Time Trends in Incidence and Mortality of Acute Myocardial Infarction, and All-Cause Mortality following a Cardiovascular Prevention Program in Sweden.

BACKGROUND: In 1988, a cardiovascular prevention program which combined an individual and a population-based strategy was launched within primary health-care in Sollentuna, a municipality in Stockholm County. The aim of this study was to investigate time trends in the incidence of and mortality from acute myocardial infarction and all-cause mortality in Sollentuna compared with the rest of Stockholm County during a period of two decades following the implementation of a cardiovascular prevention program. MATERIALS AND METHODS: The average population in Sollentuna was 56,589 (49% men) and in Stockholm County (Sollentuna included) 1,795,504 (49% men) during the study period of 1987-2010. Cases of hospitalized acute myocardial infarction and death were obtained for the population of Sollentuna and the rest of Stockholm County using national registries of hospital discharges and deaths. Acute myocardial infarction incidence and mortality were estimated using the average population of Sollentuna and Stockholm in 1987-2010. RESULTS: During the observation period, the incidence of acute myocardial infarction decreased more in Sollentuna compared with the rest of Stockholm County in women (-22% vs. -7%; for difference in slope <0.05). There was a trend towards a greater decline in Sollentuna compared to the rest of Stockholm County in the incidence of acute myocardial infarction (in men), acute myocardial mortality, and all-cause mortality but the differences were not significant. CONCLUSION: During a period of steep decline in acute myocardial infarction incidence and mortality in Stockholm County the municipality of Sollentuna showed a stronger trend in women possibly compatible with favorable influence of a cardiovascular prevention program. TRIAL REGISTRATION: ClinicalTrials.gov NCT02212145.

Leptin and adiponectin: distribution and associations with cardiovascular risk factors in men and women of the general population.

OBJECTIVE: In view of the increasing prevalence of obesity worldwide, understanding the role of the recently discovered adipokines leptin and adiponectin is of high clinical relevance. The aim of the present study was to assess the association between levels of leptin and adiponectin with age, known cardiovascular risk factors and to establish whether there are differences between men and women of the general population. METHODS: A total of 98 men and 107 women of the general population, aged between 20 and 74 years, underwent a medical examination at a clinical research center and fasting morning blood samples were also taken. RESULTS: Leptin (mean 7.5 µg l(-1) in men and 16.0 µg l(-1) in women) and adiponectin (mean 7.3 mg l(-1) in men and 11.9 mg l(-1) in women) levels were higher in women than men (Ps < 0.001). Both leptin and adiponectin levels increased with advancing age in both men and women (Ps < 0.05). Leptin was highly associated with factors for metabolic syndrome in men while in women, leptin was highly associated with inflammatory factors. Adiponectin was associated with blood lipids in both men and women, and glucose homeostasis more in women than in men. CONCLUSIONS: Leptin and adiponectin levels were ∼2 times and 1.5 times higher in women than in men, respectively. In addition, although leptin and adiponectin were associated to CVD risk factors in both men and women, we observed differences in specific CVD risk factor groups between men and women. These differences may be due to different regulatory mechanisms and effects of these adipokines in men and women.

Workplace bullying, working environment and health.

Improved work organisation could be of importance for decreased bullying in workplaces. Participants in the Swedish Longitudinal Occupational Survey of Health (SLOSH) responded to questions about work and workplace and whether they had been bullied during the past year in 2006. Those in worksites with at least five employees who did not report that they had been bullied in 2006 and without workplace change between 2006 and 2008 constituted the final sample (n=1,021 men and 1,182 women). Work characteristics and workplace factors in 2006 were used in multiple logistic regression as predictors of bullying in 2008. Separate analyses were performed for work characteristics and workplace factors respectively. Adjustments for demographic factors were made in all analyses. The question used for bullying was: "Are you exposed to personal persecution by means of vicious words or actions from your superiors or your workmates?" Such persecution any time during the past year was defined as bullying. For both genders organisational change and conflicting demands were identified as risk factors, and good decision authority as a protective factor. Dictatorial leadership, lack of procedural justice and attitude of expendability were male and lack of humanity a female risk factor for bullying.

Conflicts at work--the relationship with workplace factors, work characteristics and self-rated health.

Few studies have considered the work environment in relation to workplace conflicts and those who have been published have included relatively few psychosocial work environment factors. Little research has been published on the consequences of workplace conflicts in terms of employee health. In this study, the statistical relationships between work and workplace characteristics on one hand and conflicts on the other hand are examined. In addition, the relationship between conflicts at work and self-rated health are described. The study population was derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH) 2006; n=5,141. Among employees at workplaces with more than 20 employees (n=3,341), 1,126 (33.7%) responded that they had been involved in some type of conflict during the two years preceding the survey. Among the work and workplace characteristics studied, the following factors were independently associated with increased likelihood of ongoing conflicts: Conflicting demands, emotional demands, risk of transfer or dismissal, poor promotion prospects, high level of employee influence and good freedom of expression. Factors that decreased the likelihood of ongoing conflicts were: Good resources, good relations with management, good confidence in management, good procedural justice (fairness of decisions) and good social support. After adjustment for socioeconomic conditions the odds ratio for low self-rated health associated with ongoing conflict at work was 2.09 (1.60-2.74). The results provide a good starting point for intervention and prevention work.

The prevalence of peripheral neuropathy in a population-based study of patients with type 2 diabetes in Sweden.

AIMS: To assess peripheral neuropathy following a standardized foot examination protocol in a representative population-based cohort of subjects with type 2 diabetes. METHODS: In a geographically defined population, aged 40-70 years with diabetes prevalence of 3.5% according to medical records, we investigated 156 type 2 diabetic subjects, 95% Caucasian, mean age 61.7±7.2 years, duration of diabetes 7.0±5.7 years, and HbA(1c) 7.3±2.4% (6.4% Mono-S), by questionnaires, clinical examinations, blood sampling, and review of medical records. Foot examination included clinical signs of peripheral neuropathy and tests of sensibility with monofilament, tuning fork, and assessments of the vibration perception thresholds (VPT). RESULTS: Peripheral autonomic neuropathy (PAN) as judged by two or more signs of dysfunction was the most common and affected 43%. The prevalence of peripheral sensory neuropathy (PSN) was 15% by monofilament, 24% by tuning fork, and 28% by VPT expressed as ZscoreVPT ≥2.0 S.D. Twenty-nine percent had a VPT ≥25 V. Signs of peripheral motor neuropathy (PMN) affected 15%. Peripheral neuropathy, at least one variable, affected 67%, whereas 25% were affected by more than one variable of neuropathy, i.e., polyneuropathy. Exclusion of other identified causes for neuropathy than diabetes reduced the prevalence of diabetic polyneuropathy to 23%. Concurrent diabetic complications were 29% for retinopathy, 14% for incipient nephropathy, and 8% for overt nephropathy. The prevalence of macrovascular complications was 62% for CVD, 26% for PVD, and 11% for cerebrovascular lesion (CVL). CONCLUSION: Peripheral neuropathy was common in this representative type 2 diabetes population. Clinical signs of PAN were the most frequent followed by diminished perception of vibration and touch.

Peripheral sensory neuropathy associates with micro- or macroangiopathy: results from a population-based study of type 2 diabetic patients in Sweden.

OBJECTIVE: To assess associations between peripheral sensory neuropathy (PSN) and other diabetes-related complications. RESEARCH DESIGN AND METHOD: In an area-based cohort of type 2 diabetic subjects, we investigated 156 subjects (age 61.7 +/- 7.2 years and diabetes duration 7.0 +/- 5.7 years) by questionnaires, clinical examinations, blood and urine sampling, and review of medical records. RESULTS: Prevalence of PSN, assessed by monofilament and neurothesiometer testing, increased with severity of retinopathy (50% frequency in moderate and 100% in severe or proliferative retinopathy; P = 0.02). Vibration perception threshold was higher in subjects with retinopathy (25.6 +/- 8.9 vs. 20.5 +/- 8.9 V; P = 0.007). PSN was more common in subjects with overt nephropathy, with higher vibration perception thresholds, than in subjects without overt nephropathy. Subjects with PSN but no retinopathy had twice the prevalence of peripheral vascular disease (PVD) (52%) as subjects with both PSN and retinopathy (19%; P = 0.05). In subjects with PSN alone, PVD was three times more likely (52%) than in subjects without PSN (16%; P = 0.001). In multivariate analysis, PSN was independently associated with PVD (odds ratio 2.31; P = 0.007), age (1.12; P = 0.008), male sex (2.01; P = 0.02), and HDL cholesterol (0.21; P < 0.05) and tended to be independently associated with IGF-1 binding protein (1.03; P = 0.05) but not with diabetes duration or A1C. CONCLUSIONS: In a representative population of type 2 diabetes, PSN is related to microvascular and macrovascular pathology. PSN is possibly affected by the IGF axis.

Excess mortality in persons with severe mental disorder in Sweden: a cohort study of 12 103 individuals with and without contact with psychiatric services.

BACKGROUND: Investigating mortality in those with mental disorder is one way of measuring effects of mental health care reorganisation. This study's aim was to investigate whether the excess mortality in those with severe mental disorder remains high in Sweden after the initiation of the Community Mental Health Care Reform. We analysed excess mortality by gender, type of mental health service and psychiatric diagnosis in a large community-based cohort with long-term mental disorder. METHODS: A survey was conducted in Stockholm County, Sweden in 1997 to identify adults with long-term disabling mental disorder (mental retardation and dementia excluded). The 12 103 cases were linked to the Hospital Discharge Register and the Cause of Death Register. Standardised mortality ratios (SMRs) for 1998-2000 were calculated for all causes of death, in the entire cohort and in subgroups based on treatment setting and diagnosis. RESULTS: Mortality was increased in both genders, for natural and external causes and in all diagnostic subgroups. Excess mortality was greater among those with a history of psychiatric inpatient care, especially in those with substance use disorder. For the entire cohort, the number of excess deaths due to natural causes was threefold that due to external causes. SMRs in those in contact with psychiatric services where strikingly similar to those in contact with social services. CONCLUSION: Mortality remains high in those with long-term mental disorder in Sweden, regardless of treatment setting. Treatment programs for persons with long-term mental disorder should target physical as well as mental health.

Gender differences in self-rated health, quality of life, quality of care, and metabolic control in patients with diabetes.

BACKGROUND: Because the projected increase in the number of diabetic patients is expected to strain the capabilities of health care providers worldwide, we are challenged to find ways of reducing the burden of diabetes. Maintaining and improving health-related quality of life (QoL) for diabetic patients may be viewed as public health goals. OBJECTIVE: The aim of this cross-sectional study was to compare different aspects of health, QoL, and quality of care (QoC) between men and women with diabetes as a basis for planning and managing diabees care. METHODS: All patients in 2 age groups (aged 20-30 years [younger age group] and aged 50-60 years [middle-aged group]) who were registered with the Department of Endocrinology, Metabolism, and Diabetes at Karolinska University Hospital, Stockholm, Sweden, in October 2004, were recruited for a survey. Questions were included about self-rated health (SRH), QoL, QoC, diabetes-related worries, occupational status, physical activity level, living arrangements, and educational background. Glycosylated hemoglobin (HbA1c) values were obtained from medical records. RESULTS: Of the 223 eligible patients (109 men, 114 women) in the younger age group, 49 men and 74 women responded to the questionnaire; of the 300 eligible patients (170 men, 130 women) in the middle-aged group, 120 men and 93 women responded. Middle-aged women rated their mental well-being and QoL as worse compared with men (P < 0.001 and P < 0.05, respectively). In both age groups, women reported more diabetes-related worries and less ability to cope (P < 0.05 for the younger age group and P < 0.001 for the middle-aged group for both variables), thus the differences were more marked for middleaged women. Although there were no gender differences in metabolic control, middle-aged women reported less satisfaction with diabetes care (P < 0.001). Higher HbA1c was related to worse SRH in both men and women when analyzing the age groups together (P < 0.05). This association was most prominent in young women, in whom having more diabetes-related worries was also related to higher HbA1c (P < 0.01). CONCLUSION: In this study, women with diabetes appeared to have worse QoL and mental well-being compared with men with diabetes. Therefore, identifying strategies to improve SRH and QoL among diabetic patients, especially among women, is of great importance.

Inflammatory cytokines, behaviour and age as determinants of self-rated health in women.

Self-rated health is a powerful and independent predictor of long-term health, but its biological basis is unknown. We have shown previously that self-rated health is associated with increased levels of circulating cytokines in women. The main aim of the present study was to increase the understanding of the association between markers of wellbeing, such as self-rated health, and cytokines and to investigate the impact of age on these associations. In 174 female consecutive primary health care patients divided into three age groups, we examined subjective ratings of health and aspects of wellbeing and circulating levels of IL (interleukin)-1beta, IL-1ra (IL-1 receptor antagonist), IL-6 and TNF-alpha (tumour necrosis factor-alpha). Poor self-rated health was significantly associated with higher levels of TNF-alpha in all of the age groups. For IL-1beta and IL-1ra, the correlations with self-rated health were significant only in the oldest age group. Lower ratings of other measurements of health and wellbeing were related to higher levels of cytokines, most pronounced for TNF-alpha and IL-1beta, and in the middle and olderst age groups. More symptoms resembling a sickness response induced by inflammation were implicated to be associated with lower self-rated health. The strength of the association between inflammatory cytokines and poor health perception increased with advanced age, indicating an increased vulnerability for inflammatory activity during aging. It is suggested that higher levels of TNF-alpha are connected to a sickness response that, in turn, is connected to self-rated health. The results provide a possible psychobiological basis to understand better diffuse subjective symptoms and poor subjective health in women.

Do different factors explain self-rated health in men and women?

BACKGROUND: Self-rated health has elicited special interest, in the wake of a number of studies demonstrating that it is a powerful predictor of future mortality, mare so for men than for women. The association between self-rated health and biological correlates also appears to differ between men and women, for reasons unknown. OBJECTIVE: The purpose of this study was to examine gender differences in the interpretation and/or valuation of health-related information by comparing men and women's association of abroad array of perceived health determinants with their statements about health. METHODS: We conducted a cross-sectional study in a randomly selected population of 8200 men and women aged >17 years in Stockholm, Sweden. Subjects received a 120-item questionnaire that included measures of health care utilization, lifestyle, demographics, psychosocial factors, and mental, functional, and physical health. RESULTS: Among the 5470 people who responded to the questionnaire, most of the 42 potential correlates (41 for men, 40 for women) were significantly correlated to self-rated health. The overall association pattern was surprisingly similar for men and women. However, some small differences appeared: educational level, physical activity, and cultural activities played a more crucial role when men judged their health, whereas satisfaction with sleep and doctor visits played a more crucial role when women judged their health. These results were also for the most part confirmed in regression analyses that included all variables. The correlates explained 50% of the variance in self-rated health for both men and women. CONCLUSIONS: Our results highlight the necessity of taking a broad perspective on potential correlates when analyzing mechanisms of self-rated health. When judging their own health, men and women appear to consider approximately the same broad array of factors. The similarities in association patterns indicate that men and women interpret and/or value health-related factors similarly when making statements about health. These results may influence the medical profession's acceptance or consideration of self-rated health. Understanding the gender-specific mechanisms involved in the assessment of self-rated health may contribute to the promotion of health-protective behavior and health intervention practices.

Predictors of suicide in a community-based cohort of individuals with severe mental disorder.

BACKGROUND: Rate of suicide is probably an indicator of the quality of mental health services within an area. The aim of this study was to identify predictors of suicide in a large community-based cohort of persons with long-term mental disorder. METHODS: A survey was conducted in Stockholm County, Sweden, in 1997 to identify adults with long-term disabling mental disorder (mental retardation and dementia excluded). The survey included an inventory of unmet needs as perceived by the service providers. The 12,247 cases were linked to the national in-patient register and the cause-of-death register. Predictors of suicide in 1997-2000 were determined by bivariate analysis and multiple logistic regression. RESULTS: Predictors of suicide included a history of in-patient psychiatric care, previous suicide attempt, substance abuse and unmet need of a contact person. Personality disorder, especially borderline personality disorder, was the strongest diagnostic predictor of suicide among those with a history of in-patient psychiatric care. CONCLUSION: Unmet needs may signal increased suicide risk in persons with severe mental disorder. Methods to improve suicide prevention in persons with personality disorder should be further developed. Interventions to reduce suicide in persons with a long-term mental disorder will require collaboration between psychiatric and social services.

Reduction of high cholesterol levels associated with younger age and longer education in a primary health care programme for cardiovascular prevention.

OBJECTIVE: To study possible social predictors for reduction of hyperlipidaemia in subjects offered lifestyle intervention in primary health care after an opportunistic screening. SETTING: Primary health care in Sollentuna, Sweden. DESIGN: Follow-up study of changes in high lipid levels in men and women aged 20-60 years participating in a voluntary screening and cardiovascular prevention programme. SUBJECTS AND MAIN OUTCOME MEASURES: A total of 1904 individuals had a follow-up visit registered after a mean of 466 days. Men and women with raised lipid levels (serum cholesterol = 6.5 mmol/l, and/or triglycerides = 2.3 mmol/l) at baseline were compared with normolipidaemic participants. Data on social characteristics such as education, occupation, marital status, and income were collected from national censuses. Associations between socioeconomic factors and changes in lipid levels were studied. RESULTS: Men and women with hyperlipidaemia were generally (p < 0.001) older (men 6-8 years, women 8-10 years) and less educated than normolipidaemic subjects. Significant predictors for reducing hypercholesterolaemia were younger age, OR 0.97 (0.95-1.00) for increasing age, and longer education, OR 0.47 (0.24-0.91) for low education (<9 years). Foreign-born subjects were more likely to achieve a high success rate in reducing hypercholesterolaemia, OR 3.43 (1.00-11.8), than the Swedish-born. No significant predictors were detected for reduction of high triglyceride levels. CONCLUSION: A successful reduction of high cholesterol levels was associated with younger age and longer education in a primary health care-based programme for cardiovascular prevention.

Gender differences in the relation of insulin-like growth factor binding protein-1 to cardiovascular risk factors: a population-based study.

OBJECTIVE: A possible involvement of insulin-like growth factor-I (IGF-I) and its binding protein IGFBP-1 in the pathogenesis of cardiovascular disorder has been suggested. However, few publications have addressed the gender differences in cardiovascular risk factors in relation to the IGF/IGFBP system. The aim of the present study was to study gender differences in the relationship between fasting serum levels of IGFBP-1 and cardiovascular risk factors in a normal population of men and women. DESIGN: Cross-sectional study. Patients A normal population of 273 men and women aged 20-74 years. MEASUREMENTS: A medical examination was performed and blood drawn in the morning after subjects had been fasting overnight. Before the examination, they were asked to fill out a questionnaire concerning lifestyle and psychosocial factors. RESULTS: Fasting IGFBP-1 was lower in men than in women and was positively correlated to age in men but not in women. The men had in general a more disadvantageous cardiovascular risk profile than women, with several indicators of the metabolic syndrome: higher blood pressure and higher serum levels of total cholesterol, triglycerides, low density lipoprotein cholesterol (LDL-C), plasma-glucose and insulin, as well as lower IGFBP-1. Women had lower physical activity, lower consumption of alcohol, and lower values on indicators of psychosocial and mental health but had a healthier diet. Our findings indicate that low circulating levels of IGFBP-1 are associated with the well-known risk factors of cardiovascular disease; however, the association showed a different pattern for men and women. In men we found a negative association with body mass index (BMI), insulin resistance and diastolic blood pressure, and a positive association with SHBG, cortisol and testosterone. For women low IGFBP-1 appears in negative associations with BMI, waist-hip ratio (WHR), insulin resistance and testosterone, and in positive associations with SHBG and cortisol. Significant gender differences in the correlation with IGFBP-1 are seen for testosterone, cortisol, SHBG, WHR and oestradiol. For HDL-C and diastolic blood pressure the gender difference in correlation was at the limit of significance (P < 0.10). CONCLUSION: Low circulating levels of IGFBP-1 are associated with the well-known risk factors of cardiovascular disease; however, the association showed a different pattern for men and women. The most marked gender differences in the correlation with IGFBP-1 are seen for testosterone, cortisol, SHBG, WHR, oestradiol, HDL-C and diastolic blood pressure. Our study emphasizes the importance of separate analyses for men and women. The results presented are a step towards gaining a better understanding of the gender differences in cardiovascular disease and in the regulation of IGFBP-1, though further prospective studies are needed.

Locus of control and weight reduction.

The objective of this study was to determine if locus of control orientation is predictive for weight loss among participants in a behaviour modification weight reduction programme. The subjects completed a locus of control questionnaire consisting of 40 questions before starting the programme and again after 1 year. Forty-one participants started the programme, 28 remained after 1 year. Their weight loss was significant (P < 0.001) and associated with an internal locus of control orientation (P < 0.05). The findings suggest that different weight reduction activities could be offered depending on the person's locus of control orientation. Participants with an internal orientation could be offered a standard weight reduction programme. Others, with a more external locus of control orientation, could be offered an adapted programme, which also focused on and encouraged the participants' internal orientation.

Are sexual dissatisfaction and sexual abuse associated with obesity? A population-based study.

OBJECTIVE: To investigate whether there is any association between obesity and sexual satisfaction and sexual abuse in a normal population. RESEARCH METHODS AND PROCEDURES: A representative sample of 2810 subjects from a population study was interviewed about sexual satisfaction, sexual abuse, and life satisfaction. The answers from normal weight, overweight, and obese participants were compared. Univariate and multivariate analyses were performed. RESULTS: Data were presented separately for two age groups, 18 to 49 and 50 to 74 years, and gender. The older group of obese men reported a greater decrease of sexual desire compared with 5 years prior than normal weight men [odds ratios (OR), 2.44; 95% confidence interval (CI), 1.4 to 4.3]. The older group of overweight men reported involuntary participation in sexual activities more often than normal weight men (OR, 2.06; 95% CI, 1.1 to 3.8). Although older overweight and obese women were diagnosed with a lingering disease (defined as >1 month) more often than normal weight women (overweight: OR, 2.41; 95% CI, 1.3 to 4.4; obese: OR, 4.45; 95% CI, 1.7 to 11.5), there was no difference between BMI groups in satisfaction with physical health. DISCUSSION: Overweight and obese groups seem to be heterogeneous with respect to sexual satisfaction and experiences of sexual abuse. No significant differences were detected between BMI groups, which does not exclude the possibility of significant differences between BMI groups among patients seeking medical attention.

Self-rated health is related to levels of circulating cytokines.

OBJECTIVE: Self-rated health is a powerful and independent predictor of long-term health, but its biological basis is unknown. Because factors associated with poor self-rated health (eg, pain, daily discomforts, and low energy and fitness) resemble symptoms of a generalized cytokine-induced sickness response, we examined the relationship between circulating cytokines and self-rated health. METHODS: In 265 consecutive primary health care patients (174 women and 91 men), we examined self-rated and physician-rated health, circulating levels of interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1ra), IL-6, and tumor necrosis factor (TNF)-alpha as determined from plasma samples using high-sensitivity enzyme-linked immunoassay. RESULTS: Self-rated health correlated with levels of IL-1beta (r = 0.27; p <.001), IL-1ra (r = 0.19; p <.05) and TNF-alpha (r = 0.46; p <.001) in women but not in men. Thus, poorer subjective health was associated with higher levels of inflammatory cytokines. Even when controlling for age, education, physical health, and diagnoses in multiple regression analyses, self-rated health was an independent and more robust predictor of cytokine levels than physician-rated health. CONCLUSIONS: The present findings suggest that an individual's health perception may be coupled to circulating cytokines. Because epidemiological research established that self-rated health predicts morbidity and mortality, the biological correlates and mechanisms of self-rated health need to be understood.

IGF-I in a normal population: relation to psychosocial factors.

OBJECTIVE: IGF-I has important actions on cell division, apoptosis, differentiation and metabolism, as well as on cell proliferation in vascular smooth muscle. Deficiency of GH, an important regulator of IGF-I, is associated with reduced well-being. IGF-I levels have been related to cognitive function in older individuals. The aim of the present study was to investigate the IGF-I concentrations in a normal population of men and women aged 20-74 years and to determine the influence of a variety of behavioural and psychosocial factors as well as metabolic factors on these concentrations. DESIGN: Cross-sectional study. PATIENTS: The study group consisted of 408 randomly selected people who had answered a questionnaire concerning health care utilization and quality of life that was administered to a random sample of 4200 people over age 17 from the northwestern region of greater Stockholm in 1995. Thirty-four men and 34 women were randomly selected from the age group 20-24 and from each 10-year age group between the ages of 25-75 years. Seventy-one per cent of the 408 people invited to come in for an examination agreed to attend, making a total sample size of 288 people. MEASUREMENTS: A medical examination was performed and blood drawn in the morning after subjects had been fasting overnight. Before the examination, they were asked to fill out a questionnaire concerning lifestyle and psychosocial factors. RESULTS: The distribution of IGF-I was positively skewed, but using logarithmically transformed IGF-I, a more symmetrical distribution was obtained. A linear inverse correlation was found between logarithmically transformed IGF-I levels and age which explained more than 40% of the variation in men and women. Linear correlation analysis between IGF-I and different parameters of health and disease, lifestyle and psychosocial factors, resulted in several significant correlations most of which disappeared after controlling for age. In the younger age group (20-44) there were positive correlations between IGF-I and psychosocial factors representing quality of life and psychological well-being. In the middle age group (45-59) higher IGF-I levels were related to better physical health, higher education and higher concentrations of lipoprotein Lp(a). In the older age group (over 59 years) higher levels of low-density lipoprotein-cholesterol (LDL-C) and lower levels of SHBG were associated with higher IGF-I levels. CONCLUSION: In a randomly selected (nondisease) population, IGF-I concentrations show a consistent decrease with age in both men and women, accompanied by different association patterns relevant to disease risk. Levels are related to psychosocial parameters in the younger age group and metabolic impairment associated with increased cardiovascular risk in the older age groups. We speculate on the relative roles of age and cohort differences in rearing conditions in determining these differences.