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From the city center of Copenhagen, almost 20,000 people, 20 years of age and older, were randomly selected for examination after age and sex stratification. The participation rate was 72%. 231 persons responded affirmatively to a questionnaire concerning cerebrovascular disease. After neurological examination the diagnosis was confirmed in 115 cases. Adjusted on the basis of the age distribution of the Danish population (1976) the prevalence rate was calculated to be 651/100,000 for men and 385/100,000 for women. The frequency of myocardial infarction and hypertension was significantly higher in the stroke patients than in the study population. The risk factors: cigarette smoking, serum-cholesterol, and high-density-lipoprotein concentration, showed no significant differences between the patients and the study population. 44% of the patients had had their stroke more than 5 years before the prevalence date. In 41% of the patients, residual neurological signs could not be demonstrated, while 59% of the patients had neurological deficits of varying severity. 30% of the surviving patients were in gainful work or managed domestic activities as they had done before the stroke. Nearly 1/2 of the severely disabled patients were independent in self care. The age group above 80 years was under-represented in this study.

To study the possible impact of alcohol consumption on lung function (FEV1 and FVC), we observed 11,135 men and women for 5 yr. Subjects were between 20 and 90 yr of age and were selected so that they were representative of the population of the city of Copenhagen. The study population was stratified according to smoking habits and alcohol consumption. A total of 8,765 persons did not significantly change alcohol or smoking habits during the 5 yr of observation and constituted the study sample. The study sample included 32 women and 301 men with an alcohol consumption of greater than or equal to 350 g/wk (78 were nonsmokers). Multiple regression analysis showed that alcohol consumption significantly accelerated the loss of FEV1 and the loss of FVC with time. Consumption of 350 g of alcohol/wk had an effect on FEV1 comparable to the effect of smoking 15 g of tobacco/day.

Objective: To assess the relations among prevalence of arterial hypertension, history of weight change, and current body weight in the range from normal weight to severe obesity., Design: Retrospective analysis of medical records of men registered with Danish military authorities from 1943 to 1977 and followed up four to 40 years later., Setting: Draft board of Copenhagen and surrounding counties and the rest of Sjaelland and surrounding islands., Subjects: 964 Men who were severely obese (body mass index greater than or equal to kg/m2 at the first examination) and 1134 random controls., Main Outcome Measures: Blood pressure and weight., Results: Hypertension was more prevalent in subjects with an unchanged body mass index as that index increased over the range studied. At any body mass index hypertension was more prevalent in subjects who had increased to this index and less common in those who had decreased to it than in those who had stayed the same weight since the first examination. Hypertension among controls was most common in those subjects who had become obese during adulthood., Conclusions: Changes in body weight have a great influence on arterial hypertension independent of the effect of attained weight, particularly in obese subjects.

It is well documented that elevations of serum enzymes used as criteria in establishing the diagnosis of acute myocardial infarction (AMI) often show a pattern of AMI after physical exercise without other clinical signs of myocardial damage. Since a clinical condition resembling AMI sometimes appears after strenuous physical exercise, this study was designed to show if the new, almost heart-specific, isoenzyme creatine kinase MB (CK-MB) would solve the diagnostic problems. Ten well trained volunteers took part in a 26 km jogging race. None of them had any cardiovascular symptoms, but the 'old' cardiac enzymes rose in some of them above the discriminatory levels, whereas CK-MB was below these levels in all cases. It is concluded that CK-MB determination is a valuable diagnostic tool, also in patients who have recently exercised extensively.

The Copenhagen City Heart Study was designed to evaluate the incidence of and risk factors for cardiovascular disease. Information about potential risk factors was collected from 14,223 persons during an initial examination (1976-78) (attendance rate 74%). Information about new cases of acute myocardial infarction (AMI) was obtained from a second examination (1981-83), hospital registries and death registries up to December 31st 1983. This article deals with 'basic' risk factors, namely age, sex, some factors presumably of genetic character (family history of AMI, early parental death, height and earlobe crease) and social factors such as length of school education, income and marital status. The Cox regression model was used. As expected, the risk of first AMI increased with age and was highest among males. Earlobe crease and family history of AMI were found to be significant risk factors, the relative risk being 1.4 for both. No effect was found of early parental death and height. Low grade of education was associated with a higher risk, significantly so only in women, the relative risk being 1.7. Low income carried an increased risk, particularly for females. Cohabitation carried a higher risk, most pronounced in the low income group. Approximately half the effect of education was exerted through its influence on income and marital status.

During its "heart week" in February, 1975, the Danish Heart Foundation drew the attention of the public to the problem of heart-disease with special reference to high blood-pressure; and 24 377 people attending supermarkets in Copenhagen took advantage of an offer to have their blood-pressure checked. There was a small charge for measurement, but the supermarket owners usually paid the fee on behalf of their customers. This unconventional approach to blood-pressure screening proved to be cheap, straightforward, and acceptable to the public. 23% of people measured were referred to their general practitioners for further evaluation.

Study Objective: The aim was to investigate the characteristics of non-responders to an invitation to attend a health examination., Design: Taking advantage of an ongoing study of obesity, this was a survey of a cohort of severely obese men, with a randomly selected control group., Participants: The participants were draftees to the compulsory Danish military draft board examination between 1943 and 1977. Among 362,200 draftees, 1940 were identified as severely obese (body mass index greater than or equal to 31 kg/m2). A comparison group of 1801 subjects was randomly drawn from the remaining population. During the period 1981-3 those still alive and living in the same region (1651 obese, 1504 control) were invited to a health examination., Measurements and Main Results: The examination was attended by 964 obese (58%) and 1134 controls (75%). In both groups an increasing response rate was associated with decreasing body mass index, and increasing intelligence test score, educational level, current social class, age (up to 50 years) and proximity of residence. Logistic regression analysis showed that all these variables had independent effects on response rate. Frequency and duration of hospital admissions during the period 1977-82 did not differ among responders and non-responders in either group., Conclusion: Response rates in health surveys are strongly influenced by degree of fatness, intelligence, educational level, social class, age, and proximity of residence.

We analysed data from the Copenhagen City Heart Study to study the prevalence, possible risk factors for, and inter-relations between bronchial hypersecretion (BH) and chronic airflow limitation. The study sample consisted of 12,698 subjects between 20 years and 90 years of age, randomly selected from the population of the city of Copenhagen. The age-adjusted overall prevalence of BH in the population of Copenhagen was estimated to be 10.1%; 12.5% in men and 8.2% in women. The overall prevalence of clinically relevant chronic airflow limitation (forced expiratory volume in 1 s less than 60% of that predicted) was 3.7% and not significantly different between sexes. Both airflow limitation and BH increased with age, smoking, alcohol consumption, short education, and low income. However, the association of airflow limitation with alcohol consumption, education and income was much weaker than the association with smoking. Regardless of smoking habits, the majority of subjects with airflow limitation did not report symptoms of bronchial hypersecretion.

Using a precise and accurate ultrasonic scanning technique we have measured the volume of the thyroid gland in vivo in 271 healthy subjects (13-91 yr old). In these subjects the mean (+/- SD) thyroid volume was 18.6 +/- 4.5 ml. A significant difference between males (19.6 +/- 4.7 ml; n = 139) and females (17.5 +/- 4.2 ml; n = 132) was found (P less than 0.001). The thyroid volume was significantly correlated with both body weight and age, described by: Y = 1.97 + 0.21 . x1 + 0.06 . x2, where Y is the thyroid volume (milliters), x1 is the body weight (kilograms), and x2 is the age (years). The influence of body weight on the thyroid volume was about 3 times that of age. The difference in thyroid gland volume between males and females was explained solely by a difference in body weight.

Stroke incidence in Copenhagen, Denmark was recorded in a random population sample of 19,327 persons invited for two health examinations with 5 years' interval from 1976 to 1983. Stroke incidence increased exponentially with age. After adjustment to the age and sex distribution of the Danish population in 1980, the estimated incidence of first stroke was 1.41/1000 women and 2.48/1000 men; the total incidence was 1.94/1000 population. Risk factor analysis was based on the initial examination of 13,088 persons greater than 35 years old without previous stroke who responded to the first invitation, in whom 295 first strokes were subsequently observed. We used the regression model of Cox. However, our use of this model differs from the somewhat automatic procedures normally used to develop prognostic models. Evaluation of the causative effect of a particular risk factor requires that the direction of mutual influences between the factor in question and other risk factors is established/postulated. Among the 16 potential risk factors for stroke we examined, significant effects were found for age, sex, household income, smoking habits, systolic blood pressure, diabetes, plasma cholesterol concentration, ischemic heart disease, and atrial fibrillation. No significant effect could be demonstrated for a positive family history of stroke, years of school education, marital status, alcohol consumption, daily use of tranquilizers, body mass index, or postmenopausal hormone treatment.

A number of studies have reported hyperoestrogenaemia in men surviving an acute myocardial infarction (AMI). This has led to speculations that hyperoestrogenaemia might be a coronary risk factor. It is not clear why plasma levels of oestrogens should be elevated in coronary heart disease. To ascertain whether hyperoestrogenaemia might be present before the onset of a myocardial infarction, we performed a prospective study in 252 men above the age of forty who within the following 5 years suffered an AMI and, as controls, 526 men matched for age and coronary risk factors and 329 randomly selected men. Mean plasma concentrations of oestradiol and oestrone did not differ significantly between the groups. This suggests that hyperoestrogenaemia is not a coronary risk factor and thus, if present after the AMI, is more likely develop concurrently with the myocardial infarction.

During its "Heart-week" in Feb. 1975, the Danish Heart Foundation drew the attention of the public to the importance of blood pressure measurements as a vital part of health control and prevention. In all, 24 thousand men and women attending supermarkets in Copenhagen took advantage of an offer to have their BP checked. 23% of the screened, who had systolic BP greater than or equal to age+110 (and this sum exceeded 145) and/or diastolic BP greater than or equal to 100 mmHg for all ages, were advised to contact a general practitioner for further evaluation. The campaign showed that it is possible to measure BP and obtain reliable results in an easy, quick, inexpensive and unorthodox way accepted by a public accustomed to free medical care.

As an offshoot of a larger prospective cardiovascular population study, the present study aimed to determine the 12 months frequency of focal cerebral transient ischemic attacks (TIAs) in persons randomly selected after age stratification from the Copenhagen city population register. A questionnaire of 5 questions pertaining to cerebrovascular attacks sustained within the last 12 months was distributed to 2,357 persons. The TIA-questionnaire was returned by 88%, of whom 22% responded affirmatively to one or more questions. The positive responders were interviewed by phone, and when suspected of having TIAs they were examined by a neurologist. A total of 11 persons proved to have had TIAs, which for the age group of 60 years and over gives o 12 months frequency of 8/1000. Dizziness, ophthalmologic problems and migraine were the most frequent causes of a "false" positive response.

To assess possible associations between diabetes mellitus (DM), plasma glucose, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), we analysed the results from a cross-sectional study of 11,763 subjects. The subjects were 20 yrs of age or older and were representative of the population of Copenhagen City. Two hundred and eighty four of the participants had DM as assessed by questionnaire. One hundred and seven subjects who did not report having DM had a plasma concentration of glucose higher than or equal to 11.1 mmol.l-1. In all age groups of diabetic subjects there was a slight impairment of lung function. It was more prominent in diabetic subjects treated with insulin than in subjects treated with oral hypoglycaemic agents and/or diet. Even in subjects without known DM, there was a significant association between reduction in lung function and raised plasma glucose concentration. On average, FVC (and FEV1) was reduced by 334 ml (and 239 ml) in diabetic subjects treated with insulin, and by 184 ml (and 117 ml) in diabetic subjects treated with hypoglycaemic agents and/or diet compared to control subjects.

111 healthy subjects, 57 males and 54 females, 20-79 years of age, randomly selected among the participants of the Copenhagen City Heart Study were tested for ventricular ectopic activity using ambulatory 24-h ECG recording. One or more premature ventricular beats (PVBs) appeared in 68 subjects (61%), 35 males and 33 females (61% of each group). The prevalence of PVBs increased significantly with age: 31, 68 and 84% in the respective age groups: 20-39, 40-59 and 60-79 (P less than 0.05). The number of PVBs per 24 h was less than 24 in 88 (79%), less than 300 in 105 (95%), and less than 500 in 107 (96%). More than 1000 PVBs per 24 h appeared in 3 (2.7%), one of whom had 11 669. The number of PVBs per 24 h increased with age, but the increase was not statistically significant. The number of PVBs per 100 000 recorded QRS-complexes did not differ significantly from the number of PVBs per 24 h. The number of PVBs h-1 was highest in daytime, and apparently higher in males than in females. However, the difference between the two sexes was not statistically significant. Multiform PVBs appeared in 4 subjects, interpolated PVBs in 2, a run of 5 PVBs in 1, dropped beats in 3, two pauses of 1900 ms duration in 1, and several post-acceleration pauses of 1300 ms duration in 1.

Data on the body mass index (BMI) from four Scandinavian countries are compared. The Finnish values are markedly higher than those of the other countries. This holds for both sexes. Among these the Norwegians deviate by showing higher values for females, though not reaching the Finnish level, but lower values for the males. The populations from which the observations are drawn are differently sampled. There is no evidence that differences as to composition in rural/urban populations can explain the differences.

The results of blood-lipid screening of 200 39--49-year-old participants with incidentally diagnosed corneal arcus from the Copenhagen City Heart Study are reported. A large sample of study-participants of the same age-group without arcus served as controls. In general, the arcus-group had higher se.-cholesterol than the control-group (P less than 0.01 in males and less than 0.02 in females). The se.-triglycerides in the two groups did not differ. A trend towards positive correlation between arcus-intensity and cholesterol-level was demonstrated by non-parametrical statistics. By use of the same statistics, an association between lipids and arcus-localisation was searched out. Dense arcus in the nasal/lower limbal regions occurred together with hypercholesterolemia more often than did a marked upper/outer arcus. Consequently, based on the present investigation, se.-cholesterol-screening of middle-aged persons with marked lower/nasal arcus seems justified, since hypercholesterolemia might will be an underlying cause. Finally, the importance of diagnosing and treating hypercholesterolemia is briefly discussed.

Hearing for pure tone air-conduction in a sample of women survivors of myocardial infarction (MI) and a random sample of women living in Copenhagen has been examined. For both groups we found that the hearing decreases with age, but the MI survivors at all frequencies have the poorest hearing compared with the random sample. There was no difference between the two groups as regards smoking habits or blood pressure. The noise exposure in the two groups was also the same. There was a significant difference in the mean values of s-cholesterol between the two groups, but we found no correlation between s-cholesterol and hearing in the random sample. Our study supports the hypothesis that MI survivors are more biologically aged than age-matched controls.

Data from a prospective study of 3884 smokers and 3676 non-smokers followed for five years were analysed to investigate the determinants of chronic mucus hypersecretion (CMH). During the follow-up 414 (10.7%) smokers and 140 (3.8%) non-smokers developed CMH. The influence of the type of tobacco smoked (plain cigarettes, filter cigarettes, pipe and cheroots/cigars), lifetime tobacco consumption, age, alcohol consumption, and socioeconomic status on the development of CMH was assessed in men and women separately using multiple logistic regression. In smokers of both sexes, the risk of developing CMH increased significantly with lifetime tobacco consumption and almost significantly with age. In male smokers, the risk of developing CMH increased with alcohol consumption but was not significantly related to the type of tobacco smoked. In female smokers, the risk of CMH increased significantly with short school education and was, after adjustment for the amount of tobacco smoked, approximately twice as high in cigarette smokers as in cheroot smokers. However, as female cheroot smokers on the average consumed much more tobacco than female cigarette smokers the incidence of CMH was almost the same in the two groups. Among current non-smokers, the risk of developing CMH increased with age and previous tobacco consumption. It is concluded that although a number of factors are associated with the development of CMH, tobacco smoking, regardless of the type of tobacco, is a major determinant of CMH.

Previous studies have demonstrated an inverse relationship between plasma high density lipoproteins (HDL) cholesterol and coronary heart disease risk. In the present study we investigated prospectively the effect of a moderate physical conditioning programme on plasma lipids and lipoproteins, especially HDL-cholesterol and apolipoprotein A-I (apo A-I), the major apoprotein of HDL. Healthy, sedentary, middle-aged men were randomly selected and assigned either to a training group (n = 24, age 40 +/- 3.4, mean +/- SD) or to a control group (n = 13, age 39 +/- 5.0). Training consisted of various indoor and outdoor sports activities 45 min/day, 3 times/week for 12 weeks at an intensity of approximately 80% of measured maximal oxygen uptake (VO2 max). The trained subjects were studied at 4, 8 and 12 weeks. The training increased VO2 max by 12% (P less than 0.01). Increases were observed in both apo A-I (10%, P less than 0.02) and HDL-cholesterol (8%, P less than 0.02) after training, with significant increases already after 4 and 8 weeks, respectively. Furthermore, decreases in total plasma cholesterol (5%, P less than 0.004) and plasma triglycerides (26%, P less than 0.003) were found without changes in body weight, body composition, cigarette smoking, alcohol consumption or the percentage composition of dietary intake. Fasting serum-insulin concentrations decreased significantly during training. No changes were noted in the control group. The present study demonstrates prospectively that moderate physical training can increase HDL.

The aim of this study was to examine the effects of cigarette smoking and changes in smoking habits on the decline of forced expiratory volume in the first second of expiration (FEV1). We studied 7,764 men and women for 5 yrs. The subjects were grouped according to self-reported smoking habits during the observation period. We found that persistent cigarette smoking, in particular heavy smoking, accelerated the decline in FEV1. In 310 subjects who quitted smoking during the observation period, the decline of FEV1 was less pronounced than the decline observed in persistent smokers. In subjects younger than 55 yrs of age, smoking reduction was associated with a less pronounced FEV1 decline, while in the elderly subjects smoking reduction had no effect on the FEV1 decline. An increase in the number of cigarettes smoked was generally associated with a more rapid decline of FEV1, while the beginning of smoking during the 5 yrs of observation did not seem to influence the decline of FEV1. We conclude that smoking cessation or reduction may lead to a demonstrable beneficial effect on the FEV1 decline within a few years.