Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Few studies investigated the association between smoking, alcohol consumption, or physical activity and the risk of unstable angina pectoris (UAP), while the strength of these associations may differ compared to other coronary diseases such as acute myocardial infarction (AMI). Therefore, we investigated whether the associations of these lifestyle factors with UAP differed from those with AMI. Additionally, we investigated whether these effects differed between subjects with and without a family history of myocardial infarction (MI).</p> <p>Methods</p> <p>The CAREMA study consists of 21,148 persons, aged 20-59 years at baseline and randomly sampled from the Maastricht region in 1987-1997. At baseline, all participants completed a self-administered questionnaire. After follow-up of maximally 16.9 years, 420 AMI and 274 UAP incident cases were registered. Incidence rate ratios (RRs) were estimated using Cox proportional hazards models.</p> <p>Results</p> <p>For both diseases, smoking increased the risk while alcohol consumption was associated with a protective effect. Associations with both risk factors were stronger for AMI than UAP, although this difference was only statistically significant for smoking. In men, an inverse association was found with physical activity during leisure time which seemed to be stronger for the risk of UAP than of AMI. On the contrary, physical activity during leisure time was associated with an increased risk of both AMI and UAP in women which seemed to be weaker for UAP than for AMI. Except for occupational physical activity in women, no significant interactions on a multiplicative scale were found between the lifestyle factors and family history of MI. Nevertheless, the highest risks were found in subjects with both a positive family history and the most unfavorable level of the lifestyle factors.</p> <p>Conclusions</p> <p>The strength of the associations with the lifestyle factors did not differ between AMI and UAP, except for smoking. Furthermore, the effects of the lifestyle factors on the risk of both coronary diseases were similar for subjects with and without a positive family history.</p

dietary investigation in relation to the Seven Countries Study, 1985-1988

Een van de doelstellingen van de Zeven Landen Studie is om op populatie niveau verbanden tussen voeding en sterfte aan chronische ziekten te onderzoeken. Tijdens het basisonderzoek (rond 1960) is bij aselecte steekproeven uit de 16 cohorten informatie over de voeding verzameld m.b.v. de opschrijfmethode. Tevens zijn in duplicaat voedingen de vetzuursamenstelling en totaal eiwit bepaald. Omdat toen een groot aantal voedingsstoffen en non-nutritieve stoffen niet bepaals zijn, is besloten om de in de jaren zestig geconsumeerde voeding opnieuw chemisch te analyseren. Er is begonnen met het coderen van de voedingsgegevens, die verzameld zijn rond 1960. Op grond hiervan is per cohort een gemiddelde dagvoeding berekend, die als uitgangspunt diende voor het inkopen van de voedingsmiddelen. De voedingsmiddelen zijn vervolgens in de zeven landen ingekocht en gekoeld naar Nederland getransporteerd. De resultaten van de chemische analyses zullen gepubliceerd worden in samenhang met de 25-jaars mortaliteitsgegevens van de Zeven Landen Studie. Tijdens het onderzoek is samengewerkt met de vakgroep Humane Voeding, LU Wageningen, RIKILT, Wageningen en het Laboratorium voor Analytisch Residu Onderzoek, RIVM, Bilthoven.Abstract not availableRIV

Regional health profiles: a description of the health status in 64 public health service districts in the Netherlands

The Association of Directors of Municipal Public Health Services has appointed the Department of Epidemiology of the National Institute of Public Health and Environmental Protection (RIVM) to analyse and report on the project: Regional Health Profiles. This Association developed a set of health indicators that could be used to describe the health status of the population. The indicators include demographic characteristics, mortality data, hospital discharge data etc. The goal of the project was to obtain a valid overview on the health status in each Public Health Service District (PHSD). At the same time the standardized methodology enables to compare between districts or to compare a district with the overall situation in the Netherlands. Notably district policy makers need this basic information for the local health policy in order to plan intervention programs or health care facilities. The project started in January 1991 by collecting databases from authorized registries in het Netherlands such as the Central Bureau of Statistics (CBS) of Dutch Center for Health Care Information (SIG). The products of this project are a book, a demonstration diskette, and a diskette with basic - less aggregated - figures for each district. The book describes the health situation per district for each of the 19 indicators. Furthermore a map section on the situation in the 12 provinces and the Netherlands as a whole is included. The demonstration diskette is a user-friendly automated version of the book. The project will be finished in March '92. Possibilities to repeat the project every two years are under consideration.WV

Overview of investigations on health, chronic diseases, biological risk factors and life-style habits in elderly men in the Zutphen Study

Abstract niet beschikbaarThe Zutphen Study is a longitudinal investigation on chronic disease risk factors that was initiated in 1960 as the Dutch contribution to the Seven Countries Study. In 1985 the focus of the study was extended, and gerontological aspects were taken into account. At that time 939 men, aged 65-84 year, were examined extensively. In the spring of 1990 the examinations were repeated in 560 participants of this cohort, then aged 70-89 year. In the forthcoming period the focus will be on data- analysis. The morbidity and mortality follow-up will continue. Twelve projects can be discerned. Planned analyses include e.g. studies on objective and subjective health at old age, and investigations on classical risk factors and diet in relation to the incidence of coronary heart disease in the elderly. Some of the projects are conducted in cooperation with investigators from other institutions, such as the studies on physical activity, anti-carcinogens in foods, electro- cardiographical disorders and chronic non-specific lung disease. A list of publications from the Zutphen Study regarding the period 1960-1990 is included.RIV

Results of an analysis of the Zutphen-studie concerning competing death risks.]

Competing death risks have been analysed with data from the Zutphen-cohort. The dependencies between the specific hazards are modelled using joint risk factors. The Zutphen-cohort consists of 878 men that have been followed since 1960. A survival analysis has been performed using the Cox proportional hazards and the logistic model. The authors show how time and time-effects can be fitted into these models. Separated models have been fitted for the total mortality and the specific death risks, for conditioning on age or on period, and for correction for entry time or not. Finally, the separated models for the specific death risks have been combined into one model of the total hazard. Two combination methods (a non-parametric and a parametric one) have been investigated. The combined model of the hazard rate has been used to show the differences between independent (substitutive) and dependent (competitive) death risks. Finally, the authors draw some conclusions on the analysis of dependent competing death risks.DGVGZ/PA

The role of low-fat diets in body weight control: a meta-analysis of ad libitum dietary intervention studies

OBJECTIVES: Low-fat high-carbohydrate diets are recommended to prevent weight gain in normal weight subjects and reduce body weight in overweight and obese. However, their efficacy is controversial. We evaluated the efficacy of ad libitum low-fat diets in reducing body weight in non-diabetic individuals from the results of intervention trials. DESIGN: Studies were identified from a computerized search of the Medline database from January 1966 to July 1999 and other sources. Inclusion criteria were controlled trials lasting more than 2 months comparing ad libitum low-fat diets as the sole intervention with a control group consuming habitual diet or a medium-fat diet ad libitum. MAIN OUTCOME MEASURES: Differences in changes in dietary fat intake, energy intake and body weight. Weighted mean differences for continuous data and 95% confidence intervals (Cls) were calculated. RESULTS: Two authors independently selected the studies meeting the inclusion criteria and extracted data from 16 trials (duration of 2-12 months) with 19 intervention groups, enrolling 1910 individuals, Fourteen were randomized. Weight loss was not the primary aim in 11 studies. Before the interventions the mean proportions of dietary energy from fat in the studies were 37.7% (95% Cl, 36.9-38.5) in the low-fat groups, and 37.4% (36.4-38.4) in the control groups. The low-fat intervention produced a mean fat reduction of 10.2% (8.1-12.3). Low-fat intervention groups showed a greater weight loss than control groups (3.2kg, 95% confidence interval 1.9-4.5 kg;