1
|
Feuth E, Nieminen V, Palomäki A, Ranti J, Sucksdorff M, Finnilä T, Oksi J, Vuorinen T, Feuth T. Prolonged viral pneumonia and high mortality in COVID-19 patients on anti-CD20 monoclonal antibody therapy. Eur J Clin Microbiol Infect Dis 2024; 43:723-734. [PMID: 38358552 DOI: 10.1007/s10096-024-04776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE In clinical practice, we observed an apparent overrepresentation of COVID-19 patients on anti-CD20 monoclonal antibody therapy. The aim of this study was to characterize the clinical picture of COVID-19 in these patients. METHODS All adult patients from Turku University Hospital, Turku, Finland, with COVID-19 diagnosis and/or positive SARS-CoV-2 PCR test result up to March 2023, and with anti-CD20 therapy within 12 months before COVID-19 were included. Data was retrospectively obtained from electronic patient records. RESULTS Ninety-eight patients were identified. 44/93 patients (47.3%) were hospitalized due to COVID-19. Patients with demyelinating disorder (n = 20) were youngest (median age 36.5 years, interquartile range 33-45 years), had less comorbidities, and were least likely to be hospitalized (2/20; 10.0%) or die (n = 0). COVID-19 mortality was 13.3% in the whole group, with age and male sex as independent risk factors. Persistent symptoms were documented in 33/94 patients (35.1%) alive by day 30, in 21/89 patients (23.6%) after 60 days, and in 15/85 after 90 days (17.6%), mostly in patients with haematological malignancy or connective tissue disease. Prolonged symptoms after 60 days predisposed to persistent radiological findings (odds ratio 64.0; 95% confidence interval 6.3-711; p < 0.0001) and persistently positive PCR (odds ratio 45.5, 95% confidence interval 4.0-535; p < 0.0001). Several patients displayed rapid response to late antiviral therapy. CONCLUSION Anti-CD20 monoclonal antibody therapy is associated with high COVID-19 mortality and with a phenotype consistent with prolonged viral pneumonia. Our study provides rationale for retesting of immunocompromised patients with prolonged COVID-19 symptoms and considering antiviral therapy.
Collapse
Affiliation(s)
- Eeva Feuth
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Valtteri Nieminen
- Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, and Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Juha Ranti
- Department of Haematology, Turku University Hospital, Turku, Finland
| | - Marcus Sucksdorff
- Turku PET Centre, and Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Taru Finnilä
- Department of Hospital Hygiene & Infection Control, Turku University Hospital, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tytti Vuorinen
- Department of Clinical Microbiology, Turku University Hospital and Institute of Biomedicine, University of Turku, Turku, Finland
| | - Thijs Feuth
- Department of Pulmonary Diseases and Clinical Allergology, Turku University Hospital and University of Turku, Turku, Finland.
| |
Collapse
|
2
|
Aaramaa HK, Mars N, Helminen M, Kerola AM, Palomäki A, Eklund KK, Gracia-Tabuenca J, Sinisalo J, FinnGen, Isomäki P. Risk of cardiovascular comorbidities before and after the onset of rheumatic diseases. Semin Arthritis Rheum 2024; 65:152382. [PMID: 38308930 DOI: 10.1016/j.semarthrit.2024.152382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES To elucidate the risk and temporal relationship of cardiovascular (CV) comorbidities in rheumatic diseases. METHODS Patients in the FinnGen study diagnosed between 2000 and 2014 with seropositive (n = 2368) or seronegative (n = 916) rheumatoid arthritis (RA), ankylosing spondylitis (AS, n = 715), psoriatic arthritis (PsA, n = 923), systemic lupus erythematosus (SLE, n = 190), primary Sjogren's syndrome (pSS, n = 412) or gout (n = 2034) were identified from healthcare registries. Each patient was matched based on age, sex, and birth region with twenty controls without any rheumatic conditions. Overall risk ratios (RR) were calculated by comparing the prevalence of seven CV diseases between patients and controls. Logistic regression models were used for estimating odds ratios (OR) for CV comorbidities before and after the onset of rheumatic diseases. RESULTS The RR for 'any CVD' varied from 1.14 (95 % confidence interval [CI] 1.02-1.26) in PsA to 2.05 (95 % CI 1.67-2.52) in SLE. Patients with SLE or gout demonstrated over two-fold risks for several CV comorbidities. Among CV comorbidities, venous thromboembolism (VTE) showed the highest effect sizes in several rheumatic diseases. The ORs for CV comorbidities were highest within one year before and/or after the onset of the rheumatic disease. However, in gout the excess risk of CV disease was especially high before gout diagnosis. CONCLUSIONS The risk of CV comorbidities was elevated in all studied rheumatic diseases, with highest risks observed in SLE and gout. The risk for CV diseases was highest immediately before and/or after rheumatic disease diagnosis, highlighting the increased risk for CV comorbidities across all rheumatic diseases very early on the disease course.
Collapse
Affiliation(s)
- Hanna-Kaisa Aaramaa
- Centre for Rheumatic Diseases, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Nina Mars
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland; Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA 02142, USA
| | - Mika Helminen
- Tays Research Services, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland; Faculty of Social Sciences, Health Sciences, Tampere University, Kalevantie 4, Tampere 33014, Tampere, Finland
| | - Anne M Kerola
- Inflammation Center, Rheumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland; Faculty of Medicine, University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland; Department of Medicine, Turku University, 20014 Turku University, Finland
| | - Kari K Eklund
- Inflammation Center, Rheumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland
| | - Javier Gracia-Tabuenca
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland
| | - FinnGen
- FinnGen consortium (see Supplementary Table S1)
| | - Pia Isomäki
- Centre for Rheumatic Diseases, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland; Molecular Immunology Group, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
| |
Collapse
|
3
|
Kerola AM, Palomäki A, Laivuori H, Laitinen T, Färkkilä M, Eklund KK, Ripatti S, Perola M, Ganna A, Lindbohm JV, Mars N. Patterns of reproductive health in inflammatory rheumatic diseases and other immune-mediated diseases: a nationwide registry study. Rheumatology (Oxford) 2024:keae122. [PMID: 38503536 DOI: 10.1093/rheumatology/keae122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/17/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES Rheumatic diseases may impair reproductive success and pregnancy outcomes, but systematic evaluations across diseases are lacking. We conducted a nationwide cohort study to examine the impact of rheumatic diseases on reproductive health measures, comparing the impacts with those of other immune-mediated diseases (IMDs). METHODS Out of all of the 5 339 804 Finnish citizens, individuals born 1964-1984 and diagnosed with any of the 19 IMDs before age 30 (women) or 35 (men) were matched with 20 controls by birth year, sex, and education. We used data from nationwide health registers to study the impact of IMDs on reproductive health measures, such as reproductive success and, for women, ever having experienced adverse maternal and perinatal outcomes. RESULTS Several of the rheumatic diseases, particularly SLE, JIA, and seropositive RA, were associated with higher rates of childlessness and fewer children. The risks for pre-eclampsia, newborns being small for gestational age, preterm delivery, non-elective Caesarean sections, and need of neonatal intensive care were increased in many IMDs. Particularly, SLE, SS, type 1 diabetes, and Addison's disease showed >2-fold risks for some of these outcomes. In most rheumatic diseases, moderate (1.1-1.5-fold) risk increases were observed for diverse adverse pregnancy outcomes, with similar effects in IBD, celiac disease, asthma, ITP, and psoriasis. CONCLUSION Rheumatic diseases have a broad impact on reproductive health, with effects comparable with that of several other IMDs. Of the rheumatic diseases, SLE and SS conferred the largest risk increases on perinatal adverse event outcomes.
Collapse
Affiliation(s)
- Anne M Kerola
- Department of Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Hannele Laivuori
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland
- Centre for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tarja Laitinen
- Tampere University Hospital, Pirkanmaa Wellbeing Services County, Tampere, Finland
| | - Martti Färkkilä
- Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kari K Eklund
- Department of Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
- ORTON Orthopaedic Hospital of the Orton Foundation, Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Massachusetts General Hospital, Boston, MA, USA
| | - Markus Perola
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Andrea Ganna
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Joni V Lindbohm
- Department of Public Health, University of Helsinki, Helsinki, Finland
- The Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Faculty of Brain Sciences, University College London, London, UK
| | - Nina Mars
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| |
Collapse
|
4
|
Paltta J, Suuronen S, Pirilä L, Palomäki A. Differential diagnostics of polymyalgia rheumatica in a university hospital in Finland. Scand J Rheumatol 2023; 52:689-695. [PMID: 37335188 DOI: 10.1080/03009742.2023.2215044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Diagnosing polymyalgia rheumatica (PMR) can be difficult as many conditions present with similar symptoms and findings. This study aimed to analyse how often the diagnosis of PMR changes during follow-up in a university hospital setting and to determine the most common clinical conditions initially misdiagnosed as PMR. METHOD All patients with a new primary diagnosis of PMR on at least one visit during the years 2016-2019 were identified from the hospital discharge register of Turku University Hospital, Finland. A diagnosis of PMR was confirmed if the patient met at least one of the five classification criteria, complete clinical follow-up (median 34 months) was compatible with PMR, and no other diagnosis better explained their condition. RESULTS Of the patients initially diagnosed with PMR, 65.5% were considered to have PMR after further evaluation and clinical follow-up. The most common conditions initially diagnosed as PMR were inflammatory arthritides (34.9%), degenerative or stress-related musculoskeletal disorders (13.2%), infection (9.3%), malignancy (9.3%), giant cell vasculitis (6.2%) and other vasculitis (6.2%), and a wide range of other less common diseases. The diagnosis of PMR remained in 81.3% of patients who fulfilled the 2012 American College of Rheumatology/European League Against Rheumatism PMR classification criteria and in 45.5% of patients who did not. CONCLUSIONS Diagnosing PMR is challenging, even in a university hospital. One-third of the initial diagnoses of PMR changed during further evaluation and follow-up. There is a substantial risk of misdiagnosis, especially in patients with atypical presentation, and the differential diagnoses of PMR must be considered carefully.
Collapse
Affiliation(s)
- J Paltta
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - S Suuronen
- Department of Medicine, University of Turku, Turku, Finland
| | - L Pirilä
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - A Palomäki
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| |
Collapse
|
5
|
Koskivirta I, Ruotsalainen J, Kurki S, Lakkakorpi P, Salminen-Mankonen H, Pirilä L, Harvima R, Palomäki A. Real-world registry-based study on apremilast use in psoriasis and psoriatic arthritis in Finland. Scand J Rheumatol 2023; 52:549-555. [PMID: 36644971 DOI: 10.1080/03009742.2022.2151109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/21/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study assessed the position of apremilast in the treatment pathway of psoriasis (PsO) and psoriatic arthritis (PsA) in Finnish clinical practice, compared the characteristics of apremilast and biologic therapy users, evaluated persistence with apremilast and identified factors influencing treatment discontinuation. METHOD This retrospective study used data from Finnish national health registries. The target group was identified based on L40* diagnosis and medication records between 2015 and 2018. Treatment persistence was analysed using Kaplan-Meier curves and Cox regression. RESULTS Of eligible patients (PsO 31 202; PsA 12 386), 1% (n = 471) used apremilast and 10% (n = 4214) biologics, apremilast users being older (mean age 55.9 vs 52.4 years, p < 0.001) with a higher Charlson comorbidity score (0.71 vs 0.54, p < 0.001). Most patients switched to apremilast from conventional synthetic therapy (PsO 75%; PsA 76%); 47% of patients remained on apremilast during the observation period (PsO 58%; PsA 42%). Most patients discontinuing apremilast switched to biologics (PsO 51%; PsA 51%). Apremilast persistence increased with age (p = 0.042) and was higher in PsO than in PsA (median 14 vs 11 months; p = 0.005). Compared to prior conventional synthetic therapy, prior biologic therapy decreased persistence (hazard ratio for discontinuation 2.15, 95% confidence interval 1.42-3.25). CONCLUSION In Finnish clinical practice, apremilast is mainly used between conventional synthetic therapy and biologics, with at least as high treatment persistence as reported in previous studies. Apremilast users were older with higher comorbidity burden than biologics users.
Collapse
Affiliation(s)
- I Koskivirta
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - J Ruotsalainen
- Real-world Evidence and Research Services, Oriola Finland Ltd, Espoo, Finland
| | - S Kurki
- Real-world Evidence and Research Services, Oriola Finland Ltd, Espoo, Finland
| | | | - H Salminen-Mankonen
- Real-world Evidence and Research Services, Oriola Finland Ltd, Espoo, Finland
| | - L Pirilä
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - R Harvima
- Departments of Dermatology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - A Palomäki
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| |
Collapse
|
6
|
Paltta J, Heikkilä HK, Pirilä L, Eklund KK, Huhtakangas J, Isomäki P, Kaipiainen-Seppänen O, Kristiansson K, Havulinna AS, Sokka-Isler T, Palomäki A. The validity of rheumatoid arthritis diagnoses in Finnish biobanks. Scand J Rheumatol 2023; 52:1-9. [PMID: 34643165 DOI: 10.1080/03009742.2021.1967047] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of this study was to determine the validity of rheumatoid arthritis (RA) diagnoses in patients participating in Finnish biobanks. METHOD We reviewed the electronic medical records of 500 Finnish biobank participants: 125 patients with at least one visit with a diagnosis of seropositive RA, 125 patients with at least one visit with a diagnosis of seronegative RA, and 250 age- and gender-matched controls. The patients were chosen from five different biobank hospitals in Finland. A rheumatologist reviewed the medical records to assess whether each patients' diagnosis was correct. The diagnosis was compared with the diagnostic codes in the Finnish Care Register for Health Care (CRHC) and special reimbursement data of the Social Insurance Institution of Finland. RESULTS The positive predictive value (PPV) of CRHC diagnosis of RA (for seropositive and seronegative RA combined) was 0.82. For patients with a special reimbursement for anti-rheumatic medications for RA, the PPV was 0.89. The PPV was higher in patients with more than one visit. For one, two, five, and 10 visits, the PPV was 0.82, 0.85, 0.89, and 0.90, respectively, and for patients who also had the special reimbursement, the PPV was 0.89, 0.91, 0.93, and 0.94 for one, two, five, and 10 visits, respectively. In patients positive for anti-citrullinated protein antibodies, the PPV was 0.98. CONCLUSION These results demonstrate that the validity of RA diagnoses in Finnish biobanks was good and can be further improved by including data on special reimbursement for medication, number of visits, and serological data.
Collapse
Affiliation(s)
- J Paltta
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - H-K Heikkilä
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland
| | - L Pirilä
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - K K Eklund
- Department of Rheumatology, Helsinki University Hospital, University of Helsinki and Orton Orthopaedic Hospital, Helsinki, Finland
| | - J Huhtakangas
- Division of Rheumatology, Department of Internal Medicine, Oulu University Hospital and Medical Research Center Oulu, Oulu, Finland
| | - P Isomäki
- Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - K Kristiansson
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - A S Havulinna
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - T Sokka-Isler
- Department of Medicine, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - A Palomäki
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland.,Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | -
- FinnGen members are listed in the Supplementary material
| |
Collapse
|
7
|
Kurki MI, Karjalainen J, Palta P, Sipilä TP, Kristiansson K, Donner KM, Reeve MP, Laivuori H, Aavikko M, Kaunisto MA, Loukola A, Lahtela E, Mattsson H, Laiho P, Della Briotta Parolo P, Lehisto AA, Kanai M, Mars N, Rämö J, Kiiskinen T, Heyne HO, Veerapen K, Rüeger S, Lemmelä S, Zhou W, Ruotsalainen S, Pärn K, Hiekkalinna T, Koskelainen S, Paajanen T, Llorens V, Gracia-Tabuenca J, Siirtola H, Reis K, Elnahas AG, Sun B, Foley CN, Aalto-Setälä K, Alasoo K, Arvas M, Auro K, Biswas S, Bizaki-Vallaskangas A, Carpen O, Chen CY, Dada OA, Ding Z, Ehm MG, Eklund K, Färkkilä M, Finucane H, Ganna A, Ghazal A, Graham RR, Green EM, Hakanen A, Hautalahti M, Hedman ÅK, Hiltunen M, Hinttala R, Hovatta I, Hu X, Huertas-Vazquez A, Huilaja L, Hunkapiller J, Jacob H, Jensen JN, Joensuu H, John S, Julkunen V, Jung M, Junttila J, Kaarniranta K, Kähönen M, Kajanne R, Kallio L, Kälviäinen R, Kaprio J, Kerimov N, Kettunen J, Kilpeläinen E, Kilpi T, Klinger K, Kosma VM, Kuopio T, Kurra V, Laisk T, Laukkanen J, Lawless N, Liu A, Longerich S, Mägi R, Mäkelä J, Mäkitie A, Malarstig A, Mannermaa A, Maranville J, Matakidou A, Meretoja T, Mozaffari SV, Niemi MEK, Niemi M, Niiranen T, O Donnell CJ, Obeidat ME, Okafo G, Ollila HM, Palomäki A, Palotie T, Partanen J, Paul DS, Pelkonen M, Pendergrass RK, Petrovski S, Pitkäranta A, Platt A, Pulford D, Punkka E, Pussinen P, Raghavan N, Rahimov F, Rajpal D, Renaud NA, Riley-Gillis B, Rodosthenous R, Saarentaus E, Salminen A, Salminen E, Salomaa V, Schleutker J, Serpi R, Shen HY, Siegel R, Silander K, Siltanen S, Soini S, Soininen H, Sul JH, Tachmazidou I, Tasanen K, Tienari P, Toppila-Salmi S, Tukiainen T, Tuomi T, Turunen JA, Ulirsch JC, Vaura F, Virolainen P, Waring J, Waterworth D, Yang R, Nelis M, Reigo A, Metspalu A, Milani L, Esko T, Fox C, Havulinna AS, Perola M, Ripatti S, Jalanko A, Laitinen T, Mäkelä TP, Plenge R, McCarthy M, Runz H, Daly MJ, Palotie A. FinnGen provides genetic insights from a well-phenotyped isolated population. Nature 2023; 613:508-518. [PMID: 36653562 PMCID: PMC9849126 DOI: 10.1038/s41586-022-05473-8] [Citation(s) in RCA: 505] [Impact Index Per Article: 505.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/21/2022] [Indexed: 01/20/2023]
Abstract
Population isolates such as those in Finland benefit genetic research because deleterious alleles are often concentrated on a small number of low-frequency variants (0.1% ≤ minor allele frequency < 5%). These variants survived the founding bottleneck rather than being distributed over a large number of ultrarare variants. Although this effect is well established in Mendelian genetics, its value in common disease genetics is less explored1,2. FinnGen aims to study the genome and national health register data of 500,000 Finnish individuals. Given the relatively high median age of participants (63 years) and the substantial fraction of hospital-based recruitment, FinnGen is enriched for disease end points. Here we analyse data from 224,737 participants from FinnGen and study 15 diseases that have previously been investigated in large genome-wide association studies (GWASs). We also include meta-analyses of biobank data from Estonia and the United Kingdom. We identified 30 new associations, primarily low-frequency variants, enriched in the Finnish population. A GWAS of 1,932 diseases also identified 2,733 genome-wide significant associations (893 phenome-wide significant (PWS), P < 2.6 × 10-11) at 2,496 (771 PWS) independent loci with 807 (247 PWS) end points. Among these, fine-mapping implicated 148 (73 PWS) coding variants associated with 83 (42 PWS) end points. Moreover, 91 (47 PWS) had an allele frequency of <5% in non-Finnish European individuals, of which 62 (32 PWS) were enriched by more than twofold in Finland. These findings demonstrate the power of bottlenecked populations to find entry points into the biology of common diseases through low-frequency, high impact variants.
Collapse
Affiliation(s)
- Mitja I Kurki
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Juha Karjalainen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Priit Palta
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Timo P Sipilä
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | | | - Kati M Donner
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Mary P Reeve
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Hannele Laivuori
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health, University of Tampere, Tampere, Finland
| | - Mervi Aavikko
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Mari A Kaunisto
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Anu Loukola
- Helsinki Biobank, University of Helsinki and Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Elisa Lahtela
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Hannele Mattsson
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Päivi Laiho
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pietro Della Briotta Parolo
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Arto A Lehisto
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Masahiro Kanai
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Nina Mars
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Joel Rämö
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Tuomo Kiiskinen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Henrike O Heyne
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam Potsdam, Potsdam, Germany.,Hasso Plattner Institute for Digital Health at Mount Sinai, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kumar Veerapen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Sina Rüeger
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Susanna Lemmelä
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Wei Zhou
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Sanni Ruotsalainen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Kalle Pärn
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Tero Hiekkalinna
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Sami Koskelainen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Teemu Paajanen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Vincent Llorens
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Javier Gracia-Tabuenca
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Harri Siirtola
- TAUCHI Research Center, Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Kadri Reis
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | | | - Benjamin Sun
- Translational Biology, Research and Development, Biogen, Cambridge, MA, USA.,BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christopher N Foley
- Optima Partners, Edinburgh, UK.,MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Kaur Alasoo
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Mikko Arvas
- Finnish Red Cross Blood Service, Helsinki, Finland
| | | | | | | | - Olli Carpen
- Helsinki Biobank, University of Helsinki and Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | | | - Oluwaseun A Dada
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Zhihao Ding
- Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | | | - Kari Eklund
- Division of Rheumatology, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.,Orton Orthopedic Hospital, Helsinki, Finland
| | - Martti Färkkilä
- Abdominal Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Hilary Finucane
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea Ganna
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Awaisa Ghazal
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | | | | | - Antti Hakanen
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Åsa K Hedman
- Pfizer, New York, NY, USA.,Department of Medicine, Karolinska Institute, Solna, Sweden
| | - Mikko Hiltunen
- Clinical Biobank Tampere, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Reetta Hinttala
- Medical Research Center Oulu and PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| | - Iiris Hovatta
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | | | - Laura Huilaja
- PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | | | | | | | - Heikki Joensuu
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Valtteri Julkunen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland
| | - Marc Jung
- Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Juhani Junttila
- Northern Finland Biobank Borealis, University of Oulu, Northern Ostrobothnia Hospital District, Oulu, Finland
| | - Kai Kaarniranta
- Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland.,Department of Ophthalmology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Risto Kajanne
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Lila Kallio
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Reetta Kälviäinen
- Epilepsy Center, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Nurlan Kerimov
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Johannes Kettunen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,Computational Medicine, Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Elina Kilpeläinen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Terhi Kilpi
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - Veli-Matti Kosma
- Biobank of Eastern Finland, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
| | - Teijo Kuopio
- Central Finland Biobank, Central Finland Health Care District, Jyväskylä, Finland
| | - Venla Kurra
- Department of Clinical Genetics, Tampere University Hospital, Tampere, Finland.,Department of Clinical Genetics, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Triin Laisk
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Jari Laukkanen
- Central Finland Biobank, Central Finland Health Care District, Jyväskylä, Finland.,Department of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Aoxing Liu
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | | | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | | | - Antti Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Helsinki, Finland
| | - Anders Malarstig
- Pfizer, Cambridge, MA, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Arto Mannermaa
- Biobank of Eastern Finland, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
| | | | - Athena Matakidou
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Tuomo Meretoja
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Mari E K Niemi
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Marianna Niemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,TAUCHI Research Center & Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Teemu Niiranen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,Turku University Hospital and University of Turku, Turku, Finland
| | | | - Ma En Obeidat
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - George Okafo
- Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Hanna M Ollila
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Antti Palomäki
- Turku University Hospital and University of Turku, Turku, Finland
| | - Tuula Palotie
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Jukka Partanen
- Finnish Red Cross Blood Service, Helsinki, Finland.,Finnish Hematological Biobank, Helsinki, Finland
| | - Dirk S Paul
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Margit Pelkonen
- Department of Pulmonary Diseases, Kuopio University Hospital, Kuopio, Finland
| | | | - Slavé Petrovski
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Anne Pitkäranta
- Department of Otorhinolaryngology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Adam Platt
- Translational Science and Experimental Medicine, Research and Early Development, Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | | | - Eero Punkka
- Helsinki Biobank, University of Helsinki and Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Pirkko Pussinen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | | | | | - Deepak Rajpal
- Translational Sciences, Sanofi R&D, Framingham, MA, USA
| | - Nicole A Renaud
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | | | - Rodosthenis Rodosthenous
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Elmo Saarentaus
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Aino Salminen
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Eveliina Salminen
- Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Genetics, HUSLAB, HUS Diagnostic Center, University of Helsinki, Helsinki, Finland
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Johanna Schleutker
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | - Raisa Serpi
- Northern Finland Biobank Borealis, University of Oulu, Northern Ostrobothnia Hospital District, Oulu, Finland
| | - Huei-Yi Shen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Richard Siegel
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Kaisa Silander
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Sanna Siltanen
- Finnish Clinical Biobank Tampere, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Sirpa Soini
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Ioanna Tachmazidou
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Kaisa Tasanen
- PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Pentti Tienari
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Translational Immunology, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Sanna Toppila-Salmi
- Department of Allergy, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Taru Tukiainen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Tiinamaija Tuomi
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Abdominal Center, Endocrinology, Helsinki University Hospital, Helsinki, Finland.,Folkhalsan Research Center, Helsinki, Finland.,Research Program of Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Joni A Turunen
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Eye Genetics Group, Folkhälsan Research Center, Helsinki, Finland
| | - Jacob C Ulirsch
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Felix Vaura
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland.,University of Turku, Turku, Finland
| | - Petri Virolainen
- Auria Biobank, University of Turku and Turku University Hospital, Turku, Finland
| | | | | | | | - Mari Nelis
- Genomics Core Facility, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Anu Reigo
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Andres Metspalu
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Tõnu Esko
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | | | - Aki S Havulinna
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Markus Perola
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Anu Jalanko
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Tarja Laitinen
- Finnish Clinical Biobank Tampere, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Tomi P Mäkelä
- Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | | | | | | | - Mark J Daly
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland. .,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA. .,Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA. .,Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
8
|
Paltta J, Kortelainen S, Käyrä M, Pirilä L, Huhtakangas J, Palomäki A. The validity of systemic sclerosis diagnoses in two university hospitals in Finland. Scand J Rheumatol 2023; 52:84-87. [PMID: 35442148 DOI: 10.1080/03009742.2022.2056999] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study aimed to determine the validity of systemic sclerosis (SSc) diagnoses in Finnish university hospitals. METHOD Electronic medical records for 385 patients with a registered diagnosis of SSc (ICD-10 code M34) in two Finnish university hospitals from 2008 to 2018 were reviewed to assess whether each patient's diagnosis was correct. RESULTS The positive predictive value (PPV) of a diagnosis of SSc was 0.66 when fulfilment of the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc was required; the PPV was 0.75 if patients meeting the 2001 LeRoy and Medsger classification criteria for early SSc were also included. When a diagnosis of SSc was made in a department of rheumatology, the PPV was 0.78, and 0.90 when including patients with early SSc. For the more specific diagnosis of limited cutaneous SSc (lcSSc), the PPV was 0.80, and 0.95 when including early SSc. For an lcSSc diagnosis made in rheumatology, the PPV was 0.81, and 0.97 with early SSc included. CONCLUSION These results demonstrate that in these two Finnish university hospitals, the diagnostic validity of a diagnosis of SSc was good if it was diagnosed in the department of rheumatology. For a more specific diagnosis of lcSSc, the most prevalent form of SSc in Finland, the validity was good even when registered in any department.
Collapse
Affiliation(s)
- J Paltta
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland.,Department of Medicine, University of Turku, Turku, Finland
| | - S Kortelainen
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - M Käyrä
- Division of Rheumatology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - L Pirilä
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland.,Department of Medicine, University of Turku, Turku, Finland
| | - J Huhtakangas
- Division of Rheumatology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland.,Medical Research Centre Oulu, Oulu, Finland.,Division of Rheumatology, Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland
| | - A Palomäki
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland.,Department of Medicine, University of Turku, Turku, Finland
| |
Collapse
|
9
|
Kerola AM, Semb AG, Juonala M, Palomäki A, Rautava P, Kytö V. Long-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction. Cardiovasc Diabetol 2022; 21:177. [PMID: 36068573 PMCID: PMC9450422 DOI: 10.1186/s12933-022-01608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background To explore long-term cardiovascular prognosis after myocardial infarction (MI) among patients with type 1 diabetes. Methods Patients with type 1 diabetes surviving 90 days after MI (n = 1508; 60% male, mean age = 62.1 years) or without any type of diabetes (n = 62,785) in Finland during 2005–2018 were retrospectively studied using multiple national registries. The primary outcome of interest was a combined major adverse cardiovascular event (MACE; cardiovascular death, recurrent MI, ischemic stroke, or heart failure hospitalization) studied with a competing risk Fine-Gray analyses. Median follow-up was 3.9 years (maximum 12 years). Differences between groups were balanced by multivariable adjustments and propensity score matching (n = 1401 patient pairs). Results Cumulative incidence of MACE after MI was higher in patients with type 1 diabetes (67.6%) compared to propensity score-matched patients without diabetes (46.0%) (sub-distribution hazard ratio [sHR]: 1.94; 95% confidence interval [CI]: 1.74–2.17; p < 0.0001). Probabilities of cardiovascular death (sHR 1.81; p < 0.0001), recurrent MI (sHR 1.91; p < 0.0001), ischemic stroke (sHR 1.50; p = 0.0003), and heart failure hospitalization (sHR 1.98; p < 0.0001) were higher in patients with type 1 diabetes. Incidence of MACE was higher in diabetes patients than in controls in subgroups of men and women, patients aged < 60 and ≥ 60 years, revascularized and non-revascularized patients, and patients with and without atrial fibrillation, heart failure, or malignancy. Conclusions Patients with type 1 diabetes have notably poorer long-term cardiovascular prognosis after an MI compared to patients without diabetes. These results underline the importance of effective secondary prevention after MI in patients with type 1 diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01608-3.
Collapse
Affiliation(s)
- Anne M Kerola
- Inflammation Center, Rheumatology, Helsinki University Hospital, Helsinki, Finland. .,Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Palomäki
- Department of Medicine, University of Turku, Turku, Finland.,Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
10
|
Kerola AM, Juonala M, Palomäki A, Semb AG, Rautava P, Kytö V. Case Fatality of Patients With Type 1 Diabetes After Myocardial Infarction. Diabetes Care 2022; 45:1657-1665. [PMID: 35679070 PMCID: PMC9274223 DOI: 10.2337/dc22-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is a risk factor for myocardial infarction (MI). We aimed to evaluate the case fatality in patients with type 1 diabetes after MI. RESEARCH DESIGN AND METHODS Consecutive patients experiencing MI with type 1 diabetes (n = 1,935; 41% female; mean age 62.5 years) and without diabetes (n = 74,671) admitted to 20 hospitals in Finland from 2005 to 2018 were studied using national registries. The outcome of interest was death within 1 year after MI. Differences between groups were balanced by multivariable adjustments and propensity score matching. RESULTS Case fatality was higher in patients with type 1 diabetes than in propensity score-matched controls without diabetes at 30 days (12.8% vs. 8.5%) and at 1 year (24.3% vs. 16.8%) after MI (hazard ratio 1.55; 95% CI 1.32-1.81; P < 0.0001). Patients with type 1 diabetes had poorer prognosis in subgroups of men and women and of those with and without ST-elevation MI, with and without revascularization, with and without atrial fibrillation, and with and without heart failure. The relative fatality risk in type 1 diabetes was highest in younger patients. Older age, heart failure, peripheral vascular disease, renal failure, and no revascularization were associated with worse prognosis after MI. The case fatality among patients with type 1 diabetes decreased during the study period, but outcome differences compared with patients without diabetes remained similar. CONCLUSIONS Patients with type 1 diabetes are at higher risk of death after MI than patients without diabetes. Our findings call for attention to vigorous cardiovascular disease prevention in patients with type 1 diabetes.
Collapse
Affiliation(s)
- Anne M Kerola
- Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Palomäki
- Department of Medicine, University of Turku, Turku, Finland.,Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
11
|
Aaramaa HK, Isomäki P, Mars N, Helminen M, Kerola A, Palomäki A, Eklund K, Gracia Tabuenca J, Sinisalo J. POS0324 RISK OF CARDIOVASCULAR COMORBIDITIES IN RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCardiovascular diseases (CVD’s) are the most significant comorbidities in rheumatic diseases, causing also increased mortality. [1,2] However, there is only limited data on how the risk of CV comorbidities varies between different rheumatic diseases.ObjectivesThe aim of our study was to estimate the risk of certain CV comorbidities across rheumatic diseases.MethodsThe ongoing FinnGen project links nationwide healthcare register data with genome data. The study (data freeze 7) included 321 302 individuals, and from this group we identified patients with seropositive (N=4293) and seronegative (N=1733) rheumatoid arthritis (RA), ankylosing spondylitis (AS, N=1247), psoriatic arthritis (PsA, N=1235), systemic lupus erythematosus (SLE, N=386), primary Sjogren’s syndrome (pSS, N=557) and gout (N=2178). Each patient was matched based on age, sex and municipality of residence with twenty individuals without any rheumatic conditions. The CV comorbidities studied were any CV disease (CVD), major coronary heart disease event (myocardial infarction and/or revascularization; CHD), ischemic stroke, atrial fibrillation and flutter (AF), deep vein thrombosis of lower extremities (DVT) and pulmonary embolism (PE), chronic heart failure (CHF) and valvular heart disease excluding rheumatic fever (VHD). From the prevalence of each CV disease among rheumatic disease cohorts, we calculated the risk ratio (RR) for each CV disease by comparing the prevalence of these diseases between rheumatic diseases and controls.ResultsThe average age at the time of diagnosis ranged from 39.6 to 64.4 years, and the average duration of follow-up varied from 9 to 19.5 years in different rheumatic diseases. The risk for any CVD was elevated in all rheumatic disease cohorts with RR varying from 1.14 in seropositive RA to 1.65 in SLE. SLE patients carried the highest relative risk for CV comorbidities, demonstrating over 2.5-fold risk for DVT/PE (RR 3.57), stroke (RR 2.57), CHF (RR 2.64) and VHD (RR 2.98). At least two-fold risk compared to controls was identified for AF (RR 2.03), DVT/PE (RR 2.44) and CHF (RR 3.03) in patients with gout, for DVT/PE (RR 2.15) and CHF (RR 2.0) in patients with pSS, and for DVT/PE (RR 2.03) in patients with PsA. Seropositive and seronegative RA demonstrated similar CV risk profiles. In patients with seropositive or seronegative RA, PsA, pSS or SLE, DVT/PE demonstrated the highest RR’s among various CV comorbidities.ConclusionThe risk of CV comorbidities is increased in all studied rheumatic diseases, with the largest effects observed in patients with SLE and gout. Among CV comorbidities, DVT/PE displayed the largest effect sizes in several rheumatic diseases. The current results further strengthen the importance of evaluating and treating risk factors for CV comorbidities across rheumatic diseases, focusing also to the excess risk for thromboses.References[1]Han C., Robinson DW Jr et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. J Rheumatol. 2006;33(11):2167-2172.[2]Avina-Zubieta JA, Choi HK et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008; 15;59(12):1690-1697.AcknowledgementsSpecial thanks to Finnish Foundation of Rheumatology Research and the Foundation of Maire Lisko for issuing research grants to help with the research process and writing of this abstract.Disclosure of InterestsHanna-Kaisa Aaramaa: None declared, Pia Isomäki Speakers bureau: Speaker or chair for AbbVie, Eli Lilly and Pfizer., Consultant of: Consultant for AbbVie, Eli Lilly, Pfizer, Roche and ViforPharma., Grant/research support from: A research grant from Pfizer., Nina Mars: None declared, Mika Helminen: None declared, Anne Kerola: None declared, Antti Palomäki Speakers bureau: Lecture free from Pfizer and Sanofi, Consultant of: Consulting fee from Abbvie, Amgen and Pfizer, Kari Eklund: None declared, Javier Gracia Tabuenca: None declared, Juha Sinisalo: None declared
Collapse
|
12
|
Paltta J, Suuronen S, Pirilä L, Palomäki A. POS1383 DIFFERENTIAL DIAGNOSTICS OF POLYMYALGIA RHEUMATICA IN A UNIVERSITY HOSPITAL IN FINLAND. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPolymyalgia rheumatica (PMR) is an inflammatory disease that causes muscle pain and morning stiffness, especially in the shoulders and hips. Diagnosing PMR can be difficult, as the diagnosis is mainly clinical without a definitive diagnostic test, and many symptoms and findings of PMR may also be present in other conditions. There is little recent data on differential diagnostics of PMR.ObjectivesThe aim of our study was to analyse patients diagnosed with polymyalgia rheumatica (PMR) in Turku University Hospital in Finland and determine how often a competing diagnosis better explaining the patients’ symptoms was found during further evaluation and clinical follow-up. We also aimed to find out what are the most common conditions initially misdiagnosed as PMR.MethodsAll patients with a new primary diagnosis of PMR (International Classification of Diseases – 10th revision [ICD-10] code M35.3) on at least one (in- or outpatient) visit during years 2016–2019 were identified from the hospital discharge register of Turku University hospital in Finland. We did a chart review of the patient charts including the full clinical follow-up period (median 34 months). We studied how often the primary diagnosis of PMR changed after further diagnostic evaluation or during follow-up.ResultsIn 125 (32.7%) of the 382 patients, the initial diagnosis of PMR changed during further diagnostic evaluation or follow-up. Most common diagnoses initially misdiagnosed as PMR were inflammatory arthritides 36.0% (45/125), degenerative or stress-related musculoskeletal disorder 12.8% (16/125), infection 9.6% (12/125), malignancy 9.6% (12/125), giant cell vasculitis 6.4% (8/125) and other vasculitis 6.4% (8/125) (Table 1). Diagnosis changed in 19% (39/207) of patients fulfilling the 2012 ACR/EULAR PMR classification criteria and in 49% (86/175) of patients who did not.Table 1.Demographic and clinical characteristics of the study sample.Number of patients382Female (%)218 (57.1%)Age at diagnosis in years [IQR]70.0 [64.0–77.8]Follow-up in months [IQR]34.0 [21.0–49.0]Diagnosed in rheumatology (%)299 (79%)Treated in rheumatology (%)310 (81%)Nr. of visits [IQR]6.5 [3.0–12.0]Diagnosis changed during follow-up (%)125 (32.7%)Final diagnosis in 125 patients whose initial diagnosis of PMR changedInflammatory arthritides (%)45 (36.0%)Degenerative or stress-related musculoskeletal disorder (%)16 (12.8%)Infection (%)12 (9.6%)Malignancy (%)12 (9.6%)Giant cell vasculitis (%)8 (6.4%)Other vasculitis (%)8 (6.4%)Other rheumatological disease (%)7 (5.6%)Fibromyalgia or other chronic pain syndrome (%)4 (3.2%)Gout or other crystal arthropathy (%)2 (1.6%)Endocrinological disease (%)2 (1.6%)Other or unknown (%)14 (11.2%)Continuous variables are expressed as medians with interquartile ranges, and categorical variables are described as counts with percentages.ConclusionIn a university hospital setting, a third of initial diagnoses of PMR were changed during further evaluation and follow-up. Our findings highlight that thorough consideration of differential diagnosis is always essential when diagnosing PMR. Especially in patients with atypical presentation, there is a substantial risk for misdiagnosis.Disclosure of InterestsJohanna Paltta: None declared, Saara Suuronen: None declared, Laura Pirilä Consultant of: Has received consulting fees from Novartis, UCB, Pfizer, Lilly, Roche, Sanofi, Abbvie, Bristol-Myers-Squibb, Jansen-Cilag, Celgene and MSD, all unrelated to this work, Antti Palomäki Speakers bureau: Has received a lecture fee from Pfizer and Sanofi, all unrelated to this work, Consultant of: Has received consulting fees from Pfizer, Amgen and Abbvie, all unrelated to this work
Collapse
|
13
|
Bah A, Nuotio I, Palomäki A, Mustonen P, Kiviniemi T, Ylitalo A, Hartikainen P, Airaksinen KEJ, Hartikainen JEK. Inadequate oral anticoagulation with warfarin in women with cerebrovascular event and history of atrial fibrillation: the FibStroke study. Ann Med 2021; 53:287-294. [PMID: 33475002 PMCID: PMC7877996 DOI: 10.1080/07853890.2021.1875499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/08/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Women with atrial fibrillation (AF) may be treated less actively with oral anticoagulation (OAC) than men. PATIENTS AND METHODS We assessed sex differences in the implementation of stroke risk stratification with CHADS2 and CHA2DS2-VASc scores and reasons not to use OAC in 1747 AF patients suffering their first cerebrovascular event after the AF diagnosis. RESULTS Women were older and had more often a high stroke risk (CHADS2/CHA2DS2-VASc ≥2) than men (p < .001). On admission, 46.4% of women and 48.2% of men were on OAC with no sex difference (p = .437). However, of patients without OAC, 74.4% of women and 49.5% of men should have been on OAC based on CHADS2/CHA2DS2-VASc ≥2 (p < .001). Conversely, 34.8% of men and 17.5% of women on OAC had a low or moderate risk (CHADS2/CHA2DS2-VASc 0-1, p < .001). A valid reason to omit OAC was reported in 38.6% of patients and less often in women (p < .001). CONCLUSIONS OAC was underused in high-risk AF patients, particularly women, but prescribed often in men with low or moderate stroke risk. Reasons for omitting OAC treatment were poorly reported, particularly for women. KEY MESSAGE Women were at higher stroke risk, but were less often treated with oral anticoagulation (OAC). Men were more often on OAC at low or moderate stroke risk. Reasons for omitting guideline based OAC were poorly reported, particularly for women.
Collapse
Affiliation(s)
- Aissa Bah
- Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ilpo Nuotio
- Department of Acute Internal Medicine, Turku University Hospital, Turku, Finland
| | - Antti Palomäki
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Pirjo Mustonen
- Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland
- Faculty of Information Technology, Jyväskylä University, Jyväskylä, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Ylitalo
- Heart Center, Satakunta Central Hospital, Pori, Finland
| | | | | | - Juha E. K. Hartikainen
- Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
14
|
Malmberg M, Palomäki A, Sipilä JOT, Rautava P, Gunn J, Kytö V. Long-term outcomes after coronary artery bypass surgery in patients with rheumatoid arthritis. Ann Med 2021; 53:1512-1519. [PMID: 34461789 PMCID: PMC8409967 DOI: 10.1080/07853890.2021.1969591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the long-term outcomes of coronary artery bypass grafting surgery (CABG) in patients with rheumatoid arthritis (RA). METHODS Patients with RA (n = 378) were retrospectively compared to patients without RA (n = 7560), all treated with CABG in a multicentre, population-based cohort register study in Finland. The outcomes were studied with propensity score-matching adjustment for baseline features. The median follow-up was 9.7 years. RESULTS Diagnosis of RA was associated with an increased risk of mortality after CABG compared to patients without RA (HR 1.50; CI 1.28-1.77; p < .0001). In addition, patients with RA were in higher risk of myocardial infarction during the follow-up period (HR 1.61; CI 1.28-2.04; p < .0001). Cumulative rate of repeated revascularization after CABG was 14.4% in RA patients and 12.0% in control patients (p = .060). Duration of RA before CABG (p = .011) and preoperative corticosteroid usage in RA (p = .041) were independently associated with higher mortality after CABG. There were no differences between the study groups in 30-d mortality or in the post-operative usage of cardiovascular medications. CONCLUSIONS RA is independently associated with worse prognosis in coronary artery disease treated with CABG. Preoperative corticosteroid use and longer RA disease duration are additional risk factors for mortality.Key messagesPatients with rheumatoid arthritis (RA) have impaired long-term outcomes after coronary artery bypass surgery (CABG).Glucocorticoid use before CABG and duration of RA are associated with higher mortality.Special attention should be paid in secondary prevention of cardiovascular disease in RA patients after CABG.
Collapse
Affiliation(s)
- Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Palomäki
- Centre of Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Jussi O. T. Sipilä
- Department of Neurology, North Karelia Central Hospital, Siun Sote, Joensuu, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Administrative Center, Hospital District of Southwest Finland, Turku, Finland
| |
Collapse
|
15
|
Abstract
Background Evidence on the impact of sex on prognoses after myocardial infarction (MI) among older adults is limited. We evaluated sex differences in long-term cardiovascular outcomes after MI in older adults. Methods and Results All patients with MI ≥70 years admitted to 20 Finnish hospitals during a 10-year period and discharged alive were studied retrospectively using a combination of national registries (n=31 578, 51% men, mean age 79). The primary outcome was combined major adverse cardiovascular event within 10-year follow-up. Sex differences in baseline features were equalized using inverse probability weighting adjustment. Women were older, with different comorbidity profiles and rarer ST-segment-elevation MI and revascularization, compared with men. Adenosine diphosphate inhibitors, anticoagulation, statins, and high-dose statins were more frequently used by men, and renin-angiotensin-aldosterone inhibitors and beta blockers by women. After balancing these differences by inverse probability weighting, the cumulative 10-year incidence of major adverse cardiovascular events was 67.7% in men, 62.0% in women (hazard ratio [HR], 1.17; CI, 1.13-1.21; P<0.0001). New MI (37.0% in men, 33.1% in women; HR, 1.16; P<0.0001), ischemic stroke (21.1% versus 19.5%; HR, 1.10; P=0.004), and cardiovascular death (56.0% versus 51.1%; HR, 1.18; P<0.0001) were more frequent in men during long-term follow-up after MI. Sex differences in major adverse cardiovascular events were similar in subgroups of revascularized and non-revascularized patients, and in patients 70 to 79 and ≥80 years. Conclusions Older men had higher long-term risk of major adverse cardiovascular events after MI, compared with older women with similar baseline features and evidence-based medications. Our results highlight the importance of accounting for confounding factors when studying sex differences in cardiovascular outcomes.
Collapse
Affiliation(s)
- Anne M Kerola
- Department of Internal Medicine Päijät-Häme Joint Authority for Health and Wellbeing Lahti Finland.,Preventive Cardio-Rheuma Clinic Division of Rheumatology and Research Diakonhjemmet Hospital Oslo Norway.,Faculty of Medicine University of Helsinki Helsinki Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology Division of Medicine Turku University Hospital Turku Finland.,Department of Medicine University of Turku Turku Finland
| | - Päivi Rautava
- Department of Public Health University of Turku Turku Finland.,Turku Clinical Research Center Turku University Hospital Turku Finland
| | - Maria Nuotio
- Research Services and Department of Clinical Medicine Turku University Hospital Turku Finland.,Division of Geriatric Medicine University of Turku Turku Finland
| | - Ville Kytö
- Heart Center Turku University Hospital and University of Turku Turku Finland.,Research Center of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland.,Center for Population Health Research Turku University Hospital and University of Turku Turku Finland.,Administrative Center Hospital District of Southwest Finland Turku Finland.,Department of Public Health Faculty of Medicine University of Helsinki Helsinki Finland
| |
Collapse
|
16
|
Palomäki A, Palotie A, Koskela J, Eklund KK, Pirinen M, Ripatti S, Laitinen T, Mars N. Lifetime risk of rheumatoid arthritis-associated interstitial lung disease in MUC5B mutation carriers. Ann Rheum Dis 2021; 80:1530-1536. [PMID: 34344703 PMCID: PMC8600604 DOI: 10.1136/annrheumdis-2021-220698] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/20/2021] [Indexed: 01/17/2023]
Abstract
Objectives To estimate lifetime risk of developing rheumatoid arthritis-associated interstitial lung disease (RA-ILD) with respect to the strongest known risk factor for pulmonary fibrosis, a MUC5B promoter variant. Methods FinnGen is a collection of epidemiological cohorts and hospital biobank samples, integrating genetic data with up to 50 years of follow-up within nationwide registries in Finland. Patients with RA and ILD were identified from the Finnish national hospital discharge, medication reimbursement and cause-of-death registries. We estimated lifetime risks of ILD by age 80 with respect to the common variant rs35705950, a MUC5B promoter variant. Results Out of 293 972 individuals, 1965 (0.7%) developed ILD by age 80. Among all individuals in the dataset, MUC5B increased the risk of ILD with a HR of 2.44 (95% CI: 2.22 to 2.68). Out of 6869 patients diagnosed with RA, 247 (3.6%) developed ILD. In patients with RA, MUC5B was a strong risk factor of ILD with a HR similar to the full dataset (HR: 2.27, 95% CI: 1.75 to 2.95). In patients with RA, lifetime risks of ILD were 16.8% (95% CI: 13.1% to 20.2%) for MUC5B carriers and 6.1% (95% CI: 5.0% to 7.2%) for MUC5B non-carriers. The difference between risks started to emerge at age 65, with a higher risk among men. Conclusion Our findings provide estimates of lifetime risk of RA-ILD based on MUC5B mutation carrier status, demonstrating the potential of genomics for risk stratification of RA-ILD.
Collapse
Affiliation(s)
- Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, and Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland.,Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | | | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jukka Koskela
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Kari K Eklund
- Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Orton Orthopaedic Hospital, Helsinki, Finland
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | | | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Tarja Laitinen
- Administration Center, Tampere University Hospital, Tampere, Finland
| | - Nina Mars
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| |
Collapse
|
17
|
Palomäki A, Laitinen T, Koskela J, Palotie A, Mars N. OP0007 MUC5B PROMOTER VARIANT AND LONG-TERM INCIDENCE OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS: A POPULATION BIOBANK STUDY OF 250,000 INDIVIDUALS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The promoter variant rs35705950 in MUC5B is the strongest known genetic risk factor for rheumatoid arthritis-associated interstitial lung disease (RA-ILD) [1]. There is, however, no large-scale data on the impact of MUC5B on the long-term incidence of RA-ILD.Objectives:To describe long term risk of RA-ILD in RA patients carrying MUC5B variant compared to non-carriers with RA.Methods:FinnGen is a collection of epidemiological cohorts and hospital biobank samples, linking genotypes with up to 46 years of follow-up within nationwide registries. Diagnoses of RA and ILD were identified from the Finnish national hospital discharge, medication reimbursement and cause-of-death registries. We estimated lifetime risks of ILD by age 80. MUC5B is a common variant and has an allele frequency of 0.1 in the Finnish population.Results:Out of the 248,400 individuals, 5534 patients have been diagnosed with RA, out of whom 178 (3.2%) developed ILD. MUC5B was a strong predictor of ILD in RA patients (HR 2.14, 95%CI 1.56-2.92). In patients with RA, MUC5B conferred a lifetime risk of 14.5% (95%CI 10.7-18.1%), compared to 5.2% (4.1-6.2%) in MUC5B non-carriers with RA (Figure). In the population, MUC5B carriers and MUC5B non-carriers had lifetime risks of 3.9% and 1.3%, respectively. The risk difference started to emerge at age 65. The risk was highest in men with RA who are MUC5B carriers: 18.5% (11.1-25.2%) developed ILD, compared to 8.5% (6.1-10.9%) of MUC5B non-carriers with RA.Conclusion:We report findings from a large longitudinal study, showing that MUC5B confers a considerable lifetime risk of RA-ILD, and contributes to increased morbidity. These findings have clinical implications for improving identification of RA patients at high risk of developing ILD.References:[1]Juge P-A, Lee JS, Ebstein E, et al. MUC5B Promoter Variant and Rheumatoid Arthritis with Interstitial Lung Disease. N Engl J Med 2018;379:2209–19Disclosure of Interests:Antti Palomäki Speakers bureau: MSD, Pfizer, Sanofi, Consultant of: Pfizer, Abbvie, Tarja Laitinen: None declared, Jukka Koskela Speakers bureau: Pfizer, Aarno Palotie: None declared, Nina Mars: None declared
Collapse
|
18
|
Forss V, Yli-Ollila H, Vatanen J, Kölhi P, Poutanen VP, Palomäki A. The reliability of radiation dose display of a computed tomography scanner. Eur J Radiol Open 2021; 8:100345. [PMID: 33898654 PMCID: PMC8056233 DOI: 10.1016/j.ejro.2021.100345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
There is variation in the difference between the radiation dose reported by the CT scanner and actual measured dose. This variation is substantial and may differ from zero. To achieve more precise radiation dose data, especially in comparing studies, the average difference should be determined. A correction factor for radiation dose should be utilized for every scanner used in studies.
Background Internationally, the typical allowed difference between the measured radiation dose and dose reported by a computed tomography (CT) scanner is ±20 %. The objective is to describe a method in order to analyse this difference in a CT scanner in the Emergency Department of Kanta-Häme Central Hospital, and to calculate a correction factor for more comparable radiation dose values in further studies. Methods Ten intra-day radiation dose measurements were performed with undisturbed setting. Measurement reports on differences between measured and displayed dose were gathered from the vendor maintenance and supervising authority over a 12-year period. Additionally, two in-house measurements were made. A total of 18 datapoints were collected, with some differences in measurement settings. Data were also analysed against imaging parameters, ambient air pressure and time to identify trends or associations in the variation of the discrepancy. Results Measured doses were generally lower than displayed doses. Differences between displayed and measured doses varied between −3.46 and −0.10 %, with a mean of −1.26 % in the intra-day measurements, and between +4.65 and −17.3 %, with a mean of −7.53 % in the long-term data. There were no trends nor connections in the variations. Conclusion Since the acceptable difference between the radiation dose display and the measured dose is relevant, the average difference for every CT scanner should be determined before radiation dose studies, especially when comparing multiple scanners.
Collapse
Affiliation(s)
- V Forss
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Kanta-Häme Central Hospital, Emergency Department, Hämeenlinna, Finland
| | - H Yli-Ollila
- Kanta-Häme Central Hospital, Department of Radiology, Hämeenlinna, Finland
| | - J Vatanen
- Kanta-Häme Central Hospital, Emergency Department, Hämeenlinna, Finland
| | - P Kölhi
- Kanta-Häme Central Hospital, Department of Radiology, Hämeenlinna, Finland
| | - V-P Poutanen
- Kanta-Häme Central Hospital, Department of Radiology, Hämeenlinna, Finland
| | - A Palomäki
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.,Kanta-Häme Central Hospital, Emergency Department, Hämeenlinna, Finland
| |
Collapse
|
19
|
Palomäki A, Kerola AM, Malmberg M, Rautava P, Kytö V. Patients with rheumatoid arthritis have impaired long-term outcomes after myocardial infarction - a nationwide case-control registry study. Rheumatology (Oxford) 2021; 60:5205-5215. [PMID: 33667301 PMCID: PMC8566209 DOI: 10.1093/rheumatology/keab204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/14/2021] [Indexed: 01/06/2023] Open
Abstract
Objective To investigate the long-term outcomes of patients with RA after myocardial infarction (MI). Methods All-comer, real-life MI patients with RA (n = 1614, mean age 74 years) were retrospectively compared with propensity score (1:5) matched MI patients without RA (n = 8070) in a multicentre, nationwide, cohort register study in Finland. The impact of RA duration and the usage of corticosteroids and antirheumatic drugs on RA patients’ outcomes were also studied. The median follow-up was 7.3 years. Results RA was associated with an increased 14-year mortality risk after MI compared with patients without RA [80.4% vs 72.3%; hazard ratio (HR) 1.25; CI: 1.16, 1.35; P <0.0001]. Patients with RA were at higher risk of new MI (HR 1.22; CI: 1.09, 1.36; P =0.0001) and revascularization (HR 1.28; CI: 1.10, 1.49; P =0.002) after discharge from index MI. Cumulative stroke rate after MI did not differ between RA and non-RA patients (P =0.322). RA duration and corticosteroid usage before MI, but not use of methotrexate or biologic antirheumatic drugs, were independently associated with higher mortality (P <0.001) and new MI (P =0.009). A higher dosage of corticosteroids prior to MI was independently associated with higher long-term mortality (P =0.002) and methotrexate usage with lower stroke rate (P =0.034). Serological status of RA was not associated with outcomes. Conclusion RA is independently associated with poorer prognosis after MI. RA duration and corticosteroid usage and dosage were independent predictors of mortality after MI in RA. Special attention is needed for improvement of outcomes after MI in this vulnerable population.
Collapse
Affiliation(s)
- Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland.,Department of Medicine, University of Turku, Turku, Finland.,Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Anne M Kerola
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.,Department of Rheumatology, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Centre, Hospital District of Southwest Finland, Turku, Finland
| |
Collapse
|
20
|
Laaksonen N, Varjonen JM, Blomster M, Palomäki A, Vasankari T, Airaksinen J, Huupponen R, Scheinin M, Juuso Blomster. Assessing an Electronic Health Record research platform for identification of clinical trial participants. Contemp Clin Trials Commun 2021; 21:100692. [PMID: 33409423 PMCID: PMC7773855 DOI: 10.1016/j.conctc.2020.100692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/05/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022] Open
Abstract
Electronic health records (EHR) are a potential resource for identification of clinical trial participants. We evaluated how accurately a commercially available EHR Research Platform, InSite, is able to identify potential trial participants from the EHR system of a large tertiary care hospital. Patient counts were compared with results obtained in a conventional manual search performed for a reference study that investigated the associations of atrial fibrillation (AF) and cerebrovascular incidents. The Clinical Data Warehouse (CDW) of Turku University Hospital was used to verify the capabilities of the EHR Research Platform. The EHR query resulted in a larger patient count than the manual query (EHR Research Platform 5859 patients, manual selection 2166 patients). This was due to the different search logic and some exclusion criteria that were not addressable in structured digital format. The EHR Research Platform (5859 patients) and the CDW search (5840 patients) employed the same search logic. The temporal relationship between the two diagnoses could be identified when they were available in structured format and the time difference was longer than a single hospital visit. Searching for patients with the EHR Research Platform can help to identify potential trial participants from a hospital's EHR system by limiting the number of records to be manually reviewed. EHR query tools can best be utilized in trials where the selection criteria are expressed in structured digital format.
Collapse
Affiliation(s)
- Niina Laaksonen
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland
| | - Juha-Matti Varjonen
- Auria Clinical Informatics, Hospital District of Southwest Finland, PO Box 52, FI-20521, Turku, Finland
| | - Minna Blomster
- Auria Clinical Informatics, Hospital District of Southwest Finland, PO Box 52, FI-20521, Turku, Finland
| | - Antti Palomäki
- Heart Centre, Turku University Hospital, PO Box 52, FI-2052, Turku, Finland
| | - Tuija Vasankari
- Heart Centre, Turku University Hospital, PO Box 52, FI-2052, Turku, Finland
| | - Juhani Airaksinen
- Heart Centre, Turku University Hospital, PO Box 52, FI-2052, Turku, Finland
| | - Risto Huupponen
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland
| | - Mika Scheinin
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland
| | - Juuso Blomster
- Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, FI-20520, Turku, Finland.,Heart Centre, Turku University Hospital, PO Box 52, FI-2052, Turku, Finland
| |
Collapse
|
21
|
Palomäki A, Paltta J, Pirilä L, Heikkilä HK, Isomäki P, Huhtakangas J, Sokka-Isler T, Kaipiainen-Seppänen O, Eklund K. AB1251 VALIDITY OF RHEUMATOID ARTHRITIS DIAGNOSES IN FINNISH BIOBANK PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Finnish healthcare registers are used in medical research, but there is little data about the validity of these registers in rheumatology.Objectives:The aim of our study was to determine the validity of rheumatoid arthritis (RA) diagnoses in patients participating in the Finnish Biobanks.Methods:We reviewed the electronic patient charts of 125 patients with at least one visit with a diagnosis of seropositive RA, 125 patients with at least one visit with a diagnosis of seronegative RA and 250 age-and-sex matched controls. Patients were randomly selected from Finnish biobank participants. We evaluated whether the patients’ diagnosis of RA recorded in the hospital discharge registry at the participating hospital was correct according to chart review and expert opinion. In the control group it was investigated whether the diagnosis of RA was written in the patients’ chart, but the diagnosis code was not recorded.Results:The positive predictive value (PPV) of a single hospital registry diagnosis of seropositive RA was 0.74 but rose to 0.98 in patients with a special reimbursement for seropositive RA and 0.98 in anti-citrullinated protein antibody positive patients. For seronegative RA, the PPV of a diagnosis was 0.72 and in patients with a special reimbursement for seronegative RA 0.89. The PPV was higher in patients with more than one visit with the diagnosis: 0.92 if the patients had at least 5 visits with seropositive RA and 0.88 with at least 5 visits with seronegative RA. Negative predictive value for RA diagnosis was 0.99.Conclusion:These results demonstrate that the validity of RA diagnoses in healthcare registers can be markedly improved with data about special reimbursement for medication, number of visits and serological data.Disclosure of Interests:Antti Palomäki Consultant of: Pfizer, Speakers bureau: Pfizer, Sanofi, MSD, Johanna Paltta Consultant of: Lilly, Abbvie, Laura Pirilä Consultant of: Novartis, MSD Finland, Roche, Bristol-Myers-Squibb, Pfizer, Sanofi, Abbvie, Oy Eli LIlly Finland Ab, UCB Pharma Oy Finland, Jansen-Cilag, Mylan, Sandoz, Boehringer-Ingelheim, Paid instructor for: Boehringer -Ingelheim, MSD Finland, Speakers bureau: Boehringer-Ingelheim, Pfizer Finland, Hanna-Kaisa Heikkilä: None declared, Pia Isomäki Consultant of: Abbvie, BMS, Eli Lilly, MSD, Novartis, Pfizer, Roche, Sanofi, Johanna Huhtakangas Consultant of: Boehringer Ingelheim, Tuulikki Sokka-Isler: None declared, Oili Kaipiainen-Seppänen Speakers bureau: Boehringer Ingelheim, Kari Eklund Consultant of: Celgene, Lilly, Speakers bureau: Pfizer, Roche
Collapse
|
22
|
Jaakkola J, Hartikainen P, Kiviniemi TO, Nuotio I, Palomäki A, Hartikainen JEK, Ylitalo A, Mustonen P, Airaksinen KEJ. Distribution of ischemic strokes in patients with atrial fibrillation: The FibStroke Study. Neurol Clin Pract 2019; 9:330-336. [PMID: 31583188 DOI: 10.1212/cpj.0000000000000683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aimed to determine the relative frequency of affected cerebrovascular territories in patients with atrial fibrillation (AF) suffering an ischemic stroke. METHODS Altogether, 1,976 patients who suffered their first-ever ischemic stroke during 2003-2012 and were diagnosed with AF either before or within 30 days after the event were included in this retrospective multicenter cohort study. Strokes were classified radiographically to be located either within the anterior or the posterior cerebrovascular territory, and the effect of the CHA2DS2-VASc score, oral anticoagulant (OAC) use, and timing of AF diagnosis on lesion localization was determined. RESULTS The median age of the patients was 78.4 (interquartile range: 71.7-84.2) years, 1,137 (57.5%) of them were women, their mean CHA2DS2-VASc score was 3.5 (95% confidence interval: 3.4-3.5), 656 (33.2%) were receiving OAC drugs, and altogether, 1,450 (73%) had a previous AF diagnosis. The localization of ischemic lesions between the anterior and the posterior cerebrovascular territories was not affected by the timing of AF diagnosis (p = 0.46), use of OACs (p = 0.70), or the CHA2DS2-VASc score (p = 0.10). Within the anterior territory, altogether 774 strokes (53.2%) were located in the left hemisphere and 3 (0.2%) were bilateral. The timing of AF diagnosis (p = 0.84), use of OACs (p = 0.90), or the CHA2DS2-VASc score (p = 0.21) did not affect the location of the ischemic lesion between the hemispheres. CONCLUSIONS The timing of AF diagnosis, use of OAC drugs, or the CHA2DS2-VASc score did not affect the distribution of ischemic strokes. Anterior territory strokes were slightly more often located within the left hemisphere.
Collapse
Affiliation(s)
- Jussi Jaakkola
- Turku University Hospital (JJ, TOK, IN, AP, AY, KEJA), Turku; Kuopio University Hospital (PH, JEKH), Kuopio; Satakunta Central Hospital (AY), Pori; and Central Finland Central Hospital (PM), Jyväskylä, Finland
| | - Päivi Hartikainen
- Turku University Hospital (JJ, TOK, IN, AP, AY, KEJA), Turku; Kuopio University Hospital (PH, JEKH), Kuopio; Satakunta Central Hospital (AY), Pori; and Central Finland Central Hospital (PM), Jyväskylä, Finland
| | - Tuomas O Kiviniemi
- Turku University Hospital (JJ, TOK, IN, AP, AY, KEJA), Turku; Kuopio University Hospital (PH, JEKH), Kuopio; Satakunta Central Hospital (AY), Pori; and Central Finland Central Hospital (PM), Jyväskylä, Finland
| | - Ilpo Nuotio
- Turku University Hospital (JJ, TOK, IN, AP, AY, KEJA), Turku; Kuopio University Hospital (PH, JEKH), Kuopio; Satakunta Central Hospital (AY), Pori; and Central Finland Central Hospital (PM), Jyväskylä, Finland
| | - Antti Palomäki
- Turku University Hospital (JJ, TOK, IN, AP, AY, KEJA), Turku; Kuopio University Hospital (PH, JEKH), Kuopio; Satakunta Central Hospital (AY), Pori; and Central Finland Central Hospital (PM), Jyväskylä, Finland
| | - Juha E K Hartikainen
- Turku University Hospital (JJ, TOK, IN, AP, AY, KEJA), Turku; Kuopio University Hospital (PH, JEKH), Kuopio; Satakunta Central Hospital (AY), Pori; and Central Finland Central Hospital (PM), Jyväskylä, Finland
| | - Antti Ylitalo
- Turku University Hospital (JJ, TOK, IN, AP, AY, KEJA), Turku; Kuopio University Hospital (PH, JEKH), Kuopio; Satakunta Central Hospital (AY), Pori; and Central Finland Central Hospital (PM), Jyväskylä, Finland
| | - Pirjo Mustonen
- Turku University Hospital (JJ, TOK, IN, AP, AY, KEJA), Turku; Kuopio University Hospital (PH, JEKH), Kuopio; Satakunta Central Hospital (AY), Pori; and Central Finland Central Hospital (PM), Jyväskylä, Finland
| | - K E Juhani Airaksinen
- Turku University Hospital (JJ, TOK, IN, AP, AY, KEJA), Turku; Kuopio University Hospital (PH, JEKH), Kuopio; Satakunta Central Hospital (AY), Pori; and Central Finland Central Hospital (PM), Jyväskylä, Finland
| |
Collapse
|
23
|
Lehtola H, Palomäki A, Mustonen P, Hartikainen P, Airaksinen J, Hartikainen J. Author response: Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin. Neurol Clin Pract 2019; 9:3-4. [DOI: 10.1212/cpj.0000000000000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
24
|
Lehtola H, Palomäki A, Mustonen P, Hartikainen P, Kiviniemi T, Sallinen H, Nuotio I, Ylitalo A, Airaksinen KEJ, Hartikainen J. Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin. Neurol Clin Pract 2018; 8:311-317. [PMID: 30140582 DOI: 10.1212/cpj.0000000000000491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/16/2018] [Indexed: 11/15/2022]
Abstract
Background Intracranial hemorrhage is the most devastating complication in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC). It can be either spontaneous or caused by head trauma. We sought to address the prevalence, clinical characteristics, and prognosis of traumatic and spontaneous intracranial hemorrhages in AF patients on OAC. Methods Multicenter FibStroke registry of 5,629 patients identified 592 intracranial hemorrhages during warfarin treatment between 2003 and 2012. Results A large proportion (40%) of intracranial hemorrhages were traumatic. Of these, 64% were subdural hemorrhages (SDHs) and 20% intracerebral hemorrhages (ICHs). With respect to the spontaneous hemorrhages, 25% were SDHs and 67% ICHs. Patients with traumatic hemorrhage were older (81 vs 78 years, p = 0.01) and more often had congestive heart failure (30% vs 16%, p < 0.01) and anemia (7% vs 3%, p = 0.03) compared to patients with spontaneous hemorrhage. Admission international normalized ratio (INR) values (2.7 vs 2.7, p = 0.79), as well as CHA2DS2-VASc (median 4 vs 4, p = 0.08) and HAS-BLED (median 2 vs 2, p = 0.05) scores, were similar between the groups. The 30-day mortality after traumatic hemorrhage was significantly lower than after spontaneous hemorrhage (25% vs 36%, p < 0.01). Conclusions A significant proportion of intracranial hemorrhages in anticoagulated AF patients were traumatic. Traumatic hemorrhages were predominantly SDHs and less often fatal when compared to spontaneous hemorrhages, which were mainly ICHs. Admission INR values as well as CHA2DS2-VASc and HAS-BLED scores were similar in patients with spontaneous and traumatic intracranial hemorrhage. Clinicaltrialsgov identifier NCT02146040.
Collapse
Affiliation(s)
- Heidi Lehtola
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| | - Antti Palomäki
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| | - Pirjo Mustonen
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| | - Päivi Hartikainen
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| | - Tuomas Kiviniemi
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| | - Henri Sallinen
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| | - Ilpo Nuotio
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| | - Antti Ylitalo
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| | - K E Juhani Airaksinen
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| | - Juha Hartikainen
- Department of Medicine (HL, PM), Keski-Suomi Central Hospital, Jyvaskyla; Department of Cardiology (HL), Oulu University Hospital; Heart Center (AP, TK, HS, AY, KEJA) and Department of Acute Internal Medicine (IN), Turku University Hospital; NeuroCenter (PH), Kuopio University Hospital; University of Turku (IN, KEJA); Satakunta Central Hospital (AY), Pori; and Heart Center (JH), Kuopio University Hospital and University of Eastern Finland
| |
Collapse
|
25
|
Jaakkola S, Kiviniemi TO, Nuotio I, Hartikainen J, Mustonen P, Palomäki A, Jaakkola J, Ylitalo A, Hartikainen P, Airaksinen KJ. Usefulness of the CHA 2DS 2-VASc and HAS-BLED Scores in Predicting the Risk of Stroke Versus Intracranial Bleeding in Patients With Atrial Fibrillation (from the FibStroke Study). Am J Cardiol 2018. [PMID: 29526276 DOI: 10.1016/j.amjcard.2018.01.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CHA2DS2-VASc and HAS-BLED scores stratify the risk of thromboembolic and bleeding events respectively in patients with atrial fibrillation. There is only little information on how they differentiate which of the 2 clinically most important complications (ischemic stroke [IS] or an intracranial bleeding [IB]) the patient is more prone to suffer. We evaluated both scores in patients with either of these major complications. The FibStroke Study collected data on all patients with atrial fibrillation with either an IS or an IB event between 2003 and 2012 in 4 Finnish hospital districts. Individual electronic patient records were manually reviewed to collect the study data. To assess the relative risk of IS and IB, an IS/IB-ratio was calculated by dividing the absolute number of ISs with the absolute number of IBs within each score category. A total of 3,816 (82.7%) ISs and 798 (17.3%) IBs were detected in 3,909 patients. In general, ISs occurred more often than IBs in patients on oral anticoagulation in each score category (ratio 1.6 to 5.1). The ratio decreased below 1, however, only with very high HAS-BLED scores (>4). Moreover, 221 ISs and 53 IBs occurred in patients with HAS-BLED > CHA2DS2-VASc, of whom only 19.7% were on anticoagulation. In conclusion, IS was the predominant intracranial event irrespective of CHA2DS2-VASc score, HAS-BLED score ≤4, or use of oral anticoagulation, also in patients with low estimated thromboembolic risk (CHA2DS2-VASc 0 to 1). Furthermore, the HAS-BLED score predicted the excess of IBs over ISs only at very high-risk levels.
Collapse
|
26
|
Lehtola H, Hartikainen J, Hartikainen P, Kiviniemi T, Nuotio I, Palomäki A, Ylitalo A, Airaksinen KEJ, Mustonen P. How do anticoagulated atrial fibrillation patients who suffer ischemic stroke or spontaneous intracerebral hemorrhage differ? Clin Cardiol 2018; 41:608-614. [PMID: 29745996 DOI: 10.1002/clc.22935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/11/2018] [Accepted: 02/23/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) increases risk of ischemic stroke, and oral anticoagulation (OAC) increases risk of intracerebral hemorrhage (ICH). This study aimed to compare OAC-treated AF patients with an ischemic stroke/transient ischemic attack (TIA) or spontaneous ICH as their first lifetime cerebrovascular event, especially focusing on patients with therapeutic international normalized ratio (INR). HYPOTHESIS We assumed that in AF patients suffering ischemic stroke/TIA or ICH, patient characteristics could be different in patients with therapeutic INR than in patients with warfarin. METHODS FibStroke is a multicenter, retrospective registry collating details of AF patients with ischemic stroke/TIA or intracranial hemorrhage in 2003-2012. This substudy included AF patients on OAC with first lifetime ischemic stroke/TIA or spontaneous ICH. RESULTS A total of 1457 patients with 1290 ischemic strokes/TIAs and 167 ICHs were identified. Of these, 553 (42.9%) strokes/TIAs and 96 (57.5%) ICHs occurred in patients with INR within therapeutic range. During OAC with therapeutic INR, congestive heart failure (odds ratio [OR]: 2.33, 95% confidence interval [CI]: 1.18-4.58) and hypercholesterolemia (OR: 2.52, 95% CI: 1.51-4.19) were more common in patients with ischemic stroke/TIA, whereas a history of bleeding (OR: 0.30, 95% CI: 0.11-0.82) was less common when compared with patients with ICH. In the whole cohort, renal impairment (OR: 1.86, 95% CI: 1.23-2.80) and mechanical valve prosthesis (OR: 4.41, 95% CI: 1.32-14.7) were overrepresented in patients with stroke/TIA, whereas aspirin use (OR: 0.52, 95% CI: 0.30-0.91) and high INR (OR: 0.40, 95% CI: 0.33-0.48) were overrepresented in patients with ICH. CONCLUSIONS In anticoagulated AF patients with therapeutic INR and first lifetime cerebrovascular event, congestive heart failure and hypercholesterolemia were associated with ischemic stroke/TIA and history of bleeding with ICH.
Collapse
Affiliation(s)
- Heidi Lehtola
- Department of Medicine, Keski-Suomi Central Hospital, Jyvaskyla, Finland.,Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | | | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilpo Nuotio
- Department of Acute Internal Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Palomäki
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Ylitalo
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Satakunta Central Hospital, Pori, Finland
| | | | - Pirjo Mustonen
- Department of Medicine, Keski-Suomi Central Hospital, Jyvaskyla, Finland
| |
Collapse
|
27
|
Jaakkola S, Kiviniemi T, Nuotio I, Hartikainen J, Mustonen P, Palomäki A, Jaakkola J, Ylitalo A, Hartikainen P, Airaksinen J. CHA2DS2-VASC AND HAS-BLED SCORES IN PREDICTING THE RISK OF STROKE VERSUS INTRACRANIAL BLEED: THE FIBSTROKE STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30840-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
28
|
Lehtola H, Airaksinen KEJ, Hartikainen P, Hartikainen JEK, Palomäki A, Nuotio I, Ylitalo A, Kiviniemi T, Mustonen P. Stroke recurrence in patients with atrial fibrillation: concomitant carotid artery stenosis doubles the risk. Eur J Neurol 2017; 24:719-725. [DOI: 10.1111/ene.13280] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 02/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- H. Lehtola
- Department of Medicine; Keski-Suomi Central Hospital; Jyvaskyla Finland
| | | | - P. Hartikainen
- Neurology; NeuroCenter; Kuopio University Hospital; Kuopio Finland
| | | | - A. Palomäki
- Heart Center; Turku University Hospital; University of Turku; Turku Finland
| | - I. Nuotio
- Department of Acute Medicine; Turku University Hospital; University of Turku; Turku Finland
| | - A. Ylitalo
- Heart Center; Turku University Hospital; University of Turku; Turku Finland
- Satakunta Central Hospital; Pori Finland
| | - T. Kiviniemi
- Heart Center; Turku University Hospital; University of Turku; Turku Finland
| | - P. Mustonen
- Department of Medicine; Keski-Suomi Central Hospital; Jyvaskyla Finland
| |
Collapse
|
29
|
Jaakkola J, Mustonen P, Kiviniemi T, Hartikainen JEK, Palomäki A, Hartikainen P, Nuotio I, Ylitalo A, Airaksinen KEJ. Stroke as the First Manifestation of Atrial Fibrillation. PLoS One 2016; 11:e0168010. [PMID: 27936187 PMCID: PMC5148080 DOI: 10.1371/journal.pone.0168010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022] Open
Abstract
Atrial fibrillation may remain undiagnosed until an ischemic stroke occurs. In this retrospective cohort study we assessed the prevalence of ischemic stroke or transient ischemic attack as the first manifestation of atrial fibrillation in 3,623 patients treated for their first ever stroke or transient ischemic attack during 2003–2012. Two groups were formed: patients with a history of atrial fibrillation and patients with new atrial fibrillation diagnosed during hospitalization for stroke or transient ischemic attack. A control group of 781 patients with intracranial hemorrhage was compiled similarly to explore causality between new atrial fibrillation and stroke. The median age of the patients was 78.3 [13.0] years and 2,009 (55.5%) were women. New atrial fibrillation was diagnosed in 753 (20.8%) patients with stroke or transient ischemic attack, compared to 15 (1.9%) with intracranial hemorrhage. Younger age and no history of coronary artery disease or other vascular diseases, heart failure, or hypertension were the independent predictors of new atrial fibrillation detected concomitantly with an ischemic event. Thus, ischemic stroke was the first clinical manifestation of atrial fibrillation in 37% of younger (<75 years) patients with no history of cardiovascular diseases. In conclusion, atrial fibrillation is too often diagnosed only after an ischemic stroke has occurred, especially in middle-aged healthy individuals. New atrial fibrillation seems to be predominantly the cause of the ischemic stroke and not triggered by the acute cerebrovascular event.
Collapse
Affiliation(s)
- Jussi Jaakkola
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Pirjo Mustonen
- Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Antti Palomäki
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Ilpo Nuotio
- Division of Medicine, Department of Acute Internal Medicine, Turku University Hospital, Turku, Finland
| | - Antti Ylitalo
- Heart Center, Satakunta Central Hospital, Pori, Finland
| | | |
Collapse
|
30
|
Palomäki A, Hällberg V, Ala-Korpela M, Kovanen PT, Malminiemi K. Prompt impact of first prospective statin mega-trials on postoperative lipid management of CABG patients: a 20-year follow-up in a single hospital. Lipids Health Dis 2016; 15:124. [PMID: 27460359 PMCID: PMC4962493 DOI: 10.1186/s12944-016-0292-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 07/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-term success of coronary artery bypass grafting (CABG) depends on secondary prevention. Vast evidence provided by the results of cholesterol mega-trials over two decades has shown that effective reduction of LDL cholesterol improves the prognosis of patients with coronary heart disease. However, the implementation of these results into the clinical practice has turned out to be challenging. We analysed how the information derived from clinical statin trials and international recommendations affected the local treatment practices of dyslipidaemia of CABG patients during a 20-year time period. METHODS The cohort includes all CABG patients (n = 953) treated in Kanta-Häme Central Hospital during the time period 1990-2009. At the postoperative visits in the cardiology outpatient clinic, each patient's statin prescription was recorded, and blood lipids were determined. RESULTS During 1990-1994, 12.0 % of patients were on statins and during the following 5-year time periods the proportion was 57.2, 82.2 and 96.8 %, respectively. During the 20-year observation period (1990-2009), the effective statin dose increased progressively during these 5-year periods up to 36-fold, while the mean concentration of LDL cholesterol decreased from 3.7 to 2.1 mmol/l and that of apolipoprotein B from 1.3 to 0.8 g/l. In the very last year of follow-up, the mean concentrations of LDL-C and apoB were 1.83 mmol/l and 0.78 g/l, respectively. The most prominent increase in statin use and dosage took place during 1994-1996 and 2003-2005, respectively. CONCLUSIONS Among CABG patients the lipid-lowering efficacy of statin therapy improved dramatically since 1994. This progress was accompanied by significant and favourable changes of lipid and apolipoprotein-B values. This study shows that it is possible to effectively improve lipid treatment policy once the results of relevant trials are available, and that this may happen even before international or national guidelines have been updated.
Collapse
Affiliation(s)
- A Palomäki
- Department of Emergency Medicine, Kanta-Häme Central Hospital, FIN-13530, Hämeenlinna, Finland.,Medical School, University of Tampere, Tampere, Finland
| | - V Hällberg
- Department of Emergency Medicine, Kanta-Häme Central Hospital, FIN-13530, Hämeenlinna, Finland. .,Medical School, University of Tampere, Tampere, Finland.
| | - M Ala-Korpela
- University of Oulu, Institute of Health Sciences, Computational Medicine and Oulu University Hospital, Oulu, Finland.,School of Social and Community Medicine and Medical Research Council Integrative Epidemiology Unit, Computational Medicine, University of Bristol, Bristol, UK
| | - P T Kovanen
- Wihuri Research Institute, Helsinki, Finland
| | - K Malminiemi
- Medical School, University of Tampere, Tampere, Finland.,Department of Emergency Medicine, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
31
|
Palomäki A, Kiviniemi T, Hartikainen JEK, Mustonen P, Ylitalo A, Nuotio I, Hartikainen P, Jaakkola J, Luite R, Airaksinen KEJ. Postoperative Strokes and Intracranial Bleeds in Patients With Atrial Fibrillation: The FibStroke Study. Clin Cardiol 2016; 39:471-6. [PMID: 27240121 DOI: 10.1002/clc.22554] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/15/2016] [Accepted: 04/15/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) frequently undergo invasive procedures. Optimal perioperative use of oral anticoagulation (OAC) and heparin bridging is not well defined. HYPOTHESIS Discontinuation of OAC for minor procedures/operations places AF patients at risk for thromboembolism. METHODS In this study, we assessed perioperative antithrombotic treatment in patients with AF who suffered a postoperative stroke or intracranial bleeding. The FibStroke Study includes AF patients with an ischemic stroke or intracranial bleed identified from the discharge registries of 4 Finnish hospitals. In total, 3632 consecutive patients developed 3252 ischemic strokes and 794 intracranial bleeds. All invasive procedures during the 30 days preceding the stroke or intracranial bleed were identified. RESULTS A total of 194/3252 (6.0%) ischemic strokes and 23/794 (2.9%) intracranial bleeds were preceded by a procedure. Altogether, 69% of the patients were on OAC prior to index procedure, OAC was interrupted in 81.2% of the procedures preceding a stroke, and heparin bridging was used in 27.8% of interruptions. Of the procedures leading to stroke, 42.3% were low-bleeding-risk procedures, and OAC was interrupted in 84.7% of these procedures. The median time from procedure to stroke was 4 days. Heparin bridging was used in 54.5% of OAC interruptions preceding intracranial bleeding and combination of anticoagulation with antiplatelet therapy by 43.5% of patients with postoperative intracranial bleeding. CONCLUSIONS Perioperative interruption of OAC is common in patients who suffer a postoperative stroke, even in patients with low-bleeding-risk procedures. Postoperative intracranial bleeding is frequently preceded by perioperative heparin bridging.
Collapse
Affiliation(s)
- Antti Palomäki
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Pirjo Mustonen
- Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | - Antti Ylitalo
- Heart Center, Satakunta Central Hospital, Pori, Finland
| | - Ilpo Nuotio
- Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Hartikainen
- Heart Center, Kuopio University Hospital, Kuopio, Finland.,NeuroCenter, Neurology Department, Kuopio University Hospital, Kuopio, Finland
| | - Jussi Jaakkola
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Riho Luite
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | | |
Collapse
|
32
|
Palomäki A, Mustonen P, Hartikainen JE, Nuotio I, Kiviniemi T, Ylitalo A, Hartikainen P, Lehtola H, Luite R, Airaksinen KJ. Strokes after cardioversion of atrial fibrillation — The FibStroke study. Int J Cardiol 2016; 203:269-73. [DOI: 10.1016/j.ijcard.2015.10.168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/01/2015] [Accepted: 10/19/2015] [Indexed: 01/08/2023]
|
33
|
Palomäki A, Mustonen P, Hartikainen JEK, Nuotio I, Kiviniemi T, Ylitalo A, Hartikainen P, Airaksinen KEJ. Underuse of anticoagulation in stroke patients with atrial fibrillation--the FibStroke Study. Eur J Neurol 2015; 23:133-9. [PMID: 26263442 DOI: 10.1111/ene.12820] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/29/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Current guidelines recommend oral anticoagulation (OAC) for patients with atrial fibrillation (AF) and increased risk of thromboembolic events. The reasons for not using OAC in AF patients suffering stroke or transient ischaemic attack (TIA) were assessed. METHODS This retrospective registry included 3404 patients with previously diagnosed AF who suffered a total of 2955 ischaemic strokes and 895 TIAs during 2003-2012. RESULTS A CHA2DS2-VASc score ≥2 and a CHADS2 score ≥2 was observed in 3590 (93.2%) and in 2784 (72.3%) of the events, respectively. Of the high-risk patients (CHADS2 ≥2) only 55.1% were on OAC before the onset of stroke or TIA. The most frequently documented reasons for withholding OAC were infrequent paroxysms of AF (14%), previous bleeding episodes (13%) and the patient's decline/independent discontinuation of treatment (9%). Moreover, patients with paroxysmal AF (40% using OAC), previous bleeding (26% using OAC) and alcohol abuse (30% using OAC) were using OAC significantly less often than patients without these characteristics. A significant increase in the proportion of high-risk patients using OAC from 49% in 2003 to 65% in 2012 was seen. CONCLUSIONS Underuse of anticoagulation is a common contributor to ischaemic strokes and TIA episodes in patients with AF. Infrequent AF episodes, previous bleeds, patient preference and alcohol abuse were the most common reasons for not using OAC.
Collapse
Affiliation(s)
- A Palomäki
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - P Mustonen
- Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland
| | | | - I Nuotio
- Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - T Kiviniemi
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - A Ylitalo
- Heart Center, Satakunta Central Hospital, Pori, Finland
| | - P Hartikainen
- Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - K E J Airaksinen
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| |
Collapse
|
34
|
Rautava V, Valpas T, Nurmikari M, Palomäki A. Establishing a new emergency department: effects on patient flow. Crit Care 2013. [PMCID: PMC3642810 DOI: 10.1186/cc12198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
35
|
Alaspää AO, Valpas T, Rautava V, Palomäki A. Reform of emergency services: immediate effects on cardiac care unit and ICU patient intake. Crit Care 2013. [PMCID: PMC3642575 DOI: 10.1186/cc12213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
36
|
Pohjantähti-Maaroos H, Palomäki A. Comparison of metabolic syndrome subjects with and without erectile dysfunction - levels of circulating oxidised LDL and arterial elasticity. Int J Clin Pract 2011; 65:274-80. [DOI: 10.1111/j.1742-1241.2010.02595.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
37
|
Alametsä J, Värri A, Viik J, Hyttinen J, Palomäki A. Ballistocardiogaphic studies with acceleration and electromechanical film sensors. Med Eng Phys 2009; 31:1154-65. [PMID: 19713144 DOI: 10.1016/j.medengphy.2009.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 05/29/2009] [Accepted: 07/21/2009] [Indexed: 11/24/2022]
Abstract
The purpose of this research is to demonstrate and compare the utilization of electromechanical film (EMFi) and two acceleration sensors, ADXL202 and MXA2500U, for ballistocardiographic (BCG) and pulse transit time (PTT) studies. We have constructed a mobile physiological measurement station including amplifiers and a data collection system to record the previously mentioned signals and an electrocardiogram signal. Various versions of the measuring systems used in BCG studies in the past are also presented and evaluated. We have showed the ability of the EMFi sensor to define the elastic properties of the cardiovascular system and to ensure the functionality of the proposed instrumentation in different physiological loading conditions, before and after exercise and sauna bath. The EMFi sensor provided a BCG signal of good quality in the study of the human heart and function of the cardiovascular system with different measurement configurations. EMFi BCG measurements provided accurate and repeatable results for the different components of the heart cycle. In multiple-channel EMFi measurements, the carotid and limb pulse signals acquired were detailed and distinctive, allowing accurate PTT measurements. Changes in blood pressure were clearly observed and easily determined with EMFi sensor strips in pulse wave velocity (PWV) measurements. In conclusion, the configuration of the constructed device provided reliable measurements of the electrocardiogram, BCG, heart sound, and carotid and ankle pulse wave signals. Attached EMFi sensor strips on the neck and limbs yield completely new applications of the EMFi sensors aside from the conventional seat and supine recordings. Higher sensitivity, ease of utilization, and minimum discomfort of the EMFi sensor compared with acceleration sensors strengthen the status of the EMFi sensor for accurate and reliable BCG and PWV measurements, providing novel evaluation of the elastic properties of the cardiovascular system.
Collapse
Affiliation(s)
- J Alametsä
- Tampere University of Technology, Department of Biomedical Engineering, Tampere, Finland.
| | | | | | | | | |
Collapse
|
38
|
|
39
|
Tikkanen MJ, Jackson G, Tammela T, Assmann G, Palomäki A, Kupari M, Olsson A. Erectile dysfunction as a risk factor for coronary heart disease: implications for prevention. Int J Clin Pract 2007; 61:265-8. [PMID: 17263713 DOI: 10.1111/j.1742-1241.2006.01271.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
There is now mounting evidence that erectile dysfunction (ED) is an early predictor of coronary heart disease (CHD). Men presenting with ED but no other cardiovascular symptoms provide an opportunity for the treating physician to test for asymptomatic CHD and to reduce CHD risk factors.
Collapse
Affiliation(s)
- M J Tikkanen
- Helsinki University Central Hospital, Helsinki, Finland.
| | | | | | | | | | | | | |
Collapse
|
40
|
Malminiemi K, Palomäki A, Malminiemi O. Comparison of LDL trap assay to other tests of antioxidant capacity; effect of vitamin E and lovastatin treatment. Free Radic Res 2000; 33:581-93. [PMID: 11200090 DOI: 10.1080/10715760000301111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Oxidized low density lipoprotein (LDL) has a major impact in the development of atherosclerosis. Risk for oxidative modification of LDL is usually determined indirectly by measuring the capability of LDL to resist radical insult. We compared three different methods quantifying the antioxidative capacity of LDL ex vivo in dyslipidemic patients with coronary heart disease. Plasma samples were obtained from two double-blinded cross-over trials. The duration of all interventions (placebo, lovastatin 60 mg/day, RRR-alpha-tocopherol 300 mg/day and lovastatin + RRR-alpha-tocopherol combined) was 6 weeks. The total radical capturing capacity of LDL (TRAP) in plasma was determined using 2,2-azo-bis(2,4-dimethyl-valeronitrile) (AMVN) -induced oxidation, and measuring the extinction time of chemiluminescence. TRAP was compared to the variables characterizing formation of conjugated dienes in copper-induced oxidation. Also the initial concentrations and consumption times of reduced alpha-tocopherol (alpha-TOH) and ubiquinol in AMVN-induced oxidation were determined. Repeatability of TRAP was comparable to that of the lag time in conjugated diene formation. Coefficient of variation within TRAP assay was 4.4% and between TRAP assays 5.9%. Tocopherol supplementation produced statistically significant changes in all antioxidant variables except those related to LDL ubiquinol. TRAP increased by 57%, the lag time in conjugated diene formation by 34% and consumption time of alpha-TOH by 88%. When data of all interventions were included in the analyses, TRAP correlated with the lag time (r = 0.75, p < 10(-6)), with LDL alpha-TOH (r = 0.50, p < 0.001) and with the consumption time of alpha-TOH (r = 0.58, p < 0.0001). In the baseline data, the associations between different antioxidant variables were weaker. TRAP correlated with the lag time (r = 0.55, p < 0.001) and alpha-TOH consumption time (r = 0.48, p < 0.05), and inversely with apolipoprotein Al (r = -0.51, p < 0.05). Lag time at the baseline did not correlate with ubiquinol or tocopherol parameters, or with any plasma lipid or lipoprotein levels analyzed. Lovastatin treatment did not significantly affect the antioxidant capacity of LDL. In conclusion, TRAP reflects slightly different properties of LDL compared to the lag time. Thus, LDL TRAP assay may complement the other methods used to quantify the antioxidant capacity of LDL. However, TRAP and the lag time react similarly to vitamin E supplementation.
Collapse
Affiliation(s)
- K Malminiemi
- Department of Clinical Pharmacology, Tampere University Hospital, Finland.
| | | | | |
Collapse
|
41
|
Palomäki A, Malminiemi K, Malminiemi O, Solakivi T. Effects of lovastatin therapy on susceptibility of LDL to oxidation during alpha-tocopherol supplementation. Arterioscler Thromb Vasc Biol 1999; 19:1541-8. [PMID: 10364087 DOI: 10.1161/01.atv.19.6.1541] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A randomized, double-masked, crossover clinical trial was carried out to evaluate whether lovastatin therapy (60 mg daily) affects the initiation of oxidation of low density lipoprotein (LDL) in cardiac patients on alpha-tocopherol supplementation therapy (450 IU daily). Twenty-eight men with verified coronary heart disease and hypercholesterolemia received alpha-tocopherol with lovastatin or with dummy tablets in random order. The two 6-week, active-treatment periods were preceded by a washout period of at least 8 weeks. The oxidizability of LDL was determined by 2 methods ex vivo. The depletion times for LDL ubiquinol and LDL alpha-tocopherol were determined in timed samples taken during oxidation induced by 2, 2-azobis(2,4-dimethylvaleronitrile). Copper-mediated oxidation of LDL isolated by rapid density-gradient ultracentrifugation was used to measure the lag time to the propagation phase of conjugated-diene formation. alpha-Tocopherol supplementation led to a 1.9-fold concentration of reduced alpha-tocopherol in LDL (P<0.0001) and to a 2.0-fold longer depletion time (P<0.0001) of alpha-tocopherol compared with determinations after the washout period. A 43% prolongation (P<0.0001) was seen in the lag time of conjugated-diene formation. Lovastatin decreased the depletion time of reduced alpha-tocopherol in metal ion-independent oxidation by 44% and shortened the lag time of conjugated-diene formation in metal ion-dependent oxidation by 7%. In conclusion, alpha-tocopherol supplementation significantly increased the antioxidative capacity of LDL when measured ex vivo, which was partially abolished by concomitant lovastatin therapy.
Collapse
Affiliation(s)
- A Palomäki
- Department of Internal Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | | | | | | |
Collapse
|
42
|
Palomäki A, Malminiemi K, Solakivi T, Malminiemi O. Ubiquinone supplementation during lovastatin treatment: effect on LDL oxidation ex vivo. J Lipid Res 1998; 39:1430-7. [PMID: 9684746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
A randomized, double-masked, placebo-controlled cross-over trial was carried out to evaluate whether ubiquinone supplementation (180 mg daily) corrects impaired defence against initiation of oxidation of low density lipoprotein (LDL) related to effective (60 mg daily) lovastatin treatment. Nineteen men with coronary heart disease and hypercholesterolemia received lovastatin with or without ubiquinone during 6-week periods after wash-out. The depletion times for LDL ubiquinol and reduced alpha-tocopherol were determined during oxidation induced by 2,2-azobis(2,4-dimethylvaleronitrile) (AMVN). Copper-mediated oxidation of LDL isolated by rapid density-gradient ultracentrifugation was used to measure the lag time to the propagation phase of conjugated diene formation. Compared to mere lovastatin therapy, ubiquinone supplementation lead to a 4.4-fold concentration of LDL ubiquinol (P < 0.0001). In spite of the 49% lengthening in depletion time (P < 0.0001) of LDL ubiquinol, the lag time in copper-mediated oxidation increased only by 5% (P = 0.02). Ubiquinone loading had no statistically significant effect on LDL alpha-tocopherol redox kinetics during high radical flux ex vivo. The faster depletion of LDL ubiquinol and shortened lag time in conjugated diene formation during high-dose lovastatin therapy may, at least partially, be restored with ubiquinone supplementation. However, the observed improvement in LDL antioxidative capacity was scarce, and the clinical relevance of ubiquinone supplementation during statin therapy remains open.
Collapse
Affiliation(s)
- A Palomäki
- Department of Internal Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | | | | | | |
Collapse
|
43
|
Miettinen HE, Jauhiainen M, Gylling H, Ehnholm S, Palomäki A, Miettinen TA, Kontula K. Apolipoprotein A-IFIN (Leu159-->Arg) mutation affects lecithin cholesterol acyltransferase activation and subclass distribution of HDL but not cholesterol efflux from fibroblasts. Arterioscler Thromb Vasc Biol 1997; 17:3021-32. [PMID: 9409289 DOI: 10.1161/01.atv.17.11.3021] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We showed earlier that the apolipoprotein A-I Leu159-->Arg mutation (apoA-IFin) results in dominantly inherited hypoalphalipoproteinemia. In the present study we investigated the effect of the apoA-IFin mutation on lipoprotein profile, apoA-I kinetics, lecithin:cholesterol acyltransferase (LCAT) activation, and cholesterol efflux in vitro. Carriers (n = 9) of the apoA-IFin mutation exhibited several lipoprotein abnormalities. The serum HDL cholesterol level was diminished to 20% of normal, and nondenaturing gradient gel electrophoresis of HDL showed disappearance of particles at the 9.0- to 12-nm size range (HDL2-type) and the presence of small 7.8- to 8.9-nm (mostly HDL3-type) particles only. HDL3-type particles from both the mutation carriers and nonaffected family members were similarly converted to large, HDL2-type particles by phospholipid transfer protein in vitro. Studies on apoA-I kinetics in four affected subjects favored accelerated catabolism of apoA-I. Experiments with reconstituted proteoliposomes showed that the capacity of apoA-IFin protein to activate LCAT was reduced to 40% of that of the wild-type apoA-I. The impact of the apoA-IFin protein on cholesterol efflux was examined in vitro using [3H]cholesterol-loaded human fibroblasts and three different cholesterol acceptors: (1) total HDL, (2) total apoA-I combined with phospholipid, and (3) apoA-I isoform (apoA-IFin or wild-type apoA-I isoform 1) combined with phospholipid. ApoA-IFin did not impair phospholipid binding or cholesterol efflux from fibroblasts to any of the acceptors used. Only one of the nine apoA-IFin carriers appears to have evidence of clinically manifested atherosclerosis. In conclusion, although the apoA-IFin mutation does not alter the properties of apoA-I involved in promotion of cholesterol efflux, its ability to activate LCAT in vitro is defective. In vivo, apoA-IFin was found to be associated with several lipoprotein composition rearrangements and increased catabolism of apoA-I.
Collapse
Affiliation(s)
- H E Miettinen
- Department of Medicine, University of Helsinki, Finland.
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
A double-blinded, placebo-controlled cross-over trial was carried out with 27 hypercholesterolemic men with coronary heart disease. During the 6-week treatment period lovastatin (60 mg/day) decreased fasting serum LDL cholesterol by 45%, LDL phosphorus by 38% and apoB by 33%. Ubiquinol content diminished by 13% as measured per LDL phosphorus. When LDL was oxidized ex vivo with AMVN both LDL ubiquinol and alpha-tocopherol were exhausted faster after lovastatin treatment compared to placebo, by 24% (P < 0.005) and 36% (P < 0.0001), respectively. Lag time in copper-induced oxidation of LDL decreased by 7% (P < 0.01). This suggests diminished antioxidant-dependent resistance of LDL to the early phase of oxidative stress.
Collapse
Affiliation(s)
- A Palomäki
- Kanta-Häme Central Hospital, Hameenlinna, Finland
| | | | | |
Collapse
|