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Article History

Accepted: 22 September 2025

First Online: 7 October 2025

Declarations

:

: K.E.J.A.: Grants: The Finnish Foundation for Cardiovascular Research; Speaker: Bayer, Pfizer, Boehringer-Ingelheim. Ja.H.: Research grants: EU Horizon 2020, EU FP7; Speaker: Bayer. J.P.: Grants: Academy of Finland, Finnish Foundation for Cardiovascular research, Sigrid Juselius Foundation, Helsinki and Uusimaa Hospital District; Consultant: Herantis Pharma, Novo Nordisk; Speaker: Abbott, BMS-Pfizer, Bayer. P.M.: Consultant: Roche, BMS-Pfizer-alliance, Novartis Finland, Boehringer Ingelheim, MSD Finland, Bayer. K.T.: Grants: The Finnish Foundation for Cardio vascular Research. A.L.A.: Grants: Finnish Foundation for Cardiovascular Research, Sigrid Juselius Foundation; Speaker: Abbott, Johnson & Johnson, Sanofi, Bayer, Boehringer-Ingelheim. Ju.H.: Grants: Finnish Foundation for Cardiovascular Research, EU Horizon 2020; Speaker: Novo Nordisk. M.Le.: Consultant and speaker: BMS-Pfizer-alliance, Bayer, Boehringer-Ingelheim, MSD; Grants: Boehringer-Ingelheim. M.Li.: Speaker: BMS-Pfizer alliance. All other authors declare they have no conflicts of interest.

: Conceptualization: Olli Halminen, K.E. Juhani Airaksinen, Jari Haukka, Jukka Putaala, Pirjo Mustonen, Aapo L. Aro, Juha Hartikainen, Mika Lehto, Miika Linna. Data curation: Olli Halminen, Ossi Lehtonen, Jari Haukka, Miika Linna. Formal analysis: Ossi Lehtonen, Olli Halminen, Miika Linna. Funding acquisition: Mika Lehto. Methodology: Olli Halminen, Miika Linna. Visualization: Ossi Lehtonen, Olli Halminen. Writing—original draft: Ossi Lehtonen. Writing—review and editing: Olli Halminen, K.E. Juhani Airaksinen, Jari Haukka, Jukka Putaala, Pirjo Mustonen, Aapo L. Aro, Juha Hartikainen, Mika Lehto, Miika Linna, Konsta Teppo, Elis Kouki. All authors read and approved the final version.

: The ethical permission is permitted by the ethical committee of the Medical Faculty of Helsinki University, Helsinki Finland (nr. 15/2017 and 15/2024), and study permission was obtained from the Helsinki University Hospital (HUS/46/2018 and HUS/217/2024).

: The study at hand only included previously collected registry information, and thus the patients were not contacted at any point. The data were pseudonymized, and the patients could therefore not be directly identified. Informed consent was waived because of the retrospective design of the study.

: Not applicable.

: Code is available from the corresponding author on a reasonable request.

: The data underlying this article cannot be shared publicly due to its sensitive nature and in accordance with the agreements made with the Finnish registries. Requests to access the data set from qualified researchers trained in human subject confidentiality protocols may be sent to the Finnish national register holders (KELA, Finnish Institute for Health and Welfare, Population Register Centre, and Tax Register).