Marianne Schroll

Epidemiology of headache in a general population—A prevalence study

We present the first prevalence study of specific headache entities using the operational diagnostic criteria of the International Headache Society. One thousand 25-64 year old men and women, who lived in the western part of Copenhagen County were randomly drawn from the Danish National Central Person Registry. All subjects were invited to a general health examination focusing on headache and including: a self-administered questionnaire concerning sociodemographic variables, a structured headache interview and a general physical and neurological examination. The participation rate was 76%. Information about 79% of the non-participants showed a slightly differing headache prevalence which was not quantitatively important. The following results in participants are therefore representative of the total sample. The lifetime prevalences of headache (including anybody with any form of headache), migraine, and tension-type headache were 93, 8 and 69% in men; and 99, 25 and 88% in women. The point prevalence of headache was 11% in men and 22% in women. Prevalence of migraine in the previous year was 6% in men and 15% in women and the corresponding prevalences of tension-type headache were 63 and 86%. Differences according to sex were significant with a male: female ratio of 1:3 in migraine, and 4:5 in tension-type headache. The prevalence of tension-type headache decreased with increasing age, whereas migraine showed no correlation to age within the studied age interval. Headache disorders are extremely prevalent and represent a major health problem, which merits increased attention.

Symptoms of Depression, Acute Myocardial Infarction, and Total Mortality in a Community Sample

BACKGROUND Depression has been shown to adversely affect the prognosis of patients with established coronary artery disease, but there is comparatively little evidence to document the role of depression in the initial development of coronary disease. METHODS AND RESULTS Study participants were 409 men and 321 women who were residents of Glostrup, Denmark, born in 1914. Physical and psychological examinations in 1964 and 1974 established their baseline risk factor and disease status and their level of depressive symptomatology. Initial myocardial infarction (MI) was observed in 122 participants, and there were 290 deaths during follow-up, which ended in 1991. A 2-SD difference in depression score was associated with relative risks of 1.71 (P = .005) for MI and 1.59 (P < .001) for deaths from all causes. These findings were unchanged after we controlled for risk factors and signs of disease at baseline. There were no sex differences in effect sizes. CONCLUSIONS High levels of depressive symptomatology are associated with increased risks of MI and mortality. The graded relationships between depression scores and risk, long-lasting nature of the effect, and stability of the depression measured across time suggest that this risk factor is best viewed as a continuous variable that represents a chronic psychological characteristic rather than a discrete and episodic psychiatric condition.

Urinary Albumin Excretion An Independent Predictor of Ischemic Heart Disease

Cross-sectional studies suggest that an increased urinary albumin excretion rate is associated with cardiovascular disease, dyslipidemia, and hypertension. The purpose of this study was to analyze prospectively whether the urinary albumin-to -creatinine (A/C) ratio can independently predict ischemic heart disease (IHD) in a population-based cohort. In 1983, urinary albumin and creatinine levels were measured, along with the conventional atherosclerotic risk factors, in 2085 consecutive participants without IHD, renal disease, urinary tract infection, or diabetes mellitus. The participants were followed up until death, emigration, or December 31, 1993. IHD was defined as a hospital discharge diagnosis or cause of death including the diagnoses ICD-8 and 410 to 414. Seventy-nine individuals developed IHD during the 21 130 person-years of follow-up. They were characterized by a preponderance of males and higher age, body mass index, blood pressure, lipoproteins, and proportion of current smokers. Microalbuminuria was defined as an A/C ratio) >90 percentile (>0.65 mg/mmol). When adjusted for other risk factors, the relative risk of IHD associated with microalbuminuria was 2.3 (95% CI, 1.3 to 3.9, P=0.002), and the 10-year disease-free survival decreased from 97% to 91% (P<0.0001) when microalbuminuria was present. An interaction between microalbuminuria and smoking was observed, and the presence of microalbuminuria more than doubled the predictive effect of the conventional atherosclerotic risk factors for development of IHD. It is concluded that microalbuminuria is not only an independent predictor of IHD but also substantially increases the risk associated with other established risk factors.

Arterial Hypertension, Microalbuminuria, and Risk of Ischemic Heart Disease

Albumin excretion in urine is positively correlated with the presence of ischemic heart disease and atherosclerotic risk factors. We studied prospectively whether a slight increase of urinary albumin excretion, ie, microalbuminuria, adds to the increased risk of ischemic heart disease among hypertensive subjects. In 1983 and 1984, blood pressure, urinary albumin/creatinine concentration ratio, plasma total and HDL cholesterol levels, body mass index, and smoking status were obtained in a population-based sample of 2085 subjects, aged 30 to 60 years, who were free from ischemic heart disease, diabetes mellitus, and renal or urinary tract disease. Untreated arterial hypertension or borderline hypertension was present in 204 subjects, who were followed until 1993 by the National Hospital and Death Certificate Registers with respect to development of ischemic heart disease. During 1978 person-years, 18 (9%) of the hypertensive subjects developed ischemic heart disease. Microalbuminuria, defined as a urinary albumin/creatinine ratio above the upper decile (1.07 mg/mmol), was the strongest predictor of ischemic heart disease, with an unadjusted relative risk of 4.2 (95% CI 1.5 to 11.9, P=0.006) and a relative risk of 3.5 (95% CI 1.0 to 12.1, P=0.05) when adjusted for all other atherosclerotic risk factors, including age and gender. In conclusion, microalbuminuria confers a 4-fold increased risk of ischemic heart disease among hypertensive or borderline hypertensive subjects. Urinary albumin excretion should be measured regularly in a hypertension clinic, and a rigorous control of blood pressure and of other atherosclerotic risk factors is recommended in hypertensive patients with microalbuminuria.

Estimation of peripheral arteriosclerotic disease by ankle blood pressure measurements in a population study of 60-year-old men and women.

Abstract The systolic ankle and arm blood pressure has been measured by Doppler ultrasound technique in 666 men and women aged 60 yr. The Doppler method was found suitable for use in a population survey as the cost is low, the measurements are rapid, painless and can be well standardized. The reproducibility was 2.9 mm Hg, measured as the mean standard deviation of 10 measurements in ten persons. Decreased ankle blood pressure was defined as a ratio between the systolic ankle pressure and the arm pressure of less than 90% in at least one of the four leg arteries examined. Decreased ankle pressure in one or more arteries was present in 16% of the men and 13% of the women. The prevalence of intermittent claudication was 5.8% in men and 1.3% in women. Pulselessness in one or two of the arteries of the foot occurred in 11.9% of the men and 8.8% of the women. According to all three criteria 2.3% of the population were abnormal, 3.3% of the men and 1.0% of the women. 82% had no signs of arteriostenosis. The normal individuals had on an average ankle/arm blood pressure indices higher than 100%. The ankle/ arm indices were related to other signs of arteriosclerosis: Angina pectoris, dyspnoea on effort and ECG signs of ischemia. The findings have been used in an evaluation of the risk factors for peripheral arteriosclerosis. The values, at age 50, of blood pressure, serum cholesterol, serum triglyceride, smoking habits, heart rate and male sex were significantly associated with signs of peripheral arteriostenosis and with the ankle/arm index at age 60.

Dietary patterns and mortality in Danish men and women: a prospective observational study

The analysis of dietary patterns emerged recently as a possible approach to examining diet-disease relation. We analysed the risk of all-cause and cardiovascular mortality associated with dietary patterns in men and women, while taking a number of potential confounding variables into account. Data were from a prospective cohort study with follow-up of total and cause-specific mortality. A random sample of 3698 men and 3618 women aged 30-70 years and living in Copenhagen County, Denmark, were followed from 1982 to 1998 (median 15 years). Three dietary patterns were identified from a twenty-eight item food frequency questionnaire, collected at baseline: (1) a predefined healthy food index, which reflected daily intakes of fruits, vegetables and wholemeal bread, (2) a prudent and (3) a Western dietary pattern derived by principal component analysis. The prudent pattern was positively associated with frequent intake of wholemeal bread, fruits and vegetables, whereas the Western was characterized by frequent intakes of meat products, potatoes, white bread, butter and lard. Among participants with complete information on all variables, 398 men and 231 women died during follow-up. The healthy food index was associated with reduced all-cause mortality in both men and women, but the relations were attenuated after adjustment for smoking, physical activity, educational level, BMI, and alcohol intake. The prudent pattern was inversely associated with all-cause and cardiovascular mortality after controlling for confounding variables. The Western pattern was not significantly associated with mortality. This study partly supports the assumption that overall dietary patterns can predict mortality, and that the dietary pattern associated with the lowest risk is the one which is in accordance with the current recommendations for a prudent diet.

Ageing, tumour necrosis factor-alpha (TNF-alpha) and atherosclerosis

Ageing is associated with increased inflammatory activity in the blood. The purpose of this study was to investigate if age‐related increased plasma levels of TNF‐α were associated with atherosclerosis in a cohort of 130 humans aged 81 years. The elderly cohort had increased circulating levels of TNF‐α, C‐reactive protein (CRP), total cholesterol (TC), low‐density lipoproteins (LDL) and a low high‐density lipoprotein (HDL)/TC ratio compared with a young control group (n = 44). The elderly cohort was divided by tertiles into three subgroups with low, intermediate, and high levels of TNF‐α, respectively. In the group with high TNF‐α concentrations a significantly larger proportion had clinical diagnoses of atherosclerosis. Furthermore, weak correlations were found between TNF‐α on one hand and blood concentrations of triglycerides, leucocytes, CRP and a low HDL/TC ratio on the other which are known as risk factors of atherogenesis and thromboembolic complications. No correlations were found between TNF‐α, TC, LDL, or the body mass index. In conclusion, the present study shows that in a cohort of 81‐year‐old humans, high levels of TNF‐α in the blood were associated with a high prevalence of atherosclerosis.

Healthy centenarians do not exist, but autonomous centenarians do : A population-based study of morbidity among Danish centenarians

OBJECTIVE: To assess the prevalence of common illnesses in an unselected population of centenarians.

Predicting death from tumour necrosis factor-alpha and interleukin-6 in 80-year-old people

Ageing is associated with low‐grade inflammation and markers such as IL‐6 possess prognostic value. Tumour necrosis‐alpha (TNF‐α) initiates the inflammatory cascade and has been linked to several age‐associated disorders. It remains, however, unknown if TNF‐α is associated with mortality in old populations. The aim of the present study was to investigate if serum levels of TNF‐α were associated with all‐cause mortality independently of interleukin (IL)‐6 in a prospective study of 333 relatively healthy 80‐year‐old people. A Cox regression model was used to explore effects of TNF‐α and IL‐6 on survival in the following 6 years. A total of 133 participants died during this follow‐up period. TNF‐α was associated with mortality in men, but not in women, whereas low‐grade elevations in IL‐6 were associated strongly with mortality in both sexes. TNF‐α explained only 7% of the variability in IL‐6 and effects of the two cytokines were independent of each other as well as of other traditional risk factors for death [smoking, blood pressure, physical exercise, total cholesterol, co‐morbidity, body mass index (BMI) and intake of anti‐inflammatory drugs]. These findings indicate that at least in old populations chronic elevated levels of TNF‐α and IL‐6 have different biological functions that trigger age‐associated pathology and cause mortality.

Impaired production of proinflammatory cytokines in response to lipopolysaccharide (LPS) stimulation in elderly humans

Ageing is associated with decreased resistance to bacterial infections and concomitant increased circulating levels of inflammatory cytokines. The purpose of the present study was to research age‐related changes in levels of early mediators of the acute‐phase response in whole blood supernatants following LPS stimulation, representing an ex vivo model of sepsis. Levels of tumour necrosis factor‐alpha (TNF‐α), IL‐1β and IL‐6 in whole blood supernatants were measured after in vitro LPS stimulation for 24 h in 168 elderly humans aged 81 years from the 1914 cohort in Glostrup, Denmark and in 91 young controls aged 19–31 years. Levels of TNF‐α and IL‐1β were significantly lower in elderly humans compared with young controls, whereas no difference was detected with regard to IL‐6. Elderly humans with low body mass index had the lowest levels of IL‐1β. Young women had lower levels of proinflammatory cytokines compared with young men, but this difference was blurred by ageing. No relation was found between circulating plasma levels of TNF‐α and levels after in vitro LPS stimulation. In conclusion, decreased production of TNF‐α and IL‐1β after exposure to LPS may reflect impaired host defence against infections in the elderly and be of importance in elderly humans with underlying health disorders. However, the clinical relevance is questionable in healthy elderly people because decreased levels were found compared with young men but not compared with young women.