At a follow-up 7-10 years after a health screening of 50-year-old men in Uppsala, 101 of the 2322 participants and 51 of the 446 non-participants had died. The incidence was thus almost three times as high among non-participants as among participants. Registration at the Temperance Board and/or the Bureau of Social Services was 2-3 times more common among the deceased subjects than among the living irrespective of participation in the health screening. A multiple logistic analysis revealed that non-participation and both types of registration were associated with an increased risk of death. For death from neoplasm only registration at the Bureau of Social Services, and not that at the Temperance Board, was a risk factor. For ischaemic heart disease (IHD), on the other hand, registration at the Temperance Board was the strongest risk factor, the other type of registration being secondary, and non-participation in the screening was a non-significant risk factor. The importance of alcohol intemperance as a risk factor for IHD was reflected in the fact that every second subject dying a sudden death (classified as IHD death) was registered at the Temperance Board. These results indicate that alcohol intemperance entails an increased risk of developing fatal complications to IHD, and social disability may carry with it a risk of both neoplasm and, to a lesser extent, death from IHD.
Ten years after a health screening examination was offered to 50 year old men 32 of the 2322 participants and 12 of the 454 nonparticipants had died of ischaemic heart disease. Of these, 26 and 11 respectively had suffered sudden death, for which necropsy was performed. Half of the men who had died suddenly had been registered for alcohol intemperance up to 1973, which was four times the prevalence of such registrations in the general population. Registration at both the Swedish Temperance Board and the Bureau of Social Services was associated with an odds ratio of 3.74 for sudden death as compared with not being registered at either. Logistic analysis including the classical risk factors for ischaemic heart disease together with registration for alcohol intemperance and at the Bureau of Social Services showed only the two types of registration and systolic blood pressure to be independent risk factors. On the other hand, there was no overrepresentation of subjects entered in the registers among those surviving a myocardial infarction. For non-fatal myocardial infarction blood pressure and serum triglyceride concentration were significant risk factors and serum cholesterol concentration, smoking, and body mass index probable risk factors; the two types of registration were not independent risk factors. Alcohol intemperance is strongly associated with an increased risk of sudden death after myocardial infarction.
Autoantibodies against oxidatively modified low-density lipoproteins (oxLDL) and cardiolipin occur in patients with vascular diseases, including atherosclerosis. The ability of such antibodies to predict myocardial infarction (MI) was investigated in a prospective nested case-control study in which healthy 50-year-old men were followed up for 20 years. Raised levels of antibodies against oxLDL and cardiolipin at 50 years of age correlated positively with the incidence of MI and mortality related to MI 10 to 20 years later. IgG and IgA antibodies against cardiolipin were associated with MI between 50 to 60 years of age and IgG and IgA antibodies against oxLDL with MI at 60 to 70 years of age. Moreover, higher antibody levels were noted in those who died from acute MI in comparison to those who survived. The predictive power of IgA and IgG antibodies was strong and largely independent of that of other strong risk factors. In conclusion, raised levels of antibodies against oxLDL and cardiolipin may predict MI and MI-related death.
BACKGROUND AND PURPOSE: Cerebrovascular disease is increasingly recognized as a cause of dementia and cognitive decline. We have previously reported an association between hypertension and diabetes and low cognitive function in the elderly. Atrial fibrillation is another main risk factor for cerebrovascular disease. The aim of this study was to investigate whether atrial fibrillation is associated with low cognitive function in elderly men with and without previous manifest stroke. METHODS: This was a cross-sectional study based on a cohort of 952 community-living men, aged 69 to 75 years, in Uppsala, Sweden. Cognitive functions were assessed by the Mini-Mental State Examination and the Trail Making Tests, and a composite z score was calculated. The relation between atrial fibrillation and cognitive z score was analyzed, with stroke and other vascular risk factors taken into account. RESULTS: All analyses were adjusted for age, education, and occupational level. Men with atrial fibrillation (n=44) had lower mean adjusted cognitive z scores (-0.26+/-0.11) than men without atrial fibrillation (+0.14+/-0.03; P=0.0003). The exclusion of stroke patients did not alter this relationship; the mean cognitive z score was -0.24+/-0.12 in the 36 men with atrial fibrillation and +0.17+/-0.03 in those without atrial fibrillation (P=0.0004), corresponding to a difference of 0.4 SDs between groups. Adjustments for 24-hour diastolic blood pressure and heart rate, diabetes, and ejection fraction did not change this relationship. Men with atrial fibrillation who were treated with digoxin (n=27) performed markedly better (-0.05+/-0.21) than those without treatment (n=9; -1.14+/-0.34; adjusted P=0.0005). Previous myocardial infarction was not associated with impaired cognitive results. CONCLUSIONS: In these community-living elderly men, we found an association between atrial fibrillation and low cognitive function independent of stroke, high blood pressure, and diabetes. Interventional studies are needed to answer the question of whether optimal treatment of atrial fibrillation may prevent or postpone cognitive decline and dementia.
A health examination survey comprising 2 322 men born in 1920-24 was carried out in 1970-73 at the University Hospital, Uppsala. Untreated subjects with a diastolic BP greater than or equal to 105 mmHg and those already on treatment for hypertension were considered hypertensives. If a BP elevation was verified at a second screening and the patient had no established contact with a physician, he was offered treatment. Thus, 83 men have been followed up for at least 6 years. The overall reduction in SBP after 6 years was 29.0 mmHg and in DBP 19.6 mmHg. Six men have died, four of them from myocardial infarction, five have dropped out for other reasons. The percentage of non-responders (DBP greater than or equal to 105 mmHg) 1, 2, 3, 4 and 5 years +/- 3 months after the start of treatment was high, about 20% on the average. On the other hand, when the mean BP for the non-responders at all visits to the hypertension clinic was compared with their pretreatment value, a reduction of 29.3 mmHg in SBP and 17.0 mmHg in DBP was achieved. The results with regard to compliance and BP reduction are encouraging and would seem to justify more widespread screening and treatment.
The classical risk factors, hypercholesterolemia, smoking, hypertension and diabetes, explain only a part of the epidemiological features of atherosclerotic coronary heart disease. Investigations in the past few years have shown involvement of immunological mechanisms in atherosclerosis. Circulating immune complexes accelerate atherosclerosis both in experimental animal models and in humans. The fourth component of complement (C4) plays an important role in the solubilisation and elimination of immune complexes. C4 consists of two allotypes, C4A and C4B. An earlier report showed an association between C4B null alleles (C4B*Q0) and myocardial infarction and to infarction related mortality. In the present investigation, C4A*Q0 and C4B*Q0 were studied in two population samples. The first (Group I) was a cross sectional study of 100 consecutive males with myocardial infarction before the age of 45 years and 164 population based healthy controls, age and sex matched. The second (Group II) was a nested case control study in which a cohort of 50 year-old males were followed for 20 years for development of myocardial infarction between 50-60 and 60-70 years, and the results compared with those who did not develop MI. We observed no association of homozygous and/or heterozygous C4A*Q0 or C4B*Q0 with myocardial infarction occurring in the age groups 0.05). The prevalence/frequency of C4A*Q0 and C4B*Q0 was not related to the age at which MI occurred. The prevalence of C4A*Q0 was not affected by age. We thus conclude that partial deficiency of C4 does not appear to be a major risk factor for myocardial infarction.
Hypertensive patients still face a considerable risk of cardiovascular disease in spite of drug treatment in many studies. This may partly be explained by metabolic disturbances, both primarily linked to hypertension but also secondarily influenced by anti-hypertensive drugs themselves. In order to evaluate residual cardiovascular risk factors we investigated 1915 treated hypertensives (912 males, 1003 females) attending 128 health centres from all parts of Sweden. Mean blood pressure was 148/91 mmHg for males and 151/90 for females, but a substantial proportion of all patients were not well controlled, having a diastolic blood pressures > or = 100 mmHg (17% males, 12% females). Total cholesterol and HDL-cholesterol were 6.03 and 1.25 mmol l-1 for males, and 6.40 and 1.50 for females. The corresponding figures for serum triglycerides were 2.03 and 1.72 mmol l-1, respectively. In all, 38% of the hypertensives had hypercholesterolaemia (> or = 6.5 mmol l-1) and 27% hypertriglyceridaemia (> or = 2.3 mmol l-1). The lipid/lipoprotein findings may also be influenced by the various anti-hypertensive drugs used in Sweden. The prevalence of smoking and diabetes mellitus were 25% and 11% for men, and for women 24% and 9%. In conclusion, Swedish hypertensives show evidence of significant residual cardiovascular risk factors in spite of treatment. This may be of importance for future relative and absolute cardiovascular risk. It is time to re-evaluate the effectiveness of our management and care of hypertensive patients.
We previously reported the results of a multicentre, randomised, double-blind, parallel-group study comparing the efficacy and safety of cerivastatin 0.4 mg/day and cerivastatin 0.2 mg/day in patients with primary hypercholesterolaemia. Exploratory analysis in this study suggested a gender difference in the 0.4 mg group: mean low-density lipoprotein cholesterol (LDL-C) decreased by 44.4 +/- 8.9% in women, compared with a mean decrease of 37.0 +/- 0.9% in men (p 40%, compared with 38.0% (n = 76) of men taking the same dose. In the cerivastatin 0.2 mg PP population, 34% (n = 17) of women had an LDL-C decrease of > 40%, compared with 19% (n = 18) of men. Mean LDL-C/HDL-C ratio decreased by 43% from baseline to the end of the study in the cerivastatin 0.4 mg PP group: -41.3% in males vs. -48.3% in females. In the cerivastatin 0.2 mg group, the decrease in LDL-C/HDL-C ratio from baseline to endpoint did not markedly differ between genders: -37.0% for males vs. -37.3% for females. Categorial analysis of the LDL-C/HDL-C ratio found that 90% of PP patients taking cerivastatin 0.4 mg, and 84% of PP patients taking cerivastatin 0.2 mg, had a low CHD risk (defined as a LDL-C/HDL-C ratio
OBJECTIVES: A low level of education is associated with an increased risk of developing a dementia disorder, as well as with a higher risk of cardiovascular disease. The aim of this study was to investigate the association between education and cardiovascular risk factors, and to study the relation between these factors and cognitive function in elderly men. DESIGN: Cross-sectional population-based study. SETTING: Uppsala, Sweden. SUBJECTS: 504 men aged 69-74 years, participants in a longitudinal health survey concerning cardiovascular risk factors. MAIN OUTCOME MEASURE: Cognitive function as measured by a composite score of 13 standard psychometric tests. RESULTS: A low level of education was associated with poorer cognitive performance, as well as with obesity, smoking, diabetes, high concentrations of serum triglycerides and plasma fibrinogen. In the entire cohort, subjects with obesity, smoking, diabetes or hypertriglyceridaemia showed impaired cognitive test results, independent of socio-economic factors. When stroke cases were excluded, obesity and smoking were still related to impaired cognitive function. CONCLUSIONS: Smoking and obesity with associated metabolic disturbances are inversely related both to educational level and to cognitive function. Cognitive decline of vascular origin is potentially preventable by treatment of risk factors. The question of whether the increased vascular risk contributes to the higher prevalence of cognitive disorders in individuals with low socio-economic status, needs to be further evaluated in longitudinal population-based studies.
Comparison of effects of quinapril and metoprolol on glycaemic control, serum lipids, blood pressure, albuminuria and quality of life in non-insulin-dependent diabetes mellitus patients with hypertension. Swedish Quinapril Group.
OBJECTIVE: To compare the long-term effects of the angiotensin-converting enzyme (ACE)-inhibitor quinapril and the cardioselective beta-adrenergic blocking agent metoprolol on glycaemic control, with glycosylated haemoglobin (HbA1c) as the principal variable, in non-insulin-dependent diabetes mellitus (NIDDM) patients with hypertension. DESIGN: A randomized, double-blind, double-dummy, multicentre study during 6 months preceded by a 4 week wash-out and a 3 week run-in placebo period. Quinapril (20 mg) and metoprolol (100 mg, conventional tablets) were given once daily. No change was made in the treatment of diabetes (diet and hypoglycaemic agents). SUBJECTS: Seventy-two patients fulfilling the criteria were randomized and entered the double-blind period. Twelve patients did not complete the study. Sixty patients, 26 on quinapril and 34 on metoprolol, were available for the final analysis. MAIN OUTCOME MEASURES: The effect was assessed by changes in HbA1c, the fasting serum glucose and the post-load serum glucose, C-peptide and insulin levels during the oral glucose tolerance test. RESULTS: In the quinapril group, the fasting serum glucose, oral glucose tolerance and the C-peptide and insulin responses, determined as the incremental area under the curves (AUC), showed no change, but the mean HbA1c level increased from 6.2 +/- 1.1% to 6.5 +/- 1.3% (P