The relationship between non-esterified fatty acids (NEFA) in serum and heart muscle was examined in 15 patients who died of myocardial infarction (MI) and seven people who died suddenly in accidents. There was no correlation between NEFA levels of serum and non-infarcted cardiac muscle in patients with fatal MI. No significant difference was encountered in cardiac NEFA content between patients with fatal MI and people who died in accidents. The phospholipid (PL) content was significantly lower in patients with fatal MI than observed in people who died in accidents. The arachidonic acid (20:4 (n-6)) concentration of serum NEFA was significantly lower in patients with fatal MI compared to normal subjects. The cardiac NEFA and PL in patients with fatal MI contained significantly lower percentage levels of arachidonic acid compared to people who died in accidents. The results indicate that the death of the MI patients was not accompanied by elevated cardiac NEFA levels.
BACKGROUND: High intakes of trans fatty acids (TFA) have been found to exert an undesirable effect on serum lipid profiles, and thus may increase the risk for cardiovascular disease. OBJECTIVES: Investigation of the association between TFA intake and serum lipids. DESIGN: Cross-sectional study in eight European countries (Finland, France, Greece, Iceland, The Netherlands, Portugal, Spain, Sweden) among 327 men and 299 women (50-65 y). Using a dietary history method, food consumption was assessed and TFA intake was calculated with recent figures on TFA levels of foods, collected in the TRANSFAIR study. RESULTS: Mean (+/-s.d.) TFA intake was 2.40+/-1.53 g/day for men and 1.98+/-1.49 g/day for women (0.87+/-0.48% and 0. 95+/-0.55% of energy, respectively), with the highest consumption in Iceland and the lowest in the Mediterranean countries. No associations were found between total TFA intake and LDL, HDL or LDL/HDL ratio after adjustment for cardiovascular risk factors. Additional adjustment for other fatty acid clusters resulted in a significant inverse trend between total TFA intake and total cholesterol (Ptrend
In a randomly selected population of 9067 individuals, 32-64 years of age in 1967-1970, 25 (0.28%) had chronic atrial fibrillation (CAF). Eight had lone atrial fibrillation. In 1984 the cases were compared with an age- and sex-matched control group of 50 and found to have more cerebrovascular accidents (6 versus 2; P less than 0.05), congestive heart failure (9 versus 1; P less than 0.001), and valvular rheumatic heart disease (3 versus 0) or history consistent with rheumatic fever (6 versus 0; P less than 0.01). The mortality in the CAF group was 60% higher due to an excess in cardiovascular (relative risk 6.1; P less than 0.05) and cerebrovascular (relative risk 12.2; P less than 0.05) causes. The prevalence or incidence of ischaemic or hypertensive heart disease or the presence of coronary risk factors did not significantly differ in the two groups. By M-mode echocardiography the left atrial size, left ventricular enddiastolic dimension and left ventricular mass were increased in the CAF patients, while the systolic left ventricular shortening was significantly less. Thus, the prevalence of CAF is low in a randomly selected population 32-64 years of age and CAF is not strongly associated with ischaemic heart disease or hypertension. The CAF patients have an increased risk of dying prematurely particularly from cerebrovascular causes, even in the absence of valve disease.
A number of 2203 middle-aged Icelandic men (aged 34-61 years) participated in a health survey in Reykjavik in 1967-68. Blood glucose in the fasting state and during an oral glucose tolerance test (OGTT) showed a unimodal distribution with a slight skewness towards higher values. A positive age gradient was established, which showed an increment of about 7 mg/dl per decade in capillary blood sugar values at 11/2 hours after a 50 g oral glucose load. The age gradient was mostly independent of age-related changes in body weight. A 71/2 year followup of the eligible participants (response rate 80%) showed an overall 1% incidence of metabolic deterioration to "overt diabetes" during this period. Those with positive screening tests (50 g OFTT) at baseline were at greater risk of developing diabetes, but the incidence of deterioration in this group was low, about 1% per year. The progression to diabetes was significantly related to body weight at baseline, suggesting that weight reduction might be beneficial in individuals showing impaired glucose tolerance at medical examination. This study, however, lends support to recent reports showing that mildly impaired glucose tolerance cannot be equated with early diabetes.
Coronary heart disease mortality amongst non-insulin-dependent diabetic subjects in Iceland: the independent effect of diabetes. The Reykjavik Study 17-year follow up.
OBJECTIVES: The main aim of this study was to estimate the independent risk for coronary heart disease (CHD) death associated with non-insulin dependent (Type 2) diabetes (NIDDM) and effect on life expectancy. DESIGN AND SETTING: The Reykjavik Study is a prospective cardiovascular population study which started in 1967. A randomized selection procedure identified individuals for invitation to participate, based on their year and date of birth. Participants were examined in the years 1967-91 in one research clinic in Reykjavik. SUBJECTS AND METHODS: The population in this survey were Icelandic Caucasian males and females, born 1907-35 and therefore 34-79 years old when their examination was performed. Altogether 9139 males and 9773 females attended, and of those 267 males and 210 female were NIDDM as defined by a questionnaire or an oral glucose tolerance test. Other factors measured in the study included systolic and diastolic blood pressure, fasting total cholesterol, triglycerides, uric acid, smoking habits, height, and weight. The causes of death were determined by a review of all death certificates. Results. The relative risk of death from CHD (95% confidence limits), independently associated with NIDDM, was 2.0 (1.5-2.6) for males and 2.4 (1.6-3.6) for females. The relative risk of death from all causes was 1.9 (1.6-2.3) and 1.7 (1.3-2.1), respectively, for male and female diabetic patients. CONCLUSIONS: Non-insulin dependent diabetes mellitus carried twice the risk of CHD death in both sexes, independently of other risk factors. The diagnosis of NIDDM at the age 55 years reduced an individual's life expectancy by about five years, mostly because of increased CHD death rate.
BACKGROUND. Evidence about the influence of hypertension in pregnancy on later health and in particular the risk of cardiovascular disorders is conflicting, although a link has been suggested. In a population-based study with a long follow-up time the potential association between hypertension in pregnancy, preeclampsia and eclampsia with increased death rates from ischemic heart disease (IHD) was investigated. METHODS. All 7543 case records at the main maternity hospital in Iceland during 1931-1947 were reviewed to identify women with hypertension in pregnancy, subdivided by parity and severity of disease into those with eclampsia, preeclampsia and hypertension alone. Information on those who had died was obtained from death certificates, supplemented by autopsy reports and hospital records. Death rates from IHD were compared to population data from public health and census reports during corresponding periods and between study groups. RESULTS. Of 374 hypertensive women 177 had died. The death rate was slightly higher among women with any hypertension in pregnancy than in the reference population (RR = 1.20; 95% CI 1.01-1.42). About half of the increase was attributed to excess mortality from IHD with a relative risk of dying of 1.47 (95% CI 1.05-2.02). The relative risk of dying from IHD was significantly higher among eclamptic women (RR = 2.61; 95% CI 1.11-6.12) and those with preeclampsia (RR = 1.90; 95% CI 1.02-3.52) than those with hypertension alone. Parous women at the index pregnancy had a twofold higher risk of dying from IHD than primigravid women (RR = 2.05; 95% CI 1.19-3.55; p = 0.01). CONCLUSION. There is an indication of increased death rates among women with a history of hypertension in pregnancy, where ischemic heart disease may be more common than in the general population.
OBJECTIVE--To monitor trends in mortality and morbidity due to ischaemic heart disease and compare these with observed levels of risk factors from population surveys. DESIGN--Analysis of trends in death rates from ischaemic heart disease in Iceland compared with expected rates computed from population surveys. Risk factor levels together with beta factors obtained from Cox's regression analysis were used to compute expected death rates. Trends in morbidity due to acute myocardial infarction were assessed and secular trends in dietary consumption compared with trends in cholesterol concentrations. SETTING--Reykjavik, Iceland (total population 250,000; over half the population live in Reykjavik). SUBJECTS--12,814 randomly selected residents in the Reykjavik area aged 45-64 (6623 men, 6191 women; 72% and 80% of those invited). MAIN OUTCOME MEASURES--Age adjusted rates of myocardial infarction and deaths from ischaemic heart disease. Expected risk from risk factor levels (smoking, total serum cholesterol concentration, systolic blood pressure) at each unique survey visit. RESULTS--Mortality from ischaemic heart disease has decreased by 17-18% since 1970. During 1981-6 the myocardial infarction attack rate in men under 75 decreased by 23%. A decrease occurred in the level of all three major risk factors after 1968. The fall in the serum cholesterol concentration coincided with a reduction in consumption of dairy fat and margarine. The calculated reduction in risk for the age group 45-64 was about 35%, which was closely similar to the observed decrease in mortality due to ischaemic heart disease in that age group. CONCLUSION--The reduction in mortality from ischaemic heart disease was substantially due to a decreased incidence of myocardial infarction and could be attributed largely to the reduction in risk factors.
In the first stage of a prospective cardiovascular health survey, 2955 males aged 34-61 years were invited for examination during a 12-month period. The response was 75%. Appointments were arranged in such a way that all age groups would be equivalent with respect to time of day, weekday and time of year on which appointments were given. In fasting blood and urine samples the following quantities were estimated: s-alkaline phosphatase (AP), s-bilirubin (Bil), s-creatinine (Cre), s-uric acid (UA), haemoglobin (Hb), haematocrit (Hct), mean cell haemoglobin content (MCHC), erythrocyte sedimentation rate (ESR) and urine specific gravity (USG). The approximate 5% and 95% centiles were as follows: (table; see text) No indication of seasonal variation was found in these results.
BACKGROUND: Stroke is a major cause of illness, death, and health expenditures. Leisure-time physical activity may reduce the risk for stroke. OBJECTIVE: To examine the association of leisure-time physical activity and pulmonary function with risk for stroke. DESIGN: Prospective cohort study. SETTING: Reykjavík, Iceland. PARTICIPANTS: 4484 men 45 to 80 years of age followed for a mean (+/-SD) of 10.6 +/- 3.6 years. MEASUREMENTS: Patients underwent physical examination, blood sampling, and spirometry and completed a questionnaire about health and exercise. Computerized hospital records were used to identify strokes, and the Icelandic National Registry was used to identify deaths. RESULTS: New stroke developed in 249 men (5.6%) (hemorrhagic stroke in 44 [18%] and ischemic stroke in 205 [82%]). In a multivariable hazard analysis that controlled for known risk factors for cerebrovascular disease, leisure-time physical activity maintained after 40 years of age was associated with a reduced risk for stroke (relative risk, 0.69 [CI, 0.47 to 1.01] for total stroke and 0.62 [CI, 0.40 to 0.97] for ischemic stroke). Risk for stroke increased with diminished ventilatory function (FVC or FEV1) (relative risk, 1.9 [CI, 1.06 to 3.25] for the lowest compared with the highest quintile). CONCLUSION: Middle-aged men who participate in leisure-time physical activity and have good pulmonary function seem to have a lower risk for stroke than men who are not active or have diminished pulmonary function.
Dupuytren's disease or palmar fibromatosis is a common disabling hand disorder, mainly confined to Caucasians of northwestern European origin. The prevalence of Dupuytren's disease and possible risk factors related to the disease were evaluated in a random sample of 1297 males and 868 females, aged 46 to 74 years. Blood samples were collected and biochemical parameters were evaluated. The possible relation between the disease and clinical, social, and biochemical parameters were estimated with age-adjusted univariate logistic regression analysis. Altogether 19.2% of the males and 4.4% of the female participants had clinical signs of Dupuytren's disease. The prevalence increased with age, from 7.2% among males in the age group 45-49 years up to 39.5% in those 70-74 years old. The more severe form of the disease, finger contractures, was found in 5.0% of the men and 1.4% had required operation, while this was rarely seen among women. In men elevated fasting blood glucose (P
