Although Coronary Mortality Has Decreased, Rates of Cardiovascular Disease Remain High: 21 Years of Follow‐Up Comparing Cohorts of Men Born in 1913 With Men Born in 1943

Abstract

BackgroundDespite a decline in mortality rates from cardiovascular disease (CVD) in the past few decades, the burden of CVD in a contemporary population remains inadequately addressed. Therefore, this study was aimed to investigate secular trends in mortality from coronary artery disease and all‐cause mortality over 2 decades, by comparing 2 cohorts of men born 30 years apart and evaluate the prediction of the risk of CVD and all‐cause death in a contemporary random sample of Swedish men.Methods and ResultsTwo cohorts of randomly selected men born in 1913 (855 men) and 1943 (798 men) were first examined at age 50 in 1963 and 1993, respectively, and followed longitudinally over 21 years. All‐cause mortality and coronary artery disease death were lower in 50‐ to 71‐year‐old men born in 1943 compared with those born in 1913, with unadjusted hazard ratios of 0.57 (0.45–0.71) and 0.34 (0.22–0.53), respectively. After adjustment for risk factors (smoking, serum cholesterol, hypertension, systolic blood pressure, diabetes mellitus, body mass index, and physical activity), the differences between the cohorts remained significant for coronary artery disease, hazard ratios 0.57 (0.34–0.94), P=0.029, but not for all‐cause mortality hazard ratios 0.82 (0.62–1.07), P=0.14. However, the rate of CVD events during follow‐up was still high (30.7%) for the men born in 1943. No statistically significant interaction by birth cohort in contribution of risk factors to death was found between 2 cohorts except physical inactivity.ConclusionsDespite a marked reduction in the rate of coronary artery disease death over the past 30 years, the burden of CVD events and all‐cause mortality remains high. Therefore, intensified efforts to modify contributing risk factors are still required.

Impact of changes in heart rate with age on all-cause death and cardiovascular events in 50-year-old men from the general population

“…‘The study of Men Born in 1943’ is a longitudinal, prospective, population-based study of men born in 1943 and living in the city of Gothenburg in western Sweden at the age of 50 years19. From the Swedish Population Register, a random sample of 50% of all men born in 1943 and living in Gothenburg received an invitation to attend the study in 1993 (n=1450).…”

Comparison of incidence rates and risk factors of heart failure between two male cohorts born 30 years apart

“…Two population samples of men born in 1913 and 1943 were first examined at age 50 years in 1963 and 1993, respectively, and followed up longitudinally over 21 years 23 24. In 1963, a sample was drawn from the population register consisting of all men born in 1913 (the 1913 cohort) on a day divisible by 3 (ie, the third, the sixth and ninth day of each month) and living in the city of Gothenburg.…”

“…Both cohorts of men born in 1913 and in 1943 were followed up for 21 years from 50 to 71 years of age. The cohort of men born in 1913 were re‐examined at the ages of 54, 60 and 67 years25; the men born in 1943 were re-examined at ages 60 and 71 years 24…”

The impact of time-updated resting heart rate on cause-specific mortality in a random middle-aged male population: a lifetime follow-up

“…'The Study of Men Born in 1913' is a prospective cohort established in 1963 and comprises one-third of the male population born in 1913 and living in Gothenburg, Sweden, at the time of sampling. Details of the cohort and the sampling process have been given previously [18][19][20][21]. At baseline in 1963, 855 men (87.9% of the whole sample who fulfilled the inclusion criteria) agreed to participate in the study.…”