Active and passive smoking and the risk of myocardial infarction in 24,968 men and women during 11 year of follow-up: the Tromsø Study

Active smoking is a well-established risk factor for myocardial infarction, but less is known about the impact of passive smoking, and possible sex differences in risk related to passive smoking. We investigated active and passive smoking as risk factors for myocardial infarction in an 11-year follow-up of 11,762 men and 13,206 women included in the Tromsø Study. There were a total of 769 and 453 incident cases of myocardial infarction in men and women, respectively. We found linear age-adjusted relationships between both active and passive smoking and myocardial infarction incidence in both sexes. The relationships seem to be stronger for women than for men. Age-adjusted analyses indicated a stronger relationship with passive smoking in ever-smokers than in never-smokers. After adjustment for important confounders (body mass index, blood pressure, total cholesterol, HDL cholesterol and physical activity) the associations with active and passive smoking were still statistically significant. Adjusting for active smoking when assessing the effect of passive smoking and vice versa, indicated that the effect of passive smoking in men may be explained by their own active smoking. In women, living with a smoker ≥30 years after the age of 20 increased the myocardial infarction risk by 40 %, even after adjusting for active smoking. Passive smoking is a risk factor for myocardial infarction on its own, but whereas the effect for men seems to be explained by their own active smoking, the effect in females remains statistically significant.     

Determinants of serum calcium in men and women. The Tromsø Study

The level of serum calcium appears to be associated with blood pressure and metabolic risk factors for cardiovascular disease. Determinants of serum calcium may therefore be of interest. In a health survey in Tromsø in 1994–1995, 27,159 subjects were examined. The survey included measurements of serum calcium and questionnaires on diet and lifestyle factors. In males mean serum calcium declined from 2.41 mmol/l for those in their 20s to 2.34 mmol/l for those in their 80s. In females mean serum calcium was stable at a level of 2.35 mmol/l before the menopause, and thereafter reached a plateau of 2.39 mmol/l. In both sexes serum calcium showed a positive association with body mass index (BMI) and coffee consumption that persisted after correcting for other variables in a multiple regression model (p < 0.05). Physical activity had no significant association with serum calcium. In females alcohol consumption was negatively, and cigarette smoking positively associated with serum calcium (p < 0.01). No significant effect on the serum calcium levels was found for the intake of calcium or vitamin D, except for males with a calcium intake below 200 mg/day. Some of the observed effects, like the variation with age, may partly be explained by alterations in levels of serum albumin to which approximately 40% of circulating calcium is bound and which was not adjusted for in this study, whereas that is hardly the case for the association with BMI and coffee consumption. However, none of these factors could affect the serum calcium level more than 0.02 mmol/l, and the biological significance of the observed associations questionable.     

Longitudinal changes in forearm bone mineral density in women and men aged 25-44 years: the Tromsø study: a population-based study

The aim of this study was to describe and compare bone mineral density (BMD) development in Norwegian women and men aged 25-44 years in a population-based, longitudinal study. BMD was measured twice at distal and ultradistal forearm sites by single x-ray absorptiometry in 258 women and 147 men (mean follow-up time, 6.4 (standard deviation, 0.6) years). At the distal site, a small annual gain of approximately 0.1% became a small loss beginning at age 34 years in men and age 36 years in women. At the ultradistal site, BMD change was predicted by age in women only, and bone loss started at age 38 years. A high degree of tracking of BMD measurements was observed for both sexes and both sites, r > 0.93. Depending on total BMD change, participants were grouped into "losers", "nonlosers", and "gainers", and more than 6% lost more than the smallest detectable amount of BMD: > or =3.46% at the distal site and > or =5.14% at the ultradistal site. In both sexes, bone mineral content (grams) decreased, whereas area (centimeters squared) increased significantly in "losers" compared with "gainers". This finding might represent physiologic compensation preserving bone strength. No cohort effects were observed when 1994 and 2001 measures from similar age groups were compared.     

Body mass index and disease burden in elderly men and women: The Tromsø Study

Chronic health problems may be related to body mass index (BMI, kg/m²), but this has been best documented in overweight and obese adults. The primary objective of this study was to identify factors associated with different categories of BMI in elderly men and women from the general population, also including the lower categories of BMI. In a cross-sectional population survey from the municipality of Tromsø, Norway we analyzed associations between BMI and a wide range of chronic disease conditions, lifestyle and socioeconomic factors. BMI was categorized into six groups (<20, 20.0–22.4, 22.5–24.9, 25.0–27.4, 27.5–29.9, ≥30.0 kg/m²). The study included 4,259 men and women aged 65 years and older from the general population. We found low relative weight (BMI < 20 kg/m²) to be associated with increasing prevalence of mental distress, hip fracture, smoking and low handgrip strength. A U-shaped relation to BMI was found for asthma and chronic bronchitis, poor current health and low physical activity. The higher categories of BMI were associated with low education level, a difficult economical situation, diabetes mellitus and ischemic heart disease. These results demonstrate that both low and high BMI are associated with a wide range of prevalent conditions and diseases in elderly men and women. For the clinician the findings emphasize the importance of nutritional assessment as part of the medical evaluation of elderly patients.     

Leisure time physical activity in adulthood is positively associated with bone mineral density 22 years later. The Tromsø study

Although the positive association between physical activity and bone mineral density (BMD) is well established, few epidemiological studies have investigated the long-term associations between physical activity during adulthood and BMD later in life. The aim of this prospective, population-based study was to examine the association between leisure time physical activity in adulthood and areal BMD (aBMD) later in life. We examined 1,766 women and 1,451 men aged 20–54 years at baseline who were followed up 22 years later, as part of a population-based study in Norway. Leisure time physical activity was assessed by questionnaire at baseline and follow-up. aBMD was measured at the hip and forearm at follow-up, using X-ray absorptiometry. The association between aBMD and physical activity was analyzed using general linear models. We observed a positive linear trend in aBMD across physical activity levels in both women and men, after adjustments for baseline age, height, weight, and smoking status (P < 0.05). The relationship between aBMD and leisure time physical activity was consistent over different sites of the hip (total hip, femoral neck and trochanter area) and forearm (distal and ultradistal area). In a subsample of 2,436 men and women under 70 years of age, those who where sedentary at both baseline and follow-up (6%) had lower aBMD than those who were moderately active or active at both baseline and follow-up (71%) (P ≤ 0.01). This study suggests that leisure time physical activity in adulthood is associated with higher aBMD and reduced risk of osteoporosis later in life.     

Uninsured adults aged 65 years and older: is their health at risk?

Some U.S. adults aged 65 years and older lack health care coverage. As a result, they may have unmet health needs and be vulnerable to excess morbidity and mortality. Due to their small numbers, little data on them exist. We used data from the 1996-2000 Behavioral Risk Factor Surveillance System, an ongoing telephone survey operated by the state health departments with assistance from the Centers for Disease Control and Prevention, to examine a representative sample of adults 65 years old and older. We found that blacks and Hispanics were disproportionately represented among uninsured older adults. Compared with their insured counterparts, the uninsured elderly experienced cost barriers to needed care, lacked receipt of an annual checkup, and did not receive preventive health screenings. Given the projected growth of the elderly population, particularly among blacks and Hispanics, it is crucial to ensure all older adults have access to preventive health services.     

A comparison of physical activity in men and women with cardiac disease: do gender roles complicate recovery?

Fifty-four male and twenty-six female married cardiac patients were studied for five months post-hospital discharge. Participants completed activity diaries for three days at 5, 10, 15, and 20 weeks. Reported activities were converted to METs. Patients increased activity across the five-month study period. Patients also tended to engage in higher levels of activity in the morning hours. Men and women did not differ in average total METs expended. Comparisons for specific activities indicated that women consistently expended more energy on domestic responsibilities, such as cleaning and laundry. Men engaged more in repairs, yardwork and carrying, but these activities were performed sporadically and involved low METs requirements. The concentrated domestic activity assumed by women early in recovery may pose a risk of complications.     

Validation of the Cummings’ risk score; how well does it identify women with high risk of hip fracture: The Tromsø Study

Objective

We examined a two-step case-finding strategy where the Cummings’ risk score (NEJM 1995) was applied in a population-based setting together with bone mineral density (BMD) measurements in order to validate its ability to identify women with high risk of hip fracture.

Methods

All Tromsø women aged between 65 and 74 were invited to the Tromsø Osteoporosis Study (TROST) together with a 5% random sample of women aged 75–84 years (n = 1410). All had forearm BMD measurements in 1994/95 and were followed for 5 years with respect to first hip fracture. A risk score was constructed matching the Cummings score as closely as possible.

Results

In all 759, 578 and 73 women had 0–2, 3–4 and 5+ risk factors, respectively. Women with 5+ risk factors had a 5-year hip fracture risk of 11% (95% confidence interval (CI) 3.7–18.2%). BMD screening applied to these women identified 74% of them as osteoporotic and 19% as osteopenic with, respectively, 5-year hip fracture risk of 13% and 7.1%.

Conclusion

In a population different from the one the score was generated in, this simple risk score identifies a group of women with high risk of hip fractures. With no additional BMD measurements, those high-risk women could benefit from early intervention measures.     

Does influence at work modify the relation between high occupational physical activity and risk of heart disease in women?

Purpose

To investigate whether influence at work modifies the association between demanding and strenuous occupational physical activity (OPA) and risk of ischaemic heart disease (IHD).

Methods

A sample of 12,093 nurses aged 45–64 years from the Danish Nurse Cohort Study was followed for 20.6 years by individual linkage to incident IHD in the Danish National Patient Registry. Information on OPA, influence at work, other occupational factors and known risk factors for IHD was collected by self-report in 1993.

Results

During follow-up 869 nurses were hospitalised with incident IHD. Nurses exposed to strenuous OPA and low influence at work had a 46% increased risk of IHD [hazard ratio (HR) 1.46 (95% confidence interval (CI) 1.02–2.09)] compared to the reference group of nurses with moderate OPA and high influence at work. Nurses exposed to strenuous OPA and high influence at work were not at an increased risk of IHD [HR 1.10 (95% CI 0.59–2.06)]. An additive hazards model showed there were 18.0 (95% CI ?0.01 to 36.0) additional cases of IHD per 10,000 person years among nurses with strenuous OPA and low influence at work compared to nurses with moderate OPA and high influence at work. A detrimental additive interaction between strenuous OPA and low influence at work that could explain the additional cases of IHD among nurses with strenuous OPA and low influence at work was indicated.

Conclusion

The findings suggest that high influence at work may buffer some of the adverse effects of strenuous OPA on risk of IHD.

     

Lack of time for physical activity: perception or reality for African American and Hispanic women?

Lack of time is a well-known barrier to physical activity. It is not known, however, whether this barrier reflects actual time commitments. This study examined time commitments of women and assessed the relationship between time commitments and perceived lack of time for physical activity. Participants were 249 African American and Hispanic women, aged 45 to 70 years. These women devoted much of their time to their responsibilities as workers, housekeepers, mothers and wives. They also spent 28 hours per week in sedentary leisure-time activity. Actual time commitments did not predict perceived lack of time for physical activity. These findings can be used to address the misperceptions of women about time available to them for physical activity.     

Bone mineral density at the hip in Norwegian women and men—prevalence of osteoporosis depends on chosen references: the Tromsø Study

This study describes bone mineral density (BMD) and the prevalence of osteoporosis in women and men between 30–89 years in an unselected population. BMD was measured in g/cm² at total hip and femoral neck by dual-energy-X-ray absorptiometry in 3,094 women and 2,132 men in the 2001 Tromsø Study. BMD levels were significantly explained by age and declined progressively in both sexes from middle into old age, with highest decline in women. With osteoporosis defined as a T-score of two and a half standard deviation below the young adult mean BMD, the prevalence at the total hip in subjects above 70 years was 6.9% in men and 15.3% in women, respectively, using the Lunar reference material for T-score calculations. The prevalence increased significantly to 7.3% in men and 19.5% in women, when T-scores were calculated on basis of the young adult mean BMD (age group 30–39 years) in the study population. At the femoral neck, prevalence of osteoporosis increased from 13.5 to 18.5% in men, and from 20.4 to 35.2% in women above 70 years, respectively, depending on how T-scores were calculated. The study highlights the challenges with fixed diagnostic levels when measuring normally distributed physiologic parameters. Although BMD only partly explains fracture risk, future studies should evaluate which calculations give optimal fracture prediction.     

Dispositional optimism and depression risk in older women in the Nurses´ Health Study: a prospective cohort study

European Journal of Epidemiology - Dispositional optimism is a potentially modifiable factor and has been associated with multiple physical health outcomes, but its relationship with depression,...     

Myocardial infarction and future risk of cancer in the general population—the Tromsø Study

The association between myocardial infarction (MI) and future risk of incident cancer is scarcely investigated. Therefore, we aimed to study the risk of cancer after a first time MI in a large cohort recruited from a general population. Participants in a large population-based study without a previous history of MI or cancer (n = 28,763) were included and followed from baseline to date of cancer, death, migration or study end. Crude incidence rates (IRs) and hazard ratios (HRs) for cancer after MI were calculated. During a median follow-up of 15.7 years, 1747 subjects developed incident MI, and of these, 146 suffered from a subsequent cancer. In the multivariable-adjusted model (adjusted for age, sex, BMI, systolic blood pressure, diabetes mellitus, HDL cholesterol, smoking, physical activity and education level), MI patients had 46% (HR 1.46; 95% CI: 1.21–1.77) higher hazard ratio of cancer compared to those without MI. The increased cancer incidence was highest during the first 6 months after the MI, with a 2.2-fold higher HR (2.15; 95% CI: 1.29–3.58) compared with subjects without MI. After a 2-year period without higher incidence rate, MI patients displayed 60% (HR 1.60; 95% CI: 1.27–2.03) higher HR of future cancer more than 3 years after the event. The increased IRs were higher in women than men. Patients with MI had a higher short- and long-term incidence rate of cancer compared to subjects without MI. Our findings suggest that occult cancer and shared risk factors of MI and cancer may partly explain the association.     

Risk of malnutrition and health-related quality of life in community-living elderly men and women: The Tromsø study

Purpose  

To explore the association between risk of malnutrition as well as current body mass index (BMI) and health-related quality of life (HRQoL) in elderly men and women from the general population.     

Low migrant mortality in Germany for men aged 65 and older: fact or artifact?

Migrant mortality in Europe was found to be lower than mortality of host populations. In Germany, residents with migrant background constitute nearly one tenth of the population aged 65+ with about 40% of them being foreigners. The German Pension Scheme follows vital status of pensioners very accurately. Mortality re-estimation reveals two-fold underestimation of mortality of foreigners due to biased death numerator and population denominator.