Jukka Kontto

• M.Soc.Sc.
• Finnish Institute for Health and Welfare

Aims: To compare the attitudes towards gambling in Finland by age among women and men from 2011 to 2023. Methods: Four cross-sectional random sample data sets of 15–74-year-olds were collected in 2011, 2015, 2019 and 2023. The data were weighted based on gender, age and residential area. The eight-item Attitude Towards Gambling Scale (ATGS-8) was u...

Lower-risk Gambling Guidelines (LRGGs) were developed in Canada to reduce the risk of gambling-related harm. The LRGGs, published in 2021, consist of three limits: gamble no more than 1% of household income per month; gamble no more than four days per month; and avoid regularly gambling at more than two types of games. All three limits should be fo...

Background and aims This is the first nation‐wide register study based on a total population sample measuring the gender‐specific incidences of chronic diseases and conditions among adults diagnosed with gambling disorder (GD). Design, setting and participants The study used aggregated data for 2011–22 retrieved from the Register of Primary Health...

Aims: To examine age-group and birth-cohort trends in perceived work ability in Finland in 2000–2020 and make projections of perceived work ability up to 2040 based on the observed birth-cohort development. Methods: Ten population-representative cross-sectional surveys conducted in Finland between 2000 and 2020 were used (overall N = 61,087, range...

Background Population in Europe and throughout the world is ageing rapidly. Projections of the work ability of the working-age population are of importance for policy makers to prepare for future challenges. The aim of this study is to examine age-group and birth-cohort trends in perceived work ability in Finland in 2000-2020 and make projections o...

Background Projections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of mobility limitations among older people in the United States, England, and Finland. Methods We applied multiple imputation modelling with bootstrapping to generate proje...

The aim of this study was to examine the relationship between socio-demographic factors, gambling behaviour, and the level of gambling expenditure. The data were drawn from the population-based Gambling Harms Survey 2016 and 2017 conducted in Finland. The data were linked to register-based variables. Past-year gamblers were included (Wave 1; n = 5...

A Correction to this paper has been published: https://doi.org/10.1038/s41588-021-00832-z.

Aims There is inconsistent evidence on the relation of alcohol intake with incident atrial fibrillation (AF), in particular at lower doses. We assessed the association between alcohol consumption, biomarkers, and incident AF across the spectrum of alcohol intake in European cohorts. Methods and results In a community-based pooled cohort, we foll...

Genetic studies of blood pressure (BP) to date have mainly analyzed common variants (minor allele frequency > 0.05). In a meta-analysis of up to ~1.3 million participants, we discovered 106 new BP-associated genomic regions and 87 rare (minor allele frequency ≤ 0.01) variant BP associations (P < 5 × 10⁻⁸), of which 32 were in new BP-associated loci...

Genetic studies of blood pressure (BP) to date have mainly analyzed common variants (minor allele frequency > 0.05). In a meta-analysis of up to ~1.3 million participants, we discovered 106 new BP-associated genomic regions and 87 rare (minor allele frequency ≤ 0.01) variant BP associations (P < 5 × 10−8), of which 32 were in new BP-associated loci...

Background: Gastric cancer is the world's third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia assessment (OLGIM), have been developed to detect h...

Understanding on sociodemographic variation of the co-occurrence of cardiovascular disease risk factors is crucial for planning future prevention strategies. We aimed at examining (1) the co-occurrence of smoking, obesity, hypertension and elevated serum cholesterol by education and marital status, and (2) its trends in different sociodemographic g...

Background Differences in risk factors for atrial fibrillation (AF) and heart failure (HF) are incompletely understood. Aim of this study was to understand whether risk factors and biomarkers show different associations with incident AF and HF and to investigate predictors of subsequent onset and mortality. Methods and Results In N=58 693 individu...

The Reference Values for Arterial Stiffness Collaboration has derived an equation using age and mean blood pressure to estimated pulse wave velocity (ePWV), which predicted cardiovascular events independently of Systematic COoronary Risk Evaluation (SCORE) and Framingham Risk Score. The study aim was to investigate the independent association betwe...

Objectives The aims of this study were to characterize the association of high-sensitivity cardiac troponin I (hs-cTnI) with heart failure (HF), to determine its predictive value beyond classical cardiovascular risk factors (CVRFs) and N-terminal pro–B-type natriuretic peptide, and to derive a relevant cutoff for potential clinical application. Ba...

Background: The relevance of blood lipid concentrations to long-term incidence of cardiovascular disease and the relevance of lipid-lowering therapy for cardiovascular disease outcomes is unclear. We investigated the cardiovascular disease risk associated with the full spectrum of bloodstream non-HDL cholesterol concentrations. We also created an...

Aims: Limited evidence is available on the temporal relationship between atrial fibrillation (AF) and ischaemic stroke and their impact on mortality in the community. We sought to understand the temporal relationship of AF and ischaemic stroke and to determine the sequence of disease onset in relation to mortality. Methods and results: Across fi...

Background Understanding on sociodemographic variation of the co-occurrence of cardiovascular disease (CVD) risk factors is crucial for planning public health policy and future prevention strategies. We aimed at examining 1) the co-occurrence of smoking, hypertension, elevated cholesterol and obesity by education, and 2) the trends in educational d...

Importance Risk stratification for coronary heart disease (CHD) remains challenging because of the complex causative mechanism of the disease. Metabolomic profiling offers the potential to detect new biomarkers and improve CHD risk assessment. Objective To evaluate the association between circulating metabolites and incident CHD in a large Europea...

Background Although atrial fibrillation (AF) and heart failure (HF) have a similar cardiovascular risk profile, the differential associations of the risk factors with both disease are incompletely understood. Aim The aim of this study was to understand whether common clinical risk factors and cardiovascular biomarkers show different associations w...

Aims Heart failure (HF) is an increasingly important contributor to the overall burden of cardiovascular disease in the population. We aimed to determine the distribution of the cardiac biomarkers high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations across the European popul...

Aims: Population-based gambling surveys provide important information about gambling frequency, problems, attitude and opinions of the general population. This information can be used by social and health care professionals, service providers and policy makers. However, low response rates may cause biased findings. The aim was to define the profil...

The insulin-like growth factor (IGF) axis may be involved in the development of type 2 diabetes. We examined the associations of IGF-I and IGF binding proteins (IGFBP)-1 and -3 with diabetes risk and evaluated macronutrient intakes related to the observed associations. In a nested case–control study of the Alpha-Tocopherol, Beta-Carotene Cancer Pre...

Objectives: The aim of this study was to evaluate long-term gastric cancer risk in male smokers with and without atrophic gastritis. Materials and methods: A total of 22,346 elderly male smokers participated in the Helsinki Gastritis Study between the years 1989 and 1993. Serum pepsinogen I (PGI) was measured for the men, and 2,132 men with low PGI...

Smoking is a major heritable and modifiable risk factor for many diseases, including cancer, common respiratory disorders and cardiovascular diseases. Fourteen genetic loci have previously been associated with smoking behaviour-related traits. We tested up to 235,116 single nucleotide variants (SNVs) on the exome-array for association with smoking...

Background: Excessive expenditure and financial harms are core features of problem gambling. There are various forms of gambling and their nature varies. The aim was to measure gambling expenditure by game type while controlling for demographics and other gambling participation factors. A further aim was to find out how each game type was associat...

Understanding of the harmfulness of game types is needed when planning harm minimization and prevention strategies. Adult data (N = 3555) from the Finnish Gambling 2015 survey was used to investigate the associations between different game types and gambling-related harms. A negative binomial regression model was used to analyse the effects of demo...

Aims: Factors that contribute to the development of overweight are numerous and form a complex structure with many unknown interactions and associations. We aimed to explore this structure (i.e. the mutual importance or hierarchy of sociodemographic and lifestyle-related risk factors of being overweight) using a machine-learning technique called r...

Suomalaisten rahapelikulutusta ja haittoja on tutkittu niukasti, vaikka suomalaiset pelaavat väestöpohjaan suhteutettuna eniten Euroopassa. Runsaaseen rahapelaamiseen liittyy rahapelihaittoja. Tämän tutkimuksen tarkoituksena on tarkastella rahapelikulutusta, sosiodemogra sia taustatekijöitä, koettua terveydentilaa ja rahapelaamista suomalaisessa vä...

Aims: To investigate gambling expenditure and its relationship with socio-demographics, health-related correlates and past-year gambling behaviour. Design: Cross-sectional population survey. Setting: Population-based survey in Finland. Participants: Finnish people aged 15-74 years randomly drawn from the Population Information System. The pa...

Aims: As promising compounds to lower Lipoprotein(a) (Lp(a)) are emerging, the need for a precise characterization and comparability of the Lp(a)-associated cardiovascular risk is increasing. Therefore, we aimed to evaluate the distribution of Lp(a) concentrations across the European population, to characterize the association with cardiovascular...

Objective: To examine the association between chronotype and timing of energy and macronutrient intakes in adults. Methods: The study sample included 1,854 participants from the National FINRISK 2007 and FINDIET 2007 studies, aged 25 to 74 years. Diet was assessed with 48-hour dietary recalls. Chronotype was assessed with a shortened version of...

\textbf{Aims}$ Darapladib, a potent inhibitor of lipoprotein-associated phospholipase A$_{2}$ (Lp-PLA$_{2}$), has not reduced risk of cardiovascular disease outcomes in recent randomized trials. We aimed to test whether Lp-PLA$_{2}$ enzyme activity is causally relevant to coronary heart disease. $\textbf{Methods }$ In 72,657 patients with coronary...

Background: Genome-wide association studies have so far identified 56 loci associated with risk of coronary artery disease (CAD). Many CAD loci show pleiotropy; that is, they are also associated with other diseases or traits. Objectives: This study sought to systematically test if genetic variants identified for non-CAD diseases/traits also associa...

Height is a highly heritable, classic polygenic trait with approximately 700 common associated variants identified through genome-wide association studies so far. Here, we report 83 height-associated coding variants with lower minor-allele frequencies (in the range of 0.1–4.8%) and effects of up to 2 centimetres per allele (such as those in IHH, ST...

Background Genome-wide association studies have so far identified 56 loci associated with risk of coronary artery disease (CAD). Many CAD loci show pleiotropy; that is, they are also associated with other diseases or traits. Objectives This study sought to systematically test if genetic variants identified for non-CAD diseases/traits also associat...

BACKGROUND: Healthy dietary patterns that conform to national dietary guidelines are related to lower chronic disease incidence and longer life span. However, the precise mechanisms involved are unclear. Identifying biomarkers of dietary patterns may provide tools to validate diet quality measurement and determine underlying metabolic pathways infl...

Aims: Darapladib, a potent inhibitor of lipoprotein-associated phospholipase A2 (Lp-PLA2), has not reduced risk of cardiovascular disease outcomes in recent randomized trials. We aimed to test whether Lp-PLA2 enzyme activity is causally relevant to coronary heart disease. Methods: In 72,657 patients with coronary heart disease and 110,218 contro...

High blood pressure is a major risk factor for cardiovascular disease and premature death. However, there is limited knowledge on specific causal genes and pathways. To better understand the genetics of blood pressure, we genotyped 242,296 rare, low-frequency and common genetic variants in up to 192,763 individuals and used ~155,063 samples for ind...

High blood pressure is a major risk factor for cardiovascular disease and premature death. However, there is limited knowledge on specific causal genes and pathways. To better understand the genetics of blood pressure, we genotyped 242,296 rare, low-frequency and common genetic variants in up to 192,763 individuals and used ∼155,063 samples for ind...

Regulatory authorities have indicated that new drugs to treat type 2 diabetes (T2D) should not be associated with an unacceptable increase in cardiovascular risk. Human genetics may be able to guide development of antidiabetic therapies by predicting cardiovascular and other health endpoints. We therefore investigated the association of variants in...

Regulatory authorities have indicated that new drugs to treat type 2 diabetes (T2D) should not be associated with an unacceptable increase in cardiovascular risk. Human genetics may be able to guide development of antidiabetic therapies by predicting cardiovascular and other health endpoints. We therefore investigated the association of variants in...

Aims Our aims were to evaluate the distribution of troponin I concentrations in population cohorts across Europe, to characterize the association with cardiovascular outcomes, to determine the predictive value beyond the variables used in the ESC SCORE, to test a potentially clinically relevant cut-off value, and to evaluate the improved eligibilit...

Polymorphisms in the nicotinic acetylcholine receptor gene (CHRNA5/CHRNA3 locus) have been associated with several smoking related traits such as nicotine dependence, cigarette consumption, smoking cessation, lung cancer, and COPD. The aim of this candidate gene study was to study the locus among the Finnish COPD patients and long-term smokers with...

High blood pressure is a major risk factor for cardiovascular disease and premature death. However, there is limited knowledge on specific causal genes and pathways. To better understand the genetics of blood pressure, we genotyped 242,296 rare, low-frequency and common genetic variants in up to ~192,000 individuals, and used ~155,063 samples for i...

Introduction: Alcohol is the second most energy-dense macronutrient and it is metabolized very effectively. The previous results, however, do not conclusively confirm a positive association between alcohol consumption and BMI. In several studies, moderate alcohol consumers have shown lower BMI than abstainers, despite their higher daily energy inta...

In the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study among 29,133 Finnish male smokers aged 50-69 years, daily α-tocopherol (50 mg) for a median of 6.1 years decreased the risk of prostate cancer, whereas β-carotene (20 mg) increased risk of lung cancer and overall mortality. To determine the postintervention effects of α-tocopherol and β...

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...

We have examined the associations between dietary glycaemic index (GI), substitutions of total, low-, medium- and high-GI carbohydrates for fat and the risk of CHD. The study consisted of 21 955 male smokers, aged 50-69 years, within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The diet was assessed at baseline using a validated FFQ...

Objective: Recently, the general public opinion is that nutritional recommendations promote obesity rather than prevent it. We created the Recommended Finnish Diet Score (RFDS) that illustrates the Finnish nutrition recommendations and assessed whether this score is associated with BMI, waist circumference (WC) and body fat percentage (BF%). Desi...

More accurate coronary heart disease (CHD) prediction, specifically in middle-aged men, is needed to reduce the burden of disease more effectively. We hypothesised that a multilocus genetic risk score could refine CHD prediction beyond classic risk scores and obtain more precise risk estimates using a prospective cohort design. Using data from nine...

β coefficients for each genetic risk score. HAGTG and HGGTC refer to LPA haplotypes. (DOCX)

Association between SNPs and coronary heart disease. Univariate associations of the SNPs were tested with Cox proportional hazards model adjusted for sex, area/cohort. We investigated the model fit with alternative models of effect (dominant, additive, recessive) operating at each locus. (DOCX)

Haplotypes reported by ref 20 covering the gene region SLC22A3, LPAL2, LPA and their association with CHD in MORGAM. While the association analysis conditioned on a different set of alleles in MORGAM, these combinations are consistent with those reported in the ref which are given here for comparison. The association was tested with Cox proportiona...

Net reclassification tables for comparison of a baseline model including Framingham coefficients and area to a model including genetic risk scores (GRS1, GRS2 and GRS3 respectively) and the baseline model. Numbers are estimated from a model originally based on 10 year predicted risk on the basis of FRS score, accounting for case-cohort weighting an...

Ten year risk of CHD in the population is calculated for a baseline model adjusted for area for 1736 cases and 3082 non-cases related back to the full cohort. Ten year risk with modified risk of each risk factor is calculated by bringing those with above average risk factor values to the population mean and calculating the difference to estimate th...

Net reclassification results for the comparison of a baseline model including Framingham coefficients and area to a model including genetic risk scores (GRS1 including the MRAS SNP and the baseline model. Genetic risk scores have been derived in all men and men aged 50–59 years at baseline. (DOCX)

(DOCX)

Background characteristics of the nine cohorts given for cases and non-cases. Data are mean (SD) or number %. NA = not available. As ATBC and MONICA-KORA did not collect information on current drug therapy, these were considered as ‘no medication’ for the analysis. (DOCX)

Average correlations between SNPs are calculated across the different centres weighted by the subcohort size (N = 3390). (DOCX)

Definitions of self reported family history of CHD/MI used in the MORGAM cohorts. (DOCX)

Net reclassification results for the comparison of a baseline model including Framingham coefficients and area to a model including genetic risk scores (GRS1, GRS2 and GRS3 respectively) and the baseline model. Genetic risk scores have been derived in all men and validated in men aged 50–59 at baseline). (DOCX)

Reclassification results comparing a baseline model including family history (FH); to models including genetic risk scores for all men (627 cases, 1342 non-cases). (DOCX)

We examined the associations between carbohydrate substitutions (total; low-, medium-, high-glycemic index (GI) carbohydrates) for fat or protein and risk of type 2 diabetes. The cohort comprised 25,943 male smokers among whom 1098 diabetes cases were identified from a national register during a 12-year follow-up. Diet was assessed by a validated f...

A deterministic exposure assessment using the Nusser method that adjusts for within-subject variation and for nuisance effects among Finnish children and adults was carried out. The food consumption data covered 2038 adults (25-74 years old) and 1514 children of 1, 3 and 6 years of age, with the data on foods' acrylamide content obtained from publi...

Oxidative stress may induce insulin resistance in peripheral tissues and impair insulin secretion from pancreatic β-cells. Antioxidants are suggested to decrease the risk of diabetes through reduction of oxidative stress. However, only a few studies exist on dietary antioxidants and the risk of type 2 diabetes. We investigated the association of di...

To assess the association between dietary acrylamide intake and the risk of cancer among male smokers. The study consisted of 27,111 male smokers, aged 50-69 years, without history of cancer. They were participants of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study in Finland. The men completed a validated dietary questionnaire a...

Findings on dietary glycaemic index (GI) and glycaemic load (GL) as risk factors for type 2 diabetes have been controversial. We examined the associations of dietary GI and GL and the associations of substitution of lower-GI carbohydrates for higher-GI carbohydrates with diabetes risk in a cohort of Finnish men. The cohort consisted of 25 943 male...

To determine whether alpha-tocopherol or beta-carotene supplementation affects diabetic macrovascular complications and total mortality. This study was carried out as part of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a double-blind, randomized trial with a 2x2 factorial design. A total of 29,133 middle-aged male smokers received...

Risk of weight change and fluctuation for type 2 diabetes was studied in a prospective study among 20,952 Finnish male smokers aged 50-69 years. Baseline data on lifestyle and medical history were collected, and height and weight measured. Weight was measured thrice after the baseline, 1 year apart. Weight change was defined as the slope of the reg...

Relatively small lifestyle modifications related to weight reduction, physical activity and diet have been shown to decrease the risk of type 2 diabetes. Connected with diet, low consumption of meat has been suggested as a protective factor of diabetes. The aim of the present study was to examine the association between the consumption of total mea...

Consumption of milk and other dairy foods has been associated with reduced risk of stroke, although not all studies have shown this consistently. We examined the association between dairy food intake and risk of stroke subtypes within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Between 1985 and 1988, 26,556 Finnish male smokers age...

There is convincing evidence that a high dietary fiber intake may lower the risk of coronary heart disease. However, the role of fiber in the prevention of stroke is unclear. We examined the associations of dietary fiber and fiber-rich food intake with risk of stroke within the Alpha-tocopherol, Beta-carotene Cancer Prevention Study. Between 1985 a...

Coffee and tea consumption could potentially reduce the risk of stroke because these beverages have antioxidant properties, and coffee may improve insulin sensitivity. We examined the associations of coffee and tea consumption with risk of stroke subtypes. We used prospective data from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a...

The associations of dietary folate, vitamin B(6), vitamin B(12), and methionine intakes with risk of stroke subtypes were examined among 26,556 male Finnish smokers, aged 50-69 years, enrolled in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Dietary intake was assessed at baseline by using a validated food frequency questionnaire. Du...

Type 2 diabetes is associated with reduced antioxidant defence. Only a few human studies have investigated the role of antioxidants in the pathogenesis of diabetes. This study aimed to examine whether alpha-tocopherol or beta-carotene affected the occurrence of type 2 diabetes. In the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study,...

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