Physical activity for a healthy life.

The evidence surveyed by Blair and Connelly (1996) now provides a clearly outlined challenge for action in applying physical activity for health promotion. Strategies to choose are single risk or broad spectrum within an individual or community approach. The 20-year results of the broad spectrum, community intervention in North Karelia, Finland more than halved the coronary mortality of participants aged 35-64 years (Puska, Tuomilehto, Vartiainen, Korhonen, & Torppa, 1995). Many facets of human lives, including physical activity, were charted in another project: the 11-year follow-up of Finnish municipal employees aged 45-58 years at entry into the project (Tuomi, 1991). In this project, physical activity showed marked positive associations with work capacity, lifestyle, and well-being. Thus, in addition to reducing morbidity and mortality, physical activity and fitness also promote mental and social health and improve the quality of life.

Ultrasonographic manifestations of common carotid atherosclerosis in elderly eastern Finnish men. Prevalence and associations with cardiovascular diseases and risk factors.

We investigated the prevalence and associations with cardiovascular symptoms, signs, and risk factors of common carotid atherosclerosis using B-mode ultrasonography in a population sample of 182 eastern Finnish men aged 70 to 89 years. Men were examined in 1989 as a part of the 30-year follow-up examination of the eastern Finnish cohort of the Seven Countries Study. The mean maximal intima-media thickness (IMT) of the right and left common carotid arteries was 1.5 mm (range, 0.7 to 5.3 mm; standard deviation, 0.7 mm). Fifty-one percent of the subjects had nonmineralized atheroma and 91% had single or multiple mineralizations in any of the arterial segments imaged. Both mean maximal IMT and nonmineralized atheromas were associated significantly (P < .05) with the presence of cerebral atherosclerosis, carotid murmur, at least one nonpalpable peripheral arterial pulse, ischemic resting electrocardiographic abnormalities, and history of coronary heart disease but not with intermittent claudication at the 30-year follow-up. No significant associations were found between carotid mineralizations and clinical cardiovascular disease. Long-term elevations of serum cholesterol and long-term smoking, measured as the number of risk factor elevations in the six examinations, were associated with the presence of nonmineralized atheroma in the elderly (in 1989). Smoking and repeatedly detected hypertension, on the other hand, had an association with the presence of mineralizations in 1989.

Changes in serum cholesterol level and mortality: a 30-year follow-up. The Finnish cohorts of the seven countries study.

The association of past changes in serum cholesterol level with cause-specific mortality between 1974 and 1989 was examined in a cohort of 784 Finnish men aged 55-74 years who were free of symptomatic coronary heart disease in 1974. Changes in serum cholesterol level were computed based on measurements made in 1959, 1964, 1969, and 1974. Of the 405 deaths, 202 were due to cardiovascular diseases and 107 due to cancer. Men with a decline in serum cholesterol level between 1959 and 1974 also experienced greater than average declines in body mass index and tended to be more often current smokers in 1974. Among 339 men aged 65-74 years in 1974, men in the lowest tertile of serum cholesterol change, i.e., with greatest declines, had increased cardiovascular (hazard ratio, 1.58; 95% confidence interval 1.00-2.50) and all-cause (hazard ratio, 1.46; 95% confidence interval 1.06-2.02) mortality compared with men in the middle tertile of change, i.e., with least change, in multivariate analysis. Among 445 men aged 55-64 years in 1974, there was a significant U-shaped association between change in serum cholesterol level and coronary and all-cause mortality risk. The authors suggest that both the decline in serum cholesterol level and the associated high mortality may be caused by a third factor, such as increased prevalence of chronic diseases or other changes associated with aging. This would help to explain why several studies have not found an association of serum cholesterol with coronary risk among the elderly.

Genetic susceptibility to non-insulin dependent diabetes mellitus and glucose intolerance are located in HLA region.

OBJECTIVES: To test the hypothesis that the genetic susceptibility to non-insulin dependent diabetes mellitus is the same as that to insulin dependent disease and to see whether glucose intolerance is associated with specific HLA haplotypes. DESIGN: Population based study of men in 1989 first tested for glucose tolerance in 1984. HLA haplotypes, including HLA-A, C, B, DR, and DQ, were defined serologically. HLA haplotype data from a population based Finnish study of childhood diabetes were used for predicting non-insulin dependent diabetes and impaired glucose tolerance. SETTING: Two communities in Finland. SUBJECTS: Representative cohort of Finnish men aged 70-89, comprising 98 men with non-insulin dependent diabetes mellitus and a randomly selected group of 74 men, who served as controls, who were tested for glucose tolerance twice within five years. MAIN OUTCOME MEASURES: Non-insulin dependent diabetes, impaired glucose tolerance, blood glucose concentration. RESULTS: Diabetes associated HLA haplotypes were present in 94% (85/90) of diabetic subjects, 79% (27/34) of subjects with impaired glucose tolerance, and only 13% (3/23) of non-diabetic subjects. In this group of elderly men sensitivity of the diabetes associated HLA haplotypes for non-insulin dependent diabetes and impaired glucose tolerance was 90%, specificity 87%, and predictive power 97%. Mean fasting blood glucose concentration was only just significantly higher in men with diabetes associated haplotypes than in men with no such haplotypes, but there was a substantial difference in blood glucose values two hours after glucose loading (10.4 and 6.4 mmol/l in men with diabetes associated HLA haplotypes and men with no such haplotypes, respectively (p < 0.0001)). CONCLUSIONS: These findings support the hypothesis that specific HLA haplotypes exhibit a common genetic determinant for insulin dependent and non-insulin dependent diabetes. Furthermore, HLA is a major genetic determinant of glucose intolerance in elderly Finnish men. The belief that the HLA predisposition to diabetes is specific for insulin dependent diabetes mellitus is largely incorrect.

Does the predictive value of baseline coronary risk factors change over a 30-year follow-up?

The association of baseline serum total cholesterol, systolic blood pressure, smoking and body mass index with coronary heart disease (CHD) mortality was analyzed among 1,619 men aged 40-59 at baseline. Analyses were made separately for the first, second and third decade of follow-up. Serum cholesterol and smoking more than 9 cigarettes daily were strong predictors of risk of CHD death (n = 450) occurring early and late during the 30-year follow-up. After 20 years of follow-up, systolic blood pressure was no longer associated with CHD risk. In contrast, highest tertile of body mass index (over 24.7 kg/m2) was only then associated with increased CHD risk. The correlations between the baseline and the 30-year risk factor values were 0.42 for serum cholesterol (n = 444), 0.28 for systolic blood pressure (n = 444) and 0.57 for body mass index (n = 429). Our results showed large differences in the long-term predictive power of the classical coronary risk factors. The reasons for these differences are discussed.

Changes in glucose tolerance among elderly Finnish men during a five-year follow-up: the Finnish cohorts of the Seven Countries Study.

UNLABELLED: It was the purpose of this study to report the natural history of glucose tolerance during a five-year follow-up among elderly Finnish men, and to evaluate the role of age and body-mass index in explaining the variation in glucose tolerance both cross-sectionally and longitudinally. In the survivors of the Finnish cohorts of the Seven-Countries Study, aged 65 to 84 years at baseline, a two-hour oral glucose-tolerance test was performed according to current WHO criteria. Subjects with fasting blood glucose > 10 mmol/l were directly classified as having diabetes at baseline.-- FINDINGS: At baseline, of the 637 men 216 had normal and 234 had impaired glucose tolerance, 187 were diabetic. At follow-up, 172 men had died; 38 (18%) of the subjects with normal glucose tolerance at baseline had either impaired glucose tolerance or diabetes; 17 (7%) of the men with initially impaired glucose tolerance had developed diabetes, and 79 (34%) were normalized. 25 (13%) and 22 (12%) of the initially diabetic subjects had reverted to impaired or normal glucose tolerance, respectively. The age was able to explain 1-2% of variation in blood glucose level in cross-sectional but not in longitudinal comparison. Body-mass index was an important predictor of abnormal glucose tolerance in previously normally responding men. By contrast, obesity did not contribute to the development of diabetes among men with impaired glucose tolerance.-- PRINCIPAL CONCLUSIONS: The incidence of impaired glucose tolerance was high in these elderly Finnish men as compared with studies in middle-aged Caucasoid subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes mellitus, impaired glucose tolerance and mortality among elderly men: the Finnish cohorts of the Seven Countries Study.

We studied the association of glucose intolerance with total and cause-specific mortality during a 5-year follow-up of 637 elderly Finnish men aged 65 to 84 years. Total mortality was 276 per 1000 for men aged 65 to 74 years and 537 per 1000 for men aged 75 to 84 years. Five-year total mortality adjusted for age was 364 per 1000 in diabetic men, 234 per 1000 in men with impaired glucose tolerance and 209 per 1000 in men with normal glucose tolerance. The relative risk of death among diabetic men was 2.10 (95% confidence interval 1.26 to 3.49) and among men with impaired glucose tolerance 1.17 (95% confidence interval 0.71 to 1.94) times higher compared with men with normal glucose tolerance. Cardiovascular disease was the most common cause of death in every glucose tolerance group. The multivariate adjusted relative risk of cardiovascular death was increased (1.55) in diabetic patients, albeit non-significantly (95% confidence interval 0.84 to 2.85). Diabetes resulted in an increased risk of cardiovascular mortality among men aged 65-74 years but not among the 75- 84-year-old men. Relative risk of death from non-cardiovascular causes was slightly increased among diabetic subjects. In conclusion, diabetes mellitus is a significant determinant of mortality among elderly Finnish men.

Short- and long-term association of serum cholesterol with mortality. The 25-year follow-up of the Finnish cohorts of the seven countries study.

The association of serum cholesterol with cause-specific and all-cause mortality was assessed in a cohort of 1,426 men aged 40-59 years who were free of clinically evident heart disease at baseline (1959). A total of 748 deaths (53 percent of the participants) occurred during the 25-year follow-up period. Men with high serum cholesterol levels at baseline had high mortality due to coronary heart disease during both the early and later parts of the follow-up period. In contrast, the association of serum cholesterol with mortality due to causes other than coronary heart disease changed during follow-up (interaction of cholesterol with follow-up period: p = 0.004). During the first 10 years of follow-up, despite their high coronary mortality, men with high cholesterol levels had lower all-cause mortality (age-adjusted relative risk = 0.71 for serum cholesterol above 5.79 mmol/liter vs. below 5.80 mmol/liter; p = 0.03) because of their low cancer mortality (relative risk = 0.55, p = 0.03) and residual mortality (relative risk = 0.49, p less than 0.01). During the last 15 years of follow-up, cholesterol at baseline was no longer associated with mortality due to causes other than coronary heart disease, and consequently, because of their high coronary mortality, men with high cholesterol levels also had higher all-cause mortality (relative risk = 1.22, p = 0.05). The results suggest that to fully analyze the association of serum cholesterol with all-cause mortality, the follow-up period should be sufficiently long--possibly more than 10 years--and the possibility of a change in the direction of the association studied should always be considered.

Risk factor dynamics, mortality and life expectancy differences between eastern and western Finland: the Finnish Cohorts of the Seven Countries Study.

Prior studies have not accounted for male mortality being higher in east than west Finland. Efforts to identify the mechanisms producing higher mortality in the east, due primarily to cardiovascular diseases (CVD), initially focused on a search for new risk factors. An alternate approach is to examine the assumptions of the analysis. This was investigated using a model which described (a) changes in risk factors over time, (b) dependency of risk factor effects on age, and (c) interactions and nonlinear effects of risk factors on mortality. The model was applied to 25-year follow-up data from cohorts of eastern (N = 823) and western (N = 888) Finnish men using pulse pressure, diastolic blood pressure, body mass index, total cholesterol, vital capacity index, cigarette smoking, and heart rate as risk factors. At age 40, men in the west had a life expectancy 2.4 years higher. Of the difference 29% (0.7 years) was associated with area differences in risk factor means, variances, and their change with age. The remainder, 1.7 years, was associated with age differences in the relation of risk factor interactions to CVD mortality. Possible reasons for these differences, such as joint elevation of several risk factors inducing rapid progression of atherogenesis, are discussed. No significant area differences were observed for mortality from either cancer or other causes.

Twenty-five-year mortality from coronary heart disease and its prediction in five cohorts of middle-aged men in Finland, The Netherlands, and Italy.

Five cohorts of men ages 40-59 (Finland: 2 cohorts of 1,677 men; Netherlands: 1 cohort of 878 men; Italy: 2 cohorts of 1,712 men) were examined and evaluated for cardiovascular risk factors in 1959-1960 and subsequently followed-up for mortality over the next 25 years. Age-adjusted death rates from coronary heart disease were highest in Finland (244 per 1,000), intermediate in The Netherlands (195 per 1,000), and lowest in Italy (122 per 1,000) with a twofold range between the extremes. The Cox proportional hazards model was used for single cohorts and for the pools of national cohorts with coronary heart disease deaths as endpoints and 12 risk factors as covariates. It showed the significant and almost universal predictive value of these factors (with some rare exceptions). The most highly predictive values were age, blood pressure, total serum cholesterol, cigarette smoking, and physical activity (negative relationship). The prediction of events within each country using the risk function of the others produced errors ranging from -19% to +51%. The largest errors were those involving the Italian cohorts whose experience tended to underpredict coronary heart disease mortality elsewhere and to be overpredicted by the risk functions of the other countries. Solving a Cox model which included all the cohorts, and adding dummy variables for the identification of nationality, it appears that the relative risk, everything else being equal, is 1.49 and 1.34 for a Finnish man, compared with Italian and Dutch men, respectively.

Risk factors and 25 year risk of coronary heart disease in a male population with a high incidence of the disease: the Finnish cohorts of the seven countries study.

OBJECTIVE: To assess the efficacy of high serum cholesterol concentration, raised blood pressure, and smoking as predictors of coronary heart disease. DESIGN: Prospective cohort study of middle aged men conducted over 25 years. SETTING: Finish components of an ongoing international study (seven countries study). PARTICIPANTS: 1520 Men who at age 40-59 in 1959 were free of clinically evident heart disease. INTERVENTIONS: At each follow up visit a detailed medical examination including resting electrocardiography was performed, blood pressure and serum total cholesterol concentration were measured, and smoking was assessed. MEASUREMENTS AND MAIN RESULTS: 825 Deaths (54% of participants) occurred during follow up, of which 335 were due to coronary heart disease. The hazard ratio for death from coronary heart disease with respect to risk factors at entry were: for serum cholesterol concentrations above 8.4 mmol/l v below 5.2 mmol/l, 2.68 (95% confidence interval 1.62 to 4.42); for systolic blood pressure in the highest quintile v that in the lowest quintile, 2.46 (1.72 to 3.50); and for smoking 10 or more cigarettes daily v never smoking, 1.95 (1.36 to 2.79). The hazard ratios with respect to cholesterol concentrations and blood pressure remained constant during follow up but the ratio with respect to smoking diminished, mainly owing to men giving up the habit. The estimated conditional probability of a 50 year old man dying of coronary heart disease in the next 25 years ranged from 12% among those with the most favourable risk factor profile to 75% among those with the least favourable profile. CONCLUSIONS: High risk factor levels (as determined in this study) in middle aged men may greatly increase the absolute probability of death from coronary heart disease when the period of study is relevant to the human life span.

Serum cholesterol and risk of accidental or violent death in a 25-year follow-up. The Finnish cohorts of the Seven Countries Study.

In the two most recent cholesterol-lowering drug trials, the achieved reductions in coronary heart disease mortality were offset by increases in mortality due to accidents and violence. A possible biochemical explanation has been suggested for an association between low serum cholesterol level and increased risk of death due to injury. We, therefore, examined the association between serum cholesterol level and risk of death from accidents or violence in the 25-year follow-up of two cohorts of Finnish men (N = 1580). Although a statistically nonsignificant, negative association was observed in one cohort (hazard ratio, 0.84, with a 1 mmol/L increase in cholesterol), the other cohort showed a statistically significant, positive association in multivariate analysis (hazard ratio, 1.39). We conclude that the observed associations between serum cholesterol and deaths from injury in the present study and in cholesterol-lowering trials are probably determined by other, presently unknown factors, or by chance.

Subjective health status of day and shift-working policemen.

To assess the subjective health status of day- and shift-working police officers, a questionnaire-based study was carried out. All the day-workers had previous shift experience. To control the age factor the total population of 2659 shift-working and 1303 day-working police officers was divided into four ten-year age classes. Factor analysis revealed that all the symptoms included in the questionnaire could be grouped into six factors. The prevalence rates of complaints showed that four of these factors (autonomous symptoms, musculo-skeletal symptoms, disturbance of appetite and indigestion, respiratory infections) were influenced by the main effects of age and shift work. Across all age classes the age-related changes in prevalence rates were strengthened by shift-work. In the other two factors (nervous symptoms, gastro-intestinal symptoms) an additional interaction effect could be observed. While the prevalence rates of the day-workers increased with age, those of the shift-workers decreased in the oldest age class. This drop of prevalence rates may be attributed to the influence of selection processes.

Seven Countries Study. First 20-year mortality data in 12 cohorts of six countries.

Out of the original 16 cohorts in the Seven Countries Study on Cardiovascular Diseases, 12 population samples in six countries have reached the 20 year follow-up deadline. Data on mortality became fully available for a total of 8287 men aged 40-59 at entry examination (two cohorts in Finland, one in the Netherlands, three in Italy, two in Yugoslavia, two in Greece, and two in Japan). Death rates from CHD as well as from all causes follow the traditional falling north to south trend (18 fold between the extremes for CHD; 2.7 fold for total mortality). The differences in all causes mortality are, however, largely accounted for by the variation in CHD mortality. The mean entry levels of serum cholesterol and representative levels of the consumption of saturated fats, mono-unsaturated fats, poly-unsaturated fats and carbohydrates explain a large proportion of inter-cohort difference in CHD mortality (81% for saturated fats). By applying the proportional hazards model to the pools of national cohorts, with CHD deaths as end-point and five risk factors as covariates, only age and mean blood pressure are universally significant predictors of fatal events. Cholesterol, smoking habits, body mass index and physical activity play some part but not in all the pools. Age and mean blood pressure are also the only universal risk factors for all causes of death.

Risk factors for cardiovascular disease among 55 to 74 year-old Finnish men: a 10-year follow-up.

The importance of serum total cholesterol, systolic blood pressure, and smoking as predictors of cardiovascular (CVD) disease were studied in 867 men aged 55 to 74 years belonging to the Finnish cohorts of the Seven Countries Study. Men had no definite history of myocardial infarction nor any signs of cerebrovascular disease at baseline in 1974. During the 10-year follow-up 248 men either died from CVD or had non-fatal CVD event, including a total of 188 fatal and nonfatal coronary heart disease (CHD) events. Age-adjusted relative risk of CVD event for men aged 55 to 64 with cholesterol over 7.4 mmol/l compared to below 6.0 mmol/l was 2.6, with systolic blood pressure over 159 mmHg vs. below 135 mmHg 1.8, and smoking over 19 cigarettes per day vs. never smoker 1.7. Corresponding relative risks for men aged 65 to 74 were 1.0, 1.4 and 1.2, respectively. The results for CHD events were closely similar. The results indicate that, in terms of relative risk, systolic blood pressure retains its importance as risk factor for CVD and CHD from late middle age to old age, whereas the importance of smoking is diminished, and serum cholesterol is of little importance in old age.

Changes in alcohol consumption and mortality in aged Finnish men.

Drinking patterns and changes in alcohol consumption from 1974 to 1984 and associations between alcohol consumption in 1974 and ten-year mortality rates from cardiovascular, violent, cancer or all causes were studied among Finnish men born between 1900 and 1919. The overall absolute alcohol consumption was low in both 1974 and 1984. The average alcohol consumption and drinking pattern did not significantly change with increasing age, though some individual changes occured. Moderate or heavier alcohol consumption was a significant risk factor for cancer deaths among non-smoking men, but not in male smokers. Moderate or heavier alcohol consumption might also be a significant risk factor in violent death. Low, moderate or heavier alcohol consumption was not a significant risk factor for coronary deaths among the men in this rural Finnish population.

Association of physical activity with coronary risk factors and physical ability: twenty-year follow-up of a cohort of Finnish men.

The association of physical activity with coronary risk factors and self-reported physical ability was studied in a cohort of 331 healthy Finnish men aged 45-64 years at entry, representing the survivors of a 20-year longitudinal study from 1964 to 1984. Baseline physical activity was not significantly related to levels of coronary risk factors at subsequent 5-year, 10-year or 20-year follow-up examinations. The 72 who increased their physical activity during the study period smoked less at 20-year follow-up than those who remained sedentary (p = 0.03). No other significant associations between 20-year changes of physical activity and coronary risk factors were seen. Although baseline physical activity was not, physical activity and exercise at 20-year follow-up were positively related to indices of functional capacity assessed at the end of the study period, when the subjects had reached a mean age of 73 years. It is concluded from this long-term study that a relative increase of physical activity between middle and old age is associated with both less smoking and a maintained high level of physical ability.