Trends in risk factors for coronary heart disease in the Netherlands.

BACKGROUND: Favourable trends in risk factor levels in the general population may partly explain the decline in coronary heart disease (CHD) morbidity and mortality. Our aim was to present long-term national trends in established risk factors for CHD. METHODS: Data were obtained from five data sources including several large scale population based surveys, cohort studies and general practitioner registers between 1988 and 2012. We applied linear regression models to age-standardized time trends to test for statistical significant trends. Analyses were stratified by sex and age (younger <65 and older ≥65 years adults). RESULTS: The results demonstrated favourable trends in smoking (except in older women) and physical activity (except in older men). Unfavourable trends were found for body mass index (BMI) and diabetes mellitus prevalence. Although systolic blood pressure (SBP) and total cholesterol trends were favourable for older persons, SBP and total cholesterol remained stable in younger persons. CONCLUSIONS: Four out of six risk factors for CHD showed a favourable or stable trend. The rise in diabetes mellitus and BMI is worrying with respect to CHD morbidity and mortality.

Genetic variation in TIMP1 but not MMPs predict excess FEV1 decline in two general population-based cohorts.

BACKGROUND: An imbalance in matrix metalloproteases (MMPs) and tissue inhibitors of MMPs (TIMPs) contributes to chronic obstructive pulmonary disease (COPD) development. Longitudinal studies investigating Single Nucleotide Polymorphisms (SNPs) in MMPs and TIMPs with respect to COPD development and lung function decline in the general population are lacking. METHODS: We genotyped SNPs in MMP1 (G-1607GG), MMP2 (-1306 C/T), MMP9 (3 tagging SNPs), MMP12 (A-82G and Asn357Ser) and TIMP1 (Phe124Phe and Ile158Ile) in 1390 Caucasians with multiple FEV1 measurements from a prospective cohort study in the general population. FEV1 decline was analyzed using linear mixed effect models adjusted for confounders. Analyses of the X-chromosomal TIMP1 gene were stratified according to sex. All significant associations were repeated in an independent general population cohort (n=1152). RESULTS: MMP2 -1306 TT genotype carriers had excess FEV1 decline (-4.0 ml/yr, p=0.03) compared to wild type carriers. TIMP1 Ile158Ile predicted significant excess FEV1 decline in both males and females. TIMP1 Phe124Phe predicted significant excess FEV1 decline in males only, which was replicated (p=0.10) in the second cohort. The MMP2 and TIMP1 Ile158Ile associations were not replicated. Although power was limited, we did not find associations with COPD development. CONCLUSIONS: We for the first time show that TIMP1 Phe124Phe contributes to excess FEV1 decline in two independent prospective cohorts, albeit not quite reaching conventional statistical significance in the replication cohort. SNPs in MMPs evidently do not contribute to FEV1 decline in the general population.

The prevalence of subclinical hypothyroidism at different total plasma cholesterol levels in middle aged men and women: a need for case-finding?

OBJECTIVE: In order to determine whether screening of thyroid function is justified in patients with hypercholesterolaemia, we determined the prevalence of subclinical hypothyroidism at different levels of total plasma cholesterol in middle-aged men and women. DESIGN AND METHODS: 1200 participants were selected from a population based cross sectional study on risk factors for cardiovascular diseases. The participants were divided into three groups: total plasma cholesterol < 5 mmol/l, total plasma cholesterol 5-8 mmol/l, total plasma cholesterol > 8 mmol/l. Each group was comparable in size and sex distribution. Subclinical hypothyroidism was defined as plasma TSH levels higher than 4 mU/l, in the presence of normal free thyroxine (FT4(4)) concentration. RESULTS: Plasma samples of a total of 1191 participants were analyzed. The overall prevalence of subclinical hypothyroidism was 1.9% in men and 7.6% in women of middle age. In women the prevalence of subclinical hypothyroidism increased from 4.0 percent in the lowest, to 10.3 percent in the highest cholesterol stratum (P = 0.02). In men, the mean prevalence was 1.8 percent and roughly similar in the various strata. After age correction, an increase of 1 mU/l TSH in women was associated with an increase of 0.09 mmol/l total plasma cholesterol (95% confidence interval (CI) 0.02-0.16 mmol/l). A similar trend was found in men (0.16 mmol/l, 95% CI -0.02-0.34 mmol/l). CONCLUSIONS: In the population, the prevalence of subclinical hypothyroidism is up to 10 percent in middle aged women with high levels of total plasma cholesterol and may justify case-finding. In these women approximately 0.5 mmol/l of total plasma cholesterol can be attributed to the subclinical thyroid dysfunction. In men a similar correlation between thyroid dysfunction and total plasma cholesterol is seen, but the prevalence of thyroid dysfunction is considerably lower.

Perception of weight status and dieting behaviour in Dutch men and women.

OBJECTIVE: To study the perception of weight status, the accuracy of self-assessment of weight status and weight control practices relative to the degree of adiposity in Dutch men and women. DESIGN: A cross-sectional study. SUBJECTS: 2155 men and 2446 women, aged 20-65y, of mostly caucasian origin, non-diabetic, not pregnant or with cancer. MEASUREMENTS: Body weight, height, waist and hip, total cholesterol, high density lipoprotein (HDL) cholesterol, blood pressure, self-administered questionnaire (including questions concerning demographic variables), weight loss practices, dietary intake, participation in sport as part of Dutch Monitoring Project on Risk Factors for Chronic Diseases (MORGEN). RESULTS: In the study population, 53% of men and 39% of women were overweight or obese. An association was shown between degree of adiposity and participation in sport for both men and women, and dietary fat intake in men. Of the subjects studied 56% of men and 52% of women described their weight as appropriate. A degree of inaccuracy in the estimation of relative body weight was observed. While dieting was prevalent, particularly among women, there was a lack of weight control action on the part of many overweight or obese individuals. This effect was most marked in men. Body Mass Index (BMI) was the strongest determinant of weight perception and dieting behaviours with some effect of educational level in men. Physical activity was not widely used as a method of weight control. CONCLUSION: These results point to a need for regular assessment of an individual's relative weight and health risk, gender specific obesity treatments and prevention strategies, and an emphasis in treatment and prevention of obesity on physical activity.

Trend in serum total cholesterol level in 110,000 young adults in The Netherlands, 1974 to 1986.

Data from two screening projects on cardiovascular risk factors were used to analyze the trend in serum total cholesterol level in the Netherlands between 1974 and 1986. Cholesterol levels were measured in a single reference laboratory of the World Health Organization throughout the entire study period. Between 1974 and 1980, about 30,000 men and women aged 37 to 43 years (mean age, approximately 40 years) were screened. A decrease in mean serum total cholesterol level was observed until the end of 1977, when it was followed by an increase. This resulted in a net change over the entire study period of -0.07 mmol/liter (3 mg/dl) in men and -0.03 mmol/liter (1 mg/dl) in women. Between 1981 and 1986, about 80,000 men aged 33 to 37 years (mean age, 35 years) were screened. During this period, a decrease of 0.20 mmol/liter (8 mg/dl) in the mean total cholesterol level was observed. In spite of the decline in the mean total cholesterol level, the prevalence of cholesterol values of greater than or equal to 6.5 mmol/liter (greater than or equal to 251 mg/dl) in young adult men was still high in 1986 (16 percent). A further reduction is therefore desirable. The decline in the mean total cholesterol level in young adults might indicate that a further decline in mortality from coronary heart disease can be expected.

Trends in obesity in young adults in The Netherlands from 1974 to 1986.

Data from two screening projects on cardiovascular risk factors were used to investigate trends in body mass index (BMI; weight(kg)/height(m)2) and in the prevalence of obesity in The Netherlands between 1974 and 1986. In the period 1974-80 about 30,000 men and women aged 37-43, with a mean age of 40, were screened. In the period 1981-6 about 80,000 men aged 33-37, with a mean age of 35, were examined. In men, an increase in mean BMI of about 0.5 kg/m2 was observed between 1974 and 1980, which was reflected in an increase in the prevalence of a BMI between 27 and 30 kg/m2 of about 4 percentage points. In the period 1981-6, no change in mean BMI was observed in men, although there was a slight decrease in the percentage of men with a BMI between 25 and 27 kg/m2 (about 2 percentage points). In women, no change in mean BMI or in the prevalence of different grades of obesity was observed in the period 1974-80. The prevalence of grade I obesity (BMI 25-29.9 kg/m2) was 40-45 per cent in men aged 40 and 25-30 per cent in women aged 40 in the period 1974-1980. The prevalence of grade II obesity (BMI greater than or equal to 30 kg/m2) during that period was 5-6 per cent in men and 7-8 per cent in women. The prevalence of grade I and grade II obesity in men aged 35 was 35-40 per cent and 5-6 per cent respectively during the period 1981-6. The prevalence of grade II obesity in The Netherlands is comparable with that in some other Western European countries, but much lower than in the United States and Canada.