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J Kuusisto

Publications and source records attributed to J Kuusisto.

60 records · Page 4Linked to original sources
PubMed1994

Increased risk of non-insulin-dependent diabetes mellitus in elderly hypertensive subjects.

BACKGROUND: In several studies hypertension has been shown to be associated with an increased incidence of non-insulin-dependent diabetes mellitus (NIDDM). This may be due to hypertension itself or to the deleterious effects of some antihypertensive agents on glucose tolerance and insulin sensitivity. METHODS: We examined the 3.5-year incidence of diabetes mellitus in relation to hypertension and antihypertensive medication in a population-based study of elderly subjects (n = 805) aged 65-74 years in Kuopio, Finland. RESULTS: Of the subjects studied, 60% had hypertension at baseline and 50% of the hypertensive subjects were on drug therapy at baseline. Hypertensive subjects had a significantly higher incidence of NIDDM than non-hypertensive subjects. However, after adjustment for age, body mass index, waist: hip ratio, sex, and fasting glucose and insulin levels, the increased risk of NIDDM in hypertensive subjects was no longer statistically significant. Subjects with high blood pressure (> or = 160/95 mmHg) at the baseline examination who were not taking beta-blockers or diuretic medication had a 1.56-fold increased risk of developing NIDDM, whereas subjects with hypertension who were taking those agents had a 1.88-fold risk of developing NIDDM compared with subjects with normal blood pressure. The risk of developing NIDDM was accompanied by elevated fasting insulin levels. After adjustment for age, sex, body mass index, waist:hip ratio, and fasting glucose and insulin levels, hypertensive subjects taking diuretics or beta-blockers, or both, still had a 1.56-fold increased risk of developing NIDDM relative to normotensive subjects. Hypertensive subjects taking diuretics or beta-blockers, or both, had a significantly higher incidence of NIDDM than hypertensive subjects not on pharmacological therapy. However, after adjustment for 2-h glucose and insulin concentrations, the incidence of NIDDM did not differ between the hypertensive subjects. CONCLUSION: The data presented suggest that the increased risk of NIDDM in hypertensive subjects taking beta-blockers or diuretics, or both, is explained at least partly by metabolic disturbances related to drug therapy.

Adrenergic beta-Antagonists↗
PubMed1993

Cardiovascular disease risk factors as predictors of type 2 (non-insulin-dependent) diabetes mellitus in elderly subjects.

Risk factors measured in a cross-sectional study in subjects aged 65-74 years living in eastern Finland were correlated with the risk of developing diabetes 3.5 years later. Sixty-nine of 892 initially non-diabetic subjects developed diabetes during the follow-up. Subjects who subsequently developed diabetes had multiple adverse changes in risk factor levels before the diagnosis of diabetes. Subjects who developed diabetes had higher body mass index and waist-hip ratio as well as higher levels of fasting and 2-h plasma glucose and insulin and higher prevalence of family history of diabetes than those who remained healthy. Furthermore, prevalence of hypertension and levels of diastolic blood pressure and total triglycerides were higher and HDL cholesterol lower among subjects who developed diabetes than among those who remained healthy. The highest risk of developing diabetes was associated with impaired glucose tolerance (World Health Organisation criteria) (odds ratio = 9.8, 95% confidence interval = 6.1-5.8). The risk of developing diabetes was 3.7 (3.2-6.1) among subjects in the highest quartile of 2-h insulin distribution, 3.5 (2.0-6.1) in those with triglycerides greater than 2.5 mmol/l, 2.7 (1.5-4.6) in those with waist-hip ratio greater than 1.0, 2.5 (1.5-4.4) in those with HDL cholesterol less than 1.0 mmol/l, 2.1 (1.2-3.6) in those with body mass index greater than 30 kg/m2, 1.9 (1.1-3.3) among those in the highest quartile of fasting insulin distribution, 1.8 (1.0-3.1) in those having hypertension, and 1.7 (1.0-2.9) in those with a family history of diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Essential hypertension and cognitive function. The role of hyperinsulinemia.

The relation between hypertension and cognitive function is not well established. Therefore, we examined cognitive function in a random sample of 744 nondiabetic elderly inhabitants of Kuopio, East Finland. Five brief neuropsychological tests known to be sensitive to cognitive impairment due to dementia--the Mini-Mental State Examination (MMSE), the Trail Making Test (TMT), the Buschke Selective Reminding Test (BSR), Russell's Adaptation of the Visual Reproduction Test (HVR), and the Verbal Fluency Test (VFT)--were used to evaluate cognitive function. The performance of the hypertensive group (n = 378) was impaired in almost all test items compared with that of the normotensive group (n = 366), but the difference between these two groups was statistically significant in 5 of 19 test items only. Moreover, within the hypertensive group, hyperinsulinemic (fasting plasma insulin > 17.9 mU/L) hypertensive subjects (n = 57) scored worse than normoinsulinemic hypertensive subjects (n = 321) in 16 of 19 test items and worse than the normotensive subjects in the same 16 of 19 test items. The difference between the hyperinsulinemic hypertensive and normotensive groups was significant in 11 test items that reflected complex cognitive function such as calculation, language, semantic memory, and problem solving. This difference in neuropsychological tests among the three study groups (normotensive, normoinsulinemic hypertensive, and hyperinsulinemic hypertensive subjects) persisted after adjustment for fasting plasma glucose, age, sex, and education in 3 test items measuring calculation, copying, and semantic memory. Thus, essential hypertension in the elderly is associated with an impairment in complex cognitive function.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Improvement of metabolic control does not normalize auditory brainstem latencies in subjects with insulin-dependent diabetes mellitus.

INTRODUCTION: In our previous study (Am J Otolaryngol 14:413-418, 1993), we reported that prolonged auditory brainstem response latencies are associated with microvascular complications and the duration of diabetes in patients with insulin-dependent diabetes mellitus (IDDM). To investigate whether short-term improvement in metabolic control also affects ABR-responses, we compared ABR-latencies in subjects with IDDM before and after intensified insulin and diet therapy. MATERIALS AND METHODS: Auditory brainstem latencies were measured in 13 subjects with IDDM (mean age: 25 years) before and after intensified insulin and diet therapy. The acoustic stimulus was a half sine wave with a duration of 0.250 millisecond and a frequency of 2,000 Hz. The stimulus was presented monaurally with fixed polarity through shielded headphones TDH-39 at repetition rate of 10 Hz and at 90 dB hearing level. All subjects had normal hearing ability. Glycated hemoglobin A1C (GHbA1C), blood glucose immediately before ABR-measurements, and mean blood glucose during 24 hours before auditory studies were measured before and after intensified therapy. RESULTS: During intensified insulin therapy, GHbA1C improved significantly (P < .05) in study subjects. However, no changes were observed in ABR-latencies. We also studied those 10 patients whose blood glucose improved during intensified insulin therapy. Although blood glucose was significantly lower (P < .01) after intensified insulin therapy compared with that at baseline, no changes were observed between ABR-latencies at baseline and follow-up. CONCLUSION: ABR-latencies were not affected by improvement in metabolic control in patients with IDDM. Our finding suggests that delayed ABR-latencies found in patients with IDDM are not caused by poor metabolic control of diabetes but rather by other mechanisms, for example, microvascular complications.

Adult↗
PubMedDate not supplied

Apolipoprotein E phenotype alone does not influence survival in Alzheimer's disease: a population-based longitudinal study.

Apolipoprotein E4 (ApoE4) phenotype is a known risk factor for development of Alzheimer's disease (AD). Contradictory results exist concerning the role of ApoE4 in the rate of decline and mortality in AD. Conflicting findings have also been reported about ApoE and gender interactions with respect to survival. We examined the survival of subjects with AD and non-AD controls with respect to ApoE phenotype and gender in a population-based longitudinal study. Cognitive evaluation was performed for a total of 980 subjects (then aged 69-78 years), and 48 cases with AD were identified. ApoE4 phenotype was more frequently present among subjects with AD. In the whole study population, survival was not related to the presence of AD or ApoE4 phenotype. Risk of death was increased for men compared to women, independently of the ApoE4 phenotype (HR 0.5, 95% confidence interval 0.44-0.69). In subjects with AD, the presence of ApoE4 alone did not influence survival. However, in the AD group, ApoE4-negative men had significantly increased risk of mortality compared to the risk in ApoE4-negative women (p < 0.01). We conclude that the presence of ApoE4 phenotype or AD did not influence mortality in the aged population. Once AD had become manifest, ApoE4 alone did not relate to survival. However, in subjects with AD not carrying ApoE4, men had reduced survival compared to women.

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