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 Malm8. They were screened when aged 46-48 and then followed up for 31-8 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= 0000012), and diastolic blood pressure (p=00021) 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 y glutamyltransferase activity (p <0 0001), points scored in a questionnaire screening for alcoholism (p <0 0001), and, inversely, serum cholesterol (p= 00046) 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= 0056-0-031).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.
Among the first screened 2439 males born in 1926 and 1927, aged 48-49 years at the time of screening and representing 76% of these age cohorts, uncontrolled or partly controlled hypertension was found in 7.5%. Of these individuals, 30% preferred to remain with their physicians, regardless of the degree of control they had achieved. Among those who were referred to the Hypertension Unit (5.2% of the screened population), elevated S-GT levels (21.10 pkat/l) were found in 38.3%, against 18.5% in the two cohorts. During 24 months of treatment and follow-up only two men among the entire group of hypertensives referred dropped out, both were heavy drinkers (>SO g alcohol daily). The mean BP after treatment was significantly lower among men with normal than high S G T values or in those who admitted to heavy drinking. Of the 99 males treated for more than two years, 82 (83%) were responders (supine DBP s95 mmHg). C, ! the non-responders, 70% were either heavy drinkers or had abnormal S-GT values. The possible role of alcohol in the pathogenesis of essential hypertension in middleaged males is discussed.-Abbreviations: BP = blood pressure, DBP = diastolic BP, SBP = systolic BP, S-GT = serum gamma glutamyl transpeptidase, ASAT = aspartate aminotransferase, ALAT = alanine aminotransferase, ALP = alkaline phosphatase, HR = heart rate.
1. Whole-body elimination rate of 22Na+ was decreased in normotensive or borderline first-degree relatives of hypertensive probands. 2. Whole-body potassium, exchangeable sodium and urine excretion of sodium, potassium and creatinine were similar in relatives and controls. 3. Erythrocyte net influx of 22Na+ was significantly increased in normotensive relatives. 4. Abnormal whole-body and cellular handling of sodium (22Na+) demonstrated in relatives indicates that this abnormality may have an important role in the development of essential hypertension in man.
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