Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation

BACKGROUND

The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy.

METHODS

For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU.

FINDINGS

For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier.

INTERPRETATION

Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes.

FUNDING

British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.

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

OBJECTIVES

Elevated systolic blood pressure (SBP) is associated with an increased risk of cardiovascular disease (CVD) mortality, whereas frequent sauna bathing reduces the risk. Whether frequent sauna bathing mitigates CVD mortality among adults with elevated SBP has not been previously investigated.

DESIGN AND SETTING

We examined the interactions between SBP and frequency of sauna bathing (FSB) with the risk of CVD mortality in a cohort of Caucasian men.

PARTICIPANTS

The Kuopio Ischaemic Heart Disease Study cohort comprising of 2,575 men aged 42-61 years at baseline was employed for this prospective study analysis.

MEASUREMENTS

Resting blood pressure was measured using a standardized protocol and sauna bathing habits were assessed by a self-administered questionnaire. Systolic blood pressure was categorized as normal and high (<140 and ≥140 mmHg, respectively) and FSB as low and high (defined as ≤ 2 and 3-7 sessions/week, respectively).

RESULTS

A total of 744 CVD deaths were recorded during a median follow-up of 27.8 yr. Comparing high vs normal SBP, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.44 (1.23-1.68). Comparing low vs high FSB, the multivariable-adjusted HR (95% CI) for CVD mortality was 1.24 (1.03-1.51). The associations persisted following mutual adjustment for each exposure. Compared with men with normal SBP-high FSB, high SBP-low FSB was associated with an increased risk of CVD mortality 1.81 (1.39-2.36), with attenuated but persisting evidence of an association for men with high SBP and high FSB 1.52 (1.06-2.16). When SBP was categorized as normal and high (<130 and ≥130 mmHg, respectively), there was no evidence of an association for men with high SBP and high FSB 1.11 (0.77-1.61).

CONCLUSION

There might be an interaction between SBP, sauna bathing and CVD mortality risk in middle-aged and older Caucasian males. Frequent sauna baths may offset the increased risk of CVD mortality in men with high-normal SBP but not elevated SBP.

Circulating metabolome does not predict development of aortic stenosis

Background

Calcific aortic valve disease (CAVD) is the most common valvular heart disease in Western world. CAVD is ranging from mild aortic valve sclerosis to severe obstructive aortic stenosis (AS). The development of AS has been associated with several risk factors including age, sex and hypertension. However, there is limited knowledge about factors that predict the development of aortic stenosis.

Purpose

We investigated if the circulating metabolite profile can predict the development of aortic stenosis in Finnish males.

Methods

We did a non-targeted LC-MS metabolomics analysis to baseline (1984–1989) serum samples from a prospective population-based Kuopio Ischemic Heart Disease risk factor study (KIHD) cohort of 2682 random Finnish males aged from 42 to 60 years. During the follow-up (until year 2020), 53 subjects developed either moderate (peak flow gradient 36–64mmHg or mean flow gradient 20–40mmHg) or severe aortic valvular stenosis (peak flow gradient over 64mmHg or mean gradient over 40mmHg). The AS patients were collected from the KIHD database using appropriate ICD-10 -codes for aortic valvular disease (from baseline to the end of the year 2017) and the diagnosis was checked manually using hospital medical records of the individuals.

Results

The AS patients seemed to have altered lipid metabolism and possibly altered composition of gut microbiota, since several acylcarnitines (e.g. octanoylcarnitine [Cohen's d=−0.40], decanoylcarnitine [d=−0.43], layroylcarnitine [d=−0.41], and oleoylcarnitine [d=−0.40]), and branched chain amino acids (BCAA, e.g. leucine [d=0.39], and isoleucine [d=0.49]) had p-values below 0.05. However, after correction for multiple testing, there were no significant differences between the cases and controls.

Conclusions

The present preliminary results, in need of verification with a larger set of samples, suggest that subjects, who will later develop AS might have reduced levels of acylcarnitines and increased levels of BCAA when compared to matched controls. However, these changes do not have large effects sizes and are likely not good candidates for biomarkers to predict future diagnosis of AS.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Finnish Cultural Foundation, The Finnish Foundation for Cardiovascular Research.

Life"s simple 7 and the risk of stroke in Finnish men: a prospective cohort study

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): North Savo Regional Fund and Finnish Foundation for Cardiovascular Research

Background

Population-wide preventive measures constitute important approaches toward reducing stroke risk and its associated burden. We sought to examine the association between American Heart Association’s (AHA) Life’s Simple7 (LS7) score and the risk of stroke in men.

Methods

The study is based on the prospective population-based Kuopio Ischaemic Heart Disease cohort comprising men (42-60 years) without pre-existing history of stroke at baseline. LS7 was computed from AHA’s cardiovascular health metrics for 2520 men and includes data on diet, physical activity, body mass index, smoking status, blood pressures, total cholesterol and blood glucose. Participants were classified into three LS7 groups based on the number of ideal metrics: inadequate (0–2), average (3–4) and optimal (5–7). Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LS7 scores for total and ischaemic stroke.

Results

During a median follow-up of 26years, 428 total and 362 ischaemic incident stroke events were recorded. The risk of both stroke outcomes decreased continuously with increasing LS7 scores across the range 2 to 6. Men with optimal LS7 had 48% (HR: 0.52; 95%CI: 0.32–0.86) lower risk of total stroke when compared with those with inadequate LS7. The association was similar for the risk of ischaemic stroke, with 50% (HR: 0.50; 95%CI: 0.29–0.87) lower risk among men with an optimal LS7 compared with those with inadequate LS7.

Conclusion

LS7 was strongly, inversely and linearly associated with risk of total and ischaemic strokes among a middle-aged male Caucasian population.

Life’s Simple 7 and the risk of stroke Total Stroke Ischaemic Stroke LS7 score 0-2† (inadequate) 3-4 (average) 5-7 (optimal) 0-2† (inadequate) 3-4 (average) 5-7 (optimal) n/N 224/1109 187/1273 17/138 192/1109 156/1273 14/138 Model 1 HR (95%CI) 1 0.65 (0.53 - 0.79) 0.49 (0.30 - 0.81) 1 0.63 (0.51 - 0.78) 0.47 (0.27 - 0.82) p value* &lt;0.001 0.005 &lt;0.001 0.007 Model 2 HR (95%CI) 1 0,69 (0.56 - 0.84) 0.52 (0.32 - 0.86) 1 0.67 (0.54 - 0.84) 0.50 (0.29 - 0.87) p value* &lt;0.001 0.01 &lt;0.001 0.014 n/N, number of events/Total; HR, hazard ratio; CI, Confidence interval *p-values for the HRs &lt;0.05 are considered statistically significant †Reference category Model 1: adjusted for age, alcohol consumption and socioeconomic status Model 2: Model 1 plus history of coronary heart disease and history of type 2 diabetes mellitus

Socioeconomic Inequalities in Mental Health in Mongolia

Background

Promotion of mental health and well-being is recently recognized as a health priority at the global level. In Mongolia, mental health issues have been on the rise. However, less is known on socioeconomic inequality in mental health in the country. The aim of this study is to examine socioeconomic inequality in mental health in the adult population in Mongolia.

Methods

This study analyzed the data of 30,567 adults from the Household Socio-Economic Survey, collected in 2012 by the National Statistical Office of Mongolia. Self-reported mental health was used as a health outcome variable. Socioeconomic status was measured by household income. We employed the Wagstaff's concentration index to assess the degree of socioeconomic inequality in mental health.

Results

The results show that the prevalence of self-reported mental health was 1.17% among the respondents. The adults living in urban areas suffer significantly more with mental illness compared to the adults living in rural settlements. The Wagstaff's concentration index for mental health was significantly negative (-0.243), indicating that mental health problems were concentrated among the lower-income groups. The decomposition results show that education, economic activity status and marital status were the main contributors to socioeconomic inequalities in mental health after removing age-sex related contributions.

Conclusions

Socioeconomic inequality in mental health exists in the adult population in Mongolia, which was mainly explained by the education level, employment and marital status. Prospective policies are needed to reduce socioeconomic inequality in mental health in the country.

Key messages

Socioeconomic inequality in mental health exists in Mongolia. It calls for further policy actions.

Preserved cognition and reduced age-related cognitive decline during treatment with angiotensin II receptor blockers: A 20-year follow-up study

Introduction

Modulators of the brain renin-angiotensin system (RAS) have been shown to improve cognitive functioning in several animal models of neuropsychiatric disorders. Moreover, the brain RAS has been considered a new target for the treatment of Alzheimer's disease (AD). However, there are no population-based follow-up studies supporting this hypothesis.

Objectives

Cross-sectional and prospective relationships between cognitive decline and ARB treatment were examined in the population-based Kuopio Ischemic Heart Disease Risk Factor Study.

Aims

To evaluate procognitive/antidementia capacity of orally delivered angiotensin II receptor blockers (ARB).

Methods

The study was conducted on a sample of 1774 subjects (920 females, 854 males; age range at baseline: 42–61 years) from Eastern Finland. An established cutoff score of at least 2-point decrease in the Mini Mental State Examination over a 9-year follow-up was used to detect age-related cognitive decline in the cross-sectional setting. In the prospective setting, a hospital discharge diagnosis of dementia/AD was used as outcome variable. Cross-sectional relationships were determined with logistic regression and prospective analyses were conducted with the Cox proportional hazards model (both adjusted for relevant background variables).

Results

Cross-sectional analysis displayed a decrease of the odds of cognitive decline (n = 87; 4.9% of participants) in those with ARB treatment; OR = 0.445, 95% CI: 0.22–0.90, P = 0.024. Furthermore, in the prospective setting, the risk of dementia/AD diagnosis (n = 149; 8.4% of participants) was significantly reduced in ARB treated participants; HR = 0.621, 95% CI: 0.40–0.98, P = 0.038.

Conclusions

ARB treatment is associated with a decreased risk for age-related cognitive decline and dementia/AD manifestation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Serum long-chain omega-3 polyunsaturated Fatty acids and future blood pressure in an ageing population

OBJECTIVES

To investigate the associations of serum long-chain omega-3 polyunsaturated fatty acids (PUFA) and hair mercury with future blood pressure in an ageing population.

DESIGN

Prospective study with baseline measurements in 1998-2001 and follow-up measurements in 2005-2008. The linear relationships (β) of baseline serum fatty acids and hair mercury with future systolic and diastolic blood pressure and pulse pressure were analyzed with multiple linear regression models, using log-transformed values.

PARTICIPANTS

181 men and 200 women aged 53-73 y from the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD) population in Eastern Finland, who were free of cardiovascular disease, diabetes or hypertension at baseline.

MEASUREMENTS

Total serum esterified and nonesterified fatty acids and pubic hair mercury were used as markers for exposure. Anthropometric and other lifestyle and health-related data were collected.

RESULTS

The mean serum concentrations were 1.67% (SD 0.92) for eicosapentaenoic acid (EPA), 0.79% (SD 0.16) for docosapentaenoic acid (DPA) and 2.78 (SD 0.92) for docosahexaenoic acid (DHA), of all serum fatty acids. The mean hair mercury concentration was 1.5 µg/g (SD 1.6). We did not find statistically significant associations between the baseline serum long-chain omega-3 PUFA concentrations or hair mercury content and future blood pressure. Hair mercury did not modify the associations with the long-chain omega-3 PUFAs, either.

CONCLUSIONS

Higher serum long-chain omega-3 PUFA concentration, a biomarker of fish or fish oil consumption, may not have an impact on future blood pressure in an ageing population.

[THE REGULARITIES OF DEVELOPMENT OF CANCER MORBIDITY AND MORTALITY RATE OF THE POPULATION IN THE REPUBLIC OF TATARSTAN AND FINLAND]

There were revealed gender differences in cancer morbidity and mortality rate in the Republic of Tatarstan over the period from 1996 till 2013. The morbidity rate was increased by 1.54 times in both urban and rural areas. The morbidity rate level in men was two times higher than in women. The maximum share of new cases of cancer morbidity according to the primary lesion in men in Finland in 2008-2012 was noted in the age groups of 60-64, 70-79 and 85 years and older.

[THE REGULARITIES OF DEVELOPMENT OF CANCER MORBIDITY AND MORTALITY RATE OF THE POPULATION IN THE REPUBLIC OF TATARSTAN AND FINLAND]

There were revealed gender differences in cancer morbidity and mortality rate in the Republic of Tatarstan over the period from 1996 till 2013. The morbidity rate was increased by 1.54 times in both urban and rural areas. The morbidity rate level in men was two times higher than in women. The maximum share of new cases of cancer morbidity according to the primary lesion in men in Finland in 2008-2012 was noted in the age groups of 60-64, 70-79 and 85 years and older

The frequency of alcohol consumption is associated with the stroke mortality

OBJECTIVES

The purpose of this study was to examine the association between the frequency of alcohol consumption and stroke mortality among eastern Finnish men.

MATERIAL AND METHODS

This study is a population-based sample of men with an average follow-up of 20.2 years. A total of 2609 men with no history of stroke at baseline participated in the study. During the follow-up, 66 deaths from stroke occurred.

RESULTS

After adjustment for systolic blood pressure, smoking, BMI, diabetes, and socioeconomic status, the relative risk (RR) among men who consumed alcohol <0.5 times per week was 0.70 (95% CI, 0.30-1.66; P = 0.419) compared with nondrinkers. Respective RR was 1.08 (95% CI, 0.51-2.27; P = 0.846) for men with alcohol consumption of 0.5-2.5 times per week and 2.44 (95% CI, 1.11-5.40; P = 0.027) for men who consumed alcohol >2.5 times per week after adjustment for risk factors. When the total amount of alcohol consumption (g/week) was taken into account with other covariates, RR was 0.71 (95% CI, 0.30-1.68; P = 0.437) for men with alcohol consumption <0.5 times per week and 1.16 (95% CI, 0.54-2.50; P = 0.704) among men who consumed alcohol 0.5-2.5 times per week. Among men who consumed alcohol >2.5 times per week compared with nondrinkers, RR was 3.03 (95% CI, 1.19-7.72; P = 0.020).

CONCLUSIONS

This study shows a strong association between the frequency of alcohol consumption and stroke mortality, independent of total amount of alcohol consumption. The risk of stroke death was the highest among men who consumed alcohol >2.5 times per week.

Hangover and the risk of stroke in middle-aged men

OBJECTIVES

The aim of this study was to examine the association between hangover and the risk of stroke.

MATERIAL AND METHODS

A population-based sample of men with an average follow-up of 15.7 years. 2466 men with no history of stroke at baseline participated. Two hundred and six strokes occurred, of which 167 were ischemic strokes.

RESULTS

The age-adjusted, relative risk (RR) for any stroke among men with ≥1 hangover per year was 2.33-fold (95% confidence interval (CI), 1.19-4.56; P = 0.013) relative to men without hangover, and 2.99-fold (95% CI, 1.52-5.86; P = 0.001) for ischemic stroke, respectively. After adjustment for age, smoking, high density lipoprotein (HDL)-cholesterol, LDL-cholesterol, BMI, SBP, myocardial ischemia during exercise, symptomatic coronary heart disease (CHD) and CHD in family, C-reactive protein, diabetes, and total alcohol consumption, the RR for any stroke was 1.94-fold (95% CI, 0.95-3.96; P = 0.070) and 2.58-fold (95% CI, 1.24-5.36; P = 0.011) for ischemic stroke among men with hangovers. Additional adjustment of atrial fibrillation and cardiac failure and risk was 2.45-fold (95% CI, 1.18-5.12; P = 0.017) for ischemic strokes.

CONCLUSION

This study shows that at least one hangover a year is related to an increased risk of ischemic stroke in men.

Plasma carotenoids are related to intima--media thickness of the carotid artery wall in men from eastern Finland

BACKGROUND

Several previous epidemiological studies have suggested that high plasma concentrations of carotenoids may slow the development of early atherosclerosis, but results have been inconclusive.

METHODS

We examined the effect of carotenoids on early atherosclerosis in a population-based study. The association between plasma carotenoid concentrations and intima-media thickness of the common carotid artery (CCA-IMT) was investigated in 1212 elderly men (aged 61-80 years) in Eastern Finland. They were examined by B-mode ultrasound to detect early signs of carotid atherosclerosis, and plasma concentrations of carotenoids were measured by high-performance liquid chromatography.

RESULTS

Men in the lowest quartile of CCA-IMT had significantly higher concentrations of plasma β-cryptoxanthin, lycopene and α-carotene than men in the highest quartile (P for the differences: 0.043, 0.045 and 0.046, respectively), after adjustment for age, examination year, body mass index, smoking, alcohol intake, years of education, symptomatic coronary heart disease (CHD) or CHD history, diabetes, low-density lipoprotein cholesterol, medications and season. The concentrations of plasma β-cryptoxanthin, lycopene and α-carotene decreased linearly with increasing CCA-IMT.

CONCLUSIONS

The results of this study suggest that high plasma concentrations of β-cryptoxanthin, lycopene and α-carotene may be associated with decreased carotid atherosclerosis in elderly men from eastern Finland.

Low maximal oxygen uptake is associated with elevated depressive symptoms in middle-aged men

A low level of physical activity has been associated with depression, and increased physical activity has been found to have a positive effect on mood. However, the association between maximal oxygen uptake (VO(2max)) and mood has been poorly studied. In this study VO(2max) (ml/kg per min) was measured in a sample of 1,519 men aged 46-61 years during a cycle ergometer test by using respiratory gas exchange. Men with a history of psychiatric disorder or serious physical illness were excluded. Depressive symptoms were assessed using the 18-item Human Population Laboratory Depression Scale (HPL). Those who scored 5 or more in the HPL were considered to have elevated depressive symptoms. The participants were classified into quartiles according to the VO(2max). Those in the lowest quartile had a more than 3-fold (OR: 3.42; 95% CI: 1.65-7.09; p < 0.001) higher risk of having elevated depressive symptoms compared with those in the highest quartile, even after adjusting for several confounders (OR: 3.38; 95% CI: 1.60-7.14; p < 0.001). In conclusion, low VO(2max) is associated with having elevated depressive symptoms in middle-aged men.

Alexithymia behaves as a personality trait over a 5-year period in Finnish general population

OBJECTIVE

Temporal stability is a basic assumption underlying any personality trait construct. Previous research on the stability of alexithymia has led to a controversy over whether alexithymia should be viewed as a state-dependent phenomenon or as a stable personality trait. The aim of this 5-year longitudinal study was to examine the temporal stability of alexithymia in the general population in Finland.

METHODS

Alexithymia was measured with the 20-Item Toronto Alexithymia Scale (TAS-20) at the baseline and 5 years later.

RESULTS

The test-retest correlations of the TAS-20 total and factor-specific scores at the baseline and at the 5-year follow-up ranged from moderate to high in both genders, reflecting a rather high relative stability of the TAS-20 scores over a period of 5 years.

CONCLUSIONS

The findings of our study suggest that alexithymia behaves like a stable personality trait in the general population.

Depression and early retirement: prospective population based study in middle aged men

BACKGROUND

Mental depression is an important health problem in many countries. It reduces productivity at work and is the fastest increasing reason for early retirement.

METHODS

This study followed up a Finnish cohort of 1726 men from 1984 to 2000. Depression was assessed at baseline by HPL depression score. Pension records were obtained from the national pension registers. Cox's regression analysis was used to estimate the associations of depression with the risk of all disability pensions combined, separately for different causes of disability, and non-illness based pension.

RESULTS

During the follow up, 839 men (48.6%) received a disability pension. A total of 142 men (16.9% of all disability pensions) retired because of mental disorder and of these, 75 (52.8%) because of depression. After adjustment for the potential confounders, men in the highest third of depression score had an increased risk of non-illness based pension (RR 1.86 95% CI 1.37 to 2.51) and disability pension attributable to mental disorders (RR 2.74, 95% CI 1.68 to 4.46), chronic somatic diseases (RR 1.68, 95% CI 1.05 to 2.71), cardiovascular diseases (RR 1.61, 95% CI 1.12 to 2.32). The mean age of retirement for men with a high and low depression score was 57.6 years (SD 3.87) and 59.1 years (SD 3.65) (p<0.001) respectively.

CONCLUSIONS

A high depression score predicted disability attributable to any cause, especially mental disorders, and non-illness based pensions. Depressed people retired on average 1.5 years younger than those without depression. Further studies are needed to elucidate the pathways of how mental depression leads people to seek retirement pension.

Cardiorespiratory fitness and risk of disability pension: a prospective population based study in Finnish men

BACKGROUND

Early retiring is a major social problem in many western countries.

AIM

To investigate whether good cardiorespiratory fitness prevents disability pensioning in Finnish middle-aged men.

METHODS

Subjects were a random population based sample of 1307 men who were 42-60 years old at baseline, had not retired before baseline or died during follow up, and had undergone a cycle ergometer test at baseline. Cardiorespiratory fitness was assessed at baseline with a maximal but symptom limited exercise test on an electrically braked cycle ergometer.

RESULTS

During a follow up of 11 years on average, 790 (60.4%) men were awarded a disability pension, only 254 (19.4%) men reached the old-age pension without previous early pension, and 263 (20.1%) men were still working at the end of follow up. After adjustment for age, body mass index, alcohol consumption, smoking, education, occupation, and baseline chronic diseases, an inverse association was observed between cardiorespiratory fitness and the risk of disability pension. Men with VO2max <25.98 ml/kg/min (lowest fifth) had a 3.28-fold (95% CI 1.70 to 6.32) and men with the duration of exercise test <9.54 minutes (lowest fifth) had a 4.66-fold (95% CI 2.43 to 8.92) risk of disability pension due to cardiovascular diseases compared with men in the highest fifths. Men with lowest fitness level also had an increased risk of disability pension due to musculoskeletal disorders, or all reasons combined.

CONCLUSIONS

Physical fitness is inversely associated with the risk of disability pension and especially with the risk of disability due to cardiovascular diseases.

Ethanol consumption and DRD2 gene TaqI a polymorphism among socially drinking males

The dopaminergic system in the human brain is thought to play a major role in the development of alcohol consumption habits and alcoholism. It has been reported that homozygous D2-/- knock-out mice lacking D2 receptors consume about 50% to 60% less ethanol than wild-type D2+/+ mice, and heterozygous mice have an intermediate level of alcohol consumption. The DRD2 gene TaqI A polymorphism has been suggested to associate with a low D2 receptor density in post mortem and in vivo measurements. Numerous association studies on this polymorphism and alcoholism have shown most controversial results. We studied whether DRD2 TaqI A genotype affects alcohol consumption in an ethnically homogeneous, representative sample of 1,019 Finnish Caucasian males. After excluding the abstainers from the study, the self-reported alcohol consumption among the remaining 884 non-abstainers was compared in the TaqI A genotype groups (A1/A1, A1/A2, A2/A2). The alcohol consumption of the homozygous A1/A1 group was about 30% lower than in A1/A2 group, and 40% lower than in A2/A2 group (P = 0.042 and 0.041 in a sociodemographic variable-adjusted multivariate model). The results indicate an association between DRD2 genotype and alcohol consumption habits in humans. These results in the large sample of non-alcoholic males are also opposite to some previous findings on the higher A1 allele frequency among alcoholic populations.

G-protein beta3 subunit C825T polymorphism: no association with risk for hypertension and obesity

OBJECTIVE

Several recent studies have indicated that a C825T polymorphism in the gene encoding the G-protein beta3 subunit is a significant risk factor for hypertension and obesity. In this study, we tested whether this polymorphism is associated with hypertension and obesity in white men.

DESIGN

Population-based prospective cohort study.

METHODS

We followed a cohort of 903 men, aged 42-61 years at baseline, for an average time of 4.2 years. Genotyping was performed by polymerase chain reaction.

RESULTS

The genotype distribution was in Hardy-Weinberg equilibrium: 514 (57%) had the CC genotype, 49 (5%) had the TT genotype and 340 (38%) were heterozygous (T:C = 0.24:0.76). There was no statistically significant difference between the genotype groups in respect to baseline and end of follow-up risk for hypertension or obesity, systolic or diastolic blood pressure, or body mass index.

CONCLUSION

We conclude that the C825T polymorphism of the G-protein beta3 subunit gene does not notably contribute to the development of hypertension or obesity, and is not a significant determinant for blood pressure and body mass index in white men.

Leucine7 to proline7 polymorphism in the preproneuropeptide Y is associated with the progression of carotid atherosclerosis, blood pressure and serum lipids in Finnish men

A rather common leucine7-to-proline7 (Leu7Pro) polymorphism in the preproneuropeptide Y (prepro-NPY) gene signal peptide may be important in blood pressure regulation, cholesterol metabolism and the pathogenesis of atherosclerosis in humans. We examined the associations of the Leu7Pro polymorphism with carotid atherosclerotic progression, blood pressure and serum lipids in a population-based sample of 966 men aged 42-60 years in Finland. The Pro7 substitution (carrier frequency 12.2%) was associated with accelerated four-year increase in the mean (P=0.01) and maximal (P=0.007) common carotid intima-media thickness (IMT) and with slightly increased systolic (P=0.03) and diastolic (P=0.02) blood pressures, adjusted for other major risk factors. Men with Pro7 substitution had 30.6% (95% CI 6.9-54.0%) greater increase in the mean IMT and 20.0% (95% CI 5.3-34.4%) greater increase in the maximal IMT than men with Leu7/Leu7 genotype. The Pro7 substitution was also related to increased serum total cholesterol (P=0.01) and LDL cholesterol (P=0.02) in obese (body mass index (BMI)>30 kg/m(2)) men. This study provides important evidence suggesting that the Pro7 substitution in the prepro-NPY is an important risk factor for accelerated atherosclerotic progression, increased blood pressure and increased serum cholesterol in humans.

An insertion/deletion polymorphism in the alpha2B-adrenergic receptor gene is a novel genetic risk factor for acute coronary events

OBJECTIVES

Our aim was to study whether an insertion/deletion (I/D) polymorphism in the alpha2B-adrenoceptor gene is associated with the risk for cardiovascular diseases.

BACKGROUND

alpha2-adrenoceptors mediate contraction of vascular smooth muscle and induce coronary vasoconstriction in humans. The alpha2-adrenoceptor subtype B mediates vasoconstriction in mice. A variant of the human alpha2B-adrenoceptor gene that encodes a D of three residues in an intracellular acidic motif has been shown to confer decreased receptor desensitization. This receptor variant could, therefore, be involved in diseases associated with enhanced vasoconstriction.

METHODS

This study was part of a prospective population-based study investigating risk factors for cardiovascular diseases in a cohort of middle-aged men from eastern Finland. Nine hundred twelve men aged 46 to 64 years were followed for an average time of 4.5 years.

RESULTS

In this study population, 192 men (21%) had the D/D genotype; 256 (28%) had the I/I genotype, and 464 (51%) had a heterozygous genotype. In a Cox model adjusting for other coronary risk factors, men with the D/D genotype had 2.2 times (95% confidence interval: 1.1 to 4.4, p = 0.02) the risk to experience an acute coronary event (n = 15 for D/D, 10 for I/I and 12 for I/D) compared with men carrying either of the other two genotypes. The alpha2B-adrenoceptor genotype was not associated with hypertension in this study population.

CONCLUSIONS

The D/D genotype of the alpha2B-adrenoceptor is a novel genetic risk factor for acute coronary events, but not for hypertension.

Psychometric properties of the Finnish 20-item Toronto Alexithymia Scale

The aim of this study was to examine the factor structure and the validity of the Finnish version of the 20-item Toronto Alexithymia Scale (TAS-20). As part of the Northern Finland 1966 Birth Cohort Project, the TAS-20 was presented to a sample of 5034 31-year old persons. A confirmatory factor analysis showed that the three-factor model, earlier established with the original TAS-20, was in agreement with the Finnish version of the scale. Three criteria of goodness-of-fit met the standards for adequacy of fit. For the total scale, internal reliability (Cronbach's alpha) was 0.83 and for the three subscales (factors 1, 2, and 3) it was 0.81, 0.77, and 0.66, respectively. Two- and one-factor models for TAS-20 were also examined, but the other models did not perform as well as the three-factor model. The factor model also worked well with a sample of 516 students with a mean age of 24.8 years. In conclusion, the TAS-20 scale is useful in the Finnish version, too.

Pain as a reason to visit the doctor: a study in Finnish primary health care

This study aims to demonstrate the prevalence of pain as a reason for seeing a physician in primary care. We also performed an analysis of the localization, duration and frequency of pains, as well as the diagnoses of patients having pain. A total of 28 physicians at 25 health centers in Finland collected the data, comprising 5646 patient visits. Pain was identified as the reason for 2237 (40%) of the visits. The most common localizations were in the lower back, abdomen and head. One-fifth of the pain patients had experienced pain for over six months. Analysis of the diagnoses revealed half of the pains to be musculoskeletal. Patients experienced considerable limitations in various activities of life due to pain. A quarter of the pain patients of active working age received sick leave. Our results confirm that pain is a major primary health care problem, which has an enormous impact on public health.

Neuropeptide Y polymorphism and alcohol consumption in middle-aged men

Neuropeptide Y (NPY) plays an important role in the hypothalamic regulation of food intake and energy balance. According to recent findings in animals, NPY also seems to be a potent regulator of alcohol consumption. We used the recently identified Leu(7) to Pro(7) polymorphism in the signal peptide part of NPY to investigate whether the NPY system is associated with alcohol consumption in humans. The subjects (N = 889) were an ethnically homogeneous, nonselected population sample of middle-aged men from Eastern Finland. The gene variant producing Pro(7) substitution was associated with a 34% higher average alcohol consumption, even after adjustment for a number of covariates (P = 0.03). The proportion of heavy drinkers (over 230 g of ethanol/week) was also somewhat higher in this group (13.1% vs. 8.2%, P = 0.10). Our study provides the first evidence that alcohol preference in humans is likely to be regulated by the NPY system.

Lack of association between the functional variant of the catechol-o-methyltransferase (COMT) gene and early-onset alcoholism associated with severe antisocial behavior

Addictive drugs, including ethanol, increase the brain's dopaminergic transmission, and catechol-o-methyltransferase (COMT) enzyme has a crucial role in dopamine inactivation. A common functional polymorphism in the COMT gene results in a three- to four-fold variation in enzyme activity. In a previous study, we found an association between type 1 (with late-onset but without prominent antisocial behavior) alcoholism and the low activity allele of the COMT gene. In this work we analyzed whether the COMT polymorphism has any effect on the development of type 2 (with early-onset and habitual impulsive violent behavior) alcoholism. The COMT genotype was determined in 62 impulsive violent recidivist offenders with early-onset (type 2) alcoholism, 123 late-onset nonviolent (type 1) alcoholics, and 267 race and gender-matched controls. The allele and genotype frequencies of these groups were compared with each other and also with previously published data from 3,140 Finnish blood donors. The type 2 alcoholics did not differ from either the blood donors or the controls. The low activity (L) allele frequency was higher among type 1 alcoholics (chi(2) = 4.98, P = 0.026) when compared with type 2 cases. The odds ratio for type 1 alcoholism as compared with type 2 alcoholism for those subjects with the LL genotype versus the HH genotype was 3.0 (95% confidence interval 1.1-8.4, P = 0.017). The results suggest that COMT genotype has no major role in the development of early-onset alcoholism with severe antisocial behavior.

Association between the functional polymorphism of catechol-O-methyltransferase gene and alcohol consumption among social drinkers

BACKGROUND

A common functional genetic polymorphism in the catechol-O-methyltransferase (COMT) gene (Val158 Met) results in 3- to 4-fold differences in COMT enzyme activity and dopamine inactivation rate. Previous studies have shown that type I alcoholism is more common among subjects with low activity COMT genotype (LL), compared with high activity (HH) or heterozygotic (LH) genotypes.

METHODS

We studied alcohol consumption and the COMT genotype in middle-aged Finnish men (n 896), who represented an unselected ethnically homogenous population sample and reported using alcohol during the past year. Average alcohol use in pure ethanol (grams per week) was compared between subjects with LL genotype and subjects with LH or HH genotypes.

RESULTS

Men with LL genotype (30% of all subjects) reported 27% higher weekly alcohol consumption compared with the two other genotype groups (p < 0.05). The difference remained statistically significant after a multivariate adjustment for sociodemographic factors and prior or existing diseases (p = 0.031).

CONCLUSIONS

The results indicate that COMT polymorphism may contribute significantly to alcohol intake not only in alcoholics but also in a general male population.

Pattern of alcohol drinking and progression of atherosclerosis

Most studies that examine the role of alcohol consumption in atherosclerosis and cardiovascular disease have overlooked the possible effect of drinking pattern. We investigated the association between the habit of heavy acute intake of beer and spirits (binging) and the 4-year progression of carotid atherosclerosis in a population-based sample of middle-aged Finnish men. Data from the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD) were used to estimate changes in maximum and mean intima-media thickness (IMT) and the maximum plaque height in 764 KIHD participants who reported using beer and in 871 participants who used spirits. After adjustment for age, baseline carotid atherosclerosis, and average weekly alcohol consumption level, we observed the highest atherosclerosis progression in men who usually consumed a whole bottle of vodka or more in 1 session. For beer binging (>6 beers at a time), the magnitude of IMT progression was even higher, although this association was only marginally significant (P<0.1) because of smaller numbers. The associations were largely unaffected by adjustments for blood pressure, lipids, smoking, BMI, and medication. The magnitude of the difference was generally higher in a subgroup that was free of IHD at baseline. We conclude that the pattern of drinking associates with the progression of carotid atherosclerosis independently of the total level of alcohol consumption and risk factors.

Association between low activity serotonin transporter promoter genotype and early onset alcoholism with habitual impulsive violent behavior

A common 44-base pair insertion/deletion polymorphism in the promoter region of the human serotonin transporter (5-HTT) gene has been observed to be associated with affective illness and anxiety-related traits. This biallelic functional polymorphism, designated long (L) and short (S), affects 5-HTT gene expression since the S promoter is less active than the L promoter. Since there is strong evidence of a disturbance in brain serotonergic transmission among antisocial, impulsive, and violent type 2 alcoholic subjects, we decided to test the hypothesis that the frequency of the S allele, which is associated with reduced 5-HTT gene expression, is higher among habitually violent type 2 alcoholics when compared with race and gender-matched healthy controls and non-violent late-onset (type 1) alcoholics. The 5-HTT promoter genotype was determined by a PCR-based method in 114 late onset (type 1) non-violent alcoholics, 51 impulsive violent recidivistic offenders with early onset alcoholism (type 2), and 54 healthy controls. All index subjects and controls were white Caucasian males of Finnish origin. The S allele frequency was higher among type 2 alcoholics compared with type 1 alcoholics (chi2 = 4.86, P = 0.028) and healthy controls (chi2 = 8.24, P = 0.004). The odds ratio for SS genotype vs LL genotype was 3.90, 95% Cl 1.37-11.11, P = 0.011 when type 2 alcoholics were compared with healthy controls. The results suggest that the 5-HTT 'S' promoter polymorphism is associated with an increased risk for early onset alcoholism associated with antisocial personality disorder and impulsive, habitually violent behavior.

Association between the functional variant of the catechol-O-methyltransferase (COMT) gene and type 1 alcoholism

Catechol-O-methyltransferase (COMT) is an enzyme which has a crucial role in the metabolism of dopamine. It has been suggested that a common functional genetic polymorphism in the COMT gene, which results in 3 to 4-fold difference in COMT enzyme activity, may contribute to the etiology of mental disorders such as bipolar disorder and alcoholism. Since ethanol-induced euphoria is associated with the rapid release of dopamine in limbic areas, it is conceivable that subjects who inherit the allele encoding the low activity COMT variant would have a relatively low dopamine inactivation rate, and therefore would be more vulnerable to the development of ethanol dependence. The aim of this study was to test this hypothesis among type 1 (late-onset) alcoholics. The COMT polymorphism was determined in two independent male late onset (type 1) alcoholic populations in Turku (n = 67) and Kuopio (n = 56). The high (H) and low (L) activity COMT genotype and allele frequencies were compared with previously published data from 3140 Finnish blood donors (general population) and 267 race- and gender-matched controls. The frequency of low activity allele (L) was markedly higher among the patients both in Turku (P = 0.023) and in Kuopio (P = 0.005) when compared with the general population. When all patients were compared with the general population (blood donors), the difference was even more significant (P = 0.0004). When genotypes of all alcoholics (n = 123) were compared with genotypes of matched controls, the odds ratio (OR) for alcoholism for those subjects having the LL genotype vs those with HH genotype was 2.51, 95% CI 1.22-5.19, P = 0.006. Also, L allele frequency was significantly higher among alcoholics when compared with controls (P = 0.009). The estimate for population etiological (attributable) fraction for the LL genotype in alcoholism was 13.3% (95% CI 2.3-25.7%). The results indicate that the COMT polymorphism contributes significantly to the development of late-onset alcoholism.

Prevalence of alexithymia and its association with sociodemographic variables in the general population of Finland

The prevalence of alexithymia and its association with sociodemographic variables were studied in a sample of 1285 subjects representing the general population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20). Alexithymia was normally distributed in the population in both genders, confirming that it is a personality dimension. The prevalence of alexithymia was 13%. Men were alexithymic almost twice (17%) as often as women (10%). Multivariate analysis showed that alexithymia was associated with male gender, advanced age, low educational level, and low socioeconomic status. As to the three factors of the TAS-20, men scored higher in factors 2 (difficulty in describing feelings) and 3 (externally oriented thinking). but there was no gender difference in factor 1 (difficulty in identifying feelings). Comparative population studies in other countries are needed to find out whether there are any differences in the prevalence of alexithymia between cultures.

Beer binging and mortality: results from the Kuopio ischaemic heart disease risk factor study, a prospective population based study

OBJECTIVE

To examine the association between beer binging (regular sessions of heavy beer drinking) and mortality.

DESIGN

Prospective population based study with the baseline assessment of level of alcohol intake (dose), by type of drink and drinking pattern, previous and existing diseases, socioeconomic background, occupational status, involvement in organisations during leisure time, physical activity in leisure time, body mass index, blood pressure, serum lipids and plasma fibrinogen concentration, during an average of 7.7 years' follow up of mortality.

SETTING

Finland.

SUBJECTS

A population sample of 1641 men who consumed beer who were aged 42, 48, 54, or 60 years at baseline.

MAIN OUTCOME MEASURES

All cause mortality, cardiovascular mortality, death due to external causes, fatal myocardial infarctions.

RESULTS

The risk of death was substantially increased in men whose usual dose of beer was 6 or more bottles per session compared with men who usually consumed less than 3 bottles, after adjustment for age and total alcohol consumption (relative risk 3.01 (95% confidence interval 1.54 to 5.90) for all deaths; 7.10 (2.01 to 25.12) for external deaths; and 6.50 (2.05 to 20.61) for fatal myocardial infarction). The association changed only slightly when smoking, occupational status, previous diseases, systolic blood pressure, low density lipoprotein and high density lipoprotein cholesterol concentration, plasma fibrinogen concentration, body mass index, marital status, leisure time physical activity, and involvement in organisations were controlled for.

CONCLUSION

The pattern of beer binging is associated with increased risk of death, independently of the total average consumption of alcoholic drinks. The relation is not explained by known behavioural, psychosocial, or biological risk factors. Death due to injuries and other external causes is overrepresented among beer bingers, but a strong association with fatal myocardial infarction suggests that the pathway may also involve other acute triggers of severe health events.

Hostility and increased risk of mortality and acute myocardial infarction: the mediating role of behavioral risk factors

Cynical hostility has been associated with increased cardiovascular morbidity and mortality; yet few studies have investigated this relation in population-based samples, and little is known about underlying mechanisms. This study examined the association between hostility, measured by the eight-item Cynical Distrust Scale, and risk for all-cause and cardiovascular mortality and incident myocardial infarction. Subjects were 2,125 men, ages 42-60 years, from the Kuopio Ischemic Heart Disease Risk Factor Study, a longitudinal study of unestablished and traditional risk factors for ischemic heart disease, mortality, and other outcomes. There were 177 deaths (73 cardiovascular) in 9 years of follow-up. Men with hostility scores in the top quartile were at more than twice the risk of all-cause mortality (relative hazards (RH) 2.30, 95% confidence interval (CI) 1.47-3.59) and cardiovascular mortality (RH 2.70, 95% CI 1.27-5.76), relative to men with scores in the lowest quartile. Among 1,599 men without previous myocardial infarction or angina, high scorers also had an increased risk of myocardial infarction (RH 2.18, 95% CI 1.01-4.70). Biologic and socioeconomic risk factors, social support, and prevalent diseases had minimal impact on these associations, whereas adjustments for the behavioral risk factors of smoking, alcohol consumption, physical activity, and body mass index substantially weakened the relations. Simultaneous risk factor adjustment eliminated the observed associations. Results show that high levels of hostility are associated with increased risk of all-cause and cause-specific mortality and incident myocardial infarction and that these effects are mediated primarily through behavioral risk factors.

Frequent hangovers and cardiovascular mortality in middle-aged men

We studied the relation between frequent hangovers and cardiovascular mortality in a representative population sample of middle-aged Finnish men who participated in the Kuopio Ischemic Heart Disease Risk Factor Study. Complete data on alcohol consumption, hangover frequency, prior cardiovascular diseases, and risk factors were obtained for 2,160 non-abstinent men. Frequent hangovers were rare in the three lowest alcohol consumption quartiles, but in the highest quartile, a total of 239 men (43.6%) reported having a hangover at least monthly. During an average follow-up time of 6.7 years, these men had a 2.36-fold (95% confidence interval = 1.02-5.48) risk of cardiovascular death compared with men with fewer hangovers, with adjustment for age and total alcohol consumption. The association was somewhat attenuated after adjustments for smoking, income, and prior cardiovascular diseases. Systolic blood pressure, body mass index, resting heart rate, or serum lipids had no appreciable role in the relation, but plasma fibrinogen concentration appeared as one possible pathway to increased risk of cardiovascular death in men who frequently experience hangovers. The findings underline the importance of preventive actions regarding not only the amount but also the way people consume alcohol.

Alexithymia and risk of death in middle-aged men

We prospectively examined the association between alexithymia and risk of death over an average follow-up time of nearly 5.5 years in 42- to 60-year-old men (N = 2297) participating in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Alexithymia, impairment in identification, processing, and verbal expression of inner feelings, was assessed by the validated Toronto Alexithymia Scale (TAS) In age-adjusted survival analyses, men in the highest alexithymia quintile had a twofold greater risk of all-cause death (p < 0.001) and a threefold greater risk of death from accidents, injury, or violence (p < 0.02) relative to the men in the three lowest alexithymia quintiles. There was little evidence for confounding by behavioral factors (smoking, alcohol consumption, physical activity). physiological risk factors (LDL, HDL, body mass index, hypertension), socioeconomic status, marital status, perceived health, prior diseases and diagnoses, depressive symptoms or social connections. Consistent and even stronger associations between alexithymia and all-cause death were found in a healthy subgroup (N = 1650). Why difficulties in dealing with emotions associate with increased mortality remains unclear. Our findings suggest that the association is independent from the effect of well-known behavioral, biological, and psychosocial risk factors.