Metabolic disturbances in hypertension: results from the population study 'men born in 1913'.

A clustering of metabolic disturbances has been indicated in hypertension. The distribution of such factors was assessed among hypertensives and normotensives in a general population sample of 644 men aged 67 years. Fasting serum insulin, glucose and triglyceride levels were measured. In this study hypertension was defined as DBP > or = 95 mmHg or present use of antihypertensives. Impaired glucose tolerance (IGT) or diabetes mellitus, hyperinsulinaemia (> or = 20 mU l-1) and hypertriglyceridaemia (> or = 2.3 mmol l-1) were defined as metabolic disturbances. When all these disturbances were present simultaneously a complete 'metabolic syndrome' was considered to be present. Hypertension was found in 185 (29%) men, IGT in 15%, diabetes mellitus in 11%, hyperinsulinaemia in 18% and hypertriglyceridaemia in 19%. Among hypertensives, 11 (6%) men had a 'metabolic syndrome', compared to 12 (3%) men in the normotensive group (P = 0.039). At least one metabolic disturbance was present in 109 (59%) of the hypertensive men, and in 173 (38%) of the normotensive men (P < 0.001). The prevalence rates of metabolic disturbances did not differ significantly between lean (BMI < 26 kg m-2) and obese (BMI > or = 26 kg m-2) hypertensives. Only hypertriglyceridaemia was more frequent in obese than in lean hypertensives (20% vs. 37%, P = 0.015). The 'metabolic syndrome' was found in 6% of all hypertensives, which was twice as common as in the normotensive population. The 'metabolic syndrome' was uncommon in both lean and obese hypertensives (5% vs. 7%, NS). These findings indicate that hypertension and metabolic disturbances may have a common underlying cause, at least in some individuals.

Hyperinsulinaemia is not a major coronary risk factor in elderly men. The study of men born in 1913.

Insulin and insulin resistance have attracted considerable interest as possible risk factors for coronary heart disease during the last decade. We therefore examined the 8-year incidence of coronary heart disease in 595 67-year-old men in relation to baseline insulin and other risk factors. The incidence of coronary heart disease increased from 9% among non-diabetic men to 13.5% among those with impaired glucose tolerance, 12.9% among newly-detected diabetic men and up to 31.3% among men with known diabetes. The incidence of coronary heart disease was related to fasting blood glucose and 1 h and 2 h blood glucose during the oral glucose tolerance test and to serum cholesterol and serum triglycerides. Fasting serum insulin was of borderline significance for the risk of coronary heart disease. When known diabetic subjects were excluded only serum cholesterol and serum triglycerides remained as statistically significant risk factors. Among diabetic subjects (known and newly-detected) only blood glucose was related to the risk of coronary heart disease. In multivariate analyses the different degrees of glucose intolerance or fasting blood glucose were independently related to the risk of coronary heart disease (p = 0.008-0.010). Serum triglycerides were also an independent risk factor in three out of four multivariate models (p = 0.02-0.09). Fasting serum insulin was not an independent risk factor. These findings do not support the hypothesis that hyperinsulinaemia is a major risk factor for coronary heart disease in elderly men. Hyperglycaemia (or diabetes mellitus) seems to be the most important risk factor.

Triglycerides, a major coronary risk factor in elderly men. A study of men born in 1913.

We examined two 'cohorts' of elderly men, 60 and 67 years old. The two 'cohorts' overlapped to a large extent in terms of numbers but not in the follow-up periods. The mean have been followed-up for 7 and 8 years respectively. Among the 748 60-year-old men without prior myocardial infarction the 7-year incidence of coronary heart disease was 8%. The incidence was related to blood pressure, smoking habits and serum triglycerides (but not serum cholesterol) both in univariate and multivariate analyses. The incidence of coronary heart disease increased 5-fold from the lowest to the highest quintile of triglycerides. Among the 595 67-year-old men without prior myocardial infarction the 8-year incidence of coronary heart disease was 11%. Both serum cholesterol and triglycerides were significant risk factors in univariate analyses but only triglycerides in multivariate analyses. The incidence of coronary heart disease increased almost three-fold from the lowest to the highest quintile of triglycerides. Increased serum triglycerides is a major coronary risk factor in elderly men.

Risk factors for heart failure in the general population: the study of men born in 1913.

In 1963 a sample of 973 men, all 50 years old, was drawn from the population register of Gothenburg, Sweden. These men have been followed up for 17 years with repeated examinations regarding a number of variables possibly related to cardiovascular disease. The latest examination, at the age of 67 years, focused on congestive heart failure (CHF). The incidence rate of manifest CHF varied from 1.5 to 10.2 cases (1000 population)-1 yr-1, depending on which age group was being studied. For the age group 50-67 years the incidence of manifest CHF was 5.5 (1000)-1 yr-1. A large number of factors associated with the risk of acquiring CHF were identified. In multivariate regression analyses, hypertension and smoking were the major independent risk factors. Body weight, heart volume, T-wave abnormalities, heart rate variability, peak expiratory flow rate, psychological stress and Fy-antigen (a genetic marker?) were also independent risk factors. Possible strategies for prevention are discussed.

A cross-sectional analysis of glucose tolerance and cardiovascular disease in 67-year-old men.

The relationship between degree of glucose tolerance and cardiovascular disease has been studied in a cross-sectional population survey of 644 men born in 1913, randomly sampled and examined at the age of 67. The cohort was divided into different groups according to current diagnostic criteria for diabetes and impaired glucose tolerance. An almost 2-fold higher prevalence of hypertension, myocardial infarction, angina pectoris, and congestive heart failure was found in the group with impaired glucose tolerance compared to the group with a normal glucose tolerance. Fifty per cent of the men with impaired glucose tolerance were being treated with some drug for cardiovascular disease, usually diuretics for hypertension. Intermittent claudication showed a 2.5-fold higher prevalence among the diabetic patients. A computerized 12-lead exercise-ECG test, with a unique accuracy in measuring ST-segment changes, was performed in a subset of 135 men. This showed no association between ST-segment depression and different degrees of glucose tolerance, even when accounting for confounding factors such as treatment with beta-blocker agents or digoxin, pathological Q-waves, and differences in maximal heart rate.

Risk factors for type 2 (non-insulin-dependent) diabetes mellitus. Thirteen and one-half years of follow-up of the participants in a study of Swedish men born in 1913.

This report presents data on antecedents of Type 2 (non-insulin-dependent) diabetes mellitus in a homogeneous sample of randomly selected 54-year-old men from an urban Swedish population with a diabetes incidence of 6.1% during 13.5 years of follow-up. The increased risk leading to diabetes for those in the top quintile compared to the lowest quintile of the distribution of statistically significant risk factors were: body mass index = 21.7, triglycerides = 13.5, waist-to-hip circumference ratio = 9.6, diastolic blood pressure = 6.7, uric acid = 5.8, glutamic pyruvic transaminase = 3.9, bilirubin = 3.2, blood glucose = 2.7, lactate = 2.4 and glutamic oxaloacetic transaminase = 2.0. Those with a positive family history of diabetes had 2.4-fold higher risk for developing diabetes than those without such a history. In a multivariate analysis glutamic pyruvic transaminase, blood glucose, body mass index, bilirubin, systolic blood pressure, uric acid and a family history of diabetes were all significantly associated with the development of diabetes. Our study demonstrates the great importance of adiposity and body fat distribution for the risk of diabetes. A number of established risk factors for coronary heart disease are risk factors for diabetes as well. Disturbed liver function and increased levels of lactate are early risk factors for diabetes - presumably indicators of the presence of impaired glucose tolerance and/or hyperinsulinaemia.

Quality of life in early heart failure. The study of men born in 1913.

To see whether well-being and quality-of-life are affected in congestive heart failure (CHF), a number of health variables, self-assessed and objectively measured, were estimated among 67-year-old men sampled from the general population of Gothenburg, Sweden. Based on history, physical examination and drug treatment, 407 men were studied and grouped into 4 stages of CHF, ranging from no signs or symptoms of CHF to advanced CHF. Men with CHF had more of other cardiovascular disease manifestations, utilized more health care, and reported less well-being and a higher rate of self-assessed disability than men with no CHF. These quality-of-life changes were found not only in the overt cases but also in early CHF. Regardless of CHF stage, quality-of-life seemed more affected in men on drug treatment, compared with those not treated.

Early heart failure in the population. The study of men born in 1913.

A cross-sectional analysis of characteristics possibly associated with congestive heart failure (CHF) was performed among 644 men, all 67 years of age and randomly selected from the general population. A total of 13% had symptoms and signs of overt CHF. Another 10% had early or "latent" CHF. Among overt CHF cases, 46% had hypertension, 55% coronary heart disease and 79% any one of these conditions. Among "latent" CHF cases, the corresponding proportions were 52%, 25% and 65%. Simple indices of left ventricular diastolic function and filling pressure as well as of pulmonary artery pressure were closer related to the CHF stage, than were measures of systolic left ventricular function. Smoking habits, hypertension, blood lipids, weight and other measures of body fat, blood glucose, and serum insulin were all correlated to CHF stage. In a multivariate analysis, smoking habits, hypertension, body weight, and serum insulin were independently and significantly correlated to CHF stage.

Cardiac and pulmonary causes of dyspnoea--validation of a scoring test for clinical-epidemiological use: the Study of Men Born in 1913.

Dyspnoea is one of the earliest symptoms in several conditions, such as heart disease and airway obstruction. However, the early phases of these two conditions are hard to distinguish in a reproducible way. In a population study of the natural history and epidemiology of congestive heart failure a scoring test to differentiate the two conditions was developed. In this report the test is presented and evaluated against various clinical and laboratory measures in 644 men sampled from the general population. The test provides a 'cardiac score' and a 'pulmonary score', both based on history and findings at the physical examination. Men who had pulmonary scores (indicating a pulmonary cause of the dyspnoea) had significantly lower values of spirometry variables but no significant pulmonary congestion at X-ray compared to a reference group (no dyspnoea, no pulmonary scores). Men with cardiac scores had significantly larger hearts and more congestion but no significant change of variables measuring airways obstruction compared to the reference group (no dyspnoea, no cardiac scores). Even though there was a moderate overlap of impaired cardiac and pulmonary function in the dyspnoea group, perhaps due to smoking being a common causal agent, the test appears to differentiate the causes of dyspnoea in a manner similar to clinical evaluation but, in contrast to the latter, in a defined and therefore reproducible way.

Dyspnoea in a cross-sectional and a longitudinal study of middle-aged men: the Study of Men Born in 1913 and 1923.

In a longitudinal population study, 855 men, born in 1913 and initially examined when 50 years old, were followed for 17 years with measurements of dyspnoea and other variables performed at ages 50, 54, and 67 years. In addition a sample of 226 men born in 1923 was followed from 50 to 57 years of age. At the latest examination, four different methods for measuring dyspnoea were used, one based on questionnaire, one on interview, and two on visual analogue scales. The estimates from these methods were highly intercorrelated, and correlated with measures of cardiopulmonary function as well. The prevalence of dyspnoea grade 2 (shortness of breath when walking with someone of the same age on the level) or more, not counting the mildest form of dyspnoea in these populations, was 2.8%, 3.0%, 5.2% and 10.3% at 50, 54, 57 and 67 years of age, respectively. Dyspnoea grade 1 (shortness of breath when walking quickly on the level or uphill) was less well related to age. A scoring system to differentiate various possible causes of dyspnoea was applied. About one third of the dyspnoeic men had signs and symptoms of cardiac disease, one quarter had pulmonary disease, and a quarter had a combination of both causes. The remaining 20% had no signs or symptoms indicating cardiopulmonary disease but in the majority of the cases other plausible causes were found.

Diabetes mellitus in Swedish middle-aged men. The study of men born in 1913 and 1923.

As part of a study of the epidemiology of diabetes mellitus in middle-aged Swedish men, the present paper reports the prevalence and incidence of diabetes and the prevalence of impaired glucose tolerance. Two cohorts of 50-year-old men, representative of the corresponding male population of Gothenburg, Sweden, were examined in 1963 and 1973, respectively, and then followed until 1980. In the cohort of men born in 1913 (n = 855) the diabetes prevalence (WHO criteria), based on a questionnaire and fasting blood glucose, increased from 1.5% at age 50 to 7.6% at age 67. In the cohort of men born in 1923 (n = 226) the prevalence was 3.7% at age 50 and 4.0% at age 57. The overall prevalence of diabetes and impaired glucose tolerance was 25% among men born in 1913 (age 67) and 18% among men born in 1923 (age 57). The cumulative risk of developing diabetes from age 50 to 67 was 7.8%. Variables associated with impaired glucose tolerance and newly found diabetes, when degree of obesity was considered, were systolic blood pressure and triglycerides, well known risk factors for both coronary heart disease and diabetes. Uric acid, fasting insulin and glutamic puruvic transaminase, recently discussed as possible risk factors, were also associated with impaired glucose tolerance and newly found diabetes. Thus, both impaired glucose tolerance and newly found diabetes were associated with a clustering of risk factors, not only for diabetes but also for coronary heart disease.

The mortality in an age cohort followed from birth to age 70.

The Study of Men Born in 1913 is a prospective population study of cardiovascular diseases in Gothenburg, Sweden, that started in 1963. To describe survival curves and mortality pattern, all boy-children born alive in 1913 in the city of Gothenburg, were identified. This birth cohort was followed from birth to age 70 for residence, vital status and cause of death. At the age of 50 years, 25% of the birth cohort were dead and at age 70, 43% had died. The high infant mortality and the great impact of infectious diseases in the beginning of this century is illustrated. The death rate for the cohort was almost identical to national figures for men in the same age group. Men who migrated from Gothenburg had a death rate very similar to those who stayed. It can therefore be concluded that the men in the Study of Men Born in 1913 is a representative sample not only of men in Gothenburg but also of men in Sweden as far as mortality is concerned. Special attention was paid to death from otitis media complications, congestive heart failure, and diabetes. Few persons died from these diseases before age 50 when the prospective study started and therefore did not influence the study of the natural history for these conditions to any great extent. Otitis media infections might be studied retrospectively from this age.

Fasting blood glucose and risk of coronary heart disease, stroke, and all-cause mortality: a 17-year follow-up study of men born in 1913.

This report concerns the relationship between baseline levels of fasting blood glucose (FBG) in non-diabetics and the subsequent 17-year incidence of coronary heart disease (CHD), stroke and all-cause mortality. In 1963, 973 men aged 50 years were recruited from a general Swedish urban population for a prospective study of risk factors for CHD. Eight hundred and fifty-five (88%) men agreed to participate and have been observed for 17 years. The 832 men who had no history of myocardial infarction, stroke, diabetes mellitus or who had a fasting blood glucose below 7.0 mmol/l at baseline were selected for this analysis. CHD occurred in 106 men, 35 developed a stroke and 137 died during follow-up. When quintiles and deciles of the FBG distribution were considered, no trend of 17-year incidence of CHD, stroke or death was apparent. However, for men with an FBG above the 95th percentile (greater than 5.7 mmol/l) a non-significant trend towards increasing risk was indicated.

The influence of body fat distribution on the incidence of diabetes mellitus. 13.5 years of follow-up of the participants in the study of men born in 1913.

In a prospective study of risk factors for ischemic heart disease, 792 54-yr-old men selected by year of birth (1913) and residence in Göteborg, Sweden, agreed to attend for questioning and a number of anthropometric and other measurements in 1967. Thirteen and one-half years later, these baseline findings were reviewed in relation to the number of men who had subsequently developed diabetes mellitus. This analysis focused on the importance of abdominal adipose tissue distribution, measured as the waist-to-hip circumference ratio, as a predictor for development of diabetes. Even when the confounding effect of body mass index, as a measure of the total body fat mass, was accounted for, the waist-to-hip ratio was positively and significantly associated with the risk for diabetes. These results from a prospective study strongly support previous cross-sectional findings indicating that not only the degree of obesity but also the localization of fat is a risk factor for diabetes.

Body temperature in general population samples. The study of men born in 1913 and 1923.

Oral body temperature was measured in 816 men, 57 and 67 years old, sampled from the general population of Göteborg, Sweden, and 22 physically highly active men, sampled on clinical grounds. The measurements were taken in the morning for 14 months. After adding 0.3 degrees C to the readings to make them comparable with rectal readings, the mean body temperature was 36.8 +/- 0.4 degrees C. There was a seasonal variation with a peak during the winter and a trough during the summer. Body temperature was inversely correlated with height and positively correlated with weight and body fat but not with lean body mass. High physical activity and sensitivity to heat were associated with a higher than average body temperature. Sensitivity to cold was associated with a lower than average body temperature. Smoking prior to the measurements did not appear to affect body temperature.

Health and aging characteristics of highly physically active 65-year-old men.

Eighteen highly physically active men aged 65 years, training since youth, were compared to 67-year-old men from the general population. Body fat was low in the well-trained men, particularly in the central regions of the body. They smoked less. They characterized themselves as being in a general state of good health and well-being. Plasma insulin values were remarkably low. Blood pressure and resting heart rate were lower and ventilatory capacity better than in controls, and they had less heart diseases. The "juvenile" traits in their energy metabolism as well as in blood pressure and in their own perception of being highly energetic were not associated with less aging characteristics of hair, skin, or function of senses. The results obtained in this selected group suggest that physical activity protects against several age-dependent conditions as well as obesity, also at a fairly advanced age. These findings as well as the observations of differences in ventilatory function, smoking habits, and well-being between the group of highly physically active men and the control group deserve further studies.

Health and ageing characteristics of highly physically active 65-year-old men.

Eighteen highly physically active men at mean age of 65 years, and who had training since youth, were compared with men from the general population at 67 years of age (N = 644). Body fat was low in the well-trained men, particularly in central regions of the body. They smoked less and characterized themselves as being in a general state of good health and well-being. Plasma insulin values were remarkably low and blood pressure and resting heart rate were lower and ventilatory capacity better than in controls. The 'juvenile' traits in their energy metabolism, as well as in blood pressure and in their own perception of being highly energetic were not associated with less ageing characteristics of hair, skin or function of senses. The results obtained in this highly selected group suggest that physical activity might retard the rate of decline of some age-dependent factors, also at a fairly advanced age.