental disability in old age.

Aged↗

PubMed1989

Functional capacity and associated factors in elderly Finnish men.

Functional capacity and associated factors were studied in 321 men from eastern Finland and 395 men from southwestern Finland in connection with the 25-year follow-up survey of the East-West Study. The survey was carried out in autumn 1984, when the men were 65-84 years of age. In the measurement of different activities of daily living, 55 to 95% in the east and 62 to 97% in the south-west reported that they managed daily activities without another person's help. Both the mean age of the men and the mean of the sum index of functional capacity as stratified by age were in southwestern Finland significantly higher than in eastern Finland. Older age groups had lower functional capacity in both areas. Lowered functional capacity was associated with cardiovascular diseases, diabetes mellitus and impairments of vision in both areas, and with impairments of the locomotor system in the south-west. High pulmonary function was associated with high functional capacity. No connection was found between smoking and functional capacity, but heavier alcohol and coffee consumption were associated with high functional capacity.

Activities of Daily Living↗

PubMed1989

Risk factors for cardiovascular disease among 55 to 74 year-old Finnish men: a 10-year follow-up.

The importance of serum total cholesterol, systolic blood pressure, and smoking as predictors of cardiovascular (CVD) disease were studied in 867 men aged 55 to 74 years belonging to the Finnish cohorts of the Seven Countries Study. Men had no definite history of myocardial infarction nor any signs of cerebrovascular disease at baseline in 1974. During the 10-year follow-up 248 men either died from CVD or had non-fatal CVD event, including a total of 188 fatal and nonfatal coronary heart disease (CHD) events. Age-adjusted relative risk of CVD event for men aged 55 to 64 with cholesterol over 7.4 mmol/l compared to below 6.0 mmol/l was 2.6, with systolic blood pressure over 159 mmHg vs. below 135 mmHg 1.8, and smoking over 19 cigarettes per day vs. never smoker 1.7. Corresponding relative risks for men aged 65 to 74 were 1.0, 1.4 and 1.2, respectively. The results for CHD events were closely similar. The results indicate that, in terms of relative risk, systolic blood pressure retains its importance as risk factor for CVD and CHD from late middle age to old age, whereas the importance of smoking is diminished, and serum cholesterol is of little importance in old age.

Aged↗

PubMed1989

Changes in alcohol consumption and mortality in aged Finnish men.

Drinking patterns and changes in alcohol consumption from 1974 to 1984 and associations between alcohol consumption in 1974 and ten-year mortality rates from cardiovascular, violent, cancer or all causes were studied among Finnish men born between 1900 and 1919. The overall absolute alcohol consumption was low in both 1974 and 1984. The average alcohol consumption and drinking pattern did not significantly change with increasing age, though some individual changes occured. Moderate or heavier alcohol consumption was a significant risk factor for cancer deaths among non-smoking men, but not in male smokers. Moderate or heavier alcohol consumption might also be a significant risk factor in violent death. Low, moderate or heavier alcohol consumption was not a significant risk factor for coronary deaths among the men in this rural Finnish population.

Aged↗

PubMed1989

Vitamin A, vitamin E and selenium status in an aged Finnish male population.

Vitamin A (retinol), vitamin E (alpha-tocopherol) and selenium concentrations in serum were studied during the autumn season (October and November) in two Finnish male populations aged 65-84 years and living either in eastern or southwestern Finland. The mean vitamin A concentration was higher in south-western, but the mean selenium concentration was higher in eastern Finland. Mean vitamin A concentrations did not differ between age groups, but in the south-west highest vitamin E and selenium concentrations were found among the youngest population. A severe vitamin A deficiency (below 300 micrograms/l) was found only in 3 (1%) men in the east and 4 (1%) men in the south-west, and a mild deficiency (300-399 micrograms/l) in 11 (4%) men in the east and 16 (4%) men in the south-west. Vitamin E deficiency after the correction by serum total cholesterol (below 2 mg/l/g/l) was found only in 3 (1%) men in the east and 1 (0%) man in the south-west, and low values (2.0-2.9 mg/l/g/l) were found in 13 (4%) men in the east and 34 (9%) men in the south-west. A severe deficiency of selenium (below 46 micrograms/l) was found in 10 (3%) men in the east and 15 (4%) men in the south-west, while a mild deficiency (46-69 micrograms/l) was found in 140 (45%) men in the east and 197 (52%) men in the south-west. The overall vitamin A and vitamin E status of elderly Finnish men was relatively adequate, while severe or mild deficiencies of selenium were common.

Aged↗

PubMed1989

Serum cholesterol and risk of accidental or violent death in a 25-year follow-up. The Finnish cohorts of the Seven Countries Study.

In the two most recent cholesterol-lowering drug trials, the achieved reductions in coronary heart disease mortality were offset by increases in mortality due to accidents and violence. A possible biochemical explanation has been suggested for an association between low serum cholesterol level and increased risk of death due to injury. We, therefore, examined the association between serum cholesterol level and risk of death from accidents or violence in the 25-year follow-up of two cohorts of Finnish men (N = 1580). Although a statistically nonsignificant, negative association was observed in one cohort (hazard ratio, 0.84, with a 1 mmol/L increase in cholesterol), the other cohort showed a statistically significant, positive association in multivariate analysis (hazard ratio, 1.39). We conclude that the observed associations between serum cholesterol and deaths from injury in the present study and in cholesterol-lowering trials are probably determined by other, presently unknown factors, or by chance.

Accidents↗

PubMed1988

Determinants and predictors of heavy alcohol consumption among aging Finnish men.

The aim was to identify socioeconomic, health behaviour, and health factors associated with or predicting heavy alcohol consumption in late middle age (55-74 years) or in old age (65-84 years). The material included a follow-up study of two cohorts of Finnish males resident either in eastern or south-western Finland. The main variables associated with heavy alcohol consumption in late middle age were: relatively young age and heavy smoking. The main associated variables in old age were good mental and physical capacity, occurrence of chronic bronchitis, the absence of certain cardiac diseases, and heavy smoking. Heavy smoking was the main predictor of heavy alcohol consumption 5-25 years later; alcohol consumption 10 years earlier was also an important predictor. Some regional differences were found in associated or predictive variables. The results suggest that, with the exception of alcohol consumption itself and heavy smoking, socioeconomic, health and other health behaviour factors are not very important in explaining or predicting heavy alcohol consumption among aging Finnish men. Drinking and smoking habits were closely related in these aging or aged men.

Age Factors↗

PubMed1987

Serum selenium and risk of cancer. A prospective follow-up of nine years.

The association between serum selenium concentration and the risk of cancer was studied in 1110 men aged 55 to 74 years in two rural areas of Finland. The men were followed-up prospectively for 9 years and there were 109 new cases of cancer, with the cases of the first follow-up year excluded. The serum selenium concentrations were adjusted for age, area, smoking, serum cholesterol, and alcohol intake. The patients had a slightly lower adjusted mean serum selenium than the subjects without cancer at the end of the follow-up (+/- standard error of mean) 53.9 +/- 1.5 and 55.3 +/- 0.5 micrograms/l, respectively. The relative risks of cancer were essentially the same when these were calculated in the tertiles of the serum selenium distribution. Thirty-seven men had a history of cancer at baseline or had cancer diagnosed during the first follow-up year and their adjusted mean serum selenium was 49.4 +/- 2.6 micrograms/l, which was significantly lower (P less than 0.05) than that of the subjects without cancer during the follow-up.

Aged↗

PubMed1987

Reduction of premature mortality by high physical activity: a 20-year follow-up of middle-aged Finnish men.

The association of physical activity level with the risk of death was analysed for a cohort of 636 healthy Finnish men aged 45-64 years followed up for 20 years. 39% of the cohort were classed as highly active physically at baseline in 1964. Up to 1984 there were 287 deaths, 106 of them due to coronary heart disease (CHD). During the first-two thirds of the follow-up, men with high physical activity had a lower risk of death than did men with low physical activity. During the last third, the survival curves of the men with high and low physical activity gradually converged. Of the men who died, those with high physical activity lived 2.1 years longer (p = 0.002) than those with low physical activity, after adjustment for age, smoking, blood pressure, serum cholesterol, and body mass index. This difference was due mainly to fewer CHD deaths among the highly active group. Low physical activity was clearly weaker than smoking as a predictor of risk of death. High physical activity may thus independently prevent premature death among middle-aged men, but it probably does not prolong the maximum achievable life-span.

Adult↗