A decrease in cardiovascular risk factors in healthy 40-year-old Swedish men between 1980-1983 and 1991-1992

Time trends in incidence of myocardial infarction in male and female dominated occupations in Stockholm, Sweden

Aims: To investigate time trends in first acute myocardial infarction (MI) incidence in male and female dominated occupations in Stockholm during 1977—1996. Methods: Population-based case-control study, where all first events of acute MI among participants aged 40—69 in Stockholm 1977—1996 were identified, using registers of hospital discharges and deaths. Controls were selected randomly using national population registers. There were 16,531 male and 4382 female cases and 117,015 male and 102,083 female controls. In all, 222 female cases worked in male dominated occupations and 844 male cases worked in female dominated occupations. Results: Both women and men in male dominated occupations showed an elevated relative risk of first MI compared to other employees during the study period. Between 1985—1996, when there was a general decline in MI incidence in Sweden, women in male dominated occupations tended to show an increasing trend. Women in female dominated high and intermediate occupations had a lower relative risk of MI compared to other women in the same socioeconomic group. In male dominated and non-manual female dominated occupations a decline in the incidence of MI was seen during 1985—1996 in men but not in women. Conclusions: Work in male dominated occupations appears to be associated with an increased risk of MI in both genders. There is a need to investigate possible work related or other factors that may be driving this elevated risk.

Reduction of high cholesterol levels associated with younger age and longer education in a primary health care programme for cardiovascular prevention

OBJECTIVE

To study possible social predictors for reduction of hyperlipidaemia in subjects offered lifestyle intervention in primary health care after an opportunistic screening.

SETTING

Primary health care in Sollentuna, Sweden.

DESIGN

Follow-up study of changes in high lipid levels in men and women aged 20-60 years participating in a voluntary screening and cardiovascular prevention programme.

SUBJECTS AND MAIN OUTCOME MEASURES

A total of 1904 individuals had a follow-up visit registered after a mean of 466 days. Men and women with raised lipid levels (serum cholesterol = 6.5 mmol/l, and/or triglycerides = 2.3 mmol/l) at baseline were compared with normolipidaemic participants. Data on social characteristics such as education, occupation, marital status, and income were collected from national censuses. Associations between socioeconomic factors and changes in lipid levels were studied.

RESULTS

Men and women with hyperlipidaemia were generally (p < 0.001) older (men 6-8 years, women 8-10 years) and less educated than normolipidaemic subjects. Significant predictors for reducing hypercholesterolaemia were younger age, OR 0.97 (0.95-1.00) for increasing age, and longer education, OR 0.47 (0.24-0.91) for low education (<9 years). Foreign-born subjects were more likely to achieve a high success rate in reducing hypercholesterolaemia, OR 3.43 (1.00-11.8), than the Swedish-born. No significant predictors were detected for reduction of high triglyceride levels.

CONCLUSION

A successful reduction of high cholesterol levels was associated with younger age and longer education in a primary health care-based programme for cardiovascular prevention.

Time trends in the incidence of myocardial infarction among professional drivers in Stockholm 1977-96

AIMS

To investigate time trends in the incidence of first myocardial infarction (MI) among bus, taxi, and lorry drivers in Stockholm.

METHODS

In this population based case-control study, all first events of acute MI among men aged 40-69 in Stockholm County 1977-96 were identified using registers of hospital discharges and deaths. Controls were selected randomly from the general population. National censuses were used for information on occupational titles. A total of 20,364 cases and 136,342 controls were included in the study. Among these, 1183 cases and 6072 controls had worked as drivers.

RESULTS

During 1977-84 the MI incidence was higher in all three driver groups than among other manual workers. There was a decline in MI incidence among drivers as well as in the general population during the study period. The decline was greater among drivers than among other manual workers. During 1985-96 the relative risk remained increased compared to other manual workers among taxi and lorry drivers, but not among bus drivers.

CONCLUSIONS

Despite a reduced MI incidence for professional drivers in recent years, preventive measures to reduce the risk of MI in these occupational groups, and in particular among taxi and lorry drivers, continue to be of importance.

Relationship between ethnicity and glycemic control, lipid profiles, and blood pressure during the first 9 years of type 2 diabetes: U.K. Prospective Diabetes Study (UKPDS 55)

OBJECTIVE

To assess the relationship among self-reported ethnicity, metabolic control, and blood pressure during treatment of type 2 diabetes.

RESEARCH DESIGN AND METHODS

We studied 2,999 newly diagnosed type 2 diabetic patients recruited to the U.K. Prospective Diabetes Study who were randomized to conventional or intensive glucose control policies if their fasting plasma glucose levels remained >6 mmol/l after a dietary run-in. A total of 2,484 patients (83%) were white Caucasian (WC), 265 patients (9%) were Afro-Caribbean (AC), and 250 patients (8%) were Asian of Indian origin (IA). Variables were assessed at 3, 6, and 9 years.

RESULTS

During the 9-year study period, body weight increased more in WC patients (mean 5.0 kg) than in AC (3.0 kg) and IA (2.5 kg) patients (P < 0.001). After adjusting for age, sex, baseline value, treatment allocation, and change in weight, there were no consistent ethnic differences in mean change in fasting plasma glucose or HbA(1c). After adjustment for antihypertensive therapy, increase in systolic blood pressure at 9 years was greatest in AC patients (7 mmHg; P < 0.01 vs. WC patients). Mean diastolic blood pressure, total cholesterol, and LDL cholesterol decreased progressively during the 9 years in each group. In AC patients, the mean increase in HDL cholesterol (0.16 mmol/l) at 3 years, maintained to 9 years, and the mean decrease in plasma triglyceride level (0.4 mmol/l) at 9 years were greater than in WC and IA patients (P < 0.001).

CONCLUSIONS

This study shows important ethnic differences in body weight, lipid profiles, and blood pressure, but not glycemic control, during 9 years after diagnosis of type 2 diabetes. AC patients maintained the most favorable lipid profiles, but hypertension developed in more AC patients than WC or IA patients. Ethnicity-specific glycemic control of type 2 diabetes seems unnecessary, but other risk factors need to be addressed independently.

Four years experience of a cardiovascular opportunistic screening and prevention programme in the primary health care in Sollentuna, Sweden

OBJECTIVE

To study the feasibility of a cardiovascular prevention programme.

DESIGN

Opportunistic screening for cardiovascular risk factors. Advice and treatment to reduce identified cardiovascular risk factors. Individually designed follow-up.

SETTING

Primary health care in Sollentuna (51,000 inhabitants), Sweden.

SUBJECTS

Visitors to health care centres.

MAIN OUTCOME MEASURES

Feasibility and effectiveness to reduce identified cardiovascular risk factors.

RESULTS

During 4 years 5622 persons, of whom 4655 (83%) were in the age group 20-60 years, participated in the programme. The prevalences of risk factors as smoking, overweight, hypertension, hypercholesterolaemia and hypertriglyceridaemia were high. At follow-up investigations, mean S-cholesterol levels were reduced by 7% among men and 10% among women. S-triglycerides were reduced by 24% and 42%, respectively. Diastolic blood pressures were reduced in men from 95 to 90 mmHg and in women from 94 to 88 mmHg. However, no effects on weight were noted and due to a low follow-up rate meaningful analysis of smoking habits was not possible.

CONCLUSION

A programme for cardiovascular screening and prevention can be integrated in the primary health care system. Prevalent cardiovascular risk factors like hypercholesterolaemia, hypertriglyceridaemia and high blood pressure were significantly reduced after intervention.