Hans Lingfors

Cardiovascular risk during early adult life. Risk markers among participants in "Live for Life" health promotion programme in Sweden.

STUDY OBJECTIVE: To study differences in cardiovascular lifestyle risk factors and biological risk markers in early adult life, with special attention to age and sex differences. Lifestyle cardiovascular risk factors included dietary habits, physical inactivity, smoking, alcohol habits, psychosocial strain, and mental stress. Biological risk markers included anthropometric variables, arterial blood pressure, and serum cholesterol concentration. DESIGN: A combined individual and community based preventive programme, including health examinations. SETTING: All communities in the County of Skaraborg in south western Sweden. PARTICIPANTS: Altogether 12,982 men and women aged 30 or 35 years who underwent health examinations over seven years. MAIN RESULTS: In both sexes, biological risk markers studied were worse in 35 year old subjects than in 30 year olds. Furthermore, a larger proportion of men aged 35 years were smokers and were physically inactive compared with 30 year old men. However, dietary habits were better in both sexes in the upper age group. At both ages there were also significant differences between men and women. Women, compared with men, had better dietary habits and lower alcohol consumption but smoked more and experienced greater mental stress and psychosocial strain. All biological risk markers were worse in men than in women at both ages studied. During the observation period, some improvement of the health profile of the participants was observed, indicating a beneficial effect of the intervention programme. CONCLUSIONS: The results indicate that the risk of cardiovascular disease, as assessed from studying lifestyle and biological risk markers, increases early in life, suggesting that preventive measures should start early.

Lifestyle changes after a health dialogue. Results from the Live for Life health promotion programme.

Objective – To evaluate the effect of a health dialogue on lifestyle habits, and to relate the lifestyle changes to changes of biological risk markers for ischaemic heart disease. Design – Cross-sectional study, intervention and follow-up. Setting – The community of Habo, population 9500, located in Skaraborg, Sweden. Patients – All 35-year-old inhabitants in Habo were invited to a health examination during a study period between 1989 and 1992. A community intervention programme was combined with a health examination consisting of a health dialogue with a specially trained nurse and use of a “health curve” as an educational tool. The effect of the health examination was examined by comparing baseline characteristics of participants in 1989–1992 with their follow-up data in 1993. Results – Participants in the health dialogue who were re-examined reported lifestyle improvements including less smoking, decreased dietary fat intake and increased physical activity. Those who reported improved dietary intake and increased physical activity improved their biological risk markers correspondingly (body mass index, waist to hip ratio, serum cholesterol concentration). Conclusions – The combination of a community and an individually based health programme can be effective with respect to lifestyle variables and, in those improving their lifestyle, in biological risk markers.

A study of men aged 33–42 in Habo, Sweden with special reference to cardiovascular risk factors Design, health profile and characteristics of participants and non-participants

An intervention study of men living in the Community of Habo in southwestern Sweden has been carried out. All men aged 33–42 and living in the community were invited. Altogether 652 men participated. The study included a questionnaire, an interview made by a nurse, anthropometric measurements, blood pressure measurements, measurements of respiratory function and work performance capacity, and blood sampling for chemical analyses. The participation rate was high, 86.1%, after one mail invitation even considering the fact that two reminders were sent. Most of the non-participants had recently been in contact with the health care organisation, either because they were high-consumers of health care, or because they had attended a health examination at work. A health profile was worked out comprising 11 different potential risk factors for coronary heart disease. This health profile turned out to be a useful educational tool when discussing the results of the examination with the participants. Risk points were given according to certain predetermined criteria. The distribution of risk factors was similar in the different ages studied. Most of the participants had at least one risk factor as defined, but many of them had two or more risk factors.

Evaluation of “Live for Life”, a health promotion programme in the County of Skaraborg, Sweden

STUDY OBJECTIVE To evaluate a health promotion programme, combining a population and individual based strategy, in the County of Skaraborg, Sweden, with special attention to outcome. DESIGN The evaluation was subdivided into structure, process and outcome. The evaluation procedure as a total is described here, but the results presented refer only to outcome. In order to study the potential effect of the individually based health examination, 35 year old subjects who had participated five years previously were in 1994–1996 compared with 35 year old subjects who had not participated before, and compared with their own values five years earlier. The results during 1995–1996 were compared with those of 1989–1990 for corresponding ages in order to study the effect of, particularly, the population based strategy. SETTING The County of Skaraborg in the south western part of Sweden with about 270 000 inhabitants. In addition to population strategy, involving the total county, men and women aged 30 and 35 years were invited to an individually based examination. MAIN RESULTS Factors related to body weight increased during the study period, while other factors mostly changed in the direction wanted. As a whole the changes were rather modest. There were favourable changes in lifestyle variables, for example, concerning smoking and dietary habits. CONCLUSIONS There were beneficial effects from the health promotion programme, but there is a need for continuous improvement of methods of intervention referred to lifestyle.

Time for a "vision zero" concerning premature death from ischaemic heart disease?

Objective - To study the trend in premature mortality (before 75 years of age) from ischaemic heart disease (IHD) in a Swedish primary health care district compared to communities of similar demographic situation and all Sweden. Design - Mortality from IHD in men and women was compared between the community of Habo and other Swedish communities of similar size and all Sweden for the period 1984-96. Setting - The community of Habo in Sweden with about 9600 inhabitants. Intervention - Intensified efforts by the local primary health care organisation, in co-operation with the community, in respect of primary and secondary cardiovascular prevention since the beginning of the 1980s. Results - Mortality from IHD has decreased significantly both in Habo and in Sweden during these years. The decrease has been more prominent in Habo than in Sweden as a whole and other Swedish communities of similar demographic situation. Conclusion - With increased and purposeful efforts in primary and secondary prevention, in co-operation between the community and primary health care, it is possible to substantially decrease mortality from IHD in the community.

Gender differences in secondary prevention of coronary heart disease: reasons to worry or not?

Scand J Prim Health Care 2003;21:37-42. ISSN 0281-3432 Objective - To analyse potential gender differences in cardiovascular risk factors and treatment patterns, reflecting clinical practice in secondary prevention. Design - Observational national study during 3 years of patients eligible for secondary prevention of coronary heart disease (CHD). Setting - Fifty-two healthcare districts in Sweden, involving primary health care and hospitals in collaboration, participating in a national quality assurance programme for the prevention of CHD. Subjects - A national sample of male and female patients surviving acute myocardial infarction, or following CABG/PTCA interventions for CHD, controlled at 3-6 months (n=9135) and 12 months (n=4802) of follow-up. The proportion of female patients (25%) did not differ between visits. Main outcome measures - Self-reported data on lifestyle, drug treatment and cardiovascular risk factor levels after consultation in general practice or at hospital policlinics. Results - No major gender differences were recorded in risk factor levels or in cardiovascular drug treatment patterns at 12 months of follow-up. Female patients participated in educational programmes to improve lifestyle to a higher degree than males (52.0 vs 45.1%), but after 1 year were more often (p<0.001) self-reported smokers (11.7 vs 8.4%). Female patients showed higher levels of blood pressure, total cholesterol and HDL cholesterol, but not LDL cholesterol compared to male patients. Conclusions - In general, a gender-equal level of lipid control and access to medical drug treatment has been established for patients in secondary prevention from a national sample in Sweden, followed for 1 year after CHD manifestations and related interventions.

Results from an intervention programme dealing with cardiovascular risk factors: Experiences from a study of men aged 33–42 in Habo, Sweden

OBJECTIVE To evaluate the long-term effect of a health examination and intervention programme in a Swedish community. DESIGN A health examination was carried out with the purpose of improving cardiovascular risk factors. A health profile was created as an educational tool, by means of which a nurse discussed the results of the health examination with the participants. Follow-up studies were carried out after 1 year and after 3-6 years. PARTICIPANTS All men aged 33-42 living in a Swedish community (Habo) were invited to the health examination. Altogether 652 participated, corresponding to a participation rate of 86.1%. MAIN RESULTS In the 1-year follow-up study, improvement with respect to cardiovascular risk factors was seen in a high-risk group (n = 161) for systolic blood pressure and lifestyle factors such as alcohol consumption, smoking, mental stress, mental health, and for the sum of risk points according to the health profile. Corresponding improvement was not seen in other men of similar age in the same community who had not participated in the health survey. In the 3-6 year follow-up only minor improvements remained, mainly for blood pressure and sum of risk points. CONCLUSION Even if the results are rather promising in the short run, it seems urgent to make the methods for improving cardiovascular risk factors better, especially with regard to long-term results.

Effects of a global health and risk assessment tool for prevention of ischemic heart disease in an individual health dialogue compared with a community health strategy only: Results from the Live for Life health promotion programme

OBJECTIVE To evaluate the effect of an individual health dialogue on health and risk factors for ischemic heart disease in addition to that of a community based strategy. METHOD Inhabitants in four communities in the area of Skaraborg, Sweden were invited to a health examination including a health dialogue both at the age of 30 and 35 (target communities). In another four communities inhabitants were invited only at the age of 35 (reference communities). Health and risk factors in 35-year old inhabitants in the target communities who participated in the health dialogue in 1989-1991 and 1994-1996 were analysed and compared with 35-year olds in the reference communities participating during the same periods of time. RESULTS Inhabitants in communities where there had been a previous individualised health intervention programme had, on the community level, a more favourable development concerning dietary habits, mental stress, body mass index, waist circumference, cholesterol, blood pressure and metabolic risk profile compared to inhabitants in communities with only a community based health intervention programme. CONCLUSIONS An individual lifestyle oriented health dialogue supported by a global health and risk assessment pedagogic tool seems to be more effective than a community health strategy only.

The Swedish National Programme for Quality Control of Secondary Prevention of Coronary Artery Disease--results after one year.

Background Guidelines for the prevention of coronary artery disease (CAD) have been developed both in Europe and in the USA. However, several surveys have shown that these guidelines are poorly implemented in clinical practice. Design/methods The Swedish Quality Control Programme on Secondary Prevention of CAD includes patients after myocardial infarction, or having undergone coronary artery surgery or percutaneous coronary intervention. Fifty of Swedens 79 hospital districts are currently participating. Patients are asked to send report-cards regarding risk factor management to a central registry after discharge from hospital, at a 3-6 month visit and then yearly for 5 years. Results Results based on data from 1 year after the index event show that a majority of patients reach targets for serum cholesterol (70%), and low-density lipoprotein (LDL)-cholesterol (71%). Mean value for total cholesterol is 4.6 (± SD 0.9) mmol/l, LDL-cholesterol 2.7 (± SD 0.8) mmol/l. Blood pressure targets are less often achieved, with 58% reaching the European Society of Cardiology target for systolic (<140 mmHg) and 81% for diastolic (<90 mmHg) blood pressure. A large proportion of patients are prescribed preventive drugs: aspirin (96%), beta-blockers (78%) and lipid-lowering drugs (83%). Conclusions The Swedish Quality Control Programme is one of the first attempts to assess implementation of guidelines on a national level based on patient participation. It is hoped that shared care programmes and increased patient involvement with feedback on achieved treatment goals in relation to guidelines will improve outcomes in patients with CAD.

The possibility of lifestyle and biological risk markers to predict morbidity and mortality in a cohort of young men after 26 years follow-up

Objectives To study the association between lifestyle and biological risk markers measured at one occasion, morbidity and mortality from cardiovascular disease (CVD) and cancer, and morbidity from diabetes approximately 26 years later. Design A follow-up study of a cohort of men, 33–42 years old at baseline. Setting Primary healthcare centre in Sweden. Participants All 757 men, living in the community of Habo in Sweden in 1985, and all 652 of these participating in a health examination in 1985–1987. Interventions Health profile and a health dialogue with a nurse. A doctor invited the high-risk group to further dialogue and examination. Intervention programmes were carried out in the primary healthcare centre and in cooperation with local associations. Main outcome measures CVD and cancer diagnoses from the Swedish National Board of Health and Welfare. Data from pharmacy registers of sold drugs concerning diabetes mellitus. Results The participants were divided in three groups based on summarised risk points from lifestyle (smoking, physical activity, alcohol consumption) and biological risk markers (body mass index (BMI), blood pressure, serum cholesterol) selected from the health profile. Comparisons were done between these groups. The group with the lowest summarised total risk points had a significantly lower risk for CVD and cancer compared with the group with the highest summarised risk points. The group with the lowest risk points concerning lifestyle had a significantly lower risk for CVD, and the group with lowest risk points for biological risk markers had a significantly lower risk for both CVD and cancer compared with the groups with the highest risk points. Smoking and serum cholesterol were the most important risk factors. In association to diabetes, BMI and smoking were the most important risk factors. Conclusions Risk factors measured on one occasion seemed to be able to predict CVD, cancer and diabetes 26 years later.