Antti Reunanen

Depression and cardiovascular diseases

We first review the asSociations between depression and cardiovascular diseases (CVDs). Then we examine them in the nationally representative Mini‐Finland Health Survey, which covers 8,000 persons. Chronic somatic diseases and mental disorders were diagnosed using standardized methods. Cross‐sectionally, CVDs and neurotic depression were asSociated both before and after adjustment for covariates. The strongest asSociations were observed in the case of severe CVDs. During a 6.6 year follow‐up, the risk of CVD death and coronary death was elevated in depressed persons both with and without CVDs at entry. Much of the cross‐sectional asSociation is probably due to depression caused by CVDs. The outcome of CVD may be poorer in depressed persons. The hypothesis that depression is a cause of CVDs requires further study.

Risk factors for subarachnoid hemorrhage in a longitudinal population study

The known risk factors of atherosclerotic diseases may be involved in the development of a subarachnoid hemorrhage. We studied the morbidity and mortality due to subarachnoid hemorrhage among 42,862 men and women aged 20-69 years who had participated in a large health survey in Finland. During a mean follow-up of 12 years, 102 non-fatal and 85 fatal cases of subarachnoid hemorrhage were observed. The total incidence was 37 per 100,000 person-years. Smoking and hypertension were positively associated and body mass index was inversely associated with the risk of subarachnoid hemorrhage. These associations were not confounded by age or each other. No statistically significant association with risk was detected for serum cholesterol level, hematocrit content, known heart disease, or diabetes. The risk was especially elevated among lean hypertensive subjects and lean smoking subjects. The age-adjusted relative risks of subarachnoid hemorrhage for lean, hypertensive smokers were 18.3 (95% confidence interval (CI), 7.8-42.7) among women and 6.7 (95% CI, 2.3-19.7) among men as compared to the risk among subjects without these risk factors. We conclude that modifiable risk factors are predictive of subarachnoid hemorrhage, for which reason subarachnoid hemorrhage may in part be preventable. Leanness combined with arterial hypertension and/or smoking, in particular, poses a substantially elevated risk.

Heart rate and mortality

Abstract. Reunanen A, Karjalainen J, Ristola P, Heliövaara M, Knekt P, Aromaa A (National Public Health Institute, Helsinki, Central Military Hospital, Helsinki, and Kvaerner Masa‐Yards Helsinki New Shipyard, Helsinki, Finland). Heart rate and mortality. J Intern Med 2000; 247: 231–239.

Serum cholesterol and risk of cancer in a cohort of 39,000 men and women

Serum cholesterol concentration was studied for its prediction of cancer in 39,268 men and women aged 15-99 years and initially free from cancer. During a median follow-up of 10 years 1381 cancer cases were diagnosed. Serum cholesterol level was inversely associated with cancer incidence among non-smokers. Age-adjusted relative risks of cancer in quintiles of serum cholesterol were in male non-smokers 1.0, 0.81, 0.73, 0.69, and 0.46 and in female non-smokers 1.0, 0.75, 0.84, 0.78, and 0.70. The associations were not found to be confounded by serum vitamins A or E, serum selenium or several other factors. The association between serum cholesterol level and risk of cancer varied from strongly negative to slightly positive according to subpopulation and site of cancer. The strongest negative associations were found to appear during the first years of follow-up, especially for rapidly developing cancers. Thus the increased occurrence of cancer at low cholesterol levels seems mainly to be due to preclinical cancer.

PREVALENCE AND TEN‐YEAR (1970‐1979) INCIDENCE OF INSULIN‐DEPENDENT DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS IN FINLAND

ABSTRACT. The prevalence and incidence of insulin‐dependent diabetes mellitus in Finnish children and adolescents were studied by means of a national register of drug‐treated diabetics and hospital records. At the end of 1979 the prevalence of diabetes in children aged 0‐14 was 191/100000, and in those aged 0‐19, 262/100000 respectively. During the 10‐year period from 1970 to 1979, 3916 new diabetics aged 0‐19 years were registered. The annual incidence of diabetes was 27.3/100000 in the age group 0‐19 years and 28.6/100000 in those 0‐14 years. The peak incidence of diabetes in girls occurred at 12 years of age and in boys at 14 years. There was a seasonal variation in the symptom debut, with peaks in April and in September and low rates in the summer. A regional variation in the prevalence and incidence rates was evident the rates being highest in eastern and lowest in northern Finland. The prevalence of diabetes mellitus increased clearly during the observation period, and the incidence tended to increase especially during the last years. Both prevalence and incidence rates of diabetes mellitus in Finnish children are high by international standards, possibly the highest in the world.

Body iron stores, dietary iron intake and coronary heart disease mortality

Abstract. Objectives. To assess whether increased body iron stores and dietary iron intake are associated with an increased risk of coronary heart disease mortality.

Low vitamin E status is a potential risk factor for insulin‐dependent diabetes mellitus

Objectives. To study the association of vitamin E status with occurrence of insulin‐dependent diabetes mellitus (IDDM).

Homocysteine and major coronary events: a prospective population study amongst women.

Abstract. Knekt P, Alfthan G, Aromaa A, Heliövaara M, Marniemi J, Rissanen H, Reunanen A (National Public Health Institute, Helsinki, and Social Insurance Institution, Turku, Finland). Homocysteine and major coronary events; a prospective population study amongst women. J Intern Med 2001; 249: 461–465.

Recent Trends in the Consumption of Lipid-Lowering Drugs in Finland

The consumption of lipid-lowering drugs in Finland and in other Nordic countries increased almost steadily in 1988-1993. The exceptions were the year 1992 in Finland and 1993 in Iceland, when consumption was lower than in the previous year. In both cases the temporary decline in consumption was associated with a reduction in reimbursement for the costs of lipid-lowering drugs. In 1993, the consumption level was 2.7 defined daily doses/1000 inhabitants/day in Finland and ranged from 2.3 to 4.0 in other Nordic countries. According to the Finnish nationwide prescription register, 0.5% of men and 0.6% of women purchased lipid-lowering drugs in the period from January to September, 1994. The rate of use was highest among people of middle age. In the early 1990s, statins took the lead in the consumption of lipid-lowering drugs, accounting for 70% of prescriptions in 1993; the percentages of fibrates, resins, and nicotinic acid derivatives declined in the same period. In 1994 the prevalence of familial hypercholesterolemia (FH) according to strictly predetermined criteria was 0.8 per 1000 among Finns, and the proportion of FH patients among all users of lipid-lowering drugs was 11%. The use of lipid-lowering drugs is not particularly high in Finland and seems to be reasonably targeted.

Glucose tolerance and coronary heart disease in middle-aged Finnish men: Social Insurance Institution's Coronary Heart Disease Study.

Abstract The relationship of plasma glucose 1 hr after an oral glucose load to the prevalence of symptoms and ECG signs of coronary heart disease and to 4-yr mortality was investigated in 3351 men aged 40–59 yr from the Finnish Social Insurance Institutions Coronary Heart Disease Study. The 1-hr post-load plasma glucose appeared to have no relationship to symptoms of coronary heart disease but showed a linear and partly independent relationship to ischaemic ECG abnormalities. During a 4-yr follow-up, the 1-hr post-load plasma glucose level had no relationship to total mortality or mortality from cardiovascular diseases or coronary heart disease.