Experimental evidence suggests that in addition to hypertension, serum lipids might also accelerate the decline in renal function. We tested this hypothesis in 2702 dyslipidemic middle-aged men without renal disease participating in the Helsinki Heart Study, a coronary primary prevention trial. The decline in renal function was estimated from linear regression slopes based on reciprocals of 10 serum creatinine determinations over the study period. Renal function deteriorated 3% on average during the 5-year study, and hypertension accelerated this change. Subjects with an elevated ratio of low- to high-density lipoprotein cholesterol ( > 4.4) had a 20% faster decline than those with a ratio less than 3.2. Both the contribution of the lipoprotein ratio and the protective effect of high-density lipoprotein cholesterol alone remained significant in multiple regression analyses. In the study of joint effects the contribution of lipids was confined to subjects with simultaneous elevation of blood pressure and lipids. The results suggest that in addition to hypertension, blood lipids also modify the decline in renal function.

Objectives The combined effects of age, leisure-time physical activity, smoking, alcohol consumption, and different forms of shift work on the prevalence of sleep compIaints and daytime sleepiness were studied among workers in industly, transport, and traffic. Methods Altogether 3020 subjects were studied using a psychosocial questionnaire. The participants were currently employed men, aged 45-60 years, from a postal and telecommunication agency, the railway company, and 5 industrial companies. On the basis of a factor analysis of an 1 I-item sleep questionnaire, the sleep complaints were grouped into the categories of insomnia, sleep deprivation, daytime sleepiness, and snoring. The importance of the shift schedule, age, and lifestyle factors as simultaneous predictors of the complaints was studied in a logistic regression analysis and an analysis of covariance. Results The prevalence of insomnia, sleep deprivation, and daytime sleepiness depended significantly on the shift system. All sleep complaints were more common in 2-and 3-shift work and in irregular shift work than in day work. The prevalence of daytime sleepiness was 20-37%, depending on the shift system. Leisure-time physical activity and alcohol consumption were the most important lifestyle factors predicting all sleep complaints, except snoring. The effects of physical activity and alcohol consumption differed for different shift schedules. C O~~C~U S~O~~S Different shift systems, also 2-shift work and permanent night work, seem to increase the frequency of sleep complaints. Especially 3-shift work seems to interact with lifestyle factors by increasing the adverse effects and decreasing the beneficial effects on sleep and sleepiness.

Abstract. Man$ tta$ ri M, Tenkanen L, Alikoski T, Manninen V (Department of Medicine, Helsinki University and Helsinki Heart Study, Helsinki, Finland). Alcohol and coronary heart disease : the roles of HDL-cholesterol and smoking. J. Intern Med 1997 ; 241 : 157-63. Objectives.To study the role of HDL-cholesterol (HDLc) in the causal pathway mediating the effect of alcohol on coronary heart disease (CHD). Design. Cox proportional hazard models were used to compare the relative CHD risks in various HDLcsmoking categories. Setting. A prospective, multicentre, placebocontrolled, double-blind CHD primary prevention trial with gemfibrozil in primary (occupational) health care units, the Helsinki Heart Study. Subjects. Dyslipidaemic middle-aged men with available alcohol consumption data (1924 of 2035) in the placebo arm of the 5-year study. Main outcome measures. Seventy-seven (of 84) cases of nonfatal myocardial infarction or cardiac death.

ObjectivesThe risk of coronary heart disease (CHD) in shift work and the possible pathways for CHD in industrial workers were studied along with the importance of shift work as an occupational class gradient of CHI) risk. Methods Data from a psychosocial questionnaire and on life-style factors, blood pressure, and serum lipid levels were used for a follow-up study of a cohort of 1806 workers. CHD was determined from official Fi~~nish registers. Cox's proportional hazards models were used with different covariates to evaluate the relative rislcs associated with shift work. Results All the blue-collar workers smoked more and a had higher systolic blood pressure than the whitecollar workers. Three-shift workers scored low for job-decision latitude on the Karasek job stress scales. There were no differences in the total cholesterol or high-density lipoprotein cholesterol levels. When all the shift workers were compared with all the day workers, the relative risk of CHD was 1.5 [95% confidence interval (95% CI) 1.1-2.11 when only age was adjusted for and 1.4 (95% CI 1.0-1.9) when life-style factors, blood pressure, and serum lipids were also adjusted for. The blue-collar day workers and 2-shift and 3-shift workers had relative risks of 1.3 (95% CI 0.8-2.0), 1.9 (95% CI 1.1-3.4), and 1.7 (95% CI 1.1-2.7), respectively, when compared with the white-collar day workers. C O~C~U S~O~S Shift work is an important part of the occupational gradient in CHD risk among industrial workers; some evidence was found for the hypothesis that a direct stress-related mechanism explains part of the increased CHD risk.Key terms blood pressure, coronary heart disease, job stress, life-style, occupation, shift work.While most occupational health hazards have been strongly curtailed in Western industrialized countries, shift work remains common. In fact, the number of shift workers has even increased in some branches of industry, for example, in manufacturing (1). The total number of night and shift workers seems to be between some 15% and 20% of the total working population in most European Community countries (1). Approximately 20% of shift workers are forced to move to day work during their first year of employment due to disturbances in their circadian rhythm, with accompanying sleep disturbances, difficulties in social life, and various stress reactions (2). Even those who accommodate may nevertheless be at increased risk of long-term health hazards. Whether or not shift workers are at increased risk of coronary heart disease (CHD) has been studied since the middle of the century with contrasting findings. In 1978 Harrington (3) concluded in his review that there was no conclusive evidence for an increased incidence of cardiovascular disorders for shift workers. After the followup study of Knutsson et a1 (4) and the massive aggregated data study by Alfredsson et a1 (3, Waterhouse and his colleagues (6) found, in their review from 1992, that the evidence in favor of an increased risk of CHD in association with shift work is becoming more...

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To investigate the influence of antihypertensive therapy and the success of blood pressure control on coronary heart disease incidence and total mortality, we studied dyslipidemic middle-aged men participating in the placebo arm of the Helsinki Heart Study, a randomized coronary primary prevention trial with gemfibrozil. Based on blood pressure level and the presence of antihypertensive therapy at study entry, the participants were classified into four categories. Relative risks of coronary heart disease (nonfatal myocardial infarction or cardiac death) and total mortality during the 5-year trial period were calculated using Cox proportional hazards models. With subjects who were not using antihypertensive drugs and who had normal blood pressure (category I) as reference, the relative risks of coronary heart disease during the trial period were 2.1 (95% confidence interval [CI], 1.3 to 3.3) in untreated hypertensive subjects (category II), 0.9 (95% CI, 0.2 to 3.8) in subjects with successful antihypertensive therapy (category III), and 2.0 (95% CI, 1.0 to 4.1) in subjects who remained hypertensive despite drug therapy (category IV). The relative risks of death were 1.9 (95% CI, 0.9 to 3.9) in category II and 1.0 (95% CI, 0.1 to 7.3) in category III; in category IV subjects, those with unsuccessful antihypertensive therapy, the relative risk was 4.4 (95% CI, 2.0 to 9.6). The excess mortality in this category was due to cardiovascular causes and was clustered in subjects with multiple drug therapy for hypertension control. We conclude that successful antihypertensive therapy in dyslipidemic men reduced coronary heart disease incidence despite its adverse effects on high-density lipoprotein cholesterol and triglycerides.(ABSTRACT TRUNCATED AT 250 WORDS)