Ulla Arthur Hvidtfeldt

Alcohol Intake and Risk of Coronary Heart Disease in Younger, Middle-Aged, and Older Adults

Background— Light to moderate alcohol consumption is associated with a reduced risk of coronary heart disease. This protective effect of alcohol, however, may be confined to middle-aged or older individuals. Coronary heart disease incidence is low in men <40 years of age and in women <50 years of age; for this reason, study cohorts rarely have the power to investigate the effects of alcohol on coronary heart disease risk in younger adults. This study examined whether the beneficial effect of alcohol on coronary heart disease depends on age. Methods and Results— In this pooled analysis of 8 prospective studies from North America and Europe including 192 067 women and 74 919 men free of cardiovascular diseases, diabetes, and cancers at baseline, average daily alcohol intake was assessed at baseline with a food frequency or diet history questionnaire. An inverse association between alcohol and risk of coronary heart disease was observed in all age groups; hazard ratios among moderately drinking men (5.0 to 29.9 g/d) 39 to 50, 50 to 59, and ≥60 years of age were 0.58 (95% confidence interval [CI], 0.36 to 0.93), 0.72 (95% CI, 0.60 to 0.86), and 0.85 (95% CI, 0.75 to 0.97) compared with abstainers. However, the analyses indicated a smaller incidence rate difference between abstainers and moderate consumers in younger adults (incidence rate difference, 45 per 100 000; 90% CI, 8 to 84) than in middle-aged (incidence rate difference, 64 per 100 000; 90% CI, 24 to 102) and older (incidence rate difference, 89 per 100 000; 90% CI, 44 to 140) adults. Similar results were observed in women. Conclusion— Alcohol is also associated with a decreased risk of coronary heart disease in younger adults; however, the absolute risk was small compared with middle-aged and older adults.

The Relationship Between Body Mass Index and Periodontitis in the Copenhagen City Heart Study

BACKGROUND Obesity is hypothesized to involve immunoinflammatory alterations, and the condition has been related to increased susceptibility to periodontitis. The present study analyzed the association between overweight/obesity and periodontitis assessed as clinical attachment loss (AL) and bleeding on probing (BOP) in a cross-sectional design. METHODS Participants included 878 women and 719 men aged 20 to 95 years (participation rate 54%) who underwent an oral examination, including full-mouth recording of clinical AL and BOP. Overweight and obesity were assessed by body mass index (BMI) using the World Health Organization criteria. BMI was related to clinical AL (defined as mean > or =3 mm) and BOP (defined as > or =25%) by multivariable logistic regression in the total population and in subjects stratified by gender and smoking habits. RESULTS Obese participants had a lower odds ratio (OR) for clinical AL compared to participants with normal weight (OR: 0.60; 95% confidence interval [CI]: 0.36 to 0.99). The same tendency was observed in subjects stratified by smoking habit. Obese never-smokers had a lower OR for clinical AL compared to never-smoking participants with normal weight (OR: 0.32; 95% CI: 0.11 to 0.91). Overweight participants had a higher OR for BOP compared to subjects with normal weight (OR: 1.36; 95% CI: 1.04 to 1.78). In addition, overweight never-smokers had a higher OR for BOP compared to normal weight never-smokers (OR: 1.63; 95% CI: 1.03 to 2.59). CONCLUSION BMI may be inversely associated with clinical AL but positively related to BOP.

The number of persons with alcohol problems in the Danish population

Aims: A) To qualify the existing estimates of the prevalence of heavy drinking, harmful alcohol use and alcohol dependency by applying adjustment for non-participation. B) To describe socio-demographic correlates of heavy drinkers. Methods: Data came from the Danish Health Interview Survey 2005, which included a personal interview of 14,566 individuals (response rate 66.7 %), and of 5,552 individuals who completed a self-administered questionnaire containing the Alcohol Use Disorder Test (AUDIT) (response rate 50.9%). Heavy drinkers were defined as consuming >14/21 drinks/week (women/men). Identification of harmful alcohol users and dependent drinkers was based on the score of specific AUDIT questions (harmful alcohol use a score of ≥4 in questions 7—10, dependent drinkers ≥4 in questions 4—6). Adjustment for non-participation was performed using data from the Danish National Patient Registry. Results: In the Danish population, 20% were heavy drinkers (862,876 persons 95% confidence interval (95% CI): 672,002—1,195,069), 14% had harmful alcohol use (620,301 persons 95% CI: 439,221—944,992), 3% were dependent drinkers (147,528 persons 95% CI: 118,196—188,384). Being male was associated with heavy drinking (odds ratio (OR): 1.70; 95% CI: 1.53—1.89), as was being a single male (OR: 1.27; 95% CI: 1.01—1.61) and being a smoker (men: OR: 1.96; 95% CI: 1.67—2.30 / women: OR: 2.08; 95% CI: 1.72—2.52). Conclusions: The number of heavy drinkers in the Danish population and the number of people with harmful alcohol use is considerably higher than earlier prevalence estimates. The number of dependent drinkers is similar to earlier estimates.

Quantifying mediating effects of endogenous estrogen and insulin in the relation between obesity, alcohol consumption and breast cancer

Background: Increased exposure to endogenous estrogen and/or insulin may partly explain the relationship of obesity, physical inactivity, and alcohol consumption and postmenopausal breast cancer. However, these potential mediating effects have not been formally quantified in a survival analysis setting. Methods: We combined data from two case–cohort studies based in the Womens Health Initiative-Observational Study with serum estradiol levels, one of which also had insulin levels. A total of 1,601 women (601 cases) aged 50 to 79 years who were not using hormone therapy at enrollment were included. Mediating effects were estimated by applying a new method based on the additive hazard model. Results: A five-unit increase in body mass index (BMI) was associated with 50.0 [95% confidence interval (CI), 23.2–76.6] extra cases per 100,000 women at-risk per year. Of these, 23.8% (95% CI, 2.9–68.4) could be attributed to estradiol and 65.8% (95% CI, 13.6–273.3) through insulin pathways. The mediating effect of estradiol was greater (48.8%; 95% CI, 18.8–161.1) for BMI when restricted to estrogen receptor positive (ER+) cases. Consuming 7+ drinks/wk compared with abstinence was associated with 164.9 (95% CI, 45.8–284.9) breast cancer cases per 100,000, but no significant contribution from estradiol was found. The effect of alcohol on breast cancer was restricted to ER+ breast cancers. Conclusions: The relation of BMI with breast cancer was partly mediated through estradiol and, to a greater extent, through insulin. Impact: The findings provide support for evaluation of interventions to lower insulin and estrogen levels in overweight and obese postmenopausal women to reduce breast cancer risk. Cancer Epidemiol Biomarkers Prev; 21(7); 1203–12. ©2012 AACR.

Quantification of the healthy worker effect: a nationwide cohort study among electricians in Denmark

BackgroundThe healthy worker effect (HWE) is a well-known phenomenon. In this study we used the extensive registration of all Danish citizens to describe the magnitude of HWE among all Danish electricians and evaluated strategies for minimizing HWE bias of the association between occupation and mortality.MethodsAll Danish male citizens aged 26-56 years in the period 1984-1992 were followed for three years in several registers. We evaluated HWE bias among electricians because they were unexposed to detrimental occupational exposures. We compared electricians to three reference groups (general population, construction industry and carpenters/brick layers) and utilized analytical methods for minimizing HWE bias (lag time analyses, age-stratified analyses, marginal structural model and restriction to employed, newly employed or long-term workers).ResultsThe mortality rate was higher among electricians, who the year following active employment received incapacity benefits or were on long-term sick leave. Electricians receiving incapacity benefits, on long-term sick leave, unemployed, or with increased comorbidity index had lower odds of re-employment. Electricians had lower mortality rate (rate ratio,0.60;95%CI,0.52-0.69) compared to the general population, while electricians leaving employment had increased mortality (1.90;1.50-2.40). Adjusting for several social events slightly attenuated the estimates, while the marginal structural model did not minimize bias. Electricians had the same mortality as the construction industry and carpenters/brick layers. Mortality was comparable to the general population after three or more years of lag time.ConclusionsIn this nationwide study, employment as electricians had marked effect on mortality. Appropriate reference selection and lag time analyses minimized the HWE bias.

Amount and type of alcohol and periodontitis in the Copenhagen City Heart Study

AIM The aim of this study was to study the association between alcohol consumption and periodontitis assessed as clinical attachment loss (CAL) and bleeding on probing (BOP) in a cross-sectional design. MATERIAL AND METHODS The study included 1,521 adults aged 20-95 years, who underwent an oral examination including full-mouth registration of CAL and BOP. Alcohol was ascertained using a food-frequency questionnaire. The association between total and type-specific alcohol and periodontitis was assessed by means of multivariate logistic regression. RESULTS A lower odds ratio (OR) for CAL (defined as mean >or=3 mm) was observed in men consuming 21-34 [OR=0.51, 95% confidence interval (CI), 0.27-0.95] and 35+ drinks/week (OR=0.34, 95% CI, 0.15-0.79) compared with men drinking 1-13 drinks/week. Also, men with a weekly wine consumption of more than 14 drinks compared with men who reported no wine intake had lower OR for CAL (OR=0.24; 95% CI, 0.09-0.62). A higher OR for BOP (defined as >or=25%) among male abstainers was observed (OR=1.79, 95% CI, 1.03-3.12) compared with men in the light-drinking group (1-13 drinks/week). No significant association was observed for either CAL or BOP in women. CONCLUSIONS The results indicate that higher alcohol consumption, particularly intake of wine, is inversely associated with CAL in men. Such an association is not found in women.

Smoking and Risk of Coronary Heart Disease in Younger, Middle-Aged, and Older Adults

OBJECTIVES We investigated associations of smoking and coronary heart disease (CHD) by age. METHODS Data came from the Pooling Project on Diet and Coronary Heart Disease (8 prospective studies, 1974-1996; n = 192,067 women and 74,720 men, aged 40-89 years). RESULTS During follow-up, 4326 cases of CHD were reported. Relative to never smokers, CHD risk among current smokers was highest in the youngest and lowest in the oldest participants. For example, among women aged 40 to 49 years the hazard ratio was 8.5 (95% confidence interval [CI] = 5.0, 14) and 3.1 (95% CI = 2.0, 4.9) among those aged 70 years or older. The largest absolute risk differences between current smokers and never smokers were observed among the oldest participants. Finally, the majority of CHD cases among smokers were attributable to smoking. For example, attributable proportions of CHD by age group were 88% (40-49 years), 81% (50-59 years), 71% for (60-69 years), and 68% (≥ 70 years) among women who smoked. CONCLUSIONS Among smokers, the majority of CHD cases are attributable to smoking in all age groups. Smoking prevention is important, irrespective of age.

Risk of breast cancer in relation to combined effects of hormone therapy, body mass index, and alcohol use, by hormone-receptor status.

Background: Alcohol consumption, increased body mass index (BMI), and hormone therapy are risk factors for postmenopausal breast cancer, but their combined effects are not well understood. Because hormone therapy is effective for the relief of menopausal symptoms, the identification of “high-risk” users is important for therapeutic reasons. We investigated interactions between hormone therapy use and alcohol-use/high BMI status in relation to invasive breast cancer risk, both overall and according to estrogen receptor (ER) status. Methods: Two Danish prospective cohorts were pooled, including 30,789 women ages 50+ years (study period 1981 to 2009). Information on risk factors was obtained in baseline questionnaires. We performed analyses using the Aalen additive hazards model. Serum estradiol and testosterone measurements were obtained in a subsample of approximately 1000 women. Results: During 392,938 person-years of follow-up, 1579 women developed invasive breast cancer. Among nonusers of hormone therapy, the risk of breast cancer was slightly increased with overweight/obesity and increasing alcohol consumption. Compared with normal-weight nonusers, the risk of breast cancer was higher in hormone therapy users across all BMI strata (P for interaction = 0.003). A markedly higher risk of breast cancer was also observed for alcohol combined with hormone therapy use compared with abstinent nonusers (P for interaction = 0.02). These effects were primarily restricted to ER-positive cases. Combined effects of hormone therapy/high BMI and hormone therapy/alcohol on serum estradiol and testosterone supported the hypothesis of a hormonal pathway linking these exposures to breast cancer. Conclusion: These analyses suggest an increased risk of breast cancer associated with hormone therapy use—a risk that may be particularly strong among women consuming alcohol.

The Copenhagen Oral Health Senior Cohort: design, population and dental health

BACKGROUND   In order to study the way old age influence oral health, the Copenhagen Oral Health Senior Cohort (COHS) has been established. OBJECTIVES   To describe the design, measurement procedures, and baseline values for COHS including spatial distribution of restorations and dental caries as well as reasons for non-participation. MATERIALS AND METHODS   Seven hundred and eighty-three individuals aged 65 years or older, from a total of 1918 invited elderly people, underwent an interview regarding oral health-related behaviour and a clinical oral examination including measurement of unstimulated whole saliva flow rate. RESULTS   Twelve percent of the COHS was edentulous. The number of dental restorations was higher for women compared to men; however, men had more caries than women. Coronal caries was most frequent on mesial and distal surfaces and on the maxillary incisors and canines; root caries was most frequent on labial surfaces and evenly distributed within the dentition. Only 41% of all invited elderly people accepted the invitation, with old age and poor health being the primary reasons for non-participation. CONCLUSION   The baseline values for COHS show that a substantial proportion of the participants had retained a natural dentition and that dental caries was prevalent with the anterior maxillary teeth being most affected.

Five year change in alcohol intake and risk of breast cancer and coronary heart disease among postmenopausal women: prospective cohort study

Objective To test the hypothesis that postmenopausal women who increase their alcohol intake over a five year period have a higher risk of breast cancer and a lower risk of coronary heart disease compared with stable alcohol intake. Design Prospective cohort study. Setting Denmark, 1993-2012. Participants 21 523 postmenopausal women who participated in the Diet, Cancer, and Health Study in two consecutive examinations in 1993-98 and 1999-2003. Information on alcohol intake was obtained from questionnaires completed by participants. Main outcome measures Incidence of breast cancer, coronary heart disease, and all cause mortality during 11 years of follow-up. Information was obtained from the Danish Cancer Register, Danish Hospital Discharge Register, Danish Register of Causes of Death, and National Central Person Register. We estimated hazard ratios according to five year change in alcohol intake using Cox proportional hazards models. Results During the study, 1054, 1750, and 2080 cases of breast cancer, coronary heart disease, and mortality occurred, respectively. Analyses modelling five year change in alcohol intake with cubic splines showed that women who increased their alcohol intake over the five year period had a higher risk of breast cancer and a lower risk of coronary heart disease than women with a stable alcohol intake. For instance, women who increased their alcohol intake by seven or 14 drinks per week (corresponding to one or two drinks more per day) had hazard ratios of breast cancer of 1.13 (95% confidence interval 1.03 to 1.23) and 1.29 (1.07 to 1.55), respectively, compared to women with stable intake, and adjusted for age, education, body mass index, smoking, Mediterranean diet score, parity, number of births, and hormone replacement therapy. For coronary heart disease, corresponding hazard ratios were 0.89 (0.81 to 0.97) and 0.78 (0.64 to 0.95), respectively, adjusted for age, education, body mass index, Mediterranean diet score, smoking, physical activity, hypertension, elevated cholesterol, and diabetes. Results among women who reduced their alcohol intake over the five year period were not significantly associated with risk of breast cancer or coronary heart disease. Analyses of all cause mortality showed that women who increased their alcohol intake from a high intake (≥14 drinks per week) to an even higher intake had a higher mortality risk that women with a stable high intake. Conclusion In this study of postmenopausal women over a five year period, results support the hypotheses that alcohol intake is associated with increased risk of breast cancer and decreased risk of coronary heart disease.