Stroke case fatality in Denmark from 1977 to 1992: the Copenhagen City Heart Study.

BACKGROUND AND PURPOSE: Stroke mortality rates have decreased in Denmark but little is known about the reasons for these changes. One possible explanation is decreased case-fatality, and the aim of the present investigation was to study trends in case-fatality for first-ever stroke in a large population-based cohort study in Copenhagen, Denmark. SUBJECTS AND METHODS: The Copenhagen City Heart Study comprised 19,698 inhabitants in Copenhagen, Denmark. Linkage to two national registers enabled identification of all subjects irrespective of participation in the study examinations. Follow-up in the present study was from January 1, 1977 to December 31, 1992. Case fatality after 7 days, 28 days, 1 year and 1 year in 28-day survivors was assessed for first-ever stroke. Uniform identification and validation methods made it possible to estimate trends in case-fatality. The World Health Organization's definition of stroke was used, and stroke was categorized into either unspecified stroke, ischemic infarction, intracerebral hemorrhage, or subarachnoid hemorrhage. The effect of time was estimated by means of multiple logistic regression analyses adjusting for gender, age at onset and type of stroke. RESULTS: A total of 1,213 strokes occurred during the study period from 1977 to 1992 in the study population. The case-fatality was highest during the first 28 days, and especially the initial 7 days; thereafter a steady state was reached. From the period 1977-1980 to the period 1989-1992 case-fatality did not change in analyses of 7-day case-fatality odds ratio (OR) = 1.14 (95% confidence interval, CI: 0.98-1.33), or of 28-day case-fatality OR = 1.06 (95% CI: 0.92-1.20), or of 1-year case-fatality OR = 0.95 (95% CI: 0.84-1.07). In the 1-year case-fatality, including only 28-day survivors, a significant decrease was found OR = 0.81 (95% CI: 0.67-0.97). Men had a significantly lower 7-day case-fatality than women; OR = 0.73 (95% CI: 0.52-0.99), but the difference attenuated in subsequent analyses and did not remain statistically significant. CONCLUSION: During the period 1977-1992, the 1-year case-fatality decreased in stroke patients who survived the initial 28 days, whereas no changes were observed in 7-day, 28-day and 1-year case-fatality.     

Job strain and cardiovascular risk factors among members of the Danish parliament

Sudden cardiovascular events among well-known politicians attractmuch attention—from the mass media and from the public.No previous studies have assessed the job strain profile andlevel of known cardiovascular risk factors among parliamentarypoliticians. The study was carried out within the frameworksof the Copenhagen City Heart Study. Some 102 members of theDanish parliament (70 men and 32 women) agreed to participate,giving a response rate of 55%. Three sex- and age-matched participantswere drawn for each politician from the Copenhagen City HeartStudy. In addition to the completion of large questionnaireson health and working conditions, all participants had a thoroughexamination, including measurements of height and weight andblood pressure and the drawing of a venous blood sample forthe determination of serum lipids, Apolipoprotein_A1 and Apolipoprotein_Band fibrinogen. Job strain factors and established cardiovascularrisk factors were the main outcome factors. Politicians reportedmuch higher job demands, but also much more influence on theirjob than others. Politicians smoked less, consumed more wine,had higher levels of Apolipoprotein_A1, and were taller. Withrespect to other major cardiovascular risk factors, serum lipids,blood pressure and physical activity, there was no differencebetween politicians and controls. Politicians had greater jobdemands, but also more control over their job than others, indicatingthat the job strain phenomenon should not increase their riskof cardiovascular disease. Other cardiovascular risk factors,job related or conventional, which were unevenly distributedbetween politicians and controls all favoured politicians. Inconclusion, politicians had a more beneficial cardiovascularrisk factor profile than a matched random sample from a comparablebackground population.     

Pulmonary function is influenced by heavy alcohol consumption

To study the possible impact of alcohol consumption on lung function (FEV1 and FVC), we observed 11,135 men and women for 5 yr. Subjects were between 20 and 90 yr of age and were selected so that they were representative of the population of the city of Copenhagen. The study population was stratified according to smoking habits and alcohol consumption. A total of 8,765 persons did not significantly change alcohol or smoking habits during the 5 yr of observation and constituted the study sample. The study sample included 32 women and 301 men with an alcohol consumption of greater than or equal to 350 g/wk (78 were nonsmokers). Multiple regression analysis showed that alcohol consumption significantly accelerated the loss of FEV1 and the loss of FVC with time. Consumption of 350 g of alcohol/wk had an effect on FEV1 comparable to the effect of smoking 15 g of tobacco/day.     

Effects of smoking and changes in smoking habits on the decline of FEV1

The aim of this study was to examine the effects of cigarette smoking and changes in smoking habits on the decline of forced expiratory volume in the first second of expiration (FEV1). We studied 7,764 men and women for 5 yrs. The subjects were grouped according to self-reported smoking habits during the observation period. We found that persistent cigarette smoking, in particular heavy smoking, accelerated the decline in FEV1. In 310 subjects who quitted smoking during the observation period, the decline of FEV1 was less pronounced than the decline observed in persistent smokers. In subjects younger than 55 yrs of age, smoking reduction was associated with a less pronounced FEV1 decline, while in the elderly subjects smoking reduction had no effect on the FEV1 decline. An increase in the number of cigarettes smoked was generally associated with a more rapid decline of FEV1, while the beginning of smoking during the 5 yrs of observation did not seem to influence the decline of FEV1. We conclude that smoking cessation or reduction may lead to a demonstrable beneficial effect on the FEV1 decline within a few years.     

Presenile corneal arcus in healthy persons. A possible cardiovascular risk indicator in younger adults

The results of blood-lipid screening of 200 39--49-year-old participants with incidentally diagnosed corneal arcus from the Copenhagen City Heart Study are reported. A large sample of study-participants of the same age-group without arcus served as controls. In general, the arcus-group had higher se.-cholesterol than the control-group (P less than 0.01 in males and less than 0.02 in females). The se.-triglycerides in the two groups did not differ. A trend towards positive correlation between arcus-intensity and cholesterol-level was demonstrated by non-parametrical statistics. By use of the same statistics, an association between lipids and arcus-localisation was searched out. Dense arcus in the nasal/lower limbal regions occurred together with hypercholesterolemia more often than did a marked upper/outer arcus. Consequently, based on the present investigation, se.-cholesterol-screening of middle-aged persons with marked lower/nasal arcus seems justified, since hypercholesterolemia might will be an underlying cause. Finally, the importance of diagnosing and treating hypercholesterolemia is briefly discussed.     

Ventilatory function and chronic mucus hypersecretion as predictors of death from lung cancer

The relation of ventilatory function and chronic mucus hypersecretion to death from lung cancer has been studied in 13,946 subjects randomly selected from the general population of the city of Copenhagen, Denmark. During the 10-yr follow-up, 225 subjects died from lung cancer. Percent predicted FEV1 (%FEV1) and presence of chronic phlegm were used to characterize ventilatory function and chronic mucus hypersecretion, respectively. Mortality analysis employed the multiple regression model of Cox and included age, sex, pack-years of smoking, and inhalation as confounding factors. %FEV1 and chronic phlegm were found to be significant predictors of death from lung cancer. In both men and women with chronic phlegm, the risk of dying from lung cancer was 1.5 greater than in those without phlegm. Compared with subjects with %FEV1 greater than or equal to 80, the subjects with %FEV1 less than 40 and those with %FEV1 between 40 and 79 had a 3.9 and 2.1 higher risk of lung cancer death, respectively. A similar regression model in which %FEV1 was replaced with the ratio of FEV1 to FVC (FEV1/FVC) showed that lowered FEV1/FVC was also a significant predictor of lung cancer death, the subjects with FEV1/FVC less than 0.6 (0.6 to 0.7) having a 2.6 (1.5) higher risk for lung cancer death than those with FEV1/FVC greater than or equal to 0.7. It is concluded that lowered ventilatory function and chronic mucus hypersecretion are both significant predictors of death from lung cancer, even after standardization for smoking.     

Muscle strength and functional capacity in 78–81-year-old men and women

Summary Muscle strength was measured in 23 men and 29 women regarded as representative of the healthy urban population of about 80 years of age. Isometric and isokinetic strengths of right knee-extension, plantar, and dorsal flexion, and the isometric strength of some upper extremity functions were measured. For knee-extension there was a decrease in strength of about 30% from the values in a population study of 70-year-old subjects (Aniansson et al. 1980). Muscle strength was significantly lower in women than in men in all muscle groups except for plantar and dorsal flexion of the foot. Body cell mass was reduced compared to younger age groups by about the same extent as muscle strength, and correlated to knee-extension and hand grip strengths.Functional examinations such as step tests and walking tests were performed. A correlation between the results of these tests and muscle strength was not found except for knee-extension at 60 degrees/s in men. The rather low speed in comfortable walking (men 1.0 m·s^–1, women 0.9 m·s^–1) and the reduced capacity for step climbing diminish the possibility of using public transport and pedestrian street intersections in relatively healthy old people.     

Egg consumption and high-density-lipoprotein cholesterol

Abstract. Objectives . To examine if increased egg consumption raises serum high-density-lipoprotein (HDL) cholesterol in healthy individuals. Design . A cross-over study. Setting . A private clinic for preventive health examinations in Copenhagen. Subjects . Twenty-four healthy adults, 12 men and 12 women, aged 23–52 (median 40) years. Interventions . After a 1-week control period each person added two bolled eggs to the usual daily diet for 6 weeks. All persons were instructed not to change the lifestyle in other ways during the whole study period. Main outcome measures . Serum HDL cholesterol, total cholesterol and triglycerides were measured before, during and after 6 weeks of extra egg consumption. The corresponding serum Iow-density-lipoprotein (LDL) cholesterol was calculated from the Friedewald formula. Results . After 6 weeks of extra egg consumption serum HDL cholesterol increased by 10% (P < 0.05) and total cholesterol increased 4% (P < 0.05), whereas the ratio total cholesterol/HDL cholesterol did not change significantly. Serum triglycerides and LDL cholesterol were also unchanged. Conclusions . A moderate egg intake should not be rigorously restricted in healthy individuals.     

Changes in leisure-time physical activity and risk of death: an observational study of 7,000 men and women

Associations of regular leisure-time physical activity and changes in leisure-time physical activity with risk of death were studied in 7,023 healthy men and women aged 20-79 years in Copenhagen, Denmark. Physical activity was estimated in both 1976-1978 and 1981-1983. Men consistently engaging in a moderate or high degree of physical activity, respectively reported at both examinations, had significantly lower risks of death than men reporting low activity at both examinations. Adjusted relative risks were 0.71 (95% confidence interval (CI): 0.57, 0.88; p = 0.002) and 0.61 (95% CI: 0.48, 0.76; p < 0.001), respectively. Similar relative risks were found in women: 0.64 (95% CI: 0.52, 0.79; p < 0.001) and 0.66 (95% CI: 0.51, 0.85; p = 0.001), respectively. Men who increased their leisure-time physical activity from low to moderate or high had a significantly lower risk of death than men reporting low physical activity at both examinations (relative risk = 0.64, 95% CI: 0.50, 0.81; p < 0.001). In this study, maintaining or adopting a moderate or high degree of physical activity was associated with lower risk of death across a wide range of ages in both sexes.