The SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.

Treatment with B vitamins did not lower the risk of recurrent cardiovascular disease after acute myocardial infarction. A harmful effect from combined B vitamin treatment was suggested. Such treatment should therefore not be recommended. (ClinicalTrials.gov number, NCT00266487.).

The Hordaland Homocysteine Study (HHS) is a population-based study of more than 18,000 men and women in the county of Hordaland in Western Norway. The first investigation (HHS-I) took place in 1992-93, when the subjects were aged 40-67 y. In 1997-99, a follow-up study (HHS-II) of 7,053 subjects was carried out. In this large population, plasma levels of total homocysteine (tHcy) are associated with several physiologic and lifestyle factors and common diseases. Increasing age, male sex, smoking, coffee consumption, high blood pressure, unfavorable lipid profile, high creatinine, and the MTHFR 677C > T polymorphism are among the factors associated with increased tHcy levels; physical activity, moderate alcohol consumption, and a good folate or vitamin B-12 status are associated with lower tHcy levels. Subjects with raised tHcy levels have increased risk of cardiovascular morbidity, cardiovascular and noncardiovascular mortality, and are more likely to suffer from depression and from cognitive deficit (elderly). Among women, raised tHcy levels are associated with decreased bone mineral density and increased risk of osteoporosis. Women with raised tHcy levels also have an increased risk of having suffered from pregnancy complications and an adverse pregnancy outcome. Significant associations between tHcy and clinical outcomes are usually observed for tHcy levels > 15 micromol/L, but for most conditions, there is a continuous concentration-response relation with no apparent threshold concentration. Overall, the findings from HHS indicate that a raised tHcy level is associated with multiple clinical conditions, whereas a low tHcy level is associated with better physical and mental health.

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The prevalence of obesity in childhood and adolescence has increased worldwide. Long-term effects of adolescent obesity on cause-specific mortality are not well specified. The authors studied 227,000 adolescents (aged 14-19 years) measured (height and weight) in Norwegian health surveys in 1963-1975. During follow-up (8 million person-years), 9,650 deaths were observed. Cox proportional hazards regression was used to compare cause-specific mortality among individuals whose baseline body mass index (BMI) was below the 25th percentile, between the 75th and 84th percentiles, and above the 85th percentile in a US reference population with that of individuals whose BMI was between the 25th and 75th percentiles. Risk of death from endocrine, nutritional, and metabolic diseases and from circulatory system diseases was increased in the two highest BMI categories for both sexes. Relative risks of ischemic heart disease death were 2.9 (95% confidence interval (CI): 2.3, 3.6) for males and 3.7 (95% CI: 2.3, 5.7) for females in the highest BMI category compared with the reference. There was also an increased risk of death from colon cancer (males: 2.1, 95% CI: 1.1, 4.1; females: 2.0, 95% CI: 1.2, 3.5), respiratory system diseases (males: 2.7, 95% CI: 1.4, 5.2; females: 2.5, 95% CI: 1.4, 4.8), and sudden death (males: 2.2, 95% CI: 1.2, 4.3; females: 2.7, 95% CI: 1.1, 6.6). Adolescent obesity was related to increased mortality in middle age from several important causes.

Objectives: To determine the risk in men and women smoking 1-4 cigarettes per day of dying from specified smoking related diseases and from any cause. Design: Prospective study. Setting: Oslo city and three counties in Norway. Participants: 23 521 men and 19 201 women, aged 35-49 years, screened for cardiovascular disease risk factors in the mid 1970s and followed throughout 2002. Outcomes: Absolute mortality and relative risks adjusted for confounding variables, of dying from ischaemic heart disease, all cancer, lung cancer, and from all causes. Results: Adjusted relative risk (95% confidence interval) in smokers of 1-4 cigarettes per day, with never smokers as reference, of dying from ischaemic heart disease was 2.74 (2.07 to 3.61) in men and 2.94 (1.75 to 4.95) in women. The corresponding figures for all cancer were 1.08 (0.78 to 1.49) and 1.14 (0.84 to 1.55), for lung cancer 2.79 (0.94 to 8.28) and 5.03 (1.81 to 13.98), and for any cause 1.57 (1.33 to 1.85) and 1.47 (1.19 to 1.82). Conclusions: In both sexes, smoking 1-4 cigarettes per day was associated with a significantly higher risk of dying from ischaemic heart disease and from all causes, and from lung cancer in women. Smoking control policymakers and health educators should emphasise more strongly that light smokers also endanger their health. Is there a threshold value for daily cigarette consumption that must be exceeded before serious health consequences occur? Numerous population studies have reported on a strong dose-response relationship between cigarette consumption and severe diseases. In most studies, however, the lowest consumption group was set at 1-9 or 1-15 cigarettes per day. One may argue that smokers in these groups clustered close to the upper limit of this consumption span, and that a threshold value might be found on a lower level.Only a few prospective studies have reported on the health consequences of smoking fewer than five cigarettes per day. [1][2][3] Our aim was to determine the risk in men and women smoking 1-4 cigarettes per day of dying from specified smoking related diseases and from any cause. We report on a Norwegian population of 23 521 men and 19 201 women, aged 35-49 years, who in the mid 1970s were screened for cardiovascular disease risk factors and followed throughout 2002 for deaths from ischaemic heart disease, all cancer, lung cancer, and from all causes. METHODS ParticipantsFrom 1972 to 1978 screening examinations for cardiovascular disease were undertaken in the Norwegian capital, Oslo, and in three Norwegian counties with a mainly rural settlement. In Oslo, all male residents aged 40-49 years were invited, and a 7% random sample of male residents aged 20-39. 4 In the counties, all male and female residents aged 35-49 years were invited, and a 10% random sample of all residents aged 20-34. 5The screening programmes in the four areas included a questionnaire related to cardiovascular diseases. Height, weight, and blood pressure were measured according to an identical protocol. A non-fasting blood sample was dr...

Data from a prospective study were used to investigate risk factors for hip fracture among a representative population of middle-aged adults. During the years 1974-1978, all women (n = 25,298) and men (n = 27,015) aged 35-49 years in three Norwegian counties were invited to attend a cardiovascular screening (attendance rate = 91.5%). This cohort was followed throughout 1990 with respect to hip fracture, for a total of 572,006 person-years. A total of 281 new fractures were identified, of which 71 were excluded from the analysis due to high-energy trauma or fracture in metastatic bone. Age-adjusted relative risks (RR) and 95% confidence intervals (CI) for hip fracture increased with body height in women (RR = 3.62, 95% CI 1.46-8.97, > or = 1.70 m vs. < 1.55 m) and men (RR = 2.92, 95% CI 0.94-9.05, > or = 1.85 m vs. < 1.70 m). A history of diabetes mellitus also gave elevated risk of fracture (RR = 5.81, 95% CI 2.15-15.71 in women and RR = 7.67, 95% CI 2.40-24.53 in men). In addition, hip fracture was related to body mass index (inverse), disability pension, and marital status. An increased risk for smokers appeared only among those consuming > or = 15 cigarettes per day. In multivariate analysis, all these risks remained elevated. This study suggests that, as in older populations, known risk factors for low bone mass are related to hip fracture among middle-aged adults. In addition, body height seems to have an independent influence on hip fracture incidence in this age group.

Elevated tHcy concentration is associated with common pregnancy complications and adverse pregnancy outcomes.