Biomarkers and clinical parameters in comprehensive cardiovascular risk estimation

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu University Hospital, auditorium 10. Remote access:

Topic of the dissertation

Biomarkers and clinical parameters in comprehensive cardiovascular risk estimation

Doctoral candidate

Bachelor of Medicine Karri Parkkila

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Research Unit of Internal Medicine

Subject of study



Professor Teemu Niiranen, University of Turku


Professor Olavi Ukkola, University of Oulu

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Individual cardiovascular disease risk estimation – novel information on the role of simple clinical parameters in a Finnish general population

Cardiovascular (CV) diseases are the most common cause of death in the world. Effective primary prevention of CV diseases is based on, above all, healthy lifestyle. However, it is equally important to treat existing CV risk factors (high blood pressure, cholesterol) via medical treatments if lifestyle changes are not sufficient.

Individual CV risk estimation plays an essential role in maximizing the benefits of preventive treatments and in planning individual treatment goals. International guidelines recommend using standardized CV risk calculators (e.g. FINRISK in Finland) to estimate individual CV risk and to support treatment decisions. It is challenging, however, when the patient’s CV risk is defined as “borderline” based on these risk calculators and definite decisions on, for example, starting cholesterol medication cannot be made.

The aim of this thesis was to explore whether simple and easy-to-obtain clinical information could refine individual CV risk estimation, and therefore support daily decision-making related to prevention of CV diseases. The study population consisted middle-aged and elderly Finnish subjects who participated in the Oulu Project Elucidating Risk of Atherosclerosis (OPERA) study. A total of 520 males and 525 females participated in the study. The participants were examined to define their plasma resistin concentration, their carotid and femoral arteries were auscultated to detect bruits, and their carotid artery wall thickness as well as the length of their abdominal aorta plaques were measured using ultrasound. The association between the aforementioned clinical measurements and CV events was analyzed over a period of over 20 years.

In study I, our results indicated that increased plasma resistin concentration is associated with significantly increased risk of death due to all causes in elderly Finnish people. In study II, we showed that detecting an audible bruit from either carotid or femoral arteries was associated with markedly elevated risk of fatal CV events during a very long follow-up period. Carotid artery wall thickness has been stated as a controversial CV risk factor, and in study III we concluded that carotid artery wall thickness, indeed, does not provide information on individual CV risk in addition to traditional risk factors. On the other hand, our novel results in study III showed that abdominal aorta plaques were strongly associated with future CV events in a middle-aged Finnish population over a period of over 20 years.

Taken together, the results of this thesis indicate that it is clinically feasible to gain significant prognostic information on individual CV risk over a period of over 20 years by simply auscultating the patient’s carotid or femoral arteries, and particularly by examining the abdominal aorta via ultrasound. Implementing these clinical measurements into clinical practice might help in refining individual CV risk estimation and guide daily decision-making aimed at reducing the global burden of CV diseases.
Last updated: 1.3.2023