Cancer mortality in women and men who survived the siege of Leningrad (1941-1944).

The population of Leningrad suffered from severe starvation, cold and psychological stress during the siege in World War II in 1941-1944. We investigated the long-term effects of the siege on cancer mortality in 3,901 men and 1,429 women, born between 1910 and 1940. All study subjects were residents of St. Petersburg, formerly Leningrad, between 1975 and 1982. One third of them had experienced the siege as children, adolescents or young adults (age range, 1-31 years at the peak of starvation in 1941-1942). Associations of siege exposure with risk of death from cancer were studied using a multivariable Cox regression, stratified by gender and period of birth, adjusted for age, smoking, alcohol and social characteristics, from 1975 to 1977 (men) and 1980 to 1982, respectively (women), until the end of 2005. Women who were 10-18 years old at the peak of starvation were taller as adults (age-adjusted difference, 1.7 cm; 95% CI, 0.5-3.0) and had a higher risk of dying from breast cancer compared with unexposed women born during the same period (age-adjusted HR, 9.9; 95% CI, 1.1-86.5). Mortality from prostate cancer was nonsignificantly higher in exposed men. The experience of severe starvation and stress during childhood and adolescence may have long-term effects on cancer in surviving men and women.

Blood pressure, hypertension and mortality from circulatory disease in men and women who survived the siege of Leningrad.

The population of Leningrad suffered from severe starvation, cold and psychological stress during the siege in 1941-1944. We investigated long-term effects of the siege on cardiovascular risk factors and mortality in surviving men and women. 3905 men born 1916-1935 and 1729 women born 1910-1940, resident in St Petersburg (formerly Leningrad) between 1975 and 1982, of whom a third experienced the siege as children, adolescents or young adults, were examined for cardiovascular risk factors in 1975-1977 and 1980-1982 respectively and followed till end 2005. Effects of siege exposure on blood pressure, lipids, body size, and mortality were studied in multivariate analysis stratified by gender and period of birth, adjusted for age, smoking, alcohol and social characteristics. Women who were 6-8 years-old and men who were 9-15 years-old at the peak of starvation had higher systolic blood pressure compared to unexposed subjects born during the same period of birth (fully adjusted difference 8.8, 95% CI: 0.1-17.5 mm Hg in women and 2.9, 95% CI: 0.7-5.0 mm Hg in men). Mean height of women who were exposed to siege as children appeared to be greater than that of unexposed women. Higher mortality from ischaemic heart disease and cerebrovascular disease was noted in men exposed at age 6-8 and 9-15, respectively. The experience of severe stress and starvation in childhood and puberty may have long-term effects on systolic blood pressure and circulatory disease in surviving men and women with potential gender differences in the effect of siege experienced at pre-pubertal age.

Long term mortality after severe starvation during the siege of Leningrad: prospective cohort study.

OBJECTIVES: To determine whether starvation during periods of increased growth after birth have long term health consequences. DESIGN: Analysis of cardiovascular risk factors and mortality in a longitudinal follow up after the 1941-4 siege of Leningrad. Mortality measured from 1975 up to the end of 1999. SETTING: St Petersburg, Russia (formerly Leningrad). PARTICIPANTS: 5000 men born 1916-35 who lived in Leningrad, randomly selected to take part in health examinations in 1975-7. Of the 3905 men who participated, a third had experienced the siege. MAIN OUTCOME MEASURES: Relative risk of ischaemic heart disease and mortality from stroke by siege exposure. Odds ratios and means for several cardiovascular risk factors. RESULTS: Three to six decades after the siege, in men who experienced the siege around the age of puberty blood pressure was raised (mean difference in systolic 3.3 mm Hg, in diastolic 1.3 mm Hg) as was mortality from ischaemic heart disease (relative risk 1.39, 95% confidence interval 1.07 to 1.79) and stroke (1.67, 1.15 to 2.43), including haemorrhagic stroke (1.71, 0.90 to 3.22). The effect on mortality was partly mediated via blood pressure but not by any other measured biological, behavioural, or social factor. CONCLUSIONS: Starvation, or accompanying chronic stress, particularly at the onset of or during puberty, may increase vulnerability to later cardiovascular disease.