Non insulin dependent diabetes mellitus (NIDDM) and essential hypertension (EH) are two of several manifestations of the insulin resistance syndrome. Although subjects with NIDDM and subjects with EH share a common defect in carbohydrate metabolism, only diabetics are advised to avoid sugar. We tested the theory that an adverse effect of diuretics treatment in men with EH with respect to risk of ischaemic heart disease (IHD) would depend on the intake of dietary sugar using sugar in hot beverages as a marker. The cohort consisted of 2,899 men from the Copenhagen Male Study aged 53-74 years (mean 63) who were without overt cardiovascular disease. Potential confounders were: age, alcohol,smoking, physical activity, body mass index, blood pressure, fasting lipids, cotinine, NIDDM,and social class. A total of 340 men took antihypertensives; 211 took diuretics (95% thiazides and related agents), and 129 used other antihypertensives. During 6 years, 179 men (6.2%) had a first IHD event. Among the 340 men taking antihypertensives, the incidence rate was 11%. Diuretics use was associated with a high risk of IHD in hypertensive men with a relatively high intake of dietary sugar; the cumulative incidence rate was 22%; in diuretics treated men with a low intake of sugar, the rate was 7%. After controlling for potential confounders, relative risk (95% ci.) was 3.1(1.3-7.6), p = 001. Among the 129 men who took other forms of antihypertensive drugs, the IHD incidence rate was 8%, and independent of the intake of sugar. The results indicate that the risk of IHD in hypertensives using diuretics is associated with intake of dietary sugar, which may explain at least some of the discouraging effects of antihypertensive agents on the reduction of risk of IHD.
BACKGROUND: Patients' health beliefs influence their willingness to comply with medical advice. In an earlier study, it was found that men with a previous history of information on risk factors for ischaemic heart disease expressed more feelings of threat to their health than did men without this experience. As anxiety may have adverse effects, such as making patients avoid the desired action, this could complicate adequate patient treatment. AIMS: To investigate the impact on health beliefs caused by participation in a screening programme for risk factors for ischaemic heart disease, including individualized information to patients with hypercholesterolaemia. METHODS: A random sample of middle-aged, urban men participating in a health screening completed a questionnaire on socioeconomic factors, medical history, lifestyle, and health beliefs. Blood pressures and plasma cholesterol values were measured. Four months after the initial screening, hypercholesterolaemic men and controls completed the questionnaire again. RESULTS: In a univariate analysis, no differences in health belief indices were found between cases and controls at the baseline screening. Controls achieved lower values of the indices "perceived control over illness" and "medical motivation" at follow-up. In a matched case-control design, the differences in "medical motivation" increased between cases and controls because controls reported lower values. "Perceived threat to health" did not change, and it is suggested that this is due to the supportive information to the patients. CONCLUSION: Individualized and supportive patient information on risk factors for cardiovascular disease does not increase patients' perceptions of threat.
OBJECTIVE: To analyse agreement between patients' and GPs' perceptions of risk factors and overall risk of ischaemic heart disease (IHD). DESIGN: Cross-sectional study based on paired information from patients and GPs. SETTING: Twenty-six GPs in the County of Ringkøbing, Denmark, participating in a medical audit during 3 weeks in May 1999. SUBJECTS: 252 patients with IHD and 1239 without IHD. MAIN OUTCOME MEASURES: GPs and patients were asked about specific risk factors for IHD and their perception of overall risk. Their agreement was evaluated by Kappa statistics. RESULTS: Agreement between GPs and patients varied from 70% to 97%. Disagreement was observed most often for patients with IHD and patients listed with elderly GPs ( > 50 years). Generally, patients perceived the overall risk of IHD lower than their doctors, and for most patients with a perception of low risk the GP estimated the risk as high. CONCLUSIONS: Patients and GPs have different perceptions of the risk of [HD. This may be due to different perceptions of the importance of specific risk factors and different reference frames for risk perception. GPs have an important role in communicating the meaning of risk factors and interventions should be considered to improve risk communication in general practice.
Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials. Radiotherapy Committee of the Danish Breast Cancer Cooperative Group.
BACKGROUND: Radiotherapy in addition to systemic treatment after mastectomy prolongs survival in high-risk breast-cancer patients. However, adjuvant radiotherapy has a potential association with ischaemic heart disease. We assessed morbidity and mortality from ischaemic heart disease in patients treated with postmastectomy radiotherapy. METHODS: Between 1982 and 1990, we randomly assigned 3083 women at high risk of breast cancer, after mastectomy, adjuvant systemic treatment with (n=1538) or without (n=1545) radiotherapy. An anterior photon field was used against the periclavicular region and the axilla. The chest wall was treated through two anterior shaped electron fields, one including the internal mammary nodes. The intended dose was 48-50 Gy in 22-25 fractions, at four to five fractions per week. We obtained information on morbidity and mortality of ischaemic heart disease over a median of 10 years. Analysis was by intention to treat. FINDINGS: More women in the no-radiotherapy group than in the radiotherapy group died of breast cancer (799 [52.5%] vs 674 [44.2%]), whereas similar proportions of each group died from ischaemic heart disease (13 [0.9%] vs 12 [0.8%]). The relative hazard of morbidity from ischaemic heart disease among patients in the radiotherapy compared with the no-radiotherapy group was 0.86 (95% CI 0.6-1.3), and that for death from ischaemic heart disease was 0.84 (0.4-1.8). The hazard rate of morbidity from ischaemic heart disease in the radiotherapy group compared with the no-radiotherapy group did not increase with time from treatment. INTERPRETATION: Postmastectomy radiotherapy with this regimen does not increase the actuarial risk of ischaemic heart disease after 12 years.
OBJECTIVE: Misclassification of smokers as non-smokers may bias estimates of the excess morbidity and mortality associated with smoking. The issue has been given little, if any, attention in prospective epidemiological studies. This study examined characteristics of potentially misclassified smokers with respect to mortality, morbidity, and risk factors. METHOD: A prospective study (within The Copenhagen Male Study, Denmark) used serum cotinine as an objective marker of use of tobacco. A serum concentration of 100 ng/ml was regarded as a relevant threshold for active smoking. In all, 3270 males aged 53-74 years who reported their previous and current tobacco habits, including the use of chew tobacco and snuff, were included. Incidence of all causes of mortality (ACM) during 9 years and death due to ischaemic heart disease (IHD) during 8 years of follow-up were the main outcome measures. RESULTS: Overall cumulative incidence rates of ACM and IHD were 19.1% and 4.3%, respectively. Of 1405 men who reported being non-tobacco users, i.e. no current smoking and no use of chewing tobacco or snuff, 1377 had levels
The Copenhagen Male Study is a prospective, cardiovascular cohort study initiated in 1970 and consisting of 5249 employed men aged from 40 to 59 years. A total of 4710 men, who had reported their tobacco habits and were initially free of ischaemic heart disease (IHD), had their mortality and morbidity recorded over a 17-year period: 585 men suffered a first incident of ischaemic heart disease, and 248 cases were fatal. There was a strong social gradient in the risk of IHD, Kendall's Tau B = 0.12, p
BACKGROUND: Vital exhaustion, a psychological measure characterized by fatigue and depressive symptoms, has been suggested to be an independent risk factor for ischaemic heart disease (IHD) but the generality of the phenomenon remains in question. The aim of this study is to describe prevalence of these symptoms in a community sample and determine whether they prospectively predict increased risk of IHD and all-cause mortality in men and women. METHODS: The study base was 4084 men and 5479 women aged 20-98 free of IHD examined in 1991-1993 in the Copenhagen City Heart Study. Events were ascertained through record linkage until 1998 for IHD and September 2000 for all-cause mortality. There were 483 first hospital admissions and deaths caused by IHD and 1559 deaths from all causes during follow-up. RESULTS: The 17 items on the vital exhaustion questionnaire were frequently endorsed with prevalence ranging from 6 to 47 per cent, higher in women. All but 4 of the 17 items were significantly associated with IHD with significant relative risks (RR) ranging between 1.36 (95% CI: 1.08, 1.72) and 2.10 (95% CI: 1.63, 2.71). Associations with all-cause mortality were also observed, but were weaker. RR of both IHD and all-cause mortality increased with increasing item sum score and were similar in men and women. For IHD, RR reached a maximum of 2.57 (95% CI: 1.65, 4.00) for subjects endorsing >9 items. The similar RR for all-cause mortality was 2.50 (95% CI: 2.09, 2.99). Multivariate adjustment for biological, behavioural, and socioeconomic risk factors did not substantially affect the association for IHD but attenuated the association with all-cause mortality. CONCLUSIONS: Measures of fatigue and depression were common symptoms in this population sample and convey increased risk of IHD and of all-cause mortality. We propose this knowledge begin to be implemented in risk assessment in clinical practice.
Comment In: Int J Epidemiol. 2003 Dec;32(6):997-914681263
Four groups of men with non-daytime work were identified in two surveys. The relative risk of being admitted to hospital due to ischaemic heart disease (IHD) (ICD-8, 410-414) was measured in a 4-year cohort study of all 1,293,888 economically active men in Denmark, aged 20-59 years. Compared with occupational groups having day-work only, men in occupations with frequent night and early morning work had an excess standardized hospitalization ratio (SHR) of 193, occupational groups with late evening work had an excess SHR of 216, groups working in rosters covering 24-hour services had an excess SHR of 174, and groups having other irregular working hours had an excess SHR of 172. We conclude that night work rather than shifts is responsible for a raised risk of IHD. More research is needed to develop preventive strategies.