Howard A. Lindberg

Alcohol consumption, cardiovascular risk factors, and mortality in two Chicago epidemiologic studies.

Multivariate analysis of the association at baseline between problem drinking and cardiovascular risk factors among 1,233 white male employees of the Chicago Peoples Gas Company age 40-59 showed the 38 problem drinkers with significantly higher blood pressures and cigarette consumption and significantly lower relative weights than the others. Similar analyses among 1,899 white male employees of the Hawthorne Works of the Western Electric Company in Chicago age 40-55 showed the 117 men consuming 5 or more drinks per day with significantly higher blood pressures and cigarette use than the others. No significant differences were recorded between heavy drinkers and the others in serum cholesterol level. The gas company problem drinkers had significantly higher 15- year mortality rates from all causes, cardiovascular diseases, coronary heart disease, and sudden death. These differences could not be entirely explained by their blood pressure, smoking, and relative weight status. The Western Electric heavy drinkers had increased 10-year mortality rates both for all causes and noncardiovascular causes.

Prevalence and incidence of coronary heart disease in strata of the labor force of a Chicago industrial corporation

Abstract 1. 1. An epidemiologic analysis of coronary heart disease and other cardiovascular-renal diseases was accomplished, utilizing the accumulated medical and personnel records on the entire male labor force aged 50 to 59 years (784 men) of a Chicago utility company. 2. 2. Observed prevalence and incidence rates for coronary heart disease were 71/1,000 and 61/1,000 for 4 years, respectively. 3. 3. The over-all mortality rate from coronary heart disease was 25/1,000 for 4. 4 years. The mortality rate in those free of coronary heart disease at the onset of the study was 17/1,000 for 4 years. Of all deaths, 47 per cent occurred suddenly. 5. 4. Hypertension, obesity, diabetes mellitus, and suspected coronary heart disease were associated with increased incidence rates of definite coronary heart disease. 6. 5. Prevalence rates of hypertension and obesity were similar in sociologic subgroups of the total population under study. Sociologic stratifications were made based on nativity, residence, military experience, education, occupation, physical activity of work, indoor versus outdoor work, and type and amount of income. 7. 6. Coronary heart disease incidence rates were similar in the sociologic subgroups, with the exception that significantly lower rates were observed in the foreign-born than in the native-born. Coronary heart disease incidence rates are high in all strata of the middle-aged male population in the United States.

Relationship of education to major risk factors and death from coronary heart disease, cardiovascular diseases and all causes, Findings of three Chicago epidemiologic studies.

The relationship of education to risk factors at baseline and to long‐term mortality from coronary heart disease (CHD), cardiovascular diseases (CVD), and all causes was analyzed for three cohorts of middle‐aged employed white men in Chicago: 8047 from the Chicago Heart Association Detection Project in Industry (CHA) (entry 1967‐1973), 1250 from the Peoples Gas Company Study (PG) (entry 1958-1959) and 1730 from the Western Electric Study (WE) (entry 1957-1958). Each man was classified into one of four groups: not a high school graduate, high school graduate, some college but not a graduate, or college graduate. For all three cohorts, a graded, inverse association was observed at baseline between education and blood pressure, which was statistically significant for CHA and WE men and independent of age and relative weight. For all three cohorts, a significant, graded, inverse association was also recorded between education and cigarette use at entry. For serum cholesterol, no clear pattern was observed for the education groups in any of the three cohorts. CHA men showed a graded, inverse relationship between education and relative weight. This cohort was the only one of three showing a significant, graded inverse association between education and prevalence of ECG abnormalities at entry. For this CHA cohort, 5-year follow-up data showed a statistically significant, graded, inverse relationship between education and ageadjusted mortality rates from CHD, CVD and all causes. With adjustment for entry age, diastolic pressure, cigarettes, serum cholesterol, relative weight and ECG abnormalities, this inverse relationship remainedreduced in degree, but still statistically significant for CVD mortality. Similarly, for the pooled PG-WE cohort of 2980 with 20-21 years of follow-up, education and the three mortality end points were inversely related but not graded, with statistical significance for all three end points in the univariate analyses. The results of these studies indicate inverse relationships between education and lifestyle-related risk factors at baseline and between education and long-term risk of CHD, CVD and all-causes mortality. The inverse relationship between education and mortality is accounted for in part by the established major biomedical risk factors.

Relationship of relative weight and body mass index to 14-year mortality in the Chicago Peoples Gas Company study.

Abstract The importance of relative weight and body mass index to 14-yr mortality of 1233 white males of the Chicago Peoples Gas Company Study is analyzed by the inclusion of a quadratic term for weight in the multiple logistic function. The endpoints of death, all causes, CVR death, and CHD death are found to have a significant quadratic relationship to body mass index for the total cohort of 1233 men, while relative weight is found to have a quadratic relationship only with death, all causes. When the group is broken into men aged 40–49 and 50–59, body mass continues to show an important quadratic relationship to all three endpoints, while relative weight shows only an important quadratic relationship to death, all causes, among men aged 50–59. When the cohort is divided into smokers and nonsmokers, body mass index shows a significant quadratic relationship to all endpoints except CHD death among nonsmokers. Relative weight, on the other hand, is related quadratically only to total mortality in both groups. The weights corresponding to the lowest mortality are found to be about 25–35 per cent above the ideal published by the Metropolitan Life Insurance Company. Thus, for this cohort moderate overweight appears to be a sign of good health. Those individuals with the highest risk are those near the so-called ideal weight and those who are markedly obese, say with a relative weight above 150 or 160.

Serum cholesterol and risk of death from cancer and other causes in three Chicago epidemiological studies

Abstract Although hypercholesterolemia is established as a major risk factor for coronary heart disease, the finding in some epidemiological studies of no association between serum cholesterol and all causes mortality suggests that serum cholesterol may be inversely related to the risk of death from non-cardiovascular causes, e.g. cancer. This possibility led to the examination of this question in middle-aged white males from the Chicago Peoples Gas Company and Chicago Western Electric Company studies, and in middle-aged white males and females from the Chicago Heart Association Detection Project in Industry. In each of these studies, there was no significant association between initial serum cholesterol level and subsequent mortality from cancer, or from causes other than cancer and the cardiovascular diseases in men. There was, however, a significant inverse association with other causes of death in women. When the cancer deaths were examined by site, there was a significant inverse association between serum cholesterol and deaths from sarcoma, leukemia and Hodgkins disease in the Western Electric men and one that was nearly so in the Chicago Heart Association men. Serum cholesterol was not significantly related to lung cancer, colorectal cancer, oral cancer, pancreatic cancer, or to all other cancers combined in any of the three studies in men or in women. There was, however, the suggestion of a positive association for breast cancer in women. Thus, the results of these three studies do not generally support the hypothesis of an inverse association between serum cholesterol and cancer in urban middle-aged white American males and females.

Uric acid: a risk factor for coronary heart disease?

The association between serum uric acid the prevalence of ECG abnormalities was analyzed for 24,997 employed men women, white black, age 18–64 years, from the Chicago Heart Association (CHA) Detection Project in Industry. In addition, the relationships between uric acid 5-year mortality from all causes, from cardiovascular diseases (CVD), from coronary heart disease (CHD) were analyzed for 7804 white men women age 45-64 years from this study 967 white men age 44–63 years from the Chicago Peoples Gas Company Study. For men, the associations between uric acid the prevalence of ECG abnormalities with mortality appear to be secondary to associations between uric acid other risk factors. For women, however, the associations could not be explained by other risk factors.

HIGH BLOOD-PRESSURE: A RISK FACTOR FOR CANCER MORTALITY ?

Univariate and multivariate analyses have been made of the relationship of systolic and diastolic blood-pressure measured at study entry to subsequent 14-year mortality among 1233 White males originally age 40-59 in 1958 from the Chicago Peoples Gas Company prospective study. With age, serum-cholesterol, and cigarettes per day controlled, both elevated systolic and electaed diastolic blood-pressure in 1958 were found to be strongly related to subsequent mortality from cancer in the men of this study. The possibility that this finding was due either to an association between antihypertensive medication in general, and cancer, or to an association was found that could explain the excess cancer mortality among those with elevated blood-pressure in 1958, either with medication in general, or with reserpine and rauwolfia in particular. These findings thus pose the question, is high blood-pressure associated with an increased risk of death due to cancer?

Independent contribution of electrocardiographic abnormalities to risk of death from coronary heart disease, cardiovascular diseases and all causes. Findings of three Chicago epidemiologic studies.

The importance of major and minor ECG abnormalities at baseline for subsequent risk of death from coronary heart disease, cardiovascular diseases and all causes was analyzed for middle-aged white men from the Chicago Peoples Gas Company, Chicago Western Electric Company and Chicago Heart Association Detection Project in Industry studies. Univariate analysis showed that in all three studies, men with major ECG abnormalities had death rates considerably higher than those with normal ECGs. When baseline age, diastolic pressure, serum cholesterol, relative weight and number of cigarettes per day were taken into consideration in multivariate analysis, ECG abnormalities retained significant relationship to the three death end points. Findings from the Chicago Western Electric Company and Chicago Heart Association studies showed independent relationship between minor ECG abnormalities and the three death end points. In the Chicago Peoples Gas Company (20-year follow-up) and in the Chicago Western Electric Company (17-year follow-up), when the deaths were divided into those that occurred within the first 10 years of follow-up and those that occurred more than 10 years after entry, the association between ECG abnormalities and mortality held for both the first and second decades of follow-up. Overall, findings from this study demonstrate an independent relationship between ECG abnormalities and death from coronary heart disease, cardiovascular disease and all causes.

Pulse pressure-III. Prognostic significance in four Chicago epidemiologic studies

This report, the third in a series on pulse pressure and pure systolic hypertension, examines the associations between blood pressure and the cardiovascular diseases and coronary heart disease, both cross-sectionally and prospectively, utilizing data from four Chicago epidemiologic studies, in an effort to determine whether or not a widened pulse pressure, or pure systolic hypertension, is an independent risk factor. In these analyses, blood pressure is divided into two components, one related to level and the other to pulse pressure, with pulse pressure redefined so that the association between pulse pressure and the prevalence of ECG abnormalities or mortality, indicates whether the endpoint is more strongly related to systolic or diastolic blood pressure. In these studies, blood pressure level is significantly related to both ECG abnormalities and mortality. In the cross-sectional analyses, pulse pressure is generally positively related to the prevalence of ECG abnormalities, indicating a stronger association for systolic blood pressure, and thus a possible association with pure systolic hypertension. However, in the prospective analyses, pulse pressure is generally not related to mortality, indicating an equal association with mortality for systolic and diastolic blood pressure in these studies. Thus, although the cross-sectional analyses generally support the hypothesis that a widened pulse pressure, or pure systolic hypertension, is an independent risk factor for the cardiovascular diseases and coronary heart disease, the prospective analyses do not.

Asymptomatic hyperglycemia and coronary heart disease in middle-aged men in two employed populations in Chicago

Abstract Studies of possible association between asymptomatic hyperglycemia and coronary disease were conducted among middle-aged employed men in Chicago. In one cohort, frequency of ECG abnormalities at baseline was examined among men at different glucose levels. In univariate analysis, those at the highest glucose levels had higher rates of ECG evidence of CHD, but this association did not remain when such factors as age, blood pressure, weight, cholesterol and cigarettes were taken into account in multivariate analysis. Among the studies, long-term follow-up to mortality (10, 13 and 15 yr) showed inconsistent findings on association of hyperglycemia and subsequent death. In one cohort (Gas Company men followed for 10 yr after a 1-hr post-load glucose determination) a positive glucose-mortality association was found in both univariate and multivariate analysis. But in the two remaining cohorts (Gas Company 13 yr after casual glucose determination and Western Electric 15 yr after 2-hr post-load determination), no such association was found. While differences in method and sample size as well as other limitations may have contributed to the differences observed, the inconsistency of the findings do not permit a conclusion that asymptomatic hyperglycemia is a positive coronary risk factor.