High alcohol consumption is one of the major risk indicators for premature death in middle-aged men. An indicator of alcohol abuse--registration with the social authorities for alcoholic problems--was used to evaluate the role of alcohol in relation to general and cause-specific mortality in a general population sample. Altogether 1,116 men (11%) out of a total population of 10,004 men were registered for alcoholic problems. Total mortality during 11.8 years' follow-up was 10.4% among the non-registered men, compared to 20.5% among men with occasional convictions for drunkenness and 29.6% among heavy abusers. Fatal cancer as a whole was not independently associated with alcohol abuse, but oropharyngeal and oesophageal cancers together were seven times more common in the alcohol-registered groups. Total coronary heart disease (CHD) was significantly and independently associated with alcohol abuse, but nearly all the excess CHD mortality among the alcohol-registered men could be attributed to sudden coronary death. Cases with definite recent myocardial infarction were not more common in the alcoholic population. A combined effect of coronary arteriosclerosis and heart muscle damage secondary to alcohol abuse is suggested. Other causes of death strongly associated with registration for alcohol abuse include pulmonary embolism, pneumonia and peptic ulcer, as well as death from liver cirrhosis and alcoholism. Of the excess mortality among alcohol-registered subjects, 20.1% could be attributed to CHD, 18.1% to violent death, 13.6% to alcoholism without another diagnosis and 11.1% to liver cirrhosis.
Angina pectoris was studied in a representative series of male patients (n = 504) with a first myocardial infarction (MI) surviving the hospital stay. The prevalence of questionnaire angina before MI was 28% and of effort-induced chest pain alone 40%. Of the patients with effort-induced chest pain, 72% retained symptoms also after MI. No correlation with age was found. Three months after and one year after infarction the prevalence of effort-induced chest pain was 55% and 45%, respectively. The patients with effort-induced chest pain before MI had a somewhat more severe clinical course and a significantly higher death rate (15% versus 6%) than those without chest pain.
There have been conflicting reports concerning the relationship between increased alcohol intake and mortality from ischaemic heart disease. In this investigation, social register data also containing life-long registration data for alcoholic intemperance were related to cause of death for 302 men aged 35-44 in 1968-74. A random population sample of 940 male survivors of the same age was used for comparison. "Social problems only" were less common for the deceased, irrespective of cause of death, than for the controls. Registration for alcoholic problems was significantly more common for ischaemic heart disease, accidents, suicide and "other deaths" but not for cancer. The variables "detained by the police for drunkenness" and "in prison for crime" showed similar associations. Possible explanations are discussed, especially the association between alcoholic intemperance and death from ischaemic heart disease. The most probable mechanism is effects on the myocardial cell enzyme functions with following arrhythmias in subjects susceptible to malignant arrhythmias due to coronary artery disease and myocardial ischaemia.
A series of 299 men, aged 27-67, who had survived their first myocardial infarction (MI), have been compared with representative population samples with respect to tobacco consumption, alcoholic intemperance, physical activity during work and leisure time, occurrence of hypertension, and cholesterol and triglyceride levels in serum. The infarction patients comprised 90% of all surviving, diagnosed cases of primary MI in men aged 67 years or below during 1968-70 in Göteborg, Sweden. The comparison between infarction patients and general population samples revealed that the patients smoked more, and were less physically active during leisure time but not during work. They had more often a positive history of hypertension and treatment for high BP and their serum cholesterol and serum triglyceride values were higher. For all these variables the difference decreased with increasing age and was generally not statistically significant above the age of 60 years. Alcoholic intemperance was more common among infarction patients who died outside hospital, but there was no difference in this respect between surviving patients and the general population.
The possible association between coffee and myocardial infarction (MI) has been studied both prospectively in a random population sample of Swedish men aged 50 years (n=834) and with case control methodology in non-selected male patients surviving a MI (age 40-57 years, n=230). Coffee consumption was significantly associated with two other important risk factors for MI, namely smoking and alcoholic intemperance, but weak (non-significant) relationships were found with serum cholesterol, serum triglycerides, systolic or diastolic BP, and dyspnoea on exertion. In the prospective study there was no significant relationship between coffee and MI, either with univariate or multivariate analysis. The retrospectively reported coffee consumption of MI patients was higher than of those who later suffered a MI (the population sample). With the aid of non-parametric multivariate analysis of the combined population sample and the series of MI patients, a significant association was found between coffee consumption and MI. The experience of having had a MI may have affected the patients' rating of coffee consumption, or their consumption may have really increased during some months or a few years before the MI.
STUDY OBJECTIVE: To assess the influence of sociodemographic characteristics on self-reported well-being and symptoms. DESIGN: A postal questionnaire was sent to a representative population sample drawn from the population census. SETTING: The municipality of Håbo, Sweden. PARTICIPANTS: Out of 1312 subjects in the population sample, 827 (63%) participated in the study, i.e. answered the questionnaire. RESULTS: Sociodemographic characteristics significantly influenced most well-being variables and symptoms. The prevalence of symptoms in the categories depression and tension, as well as headache, decreased while most other symptoms increased with age. Women had more symptoms than men. Married subjects, compared to others, had higher social and mental but lower physical well-being. Subjects from households with up to three persons, and subjects with comprehensive school only, had lower physical well-being than other subjects. Working subjects generally had a higher well-being than non-working subjects. CONCLUSION: Sociodemographic characteristics had a significant influence on most well-being variables and symptoms.
The effect of a multifactorial intervention programme on coronary heart disease (CHD), stroke incidence and total mortality was determined in a random sample of men, 47-55 years old at entry. The intervention group comprised 10 004 men, and the two control groups were of similar size. The intervention consisted of antihypertensive treatment in subjects with screening blood pressure above 175 mmHg systolic or 115 mmHg diastolic, dietary advice to men with serum cholesterol levels above 260 mg per 100 ml (= 6.8 mMol l-1), advice to stop smoking to subjects who smoked more than 15 cigarettes per day. The intervention was applied for 10 years during which time CHD and stroke incidence and mortality were followed by means of special registers. Participation rate at first screening examination was 75%. The risk factor levels, i.e. blood pressure, serum cholesterol and smoking decreased markedly during 10 years in the intervention group, but also among the control groups. Total mortality, stroke and CHD incidence did not differ significantly between the intervention group and any of the two control groups. We conclude that a decrease has taken place in all three major risk factors for CHD in the general male population in Göteborg, Sweden. Strategies other than intervention on high-risk individuals must be chosen if a major impact on disease incidence is to be achieved in the general population.
All male inhabitants of the city of Göteborg, who were born between 1915-1922 and 1924-1925 were included in the trial, and were 47 to 55 years of age on entry to the study in 1970 to 1973. One-third of these men were randomly allocated to an intervention group, whilst the other two-thirds acted as controls. Men of all social classes, employed as well as unemployed, health conscious as well as careless, were invited, with 75% of these responding to the invitation. The intervention group contained 10,000 men and the control group 20,000 men. The intervention group were given advice on diet, both individually and in groups, the type of advice depending upon serum cholesterol level. Smokers were advised to stop smoking, and men with elevated blood pressure were treated with antihypertensive drugs. Due to the large size of the groups and because they formed a random population sample, it was assumed that they had similar characteristics at the start of the trial. Risk factors were only measured in the intervention group at this time, followed by intervention. This design feature solved several ethical problems with regard to no treatment in the control group. These men were, however, subjected to health examinations and treatment as well as general health advice. Risk factor levels were measured in the intervention group, and also in random subsamples (11%) of the control group after 4 and 10 years. Serum cholesterol, blood pressure and smoking decreased among men in both groups, and only slightly more in the intervention group.(ABSTRACT TRUNCATED AT 250 WORDS)
The bias introduced by non-participation in a study depends on the size and the composition of the non-participant group. Out of 10,000 men invited to a screening examination in a large primary prevention trial in Göteborg, Sweden, 25% did not come to the examination. The non-participants could be shown to be registered by the Board of Social Welfare for social problems and alcohol abuse to a greater extent than the participants in the study. The annual mortality among the non-participants was about twice that of the participants during the entire follow-up period of 11.8 years. The incidence of non-fatal myocardial infarction was not significantly higher in non-participants. Coronary death, on the other hand, was significantly more common among those not attending the examination (3.5 vs. 7.6%). Participants registered for alcoholic problems had coronary death rates approaching those of the non-participants. Sudden coronary death accounted for most of the excess coronary mortality. Most of the excess mortality in the non-participant group was from other causes than cardiovascular diseases and cancer but even so, about one third of the excess deaths could be attributed to coronary heart disease. Possible explanations of this excess coronary mortality include that non-participants may smoke more, more frequently have alcoholic problems and that non-participation may reflect an unwillingness to seek medical care even in the event of illness.
The registration of all myocardial infarctions (MI) in the city of Göteborg started on Jan. 1st 1968, when a special clinic was set up for ambulatory posthospital care of infarction patients. In 1970 this clinic was expanded to cover all patients below 67 years of age with MI in the city of Göteborg, the aim being to standardize and unify patient care and therapeutic regimens to provide opportunities for the study of patient characteristics, natural history, risk factors and effects of preventive measures. Results from such studies have been published, but so far no unified description of this special out-patient unit, nor of any similar unit elsewhere. Patient recruitment, considerations concerning personnel, patient education procedures and return visit routines are covered, together with investigative methods and criteria for the treatment of complications, symptoms and risk factors. The cumulative drop-out rate up to and including 2 years follow-up was only 3%. A brief bibliography of studies originating at the Postmyocardial Infarction Clinic is included.