RESUMEN
OBJECTIVE: To systematically review the evidence on the effect of constraint-induced movement therapy compared with bimanual intensive training in children with unilateral cerebral palsy. DATA SOURCES: Seven electronic databases (Cinahl, Cochrane Library, EMBASE, Ovid MEDLINE, PEDro, PsycINFO, PubMed) were searched from database inception through December 2016. METHODS: A systematic review was performed using the American Academy of Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Standardised mean differences (effect sizes) were calculated for each study and outcome. RESULTS: Nine studies met the eligibility criteria. All studies provided level II evidence. Methodological quality was high in two studies, moderate in four studies and low in three studies. The methodology, participant and intervention characteristics were heterogeneous. The participants' ages ranged from 1.5 to 16 years. Their initial hand function ranged from Manual Ability Classification System Level I to Level III. The total intervention dose ranged from 24 to 210 hours and duration from one week to ten weeks. The studies measured outcomes assessing unimanual and bimanual hand and arm function, participation and attainment of individualised goals. Overall, the effect sizes did not favour one of the interventions at short- or long-term follow-up. The 95% confidence intervals were broad, indicating inaccurate precision of the effect sizes. Pooling of the data for a meta-analysis was judged to be of little clinical value owing to heterogeneity. CONCLUSION: It is not possible to conclude whether constraint-induced movement therapy or bimanual intensive training is more effective than the other in children with unilateral cerebral palsy.
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Parálisis Cerebral/rehabilitación , Modalidades de Fisioterapia , Restricción Física , HumanosRESUMEN
BACKGROUND: Permanent smoking cessation reduces loss of pulmonary function. Less is known in the long term about individuals who give up smoking temporarily or quitters with lower initial pulmonary function. Little is known also about the relationship between decline in pulmonary function and mortality. We examined these aspects and the association between smoking, decline in pulmonary function, and mortality. METHODS: Two middle aged male Finnish cohorts of the Seven Countries Study and their re-examinations on five occasions during a 30 year period of follow up were analysed. RESULTS: During the first 15 years (n=1007) adjusted decline in forced expiratory volume in 0.75 seconds (FEV(0.75)) was 46.4 ml/year in never smokers, 49.3 ml/year in past smokers, 55.5 ml/year in permanent quitters, 55.5 ml/year in intermittent quitters, and 66.0 ml/year in continuous smokers (p<0.001 for trend). Quitters across the entire range of baseline FEV(0.75) had a slower decline in FEV(0.75) than continuous smokers. Among both continuing smokers and never smokers, non-survivors had a significantly (p<0.001) more rapid decline in FEV(0.75) than survivors. The adjusted relative hazard for total mortality was 1.73 (95% confidence interval (CI) 1.41 to 2.11) and 1.24 (95% CI 1.02 to 1.52) in the lowest and middle tertiles of decline in FEV(0.75). Never smokers, past smokers, and quitters had significantly lower total mortality than continuous smokers, partly because of their slower decline in FEV(0.75). CONCLUSION: These results highlight the positive effect of smoking cessation, even intermittent cessation, on decline in pulmonary function. Accelerated decline in pulmonary function was found to be a risk factor for total mortality. The beneficial effect of smoking cessation on mortality may partly be mediated through a reduced decline in pulmonary function.
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Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/mortalidad , Adulto , Estudios de Cohortes , Finlandia/epidemiología , Estudios de Seguimiento , Volumen Espiratorio Forzado/fisiología , Humanos , Masculino , Persona de Mediana Edad , Análisis de Regresión , Factores de Riesgo , Fumar/efectos adversos , Fumar/fisiopatologíaRESUMEN
BACKGROUND: This study aims to examine cardiovascular risk factors in relation to all-cause mortality in elderly populations of different European countries. METHODS: Men aged 65--84 years from defined administrative areas were enrolled in Finland (rural areas of east and west Finland; n=716), in the Netherlands (the town of Zutphen; n=887), and in Italy (the rural areas of Crevalcore and Montegiorgio; n=682). Ten-year all-cause mortality was studied in relation to measurements taken at entry: age, systolic blood pressure, HDL- and non-HDL-cholesterol, body mass index, heart rate and smoking habits. Univariate and multivariate analyses were performed with all-cause mortality as the end-point. RESULTS: Ten-year death rates from all causes were higher in Finland (574 per 1000), lower in the Netherlands (475 per 1000), and Italy (466 per 1000). Age, heart rate and smoking in all three countries were independently associated with 10-year all-cause mortality. Non-HDL-cholesterol was not related with all-cause mortality. The observed associations between HDL-cholesterol, systolic blood pressure, body mass index and all-cause mortality were dependent on the in- or exclusions of early death. CONCLUSION: In these elderly men only age, smoking habits and heart rate were consistently associated with all-cause mortality.
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Anciano , Enfermedades Cardiovasculares/mortalidad , Mortalidad , Factores de Edad , Anciano de 80 o más Años , Europa (Continente) , Salud Global , Frecuencia Cardíaca , Humanos , Masculino , Análisis Multivariante , Valor Predictivo de las Pruebas , Factores de Riesgo , Fumar/efectos adversosRESUMEN
OBJECTIVES: To examine whether short stature is associated with an increased risk of coronary heart disease. DESIGN: Follow-up study. SETTING: Two geographically defined areas in eastern and western Finland. SUBJECTS: A total of 1441 men who were free of coronary heart disease at the start of the follow-up. MAIN OUTCOME MEASURES: Hazard ratios for fatal and non-fatal coronary heart disease RESULTS: Height was inversely related to fatal coronary heart disease and incident non-fatal coronary heart disease during the follow-up. These relationships persisted after adjusting for other major cardiovascular risk factors. Comparing the high-risk area in eastern Finland with the low-risk area in south-western Finland, no difference in fatal coronary heart disease and cumulative incidence of non-fatal coronary heart disease was seen in tall men. The increase in risk of coronary heart disease death was 19% for a 10 cm decrease in height (OR = 0.81, 95% CI = 0.68-0.95). CONCLUSIONS: Our results show that short stature is an independent risk factor for coronary heart disease. Differences in stature partly explain the Finnish east-west difference in the incidence of coronary heart disease.
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Estatura , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etiología , Análisis de Varianza , Causas de Muerte , Finlandia/epidemiología , Estudios de Seguimiento , Humanos , Hipercolesterolemia/complicaciones , Hipertensión/complicaciones , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Vigilancia de la Población , Modelos de Riesgos Proporcionales , Características de la Residencia , Riesgo , Factores de Riesgo , Fumar/efectos adversosRESUMEN
AIMS: The risk of early and late death in relation to smoking and ex-smoking were studied. METHODS AND RESULTS: A cohort of 1711 Finnish men born between 1900 and 1919 were recruited in 1959 and followed up for 35 years. Information on smoking status was collected at each of six examinations made from 1959 to 1989 using a standardized questionnaire. Vital status at the end of 1994 was collected for every man. The effect of smoking on mortality was assessed using Cox proportional hazards model. Adjusted ratios for 35-year all-cause mortality were 1.62 (95% CI 1.40-1.88) in current smokers and 1.13 (CI 0.93-1.36) in former smokers compared with non-smokers. The hazards ratios for 35-year coronary heart disease mortality were 1. 63 (CI 1.24-2.13) and 1.39 (CI 1.00-1.94), respectively. The risk for 10 year mortality was stronger than for 35 year mortality among both former and current smokers, given the same amount of cigarettes consumed. Men smoking persistently were most at risk, while those who persisted in quitting had no increased risk of death compared with non-smokers. CONCLUSION: Smoking increases the risk of premature death in middle-aged men and giving up smoking earlier in life can prevent smoking attributable premature death.
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Enfermedad Coronaria/mortalidad , Fumar/mortalidad , Adulto , Causas de Muerte/tendencias , Enfermedad Coronaria/etiología , Enfermedad Coronaria/prevención & control , Finlandia/epidemiología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Fumar/efectos adversos , Cese del Hábito de Fumar/estadística & datos numéricos , Prevención del Hábito de Fumar , Encuestas y Cuestionarios , Tasa de Supervivencia/tendenciasRESUMEN
BACKGROUND: Although it is well known that impaired pulmonary function is a strong predictor of mortality and that smoking decreases pulmonary function, little is known about the long term effect of smoking cessation on mortality at different levels of pulmonary function. We have studied the impact of smoking cessation on mortality over the entire range of baseline pulmonary function. METHODS: The study subjects consisted of men aged 40-59 at entry who were the Finnish participants in the Seven Countries Study during 1959-89. RESULTS: In all the participants (n = 1582) impaired forced expiratory volume in 0.75 seconds (FEV(0.75)) was significantly associated with increased all cause mortality. When those who gave up smoking during the follow up period were compared with continuous smokers (n = 860) all cause mortality was found to be decreased among those who quit. The relative adjusted hazard (HR) was 0.71 (95% confidence interval 0.50 to 1.00). The median survival time in those who stopped smoking compared with those who continued to smoke from 1969 onwards was 7.65, 7.59, and 6.30 years longer in the lowest, middle and highest tertiles of adjusted FEV(0.75) distribution, respectively. In those who gave up smoking, mortality from cardiovascular causes was significantly lower (HR 0.60 (95% CI 0.37 to 0.98)). CONCLUSIONS: These findings suggest that smokers across the entire range of pulmonary function may increase their expectation of lifespan by giving up smoking.
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Enfermedades Pulmonares/fisiopatología , Cese del Hábito de Fumar , Fumar/mortalidad , Adulto , Estudios de Cohortes , Finlandia/epidemiología , Estudios de Seguimiento , Volumen Espiratorio Forzado/fisiología , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Fumar/efectos adversos , Fumar/fisiopatología , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
A common assumption underlying most genetic studies is that individuals with different genotypes respond similarly to exposure to internal (epigenetic and background genotype effects) and external (ecological) environments. Here we evaluate whether this assumption is true in individuals with different genotypes of the gene coding for the apolipoprotein E (Apo E) molecule, an important determinant of the metabolic fate of plasma lipids and lipoproteins. We addressed whether the utility of known risk factors of coronary heart disease (CHD) in the prediction of CHD death in a 5-year follow-up is the same for the two most common Apo E genotypes, epsilon3/3 and epsilon4/3, in two cohorts of elderly Finnish men (age at baseline: 65-84 years), one in Eastern and the other in Southwestern Finland. The CHD mortality rate was higher in the epsilon4/3 than in the epsilon3/3 genotype in both cohorts (11.1 versus 7.8%, Pr = 0.281 in the Eastern cohort and 19.6 versus 8.2%, Pr = 0.002 in the Southwestern cohort). In the Eastern cohort, serum high density lipoprotein (HDL) cholesterol level was identified as a strong predictor of CHD death in the epsilon3/3 genotype (beta = -2.155, Pr = 0.019). In the Southwestern cohort, age (beta = 0.139, Pr = 0.006), body mass index (BMI) (beta = 0.149, Pr = 0.016), and serum total cholesterol level (beta = 0.453, Pr = 0.051) were identified as strong predictors in the epsilon3/3 genotype, as were smoking (beta = 0.236, Pr = 0.008) and BMI (beta = -0.124, Pr = 0.057) in the epsilon4/3 genotype. The latter observation indicates that in Southwestern Finland the probability of CHD death decreases with increasing BMI in elderly men with the epsilon4/3 genotype, while in their counterparts with the epsilon3/3 genotype the risk increases with increasing BMI. This difference was statistically significant (Pr = 0.002). These observations clearly argue against the assumption that individuals with different genotypes respond similarly to exposures to internal and/or external environments. These observations are consistent with a complex pathobiology of CHD involving biochemical and physiological agents that are under the influence of interactions between genetic and environmental factors. Information about these interactions is necessary for developing a more precise risk assessment and ultimately to improve public health and clinical strategies to prevent this devastating disease both at the individual and population levels.
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Apolipoproteínas E/genética , Enfermedad Coronaria/epidemiología , Anciano , Anciano de 80 o más Años , Enfermedad Coronaria/genética , Enfermedad Coronaria/mortalidad , Finlandia/epidemiología , Variación Genética , Genotipo , Geografía , Humanos , Estudios Longitudinales , Masculino , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
PURPOSE: To examine the prognostic significance of electrocardiographic (ECG) abnormalities among the elderly. MATERIALS AND METHODS: The Finnish cohorts of the Seven Countries Study involved 697 men aged 65 to 84 years at baseline in 1984. A 5-year follow-up was made from 1984 to 1989. Fatal myocardial infarction, nonfatal myocardial infarction, and all-cause mortality were outcome measures. RESULTS: Seventy-four fatal myocardial infarctions (MI), 101 fatal or nonfatal Mis, and 207 deaths occurred. When electrocardiographic changes were analyzed one by one, men with Q waves (n = 98), high-amplitude R waves (n = 112), depressed ST-interval (n = 122) or T-wave changes (n = 263) had significantly (P < 0.05) higher risk of coronary events and all-cause mortality than men without these changes. Additionally, men with atrial fibrillation (n = 49) had significantly higher risk of death. Highest risk was observed among men with Q waves together with ST- or T-wave changes. Men with both ST depression and T flattening/inversions without Q waves had also increased risk, whereas this was not true for men with Q waves without concomitant ST- or T-wave changes. CONCLUSION: Electrocardiographic abnormalities suggestive of coronary heart disease are associated with a high risk for coronary events and total mortality among elderly men. Among the elderly, a reliable history of coronary heart disease may not be easily achievable, thus the ECG could potentially be used as an indicator of symptomless or atypical heart disease.
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Enfermedad Coronaria/fisiopatología , Electrocardiografía , Anciano , Anciano de 80 o más Años , Causas de Muerte , Enfermedad Coronaria/mortalidad , Finlandia/epidemiología , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Valor Predictivo de las Pruebas , Pronóstico , RiesgoRESUMEN
BACKGROUND: This study aims at identifying determinants of all-cause mortality in elderly populations of different countries. METHODS: Men ages 65-84 years from defined administrative areas were enrolled in Finland (rural areas of east and west Finland; N = 693), in the Netherlands (the town of Zutphen; N = 851), and in Italy (the rural areas of Crevalcore and Montegiorgio; N = 682). They were survivors of cohorts studies for 25 years within the Seven Countries Study with the addition of a subgroup of the same ages in the Netherlands. RESULTS: Five-year death rates from all causes were higher in Finland (297 per 1000), intermediate in the Netherlands (231 per 1000), and lower in Italy (191 per 1000). Five-year all-cause mortality was studied in relation to measurements taken at entry (age, systolic and diastolic blood pressure, non-high-density lipoprotein (HDL) and HDL cholesterol, body mass index, heart rate, smoking habits, and presence of coronary heart disease manifestations). Univariate and multivariate analyses were performed (in the latter models, both linear and quadratic terms were used for most variables) with all-cause mortality as endpoint. Results suggested significant predictive power of age (direct relationship) and, in most cases, U-shaped relationships of risk factors to mortality. Non-HDL cholesterol showed significant relationships with mortality in Finland and the Netherlands, HDL cholesterol in all three countries, systolic blood pressure only in Finland, body mass index in Finland and the Netherlands, smoking habits only in Finland, and heart rate in none. Levels of risk factors associated with the lowest death rate in the pool of all countries were 183.3 mg/dl for non-HDL cholesterol, 59.8 for HDL cholesterol, 177.5 mm Hg for blood pressure, and 30.2 kg/m square for body mass index. CONCLUSIONS: In these elderly men the association of traditional risk factors with all-cause mortality is reduced, U-shaped, or even inverted. This is probably due to selection due to previous mortality, to comorbidity, and to changes in homeostatic mechanisms.
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Causas de Muerte , Mortalidad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Presión Sanguínea , Índice de Masa Corporal , Colesterol/sangre , Enfermedad Coronaria/epidemiología , Finlandia/epidemiología , Frecuencia Cardíaca , Humanos , Italia/epidemiología , Masculino , Países Bajos/epidemiología , Modelos de Riesgos Proporcionales , Factores de Riesgo , Fumar/efectos adversosRESUMEN
OBJECTIVES: We attempted to determine whether elevated levels of the classic coronary heart disease risk factors are associated with increased coronary risk and all-cause mortality among elderly men with and without coronary heart disease at baseline. BACKGROUND: The strength of any association between the classic coronary risk factors and survival among elderly men with and without coronary heart disease has not been established. METHODS: The classic coronary risk factor levels and risk of coronary events and total mortality during a 5-year follow-up interval were studied among men aged 65 to 84 years. Coronary events were fatal myocardial infarction (n = 71), any myocardial infarction (n = 96) and, among the men without disease, other nonfatal coronary heart disease events (n = 80). RESULTS: Among the 171 men with prevalent coronary heart disease, significant (p < 0.05) risk factors for fatal myocardial infarction (n = 42) in multivariate analyses were low high density lipoprotein cholesterol (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1 to 0.8 for 1-mmol/liter increase), high ratio of total to high density lipoprotein cholesterol (OR 1.4, 95% CI 1.1 to 1.7 for 1-U increase), and smoking more than nine cigarettes daily (OR 6.0, 95% CI 1.5 to 24.9 vs. values in men who had never smoked). Among the 476 men without prevalent coronary heart disease, only high serum total cholesterol was a risk factor for fatal myocardial infarction (n = 29) (OR 1.4, 95% CI 1.0 to 2.0 for 1-mmol/liter increase). Among men with prevalent coronary heart disease, the only significant (p < 0.05) risk factor for total mortality was smoking more than nine cigarettes daily (OR 3.9, 95% CI 1.1 to 13.4 vs. values among men who had never smoked). Among men without prevalent coronary heart disease, only the use of antihypertensive medication (OR 2.0, 95% CI 1.2 to 3.3 between men with and without such medication) was a risk factor for total mortality. CONCLUSIONS: The classic risk factors for coronary heart disease appear to be of importance even in old age, especially among men with prevalent coronary heart disease.
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Enfermedad Coronaria/etiología , Infarto del Miocardio/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , HDL-Colesterol/sangre , Estudios de Cohortes , Enfermedad Coronaria/mortalidad , Finlandia/epidemiología , Estudios de Seguimiento , Humanos , Masculino , Mortalidad , Análisis Multivariante , Oportunidad Relativa , Factores de Riesgo , Factores Sexuales , FumarRESUMEN
OBJECTIVE: To study the association between blood pressure and change in blood pressure with future coronary risk among elderly men. DESIGN: Cohort study. SETTING: Finnish cohorts of the Seven Countries Study. PARTICIPANTS: Four hundred and seventy-six men aged 65-84 years and free of clinically manifested coronary heart disease at baseline, in 1984. MAIN OUTCOME MEASURES: Fatal myocardial infarction (n = 29), any myocardial infarction (n = 42), and incidence of any new signs and symptoms of coronary heart disease (n = 80) during a 5-year follow-up. RESULTS: In multivariate analysis, a significant inverse U-shaped relationship was observed between baseline diastolic blood pressure and future fatal myocardial infarction, any myocardial infarction and any coronary heart disease. In models predicting the risk of coronary heart disease during 1984-1989, there was a significant interaction between both systolic (SBP) and diastolic blood pressure (DBP) in 1969-1974 and change in blood pressure between 1969-1974 and 1984. In categorical analyses, men (n = 42) who experienced a decline in DBP of > or = 4 mmHg from initial levels of > or = 90 mmHg had a higher risk of any myocardial infarction than men (n = 112) with a change of < 4 mmHg (odds ratio 4.5). For a decline of > or = 10 mmHg or more in SBP from levels of > or = 160 mmHg the corresponding odds ratio was 2.9. Men who experienced a decline in DBP or SBP from normotensive levels or an increase in blood pressure had no excess risk compared with men with stabile (change in DBP < 4 mmHg and change in SBP < 10 mmHg) blood pressure values. CONCLUSION: The present results suggest that among elderly men a decline in DBP or SBP from previously hypertensive levels may be associated with increased coronary risk.
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Presión Sanguínea , Enfermedad Coronaria/etiología , Hipertensión/fisiopatología , Infarto del Miocardio/etiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Estudios de Cohortes , Enfermedad Coronaria/mortalidad , Estudios de Seguimiento , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Análisis Multivariante , Infarto del Miocardio/mortalidad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
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.
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Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/epidemiología , Arteria Carótida Común/diagnóstico por imagen , Arteriosclerosis Intracraneal/diagnóstico por imagen , Arteriosclerosis Intracraneal/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Enfermedades Cardiovasculares/complicaciones , Enfermedades de las Arterias Carótidas/complicaciones , Trastornos Cerebrovasculares/complicaciones , Enfermedad Coronaria/epidemiología , Finlandia , Humanos , Arteriosclerosis Intracraneal/complicaciones , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , UltrasonografíaRESUMEN
The prevalence of coronary heart disease (CHD), cardiovascular disease (CVD) and associated risk factors was studied in 413 men aged 70-89, the survivors of the Finnish cohorts of the Seven Countries Study. Men were divided into five categories according to manifestations of prevalent CVD: I, history or ECG evidence of previous myocardial infarction (MI; 48 men, 12%); II, typical angina pectoris (AP; 56 men, 14%); III, other ischaemic electrocardiographic (ECG) changes (82 men, 20%); IV, stroke, transient ischaemic attack, intermittent claudication or minor ECG changes (other CVD; 78 men, 19%); V, free of CVD (149 men, 36%). Both systolic and diastolic blood pressures were lowest in men with previous MI and in men free of CVD, and highest in men with other ischaemic ECG changes (P = 0.017). Low HDL-cholesterol (< 0.9 mmol/l) was more prevalent and the total/HDL-cholesterol ratio and triglyceride levels were higher in men with prevalent CHD (P < 0.05). Total and LDL-cholesterol, smoking, body mass index, fibrinogen, coagulation factor VIIc, apolipoprotein A-I, apolipoprotein B and lipoprotein(a) were not associated with prevalent CVD. The results show that manifestations of CHD and CVD are common among elderly Finnish men. Low HDL-cholesterol, total/HDL ratio, triglycerides and hypertension were associated with manifest CVD cross-sectionally.
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Enfermedad Coronaria/epidemiología , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Estudios de Cohortes , Enfermedad Coronaria/sangre , Enfermedad Coronaria/diagnóstico , Finlandia/epidemiología , Humanos , Lípidos/sangre , Masculino , Prevalencia , Factores de RiesgoRESUMEN
In a 30-year follow-up survey of the Finnish cohorts of the Seven Countries Study in 1989, 470 men aged 70-89 years were examined in two rural areas of Finland, in the East and in the West. Life-style-related coronary heart disease risk factors were at high levels in both groups, but the difference between areas found in the same cohort in middle age had mostly disappeared or partially reversed. Mean levels of systolic/diastolic blood pressure, body mass index, fasting blood glucose, blood glucose after 2-hour oral glucose tolerance test, and plasma fibrinogen were higher in the West than in the East (p < or = 0.05), but serum thiocyanate which reflects smoking habits was higher in the East (p < 0.001). No significant differences between areas were found in mean levels of serum total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apolipoprotein A-I, apolipoprotein B, lipoprotein (a), plasma coagulation factor VIIc, and prevalence of current smoking.
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Enfermedad Coronaria/epidemiología , Evaluación Geriátrica , Población Rural/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Enfermedad Coronaria/etiología , Enfermedad Coronaria/mortalidad , Enfermedad Coronaria/prevención & control , Estudios Transversales , Finlandia/epidemiología , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
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.