Papers by Piia Lavikainen
PLOS ONE, Oct 12, 2023
The primary aim of revascularization in stable coronary artery disease (CAD) is symptom relief. T... more The primary aim of revascularization in stable coronary artery disease (CAD) is symptom relief. The severity of symptoms is usually evaluated by the physician, not by the patient. We examined the agreement between physician-and patient-reported Canadian Cardiovascular Society (CCS) scores among patients scheduled for elective coronary angiography in a cross-sectional study. Patients (n = 650) and cardiologists evaluated the severity of angina symptoms by filling the CCS questionnaire before coronary angiography. Patients were divided into those without CAD (stenosis diameter <50%, n = 445) and those with CAD (stenosis diameter >50%, n = 205). CAD patients were further divided into three groups according to disease severity (single-, double-or triple-vessel disease). The mean age of the patients was 67.6 (9.9) years and 50.6% were women. In 51.8% (95% CI 44.5%-59.0%) of patients with CAD and 51.9% (95% CI 47.0%-56.8%) of those without, physician-and patient reported CCS scores agreed. The physician reported better CCS scores in 33.9% (95% CI 27.6%-40.7%) of patients with CAD and 36.2% (95% CI 31.8%-41.0%) of patients without CAD. The proportions of full or partial agreement between physician-and patient reported CCS scores were similar across the CAD severity groups. To summarize, we observed a significant discrepancy between the physician-and patient-reported symptom severity in patients with or without CAD scheduled for angiography. The physician underestimated the symptoms in third of the cases. Thus, patient-reported symptom severity, rather than physician's evaluation, should be the cornerstone of treatment decisions.
Frontiers in Genetics
Type 2 diabetes (T2D) with increasing prevalence is a significant global public health challenge.... more Type 2 diabetes (T2D) with increasing prevalence is a significant global public health challenge. Obesity, unhealthy diet, and low physical activity are one of the major determinants of the rise in T2D prevalence. In addition, family history and genetic risk of diabetes also play a role in the process of developing T2D. Therefore, solutions for the early identification of individuals at high risk for T2D for early targeted detection of T2D, prevention, and intervention are highly preferred. Recently, novel genomic-based polygenic risk scores (PRSs) have been suggested to improve the accuracy of risk prediction supporting the targeting of preventive interventions to those at highest risk for T2D. Therefore, the aim of the present study was to assess the cost-utility of an additional PRS testing information (as a part of overall risk assessment) followed by a lifestyle intervention and an additional medical therapy when estimated 10-year overall risk for T2D exceeded 20% among Finnish...
Value in Health, Dec 1, 2022
PLOS ONE, Jul 31, 2014
There is an error in Table 1. There are several lines out of place in the original table. Please ... more There is an error in Table 1. There are several lines out of place in the original table. Please find a corrected version below.
WOS, 2016
A lzheimer disease is the most common form of dementia, accounting for 60%-70% of all cases. 1,2 ... more A lzheimer disease is the most common form of dementia, accounting for 60%-70% of all cases. 1,2 In 2011, there were 35.6 million people with dementia globally, and the number is estimated to double every 20 years. Aging is the major risk factor for Alzheimer disease; thus, population aging is leading to major public health challenges related to dementia disorders. Dementia and Alzheimer disease result in frequent health care service utilization and substantial health care costs. 3 Current drug therapy for Alzheimer disease has only modest efficacy. 4 Behavioural and psychological symptoms of dementia are frequent 5,6 and often treated with psychotropic drugs, 7 although these symptoms are not approved indications for most of these drugs. Use of benzodiazepines and similarly acting non-benzodiazepines (Z-drugs) is frequent among those with Alzheimer disease, and many patients use these drugs long term, 8 although clinical care guidelines recommend only short-term use. 5,6 Incidence of pneumonia increases with age. 9 Pneumonia is frequent and one of the leading causes of admission to hospital among adults with Alzheimer disease. 10 Other risk factors include female sex, smoking, alcohol abuse, respiratory diseases and many other
Neurology, Apr 23, 2020
Objective To evaluate the risk of death in relation to incident antiepileptic drug (AED) use comp... more Objective To evaluate the risk of death in relation to incident antiepileptic drug (AED) use compared with nonuse in people with Alzheimer disease (AD) through the assessment in terms of duration of use, specific drugs, and main causes of death. Methods The MEDALZ (Medication Use and Alzheimer Disease) cohort study includes all Finnish persons who received a clinically verified AD diagnosis (n = 70,718) in 2005-2011. Incident AED users were identified with 1-year washout period. For each incident AED user (n = 5,638), 1 nonuser was matched according to sex, age, and time since AD diagnosis. Analyses were conducted with Cox proportional regression models and inverse probability of treatment weighting (IPTW). Results Nearly 50% discontinued AEDs within 6 months. Compared with nonusers, AED users had an increased relative risk of death (IPTW hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.12-1.36). This was mainly due to deaths from dementia (IPTW HR, 1.62; 95% CI, 1.42-1.86). There was no difference in cardiovascular and cerebrovascular deaths (IPTW HR, 0.98; 95% CI, 0.67-1.44). The overall mortality was highest during the first 90 days of AED use (IPTW HR, 2.40; 95% CI, 1.91-3.03). Among users of older AEDs, relative risk of death was greater compared to users of newer AEDs (IPTW HR, 1.79; 95% CI, 1.52-2.16). Conclusion In older vulnerable patients with a cognitive disorder, careful consideration of AED initiation and close adverse events monitoring are needed.
The Journal of Nutrition Health and Aging, 2008
Recent demographic evolution has changed the trends of the two fundamental variables - natality a... more Recent demographic evolution has changed the trends of the two fundamental variables - natality and mortality - with a new slope noted. It was thus made possible for a new age structure pattern, very different from the previous one, to appear. According to the 1956 census, the ...
Diabetes Spectrum
Objective This study aimed to demonstrate the effectiveness of long-term use of intermittently sc... more Objective This study aimed to demonstrate the effectiveness of long-term use of intermittently scanned continuous glucose monitoring (isCGM) in adult patients with type 1 diabetes. Design and methods In this retrospective real-world study, 689 patients with type 1 diabetes who were >18 years of age and using isCGM were identified from the electronic patient records in North Karelia, Finland. A1C data were collected before and after the initiation of isCGM. The primary outcome was a change in the mean A1C over time after isCGM started. Results The greatest reductions in the mean A1C levels were observed 6 months (−0.54% [−5.9 mmol/mol], P <0.001) and 12 months (−0.42% [−4.6 mmol/mol], P <0.001) after the initiation of isCGM. Reduction in A1C remained significant for 4 years, although the mean reduction in A1C was −0.18% (−2.05 mmol/mol) (P = 0.009) at 48 months compared with baseline. In a subgroup analysis, patients with a baseline A1C >9% (75 mmol/mol) benefited the mos...
Use of existing data sources in clinical epidemiology: Finnish health care registers in Alzheimer... more Use of existing data sources in clinical epidemiology: Finnish health care registers in Alzheimer’s disease research – the Medication use among persons with Alzheimer’s disease (MEDALZ-2005) study
Acta Diabetologica
Aims To determine the effect of the use of intermittently scanned continuous glucose monitoring (... more Aims To determine the effect of the use of intermittently scanned continuous glucose monitoring (isCGM) on acute diabetes-related complications in adult type 1 diabetes patients. Methods Six hundred and forty-two adult type 1 diabetes patients with isCGM were identified from electronic health records in Siun sote region in Eastern Finland. A retrospective real-world analysis was conducted combining hospital admission and prehospital emergency service data to compare incidences of hypoglycemia requiring emergency medical support (EMS) involvement or hospital admission and diabetic ketoacidosis (DKA) before and after the start of isCGM. Data were collected from January 2015 to April 2020. Primary outcome was the rate of hypoglycemia requiring EMS involvement or hospital admission and DKA events. HbA1c was recorded at the start of isCGM and was compared with the last known HbA1c during the use of isCGM. The isCGM used in the study did not contain alarm functions. Results Altogether 220...
Clinical Epidemiology
To gain an understanding of the heterogeneous group of type 2 diabetes (T2D) patients, we aimed t... more To gain an understanding of the heterogeneous group of type 2 diabetes (T2D) patients, we aimed to identify patients with the homogenous long-term HbA1c trajectories and to predict the trajectory membership for each patient using explainable machine learning methods and different clinical-, treatment-, and socioeconomic related predictors. Patients and Methods: Electronic health records data covering primary and specialized healthcare on 9631 patients having T2D diagnosis were extracted from the North Karelia region, Finland. Six-year HbA1c trajectories were examined with growth mixture models. Linear discriminant analysis and neural networks were applied to predict the trajectory membership individually. Results: Three HbA1c trajectories were distinguished over six years: "stable, adequate" (86.5%), "improving, but inadequate" (7.3%), and "fluctuating, inadequate" (6.2%) glycemic control. Prior glucose levels, duration of T2D, use of insulin only, use of insulin together with some oral antidiabetic medications, and use of only metformin were the most important predictors for the long-term treatment balance. The prediction model had a balanced accuracy of 85% and a receiving operating characteristic area under the curve of 91%, indicating high performance. Moreover, the results based on SHAP (Shapley additive explanations) values show that it is possible to explain the outcomes of machine learning methods at the population and individual levels. Conclusion: Heterogeneity in long-term glycemic control can be predicted with confidence by utilizing information from previous HbA1c levels, fasting plasma glucose, duration of T2D, and use of antidiabetic medications. In future, the expected development of HbA1c could be predicted based on the patient's unique risk factors offering a practical tool for clinicians to support treatment planning.
Pharmacoepidemiology and Drug Safety
Additional file 2. Population used in the Markov model showing the steps used to estimate the siz... more Additional file 2. Population used in the Markov model showing the steps used to estimate the size of the reached population cohort. A graph showing how the population cohort was estimated.
Objectives: Season of birth, an exogenous indicator of early life environment, has been related t... more Objectives: Season of birth, an exogenous indicator of early life environment, has been related to higher risk of adverse psychiatric outcomes, but the findings for Alzheimer’s disease (AD) have been inconsistent. We investigated whether the month or season of birth are associated with AD. Methods: A nationwide nested case-control study including all community-dwellers with clinically verified AD diagnosed in 2005-2012 (n=70719) and up to four age-, sex-, and region of residencematched controls (n=282862) residing in Finland. Associations between month and season of birth and AD were studied with conditional logistic regression. Results: Month of birth was not associated with AD (P=0.09). No strong associations were observed with season (P=0.13), although in comparison to winter births (December-February), summer births (June-August) were associated with higher odds of AD (odds ratio 1.03, 95% confidence interval 1.00-1.05). However, the absolute difference in prevalence was only 0....
Osteoarthritis and Cartilage, 2020
Value in Health, 2019
female) with median follow-up of 2.61 years. SH was associated with twofold risk of all-cause mor... more female) with median follow-up of 2.61 years. SH was associated with twofold risk of all-cause mortality (10.54% vs. 5.17%; HR=2.14, 95% CI 1.77-2.58, P,0.001). Patients in the SH cohort had higher incidence of transient ischemic attack compared with non-SH (10.54% vs. 8.03%; P,0.05), while the significance disappeared in the adjusted Cox analyses. No significant difference was observed for other complications. Conclusions: In Chinese patients with T2DM, severe hypoglycemia is a potent marker of increased risk of all-cause mortality, but no significant association between severe hypoglycemia with acute cardiovascular and cerebral vascular events was observed. Further studies with longer follow-up period is needed in future.
International Psychogeriatrics, 2018
ABSTRACTBackground:We analyzed the impact of opioid initiation on the prevalence of antipsychotic... more ABSTRACTBackground:We analyzed the impact of opioid initiation on the prevalence of antipsychotic and benzodiazepine and related drug (BZDR) use among community-dwelling persons with Alzheimer's disease (AD).Methods:We utilized the register-based Medication use and Alzheimer's disease (MEDALZ) cohort for this study. We included all community-dwelling persons diagnosed with AD during 2010–2011 in Finland initiating opioid use (n = 3,327) and a matched cohort of persons not initiating opioids (n = 3,325). Interrupted time series analyses were conducted to compare the prevalence of antipsychotic and BZDR use in 30-day periods within six months before opioid initiation to 30-day periods six months later.Results:Before opioid initiation, prevalence of antipsychotic use among opioid initiators was 13.3%, 18.3% at opioid initiation, and 17.3% six months later.…
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Papers by Piia Lavikainen