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Lohi P, Auvinen A, Niskanen L, Partonen T, Haukka J. Does the duration of diabetes increase the risk of cancer? A nationwide population-based cohort of patients with new-onset diabetes and a matched reference cohort. Int J Cancer 2024; 154:1940-1947. [PMID: 38450737 DOI: 10.1002/ijc.34858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/05/2023] [Accepted: 12/29/2023] [Indexed: 03/08/2024]
Abstract
Diabetes mellitus and cancer are both common health issues, but the correlation between these two diseases remains unclear. We investigated the association of cumulative exposure of diabetes mellitus as an indication of hyperglycemia in terms of disease duration on multiple cancer types. We hypothesized that the risk of cancer would increase over time after the onset of diabetes. The study population consisted of a population-based cohort of 398,708 people and it was constructed from the Finnish CARING project. The Diabetes group consisted of 185,258 individuals, and the non-diabetic reference group comprised 187,921 individuals. Over 4.1 million person-years were accumulated, and the median follow-up time was 10.55 years. In the diabetes group, 25,899 cancer cases were observed compared with 23,900 cancers in the non-diabetic group. We did not find a clear relationship between the duration of diabetes mellitus and most cancer types examined. However, for cancers of the pancreas, prostate gland, bronchus, and lungs, a temporal relationship was found. Furthermore, even within the cancer types where the relationship was detected, it did not change over time. These findings indicate that diabetes does not independently increase the risk of cancer. Instead, the development of diabetes may be attributed to shared risk factors with cancer, such as obesity and/or insulin resistance accompanied by hyperinsulinemia. Thus, it is likely that the clock for increased cancer risk starts ticking already before onset of diabetes and hyperglycemia.
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Affiliation(s)
- Petrus Lohi
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Leo Niskanen
- Department of Endocrinology, Päijät-Häme Central Hospital, Lahti, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Timo Partonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jari Haukka
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Bernhardsen GP, Thomas O, Mäntyselkä P, Niskanen L, Vanhala M, Koponen H, Lehto SM. Metabolites and depressive symptoms: Network- and longitudinal analyses from the Finnish Depression and Metabolic Syndrome in Adults (FDMSA) Study. J Affect Disord 2024; 347:199-209. [PMID: 38000471 DOI: 10.1016/j.jad.2023.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Depression is associated with metabolic abnormalities linked to metabolic syndrome and tissue inflammation, but the interplay between metabolic markers and their association with subsequent depression is unknown. Therefore, we aimed to describe the network of metabolites and their prospective association with depressive symptoms. METHODS The Finnish Depression and Metabolic Syndrome in Adults (FDMSA) cohort, originally a prospective case-control study, comprised a group with Beck Depression Inventory (BDI)-I scores ≥10 at baseline, and controls (n = 319, BDI-I < 10); mean (sd) follow-up time: 7.4 (0.7) years. Serum metabolic biomarkers were determined by proton nuclear magnetic resonance (NMR), and depressive symptoms sum-score by using the BDI-I. We examined the prospective associations between metabolites at baseline and BDI score at follow-up utilizing multivariate linear regression, parsimonious predictions models and network analysis. RESULTS Some metabolites tended to be either negatively (e.g. histidine) or positively associated (e.g. glycoprotein acetylation, creatinine and triglycerides in very large high density lipoproteins [XL-HDL-TG]) with depressive symptoms. None of the associations were significant after correction for multiple testing. The network analysis suggested high correlation among the metabolites, but that none of the metabolites directly influenced subsequent depressive symptoms. LIMITATIONS Although the sample size may be considered satisfactory in a prospective context, we cannot exclude the possibility that our study was underpowered. CONCLUSIONS Our results suggest that the investigated metabolic biomarkers are not a driving force in the development of depressive symptoms. These findings should be confirmed in studies with larger samples and studies that account for the heterogeneity of depressive disorders.
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Affiliation(s)
- Guro Pauck Bernhardsen
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
| | - Owen Thomas
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland; Clinical Research and Trials Centre, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Leo Niskanen
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland; Departments of Internal Medicine, Endocrinology/Diabetology, Päijät-Häme Central Hospital, Lahti, Finland; Eira Medical Center and Hospital, Helsinki, Finland
| | - Mauno Vanhala
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
| | - Hannu Koponen
- Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Soili M Lehto
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry, University of Helsinki, Helsinki, Finland
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Niskanen L, Hannula M, Kysenius K, Kaijala S, Lassenius MI, Valle TT. Trends in clinical characteristics, medication use, and glycemic control in insulin-treated patients with type 1 and type 2 diabetes in Finland in 2012-2019: Nationwide real-world evidence study. J Diabetes 2024. [PMID: 38273701 DOI: 10.1111/1753-0407.13491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 01/27/2024] Open
Abstract
AIMS To describe the clinical characteristics and medication purchases of insulin-treated adults in Finland at index (January 1, 2012 or first insulin purchase) and December 31, 2019. Additionally, to describe basal insulin (BI) treatment patterns and associated changes in hemoglobin A1c (HbA1c) values. MATERIALS AND METHODS In this descriptive study using nationwide registries, we included adults with at least two reimbursed insulin purchases within 12 months of the first purchase between January 1, 2012 and December 31, 2019. We formed four study groups: type 1 diabetes (T1D) and type 2 diabetes (T2D)-diagnosed people who were further divided into prevalent or naïve users (start of insulin use before or after January 1, 2012). Insulin treatment patterns were estimated from medication purchase data and glycemic control from HbA1c results. RESULTS Out of 145 020 people included, 34 359 had T1D and 110 661 T2D. By 2019, in parallel with the adaptation of new noninsulin medications, second-generation basal insulin (BI) analogues were adopted by 45.9% and 21.1% of prevalent T1D and T2D users. At index, HbA1c target (≤53 mmol/mol) was reached by 17% and 35% of T2D naïve and prevalent users, respectively, and by 17% of T1D prevalent users. At study end, the target was reached respectively by 41%, 34%, and 22% of insulin users. Insulin initiation improved and discontinuation worsened glycemic control in T2D, with lesser effects seen after treatment gaps or switches between BIs. CONCLUSIONS Our study showed that glycemic control in insulin users has remained stable or improved between 2012 and 2019 despite aging population and in parallel with introduction of new treatment options, providing valuable insight into Finnish national diabetes care.
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Affiliation(s)
- Leo Niskanen
- Päijät-Häme Central Hospital, Department of Internal Medicine, Lahti, Finland, Eira Hospital, Helsinki Finland and University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland
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Metsärinne K, Pietilä M, Kantola I, K Stenman L, Vesikansa A, Ruokolainen L, Niskanen L. Chronic kidney disease stage is associated with the number of risk factors in type 2 diabetes patients (STages Of NEphropathy in type 2 diabetes and Heart Failure - STONE HF). Prim Care Diabetes 2023; 17:632-638. [PMID: 37891057 DOI: 10.1016/j.pcd.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
AIMS To study the association between risk factors and chronic kidney disease (CKD), and characterize medication use in Finnish primary care type 2 diabetes (T2D) patients. METHODS Data on clinical characteristics, laboratory measurements, and medications were collected from medical records. The primary outcome measure was notable CKD (stage 3-5, eGFR <60 ml/min/1.73 m2) and/or increased albuminuria. The explanatory variables were individual risk factors and risk factor groups based on their number (0-2, 3-4, 5-6, >7). Spearman's rank correlation coefficient and risk ratio analysis were used to analyze the association between the number of risk factors and CKD stage, and between the number of risk factors and notable CKD, respectively. RESULTS Altogether, 1335 patients with T2D in 60 Finnish primary care centers were recruited for this cross-sectional study. Three-quarters of T2D patients had 3 risk factors and 36% had ≥ 5 risk factors. Compared to patients with 0-2 risk factors, patients with 3-4, 5-6, and ≥ 7 risk factors had a 5.5-fold, 9.9-fold, and 15.9-fold risk of notable CKD (p < 0.001), respectively. Heart failure was most strongly associated with notable CKD (risk ratio, 3.7; p < 0.001). CONCLUSIONS Number of risk factors was strongly associated with advanced-stage CKD.
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Affiliation(s)
- Kaj Metsärinne
- Turku University Hospital, Department of Nephrology, Turku, Finland
| | - Mikko Pietilä
- Turku University Hospital, Heart Centre, Turku, Finland
| | - Ilkka Kantola
- Turku University Hospital, Division of Medicine, Turku, Finland
| | | | | | | | - Leo Niskanen
- Päijät-Häme Central Hospital, Department of Internal Medicine, Lahti, Finland; University of Eastern Finland, Institute of Clinical Sciences, Kuopio, Finland
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Loukovaara S, Korhonen A, Niskanen L, Haukka J. Development of diabetic macular oedema shows associations with systemic medication - An epidemiological study. Acta Ophthalmol 2023. [PMID: 37789702 DOI: 10.1111/aos.15778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE To identify associations between systemic drugs and the incidence of diabetic macular oedema (DME). Of interest was to find beneficial and/or deleterious associations of used drugs. METHODS A historic cohort design based on administrative data. Study population consisted of 150 353 individuals with diabetes. Endpoint event was the development of DME (ICD-10 H36.01), censoring events were death or study end December 2017. The follow-up started between 1997 and 2010. The systemic medication consisted of 95 substances. We constructed a nested case-control study design comparing 2630 cases with DME to 13 144 age- and sex-matched controls without DME. Results are reported as odds ratios (ORs) with 95% confidence intervals (CIs) based on conditional logistic regression models. RESULTS Incidence rate for DME was 1.80 per 1000 person-years (95% CI 1.73-1.87). In all, we observed a lower incidence rate of DME in females (IRR 0.57; 95% CI 0.52-0.62) compared to males. Exposure to hormone replacement therapy estradiol (OR 0.42; 0.25-0.68), temazepam (0.23; 0.08-0.62) and allopurinol (0.61; 0.43-0.86) were associated with lower risk of DME, while use of insulin or insulin analogue (3.30; 2.99-3.64), sulfonylureas (1.21; 1.05-1.40), diuretic furosemide (1.90; 1.61-2.24), calcium channel blocker amlodipine (1.53; 1.34-1.75), ACE inhibitors ramipril (1.66; 1.46-1.89) and enalapril (1.38; 1.16-1.64) were associated with an increased risk of DME. CONCLUSIONS Large-scale studies examining the incidence of DME are lacking. Our findings suggest that associations of systemic medications with the incidence of DME may shed light on the pathogenesis of complex DME, encouraging further studies.
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Affiliation(s)
- Sirpa Loukovaara
- Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland
- Unit of Vitreoretinal Surgery, Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Ani Korhonen
- Individualized Drug Therapy Research Program, University of Helsinki, Helsinki, Finland
| | - Leo Niskanen
- Päijät-Häme Central Hospital, Lahti and Eira Hospital, Helsinki Finland and University of Eastern Finland, Kuopio, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Ould Setti M, Voutilainen A, Niskanen L, Tuomainen TP. The association between renal hyperfiltration and mortality is not mediated by diabetes mellitus. Int Urol Nephrol 2023; 55:2639-2645. [PMID: 36952107 PMCID: PMC10499930 DOI: 10.1007/s11255-023-03562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Renal hyperfiltration (RHF), recently established as a risk factor for mortality, is linked to current and subsequent diabetes mellitus (DM). DM could be seen as a mediator in the pathway between RHF and mortality. However, the mediating role of DM in the relationship between RHF and mortality is unclear. METHODS AND RESULTS Based on a cohort of 2682 Finnish men from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) followed-up for 35 years, we evaluated the association between RHF and mortality, with DM as a mediator, following two methods: a classic mediation analysis approach, using Cox regression, and a counterfactual framework for mediation analysis, using g-computation, Cox regression, and logistic regression. RHF is associated with an increased risk of mortality. This association was not mediated by DM. Under a counterfactual framework and on a hazard ratio scale, RHF association with mortality had a total effect of 1.54 (95% confidence interval, 1.26-1.98) and a controlled direct effect of 1.66 (1.34-2.16). CONCLUSION An association between RHF and mortality risk, independent of DM, was established. RHF should be considered, managed, and followed-up as a mortality-associated condition, regardless of the status of DM. We suggest clinicians to consider including RHF screening in routine clinical care, especially diabetic care.
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Affiliation(s)
- Mounir Ould Setti
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1., 70210, Kuopio, Finland.
- Global Database Studies, IQVIA, Espoo, Finland.
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1., 70210, Kuopio, Finland
| | - Leo Niskanen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Yliopistonranta 1., 70210, Kuopio, Finland
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Teppo K, Kouki E, Salmela B, Niskanen L, Jaakkola J, Halminen O, Haukka J, Putaala J, Linna M, Mustonen P, Hartikainen J, Juhani Airaksinen KE, Lehto M. Trends and burden of diabetes in patients with atrial fibrillation during 2007-2018: A Finnish nationwide cohort study. Diabetes Res Clin Pract 2023; 203:110875. [PMID: 37582425 DOI: 10.1016/j.diabres.2023.110875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023]
Abstract
AIMS We assessed the temporal trends in the prevalence of diabetes and in its associations with outcomes among patients with atrial fibrillation (AF). METHODS The registry-based FinACAF study covered all patients with incident AF in Finland between 2007 and 2018. Ischemic stroke (IS) and mortality rates were computed using Poisson regression model. RESULTS We identified 229565 patients (50.0% female; mean age 72.7 years; mean follow-up 4.0 years) patients with incident AF. The prevalence of diabetes increased steadily from 15.5% in 2007 to 26.3% in 2018. A decrease in IS and mortality rates was observed during the study period both in patients with and without diabetes. Diabetes was associated with IS and mortality (adjusted incidence rate ratios with 95% confidence intervals 1.22 (1.17-1.26) and 1.32 (1.29-1.34), respectively). The impact of diabetes on IS risk remained stable, while its effect on mortality increased slightly during the observation period. CONCLUSIONS The prevalence of diabetes has increased considerably among patients with AF between 2007 and 2018. There have been substantial improvements in the prognosis of AF patients with diabetes. However, diabetes remains a significant risk factor for IS and mortality in this patient population.
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Affiliation(s)
- Konsta Teppo
- Turku University Hospital and University of Turku, Turku, Finland.
| | - Elis Kouki
- University of Helsinki, Helsinki, Finland
| | - Birgitta Salmela
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Leo Niskanen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland; University of Eastern Finland, Kuopio, Finland
| | - Jussi Jaakkola
- Turku University Hospital and University of Turku, Turku, Finland
| | | | | | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Miika Linna
- Aalto University, Espoo, Finland; University of Eastern Finland, Kuopio, Finland
| | - Pirjo Mustonen
- Turku University Hospital and University of Turku, Turku, Finland
| | | | | | - Mika Lehto
- Jorvi Hospital, Department of Internal Medicine, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Vistisen D, Carstensen B, Elisabetta P, Lanzinger S, Tan ECH, Yabe D, Kim DJ, Sheu WHH, Melzer-Cohen C, Holl RW, Núñez J, Ha KH, Halvorsen S, Langslet G, Karasik A, Nyström T, Niskanen L, Guleria S, Klement R, Carrasco M, Foersch J, Shay C, Koeneman L, Hoti F, Farsani SF, Khunti K, Zaccardi F, Subramanian A, Nirantharakumar K. Empagliflozin is associated with lower cardiovascular risk compared with dipeptidyl peptidase-4 inhibitors in adults with and without cardiovascular disease: EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study results from Europe and Asia. Cardiovasc Diabetol 2023; 22:233. [PMID: 37653496 PMCID: PMC10472675 DOI: 10.1186/s12933-023-01963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Studies that have reported lower risk for cardiovascular outcomes in users of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2i) are limited by residual cofounding and lack of information on prior cardiovascular disease (CVD). This study compared risk of cardiovascular events in patients within routine care settings in Europe and Asia with type 2 diabetes (T2D) initiating empagliflozin compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) stratified by pre-existing CVD and history of heart failure (HF). METHODS AND RESULTS Adults initiating empagliflozin and DPP-4i in 2014-2018/19 from 11 countries in Europe and Asia were compared using propensity score matching and Cox proportional hazards regression to assess differences in rates of primary outcomes: hospitalisation for heart failure (HHF), myocardial infarction (MI), stroke; and secondary outcomes: cardiovascular mortality (CVM), coronary revascularisation procedure, composite outcome including HHF or CVM, and 3-point major adverse cardiovascular events (MACE: MI, stroke and CVM). Country-specific results were meta-analysed and pooled hazard ratios (HR) with 95% confidence intervals (CI) from random-effects models are presented. In total, 85,244 empagliflozin/DPP4i PS-matched patient pairs were included with overall mean follow-up of 0.7 years. Among those with pre-existing CVD, lower risk was observed for HHF (HR 0.74; 95% CI 0.64-0.86), CVM (HR 0.55; 95% CI 0.38-0.80), HHF or CVM (HR 0.57; 95% CI 0.48-0.67) and stroke (HR 0.79; 95% CI 0.67-0.94) in patients initiating empagliflozin vs DPP-4i. Similar patterns were observed among patients without pre-existing CVD and those with and without pre-existing HF. CONCLUSION These results from diverse patient populations in routine care settings across Europe and Asia demonstrate that initiation of empagliflozin compared to DPP-4i results in favourable cardioprotective effects regardless of pre-existing CVD or HF status.
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Affiliation(s)
- Dorte Vistisen
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Patorno Elisabetta
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Stefanie Lanzinger
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Elise Chia-Hui Tan
- Department of Health Service Administration, China Medical University, Taichung, Taiwan
| | - Daisuke Yabe
- Yutaka Seino Distinguished Centre for Diabetes Research, Kansai Electric Power Medical Research Institute, Kobe, Japan
- Department of Diabetes, Metabolism and Endocrinology/Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan
- Center for Healthcare Information Technology, Tokai National Higher Education and Research System, Nagoya, Japan
- Preemptive Food Research Centre, Gifu University Institute for Advanced Study, Gifu, Japan
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Wayne H-H Sheu
- Insititute of Molecular and Genomic Medicine, National Health Research Institutes, Taipei City, Taiwan
| | - Cheli Melzer-Cohen
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - Júlio Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBER Cardiovascular, Valencia, Spain
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway
| | - Gisle Langslet
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - Avraham Karasik
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Thomas Nyström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Leo Niskanen
- Päijät-Häme Joint Authority for Health and Wellbeing, Päijät-Häme Central Hospital, Lahti, Finland
- University of Eastern Finland, Kuopio, Finland
| | | | | | - Marc Carrasco
- Boehringer Ingelheim Pharmaceuticals, Inc., Barcelona, Spain
| | | | - Christina Shay
- Boehringer Ingelheim Pharmaceuticals USA, 00 Ridgebury Road, Ridgefield, CT, 06877, USA.
| | | | | | | | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | | | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
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Karasik A, Lanzinger S, Chia-Hui Tan E, Yabe D, Kim DJ, Sheu WHH, Melzer-Cohen C, Holl RW, Ha KH, Khunti K, Zaccardi F, Subramanian A, Nirantharakumar K, Nyström T, Niskanen L, Linnemann Jensen M, Hoti F, Klement R, Déruaz-Luyet A, Kyaw MH, Koeneman L, Vistisen D, Carstensen B, Halvorsen S, Langslet G, Fazeli Farsani S, Patorno E, Núñez J. Empagliflozin cardiovascular and renal effectiveness and safety compared to dipeptidyl peptidase-4 inhibitors across 11 countries in Europe and Asia: Results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study. Diabetes Metab 2023; 49:101418. [PMID: 36608816 DOI: 10.1016/j.diabet.2022.101418] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Continued expansion of indications for sodium-glucose cotransporter-2 inhibitors increases importance of evaluating cardiovascular and kidney efficacy and safety of empagliflozin in patients with type 2 diabetes compared to similar therapies. METHODS The EMPRISE Europe and Asia study is a non-interventional cohort study using data from 2014-2019 in seven European (Denmark, Finland, Germany, Norway, Spain, Sweden, United Kingdom) and four Asian (Israel, Japan, South Korea, Taiwan) countries. Patients with type 2 diabetes initiating empagliflozin were 1:1 propensity score matched to patients initiating dipeptidyl peptidase-4 inhibitors. Primary endpoints included hospitalization for heart failure, all-cause mortality, myocardial infarction and stroke. Other cardiovascular, renal, and safety outcomes were examined. FINDINGS Among 83,946 matched patient pairs, (0·7 years overall mean follow-up time), initiation of empagliflozin was associated with lower risk of hospitalization for heart failure compared to dipeptidyl peptidase-4 inhibitors (Hazard Ratio 0·70; 95% CI 0.60 to 0.83). Risks of all-cause mortality (0·55; 0·48 to 0·63), stroke (0·82; 0·71 to 0·96), and end-stage renal disease (0·43; 0·30 to 0·63) were lower and risk for myocardial infarction, bone fracture, severe hypoglycemia, and lower-limb amputation were similar between initiators of empagliflozin and dipeptidyl peptidase-4 inhibitors. Initiation of empagliflozin was associated with higher risk for diabetic ketoacidosis (1·97; 1·28 to 3·03) compared to dipeptidyl peptidase-4 inhibitors. Results were consistent across continents and regions. INTERPRETATION Results from this EMPRISE Europe and Asia study complements previous clinical trials and real-world studies by providing further evidence of the beneficial cardiorenal effects and overall safety of empagliflozin compared to dipeptidyl peptidase-4 inhibitors.
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Affiliation(s)
- Avraham Karasik
- Maccabi Institute for Research and Innovation Center, Tel Aviv University, Tel Aviv, Israel
| | - Stefanie Lanzinger
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; German Centre for Diabetes Research (DZD), Neuherberg, München, Germany
| | - Elise Chia-Hui Tan
- Department of Health Service Administration, China Medical University, Taichung, Taiwan
| | - Daisuke Yabe
- Yutaka Seino Distinguished Center for Diabetes Research, Kansai Electric Power Medical Research Institute, Kyoto, Japan; Department of Diabetes, Metabolism and Endocrinology/Department of Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan; Center for Healthcare Information Technology, Tokai National Higher Education and Research System, Nagoya, Japan; Preemptive Food Research Center, Gifu University Institute for Advanced Study, Gifu, Japan
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Wayne H-H Sheu
- Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheli Melzer-Cohen
- Maccabi Institute for Research and Innovation Center, Tel Aviv University, Tel Aviv, Israel
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | | | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Midlands Health Data Research UK, Birmingham, UK; DEMAND Hub, University of Birmingham, Birmingham, UK
| | - Thomas Nyström
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Sweden
| | - Leo Niskanen
- Päijät-Häme Joint Authority for Health and Wellbeing, Päijät-Häme Central Hospital, Lahti Finland and University of Eastern Finland, Kuopio, Finland
| | | | | | | | - Anouk Déruaz-Luyet
- Boehringer Ingelheim International GmbH; Binger Strasse 173, Ingelheim 55216, Germany
| | - Moe H Kyaw
- Boehringer Ingelheim International GmbH, United States
| | | | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway
| | - Gisle Langslet
- Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Júlio Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBER Cardiovascular, Valencia, Spain
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10
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Lahtinen P, Juuti A, Luostarinen M, Niskanen L, Liukkonen T, Tillonen J, Kössi J, Ilvesmäki V, Viljakka M, Satokari R, Arkkila P. Effectiveness of Fecal Microbiota Transplantation for Weight Loss in Patients With Obesity Undergoing Bariatric Surgery: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2247226. [PMID: 36525272 PMCID: PMC9856235 DOI: 10.1001/jamanetworkopen.2022.47226] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Severe obesity is a major health concern. However, a few patients remain resistant to bariatric surgery and other treatments. Animal studies suggest that weight may be altered by fecal microbiota transplantation (FMT) from a lean donor. OBJECTIVE To determine whether FMT from a lean donor reduces body weight and further improves the results of bariatric surgery. DESIGN, SETTING, AND PARTICIPANTS This double-blinded, placebo-controlled, multicenter, randomized clinical trial was conducted in 2018 to 2021 among adult individuals with severe obesity treated at 2 bariatric surgery centers in Finland and included 18 months of follow-up. Patients eligible for bariatric surgery were recruited for the study. Data were analyzed from March 2021 to May 2022. INTERVENTIONS FMT from a lean donor or from the patient (autologous placebo) was administered by gastroscopy into the duodenum. Bariatric surgery was performed 6 months after the baseline intervention using laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG). MAIN OUTCOMES AND MEASURES The main outcome was weight reduction measured as the percentage of total weight loss (TWL). RESULTS Forty-one patients were recruited to participate in the study and were included in the final analysis (29 women [71.1%]; mean [SD] age, 48.7 [8.7] years; mean [SD] body mass index, 42.5 [6.0]). A total of 21 patients received FMT from a lean donor, and 20 received an autologous placebo. Six months after FMT, 34 patients underwent LRYGB and 4 underwent LSG. Thirty-four patients (82.9%) attended the last visit 18 months after the baseline visit. The percentage of TWL at 6 months was 4.8% (95% CI, 2.7% to 7.0%; P < .001) in the FMT group and 4.6% (95% CI, 1.5% to 7.6%; P = .006) in the placebo group, but no difference was observed between the groups. At 18 months from the baseline (ie, 12 months after surgery), the percentage of TWL was 25.3% (95% CI, 19.5 to 31.1; P < .001) in the FMT group and 25.2% (95% CI, 20.2 to 30.3; P < .001) in the placebo group; however, no difference was observed between the groups. CONCLUSIONS AND RELEVANCE FMT did not affect presurgical and postsurgical weight loss. Further studies are needed to elucidate the possible role of FMT in obesity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03391817.
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Affiliation(s)
- Perttu Lahtinen
- Department of Gastroenterology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Anne Juuti
- Department of Gastrointestinal Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Luostarinen
- Department of Gastrointestinal Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Leo Niskanen
- Department of Endocrinology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tarja Liukkonen
- Department of Nutrition, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jyrki Tillonen
- Department of Gastroenterology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Jyrki Kössi
- Department of Gastrointestinal Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Vesa Ilvesmäki
- Department of Endocrinology, Päijät-Häme Central Hospital, Lahti, Finland
| | - Mikko Viljakka
- Department of Gastrointestinal Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Reetta Satokari
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Perttu Arkkila
- Department of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
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11
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Costa R, Tuomainen TP, Virtanen J, Niskanen L, Bertone-Johnson E. Associations of reproductive factors with postmenopausal follicle stimulating hormone. Womens Midlife Health 2022; 8:8. [PMID: 36059005 PMCID: PMC9442942 DOI: 10.1186/s40695-022-00079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/14/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Recent studies have suggested that higher postmenopausal follicle stimulating hormone (FSH) may be associated with lower risk of diabetes. However, relatively little is known about postmenopausal FSH levels, including the level of variation between women and whether reproductive factors are associated with this variation. Methods We assessed the relationship of multiple reproductive factors with FSH levels among 588 postmenopausal women in the Kuopio Ischaemic Heart Disease Risk Factor Study. Participants were aged 53 to 73 years and not using hormone therapy at study enrollment (1998–2001) when reproductive factors were assessed and FSH was measured. Results After adjustment for age, menopause timing, sex steroid levels, adiposity and behavioral factors, we observed numbers of pregnancies and age at first birth were each inversely associated with FSH levels. For example, women with ≥ 3 births and an age at first birth ≥ 25 years had mean FSH levels that were 7.8 IU/L lower than those of women with 1–2 births and an age at first birth ≤ 24 years (P = 0.003). Number of miscarriages was inversely associated with FSH levels (-2.7 IU/L per miscarriage; P = 0.02). Women reporting 4 or more years of past hormone therapy use had significantly higher mean FSH levels than women who had never used hormone therapy (P for trend = 0.006). Conclusion Multiple reproductive factors were associated with postmenopausal FSH, independent of estradiol, adiposity and other confounders. These findings warrant replication and further exploration of potential underlying mechanism.
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Affiliation(s)
- Rebecca Costa
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jyrki Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Leo Niskanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Departments of Internal Medicine, Endocrinology/Diabetology, Päijät-Häme Central Hospital, Lahti, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Elizabeth Bertone-Johnson
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA. .,Department of Health Promotion and Policy, University of Massachusetts, Amherst, MA, USA. .,Arnold House, University of Massachusetts, 715 North Pleasant Street, Amherst, MA, 01003-9304, USA.
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12
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Heikkilä P, Niskanen L, But A, Sorsa T, Haukka J. Oral health associated with incident diabetes but not other chronic diseases: A register-based cohort study. Front Oral Health 2022; 3:956072. [PMID: 36060115 PMCID: PMC9433743 DOI: 10.3389/froh.2022.956072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Oral infectious diseases are common chronic oral diseases characterized by a chronic inflammatory condition. We investigated chronic oral diseases as potential risk factors for systemic chronic diseases, diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis, and Crohn's disease, as well as severe psychotic and other severe mental disorders. Methods The cohort comprised 68,273 patients aged ≥ 29 years with at least one dental visit to the Helsinki City Health Services between 2001 and 2002. The cohort was linked to the data on death (Statistics Finland), cancer (Finnish Cancer Registry), and drug reimbursement (Finnish Social Insurance Institution) and followed until death or the end of 2013. The outcomes of interest were the incidences of chronic diseases measured starting with special refund medication, which means Social Insurance Institution partly or fully reimburses medication costs. Outcomes of interest were diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis and Crohn's disease, and severe mental disorders. Results The mean follow-up time was 9.8 years. About 25% of the study population had periodontitis, 17% caries, over 70% apical periodontitis, and 9% <24 teeth at the start of follow-up. Diabetes was the only chronic systemic condition associated with oral health variables. Having 24 to 27 teeth was associated with a higher incidence rate ratio (IRR) (1.21, 95% confidence interval 1.09-1.33) compared to having 28 or more teeth; the IRR for having 23 or less was 1.40 (1.22-1.60). Having periodontitis (1.10, 1.01-1.20), caries (1.12, 1.01-1.23), or apical periodontitis (1.16, 1.04-1.30) is also associated with a higher risk of diabetes. Conclusion Our epidemiological 10 years follow-up study suggests that the association exists between chronic oral diseases and diabetes, warranting close collaboration among patient's healthcare professionals.
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Affiliation(s)
- Pia Heikkilä
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leo Niskanen
- Internal Medicine, Päijät-Häme Central Hospital Hospital and Universities of Helsinki and Eastern Finland, Lahti, Finland
| | - Anna But
- Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Jari Haukka
- Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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13
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Metsärinne K, Pietilä M, Kantola I, Stenman LK, Hätinen OP, Vesikansa A, Poussa T, Niskanen L. The majority of type 2 diabetic patients in Finnish primary care are at very high risk of cardiovascular events: A cross-sectional chart review study (STONE HF). Prim Care Diabetes 2022; 16:135-141. [PMID: 34972659 DOI: 10.1016/j.pcd.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
AIMS To characterize clinical profiles, prevalence of chronic kidney disease (CKD), and treatment patterns in type 2 diabetes (T2D) and heart failure (HF) patients in Finnish primary care. METHODS A total of 1385 patients (1196 with T2D, 50 with HF, and 139 with T2D and HF) in 60 Finnish primary care centers were recruited to this cross-sectional study. Data on demographic and clinical characteristics, laboratory measurements, and medications were collected retrospectively from medical records. T2D patients were classified according to their risk of cardiovascular (CV) events as very high-risk (62%) and other patients (38%). RESULTS Of the T2D patients, 10% (139/1335) had a diagnosis of HF and 42% (457/1090) had stage 3-5 CKD and/or albuminuria based on laboratory measurement. Of the HF patients, 74% (139/189) had T2D and 78% (114/146) had stage 3-5 CKD and/or albuminuria. Metformin was the most frequently used medication in both very high-risk patients (74%) and other patients (86%). SGLT2 inhibitors and/or GLP-1 analogues were used by 37% of very high-risk patients compared to 42% in other patients. CONCLUSIONS The majority of T2D patients in Finnish primary care are at very high risk of cardiovascular events. However, the implementation of treatments with proven cardioprotective effects in very high-risk patients is currently suboptimal.
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Affiliation(s)
- Kaj Metsärinne
- Turku University Hospital, Department of Nephrology, Turku, Finland.
| | - Mikko Pietilä
- Turku University Hospital, Heart Centre, Turku, Finland
| | - Ilkka Kantola
- Turku University Hospital, Division of Medicine, Turku, Finland
| | | | | | | | | | - Leo Niskanen
- Päijät-Häme Central Hospital, Department of Internal Medicine, Lahti, Finland; University of Eastern Finland, Institute of Clinical Sciences, Kuopio, Finland
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14
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Setti MO, Kacimi SEO, Niskanen L, Virtanen J, Tuomainen TP. Synergic Interaction of Vitamin D Deficiency and Renal Hyperfiltration on Mortality in Middle-Aged Men. J Ren Nutr 2022; 32:692-701. [DOI: 10.1053/j.jrn.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/11/2022] Open
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15
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Ould Setti M, Voutilainen A, Tajik B, Niskanen L, Tuomainen TP. Negative interaction of fatty liver and hypertension on cardiovascular mortality in non-diabetic men: 34 years of follow-up. Scand J Gastroenterol 2021; 56:1096-1102. [PMID: 34362281 DOI: 10.1080/00365521.2021.1951836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Fatty liver disease (FLD) and hypertension are separately associated with cardiovascular (CV) mortality. The two conditions are related in multiple ways. This work aimed to study the joint effect and interaction of FLD and hypertension in respect to overall and CV mortality. METHODS The population-based cohort, Kuopio Ischaemic Disease Risk Factor Study, followed 1569 middle-aged non-diabetic Finnish men for 34 years. Considering adjustment for age, body mass index, smoking and alcohol consumption, separate and combined effects of FLD and hypertension and their interaction at the multiplicative and additive scales regarding all-cause and CV death were assessed using Cox proportional hazards models. RESULTS FLD and hypertension coexisted in 8.54% of the men (n = 134). FLD and hypertension associated, independently and combined, with an increased hazard of all-cause and CV deaths. Non-CV mortality associated with FLD, but not with hypertension. We found a negative interaction between FLD and hypertension regarding the hazard of all-cause (relative excess risk due to interaction (RERI), -0.97; 95% confidence interval (CI), -1.65 to -0.28) and CV mortality (RERI, -1.74; 95% CI, -2.98 to -0.5). The interaction was also found on a multiplicative scale. CONCLUSIONS We found evidence of a negative interaction between FLD and hypertension in respect to CV mortality. We thus recommend adjusting for FLD or hypertension when studying the effect of the other condition on mortality or CV diseases in middle-aged men.
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Affiliation(s)
- Mounir Ould Setti
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Global Database Studies, IQVIA, Espoo, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Behnam Tajik
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Leo Niskanen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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16
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Ould Setti M, Voutilainen A, Tajik B, Niskanen L, Tuomainen TP. Abstract P156: Negative Interaction Of Fatty Liver And Hypertension On Cardiovascular Mortality In Non-diabetic Men. Hypertension 2021. [DOI: 10.1161/hyp.78.suppl_1.p156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatty liver disease (FLD) and hypertension are separately associated with cardiovascular (CV) mortality. While the two conditions are established as separate predictors of CV outcomes, FLD and hypertension are interrelated in multiple ways. A biological interaction in respect to CV disease outcomes could exist between FLD and hypertension. In this study, we investigated the joint effect and interaction of FLD and hypertension regarding CV mortality using an interaction framework. Using a population-based cohort, we followed 1,569 middle-aged non-diabetic Finnish men for 34 years. We computed the fatty liver index and considered values ≥60 as indicative of FLD. We defined hypertension as either i) self-reported hypertension and a confirmed use of antihypertension medication, or ii) a mean systolic ≥160 or diastolic ≥105 blood pressure on baseline examination. The choice of the blood pressure measurement threshold to define hypertension was based on a sensitivity analysis. With adjustment for age, body mass index, smoking, and alcohol consumption, separate and combined effects of FLD and hypertension and their interaction at the multiplicative and additive scales regarding all-cause and CV death were assessed using Cox proportional hazards models. Among the men, 372 had FLD and 342 had hypertension. FLD and hypertension coexisted in 134 men. FLD and hypertension associated, independently and combined, with an increased hazard of all-cause and CV deaths. Non-cardiovascular mortality associated with FLD, but not with hypertension. We found a negative interaction between FLD and hypertension regarding the hazard of all-cause (relative excess risk due to interaction [RERI], -0.97; 95% confidence interval [CI], -1.65 to -0.28) and CV mortality (RERI, -1.74; 95% CI, -2.98 to -0.50). The interaction was also found on a multiplicative scale. We found evidence of a negative interaction between FLD and hypertension in respect to CV mortality. Our findings were robust to different definitions of hypertension but were more relevant at high blood pressure thresholds. We thus recommend adjusting for FLD or hypertension when studying the effect of the other condition on mortality or CV diseases in middle-aged men and call for further research on the topic.
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17
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Värri M, Niskanen L, Tuomainen TP, Honkanen R, Kröger H, Tuppurainen MT. Metabolite Profiling of Osteoporosis and Atherosclerosis in Postmenopausal Women: A Cross-Sectional Study. Vasc Health Risk Manag 2020; 16:515-524. [PMID: 33293818 PMCID: PMC7719314 DOI: 10.2147/vhrm.s279028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/19/2020] [Indexed: 02/02/2023] Open
Abstract
Purpose Atherosclerosis (AS) and osteoporosis (OP) are common causes of morbidity and mortality in postmenopausal women and are connected via an unknown mechanistic link. Metabolite profiling of blood samples may allow the identification of new biomarkers and pathways for this enigmatic association. Patients and Methods We studied the difference in 148 metabolite levels from serum samples in postmenopausal women with AS and OP compared with those in healthy participants in this cross-sectional study. Quantitative AS was assessed by carotid artery intima-media thickness (cIMT) and carotid artery calcifications (CACs) by ultrasound, as well as OP by femoral neck (FN) bone mineral density (BMD) and 148 metabolic measures with high-throughput proton (1H) nuclear magnetic resonance (NMR) in serum samples from 280 postmenopausal (PM) women. Subjects were a randomly selected subsample from the population-based Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study. The final study population included the following groups: OP with CAC (n=16, group I), non-OP with no CAC (n=59, group II), high cIMT tertile with OP (n=11, group III) and low cIMT tertile without OP (n=48, group IV). Results There were differences in several metabolite levels between groups I and II. The acetate level was lower in group I compared to that in group II (group I mean ± SD: 0.033 ± 0.0070; group II: 0.041 ± 0.014, CI95%: 0.018‒0.15, p=0.014). The result was similar with diacylglycerol (p=0.002), leucine (p=0.031), valine (p=0.022) and several very low-density lipoprotein (VLDL) metabolite levels, which were lower in group I compared to those in group II. However, no associations were found in adjusted analyses with total body (TB) fat mass (FM), age and statin use (p>0.05). Conclusion Our novel study found differences in the metabolite profiling of altered amino acid and lipoprotein metabolism in participants with OP and AS compared with those in healthy women. The causative mechanisms remain unknown and further studies are needed.
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Affiliation(s)
- Miika Värri
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Leo Niskanen
- Department of Endocrinology and Metabolism, Abdominal Centre, Helsinki University Hospital, Universities of Helsinki and Eastern Finland, Helsinki, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Lapland Hospital District, Rovaniemi, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Marjo T Tuppurainen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland
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18
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Affiliation(s)
- Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 70211, Kuopio, Finland.
| | - Leo Niskanen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
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19
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Lavikainen P, Aarnio E, Niskanen L, Mäntyselkä P, Martikainen J. Short-term impact of co-payment level increase on the use of medication and patient-reported outcomes in Finnish patients with type 2 diabetes. Health Policy 2020; 124:1310-1316. [PMID: 32878700 DOI: 10.1016/j.healthpol.2020.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/08/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022]
Abstract
A new reimbursement scheme for non-insulin medications used for treatment of hyperglycemia in type 2 diabetes (T2D) was implemented in Finland on January 1, 2017. The aim of the study was to evaluate the impact of this co-payment increase (i.e. + 35 percentage points) on patient-reported satisfaction for diabetes care, diabetes medication use, and financial difficulties. Baseline data were collected in 114 pharmacies, where patients with T2D were asked to fill in a questionnaire in November 2016. Follow-ups were conducted at 6 and 12 months. In total, 955 participants with T2D attended the baseline examination. During the follow-up, satisfaction with diabetes care decreased significantly (p < 0.001). Use of insulin increased (OR 1.16, 95 % CI 1.06-1.27) whereas use of metformin and DPP-4 inhibitors decreased (metformin: OR 0.80, 95 % CI 0.70‒0.90; DPP-4 inhibitors: OR 0.82, 95 % CI 0.73‒0.93). Financial difficulties with the purchase of diabetes medications were reported more often both at 6 (OR 2.44, 95 % CI 1.96-3.03) and at 12 months (OR 2.70, 95 % CI 2.18-3.35) than at baseline. These negative short-term effects require future studies. If persistent, the long-term effects of lower treatment satisfaction and increased financial difficulties may imply impaired metabolic control and increased diabetes complication risk and health care costs. Patient perspective should be taken into account in future policy making.
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Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Emma Aarnio
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Leo Niskanen
- Internal Medicine, Päijät-Häme Central Hospital, P.O. BOX, FI-15850 Lahti, Finland.
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, P.O. Box 100, FI-70029, Kuopio, Finland.
| | - Janne Martikainen
- School of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
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20
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Niskanen L, Partonen T, Auvinen A, Haukka J. Trends and predictors in all-cause and cause-specific mortality in diabetic and reference populations during 21 years of follow-up. J Epidemiol Community Health 2020; 74:950-956. [PMID: 32620580 DOI: 10.1136/jech-2019-213602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with diabetes mellitus (DM) have a markedly higher overall mortality from coronary heart disease (CHD), as well as many other causes of death like cancer. Since diabetes is a multisystem disease, this fact together with the increased lifespan among individuals with diabetes may also lead to the emergence of other diabetes-related complications and ultimately to diversification of the causes of death. METHODS The study population of this observational historic cohort study consisted of subjects with DM, who had purchased for at least one insulin prescription and/or one oral antidiabetic between January 1, 1997 and December 31, 2010 (N=199 354), and a reference population matched by age, sex and hospital district (N=199 354). Follow-up was continued until December 31, 2017. All-cause and cause-specific mortality (cancer, CHD and stroke) was analysed with Poisson and Cox's regression. Associations between baseline medications and mortality were analysed using LASSO (Least Absolute Shrinkage and Selection Operator) models. RESULTS The mortality rates were significantly elevated among the patients with DM. However, the relative risk of all-cause mortality between the DM and reference populations tended to converge during the follow-up. The lowering trend was most apparent in CHD mortality. The difference between DM and reference populations in stroke mortality vanished with a later entrance to the follow-up period. There were a few differences between DM and no-DM groups with respect to how baseline medications were associated with mortality. CONCLUSIONS The gap between the mortality of patients with diabetes compared to subjects who are non-diabetic diminished markedly during the 21-year period. This was driven primarily by the reduced CHD mortality.
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Affiliation(s)
- Leo Niskanen
- Central Hospital Stomach Centre, Helsinki University, Helsinki, Finland
| | - Timo Partonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anssi Auvinen
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jari Haukka
- Public Health, University of Helsinki, Helsinki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Niskanen L, Hahl J, Haukka J, Leppä E, Miettinen T, Mushnikov V, Sipilä R, Tamminen N, Vattulainen P, Korhonen P. Type 2 diabetes and treatment intensification in primary care in Finland. Acta Diabetol 2018; 55:1171-1179. [PMID: 30083982 DOI: 10.1007/s00592-018-1199-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022]
Abstract
AIM To identify how the electronic health record (EHR) systems and national registers can be used for research purposes. We focused on how the primary care physicians adhere to clinical guidelines. METHODS Study population included incident type 2 diabetes patients from four selected regions. Data were collected in two phases. At the first phase study cohort was identified using the prescription registers of the Social Insurance Institution (SII) and EHR systems used within the study regions. At second phase, data were collected from SII's registers, local EHR systems, the hospital discharge and the primary care registers of National Institute for Health and Welfare. RESULTS Metformin was the most common choice as first drug. Among all study patients, 8375 (76.0%) started metformin monotherapy or combinations. The treatment was intensified at variable levels of HbA1c depending on the area. DPP4-inhibitors were by far the most common agent for treatment intensification. Sulphonylureas were used less often than basal insulin as the second-line agent. The use of DPP4-inhibitors increased between years 2009-2010, when first DPP4-inhibitor received reimbursement and this class became dominant drug for treatment intensification increasingly thereafter. CONCLUSIONS The EHR systems and national registers can be used for research purposes in Finland. The realization of diabetes treatment national guidelines are followed in primary care to a large extent. However, the subsequent intensification of therapy was delayed and occurred at elevated Hba1c levels.
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Affiliation(s)
- Leo Niskanen
- Endocrinology and Diabetology, Helsinki University Hospital, Meilahti Hospital, Tower Building (III floor), P.O. Box 340, 00029, Helsinki, Finland.
- University of Eastern Finland, Kuopio, Finland.
| | | | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Elli Leppä
- Pharmaceutical Information Centre Ltd, Oulu, Finland
| | | | | | - Raija Sipilä
- Current Care Guidelines, The Finnish Medical Society Duodecim, Helsinki, Finland
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Abstract
AIMS To characterize the burden of external causes of death attributable to alcohol-related causes, accidents and suicide among diabetic patients in a large national cohort. METHODS The population included diabetic individuals who had purchased and received reimbursement for at least one insulin prescription and/or one oral antidiabetic drug prescription between January 1997 and December 2010, and a non-diabetic reference population matched by sex, age and area. All new insulin users in this period were included, as well as 50% of new oral drug (OAD) users as a random sample. The data were collected by means of linkage from national registries. We analyzed the cohort data using Poisson regression models separately for each end-point and by gender (mortality rate ratio (MRR)). We subjected the case-cohort data to conditional logistic regression analysis based on exposure information within 1 year of the end-point event. The follow-up started on the date of the first diabetes medication prescription and ended on 31 December 2012 or on the date of death. RESULTS The study population comprised 434 629 individuals (226 372 men; diabetes population: 208 148 subjects, of whom 76% were treated only with OAD). The mean follow-up time was 7.1 years, during which there were 2832 deaths attributable to alcohol, 3187 to accidents and 853 to suicide. The diabetic subjects had higher mortality at almost all end-points, especially those treated with insulin: the adjusted MRRs for alcohol-related deaths were 1.71 for diabetic men treated with OAD and 6.92 for those on insulin; the respective MRRs for diabetic women were 2.10 and 10.60. There were more accident-related deaths among those treated with insulin (MRRs: 2.06 and 1.53 for men and women, respectively), and more suicides (MRR: 2.10 for men treated with insulin and 1.62 among women treated only with OAD). The results from the cohort study and the case-cohort study were rather similar. A time-dependent effect of diabetes was observed in alcohol-related mortality among men. CONCLUSIONS The findings from this large nationwide cohort indicate higher mortality attributable to suicide, alcoholrelated causes and accidents among diabetic patients than among the non-diabetic population. The results emphasize the importance of effective psychosocial interventions among high-risk diabetic patients.
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Affiliation(s)
- Leo Niskanen
- Endocrinology and Diabetology, Abdominal Center, Helsinki University Hospital and the Universities of Helsinki and Eastern Finland, Helsinki, Finland
| | - Timo Partonen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anssi Auvinen
- Epidemiology/Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Haukka J, Partonen T, Niskanen L. Excess mortality in diabetic subjects due to alcohol, accidents and suicide: A nationwide cohort study. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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24
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Mäntyselkä P, Ali-Sisto T, Kautiainen H, Niskanen L, Viinamäki H, Velagapudi V, Lehto SM. The Association Between Musculoskeletal Pain and Circulating Ornithine: A Population-Based Study. Pain Med 2018; 18:1145-1151. [PMID: 28034972 DOI: 10.1093/pm/pnw285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective Based on several previous clinical studies, we hypothesized that ornithine levels are different among subjects with persistent musculoskeletal pain compared with other subjects in the population. Design The study sample consisted of 221 adults with nonpersistent pain, 76 with persistent pain, and 61 with no pain. Concentrations of glutamic acid, ornithine, citrulline, arginine, proline, and spermidine were analyzed using a mass spectrometer. Setting Lapinlahti municipality in Finland. Results For the subjects with no pain, nonpersistent pain, and persistent pain, the ornithine concentrations for men were 85.3 µmol/L (SD = 28.9 µmol/L), 98.9 µmol/L (SD = 37.8 µmol/L), and 102.1 µmol/L (SD = 37.1 µmol/L; P = 0.033), respectively. The corresponding concentrations for women were 82.8 µmol/L (SD = 25.2 µmol/L), 83.7 µmol/L (SD = 27.8 µmol/L), and 103.2 µmol/L (SD = 34.9 µmol/L; P = 0.0031). There were no significant differences between the pain groups for any of the other investigated amino acids. Relative sex-specific ornithine concentration adjusted for age, glomerular filtration rate, smoking, body mass index, physical activity, and depressive symptoms was associated with pain ( P = 0.025), the ornithine level being higher in the persistent pain group than in the no pain ( P = 0.006) and nonpersistent pain ( P = 0.032) groups. Conclusion Ornithine levels are elevated in general population subjects with persistent pain.
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Affiliation(s)
- Pekka Mäntyselkä
- General Practice, Institute of Public Health and Clinical Nutrition.,Primary Health Care Unit and
| | - Toni Ali-Sisto
- Psychiatry, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit and.,Department of General Practice, Unit of Primary Health Care, and
| | - Leo Niskanen
- Endocrinology, Abdominal Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Heimo Viinamäki
- Psychiatry, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Vidya Velagapudi
- Metabolomics Unit, Institute for Molecular Medicine Finland FIMM, Helsinki, Finland
| | - Soili M Lehto
- Psychiatry, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
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25
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Bertone-Johnson ER, Virtanen JK, Nurmi T, Niskanen L, Mursu J, Voutilainen S, Ronkainen K, Kauhanen J, Tuomainen TP. Follicle-Stimulating Hormone Levels and Subclinical Atherosclerosis in Older Postmenopausal Women. Am J Epidemiol 2018; 187:16-26. [PMID: 29309514 DOI: 10.1093/aje/kwx174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/17/2017] [Indexed: 12/28/2022] Open
Abstract
Recent studies of perimenopausal women suggest that follicle-stimulating hormone (FSH) levels may be associated with atherosclerosis, independent of estradiol. Whether FSH is related to atherosclerosis in older postmenopausal women, who have completed the menopausal transition, remains unknown. We assessed the relationship of serum FSH and estradiol levels with carotid artery intima-media thickness (IMT) among 587 postmenopausal participants in the Kuopio Ischemic Heart Disease Risk Factor Study (Kuopio, Finland). Participants were aged 53-73 years and not using hormone therapy at baseline (1998-2001). Mean IMT was measured via high-resolution ultrasonography. We observed a significant inverse association between FSH levels and IMT. Mean IMTs among women in quartiles 1-4 of FSH were 0.94 mm, 0.91 mm, 0.87 mm, and 0.85 mm, respectively (P-trend < 0.001). After adjustment for age, estradiol, testosterone, body mass index (weight (kg)/height (m)2), lipids, and other factors, FSH levels remained significantly associated with IMT (regression coefficients for quartiles 2-4 vs. quartile 1 were -0.038, -0.045, and -0.062, respectively; P-trend = 0.01). Findings were strongest in women aged 64-73 years (P-trend = 0.006) and did not vary by body mass index. In contrast, estradiol levels were not related to IMT. In summary, high postmenopausal FSH levels were associated with a lower atherosclerotic burden, independent of estradiol, adiposity, and other factors. Our findings warrant replication and the further exploration of potential underlying mechanisms.
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Affiliation(s)
- Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tarja Nurmi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Leo Niskanen
- Department of Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jaakko Mursu
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Sari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kimmo Ronkainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Haukka J, Niskanen L, Auvinen A. Risk of Cause-Specific Death in Individuals with Cancer-Modifying Role Diabetes, Statins and Metformin. Int J Cancer 2017; 141:2437-2449. [DOI: 10.1002/ijc.31016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/08/2017] [Accepted: 08/17/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Jari Haukka
- University of Helsinki, Clinicum; Helsinki Finland
| | - Leo Niskanen
- Endocrinology and Diabetology, Abdominal Center, Helsinki University Hospital and Universities of Helsinki and Eastern Finland, Helsinki, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences/Health Sciences, University of Tampere; Tampere Finland
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Ryhänen EM, Leijon H, Metso S, Eloranta E, Korsoff P, Ahtiainen P, Kekäläinen P, Tamminen M, Ristamäki R, Knutar O, Löyttyniemi E, Niskanen L, Väisänen M, Heiskanen I, Välimäki MJ, Laakso M, Haglund C, Arola J, Schalin-Jäntti C. A nationwide study on parathyroid carcinoma. Acta Oncol 2017; 56:991-1003. [PMID: 28362521 DOI: 10.1080/0284186x.2017.1306103] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Parathyroid carcinoma (PC) is rare and diagnostically challenging. Reported outcomes are rather poor and the incidence might be increasing. MATERIAL AND METHODS We performed a nationwide study on all cases (n= 32) diagnosed in 2000-2011 in Finland, and compared clinical and histopathological characteristics and outcome to atypical parathyroid (APA; n= 28) and parathyroid adenomas (PA; n= 72). The incidence in years 1955-1999 was compared to that in 2000-2013. RESULTS Preoperatively, calcium and parathyroid hormone concentrations were higher in PC compared to APA and PA (1.76, 1.56 and 1.44 mmol/l, p < .001; and 989, 355 and 160 μmol/l, p < .001, respectively). Calcium was ≤1.77 mmol/l for all PAs. Hospitalization (44% vs. 22% and 3%, respectively, p = .01), renal (50% vs. 48% vs. 22%, respectively, p = .01) and bone (47% vs. 15% vs. 38%, respectively p = .002) manifestations were more common. PC and APA tumors were larger than PA (p < .001). Histopathological characteristics of PC compared to PA are increased mitotic activity (p= .001), chief cells (p = .003), diffuse growth pattern (p < .001), higher Ki67 (p< .001) and negative parafibromin (p < .001). One PC (1/18) and one APA (1/16) patient had a CDC73 mutation. After 6.7 (2-13.9) years of follow-up, 9.4% of PC had residual, 21% recurrent disease and 12.5% died of disease. Overall mortality did not differ between subgroups (p = .094). Recurrent PC was characterized by vascular invasion, lymph node metastases, high mitotic activity, necrosis and negative parafibromin. Incidence increased from 1.42 (range 0.52-2.14) to 7.14 (range 3.42-10.38)/10.000.000/years; (p < .001). CONCLUSIONS PC associates with severe primary hyperparathyroidism and must be suspected if calcium ≥1.77 mmol/l. The prevalence of CDC73 germline mutations in PC and APA in Finland is 6%. PC has distinct histopathological characteristics and its incidence has increased over the past decades.
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Affiliation(s)
- Eeva M. Ryhänen
- The Division of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Helena Leijon
- Department of Pathology, Huslab and University of Helsinki, Helsinki, Finland
| | - Saara Metso
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Eija Eloranta
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Pirkko Korsoff
- Department of Internal Medicine, Satakunta Central Hospital, Pori, Finland
| | - Petteri Ahtiainen
- Department of Internal Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Päivi Kekäläinen
- Department of Internal Medicine, North Carelia Central Hospital, Joensuu, Finland
| | - Marjo Tamminen
- Department of Internal Medicine, Kymenlaakso Central Hospital, Kotka, Finland
| | - Raija Ristamäki
- Department of Oncology, Turku University Hospital, Turku, Finland
| | - Otto Knutar
- Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland
| | | | - Leo Niskanen
- The Division of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Väisänen
- Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Heiskanen
- Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Matti J. Välimäki
- The Division of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Finland
| | - Caj Haglund
- Department of Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
| | - Johanna Arola
- Department of Pathology, Huslab and University of Helsinki, Helsinki, Finland
| | - Camilla Schalin-Jäntti
- The Division of Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Christiansen JS, Niskanen L, Rasmussen S, Johansen T, Fulcher G. Lower rates of hypoglycemia during maintenance treatment with insulin degludec/insulin aspart versus biphasic insulin aspart 30: a combined analysis of two Phase 3a studies in type 2 diabetes. J Diabetes 2016; 8:720-8. [PMID: 26612062 DOI: 10.1111/1753-0407.12355] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/09/2015] [Accepted: 10/23/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Insulin degludec/insulin aspart (IDegAsp) is a soluble coformulation of the basal analog insulin degludec and the rapid-acting prandial insulin aspart in a single injection. The present combined analysis of two Phase 3a trials compared the incidence of hypoglycemia in participants treated twice daily with IDegAsp or biphasic insulin aspart 30 (BIAsp 30). METHODS Hypoglycemia data were analyzed from two similarly designed randomized controlled open-label treat-to-target Phase 3a clinical trials of adults with type 2 diabetes (T2D). Participants were treated twice daily with IDegAsp or BIAsp 30, with breakfast and their main evening meal. RESULTS Over 26 weeks, the rates of overall confirmed, nocturnal confirmed and severe hypoglycemic events were 19%, 57%, and 39% lower, respectively, with IDegAsp (n = 504) than BIAsp 30 (n = 364); estimated rate ratios were 0.81 (95% confidence interval [CI] 0.67, 0.98; P = 0.0341), 0.43 (95% CI 0.31, 0.59; P = 0.0001), and 0.61 (95% CI 0.26, 1.45; P = NS). The between-treatment differences were more pronounced during the maintenance period (≥16 weeks); compared with BIAsp 30, rates of overall confirmed, nocturnal confirmed and severe hypoglycemic events with IDegAsp were 0.69 (95% CI 0.55, 0.87; -31%; P = 0.0015); 0.38 (95% CI 0.25, 0.58; -62%; P < 0.0001), and 0.16 (95% CI 0.04, 0.59; -84%; P = 0.0061), respectively. CONCLUSIONS Compared with BIAsp 30 twice daily, IDegAsp twice daily provided similar improvements in glycemic control with a lower risk of hypoglycemia, particularly nocturnal hypoglycemia, in subjects with T2D previously treated with insulin.
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Affiliation(s)
| | - Leo Niskanen
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | | | - Greg Fulcher
- University of Sydney, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Varis J, Metsärinne K, Koivisto V, Niskanen L, Rissanen A, Virkamäki A, Appelroth T, Pöntynen N, Poussa T, Kantola I. Improved control of blood pressure and albuminuria among patients with type-2 diabetes in Finnish open care. Blood Press 2016; 26:67-73. [PMID: 27310566 DOI: 10.1080/08037051.2016.1190917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Risk of cardiovascular events within the diabetic population has decreased and survival increased with patients living longer and thus facing the development of end-stage renal disease (ESRD). This calls for good care of patient with diabetes with a focus on hypertension. Patient data were collected from 42 Finnish primary care centres. Each was asked to enrol 10-12 consecutive patients with type-2 diabetes between March 2011 and August 2012. Along with the office blood pressure measurements and laboratory tests, the presence of albuminuria was measured and glomerular filtration rate estimated (eGFR). The 2013 ESH criteria for diabetic hypertensive patients (<140/85 mmHg) was reached by 39% of all 625 study patients and 38% of the pharmacologically treated 520 patients. The absence of detectable albumin in urine was significantly associated with the control of systolic blood pressure and achievement of treatment goals. Beta blockers were the most common antihypertensive agents and patients treated with them had lower eGFR compared to those not treated with these agents. The blood pressure of patients was not in full concordance with the present guideline recommendations. However, satisfactory improvement in blood pressure control, reduction of albuminuria and hence ESRD prevention was achieved.
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Affiliation(s)
- Juha Varis
- a Division of Medicine , Turku University Hospital and University of Turku , Turku , Finland
| | - Kaj Metsärinne
- a Division of Medicine , Turku University Hospital and University of Turku , Turku , Finland
| | | | - Leo Niskanen
- d Abdominal Centre, Endocrinology, Helsinki University Central Hospital , Helsinki , Finland
| | - Aila Rissanen
- e Obesity Research Unit, Biomedicum, Departments of Medicine and Psychiatry , Helsinki University Central Hospital , Helsinki , Finland
| | | | | | | | | | - Ilkka Kantola
- a Division of Medicine , Turku University Hospital and University of Turku , Turku , Finland
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Värri M, Niskanen L, Tuomainen T, Honkanen R, Kröger H, Tuppurainen MT. Association of adipokines and estradiol with bone and carotid calcifications in postmenopausal women. Climacteric 2016; 19:204-11. [PMID: 26849745 DOI: 10.3109/13697137.2016.1139563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Carotid artery calcifications (CAC) and high carotid artery intima-media thickness (cIMT) are associated with low bone mineral density (BMD) by unknown mechanisms in postmenopausal women. Leptin, adiponectin and estradiol may mediate these associations. Our aim was to study the relationships of the aforementioned factors to bone health (BMD) and carotid atherosclerosis (CAC and cIMT). METHOD Participants (n = 290, mean age 73.6 years) for this cross-sectional OSTPRE-BBA study (Kuopio Osteoporosis Risk Factor and Prevention - Bone, Brain and Atherosclerosis) were randomly selected from the OSTPRE cohort in 2009. Femoral neck and total body BMDs, trunk and total body fat mass were measured with dual-energy X-ray absorptiometry, and cIMT (mm) and CAC (no/yes) were measured with B-type ultrasound. Free estradiol, adiponectin and leptin were measured from serum samples. RESULTS Circulating estradiol levels were associated with leptin (β = 0.131, p < 0.001), but not with adiponectin (p > 0.05), when adjusted for total body fat mass. There were no associations between estradiol tertiles and BMDs, or with cIMT or CAC. Adiponectin levels were inversely associated with femoral neck BMD (p = 0.019, β = -0.138) and total body BMD (p = 0.009, β = -0.142), adjusted for total body fat mass, age, current smoking and estradiol, but showed no relationship with CAC or cIMT. Leptin levels were not associated with BMDs or cIMT; but the odds ratio was 1.5 between the CAC and leptin quartiles (p = 0.014), adjusted for total body fat mass, age, statin use and calcium intake. CONCLUSION The adipokines are associated with vascular calcification and low BMD. Moreover, estradiol was not independently associated with BMD or CAC.
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Affiliation(s)
- M Värri
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - L Niskanen
- b Endocrinology , Helsinki University Hospital and University of Helsinki , Finland
| | - Tp Tuomainen
- c Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland
| | - R Honkanen
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland ;,d Lapland Hospital District , Rovaniemi , Finland
| | - H Kröger
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland ;,e Department of Orthopaedics, Traumatology and Hand Surgery , Kuopio University Hospital , Kuopio , Finland
| | - M T Tuppurainen
- a Kuopio Musculoskeletal Research Unit, Surgery , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland ;,f Department of Obstetrics and Gynaecology , Kuopio University Hospital , Kuopio , Finland
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Salmela P, Metso S, Moilanen L, Niskanen L, Nuutila P, Schalin-Jäntti C. [Treatment of primary hypothyroidism in adult patients]. Duodecim 2016; 132:33-42. [PMID: 27044179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The diagnosis of hypothyroidism is based on the findings of an increased serum TSH (above the reference range) and decreased serum free T4 (below the reference range) concentration. Treatment of subclinical hypothyroidism is indicated if serum THS is above 10 mU/l. For less severe forms of subclinical hypothyroidism, the treatment should be individually tailored. The treatment of choice is synthetic human levothyroxine. The goals for treatment are amelioration of symptoms and normalization of TSH and free T4 concentrations.
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Schernthaner G, Durán-Garcia S, Hanefeld M, Langslet G, Niskanen L, Östgren CJ, Malvolti E, Hardy E. Efficacy and tolerability of saxagliptin compared with glimepiride in elderly patients with type 2 diabetes: a randomized, controlled study (GENERATION). Diabetes Obes Metab 2015; 17:630-8. [PMID: 25761977 DOI: 10.1111/dom.12461] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/13/2015] [Accepted: 03/08/2015] [Indexed: 12/01/2022]
Abstract
AIMS To assess the efficacy and safety of adjunctive saxagliptin vs glimepiride in elderly patients with type 2 diabetes (T2D) and inadequate glycaemic control. METHODS In this multinational, randomized, double-blind, phase IIIb/IV study (GENERATION; NCT01006603), patients aged ≥65 years were randomized (1 : 1) to receive saxagliptin 5 mg/day or glimepiride ≤6 mg/day, added to metformin, during a 52-week treatment period. The primary endpoint was achievement of glycated haemoglobin (HbA1c) <7.0% at week 52 without confirmed/severe hypoglycaemia. The key secondary endpoint was incidence of confirmed/severe hypoglycaemia. Safety and tolerability were also assessed. RESULTS Of 720 patients randomized (360 in each treatment group; mean age 72.6 years; mean T2D duration 7.6 years), 574 (79.8%) completed the study (saxagliptin 80.3%; glimepiride 79.2%). Similar proportions of patients achieved the primary endpoint with saxagliptin and glimepiride (37.9 vs 38.2%; odds ratio 0.99, 95% confidence interval 0.73, 1.34; p = 0.9415); however, a significant treatment-by-age interaction effect was detected (p = 0.0389): saxagliptin was numerically (but not significantly) superior to glimepiride for patients aged <75 years (39.2 vs 33.3%) and numerically inferior for patients aged ≥75 years (35.9 vs 45.5%). The incidence of confirmed/severe hypoglycaemia was lower with saxagliptin vs glimepiride (1.1 vs 15.3%; nominal p < 0.0001). Saxagliptin was generally well tolerated, with similar incidences of adverse events compared with glimepiride. CONCLUSION As avoiding hypoglycaemia is a key clinical objective in elderly patients, saxagliptin is a suitable alternative to glimepiride in patients with T2D aged ≥65 years.
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Affiliation(s)
- G Schernthaner
- Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria
| | - S Durán-Garcia
- Unidad de Gestion de Endocrinología y Nutrición, Hospital Universitario de Valme, Sevilla, Spain
| | - M Hanefeld
- Study centre Professor Hanefeld, GWT-TUD GmbH, Dresden, Germany
| | - G Langslet
- Lipid Clinic, Oslo University Hospital, Oslo, Norway
| | - L Niskanen
- Endocrinology and Metabolism, Abdominal Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - C J Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - E Hardy
- AstraZeneca LP, Wilmington, DE, USA
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Metsärinne K, Bröijersen A, Kantola I, Niskanen L, Rissanen A, Appelroth T, Pöntynen N, Poussa T, Koivisto V, Virkamäki A. High prevalence of chronic kidney disease in Finnish patients with type 2 diabetes treated in primary care. Prim Care Diabetes 2015; 9:31-38. [PMID: 25066820 DOI: 10.1016/j.pcd.2014.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/11/2014] [Accepted: 06/01/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the prevalence of chronic kidney disease (CKD) and related cardiovascular morbidity in a cross-sectional population in patients with type 2 diabetes (T2D) treated in a primary care setting in Finland. RESEARCH DESIGN AND METHODS Data were collected and recorded from 42 primary care centres, which recruited 629 patients diagnosed with type 2 diabetes (T2D) to this non-interventional study. Data including patient characteristics, kidney function and albuminuria, blood pressure, HbA1c, lipid and lipoprotein levels, and diabetes duration as well as current medication was collected in each patient. RESULTS In the final study population of 625 patients, the mean age was 67 years (range 29-92 years), BMI 32.8 kg/m(2) (95% CI 32-33), blood pressure 142/80 mmHg (140-143/80-81) and HbA1c 7.1% (7.0-7.2) (53.8 mmol/mol, 53-55) and the median duration of diabetes was 9.2 years ranging from newly diagnosed to 43 years. History of dyslipidemia had in 73.3% of patients, 27.8% had cardiovascular disease and 82.7% had hypertension. The primary endpoint, prevalence of CKD of any grade (1-5) or albuminuria, was 68.6%. Regarding declined renal function, 16.2% of patients had an estimated glomerular filtration rate (eGFR) <60 ml/min/1.72 m(2), classifying as CKD 3-5. Only one patient was within CKD5. Regarding renal damage, albuminuria was present in 24.3% of patients, with microalbuminuria in 17.1% and macroalbuminuria in 7.2%, respectively. Combining the patients with CKD 3-5 and/or the presence of albuminuria, 34.7% seemed to suffer from significant CKD. The proportion of patients with albuminuria increased with a decrease in glomerular filtration rate. Historically, diabetic nephropathy had been diagnosed in 24.3% of the patients. CONCLUSIONS Nearly 70% of patients with T2D treated in primary care in Finland have some sign of CKD and nearly half of all T2D patients have a significant CKD. However, only half of the latter had it diagnosed and documented in their patient charts, thus highlighting the importance of performing routine screening of nephropathy by measuring both albuminuria and eGFR in patients with T2D. Prevention of this complication with active therapy for risk factors, such as hypertension and dyslipidemia is warranted.
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Affiliation(s)
- Kaj Metsärinne
- Turku University Hospital, Department of Nephrology, Finland
| | | | | | - Leo Niskanen
- Faculty of Health Sciences, School of Medicine, University of Eastern Finland, Finland
| | - Aila Rissanen
- Obesity Research Unit, Biomedicum, Departments of Medicine and Psychiatry, Helsinki University Central Hospital, Finland
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Suuronen S, Niskanen L, Paajanen P, Paajanen H. Declining cholecystectomy rate during the era of statin use in Finland: a population-based cohort study between 1995 and 2009. Scand J Surg 2015; 102:158-63. [PMID: 23963029 DOI: 10.1177/1457496913492463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Aging with comorbidities, obesity, and rapid recovery from operation may increase the need for laparoscopic cholecystectomy, but long-term use of statins may be associated with a decreased risk of gallstones. This population-based cohort study presents the changing rate and causative factors of laparoscopic cholecystectomy in Finland during the era of statin use. MATERIALS AND METHODS Age structure of the population, changes in body mass index and diabetes, and the number of all cholecystectomies in 1995-2009 were retrieved from the registers of National Institute for Health and Welfare. Additionally, these results were supplemented by a population-based retrospective cohort (1581 laparoscopic cholecystectomy) in one community-based hospital area. The risk factors for laparoscopic cholecystectomy, use of statins, and surgical outcome were analyzed. RESULTS During the 15 years, 123,794 cholecystectomies were performed in Finland, of which 94,740 (76.5%) were performed using laparoscopic technique. The median rate of laparoscopic cholecystectomy varied between 110 and 140 operations per 100,000 inhabitants. In 1995-2009, the annual number of cholecystectomies decreased from 8600 to 7500, the number of laparoscopic cholecystectomies increased by 10%, and the number of open cholecystectomies declined by 60%. In a cohort of 1581 laparoscopic cholecystectomies, the proportion of elderly (>65 years of age), obese (body mass index > 30 kg/m(2)), and diabetic patients increased from 17% to 28%, 9% to 34%, and 4% to 8%, respectively. Use of statins increased more than fourfold during the 15 years. CONCLUSIONS The rates of all cholecystectomies decreased despite marked increase in laparoscopic cholecystectomies performed. The increase in risk factors for gallstones in Finland implied more marked increase in laparoscopic cholecystectomies. The possible role of statins on gallstone disease is discussed.
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Affiliation(s)
- S Suuronen
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
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Koskela HO, Salonen PH, Romppanen J, Niskanen L. A history of diabetes but not hyperglycaemia during exacerbation of obstructive lung disease has impact on long-term mortality: a prospective, observational cohort study. BMJ Open 2015; 5:e006794. [PMID: 25633287 PMCID: PMC4316436 DOI: 10.1136/bmjopen-2014-006794] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Hyperglycaemia is very common during exacerbations of asthma and chronic obstructive pulmonary disease (COPD). However, its clinical significance is not clear. The objective of the present study was to assess whether exacerbation-associated hyperglycaemia affects long-term mortality in these patients. DESIGN A prospective, observational cohort study. SETTING A single hospital in eastern Finland. PARTICIPANTS 153 consecutive patients who were hospitalised due to mild to moderate obstructive lung disease exacerbation (110 with asthma and 43 with COPD) and who survived at least 30 days. INTERVENTIONS Plasma glucose levels were recorded seven times during the first day on the ward. Several possible confounders were also recorded. The median follow-up time was 6 years and 2 months. RESULTS During the follow-up, 57 (37%) of the patients died. Previously diagnosed diabetes was strongly associated with elevated mortality (adjusted HR (aHR) 3.03 (1.28 to 7.18). The highest fasting glucose value (aHR 1.10 (1.01 to 1.20) per 1 mmol/L) and the highest postprandial glucose value ((aHR 1.07 (1.00 to 1.16)) were also associated with late mortality. However, the associations between highest glucose values and mortality vanished when the diagnosis of diabetes was included in the same model. Within the patients without diabetes, neither fasting (aHR 0.92 (0.42 to 2.02)) nor postprandial ((aHR 1.04 (0.50 to 2.12)) hyperglycaemia was associated with late mortality. There were no statistically significant differences in the underlying causes of death between the patients with and without diabetes. CONCLUSION A history of diabetes but not hyperglycaemia during exacerbation of obstructive lung disease has impact on long-term mortality.
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Affiliation(s)
- Heikki O Koskela
- Pulmonary Division, Unit for Medicine and Clinical Research, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Sciences, University of Eastern Finland, Kuopio, Finland
| | - Päivi H Salonen
- Pulmonary Division, Unit for Medicine and Clinical Research, Kuopio University Hospital, Kuopio, Finland
| | | | - Leo Niskanen
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Sciences, University of Eastern Finland, Kuopio, Finland
- Finnish Medicines Agency Fimea, Helsinki, Finland
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Prami T, Sulamaa A, Sipilä R, Linna M, Hahl J, Miettinen T, Leppä E, Haukka J, Tuomilehto J, Enlund H, Niskanen L, Korhonen P. Uses of Electronic Patient Information Systems and National Registers - Implementation of the Clinical Practice Guideline and Evaluation of Costs and Use of Resources in Patients with Incident Type 2 Diabetes in Finland. Value Health 2014; 17:A336. [PMID: 27200599 DOI: 10.1016/j.jval.2014.08.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- T Prami
- EPID Research, Espoo, Finland
| | - A Sulamaa
- Pharma Industry Finland, Helsinki, Finland
| | - R Sipilä
- Finnish Medical Society Duodecim, Helsinki, Finland
| | - M Linna
- Aalto University, HEMA Institute, Espoo, Finland
| | - J Hahl
- AT Medical Affairs Consulting, Espoo, Finland
| | - T Miettinen
- AT Medical Affairs Consulting, Espoo, Finland
| | - E Leppä
- Pharmaceutical Information Centre, Helsinki, Finland
| | | | | | - H Enlund
- Finnish Medicines Agency Fimea, Helsinki, Finland
| | - L Niskanen
- Finnish Medicines Agency Fimea, Helsinki, Finland
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de Jong HJI, Meyboom RHB, Helle MJ, Klungel OH, Niskanen L, Cohen Tervaert JW. Giant cell arteritis and polymyalgia rheumatica after reexposure to a statin: a case report. Ann Intern Med 2014; 161:614-5. [PMID: 25329212 DOI: 10.7326/l14-5020-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Koskela HO, Salonen PH, Romppanen J, Niskanen L. Long-term mortality after community-acquired pneumonia--impacts of diabetes and newly discovered hyperglycaemia: a prospective, observational cohort study. BMJ Open 2014; 4:e005715. [PMID: 25146717 PMCID: PMC4156798 DOI: 10.1136/bmjopen-2014-005715] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Community-acquired pneumonia is associated with a significant long-term mortality after initial recovery. It has been acknowledged that additional research is urgently needed to examine the contributors to this long-term mortality. The objective of the present study was to assess whether diabetes or newly discovered hyperglycaemia during pneumonia affects long-term mortality. DESIGN A prospective, observational cohort study. SETTING A single secondary centre in eastern Finland. PARTICIPANTS 153 consecutive hospitalised patients who survived at least 30 days after mild-to-moderate community-acquired pneumonia. INTERVENTIONS Plasma glucose levels were recorded seven times during the first day on the ward. Several possible confounders were also recorded. The surveillance status and causes of death were recorded after median of 5 years and 11 months. RESULTS In multivariate Cox regression analysis, a previous diagnosis of diabetes among the whole population (adjusted HR 2.84 (1.35-5.99)) and new postprandial hyperglycaemia among the non-diabetic population (adjusted HR 2.56 (1.04-6.32)) showed independent associations with late mortality. New fasting hyperglycaemia was not an independent predictor. The mortality rates at the end of follow-up were 54%, 37% and 10% among patients with diabetes, patients without diabetes with new postprandial hyperglycaemia and patients without diabetes without postprandial hyperglycaemia, respectively (p<0.001). The underlying causes of death roughly mirrored those in the Finnish general population with a slight excess in mortality due to chronic respiratory diseases. Pneumonia was the immediate cause of death in just 8% of all late deaths. CONCLUSIONS A previous diagnosis of diabetes and newly discovered postprandial hyperglycaemia increase the risk of death for several years after community-acquired pneumonia. As the knowledge about patient subgroups with an increased late mortality risk is gradually gathering, more studies are needed to evaluate the possible postpneumonia interventions to reduce late mortality.
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Affiliation(s)
- Heikki O Koskela
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Sciences, University of Eastern Finland, Kuopio, Finland
| | - Päivi H Salonen
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland
| | | | - Leo Niskanen
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Sciences, University of Eastern Finland, Finland
- Finnish Medicines Agency Fimea, Helsinki, Finland
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Värri M, Tuomainen TP, Honkanen R, Rikkonen T, Niskanen L, Kröger H, Tuppurainen MT. Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study. Maturitas 2014; 78:304-9. [DOI: 10.1016/j.maturitas.2014.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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Salminen M, Vahlberg T, Räihä I, Niskanen L, Kivelä SL, Irjala K. Sex hormones and the risk of type 2 diabetes mellitus: A 9-year follow up among elderly men in Finland. Geriatr Gerontol Int 2014; 15:559-64. [DOI: 10.1111/ggi.12312] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Marika Salminen
- Institute of Clinical Medicine, Family Medicine; University of Turku; Turku Finland
- Härkätie Health Center; Lieto Finland
- Unit of Family Medicine; Turku University Hospital; Turku Finland
| | - Tero Vahlberg
- Institute of Clinical Medicine, Biostatistics; University of Turku; Turku Finland
| | - Ismo Räihä
- Institute of Clinical Medicine, Family Medicine; University of Turku; Turku Finland
- Department of Internal Medicine; Turku City Hospital; Turku Finland
| | - Leo Niskanen
- Finnish Medicines Agency Fimea; Helsinki Finland
- Institute of Clinical Medicine, Internal Medicine; University of Eastern Finland; Kuopio Finland
| | - Sirkka-Liisa Kivelä
- Institute of Clinical Medicine, Family Medicine; University of Turku; Turku Finland
- Faculty of Pharmacy, Division of Social Pharmacy; University of Helsinki; Helsinki Finland
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Vähäsarja K, Salmela S, Villberg J, Rintala P, Vanhala M, Saaristo T, Peltonen M, Keinänen-Kiukaanniemi S, Korpi-Hyövälti E, Moilanen L, Niskanen L, Oksa H, Poskiparta ME. Perceived sufficiency of physical activity levels among adults at high risk of type 2 diabetes: the FIN-D2D study. Int J Behav Med 2014; 21:99-108. [PMID: 23224617 DOI: 10.1007/s12529-012-9285-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Any increase from a low level of physical activity reduces the risk of type 2 diabetes. However, lack of awareness of one's physical activity level insufficiency may act as an obstacle to increased physical activity. PURPOSE This study assessed the determinants of perceived physical activity levels (PALs) among adults at high risk of diabetes and the associations with self-reported physical activity. METHODS In total, 10,149 adults participated in the FIN-D2D lifestyle intervention at baseline. Opportunistic screening was used in identifying high-risk individuals. Physical activity and perceived PAL sufficiency were assessed and compared. Key risk factors for diabetes and psychosocial and demographic characteristics were analyzed as determinants using logistic regression. RESULTS PAL sufficiency was rated realistically by 73 % of men and 75 % of women. Perception of sufficient PAL was more likely among individuals with a smaller waist circumference, a higher level of perceived fitness, and no exercise intention. In men, a higher age, and in women, a lower education, and a lower occupational status, also increased the likelihood of perceiving PAL as sufficient. Out of all the participants, 65 % of men and 66 % of women were inactive. Among the inactive participants, 20 (men) and 16 % (women) overestimated their PAL sufficiency. In both genders, such overestimation was predicted by dyslipidemia, a lower waist circumference, a higher level of perceived fitness, and no exercise intention; also (among men) by a higher age and a family history of diabetes, and (among women) by a lower occupational status, and a lower BMI. CONCLUSIONS In diabetes prevention, it is important to recognize the groups that perceive their PAL as sufficient since they may not see increased PAL as a tool for decreasing their risk of diabetes.
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Affiliation(s)
- Kati Vähäsarja
- Research Centre for Health Promotion, Department of Health Sciences, University of Jyväskylä, 40014, Jyväskylä, Finland,
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Mäntyselkä P, Niskanen L, Kautiainen H, Saltevo J, Würtz P, Soininen P, Kangas AJ, Ala-Korpela M, Vanhala M. Cross-sectional and longitudinal associations of circulating omega-3 and omega-6 fatty acids with lipoprotein particle concentrations and sizes: population-based cohort study with 6-year follow-up. Lipids Health Dis 2014; 13:28. [PMID: 24507090 PMCID: PMC3922432 DOI: 10.1186/1476-511x-13-28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/06/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cross-sectional studies have suggested that serum omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) are related to favorable lipoprotein particle concentrations. We explored the associations of serum n-3 and n-6 PUFAs with lipoprotein particle concentrations and sizes in a general population cohort at baseline and after 6 years. FINDINGS The cohort included 665 adults (274 men) with a 6-year follow-up. Nutritional counseling was given at baseline. Serum n-3 and n-6 PUFAs and lipoprotein particle concentrations and the mean particle sizes of VLDL, LDL, and HDL were quantified by nuclear magnetic resonance (NMR) spectroscopy for all baseline and follow-up samples at the same time. Concentrations of n-3 and n-6 PUFAs were expressed relative to total fatty acids. At baseline, n-3 PUFAs were not associated with lipoprotein particle concentrations. A weak negative association was observed for VLDL (P = 0.021) and positive for HDL (P = 0.011) particle size. n-6 PUFA was negatively associated with VLDL particle concentration and positively with LDL (P < 0.001) and HDL particle size (P < 0.001). The 6-year change in n-3 PUFA correlated positively with the change in particle size for HDL and LDL lipoproteins but negatively with VLDL particle size. An increase in 6-year levels of n-6 PUFAs was negatively correlated with the change in VLDL particle concentration and size, and positively with LDL particle size. CONCLUSION Change in circulating levels of both n-3 and n-6 PUFAs, relative to total fatty acids, during 6 years of follow-up are associated with changes in lipoprotein particle size and concentrations at the population level.
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Affiliation(s)
- Pekka Mäntyselkä
- Faculty of Health Sciences, School of Medicine, University of Eastern Finland, Kuopio 70211, Finland.
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Honkalampi K, Viinamäki H, Niskanen L, Koivumaa-Honkanen H, Valkonen-Korhonen M, Elomaa AP, Harvima I, Herzig KH, Lehto SM. Reduced serum adiponectin levels in alexithymia. Neuroimmunomodulation 2014; 21:234-9. [PMID: 24603661 DOI: 10.1159/000357051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 11/04/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Clinical studies have demonstrated that circulating cytokine profiles may differ between alexithymic and non-alexithymic subjects. We examined whether the levels of adiponectin (μg/ml) and resistin (ng/ml) are independently related to alexithymic features in a population-based sample. METHODS In 2005, clinical data including laboratory assessments were obtained from a sub-sample (n = 308) of the Kuopio Depression Study general population study including subjects aged 25-64 years. Based on the Toronto Alexithymia Scale score in 1998, 1999, 2001 and 2005, a group of subjects with high alexithymic features (n = 85) was formed and compared with non-alexithymic controls (n = 206). RESULTS Serum adiponectin levels were significantly lower in subjects with alexithymic features than in non-alexithymic control subjects. No difference was found in resistin levels. Similarly, in a logistic regression model adjusted for age, gender and body mass index (BMI), lowered levels of adiponectin, but not resistin, were associated with an increased likelihood of belonging to the group with alexithymic features. Further adjustments for cardiovascular risk factors (i.e. smoking, BMI, metabolic syndrome, alcohol use, and coronary heart disease), depressive symptoms (Hamilton Depression Rating Scale with 17 items) and the use of antidepressants in addition to age and gender did not change these patterns. CONCLUSIONS Our findings suggest that a disturbed anti-inflammatory balance may characterize alexithymia. In addition, our results widen the concept of alexithymia and highlight the role of immune system alterations and stress in alexithymic individuals.
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Affiliation(s)
- Kirsi Honkalampi
- Department of Education and Psychology, University of Eastern Finland, Joensuu, Finland
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Elomaa AP, Koivumaa-Honkanen H, Niskanen L, Honkalampi K, Valkonen-Korhonen M, Herzig KH, Viinamäki H, Lehto SM. Self-reported sleep disturbance is associated with elevated levels of PAI-1 in individuals with a recorded history of depressive symptoms. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:46-51. [PMID: 23911442 DOI: 10.1016/j.pnpbp.2013.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/10/2013] [Accepted: 07/23/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The majority of depressed individuals report insomnia. Self-reported symptoms of insomnia, in particular, more strongly predict adverse health effects than the actual measured sleep time. The physiological alterations in individuals with insomnia are complex, as both autonomic and endocrine dysfunctions are present. Plasminogen activator inhibitor (PAI)-1 is a stress-related acute-phase reactant that has also been suggested to regulate the circadian rhythm and sleep patterns. It has been suggested to contribute to both depressive symptoms and sleep disorders, although data on the relationships between these parameters are scarce. OBJECTIVE This study examined the role of self-reported sleep disturbance and its association with PAI-1 among individuals with a history of depressive symptoms. METHODS Differences in the serum levels of PAI-1 between two groups (group 1: moderate to very severe sleep disturbance, n=37; group 2: mild or no sleep disturbance, n = 90) were examined in a population-based sample of individuals with a recorded history of depressive symptoms. RESULTS Multivariate analysis controlling for potential confounding factors (age, sex, body mass index, depression severity) showed that each 1-unit increase in PAI-1 (μg/mL) increased the likelihood for belonging to the group with moderate to very severe sleep disturbance by 23% (OR = 1.23, C.I. 95% = 1.04-1.45, p = 0.016). This statistical significance remained after additional adjustments for regular smoking and the use of sleep or lipid-lowering medication. CONCLUSION Our observations may further clarify the physiological alterations related to sleep disturbance in depressive individuals. In the present study, self-reported sleep disturbance in individuals with a recorded history of depressive symptoms was associated with an elevation of PAI-1. This finding may illustrate the association of subjective sleep disturbance with sympathetic activation. Our study highlights the importance of effects of perceived sleep disturbance on individual homeostasis, and may provide potential directions for research on treatment options.
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Affiliation(s)
- Antti-Pekka Elomaa
- Department of Psychiatry, Kuopio University Hospital & University of Easterrn Finland, 70210 Kuopio, Finland.
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Savolainen J, Kautiainen H, Miettola J, Niskanen L, Mäntyselkä P. Low quality of life and depressive symptoms are connected with an unhealthy lifestyle. Scand J Public Health 2013; 42:163-70. [DOI: 10.1177/1403494813504837] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The Lapinlahti 2005 study was carried out to explore cardiovascular disease risk factors, lifestyle and quality of life in Lapinlahti residents in eastern Finland. Our aim was to study the association between lifestyle and health-related quality of life (HRQoL) in the community. Subjects and methods: The present study is based on the baseline data of the followed up (2005–2010) population-based cohort ( N = 376, n of males = 184). A trained research nurse measured weight, height, waist circumference and blood pressure. Self-reported HRQoL was measured using a 15D questionnaire. A BDI-21 inventory was used to assess the presence of self-reported depressive symptoms. Lifestyle factors (nutrition, exercise, smoking and alcohol use) were examined with a structured questionnaire. Each lifestyle item was valued as −1, 0 or 1, depending on how well it corresponded to the recommendations. Based on the index the participants were divided into three lifestyle sum tertiles: I = unhealthy, II = neutral and III = healthy. The age- and sex-adjusted linear trend between the tertiles was tested. Results: The 15D score had a positive linear relationship with the lifestyle tertiles ( P = .0048 for linearity, age- and sex-adjusted). Respectively, self-reported depressive symptoms were less frequent among subjects with a healthier lifestyle ( P = .038). Conclusions: People who are expected to strive most to change their lifestyle have the lowest quality of life and psychological welfare, which should be taken into account in both clinical work and health promotion.
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Affiliation(s)
- Jorma Savolainen
- Institute of Public Health and Clinical Nutrition, Primary Health Care, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Turku University Hospital, Turku, Finland
| | - Juhani Miettola
- Institute of Public Health and Clinical Nutrition, Primary Health Care, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Leo Niskanen
- University of Eastern Finland, Faculty of Health Sciences, School of Medicine, Kuopio, Finland
- Finnish Medicines Agency Fimea
| | - Pekka Mäntyselkä
- Unit of Primary Health Care, Turku University Hospital, Turku, Finland
- Institute of Clinical Medicine, General Practice, University of Turku, Finland
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Cefalu WT, Leiter LA, Yoon KH, Arias P, Niskanen L, Xie J, Balis DA, Canovatchel W, Meininger G. Efficacy and safety of canagliflozin versus glimepiride in patients with type 2 diabetes inadequately controlled with metformin (CANTATA-SU): 52 week results from a randomised, double-blind, phase 3 non-inferiority trial. Lancet 2013; 382:941-50. [PMID: 23850055 DOI: 10.1016/s0140-6736(13)60683-2] [Citation(s) in RCA: 554] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycaemia in patients with type 2 diabetes by enhancing urinary glucose excretion. We compared the efficacy and safety of canagliflozin, an SGLT2 inhibitor, with glimepiride in patients with type 2 diabetes inadequately controlled with metformin. METHODS We undertook this 52 week, randomised, double-blind, active-controlled, phase 3 non-inferiority trial at 157 centres in 19 countries between Aug 28, 2009, and Dec 21, 2011. Patients aged 18-80 years with type 2 diabetes and glycated haemoglobin A1c (HbA1c) of 7·0-9·5% on stable metformin were randomly assigned (1:1:1) by computer-generated random sequence via an interactive voice or web response system to receive canagliflozin 100 mg or 300 mg, or glimepiride (up-titrated to 6 mg or 8 mg per day) orally once daily. Patients, study investigators, and local sponsor personnel were masked to treatment. The primary endpoint was change in HbA1c from baseline to week 52, with a non-inferiority margin of 0·3% for the comparison of each canagliflozin dose with glimepiride. If non-inferiority was shown, we assessed superiority on the basis of an upper bound of the 95% CI for the difference of each canagliflozin dose versus glimepiride of less than 0·0%. Analysis was done in a modified intention-to-treat population, including all randomised patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT00968812. FINDINGS 1450 of 1452 randomised patients received at least one dose of glimepiride (n=482), canagliflozin 100 mg (n=483), or canagliflozin 300 mg (n=485). For lowering of HbA1c at 52 weeks, canagliflozin 100 mg was non-inferior to glimepiride (least-squares mean difference -0·01% [95% CI -0·11 to 0·09]), and canagliflozin 300 mg was superior to glimepiride (-0·12% [-0·22 to -0·02]). 39 (8%) patients had serious adverse events in the glimepiride group versus 24 (5%) in the canagliflozin 100 mg group and 26 (5%) in the 300 mg group. In the canagliflozin 100 mg and 300 mg groups versus the glimepiride group, we recorded a greater number of genital mycotic infections (women: 26 [11%] and 34 [14%] vs five [2%]; men: 17 [7%] and 20 [8%] vs three [1%]), urinary tract infections (31 [6%] for both canagliflozin doses vs 22 [5%]), and osmotic diuresis-related events (pollakiuria: 12 [3%] for both doses vs one [<1%]; polyuria: four [<1%] for both doses vs two [<1%]). INTERPRETATION Canagliflozin provides greater HbA1c reduction than does glimepiride, and is well tolerated in patients with type 2 diabetes receiving metformin. These findings support the use of canagliflozin as a viable treatment option for patients who do not achieve sufficient glycaemic control with metformin therapy. FUNDING Janssen Research & Development, LLC.
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Affiliation(s)
- William T Cefalu
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
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Koskela HO, Salonen PH, Niskanen L. Hyperglycaemia during exacerbations of asthma and chronic obstructive pulmonary disease. Clin Respir J 2013; 7:382-9. [PMID: 23902130 DOI: 10.1111/crj.12020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/18/2012] [Accepted: 01/03/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Hyperglycaemia is a well-known phenomenon among patients with an exacerbation of asthma or chronic obstructive pulmonary disease (COPD). It may be associated with increased risks of death and complications. OBJECTIVES To define the prevalence and determinants of hyperglycaemia in patients with an exacerbation of asthma or COPD. METHODS This was a prospective, cross-sectional study including 153 hospitalised patients with an exacerbation of asthma or COPD. All received inhaled beta-2-adrenergic bronchodilators and oral glucocorticoids in internationally recommend doses. Plasma glucose was measured seven times during the first day. Hyperglycaemia was defined as fasting glucose >6.9 mmol/L or postprandial glucose >11.1 mmol/L. In addition, the family history for diabetes and the Karnofsky performance score were assessed. Height, weight, waist circumference, oxygen saturation, blood pressure, temperature and heart rate were measured. Glycosylated haemoglobin A1c (gHbA1c), C-reactive protein, leucocytes, urea and arterial blood gas values were analysed. RESULTS Eighty-two per cent of the patients demonstrated hyperglycaemia, with similar prevalence between asthma and COPD. Of the 130 patients without a previous diagnosis of diabetes, 79% showed hyperglycaemia. In binary logistic regression analysis, high gHbA1c, high C-reactive protein and Karnofsky score less than 80% associated with the presence of fasting hyperglycaemia. High gHbA1c and current smoking associated with postprandial hyperglycaemia. CONCLUSIONS Hyperglycaemia is very common among hospitalised patients with an exacerbation of asthma or COPD. It is probably triggered by the medication and the patient's metabolic predisposition mainly determines its presence. Current smoking is the main treatable contributor to hyperglycaemia.
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Affiliation(s)
- Heikki O Koskela
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland
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Rautio N, Kautiainen H, Koponen H, Mäntyselkä P, Timonen M, Niskanen L, Saaristo T, Oksa H, Peltonen M, Puolijoki H, Vanhala M, Keinänen-Kiukaanniemi S. Financial satisfaction and its relationship to depressive symptoms in middle-aged and older adults: results from the FIN-D2D survey. Int J Soc Psychiatry 2013; 59:239-46. [PMID: 22234975 DOI: 10.1177/0020764011433635] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies using traditional measures of socio-economic position, such as education, income and occupation, have found inequalities in depressive symptoms, but less is known about the association between financial satisfaction and depressive symptoms. AIMS To examine the association of depressive symptoms with financial satisfaction in Finnish adults in a population-based cross-sectional FIN-D2D survey. METHODS Four thousand, five hundred randomly selected individuals aged 45-74 years were invited to the study. Participation rate for health examinations was 64%. Complete information on depressive symptoms and financial satisfaction was available for 2,819 individuals. Financial satisfaction was asked using a questionnaire. Depressive symptoms were measured by Beck Depression Inventory (≥ 10) and/or use of antidepressants. RESULTS Altogether 11.6% of individuals who were satisfied with their financial situation had depressive symptoms. Corresponding figures for individuals who were somewhat satisfied or dissatisfied were 20.6% and 42.6%, respectively. Individuals who were less satisfied with their financial situation were more likely to suffer from depressive symptoms even after adjusting for gender, age, marital status, number of chronic diseases, smoking, binge drinking, physical activity, education and household income. CONCLUSIONS Instead of more traditional measures of socio-economic position, financial dissatisfaction seems to be associated with depressive symptoms in Finnish adults.
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Affiliation(s)
- Nina Rautio
- Pirkanmaa Hospital District, Tampere, Finland.
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Koski AM, Löyttyniemi E, Väänänen H, Laine H, Niskanen L, Nevalainen PI, Korpi-Hyövälti E, Välimäki MJ. The effectiveness of teriparatide in the clinical practice--attenuation of the bone mineral density outcome by increasing age and bisphosphonate pretreatment. Ann Med 2013; 45:230-5. [PMID: 23330730 DOI: 10.3109/07853890.2012.742560] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Teriparatide is a potent anabolic agent for severe osteoporosis. OBJECTIVES A primary objective of this retrospective study was to define the efficacy of teriparatide in terms of bone mineral density (BMD) changes and relief of back pain in clinical practice. METHODS The patient population comprises 119 osteoporotic patients treated with teriparatide for median 539 (range 179-926) days. RESULTS The mean BMD gain was 0.9% in the total hip (P = 0.0075), 2.1% in the femoral neck (P = 0.0006), and 8.5% in the lumbar spine (P = 0.0085). In the whole patient population age associated inversely with BMD changes in the total hip (P = 0.019) and in the femoral neck (P = 0.0036). A history of significant bisphosphonate pretreatment (n = 90) reduced BMD response in the total hip (P = 0.039). The total exposure of any prior bisphosphonate was negatively correlated with BMD response in the total hip (P = 0.0421). Half of the patients reported relief of back pain during the treatment. Leg pain, nausea, and dizziness were most frequent adverse concerns. CONCLUSIONS Teriparatide works in clinical practice as well as in clinical trials. Younger subjects benefited more than older patients from teriparatide in the total hip and in the femoral neck. Bisphosphonate pretreatment attenuated teriparatide-induced BMD gain.
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Törrönen R, Kolehmainen M, Sarkkinen E, Poutanen K, Mykkänen H, Niskanen L. Berries reduce postprandial insulin responses to wheat and rye breads in healthy women. J Nutr 2013; 143:430-6. [PMID: 23365108 DOI: 10.3945/jn.112.169771] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Starch in white wheat bread (WB) induces high postprandial glucose and insulin responses. For rye bread (RB), the glucose response is similar, whereas the insulin response is lower. In vitro studies suggest that polyphenol-rich berries may reduce digestion and absorption of starch and thereby suppress postprandial glycemia, but the evidence in humans is limited. We investigated the effects of berries consumed with WB or RB on postprandial glucose and insulin responses. Healthy females (n = 13-20) participated in 3 randomized, controlled, crossover, 2-h meal studies. They consumed WB or RB, both equal to 50 g available starch, with 150 g whole-berry purée or the same amount of bread without berries as reference. In study 1, WB was served with strawberries, bilberries, or lingonberries and in study 2 with raspberries, cloudberries, or chokeberries. In study 3, WB or RB was served with a mixture of berries consisting of equal amounts of strawberries, bilberries, cranberries, and blackcurrants. Strawberries, bilberries, lingonberries, and chokeberries consumed with WB and the berry mixture consumed with WB or RB significantly reduced the postprandial insulin response. Only strawberries (36%) and the berry mixture (with WB, 38%; with RB, 19%) significantly improved the glycemic profile of the breads. These results suggest than when WB is consumed with berries, less insulin is needed for maintenance of normal or slightly improved postprandial glucose metabolism. The lower insulin response to RB compared with WB can also be further reduced by berries.
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Affiliation(s)
- Riitta Törrönen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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