Publications by authors named "Sudhir Kurl"

151 Publications

Serum copper-to-zinc ratio is associated with heart failure and improves risk prediction in middle-aged and older Caucasian men: A prospective study.

Nutr Metab Cardiovasc Dis 2022 May 20. Epub 2022 May 20.

Central Finland Health Care District Hospital District, Department of Medicine, Finland District, Jyväskylä, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland.

Background And Aims: Serum copper (Cu) and zinc (Zn) may play a role in the development of adverse cardiovascular outcomes including heart failure (HF). Serum Cu/Zn-ratio has been shown to be a risk indicator for cardiovascular disease, but its relationship with HF has not been previously investigated. We aimed to assess the association between Cu/Zn-ratio and incident HF risk using a prospective cohort study.

Methods And Results: Study participants were recruited in eastern Finland with baseline examinations carried out between March 1998 and December 2001. Serum levels of Cu and Zn were measured using atomic absorption spectrometry in 1866 men aged 42-61 years without a history of HF at baseline. Multivariable-adjusted hazard ratios (HRs) with confidence intervals (CIs) were calculated for incident HF. During 26.5 years median follow-up, 365 HF cases occurred. Restricted cubic splines suggested linear relationships of serum Cu/Zn-ratio, Cu and Zn with HF risk. A unit increase in Cu/Zn-ratio was associated with an increased HF risk in analysis adjusted for several potential confounders including nutritional factors such as total energy intake, intake of fruits, berries and vegetables, and red meat (HR 1.63; 95% CI 1.06-2.51). The corresponding multivariable-adjusted HRs (95% CIs) for serum Cu and Zn were 2.42 (1.32-4.44) and 1.34 (0.50-3.63), respectively. Addition of Cu/Zn-ratio to a HF risk prediction model was associated with improved risk prediction.

Conclusion: In middle-aged and older Finnish men, increased serum Cu/Zn-ratio is associated with an increased risk of HF in a linear dose-response fashion and might improve HF risk assessment.
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http://dx.doi.org/10.1016/j.numecd.2022.05.005DOI Listing
May 2022

Cardiorespiratory Fitness, Inflammation, and Risk of Sudden Cardiac Death in Middle-Aged Men.

Am J Cardiol 2022 07 26;174:166-171. Epub 2022 Apr 26.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom; Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, United Kingdom.

Inflammation and cardiorespiratory fitness (CRF) are each independently related to the risk of sudden cardiac death (SCD). The interplay between CRF, inflammation and SCD is not well understood. We aimed to study the separate and joint associations of inflammation (high-sensitivity C-reactive protein [hsCRP]) and CRF with SCD risk in a cohort of Caucasian men. In 1,749 men aged 42 to 61 years without a history of coronary heart disease at baseline, serum hsCRP was measured using an immunometric assay, and CRF was assessed using a respiratory gas exchange analyzer during exercise testing. hsCRP was categorized as normal and high (≤3 and >3 mg/L, respectively) and CRF as low and high (median cutoff). A total of 148 SCD events occurred during a median follow-up of 28.9 years. Comparing high versus normal hsCRP, the multivariable-adjusted hazard ratio (95% confidence interval) for SCD was 1.65 (1.11 to 2.45), which remained similar on further adjustment for CRF 1.62 (1.09 to 2.40). Comparing high versus low CRF, the multivariable-adjusted hazard ratio for SCD was 0.61 (0.42 to 0.89), which remained persistent after adjustment for hsCRP 0.64 (0.44 to 0.93). Compared with normal hsCRP-low CRF, normal hsCRP-high CRF was associated with a decreased SCD risk of 0.65 (0.43 to 0.99), high hsCRP-low CRF was associated with an increased SCD risk of 1.72 (1.10 to 2.69), with no evidence of a relationship between high hsCRP-high CRF and SCD risk 0.86 (0.39 to 1.88). Positive additive and multiplicative interactions were found between hsCRP and CRF. In a middle-aged Finnish male population, both hsCRP and CRF are independently associated with SCD risk. However, high CRF levels appear to offset the increased SCD risk related to high hsCRP levels.
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http://dx.doi.org/10.1016/j.amjcard.2022.03.032DOI Listing
July 2022

Exercise cardiac power and the risk of heart failure in men: A population-based follow-up study.

J Sport Health Sci 2022 03 24;11(2):266-271. Epub 2020 Feb 24.

Institute of Public Health and Clinical Nutrition, Department of Medicine, University of Eastern Finland, Kuopio 70210, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä 40620, Finland; Central Finland Health Care District, Jyväskylä 40620, Finland.

Background: Little is known about exercise cardiac power (ECP), defined as the ratio of directly measured maximal oxygen uptake with peak systolic blood pressure during exercise, on heart failure (HF) risk. We examined the association of ECP and the risk of HF.

Methods: This was a population-based cohort study of 2351 men from eastern Finland. The average time to follow-up was 25 years. Participants participated at baseline in an exercise stress test. A total of 313 cases of HF occurred.

Results: Men with low ECP (<9.84 mL/mmHg, the lowest quartile) had a 2.37-fold (95% confidence interval (95%CI): 1.68-3.35, p < 0.0001) hazards ratio of HF as compared with men with high ECP (>13.92 mL/mmHg, the highest quartile), after adjusting for age. Low ECP was associated with a 1.96-fold risk (95%CI: 1.38-2.78, p < 0.001) of HF after additional adjustment for conventional risk factors. After further adjustment for left ventricular hypertrophy, the results hardly changed (hazards ratio = 1.87, 95%CI: 1.31-2.66, p < 0.001). One SD increase in ECP (3.16 mL/mmHg) was associated with a decreased risk of HF by 28% (95%CI: 17%-37%).

Conclusion: ECP provides a noninvasive and easily available measure from cardiopulmonary exercise tests in predicting HF. However, ECP did not provide additional value over maximal oxygen uptake
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http://dx.doi.org/10.1016/j.jshs.2020.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9068517PMC
March 2022

Impact of estimated pulse wave velocity and socioeconomic status on the risk of stroke in men: a prospective cohort study.

J Hypertens 2022 Jun 2;40(6):1165-1169. Epub 2022 Mar 2.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio.

Objective: High pulse wave velocity (PWV) and low socioeconomic status (SES) are each associated with increased risk of stroke, but clarification of the interplay between PWV, SES and the risk of stroke appears to be warranted to identify vulnerable populations at high risk of stroke. We conducted a prospective study that examined the independent and joint associations of PWV and SES with the risk of stroke in the general population.

Methods: The current study included 2666 men aged 42-61 years, who were enrolled in the Kuopio Ischaemic Heart Disease Study cohort. Estimated PWV (ePWV), a proxy of carotid-femoral PWV, was calculated from an equation based on age and mean blood pressure. SES was assessed using self-reported questionnaires and classified as tertiles, whereas ePWV was categorized as high (≥10m/s) and low (<10m/s).

Results: Individuals with high ePWV had a 48% higher risk of stroke after adjusting for confounding factors, whereas individuals with low SES had a similar 35% increased risk of stroke, compared with those high SES. Results of the joint associations of ePWV and SES with stroke showed high ePWV-high SES and high ePWV-low SES to be each associated with an increased risk of stroke: hazard ratios 1.53, 95% confidence intervals (CIs) (1.12-2.08) and hazard ratio 1.63, 95% CI (1.21-2.20), respectively, but low ePWV-low SES was not associated with a heightened risk of stroke (hazard ratio 1.12, 95% CI 0.87-1.44) compared with the low ePWV-high SES group.

Conclusion: ePWV and SES are each independently associated with stroke risk. The association between elevated ePWV and the heightened risk of stroke is regardless of low or high SES.
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http://dx.doi.org/10.1097/HJH.0000000000003118DOI Listing
June 2022

Combined effects of maximal oxygen uptake and glucose status on mortality: The Prospective KIHD cohort study.

Scand J Med Sci Sports 2022 May 13;32(5):913-923. Epub 2022 Feb 13.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.

Objective: To examine the combined effects of cardiorespiratory fitness (CRF) and prediabetes or diabetes on cardiovascular and noncardiovascular mortality.

Patients And Methods: This prospective study evaluated a population-based cohort of 1562 men aged 42-60 years at baseline (1984-1989). We utilized maximal oxygen uptake (VO ) for assessing aerobic capacity and CRF in the cohort and stratified participants into six groups according to both their glucose status (diabetes, prediabetes, or no diabetes) and whether they were below- or above-median VO . Deaths in the cohort were recorded till December 31 2016. Cox regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CI) for cardiovascular and noncardiovascular mortality. Smoking, alcohol consumption, BMI, blood pressure, cholesterol, diagnosis of ischemic heart disease, and socioeconomic status served as covariates in the mortality analyses.

Results: During the follow-up (mean 24.2 years), 341 men died from cardiovascular and 468 men from noncardiovascular causes. When compared to men with no diabetes and above-median VO , the presence of either diabetes (HR = 4.10, 95% CI: 2.27-7.40) or prediabetes (HR = 2.10, 95% CI: 1.18-3.73) combined with below-median VO increased the risk of cardiovascular death. Noncardiovascular mortality was increased by low oxygen uptake in men with prediabetes (HR = 2.24, 95% CI: 1.30-3.84), and among men with diabetes, the increase was not statistically significant (HR = 1.99, 95% CI: 0.91-4.32).

Conclusions: Cardiorespiratory fitness modifies the risk of death related to prediabetes and diabetes. This highlights the importance of CRF assessment and interventions to support the uptake of regular physical activity among aging men with disturbed glucose metabolism.
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http://dx.doi.org/10.1111/sms.14135DOI Listing
May 2022

Neutrophil to lymphocyte ratio is not related to carotid atherosclerosis progression and cardiovascular events in the primary prevention of cardiovascular disease: Results from the IMPROVE study.

Biofactors 2022 Jan 11;48(1):100-110. Epub 2021 Nov 11.

Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.

Inflammation is a component of the pathogenesis of atherosclerosis and is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). The neutrophil to lymphocyte ratio (NLR) is a possible inflammation metric for the detection of ASCVD risk, although results of prospective studies are highly inconsistent on this topic. We investigated the cross-sectional relationship between NLR and carotid intima-media thickness (cIMT) in subjects at moderate-to-high ASCVD risk. The prospective association between NLR, cIMT progression, and incident vascular events (VEs) was also explored. In 3341 subjects from the IMT-Progression as Predictors of VEs (IMPROVE) study, we analyzed the association between NLR, cIMT, and its 15-month progression. The association between NLR and incident VEs was also investigated. NLR was positively associated with cross-sectional measures of cIMT, but not with cIMT progression. The association between NLR and cross-sectional cIMT measures was abolished when adjusted for confounders. No association was found between NRL and incident VEs. Similarly, there were no significant differences in the hazard ratios (HRs) of VEs across NLR quartiles. NLR was neither associated with the presence and progression of carotid atherosclerosis, nor with the risk of VEs. Our findings do not support the role of NLR as a predictor of the risk of atherosclerosis progression and ASCVD events in subjects at moderate-to-high ASCVD risk, in primary prevention. However, the usefulness of NLR for patients at a different level of ASCVD risk cannot be inferred from this study.
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http://dx.doi.org/10.1002/biof.1801DOI Listing
January 2022

High fitness levels offset the increased risk of chronic obstructive pulmonary disease due to low socioeconomic status: A cohort study.

Respir Med 2021 Nov-Dec;189:106647. Epub 2021 Oct 11.

Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland.

Objective: Evidence suggests that higher cardiorespiratory fitness (CRF) levels can offset the increased risk of adverse outcomes due to other risk factors. The impact of high CRF levels on the increased risk of chronic obstructive pulmonary disease (COPD) due to low socioeconomic status (SES) is unknown. We aimed to assess the combined effects of SES and CRF on the future risk of COPD.

Methods: We employed a prospective cohort of 2312 Finnish men aged 42-61 years at study entry. Socioeconomic status was self-reported and CRF was objectively assessed using respiratory gas exchange analyzers. Both exposures were categorized as low and high based on median cutoffs. Multivariable-adjusted hazard ratios (HRs) with confidence intervals (CIs) were estimated.

Results: During 26.0 years median follow-up, 120 COPD cases occurred. Low SES was associated with increased COPD risk and high CRF was associated with reduced COPD risk. Compared with high SES-low CRF, low SES-low CRF was associated with an increased COPD risk 2.36 (95% CI: 1.44-3.87), with no evidence of an association for low SES-high CRF and COPD risk 1.46 (95% CI:0.82-2.60).

Conclusion: In middle-aged Finnish men, SES and CRF are each independently associated with COPD risk. However, high CRF levels offset the increased COPD risk related to low SES.
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http://dx.doi.org/10.1016/j.rmed.2021.106647DOI Listing
February 2022

Exercise heart rate reserve and recovery as risk factors for sudden cardiac death.

Prog Cardiovasc Dis 2021 Sep-Oct;68:7-11. Epub 2021 Sep 15.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Graduate School of Urban Public Health, University of Seoul, Seoul, Republic of Korea.

Background: Little is known if heart rate responses during and after exercise test may be associated with the risk of sudden cardiac death (SCD). Our aim was to determine if exercise heart rate reserve and recovery, providing non-invasive indices, may predict SCD risk in general male population.

Methods: We evaluated the impact of delayed heart rate reserve and slow heart rate recovery and the risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of randomly selected 1967 men aged 42-61 years at recruitment. Heart rate reserve was calculated as the difference between the maximal attained heart rate and resting heart rate, whereas heart rate recovery was defined as maximal heart rate minus the heart rate measured at 2 min of recovery, on a symptom-limited cardiopulmonary exercise testing.

Results: During a median follow-up interval of 25 years, 209 events of SCD occurred. The age and examination adjusted relative hazards of SCD were in the lowest third of heart rate reserve 3.86 (95% confidence interval (CI) 2.56-5.80, p < 0.001) and the lowest third of heart rate recovery 2.86 (95% CI 1.95-4.20, p < 0.001) as compared to men in the highest third of heart rate reserve and heart rate recovery, respectively. After adjusting for potential confounders, the respective relative hazards were 1.96 (95% CI 1.24-3.12) and 1.75 (95% CI 1.16-2.64). Each unit increment (1 beat/min) in heart rate reserve and heart rate recovery decreased the incidence of SCD by 1-2%.

Conclusions: Delayed exercise heart rate reserve and slow heart rate recovery predicted the risk of SCD, suggesting that heart rate responses may be associated with an increased risk for SCD in general population.
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http://dx.doi.org/10.1016/j.pcad.2021.09.002DOI Listing
December 2021

Relationship between Circulating PCSK9 and Markers of Subclinical Atherosclerosis-The IMPROVE Study.

Biomedicines 2021 Jul 19;9(7). Epub 2021 Jul 19.

Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy.

(1) Background and purpose: circulating proprotein convertase subtilisin/kexin type 9 (PCSK9) is one of the key regulators of cholesterol metabolism. Despite this, its role as a player in atherosclerosis development is still matter of debate. Here, we investigated the relationships between this protein and several markers of subclinical atherosclerosis. (2) Methods: the IMPROVE study enrolled 3703 European subjects (54-79 years; 48% men; with ≥3 vascular risk factors), asymptomatic for cardiovascular diseases. PCSK9 levels were measured by ELISA. B-mode ultrasound was used to measure markers of carotid subclinical atherosclerosis. (3) Results: in the crude analysis, PCSK9 levels were associated with several baseline measures of carotid intima-media thickness (cIMT) (all < 0.0001); with cIMT change over time (Fastest-IMTmax-progr) ( = 0.01); with inter-adventitia common carotid artery diameter (ICCAD) ( < 0.0001); and with the echolucency (Grey Scale Median; GSM) of both carotid plaque and plaque-free common carotid IMT (both < 0.0001). However, after adjustment for age, sex, latitude, and pharmacological treatment, all the afore-mentioned correlations were no longer statistically significant. The lack of correlation was also observed after stratification for sex, latitude, and pharmacological treatments. (4) Conclusions: in subjects who are asymptomatic for cardiovascular diseases, PCSK9 plasma levels do not correlate with vascular damage and/or subclinical atherosclerosis of extracranial carotid arteries.
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http://dx.doi.org/10.3390/biomedicines9070841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301759PMC
July 2021

Percentage of Age-Predicted Cardiorespiratory Fitness Is Inversely Associated with Cardiovascular Disease Mortality: A Prospective Cohort Study.

Cardiology 2021;146(5):616-623. Epub 2021 Jul 1.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom.

Introduction: Percentage of age-predicted cardiorespiratory fitness (% age-predicted CRF) is a potentially useful cardiopulmonary exercise testing (CPX) parameter, but there are limited data on its prognostic relevance for adverse cardiovascular disease (CVD) outcomes. We aimed to assess the association of % age-predicted CRF with CVD mortality and the extent to which % age-predicted CRF measurements could improve the prediction of CVD mortality.

Methods: Peak oxygen uptake, used as the measure of CRF, was directly assessed in 2,276 men who underwent CPX. The age-predicted CRF estimated from a regression equation for age was transformed to % age-predicted CRF with the following formula: (achieved CRF/age-predicted CRF) × 100. Hazard ratios (HRs) (95% confidence intervals [CIs]) and measures of risk discrimination for CVD mortality were calculated.

Results: During a median follow-up of 28.5 years, 643 fatal CVDs were recorded. The relationship between % age-predicted CRF and CVD mortality was dose response in nature. In analysis adjusted for conventional risk factors, one standard deviation increase in % age-predicted CRF was associated with a reduced risk of CVD mortality (HR 0.61; 95% CI: 0.56-0.67), which was minimally attenuated on further adjustment for several other confounders (HR 0.71; 95% CI: 0.64-0.78). Addition of % age-predicted CRF to a CVD mortality risk prediction model containing established risk factors significantly improved risk discrimination and reclassification.

Conclusion: Percentage of age-predicted CRF is inversely and independently associated with CVD mortality in a graded fashion and significantly improves the prediction and classification of the long-term risk for CVD mortality beyond established risk factors.
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http://dx.doi.org/10.1159/000516123DOI Listing
December 2021

The combined effect of blood pressure and C-reactive protein with the risk of mortality from coronary heart and cardiovascular diseases.

Nutr Metab Cardiovasc Dis 2021 06 21;31(7):2051-2057. Epub 2021 Apr 21.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Division of Cardiology, Central Finland Health Care District Jyväskylä, Finland.

Background And Aims: Both blood pressure and C-reactive protein (CRP) are individually associated with cardiovascular mortality risk. However, the combined effect of systolic blood pressure (SBP) and CRP on coronary heart disease (CHD) and cardiovascular disease (CVD) mortality risk, has not been studied.

Methods And Results: We evaluated the joint impact of SBP and CRP and the risk of mortality in the Kuopio Ischemic Heart Disease prospective cohort study of 1622 men aged 42-61 years at recruitment with no history of CVD. SBP and CRP were measured. SBP was categorized as low and high (cut-off 135 mmHg) and CRP as low and high (cut-off 1.54 mg/L) based on ROC curves. Multivariable adjusted hazard ratios (HRs) with confidence intervals (CI) were calculated. During a median follow-up of 28 years, 196 cases of CHD and 320 cases of CVD deaths occurred. Elevated SBP (>135 mmHg) combined with elevated (CRP >1.54 mg/L) were associated with CHD and CVD mortality (HR 3.41, 95% CI, 2.20-5.28, p < 0.001) and (HR 2.93, 95% CI, 2.11-4.06, p < 0.001) respectively after adjustment for age, examination year, smoking, alcohol consumption, BMI, Type 2 diabetes, energy expenditure, total cholesterol, serum HDL cholesterol, antihypertensive medication and use of aspirin.

Conclusion: The combined effect of both high systolic blood pressure and high CRP is associated with increased risk of future CHD and CVD mortality as compared with both low SBP and low CRP levels in general male Caucasian population.
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http://dx.doi.org/10.1016/j.numecd.2021.04.004DOI Listing
June 2021

Association Between Uric Acid, Carotid Intima-Media Thickness, and Cardiovascular Events: Prospective Results From the IMPROVE Study.

J Am Heart Assoc 2021 06 17;10(11):e020419. Epub 2021 May 17.

Centro Cardiologico MonzinoIstituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Milan Italy.

Background The association between elevated serum uric acid (SUA), cardiovascular disease (CVD) risk, and carotid atherosclerosis has long been explored, and contrasting results have been reported. Therefore, the role of SUA as an independent risk factor for vascular events (VEs) and carotid atherosclerosis deserves further attention. We investigated the relationship between SUA, incident VEs, carotid intima-media thickness (cIMT), and cIMT progression in subjects at moderate-to-high CVD risk. Methods and Results In the IMPROVE (IMT-Progression as Predictors of VEs) study, 3686 participants (median age 64 years; 48% men) with ≥ 3 vascular risk factors, free from VEs at baseline, were grouped according to SUA quartiles (division points: 244-284-328 µmol/L in women, 295-336-385 µmol/L in men). Carotid-IMT and its 15-month progression, along with incident VEs, were recorded. A U-shaped association between SUA and VEs was observed in men, with 2.4-fold ( = 0.004) and 2.5-fold ( = 0.002) increased CVD risk in the first and fourth SUA quartiles as compared with the second. Adjusted hazard ratios (HRs) for cerebro-VEs in men were the highest (first and fourth quartile versus second: HR, 5.3, = 0.010 and HR, 4.4, = 0.023, respectively). SUA level was independently associated with cIMT progression in men (β = 0.068, = 0.014). No significant association between SUA levels, CVD end points, and cIMT progression were found in women. Conclusions Both low and high SUA levels are associated with an increased risk of VEs in men at moderate-to-high CVD risk but not in women. Only elevated SUA levels predict cIMT progression and at a lesser but not significant extent in women.
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http://dx.doi.org/10.1161/JAHA.120.020419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483552PMC
June 2021

Impact of cardiorespiratory fitness on survival in men with low socioeconomic status.

Eur J Prev Cardiol 2021 05 3;28(4):450-455. Epub 2020 Feb 3.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.

Aims: Although both low socioeconomic status (SES) and poor cardiorespiratory fitness (CRF) are associated with increased chronic disease and heightened mortality, it remains unclear whether moderate-to-high levels of CRF are associated with survival benefits in low SES populations. This study evaluated the hypothesis that SES and CRF predict all-cause mortality and cardiovascular disease mortality and that moderate-to-high levels of CRF may attenuate the association between low SES and increased mortality.

Methods: This study included 2368 men, who were followed in the Kuopio Ischaemic Heart Disease Study cohort. CRF was directly measured by peak oxygen uptake during progressive exercise testing. SES was characterized using self-reported questionnaires.

Results: During a 25-year median follow-up, 1116 all-cause mortality and 512 cardiovascular disease mortality events occurred. After adjusting for potential confounders, men with low SES were at increased risks for all-cause mortality (hazard ratio 1.49, 95% confidence interval: 1.30-1.71) and cardiovascular disease mortality (hazard ratio1.38, 1.13-1.69). Higher levels of CRF were associated with lower risks of all-cause mortality (hazard ratio 0.54, 0.45-0.64) and cardiovascular disease mortality (hazard ratio 0.53, 0.40-0.69). In joint associations of SES and CRF with mortality, low SES-unfit had significantly higher risks of all-cause mortality (hazard ratio 2.15, 1.78-2.59) and cardiovascular disease mortality (hazard ratio 1.95, 1.48-2.57), but low SES-fit was not associated with a heightened risk of cardiovascular disease mortality (hazard ratio 1.09, 0.80-1.48) as compared with their high SES-fit counterparts.

Conclusion: Both SES and CRF were independently associated with subsequent mortality; however, moderate-to-high levels of CRF were not associated with an excess risk of cardiovascular disease mortality in men with low SES.
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http://dx.doi.org/10.1177/2047487319901057DOI Listing
May 2021

Association between ideal cardiovascular health and risk of sudden cardiac death and all-cause mortality among middle-aged men in Finland.

Eur J Prev Cardiol 2021 04;28(3):294-300

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.

Background: Strong associations have been demonstrated between the American Heart Association's cardiovascular health (CVH) metrics and various cardiovascular outcomes, but the association with sudden cardiac death (SCD) is uncertain. We examined the associations between these CVH metrics and the risks of SCD and all-cause mortality among men in Finland.

Methods And Results: We used the prospective population-based Kuopio Ischaemic Heart Disease cohort study, which consists of men between 42 and 60 years of age at baseline. CVH metrics were computed for 2577 men with CVH scores at baseline ranging from 0 to 7, categorized into CVH scores of 0-2 (poor), 3-4 (intermediate) and 5-7 (ideal). Multivariate Cox regression models were used to estimate the hazards ratios (HRs) and 95% confidence intervals (CIs) of ideal CVH metrics for SCD and all-cause mortality. During a median follow-up period of 25.8 years, 280 SCDs and 1289 all-cause mortality events were recorded. The risks of SCD and all-cause mortality decreased continuously with increasing number of CVH metrics across the range 2-7 (p value for non-linearity for all <0.05). In multivariable analyses, men with an ideal CVH score had an 85% reduced risk of SCD compared with men with a poor CVH score (HR 0.15; 95% CI 0.05-0.48; p = 0.001). For all-cause mortality, there was a 67% lower risk among men with an ideal CVH score compared with those with a poor CVH score (HR 0.33; 95% CI 0.23-0.49; p <0.001).

Conclusions: Ideal CVH metrics were strongly and linearly associated with decreased risks of SCD and all-cause mortality among middle-aged men in Finland.
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http://dx.doi.org/10.1177/2047487320915338DOI Listing
April 2021

Intake of food rich in saturated fat in relation to subclinical atherosclerosis and potential modulating effects from single genetic variants.

Sci Rep 2021 04 12;11(1):7866. Epub 2021 Apr 12.

Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, Box 210, 17177, Stockholm, Sweden.

The relationship between intake of saturated fats and subclinical atherosclerosis, as well as the possible influence of genetic variants, is poorly understood and investigated. We aimed to investigate this relationship, with a hypothesis that it would be positive, and to explore whether genetics may modulate it, using data from a European cohort including 3,407 participants aged 54-79 at high risk of cardiovascular disease. Subclinical atherosclerosis was assessed by carotid intima-media thickness (C-IMT), measured at baseline and after 30 months. Logistic regression (OR; 95% CI) was employed to assess the association between high intake of food rich in saturated fat (vs. low) and: (1) the mean and the maximum values of C-IMT in the whole carotid artery (C-IMT, C-IMT), in the bifurcation (Bif-), the common (CC-) and internal (ICA-) carotid arteries at baseline (binary, cut-point ≥ 75th), and (2) C-IMT progression (binary, cut-point > zero). For the genetic-diet interaction analyses, we considered 100,350 genetic variants. We defined interaction as departure from additivity of effects. After age- and sex-adjustment, high intake of saturated fat was associated with increased C-IMT (OR:1.27;1.06-1.47), CC-IMT (OR:1.22;1.04-1.44) and ICA-IMT (OR:1.26;1.07-1.48). However, in multivariate analysis results were no longer significant. No clear associations were observed between high intake of saturated fat and risk of atherosclerotic progression. There was no evidence of interactions between high intake of saturated fat and any of the genetic variants considered, after multiple testing corrections. High intake of saturated fats was not independently associated with subclinical atherosclerosis. Moreover, we did not identify any significant genetic-dietary fat interactions in relation to risk of subclinical atherosclerosis.
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http://dx.doi.org/10.1038/s41598-021-86324-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042105PMC
April 2021

The Association between HDL-C and Subclinical Atherosclerosis Depends on CETP Plasma Concentration: Insights from the IMPROVE Study.

Biomedicines 2021 Mar 11;9(3). Epub 2021 Mar 11.

Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.

The impact of cholesteryl ester transfer protein (CETP) on atherosclerosis is highly debated. This study aimed to investigate the associations between plasma CETP or CETP genotypes and carotid intima-media thickness (cIMT) and the influence of high-density lipoprotein cholesterol (HDL-C) on these associations. Plasma CETP and HDL-C concentrations were measured in 552 subjects free of any pharmacological treatment from the IMPROVE cohort, which includes 3711 European subjects at high cardiovascular risk. CETP single-nucleotide polymorphisms (SNPs) and cIMT measures (cIMT; cIMT of bifurcations, common and internal carotids; plaque-free common carotid [PF CC]-IMT) were available for the full cohort. In drug-free subjects, plasma CETP correlated with HDL-C levels (r = 0.19, < 0.0001), but not with cIMT variables. When stratified according to HDL-C quartiles, CETP positively correlated with cIMT and cIMT, but not with PF CC-IMT, in the top HDL-C quartile only. Positive associations between the CETP concentration and cIMT or cIMT were found in the top HDL-C quartile, whereas HDL-C levels were negatively correlated with cIMT and cIMT when the CETP concentration was below the median (HDL-C × CETP interaction, = 0.001 and = 0.003 for cIMT and cIMT, respectively). In the full cohort, three CETP SNPs (rs34760410, rs12920974, rs12708968) were positively associated with cIMT. rs12444708 exhibited a significant interaction with HDL-C levels in the prediction of cIMT. In conclusion, a significant interplay was found between plasma CETP and/or CETP genotype and HDL-C in the prediction of carotid plaque thickness, as indexed by cIMT. This suggests that the association of HDL-C with carotid atherosclerosis is CETP-dependent.
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http://dx.doi.org/10.3390/biomedicines9030286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999018PMC
March 2021

Inverse Association of Handgrip Strength With Risk of Heart Failure.

Mayo Clin Proc 2021 06 26;96(6):1490-1499. Epub 2021 Mar 26.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, United Kingdom; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.

Objective: To evaluate the nature, magnitude, and specificity of the association between handgrip strength (HGS) and heart failure (HF) risk.

Patients And Methods: Handgrip strength was assessed at baseline from March 1, 1998, to December 31, 2001, by use of a hand dynamometer in the Finnish Kuopio Ischemic Heart Disease prospective population-based cohort of 770 men and women aged 61 to 74 years without a history of HF. Relative HGS was obtained by dividing the absolute value by body weight. Hazard ratios (HRs) with 95% CIs were estimated with Cox regression models. We used multiple imputation to account for missing data.

Results: During a median (interquartile range) follow-up of 17.1 (11.3-18.3) years, 177 HF events were recorded. Handgrip strength was continually associated with risk of HF, consistent with a curvilinear shape. On adjustment for several established risk factors and other potential confounders, the HR (95% CI) for HF was 0.73 (0.59-0.91) per 1 SD increase in relative HGS. Comparing the top vs bottom tertiles of relative HGS, the corresponding adjusted HR was 0.55 (0.38-0.81). The association remained similar across several clinical subgroups. Imputed results were broadly similar to the observed results.

Conclusion: Relative HGS is inversely and continually associated with the future risk of HF in the general population. Studies are warranted to evaluate whether HGS may be a useful prognostic tool for HF in the general population and to determine whether resistance exercise training may lower the risk of HF.
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http://dx.doi.org/10.1016/j.mayocp.2020.09.040DOI Listing
June 2021

Percentage of age-predicted cardiorespiratory fitness and risk of sudden cardiac death: A prospective cohort study.

Heart Rhythm 2021 07 6;18(7):1171-1177. Epub 2021 Mar 6.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom; Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research, Southmead Hospital, Bristol, United Kingdom.

Background: The inverse associations between cardiorespiratory fitness (CRF) and vascular outcomes have been established. However, there has been no prospective evaluation of the relationship between percentage of age-predicted cardiorespiratory fitness (%age-predicted CRF) and risk of sudden cardiac death (SCD).

Objective: The purpose of this study was to assess the association of %age-predicted CRF with SCD risk in a long-term prospective cohort study.

Methods: CRF was assessed using the gold standard respiratory gas exchange analyzer in 2276 men who underwent cardiopulmonary exercise testing. The age-predicted CRF estimated from a regression equation for age was converted to %age-predicted CRF using (Achieved CRF/Age-predicted CRF) × 100. Hazard ratios (HRs) [95% confidence intervals (CIs)] were calculated for SCD.

Results: During median follow-up of 28.2 years, 260 SCDs occurred. There was a dose-response relationship between age-predicted CRF and SCD. A 1-SD increase in %age-predicted CRF was associated with a decreased risk of SCD in analysis adjusted for established risk factors (HR 0.60; 95% CI 0.53-0.70), which remained consistent on further adjustment for several potential confounders, including alcohol consumption, physical activity, socioeconomic status, and systemic inflammation (HR 0.73; 95% CI 0.62-0.85). The corresponding adjusted HRs were 0.34 (0.23-0.50) and 0.52 (0.34-0.79), respectively, when comparing extreme quartiles of %age-predicted CRF levels. HRs for the associations of absolute CRF levels with SCD risk in the same participants were similar.

Conclusion: Percentage of age-predicted CRF is continuously, strongly, and independently associated with risk of SCD and is comparable to absolute CRF as a risk indicator for SCD.
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http://dx.doi.org/10.1016/j.hrthm.2021.03.010DOI Listing
July 2021

Leisure-time cross-country skiing and the risk of venous thromboembolism: A prospective cohort study.

Eur J Prev Cardiol 2020 Mar 3. Epub 2020 Mar 3.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.

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http://dx.doi.org/10.1177/2047487320908978DOI Listing
March 2020

Exercise cardiac power and the risk of myocardial infarction and fatal coronary heart disease events in men.

Eur J Prev Cardiol 2020 Mar 31. Epub 2020 Mar 31.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.

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http://dx.doi.org/10.1177/2047487320914734DOI Listing
March 2020

Cardiorespiratory Fitness, Inflammation, and the Incident Risk of Pneumonia.

J Cardiopulm Rehabil Prev 2021 05;41(3):199-201

Department of Sport Science, University of Seoul, Seoul, South Korea (Dr Jae); Department of Exercise Science, Syracuse University, Syracuse, New York (Dr Heffernan); Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland (Drs Kurl and Laukkanen); National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, and Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, England (Dr Kunutsor); Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota (Drs Kim and Johnson); Preventive Cardiology and Cardiac Rehabilitation, Beaumont Health, Royal Oak, Michigan (Dr Franklin); and Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, and Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland (Dr Laukkanen).

Introduction: Both inflammation and cardiorespiratory fitness (CRF) are associated with the risk of respiratory infections. To clarify the hypothesis that CRF attenuates the incident risk of pneumonia due to inflammation, we conducted a prospective study examining the independent and joint associations of inflammation and CRF on the risk of pneumonia in a population sample of 2041 middle-aged men.

Methods: Cardiorespiratory fitness was directly measured as peak oxygen uptake (V˙o2peak) during progressive exercise testing to volitional fatigue, and categorized into tertiles. Inflammation was defined by high-sensitivity C-reactive protein (hsCRP). Pneumonia cases were identified by internal medicine physicians using the International Classification of Diseases codes in clinical practice.

Results: During a median follow-up of 27 yr, 432 pneumonia cases were recorded. High hsCRP and CRF were associated with a higher risk (HR = 1.38; 95% CI, 1.02-1.88) and a lower risk of pneumonia (HR = 0.55; CI, 0.39-0.76) after adjusting for potential confounders, respectively. Compared with normal hsCRP-Fit, moderate to high hsCRP-Unfit had an increased risk of pneumonia (HR = 1.63; CI, 1.21-2.20), but moderate to high hsCRP-Fit was not associated with an increased risk of pneumonia (HR = 1.25; CI, 0.93-1.68).

Conclusions: High CRF attenuates the increased risk of pneumonia due to inflammation. These findings have potential implications for the prevention of respiratory infection characterized by systemic inflammation, such as coronavirus disease-2019 (COVID-19).
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http://dx.doi.org/10.1097/HCR.0000000000000581DOI Listing
May 2021

Cardiorespiratory Fitness Attenuates the Increased Risk of Sudden Cardiac Death Associated With Low Socioeconomic Status.

Am J Cardiol 2021 04 24;145:164-165. Epub 2021 Jan 24.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland.

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http://dx.doi.org/10.1016/j.amjcard.2021.01.012DOI Listing
April 2021

The overlap of genetic susceptibility to schizophrenia and cardiometabolic disease can be used to identify metabolically different groups of individuals.

Sci Rep 2021 01 12;11(1):632. Epub 2021 Jan 12.

Institute of Health and Wellbeing, University of Glasgow, Room 111, Public Health, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.

Understanding why individuals with severe mental illness (Schizophrenia, Bipolar Disorder and Major Depressive Disorder) have increased risk of cardiometabolic disease (including obesity, type 2 diabetes and cardiovascular disease), and identifying those at highest risk of cardiometabolic disease are important priority areas for researchers. For individuals with European ancestry we explored whether genetic variation could identify sub-groups with different metabolic profiles. Loci associated with schizophrenia, bipolar disorder and major depressive disorder from previous genome-wide association studies and loci that were also implicated in cardiometabolic processes and diseases were selected. In the IMPROVE study (a high cardiovascular risk sample) and UK Biobank (general population sample) multidimensional scaling was applied to genetic variants implicated in both psychiatric and cardiometabolic disorders. Visual inspection of the resulting plots used to identify distinct clusters. Differences between these clusters were assessed using chi-squared and Kruskall-Wallis tests. In IMPROVE, genetic loci associated with both schizophrenia and cardiometabolic disease (but not bipolar disorder or major depressive disorder) identified three groups of individuals with distinct metabolic profiles. This grouping was replicated within UK Biobank, with somewhat less distinction between metabolic profiles. This work focused on individuals of European ancestry and is unlikely to apply to more genetically diverse populations. Overall, this study provides proof of concept that common biology underlying mental and physical illness may help to stratify subsets of individuals with different cardiometabolic profiles.
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http://dx.doi.org/10.1038/s41598-020-79964-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7804422PMC
January 2021

Chronotropic Response to Exercise Testing and the Risk of Stroke.

Am J Cardiol 2021 03 19;143:46-50. Epub 2020 Dec 19.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland.

Although the chronotropic response to exercise testing, defined as an inadequate heart rate response to incremental exercise to volitional fatigue, is associated with adverse cardiovascular outcomes, it remains unclear whether this response is related to the future risk of cerebrovascular events. We tested the hypothesis that the chronotropic response to exercise is associated with an increased risk of stroke in a general population. This prospective study was based on a population sample of 2,036 men aged 42 to 60 years in the Kuopio Ischemic Heart Disease cohort study. Chronotropic response to exercise was defined as the percentage of chronotropic index ([maximum heart rate - resting heart rate] / [220 - age - resting heart rate] × 100). Incident strokes were obtained from the Finnish national hospital discharge registry. During a median 27-year follow-up, 343 incident stroke (289 ischemic and 66 hemorrhagic) events occurred. Twelve events were diagnosed as both ischemic and hemorrhagic stroke. Comparing the bottom versus top quintile of chronotropic reserve, there was an increased risk of stroke (hazard ratio [HR] 1.73, 95% confidence Interval [CI]: 1.09 to 2.75) and ischemic stroke (HR 1.72, 95% CI, 1.04 to 2.85), but not hemorrhagic stroke (HR 2.23, 95% CI, 0.77 to 6.46) in analyses that adjusted for potential risk factors. These results suggest that an impaired chronotropic response to exercise is independently associated with a higher risk of total and ischemic stroke events in middle-aged men. The role of chronotropic incompetence during exercise testing as a potential prognostic indicator for stroke risk needs further investigation.
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http://dx.doi.org/10.1016/j.amjcard.2020.12.042DOI Listing
March 2021

Association Between Estimated Pulse Wave Velocity and the Risk of Heart Failure in the Kuopio Ischemic Heart Disease Risk Factor Study.

J Card Fail 2021 04 25;27(4):494-496. Epub 2020 Nov 25.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland District, Jyväskylä, Finland.

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http://dx.doi.org/10.1016/j.cardfail.2020.11.012DOI Listing
April 2021

Joint effect of blood pressure and C-reactive protein and the risk of sudden cardiac death: A prospective cohort study.

Int J Cardiol 2021 03 30;326:184-188. Epub 2020 Oct 30.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Central Finland Healt Care District, Department of Medicine, Jyväskylä, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland.

Background: Both blood pressure and C-reactive protein (CRP) are each independently related to mortality risk. However, the combined effect of systolic blood pressure (SBP) and CRP on sudden cardiac death (SCD) risk has not been studied.

Patients And Methods: We studied the joint impact of SBP and CRP and the risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of 1953 men aged 42-61 years with no history of ischemic heart disease. Baseline investigations were conducted between March 1984 and December 1989. SBP and CRP were measured. SBP was divided based on median values to low and high (median cutoffs 132 mmHg) and CRP as low and high (median cut-off 1.30 mg/L). Hazard ratios (HRs) with confidence intervals (CIs) were calculated after multivariate adjustment.

Results: Subjects were followed-up for 23.2 years, and 137 SCDs occurred. In this study, elevated SBP (>132 mmHg) combined with elevated (CRP >1.30 mg/L) were associated with SCD risk. Adjustment for age, examination year, alcohol consumption, BMI, energy expenditure during exercise, total cholesterol, HDL-cholesterol, type 2 diabetes, smoking, antihypertension medication and aspirin use, the risk of SCD remained statistically significant (HR, 2,73, 95% CI, 1.62-4.60, p < .001). Further adjustment for socio-economic status, years of education and history of cardiovascular disease in a family the results were only slightly changed (HR, 2.65, 95% CI, 1.57-4.49, p < .001).

Conclusions: In our male cohort study, the joint effect of high SBP together with increased CRP levels is a risk predictor of SCD compared with low SBP and CRP.
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http://dx.doi.org/10.1016/j.ijcard.2020.10.071DOI Listing
March 2021

Association between estimated pulse wave velocity and the risk of stroke in middle-aged men.

Int J Stroke 2021 07 12;16(5):551-555. Epub 2020 Oct 12.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.

Background: Increased aortic stiffness, assessed as carotid-femoral pulse wave velocity (cfPWV), contributes to cerebrovascular damage and is predictive of cerebrovascular events.

Aims And Methods: We sought to examine the association between estimated pulse wave velocity (ePWV), a proxy of carotid-femoral pulse wave velocity, and stroke and its subtypes (ischemic and hemorrhagic) in a prospective cohort of 2666 men (aged mean 53.1, range 42-61 years) enrolled in the Kuopio Ischemic Heart Disease cohort study.

Results: During a median 28-year follow-up, 471 incident stroke (397 ischemic and 94 hemorrhagic) events occurred. After adjusting for several established and emerging risk factors including age and pulse pressure, comparing the versus bottom quartiles of ePWV, there was an increased risk of stroke (hazard ratio [HR] 2.37, 95% Confidence Interval [CI]: 1.57-3.58), ischemic stroke (HR 2.23, 95% CI, 1.42-3.50), and hemorrhagic stroke (HR 3.57, 95% CI, 1.45-8.76).

Conclusion: These findings demonstrate that ePWV is independently associated with the risk of stroke in middle-aged men.
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http://dx.doi.org/10.1177/1747493020963762DOI Listing
July 2021

Sex-specific predictors of PCSK9 levels in a European population: The IMPROVE study.

Atherosclerosis 2020 09 30;309:39-46. Epub 2020 Jul 30.

Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Medical Biotechnology and Translational Medicine, Università Degli Studi di Milano, Milan, Italy. Electronic address:

Background And Aims: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is one of the key regulators of low-density lipoprotein cholesterol plasma levels. Circulating PCSK9, which differs between genders, represents a valid pharmacological target for preventing cardiovascular (CV) events. We aimed to investigate sex-related associations between PCSK9 plasma levels and biochemical and anthropomorphic factors, and familial and personal morbidities, in a large European cohort (n = 3673) of men (47.9%) and women (52.1%).

Methods: Individuals (aged 54-79 years) free of CV diseases were enrolled in seven centers of five European countries: Finland, France, Italy, the Netherlands, and Sweden. PCSK9 plasma levels were measured by ELISA.

Results: PCSK9 was higher in women than in men. Multiple linear regression analysis showed that latitude, sex, and treatments with statins and fibrates were the strongest predictors of PCSK9 in the whole group. These variables, together with triglycerides and high-density lipoprotein cholesterol, were also associated with PCSK9 in men or women. Mean corpuscular hemoglobin concentration and pack-years were PCSK9 independent predictors in women, whereas hypercholesterolemia and physical activity were independent predictors in men. The associations between PCSK9 and latitude, uric acid, diabetes, hypercholesterolemia and physical activity were significantly different in men and women (p <0.05 for all).

Conclusions: Besides confirming the association with lipids in the whole group, our study revealed previously unknown differences in PCSK9 predictors in men and women. These might be taken into account when defining individual risk for CV events and/or for refining PCSK9 lowering treatments.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.07.014DOI Listing
September 2020

Association Between Pulse Pressure and the Risk of Sudden Cardiac Death in Middle-Aged Men: A 26-Year Follow-up Population-Based Study.

Mayo Clin Proc 2020 09 6;95(9):2044-2046. Epub 2020 Aug 6.

Faculty of Sport and Health Sciences, University of Jyväskylä, Finland; Department of Medicine, Central Finland Health Care District, Finland.

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http://dx.doi.org/10.1016/j.mayocp.2020.01.033DOI Listing
September 2020

Sense of Coherence and Mortality: A Systematic Review and Meta-Analysis.

Psychosom Med 2020 Jul/Aug;82(6):561-567

From the Institute of Public Health and Clinical Nutrition (Piiroinen, Tuomainen, Kauhanen, Kurl, Voutilainen), University of Eastern Finland; Kuopio University Hospital (Tolmunen), Kuopio, Finland; Aging Research Center, Karolinska Institutet and Stockholm University (Nilsen), Stockholm, Sweden; University of Turku (Suominen), Turku, Finland; University of Skövde (Suominen), Skövde, Sweden; and Department of Nursing Science (Välimäki), University of Eastern Finland, Kuopio, Finland.

Objective: The aim of the study was to investigate the association between sense of coherence (SOC) and all-cause mortality in the general adult population.

Methods: We conducted a systematic review and meta-analysis of prospective cohort studies. We searched eight electronic bibliographic databases for eligible studies. A random effects model and the restricted maximum likelihood method were used to calculate the pooled effect size.

Results: Eight studies were eligible for the meta-analysis. The studies included 48,138 participants, of whom 5307 died during a median follow-up of 14.1 years (range, 8-29.5 years). Their age ranged from 20 to 80 years, and 53% of them were men. In the meta-analysis model of crude values, the risk of all-cause mortality for individuals with a weak SOC (lowest tertile) was 1.30 (95% confidence interval [CI] = 1.09-1.55, p = .003, I = 78.84%) compared with individuals with a strong SOC (highest tertile). In the model adjusted for age, the risk remained almost the same (risk ratio = 1.26, 95% CI = 1.15-1.38, p < .001, I = 69.59%). In the model adjusted for several other risk factors for mortality, the risk was still 1.17 (95% CI = 1.07-1.27, p < .001, I = 57.85%).

Conclusions: This meta-analysis shows that a weak SOC is associated with an increased risk of all-cause mortality in the general adult population. Future studies are needed to further develop assessment tools for SOC with good psychometric properties and to determine the disease processes that mediate the association of SOC with mortality.
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http://dx.doi.org/10.1097/PSY.0000000000000812DOI Listing
June 2021
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