Respiratory Disease In Man Research Articles

Physiological equivalent temperature (PET) index and respiratory hospital admissions in Ahvaz, southwest of Iran.

Although Ahvaz is considered as one of the warmest cities around the world, few epidemiological studies have been conducted on the adverse effects of temperature on human health using thermal indices in this city. This study investigates the relation between physiologically equivalent temperature (PET) and respiratory hospital admissions in Ahvaz. Distributed lag non-linear models (DLNMs) combined with quasi-Poisson regression models were used to investigate the relation between PET and respiratory disease hospital admissions, adjusted for the effect of time trend, air pollutants (NO2, SO2, and PM10), and weekdays. The analysis was performed by utilizing R software. Low PET values significantly decreased the risk of hospital admissions for total respiratory diseases, respiratory diseases in men and women, chronic obstructive pulmonary diseases (COPD), and bronchiectasis. However, low PET (16.9°C) in all lags except lag 0-30 significantly increased the risk of hospital admissions for asthma. The results indicate that in Ahvaz, which has a warm climate, cold weather decreased overall respiratory hospital admissions, except for asthma.

Physiological Equivalent Temperature (PET) Index and cardiovascular and respiratory hospital admissions in Ahvaz, southwest of Iran

Physiological Equivalent Temperature (PET) Index and cardiovascular and respiratory hospital admissions in Ahvaz, southwest of IranBackground: Evidence has shown that climate change may have adverse effects on human health.Although Ahvaz is one of the hottest cities in the world, there have been no studies on the effect of ambient heat on hospital admission rates.The purpose of this study was to investigate the relation between Physiologically Equivalent Temperature (PET) and cardiovascular and respiratory hospital admissions in Ahvaz.Methods: Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on hospital admissions. In this study the effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted.Results: The results demonstrated that low PET values (6.4°C, 9.9°C and 16.9°C) in lags 0, 0-2, 0-6, 0-13 and 0-20,significantly decreasedthe risk ofhospital admissionsfortotalcardiovascular diseases,hypertension, ischemic heart diseases, cardiovascular admissionsin men, women and less than 65 year olds. Also, low PET values significantly decreased the riskof hospital admissions for total respiratory diseases, respiratory diseases in men and women, chronic obstructive pulmonary disease (COPD) and bronchiectasis. In contrast, low PET values in all lags except lag 0-30significantlyincreased the risk of hospital admissionsforasthma and strokes. High PET values (43.6°C and 45.4°C) increased the risk of cardiovascular and ischemic heart diseases in men.Conclusions: The results indicate that in Ahvaz which has a warm climate, cold stressesare more involved in cardiovascular and respiratory hospital admissions; and cold stress decreased overall cardiovascular and respiratory hospital admissions, except for asthma and stroke.

Health self-perception and morbidities, and their relation with rural work in southern Brazil.

Self-assessment of health status can be considered a good predictor of population morbidity and mortality. Sociodemographic, environmental and health conditions can influence health self-perception. However, in rural areas, the identification of morbidities that affect workers' health and their general health condition is unknown. This study aims to evaluate the relationship between health self-perception and the occurrence of morbidities according to type of work. This was a cross-sectional, population-based study of a rural area of Brazil. Health self-perception outcomes were classified as good (very good or good) or not good (fair, poor or very poor). Rural work, classified as yes or no, was considered to be the exposure. Crude and adjusted Poisson regression analyses were performed, obtaining prevalence ratio (PR) estimates and the respective confidence intervals (95%CI). All analyses were stratified by sex and adjusted for confounding factors. The sample comprised 893 individuals. The not good health self-perception prevalence was 27.6%, with a significant difference between the sexes (24.2% of men v 32.5% of women, p=0.014). Although associated with rural work in the crude model, self-perception was not associated with type of work after adjustment (PR: 1.02, 95%CI: 0.83-1.27). The risk of developing obesity (PR: 0.65, 95%CI: 0.47-0.91) and cardiovascular diseases (PR: 0.32, 95%CI: 0.12-0.87) was lower in men who developed rural activities. Also, women who reported doing rural work presented a lower risk for respiratory diseases (PR: 0.47; 95%CI: 0.22-0.97). The association between rural work and not good health self-perception, cardiovascular disease and obesity in women, and respiratory diseases in men seems to be highly dependent on sociodemographic context.

Multiple cause of death analysis in multiple sclerosis: A population-based study.

To gain a better understanding of the complex patterns of causes that contribute to death due to multiple sclerosis (MS) by assessing the relationship between MS and other causes of death listed on death certificates. Multiple cause of death data for all adult deaths (aged ≥18 years) in British Columbia, Canada, between 1986 and 2013 were accessed. All causes, as listed on the death certificate, whether underlying or contributing, were considered "any mention" causes. The associations between mention of MS on the death certificate and mention of other causes of death were examined by logistic regression, adjusted for age, sex, and calendar year (Bonferroni-corrected α level = 0.002). Findings were also sex-stratified. Among 771,288 deaths, MS was mentioned on 2,153 certificates. If MS was mentioned (versus not mentioned), there was a greater chance that specific conditions contributed to the death: respiratory infection (adjusted odds ratio [aOR], 3.03 [95% confidence interval (CI), 2.73-3.36]), aspiration pneumonia (aOR, 7.15 [95% CI, 6.23-8.22]), urinary tract infection (UTI) (aOR, 10.2 [95% CI, 8.7-12.0]), other infection including sepsis (aOR, 1.34 [95% CI, 1.15-1.56]), and skin disease (aOR, 5.06 [95% CI, 3.96-6.46]). Sex differences existed for urinary tract infection (men: aOR, 14.9 [95% CI, 11.5-19.3]; women: aOR, 8.00 [95% CI, 6.53-9.81]) and chronic respiratory disease (men = aOR, 1.36 [95% CI, 1.14-1.63]; women = aOR, 0.97 [95% CI, 0.84-1.13]). Deaths attributed to MS were commonly caused by infection (especially respiratory and urinary tract-related); conditions associated with advanced disability and immobility, such as aspiration pneumonia; and chronic respiratory disease in men. All are potentially modifiable; interventions that reduce the frequency or severity of these complications could improve survival in MS.

Interleukin-1α Mediates Ozone-Induced Myeloid Differentiation Factor-88-Dependent Epithelial Tissue Injury and Inflammation

Air pollution associated with ozone exposure represents a major inducer of respiratory disease in man. In mice, a single ozone exposure causes lung injury with disruption of the respiratory barrier and inflammation. We investigated the role of interleukin-1 (IL-1)-associated cytokines upon a single ozone exposure (1 ppm for 1 h) using IL-1α-, IL-1β-, and IL-18-deficient mice or an anti-IL-1α neutralizing antibody underlying the rapid epithelial cell death. Here, we demonstrate the release of the alarmin IL-1α after ozone exposure and that the acute respiratory barrier injury and inflammation and airway hyperreactivity are IL-1α-dependent. IL-1α signaling via IL-1R1 depends on the adaptor protein myeloid differentiation factor-88 (MyD88). Importantly, epithelial cell signaling is critical, since deletion of MyD88 in lung type I alveolar epithelial cells reduced ozone-induced inflammation. In addition, intratracheal injection of recombinant rmIL-1α in MyD88acid mice led to reduction of inflammation in comparison with wild type mice treated with rmIL-1α. Therefore, a major part of inflammation is mediated by IL-1α signaling in epithelial cells. In conclusion, the alarmin IL-1α released upon ozone-induced tissue damage and inflammation is mediated by MyD88 signaling in epithelial cells. Therefore, IL-1α may represent a therapeutic target to attenuate ozone-induced lung inflammation and hyperreactivity.

Inequalities in premature mortality by indicators of material welfare in Navarre. Population monitoring study 2001-2008

ABSTRACT Background. To show the inequalities in premature mortality according to indicators of material welfare inNavarre. Methods. All citizens under 75 years of age living inNavarre in 2001 were monitored for seven years to determine their vital status. House size and number of household vehicles was used as the socioeconomic status indicator. The age-adjusted total mortality rate and mortality rate from cause-specific mortality were estimated by these indicators. Results. The rate ratio for all causes of death in the lower categories depending on house size is 1.14 (IC 95%: 1.05-1.24) and 1.25 (IC 95%: 1.18-1.32) in women and men respectively and 1.46 (IC 95%: 1.36-1.57) and 1.97 (IC 95%: 1.89-2.05) depending on the number of vehicles. AIDS is the leading cause of death having a greater difference in mortality rates among people with lower and higher material welfare. Other causes of death with a high difference in mortality rates are digestive diseases and diabetes mellitus in women and digestive diseases and respiratory diseases in men. Conclusions. The mortality rate in theNavarre population shows an inverse gradient to material welfare, except for some cancer sites. This gradient is higher among men than among women. Key words. Premature mortality. Material welfare.

Contribution of Chronic Conditions to the Disability Burden across Smoking Categories in Middle-Aged Adults, Belgium.

IntroductionSmoking is considered the single most important preventable cause of morbidity and mortality worldwide, contributing to increased incidence and severity of disabling conditions. The aim of this study was to assess the contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults in Belgium.MethodsData from 10,224 individuals aged 40 to 60 years who participated in the 1997, 2001, 2004, or 2008 Health Interview Surveys in Belgium were used. Smoking status was defined as never, former (cessation ≥2 years), former (cessation <2 years), occasional light (<20 cigarettes/day), daily light, and daily heavy (≥20 cigarettes/day). To attribute disability to chronic conditions, binomial additive hazards models were fitted separately for each smoking category adjusted for gender, except for former (cessation <2 years) and occasional light smokers due to the small sample size.ResultsAn increasing trend in the disability prevalence was observed across smoking categories in men (never = 4.8%, former (cessation ≥2 years) = 5.8%, daily light = 7.8%, daily heavy = 10.7%) and women (never = 7.6%, former (cessation ≥2 years) = 8.0%, daily light = 10.2%, daily heavy = 12.0%). Musculoskeletal conditions showed a substantial contribution to the disability burden in men and women across all smoking categories. Other important contributors were depression and cardiovascular diseases in never smokers; depression, chronic respiratory diseases, and diabetes in former smokers (cessation ≥2 years); chronic respiratory diseases, cancer, and cardiovascular diseases in daily light smokers; cardiovascular diseases and chronic respiratory diseases in men and depression and diabetes in women daily heavy smokers.ConclusionsBeyond the well-known effect of smoking on mortality, our findings showed an increasing trend of the disability prevalence and different contributors to the disability burden across smoking categories. This information can be useful from a public health perspective to define strategies to reduce disability in Belgium.

Association of green tea consumption with mortality due to all causes and major causes of death in a Japanese population: the Japan Public Health Center-based Prospective Study (JPHC Study)

PurposeWe examined the association between green tea consumption and mortality due to all causes, cancer, heart disease, cerebrovascular disease, respiratory disease, injuries, and other causes of death in a large-scale population-based cohort study in Japan. MethodsWe studied 90,914 Japanese (aged between 40 and 69 years) recruited between 1990 and 1994. After 18.7 years of follow-up, 12,874 deaths were reported. The association between green tea consumption and risk of all causes and major causes of mortality was assessed using the Cox proportional hazards regression model with adjustment for potential confounders. ResultsHazard ratios for all-cause mortality among men who consumed green tea compared with those who drank less than 1 cup/day were 0.96 (0.89–1.03) for 1–2 cups/day, 0.88 (0.82–0.95) for 3–4 cups/day, and 0.87 (0.81–0.94) for more than 5 cups/day (P for trend <.001). Corresponding hazard ratios for women were 0.90 (0.81–1.00), 0.87 (0.79–0.96), and 0.83 (0.75–0.91; P for trend <.001). Green tea was inversely associated with mortality from heart disease in both men and women and mortality from cerebrovascular disease and respiratory disease in men. No association was found between green tea and total cancer mortality. ConclusionsThis prospective study suggests that the consumption of green tea may reduce the risk of all-cause mortality and the three leading causes of death in Japan.

Household income, sex and respiratory mortality in São Paulo, Brazil, 1996–2010

Respiratory mortality rates are declining in several countries, including Brazil; however, the effect of socio-economic indicators and sex is unclear. To identify differences in mortality trends according to income and sex in the city of São Paulo, Brazil. We performed a time-trend analysis of all respiratory diseases, including chronic obstructive pulmonary disease (COPD), lung cancer and tuberculosis, using Joinpoint regression comparing high, middle and low household income levels from 1996 to 2010. The annual per cent change (APC) and 95% confidence intervals (95%CIs) for death rates from all respiratory disease in men in high-income areas was -1.1 (95%CI -2.7 to 0.5) in 1996-2002 and -4.3 (95%CI -5.9 to -2.8) in 2003-2009. In middle- and low-income areas, the decline was respectively -1.5 (95%CI -2.2 to -0.7) and -1.4 (95%CI -1.9 to -0.8). For women, the APC declined in high-income (-1.0, 95%CI -1.9 to -0.2) and low-income areas (0.8, 95%CI -1.3 to -0.2), but not in middle-income areas (-0.5, 95%CI -1.4 to 0.3) from 1996 to 2010. Death rates due to COPD and all respiratory disease declined more consistently in men from high-income areas. Mortality due to lung cancer decreased in men, but increased in women in middle- and low-income areas.

Animal models for diseases of respiratory system

Latest trends in understanding of respiratory diseases in human beings can be derived from thorough clinical studies of these diseases occurring in man, but conducting such studies in man is difficult in terms of experimental manipulation. In the last 2 decades, various types of experimental respiratory disease models has been developed and utilized by investigators, which have contributed a lot to the understanding of respiratory diseases in man, but only little investigation has been done on the naturally occurring pulmonary diseases of animals as potential models which could have added to our knowledge. There are certain selected examples of spontaneous pulmonary disease in animals that may serve as exploitable models for human chronic bronchitis, bronchiectasis, emphysema, interstitial lung disease, hypersensitivity pneumonitis, hyaline membrane disease, and bronchial asthma.

Mortality in small geographical areas and proximity to air polluting industries in the Basque Country (Spain)

ObjectivesTo study the association between proximity to air polluting industrial facilities and mortality in the Basque Country (Spain) in the 1996–2003 period.MethodsA cross-sectional ecological study with 1465 census sections (CS)...

Chronic Diseases and Dietary Changes in Relation to Korean Americans’ Length of Residence in the United States

Background National health in the United States is influenced by the dietary norms brought into the country by an increasing number of immigrants. Objectives This cross-sectional study aimed to document dietary changes and disease prevalence in relation to the length of residence in the United States for Korean Americans in Michigan. Design Of 1,860 questionnaires mailed out, 637 (34.3%) were returned with respondent-reported information, including demographics, weight and height, chronic diseases, and dietary patterns. Subjects/setting Included in the final analyses were 497 first-generation Korean-American immigrants (263 men, 234 women, aged 30 to 87 years). Statistical analyses performed Analysis of covariance with the Tukey test and logistic regression models provided sex-specific analysis of dietary changes and disease patterns. All statistical analyses were adjusted for age. Results Chronic diseases reported most frequently by men and women, respectively, were hypertension, digestive diseases, arthritis, and diabetes. Length of residence in the United States (≤15 years, 16 to 25 years, or ≥26 years) was inversely associated with the prevalence of digestive diseases in men ( P=0.017) and women ( P=0.001), and positively with respiratory diseases in men and thyroid disease in women ( P<0.05). Length of residence in the United States was inversely associated with intake of rice/rice dishes in both men (servings per week, P<0.001) and women ( P=0.012). The prevalence of digestive diseases associated inversely with length of residence and positively with servings of rice/rice dishes consumed for Korean-American men. The age-adjusted odds ratio for digestive diseases was highest among men who had the shortest length of residence in the United States (≤15 years) and greater consumption of rice/rice dishes (>2 servings per day) (odds ratio 12.10; P=0.03). Conclusions Dietary changes of Korean-American immigrants in the United States over time were associated with changes in their chronic disease patterns. These findings may help food and nutrition professionals who work with minority immigrants because they identify factors that affect changes in dietary patterns and work toward preventing diet-related diseases. Prospective studies could address underlying mechanisms of the observed diet–disease relationship with subsequent generations of Korean Americans, as well as various ethnic minority immigrants in the United States.

Illnesses caused by smoking cigarettes.

In 1964, we learned that smoking was causally related to respiratory disease in men. Since then, we have established links to disease in women and have greatly expanded the myriad of detrimental health effects we know to be caused by smoking. This list of smokingrelated conditions continues to grow. Surgeon General Reports and the International Agency for Research on Cancer have tracked the progression of our knowledge concerning smoking as a cause of 13 specific diseases and conditions. As the body of evidence has increased, smoking among US adults has decreased. However, 48 million US adults continue to smoke [1]. Additionally, smoking remains the leading cause of preventable death in the US, accounting for approximately 430,700 deaths per year [2]. As research moves into the next century, we are challenged not only to further add to our understanding of links between smoking and disease but also to find ways to decrease smoking prevalence.

Evidence of mild respiratory disease in men with congential absence of the vas deferens

Cystic fibrosis (CF) is a severe disorder, whose main characteristics are, in addition to congenital absence of the vas deferens (CAVD), progressive lung disease, pancreatic insufficiency and elevated sweat chloride levels; CAVD without any other manifest clinical evidence is commonly suggested to be a form of CF with primarily genital expression. We undertook this study to test the hypothesis that men with a CAVD phenotype could be more CF-like than it is usually assumed. Each subject from a population of 42 patients suffering from CAVD was screened for a panel of 16 mutations plus the intron 8 5-thymidine allele of the CF gene (5T), and underwent a thorough clinical evaluation which included a detailed anamnesis, anthropometric data, chest and paranasal sinuses X-rays, pulmonary function tests, sputum cultures, stool chymotrypsin determination, sweat test and, in a limited number of patients, Nasal Potential Difference (NPD) measurement. The genotype analysis detected one compound heterozygote, 23 heterozygotes and 15 individuals carrying the 5T allele; sweat chloride was positive in six, borderline in 11 and negative in 25 subjects; NPD was abnormal in 2 12 patients. Medical history and clinical examination were consistent with respiratory disease in 20 cases; there was radiological evidence of pulmonary hyperinflation in 37 39 and of sinus disease in 20 42 patients; Staphylococcus aureus was cultivated in the sputum of 9 36 , Haemophilus influentiae in 3 36 subjects and three patients showed functional evidence of airway obstruction. These findings were equally distributed among sweat positive, borderline and negative patients. These results raise questions about the supposed benignancy of the CAVD condition. A close follow-up of men with CAVD could ascertain potential complications.

Effect of exercise on concentrations of immunoreactive endothelin in bronchoalveolar lavage fluid of normal horses and horses with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) represents a major cause of loss of performance in the horse. The role of endothelin (ET), a potent bronchoconstrictive and vasoactive peptide, is currently being investigated in asthma and other obstructive respiratory diseases in man. We have previously found elevated systemic and pulmonary endothelin levels in horses during exacerbation of COPD. In the present study, our aim was to examine possible variations in ET concentrations occurring during exercise in COPD horses. We compared the effects of intense treadmill exercise on the recovery of endothelin (ET) in the bronchoalveolar lavage fluid (BALF) as well as in arterial and venous blood, in a group of 5 healthy horses and a group of 5 COPD horses studied alternately in remission and while symptomatic. We also investigated the possible correlations between ET levels and pulmonary function tests during the study. While exercise did not affect the ET levels recovered in BALF among controls, it caused a significant increase (P = 0.02) among symptomatic COPD horses. During remission, wide variations of ET levels among horses, at rest and during exercise, made any significant interpretation difficult. No correlation could be found between exercise-induced changes in ET concentrations and pulmonary function tests or changes in arterial oxygen tension with exercise. We conclude that exercise appears to affect the release of ET by the airways in COPD horses, in contrast to healthy horses. It is still unclear, however, whether these differences relate to adjustments of lung function during exercise.

Role of Innate and Adaptive Immunity in the Outcome of Primary Infection withChlamydia pneumoniae, as Analyzed in Genetically Modified Mice

AbstractInfection with Chlamydia pneumoniae is a common cause of acute respiratory disease in man and is also associated with atherosclerotic cardiovascular disorder. Herein, we have compared bacterial load and immune parameters of C. pneumoniae-infected mice genomically lacking T cell coreceptors, cytokine receptors, or cytotoxic effector molecules. A protective role for CD8+ cells is shown by the enhanced severity of infection of CD8−/− or TAP-1−/−/β2-microglobulin −/− mice. CD8+ cells hindered a parasite growth-promoting role of CD4+ T cells, as indicated by the higher sensitivity to early infection of CD8−/− than CD4−/−/CD8−/− mice, which was further confirmed in experiments in which SCID mice were reconstituted with either CD4+ or CD4+ plus CD8+ T cells. Interestingly, CD4+ T cells played a dual role, detrimental early (14 and 24 days) after infection but protective at later time points (60 days after infection). The CD8+ T cell protection was perforin independent. The early deleterious role of CD4+ in the absence of CD8+ T cells was associated with enhanced IL-4 and IL-10 mRNA levels and delayed IFN-γ mRNA accumulation in lungs. In line with this, IFN-γR−/− (but not TNFRp55 −/−) mice showed dramatically increased susceptibility to C. pneumoniae, linked to reduced inducible nitric oxide synthase (iNOS) mRNA accumulation, but not to diminished levels of specific Abs. The increased susceptibility of iNOS−/− mice indicates a protective role for iNOS activity during infection with C. pneumoniae. The higher sensitivity of IFN-γR−/− mice to C. pneumoniae compared with that of SCID or recombination-activating gene-1−/− mice suggested a relevant protective role of IFN-γ-dependent innate mechanisms of protection.

Does living near a constellation of petrochemical, steel, and other industries impair health?

OBJECTIVES: To investigate concern that local industrial air pollution in Teesside, England, was causing poor health, several areas there were compared with parts of the City of Sunderland. METHODS: Populations...

FPL 55712—An antagonist of slow reacting substance of anaphylaxis (SRS-A): A review

Compound FPL 55712 is a highly selective antagonist of SRS-A derived from guinea-pig, rat, man and dog. It equally antagonizes SRS (slow reacting substance) released by calcium ionophore from rat basophilic leukemia cells and peritoneal mono-nuclear cells and by compound 48/80 from cat paw. In comparatively high doses FPL 55712 significantly inhibits passive cutaneous anaphylaxis in rat and anaphylactic bronchoconstriction in guinea-pig and rat and antigen-induced rhythmic mechanical activity in chicken ileum and late phase of Schultz-Dale reaction in guinea-pig trachea and human bronchus. In addition, FPL 55712 inhibits the SRS-A-induced release of rabbit aorta contracting substance (RCS) from guinea-pig lung. FPL 55712 facilitates sputum clearance in allergic canine asthma. This compound also inhibits the guinea-pig ECF-A (eosinophil chemotactic factor of anaphylaxis)-induced eosinophil chemotactic response of guinea-pig eosinophils in vitro. Compound FPL 55712 is an invaluable pharmacological tool for the identification of SRS(A) and to help define the role of SRS-A in the pathophysiology of immediate hypersensitivity (e.g. anaphylaxis and allergic asthma). Clinical trials of FPL 55712 as an aerosol in allergic obstructive respiratory diseases in man and animals may help to further understand the mechanism(s) and chemical mediator(s) involved in these conditions.

Immune Respiratory Disease Associated with the Inadequate Control of Indoor Air Quality

The prevalence of immunologically determined respiratory diseases is increasing throughout the world and this has been associated with an increased mortality from bronchial asthma. Consequently, there has been considerable interest in the factors that may influence the development of allergic disorders. The first few weeks following birth have been identified as important in determining the development of sensitivity to airborne allergens and subsequent allergic respiratory disorders. The expression of allergic diseases is both genetically determined and influenced to a significant degree by environmental factors related to indoor air quality. As well as possibly initiating allergic disease in the post-natal period, poor indoor air quality may cause respiratory disease in later life. These diseases may be allergic in origin (bronchial asthma or allergic alveolitis) or may be due to infections (Legionnaires’ disease). The contamination of indoor air by micro-organisms may occur from the structure of the building, the ventilation system or be introduced into the building from the outside air. The off-gassing of chemicals within buildings has attracted considerable attention over the past few years, but the evidence that this process can cause immunological disease in man is very limited. It is concluded that indoor air quality is an important potential cause of immunological respiratory disease in man which has been and still is frequently neglected.

Why do lean hypertensives have higher mortality rates than other hypertensives? Findings of the Hypertension Detection and Follow-up Program.

Specific causes of death were analyzed for 10,908 participants in the Hypertension Detection and Follow-up Program, to explore possible explanations for the observed excess 8.3-year mortality from all causes in hypertensives with low body mass. Although the cardiovascular mortality rate among men in the lowest decile of body mass (body mass index 21.96 or less) was 50% higher than that of men in the median class (body mass index 26.4-28.8), death rate for noncardiovascular deaths was more than 2 1/2 times higher in men with lean versus median body mass. The pattern was similar among women. Among noncardiovascular causes, striking differences in mortality rates between lean hypertensives and those of average body mass were observed for cirrhotic death (relative risk of 12+ in men and 11+ in women), for nonmalignant respiratory disease in men (relative risk of 7+), for violent death (both sexes), and for malignant neoplasms in men. Prevalence of smoking was almost twice as high in the lowest compared with the median body mass group; among the lean, excess deaths, particularly noncardiovascular deaths, were concentrated among smokers. Thus, male smokers in the lowest decile of body mass constituted only 3% of the study population, but contributed 8% of all deaths, 11% of all noncardiovascular deaths, and 22% of all cirrhotic deaths. A larger proportion of deaths occurred early in follow-up in the lean versus other hypertensives, suggesting occult disease among the lean at baseline. There was no evidence that more severe or treatment-resistant hypertension was present in or could explain excess mortality among the hypertensives with low body mass. The inference from the findings is not that overweight is protective for hypertensives nor that excess risk is due to leanness per se. Rather, a reasonable hypothesis, particularly from findings on specific causes of death, is that excess mortality in lean hypertensives is due to deleterious lifestyles, particularly smoking and excess alcohol intake, contributing to both leanness and risk of death.