Vesa Korpelainen

Long-term consumption of plant stanol and sterol esters, vascular function and genetic regulation.

Polymorphisms of the ABCG5 and ABCG8 genes interfere with cholesterol absorption and synthesis. We determined whether common polymorphisms of these genes regulate the responses of serum cholesterol and vascular function during long-term inhibition of cholesterol absorption. Mildly to moderately hypercholesterolaemic subjects (n 282) completed a 1-year study consuming plant stanol or sterol ester (2 g stanol or sterol) or control spread. Serum cholesterol and non-cholesterol sterols, markers of cholesterol absorption and synthesis, and variables of vascular function and structure were analysed in relation to common polymorphisms of ABCG5 and ABCG8. At baseline, subjects with the 54K allele of ABCG8 had higher brachial endothelial-dependent flow-mediated dilatation than those without it (5.79 (se 0.31) v. 4.46 (se 0.44) %; P = 0.049), and subjects with the 632V allele of ABCG8 had larger brachial artery diameter than those without it. Polymorphisms of ABCG5 and ABCG8 were neither associated with serum cholesterol reduction nor changes in cholesterol metabolism or in vascular function. However, in subjects with the 400K allele of ABCG8, intima media thickness (IMT) was increased in all groups more than in those without it (P < 0.05). In conclusion, serum cholesterol lowering with absorption inhibition was not associated with polymorphic sites of ABCG5 and ABCG8. However, regulation of baseline cholesterol metabolism and vascular function and structure, and IMT progression during 1 year seemed to share some of the common polymorphic sites of these genes, suggesting a gene-regulated interaction between cholesterol metabolism and vascular function and structure.

Ten year trends in chronic disease risk factors in the Republic of Karelia, Russia

BACKGROUND In Russia, non-communicable diseases are leading cause of death. The aim of this article is to describe changes in chronic disease risk factors (RFs) in Pitkäranta district in Russia during ten year period of time from 1992 to 2002. METHODS Study areas were Pitkäranta and Aunus districts in the Republic of Karelia, North-West Russia. The RF surveys were carried out in Pitkäranta every fifth year since 1992 and in Aunus in 2003. Independent random samples, age 25-64, were taken from the population registers. Blood pressure, weight and height were measured. Serum cholesterol, HDL-cholesterol, triglyceride and GGT values were determined from serum samples. Smoking and alcohol consumption were asked. The total number of respondents was 2766. RESULTS Systolic and diastolic blood pressure decreased in Pitkäranta from 1992 to 2002. Total serum cholesterol increased slightly. There was no significant change in BMI or in physical activity. Smoking did not change in males but increased among females. Self-reported alcohol use increased, as also mean GGT. CONCLUSIONS The study gives valuable information on developments of RFs in Russia. Some alarming tendencies in lifestyle were seen and chronic disease RF situation has generally worsened. The results also show how big is the challenge to change lifestyles deep in culture--and in the situation where preventive work and policies do not receive strong support. A reliable monitoring of RFs and behaviours is obviously a back bone for drawing necessary attention and to steer intervention.

Isolated soya protein with standardised levels of isoflavones, cotyledon soya fibres and soya phospholipids improves plasma lipids in hypercholesterolaemia: a double-blind, placebo-controlled trial of a yoghurt formulation

The objective was to study whether a yoghurt containing isolated soya protein with standardised levels of isoflavones, cotyledon soya fibres and soya phospholipids is more effective in lowering total and LDL-cholesterol than a placebo. One hundred and forty-three subjects were randomised to the soya group (n 69) or to the placebo (n 74). The mean baseline levels were 7.6 and 5.1 mmol/l for total and LDL-cholesterol, respectively. Fasting serum lipoproteins were assessed five times during the 8-week intervention period, and 4 weeks thereafter. The results were analysed by a mixed model for unbalanced repeated measurements. During the intervention, there were highly significant differences in lipid-lowering effect in favour of the active soya intervention group compared with the control group. The significant differences were for total cholesterol (estimated mean difference 0.40 mmol/l; P<0.001), LDL-cholesterol (0.39 mmol/l; P<0.001), non-HDL-cholesterol (0.40 mmol/l; P<0.001) and for the total:HDL-cholesterol ratio (0.23; P=0.005). There was no difference in the effects on HDL-cholesterol, triacylglycerols or homocysteine. The lipid-lowering effect occurred within 1-2 weeks of intervention, and was not due to weight loss. The safety profile for active soya was similar to the placebo group, except for gastrointestinal symptoms, which caused a significantly higher dropout rate (fourteen v. three subjects) among the subjects taking active soya.

Trends and educational differences in non-communicable disease risk factors in Pitkäranta, Russia, from 1992 to 2007.

Aim: Mortality and morbidity from non-communicable diseases (NCDs) is a major public health problem in Russia. The aim of the study was to examine trends and educational differences from 1992 to 2007 in NCD risk factors in Pitkäranta in the Republic of Karelia, Russia. Methods: Four cross-sectional population health surveys were carried out in the Pitkäranta region, Republic of Karelia, Russia, in 1992, 1997, 2002, and 2007. An independent random sample of 1000 persons from the general population aged 25-64 years was studied in each survey round. The total number of respondents in the four surveys was 2672. The surveys included a questionnaire, physical measurements, and blood sampling, and they were carried out following standard protocols. Results: The NCD risk factor trends generally increased in Pitkäranta during the study period with the exception of systolic blood pressure and smoking among men. Especially significant increases were observed in alcohol consumption among both sexes and in smoking among women. Educational differences and differences in trends were relatively small with the exception of a significant increase in smoking in the lowest female educational category. Conclusions: Trends showing an increase in some major NCD risk factors and signs of emerging socio-economic differences call for stronger attention to effective health promotion and preventive policies in Russia.

Contribution of the North Karelia Project to International Work in CVD and NCD Prevention and Health Promotion.

During the decades after the start of the North Karelia Project in 1971, cardiovascular diseases and related noncommunicable diseases have emerged as the greatest global public health burden. The prevention and control of these diseases have thus become a major challenge and target for global public health, as emphasized by the Political Declaration of the United Nations (UN) General Assembly in 2011. The experiences and results of the North Karelia Project have accordingly received much international attention and have in many ways contributed to the international work in the area, including the strategies and programs of the World Health Organization. The experience of the Project shows the great potential of population-based prevention of cardiovascular diseases and other noncommunicable diseases and that influencing lifestyles related to heart health with comprehensive health promotion and national policies is the cost-effective and sustainable way to improve contemporary public health.