High serum insulin-like growth factor binding protein-1 is associated with increased cardiovascular mortality in elderly men.

Insulin-like growth factor binding protein-1 (IGFBP-1) has been implicated in the development of cardiovascular disease, but it is not known whether IGFBP-1 is related to cardiovascular mortality. We examined the relation of circulating IGFBP-1 to death from coronary heart disease, cardiovascular disease, and all causes in a cohort study consisting of 622 men aged 65 - 84 years, at baseline in 1984. Fasting serum IGFBP-1 and other risk factors were measured in 1984 and 1989. Cardiovascular events for those who died between 1984 and 1995 were analyzed, and cardiovascular diagnoses were coded centrally according to standardized procedures. Of the 622 men, 358 died between 1984 and 1995; 160 deaths were due to cardiovascular causes, 113 of which were coronary deaths. High fasting serum IGFBP-1 concentration (> 75 percentile) in 1984 was associated with increased five-year total mortality (OR 2.05, 95 % CI 1.41 - 2.99; p < 0.0002), cardiovascular mortality (OR 2.20, 95 % CI 1.37 - 3.50; p < 0.0009) and coronary heart disease mortality (OR 2.29, 95 % CI 1.35 - 3.88; p < 0.002). After adjustment for age, high serum IGFBP-1 concentrations still carried an increased risk of total mortality due to (OR 1.73, 95 % CI 1.16 - 2.59; p < 0.007), cardiovascular (OR 1.91 95 % CI 1.18 - 3.09; p < 0.008) and coronary heart disease (OR 2.02. 95 % CI 1.18 - 3.47; p < 0.01). In conclusion, high fasting serum IGFBP-1 is related to increased five-year total and cardiovascular mortality in elderly men.     

Survival in treated hypertension: follow up study after two decades

Objective: To compare survival and cause specific mortality in hypertensive men with non-hypertensive men derived from the same random population, and to study mortality and morbidity from cardiovascular diseases in the hypertensive men in relation to effects on cardiovascular risk factors during 22-23 years of follow up. Design: Prospective, population based observational study. Subjects and methods: 686 hypertensive men aged 47-55 at screening compared with 6810 non-hypertensive men. The hypertensive men were having stepped care treatment with either β adrenergic blocking drugs, thiazide diuretics, or combination treatment. Mortality, morbidity, and adverse effects were registered at yearly examinations and from death certificates. Main outcome measures: All cause mortality and cause specific mortality. Results: Treated hypertensive men had significantly impaired probability of total survival as well as survival from coronary heart disease and stroke. All cause mortality as well as coronary heart disease and stroke mortality were very similar in hypertensive men and normotensive men during the first decade, but increased steadily thereafter despite continuous good blood pressure control. Smoking, signs of target organ damage, and high serum cholesterol levels, but not blood pressure at screening, were significantly related to the incidence of coronary heart disease during follow up. In time dependent Cox’s regression analysis, the incidence of coronary heart disease was significantly related only to serum cholesterol concentrations in the study. Cancer mortality was almost similar in treated hypertensive men (61/686, 8.9%) and non-hypertensive men (732/6810, 10.8%). Conclusion: Treated hypertensive men had impaired survival and increased mortality from cardiovascular disease compared with non-hypertensive men of similar age. These differences were observed during the second decade of follow up. During an observation period of 22-23 years—about 15 000 patient years—hypertensive men receiving diuretics and β blockers had no increased risk of cancer or non-cardiovascular disease.

Key messages

• Hypertension is a prevalent (10-20%) and important risk factor for cardiovascular disease.
• In controlled trials over 3-5 years drug treatment for hypertension prevents these complications, but little is known about long term prognosis
• During 20-22 years treated hypertensive men had a significantly increased mortality, especially from coronary heart disease, compared with non-hypertensive men from the same population
• The high incidence of myocardial infarction was related to organ damage, smoking, and cholesterol at the time of entry to the study, and to achieved serum cholesterol concentrations during follow up
• The poor prognosis for mortality from coronary heart disease is dependent upon strict monitoring of serum cholesterol concentrations

     

Longitudinal study of aspergillosis in sea fan corals

Aspergillosis (a fungal disease) is affecting sea fan corals Gorgonia spp. throughout the Caribbean. To measure the impact of this disease, we established longitudinal, or in other words individual-based, monitoring studies on 3 reefs in the Florida Keys, USA, to obtain estimates of incidence, rates of disease progress, recovery, and mortality. At Western Dry Rocks (near Key West), 40 Gorgonia ventalina colonies (20 initially healthy and 20 initially diseased) were photo-monitored between June 1996 and May 1998. Additional sea fans were visually monitored during 2 localized outbreaks at Conch (May 1998 to September 1999) and Carysfort (July 2000 to May 2001) reefs located in the Upper Keys. Data from Western Dry Rocks showed that over a 2 yr period, the incidence rate was 0.58 sea fans yr(-1) and that tissue purpling can lead to tissue loss and subsequently to mortality, albeit at low frequencies. Most sea fans, once infected, maintained a low level of damage over time. Only 3 fans recovered from the disease; however 2 were subsequently re-infected. Case fatality rate was 10% (2 of 20 initially infected died), which is equivalent to 5% yr(-1). However, mortality can increase during localized outbreaks. At Conch, mortality was 46% yr(-1) among infected sea fans (compared to 8% yr(-1) at Carysfort, a less impacted site, during the same period). During an outbreak at Carysfort, mortality was 95% yr(-1) among diseased sea fans. These data clearly demonstrate the significant role aspergillosis plays in the population ecology of sea fan corals.     

On the state of the public ill health: premature mortality in the United Kingdom and Europe.

Recently published data on mortality in the European Economic Community and Scandinavia convincingly showed that mortality among men and women aged 45-64 was considerably higher in the United Kingdom than elsewhere. This applied to deaths due to circulatory and respiratory disease, cancer, and all causes. For example, in 1980 in Scotland twice as many, or more, women aged 55-64 per 100 000 died of heart disease than in Belgium, Denmark, France, Greece, West Germany, the Netherlands, Norway, and Sweden. Reductions in mortality from all causes during 1950-80 in the United Kingdom did not match those in other countries, such as Finland and France. Whether the public in the United Kingdom knows about its relatively poor mortality state is doubtful. To secure improved funding of appropriate preventive and treatment services directed at reducing premature mortality, public awareness should be raised urgently so that politicians and political parties will respond quickly in a way that the problem demands.     

Weight and mortality in the Whitehall Study.

Ten-year mortality rates in men aged 40-64 years in the Whitehall Study were analysed in relation to weight and height at the initial examination. At ages 40-49 "all-causes" mortality increased with increasing body mass index; but this simple relation disappeared at older ages, where there was an increased mortality in the lowest quintile of body mass index. The "all-ages" relation was "J"-shaped, and this could not be explained by the confounding effects of blood pressure, cholesterol values, and cigarette smoking. Some, but not all, of the J shape was due to a high short-term mortality in thin men from cancers (presumably already present at examination). At younger ages mortality from coronary heart disease was positively related to body mass index, but this depended on its association with other risk factors. Mortality from causes other than cancers or coronary heart disease was highest in the lowest quintile of body mass index.     

鸡传染性法氏囊病病毒超强毒株GX8/99株的致病性

鸡传染性法氏囊病病毒(IBDV)超强毒株GX8/99,系1999年从广西一自然发病鸡群采集到.用原始病鸡法氏囊悬液连续3次人工感染SPF鸡后,再取其法氏囊制备悬液,分装,在-70℃保存.以此悬液经卵黄囊接种10日龄SPF鸡胚,测定鸡胚的半数致死量(ELD50).随着鸡的日龄和接种剂量的不同,其致死率有很大差异.对28～30日龄SPF鸡,病毒接种量为200个ELD50时,感染后7日内死亡率最高可达73%～90.5%(11/15和19/21);感染量为20个ELD50时,死亡率亦可达53%～92%(8/15和23/25).以500个ELD50感染28～104日龄的SPF鸡,死亡率均在55.1%～67.2%;甚至113～120日龄的SPF鸡,感染后仍有10%～15%致死率.但128日龄的SPF鸡感染后既不引起死亡也不表现任何症状,但抗体全部转阳.人工接种发病死亡的鸡,其法氏囊的出血程度也随感染量和年龄而异.50日龄鸡接种2000个ELD50后,死亡的鸡100%(12/12)法氏囊严重出血;而40日龄鸡感染200个ELD50后,死亡鸡中仅17%(3/18)发生出血.在2、3、4周龄带有母源抗体的商品代蛋鸡,以2000个ELD50病毒接种后,只引起10%(2/20)、35%(7/20)和35%(7/20)的死亡率.但在5周龄商品代蛋鸡,仅接触感染的致死率可达61.3%(98/160).另一批商品代蛋鸡,在4周龄和5周龄人工接种200个ELD50病毒后,死亡率分别是81.6%～94.3%(62/76～33/35)和93.9%～94%(31/33～47/50).通过总共1200多羽鸡的试验表明,GX-8/99株是一个超强毒IBDV毒株,表现为高死亡率(最高可达94%),易感年龄延长至4月龄,中枢性免疫器官法氏囊出血严重和胸腺明显萎缩.     

Analysis of structure and causes of mortality of HIV-infected in Volga Federal District in 2005 - 2010

Among with morbidity and affection, mortality is an objective indicator of HIV-infection epidemic process intensity. Dynamics of mortality of HIV-infected in Volga Federal District (VFD) in 2005 - 2010, distribution of deceased by disease stage, period of start and coverage by antiretroviral therapy were studied based on approved statistical forms and additional collected data, the leading causes of death were revealed, comparative analysis with population of HIV-infected in penitentiary system institutions was performed. All-cause mortality was established to have dynamics of growth in HIV-infected population in VFD in 2005 - 2010, at the same time HIV-infection mortality has a certain tendency of stabilization after 2007 with subsequent decline in 2010, that apparently is related to wide use of combined antiretroviral therapy. HIV-infection mortality among HIV-infected in penitentiary system of the district is significantly higher than mortality in the general population of HIV-infected in VFD. The leading cause of death in HIV-infection is tuberculosis.     

Opportunity for natural selection in a Basque population and its secular trend: evolutionary implications of epidemic mortality

Analysis of the interaction between mortality patterns and opportunity for natural selection could help to elucidate potential evolutionary implications of epidemic mortality. In this paper secular trends are studied in relation to Crow's index (It) and its components of mortality (Im) and fertility (If), using parish records for family reconstitution in a Basque population. A principal components analysis (91% of the variance accounted for) showed marked quantitative and qualitative variations of Im and If depending on the stage of demographic transition of the population analyzed: In pretransitional societies the opportunity for natural selection is determined mainly by differential prereproductive mortality, whereas in posttransitional societies selection resulting from differential fertility plays a key role. The highest values for the mortality component (range 0.81-1.26) and for the relative contribution of Im, to It (range 47.1-57.2%) were observed in periods with a high incidence of infectious diseases and when the most severe mortality crises were detected (1830-1859, 1860-1889, and 1890-1919). A differential incidence of epidemic mortality was also found at prereproductive ages (before 16 years) and at reproductive ages (16-45 years), which provides strong support for the idea of the long-term genetic consequences of mortality crises.     

Plasma cholesterol,coronary heart disease,and cancer in the Renfrew and Paisley survey.

The relation between plasma cholesterol concentration and mortality from coronary heart disease, incidence of and mortality from cancer, and all cause mortality was studied in a general population aged 45-64 living in the west of Scotland. Seven thousand men (yielding 653 deaths from coronary heart disease, 630 new cases of cancer, and 463 deaths from cancer) and 8262 women (322 deaths from coronary heart disease, 554 new cases of cancer, and 395 deaths from cancer) were examined initially in 1972-6 and followed up for an average of 12 years. All cause mortality was not related to plasma cholesterol concentration. This was largely a consequence of a positive relation between cholesterol values and mortality from coronary heart disease being balanced by inverse relations between cholesterol and cancer and between cholesterol and other causes of death. These changes were highly significant for coronary heart disease and cancer in men and significant for coronary heart disease and other causes of death in women. The inverse association between cholesterol concentration and cancer in men was strongest for lung cancer, was not merely a function of the age at which a subject died, was present for the incidence of cancer as well as mortality from cancer, and persisted when new cases or deaths occurring within the first four years of follow up were excluded from the analysis.     

The University of Manitoba Follow-up Study: A Prospective Investigation of Cardiovascular Disease: Part I. General Description—Mortality and Incidence of Coronary Heart Disease

A prospective study of cardiovascular disease was initiated in 1946 whereby 3983 healthy North American males, 91% under age 40, were subjected to periodic electrocardiograms and medical examinations between 1948 and 1963. The health of all but five of the 3773 survivors was known in 1963. There were 210 deaths: aircraft accidents accounted for 45%, cardiovascular disease 20%, cancer 11% and other causes 23%. The aggregate mortality closely resembled that of the Canadian Life Table 1955-57 (Male). Extra deaths were observed under age 40 owing to a high frequency of flying accidents. At older ages the mortality was lower than expected because congenital and chronic diseases were excluded at entry. One hundred and forty-three developed coronary heart disease. The case fatality rate was 31%. The incidence rate for coronary heart disease rose progressively from 0.277 per thousand per year for ages 25-34 to 26.5 at ages 60-69.     

Regression analysis of recent changes in cardiovascular morbidity and mortality in The Netherlands.

OBJECTIVES: To test whether recent declines in mortality from coronary heart disease were associated with increased mortality from other cardiovascular diseases. DESIGN: Poisson regression analysis of national data on causes of death and hospital discharges. SETTING AND SUBJECTS: Population of the Netherlands, 1969-93. MAIN OUTCOME MEASURES: Annual changes in mortality from coronary heart disease, stroke, and other cardiovascular diseases and annual changes in hospital discharge rates for acute coronary events, stroke, and congestive heart failures. RESULTS: Patterns of cardiovascular mortality changed abruptly in 1987-93. Annual decline in mortality from coronary heart disease increased sharply for women and men: from -1.9% (95% confidence interval -2.2% to -1.6%) and -1.7% (-1.9% to -1.4%) respectively in 1979-86 to -3.1% (-3.5% to -2.6%) and -4.2% (-4.6% to -3.9%) in 1987-93. The longstanding decline in mortality from stroke levelled off: from annual change of -3.3% (-3.7% to -2.8%) and -3.2% (-3.7% to -2.8%) in 1979-86 to -0.1% (-0.7% to 0.4%) and -1.1% (-1.7% to -0.5%) in 1987-93. Mortality from other cardiovascular diseases, however, started to increase: from -2.0% (-2.4% to -1.6%) and -0.2% (-0.5% to 0.2%) in 1979-86 to 1.5% (1.0% to 2.0%) and 1.9% (1.5% to 2.3%) in 1987-93. Hospital discharge rates for acute coronary heart disease, congestive heart failure, and stroke increased during 1980-6. During 1987-93 discharge rates for stroke and coronary heart disease stabilised but rates for congestive heart failure increased. CONCLUSION: Improved management of coronary heart disease seems to have reduced mortality, but some of the gains are lost to deaths from stroke and other cardiovascular diseases. The increasing numbers of patients with coronary heart disease who survive will increase demands on health services for long term care.     

No substantial excess all-cause mortality among cardiac implantable electronic device patients during the first COVID‑19 lockdown in the Leiden area

Netherlands Heart Journal - In the Netherlands, the coronavirus disease 2019 (COVID?19) pandemic has resulted in excess mortality nationwide. Chronic heart disease patients are at risk for...     

Changing patterns and mortality of acute myocardial infarction in a coronary care unit.

Three groups of patients who had been admitted to a coronary care unit with infarction at different periods since 1963 were reviewed to assess whether the outcome in such patients had improved over 12 years. There was a significant reduction in mortality among consecutive patients with mild or severe infarction between 1969-70 and 1974-5. Classifying the patients in all three groups according to their risk factors showed that for each risk factor mortality had decreased since 1963. The incidence of arrhythmias and conduction defects decreased between 1969-70 and 1974-5, and mortality among patients with each arrhythmia also fell. The reduction in mortality may reflect a changing pattern in the natural history of the disease as well as a benefit of improved treatment.     

Predictors of Mortality in Hypercalcemia of Advanced Chronic Liver Disease

ObjectiveHypercalcemia is sometimes observed in patients with cirrhosis, but very little is known about the epidemiology in patients with hypercalcemia of chronic liver disease (HCLD) or how its presence may modulate the overall mortality risk. We assessed the associations between the clinical and laboratory characteristics of patients with HCLD with 90-day mortality.MethodsA systematic search of the medical records at our institution over a 10-year period was performed to retrospectively identify subjects with HCLD during inpatient admission. Univariate and multivariable regression analyses were performed to detect the risk factors for all-cause 90-day mortality.ResultsThirty-eight subjects with HCLD were identified using stringent inclusion and exclusion criteria to exclude individuals with other secondary causes of hypercalcemia. A total of 35 subjects had 90-day vital status available, which revealed 40% mortality. The model for end-stage liver disease sodium score and duration of inpatient hypercalcemia were positively associated with mortality with respective odds ratios of 1.23 (95% CI, 1.06-3.23) and 1.24 (95% CI, 1.04-1.49) in a univariate regression model and 1.30 (95% CI, 1.04-1.62) and 1.33 (95% CI, 1.04-1.71) in a multivariable regression model. The admission and peak serum calcium levels were not associated with mortality. Only 6 subjects received bisphosphonates or calcitonin during their admission, limiting our ability to assess the impact of treatment on outcomes.ConclusionIn patients admitted to the hospital with HCLD, the duration of hypercalcemia was positively associated with 90-day mortality, providing a potential interventional target to reduce mortality in this high-risk population. Studies to validate the utility of treating hypercalcemia are required.     

Historical intensity of natural selection for resistance to tuberculosis

Infections have long been thought to exert natural selection on humans. Infectious disease resistance is frequently invoked as a mechanism shaping human genetic diversity, but such hypotheses have rarely been quantitatively evaluated with direct measures of disease-related mortality. Enhancement of genetically determined resistance to tuberculosis by natural selection has been proposed as a factor explaining the decline of tuberculosis in Europe and North America in the period 1830-1950 (before the advent of antimicrobial chemotherapy) and the apparently reduced susceptibility of Europeans and their descendants to tuberculosis infection and/or disease. We used Swedish vital statistics from 1891 to 1900 to estimate that individuals who escaped mortality from pulmonary tuberculosis (PTB) during the European tuberculosis epidemic would have enjoyed a fitness advantage of 7-15% per generation compared to individuals who were susceptible to PTB mortality; individuals with 50% protection would have had a selection coefficient of 4-7%/generation. Selection during the peak of the European TB epidemic could have substantially reduced the frequency of already rare alleles conferring increased susceptibility to PTB mortality, but only if the phenotypic effects of these alleles were very large. However, if resistant alleles were rare at the beginning of this period, 300 years would not have been long enough for such selection to increase their frequency to epidemiologically significant levels. Reductions in the frequency of rare susceptibility alleles could have played at most a small part in the decline of the epidemic in the century preceding 1950. Natural selection by PTB deaths during the European TB epidemic alone cannot account for the presently low level of TB disease observed among Europeans and their descendants just prior to the appearance of antibiotic treatment.     

Health transition: examples from the western Pacific.

The Industrial Revolution ushered in a rapid transition from agriculture to industrialization. Some biological effects of this transition included increasing life expectancy, reduced infant mortality, and some decline in fertility. Reduced infant mortality first brought about an increase in life expectancy, but as humans were able to control infectious diseases, child and adult mortality also decreased. Now, accidents and chronic diseases are responsible for most mortality in many age groups. This shift from infectious diseases to accidents and chronic diseases is called the health transition. Japan and US are Pacific Basin countries which have relatively high life expectancy and low infant mortality (1988, 75.54 years vs. 71.38 years, and 4.4 vs. 9.9, respectively). These figures suggest that these countries rather advanced in the health transition. Japan may have better life expectancy than the US because of the effect of environmental factors, ethnic diversity, and health care differentials by social class on cardiovascular disease and cancer mortality. China and Thailand hold intermediate positions (67.98 years (1985-1990) vs. 63.82 years (1985-1986), and 32.4 vs. 39, respectively). Some research indicates that urban conditions and factory work increase the cardiovascular disease risk among the Chinese. Recent research suggests that access to immunization and modern medical care for acute disease are the only critical variables of the health transition rather than other variables. Papua New Guinea is not progressing very well (53.18 years and 58). Papua New Guinea has not yet been able to control infectious diseases, especially malaria. This comparison illustrates that populations progress through the health transition at different rates.     

The relation of small head circumference and thinness at birth to death from cardiovascular disease in adult life.

OBJECTIVE--To determine how fetal growth is related to death from cardiovascular disease in adult life. DESIGN--A follow up study of men born during 1907-24 whose birth weights, head circumferences, and other body measurements were recorded at birth. SETTING--Sheffield, England. SUBJECTS--1586 Men born in the Jessop Hospital. MAIN OUTCOME MEASURE--Death from cardiovascular disease. RESULTS--Standardised mortality ratios for cardiovascular disease fell from 119 in men who weighed 5.5 pounds (2495 g) or less at birth to 74 in men who weighed more than 8.5 pounds (3856 g). The fall was significant for premature cardiovascular deaths up to 65 years of age (chi 2 = 5.0, p = 0.02). Standardised mortality ratios also fell with increasing head circumference (chi 2 = 4.6, p = 0.03) and increasing ponderal index (weight/length3) (chi 2 = 3.8, p = 0.05; for premature deaths chi 2 = 6.0, p = 0.01). They were not related to the duration of gestation. Among men for whom the ratio of placental weight to birth weight was in the highest fifths the standardised mortality ratio was 137. CONCLUSION--These findings show that reduced fetal growth is followed by increased mortality from cardiovascular disease. They suggest that reduction in growth begins early in gestation. They are further evidence that cardiovascular disease originates through programming of the body''s structure, physiology, and metabolism by the environment during fetal life. Maternal nutrition may have an important influence on programming.     

Increased susceptibility of white spot syndrome virus-infected Litopenaeus vannamei to Vibrio campbellii

The concept of polymicrobial disease is well accepted in human and veterinary medicine but has received very little attention in the field of aquaculture. This study was conducted to investigate the synergistic effect of white spot syndrome virus (WSSV) and Vibrio campbellii on development of disease in specific pathogen-free (SPF) shrimp Litopenaeus vannamei. The juvenile shrimp were first injected with WSSV at a dose of 30 SID(50) shrimp(-1) (SID(50) = shrimp infectious dose with 50% endpoint) and 24 h later with 10(6) colony-forming units (cfu) of V. campbellii shrimp(-1). Controls receiving just one of the pathogens or negative inocula were included. In the treatment with WSSV only, shrimp started to die at 48-108 h post injection (hpi) and cumulative mortality reached 100% at 268-336 hpi. In the treatment with only V. campbellii injection (10(6) cfu shrimp(-1)), cumulative mortality reached 16.7%. Shrimp in the dual treatment died very quickly after V. campbellii injection and 100% cumulative mortality was obtained at 72-96 hpi. When WSSV-injected shrimp were given sonicated V. campbellii instead of live V. campbellii, no synergistic effect was observed. Density of V. campbellii in the haemolymph of co-infected moribund shrimp collected 10 h after V. campbellii injection was significantly higher than in shrimp injected with V. campbellii only (P < 0.01). However, there was no difference in WSSV replication between shrimp inoculated with WSSV only compared with dually inoculated ones. This study revealed that prior infection with WSSV enhances the multiplication and disease inducing capacity of V. campbellii in shrimp.     

Avian vacuolar myelinopathy outbreaks at a southeastern reservoir

Avian vacuolar myelinopathy (AVM) is a neurologic disease of unknown etiology that affects bald eagles (Haliaeetus leucocephalus), American coots (Fulica americana), and several species of waterfowl. An unidentified neurotoxin is suspected as the cause of AVM, which has been documented at several reservoirs in the southeastern United States. We conducted diagnostic and epidemiologic studies annually during October-March from 1998-2004 at Clarks Hill/Strom Thurmond Lake on the Georgia/South Carolina border to better understand the disease. Avian vacuolar myelinopathy was confirmed or suspected as the cause of morbidity and mortality of 28 bald eagles, 16 Canada geese (Branta canadensis), six American coots, two great-horned owls (Bubo virginianus), and one killdeer (Charadrius vociferus). Active surveillance during the outbreaks yielded annual average prevalence of vacuolar lesions in 17-94% of coots, but not in 10 beavers (Castor canadensis), four raccoons (Procyon lotor), and one gray fox (Urocyon cinereoargenteus) collected for the study. Brain lesions were not apparent in 30 Canada geese collected and examined in June 2002. The outbreaks at this location from 1998-2004 represent the most significant AVM-related bald eagle mortality since the Arkansas epornitics of 1994-95 and 1996-97, as well as the first confirmation of the disease in members of Strigiformes and Charadriiformes.     

Body weight and mortality in middle aged British men: impact of smoking.

OBJECTIVE--To assess the relation between body mass index and mortality in middle aged British men. DESIGN--Men who were recruited for the British Regional Heart Study were followed up for a mean of nine years. SETTING--General practices in 24 British towns. SUBJECTS--7735 Men aged 40-59 years selected from the age-sex registers of one group practice in each of the 24 towns. MAIN OUTCOME MEASURE--Mortality from cardiovascular and non-cardiovascular causes. RESULTS--660 Of the men died. There was a U-shaped relation between body mass index and total mortality. Very lean men (less than 20 kg/m2) had by far the highest mortality followed by lean men (20-22 kg/m2) and obese men (greater than or equal to 28 kg/m2). The high mortality in lean and very lean men was due largely to non-cardiovascular causes, particularly lung cancer and respiratory disease, which are associated with cigarette smoking. In obese men deaths were more likely to be due to cardiovascular causes. There was a strong inverse association between body weight and cigarette smoking. When the pattern of mortality was examined by age, smoking habits, and pre-existing smoking related disease both very lean men and obese men consistently had an increased mortality. The U-shaped relation was most prominent in men in the oldest age group (55-59). Current smokers had a higher mortality than former smokers at virtually all values of body mass index. An increased mortality in lean men was seen only in current smokers and in men with smoking related disease. Among men who had never smoked, lean men had the lowest total mortality, thereafter mortality increased with increasing body mass index (p less than 0.01). CONCLUSIONS--This study provides strong evidence of the impact of cigarette smoking on body weight and mortality and strongly suggests that the benefits of giving up smoking are far greater than the problems associated with the increase in weight that may occur.