Kuopio Ischemic Heart Disease Study Research Articles

The Interplay between Systolic Blood Pressure, Sauna Bathing, and Cardiovascular Mortality in Middle-Aged and Older Finnish Men: A Cohort Study

ObjectivesElevated systolic blood pressure (SBP) is associated with an increased risk of cardiovascular disease (CVD) mortality, whereas frequent sauna bathing reduces the risk. Whether frequent sauna bathing mitigates CVD mortality among adults with elevated SBP has not been previously investigated.Design and SettingWe examined the interactions between SBP and frequency of sauna bathing (FSB) with the risk of CVD mortality in a cohort of Caucasian men.ParticipantsThe Kuopio Ischaemic Heart Disease Study cohort comprising of 2,575 men aged 42–61 years at baseline was employed for this prospective study analysis.MeasurementsResting blood pressure was measured using a standardized protocol and sauna bathing habits were assessed by a self-administered questionnaire. Systolic blood pressure was categorized as normal and high (<140 and ≥140 mmHg, respectively) and FSB as low and high (defined as ≤ 2 and 3–7 sessions/week, respectively).ResultsA total of 744 CVD deaths were recorded during a median follow-up of 27.8 yr. Comparing high vs normal SBP, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.44 (1.23–1.68). Comparing low vs high FSB, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.24 (1.03–1.51). The associations persisted following mutual adjustment for each exposure. Compared with men with normal SBP-high FSB, high SBP-low FSB was associated with an increased risk of CVD mortality 1.81 (1.39–2.36), with attenuated but persisting evidence of an association for men with high SBP and high FSB 1.52 (1.06–2.16). When SBP was categorized as normal and high (<130 and ≥130 mmHg, respectively), there was no evidence of an association for men with high SBP and high FSB 1.11 (0.77–1.61).ConclusionThere might be an interaction between SBP, sauna bathing and CVD mortality risk in middle-aged and older Caucasian males. Frequent sauna baths may offset the increased risk of CVD mortality in men with high-normal SBP but not elevated SBP.

Life's Essential 8 and the risk of cardiovascular disease death and all-cause mortality in Finnish men.

The aim of the study was to examine the association between Life's Essential 8 (LE8) and the risk of cardiovascular and all-cause mortality. The LE8 was computed for 1662 men, aged 42-60 years, without pre-existing history of cardiovascular disease (CVD) at baseline in the Kuopio Ischaemic Heart Disease study. The LE8 factors include diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, blood glucose, and lipids. Each LE8 factor was scored between 0 and 100 points. The summation of all points generated the total LE8 score, which was categorized into quartiles ≤-420, >420-485, >485-550, and >550. Multivariable Cox regression models were used to estimate hazard ratios and 95% confidence intervals of LE8 scores for the outcomes. During a median follow-up of 30 years, 402 and 987 men died from CVD and any cause, respectively. The total LE8 score among participants ranged from 185 to 750. The higher the LE8 scores, the lower the risk of dying from CVD and all-cause. Following adjustment for age, alcohol consumption, and socio-economic status, every 50-unit increase in LE8 score was associated with 17% and 14% lower risk of CVD and all-cause deaths, respectively. Men within LE8 top quartile had 60% lower risk of CVD mortality when compared with those within the bottom quartile. Life's Essential 8 was strongly and inversely associated with the risk of CVD death and all-cause mortality among ageing men. Measures that promote optimal LE8 scores should be encouraged among the general population.

Inflammation, sauna bathing, and all-cause mortality in middle-aged and older Finnish men: a cohort study

Inflammation and sauna bathing are each related to the risk of all-cause mortality. The interplay between inflammation, sauna bathing and all-cause mortality is not well understood. We aimed to evaluate the separate and joint associations of inflammation (high sensitivity C-reactive protein, hsCRP) and frequency of sauna bathing (FSB) with all-cause mortality in a cohort of Caucasian men. We used the Kuopio Ischaemic Heart Disease Study cohort comprising 2575 men aged 42–61 years at baseline. Serum hsCRP was measured using an immunometric assay and sauna bathing habits were assessed by a self-administered questionnaire. High sensitivity CRP was categorized as normal and high (≤ 3 and > 3 mg/L, respectively) and FSB as low and high (defined as ≤ 2 and 3–7 sessions/week respectively). A total of 1618 deaths occurred during a median follow-up of 27.8 years. Comparing high vs normal hsCRP levels, the multivariable-adjusted HR (95% CI) for all-cause mortality was 1.27 (1.13–1.44). Comparing high vs low FSB, the multivariable-adjusted HR (95% CI) for all-cause mortality was 0.86 (0.76–0.97). Compared with normal hsCRP-low FSB, high hsCRP-low FSB was associated with an increased risk of all-cause mortality 1.28 (1.12–1.47), with no evidence of an association for high hsCRP-high FSB and all-cause mortality risk 1.06 (0.81–1.40). Positive additive and multiplicative interactions were found between hsCRP and FSB in relation to mortality. In a general Finnish male population, both hsCRP and FSB are each independently associated with all-cause mortality. However, frequent sauna baths appear to offset the increased all-cause mortality risk related to high hsCRP levels.

Frequent sauna bathing offsets the increased risk of death due to low socioeconomic status: A prospective cohort study of middle-aged and older men.

Low socioeconomic status (SES) and frequent sauna bathing are associated with increased and decreased risk of all-cause mortality, respectively. Whether there is an interplay among SES, sauna bathing and all-cause mortality risk is not known. We aimed to evaluate the separate and joint associations of SES and frequency of sauna bathing (FSB) with all-cause mortality risk in a prospective cohort study. We employed the Kuopio Ischaemic Heart Disease Study cohort comprising of 2575 men aged 42-61years at study entry. Self-reported SES and sauna bathing habits were assessed at baseline. Socioeconomic status was categorized as low and high (median cutoff) and FSB as low and high (defined as ≤2 and 3-7 sessions/week, respectively). During a median follow-up of 27.8years, 1618 deaths occurred. Comparing low vs high SES, the multivariable-adjusted HR (95% CI) for all-cause mortality was 1.31 (1.18-1.45). Comparing high vs low FSB, the multivariable-adjusted HR (95% CI) for all-cause mortality was 0.86 (0.76-0.97). Compared with high SES-low FSB, low SES-low FSB was associated with an increased risk of all-cause mortality 1.35 (1.20-1.51), without significant evidence of an association for low SES-high FSB and all-cause mortality risk 1.07 (0.89-1.29). Positive additive and multiplicative interactions were found between SES and FSB. There exists an interplay among SES, sauna bathing and all-cause mortality risk in a general Finnish male population. Frequent sauna baths may offset the increased overall mortality risk due to low SES.

P05-13 Associations between occupational physical activity and progression of carotid atherosclerosis among middle-aged women, are those with pre-existing cardiovascular disease more vulnerable?

BackgroundWorkers with high occupational physical activity (OPA) experience higher risk of cardiovascular diseases (CVD) than sedentary workers. In an ageing workforce, greater proportions will be expected to have CVD, and pre-existing CVD are shown to increase vulnerability to exposure of high OPA. However, most of the epidemiological evidence is derived from male cohorts, excluding those with pre-existing CVD, and using clinically manifest disease outcomes that are prone to healthy worker selection bias. To address these limitations and to highlight whether pre-existing CVD indicate vulnerability, this study investigated the effects of OPA on pre-clinical asymptomatic progression of carotid artery intima-media thickness (IMT) among women.MethodsWomen participants (N = 905) of the population-based Kuopio Ischemic Heart Disease Study (KIHD) with data on OPA and IMT were included. Linear mixed models, stratified by pre-existing CVD, estimated the association between OPA and the IMT progression from baseline (1998-2001) through 8-years of follow-up.ResultsNon-stratified analysis showed the greatest 8-year IMT progressions by exposure to light standing or moderately heavy active work (both 0.13 mm). Stratified analysis on within group changes and total level of IMT showed exposure to light standing and moderately heavy active work to give the greatest 8-year IMT progressions, especially pronounced among normotensives and those with pre-existing stenosis or ischemic heart disease (IHD). Women with pre-existing CVD ended up with the greatest total IMT levels (sum of baseline and estimated 8-year IMT change), in spite of less 8-year IMT change than among women with out pre-existing CVD. This may be explained by their initial high IMT level, combined with a celling effect of the change.ConclusionExposure to light standing work and moderately heavy active work was associated with accellerated progression of IMT, especially pronounced among normotensives or workers with pre-existing stenosis or IHD. The majority of the reported 8-year IMT progressions are at a clinically relevant magnitude of 0.1 mm, which associates with an 11% increased risk of acute myocardial infarction.

Serum C-reactive protein-to-albumin ratio is a potential risk indicator for pneumonia: Findings from a prospective cohort study

ObjectiveCirculating C-reactive protein (CRP) and albumin are known biomarkers of systemic inflammation. C-reactive protein-to-albumin ratio (CAR), a novel biomarker, has been suggested to be a more reliable risk indicator for inflammatory conditions compared to CRP or albumin alone. Inflammatory processes underlie the pathophysiology of pneumonia, but the association between CAR and pneumonia has not been previously investigated. We aimed to assess the prospective association of CAR with pneumonia risk. MethodsC-reactive protein and albumin were measured in serum samples at baseline from 2489 men aged 42–61 years, from the Kuopio Ischemic Heart Disease study. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated from Cox regression analysis. ResultsDuring a median follow-up of 26.1 years, 598 cases of pneumonia were recorded. In analysis adjusted for age, body mass index, smoking status, history of type 2 diabetes, prevalent coronary heart disease, history of asthma, history of chronic bronchitis, history of tuberculosis, alcohol consumption, socioeconomic status, leisure-time physical activity, and total energy intake, the HR (95% CI) for pneumonia comparing top versus bottom thirds of CAR was 1.62 (1.31–2.00). The corresponding adjusted risk for serum CRP was 1.67 (1.34–2.07). There was no evidence of an association between serum albumin and pneumonia risk. ConclusionIn middle-aged and older Finnish men, elevated serum CAR and CRP levels were each associated with an increased risk of pneumonia. Further research is needed to replicate these findings in other populations and assess the potential value of CAR in the prevention and management of pneumonia.

Differences in cardiometabolic risk profiles between Chinese and Finnish older adults with glucose impairment and central obesity

BackgroundObesity and ethnicity play important roles in cardiovascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to compare cardiometabolic risk profiles between Chinese and Finnish older adults of central obesity with prediabetes or T2DM.MethodsStudy subjects were 60–74 years old and originated from two population samples. The Finnish subjects came from the Kuopio Ischemic Heart Disease (KIHD) study (n = 1089), and the Chinese subjects came from the Shanghai High-risk Diabetic Screen (SHiDS) study (n = 818). The KIHD and SHiDS studies used similar questionnaires to determine participants’ baseline characteristics regarding the history of medication use and diseases and lifestyle factors. All study subjects participated in glucose tolerance tests and anthropometry assessments, including waist circumference measurements.ResultsAmong study subjects of central obesity with prediabetes (n = 298), fasting and 2-h glucose, and fasting insulin and insulin resistance were significantly higher in Chinese than in Finnish (p < 0.0001–0.016). In addition, triglyceride (TG) level was higher and the low-density lipoprotein cholesterol (LDL) and LDL to high-density lipoprotein cholesterol (HDL) ratio were lower in Chinese than in Finnish (p < 0.0001–0.003). Among subjects of central obesity with T2DM (n = 251), Chinese subjects had significantly less proportions of antihypertensive, glycaemic control medication, and statin users as well as lower level of physical activity (p < 0.0001 for all), while higher blood pressure (p = 0.002 for systolic blood pressure and p < 0.0001 for diastolic blood pressure), TG levels (p < 0.05) and HDL (p = 0.002) than the Finnish counterparts. There were no differences in β-cell function (HOMA-β) between Chinese and Finnish both in prediabetes and T2DM.ConclusionsOur results indicated that Chinese and Finnish older adults of central obesity with prediabetes and T2DM had similar β-cell function. However, Chinese individuals with prediabetes are prone to insulin resistance. Meanwhile, lipid metabolism dysfunction is also different between Chinese and Finnish. Chinese older adults of central obesity with prediabetes showed higher TG, but Finnish showed higher LDL and LDL/HDL. Strategic for T2DM prevention and treatment should be ethnically specific.

Impact of estimated pulse wave velocity and socioeconomic status on the risk of stroke in men: a prospective cohort study.

High pulse wave velocity (PWV) and low socioeconomic status (SES) are each associated with increased risk of stroke, but clarification of the interplay between PWV, SES and the risk of stroke appears to be warranted to identify vulnerable populations at high risk of stroke. We conducted a prospective study that examined the independent and joint associations of PWV and SES with the risk of stroke in the general population. The current study included 2666 men aged 42-61 years, who were enrolled in the Kuopio Ischaemic Heart Disease Study cohort. Estimated PWV (ePWV), a proxy of carotid-femoral PWV, was calculated from an equation based on age and mean blood pressure. SES was assessed using self-reported questionnaires and classified as tertiles, whereas ePWV was categorized as high (≥10m/s) and low (<10m/s). Individuals with high ePWV had a 48% higher risk of stroke after adjusting for confounding factors, whereas individuals with low SES had a similar 35% increased risk of stroke, compared with those high SES. Results of the joint associations of ePWV and SES with stroke showed high ePWV-high SES and high ePWV-low SES to be each associated with an increased risk of stroke: hazard ratios 1.53, 95% confidence intervals (CIs) (1.12-2.08) and hazard ratio 1.63, 95% CI (1.21-2.20), respectively, but low ePWV-low SES was not associated with a heightened risk of stroke (hazard ratio 1.12, 95% CI 0.87-1.44) compared with the low ePWV-high SES group. ePWV and SES are each independently associated with stroke risk. The association between elevated ePWV and the heightened risk of stroke is regardless of low or high SES.

Serum Copper and Risk of Cardiovascular Disease Mortality among Men without Diabetes: A 26-year Prospective Cohort Study

Background: Longitudinal studies assessing the association between copper and the risk of CVD mortality among aging populations without diabetes are scarce. We sought to examine the prospective association between serum copper and future risk of CVD mortality among a general population sample of men without diabetes in Finland. Method: We used the population-based data from the Kuopio Ischaemic Heart Disease Study, comprising men aged 42-60years at baseline. Serum copper concentrations were determined using Atomic Absorption Spectrometer and categorized into quartiles. The associations with CVD mortality were analyzed using multivariable Cox regression models. Results: After a median follow-up period of 26years, 524 CVD deaths occurred among 2,395 men. After adjustment for age, BMI, blood pressure, history of coronary heart disease(CHD), high-density cholesterol, total cholesterol, smoking, alcohol and socioeconomic status, the hazard ratios (and 95% CIs) for CVD mortality for serum copper concentrations in the second, third and fourth quartiles were 1.03(0.78-1.36), 1.32(1.04-1.68) and 1.50(1.18-1.91) respectively (using the first quartile as the referent). The association remained consistent following the exclusion of men with a history of CHD. Conclusions: This study reveals that elevated serum copper concentrations at baseline are associated with future risk of CVD mortality. Thus, prompting the possible role of serum copper levels as a biomarker for CVD mortality in men without diabetes. The role of serum copper as a putative risk factor for CVDs requires further exploration. The exact mechanisms underlying the association between elevated serum copper concentration and the risk of CVD mortality are yet to be unraveled.

Physical activity may not be associated with long-term risk of dementia and Alzheimer's disease.

BackgroundWhile it is well established that physical activity is associated with reduced risk of vascular and nonvascular outcomes as well as mortality, evidence on the association between physical activity and dementia is inconsistent. We aimed to assess the associations of physical activity with the risk of dementia and Alzheimer's disease (AD).Material and methodsWe analysed data on 2394 apparently healthy men with good baseline cognitive function from the prospective population‐based Kuopio Ischaemic Heart Disease study. We assessed habits of physical activity at baseline using a 12‐month leisure time physical activity (LTPA) questionnaire. Using Cox regression, we calculated hazard ratios adjusted for body mass index, systolic blood pressure, smoking status, history of type‐2 diabetes, total cholesterol, high‐density lipoprotein cholesterol, alcohol consumption, history of coronary heart disease and high‐sensitivity C‐reactive protein.ResultsDuring a median follow‐up of 24.9 years (interquartile range: 18.3‐26.9), 208 men developed dementia and 128 developed AD. Multivariable adjusted hazard ratios for dementia comparing top vs bottom tertiles of physical activity were 0.97 (95% confidence intervals: 0.69‐1.38) for total physical activity volume, 0.96 (0.69‐1.34) for conditioning LTPA volume and 1.13 (0.80‐1.61) for total LTPA volume. Corresponding hazard ratios for AD were 1.19 (0.76‐1.85), 0.98 (0.64‐1.49) and 1.22 (0.77‐1.93). Associations were consistent in analyses restricted to participants with ≥10 years of follow‐up.ConclusionsIn middle‐aged Caucasian men, various physical activity exposures were not associated with all‐cause dementia or AD. Future studies should address biases due to reverse causation and regression dilution and should involve objective measures of physical activity.

Impact of cardiorespiratory fitness on survival in men with low socioeconomic status.

Although both low socioeconomic status (SES) and poor cardiorespiratory fitness (CRF) are associated with increased chronic disease and heightened mortality, it remains unclear whether moderate-to-high levels of CRF are associated with survival benefits in low SES populations. This study evaluated the hypothesis that SES and CRF predict all-cause mortality and cardiovascular disease mortality and that moderate-to-high levels of CRF may attenuate the association between low SES and increased mortality. This study included 2368 men, who were followed in the Kuopio Ischaemic Heart Disease Study cohort. CRF was directly measured by peak oxygen uptake during progressive exercise testing. SES was characterized using self-reported questionnaires. During a 25-year median follow-up, 1116 all-cause mortality and 512 cardiovascular disease mortality events occurred. After adjusting for potential confounders, men with low SES were at increased risks for all-cause mortality (hazard ratio 1.49, 95% confidence interval: 1.30-1.71) and cardiovascular disease mortality (hazard ratio1.38, 1.13-1.69). Higher levels of CRF were associated with lower risks of all-cause mortality (hazard ratio 0.54, 0.45-0.64) and cardiovascular disease mortality (hazard ratio 0.53, 0.40-0.69). In joint associations of SES and CRF with mortality, low SES-unfit had significantly higher risks of all-cause mortality (hazard ratio 2.15, 1.78-2.59) and cardiovascular disease mortality (hazard ratio 1.95, 1.48-2.57), but low SES-fit was not associated with a heightened risk of cardiovascular disease mortality (hazard ratio 1.09, 0.80-1.48) as compared with their high SES-fit counterparts. Both SES and CRF were independently associated with subsequent mortality; however, moderate-to-high levels of CRF were not associated with an excess risk of cardiovascular disease mortality in men with low SES.

The Duke treadmill score with bicycle ergometer: Exercise capacity is the most important predictor of cardiovascular mortality.

BackgroundThe Duke treadmill score, a widely used treadmill testing tool, is a weighted index combining exercise time or capacity, maximum ST-segment deviation and exercise-induced angina. No previous studies have investigated whether the Duke treadmill score and its individual components based on bicycle exercise testing predict cardiovascular death.DesignTwo populations with a standard bicycle testing were used: 3936 patients referred for exercise testing (2371 men, age 56 ± 13 years) from the Finnish Cardiovascular Study (FINCAVAS) and a population-based sample of 2683 men (age 53 ± 5.1 years) from the Kuopio Ischaemic Heart Disease study (KIHD).MethodsCox regression was applied for risk prediction with cardiovascular mortality as the primary endpoint.ResultsIn FINCAVAS, during a median 6.3-year (interquartile range (IQR) 4.5–8.2) follow-up period, 180 patients (4.6%) experienced cardiovascular mortality. In KIHD, 562 patients (21.0%) died from cardiovascular causes during the median follow-up of 24.1 (IQR 18.0–26.2) years. The Duke treadmill score was associated with cardiovascular mortality in both populations (FINCAVAS, adjusted hazard ratio (HR) 3.15 for highest vs. lowest Duke treadmill score tertile, 95% confidence interval (CI) 1.83–5.42, P < 0.001; KIHD, adjusted HR 1.71, 95% CI 1.34–2.18, P < 0.001). However, after progressive adjustment for the Duke treadmill score components, the score was not associated with cardiovascular mortality in either study population, as exercise capacity in metabolic equivalents of task was the dominant harbinger of poor prognosis.ConclusionsThe Duke treadmill score is associated with cardiovascular mortality among patients who have undergone bicycle exercise testing, but metabolic equivalents of task, a component of the Duke treadmill score, proved to be a superior predictor.

Marriage Dissatisfaction and the Risk of Sudden Cardiac Death Among Men

Conflicts in marriage have been associated with potential risk of cardiovascular disease; however, there is lack of prospective evidence on the association between marriage satisfaction and sudden cardiac death (SCD). We aimed to assess the association between perceived level of marriage satisfaction and risk of SCD. This study employed the Kuopio Ischemic Heart Disease study, an ongoing prospective population-based study in Finland. Perceived level of marriage satisfaction was assessed in 2,262 men using a well-structured self-administered questionnaire. Multivariable adjusted Cox regression models were used to estimate hazard ratios (95% confidence interval [CI]) for SCD. During a median follow-up period of 25.9 years, 239 SCDs were recorded. The mean age of participants was 53 (SD 5.2) years. On adjustment for several conventional cardiovascular risk factors, hazard ratio (95% CI) of SCD was 1.90 (CI 1.09 to 3.32; p = 0.02) for men who were dissatisfied with their marriage, compared with men who were satisfied with their marriage. The association remained consistent on further adjustment for preexisting coronary heart disease, socioeconomic status, and years of education 1.86 (CI 1.07 to 3.25; p = 0.03). In conclusion, dissatisfied marriage is associated with an increased risk of SCD among middle-aged Caucasian men, independent of conventional cardiovascular risk factors.

Sleep Duration and Risk of Fatal Coronary Heart Disease, Sudden Cardiac Death, Cancer Death, and All-Cause Mortality

BackgroundSleep duration has been shown to be associated with all-cause mortality; however, its relationship with cause-specific fatal events remains uncertain. We examined the relationship between sleep duration and risk of fatal coronary heart disease, sudden cardiac death, cancer-related death, and all-cause mortality. MethodsSleep duration was self-reported at baseline examinations performed between March 20, 1984, and December 5, 1989, in 2361 men aged 42-61 years from the Kuopio Ischemic Heart Disease study. Of these, 1734 (73.4%) men were free from coronary heart disease and cancer at baseline. ResultsA total of 802 all-cause deaths, 202 fatal coronary heart disease events, 141 sudden cardiac events, and 229 cancer-related deaths were reported during a median follow-up of 25.9 (interquartile range, 20.6-28.2) years. Multivariable adjusted hazard ratios comparing the top quartile (>10 hours) of sleep duration vs the bottom quartile (<8 hours) was 1.19 (95% confidence interval [CI], 1.01-1.43) for all-cause mortality, 1.27 (95% CI, 0.88-1.84) for fatal coronary heart disease, 1.20 (95% CI, 0.78-1.86) for sudden cardiac death, and 1.29 (95% CI, 0.92-1.80) for cancer death. No differences in association of sleep duration with outcomes were found in clinically relevant subgroups, including age, history of coronary heart disease, body mass index, physical activity, and C-reactive protein levels. ConclusionsLonger duration of sleep was associated with significantly increased all-cause mortality. The mechanistic link between these findings remains to be explored further.

Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein

Purpose: We aimed to assess the prospective association of serum albumin with venous thromboembolism (VTE) risk and evaluate if the association is independent of or modified by inflammation, as measured by high sensitivity C-reactive protein (hsCRP).Design: We analysed data of 2176 men aged 42–61 years free from VTE in the Kuopio Ischemic Heart Disease study, with serum albumin concentrations measured at baseline using Coulter’s bromocresol purple colorimetric assays. Hazard ratios (HRs) (95% confidence intervals [CI]) were calculated for VTE.Results: There were 109 validated cases of VTE recorded during a median follow-up of 24.9 years. The risk of VTE increased linearly below a serum albumin concentration of ∼48 g/l. In Cox regression analysis adjusted for established risk factors and other potential confounders, the HR (95% CI) for VTE per 1 standard deviation lower serum albumin was 1.23 (1.02–1.47). The association remained persistent on further adjustment for hsCRP 1.22 (1.01–1.46). Furthermore, the association was not modified by hsCRP and persisted on exclusion of men with elevated hsCRP levels.Conclusions: In middle-aged Caucasian men, low serum albumin is associated with an increased risk of VTE, consistent with a linear dose-response relationship. The association is independent of and not modified by inflammation.Key messages • Serum albumin may be associated with future risk of venous thromboembolism (VTE); however, the shape, nature, magnitude and consistency of the association is uncertain. • In a population-based prospective cohort study, low serum albumin was associated with an increased risk of VTE in a linear dose-response manner and this association was independent of and not modified by inflammation. • Serum albumin concentrations may play a role in the development of VTE.

Gamma-glutamyltransferase and risk of chronic kidney disease: A prospective cohort study

BackgroundElevated serum gamma-glutamyltransferase (GGT) activity has been linked with an increased risk of chronic kidney disease (CKD) in Asian populations. We aimed to assess the prospective association of serum GGT with risk of CKD in a Caucasian population. Materials and methodsWe related GGT activity to the incidence of CKD in 2338 men aged 42–61years of the Kuopio Ischemic Heart Disease study with normal kidney function at baseline. Repeat measurements of GGT were used to correct for within-person variability. ResultsDuring a median follow-up of 25.6years, 221 men developed new-onset CKD. The age-adjusted regression dilution ratio of loge GGT was 0.70 (95% CI: 0.64–0.75). Gamma-glutamyltransferase was log-linearly associated with risk of CKD in age-adjusted analysis. In Cox regression analysis adjusted for age, the hazard ratio (95% CIs) for CKD per standard deviation increase in loge baseline GGT was 1.25 (1.09–1.43) which was attenuated to 1.01 (0.86–1.19) on further adjustment for several confounders. ConclusionContrary to previous evidence of an independent association between elevated GGT and increased risk of CKD in Asian populations, initial evidence of an association between GGT and CKD in Caucasian men was confounded by body mass index, lifestyle factors, and lipids.

Serum C-reactive protein increases the risk of venous thromboembolism: a prospective study and meta-analysis of published prospective evidence

Evolving debate suggests that C-reactive protein (CRP) might be associated with the development of venous thromboembolism (VTE); however, the evidence is conflicting. We aimed to assess the prospective association of CRP with VTE risk. C-reactive protein was measured in serum samples at baseline from 2420 men aged 42–61 years, from the Kuopio Ischemic Heart Disease study. Within-person variability in CRP levels was corrected for using repeat measurements of CRP taken 11 years after baseline. Incident VTE events (n = 119) were recorded during a median follow-up of 24.7 years. The age-adjusted regression dilution ratio for loge CRP was 0.57 [95% confidence interval (CIs): 0.51–0.64]. In age-adjusted Cox regression analysis, the hazard ratio (95% CIs) for VTE per 1 standard deviation (SD) increase in loge baseline CRP was 1.17 (0.98–1.40). Further adjustment for several established and emerging risk factors did not alter the association. In a meta-analysis of nine population-based studies (including the current study) comprising 81,625 participants and 2225 VTE cases, the fully-adjusted risk estimate for VTE was 1.14 (1.08–1.19) per SD increase in loge baseline CRP. In a pooled dose–response analysis, a linear association between CRP and VTE risk was suggested (P for nonlinearity = 0.272). The pooled risk estimate for VTE per 5 mg/l increment in CRP levels was 1.23 (1.09–1.38). C-reactive protein was only modestly associated with VTE risk in the primary analysis. Pooled evidence, however, suggests that elevated CRP is associated with greater VTE risk, consistent with a linear dose–response relationship.

Sauna Bathing and Incident Hypertension: A Prospective Cohort Study.

Sauna bathing is associated with reduced cardiovascular risk, but the mechanisms underlying this beneficial effect are not entirely understood. We aimed to assess the relationship between sauna bathing and risk of incident hypertension. Frequency of sauna bathing was ascertained using questionnaires in the Kuopio Ischemic Heart Disease Study, a prospective cohort study conducted in Eastern Finland that comprised a population-based sample of 1,621 men aged 42 to 60 years without hypertension at baseline. The incidence of hypertension was defined as a physician diagnosis of hypertension, systolic blood pressure (SBP) >140 mm Hg, diastolic blood pressure >90 mm Hg, or use of antihypertensive medication. During a median follow-up of 24.7 years, 251 incident cases (15.5%) were recorded. In Cox regression analysis adjusted for baseline age, smoking, body mass index, and SBP; compared to participants reporting 1 sauna session per week, the hazard ratio for incident hypertension in participants reporting 2 to 3 sessions and 4 to 7 sessions was 0.76 (95% confidence interval: 0.57-1.02) and 0.54 (0.32-0.91), respectively. The corresponding hazard ratios were similar after further adjustment for glucose, creatinine, alcohol consumption, heart rate, family history of hypertension, socioeconomic status, and cardiorespiratory fitness: 0.83 (95% confidence interval: 0.59-1.18) and 0.53 (0.28-0.98), respectively. Regular sauna bathing is associated with reduced risk of hypertension, which may be a mechanism underlying the decreased cardiovascular risk associated with sauna use. Further epidemiological and experimental studies could help elucidate the effects of sauna bathing on cardiovascular function.

High levels of cynical distrust partly predict premature mortality in middle-aged to ageing men.

The aim of this study was to evaluate the effect of cynical distrust on mortality in middle-aged and aging men. The analysis is based on Kuopio Ischemic Heart Disease study, follow-up from 1984 to 2011. Sample consisted of 2682 men, aged 42-61years at baseline. Data on mortality was provided by the National Death Registry, causes of death were classified by the National Center of Statistics of Finland. Cynical distrust was measured at baseline using Cynical Distrust Scale. Survival analyses were conducted using Cox regression models. In crude estimates after 28years of follow-up, high cynical distrust was associated with 1.5-1.7 higher hazards for earlier death compared to low cynical distrust. Adjusted for conventional risk factors, high cynical distrust was significantly associated regarding CVD-free men and CVD mortality, while non-CVD mortality in study sample was consistently but not significantly associated. The risk effects were more expressed after 12-20years rather than in earlier or later follow-up. To conclude, high cynical distrust associates with increased risk of CVD mortality in CVD-free men. The associations with non-CVD mortality are weaker and not reach statistical significance.

Changes in cardiorespiratory fitness predict incident hypertension: A population-based long-term study.

We investigated whether long-term changes in cardiorespiratory fitness (CRF) predict the risk of incident hypertension, independent of risk factors, in initially normotensive men. This prospective study from the Kuopio Ischemic Heart Disease Study included 431 male participants without hypertension who underwent symptom-limited maximal cardiopulmonary exercise testing at baseline and during a second examination, 11-years later, who were re-evaluated for hypertension at 20-year follow-up. Changes in CRF (%) were calculated as the difference in directly measured maximal oxygen uptake (VO2max ) between the baseline and second examination, and classified into decreasing tertiles as percentages. Hypertension was defined as systolic and/or diastolic blood pressure ≥140/90 mmHg or hypertension that required antihypertensive medication as diagnosed by a physician. During a 10-year follow-up after the second examination, 165 men (38%) developed hypertension. Men who demonstrated the largest decline in CRF between evaluations (-62.1% to -20.2%) had a 4.33-fold (95% CI 2.32-8.07, P < .001) risk of incident hypertension compared to men with the smallest decrease or improvement in CRF (-8.8% to 82.0%), after adjusting for age, follow-up duration, alcohol consumption, cigarette smoking, serum low and high density lipoprotein cholesterol, body mass index, daily energy expenditure (kcal) via physical activity, glomerular filtration rate, and baseline systolic blood pressure and VO2max . The present findings indicate that more marked decreases in measured CRF over time are independently associated with the risk of incident hypertension in men, suggesting that CRF should be considered a causal risk factor to predict future hypertension.