Community-based preventive medical department for individual risk factor assessment and intervention in an urban population

Trell, Erik

doi:10.1016/0091-7435(83)90248-7

Cited by 89 publications

(103 citation statements)

References 8 publications

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“…Subjects who were diagnosed with hypertension, lipid disorders, diabetes mellitus or problematic drinking behaviour were referred for further evaluation and treatment, smokers were advised to quit, but received no further help to achieve that. 8,9 Obesity alone did not lead to any further evaluation or treatment.…”

Section: Discussionmentioning

confidence: 99%

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Influence of obesity on cardiovascular risk. Twenty-three-year follow-up of 22 025 men from an urban Swedish population

et al. 2002

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OBJECTIVE:To assess to what extent the incidence of coronary events and death related to smoking, hypertension, hyperlipidemia and diabetes is modified by obesity. DESIGN: Prospective cohort study. SUBJECTS: A total of 22 025 men aged 27 to 61-y-old at entry. MEASUREMENTS: Incidence of coronary events (CE, ie acute myocardial infarctions and deaths due to chronic ischaemic heart disease) and death during 23 y of follow-up was studied in relation to body mass index (BMI), heart rate, blood pressure, blood lipids, glucose and insulin, lifestyle factors, history of angina pectoris, history of cancer, self-reported health and socio-economic conditions. RESULTS: At the end of follow-up 20% of the obese men were no longer alive, and 13% had had a coronary event. Incidence of CE was 16% lower (RR (relative risk) 0.84; 95% confidence interval (CI) 0.65 -1.10) among underweight (n ¼ 1171), 24% higher (RR 1.24; CI 1.12 -1.37) among overweight (n ¼ 7773), and 76% higher (RR 1.76; 95% CI 1.49 -2.08) among obese men (n ¼ 1343) than it was among men with normal BMI (n ¼ 11 738). The risk associated with overweight and obesity remained statistically significant after adjustment for potential confounders (RR 1.18; CI 1.07 -1.31; and 1.39; 1.17 -1.65, respectively). The association between BMI and mortality was J-shaped. In all, 1.7% of the obese men were smokers with hypertension, hyperlipidaemia and diabetes, 16.3% were not exposed to any of these risk factors. The cardiovascular risk associated with obesity was small in the absence of other risk factors. Between smoking and obesity there was a statistically significant synergistic effect. CONCLUSIONS: Obesity is associated with an increased incidence of coronary events and death. The risk associated with obesity is substantially increased by exposure to other atherosclerotic risk factors, of which smoking seems to be the most important. The preventive potential of these associations should be evaluated in controlled trials.

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Section: Discussionmentioning

confidence: 99%

“…Height (m) and weight (kg) were measured while the subject was wearing light indoor clothing. 8 BMI was calculated as weight=height 2 (kg=m 2 ). In accordance with the World Health Organization weight classification 11 the men were categorized as overweight (25.0 -29.9 kg=m 2 ) and obese ( 30 kg=m 2 ).…”

Section: Baseline Examinationmentioning

confidence: 99%

Influence of obesity on cardiovascular risk. Twenty-three-year follow-up of 22 025 men from an urban Swedish population

et al. 2002

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“…Women with hypertension, lipid disorders or diabetes were referred for further examination and treatment. Smokers were advised to quit, but received no help to achieve that [8]. The health service authority of Malmö approved the screening programme and all participants gave their written consent.…”

Section: Subjectsmentioning

confidence: 99%

Tobacco and myocardial infarction in middle‐aged women: a study of factors modifying the risk

Janzon

Hedblad

Berglund

et al. 2004

Journal of Internal Medicine

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Abstract. Janzon E, Hedblad B, Berglund G, Engström G (Department of Community Medicine; and Department of Medicine, Malmö University Hospital, Malmö, Sweden). Tobacco and myocardial infarction in middle-aged women: a study of factors modifying the risk. J Intern Med 2004; 256: 111-118. Background. Although myocardial infarction (MI)is strongly related to smoking, few have studied why some smokers are more vulnerable than others. This study explored how the risk of MI in current and former smokers is modified by other cardiovascular risk factors. Methods. Incidence of MI (fatal and nonfatal) amongst 10619 women, 48.3 ± 8.2 years old, were studied in relation to smoking, hypertension, hypercholesterolaemia, diabetes, marital status and occupational level over a mean follow-up of 14 years. Results. Of the 3738 smokers, one-third had at least one major biological risk factor besides smoking; 228 women had MI during follow-up. Smoking and hypertension showed a synergistic effect on incidence of MI. The adjusted relative risks (RR) were 12.2 (95% CI: 7.5-19.8) for smokers with

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“…13,14 Three thousand four hundred women and 22 444 men were screened as part of a baseline examination that was carried out from 1974 to 1983. For clinical purposes, to find possible correlations between plasma protein levels and the individuals' metabolic and cardiovascular risk factor profiles, the determination of plasma levels of inflammationsensitive proteins was part of the program for 30% of the male subjects selected at random (in total, 6512 men born between 1921 and 1949 and aged 28 to 61 years at the time of the screening examination).…”

Section: Study Populationmentioning

confidence: 99%

Influence of Plasma Fibrinogen Levels on the Incidence of Myocardial Infarction and Death Is Modified by Other Inflammation-Sensitive Proteins

Lind

Hedblad

Stavenow

et al. 2001

ATVB

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Abstract-Inflammation may play an important role in atherosclerotic disease. Plasma fibrinogen is an established predictor of cardiovascular events. The aim of this study was to evaluate whether other inflammation-sensitive plasma proteins modify this prediction. We studied the incidence of cardiac events and death in men in relation to fibrinogen levels alone and in combination with other proteins. The study was based on 6075 men, who were, on average, 46 years old at the time of the screening examination, which included the quantitative assessment of plasma levels of fibrinogen, orosomucoid, ␣ 1 -antitrypsin, haptoglobin, and ceruloplasmin. The concentration of each protein was divided into quartiles for each. This classification made it possible to identify 4 groups, ie, men in the first fibrinogen quartile and at the same time either not belonging to the fourth quartile of any of the other proteins (Q1/No group) or also belonging to the fourth quartile of Ն1 of the additional proteins (Q1/Yes group) and corresponding groups in the fourth fibrinogen quartile (Q4/No and Q4/Yes groups). During the follow-up, which occurred at an average of 16 years, 439 (7.2%) men experienced a cardiac event, and 653 (10.7%) died; 278 of these men died of cardiovascular diseases, with 206 deaths attributed to ischemic heart disease. From the lowest to the highest quartile, there was for each protein a stepwise increase in the incidence of cardiac events and mortality. All-cause mortality and cardiovascular mortality were significantly higher in the Q4/Yes group compared with the Q4/No group, but they were similar in the Q4/No and Q1/Yes groups. The incidence of cardiac events was significantly higher in the Q1/Yes and Q4/Yes groups compared with the Q1/No and Q4/No groups, respectively. The increased cardiovascular mortality and cardiac event rates remained after adjustment for several confounders when the Q4/Yes and Q4/No groups were compared. The results suggest that the incidence of cardiac events and death due to cardiovascular diseases in middle-aged men predicted by plasma levels of fibrinogen is modified by other inflammation-sensitive proteins.

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Community-based preventive medical department for individual risk factor assessment and intervention in an urban population

Cited by 89 publications

References 8 publications

Influence of obesity on cardiovascular risk. Twenty-three-year follow-up of 22 025 men from an urban Swedish population

Influence of obesity on cardiovascular risk. Twenty-three-year follow-up of 22 025 men from an urban Swedish population

Tobacco and myocardial infarction in middle‐aged women: a study of factors modifying the risk

Influence of Plasma Fibrinogen Levels on the Incidence of Myocardial Infarction and Death Is Modified by Other Inflammation-Sensitive Proteins

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