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Wilhelmsen L, Svärdsudd K, Eriksson H, Rosengren A, Hansson P-O, Welin C, Odén A, Welin L (Sahlgrenska University Hospital/Östra, Sahlgrenska Academy, University of Gothenburg; Uppsala University, Uppsala; Chalmers University of Technology, Gothenburg; and Lidköping Hospital, Lidköping, Sweden). Factors associated with reaching 90 years of age: a study of men born in 1913 in Gothenburg, Sweden. J Intern Med 2011; : 441-451. Increasing numbers of people reach old age. We wanted to identify variables of importance for reaching 90 years old and determine how the predictive ability of these variables might change over time. All men in the city of Gothenburg born in 1913 on dates divisible by 3, which is on the 3rd, 6th, 9th etc., were included in the study. Thus, 973 men were invited, and 855 were examined in 1963 at age 50. Further examinations were made at age 54, 60 and 67. Anthropometric data, lifestyle and parental factors, blood pressure, lung function, X-ray of heart and lungs and maximum work performance were recorded. The area under the receiver operating characteristic curve was used to analyse the predictive capacity of a variable. A total of 111 men (13%) reached 90 years of age, men who reached 90 years were more likely at age 50 to be nonsmokers, consume less coffee, have higher socio-economic status and have low serum cholesterol levels than those who did not reach this age; however, at age 50 or 62, parents' survival was of no prognostic importance. Variables of greatest importance at higher ages were low blood pressure and measures related to good cardiorespiratory function. In multivariable analysis, including all examinations, being a nonsmoker, consuming small amounts of coffee, having high housing costs at age 50, good maximum working capacity and low serum cholesterol were related to a better chance of survival to age 90. Low levels of cardiovascular risk factors, high socio-economic status and good functional capacity, irrespective of parents' survival, characterize men destined to reach the age of 90. [ABSTRACT FROM AUTHOR]

. Johansson S, Wilhelmsen L, Welin C, Eriksson H, Welin L, Rosengren A. (Sahlgrenska University Hospital/Östra, Göteborg; AstraZeneca R&D, Mölndal; and Lidköping Hospital, Lidköping, Sweden) Obesity, smoking and secular trends in cardiovascular risk factors in middle-aged women: data from population studies in Göteborg from 1980 to 2003. J Intern Med 2010; 268: 594-603. Background. To study the trends in cardiovascular risk factors in middle-aged city-dwelling Swedish women from 1980 to 2003. Methods. Using cross-sectional population-based surveys, five random population samples of a total of 1915 women aged between 45 and 54 years, participating in the BEDA study in 1980, WHO MONICA studies in 1985, 1990 and 1995, and a study of 50-year-old women in 2003 were measured for the following parameters: anthropometry, serum cholesterol and triglyceride levels, smoking habits, blood pressure, physical activity and stress. Results. Over almost 25 years, middle-aged women gained on average 4.4 kg in weight, with a net increase in body mass index (BMI) from 24.7 to 25.6 kg m−2. The proportion of participants classified as obese (≥30 kg m−2) increased by 50% from 10.4% to 15.1%. Women who were smokers in 2003 did not have lower BMI values than nonsmokers. Mean serum cholesterol concentrations decreased markedly, whereas smoking habits did not significantly change. The prevalence of hypertension decreased by 8%, whereas that of diabetes remained stable at around 2%. Optimal risk factor status - no smoking, normotension and serum cholesterol <5 mmol l−1- was present in less than one in six women in 2003, and similar across BMI categories. Conclusion. The favourable decline in cholesterol levels and hypertension and the increase in leisure time physical activity were offset by an increase in obesity, triglyceride levels and experience of stress, with only a minority of participants (less than one in six) having an optimal level of risk factors with respect to smoking, serum cholesterol and hypertension in 2003. This applied also to overweight and obese women. In earlier cohorts, subjects with low BMI values were more often smokers, whereas the opposite is observed in recent cohorts. Thus, women who smoke no longer have the advantage of lower weight. [ABSTRACT FROM AUTHOR]

Objective. To study trends over 40 years in cardiovascular risk factors in normal weight, overweight and obese men, all aged 50 when examined. Design. Cross-sectional studies of five successive cohorts of men aged 50. Setting. City of Göteborg, Sweden. Subjects. Random population samples of altogether 3251 urban Swedish men born in 1913, 1923, 1933, 1943 and 1953. Main outcome measures. Anthropometry, cardiovascular risk factors, rates of nonsmoking, normotension and serum cholesterol <5 mmol L−1 over four decades. Results. Over 40 years, there was a net increase in body mass index (BMI) from 24.8 (SD = 3.2) to 26.4 (3.7) kg m−2 ( P < 0.0001), with an increase in the prevalence of obesity (BMI ≥ 30 kg m−2) from 6.0% in 1963 to 13.8% in 2003. Favourable trends with respect to smoking, blood pressure and serum cholesterol were observed similarly amongst normal weight, overweight and obese men. In 1963, 24% of obese men were normotensive compared to 45% in 2003, and 6% had serum cholesterol <5 mmol L−1 compared to 34% in 2003. Compared with obese men in 1963, men who were obese in 2003 had an odds ratio (OR) of 3.39 being a nonsmoker [95% confidence interval (CI): 1.56 to 7.36], 2.67 of being normotensive (1.23 to 5.83) and having serum cholesterol <5 mmol L−1 of 8.30 (2.37 to 29.0). However, optimal risk factor status – no smoking, normotension and total serum cholesterol <5 mmol L−1– was still present in less than one in six men in 2003, similar across BMI categories. Conclusions. Obese Swedish men who are now in their fifties have much lower levels of other risk factors compared with obese men 40 years ago. This could contribute to explain why coronary heart disease death rates still are falling despite increasing rates of obesity. [ABSTRACT FROM AUTHOR]

Aims. Coronary risk factor changes were related to attack rate of acute myocardial infarction (AMI). Methods and results. Cross-sectional population samples of 50-year-old men were examined every 10th year from 1963 to 2003. Attack rates of AMI were recorded from 1975 to 2004. Prevalence of smoking decreased from 56% in 1963 to 22% in 2003. Leisure time physical activity decreased (n.s.), while psychological stress remained the same. Diabetes prevalence increased from 3.6% to 6.6%. Body mass index (BMI) increased from 24.8 to 26.4 kg m−2. Blood pressures decreased from 138.2/90.6 to 134.7/84.9 mmHg ( P = 0.00001). Serum total cholesterol decreased from 6.42 to 5.50 mmol L−1 ( P = 0.0001), but serum triglycerides increased from 1.26 to 1.71 mmol L−1 ( P = 0.0001). The multivariable risk according to total cholesterol, blood pressure and smoking for AMI decreased from the set value 1.0 in 1963 to 0.418. From 1975–1979 to 2000–2004 attack rates for AMI for the age groups 35–44, 45–54 and 55–64 declined to 45%, 46% and 45%, respectively. The 28-day case fatality declined from 30%, 38% and 46% to 12%, 16% and 20%. Conclusion. The more than 50% decline in attack rate of AMI during 30 years was comparable with the decline in risk factors. [ABSTRACT FROM AUTHOR]

Abstract. Rosengren A, Eriksson H, Welin C, Welin L (Sahlgrenska University Hospital/Östra, Göteborg; and Lidköpng Hospital, Lidköping; Sweden). Serum lipids in fathers and sons at middle age: the study of sons to men born in 1913. J Intern Med 2003; 254: 126–131. Objective. To relate lipid levels in middle-aged men to that of their fathers at 50 years of age measured 30 years earlier. Design and subjects. In 1963, 855 men born in 1913 took part in a cardiovascular risk factor survey when they were at 50 years of age. In 1993, 475 sons to these men, aged 44–56, were invited to another examination; 263 of these men were examined (response rate: 56%) and compared with their 217 fathers when they were examined at 50 years of age in 1963. In the 1993 survey, 798 men aged 50, were also examined, from a general population sample of men born in 1943 (response rate: 55%). Setting. City of Göteborg, Sweden. Main outcome measures. Serum lipids in sons as a function of lipids in their fathers. Results. Compared with the men born in 1913, both sons and men born in 1943 had lower mean serum cholesterol, but higher body mass index (BMI) and serum triglycerides. There was a significant relation between serum cholesterol in sons and their fathers (r = 0.25; P < 0.0001). Amongst sons to fathers in the highest cholesterol quartile (>6.9 mmol L-1 ), 37% had serum cholesterol above 6.5 mmol L-1 , compared with 16% amongst sons to fathers in the lowest quartile (<5.7 mmol L-1 ) [adjusted odds ratio 3.73 (1.52–9.12)]. Sons to fathers with the highest serum cholesterol levels had slightly lower BMI; otherwise there was no relation between serum cholesterol in the father and any other lifestyle or biological risk factor in the sons. Serum triglyceride concentration in the father was unrelated to any variable in the son. Conclusions. There was a moderately strong association between serum cholesterol... [ABSTRACT FROM AUTHOR]

Abstract. Rosengren A, Eriksson H, Larsson B, Svärdsudd K, Tibblin G, Welin L, Wilhelmsen L (Sahlgrenska University Hospital/östra, Göteborg and Uppsala University, Uppsala, Sweden). Secular changes in cardiovascular risk factors over 30 years in Swedish men aged 50: The Study of Men Born in 1913, 1923, 1933 and 1943. J Intern Med 2000; 247: 111–118. Objectives. To study secular trends in cardiovascular risk factors in men aged 50 over a period of 30 years. Design. Cross-sectional studies of successive cohorts of men from 1963 to 1993. Setting. City of Göteborg, Sweden. Subjects. Four random population samples of men born in 1913, 1923, 1933 and 1943, aged 50 when they were examined in 1963, 1973, 1983, and 1993 (n = 855, 226, 776, and 798, respectively). Main outcome measures. Anthropometric measurements, blood pressure, serum cholesterol and triglycerides and smoking habits over three decades. Results. Over 30 years, men increased in weight from a mean (SD) of 75.9 (11.0) kg to 82.8 (12.1) kg and gained 3.4 cm in height, with a net increase in body mass index from 24.8 (3.2) to 26.0 (3.4) kg m–2 (P < 0.0001), and a concomitant increase in waist circumference. The proportion of men who were overweight but not obese (BMI = 25–30 kg m–2) increased from 38 to 47%, whereas the prevalence of frank obesity (more than 30 kg m–2) increased from 6% in 1963 to 11% in 1993. Despite the increase in weight, mean systolic blood pressure fell by almost 10 mmHg (P < 0.0001). Mean serum cholesterol concentration decreased from 6.42 (1.12) to 5.88 (1.04) (P < 0.0001). Serum triglycerides increased from 1.26 (0.77) to 1.69 (1.04) mmol L–1 (P = 0.001). The proportion of men who smoked decreased from 56% in 1963 to 30% in 1993 (P < 0.0001). This was due more to an increase in smoking cessation rates than to an increase in the proportion of men who had never smoked. In particular, smokers and former smokers are now more obese than the corresponding categories 30 years ago and smokers are no longer leaner than men who have never smoked. Conclusions. Over a period of 30 years, serum cholesterol as well as systolic blood pressure and the prevalence of smoking decreased. This favourable decline in coronary risk factors was offset by an appreciable increase in body mass index and waist circumference. [ABSTRACT FROM AUTHOR]

Background: Most studies of hereditary resistance to activated protein C (APC resistance) as a risk factor for venous thromboembolism are derived from case-control studies of hospitalized patients, whilst the importance of this condition in the general population has been only sparsely investigated.Objective: To study the prevalence of APC resistance and its relationship to morbidity and mortality in a general population sample of elderly men.Design: Cross-sectional and prospective follow-up study.Setting: General community: The Study of Men Born in 1913.Subjects: A random population sample of 404 men, all 75 years of age.Main Outcome Measures: Four hundred and four men participated in a screening examination in 1988. The APC ratio was analysed in 382 of them. All the men were followed up for 5 years. Medical records were reviewed for all the men with a history of deep vein thrombosis, pulmonary embolism, myocardial infarction or stroke.Results: Twenty-five men (6.5%) were found to have APC resistance. The incidence of venous thromboembolism, myocardial infarction or stroke did not differ between men with or without APC resistance, either retrospectively or during follow-up. Only two men experienced a deep vein thrombosis before the age of 80 and there was no case of pulmonary embolism. Mortality during 5 years of follow-up did not differ between men with and without APC resistance.Conclusion: The prevalence of APC resistance was 6.5% in this study of Swedish men. Although the size of the population sample is somewhat small, the study shows that, amongst elderly men, the association between APC resistance and venous thromboembolic disease was weak and men with this hereditary condition did not have any increase in morbidity or mortality compared with men without APC resistance. [ABSTRACT FROM AUTHOR]

Objectives: Most previous studies of incidence rates of stroke are from register studies, while data from prospective cohort studies are limited. The aim of the present study was to describe hazard rates, prevalence and cumulative proportion free from stroke during a lifelong follow-up of a representative sample of middle-aged men sampled from the general population., Methods: A population-based sample of 855 men, all born in 1913, was investigated at 50 years of age and followed up with repeated medical examinations at age 54, 60, 67, 75 and 80. Data from hospital records and the Cause of Death Register were collected, and all stroke events during 48 years of follow-up were registered. Medical records were scrutinized in order to confirm and validate the stroke diagnoses., Results: One man was excluded because of stroke prior to baseline, while 176 of the remaining 854 men (20.7%) suffered a first-ever stroke during follow-up. The total 5-year stroke risk (hazard rate) increased with age, from 3.54 (95% CI: 0-7.55) per 1000 persons at risk at age 50 years, to 119.05 (95% CI: 45.39-192.70) at age 90 years. The stroke prevalence peaked at age 80 and older, with about 120 cases per 1000 years of observation. The survival rate (cumulative proportion free from stroke) at age 98 was 50.0%., Conclusion: One out of five men in this population sample suffered a stroke of any type during follow-up from 50 to 98 years of age and the cumulative incidence was close to 50%., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Despite a decline in mortality rates from cardiovascular disease (CVD) in the past few decades, the burden of CVD in a contemporary population remains inadequately addressed. Therefore, this study was aimed to investigate secular trends in mortality from coronary artery disease and all-cause mortality over 2 decades, by comparing 2 cohorts of men born 30 years apart and evaluate the prediction of the risk of CVD and all-cause death in a contemporary random sample of Swedish men., Methods and Results: Two cohorts of randomly selected men born in 1913 (855 men) and 1943 (798 men) were first examined at age 50 in 1963 and 1993, respectively, and followed longitudinally over 21 years. All-cause mortality and coronary artery disease death were lower in 50- to 71-year-old men born in 1943 compared with those born in 1913, with unadjusted hazard ratios of 0.57 (0.45-0.71) and 0.34 (0.22-0.53), respectively. After adjustment for risk factors (smoking, serum cholesterol, hypertension, systolic blood pressure, diabetes mellitus, body mass index, and physical activity), the differences between the cohorts remained significant for coronary artery disease, hazard ratios 0.57 (0.34-0.94), P =0.029, but not for all-cause mortality hazard ratios 0.82 (0.62-1.07), P =0.14. However, the rate of CVD events during follow-up was still high (30.7%) for the men born in 1943. No statistically significant interaction by birth cohort in contribution of risk factors to death was found between 2 cohorts except physical inactivity., Conclusions: Despite a marked reduction in the rate of coronary artery disease death over the past 30 years, the burden of CVD events and all-cause mortality remains high. Therefore, intensified efforts to modify contributing risk factors are still required., (© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)