Aapo Lehtonen

Continuous 15-Year Decrease in Incidence and Mortality of Stroke in Finland. The FINSTROKE Study

Background and Purpose— The purpose of this study was to analyze the incidence and mortality trends in stroke events among persons 25 to 74 years of age in Finland during 1983 to 1997. Methods— The population-based FINSTROKE register recorded 5650 new strokes among persons 25 to 74 years of age in 2 geographical areas of Finland: 2770 in the Kuopio area (east central Finland) and 2880 in Turku (southwestern Finland). Of these, 3065 were men and 2585 were women. Results— The rates of acute stroke events fell during the whole study period in both men and women. In both FINSTROKE areas combined, the average annual decline in the age-standardized incidence of first stroke events was 2.0% (95% confidence interval [CI], −2.8 to −1.2; P <0.001) among men and 1.7% (95% CI, −2.6 to −0.8; P <0.001) among women. The decline in the incidence of ischemic stroke was even steeper, 2.9%/y (95% CI, −4.9 to −1.1; P <0.001) among men and 3.1%/y (95% CI, −5.0 to −1.1; P <0.001) among women, whereas the incidence of intracerebral hemorrhage and subarachnoid hemorrhage did not change. Mortality from all stroke events declined in the FINSTROKE areas by 3.7%/y (95% CI, −5.3 to −2.0; P <0.001) among men and by 4.1%/y (95% CI, −5.9 to −2.4; P <0.001) among women. The 28-day case fatality of all stroke events also tended to decline, but the decline was of borderline statistical significance only (P =0.07 among men, P =0.05 among women). Conclusions— Incidence and mortality of stroke events declined significantly in these 2 register areas in Finland during the 15-year period of 1983 to 1997.

Trends in coronary events in Finland during 1983–1997; The FINAMI study

AIMS To analyse the trends in incidence, recurrence, case fatality, and treatments of acute coronary events in Finland during the 15-year period 1983-97. METHODS AND RESULTS Population-based MI registration has been carried out in defined geographical areas, first as a part of the FINMONICA Project and then continued as the FINAMI register. During the study period, 6501 coronary heart disease (CHD) events were recorded among men and 1778 among women aged 35-64 years. The CHD mortality declined on average 6.4%/year (95% confidence interval -5.4, -7.4%) among men and 7.0%/year (-4.7, -9.3%) among women. The mortality from recurrent events declined even more steeply, 9.9%/year (-8.3, -11.4%) among men and 9.3%/year (-5.1, -13.4%) among women. The proportion of recurrent events of all CHD events also declined significantly in both sexes. Of all coronary deaths, 74% among men and 61% among women took place out-of-hospital. The decline in 28-day case fatality was 1.3%/year (-0.3, -2.3%) among men and 3.1%/year (-0.7, -5.5%) among women. CONCLUSIONS The study period was characterized by a marked reduction in the occurrence of recurrent CHD events and a relatively modest reduction in the 28-day case fatality. The findings suggest that primary and secondary prevention have played the main roles in the decline in CHD mortality in Finland.

Decline in Out-of-Hospital Coronary Heart Disease Deaths Has Contributed the Main Part to the Overall Decline in Coronary Heart Disease Mortality Rates Among Persons 35 to 64 Years of Age in Finland The FINAMI Study

Background—Out-of-hospital deaths constitute the majority of all coronary heart disease (CHD) deaths and are therefore of considerable public health significance. Methods and Results—We used population-based myocardial infarction register data to examine trends in out-of-hospital CHD deaths in Finland during 1983 to 1997. We included in out-of-hospital deaths also deaths in the emergency room and all deaths within 1 hour after the onset of symptoms. Altogether, 3494 such events were included in the analyses. The proportion of out-of-hospital deaths of all CHD deaths depended on age and gender. In the age group 35 to 64 years, it was 73% among men and 60% among women. These proportions did not change during the study. The annual average decline in the age-standardized out-of-hospital CHD death rate was 6.1% (95% CI, −7.3, −5.0%) among men and 7.0% (−10.0, −4.0%) among women. These declines contributed among men 70% and among women 58% to the overall decline in CHD mortality rate. In all, 58% of the male and 52% of the female victims of out-of-hospital CHD death had a history of symptomatic CHD. Among men with a prior history of myocardial infarction, the annual average decline in out-of-hospital CHD deaths was 5.3% (−7.2, −3.2%), and among men without such history the decline was 2.9% (−4.4, −1.5%). Among women, the corresponding changes were −7.8% (−14.2, −1.5%) and −4.5% (−8.0, −1.0%). Conclusions—The decline in out-of-hospital CHD deaths has contributed the main part to the overall decline in CHD mortality rates among persons 35 to 64 years of age in Finland.

Serum testosterone but not leptin predicts mortality in elderly men

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Coexistence of lowered mood and cognitive impairment of elderly people in five birth cohorts.

Using Goldberg’s General Health Questionnaire (GHQ) to identify potential cases of mental disorders, we screened 246 randomly; selected persons among the 116 616 people older than 65 in the metropolitan zone of Guadalajara; 86 subjects (35%) qualified as “cases”; this figure is much higher than that reported (20.8%) in the adult population in a previous study. Among the cases, 69% were female, 66% were widowed, and 50% were divorced; 44% had not finished gradeschool, 42% had no scholastic education, 54% were unemployed, and 40% worked at home. Factors associated with anxiety and severe depression, sleep disorders, psychosomatic symptoms, and problems in interpersonal relations were studied.

Serum Lipids in Soccer and Ice-Hockey Players

The concentrations of serum cholesterol, HDL-cholesterol, triglycerides, phospholipids, and free fatty acids of Finnish top-class football and ice-hockey players were determined during different training programs and the results were compared with those of a control group. The serum levels of total cholesterol, HDL-cholesterol, and the ratio of HDL-cholesterol to total cholesterol were increased to those football players having more aerobic exercise in their training program. The concentrations of HDL-cholesterol and the HDL-cholesterol to total cholesterol ratio were lowest in the ice-hockey players, whose training is more anaerobic. There were no significant differences of serum triglyceride levels in different groups. The serum concentrations of fatty acids were highest in control group and lowest in ice-hockey and football teams during the active playing season. The differences of serum lipids seem thus to be in connection with the kinds of sport that differ in their energy metabolism requirements. This may be of importance when judging the benefit of exercise on the prophylaxis of atherosclerosis.

Eleven-Year Trends of Stroke in Turku, Finland

The Turku Stroke Register included stroke events at all ages during the years 1982–1992. The incidence of stroke declined in all age groups, even in the oldest one. An even steeper decline was observed in mortality from stroke. Ischemic strokes contributed most to the observed decline, while subarachnoid and intracerebral hemorrhage showed mainly flat trends. Flat trends were also observed for recurrent strokes. The absolute number of strokes remained stable through the study years, but the population above 75 years of age doubled. More than half of the strokes occurred in people aged 75 years or older, and three fourths of them occurred in women. The incidence and mortality rate of ischemic stroke declined steeply in all age groups. Due to an increase in elderly people in the background population, the total number of strokes remained stable. Thus, in spite of the observed declining trends in incidence, the need for stroke care has not diminished.

Aging of the population may not lead to an increase in the numbers of acute coronary events: a community surveillance study and modelled forecast of the future

Objective To examine the incidence, mortality and case fatality of acute coronary syndrome (ACS) in Finland during 1993–2007 and to create forecasts of the absolute numbers of ACS cases in the future, taking into account the aging of the population. Design Community surveillance study and modelled forecasts of the future. Setting and methods Two sets of population-based coronary event register data from Finland (FINAMI and the National Cardiovascular Disease Register (CVDR)). Bayesian age–period–cohort (APC) modelling. Participants 24 905 observed ACS events in the FINAMI register and 364 137 in CVDR. Main outcome measures Observed trends of ACS events during 1993–2007, forecasted numbers of ACS cases, and the prevalence of ACS survivors until the year 2050. Results In the FINAMI register, the average annual declines in age-standardised incidence of ACS were 1.6% (p<0.001) in men and 1.8% (p<0.001) in women. For 28-day case fatality of incident ACS, the average annual declines were 4.1% (p<0.001) in men and 6.7% (p<0.001) in women. Findings in the country-wide CVDR data were consistent with the FINAMI register. The APC model, based on the CVDR data, suggested that both the absolute numbers of ACS events and the prevalence of ACS survivors reached their peak in Finland around 1990, have declined since then, and very likely will continue to decline until 2050. Conclusions The ACS event rates and absolute numbers of cases have declined steeply in Finland. The declining trends are likely to continue in the future despite the aging of the population.

Atrial Fibrillation in Older Stroke Patients: Association with Recurrence and Mortality After First Ischemic Stroke

OBJECTIVES: The objective of this study was to determine the association of atrial fibrillation (AF) with stroke recurrence and mortality and with the causes of death in ischemic stroke patients aged 75 years and older.

Are coronary event rates declining slower in women than in men – evidence from two population-based myocardial infarction registers in Finland?

BackgroundStudies have suggested that the prevention and treatment of coronary heart disease may not have been as effective in women as in men. Therefore, we aimed to examine whether the incidence, attack rate and mortality of myocardial infarction (MI) events have declined less in women than in men.MethodsTwo large population-based MI registers, the FINAMI register and the Finnish Cardiovascular Disease Register (CVDR) were used for comparing the event rates among men and women aged ≥35 years in two time periods, 1994–1996 and 2000–2002.ResultsIn the FINAMI register a total of 5,252 events were recorded in men and 4,898 in women. Corresponding numbers in the CVDR were 78,709 and 70,464. Both FINAMI and CVDR data suggested smaller declines in incidence and attack rate of MI events in women than in men. In CVDR data the decline in mortality was also smaller in women than in men, while in FINAMI data this difference did not reach statistical significance. In the large CVDR data set, negative binomial regression models revealed smaller declines in incidence (p = 0.006), attack rate (p = 0.008) and mortality (p = 0.04) in women than in men aged <55 years. In persons ≥55 years no difference was observed between women and men.ConclusionThe incidence and attack rate of MI events have declined less in women aged <55 than in men of similar age. In older persons no significant differences were observed. Further studies are warranted to find out the reasons why the development has been less favourable for young women than for men.