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Objective. The aim of this study was to evaluate the long‐term effects of stress on changes in health behaviour and cardiac risk profile in men and women. Design. A prospective cohort study. Setting. The Copenhagen City Heart Study, Denmark. Subjects. The analyses were based on 7066 women and men from the second (1981–1983) and third (1991–1993) wave of the Copenhagen City Heart Study. All participants were asked questions on stress and health behaviour and they had their weight, height, blood pressure and level of blood lipids measured by trained personnel. Main outcome measures. Changes in health behaviour (smoking, physical activity, alcohol consumption, overweight) and cardiac risk profile (cholesterol, HDL cholesterol, blood pressure, diabetes). Results. Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking (OR = 0.58; 95% CI: 0.41–0.83), more likely to become physically inactive (1.90; 1.41–2.55), less likely to stop drinking above the sensible drinking limits (0.43; 0.24–0.79), and stressed women were more likely to become overweight (1.55; 1.12–2.15) during follow‐up. Men and women with high stress were more likely to use antihypertensive medication (1.94; 1.63–2.30), and stressed men were more than two times as likely to develop diabetes during follow‐up (2.36; 1.22–4.59). Conclusion. This longitudinal study supports a causal relation between stress and cardiovascular diseases mediated through unfavourable changes in health behaviour and cardiac risk profile.  相似文献   
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Obesity, alcohol consumption, physical inactivity and postmenopausal hormone use are known modifiable risk factors for breast cancer. We aim to measure incidence rates of breast cancer for women with favorable levels on all 4 risk factors (BMI ≤ 30 kg/m2, alcohol <1 drink/week, physically active and no current hormone use) and to evaluate their associations with estrogen. The 5,054 postmenopausal women in the Copenhagen City Heart Study were asked about risk factors at baseline in 1981–3 and were followed until 2002 in the Danish Cancer Registry, with <0.1% loss to follow‐up. Estradiol was measured in a subset of 1,042 women. During follow‐up, 263 women developed breast cancer. Twenty‐six percent of the women had a favourable risk factor profile, and their breast cancer rates were markedly lower (154 per 100,000 years) than women with 3+ risk factors (460 per 100,000 years). One, two and three risk factors were associated with hazard ratios of 1.38 (95% CI: 0.99; 1.92), 1.84 (1.26; 2.67) and 2.79 (1.59; 4.88) compared to women with a favourable profile. Each of the risk factors was associated with estrogen. In conclusion, the risk of breast cancer was markedly lower for women with a favourable risk profile than for other women and lower estrogen levels is a possible explanation. © 2008 Wiley‐Liss, Inc.  相似文献   
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AIMS: The importance of coronary heart disease risk factors may differ between individuals and community and by sex and age. METHODS AND RESULTS The Copenhagen City Heart Study followed for 21 years a random sample of 5599 men and 6478 women aged 30 to 79 years at baseline. The importance of risk factors in individuals and the community were evaluated as relative- and population-attributable risks. We traced 2180 coronary events. In Cox regression analysis with ten risk factors entered simultaneously, relative risks for coronary heart disease in men ranged from 1.69 to 1.20 with the highest risks for diabetes, hypertension, smoking, and physical inactivity. In women, relative risks ranged from 2.74 to 1.19 with the highest risks for diabetes, smoking, hypertension, and physical inactivity. Population-attributable risks in men ranged from 22% to 3% with the highest risks for smoking, hypertension, and no daily alcohol intake. In women, attributable risks ranged from 37% to 3% with the highest risks for smoking, hypertension, and hypercholesterolaemia. Several of these rankings differed by age. CONCLUSIONS: The importance of coronary heart disease risk factors may differ for individuals, the community, and by sex and age. Consequently, prevention strategies should be tailored accordingly.  相似文献   
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BACKGROUND: The less favorable trend in smoking prevalence in women compared to men may be due to lower cessation rates. We analyzed determinants of spontaneous smoking cessation with particular reference to gender differences. METHODS: Data on smoking were collected by questionnaire in three samples of the adult population, examined for the first time at intervals between 1976 and 1984. In total 11,802 (59%) subjects were smokers, and 9085 of them attended a reexamination after 5 years. Ten to 16 years later 6053 were examined once again. Logistic regression was performed to study the relation of determinants to having quit after 5 and 10-16 years. RESULTS: The prevalence of quitting was 12 and 22% at first and second follow-up, respectively. At both reexaminations, quitting smoking was positively associated with male sex and cigar smoking and negatively associated with the amount of tobacco smoked, inhalation, and alcohol consumption. Furthermore, in women, smoking cessation was positively associated with level of education and body mass index (BMI). Smoking cessation was not affected by cohabitation status, leisure activity, or bronchitis symptoms. CONCLUSIONS: Smoking cessation initiatives should be targeted at heavy cigarette smokers, and at women, in particular the lean and poorly educated.  相似文献   
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BACKGROUND: More than 600 different, but rare, mutations in the low-density lipoprotein (LDL) receptor have been identified as the cause of familial hypercholesterolaemia. In contrast, only a single common amino acid-changing polymorphism (A370T) has been reported in this gene. The association of this polymorphism with variations in lipid levels is at present unclear. METHODS: We obtained genotypes for 9238 individuals from The Copenhagen City Heart Study, of which 465 had stroke and 1019 had ischaemic heart disease. RESULTS: In this cohort from the Danish general population, 90.2% (n = 8,332), 9.5% (n = 875), and 0.3% (n = 31) were 370A homozygotes, A370T heterozygotes, and 370T homozygotes, respectively. The incidences of stroke in 370A homozygotes, A370T heterozygotes, and 370T homozygotes were 28, 26, and 100 per 10,000 person-years, respectively (370T homozygotes vs. 370A homozygotes: log-rank, P = 0.002). The relative risk and odds ratio for stroke in 370T homozygotes vs. 370A homozygotes were 3.6 (95% confidence interval, 1.5-8.8) and 3.6 (95% confidence interval, 1.3-9.8) in prospective and cross-sectional studies, respectively. Furthermore, average age at onset of stroke in 370T homozygotes tended to be lower than in heterozygotes and 370A homozygotes combined (59 vs. 66 years, P = 0.08). In contrast, neither levels of cholesterol, LDL cholesterol, apolipoprotein B, or triglycerides, nor risk of ischaemic heart disease was associated with genotype. CONCLUSION: This is the first prospective study to suggest an association between a polymorphism in the LDL receptor and stroke. Because this association is independent of lipid levels, our results point toward a hitherto unknown function of this receptor in the brain.  相似文献   
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BACKGROUND: Current recommendations prescribe that every adult should accumulate 30 min or more of moderate-intensity physical activity in leisure time, preferably all days of the week. To further support these recommendations we examined the impact of walking intensity and walking duration on all-cause mortality. DESIGN: Relative intensity and duration of walking were recorded in 7308 healthy women and men aged 20-93 at the third examination (1991-1994) of the Copenhagen City Heart Study. During an average of 12 years of follow-up 1391 deaths were recorded. RESULTS: For both sexes we found a significant inverse association between walking intensity and risk of death, but only a weak inverse association to walking duration. For women walking with average intensity, the adjusted hazard ratio (HR) of death was 0.75 [95% confidence interval (CI) 0.61-0.92; P<0.01] and walking with fast intensity 0.48 (95% CI 0.35-0.66; P<0.001) compared to women walking with slow intensity. For men the relative risks were 0.54 (95% CI 0.45-0.67; P<0.001) and 0.43 (95% CI 0.32-0.59; P<0.001), respectively. CONCLUSION: Our findings indicate that the relative intensity and not the duration of walking is of most importance in relation to all-cause mortality. Thus our general recommendation to all adults would be that brisk walking is preferable to slow.  相似文献   
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