Cardiovascular risk factors in commercial flight aircrew officers compared with those in the general population.

Cardiovascular disease is the most common reason for loss of license among commercial flight pilots. This study was done to explore cardiovascular risk factors among aircrew officers. The study group consisted of 113 male commercial flight aircrew officers (aviators), aged thirty-five to forty-four years (mean: 38.8 years) who participated in the compulsory health screening. Men investigated at the Health Screening Centre, Malmö, were used as the reference group. Group 1, for ECG, (n 771), aged thirty-eight to forty-four years (mean: 42.1). Group 2, for height, weight, body mass index (BMI) (weight kg/height m2), blood pressure, serum cholesterol (total), and smoking habits (n 5005), aged thirty-five to forty-four years (mean: 39.2). The aviators did not differ from the reference population in regard to height, weight, BMI, diastolic blood pressure, or smoking habits. However, the incidences of electrocardiographic left ventricular hypertrophy, increased systolic blood pressure, and the level of cholesterol were significantly higher in the aviators when compared with the controls. Aircrew members may primarily be selected by criteria that differ from the male population in general. Excessive environmental stress, ie, shift work, jet lag, fatigue, as well as dietary factors, may also contribute to anomalies in the group. The clinical consequences of these anomalies for the aviators should be further evaluated, for they are important both for the aviators and for flying safety.

Ten year cerebrovascular morbidity and mortality in 68 year old men with asymptomatic carotid stenosis.

OBJECTIVE: To study the natural course of carotid artery stenosis detected by ultrasonography. DESIGN: Prospective cohort study. Baseline examination in 1982-3 included ultrasound examination of carotid arteries, measurement of ankle-brachial blood pressure index, and detection of atrial fibrillation by 24 hour ambulatory electrocardiography. SETTING: Malmö, a city in southern Sweden with 230,000 inhabitants. SUBJECTS: 470 men aged 68 years randomly selected from the population. MAIN OUTCOME MEASURES: Incidence of stroke and transient ischaemic attack and all cause mortality during 10 years of follow up in relation to carotid stenosis, leg artery disease (ankle-brachial blood pressure index below 0.9), and atrial fibrillation. RESULTS: Fifty men had a stroke; six of these were haemorrhagic. Another 11 had a transient ischaemic attack. Eighteen of the men with carotid stenosis (21.6 events/1000 person years) and 43 of the men with normal carotid arteries (14.8 events/1000 person years) had a stroke or transient ischaemic attack (P = 0.188). Men with atrial fibrillation had an increased rate of cerebrovascular events (36.7/1000 person years (P = 0.048). The highest rate was found in men with asymptomatic disease of the leg arteries (38.6/1000 person years) (P < 0.001). The increased risk of stroke or transient ischaemic attack in this group remained after multivariate analysis (relative risk 2.0; 95% confidence interval 1.1 to 3.7). CONCLUSIONS: In this cohort carotid stenosis was not associated with an increased risk of stroke. Part of this lack of association was explained by the high mortality from ischaemic heart disease in men with severe stenosis. Twenty seven of the 61 cerebrovascular events, however, occurred in men who had normal carotid arteries, normal ankle pressure, and no atrial fibrillation.

Plethysmographic pulse wave amplitude and future leg arteriosclerosis.

A low pulse wave amplitude during calf plethysmography at 55 years of age was previously found to be associated with an increased mortality and incidence of myocardial infarction. In order to test the hypothesis that a low pulse wave amplitude is associated with an increased risk of future leg atherosclerosis as well, we have studied the relationship between a low ankle-brachial pressure index (ABPI; < 0.9) at 68 years of age and the pulse wave amplitude at 55 years of age in that same cohort. The prevalence of a low pulse wave amplitude (< or = 5 mm; lowest quintile) among men with a low ABPI (42%) was more than twice as high as it was among men who had a normal ABPI (19%) (P < 0.001). No association was found between a low ABPI and the plethysmographically recorded leg blood flow at 55 years of age. A low pulse wave amplitude might reflect early symptom-free arteriosclerosis, or age-dependent non-arteriosclerotic loss of vessel wall elasticity. The relationship between a low pulse wave amplitude and a low ABPI remained when controlling for smoking, hypertension and hyperlipidaemia. It is concluded that pulse wave measurement by plethysmography contributes information to improve leg atherosclerotic risk assessment in individuals exposed to known risk factors.

Low pulse-wave amplitude during reactive leg hyperaemia: an independent, early marker for ischaemic heart disease and death. Results from the 21-year follow-up of the prospective cohort study 'Men born in 1914', Malmö, Sweden.

OBJECTIVE: To study the incidence of myocardial infarction, all-cause mortality and mortality from ischaemic heart disease in relation to arterial leg blood flow determined by venous occlusion plethysmography of the calf. DESIGN: A prospective cohort study 'Men born in 1914'. SETTING: Malmö, a city in southern Sweden with 256,000 inhabitants, and a single referral hospital. SUBJECTS: Six-hundred and thirty-six 55-year-old men, randomly selected from the general population. None of them had signs or symptoms of leg artery disease. MAIN OUTCOME MEASURES: All-cause mortality, morbidity and mortality from ischaemic heart disease during 21 years of follow-up following the initial examination in 1968. RESULTS: A low pulse-wave amplitude (i.e. < 5 mm) during reactive hyperaemia was, independently of other known arteriosclerotic risk factors, associated with a higher cardiac event rate of 37.1% (relative risk: 2.2; 95% CI: 1.3-3.6) and a higher all-cause mortality rate of 62.9% (relative risk: 1.7; 95% CI: 1.2-2.4) during 21 years of follow-up. No other plethysmographically recorded variable was associated with an increased mortality and cardiac event rate. CONCLUSIONS: The plethysmographically recorded pulse-wave amplitude during reactive hyperaemia can be used as an early independent marker to identify individuals at risk of developing ischaemic heart disease and death at an early age.

A study of bone mineral density versus age in Omani women and a comparison with normal British women.

Dual photon absorptiometry (DPA) of the lumbar spine (2nd, 3rd and 4th lumbar vertebrae) was carried out using a Norland 2600 bone densitometer on 194 Omani women (OW). The exclusion criteria were (1) any medical treatment known to affect calcium metabolism or bone mass, (2) osteomalacia or secondary osteoporosis, (3) the presence of osteophytes or compression fractures of the lumbar vertebrae and (4) the presence of aortic calcifications. The bone mineral density (BMD) results showed a peak value occurring in the 30-35 year old age range (mean 1.1 g cm-2, standard deviation 0.1). The data were compared with a group of 165 normal British women (BW) with a similar age distribution whose peak BMD (obtained with dual X-ray absorptiometry) occurred in the 40-45 year old age range. The two groups were compared in each 10 year age range and the BMD of the OW group was found to be significantly lower in the 40-49 year old age range (P < 0.01) as well as the 50-59 and 60-69 year old age ranges (P < 0.001).

Non-invasively detected carotid stenosis and ischaemic heart disease in men with leg arteriosclerosis.

Since the excess mortality rate associated with an ankle-brachial blood-pressure index (ABPI) less than 0.9 was only partly explained by an excess cardiovascular mortality, we believe that leg artery disease should not only be regarded as a marker of generalised arteriosclerosis but also as a sign associated with an increased risk of premature death. 439 men who were part of a prospective population study in Malmö, Sweden, were, at 68 years of age, invited to a health examination including, ABPI, carotid-artery ultrasonography, and 24 h ambulatory electrocardiographic monitoring. Cause-specific mortality and incidence of myocardial infarction (MI) during 8 years of follow-up was compared in men with and without signs of arteriosclerotic disease. Of 60 men with an ABPI < 0.9, 20 (33%) had angina pectoris or previous MI. Another 11 (18%) had silent ST-segment depression (> or = 1 mm); 3 (5%) had a history of stroke; and 17 (28%) had symptom-free carotid stenosis (> 30% reduction of the cross-sectional diameter). Total mortality rate in men with no signs of arteriosclerotic disease was 19.6 per 1000 person-years and cardiac event rate (fatal and non-fatal MI and death from chronic ischaemic heart disease was 8.6 per 1000 person-years). Leg artery disease, carotid stenosis, and ischaemic heart disease were in a univariate analysis all associated with an increased cardiac event rate and an increased total mortality rate. In a multivariate analysis an ABPI less than 0.9 was associated with a 2.4 times higher total mortality (95% CI 1.5-3.9) and a 2.0 times higher cardiac event rate (1.1-3.9). Carotid stenosis and ischaemic heart disease contributed to the risk for MI (RR 2.1; 95% CI 1.2-3.8; and 2.1; 1.2-3.9, respectively), whereas no independent association with total mortality was found.

Low ankle-brachial pressure index in 68-year-old men: prevalence, risk factors and prognosis. Results from prospective population study "Men born in 1914", Malmö, Sweden.

The objectives were to study the distribution of ankle-brachial pressure indices (ABPI) in elderly men in relation to arteriosclerotic risk factors, cardiovascular morbidity and total mortality. The data are taken from the prospective cohort study "Men born in 1914" in Malmö, a city in southern Sweden with 220,000 inhabitants and a single referral hospital. Prevalence of low ABPI (< 0.90) at 68 years of age, total mortality, mortality from ischaemic heart disease (IHD) International Classification of Diseases (ICD) code 410.0-412.9) and cardiac event rate [fatal and non-fatal myocardial infarction (MI) and mortality from chronic ischaemic heart disease] during 8 years of follow-up was measured. Sixty-seven of 477 randomly selected men (14.0%) had an ABPI < 0.90 in one or both legs, 18/477 (3.8%) had intermittent claudication according to the Rose questionnaire, which had a sensitivity of 14.9% and a specificity of 98% when using ABPI as a reference method. Ninety-two per cent of the men with an ABPI < 0.90 were or had been smokers, compared with 80% of the men with an ABPI > or = 0.90. Mean systolic blood pressure and median plasma triglyceride levels were significantly higher in the group with low ABPI. Thirty (45%) of the men with low ABPI and 87 (21%) of the men with pressure indices above 0.90 died during follow-up (p < 0.001). Cardiac event rate was 25% (17/67) in the group with low ABPI and 10% (41/410) in the other group (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for carotid artery stenosis: an epidemiological study of men aged 69 years.

Four hundred and seventy-eight men born in 1914 and residing in the city of Malmö, Sweden, underwent ultrasonic Doppler examination of the carotid arteries in 1982/83. The known risk factors for vascular disease--blood pressure, lipids, glucose, hematocrit, alcohol consumption and Body Mass Index were also measured. A moderate stenosis (diameter reduction 30-59%) of the internal carotid artery was found in 95 men (20%); 15 men (3%) had a greater than or equal to 60% stenosis of the internal carotid artery, while 7 (1.5%) had complete unilateral occlusion. Smoking was found to be significantly related to severe carotid artery disease. There was also a significant correlation between maximum flow velocity in the internal carotid artery and triglycerides. Those quitting smoking before the age of 50 had the same incidence of internal carotid artery disease as non-smokers, while those quitting later in life had a slightly higher incidence than life-long smokers.

Social support and quitting smoking for good. Is there an association? Results from the population study, "Men born in 1914," Malmö, Sweden.

The objective in this study was to analyse whether there is independent association between social network, social support, social influence and quitting smoking for good. The study sample (n = 621) comprised a random half of all male Malmö residents born in 1914, of which 500 (80.5%) participated. A new instrument based on a model with carefully defined and well differentiated concepts was used to measure different aspects of social network, social support and social influence. In logistic regression analysis, emotional support (an important aspect of social support) had an association to quitting smoking for good (odds ratio 3.1, 95% confidence interval 1.9-5.4), when adjustments were made for social class, marital status (spousal support), alcohol consumption, physical activity, smoking of spouse and different medical conditions. Emotional support reflects the individuals' opportunity for care, encouragement of personal value and feelings of confidence and trust. This may contribute to a deeper understanding of mechanisms behind smoking cessation and could be of importance in the field of health promotion, but also for improvement of the long-term results of smoking cessation programs and in our clinical work with patients who smoke.

Carotid artery blood flow velocity related to transient ischemic attack and stroke in a population study of 69-year-old men.

A population-based sample of 478 men aged 69 years living in Malmö, Sweden, underwent Doppler ultrasonic examination of their carotid arteries; cerebrovascular symptoms and signs were recorded independently. Among 471 men with complete examinations, 117 (25%) showed significant abnormalities in carotid blood flow velocity (moderate stenoses [30-60% diameter reduction] in 20%, severe stenosis [greater than or equal to 60% reduction] or occlusion in 5%). The latter seemingly formed a group separate from the main distribution curve. Stroke was reported in 28 men (6%), during the year before examination in nine (2%). Carotid transient ischemic attack (TIA) was clinically confirmed in one man during this year, while unconfirmed symptoms were reported in 63 (13%). There was a relation between ipsilateral hemispheric stroke/TIA and severe carotid disease (p less than 0.001). Four of seven men with total occlusion had a stroke or a clinically confirmed TIA. Nevertheless, the majority of carotid stenoses (including severe stenoses) were asymptomatic. Cerebrovascular symptoms were not significantly more frequent among the men having moderate stenosis than among those having healthy arteries.

Social network and social support influence mortality in elderly men. The prospective population study of "Men born in 1914," Malmö, Sweden.

The objective of this study was to determine whether there is an association of all-cause mortality with different aspects of social network, social support, and social influence. The study sample (n = 621) was a random half of all male residents of Malmö, Sweden, born in 1914, of whom 500 (80.5%) were interviewed and examined in 1982-1983. On the basis of a model with carefully defined and well-differentiated concepts integrated in a theoretic framework of social resources, an instrument was developed to measure different aspects of social network, social support, and social influence. During the follow-up period from September 1982 to November 1987, 67 (13.4%) of the 500 participants died. In univariate analysis, a higher mortality risk was found among men with low availability of emotional support and low adequacy of social participation and among men living alone (crude relative risk = 2.3, 2.3, and 1.7, respectively). These relative mortality risks changed little after adjustments for social class, health status at baseline, cardiovascular risk factors, alcohol intake, physical activity, and body mass index in the multivariate analysis (adjusted relative mortality risk = 2.5, 2.2, and 2.0 for men with low availability of social support and low adequacy of social participation and for men living alone, respectively). These findings are consistent with the existence of a general effect of social network and social support on mortality among elderly men.

Increased mortality in men with ST segment depression during 24 h ambulatory long-term ECG recording. Results from prospective population study 'Men born in 1914', from Malmö, Sweden.

'Men born in 1914', from Malmö, Sweden, is a cohort study of the morbidity and mortality of cardiovascular diseases among 68-year-old men in an urban population. Ambulatory long-term ECG recording was part of the health examination that these men were invited to undergo in 1982. Five hundred attended (80.5%) of the 621 invited. Ninety-eight of the 394 men in whom the ECG recording was technically satisfactory had at least one episode with horizontal or downsloping ST segment depression greater than or equal to 0.1 mV. The median total duration of ST segment depression was 135 min. 90% of these episodes were not preceeded by any increase in heart rate. In only eight of the 47 men who reported an occurrence of chest symptoms during the recording period did ST segment depression and chest symptoms occur simultaneously. 43 months after the health examination, 33 (8.4%) men had died. The mortality in men without ST segment depression and without any history of coronary heart disease was 6.5%. The incidence of fatal and non-fatal myocardial infarction in men without ST depression greater than or equal to 0.1 mV and without a history of IHD was 2.3%. Men with ST depression greater than or equal to 0.1 mV in comparison with this group had a 4.4 times greater relative risk. The risk in men with both ST segment depression greater than or equal to 0.1 mV and history of coronary heart disease was 16.0 times greater. This study shows that asymptomatic ST segment depression is a frequent finding in elderly men. The occurrence of asymptomatic ST segment depression is associated with an increased cardiovascular mortality. This increased mortality is independent of a history compatible with angina pectoris or previous myocardial infarction.

A device for noninvasive assessment of perfusion pressure in the skin of healthy volunteers.

A device allowing pressure to be applied to a local skin site where the skin blood flow is followed using laser Doppler flowmetry is described. The blood flow was studied on the back of the hand in eight volunteers before and during brachial arterial occlusion and while the external pressure was increased step by step. The flowmetry value during arterial occlusion was 0.3 +/- 0.1 AU, and when the external pressure was increased to 120 mm Hg the values were similar (p = .44). The skin perfusion pressure, defined as the least external pressure needed to achieve flow cessation, was found to be 92 +/- 16 mm Hg (range 70-111 mm Hg), and the mean arterial pressure was 90 +/- 9 mm Hg (NS). The skin perfusion value is in agreement with that found by others using other techniques for measuring blood flow and a circumferent cuff for applying pressure.

Features of carotid artery flow velocity in healthy subjects and consequences for evaluating stenosis in the internal carotid artery.

C-W-Doppler analysis of flow velocity in the carotid arteries was performed in 98 healthy volunteers, age 16-74 years, 49 of each sex, and in 23 subjects with carotid disease. Maximum frequency shift (MFS) and total band-width in the healthy proximal internal carotid artery were negatively correlated to age in both sexes (p less than 0.001). MFS was lower in the normal proximal internal carotid artery than in the common carotid artery in both sexes. Minimum frequency shifts were more often, and more negative in the proximal than in the distal part of the internal carotid artery (p less than 0.001 in men and less than 0.01 in women) and still more so in the proximal part of the pathological internal carotids as compared with the normal ones (p less than 0.001). The computer-fitted regression between MFS and the degree of angiographic stenosis in the subjects with carotid artery disease was nearly identical with the mathematically calculated relationship for an ellipsoid stenosis. There is reason to believe that the degree of area stenosis calculated from frequency shift and predicted normal values gives a more true interpretation of functional stenosis than angiography, while the latter might be superior for evaluating vascular patho-anatomy, giving information also about intrathoracic and intracranial vessels, which also is important for evaluating patients with TIA and related symptoms.

Social anchorage and blood pressure in elderly men--a population study.

The present study was designed to test the hypothesis that there is an independent association between the three concepts of psychosocial factors, social network, social support, social influence and blood pressure (see Materials and methods for definition). The study sample chosen (n = 621) comprised a randomly selected group of half the male residents of Malmö born in 1914, 500 (80.5%) of whom participated. A study based on a model with clearly defined criteria was used to measure the different aspects of social network, social support and social influence. In multiple regression analysis, social anchorage (a subconcept of social network) was shown to have an association with both systolic (P = 0.03) and diastolic blood pressure (P less than 0.001), when adjustments for social class, marital status, medication for hypertension, alcohol consumption, smoking habits, body mass index (BMI) and physical activity were made. Social anchorage is a concept on a structural level, that describes to what degree the individual belongs to and is anchored within formal and informal groups in society. As such, it may contribute to a deeper understanding of mechanisms behind high blood pressure and could thus be significant in the field of health promotion.

Thermography after subcutaneous mastectomy and reconstruction with silicone gel prosthesis: a pilot study.

Patients with subcutaneously placed silicone gel prostheses, for reconstruction after subcutaneous mastectomies, often complain of cold breasts as well as of slow regaining of warmth after cooling. We have used thermography in 7 such women and in 7 healthy women of the same age group as controls. Thermography has also been used in 3 women after repositioning of the subcutaneously placed prostheses to a submuscular position in order to study any possible changes in temperature. In 2 cases thermography also was found to aid in the diagnosis of a suspected subcutaneous displacement of a submuscular prosthesis; the technique has an advantage over mammographic examination, since thermography is a simple, less expensive, and safer method.

The oral glucose tolerance test in men under 55 years of age with intermittent claudication.

Blood glucose at sixty, ninety, and one hundred twenty minutes after a standardized oral glucose load was compared in healthy middle-aged men and patients with intermittent claudication. No difference was found when the authors compared blood glucose at zero and sixty minutes. At both ninety and one hundred twenty minutes, however, they found a relative hypoglycemia in patients with peripheral arteriosclerotic disease in an early stage.

Doppler spectral analysis of the internal carotid before and after endarterectomy.

In 37 randomly selected patients, stenosis of the internal carotid artery was evaluated with Doppler spectral analysis before and 6-10 weeks after endarterectomy. Postoperatively 20 of the vessels were entirely within the normal variation range and four, though not normal, showed significantly lower blood flow velocity, indicating wider vascular lumen. In ten cases there were no significant postoperative change, and in three significant worsening of the Doppler shift was seen without clinical implications. The method is useful for evaluating the endarterectomized carotid noninvasively without use of contrast medium, and when bilateral operation is contemplated the analysis is most valuable for ruling out occlusion in the artery first operated on.

Ulceration of the carotid bifurcation. A preliminary report on a diagnostic problem.

The prevalence of ulceration in the carotid bifurcation, as judged from high-resolution 2-D ultrasound scanning and angiography, was compared with the findings at carotid endarterectomy in patients with TIA or stroke. The surgeons registered ulceration in 26 of the 29 treated carotid arteries. Angiography and ultrasonography identified ulceration in 9 and 19, respectively, of the same arteries, indicating that high-resolution 2-D ultrasound scanning is superior to angiography in the diagnosis of carotid ulceration. All arteries with tight stenosis (diameter reduction greater than or equal to 75%), but only two of four with less than 30% stenosis were ulcerated.