Indicator Of Cardiovascular Disease Risk Research Articles

Fetal exposure, heredity and risk indicators for cardiovascular disease in a Swedish welfare cohort.

The overall aim was to test whether low birthweight (LBW) in newborns is associated with the risk indicators for cardiovascular disease in early middle age, even in a welfare society. Further, a possible interaction of LBW and heredity for myocardial infarction or stroke was investigated. Overall, subjects were identified as newborns in a local birth register, and as adult participants, in the Västerbotten Intervention Program (n = 7876). Outcome measures such as systolic (SBP) and diastolic blood pressures (DBP), body mass index (BMI), cholesterol, triglycerides and anthropometrics were investigated (at age 29-41 years) in relation to LBW. Low birthweight was associated with increased SBP and DBP. Triglycerides were elevated among women with LBW and total cholesterol was elevated in men with LBW. Heredity for myocardial infarction or stroke interacted with LBW, and indicated a synergistic effect on the level of SBP. The BMI did not differ between LBW and normal birthweight subjects. Our interpretation is that the 'fetal origins' hypothesis' is valid for middle-age subjects who grow up in a welfare society. The population attributable proportions that result from different exposures to LBW were relatively small overall; from a public health perspective, heredity was more important than LBW for elevated SBP.

Black-white differences in serum antioxidant concentrations reflect differences in food intake:

P79 Blacks have been reported to have lower serum antioxidant vitamin concentrations than whites. We studied black-white patterns of antioxidant concentrations and food intake in 1985-86 (3477 nonusers of supplemental vitamins A, C, and E, 18-30 year old). Black men and women had lower levels than white men and women of serum alpha-tocopherol (aTOCO), alpha-carotene (aCARO) and beta-carotene (bCARO), but higher levels of gamma tocopherol (gTOCO) and similar levels of lycopene (LYCO), adjusted for age, plasma lipids, clinic, and smoking. Intake of minimally processed plant foods (MPPF: whole grain, fruits, vegetables, nuts, and Table legumes processed to preserve nutrient content) was positively correlated with aTOCO, aCARO, and bCARO. Further adjustment for this and related food groups reduced differences in serum antioxidant concentrations between black and white women: aTOCO (0.09vs0.06), gTOCO (.022vs.011), aCARO (2.22vs1.42) and bCARO (3.96vs1.16), all still significant except gTOCO, with a similar pattern of reductions for men. Thus, low serum antioxidants, indicators of cardiovascular disease risk in blacks, reflect differences in food intake between blacks and whites. Culturally-specific dietary interventions may be necessary for an improvement in antioxidant status to reduce the risk of developing cardiovascular disease. Table 1.

Job strain and risk indicators for cardiovascular disease in young female nurses.

Job strain and risk indicators for cardiovascular disease in young female nurses.

Job strain and risk indicators for cardiovascular disease in young female nurses.

This study examined the possible effects of job demands, decision latitude, and job-related social support on risk indicators for cardiovascular disease (CVD) in 165 female nurses. Job strain was measured with the Job Content Questionnaire; CVD risk was measured with insulin, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fibrinogen, tissue-type plasminogen activator (tPA) antigen, tPA activity, plasminogen activator inhibitor-1 antigen, and blood pressure. Multivariate analysis of covariance and regression analyses revealed no effects of either job strain or social support on these risk indicators. All risk indicators deteriorated with age and body mass index. Oral contraceptive use improved fibrinolytic potential and increased HDL-C but had adverse effects on TG levels. Results suggest that in healthy young women job strain is not associated with an unfavorable metabolic or fibrinolytic risk profile.

Obesity: does it occur in African children in a rural community in South Africa?

Total body fatness and a centripetal fat patterning are recognized as risk indicators of cardiovascular disease in adulthood. In this study, the development of these risk factors in rural South African children during the preschool years and first years of formal schooling is explored. The initial cross-sectional data from the Ellisras Longitudinal Investigations in Rural Community Children Project, ongoing since 1996, were used, involving 684 boys and 652 girls, aged 3-10 years, in the Ellisras rural community. Overweight was measured using the body mass index (BMI) (kg/m2). Overfatness was based on the sum of the triceps and subscapular skinfold thicknesses. A centripetal fat patterning was measured by the sum of trunk skinfolds relative to limb skinfolds and the ratio of the subscapular to triceps skinfold. Further, the ratio of the subscapular to supraspinale skinfold was used as an indicator of lower body fat patterning. The 85th percentiles of the NHANES III were used as cutoff values for overweight, overfatness and a centripetal fat patterning. At ages 7 and 8 years, mean BMI was statistically significantly higher in males compared to females (P < 0.05). The log transformed supraspinale skinfold thickness was larger in females compared to males at ages 4-7 years; the log transformed subscapular skinfold was larger in girls compared to boys aged 7-10 years. Less clear patterns were found for the extremity skinfolds and the skinfold ratios. Very few children (0-2.5% in males and 0-4.3% in females) had BMI values above the NHANES III 85th percentiles, indicating a very low prevalence of overweight children in the area. About 15% of the males showed overfatness at ages 3-4 years, while low prevalence was found at older ages. Few Ellisras rural children had above normal values for BMI, indicating a low prevalence of obesity in this population. In the 3- and 4-year-old group more subjects were found to have excessive fat, as indicated by the sum of the triceps and subscapular skinfold thicknesses.

Fat distribution and plasma lipid-lipoprotein concentrations in pre- and postmenopausal women.

In the postmenopausal years, women develop a central pattern of fat distribution and an increased risk of developing cardiovascular disease (CVD). The possibility that these events are related has not been extensively investigated. The object of the present study was to test the hypotheses that, 1) menopause-related differences in lipids are associated with greater estimated intra-abdominal adiposity, and 2) the relationship between individual adipose depots and plasma lipids differs with menopausal status. Cross-sectional. 141 healthy pre- and postmenopausal women aged 35-65 y. Total body fat by hydrodensitometry was used as an index of whole-body adiposity, the sum of five central skinfold measurements as an index of subcutaneous upper-body adiposity, and estimated intra-abdominal adipose tissue (IAF) as an index of visceral adiposity. Fasting plasma concentrations of total cholesterol (total-C), high- and low-density-lipoprotein cholesterol (HDL-C, LDL-C), and triglycerides were used as indices of CVD risk. Postmenopausal women had greater total body fat (P < 0.001), summed central skinfolds (P < 0.01), estimated IAF (P < 0.001), higher plasma concentrations of total-C (P < 0.001), LDL-C (P < 0.001) and triglycerides (P < 0.001), than premenopausal women. The relationship between central skinfolds and LDL-C differed with menopausal status, being significant in pre- but not postmenopausal women. Adjustment for estimated IAF with analysis of covariance decreased menopause-related differences in levels of total-C, LDL-C and triglycerides by approx 40-70%. These observations suggest that, 1) menopause-related changes in IAF may adversely affect the plasma lipid profile, and 2) menopausal status affects the relationship between central subcutaneous fat and LDL-C. Studies with measured IAF are needed to confirm present results.

Copper supplementation of adult men: Effects on blood copper enzyme activities and indicators of cardiovascular disease risk

In rats, copper deficiency leads to low copper metalloenzyme activity, high serum cholesterol, and cardiovascular lesions. In humans, moderately low copper intake may be common, but the consequences remain largely uncertain. The present study examined the effects of copper supplementation (2 mg/d for 4 weeks in a copper/placebo crossover design) in 20 adult men with moderately high plasma cholesterol. End-point measurements were three copper enzyme activities, erythrocyte superoxide dismutase (SOD), plasma ceruloplasmin (Cp), and plasma diamine oxidase (DAO), and three parameters related to the risk of cardiovascular disease (CVD), plasma cholesterol, plasma lipoprotein (a) [Lp(a)], and lag times for very—low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) oxidation in vitro. Although copper had no significant effects on any parameter for the entire study group, it did significantly increase two enzyme activities (SOD and DAO), as well as lipoprotein oxidation lag times, in 10 subjects in the lower half of a median split for precopper values. Thus, copper supplementation appeared to influence some types of measurements in subjects beginning with less than median values.

Physical activity and cardiovascular disease risk profile in women.

In a population of 4,576 Dutch women aged 49-70 years who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) in 1993-1995, the relation between physical activity and the presence of cardiovascular disease risk indicators was assessed cross-sectionally. Physical activity was determined from a self-administered questionnaire, while blood pressure, heart rate, body mass index, waist/hip ratio, and waist circumference were measured at the study center. Mean risk indicator levels were calculated for different activity categories. Blood pressure was most clearly associated with time spent in sports (mean systolic blood pressure, adjusted for age, level of education, and smoking, 128.9 mmHg in the highest sports tertile, and 132.1 mmHg in the lowest sports tertile; mean diastolic blood pressure, 77.8 mmHg and 79.0 mmHg, respectively). Body mass index, waist/hip ratio, and waist circumference showed an inverse relation with cycling, gardening, do-it-yourself-activities, and sports. In this population, leisure-time activity was inversely related to cardiovascular disease risk indicators, but work activity and housework were not. The authors conclude that if investigators wish to measure physical activity in women over age 50 years with the aim to identify high- and low-risk groups for cardiovascular disease, they should consider not only housework activity, but also leisure-time activities such as cycling, sports, and do-it-yourself activities.

Discussion

The treatment of hypertension mainly with diuretics and beta blockers reduces cardiovascular mortality and morbidity, largely due to a decreased incidence of stroke, whereas the beneficial effects of antihypertensive therapy on the occurrence of coronary events have been less than expected from epidemiological studies. Furthermore, treated hypertensive patients still have a higher cardiovascular complication rate, compared with matched normotensives. This is particularly evident in patients with left ventricular hypertrophy (LVH), a major independent risk indicator for cardiovascular disease. In addition to elevating blood pressure, angiotensin II (A-II) exerts an important influence on cardiac structure and function, stimulating cell proliferation and growth. Thus, to further reduce morbidity and mortality when treating hypertensive patients, it may be important to effectively block the effects of A-II. This can be achieved directly at the A-II receptor level by losartan, the first of a new class of antihypertensive agents. It therefore seems pertinent to investigate whether selective A-II receptor blockade with losartan not only lowers blood pressure but also reduces LVH more effectively than current therapy, and thus improves prognosis. The Losartan Intervention For Endpoint reduction (LIFE) in Hypertension study is a double-blind, prospective, parallel group study designed to compare the effects of losartan with those of the beta-blocker atenolol on the reduction of cardiovascular morbidity and mortality in approximately 8,300 hypertensive patients (initial sitting diastolic blood pressure 95 to 115 mm Hg or systolic blood pressure 160 to 200 mm Hg) with electrocardiographically documented LVH. The study, which will continue for at least 4 years and until 1,040 patients experience one primary endpoint, has been designed with a statistical power that will detect a difference of at least 15% between groups in the incidence of combined cardiovascular morbidity and mortality. It is also the first prospective study with adequate power to link reversal of LVH to reduction in major cardiovascular events. The rationale of the study, which will involve more than 800 clinical centers in Scandinavia, the United Kingdom, and the United States, is discussed, and the major features of its design and general organization are described. On April 30, 1997, when inclusion was stopped, 9,218 patients had been randomized.

The association between dietary patterns and cardio vascular disease risk indicators in healthy youngsters: results covering fifteen years of longitudinal development.

To examine longitudinal relationships between nutrition and risk indicators for cardio vascular diseases (CVD) during adolescence and young adulthood. A longitudinal study over fifteen years. 98 females and 84 males, from 13 to 27 years. By means of six interviews dietary patterns were determined. Blood samples were analyzed for serum concentration of total cholesterol (TC), and high-density-lipoprotein (HDL), blood pressure, body fat and maximal aerobic power (VO2max) were determined. The longitudinal relations were analyzed with generalized estimation equations (GEE), a statistical technique in which relations at different time-points are tested simultaneously. Compared to Dutch recommendations six out of seven macro nutrients appear to be unfavorable with respect to CVD. Borderline or high CVD risk values are apparent at 27 y in more than 25% of the subjects with respect to percentage body fat and serum total cholesterol in both sexes. In males 40% or more show borderline hypertension. The 'univariate' longitudinal analyses showed significantly positive relations: (1) between the intake of animal protein, saturated fat (SFA), cholesterol (Cho1) and TC, and HDL; (2) between total energy intake (EN) and systolic blood pressure, and VO2max. Significantly negative associations were found: (1) between EN, poly-unsaturated fat (PUFA) and TC concentrations; (2) between EN and sum of four skinfolds (SSF). With increasing age, over a period of 15 y in both sexes the SFA and Cho1 intake relate significantly to the development of a negative CVD risk profile. The intake of PUFA relates positive to a CVD risk profile. The significantly negative relation between EN intake and body fat (SSF) is partly explained by the relation between EN and VO2max.

Endurance running performance in relation to cardiovascular risk indicators in adolescents.

We evaluated endurance running performance and body mass index (BMI) in relation to biochemical cardiovascular disease (CVD) risk indicators (s-lipids, s-insulin, s-ferritin), and blood pressure in 14- and 17-year-old healthy Swedish adolescents (n = 879), also considering current dietary intake and physical activity. Endurance running performance was assessed using a 3 km running test and height, body weight, waist and hip circumference, and skinfolds were measured at clinical examination. Physical activity and dietary intake were evaluated using self-reported 7-day-records. The results showed that high endurance running performance was related to a favourable CVD risk indicator profile. Multiple regression analyses including running time, BMI, physical activity, dietary fat and iron intake, and age as independent and s-lipids, s-insulin, and s-ferritin as dependent variables revealed that, in both boys and girls, low BMI was associated to a favourable s-lipid profile and lower s-insulin values and, in boys but not in girls, also to lower s-ferritin values. There were, however, no independent associations between level of physical activity or endurance running performance on the one side and s-lipids, s-insulin, or s-ferritin values on the other. High dietary fat intake was associated to s-lipids in a non-atherogenic direction; in boys to higher HDL-C and in girls to lower TG. In conclusion the study showed that body mass seems to be the most important factor explaining the differences in s-lipid and s-insulin values between adolescents with different level of physical performance capacity. An interesting finding was, that s-ferritin, being a proposed risk factor for CVD, in the older boys related to body mass in a similar way as s-lipids and s-insulin.

Coagulation Factor VII, Serum-Triglycerides and the R/Q353 Polymorphism: Differences between Older Men and Women

Coagulation factor VII activity (FVII:C) is a risk indicator for cardiovascular disease. It is related to serum-triglycerides and the R/Q353 polymorphism (alleles R and Q) in the gene coding for factor VII is strongly associated with factor VII. The association of serum-triglycerides with factor VII may differ between the genotypes, but the results of earlier studies were inconsistent and did not include older people. We studied FVII, triglycerides and the R/Q353 polymorphism in the Rotterdam Study. In 1158 older subjects (489 men and 669 women) FVII:C, factor VII:Chr, serum-triglycerides and the R/Q353-genotype were determined. In women triglycerides were positively associated with FVII:Chr and FVII:C (FVII:Chr: beta = 12.4% PP/mmol/L, CI: 10.3-14.5; FVII:C: beta = 13.1% PP/mmol/L, CI: 10.4-15.8). These associations varied by genotype (FVII:Chr: RR: beta = 11.7, CI: 9.6-13.8, RQ/QQ: beta = 7.9, CI: 4.6-11.2; FVII:C: RR: beta = 12.5, CI: 9.5-15.5, RQ/QQ: beta = 6.4, CI: 1.4-11.4). In men, the associations of FVII:Chr and FVII:C with triglycerides were weaker (FVII:Chr: beta = 5.9, CI: 4.1-7.7; FVII:C: beta = 8.7, CI: 6.2-11.2). There was no difference between the genotype groups. These results suggest that only in older women the strength of the association of factor VII with serum-triglycerides varies according to genotype of the R/Q353 polymorphism.

Modulation of Plasma Fibrinogen Levels by Ciprofibrate and Gemfibrozil in Primary Hyperlipidaemia

An elevated plasma fibrinogen level is increasingly accepted as an independent risk indicator of cardiovascular disease. This has enhanced the interest in identifying agents that can normalize elevated plasma fibrinogen levels. One group of agents with this capacity are the fibric acid derivatives, e.g. ciprofibrate and gemfibrozil. We studied fibrinogen levels after 12 weeks of treatment with ciprofibrate (n = 48) and gemfibrozil (n = 51) in hypercholesterolenic patients. The correlation of the decrease in fibrinogen with lipid lowering and the contribution of the acute phase and genetic polymorphisms to this decrease were also evaluated. After 12 weeks of treatment, the fibrinogen levels were significantly decreased (p < 0.0005) with both drugs, although the decrease in the ciprofibrate group (mean 3.4 g/l pre-treatment to 2.4 g/l after 12 weeks) was larger than in the gemfibrozil group (mean 3.4 g/l to 3.0 g/l). The lipid lowering effect was comparable for the two drugs but there was no correlation for either ciprofibrate or gemfibrozil between the lipid lowering and the magnitude or the velocity of the fibrinogen lowering effect. An attenuation of the major regulatory mechanism of plasma fibrinogen levels, the acute phase reaction, was invoked as the underlying mechanism. However, pre-treatment C-reactive protein levels were not increased and did not change after treatment. Moreover, no effects of the polymorphisms of the fibrinogen beta-gene on the decrease of the plasma fibrinogen levels were observed. This suggests that a new, as yet unknown, mechanism is involved in fibrinogen lowering by fibrates.

Seasonal Variation in Fibrinogen in the Rotterdam Study

As evidence accumulates to implicate fibrinogen as a risk indicator for cardiovascular disease, it is of interest to study its seasonal variation. A population based cross-sectional study was performed among participants of the Rotterdam Study, a cohort of 7,983 men and women, aged 55 years and over. Fibrinogen levels were measured by the prothrombin time derived method in the first 2,325 participants of the study. Fibrinogen levels were considerably higher in winter. The seasonal difference was 0.34 g/l (95% confidence interval 0.29, 0.39) and was more pronounced in subjects aged 75 years and over than in subjects aged 55 to 75 years, 0.43 g/l (0.34, 0.52) and 0.29 g/l (0.24, 0.35), respectively. Additional adjustment for body mass index, systolic and diastolic blood pressure, and total and HDL cholesterol did not materially change the findings. After adjustment for seasons, outdoor temperature was not associated with fibrinogen. Adjustment for outdoor temperature did not change the seasonal variation of fibrinogen, seasonal difference 0.31 g/l (0.24, 0.37). In conclusion, fibrinogen levels are highest in Winter. The seasonal variation of fibrinogen is more pronounced in the elderly. Outdoor temperature does not seem to play a role in the seasonal variation of fibrinogen. Seasonal variation of fibrinogen may partly explain the increased cardiovascular disease mortality in Winter.

Variation in risk indicators of cardiovascular disease during the menstrual cycle: an investigation of within-subject variations in glutathione peroxidase, haemostatic variables, lipids and lipoproteins in healthy young women.

Variations in erythrocyte glutathione peroxidase activity, serum concentrations of lipids and lipoproteins and in blood coagulation and fibrinolysis during the menstrual cycle were studied in healthy young women. Blood samples were drawn twice a week for 9 weeks. A group of males was used for estimation of the influence on the results of factors which were not related to the menstrual cycle. Variations during the menstrual cycle were demonstrated in several of the factors analysed. The activity of glutathione peroxidase was lowest at ovulation. The clotting activity of factor II+ VII+X and the concentration of fibrinogen were lowest during mid-cycle, and the number of platelets increased in the follicular phase (days 5-9). Statistically significant variations in the fibrinolytic factors analysed (tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI) were not observed during the menstrual cycle. The serum concentrations of cholesterol and LDL cholesterol were significantly higher at the start of the menstrual cycle (days 3-8) than later in the cycle (days 19-24). The concentration of HDL cholesterol was lowest in the late luteal phase (days 23-28).

RELATION OF LIPOPSOTEIN (a) TO PARENTAL CARDIOVASCULAR DISEASE

Lipoprotein a (Lp(a)) is considered as a risk-indicator for cardiovascular disease (CKD), independent of known factors such as hypercholesterolemia, obesity, diabetes mellitus and hypertension. The aim of this study was to determine whether Lp(a) plasma concentrations in children with parents with CKD below 45 years of age is a useful risk indicator for this disease, and to establish the relationship with ethnic factors. 18 Caucasian children aged 4-15 years with parental CHD (Group A) were studied and compared with 71 Caucasians without parental CHD (group 3) and 44 Pehuenche children living in Alto Bio Bio (group C). Lp(a) was measured in serum by enzyme immunoassay using monoclonal antiapo(a) as antibody and polyclonal anti apoB peroxidase to avoid cross reaction with plasminogen. Lp(a) values higher than 30 mg/dl were considered risk indicators for CHD.In 15 children (83%) of group A, 59 (83%) of group B, and 42 (95%) of group C Lp(a) values were ≤ 30 mg/dl. None in group A, 3 (4.2%) in group B and 2 (4.5%) in group C had Lp(a) levels between 31-50 mg/dl. Three (16.6%) in group A, 9 (12.6%) in group B, and none in group C had Lp(a) levels > 50mg/dl. In group A the relative risk was 1.3 times higher compared with group B and 16.6 times higher compared with group C. When considering Lp(a) values of 31-50 mg/dl there are no relative risk differences between group A and B (RR:0.98) but there is relative risk difference in comparison with oroup C (RR:3.68).CONCLUSIONS: Lp(a) levels > 50 mg/dl pose a greater risk for CHD in Caucasian children with parental CHD compared with the general Caucasian population, and a much greater risk than in the Pehuenche population. Lp(a) levels between 31 and 50mg/dl pose a greater risk in Caucasians only when compared to the Pehuenche population. These results support the hypothesis that Lp(a) may be influenced by ethnic factors.

Regression of left ventricular hypertrophy--a meta-analysis.

Left ventricular hypertrophy (LVH) is an independent risk indicator of cardiovascular disease. Obtaining reversal of hypertension-induced cardiac hypertrophy seems to be a desirable objective of antihypertensive treatment. A total of 2,357 patients were included in a meta-analysis on the effect of antihypertensive pharmacological therapy on LVH. Overall left ventricular mass (LVM) was reduced by 11.9% (95% confidence interval (CI) 10.1-13.7) in parallel with a reduction of mean arterial pressure of 14.9% (CI 14.0 to 15.8). When evaluating the effect of first-line therapies on calculated LVM using the same formula for all studies, the absolute reductions in g were 44.7 (ACE-inhibitors), 22.8 (beta-blockers), 26.9 (calcium antagonists) and 21.4 (diuretics) when adjusted for differences between studies (ANCOVA). It can be concluded that effective antihypertensive therapy reduces LVM. ACE-inhibitors, beta-blockers and calcium antagonists reduce LVM by reducing wall hypertrophy, the effect of ACE-inhibitors being the most pronounced. Diuretics reduce LVM mainly through an effect on left ventricular inner diameter. How these effects affect prognosis is still an open question.

Regression of left ventricular hypertrophy--are there differences between antihypertensive agents?

Echocardiographically determined left ventricular mass (LVM) is currently considered to be the most powerful risk indicator for cardiovascular disease, yielding prognostic information beyond that provided by the evaluation of traditional cardiovascular risk factors, high blood pressure included. It has been considered logical to try to obtain regression of cardiac hypertrophy, even though the risk-reducing implications of such a measure remain to be fully established. Experimental and clinical studies have shown that some classes of antihypertensive compounds are less effective than others in causing reversal of left ventricular hypertrophy (LVH) in spite of being similarly efficacious in lowering blood pressure. In order to extract the maximum amount of information from clinical studies, a meta-analysis was performed. This analysis included 109 treatment studies, each conformed to strict present rules. Only studies with pharmacological antihypertensive therapy and echocardiographically determined LVM were included. An analysis of the effect of the four first-hand antihypertensive treatment principles, adjusted for differences between studies with ANCOVA, showed that the ACE inhibitors, beta-blockers and calcium antagonists all reduce LVM by reversing wall hypertrophy and that the effect is most pronounced with ACE inhibitors. Diuretics reduce LVM mainly by a reduction in left ventricular diameter. If the difference in ability to reverse LVH, between ACE inhibitors and beta-blockers/diuretics would correspond to a difference in prognosis, then the outcome of antihypertensive therapy might be expected to improve. This hypothesis is currently under investigation.

Tracking of health and risk indicators of cardiovascular diseases from teenager to adult: Amsterdam growth and health study

Cardiovascular disease is recognized as a serious public health problem. Because the underlying pathological processes start shortly after birth, tracking of recognized cardiovascular disease indicators during childhood and adolescence can help in developing preventive pediatric strategies. A prospective follow-up of both genetic and behavioral lifestyle parameters (serum cholesterol, blood pressure, percentage body fat, maximal oxygen uptake ( VO 2max), smoking, physical inactivity, and type A behavior) was designed. In the Amsterdam Growth and Health Study a population of 93 males and 107 females was measured annually from 1977 to 1980 and a fifth measurement was made in 1985. In that way longitudinal data covering a period of 8 years was collected for a group of adolescents/adults between 13 and 21 years of age. Analyses of these parameters provided the following results: The stability over the 9 years of tracking cardiovascular disease indicators, measured as the interperiod correlations, is fairly high. It varies from 0.4 to 0.8 in percentage body fat, cholesterol, and VO 2max. Blood pressure values are low (between 0.3 and 0.4). The probability of 13-year-olds having relatively high values of cardiovascular disease indicators on the basis of a quartile distribution with that at age 21 indicated a moderate to high predictive value. According to the literature, the levels of subjects that are continously relatively high over the years are more in the direction of optimal health than risk values. The exception is for percentage body fat. Interrelation of the seven cardiovascular disease indicators in constantly relatively high-risk and relatively low-risk groups during the teenage period, measured during young adulthood (21.5 years), appeared to be weak: only males and females with a high percentage body fat and a low VO 2max showed significantly high total cholesterol, low high-density lipoprotein cholesterol, and high total cholesterol/high-density lipoprotein cholesterol levels. From the three environmental cardiovascular disease indicators (smoking, physical activity, and type A/B behavior) measured in 1985, only physical activity was significantly correlated among males and females with high-density lipoprotein cholesterol, percentage body fat, and VO 2max. It can be concluded that measurement of percentage body fat in the early teenage period seems to be the most important cardiovascular disease indicator in predicting risk levels in the young adult. The amount of physical activity measured at young adult age is the only behavioral parameter to show a significant interrelation with other cardiovascular disease risk indicators. Preventive strategies such as weight reduction and stimulating daily physical activities seem to be indicated early in the teenage period.

Eighty‐year‐old men without cardiovascular disease in the community of Malmö. Part I. Social and medical factors, with special reference to the lipoprotein pattern

A total of 1280 80-year-old men were invited to a medical examination to study common risk indicators for cardiovascular disease (CVD) in the elderly. From the pool of 811 responders (63.3%), all 122 individuals who fulfilled our inclusion criteria were assigned to one of four groups: (1) no CVD, non-smokers; (2) no CVD, smokers; (3) CVD, smokers; (4) CVD, non-smokers. A telephone interview with 75 non-responders suggested that this group contained more institutionalized subjects, but otherwise did not differ from the group of participants. Subjects with CVD had higher levels of plasma cholesterol and LDL cholesterol than those without CVD, whereas plasma HDL cholesterol and plasma triglyceride concentrations did not differ between the groups; thus the LDL/HDL ratio was higher in the CVD group. Lipoprotein concentrations did not differ between smokers and non-smokers. However, the mean cholesterol levels were low (5.19 +/- 1.01 mmol l-1), suggesting selective mortality. No differences between the groups were found with regard to Lp(a). The mean blood pressure for the whole group was 149/79 mmHg, and there were no differences between subgroups. Our study suggests that mechanisms such as selective mortality modify the risk factor pattern in the elderly. In 80-year-old individuals, elevated LDL cholesterol levels can still be identified as a risk indicator for CVD, whereas there does not appear to be any association between CVD or low HDL levels or elevated blood pressure in this age group.