Change in alcohol consumption and risk of death from all causes and from ischaemic heart disease.

OBJECTIVE: To examine the association between alcohol consumption and mortality from all causes and from ischaemic heart disease with a focus on differentiating between long term abstainers and more recent non-drinkers. DESIGN: Cohort study of changes in alcohol consumption from 1965 to 1974 and mortality from all causes and ischaemic heart disease during 1974-84. SETTING: Population based study of adult residents of Alameda County, California. SUBJECTS: 2225 women and 1845 men aged 35 and over in 1965. MAIN OUTCOME MEASURES: Alcohol consumption in 1964 and 1974 and mortality from all causes and from ischaemic heart disease during 1974-84. RESULTS: There was a significantly higher risk of death from all causes and from ischaemic heart disease in women who gave up drinking between 1965 and 1974 than in women who continued to drink (relative risk 1.72, 95% confidence interval 1.11 to 2.66, and 2.75, 1.44 to 5.23, for all causes and ischaemic heart disease respectively). A significant increase in risk was not seen in men who gave up drinking (1.32, 0.87 to 2.01, and 0.95, 0.41 to 2.20, respectively). Among men, long term abstainers compared with drinkers were at increased risk of death from all causes and from ischaemic heart disease, though the associations were not significant (1.40, 0.98 to 2.00, and 1.40, 0.76 to 2.58, for all causes and ischaemic heart disease respectively). CONCLUSION: Some of the increased risk of death from all causes and from ischaemic heart disease associated with not drinking in women seems to be accounted for by higher risks among those who gave up drinking. Men who are long term abstainers may also be at an increased risk of death. The heterogeneity of the non-drinking group should be considered when comparisons are made with drinkers.

Physical activity and depression: evidence from the Alameda County Study.

The relation between level of physical activity and risk of subsequent depression was examined using three waves of data from the Alameda County Study. Among subjects who were not depressed at baseline, those who reported a low activity level were at significantly greater risk for depression at the 1974 follow-up than were those who reported high levels of activity at baseline. Adjustments for physical health, socioeconomic status, life events, social supports, and other health habits did not affect the association appreciably. Associations between 1965-1974 changes in activity level and depression in the 1983 follow-up suggest that the risk of depression can be altered by changes in exercise habits, although these associations were not statistically significant after adjustment for covariates. These results provide somewhat stronger evidence for an activity-depression link than do previous studies, and they argue for the inclusion of exercise programs as part of community mental health programs, as well as for further studies that focus on the relation between life-style and mental health.

The relationship between stressful life situations and changes in alcohol consumption in a general population sample.

Studies on the relationship between stressful life situations and alcohol consumption have almost exclusively been based on retrospective information from clinical populations. We conducted multiple regression analyses of the relationship between presumed stressful life conditions in 1965, life events during 1966-73 and psychosocial factors and amount of increase or decrease in alcohol consumption from 1965 to 1974 adjusting for age, alcohol consumption, education and health status in 1965. Data from surveys in 1965 and in 1974 in a general population sample of 4,864 subjects from Alameda County, California were used. The magnitude of the associations between the presumed stressful life situations and amount of change was generally low, although a few were statistically significant. However, among those aged 65 years and above, and especially among men, some of the associations were strong, but imprecise due to the low number of subjects in those ages. While a number of variables were associated with increase or decrease in alcohol consumption, the R2-values indicated that these variables explained little of the variation over time in alcohol consumption. Thus, people in general seem to cope with stressful life situations by means, other than a longstanding increase in alcohol consumption.

Psychosocial factors in the natural history of physical activity.

We studied the association between demographic, socioeconomic, and psychosocial factors and change in level of physical activity in 4,025 persons who were interviewed in 1965 and 1974 as part of the Alameda County study. Relative declines in physical activity were found to be associated with education level (less than a college education), race (being black or non-white [women]), low income, blue-collar occupation, unmarried status, group non-membership, social isolation, depression, personal uncertainty (women), low life satisfaction, and health perceived less than "excellent." These results demonstrate the multifactorial determination of level of physical activity.

Smoking and body mass in the natural history of physical activity: prospective evidence from the Alameda County Study, 1965-1974.

The prospective effects of smoking status and body mass on change in leisure-time physical activity from 1965 to 1974 were examined in a cohort of 4,622 persons 20-94 years of age from the Alameda County Study. With adjustment for age and baseline physical activity, current smokers showed a greater nine-year decline in leisure-time physical activity than those who had never smoked. The coefficient for current smokers from a multivariate linear regression model was of a similar magnitude among women and men (coefficient = -0.27, 95% confidence interval [CI] = -0.50 to -0.05 for women; coefficient = -0.26, 95% CI = -0.54 to 0.02 for men). Larger declines in physical activity were seen with increasing number of current pack-years exposure among both women and men. Compared with women of average body mass index, women of heaviest body mass index had larger declines (coefficient = -0.70, 95% CI = -1.04 to -0.36) while women of the lightest body mass index had larger increases (or smaller declines) in physical activity (coefficient = 0.33, 95% CI = 0.00 to 0.66). Although body mass index did not initially appear to be associated with a change in physical activity among men, age-specific analyses indicated that the effect of body mass index on physical activity varied with age such that younger (20-39 years of age), thinner men increased their activity, while older (60 years of age and over), thinner men decreased their physical activity more than men of the same age with average body mass index.

Predictors of cardiovascular events and mortality in the Systolic Hypertension in the Elderly Program pilot project.

Do the established cardiovascular risk factors for younger persons remain important predictors of cardiovascular disease events and mortality in those who are older? The authors examined this question in the Systolic Hypertension in the Elderly Program pilot project which prospectively followed 551 men and women 60 years of age and older with pretreatment systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg who were enrolled between May 1981 and July 1982. Mean age was 72 years, 37% were men, 82% were white, and 24% had attended college. The vital status of all 551 participants was known at the end of follow-up, an average of 34 months after entry; there were 39 deaths from all causes, 66 first cardiovascular events, 18 strokes, and 20 episodes of myocardial infarction/sudden death. Univariate Cox proportional hazard analysis revealed that age was a predictor (p less than 0.05) of all-cause mortality, first cardiovascular event, and stroke. Less than college education was a predictor of all-cause mortality and first cardiovascular event, smoking was a predictor of first cardiovascular event and myocardial infarction/sudden death, cholesterol was a predictor of first cardiovascular event, and lower body mass index was a predictor of increased all-cause mortality. After adjustment for covariables, age, lower education, lower body mass index, and baseline electrocardiographic abnormalities were significant predictors of all-cause mortality, and age, lower education, history of cardiovascular event, and smoking remained significant predictors of first cardiovascular event. Sex was not a risk factor, and the ability to examine hypertension as a risk factor was impaired by the fact that the entire cohort had systolic hypertension at baseline, and most were treated. These findings, combined with prior evidence, suggest that smoking, low education level, and perhaps serum cholesterol are risk factors for cardiovascular disease in the elderly. Although the excess risk conveyed by these factors is large, its reversibility needs to be demonstrated by intervention studies.