The purpose of the present study was to examine general practitioners' abilities to make a correct estimation of the risk of coronary heart disease (CHD). A 10% random sample of Norwegian primary care physicians (n = 288) received a questionnaire that presented 10 case histories containing information about five CHD risk factors. The respondents' risk estimation was compared with a composite score computed from epidemiologic data. The observed general tendency was towards underestimating the CHD risk. However, 'high-risk' histories were recognized as CHD risk persons. Assessment of CHD risk due to multiple marginal abnormalities was only exceptionally correct. Hypercholesterolaemia and hypertension in men were acknowledged as contributing to clinically significant CHD risk only by a minority of GPs. Heavy smoking and a positive family history were associated with a more accurate estimation of CHD risk. Forty per cent of the physicians did not recognize the sex dependency of cholesterol as a CHD risk factor. None of the physician characteristics could predict variation in correct risk assessment.
We analyzed data from 4,905 women aged 20-39 and 14,803 aged 40-49 who attended a health survey in Norway 1985-88, to study cardiovascular risk factors in users of oral contraceptives, all types and specifically by formulation. In age group 20-39, users of low-dose estrogen/ progestin regimens were younger, had lower body mass index (BMI), less often reported coronary heart disease in relatives, and less often used saturated fat on bread than did non-users. In age group 40-49, smoking was more prevalent in users of low-dose estrogen/progestin than in non-users. In both age groups the mean ratio of total/HDL cholesterol, the mean level of non-fasting triglycerides, and the mean systolic and diastolic blood pressures were higher in oral contraceptive users than in non-users. Among the users, a more favorable pattern was found in women using progestin-only oral contraceptives, as blood pressure levels were equal to those of non-users and total cholesterol and triglycerides were both 0.1-0.2 mmol/l below the non-users, in both age groups. However, users of low-dose estrogen formulations containing desogestrel 0.15 mg, norethisterone (norethindrone) 0.5 mg or lynestrenol 2.5 mg had the highest levels of HDL, even higher than the non-users. A pattern of higher triglycerides and higher ratio of total/ HDL cholesterol was found in smokers, compared with non-smokers, among users of any type of contraceptives, and in non-users.
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.
Screening for cardiovascular disease risk factors was carried out in 14 of Norway's 19 counties in 1986-1990 as part of a prevention programme. All residents aged 40-42 were invited. The attendance was 73.5% for males and 82.6% for females. A total of 87,761 persons were examined. The screening included determination of serum cholesterol and triglycerides, measurement of blood pressure, height and weight, and filling in a questionnaire. Mean serum cholesterol was 5.90 mmol/l for males and 5.55 mmol/l for females, mean systolic blood pressure 135.3 and 126.1 mm, and prevalence of daily smoking 43.5 and 41.8%. The risk factor levels in the 341 municipalities of the 14 counties are shown cartographically. For both sexes, the highest risk score was found in the northernmost county, the lowest in southern counties. The risk was also relatively high in some rural areas in southern Norway. By geographical area there was a strong correlation between the risk factor levels of the two sexes, and a less consistent but marked correlation between the means for the various risk factors.
Comment In: Tidsskr Nor Laegeforen. 1991 Jun 30;111(17):2061-21871733
In 1985-90, two screenings for cardiovascular disease risk factors were carried out with an interval of three years in four Norwegian counties. All residents aged 40-42 were invited to both screening rounds, and certain subgroups from the first round were re-invited to the second round. Compared with the score attained by the first generation, the total mean risk score for myocardial infarction achieved by the second generation was 19% lower in males, and 15.5% lower in females. The main cause of this reduction was lower serum cholesterol level. Based on results from the subgroups, the estimated mean risk score for the total male cohort from the first round had decreased by 10% at the rescreening three years later. It is concluded that the results indicate a continued, and perhaps accelerated, decrease in coronary heart disease mortality, as new generations populate the age groups where this disease is more prevalent. The screenings were part of a prevention programme, and it is reasonable to assume that the efforts by the primary health care services contributed to the improvement.
Relationships between coffee drinking and cancer incidence were examined in a 10-year complete follow-up of 21,735 men and 21,238 women aged 35-54 years. The study population participated in a cardiovascular screening in three countries in Norway during 1977-82. Data on coffee and smoking habits were based on information from a self-administered questionnaire. There was no association between coffee consumption and overall risk of cancer. A positive association was found between coffee drinking and risk of lung cancer, also after adjustment for age, cigarette smoking, and county of residence. Residual confounding by cigarette smoking and other lifestyle factors cannot be ruled out. A negative association was found with cancer of buccal cavity and pharynx and with malignant melanoma in women. No significant associations were found between coffee drinking and incidence of cancer of the pancreas or the bladder.
OBJECTIVE--To study the association between number of cups of coffee consumed per day and coronary death when taking other major coronary risk factors into account. DESIGN--Men and women attending screening and followed up for a mean of 6.4 years. SETTING--Cardiovascular survey performed by ambulatory teams from the National Health Screening Service in Norway. PARTICIPANTS--All middle aged people in three counties: 19,398 men and 19,166 women aged 35-54 years who reported neither cardiovascular disease or diabetes nor symptoms of angina pectoris or intermittent claudication. MAIN OUTCOME MEASURE--Predictive value of number of cups of coffee consumed per day. RESULTS--At initial screening total serum cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, height, and weight were measured and self reported information about smoking history, physical activity, and coffee drinking habits was recorded. Altogether 168 men and 16 women died of coronary heart disease during follow up. Mean cholesterol concentrations for men and women were almost identical and increased from the lowest to highest coffee consumption group (13.1% and 10.9% respectively). With the proportional hazards model and adjustment for age, total serum and high density lipoprotein cholesterol concentrations, systolic blood pressure, and number of cigarettes per day the coefficient for coffee corresponded to a relative risk between nine or more cups of coffee and less than one cup of 2.2 (95% confidence interval 1.1 to 4.5) for men and 5.1 (0.4 to 60.3) for women. For men the relative risk varied among the three counties. CONCLUSIONS--Coffee may affect mortality from coronary heart disease over and above its effect in raising cholesterol concentrations.
The health consequences of coffee drinking remain controversial. We report on an association between coffee consumption and the concentration of total homocysteine (tHcy) in plasma, a risk factor for cardiovascular disease and for adverse pregnancy outcome. The study population consisted of 7589 men and 8585 women 40-67 y of age and with no history of hypertension, diabetes, ischemic heart disease, or cerebrovascular disease. They were recruited from Hordaland county of western Norway in 1992-1993. Daily use of coffee was reported by 89.1% of the participants, of whom 94.9% used caffeinated filtered coffee. There was a marked positive dose-response relation between coffee consumption and plasma tHcy, which was stronger than the relation between coffee and total serum cholesterol. In 40-42-y-old men, mean tHcy was 10.1 mumol/L for nonusers and 12.0 mumol/L for drinkers of > or = 9 cups of coffee/d. Corresponding tHcy concentrations in 40-42-y-old women were 8.2 and 10.5 mumol/L, respectively. Although coffee drinking was associated with smoking and lower intake of vitamin supplements and fruit and vegetables, the coffee-tHcy association was only moderately reduced after these variables were adjusted for. The combination of cigarette smoking and high coffee intake was associated with particularly high tHcy concentrations. A strong inverse relation between tea and tHcy concentration in univariate analysis was substantially attenuated after smoking and coffee drinking were adjusted for. The results of the present report should promote future studies on tHcy as a possible mediator of adverse clinical effects related to heavy coffee consumption.
Comment In: Am J Clin Nutr. 1997 Dec;66(6):1475-79394702
BACKGROUND: The level of mortality from cardiovascular disease (CVD), coronary heart disease (CHD) and from all causes varies considerably within Oslo. The purpose of this study was to examine these differences according to cardiovascular risk factors and socioeconomic variables at the district level. METHODS: Total mortality rates and cardiovascular mortality rates for subjects aged 45-74 years in 1991-1995, and their relationship to cardiovascular risk factors and socioeconomic indicators in the 25 districts of Oslo were studied. Cardiovascular risk factors were based on data from 40 year olds in 1985-1988. The following variables were used as independent variables in the regression analyses to explain differences between the districts: daily smoking, cholesterol level, systolic blood pressure, education and income. RESULTS: Mortality rates were strongly related to cardiovascular risk factors and to socio-economic indicators, with correlation coefficients (Pearson) of 0.74 for smoking and CVD mortality, and -0.78 for high income and CHD mortality. Smoking explained 70% of the differences in mortality from all causes for men and 46% for women, and 61% and 49% of the differences in CVD mortality for men and women respectively. Diastolic blood pressure and total cholesterol were closely related to socioeconomic indicators and to smoking, but the relative strength of the cardiovascular risk factors in the multivariate analyses differed for males and females. CONCLUSION: diovascular risk factors and socioeconomic indicators at the population level were strongly related to mortality, and explained a large proportion of the differences in mortality between different districts of Oslo in the 1990s.