Death In Middle-aged Men Research Articles

Supine and exercise systolic blood pressure predict cardiovascular death in middle-aged men.

The outcome of 1999 apparently healthy men, aged 40-59 years, initially investigated in the period 1972-1975, has previously been ascertained at 7 and 16 year follow-ups. This has now been repeated after 21 years, to determine whether seated systolic blood pressure (BP) during a bicycle ergometer exercise test adds prognostic information on cardiovascular (CV) mortality beyond that of systolic BP measured after 5 min of supine rest. After 21 years, 41 979 years of observation, 470 patients had died, 255 from CV causes. Supine systolic BP [2 SD increase: relative risk (RR) 1.6, 95% confidence interval (CI) 1.3-2.0, P < 0.0001], 6 min exercise systolic BP (2 SD increase: RR 1.6, 95% CI 1.3-2.0, P < 0.0001) on the starting workload of 600 kpm/min (approximately 100 W, 5880 J/min) and maximal systolic BP (2 SD increase: RR 1.5, 95% CI 1.2-1.9, P = 0.0005) during work were all related to CV mortality when adjusting for a large number of variables measured in the present study including age, exercise capacity, heart rates, smoking habits, glucose tolerance and serum cholesterol. When including other systolic BPs in the continuous multivariate analysis, supine systolic BP (2 SD increase: RR 1.4, 95% CI 1.04-1.9, P = 0.029) and 6 min systolic BP at 600 kpm/min (2 SD increase: RR 1.4, 95% CI 1.06-1.9, P = 0.017) were independent predictors of CV death but not maximal systolic BP during exercise (2 SD increase: RR 1.0, 95% CI 0.7-1.2, P = 0.95). These results are different from the mortality data at 16 years, when the independent predictive effect of supine systolic BP was cancelled out by 6 min exercise systolic BP at 600 kpm/min. Twenty-one years of follow-up of 1999 apparently healthy men disclose independently predictive information on CV death, of both supine systolic BP and 6 min exercise systolic BP taken at an early moderate workload. The influence of maximal exercise systolic BP on CV death is however cancelled out by the two other systolic BPs.

Resting heart rate as a predictive risk factor for sudden death in middle-aged men.

A relative hyperadrenergic tone related to abnormalities of the autonomic nervous system is suspected in the mechanisms of sudden death. Therefore, we assessed the role of an elevated basal heart rate in the occurrence of sudden death in a long-term cohort study. 7746 subjects aged 42--53 years, underwent ECG and physical examination conducted by a physician under standardized conditions, provided blood samples for laboratory tests, and answered questionnaires administered by trained interviewers. The vital status was obtained from specific inquiries up to the time of retirement and then by death certificates. Men with known ischemic heart disease were further excluded from analysis which was conducted on the 7079 remaining subjects. After an average follow-up period of 23 years, there were 2083 deaths, among which were 603 cardiovascular deaths including 118 sudden deaths and 192 following myocardial infarction. The crude risk of sudden death increased linearly with the level of resting heart rate and the risk in men in the highest quintile of heart rate was 3.8 fold than in those in the lowest quintile, whereas rates were approximatively twice higher for fatal myocardial infarction, cardiovascular and total mortality (all P<0.01). When age, body mass index, systolic blood pressure, tobacco consumption, parental history of myocardial infarction and parental history of sudden death, cholesterol level, diabetic status, and sport activity were simultaneously entered into the survival model, resting heart rate remained an independent risk factor for sudden death (P=0.03) but not for fatal myocardial infarction. An elevated heart rate at rest was confirmed as an independent risk factor for sudden death in middle-aged men.

Nonesterified Fatty Acid Level: A New Risk Factor for Sudden Death

Fewer than 10 percent of sudden cardiac death episodes are aborted. To explore prevention strategies, these researchers studied the role of circulating nonesterified fatty acids (NEFA), also called free fatty acids, in sudden death. NEFA are released from adipose tissue and have arrhythmogenic properties in animal models; in humans, NEFA may be linked with post-MI ventricular arrhythmias. Is high NEFA concentration a risk factor for sudden death in middle-aged men …

Predicting sudden death in the population: the Paris Prospective Study I.

Sudden death was found to share the same set of usual risk factors as coronary events and therefore could not be specifically predicted in the population. It appears, however, that parental history of sudden death has not been investigated yet as a risk factor for sudden death. Therefore, we assessed risk factors, including parental sudden death, associated with the occurrence of sudden death in a long-term cohort study. We included 7746 men employed by the city of Paris who were 43 to 52 years of age in 1967 to 1972 in the Paris Prospective Study I. Each subject underwent a physical examination and an ECG, provided blood for laboratory tests, and answered questionnaires administered by trained interviewers who paid particular attention to family medical history. Men with known ischemic cardiac disease were further excluded from analysis. For 95.5% of the men, vital status was obtained from specific inquiries until retirement, then by death certificates. Resting heart rate, systolic or diastolic blood pressure, tobacco consumption, body mass index, diabetes status, serum cholesterol, and parental history of sudden death were independent factors associated with sudden death during follow-up (23 years on average). When adjusted for confounding variables, including parental history of myocardial infarction, relative risk of sudden death associated with parental sudden death was 1.80 (95% CI, 1.11 to 2.88). Parental sudden death is an independent risk factor for sudden death in middle-aged men. The existence of familial risk factors for sudden death may help provide better identification of subjects at high risk of and early prevention of sudden death.

ALCOHOL AND LIVER REGENERATION

The liver is a major target tissue for alcohol-induced damage. Given the prevalent use of alcohol, it is not surprising that alcohol abuse is the most common cause of clinically significant liver disease in the United States. Deaths from cirrhosis (the eventual consequence of chronic liver injury) correlate with per capita consumption of alcohol. Alcoholic cirrhosis , the end-stage of alcohol-induced liver injury, currently is the fourth leading cause of death in middle-aged men and is likely to remain a major cause of morbidity and mortality due to recent increases in alcohol consumption among women and young teenagers. 36 Unfortunately, there is no effective medical therapy for most patients with alcoholic liver disease . Orthotopic liver transplantation improves the survival of patients with terminal alcoholic cirrhosis; however, transplantation carries a risk of perioperative mortality and necessitates lifelong immunosuppressive therapy with attendant risks of serious infection and malignancy. Furthermore, if all patients with advanced alcoholic liver disease received liver transplants, there would be no donor organs available for patients with other forms of cirrhosis. 84 Therefore, there still is a desperate need to develop effective medical therapy for alcoholic liver disease. Over the past 3 decades, considerable progress has been made towards understanding the mechanisms by which alcohol produces liver injury. 82 It now is clear that liver injury is the end result of multiple events that are triggered by the oxidation of ethanol to acetaldehyde , a highly reactive metabolite. One important intermediary event in this pathogenic process appears to be the release of pro-inflammatory cytokines, including tumor necrosis factor–α (TNF). Plasma concentrations of TNF and TNF-inducible cytokines, including interleukins 6 (IL-6) and 8 (IL-8), correlate with mortality in patients hospitalized with alcoholic hepatitis. 10 , 41 , 49 , 62 , 63 , 64 This suggests that anticytokine agents may be useful for interrupting the pathogenesis of alcohol-induced liver injury. Indeed, treatments that decrease endotoxemia (a potent stimulus for TNF production) inhibit the evolution of hepatitis in rats that are being fed alcohol. 1 , 70 Unfortunately, unlike experimental animals that receive the antidote and the toxin concomitantly, most alcoholic patients already have sustained significant liver damage before they seek medical attention. Therefore, in clinical practice another major goal of treatment is to facilitate liver repair. Data from a number of groups, 37 , 38 , 43 , 59 , 77 , 92 including the author's, 28 , 29 , 30 , 35 indicate that ethanol inhibits the normally immense regenerative capacity of the liver. Thus, alcohol consumption may produce liver disease both by injuring the liver and by impairing the regenerative response to that injury. Relatively little is known about the mechanisms underlying ethanol's antiregenerative actions; however, these must be defined and reversed to optimize speedy and complete recovery from alcohol-induced liver injury.

Relative Risk of Sudden Cardiac Death During Marathon Running

C a 6-fold increase in the absolute incidence of exercise-related sudden cardiac death in middle-aged men compared with younger men, Thompson's 1 conclusion that vigorous physical activity transiently increases the risk of acute cardiac events agrees with relative risk analysis for a triggering effect of myocardial infarction during exercise. 2 3 Expressed as sudden cardiac death risk per person-hour, the reported rate of 1 per 50 000 marathon runners 4 represents a 5-fold increase over the average hourly incidence per person-hour. This translates into 1 death per 200 000 person-hours of competition compared with 1 sudden cardiac death per million person-hours among middle-aged men. 5 The data are finally coming in on the issue of how much exercise might be too much. The cardiovascular benefit of training for middle-aged male marathon runners may be offset by a 5-fold increase in the odds ratio for acute cardiac events during competition. At

Alexithymia and risk of death in middle-aged men

We prospectively examined the association between alexithymia and risk of death over an average follow-up time of nearly 5.5 years in 42- to 60-year-old men ( N = 2297) participating in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Alexithymia, impairment in identification, processing, and verbal expression of inner feelings, was assessed by the validated Toronto Alexithymia Scale (TAS) In age-adjusted survival analyses, men in the highest alexithymia quintile had a twofold greater risk of all-cause death ( p<0.001) and a threefold greater risk of death from accidents, injury, or violence ( p<0.02) relative to the men in the three lowest alexithymia quintiles. There was little evidence for confounding by behavioral factors (smoking, alcohol consumption, physical activity), physiological risk factors (LDL, HDL, body mass index, hypertension), socioeconomic status, marital status, perceived health, prior diseases and diagnoses, depressive symptoms or social connections. Consistent and even stronger associations between alexithymia and all-cause death were found in a healthy subgroup ( N = 1650). Why difficulties in dealing with emotions associate with increased mortality remains unclear. Our findings suggest that the association is independent from the effect of well-known behavioral, biological, and psychosocial risk factors.

Neuroticism and cynicism and risk of death in middle-aged men: the Western Electric Study.

MMPI measures of neuroticism (N) and of cynicism (C) were obtained at the initial examination of 1871 employed, middle-aged men in Chicago. Neither N nor C was significantly associated cross-sectionally with systolic blood pressure or serum cholesterol, but both were positively associated with cigarette smoking and alcohol consumption. N was not significantly associated with risk of death from coronary disease, other cardiovascular diseases, cancer, all other causes combined, or all causes combined after adjustment for C, age, cigarette smoking, alcohol consumption, systolic blood pressure, and serum cholesterol. C was significantly associated with coronary death and total mortality after adjustment for N and the other variables listed above, and relative risks of 1.4 to 1.6 were observed for all endpoints. These results support the idea that neuroticism is not associated with major causes of mortality, but that cynicism is associated with several causes. The associations between cynicism and mortality may be mediated by cigarette smoking and excessive alcohol consumption since adjustment for these factors may have been incomplete due to correlation between cynicism and errors in self-reported data.

Low density lipoproteins and hypercholesterolemia.

Coronary and vascular disease of atherosclerotic origin are the main causes of death and at the same time the most frequent reasons for early invalidity in the Federal Republic of Germany and other industrialized nations. In particular, coronary heart disease (CHD) is the major cause of death in middle-aged men.

Alcoholic intemperance, coronary heart disease and mortality in middle-aged Swedish men.

High alcohol consumption is one of the major risk indicators for premature death in middle-aged men. An indicator of alcohol abuse--registration with the social authorities for alcoholic problems--was used to evaluate the role of alcohol in relation to general and cause-specific mortality in a general population sample. Altogether 1,116 men (11%) out of a total population of 10,004 men were registered for alcoholic problems. Total mortality during 11.8 years' follow-up was 10.4% among the non-registered men, compared to 20.5% among men with occasional convictions for drunkenness and 29.6% among heavy abusers. Fatal cancer as a whole was not independently associated with alcohol abuse, but oropharyngeal and oesophageal cancers together were seven times more common in the alcohol-registered groups. Total coronary heart disease (CHD) was significantly and independently associated with alcohol abuse, but nearly all the excess CHD mortality among the alcohol-registered men could be attributed to sudden coronary death. Cases with definite recent myocardial infarction were not more common in the alcoholic population. A combined effect of coronary arteriosclerosis and heart muscle damage secondary to alcohol abuse is suggested. Other causes of death strongly associated with registration for alcohol abuse include pulmonary embolism, pneumonia and peptic ulcer, as well as death from liver cirrhosis and alcoholism. Of the excess mortality among alcohol-registered subjects, 20.1% could be attributed to CHD, 18.1% to violent death, 13.6% to alcoholism without another diagnosis and 11.1% to liver cirrhosis.

Low plasma selenium as a risk factor for cancer death in middle‐aged men

In a population study, 10,000 men (aged 46-48 years) were invited to a health screening program. At follow-up, which was up to eight years later, 61 subjects had died from cancer; from 35 of these subjects, plasma samples were available that were obtained at the initial screening. These samples, together with samples from two living controls for each case, were analyzed for selenium, retinol, cholesterol, triglyceride, and a number of plasma proteins. Plasma selenium was significantly lower (p less than 0.05) in cases than in controls (means: 1.06 vs. 1.12 mumol/l). The proportion of cases increased significantly from the highest to the lowest quintile of plasma selenium, and the relative risk for cancer death was 3.8 times higher in the lowest quintile compared with the highest. Mean plasma retinol was similar in cases (2.53 mumol/l) and controls (2.56 mumol/l). Cases and controls also had similar values for plasma cholesterol, triglyceride, uric acid, apolipoprotein B, orosomucoid, prealbumin, retinol-binding protein, and beta 2-microglobulin. Apolipoprotein AI in plasma was lower among cases (p less than 0.025). Cases smoked significantly more than controls did (p less than 0.05). Data indicate that low plasma selenium was a risk factor for cancer death in middle-aged men who lived in the same area. Further studies are necessary to establish whether differences in selenium intake, selenium metabolism, or other factors related to selenium are responsible for the relations observed. At present, the available data do not justify selenium supplementation programs in the whole population.

Risk factors for premature death in middle aged men

Risk factors for premature death in middle aged men

Inadvertent duplicate publication: Risk factors for premature death in middle aged men

Inadvertent duplicate publication: Risk factors for premature death in middle aged men

Risk factors for premature death in middle aged men

The causes of premature death and the associated risk factors were analysed in a cohort of 7935 middle aged men participating in a preventive population programme in Malmö. They were screened when aged 46-48 and then followed up for 3(1/2)-8 years. Two hundred and eighteen died, of whom 181 (83%) underwent necropsy. Three major causes of death were established: cancer in 61 (28%), deaths related to consumption of alcohol in 55 (25%), and coronary heart disease in 50 (23%).Distinctly different patterns of risk factors were found to be associated with each of the three main causes of premature death. In death due to coronary heart disease smoking (p=0.0062), serum cholesterol concentration (p=0.00014), serum triglyceride concentration (p=0.00013), systolic blood pressure (p=0.000012), and diastolic blood pressure (p=0.0021) were the strongest single determinants but diastolic blood pressure ceased to be a predictive factor in a multivariate analysis whereas all the other variables could be combined in a highly predictive logistic model. In death related to consumption of alcohol equal or even stronger associations were found for serum gamma glutamyltransferase activity (p<0.0001), points scored in a questionnaire screening for alcoholism (p<0.0001), and, inversely, serum cholesterol (p=0.0046) and serum creatinine (p<0.0001) concentrations both when applied independently and when combined in a logistic model. In death due to cancer significant associations were found for serum urate concentration (p=0.023) and, inversely, serum cholesterol concentration (p=0.056-0.031).Malignant diseases and diseases related to consumption of alcohol were at least as prominent as cardiovascular disorders in causing premature death in the cohort of men studied. All three types of conditions are potentially avoidable and seem to be associated with significant and distinctive patterns of risk factors. These patterns should be used, as blood pressure and serum lipid concentrations already are, to predict the risk of premature death and indicate preventive measures.

Analgesics and risk of coronary and other death in middle-aged men in eastern Finland.

The association between oral analgesics and the risk of death from ischaemic heart disease (IHD), cardiovascular disease, disease other than IHD, and any disease was studied in a cohort of 3551 men aged 30-59 years, based on a random sample from the population of eastern Finland. A number of potential coronary risk factors were allowed for in multiple logistic models. On the basis of these data, a regular use of oral analgesics is associated with a decreased risk of death from IHD. The relative risk was 0.6 with 95% confidence interval (CI) of 0.2-0.9 for IHD death and 0.6 (95% CI = 0.4-0.9) for cardiovascular death. No significant association was found between oral analgesics and the risk of death from diseases other than IHD.

Alcohol intake, serum beta 2-microglobulin and ventricular extrasystoles. Factors related to death in five-year follow up of middle-aged men.

Common causes of death in middle-aged men in Sweden are ischemic heart disease and malignant tumours. In this work the authors relate some findings in a healthy survey of sixty-year old men to mortality in the ensuing five-year follow-up period. Of the original population of 331, 60-year old men 15 subjects (4.5%) died in the follow-up period. The factors tested for relation to death in the follow-up period were: indices of alcohol abuse, serum concentration of β2-microglobulin and occurrence of ventricular extrasystoles in a long term (6 hrs) ambulatory electrocardiogram. It was found that in seven of the fifteen deceased subjects at least episodical heavy abuse of alcohol had prevailed. This was not evident at the health examination by use of serum gammaglutamyltransferase analysis, nor through the death certificates, but through hospital records and registration at the Temperance Board. Four subjects died (1.2%) of malignant tumours, and three of these subjects had serum-β2-microglobulin values above t...

Low Cholesterol Level as Risk Factor for Noncoronary Death in Middle-aged Men

Eighty-six deaths occurred zero to five years (mean, 2.5 years) after the screening investigation in 10,000 middle-aged men in Malmö, Sweden. The men were 47 to 50 years old at the time of the screening and represented 75% of their total birth-year cohorts in Malmö. The mortality showed two peaks, one at the higher end of the cholesterol distribution and the other and more pronounced one at the lower end of the cholesterol distribution. The first peak corresponded to the cardiovascular deaths while the second peak corresponded to the noncoronary death causes, including alcohol-related deaths.

Low cholesterol level as risk factor for noncoronary death in middle-aged men

Low cholesterol level as risk factor for noncoronary death in middle-aged men

Alcohol consumption and premature death in middle-aged men.

All the men living in Malmö born in 1926-9 were invited for a screening examination which included an assessment of alcohol consumption and measurement of gamma-glutamyltransferase (GGT) activity. They were followed for up to four years (median 2) and their mortality assessed. Sixty-two deaths occurred, 41 (0.9%) among the 4571 men who attended the screening investigation and 21 (1.3%) among the 1609 who did not respond to the invitation. Evidence of alcohol abuse or an alcohol-related cause of death was present in 25 (61%) of the deaths among the attenders and 13 (62%) of those among the non-responders. GGT values at the screening investigation were significantly increased in 19 (46%) of those who died, but established risk factors, such as cholesterol and triglyceride concentrations and blood pressure, had little predictive value. Measurement of GGT provided an objective index of alcohol consumption, though the full clinical importance of a raised value needs further assessment. The finding that heavy alcohol consumption was the single most important factor associated with premature death in these middle-aged men has important implications for prevention.

Effects of a health screening on mortality and causes of death in middle-aged men. A prospective study from 1970 to 1974 of mean in Malmö, born 1914.

All men born in even-numbered months in 1914 and domiciled in Malmö were invited in 1969 to participate in an investigation regarding risk factors for cardiovascular disease. Individuals with a blood pressure of 165/110 and over were treated and a sub-sample of heavy smokers were later invited to take part in a quit-smoking project. During the following five year period total and cause-specific mortality in the examined group was compared with corresponding data for men born in uneven months in 1914. Mortality in the examined cohort was lower than among controls and differed significantly from that in the control group with regard to cardiovascular mortality.