title: Birthplace in area with high coronary heart disease mortality predicts the severity of coronary atherosclerosis among middle-aged Finnish men who had migrated to capital area: the Helsinki sudden death study.
abstract: BACKGROUND
  Reasons why eastern-born male Finns have higher coronary heart disease (CHD) mortality than do western-born men are still unsettled. Recently, eastern birthplace was found to be an independent predictor of pre-hospital sudden cardiac death (SCD) in the new low-mortality area of residence.
  
  
  OBJECTIVE
  To investigate the association of birthplace with high CHD mortality attributes to more severe coronary atherosclerosis among men migrated to the low-mortality capital area.
  
  
  METHODS
  Coronary atherosclerosis was measured in 373 western-born and 314 eastern-born out-of-hospital male deaths aged 33-70 years in Helsinki (The Helsinki Sudden Death Study), covering 24.6% of male deaths within this age-group. CHD risk factors were obtained from an interview of a next of kin.
  
  
  RESULTS
  In multivariate analysis there was a strong birthplace-by-age interaction with atherosclerosis (P = 0.0005). Eastern-born men <54 years had larger areas of fatty streaks (P = 0.0195), fibrotic plaque (P = 0.0133), calcification (P = 0.0009), total plaque area (P = 0.0011), and greater stenosis (P = 0.0004) in the left coronary compared to western-born men, independent of CHD risk factors. Amongst older men (>or=54 years) such an association no longer appeared.
  
  
  CONCLUSIONS
  Higher CHD mortality among eastern-born men may be due to more severe coronary atherosclerosis independently of CHD risk factors, reflecting Finns' two-phase settlement history.
authors.affiliation: Department of Forensic Medicine, Medical School, University of Tampere and Centre for Laboratory Medicine, Tampere University Hospital, Tampere, Finland. petri.tyynela@uta.fi
authors.forename: Petri
authors.initials: P
authors.lastname: Tyynelä
authors.forename: Sirkka
authors.initials: S
authors.lastname: Goebeler
authors.forename: Erkki
authors.initials: E
authors.lastname: Ilveskoski
authors.forename: Jussi
authors.initials: J
authors.lastname: Mikkelsson
authors.forename: Markus
authors.initials: M
authors.lastname: Perola
authors.forename: Markku
authors.initials: M
authors.lastname: Löytönen
authors.forename: Pekka J
authors.initials: PJ
authors.lastname: Karhunen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012111:Residence Characteristics; D012307:Risk Factors; D012720:Severity of Illness Index