Gösta Tibblin

Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913.

In a prospective study of risk factors for ischaemic heart disease 792 54 year old men selected by year of birth (1913) and residence in Gothenburg agreed to attend for questioning and a battery of anthropometric and other measurements in 1967. Thirteen years later these baseline findings were reviewed in relation to the numbers of men who had subsequently suffered a stroke, ischaemic heart disease, or death from all causes. Neither quintiles nor deciles of initial indices of obesity (body mass index, sum of three skinfold thickness measurements, waist or hip circumference) showed a significant correlation with any of the three end points studied. Statistically significant associations were, however, found between the waist to hip circumference ratio and the occurrence of stroke (p = 0.002) and ischaemic heart disease (p = 0.04). When the confounding effect of body mass index or the sum of three skinfold thicknesses was accounted for the waist to hip circumference ratio was significantly associated with all three end points. This ratio, however, was not an independent long term predictor of these end points when smoking, systolic blood pressure, and serum cholesterol concentration were taken into account. These results indicate that in middle aged men the distribution of fat deposits may be a better predictor of cardiovascular disease and death than the degree of adiposity.

Fibrinogen as a Risk Factor for Stroke and Myocardial Infarction

To study the possible risk factors for cardiovascular disease, we collected data on plasma levels of coagulation factors, blood pressure, serum cholesterol, and smoking in a random sample of 792 men 54 years of age. During 13.5 years of follow-up, myocardial infarction occurred in 92 men, stroke in 37, and death from causes other than myocardial infarction or stroke in 60. The blood pressure, degree of smoking, serum cholesterol, and fibrinogen level measured at the base-line examination proved to be significant risk factors for infarction by univariate analyses during follow-up, and blood pressure and fibrinogen were risk factors for stroke. Fibrinogen and smoking were strongly related to each other. The relation between fibrinogen and infarction, and between fibrinogen and stroke, became weaker when blood pressure, serum cholesterol, and smoking habits were taken into account, but was still significant for stroke. Although causality cannot be inferred from these data, it is possible that the fibrinogen level plays an important part in the development of stroke and myocardial infarction.

The Influence of Body Fat Distribution on the Incidence of Diabetes Mellitus: 13.5 Years of Follow-up of the Participants in the Study of Men Born in 1913

In a prospective study of risk factors for ischemic heart disease, 792 54-yr-old men selected by year of birth (1913) and residence in Göteborg, Sweden, agreed to attend for questioning and a number of anthropometric and other measurements in 1967. Thirteen and one-half years later, these baseline findings were reviewed in relation to the number of men who had subsequently developed diabetes mellitus. This analysis focused on the importance of abdominal adipose tissue distribution, measured as the waistto- hip circumference ratio, as a predictor for development of diabetes. Even when the confounding effect of body mass index, as a measure of the total body fat mass, was accounted for, the waist-to-hip ratio was positively and significantly associated with the risk for diabetes. These results from a prospective study strongly support previous cross-sectional findings indicating that not only the degree of obesity but also the localization of fat is a risk factor for diabetes.

Irritable bowel syndrome and dyspepsia in the general population: Overlap and lack of stability over time

BACKGROUND & AIMS It has been suggested that irritable bowel syndrome (IBS) and functional dyspepsia represent the same disease entity, the irritable gut. The aim of this study was to test the stability, consistency, and relevance of the current classification in the entire, unselected population of persons with gastrointestinal and/or abdominal symptoms, including those who had not consulted physicians. METHODS Sequential postal questionnaires were sent to 1290 representative persons (age range, 20-79 years) sampled from the population. Questions were asked about the prevalence of 24 gastrointestinal and/or abdominal symptoms and the site and type of abdominal pain, if any. RESULTS The prevalence of dyspepsia was 14% (32% if predominant reflux symptoms and concomitant IBS symptoms were included), and the prevalence of IBS was 12.5%. The 3-month incidence rates of reflux, dyspepsia, and IBS among previously symptomless persons were 0.5, 8, and 2 per 1000, respectively. Of persons with IBS, 87% also fulfilled the dyspepsia criteria, and the overlap between dyspepsia subgroups was more than 50%. The use of stricter criteria did not eliminate this overlap. Over a 1-year period, approximately 50% changed their symptom profile. Principal component analysis did not show any natural clustering of the symptoms. CONCLUSIONS The separation of functional gastrointestinal symptoms into dyspepsia, its subgroups, and IBS may be inappropriate.

Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors

OBJECTIVE Our objective was to study the prevalence of genital prolapse and possible related factors in a general population of women 20 to 59 years of age. STUDY DESIGN Of 641 eligible women in a primary health care district, 487 (76%) answered a questionnaire and accepted an invitation to a gynecologic health examination. RESULTS The prevalence of any degree of prolapse was 30.8%. Only 2% of all women had a prolapse that reached the introitus. In a set of multivariate analyses, age (P <.0001), parity (P <.0001), and pelvic floor muscle strength (P <.01)-and among parous women, the maximum birth weight (P <.01)-were significantly and independently associated with presence of prolapse, whereas the womans weight and sustained hysterectomy were not. CONCLUSIONS Signs of genital prolapse are frequently found in the female general population but are seldom symptomatic. Of factors associated with genital prolapse found in this study, pelvic floor muscle strength appears to be the only one that could be affected.

REDUCTION OF SUDDEN DEATHS AFTER MYOCARDIAL INFARCTION BY TREATMENT WITH ALPRENOLOL: Preliminary Results

Abstract The effect of 400 mg. alprenolol daily on survival after myocardial infarction was compared to that of placebo in 230 patients discharged alive from hospital. The patients were allocated to four separate, previously validated risk strata and within each stratum randomly assigned to treatment with alprenolol or placebo. The study was double-blind and the follow-up time was two years. Other treatment was given according to standardised criteria. 16 patients did not complete the trial, due to suspected side-effects; 8 of those were treated with placebo. After two years 11 patients in the placebo group and 3 in the actively treated group had died suddenly. This difference was statistically significant and the difference in absolute numbers persisted when all deaths were studied.

Analysis of Risk Factors for Stroke in a Cohort of Men Born in 1913

We analyzed parental death from stroke and other potential risk factors in relation to the incidence of stroke among 789 men, all 54 years old at the base-line examination. During 18.5 years of follow-up, 57 men (7.2 percent) had strokes. In univariate analyses, the following characteristics correlated significantly with the incidence of stroke: increased systolic (P = 0.004) and diastolic blood pressure (P = 0.0001), larger waist circumference (P = 0.007), higher waist:hip ratio (P = 0.0004), increased plasma fibrinogen level (P = 0.01), and lower vital capacity (P = 0.03). In addition, men whose mothers had died of stroke had a threefold increase in their incidence of stroke as compared with men without such a maternal history (P = 0.0005). Potential risk factors for stroke that were not confirmed were body-mass index, serum cholesterol level, hematocrit, blood glucose level, smoking, coronary heart disease, electrocardiographic signs of left ventricular hypertrophy, and a paternal history of death from stroke. In multivariate analyses, increased blood pressure, abdominal obesity, increased plasma fibrinogen level, and maternal history still correlated significantly with the risk of stroke. A maternal history of stroke should probably be added to the list of risk factors for stroke among middle-aged men.

Risk factors for Type 2 (non-insulin-dependent) diabetes mellitus. Thirteen and one-half years of follow-up of the participants in a study of Swedish men born in 1913

SummaryThis report presents data on antecedents of Type 2 (non-insulin-dependent) diabetes mellitus in a homogeneous sample of randomly selected 54-year-old men from an urban Swedish population with a diabetes incidence of 6.1% during 13.5 years of follow-up. The increased risk leading to diabetes for those in the top quintile compared to the lowest quintile of the distribution of statistically significant risk factors were: body mass index = 21.7, triglycerides = 13.5, waist-to-hip circumference ratio = 9.6, diastolic blood pressure = 6.7, uric acid = 5.8, glutamic pyruvic transaminase = 3.9, bilirubin = 3.2, blood glucose = 2.7, lactate = 2.4 and glutamic oxaloacetic transaminase = 2.0. Those with a positive family history of diabetes had 2.4-fold higher risk for developing diabetes than those without such a history. In a multivariate analysis glutamic pyruvic transaminase, blood glucose, body mass index, bilirubin, systolic blood pressure, uric acid and a family history of diabetes were all significantly associated with the development of diabetes. Our study demonstrates the great importance of adiposity and body fat distribution for the risk of diabetes. A number of established risk factors for coronary heart disease are risk factors for diabetes as well. Disturbed liver function and increased levels of lactate are early risk factors for diabetes — presumably indicators of the presence of impaired glucose tolerance and/or hyperinsulinaemia.

Smoking and myocardial infarction.

In a representative series of male patients with primary myocardial infarction the prevalence of smokers prior to infarction was higher than in representative population samples. The difference decreased with increasing age, Those patients generally had a somewhat more severe clinical course than those who continued to smoke. Nevertheless, those who stopped had only half the rate of non-fatal recurrences (P smaller than 0.01) and half the cardiovascular mortality-rate (P smaller than 0.05) of those who continued to smoke.

PROSPECTIVE STUDY OF SOCIAL INFLUENCES ON MORTALITY: The Study of Men Born in 1913 and 1923

In a study of 989 middle-aged men followed up for 9 years social influences, measured as persons per household unit, home activities, outside-home activities, and social activities at the baseline examination, were found to be significantly associated with mortality. The association between these variables (except for home activities) and mortality was significant even when age, risk factors for coronary heart disease, and health status measured at the baseline examination were taken into consideration. Social activities may have a modifying effect on life stresses and risk factors associated with mortality.