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To determine the relationship between obesity and subsequent incidence of ischaemic heart disease (IHD). Prospective cohort survey. Study of three occupational groups, with follow up examinations. 3500 people recruited between 1972 and 1978 (80% response rate), and followed up between 1978 and 1984. This report is based on subgroup of 1511 white men aged 40-64 at entry. Information was obtained on smoking and family history of IHD. Blood pressure, weight, height, skinfold thickness at four sites, fibrinogen, factor VII activity and cholesterol were measured during follow up. Body mass index (BMI) was used as an index of obesity. BMI was found to be more strongly correlated with IHD than any of the skinfold measurements, none of which was significantly associated with IHD when BMI was allowed for. Increase in BMI by 1 SD (approximately 8 kg) was associated with a 44% increase in the risk of IHD. Of the four skinfolds, subscapular was the most closely associated with risk, confirming the relevance of central obesity. The association between obesity and IHD remained when possible mechanisms for its effects were taken into account, and its strength may increase with time: for 1 SD increase in BMI, risk of events within 5 years was increased by 28%, while risk of events after longer than 5 years was increased by 65%. Preventive strategies for IHD should include avoidance of obesity. [ABSTRACT FROM AUTHOR]

To determine whether there is an association between the use of hormonal replacement therapy (HRT) and the risk of stroke and myocardial infarction (MI). A case-control study of women with stroke or MI was undertaken. The cases were notified from 83 general practices to the coordinating centre at Northwick Park Hospital, where the diagnoses were independently confirmed. The cases, 603 white women aged 45-69, were each matched to two controls for age and general practitioner. Of the controls, 79% were the first eligible, 15% the second eligible and 6% were obtained at the third or more attempt. A research nurse completed a questionnaire for each case and both controls, which included information obtained from the medical notes on the prescriptions of HRT. An independent quality control check on the selection of controls and on the abstraction of information from the medical notes was made. More than one HRT prescription had been given to 109 cases (18%) and 174 controls (14%), showing a weak association between the risk of stroke and MI and the past use of HRT (relative risk [RR] 1.36, 95% confidence interval [CI] 1.01-1.81). There was a stronger association with preparations contained progestogen alone (RR 1.90, 95% CI 1.11-3.25). On average, HRT had been used 9 years before recruitment to the study and for 15 months. However, the observed gradients of risk according to the duration of HRT use and time since HRT use do not support a causal interpretation. Also, the estimated relative risks were reduced when allowance was made for other cardiovascular risk factors. There is no evidence that the use of HRT as recently prescribed in the UK constitutes a major cardiovascular risk or benefit. [ABSTRACT FROM AUTHOR]

The aim of this study was to characterise new users of hormonal replacement therapy (HRT) for the relief of menopausal symptoms and to compare these women with never-users of HRT; 402 new users and 804 never-users were studied. Hot flushes were the most common symptom in both users and non-users and were the most frequent reason for prescribing HRT. The prevalence of menopausal symptoms in non-users of HRT was high although substantially lower than that in users. HRT users were more likely to be current cigarette smokers than were never-users. There was also, within smokers, a significant relation between the number of cigarettes smoked and the likelihood of using HRT. This relation between HRT use and smoking could result from an anti-oestrogen effect of smoking, intensifying menopausal symptoms. Of potential clinical relevance is the suggestion that a proportion of women using HRT may be doing so in order to alleviate smoking-induced symptoms. Users of HRT were also more likely to have used oral contraceptives than were never-users; this relation was probably behavioural. [ABSTRACT FROM AUTHOR]

The increasingly accurate prediction of survival and functional recovery in patients with stroke will be of value in planning both their individual management and the health and social services needed. To establish the independent predictive effects of a range of personal and clinical characteristics, data on 900 patients admitted to Northwick Park Hospital with stroke were analysed by stepwise multiple regression. Older patients who lose consciousness at the outset and show signs of multiple neurological deficits, abnormal pupils, and conjugate deviation of the eyes are more likely to die within a year than those without these characteristics. Those who survive the acute episode and are discharged alive are more likely to die within a year if they are old and have sensory loss with severe physical disability. Older female patients who are incontinent, lose consciousness at the onset of stroke, sustain extensive motor deficits in combination with other neurological deficits, and have residual disabilities from previous strokes are particularly likely to be severely disabled on discharge from hospital. Routinely collected clinical data enable useful forecasts about mortality and disability after stroke. The accuracy of these forecasts can probably be improved further. [ABSTRACT FROM AUTHOR]

Although many studies have shown that smoking is associated with an increased risk of death from ischaemic heart disease (IHD), and that the increase appears to vary with age and amount smoked, there has been little formal specification or estimation of the relationship. In this paper two alternative models are tested, using data for different ages and levels of smoking from four major studies in three countries. One model explains 80% of the variation in mortality in terms of a positive linear function of the number of cigerettes smoked, the parameters of which decrease with age. We estimate that every cigerette smoked per day increases the risk of dying from IHD by as much as 35% at ages 35 to 44, reducing to 2% at ages 65 to 74. The risk attributable to smoking may account for more than 80% of IHD deaths of men aged 35 to 44, and 27% of those of men aged 45 to 64. Although the relative risk is highest for younger age groups, the absolute risk of death from IHD that is attributable to smoking increases with age. The evidence suggests that both are increasing with time. [ABSTRACT FROM AUTHOR]