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Article ; Online: Challenges of treating cardiovascular risk in old age

Timo E Strandberg

The Lancet. Healthy Longevity, Vol 2, Iss 6, Pp e308-e

2021 Volume 309

Keywords	Geriatrics ; RC952-954.6 ; Medicine ; R
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Benefits and limitations of statin use in primary cardiovascular prevention: recent advances.

Strandberg, Timo E

Polish archives of internal medicine

2022 Volume 132, Issue 5

Abstract: The status of low‑density lipoprotein (LDL) cholesterol is strong as an essential cause of atherosclerotic vascular disease (ASCVD) and primary target of lipid lowering. Drugs affecting primarily LDL choles-terol through an increase of LDL receptor ... ...

Abstract	The status of low‑density lipoprotein (LDL) cholesterol is strong as an essential cause of atherosclerotic vascular disease (ASCVD) and primary target of lipid lowering. Drugs affecting primarily LDL choles-terol through an increase of LDL receptor expression are the backbone of current therapy, and generic statins are generally safe, effective, and inexpensive drugs serving this purpose. Statins are indicated for practically all patients in secondary prevention, whereas treatment in primary prevention (healthy individuals) is based on a calculated 10‑year risk of ASCVD. At "borderline" (from 5% to <7.5%) and "intermediate" (from 7.5% to <20%) risk various biomarkers (eg, coronary artery calcium) are available for accurate assessment of the individual risk. The calculation of a lifetime risk instead of the 10‑year risk can be especially useful in younger people. More information about the benefits and risks of statins in primary prevention in older people (>70 years of age) will be provided by ongoing randomized and controlled trials (STAREE and PREVENTABLE). In this narrative review, I shall present recent advances in the use of statins in younger and older healthy people, and discuss their benefits and potential risks. I also raise a question whether with the current evidence base, most people in affluent societies would benefit from taking statins.
MeSH term(s)	Aged ; Atherosclerosis ; Biomarkers ; Cholesterol ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Secondary Prevention
Chemical Substances	Biomarkers ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Cholesterol (97C5T2UQ7J)
Language	English
Publishing date	2022-05-30
Publishing country	Poland
Document type	Journal Article ; Review
ZDB-ID	123500-x
ISSN	1897-9483 ; 0032-3772
ISSN (online)	1897-9483
ISSN	0032-3772
DOI	10.20452/pamw.16258
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Article ; Online: Midlife cardiovascular health factors as predictors of retirement age, work-loss years, and years spent in retirement among older businessmen.

Haapanen, Markus J / Törmäkangas, Timo / von Bonsdorff, Monika E / Strandberg, Arto Y / Strandberg, Timo E / von Bonsdorff, Mikaela B

Scientific reports

2023 Volume 13, Issue 1, Page(s) 16526

Abstract: Cardiovascular disease (CVD) is one of the leading causes of premature retirement. However, the relationship between CVD risk factors and workforce participation is not well known. We studied the relationship between midlife CVD risk, age at retirement, ... ...

Abstract	Cardiovascular disease (CVD) is one of the leading causes of premature retirement. However, the relationship between CVD risk factors and workforce participation is not well known. We studied the relationship between midlife CVD risk, age at retirement, work-loss years, and survival in retirement. Middle-aged Finnish men (initial n = 3490, mean age = 47.8 years) were assessed for CVD risk factors and general health in the 1970s. They worked as business executives and provided information on their retirement status in the year 2000. Survival was followed up to the 9th decade of life with a follow-up of up to 44 years. Work-loss years were calculated as death or retirement occurring at age ≤ 65 years. Smoking, body mass index, and alcohol use were used as covariates, excluding models of CVD risk, which were adjusted for alcohol use only. Higher risk of 10-year fatal CVD was associated with 0.32 more years (relative risk < 1 vs. 1, covariate-adjusted β = 0.32, 95% CI = 0.13, 0.53) of work-loss. Higher risk of 5-year incident (covariate-adjusted time-constant HR = 1.32, 95% CI = 1.19, 1.47) and 10-year fatal (covariate-adjusted time-dependent HR = 1.55, 95% CI = 1.30, 1.85) CVD in midlife were associated with fewer years spent in retirement. Poorer self-rated health and physical fitness and higher levels of triglycerides were associated with increased hazard of earlier retirement, more work-loss years, and fewer years spent in retirement. Poorer health and greater midlife CVD risk may be associated with earlier exit from the workforce and fewer years spent in retirement. Management of CVD risk in midlife may support people to work longer.
MeSH term(s)	Male ; Middle Aged ; Humans ; Aged ; Retirement ; Risk Factors ; Cardiovascular Diseases/etiology ; Smoking ; Finland/epidemiology
Language	English
Publishing date	2023-10-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-43666-x
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Article ; Online: Challenges of treating cardiovascular risk in old age.

Strandberg, Timo E

The Lancet. Healthy longevity

2021 Volume 2, Issue 6, Page(s) e308–e309

MeSH term(s)	Cardiovascular Diseases/epidemiology ; Heart Disease Risk Factors ; Humans ; Risk Factors
Language	English
Publishing date	2021-06-03
Publishing country	England
Document type	Journal Article ; Comment
ISSN	2666-7568
ISSN (online)	2666-7568
DOI	10.1016/S2666-7568(21)00114-8
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Article ; Online: Inflammation, infection, and cardiovascular risk.

Strandberg, Timo E / Kovanen, Petri T / Gylling, Helena

Lancet (London, England)

2024 Volume 403, Issue 10431, Page(s) 1021

MeSH term(s)	Humans ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Risk Factors ; Inflammation ; Heart Disease Risk Factors
Language	English
Publishing date	2024-03-16
Publishing country	England
Document type	Letter
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(23)02876-3
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Article ; Online: Sleep duration in midlife and old age and risk of mortality over a 48-year follow-up: The Helsinki businessmen study (HBS) cohort.

Strandberg, Timo E / Pitkälä, Kaisu H / Kivimäki, Mika

Maturitas

2024 Volume 184, Page(s) 107964

Abstract: Objectives: Both short and long sleep duration have been associated with increased mortality, but there are few truly long-term studies.: Study design: This is a cohort study of 2504 men born between 1919 and 1934. In 1974-1975 (mean age 48), ... ...

Abstract	Objectives: Both short and long sleep duration have been associated with increased mortality, but there are few truly long-term studies. Study design: This is a cohort study of 2504 men born between 1919 and 1934. In 1974-1975 (mean age 48), participants underwent baseline clinical examinations and sleep duration assessments. A follow-up examination took place 35 years later, in 2010 (mean age 82). Main outcome measure: All-cause mortality data from baseline and from old age were collected through to December 31, 2022. Results: At baseline, short sleep duration (≤6 h per night), normal sleep duration (>6 and ≤ 8 h), and long sleep duration (>8 h) was reported by 266, 2019 and 219 men, respectively. Men with short sleep duration had higher levels of smoking, alcohol consumption, body mass index, and poorer self-rated health than those with normal sleep duration. During the 48-year follow-up, 2287 men died. The unadjusted hazard ratio for mortality was 1.20 (95 % confidence interval [CI] 1.05-1.37) for short compared with normal sleep duration, but this association vanished after adjustments (1.01, 95 % CI 0.87-1.17). In old age, the corresponding hazard ratios were 1.41 (1.16-1.72) and 1.19 (0.94-1.51) for short sleep duration and 1.33 (1.09-1.63) and 1.31 (1.02-1.67) for long sleep duration. Conclusions: In a comprehensive lifespan follow-up, the modestly increased mortality among men with short sleep duration in midlife was attributed to unhealthy lifestyle factors. In old age both long and short sleep duration seemed to be associated with modestly increased mortality. Clinicaltrials: gov identifier for the HBS: NCT02526082.
Language	English
Publishing date	2024-03-08
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	80460-5
ISSN	1873-4111 ; 0378-5122
ISSN (online)	1873-4111
ISSN	0378-5122
DOI	10.1016/j.maturitas.2024.107964
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Article ; Online: Retirement as a predictor of physical functioning trajectories among older businessmen.

Haapanen, Markus J / Strandberg, Timo E / Törmäkangas, Timo / von Bonsdorff, Monika E / Strandberg, Arto Y / von Bonsdorff, Mikaela B

BMC geriatrics

2022 Volume 22, Issue 1, Page(s) 279

Abstract: Background: Associations between retirement characteristics and consequent physical functioning (PF) are poorly understood, particularly in higher socioeconomic groups, where postponing retirement has had both positive and negative implications for PF.!# ...

Abstract	Background: Associations between retirement characteristics and consequent physical functioning (PF) are poorly understood, particularly in higher socioeconomic groups, where postponing retirement has had both positive and negative implications for PF. Methods: Multiple assessments of PF, the first of which at the mean age of 73.3 years, were performed on 1709 men who were retired business executives and managers, using the RAND-36/SF-36 instrument, between 2000 and 2010. Questionnaire data on retirement age and type of pension was gathered in 2000. Five distinct PF trajectories were created using latent growth mixture modelling. Mortality- and covariate-adjusted multinomial regression models were used to estimate multinomial Odds Ratios (mOR) on the association between retirement characteristics and PF trajectories. Results: A one-year increase in retirement age was associated with decreased likelihood of being classified in the 'consistently low' (fully adjusted mOR = 0.82; 95%CI = 0.70, 0.97; P = 0.007), 'intermediate and declining' (mOR = 0.89; 95%CI = 0.83, 0.96; P = 0.002), and 'high and declining' (mOR = 0.92; 95%CI = 0.87, 0.98; P = 0.006) trajectories, relative to the 'intact' PF trajectory. Compared to old age pensioners, disability pensioners were more likely to be classified in the 'consistently low' (mOR = 23.77; 95% CI 2.13, 265.04; P = 0.010), 'intermediate and declining' (mOR = 8.24; 95%CI = 2.58, 26.35; P < 0.001), and 'high and declining' (mOR = 2.71; 95%CI = 1.17, 6.28; P = 0.020) PF trajectories, relative to the 'intact' PF trajectory. Conclusions: Among executives and managers, older age at retirement was associated with better trajectories of PF in old age. Compared to old age pensioners, those transitioning into disability and early old age pensions were at risk of having consistently lower PF in old age.
MeSH term(s)	Aged ; Disabled Persons ; Humans ; Male ; Pensions ; Retirement ; Surveys and Questionnaires
Language	English
Publishing date	2022-04-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-022-03001-x
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Article ; Online: High cholesterol absorption: A risk factor of atherosclerotic cardiovascular diseases?

Simonen, Piia / Öörni, Katariina / Sinisalo, Juha / Strandberg, Timo E / Wester, Ingmar / Gylling, Helena

Atherosclerosis

2023 Volume 376, Page(s) 53–62

Abstract: ... cholesterol absorption, i.e., >60%, is estimated to occur in approximately one third of a population ...

Abstract	Lowering elevated low-density lipoprotein cholesterol (LDL-C) concentrations reduces the risk of atherosclerotic cardiovascular diseases (ASCVDs). However, increasing evidence suggests that cholesterol metabolism may also be involved in the risk reduction of ASCVD events. In this review, we discuss if the different profiles of cholesterol metabolism, with a focus on high cholesterol absorption, are atherogenic, and what could be the possible mechanisms. The potential associations of cholesterol metabolism and the risk of ASCVDs are evaluated from genetic, metabolic, and population-based studies and lipid-lowering interventions. According to these studies, loss-of-function genetic variations in the small intestinal sterol transporters ABCG5 and ABCG8 result in high cholesterol absorption associated with low cholesterol synthesis, low cholesterol elimination from the body, and a high risk of ASCVDs. In contrast, loss-of-function genetic variations in another intestinal sterol transporter, NPC1L1 result in low cholesterol absorption associated with high cholesterol synthesis, elevated cholesterol elimination from the body, and low risk of ASCVDs. Statin monotherapy is not sufficient to reduce the ASCVD risk in cases of high cholesterol absorption, and these individuals need combination therapy of statin with cholesterol absorption inhibition. High cholesterol absorption, i.e., >60%, is estimated to occur in approximately one third of a population, so taking it into consideration is important to optimise lipid-lowering therapy to prevent atherosclerosis and reduce the risk of ASCVD events.
MeSH term(s)	Humans ; Atherosclerosis/drug therapy ; Atherosclerosis/etiology ; Atherosclerosis/genetics ; Atherosclerosis/prevention & control ; ATP Binding Cassette Transporter, Subfamily G/genetics ; Cholesterol/metabolism ; Genetic Variation ; Hypercholesterolemia/complications ; Hypercholesterolemia/drug therapy ; Hypercholesterolemia/prevention & control ; Risk Factors ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Biomarkers/blood
Chemical Substances	ATP Binding Cassette Transporter, Subfamily G ; Cholesterol (97C5T2UQ7J) ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Biomarkers
Language	English
Publishing date	2023-06-02
Publishing country	Ireland
Document type	Journal Article ; Review
ZDB-ID	80061-2
ISSN	1879-1484 ; 0021-9150
ISSN (online)	1879-1484
ISSN	0021-9150
DOI	10.1016/j.atherosclerosis.2023.06.003
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Article ; Online: Clinical trials in older people.

Pitkala, Kaisu H / Strandberg, Timo E

Age and ageing

2022 Volume 51, Issue 5

Abstract: Randomised controlled trials (RCTs) usually provide the best evidence for treatments and management. Historically, older people have often been excluded from clinical medication trials due to age, multimorbidity and disabilities. The situation is ... ...

Abstract	Randomised controlled trials (RCTs) usually provide the best evidence for treatments and management. Historically, older people have often been excluded from clinical medication trials due to age, multimorbidity and disabilities. The situation is improving, but still the external validity of many trials may be questioned. Individuals participating in trials are generally less complex than many patients seen in geriatric clinics. Recruitment and retention of older participants are particular challenges in clinical trials. Multiple channels are needed for successful recruitment, and especially individuals experiencing frailty, multimorbidity and disabilities require support to participate. Cognitive decline is common, and often proxies are needed to sign informed consent forms. Older people may fall ill or become tired during the trial, and therefore, special support and empathic study personnel are necessary for the successful retention of participants. Besides the risk of participants dropping out, several other pitfalls may result in underestimating or overestimating the intervention effects. In nonpharmacological trials, imperfect blinding is often unavoidable. Interventions must be designed intensively and be long enough to reveal differences between the intervention and control groups, as control participants must still receive the best normal care available. Outcome measures should be relevant to older people, sensitive to change and targeted to the specific population in the trial. Missing values in measurements are common and should be accounted for when designing the trial. Despite the obstacles, RCTs in geriatrics must be promoted. Reliable evidence is needed for the successful treatment, management and care of older people.
MeSH term(s)	Aged ; Clinical Trials as Topic ; Humans ; Multimorbidity
Language	English
Publishing date	2022-04-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afab282
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Article ; Online: Frailty and multimorbidity are independent and additive prognostic factors.

Strandberg, Timo E / Kivimäki, Mika

Journal of the American Geriatrics Society

2022 Volume 70, Issue 6, Page(s) 1881–1882

MeSH term(s)	Aged ; Frail Elderly ; Frailty/diagnosis ; Frailty/epidemiology ; Geriatric Assessment ; Humans ; Multimorbidity ; Prognosis
Language	English
Publishing date	2022-03-19
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.17753
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