Biomedical subjects

I L Notkola

Publications and source records attributed to I L Notkola.

15 recordsLinked to original sources

PubMed2003

Tracking of serum total cholesterol during childhood: an 8-year follow-up population-based family study in eastern Finland.

AIM: To investigate the tracking of serum total cholesterol (TC) during childhood. METHODS: All children born during 1981-1982 in a rural community of eastern Finland were followed at 6 mo, 7 y and 15 y of age. The full follow-up period was completed by 138 out of 205 children, of whom 82 (33 girls) had TC measured at 7 y and 15 y of age (-7 y, -15 y). The main outcome measurement was TC (mmol/L). RESULTS: TC-7 y was significantly associated with TC-15 y (r = 0.655; p-value < 0.001). This correlation did not change significantly after accounting for confounders. Children in the highest tertile of TC-7 y had a significantly higher risk of being in the highest tertile of TC-15 y compared with children in other tertiles of TC-7 y (relative risk = 6.4 (2.9-13.9)). TC-15 y was predicted positively by TC-7 y (linear regression beta = 0.63; p-value < 0.001) and parental high TC (TC > or = 5.0 mmol/L in at least one parent) (beta = 0.58; p-value = 0.030). Birthweight had no significant association with TC during childhood. CONCLUSION: The study confirmed the tracking of TC during childhood. The identification of children at risk of developing high TC during adolescence should take into consideration the child's previous TC values during childhood and parental TC status.

Adolescent↗

PubMed2001

Prevalence of Alzheimer's disease in very elderly people: a prospective neuropathological study.

BACKGROUND: No previous autopsy-controlled, prospective, and population-based studies are available on the prevalence of AD in very elderly people. OBJECTIVE: To study the point prevalence of neuropathologically defined AD in a population of people at least 85 years of age, stratified according to their APOE genotype. METHODS: A population-based sample of 532 (of a total population of 601) elderly Finnish individuals, aged 85 years or more, were clinically tested for dementia in 1991 (with follow-up studies of the survivors in 1994, 1996, and 1999) and genotyped for APOE. An autopsy involving neuropathologic diagnosis of AD according to modified consensus criteria was performed in 118 of 198 deceased subjects who had been demented on April 1, 1991, and in 62 of 201 nondemented individuals. RESULTS: The prevalence of neuropathologically defined AD was 33%, whereas the prevalence of clinically diagnosed AD was 16%. There was a highly significant (p < 0.001) association between the APOE epsilon4 allele and AD: Sixty-three percent of APOE epsilon4 carriers and 20% of noncarriers had neuropathologic AD. The respective figures in subjects aged 90 years or more were 71 and 22%. CONCLUSIONS: The prevalence of neuropathologically defined AD is higher than that reported in most previous studies based on clinical diagnosis. The discrepancy between the neuropathologic and clinical diagnoses of AD in very elderly subjects may affect the results of population-based studies. The APOE genotype has a strong effect on the prevalence of neuropathologically defined AD, even after 90 years of age.

Aged↗

PubMed2001

Delirium in the non-demented oldest old in the general population: risk factors and prognosis.

BACKGROUND: The oldest old are prone to develop delirium. Studies into risk factors for delirium have been carried out predominantly in younger age groups. The aim of this population-based follow-up study was to investigate the risk factors for delirium requiring medical attention and subsequent prognosis in the non-demented general population aged > or = 85 years. METHOD: The study included the non-demented subjects in the population-based Vantaa 85+ study. After the 3-year observation period, 199 subjects (91% of those surviving) were re-examined and their medical records were evaluated for episodes of delirium. The subjects were followed up with respect to mortality for another 2 years. RESULTS: During the 3-year observational period, 20 subjects (10%) had been diagnosed as having had an episode of delirium. A Mini-Mental State Examination score of < 24 (odds ratio (OR) 3.44, confidence interval (CI = 95%) 1.27-9.32) and high systolic blood pressure (OR 3.08, CI 1.08-8.79) were identified as independent risk factors for delirium. The association between the delirium episode and a new diagnosis of dementia was significant ( p = 0.001). The mortality rate was greater among those subjects who experienced delirium than among subjects without this syndrome ( p = 0.008). CONCLUSIONS: Mild cognitive impairment and high systolic blood pressure were found to be risk factors for delirium requiring medical attention in the general non-demented population aged > or = 85 years. The study also highlights the significant association between delirium and a new dementia diagnosis in this age group.

Aged↗

PubMed2001

Does apolipoprotein E influence learning and memory in the nondemented oldest old?

The objective of this study was to analyze the relationship of the apolipoprotein E (apoE) epsilon4 and epsilon2 alleles to learning and memory performances in the nondemented oldest old. Forty-six nondemented persons aged 85 years or over from a randomly selected group of 128 subjects in Vantaa, Finland, were studied. ApoE genotyping was performed using the minisequencing technique. A structured clinical examination and interview were carried out. The test variables studied were learning and memory scores (from the Fuld Object-Memory Evaluation), verbal fluency, and conceptualization (the Similarities subtest of the WAIS-R). We compared apoE-epsilon4 carriers to noncarriers and apoE-epsilon2 carriers to noncarriers. No statistically significant differences were found in any of the test variables. The results failed to confirm the hypotheses that poor cognitive performance is associated with the apoE-epsilon4 allele and good performance with the apoE-epsilon2 allele in the oldest old. This suggests that the apoE alleles do not have a detectable relationship to learning and memory in nondemented very elderly people.

Aged↗

PubMed2001

Effects of supporting community-living demented patients and their caregivers: a randomized trial.

OBJECTIVES: To determine whether community care of demented patients can be prolonged by means of a 2-year support program based on nurse case management. DESIGN: Randomized controlled intervention study with 2-year follow-up. SETTING: Demented patients entitled to payments from the Social Insurance Institution for community care, in five municipalities in eastern Finland. PARTICIPANTS: One hundred demented patients, age 65 and older, living at home with the primary support of informal caregivers, allocated at random to the intervention (n = 53) or control group (n = 47). INTERVENTION: Intervention patients and their caregivers were provided with a 2-year intervention program of systematic, comprehensive support by a dementia family care coordinator. MEASUREMENTS: Time to institutionalization (period in community care) from enrollment of patients in the study to their placement in long-term institutional care. RESULTS: During the first months, the rate of institutionalization was significantly lower in the intervention group than in the control group (P = .042), but the benefit of the intervention decreased with time (P = .028). Estimated probability of staying in community care up to 6, 12, and 24 months was 0.98, 0.92, and 0.63 in the intervention group and 0.91, 0.81, and 0.68 in the control group, respectively. Results also suggest that the intervention used in the study might be especially beneficial to patients with severe dementia and those with problems threatening the continuity of community care. CONCLUSIONS: The placement of demented patients in long-term institutional care can be deferred with the support of a dementia family care coordinator. However, by the end of the 2-year intervention, the number of patients institutionalized was similar in the intervention and control group. It seems to be beneficial to direct this type of intensive support at severely demented patients and their caregivers. On the basis of our experiences, we suggest that intervention by a dementia family care coordinator should be targeted especially at patients with problems threatening the continuity of community care.

Aged↗

PubMed2001

Smoking cessation, decline in pulmonary function and total mortality: a 30 year follow up study among the Finnish cohorts of the Seven Countries Study.

BACKGROUND: Permanent smoking cessation reduces loss of pulmonary function. Less is known in the long term about individuals who give up smoking temporarily or quitters with lower initial pulmonary function. Little is known also about the relationship between decline in pulmonary function and mortality. We examined these aspects and the association between smoking, decline in pulmonary function, and mortality. METHODS: Two middle aged male Finnish cohorts of the Seven Countries Study and their re-examinations on five occasions during a 30 year period of follow up were analysed. RESULTS: During the first 15 years (n=1007) adjusted decline in forced expiratory volume in 0.75 seconds (FEV(0.75)) was 46.4 ml/year in never smokers, 49.3 ml/year in past smokers, 55.5 ml/year in permanent quitters, 55.5 ml/year in intermittent quitters, and 66.0 ml/year in continuous smokers (p<0.001 for trend). Quitters across the entire range of baseline FEV(0.75) had a slower decline in FEV(0.75) than continuous smokers. Among both continuing smokers and never smokers, non-survivors had a significantly (p<0.001) more rapid decline in FEV(0.75) than survivors. The adjusted relative hazard for total mortality was 1.73 (95% confidence interval (CI) 1.41 to 2.11) and 1.24 (95% CI 1.02 to 1.52) in the lowest and middle tertiles of decline in FEV(0.75). Never smokers, past smokers, and quitters had significantly lower total mortality than continuous smokers, partly because of their slower decline in FEV(0.75). CONCLUSION: These results highlight the positive effect of smoking cessation, even intermittent cessation, on decline in pulmonary function. Accelerated decline in pulmonary function was found to be a risk factor for total mortality. The beneficial effect of smoking cessation on mortality may partly be mediated through a reduced decline in pulmonary function.

Adult↗

PubMed2001

Cancer incidence in hypertensive patients in North Karelia, Finland.

Cancer incidence of 20 529 hypertensive patients included in the community-based hypertension register of the North Karelia Project was determined. A total of 2511 incident cancer cases were obtained among the patients in record linkage with the nationwide Finnish Cancer Registry during the mean follow-up time of 16 years. The age-adjusted incidence rates per 100 000 person-years were 248.4 for men and 171.7 for women, which correspond to that of the general population in the area. The Cox regression model was used to analyze the effect of hypertension-related variables on cancer incidence. In men, the diastolic blood pressure was associated with an increased cancer risk but only in those who smoked >10 cigarettes per day. The functional diagnosis of hypertension (stage I, hypertension with no end-organ damage; stage II, hypertension with left cardiac hypertrophy; and stage III, hypertension with extracardiac organ damage) was associated with the increased risk significantly in men who used antihypertensive drugs at baseline. In women, the diastolic blood pressure was associated with an increased cancer risk in those who did not use antihypertensive drugs at baseline. The functional diagnosis of hypertension was associated with an increased risk only in those who smoked >10 cigarettes per day, but the number of women and cancer cases in this group was small. These results indicate a complex pattern of diastolic blood pressure, functional diagnosis, use of antihypertensive drugs, smoking, and gender in the cancer risk of hypertensive patients.

Female↗

PubMed2001

Association of lipoprotein lipase Ser447Ter polymorphism with brain infarction: a population-based neuropathological study.

BACKGROUND: Variants of the lipoprotein lipase (LPL) gene have been shown to influence serum lipid levels, risk of coronary heart disease and, as found recently, risk of clinical ischaemic cerebrovascular disease. Here we tested for an association between brain infarction and two common polymorphisms of the LPL gene, Ser447Ter and Asn291 Ser. METHOD: To avoid ascertainment and selection bias involved in many association studies, we compared the distribution of these polymorphisms in neuropathologically verified patients (n = 119) vs controls (n = 133) derived from a prospective, population-based study (the Vantaa 85+ study). RESULTS: The LPL Ter447 variant was negatively associated with neuropathologically verified brain infarcts (P = 0.006), and even more strongly with small brain infarcts (P = 0.004). In addition, we found that the Ter447 variant was associated with higher serum HDL chblesterol (P = 0.004) and lower triglyceride levels (P= 0.003), and that it was negatively associated with pathologically verified severe coronary artery disease (P=0.001) in the Vantaa 85+ study sample. The Asn291Ser polymorphism was not significantly associated with brain infarction. CONCLUSION: The Ter447 variant of LPL is associated with decreased risk of brain infarction and coronary artery disease in our very elderly population.

Aged↗

PubMed2000

Familial aggregation of serum total cholesterol: a population-based family study in eastern Finland.

BACKGROUND: The Finnish population has a high risk of coronary heart disease, which is associated to a high population level of serum total cholesterol (CHOL) already evident at early ages. The study investigated the familial aggregation of CHOL in a sample of families with young offspring from eastern Finland. METHODS: Fifteen-year-old offspring were examined during 1996-1997 and their biological parents were examined during 1993-1994. A total of 224 children were invited and 184 families participated, of which 123 were included in the analysis with complete data. The main outcome measure was the CHOL (millimoles per liter). RESULTS: Significant positive familial correlations of CHOL were found for the pairs of mother/offspring (r = 0.35, P < 0.001, n = 111), father/offspring (r = 0.29, P = 0.007, n = 82), mother/daughter (r = 0.46, P = 0.001, n = 49), mother/son (r = 0.27, P = 0.036, n = 62), and father/daughter (r = 0.35, P = 0.035, n = 36). The adjustments for the offspring's gender and body mass index (BMI) and the parent's age, BMI, education, and family history of acute myocardial infarction did not alter these results. There was a higher proportion of the offspring in the highest quartile of CHOL when the mother had CHOL > or =5 mmol/L (OR = 3.26, 95% CI = 1.2-8.9, n = 111). CONCLUSIONS: The study confirmed the familial aggregation of CHOL. The consistent CHOL association between the mother and the offspring may indicate the key role of the mother for the primary prevention of hypercholesterolemia.

Adolescent↗

PubMed2000

Familial aggregation of blood pressure: a population-based family study in eastern Finland.

Blood pressure (BP) levels in the Finnish population are amongst the highest in the world, despite favourable changes at the national level in the past two decades. The study evaluates the familial aggregation of BP and the association of some environmental factors to the familial aggregation of BP as a primary epidemiological approach of the genetics of hypertension in a sample of families with young offspring from eastern Finland. Offspring aged 15 years were examined between 1996 and 1997 and their biological parents were examined between 1993 and 1994. A total of 224 children were invited, 184 families participated, from which 144 were included in the analysis with complete data. Systolic (SBP), diastolic (DBP) and mean (MAP) arterial BPs were the main outcome measurements. After the offspring's gender and body mass index (BMI) and the parent's age and BMI were controlled for, the mother/offspring correlation of SBP and the father/offspring correlation of MAP were statistically significant (r = 0.18, P = 0.039, n = 134 and r = 0.20, P = 0.048, n = 99, respectively). The additional adjustment for the parent's education and family history of acute myocardial infarction did not change these results. There was a higher proportion of offspring in the highest quartile of SBP and MAP when the mother had a history of hypertension (OR = 3.4, 95% CI = 1.4-8.5, n = 139, and OR = 2.6, 95% CI = 1.0-6.5, n = 139, respectively). The study confirmed the familial aggregation of BP. The consistent BP association between the mother and the offspring may indicate the key role of the mother in the primary prevention of hypertension.

Adult↗

PubMed2000

Pulmonary function, smoking cessation and 30 year mortality in middle aged Finnish men.

BACKGROUND: Although it is well known that impaired pulmonary function is a strong predictor of mortality and that smoking decreases pulmonary function, little is known about the long term effect of smoking cessation on mortality at different levels of pulmonary function. We have studied the impact of smoking cessation on mortality over the entire range of baseline pulmonary function. METHODS: The study subjects consisted of men aged 40-59 at entry who were the Finnish participants in the Seven Countries Study during 1959-89. RESULTS: In all the participants (n = 1582) impaired forced expiratory volume in 0.75 seconds (FEV(0.75)) was significantly associated with increased all cause mortality. When those who gave up smoking during the follow up period were compared with continuous smokers (n = 860) all cause mortality was found to be decreased among those who quit. The relative adjusted hazard (HR) was 0.71 (95% confidence interval 0.50 to 1.00). The median survival time in those who stopped smoking compared with those who continued to smoke from 1969 onwards was 7.65, 7.59, and 6.30 years longer in the lowest, middle and highest tertiles of adjusted FEV(0.75) distribution, respectively. In those who gave up smoking, mortality from cardiovascular causes was significantly lower (HR 0.60 (95% CI 0.37 to 0.98)). CONCLUSIONS: These findings suggest that smokers across the entire range of pulmonary function may increase their expectation of lifespan by giving up smoking.

Adult↗

PubMed1998

Growth in childhood and blood pressure in Finnish children.

The aims of this prospective cohort study were to monitor childhood blood pressure (BP) and cholesterol and link them to fetal and childhood growth. Of the 215 children recruited after delivery in a rural county of eastern Finland during 1981 and 1982, 180 (83.7%) stayed in the study until the age of seven. The measurements assessed were BP, serum cholesterol and anthropometry. Of the children originally in the highest BP quartile at the age of 6 months, 58% (systolic BP (SBP)) and 68% (diastolic BP (DBP)), respectively, remained in the same quartile until the age of 7 years; 53% (SBP) and 60% (DBP), respectively, remained in the same lowest quartile. Consequently, BP at 6 months correlated strongly with SBP (r=0.69, P < 0.001) and DBP (r=0.75, P < 0.001) at 7 years of age. Birth weight, ponderal index, placental weight and placental to birth weight ratio were not related to BP level during the follow-up. Weight at 1 year of age correlated positively with SBP (r=0.18-0.25, P=0.0008-0.0215) but not with DBP during the follow-up. Weight gain during the first year of life was directly related to subsequent SBP (r=0.11-0.22, P=0.005-0.16). There was an inverse relationship between serum cholesterol at 7 years of age and placental weight (r=-0.16, P=0.048) and placental to birth weight ratio (r=-0.16, P=0.045). The BP level is already determined at 1 year of age and a higher SBP is associated with a higher growth rate during the first year of life.

Birth Weight↗

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↗

PubMed1997

Hyperinsulinemia and clustering of cardiovascular risk factors in middle-aged hypertensive Finnish men and women.

OBJECTIVE: To examine the relationship between hyperinsulinemia and clusters of cardiovascular risk factors in middle-aged hypertensive patients. DESIGN: A population-based study. SETTING: Pieksämäki District Health Center, and the Community health Center of the city of Tampere, in central Finland. SUBJECTS: Hypertensive men and women aged 36, 41, 46, and 51 years (n = 18) in the town of Pieksämäki, and a normotensive control population of 177 subjects aged 40 and 45 years in the city of Tampere. MAIN OUTCOME MEASURES: Clusters of obesity (body mass index > 30.0 kg/m2), abdominal adiposity (waist:hip ratio > 1.00 for men and > 0.88 for women), hypertriglyceridemia (> 1.70 mmol/l), a low level of high-density lipoprotein cholesterol (< 1.0 mmol/l in men and < 1.20 mmol/l in women) and abnormal glucose metabolism (impaired glucose tolerance or noninsulin-dependent diabetes as defined by World Health Organization criteria) according to statistical quartiles of the fasting plasma insulin concentration. RESULTS: Among the hypertensives, there was a 2.0- to 3.6-fold higher risk of having a clustering of the insulin-resistance associated cardiovascular risk factors compared with that of the normotensives. Among the hypertensive subjects in the highest quartile of fasting plasma insulin there was a six- to 12-fold increase in risk associated with having two or more insulin resistance-associated cardiovascular risk factors compared with the subjects in the lowest quartile. There was a positive correlation between a high number of ascertained risk factors and high levels of fasting plasma insulin. CONCLUSION: In clinical practice, knowledge of the close relationship between risk-factor cluster status and fasting plasma insulin levels offers a tool to evaluate the occurrence of hyperinsulinemia in middle-aged hypertensive men and women.

Adult↗

PubMed1993

Comparison of the lens opacities classification system II and Lensmeter 701.

We examined 447 hypercholesterolemic and 108 normocholesterolemic Eastern Finnish men, aged 42, 48, 54, or 60 years, who were participating in the Kuopio Atherosclerosis Prevention Study. Two newly developed lenticular opacity grading methods, the Lens Opacities Classification System II and Lensmeter 701, were compared. There was fair agreement between the two grading methods for nuclear color and opalescence, but the agreement was weaker for cortical and posterior subcapsular opacities. The Lens Opacities Classification System II grading of nuclear opacities explained 48% (for the right eye) and 32% (for the left eye) of the variation of Lensmeter readings. Attributable fractions were lower for the other types of lens opacities.

Adult↗