Pekka Jousilahti

National Institute for Health and Welfare, Finland, Helsinki, Southern Finland Province, Finland

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Publications (246)1774.98 Total impact

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    ABSTRACT: Rationale: Prospective cohort studies have shown that chronic exposure to particulate matter and traffic related air pollution is associated with reduced survival. However, the effects on non-malignant respiratory mortality are less studied and those reported are less consistent. Objectives: We have investigated the relationship of long-term exposure to air pollution and non-malignant respiratory mortality in 16 cohorts with individual level data within the multi center European Study of Cohorts for Air Pollution Effects (ESCAPE). Methods: Data from 16 ongoing cohort studies from Europe were used. The total number of subjects was 307,553. There were 1,559 respiratory deaths during follow-up. Measurements: Air pollution exposure was estimated by land use regression models at the baseline residential addresses of study participants and traffic-proximity variables were derived from geographical databases, following a standardized procedure within ESCAPE study. Cohort-specific hazard ratios obtained by Cox proportional hazard models from standardized individual cohort analyses were combined using meta-analyses. Main Results: We found no significant associations between air pollution exposure and non-malignant respiratory mortality. Most hazard ratios were slightly below unity, with the exception of the traffic-proximity indicators. Conclusions: In this study of 16 cohorts there was no association between air pollution exposure and non malignant respiratory mortality.
    American Journal of Respiratory and Critical Care Medicine 02/2014; · 11.04 Impact Factor
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    ABSTRACT: Introduction. To examine whether midregional pro-adrenomedullin (MR-proADM) plasma concentrations predict incident cardiovascular outcomes in the general population. Natriuretic peptides (N-terminal pro-brain natriuretic peptide (NT-proBNP), B-type natriuretic peptide (BNP), and midregional pro-atrial natriuretic peptide (MR-proANP)) were analyzed for comparison. Material and methods. MR-proADM plasma concentrations and those of the natriuretic peptides were determined in 8444 individuals of the FINRISK 1997 cohort. Patients were followed for 14 years (median). Cox regression analyses, discrimination, and reclassification analyses adjusting for Framingham risk factors were performed to evaluate the additional benefit from MR-proADM. Results. MR-proADM concentrations significantly predicted all-cause death (hazard ratio highest quintile versus lowest 1.18, 95% confidence interval 1.08-1.28), stroke (1.20, 1.05-1.38), major adverse cardiac events (MACE) (1.27, 1.17-1.37), and heart failure (1.67, 1.49-1.87). MR-proADM remained associated with MACE, death, and heart failure even after additional adjustment for NT-proBNP and C-reactive protein. Adding MR-proADM to the Framingham risk factors significantly improved discrimination (P < 0.001 for C-statistics and integrated discrimination improvement) and risk reclassification for heart failure (net reclassification improvement 12.12%, P < 0.001). Conclusions. In a healthy general population sample of the FINRISK 1997 cohort MR-proADM significantly predicted all-cause death, MACE, and especially heart failure even beyond NT- proBNP. It also improved risk reclassification for heart failure.
    Annals of medicine 02/2014; · 3.52 Impact Factor
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    ABSTRACT: Besides their role in diagnosis of acute myocardial infarction (MI), troponins may be powerful biomarkers for risk stratification in the general population. The objective of our study was to compare the performance of three troponin assays in cardiovascular disease (CVD) risk prediction in a population-based cohort without a history of CVD events. Troponin I concentrations were measured using a contemporary-sensitivity, high-sensitivity, and super-sensitivity assay in 7,899 participants of the general-population based FINRISK 1997 cohort. We used Cox proportional hazards regression to determine relative risks, followed by measures of discrimination and reclassification using 10-fold cross-validation to control for over-optimism. As outcome measures we used CVD, MI, ischemic stroke, heart failure (HF), and major adverse cardiac events (MACE). During the follow-up of 14 years 1,074 incident MACE were observed. Values above the lower limit of detection were observed in 26.4%, 81.5% and 93.9% for the contemporary-sensitivity, high-sensitivity and super-sensitivity assay, respectively. We observed significant associations of troponin concentrations with the risk of future CVD events and the results tended to become stronger with increasing assay sensitivity. For the super-sensitivity assay the multivariate adjusted hazard ratios (per one standard deviation increase) for different outcomes were: MI 1.24 [95% CI 1.11-1.39], stroke 1.14 [1.01-1.28], CVD 1.15 [1.07-1.24], HF 1.28 [1.18-1.39], and MACE 1.18 [1.11-1.25]. In subjects with intermediate risk, we found an improvement of net reclassification for HF (10.2%, p<0.001), and MACE (5.1%, p<0.001). Using a super-sensitivity assay, cardiac troponin was detectable in almost all healthy individuals. Its concentration improved risk prediction and reclassification for cardiovascular endpoints.
    PLoS ONE 01/2014; 9(3):e90063. · 3.73 Impact Factor
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    ABSTRACT: The aim of the present study was to compare the lifestyle (leisure-time physical activity, smoking habits and alcohol consumption) and dietary (energy-yielding nutrients, dietary fibre and foods) factors of Finns with a new syndrome called normal-weight obesity (NWO) with those of lean and overweight Finns. The representative population-based study included 4786 participants (25-74 years) from the National FINRISK 2007 Study with a health examination and questionnaires. Food intake was assessed using a validated FFQ. NWO was defined to include those with a normal BMI ( < 25 kg/m2) but excessive body fat (for men ≥ 20 % and for women ≥ 30 %) according to WHO definitions. The proportion of participants with a normal BMI was 28 % in men and 42 % in women. Of these, 34 % of the men and 45 % of the women had the NWO syndrome (among all the participants, 10 and 19 %, respectively). The waist circumference of the NWO participants was between that of the lean and overweight participants. Some potential risk factors, such as physical inactivity, (ex)-smoking and alcohol consumption, were related to NWO. In general, the intakes of energy-yielding nutrients were not associated with NWO. Instead, some healthy dietary factors (e.g. low intakes of meat and soft drinks) as well as unhealthy factors (e.g. low intakes of root vegetables, cereals and fish and high intake of confectionery) were related to NWO. The findings might explain why the NWO participants were of normal weight, but had an excessive body fat percentage. In conclusion, the proportion of normal-weight participants with an excessive body fat percentage was surprisingly high. The identification of NWO people may be of importance because although they appear lean, they have some unhealthy lifestyle and dietary habits related to obesity and overall health.
    The British journal of nutrition 11/2013; · 3.45 Impact Factor
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    ABSTRACT: Neuronal nicotinic acetylcholine receptor (nAChR) genes (CHRNA5/CHRNA3/CHRNB4) have been reproducibly associated with nicotine dependence, smoking behaviors, and lung cancer risk. Of the few reports that have focused on early smoking behaviors, association results have been mixed. This meta-analysis examines early smoking phenotypes and SNPs in the gene cluster to determine: (1) whether the most robust association signal in this region (rs16969968) for other smoking behaviors is also associated with early behaviors, and/or (2) if additional statistically independent signals are important in early smoking. We focused on two phenotypes: age of tobacco initiation (AOI) and age of first regular tobacco use (AOS). This study included 56,034 subjects (41 groups) spanning nine countries and evaluated five SNPs including rs1948, rs16969968, rs578776, rs588765, and rs684513. Each dataset was analyzed using a centrally generated script. Meta-analyses were conducted from summary statistics. AOS yielded significant associations with SNPs rs578776 (beta = 0.02, P = 0.004), rs1948 (beta = 0.023, P = 0.018), and rs684513 (beta = 0.032, P = 0.017), indicating protective effects. There were no significant associations for the AOI phenotype. Importantly, rs16969968, the most replicated signal in this region for nicotine dependence, cigarettes per day, and cotinine levels, was not associated with AOI (P = 0.59) or AOS (P = 0.92). These results provide important insight into the complexity of smoking behavior phenotypes, and suggest that association signals in the CHRNA5/A3/B4 gene cluster affecting early smoking behaviors may be different from those affecting the mature nicotine dependence phenotype.
    Genetic Epidemiology 11/2013; · 4.02 Impact Factor
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    ABSTRACT: Background/Objectives:Body mass index (BMI) is the most commonly used surrogate marker for evaluating the risk of cardiovascular disease (CVD) mortality in relation to general obesity, while abdominal obesity indicators have been proposed to be more informative in risk prediction.Subject/Methods:A prospective cohort study consisting of 46 651 Europeans aged 24-99 years was conducted to investigate the relationship between CVD mortality and different obesity indicators including BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-stature ratio (WSR), A Body Shape Index (ABSI) and waist-to-hip-to-height ratio (WHHR). Hazard ratio (HR) was estimated by the Cox proportional hazards model using age as timescale, and compared using paired homogeneity test.Results:During a median follow-up of 7.9 years, 3435 participants died, 1409 from CVD. All obesity indicators were positively associated with increased risk of CVD mortality, with HRs (95% confidence intervals) per standard deviation increase of 1.19 (1.12-1.27) for BMI, 1.29 (1.21-1.37) for WC, 1.28 (1.20-1.36) for WHR, 1.35 (1.27-1.44) for WSR, 1.34 (1.26-1.44) for ABSI and 1.34 (1.25-1.42) for WHHR in men and 1.37 (1.24-1.51), 1.49 (1.34-1.65), 1.45 (1.31-1.60), 1.52 (1.37-1.69), 1.32 (1.18-1.48) and 1.45 (1.31-1.61) in women, respectively. The prediction was stronger with abdominal obesity indicators than with BMI or ABSI (P<0.05 for all paired homogeneity tests). WSR appeared to be the strongest predictor among all the indicators, with a linear relationship with CVD mortality in both men and women.Conclusions:Abdominal obesity indicators such as WC, WHR, WSR and WHHR, are stronger predictors for CVD mortality than general obesity indicator of BMI.European Journal of Clinical Nutrition advance online publication, 23 October 2013; doi:10.1038/ejcn.2013.203.
    European journal of clinical nutrition 10/2013; · 3.07 Impact Factor
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    ABSTRACT: The occurrence of subjective symptoms related to heat strain in the general population is unknown. The present study aimed to describe the temperatures considered to be comfortable or hot and the prevalence of heat-related complaints and symptoms in the Finnish population. Four thousand and seven men and women aged 25-74 years, participants of the National FINRISK 2007 study, answered a questionnaire inquiring about the ambient temperatures considered to be hot and the upper limit of comfortable and about heat-related complaints and symptoms. The age trends in threshold temperatures and symptom prevalence were examined in 1-year groups by gender after smoothing with loess regression. The prevalence estimates were also adjusted for age. The temperature considered as hot averaged 26°C and the upper limit for thermal comfort was 22°C. Both temperatures declined with age (from 25 to 74 years) by 1-5°C. Approximately 80% of the subjects reported signs or symptoms of heat strain in warm weather, mostly thirst (68%), drying of mouth (43%), impaired endurance (43%) and sleep disturbances (32%). Cardiac and respiratory symptoms were reported by 6 and 7%, respectively, and their prevalence increased up to the age of 75 years. The exception was thirst, whose prevalence declined with age. Most symptoms and complaints were more prevalent in women than men. A large percentage of this northern European population suffers from heat-related complaints. Information on these is an aid in assessing the burden of summer heat on population health and is a prerequisite for any rational planning of pre-emptive measures.
    The European Journal of Public Health 10/2013; · 2.52 Impact Factor
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    ABSTRACT: Exposure to cold reportedly increases musculoskeletal pains. We assessed the prevalence of such pain and self-reported threshold temperature (TT) at which the pain emerges. A random sample of 6591 people in Finland, aged 25-74 years, answered a questionnaire on repeated cold-related musculoskeletal pain (CMP) and its TT. The response rate was 64%. We used quantile regression to quantify the effects of personal characteristics and region of residence on TT at various locations of its distribution. Of the participants, 1892 (30%) experienced CMP in at least one body site and 1692 reported TT. Ten percent of the participants who perceived CMP did so at -2 °C, 50% at -14 °C and 90% at -23 °C. Residence in the South elevated TT by 1-6 °C compared with residence in the North, depending on the proportion of participants reporting CMP at various temperatures. Joint disorders increased TT at milder temperatures, at which only 10% of all participants perceived CMP, whereas back disorders did so mainly at lower temperatures, at which 70% were affected. Overweight was associated with a 2 °C lower TT, and physical inactivity with a 1 °C higher TT, and TT increased by 1 °C per 10-year increase in age. The greatest model-estimated difference in median TT between subgroups was 12 °C. People suffering from musculoskeletal disorders and those living in the warmer areas of Finland need special advice to protect themselves against the cold. Our study provides preliminary information to support such advice.
    European journal of pain (London, England) 07/2013; · 3.37 Impact Factor
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    ABSTRACT: To compare the association between antihypertensive drug treatment and heart failure (HF) risk with the association between engaging in a healthy lifestyle and HF risk. We prospectively investigated the single and joint associations of lifestyle factors and awareness, treatment, blood pressure control status with HF risk among 38 075 Finns, who were 25-74 years old and free of HF at baseline. During a median follow-up of 14.1 years, 638 men and 445 women developed HF. Engaging in a healthy lifestyle was associated with an decreased risk of HF. Compared with normotensive people, hypertensive patients with and without antihypertensive treatment had a higher risk of HF. Hypertensive patients who used antihypertensive drugs but did not engage in a healthy lifestyle had a significantly higher risk of HF [HR 1.75; 95% confidence interval (CI) 1.39-2.21] than hypertensive patients who did not use antihypertensive drugs but engaged in a healthy lifestyle. In addition, compared with hypertensive patients who used antihypertensive drugs and engaged in a healthy lifestyle, hypertensive patients who did not use antihypertensive drug or engage in a healthy lifestyle had a significantly higher risk of HF (HR 1.55; 95% CI 1.24-1.95). The present study demonstrates that HF risk was lower in hypertensive patients who engaged in a healthy lifestyle but higher in hypertensive people using antihypertensive drug treatment.
    Journal of hypertension 07/2013; · 4.02 Impact Factor
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    ABSTRACT: Exposure to cold weather increases blood pressure (BP) and may aggravate the symptoms and influence the prognosis of subjects with a diagnosis of hypertension. We tested the hypothesis that subjects with hypertension alone or in combination with another cardiovascular disease (CVD) experience cold-related cardiorespiratory symptoms more commonly than persons without hypertension. This information is relevant for proper treatment and could serve as an indicator for predicting wintertime morbidity and mortality. A self-administered questionnaire inquiring of cold-related symptoms was obtained from 6591 men and women aged 25-74 yrs of the FINRISK Study 2002 population. BP was measured in association with clinical examinations. Symptom prevalence was compared between subjects with diagnosed hypertensive disease with (n = 395) or without (n = 764) another CVD, untreated diagnosed hypertension (n = 1308), measured high BP (n = 1070) and a reference group (n = 2728) with normal BP. Hypertension in combination with another CVD was associated with increased cold-related dyspnoea (men: adjusted odds ratio 3.94, 95% confidence interval 2.57-6.02)/women: 4.41, 2.84-6.86), cough (2.64, 1.62-4.32/4.26, 2.60-6.99), wheezing (2.51, 1.42-4.43/;3.73, 2.08-6.69), mucus excretion (1.90, 1.24-2.91/2.53, 1.54-4.16), chest pain (22.5, 9.81-51.7/17.7, 8.37-37.5) and arrhythmias (43.4, 8.91-211/8.99, 3.99-20.2), compared with the reference group. Both diagnosed treated hypertension and untreated hypertension and measured high BP resulted in increased cardiorespiratory symptoms during the cold season. Hypertension alone and together with another CVD is strongly associated with cold-related cardiorespiratory symptoms. As these symptoms may predict adverse health events, hypertensive patients need customized care and advice on how to cope with cold weather.
    The European Journal of Public Health 06/2013; · 2.52 Impact Factor
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    ABSTRACT: Aims: Socioeconomic health inequalities are partly attributed to different physical activity (PA) patterns. Psychosocial factors interacting with PA are suggested to explain the socioeconomic differences in PA to some extent. The aim of the present study was to examine whether PA self-efficacy, PA social support, and general self-control contribute to the socioeconomic status (SES) differences in leisure time physical activity (LTPA) and in total PA. Methods: The sample consisted of 25-74-year-old Finnish men (n = 2325) and women (n = 2699), who participated in the cross-sectional FINRISK Study in 2007. Physical activity was measured as total PA (MET-h/week) and as LTPA (inactive/active). A psychosocial factor questionnaire included scales measuring PA self-efficacy, PA social support, and general self-control. SES was defined by household gross income and years of education. Results: Both higher education and income were associated with higher levels of LTPA, whereas total PA was higher among those with lower SES. Subjects with high SES reported higher levels of PA self-efficacy and PA social support, but general self-control correlated only with higher income. PA self-efficacy, PA social support and general self-control had positive associations with both LTPA and total PA. These psychosocial factors partly explained the SES differences in LTPA, but not in total PA. Conclusions: Future intervention studies should examine whether, by influencing PA self-efficacy, PA social support, and general self-control, it is possible to diminish the SES differences in PA.
    Scandinavian Journal of Public Health 03/2013; · 1.97 Impact Factor
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    ABSTRACT: OBJECTIVE: To assess long-term, cause-specific mortality rates and rate ratios of the patients alive at 1 year after subarachnoid hemorrhage (SAH). METHODS: The population-based, prospective, cohort study with a nested case-control design consisted of 64,349 persons (aged 25-74 years at enrollment) who participated in the National FINRISK Study between 1972 and 2007. Four hundred thirty-seven SAH cases, 233 one-year SAH survivors, and their matched intrinsic controls were identified and followed up until the end of 2009 through the nationwide Finnish Causes of Death Register. All-cause mortality rates and rate ratios of the 1-year SAH survivors and controls were the main outcome measures. RESULTS: Eighty-eight (37.8%) of 233 one-year SAH survivors died during the total follow-up time of 2,487 person-years (median 8.6 years, range 0.1-35.8 years). The 1-year SAH survivors had a hazard ratio of 1.96 (95% confidence interval 1.57-2.47) for death compared with the matched general population with 10 controls for each SAH survivor. One-year SAH survivors had up to 31 additional deaths per 1,000 person-years compared with controls with minimal cerebrovascular risk factors. The higher long-term risk of death among SAH survivors was attributed solely to cerebrovascular diseases, and most important modifiable risk factors for death were smoking, high systolic blood pressure (≥159 mm Hg), and high cholesterol levels (≥7.07 mmol/L). CONCLUSION: One-year SAH survivors have excess mortality, which is attributed to an exceptional risk of deadly cerebrovascular events. Aggressive post-SAH cerebrovascular risk factor intervention strategies are highly warranted.
    Neurology 01/2013; · 8.25 Impact Factor
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    ABSTRACT: Prospective studies on the risk factors for subarachnoid hemorrhage (SAH) are limited. Moreover, the effect of risk factors on the incidence rates of SAH is not well known about. In this study, we aimed to identify risk factors for SAH and characterize subgroups in a population with a high incidence of SAH. After recording multiple potential risk factors for SAH at the time of enrolment, first ever SAH events between 1972 and 2009 were recorded through the nationwide Causes of Death Register and Hospital Discharge Register for the population-based cohort of 64 349 participants, who participated in the National FINRISK Study between 1972 and 2007 in Finland. During the follow-up time of 1.26 million person-years (median 17.9 years, range 0 to 37.9 years), 437 persons experienced fatal or non-fatal SAH. Crude SAH incidence was 34.8 (95% confidence interval: 31.7-38.2) per 100 000 person-years among ≥25-year-old persons. Female sex, high blood pressure values and current smoking were confirmed as risk factors for SAH. Previous myocardial infarction, history of premature stroke (any kind) in mother and elevated cholesterol levels in men were identified as new risk factors for SAH. Depending on the combination of risk factors, SAH incidence varied between 8 and 171 per 100 000 person-years. New and previously reported risk factors appear to have a much stronger association with the incidence of SAH than is ordinarily seen in cardiovascular diseases. Risk factor assessments may facilitate the identification of high-risk persons who should be the focus of preventive interventions.
    PLoS ONE 01/2013; 8(9):e73760. · 3.73 Impact Factor
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    ABSTRACT: OBJECTIVES: To evaluate the association of serum γ-glutamyltransferase (GGT) levels with heart failure (HF) risk in the Finnish population. DESIGN: Prospective population-based cohort study. SETTING: The present study, which is a part of FINRISK study, was carried out in Finland.Subject study cohorts included 18 353 Finnish men and 19 726 women who were 25-74 years of age and free of HF at baseline.Main outcome measures HF (636 men and 445 women) during a mean follow-up of 14.5 years. RESULTS: Baseline measurement of different levels of serum GGT was used to predict incident HF. The multivariable-adjusted (age, sex, study area, study year, smoking, education, alcohol consumption, physical activity, valvular heart disease, body mass index (BMI), systolic blood pressure, total cholesterol at baseline, myocardial infarction and diabetes at baseline and during follow-up) HRs of HF at five GGT groups (using the 25th, 50th, 75th and 90th percentiles) were 1.00, 1.16 (95% CI: 0.97 to 1.38), 1.20 (1.00 to 1.45), 1.29 (1.04 to 1.60) and 1.82 (1.45 to 2.29) (P(trend)<0.001). Stratification by smoking status, alcohol consumption and BMI gave similar results, while stronger association was observed among subjects aged <60 years (P(trend)=0.001) compared with subjects 60+ years of age (P(trend)=0.173). CONCLUSIONS: Moderate to high levels of serum GGT (from the 50th to the 90th percentiles) were significantly associated with incident HF in men and women in Finland, and the predictive power was stronger in subjects aged <60 years.
    Heart (British Cardiac Society) 11/2012; · 5.01 Impact Factor
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    ABSTRACT: Only few prospective studies have examined the association between coffee consumption and risk of gastric and pancreatic cancer. This study is designed to evaluate this relationship among Finns, whose coffee consumption is the highest in the world. A total of 60,041 Finnish men and women who were 26-74 years of age and without history of any cancer at baseline were included in the present analyses. Coffee consumption and other study parameters were determined at baseline using standardized measurements. Participants were prospectively followed up for onset of gastric and/or pancreatic cancer, emigration, death or until June 30, 2006. During a mean follow-up period of 18 years, 299 cases of gastric cancer and 235 cases of pancreatic cancer were found. There was a nonsignificant inverse association between coffee consumption and risk of gastric cancer among men but not in the women. The multivariate-adjusted hazard ratio of stomach and pancreatic cancer incidence for ≥10 cups of coffee per day compared with nondrinkers were 0.75 (95% CI, 0.40-1.41) (P for trend = 0.19) and 0.82 (95% CI, 0.38-1.76) (P for trend = 0.95) for the combined population of men and women, respectively. We did not find a significant association between coffee consumption and the risk of gastric and/or pancreatic cancers.
    International Journal of Cancer 08/2012; · 6.20 Impact Factor
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    ABSTRACT: The joint relationship between healthy lifestyle and antihypertensive treatment with stroke risk is unclear. We prospectively investigated the individual and joint effects of healthy lifestyle factors and antihypertensive treatment on stroke risk among 36 686 Finnish participants aged 25 to 74 years and free of coronary heart disease and stroke at baseline. During a mean follow-up of 13.7 years, 1478 people developed stroke event (1167 ischemic and 311 hemorrhagic). The stroke risk was significantly decreased in people who adhered to ≥3 healthy lifestyle factors (never smoking, normal weight, moderate/high level of exercise, vegetable consumption ≥3 times per week, and light/moderate alcohol drinking) compared with those who adhered to <3 healthy lifestyle factors. The stroke risk was significantly increased in unaware untreated, aware untreated, aware treated and controlled, and aware treated and uncontrolled hypertensive people than in normotensive people. The risks of stroke were decreased in people who adhered to ≥3 healthy lifestyle factors compared with those who adhered to <3 healthy lifestyle factors within different hypertensive status. Compared with hypertensive people who did not use antihypertensive drugs and adhered to ≥3 healthy lifestyle factors, the multivariable-adjusted hazard ratios in hypertensive people who used antihypertensive drugs and adhered to <3 healthy lifestyle factors were associated with 37% to 42% increased risks of total, ischemic, and hemorrhagic stroke in men and 121% to 131% increased risks of stroke in women. The present study demonstrates that a healthy lifestyle significantly decreases stroke risk in both men and women in different strata of hypertension status and antihypertensive drug treatments.
    Hypertension 08/2012; 60(4):906-12. · 6.87 Impact Factor
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    ABSTRACT: Recent studies have shown an association between cigarettes per day (CPD) and a nonsynonymous single-nucleotide polymorphism in CHRNA5, rs16969968. To determine whether the association between rs16969968 and smoking is modified by age at onset of regular smoking. Primary data. Available genetic studies containing measures of CPD and the genotype of rs16969968 or its proxy. Uniform statistical analysis scripts were run locally. Starting with 94,050 ever-smokers from 43 studies, we extracted the heavy smokers (CPD >20) and light smokers (CPD ≤10) with age-at-onset information, reducing the sample size to 33,348. Each study was stratified into early-onset smokers (age at onset ≤16 years) and late-onset smokers (age at onset >16 years), and a logistic regression of heavy vs light smoking with the rs16969968 genotype was computed for each stratum. Meta-analysis was performed within each age-at-onset stratum. Individuals with 1 risk allele at rs16969968 who were early-onset smokers were significantly more likely to be heavy smokers in adulthood (odds ratio [OR] = 1.45; 95% CI, 1.36-1.55; n = 13,843) than were carriers of the risk allele who were late-onset smokers (OR = 1.27; 95% CI, 1.21-1.33, n = 19,505) (P = .01). These results highlight an increased genetic vulnerability to smoking in early-onset smokers.
    Archives of general psychiatry 08/2012; 69(8):854-60. · 12.26 Impact Factor
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    ABSTRACT: The association of total and high-density lipoprotein (HDL) cholesterol with stroke risk is unclear, especially regarding hemorrhagic stroke. We prospectively investigated the associations of serum total and HDL cholesterol and total/HDL cholesterol ratio with total and type-specific stroke incidence among 58,235 Finnish people aged 25 to 74 years and free of coronary heart disease and stroke at baseline. During a mean follow-up period of 20.1 years, 3914 participants developed stroke events (3085 ischemic, 497 intracerebral hemorrhage, and 332 subarachnoid hemorrhage). The multivariable-adjusted hazard ratios at different levels of total cholesterol (<5 [reference], 5-5.9, 6-6.0, ≥7.0 mmol/L) were 1.00, 1.05, 1.16, and 1.22 for total stroke (Ptrend=0.036) and 1.00, 1.06, 1.19, and 1.27 for ischemic stroke (Ptrend=0.02) in men and 1.00, 0.58, 0.61, and 0.50 for intracerebral hemorrhagic stroke (Ptrend=0.02) in women, respectively. Low levels of HDL cholesterol and high total/HDL cholesterol ratio were associated with increased risks of total and ischemic stroke in both men and women. These associations disappeared in men but remained significant in women after further adjustment for body mass index, blood pressure, and history of diabetes. The study showed a positive association between total cholesterol and total and ischemic stroke risks in men and an inverse association between total cholesterol and intrahemorrhagic stroke risk in women. The inverse association of HDL cholesterol and a positive association of total/HDL cholesterol ratio with total and ischemic stroke risks were found in men and women. These associations attenuated after adjustment for body mass index, blood pressure, and history of diabetes.
    Stroke 04/2012; 43(7):1768-74. · 6.16 Impact Factor

Publication Stats

12k Citations
1,774.98 Total Impact Points


  • 2009–2013
    • National Institute for Health and Welfare, Finland
      • Department of Chronic Disease Prevention
      Helsinki, Southern Finland Province, Finland
  • 2012
    • Xi'an Jiaotong University
      Ch’ang-an, Shaanxi, China
    • Louisiana State University
      Baton Rouge, Louisiana, United States
  • 2010–2012
    • Pennington Biomedical Research Center
      • Chronic Disease Epidemiology Laboratory
      Baton Rouge, Louisiana, United States
    • Massachusetts General Hospital
      • Division of Gastroenterology
      Boston, Massachusetts, United States
    • University Hospital Regensburg
      Ratisbon, Bavaria, Germany
    • The Walter and Eliza Hall Institute of Medical Research
      • Division of Immunology
      Melbourne, Victoria, Australia
    • Wellcome Trust Sanger Institute
      Cambridge, England, United Kingdom
    • Turku University Hospital
      Turku, Province of Western Finland, Finland
  • 2001–2012
    • University of Helsinki
      • • Department of Dental Public Health
      • • Institute of Dentistry
      Helsinki, Southern Finland Province, Finland
  • 2011
    • Karolinska Institutet
      • Aging Research Center - ARC
      Solna, Stockholm, Sweden
  • 2009–2011
    • The Adelaide and Meath Hospital Ireland
      Dublin, Leinster, Ireland
  • 2007–2011
    • Kuopio University Hospital
      • • Department of Medicine
      • • Department of Internal Medicine
      Kuopio, Eastern Finland Province, Finland
  • 1994–2009
    • National Public Health Institute
      Helsinki, Southern Finland Province, Finland
  • 2007–2008
    • University of Tampere
      Tammerfors, Province of Western Finland, Finland
  • 2003–2007
    • Ministry of Health, Sultanate of Oman
      Masqaţ, Masqaţ, Oman
    • University of Turku
      • MediCity Research Laboratory
      Turku, Western Finland, Finland
    • University of Minnesota Twin Cities
      • School of Public Health
      Minneapolis, MN, United States
    • Royal College of Surgeons in Ireland
      • Department of Epidemiology and Public Health Medicine
      Dublin, L, Ireland
  • 2006
    • Merck
      Whitehouse Station, New Jersey, United States
    • Kyungpook National University
      • Department of Preventive Medicine
      Daikyū, Daegu, South Korea
  • 2003–2004
    • Helsinki University Central Hospital
      • Skin and Allergy Hospital
      Helsinki, Southern Finland Province, Finland
  • 2000–2002
    • University of Kuopio
      • Department of Public Health and General Practice
      Kuopio, Eastern Finland Province, Finland
  • 1999–2000
    • University of Oulu
      Uleoborg, Oulu, Finland