BACKGROUND: Elevated concentrations of plasma total homocysteine (tHcy) and serum total cholesterol are risk factors for ischemic heart disease (IHD). Previous studies showed that the consumption of very high doses of unfiltered coffee increases tHcy and total cholesterol. OBJECTIVE: A prospective intervention study was performed to assess the effects of coffee consumption on the concentrations of tHcy and total cholesterol by using doses and brewing methods common in southeastern Norway. DESIGN: The study was an unblinded, controlled trial with 191 healthy, nonsmoking, coffee-drinking volunteers aged 24-69 y randomly assigned to 3 groups who were asked to consume for 6 consecutive weeks no coffee, 1-3 cups (approximately 175-525 mL)/d, or > or =4 cups (approximately 700 mL)/d prepared in the manner to which they were accustomed. Blood samples were drawn when the subjects were randomly assigned and at 3 and 6 wk of the trial. Dietary data were collected by questionnaire. RESULTS: Ninety-seven percent of the participants reported being regular consumers of caffeinated filtered coffee. Abstention from coffee for 6 wk was associated with a decrease in the tHcy concentration of 1.08 micromol/L and a decrease in the total cholesterol concentration of 0.28 mmol/L in participants who had been drinking on average 4 cups of filtered coffee daily for the past year. Adjustments for several possible confounders did not alter the results. CONCLUSION: Abstention from filtered coffee in doses that are commonly consumed was associated with lower concentrations of tHcy and total cholesterol.
BACKGROUND. High blood pressure has been associated with elevated atherogenic blood lipid fractions, but epidemiological surveys often give inconsistent results across population subgroups. A better understanding of the relation between blood pressure and blood lipids may provide insight into the mechanism(s) whereby hypertension is associated with increased risk of coronary heart disease. METHODS AND RESULTS. We assessed the cross-sectional relations of serum total cholesterol, high density lipoprotein (HDL) cholesterol, non-HDL cholesterol (total minus HDL cholesterol), and triglyceride levels with blood pressure in a population of 8,081 men 20-54 years old and 7,663 women 20-49 years old. Stratified analyses and multivariable methods were used to control for potential confounding anthropometric and lifestyle variables. Total and non-HDL cholesterol levels increased significantly with increasing systolic or diastolic blood pressure in both sexes. Men 20-29 years old had steeper regression slopes for blood pressure by total cholesterol level than did women of similar age. In men, the association between blood pressure and total cholesterol level decreased with age, whereas in women, it increased with age. Body mass index modified the relation, whereas smoking, physical activity, and alcohol consumption had little influence on the association. Triglyceride levels increased with blood pressure, but this relation was weak in lean subjects. HDL cholesterol level correlated positively with blood pressure in population subgroups having a high alcohol consumption. CONCLUSION. These results support the hypothesis that there are biological interrelations between blood pressure and blood lipids that may influence the mechanisms whereby blood pressure is associated with risk of coronary heart disease.
Cardiovascular risk factor levels among 40-year olds in Oslo were studied from the early 1970s until the late 1980s. Comparison has been made with similar data for the same period from two other regions in the country. The serum cholesterol level in men decreased from 6.3 mmol/l in 1972-73 to 5.9 mmol/l in 1985-88 and the proportion of men who smoked on a daily basis decreased from 51.8% to 40.8%. The proportion of female smokers increased from 37.4% in 1981-84 to 39.5% in 1985-88. There was a decrease in systolic blood pressure among men from 1972-73 to 1985-88. From 1981-84 to 1985-88 there was a minor increase for both sexes in the proportion of physically inactive for both sexes or those with a body mass index > 30. Prior to 1980 cardiovascular risk factors were most favourable in Sogn og Fjordane, and least favourable in Finnmark, with men from Oslo positioned somewhere in between these counties. With the exception of women's smoking habits and, for both sexes, the degree of physical activity, people living in Oslo in 1985-88 had a more favourable risk factor status than those in Sogn og Fjordane in 1985 and in Finnmark in 1987. Despite a degree of uncertainty because of methodological issues, the results indicate a reduction in risk factors of cardiovascular disease among men in Oslo during the 15 years covered by the study.
As a part of a survey for coronary risk factors, family history of myocardial infarction (MI) was obtained in 4806 men and women aged 20--49 years. The two groups of subjects with (510) and without (3533) first degree relatives with MI showed only minor differences with respect to serum cholesterol, blood pressure, blood glucose, serum triglycerides, relative body weight and cigarette consumption. As long as no other mechanism for transmission of familial risk is revealed, the occurrence of MI among first degree relatives therefore must be considered as independent and important coronary risk factor. The material was also analyzed with regard to the three ethnic groups--Lapps, Finns and Norsemen--which comprise the study population. A discrepancy between risk factor level and MI incidence between these three groups was observed.
OBJECTIVES: To examine trends in sex ratios for different manifestations of coronary disease. DESIGN: National Swedish registers on hospital discharges and cause-specific deaths were used to calculate age- and sex-specific trends and sex ratios for coronary admissions and deaths. SETTING: Nineteen Swedish counties, average population 4.8-5.1 million in the investigated age groups. SUBJECTS: All patients aged 25-84 years with first hospital admissions or deaths as a result of coronary heart disease in 1984-99, in total 432,871 cases. MAIN OUTCOME MEASURES: Ratio men/women and rates (per 100,000) of acute myocardial infarction (AMI), acute admissions for angina and total of all acute admissions for any coronary disease. RESULTS: Below age of 65 years AMI incidence decreased more for men than for women and rates of acute admissions for angina increased more in women than in men. In men and women above 65 years trends were almost identical. In 1984-87 the ratio men/women with respect to myocardial infarction was 5.6 at age 25-44 years, but decreased to 3.7 in 1996-99. Corresponding sex ratios for angina decreased from 3.2 to 1.8 and for total coronary heart disease from 4.7 to 2.8. Amongst men and women aged 45-54 years, the sex ratio with respect to myocardial infarction decreased from 5.6 to 4.1, for angina from 2.4 to 1.7 and for total acute coronary disease from 4.2 to 2.7. Ratios men/women decreased less at higher ages and remained unchanged throughout the period in the oldest age group. CONCLUSIONS: Overall, we found decreasing sex ratios at ages below 65, but above age 65 years trends in men and women were similar. These developments could be due to changing criteria for admission and diagnosis, but true differences in the clinical manifestation of coronary disease, possibly in response to secular trends in risk factor levels, cannot be excluded.
The coronary heart disease (CHD) mortality rates for men aged 35-44 years decreased by 25% from 1966-70 to 1976-80. In older age groups only a modest decline was observed. The decrease in CHD mortality is probably due to a decrease in incidence. The reason for the decline is not known, but some changes in health-related behaviour have occurred in Norway, probably already starting in the 1960s. There was an increase in meat, sugar and total fat consumption and a decrease in the intake of cereals both before and after the Second World War. These trends seem to have slowed down and in a recent survey 44% of the population reported changes towards a low fat diet. The percentage of non-smokers is increasing, particularly since 1975-76. Physical activity in leisure time has increased since the mid-70s but there are social gradients with the most active subjects being recruited from the higher social strata. The improved medical care of CHD patients is not thought to have had a major impact upon the decline in the mortality rates. The most probable explanation for the changes is an increase of non-smokers and a turn towards a less coronary prone diet.
STUDY OBJECTIVE: The aim was to estimate health and economic consequences of interventions aimed at reducing the daily intake of salt (sodium chloride) by 6 g per person in the Norwegian population. Health promotion (information campaigns), development of new industry food recipes, declaration of salt content in food and taxes on salty food/subsidies of products with less salt, were possible interventions. DESIGN: The study was a simulation model based on present age and sex specific mortality in Norway and estimated impact of blood pressure reductions on the risks of myocardial infarction and stroke as observed in Norwegian follow up studies. A reduction of 2 mm Hg systolic blood pressure (range 1-4) was assumed through the actual interventions. The cost of the interventions in themselves, welfare losses from taxation of salty food/subsidising of food products with little salt, cost of avoided myocardial infarction and stroke treatment, cost of avoided antihypertensive treatment, hospital costs in additional life years and productivity gains from reduced morbidity and mortality were included. RESULTS: The estimated increase in life expectancy was 1.8 months in men and 1.4 in women. The net discounted (5%) cost of the interventions was minus $118 millions (that is, cost saving) in the base case. Sensitivity analyses indicate that the interventions would be cost saving unless the systolic blood pressure reduction were less than 2 mm Hg, productivity gains were disregarded or the welfare losses from price interventions were high. CONCLUSION: Population interventions to reduce the intake of salt are likely to improve the population's health and save costs to society.
OBJECTIVE--To evaluate the relative cost effectiveness of various cholesterol lowering programmes. DESIGN--Retrospective analysis. SETTING--Norwegian cholesterol lowering programme in Norwegian male population aged 40-49 (n = 200,000), whose interventions comprise a population based promotion of healthier eating habits, dietary treatment (subjects with serum cholesterol concentration 6.0-7.9 mmol/l), and dietary and drug treatment combined (serum cholesterol concentration greater than or equal to 8.0 mmol/l). MAIN OUTCOME MEASURE--Marginal cost effectiveness ratios--that is, the ratio of net treatment costs (cost of treatment minus savings in treatment costs for coronary heart disease) to life years gained and to quality of life years (QALYs) saved. RESULTS--The cost per life year gained over 20 years of a population based strategy was projected to be 12 pounds. For an individual strategy based on dietary treatment the cost was about 12,400 pounds per life year gained and 111,600 pounds if drugs were added for 50% of the subjects with serum cholesterol concentrations greater than or equal to 8.0 mmol/l. CONCLUSIONS--The results underline the importance of marginal cost effectiveness analyses for incremental programmes of health care. The calculations of QALYs, though speculative, indicate that individual intervention should be implemented cautiously and within more selected groups than currently recommended. Drugs should be reserved for subjects with genetic hypercholesterolaemia or who are otherwise at very high risk of arteriosclerotic disease.