The "Saltin-Grimby Physical Activity Level Scale" and its application to health research.

The use of a four-level questionnaire to assess leisure time physical activity (PA) and its validation is reviewed in this paper. This questionnaire was first published in 1968 and has then been used by more than 600,000 subjects, especially in different population studies in the Nordic countries. A number of modifications to the questionnaire have been published. These are mostly minor changes, such as adding practical examples of activities to illustrate the levels of PA. Some authors have also added duration requirements that were not included for all levels of PA in the original version. The concurrent validity, with respect to aerobic capacity and movement analysis using objective measurements has been shown to be good, as has the predictive validity with respect to various risk factors for health conditions and for morbidity and mortality.

Endogenous sex hormones and risk of venous thromboembolism in women and men.

BACKGROUND: Use of oral contraceptives with estrogen and hormone replacement therapy with estrogen or testosterone are associated with increased risk of venous thromboembolism (VTE). However, whether endogenous estradiol and testosterone concentrations are also associated with risk of VTE is unknown. OBJECTIVE: We tested the hypothesis that elevated endogenous total estradiol and total testosterone concentrations are associated with increased risk of VTE in the general population. METHODS: We studied 4658 women, not receiving exogenous estrogen, and 4673 men from the 1981-1983 Copenhagen City Heart Study, who had estradiol and testosterone concentrations measured. Of these, 636 developed VTE (deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) during a follow-up of 21 years (range, 0.02-32 years). Associations between endogenous estradiol and testosterone concentrations and risk of VTE were estimated by Cox proportional hazards regression with time-dependent covariates and corrected for regression dilution bias. RESULTS: Multifactorially adjusted hazard ratios of VTE for individuals with estradiol levels >75th vs. ≤25th percentile were 0.84 (95%CI, 0.25-2.85), 1.05 (0.53-2.08) and 1.05 (0.03-35.13) for pre- and post-menopausal women and men, respectively. For testosterone, corresponding risk estimates were 0.64 (0.03-12.32), 1.11 (0.66-1.86) and 1.30 (0.62-2.73). In addition, no associations were observed between extreme hormone percentiles (>95th vs. ≤75th) and risk of DVT, PE or recurrent VTE. CONCLUSION: This prospective study suggests that high endogenous concentrations of estradiol and testosterone in women and men in the general population are not associated with increased risk of VTE, DVT or PE.

Combined influence of leisure-time physical activity and hip circumference on all-cause mortality.

UNLABELLED: Hip circumference has been shown to be inversely associated with mortality. Muscle atrophy in the gluteofemoral region may be a possible explanation and thus physical activity is likely to play an important role. OBJECTIVE: To estimate the combined effects of hip circumference and physical activity on mortality. DESIGN AND METHODS: From the Copenhagen City Heart Study, 3,358 men and 4,350 women aged 21 to 93 years without pre-existing diagnosis of diabetes, stroke, ischemic heart disease, or cancer in 1991-1994 and with complete information on the variables of interest were included in the analyses. The participants were followed to 2009 in the Danish Civil Registration System, with 1.3% loss to follow-up and 2,513 deaths. Hazard ratios (HR) were estimated for combinations of physical activity and hip circumference. RESULTS: Hip circumference was inversely associated with mortality irrespective of being physically active or not. However, being physically active seemed to counterbalance some of the adverse health effects of a small hip circumference; when comparing inactive to active, the excess mortality at the 25th percentile of hip circumference is 40% in men (HR = 1.40, 95% CI: 1.14-1.72) and 33% in women (HR = 1.33, CI: 1.10-1.62). These associations were observed after adjustment for waist circumference and weight change in the 6 months before the examination. CONCLUSION: Less effects of physical activity were found in individuals with greater hip circumferences. A small hip circumference appears hazardous to survival. However, being physically active may counterbalance some of the hazardous effects of a small hip circumference.

Nonfasting cholesterol and triglycerides and association with risk of myocardial infarction and total mortality: the Copenhagen City Heart Study with 31 years of follow-up.

OBJECTIVES: We compared the ability of very high levels of nonfasting cholesterol and triglycerides to predict risk of myocardial infarction and total mortality. DESIGN: Prospective study from 1976 to 1978 until 2007. SETTING: Danish general population. PARTICIPANTS: Randomly selected population of 7581 women and 6391 men, of whom 768 and 1151 developed myocardial infarction and 4398 and 4416 died, respectively. Participation rate was 72%, and follow-up was 100% complete. Less than 2% of participants were taking lipid-lowering therapy. RESULTS: Compared to women with cholesterol <5 mmol L(-1) , multivariate-adjusted hazard ratios for myocardial infarction ranged from 1.3 [95% confidence interval (CI): 0.9-1.8] for a cholesterol level of 5.0-5.99 mmol L(-1) to 2.5 (95%CI: 1.6-4.0) for cholesterol ≥ 9 mmol L(-1) (trend: P < 0.0001). Compared with women with nonfasting triglycerides <1 mmol L(-1) , hazard ratios for myocardial infarction ranged from 1.5 (95%CI: 1.2-1.8) for triglycerides of 1.0-1.99 mmol L(-1) to 4.2 (95%CI: 2.5-7.2) for triglycerides ≥ 5 mmol L(-1) (p<0.0001). In men, corresponding hazard ratios ranged from 1.2 (95%CI: 1.0-1.5) to 5.3 (95%CI: 3.6-8.0) for cholesterol (P < 0.0001) and from 1.3 (95%CI: 1.0-1.6) to 2.1 (95%CI: 1.5-2.8) for triglycerides (P < 0.0001). Increasing cholesterol levels were not consistently associated with total mortality in women (trend: P = 0.39) or men (P = 0.02). By contrast, compared with women with triglycerides <1 mmol L(-1) , multivariate-adjusted hazard ratios for total mortality ranged from 1.1 (95%CI: 1.0-1.2) for triglycerides of 1.0-1.99 mmol L(-1) to 2.0 (95%CI: 1.5-2.9) for triglycerides ≥5 mmol L(-1) (trend: P < 0.0001); corresponding hazard ratios in men ranged from 1.1 (95%CI: 1.0-1.2) to 1.5 (95%CI: 1.2-1.7) (P < 0.0001). CONCLUSIONS: Stepwise increasing levels of nonfasting cholesterol and nonfasting triglycerides were similarly associated with stepwise increasing risk of myocardial infarction, with nonfasting triglycerides being the best predictor in women and nonfasting cholesterol the best predictor in men. Even more surprisingly, only increasing levels of nonfasting triglycerides were associated with total mortality, whereas increasing cholesterol levels were not.

Combined effects of weight loss and physical activity on all-cause mortality of overweight men and women.

OBJECTIVE: To estimate the excess deaths associated with weight loss in combination with leisure time physical activity among overweight or obese people. DESIGN: Prospective cohort study. SUBJECTS: In two consecutive examinations in 1976-1978 and 1981-1983, 11 135 people participated in the Copenhagen City Heart Study. Of these, 3078 overweight or obese participants lost weight or remained weight stable from 1976-1978 to 1981-1983, and were without pre-existing diagnosis of diabetes, stroke, ischaemic heart disease or cancer in 1981-1983. They were followed up until 2007 in the Danish Civil Registration System, with a <0.2% loss to follow-up only. MEASUREMENTS: The following measurements were taken: body mass index (BMI) and physical activity in 1976-1978 and 1981-1983 and hazard ratio (HR) of mortality during 53 976 person-years of follow-up. RESULTS: Of the initially overweight or obese subjects who either lost weight or remained weight stable, 2060 died. Overall, weight loss was associated with excess mortality when compared with weight stability. Weight loss was associated with a higher mortality among those who became physically inactive, compared with those who remained active while losing weight (men: HR 2.25, 95% confidence interval 1.31-3.84; women: 1.43, 1.07-1.91). However, losing weight while remaining physically active was still associated with excess mortality when compared with those who were weight stable and initially active (men: 1.72, 1.27-2.34; women: 1.57, 1.06-2.31). Among those who remained physically inactive, weight loss seemed associated with excess mortality when compared with weight loss among those who became active, although not statistically significant (men: 2.00, 0.94-4.29; women: 1.40, 0.82-2.39). Finally, weight loss among those who became physically active was not associated with excess mortality when compared with those who were weight stable and initially inactive (men: 1.12, 0.61-2.07; women: 1.19, 0.58-2.43). CONCLUSION: Weight loss among the overweight or obese seemed hazardous to survival. However, weight loss seemed less hazardous to survival among those who remained physically active or those who became active.

Perceived stress as a risk factor for changes in health behaviour and cardiac risk profile: a longitudinal study.

OBJECTIVE: The aim of this study was to evaluate the long-term effects of stress on changes in health behaviour and cardiac risk profile in men and women. DESIGN: A prospective cohort study. SETTING: The Copenhagen City Heart Study, Denmark. SUBJECTS: The analyses were based on 7066 women and men from the second (1981-1983) and third (1991-1993) wave of the Copenhagen City Heart Study. All participants were asked questions on stress and health behaviour and they had their weight, height, blood pressure and level of blood lipids measured by trained personnel. MAIN OUTCOME MEASURES: Changes in health behaviour (smoking, physical activity, alcohol consumption, overweight) and cardiac risk profile (cholesterol, HDL cholesterol, blood pressure, diabetes). RESULTS: Individuals with high levels of stress compared to those with low levels of stress were less likely to quit smoking (OR = 0.58; 95% CI: 0.41-0.83), more likely to become physically inactive (1.90; 1.41-2.55), less likely to stop drinking above the sensible drinking limits (0.43; 0.24-0.79), and stressed women were more likely to become overweight (1.55; 1.12-2.15) during follow-up. Men and women with high stress were more likely to use antihypertensive medication (1.94; 1.63-2.30), and stressed men were more than two times as likely to develop diabetes during follow-up (2.36; 1.22-4.59). CONCLUSION: This longitudinal study supports a causal relation between stress and cardiovascular diseases mediated through unfavourable changes in health behaviour and cardiac risk profile.

Physical activity in leisure-time is not associated with 10-year changes in waist circumference.

To examine whether physical activity (PA) is associated with changes in waist circumference (WC), and changes in WC given changes in body mass index (BMI). Longitudinal population-based study including 2026 men and 2782 women aged 21-81 years. Subjects were examined in 1991-1993 (baseline) and 2001-2003 (follow up), where height, weight and WC were measured. Information about overall PA in leisure-time (LTPA), walking, biking and sports activity was collected with self-administrated questionnaires at baseline. Outcomes were changes in WC and changes in WC given changes in BMI between baseline and follow up. The median increase in WC was 3.0 cm in men and 3.5 cm in women during follow-up, and with a considerable inter-individual variation. LTPA, walking and biking were not significantly associated with the outcomes. Inverse associations between sports activity and the outcomes were observed in both sexes, and these were significant in some analyses. Associations were not altered by adjustment for confounders or by exclusions of subjects with diseases and/or treatment by obesity-inducing medication. This study suggests that LTPA, walking and biking have no appreciable effects on changes in WC or changes in WC given changes in BMI, whereas sports activity may have small preventive effects.

Perceived stress and risk of colorectal cancer in men and women: a prospective cohort study.

OBJECTIVE: We aim to assess the relationship between stress and risk of primary colorectal cancer in men and women. DESIGN: A prospective cohort study. SETTING: The Copenhagen City Heart Study, Denmark. SUBJECTS: A total of 6488 women and 5426 men were included in the study. The participants were asked about intensity and frequency of stress at baseline in 1981-1983 and were followed until the end of 2000 in the Danish Cancer Registry. Less than 0.1% was lost to follow-up. MAIN OUTCOME MEASURES: First time incidence of primary colorectal cancer. RESULTS: During follow-up 162 women and 166 men were diagnosed with colorectal cancer. Women with moderate and high stress intensity had a hazard ratio of 0.60 (95% CI: 0.37-0.98) and 0.52 (0.23-1.14) for colorectal cancer, respectively, compared to women with no stress. For colon cancer, a one-unit increase on a seven-point stress-score was associated with an 11% lower incidence of the disease (HR = 0.89, 95% CI: 0.81-0.99) amongst women. There was no consistent evidence of an association between stress and colorectal cancer in men. CONCLUSION: Perceived stress was associated with lower risk of particularly colon cancer in women, whilst there was no clear relationship between stress and colorectal cancer in men.

Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study.

BACKGROUND: Information about the influence of regular physical activity on the course of chronic obstructive pulmonary disease (COPD) is scarce. A study was undertaken to examine the association between regular physical activity and both hospital admissions for COPD and all-cause and specific mortality in COPD subjects. METHODS: From a population-based sample recruited in Copenhagen in 1981-3 and 1991-4, 2386 individuals with COPD (according to lung function tests) were identified and followed until 2000. Self-reported regular physical activity at baseline was classified into four categories (very low, low, moderate, and high). Dates and causes of hospital admissions and mortality were obtained from Danish registers. Adjusted associations between physical activity and hospital admissions for COPD and mortality were obtained using negative binomial and Cox regression models, respectively. RESULTS: After adjustment for relevant confounders, subjects reporting low, moderate or high physical activity had a lower risk of hospital admission for COPD during the follow up period than those who reported very low physical activity (incidence rate ratio 0.72, 95% confidence interval (CI) 0.53 to 0.97). Low, moderate and high levels of regular physical activity were associated with an adjusted lower risk of all-cause mortality (hazard ratio (HR) 0.76, 95% CI 0.65 to 0.90) and respiratory mortality (HR 0.70, 95% CI 0.48 to 1.02). No effect modification was found for sex, age group, COPD severity, or a background of ischaemic heart disease. CONCLUSIONS: Subjects with COPD who perform some level of regular physical activity have a lower risk of both COPD admissions and mortality. The recommendation that COPD patients be encouraged to maintain or increase their levels of regular physical activity should be considered in future COPD guidelines, since it is likely to result in a relevant public health benefit.

Is the effect of alcohol on risk of stroke confined to highly stressed persons?

BACKGROUND: Psychological stress and alcohol are both suggested as risk factors for stroke. Further, there appears to be a close relation between stress and alcohol consumption. Several experimental studies have found alcohol consumption to reduce the immediate effects of stress in a laboratory setting. We aimed to examine whether the association between alcohol and stroke depends on level of self-reported stress in a large prospective cohort. METHODS: The 5,373 men and 6,723 women participating in the second examination of the Copenhagen City Heart Study in 1981-1983 were asked at baseline about their self-reported level of stress and their weekly alcohol consumption. The participants were followed-up until 31st of December 1997 during which 880 first ever stroke events occurred. Data were analysed by means of Cox regression modelling. RESULTS: At a high stress level, weekly total consumption of 1-14 units of alcohol compared with no consumption seemed associated with a lower risk of stroke (adjusted RR: 0.57, 95% CI: 0.31-1.07). At lower stress levels, no clear associations were observed. Regarding subtypes, self-reported stress appeared only to modify the association between alcohol intake and ischaemic stroke events. Regarding specific types of alcoholic beverages, self-reported stress only modified the associations for intake of beer and wine. CONCLUSIONS: This study indicates that the apparent lower risk of stroke associated with moderate alcohol consumption is confined to a group of highly stressed persons. It is suggested that alcohol consumption may play a role in reducing the risk of stroke by modifying the physiological or psychological stress response.

Stress and life dissatisfaction are inversely associated with jogging and other types of physical activity in leisure time--The Copenhagen City Heart Study.

The associations between physical activity in leisure time with special focus on jogging and the level of mental stress and life dissatisfaction were studied in 12 028 randomly selected men and women aged 20-79 years. The associations were similar in men and women; thus, results are given for pooled data. The odds ratios (ORs) are presented as adjusted for sex, age, body mass index, smoking, alcohol consumption, education and income. With increasing physical activity in leisure time, there was a decrease in high level of stress, between sedentary persons and joggers, OR=0.30 (95% confidence interval (CI) from 0.16 to 0.56). With increasing physical activity there was also a decrease in life dissatisfaction, between sedentary persons and joggers, OR=0.30 (95% CI from 0.18 to 0.52). Although there was a dose-response effect between physical activity and psychosocial well-being the most pronounced difference with regard to the level of stress and dissatisfaction was seen between the group with low and the group with moderate physical activity, e.g., 2-4 h of walking per week. In conclusion, we recommend that increased well-being should be a key argument in future campaigns for increased leisure-time physical activity.

Is the relationship between type of alcohol and mortality influenced by socio-economic status?

OBJECTIVES: To assess the impact of socio-economic status on the relationship between type of alcohol and all-cause mortality. DESIGN: A prospective population study. SETTING: The Copenhagen City Heart Study, Denmark. SUBJECTS: A total of 14,223 men and women participated in the first examination of The Copenhagen City Heart Study in 1976-1978. The participants were followed up until 18th of September 2001 during which 7208 persons died. The effect of beer, wine and spirits on mortality was stratified according to levels of education, income and cohabitation, and the association was examined after controlling for intake of the other types of alcohol, and for sex, smoking, physical activity and body mass index. MAIN OUTCOME MEASURES: Number and time of death from all causes. RESULTS: Consumers of wine were better educated and wealthier compared with beer and spirits drinkers. The association between type of beverage and mortality was noticed to differ according to socio-economic level, especially where the apparent protective effect of wine consumption tended to be strongest in the lower income and educational groups. CONCLUSIONS: This study finds the specific effects of beer, wine or spirits to moderately diverge in the socio-economic groups. Future studies addressing the association between the type of beverage and mortality may need to more thoroughly take socio-economic factors into account.

Longitudinal study of the long-term relation between physical activity and obesity in adults.

BACKGROUND: Earlier observational studies of the relation between physical activity and obesity are inconsistent and ambiguous, showing a clear cross-sectional inverse relation, and a prospective association only when physical activity at the time of follow-up is included. OBJECTIVE: To examine the long-term effect of leisure time physical activity (LTPA) on subsequent development of obesity and the effect of body weight on later physical inactivity in a population-based longitudinal setting taking into account the effects of historical changes on future changes as well as pertinent confounders. DESIGN: The study included 3653 women and 2626 men aged 20-78 y selected at random within sex-age strata from the general population of Copenhagen. At two surveys, 5 y apart, LTPA, body mass index (BMI) (weight/height2, kg/m2), several possible confounders and modifying factors were assessed. Obesity (defined as BMI > or =30 kg/m2) and LTPA was assessed at the 3rd survey 10 y later. Odds ratios (with 95% confidence limits) for developing obesity between the last two surveys were estimated by logistic regression analysis, taking into account baseline and preceding changes in BMI and LTPA. A similar analysis of odds ratios for physical inactivity as outcome at the 3rd survey was conducted. RESULTS: Compared to physical inactivity, the odds ratios of development of obesity among women with medium and high level of activity were 0.81 (0.53, 1.25) and 1.16 (0.73, 1.84), respectively, and among men, the odds ratios were 1.28 (0.71, 2.33) and 1.65 (0.91, 2.99), respectively. Compared to median BMI, the odds ratio of later physical inactivity among women with high BMI was 1.91 (1.39, 2.61), and among men the odds ratio was 1.50 (1.01, 2.22). The associations were not confounded or modified by age, pre-existing diseases, smoking, alcohol intake, educational level, occupational physical activity or by familial predisposition to obesity. CONCLUSION: This study did not support that physical inactivity as reported in the freely living adult population in the long term is associated with the development of obesity, but the study indicates that obesity may lead to physical inactivity.

Copenhagen City Heart Study: longitudinal analysis of ventilatory capacity in diabetic and nondiabetic adults.

The natural history of lung function in diabetes is unknown due to the lack of longitudinal observations. The decline of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was studied over 15 yrs in the 17,506 adult participants of The Copenhagen City Heart Study, which included 266 individuals with diabetes. Multiple linear regression and a mixed-effects model were used, taking into account correlation between repeated measurements and adjusting for relevant confounders. In both sexes, FEV1 and FVC were consistently lower in diabetic individuals, compared with healthy individuals, with an average reduction of approximately 8% of the predicted value. Longitudinal analyses showed that the decline of FEV1 and FVC in diabetic individuals was similar to that observed in nondiabetic subjects. It was concluded that although diabetic subjects have, on average, a lower forced expiratory volume in one second and forced vital capacity than individuals without diabetes, this deficit seems not to be progressive in the long term. These observations may be of importance with regard to diabetes treatment with inhaled pulmonary insulin, which is likely to become available within a few years.

Importance of light smoking and inhalation habits on risk of myocardial infarction and all cause mortality. A 22 year follow up of 12 149 men and women in The Copenhagen City Heart Study.

STUDY OBJECTIVE: To determine risk of myocardial infarction (MI) and all cause mortality associated with light smoking and inhalation habits in men and women. DESIGN: Prospective cohort study with follow up of MI and all cause mortality through record linkage. SETTING: The Copenhagen City Heart Study, a cardiovascular study based on a sample of the general population established in 1976. PARTICIPANTS: 6505 women and 5644 men followed up until 1998 for first MI and for death from all causes. MAIN RESULTS: During follow up 476 women and 872 men suffered a MI whereas 2305 women and 2883 men died. After adjusting for major cardiovascular risk factors there was a dose-response relation between smoking with and without inhaling and both MI and all cause mortality. Among inhaling smokers significantly increased risks were found in women at a consumption of only 3-5 grams of tobacco per day with relative risks (RR) of MI and all cause mortality of 2.14 (95% CI 1.11 to 4.13) and 1.86 (95% CI 1.37 to 2.51), respectively. In men increased risks were seen when smoking 6-9 grams per day with RR of MI and all cause mortality of 2.10 (95% CI 1.40 to 3.14) and 1.76 (95% CI 1.39 to 2.23), respectively. Risks were also increased in non-inhaling smokers, although in men only significantly so for all cause mortality. After adjusting for inhalation and quantity smoked, cigarette smokers had a higher risk of all cause mortality (RR 1.16 (95% CI 1.07 to 1.26)) but not of MI (RR 1.11 (95% CI 0.95 to 1.30)). The RR associated with smoking were significantly higher in women than in men for both MI and all cause mortality. CONCLUSIONS: Smoking as little as 3-5 grams of tobacco per day or not inhaling the smoke was shown to carry a significantly increased risk of developing MI and of all cause mortality with higher RR found in women than in men. The study emphasises the importance of recognising that even very limited tobacco consumption has detrimental health effects.

Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12 000 men and women from The Copenhagen City Heart Study.

AIMS: The importance of coronary heart disease risk factors may differ between individuals and community and by sex and age. METHODS AND RESULTS The Copenhagen City Heart Study followed for 21 years a random sample of 5599 men and 6478 women aged 30 to 79 years at baseline. The importance of risk factors in individuals and the community were evaluated as relative- and population-attributable risks. We traced 2180 coronary events. In Cox regression analysis with ten risk factors entered simultaneously, relative risks for coronary heart disease in men ranged from 1.69 to 1.20 with the highest risks for diabetes, hypertension, smoking, and physical inactivity. In women, relative risks ranged from 2.74 to 1.19 with the highest risks for diabetes, smoking, hypertension, and physical inactivity. Population-attributable risks in men ranged from 22% to 3% with the highest risks for smoking, hypertension, and no daily alcohol intake. In women, attributable risks ranged from 37% to 3% with the highest risks for smoking, hypertension, and hypercholesterolaemia. Several of these rankings differed by age. CONCLUSIONS: The importance of coronary heart disease risk factors may differ for individuals, the community, and by sex and age. Consequently, prevention strategies should be tailored accordingly.

Prevalence and prognosis of electrocardiographic left ventricular hypertrophy, ST segment depression and negative T-wave; the Copenhagen City Heart Study.

AIMS: To evaluate the prevalence and the independent prognosis of electrocardiographic left ventricular hypertrophy by voltage only, ST depression and negative T wave, isolated negative T wave and left ventricular hypertrophy plus ST depression and negative T wave for cardiac morbidity and mortality, without known ischaemic heart disease at baseline. METHODS AND RESULTS: Follow-up data from the Copenhagen City Heart Study were used. Subjects were 5243 men and 6391 women, age range 25-74 years. End-points were (1) myocardial infarction, (2) ischaemic heart disease and (3) cardiovascular disease mortality. Relative risk was age- and sex-adjusted, and multivariately adjusted for known cardiovascular risk factors. During 7 years follow-up, left ventricular hypertrophy plus ST depression and negative T wave had an age-adjusted relative risk of 3.78 (95% confidence interval 2.29-6.25) for myocardial infarction, 4.27 (2.95-6.16) for ischaemic heart disease and 3.75 (2.41-5.85) for cardiovascular disease. A negative T wave, ST depression and negative T wave changes, and left ventricular hypertrophy with negative T wave also carry independent prognostic information for myocardial infarction, ischaemic heart disease and cardiovascular disease. CONCLUSIONS: Electrocardiographic left ventricular hypertrophy with ST depression and negative T wave changes are the electrocardiographic abnormalities with the greatest prognostic information for future cardiac events. Electrocardiographic negative T waves, ST depression and negative T wave abnormalities and left ventricular hypertrophy with negative T waves, also have prognostic information.

[Joggers live longer]. / Motionslöpare lever längre.

In all 4,658 men, 20-79 years of age, with no prior myocardial infarction, attended two examinations. Jogging status was self-reported based on the question "Are you a jogger?" The study shows that regular jogging is not associated with increased mortality in men, as the joggers had significantly lower mortality than non-joggers. The lower mortality of joggers could be an effect of the physical training, but it could also be due to selection or a combination of both. On the other hand, numerous studies within the fields of epidemiology, work-physiology, psychology and biochemistry have all pointed toward a beneficial effect of physical activity on health, but the optimal intensity, frequency and duration of physical activity has yet to be established.

[Beer, wine, spirits and mortality]. / Øl, vin, spiritus og dØdelighed.

A population based cohort study investigates the association between alcohol intake and mortality from all causes, coronary heart disease and cancer. The design is prospective with baseline assessment of intake of beer, wine and spirits, smoking habits, educational level, physical activity, and body mass index and a total of 257,859 person-years follow-up on mortality. A total of 4,833 participants died, of these 1,075 from coronary heart disease and 1,552 of cancer. Compared with non-drinkers, light drinkers who avoided wine, had a relative risk of death from all causes of 0.90 (0.82-0.99) and those who drank wine had a relative risk of 0.66 (0.55-0.77). Heavy drinkers who avoided wine were at higher risk of death from all causes than were heavy drinkers who included wine in their alcohol intake. Wine drinkers had significantly lower mortality from both coronary heart disease and cancer than did non-wine drinkers (p = 0.007 and p = 0.004, respectively). In conclusion, wine intake may have a beneficial effect on all cause mortality that is additive to that of alcohol. This effect may be attributable to a reduction in death from both coronary heart disease and cancer.

[Beer, wine, spirits and mortality. Results from a prospective population study]. / Øl, vin, spiritus og dødelighed. Resultater fra Hovedstadens Center for Prospektive Befolkningsstudier.

INTRODUCTION: The aim of the present population-based cohort study was to examine the association between alcohol intake and mortality from all causes, coronary heart disease, and cancer. METHODS: A prospective population study with baseline assessment of beer, wine and spirit consumption, smoking habits, educational level, physical activity, and body mass index in a total of 257,859 person-years follow-up on mortality. RESULTS: A total of 4833 participants died, 1075 of these from coronary heart disease and 1552 of cancer. Compared with non-drinkers, light drinkers, who avoided wine, had a relative risk of death from all causes of 0.90 (0.82-0.99) and those who drank wine had a relative risk of 0.66 (0.55-0.77). Heavy drinkers, who avoided wine, were at higher risk of death from all causes than were heavy drinkers, who included wine in their alcohol consumption. Wine drinkers had a significantly lower mortality from both coronary heart disease and cancer than had non-wine drinkers (p = 0.007 and p = 0.004, respectively). CONCLUSION: A moderate consumption of wine may have a beneficial effect on all causes of mortality, which is additive to that of alcohol. This effect may be attributable to a reduction in death from both coronary heart disease and cancer.