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Dominique Hange,1 Kirsten Mehlig,2 Lauren Lissner,2 Xinxin Guo,3 Calle Bengtsson,1,† Ingmar Skoog,3 Cecilia Björkelund1 1Department of Public Health and Community Medicine/Primary Health Care, 2Department of Public Health and Community Medicine/Public Health Epidemiology, 3Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden †Calle Bengtsson passed away on 23rd March 2013 Purpose: To investigate possible association between mental stress and psychosomatic symptoms, socioeconomic status, lifestyle, as well as incident mortality in a middle-aged female population followed over 37 years. Methods: A prospective observational study initiated in 1968–1969, including 1462 women aged 60, 54, 50, 46, and 38 years, with follow-ups in 1974–1975, 1980–1981, and 2000–2001, was performed. Measures included self-reported mental stress as well as psychosomatic symptoms and smoking, physical activity, total cholesterol, S-triglycerides, body mass index, waist–hip ratio, blood pressure, socioeconomic status and mortality. Results: Smoking, not being single, and not working outside home were strongly associated with reported mental stress at baseline. Women who reported high mental stress in 1968–1969 were more likely to report presence of abdominal symptoms (odds ratio [OR] = 1.85, 95% confidence interval [CI]: 1.39–2.46), headache/migraine (OR = 2.04, 95% CI: 1.53–2.72), frequent infections (OR = 1.75, 95% CI: 1.14–2.70), and musculoskeletal symptoms (OR = 1.70, 95% CI: 1.30–2.23) than women who did not report mental stress. Women without these symptoms at baseline 1968–1969, but with perceived mental stress were more likely to subsequently report incident abdominal symptoms (OR = 2.15, 95% CI: 1.39–3.34), headache/migraine (OR = 2.27, 95% CI: 1.48–3.48) and frequent infections (OR = 2.21, 95% CI: 1.12–4.36) in 1974–1975 than women without mental stress in 1968–1969. There was no association between perceived mental stress at baseline and mortality over 37 years of follow-up. Conclusion: Women reporting mental stress had a higher frequency of psychosomatic symptoms than women who did not report these symptoms. Not working outside home and smoking rather than low socioeconomic status per se was associated with higher stress levels. Perception of high mental stress was not associated with increased mortality. Keywords: cardiovascular disease, mental stress, mortality, psychosomatic symptoms, population study, women

Objective Long-standing psychological distress increases the risk of dementia, especially Alzheimer's disease. The present study examines the relationship between midlife psychological distress and late-life brain atrophy and white matter lesions (WMLs), which are common findings on neuroimaging in elderly subjects. Methods A population-based sample of 1462 women, aged 38 to 60 years, was examined in 1968, with subsequent examinations in 1974, 1980, 1992, and 2000. Computed tomography (CT) of the brain was done in 379 survivors in 2000, and of those, 344 had responded to a standardized question about psychological distress in 1968, 1974, and 1980. WMLs, cortical atrophy, and central atrophy (ventricular sizes) were measured at CT scans. Results Compared with women reporting no distress, those reporting frequent or constant distress at one examination or more (in 1968, 1974, and 1980) more often had moderate-to-severe WMLs (multiadjusted odds ratio = 2.39, 95% confidence interval = 1.16-4.92) and moderate-to-severe temporal lobe atrophy (multiadjusted odds ratio = 2.51, 95% confidence interval = 1.04-6.05) on brain CT in 2000. Frequent/constant distress was also associated with central brain atrophy, that is, higher bicaudate ratio, higher cella media ratio, and larger third-ventricle width. Conclusions Long-standing psychological distress in midlife increases risks of cerebral atrophy and WMLs on CT in late life. More studies are needed to confirm these findings and to determine potential neurobiological mechanisms of these associations.

Background: The extent to which adult height, a biomarker of the interplay of genetic endowment and early-life experiences, is related to risk of chronic diseases in adulthood is uncertain. Methods: We calculated hazard ratios (HRs) for height, assessed in increments of 6.5 cm, using individual-participant data on 174 374 deaths or major non-fatal vascular outcomes recorded among 1 085 949 people in 121 prospective studies. Results: For people born between 1900 and 1960, mean adult height increased 0.5-1 cm with each successive decade of birth. After adjustment for age, sex, smoking and year of birth, HRs per 6.5 cm greater height were 0.97 (95% confidence interval: 0.96-0.99) for death from any cause, 0.94 (0.93-0.96) for death from vascular causes, 1.04 (1.03-1.06) for death from cancer and 0.92 (0.90-0.94) for death from other causes. Height was negatively associated with death from coronary disease, stroke subtypes, heart failure, stomach and oral cancers, chronic obstructive pulmonary disease, mental disorders, liver disease and external causes. In contrast, height was positively associated with death from ruptured aortic aneurysm, pulmonary embolism, melanoma and cancers of the pancreas, endocrine and nervous systems, ovary, breast, prostate, colorectum, blood and lung. HRs per 6.5 cm greater height ranged from 1.26 (1.12-1.42) for risk of melanoma death to 0.84 (0.80-0.89) for risk of death from chronic obstructive pulmonary disease. HRs were not appreciably altered after further adjustment for adiposity, blood pressure, lipids, inflammation biomarkers, diabetes mellitus, alcohol consumption or socio-economic indicators. Conclusion: Adult height has directionally opposing relationships with risk of death from several different major causes of chronic diseases. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2012; all rights reserved.

Rationale, aims and objectives Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline. Methods We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20‐74, who participated in the Nord-Trondelag Health Study (HUNT 2, 1995‐1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total). Results Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89‐0.99 per 1.0 mmol L -1 increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88‐1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92‐1.24) was not linear but seemed to follow a ‘U-shaped’ curve, with the highest mortality

The number of people with dementia has increased dramatically with global ageing. Nevertheless, the pathogeneses of these diseases are not sufficiently understood. The present study aims to analyse the relationship between psychological stress in midlife and the development of dementia in late-life. A representative sample of females (n = 1462) aged 38–60 years were examined in 1968–69 and re-examined in 1974–75, 1980–81, 1992–93 and 2000–03. Psychological stress was rated according to a standardized question in 1968, 1974 and 1980. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders criteria based on information from neuropsychiatric examinations, informant interviews, hospital records and registry data. During the 35-year follow-up, 161 females developed dementia (105 Alzheimer’s disease, 40 vascular dementia and 16 other dementias). We found that the risk of dementia (hazard ratios, 95% confidence intervals) was increased in females reporting frequent/constant stress in 1968 (1.60, 1.10–2.34), in 1974 (1.65, 1.12–2.41) and in 1980 (1.60, 1.01–2.52). Frequent/ constant stress reported in 1968 and 1974 was associated with Alzheimer’s disease. Reporting stress at one, two or three examinations was related to a sequentially higher dementia risk. Compared to females reporting no stress, hazard ratios (95% confidence intervals) for incident dementia were 1.10 (0.71–1.71) for females reporting frequent/constant stress at one examination, 1.73 (1.01–2.95) for those reporting stress at two examinations and 2.51 (1.33–4.77) at three examinations. To conclude, we found an association between psychological stress in middle-aged women and development of dementia, especially Alzheimer’s disease. More studies are needed to confirm our findings and to study potential neurobiological mechanisms of these associations.

Several European studies have reported sleeping problems in 20-40% of the population. We used data from the Population Study of Women in Gothenburg, based on medical examinations of three different representative cohorts of 38- and 50-year-old women in 1968-1969, 1980-1981 and 2004-2005 to study secular trends in sleep-related factors. The average reported sleep duration declined by about 15 min in the 38-year-old women during the 36 years of observation. No corresponding change in sleep duration was observed among 50-year-old women. During the same period, the proportion of women complaining of sleeping problems almost doubled in both age groups: from 17.7% in 1968 to 31.7% in 2004 in 38-year-old women, and from 21.6% to 41.8% in 50-year-old women. The prevalence of insomnia was higher in 50-year olds than in 38-year olds in all investigated cohorts. The use of sleeping medications remained unchanged since 1968. There were significant associations between perceived sleeping problems and reported lower satisfaction concerning economic, social and family situations, as well as with medical retirement and mental stress. There was, however, no association between alcohol consumption and sleeping problems. Regular leisure time physical activity was not, in most cases, associated with less perceived sleeping problems. Our study indicates that the physician should take socio-economic and family situations into consideration when examining female patients complaining of sleeping problems. Improvements on society level rather than on the individual level could be expected to be more efficient in improving women's sleep.

Enlarged subcutaneous abdominal adipocytes have been shown to predict incidence of type 2 diabetes (T2D) in the Pima population of Arizona (USA). We investigated the role of subcutaneous abdominal adipocyte size (AAS), as well as femoral adipocyte size (FAS), as predictors of T2D in a population-based Swedish cohort. In 1974-1975, a sample of 1302 middle-aged women underwent a health examination, including anthropometry and evaluation of parental medical history. In addition, body composition (total body potassium and total body water), AAS and FAS (adipose tissue needle biopsy) were assessed in a subsample of 245 women. Incidence of T2D was followed until 2001, with 36 cases eligible for inclusion in this analysis. Women developing T2D had larger AAS at baseline vs. women remaining healthy (age/heredity-adjusted hazard ratio for increase of AAS by 1 sd [AAS-HR] 1.91; P

The prevalence of bacteriuria was studied in a population sample of women aged 38-60. Significant (greater than or equal to 100 000 bacteria/ml of the same species in two consecutive specimens) or "probable" bacteriuria (greater than or equal to 100 000 in the first and 20 000-90 000 bacteria/ml of the same organism in the second specimen) were found in 5% of the women, increasing from 3.5% in women aged 38 to 8.6% in women aged 60. Escherichia coli predominated (90% of those with significant bacteriuria), and 91% of the Escherichia coli strains were sensitive to sulphonamides. About half of the women who were non-bacteriuric after short-term treatment had one or more recurrent urinary tract infections during a two-year follow-up period. Serum creatinine and urine concentrating capacity did not differentiate women with significant or "probable" bacteriuria from the others. Pathological radiological changes were found in 17% of bacteriuric women who were submitted to i.v. pyelography. When re-examined six years after the first study, 23% of initially bacteriuric and 5% of initially non-bacteriuric women had bacteriuria. Patients with renal lesions have been followed for ten years, but none of them has developed progressive renal impairment. Three women with chronic pyelonephritis and acute pyelonephritic attacks in the past were discovered when screening the concentrating capacity in this population sample, but they were non-bacteriuric when screening for bacteriuria. A study of this kind must be conducted over many years before valid conclusions can be drawn.

Women with myocardial infarction had hypertension, were on antihypertensive treatment, and had a family history of hypertension significantly more often than women in the general population. The distribution of blood pressure values in women with angina pectoris did not differ significantly from that in the general population of women. Hypertensives were significantly over-represented among women with ECG changes suggestive of ischaemic heart disease. This might be interpreted either as a sign that “coronary ECG” as defined is often a pre-symptomatic manifestation of ischaemic heart disease in hypertensives, or that these ECG changes are not specific for ischaemic heart disease.

A history of previous myocardial infarction and angina pectoris was more common in women with an acute attack of myocardial infarction than in the general population of women, as were symptoms of angina pectoris and intermittent claudication. Chronic bronchitis, gallstone disease and renal stone disease were also over-represented. The women with myocardial infarction were usually inactive when taken ill. About one third of them complained of breathlessness and/or disturbance of consciousness associated with the attack. Most women with myocardial infarction had symptoms such as nausea, vomiting and cold perspiration. The infarction area was localized with about the same frequency to the anterior and posterior wall of the heart. In about half of the women the maximum registered temperature exceeded 38.0°C. The primary mortality of the women who were hospitalized was rather low (9%). The overall mortality among those who were survivors on arrival in hospital and those who died outside hospital during the first few hours or days was 30%.

Physical activity, both at work and during leisure, decreased with age, as found from a population study of women. Physical inactivity, both at work and during leisure, had been significantly more common during the age period 20–38 in women who later had an acute myocardial infarct than in women in the general population. The same was found when comparing later periods of life. A similar tendency was noted in women with angina pectoris, though the differences mostly did not reach significant levels.

Results from retrospective and prospective studies of women in Goteborg. Sweden indicate that arterial hypertension is a risk factor for ischemic heart disease in women and of similar importance as in men.

Altogether 1462 middle-aged women aged 38-60 participated in a population study which was carried out in Goteborg, Sweden in 1968-69. Of these women, 1302 were re-investigated six years later in a follow-up study. Studied cross-sectionally, headache and nycturia were found to be more common in both untreated and treated hypertensives than in a non-hypertensive reference group. The prevalences of headache seemed to be U-shaped when related to the BP levels, with the highest prevalences in the lowest and highest quintiles of BP levels. In the longitudinal study, headache did not occur more often in those women who had started antihypertensive treatment than in the others. Dizziness as a new symptom occurred more often in women who had started to take antihypertensive drugs than in those who had not, and was more common in those who had started taking diuretics than in those starting on beta-blockers. The prevalences of eyeground phenomena and ECG changes seemed to increase linearly with increasing BP levels. It is concluded that some symptoms and signs are related to BP levels, and some of the symptoms in hypertensive women may also be related to antihypertensive treatment as such and to the type of antihypertensive treatment given.

Metoprolol, a new selective adrenergic beta1-receptor blocking drug, has been compared to placebo in a series of 24 women who previously had taken alprenolol and propranolol during a cross-over study. Blood pressure (BP) and heart rate (HR) were significantly reduced during metoprolol treatment compared to placebo. The occurrence of side-effects was similar during treatment with metoprolol and placebo. After the cross-over study the patients continued on metoprolol for more than two years, except for short periods on placebo or propranolol. During this follow-up period BP remained at a similar level when the metoprolol dose was unchanged. Dose reduction (from 50 or 100 mg t.i.d. to 50 or 100 mg b.i.d.) caused no, or only a very slight, increase in BP. No side-effects were reported during long-term treatment.

A reversible deterioration of the oral glucose tolerance has been reported in subjects with initially impaired glucose tolerance when starting to take oral diuretics. This does not seem to be the case in subjects with an initially unimpaired glucose tolerance. A deterioration in the diabetic state is commonly seen when diuretics are given to subjects with clinical diabetes. Our knowledge about the effect of beta-blockers on the glucose tolerance is limited. As for diuretics there seems to be an overrepresentation of diabetics among subjects taking beta-blockers. This overrepresentation can probably be explained by an association between diabetes and disturbances in which diuretics and beta-blockers are commonly used such as arterial hypertension and ischaemic heart disease.

Morbidity and mortality in cardiovascular and cerebrovascular diseases and total mortality have been studied in a longitudinal population study initially comprising 1462 women representative of the general female population. When related to the initial blood pressure (BP) levels of women not on antihypertensive drugs (hypertensives and non-hypertensives), the distributions of women with myocardial infarction (MI) and stroke during the 12-year follow-up period seemed to be U-shaped, with the highest incidences in women with the lowest and the highest BP levels. Women recognized as untreated hypertensives in the initial study were offered regular control by the study team during the whole 12-year period and were treated when treatment was considered indicated. They were found to be similar to the non-hypertensives with regard to the incidence of MI and stroke and total mortality. Our encouraging results may be explained by continuity of medical care, the antihypertensive treatment per se or the types of antihypertensive drugs administered.

Women from five age groups (38, 46, 50, 54, and 60 years), participating in the population study "Women in Gothenburg 1968-1969", were subjected to a 24-hour recall dietary interview (n = 1361). In a randomized subsample (n = 418), a dietary history was obtained and individuals in another randomized subsample (n = 755) submitted a 24-hour urine specimen for nitrogen analyses. There were significant differences between the 24-hour recall and dietary history figures in all five age groups with respect to energy and all nutrients. The mean protein intake calculated indirectly from the urinary nitrogen excretion came close to the figures calculated from the dietary histories in four out of five age groups. The energy intake and, consequently, the intake of most nutrients calculated from the dietary histories were higher than generally ascribed to Swedish women, as most previous data have been obtained by 24-hour dietary recall interviews. Most women (71-89% in the different age groups) consumed too much fat and most women of fertile age (80-92%) consumed too little iron. A significant decrease in the mean energy intake was apparent only in the age group 60, i.e. 1870 kcal versus 1965--2 105 in the other groups.

From a population study of middle-aged women in Goteborg, Sweden, the prevalences are given of history of myocardial infarction, angina pectoris, and ECG changes suggestive of ischaemic heart disease. A comparison is made with men of the same ages living in the same area. The prevalence of myocardial infarction was found to be higher in men than in women, while that of angina pectoris was about the same in both sexes. Q wave changes of the ECG were more common in men than in women, while other ECG changes suggestive of ischaemic heart disease such as ST depression and T wave inversion were as common in women as in men.

A larger number of co-existing “risk factors” for ischaemic heart disease was found in women who had suffered myocardial infarction than in women in the general population. Similar observations were made when comparing women who had angina pectoris or women who had ECG changes suggestive of ischaemic heart disease with women in the general population, though these differences were smaller. Diabetes mellitus, smoking and high triglycerides were especially common in women who had had myocardial infarction. At least one of these “risk factors” was present in 95 % of these women compared to 48 % of the women with angina pectoris, 43 % of women with ECG changes suggestive of ischaemic heart disease and 47 % of the women in the general population. It seems that the prevalence of a large number of “risk factors” - even though the factors may differ only moderately from those usually found in the population - per se acts as an important “risk factor” for ischaemic heart disease in women.

A longitudinal population study of 1462 women, aged 38-60, was carried out in Gothenburg, Sweden in 1968-69. Women with initially manifest diabetes mellitus had significantly increased 12-year incidence of myocardial infarction and increased mortality while no increased incidence of angina pectoris, ECG changes indicating ischaemic heart disease or stroke was observed. The association to myocardial infarction remained in multivariate analyses and was independent of age, body fat distribution, smoking, serum cholesterol and systolic blood pressure. The association to mortality was independent of these factors and also of serum triglycerides. Women who were diagnosed as "new diabetics" during the 12-year follow-up had a significantly increased 12-year incidence of myocardial infarction but no significant increase was observed for any of the other end-points studied. When women with initially manifest diabetes mellitus were excluded, no association was found between initial fasting blood glucose concentration and the end-points studied. A negative significant association was found between initial fasting blood glucose concentration and smoking.

Blood haemoglobin concentration, packed cell volume, blood cell counts, serum iron concentration, total iron binding capacity, bone marrow iron content, sideroblast count, iron absorption and menstrual blood loss were studied in 372 38-year-old women who were representative of the general female population of that age resident in Gothenburg, Sweden. The distributions of serum iron concentration, serum total iron binding capacity, and transferrin saturation were slightly skewed, whereas the distributions of iron absorption, reticulocyte count, sideroblast count, and menstrual blood loss were markedly skewed. The other variables studied were mainly normally distributed. One-third of the women (32 %) had no reticuloendothelial iron and another 14 % only traces of reticuloendothelial iron in smears from sternal bone marrow. Serum iron concentration and total iron binding capacity were rather high and menstrual blood loss low in women taking oral contraceptives, while factors such as country of origin, socio-economic group, blood donation, previous oral iron therapy or recent infection seemed to have no or only a slight influence on variables reflecting the iron status.

No significant differences in socio-economic status were found between women with IHD and women in the general population. No correlation was found between status incongruity of husband and wife and ischaemic heart disease. Women who had four children or more were significantly over-represented among those who had myocardial infarction and among those with ECG changes suggestive of ischaemic heart disease. Psychological stress, both when measured as psycho-social stress factors and as subjective stress experience, was significantly more common in women with myocardial infarction and in women with angina pectoris than in women in the general population. Among personality traits assessed, the level of aggression and neurotic self-assertiveness was significantly higher in women with myocardial infarction. Achievement and dominance displayed a tendency in the same direction but the differences did not reach statistical significance.

The number of childbirths had been significantly greater in women with angina pectoris or ECG changes suggestive of ischaemic heart disease than in women of the general population. A similar tendency was found for women with myocardial infarction. Spontaneous and/or legal abortions had been significantly more common in women with myocardial infarction. None of the women with myocardial infarction, angina pectoris or ECG changes suggestive of ischaemic heart disease had ever used oral contraceptives. Eight women who had a myocardial infarct before the age of 48 were all still menstruating when they had the infarct. A retrospective comparison revealed that significantly more women who had suffered myocardial infarction were postmenopausal at the ages of 45 and 50 than women in the general population. Menopause at the age of 50 or earlier had also taken place significantly more often in women with angina pectoris and in women with ECG changes suggestive of ischaemic heart disease. Postmenopausal 50-year old women had higher serum cholesterol and serum triglyceride values than 50-year old women still menstruating but blood pressure was lower than in the latter group of women. These differences in serum lipids and blood pressure between premenopausal and postmenopausal women were statistically significant.

In a population study in Göteborg, Sweden, comprising women in the age strata 44, 52, 56, 60 and 66 years, serum thyrotrophin (S-TSH) was determined in 283 women representative of the general population of women of these ages. No women with previously unknown hypothyroidism were found at the clinical examination; 47 (3.7%) were on thyroxine treatment, 9 (0.7%) because of spontaneous hypothyroidism. Sixteen women (1.2%) had markedly elevated S-TSH concentration (less than 14 mU/l). They were studied further by determination of thyroid hormones and circulating antithyroid microsomal and thyroglobulin antibodies, and those with goiter were subjected to fine-needle biopsy of the thyroid gland. They were furthermore followed for four years. Four euthyroid women were given thyroxine because of goiter and abnormal laboratory test results. Of nine individuals with high S-TSH concentration as well as high titers of thyroid antibodies and/or biopsy evidence of autoimmune thyroiditis, seven became hypothyroid within the four years of follow-up. The other two women had consistently elevated basal S-TSH concentration and exaggerated S-TSH response after thyroliberin administration. We conclude that the majority of individuals without previously recognized thyroid disease who have S-TSH concentration above 14 mU/l with the assay used will require thyroxine therapy within a few years. In one woman, however, with multinodular colloid goiter and high titer of antimicrosomal antibodies, the basal S-TSH concentration decreased during follow-up to a high normal value; the S-TSH response to thyroliberin was high borderline. She remained euthyroid during follow-up. The results suggest an annual incidence of spontaneous hypothyroidism of 1-2 cases per 1000 middle-aged females in Swedish west-coast population.

Smoking was more common in younger than in older women in the general population as found from a population study of women aged 38–60. Almost half of the women aged 38 were smokers as compared to about 20% of those aged 60. There was no over-representation of smokers in women who had angina pectoris or ECG changes suggestive of ischaemic heart disease. Women who had an acute attack of myocardial infarction were significantly more often smokers than women in the general population. In addition, cigarette consumption was significantly higher among female smokers who had MI than among female smokers in the general population.

Regression analysis was performed on a number of haematological variables obtained from a population sample of 38-year-old women. The correlation coefficients were higher between the blood haemoglobin concentration on the one hand and serum iron concentration, total iron binding capacity, transferrin saturation, sideroblast count, iron absorption and menstrual blood loss on the other than between packed cell volume or erythrocyte count and the same haematological variables mentioned above. The correlation coefficients between transferrin saturation and the above haematological variables were higher than the correlation coefficients between serum iron concentration or total iron binding capacity and the same variables. The highest correlation coefficients with the above mentioned haematological variables were found for reticuloendothelial iron in the bone marrow. The prevalence of women with a lack of reticuloendothelial iron in the bone marrow was high when haemoglobin concentrations and mean corpuscular haemoglobin values were within the lowest two decentiles defined as a haemoglobin concentration below 127 g/l and a mean corpuscular haemoglobin below 31 pg/erythrocyte. Mean corpuscular haemoglobin and transferrin saturation were relatively low in women with an iron absorption above 80 % and a menstrual blood loss above 40 ml per menstrual cycle.

The serum cholesterol levels of women who had suffered myocardial infarction were not higher than in the general population of women, nor the serum cholesterol levels of women with angina pectoris or ECG changes suggestive of ischaemic heart disease. The serum triglyceride values were significantly higher in women who had had myocardial infarction, and in women with ECG changes suggestive of ischaemic heart disease. There was no significant over-representation of high serum triglyceride values in women with angina pectoris.

A population sample of women in Goteborg, Sweden, was studied in 1968-69 and restudied in 1974-75. A number of metabolic variables could be studied cross-sectionally (in 1974-75) and longitudinally (intraindividual changes between 1968-69 and 1974-75). When studied cross-sectionally, increased serum urate concentrations were observed in women on diuretics and increased serum triglycerides in women on beta-blockers, compared to other women, while no obvious differences were found in blood glucose and serum cholesterol concentrations or in packed red cell volume (PCV). When studied longitudinally, a slight decrease in serum triglyceride concentration was found in women who started to take diuretics and an increase in women who started to beta-blockers compared to other women. Serum urate concentration tended to increase in women who started to take diuretics and PCV tended to decrease in women who started to take beta-blockers. Blood glucose was unimpaired. In conclusion, the differences observed were rather small and seemed to be rather unimportant compared to the threat presented by the arterial hypertension itself.

We determined the catalytic concentration of gamma-glutamyltransferase in serum from a population sample of 1408 women in seven age strata between 26 and 72 years. The range in healthy individuals for the different age groups was found to increase with age with a maximum of the central 0.95 fractile interval at 58 years (0.17-1.68 microk/l). The serum gamma-glutamyltransferase activity correlated with body mass index, blood pressure and concentrations of blood glucose and serum ferritin, triglycerides and cholesterol. During follow-up of women with gamma-glutamyltransferase activity greater than 1.20 microk/l, no woman developed any disease possibly related to the original finding of raised serum gamma-glutamyltransferase activity, several individuals being apparently healthy. Apparently, the serum gamma-glutamyltransferase assay is an unspecific indicator of several metabolic abnormalities. High values may be found in individuals in whom all commonly done investigations have given results within the health-associated reference interval.

A comprehensive population study of women aged 38–60 was carried out in Goteborg, Sweden in 1968-69. The same women were re-studied six years later, in 1974-75. Erythrocyte sedimentation rate (ESR) was studied on both occasions. A statistically significant rise in ESR with age was noted both cross-sectionally and longitudinally, which means that the increase was related to age and was not a cohort effect. The mean annual increase in ESR was about 0.6 mm/h, but there was a significant difference between the ages studied, the increment being larger in the upper age groups. Women with high ESR (here defined as ESR ≥30 mm/h) had lower Hb and Hct values than other women. Leucocyte counts were higher in women with ESR ≥30 mm/h than in the others, but differences were statistically significant only in the upper age groups. Serum iron levels were lower in women with high ESR, while TIBC values were similar to those in the other women. Significant differences were found for transferrin saturation (lower in women with high ESR). Cholesterol levels were similar, while triglyceride levels either tended to be or were significantly higher in women with high ESR. About half of the women with ESR ≥30 mm/h had a possible explanation for their increased ESR. In no case did an increased ESR give rise to a new diagnosis of clinical significance, either in 1968-69 or in 1974-75. Nor had any diagnoses been missed in women with a high ESR in 1968-69, according to the re-examination six years later. All except one woman, in whom the diagnosis of neoplastic disease was made in the interval between the two examinations, had ESR ≥30 mm/h in 1968-69, and women in whom a neoplastic disease was found later had on average no higher ESR in 1968-69 than the others. It is concluded that for screening purposes, ESR is of very limited value.

Objective To evaluate the effect of an individual health dialogue on health and risk factors for ischemic heart disease in addition to that of a community based strategy. Method Inhabitants in four communities in the area of Skaraborg, Sweden were invited to a health examination including a health dialogue both at the age of 30 and 35 (target communities). In another four communities inhabitants were invited only at the age of 35 (reference communities). Health and risk factors in 35-year old inhabitants in the target communities who participated in the health dialogue in 1989–1991 and 1994–1996 were analysed and compared with 35-year olds in the reference communities participating during the same periods of time. Results Inhabitants in communities where there had been a previous individualised health intervention programme had, on the community level, a more favourable development concerning dietary habits, mental stress, body mass index, waist circumference, cholesterol, blood pressure and metabolic risk profile compared to inhabitants in communities with only a community based health intervention programme. Conclusions An individual lifestyle oriented health dialogue supported by a global health and risk assessment pedagogic tool seems to be more effective than a community health strategy only.

The aim of this cross-sectional study was to analyze the relationship between chronic periodontitis and ischemic heart disease (IHD).A cross-section of women aged 38 to 84 years were examined in 1992-93 (analysis based on n=1056). Medical and dental examinations were included in the analysis specifically with regard to IHD and periodontitis. Other well-known risk factors for IHD were used as covariates in multivariable statistical analysis.Among the dentate women in this study (n=847), 74 had IHD and 773 did not. There was no statistically significant difference between numbers of pathological gingival pockets between these groups (58.1% had one or more pathological pockets in the IHD group compared to 57.6% in the non-IHD group). Bivariate analysis of dentate individuals showed significant associations between IHD and number of missing teeth, age, body mass index, waist/hip ratio, life satisfaction, hypertension, and levels of cholesterol and triglycerides. However, in the final multivariable logistic regression model, with the exception of age, only number of teeth (17 teeth) OR = 2.13 (CI 1.20; 3.77) was found to be significantly associated with IHD. Moreover, edentulous women had an OR of 1.94 (CI 1.05; 3.60) in relation to IHD (age-adjusted model).In the present study, periodontitis did not seem to have a statistically significant relationship with IHD. The number of missing teeth showed a strong association with IHD, and this may act as a proxy variable tapping an array of different risk factors and behaviors.

Objective The purpose of the study was to explore the relationship of weight and length at birth to diabetes in adult life and to all-cause mortality. Special attention was taken to potential confounding factors as age, family history, education, socio-economic group, physical inactivity, smoking, blood pressure, serum lipids and obesity. Research design and methods A longitudinal population study consisting of a representative sample of 1381 women aged 38–54 started in Gothenburg, Sweden, in 1968–1969 monitoring for diabetes mellitus and overall mortality over 32 years. Original delivery records were retrieved for 61.2% of the women. Death certificates were obtained for 99.3% the women who died during the 32-year follow-up period. Results We observed an inverse statistically significant relationship between birth weight and 32-year diabetes incidence independent of age, the highest incidence 16.3% in the lowest quartile of birth weight compared to 9.2% in the highest quartile. The relationship remained when controlling for the following covariates: education, socio-economic group, physical activity, smoking, systolic blood pressure, adult body mass index (BMI), waist–hip ratio, serum triglycerides and cholesterol. When overweight women (BMI ≥ 25) were excluded from the statistical analyses birth weight was even stronger related to the incidence of diabetes, 12.8% in lowest quartile and 5.7% in the highest quartile of birth weight independent of birth length, education, socio-economic group, physical activity, smoking, systolic blood pressure, body mass index, waist–hip ratio, blood glucose, serum triglycerides and cholesterol. Length at birth was a predictor for diabetes independent of age plus adult body mass index (BMI) and smoking but not independent of age only. No significant associations were observed between birth factors as birth weight and birth length and overall mortality during the 32-year of follow-up. Conclusions A low birth weight seems to be a risk factor for diabetes in adult women independent of age and most of the established risk factors for diabetes.

Objective— Asymmetrical dimethylarginine (ADMA) reduces nitric oxide by inhibiting nitric oxide synthase is associated with cardiovascular disease (CVD). Our study examined the association of ADMA with CVD prospectively in a healthy population-based cohort of women. Methods and Results— We measured baseline ADMA of 880 women in the Population Study of Women in Gothenburg using high-performance liquid chromatography. After adjustment for traditional risk factors, creatinine clearance, and homocysteine using Cox models, the HR (95% CI in parentheses) of CVD end points at 24 years for a 0.15 μmol/L (1 SD) increase in ADMA were: all-cause mortality 1.12 (0.96, 1.32), fatal CVD 1.30 (1.04, 1.62), total CVD events 1.29 (1.09, 1.53). The top quintile (ADMA ≥0.71 μmol/L) compared with the bottom four-fifths, conferred a cumulative risk 22 versus 14%, relative risk 1.75 (95% CI 1.18, 2.59) and population attributable risk 12.7% of total CVD events, and further identified individuals who are at higher than expected risk based on the SCORE and Framingham systems. Conclusions— A 0.15 μmol/L increase in baseline ADMA levels is associated with approximately 30% increase in incident cardiovascular risk at 24 years in women after adjustment. ADMA levels ≥0.71 μmol/L enhances CVD risk assessment in women.

Background Obesity is associated with increased mortality. Weight loss improves cardiovascular risk factors, but no prospective interventional studies have reported whether weight loss decreases overall mortality. In fact, many observational studies suggest that weight reduction is associated with increased mortality. Methods The prospective, controlled Swedish Obese Subjects study involved 4047 obese subjects. Of these subjects, 2010 underwent bariatric surgery (surgery group) and 2037 received conventional treatment (matched control group). We report on overall mortality during an average of 10.9 years of follow-up. At the time of the analysis (November 1, 2005), vital status was known for all but three subjects (follow-up rate, 99.9%). Results The average weight change in control subjects was less than ±2% during the period of up to 15 years during which weights were recorded. Maximum weight losses in the surgical subgroups were observed after 1 to 2 years: gastric bypass, 32%; vertical-banded gastropl...

The authors investigated the shape, sex- and age-dependency, and possible confounding of the association between birth weight and systolic blood pressure (SBP) in 197,954 adults from 20 Nordic cohorts (birth years 1910-1987), one of which included 166,249 Swedish male conscripts. Random-effects meta-regression analyses were performed on estimates obtained from age- and sex-stratified analyses within each of the cohorts. There was an inverse association between birth weight and SBP, irrespective of adjustment for concurrent body mass index. The association was linear for males, but for females with a birth weight greater than 4 kg, SBP increased with birth weight (p < 0.01). The association was stronger in the older age groups (p < 0.05), although this could have been a birth cohort effect. The association was stronger among females than among males (p = 0.005) when birth weight was less than or equal to 4 kg. The estimated effect of birth weight on SBP at age 50 years was -1.52 mmHg/kg (95% confidence interval: -2.27, -0.77) in men and -2.80 mmHg/kg (95% confidence interval: -3.85, -1.76) in women. Exclusion of the Swedish conscripts produced nearly identical results. This meta-analysis supports the evidence of an inverse birth weight-SBP association, regardless of adjustment for concurrent body size. It also reveals important heterogeneity in the shape and strength of the association by sex and age.

To investigate quality of life, measured by the SF-36 scales, in a population-based sample of women who have survived cancer at any site and, specifically, breast cancer.A representative cohort of women was observed over 24 years with regard to cancer prevalence, incidence, and quality of life.Gothenburg, Sweden.A total of 1462 women aged 38-60 years at baseline.Differences in quality of life between cancer survivors and cancer-free controls measured by the SF-36 Short Form Health Survey, with adjustment for age and additionally for social status, and history of major disease (diabetes, stroke, and myocardial infarction) at follow-up in 1992-93.In women who had survived cancer, a lower feeling of general health was the only score found to be significantly associated with having had cancer. Similar analysis was conducted separately for breast cancer cases. Survivors of breast cancer reported lower vitality and when controlled for major disease also lower general health compared with women who had not had cancer. All other results were independent when adjusted for social status, and also for history of major disease.Women who have survived cancer report lowered general health, and breast cancer cases lowered vitality, but considering the non-significant results for the other scores and summary scales it can be concluded that the well-being of women who have survived a cancer on the whole did not differ profoundly from that of other women.

To study the prevalence of subjective unspecified psychological symptoms (UPS) in a cohort of middle-aged women and the development of psychosomatic symptoms over 24 years.In 1968-1969, 1462 randomly selected women, aged 38, 46, 50, 54 and 60, were recruited. A 24-year follow-up was performed in 1992-1993 (n=836). The same structured interview concerning psychological and psychosomatic symptoms was used on both occasions.The prevalence of UPS was 28% in 1968-1969 and 20% in 1992-1993. Women with UPS in 1968-1969 were significantly more likely to have asthma/obstructive symptoms (34% vs 26%), headache (38% vs 22%) and abdominal symptoms (40% vs 21%), but not hypertension/high blood pressure (28% vs 28%), than women who did not report UPS. In 1992-1993, women with UPS in 1968-1969 were significantly still more likely to have asthmatic (25% vs 18%) and abdominal symptoms (44% vs 33%). Sixty-one per cent of women with UPS in 1968-1969 did not report such symptoms in 1992-1993, compared to 86% of women without UPS in 1968-1969 (p0.001).Women reporting UPS seemed to have a higher frequency of simultaneous psychosomatic symptoms than women not reporting UPS. However, having UPS was apparently unassociated with the development of psychosomatic symptoms over time. Psychosomatic symptoms in women seem to be self-limiting and decrease with time.

Objective. To assess associations between the intake of different types of alcoholic beverages and the 32-year incidence of myocardial infarction, stroke, diabetes, and cancer, as well as mortality, in a middle-aged female population. Design. Prospective study. Setting. Gothenburg, Sweden, population about 430 000. Subjects. Representative sample of a general population of women (1462 in total) aged 38 to 60 years in 1968–1969, followed up to the ages of 70 to 92 years in 2000–2001. Main outcome measures. Associations between alcohol intake and later risk of mortality and morbidity from myocardial infarction, stroke, diabetes, and cancer, studied longitudinally. Results. During the follow-up period, 185 women developed myocardial infarction, 162 developed stroke, 160 women became diabetic, and 345 developed cancer. Women who drank beer had a 30% lower risk (hazards ratio (HR) 0.70, 95% confidence interval (CI) 0.50–0.95) of developing myocardial infarcion and almost half the risk (HR 0.51 CI 0.33–0.80). A significant association between increased risk of death from cancer and high spirits consumption was also shown (hazards ratio [HR] 1.47, CI 1.06–2.05). Conclusions. Women with moderate consumption of beer had a reduced risk of developing myocardial infarction. High spirits consumption was associated with increased risk of cancer mortality.

Obesity is generally assumed to be an important risk factor for death and morbidity. However, the association between excess body weight and all-cause mortality among younger and older women and the impact of body mass index (BMI) and waist-to-hip ratio (WHR) concurrently is not fully understood. In 1968-1969 we initiated a prospective study comprising a population sample of 1,462 women from Gothenburg, Sweden. During a 24 year period, until 1992-1993, 265 women had died. A multivariable Cox Proportional Hazards Regression model was used to estimate the relative risk of death in relation to BMI and WHR, with age and other covariates of age-specific interest as smoking, physical activity at work and leisure time and serum triglyceride concentration, at start of the study. BMI and WHR were analyzed as independent variables. Younger women (38 and 46 years at baseline) presented a statistically significant non-linear (U-shaped) relation between BMI and mortality. Among older women (50, 54 and 60 years at baseline), a significant negative linear relationship with decreasing mortality in relation to increasing BMI values was seen. For all women a higher WHR was related to an increased risk of death. The lowest risk of death among younger women corresponded to a low WHR and a BMI within the middle range. For older women the highest survival was observed for those with lowest WHR and highest BMI. Thus, in older women a high BMI seems not to be an increased risk as long as adiposity is not centrally located.

This study was conducted among female subjects to assess the possible association between selected risk factors and lung function as well as airway symptoms in a 32-year perspective. The Prospective Population Study of Women was initiated in 1968-1969 in Goteborg, Sweden (population about 450 000) with follow-ups in 1974-1975, 1980-1981, 1992-1993 and 2000-2001. Women born in 1930, representative of women of the same age in the general population in 1968, were selected. Initially, 372 participants were included in the cohort. In 2000-2001, 231 of these women (73%), now 70 years old, underwent lung function tests. The main outcome measures were lung function values, airway symptoms and health outcome in 2000-2001 in relation to self-reported exposures in 1968-1969 including smoking status. Smoking in 1968-1969 was associated with self-reported chronic bronchitis, obstructive symptoms and poor health 32 years later as well as lower lung function values, compared to non-smokers. Obesity, low socio-economic status and self-reported mental stress in 1968-1969 were associated with obstructive symptoms 32 years later. There are only a few longitudinal studies concerning women's health problems in this field and epidemiological studies of lung function impairment in women and risk factors in a long-term perspective are scarce. The results of the study suggest that life-style factors such as mental stress, obesity and smoking among women are related to airway symptoms and also quality of life many years later.

Background and Purpose— Increased evidence suggests that poor respiratory function increases risk of ischemic damage to the brain. Longitudinal studies on respiratory function and cerebral small-vessel disease are lacking. We examined midlife and late-life respiratory function in relation to small-vessel disease on computed tomography (CT) in women followed for 26 years. Methods— White matter lesions (WMLs) and lacunar infarcts were rated on brain CT scans in 2000 in 379 women 70 to 92 years of age from a longitudinal population study in Göteborg, Sweden. Respiratory function was measured by peak expiratory flow (PEF) in 1974 and 2000 and by forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV 1 ) in 1980 and 2000. Results— Lower FVC and FEV 1 in 1980 and 2000 were associated with presence and severity of WMLs and lacunar infarcts in 2000. Per 1-SD decrease of FVC in 1980, odds ratios (95% CIs) were 1.49 (1.11 to 2.02) for presence of WMLs and 1.95 (1.34 to 2.84) for lacunar infarcts after adjustment for potential confounders. Per 1-SD decrease of FEV 1 in 1980, adjusted odds ratios were 1.46 (1.06 to 2.00) for presence of WMLs and 1.42 (1.02 to 1.97) for lacunar infarcts. PEF in 1974 and 2000 was not associated with WMLs or lacunar infarcts. Conclusions— WMLs and lacunar infarcts in elderly women were related to lower midlife respiratory function. Although our data may not establish causation between lower respiratory function and small-vessel disease, they imply the importance of good respiratory function in midlife.

AIMS: To analyse the relationship between life events, social support, psychological well-being and cardiovascular risk factors in blue- and white-collar Swedish automotive workers. METHODS: Baseline questionnaire regarding life events, social support, depressed mood and mental strain and smoking habits. Follow-up questionnaire after 5 years included the Psychological General Well-being Inventory to assess various health variables. At baseline and follow-up, anthropometric data were obtained. Blood pressure, blood glucose and serum lipids were measured and smoking habits were surveyed. RESULTS: The blue-collar workers showed a profile indicating increased cardiovascular risk with a higher proportion of smokers, a higher waist to hip ratio and higher triglycerides. They also reported themselves to have worse general health and less emotional self-control, but were less anxious than the white-collar workers. Negative life events, especially those related to work seemed to affect the well-being of the blue-collar workers more adversely than the white-collar workers. Being nervous and depressed at baseline increased the risk of poor psychological well-being at the follow-up. Social support within this 5-year perspective was a factor which predicted psychological well-being in both worker categories. Increase in cholesterol/high-density lipoprotein-cholesterol (HDL-C) ratio was the only cardiovascular risk factor associated with the strain of life events but not with work-related events. CONCLUSION: Over a 5-year period, men who experienced negative, strongly stressful and work-related life events displayed poorer psychological well-being at follow-up regardless of worker category. Social support was protective. Language: en

OBJECTIVE—To study the relation between diabetes incidence and sleep problems in a population-based sample of women followed for 32 years. RESEARCH DESIGN AND METHODS—The researchers conducted a prospective population study initiated in 1968–1969, with follow-ups in 1974–1975, 1980–1981, 1992–1993, and 2000–2001 in Gothenburg, Sweden. A total of 1,462 women born in 1908, 1914, 1918, 1922, and 1930, representative of women of the same ages in the general population, initially participated (90% participation rate). Reported sleep duration, sleep problems, and use of sleeping medication were related to incident diabetes from 1968 to 2000. Associations between sleep problems and diabetes were corrected for waist-to-hip ratio (WHR), BMI, subscapular skinfold, fasting blood glucose and serum lipid concentrations, blood pressure, heart rate, smoking, physical activity, education, and socioeconomic status. Additionally, associations between BMI, WHR, and sleep problems were examined. RESULTS—Over 32 years, 126 women (8.7%) developed diabetes. Associations between diabetes and initial sleep problems were tested in a Cox regression analysis, taking into consideration factors associated (P < 0.1) with diabetes. Sleep problems in 1968 did not increase risk of developing diabetes during the following 32 years. Obesity, particularly centralized, was associated with sleep problems. CONCLUSIONS—No association between sleep problems and developing diabetes was seen in this 32-year follow-up of middle-aged women. Obesity, on the other hand, known to cause increased risk of diabetes, was associated with current sleep problems.

OBJECTIVE— The purpose of the study was to explore the predictive value of women’s alcohol habits in relation to incidence of diabetes and all-cause mortality. Special attention was paid to potential confounding factors such as age, heredity, education, socioeconomic group, physical inactivity, smoking, blood pressure, serum lipids, and, in particular, obesity. RESEARCH DESIGN AND METHODS— A longitudinal population study consisting of a representative sample of 1,462 women aged 38–60 started in Göteborg, Sweden, in 1968–1969 monitoring for diabetes and mortality over 32 years. RESULTS— Alcohol intake, expressed as intake of wine, hard liquor, or total grams of alcohol, was significantly negatively associated to 32-year diabetes incidence independent of age. However, the apparently protective effect of the alcohol variables was attenuated when BMI was included as a covariate. The inverse relationship between wine intake and diabetes did not remain after adjustment for physical activity or socioeconomic group. Beer and wine intake were significantly negatively associated to mortality. Increase of alcohol intake between the examination in 1968–1969 and 1980–1981 was significantly inversely related to the mortality between 1980–1981 and 2000–2001 and independent of all covariates. No relationship was observed between an increase in alcohol intake and diabetes incidence. However, after adjustment for age, family history, and basal alcohol consumption altogether, a significant inverse relationship was observed between increase of alcohol and diabetes incidence. CONCLUSIONS— The initially significant inverse associations observed between alcohol and diabetes as well as mortality were dependent on a number of confounding factors, of which BMI seems to be the most important.

To study the reproducibility of self-reported age at natural menopause, reported by women in their 70s, compared with menopause age reported in the initial postmenopausal period.A prospective study conducted in Göteborg, Sweden, based on a random sample of the total female population, started in 1968-1969, with follow ups in 1974-1975, 1980-1981, and 1992-1993. A total of 1,009 women born in 1922, 1918, or 1914 (participation rate 90.3%), representative of women of the respective ages in the general population, participated in the initial examination in 1968-1969. Of those women reporting natural menopause some time between 1968 and 1981, 565 women recalled their menopause age in 1992.The mean interval between the first and second reports was 18.3 years. The mean difference between first-reported and recalled menopause was 0.05 years. When menopause age was recalled in 1992-1993, 55.6% of the women with a natural menopause recalled their age at menopause correctly within 1 year, 22.6% underestimated their menopause age by more than 1 year, and 21.8% overestimated their menopause age by more than 1 year. Women undergoing early menopause (45 years) tended to overestimate menopause age, whereas women undergoing late menopause (55 years) tended to underestimate menopause age. These differences could not be explained by age, interval since menopause, smoking, exercise, education, or socioeconomic status.Menopause ages reported at an interval of almost 20 years showed a significant correlation. However, a regression tendency of the values toward the mean was observed, suggesting that strong correlation at the group level does not imply precision at the extremes.