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A number of 2203 middle-aged Icelandic men (aged 34–61 years) participated in a health survey in Reykjavik in 1967-68. Blood glucose in the fasting state and during an oral glucose tolerance test (OGTT) showed a unimodal distribution with a slight skewness towards higher values. A positive age gradient was established, which showed an increment of about 7 mg/dl per decade in capillary blood sugar values at 1 ½ hours after a 50 g oral glucose load. The age gradient was mostly independent of age-related changes in body weight. A 7 ½-year follow-up of the eligible participants (response rate >80%) showed an overall 1% incidence of metabolic deterioration to “overt diabetes” during this period. Those with positive screening tests (50 g OGTT) at baseline were at greater risk of developing diabetes, but the incidence of deterioration in this group was low, about 1% per year. The progression to diabetes was significantly related to body weight at baseline, suggesting that weight reduction might be beneficial in individuals showing impaired glucose tolerance at medical examination. This study, however, lends support to recent reports showing that mildly impaired glucose tolerance cannot be equated with early diabetes.

The participants in a community health survey in the Reykjavik area answered the question whether a first-degree relative had had myocardial infarction (MI), hypertension (HT) or cerebral stroke. The mean total serum cholesterol level was 5-10 mg/dl higher in the group with a positive history of MI than in the negative group. The frequency of hyperlipidaemia and the levels of other risk factors measured (blood pressure and body mass index) were similar in both groups. The group with a positive family history (FH) of HT had a mean systolic blood pressure 6-8 mmHg higher and diastolic hypertension (greater than 105 mmHg) on a single measurement twice as frequently as the negative group. The mean systolic blood pressure in the group with positive FH of stroke was 8-10 mmHg higher than in the negative group. The study thus suggests that positive FH of HT or stroke among first-degree relatives is a worthy indication for blood pressure measurements, at least after the age of 40.

Several studies have explored a possible association between migraine and hyper- tension, with contradictory results. Because of this uncertainty the relation between blood pressure (BP) and migraine was studied in 10 366 men and 11 171 women in a population-based longitudinal study. A modified version of the 1988 International Headache Society criteria was used for diagnosis of migraine. Logistic regression analysis was used. The crude 1-year prevalence of migraine was 5.2% among men and 14.1% among women. No significant association was found between hypertension and migraine. For a one standard deviation (SD) increase in diastolic BP the probability of having migraine increased 14% ( P = 0.11) for men and 30% ( P < 0.0001) for women. For a 1-SD increase in systolic BP the probability of having migraine decreased 19% ( P = 0.007) for men and 25% ( P < 0.0001) for women. It was also found that for a 1-SD increase in pulse pressure the probability of having migraine decreased 13% ( P = 0.005) for men and 14% ( P < 0.0001) for women. In a population-based study of men and women it was found that subjects with migraine had lower pulse pressure, lower systolic BP and higher diastolic BP compared with controls.

BackgroundTo do a gender comparison of absolute risk of recurrent myocardial infarction (MI).DesignRegistration of all first and second MI amongst Icelandic males and females 1981–1999.MethodsThe whole of Icelandic population, 40–74 years of age.ResultsThe mean recurrence rate (second attack) for men was 45.7/1000 MI survivors/year and for women 39.0/1000 per year. The male/female (M/F) ratio was 1.17, 95% confidence interval 1.00–1.37, P = 0.05 and did not change significantly with age. The M/F ratio for first MI in comparison was two to seven, lowest in the oldest group. The recurrence rate decreased significantly and similarly in both sexes during the observation period.ConclusionThe absolute risk of MI is closely similar amongst both sexes and has decreased similarly suggesting that the same kind of secondary intervention is effective amongst both sexes in a general population. Eur J Cardiovasc Prevention Rehab 11:121–124 © 2004 The European Society of Cardiology.

The relation between erythrocyte sedimentation rate (ESR) and risk of developing coronary heart disease (CHD) or fatal cerebrovascular accident was assessed in a cohort of 7,988 men and 8,685 women who participated in The Reykjavik Study (Iceland). Cardiovascular risk assessment was based on characteristics at baseline, from 1967 to 1996. During an average follow-up of 19 and 20 years, 2,092 men and 801 women, respectively, developed CHD, and 251 men and 178 women died from cerebrovascular accident. For men, the fully adjusted increase in risk of developing CHD predicted by the top compared with the bottom quintile of ESR was 57% (hazard ratio = 1.57, 95% confidence interval: 1.38, 1.78; p < 0.001); for women, risk was increased by 49% (hazard ratio = 1.49, 95% confidence interval: 1.16, 1.90; p < 0.001). The increased risk after baseline ESR measurement was stable for up to 25 years for men and 20 years for women. The fully adjusted risk of death due to stroke predicted by increasing the ln(ESR + 1) by one standard deviation was increased by 15% for men (p = 0.06) and 16% for women (p = 0.08). In conclusion, ESR is a long-term independent predictor of CHD in both men and women. These findings support the evidence of an inflammatory process in atherosclerosis.

Thrainsdottir IS, Hardarson Th, Thorgeirsson G, Sigvaldason H, Sigfusson N (National University Hospital, Reykjavik, Iceland). Survival and trends of occurrence of left ventricular hypertrophy, gender differences, 1967–92: The Reykjavik Study. J Intern Med 2003; 253: 418–424. Objective. We estimated the prevalence, incidence and risk factors of left ventricular hypertrophy (LVH) in a prospective cohort study of 26 489 participants. Material and methods. The LVH was defined as Minnesota Code 310 on electrocardiogram (ECG). Everyone with this code at first visit was defined as a prevalence case and those who developed it between subsequent visits were incidence cases. The comparison cohort were all other participants in the Reykjavik Study stages I–V. Results. A total of 297 men and 49 women were found to have LVH of 3.2% and 0.5%, respectively. The incidence was 25 per 1000 per year amongst men and six per 1000 per year amongst women. Prevalence in both genders increased with increasing age. Risk factors at the time of diagnosis were systolic blood pressure [odds ratio (OR) per mmHg 1.02; 95% confidence interval (CI): 1.01–1.03], age (OR per year 1.04; 95% CI: 1.02–1.05), silent myocardial infarction (MI) (OR 3.18; 95% CI: 1.39–7.27) and ST-T changes (OR 3.06; 95% CI: 2.14–4.38) amongst men and systolic blood pressure and age for women with similar odds ratio. Predictive factors for acquiring LVH were systolic blood pressure [incidence ratio (IR) 1.01; 95% CI: 1.01–1.02] and angina with ECG changes (IR 2.33; 95% CI: 1.08–5.02) amongst men and systolic blood pressure amongst women (IR 1.03; 95% CI: 1.01–1.04). The risk for coronary mortality was significantly increased amongst women with hypertrophy [hazard ratio (HR) 3.07; 95% CI: 1.5–6.31] and their total survival was poorer with increasing time from diagnosis of LVH (HR 2.17; 95% CI: 1.36–3.48). Conclusions. We conclude that the presence of LVH and its appearance is associated with age and increased blood pressure amongst both genders. Women with LVH have poorer survival than other women and they are at threefold risk of dying of ischaemic heart disease.

Background: The prevalence of end-stage renal disease (ESRD) is lower in Europe than in the United States. The purpose of this study was to examine whether this difference results from a lower prevalence or slower progression of chronic renal failure (CRF) in a European cohort. Methods: We studied 18,912 subjects (9,773 women, 9,139 men) aged 33 to 81 years who participated in the Reykjavik Study between 1967 and 1991. Subjects with serum creatinine (SCr) levels of 1.7 mg/dL (150 μmol/L) or greater were considered to have CRF. We determined the crude prevalence of CRF, as well as age-standardized prevalence for 5-year age groups, in individuals aged 30 to 79 years. Progression of CRF was defined as a decrease in estimated glomerular filtration rate greater than 1 mL/min/1.73 m 2 /y. Results: Of 49 individuals who had an SCr of 1.7 mg/dL (150 μmol/L) or greater at entry, 41 individuals (26 men, 15 women) had a persistent elevation in SCr levels. Thirty-four individuals had mild CRF (SCr, 1.7 to 2.8 mg/dL [150 to 250 μmol/L]), 6 individuals had moderate CRF (SCr, 2.8 to 5.6 mg/dL [250 to 500 μmol/L]), and 1 individual had ESRD. The crude prevalence of CRF was 0.22% (220/100,000); 0.15% among women and 0.28% among men. The age-standardized prevalence was 0.23% (95% confidence interval [CI], 0.04 to 0.42) for women and 0.42% (95% CI, 0.18 to 0.66) for men. Eighty-five percent of patients with CRF were 50 years or older. Twenty-seven subjects had progressive renal failure, 17 of whom progressed to ESRD during a median of 7 years (range, 3 to 21 years). Conclusion: The prevalence of CRF is markedly lower in Iceland than in the United States. Furthermore, 27% of subjects did not show progression of their renal failure. These factors may explain in part the difference in ESRD prevalence between European countries and the United States. Am J Kidney Dis 40:955-963. © 2002 by the National Kidney Foundation, Inc.

Studies on coronary risk factors in men and women are mainly based on mortality data and few compare results of both sexes with consistent study design and diagnostic criteria. This study assesses the major risk factors for coronary events in men and women from the Reykjavik Study.Within a prospective, population-based cohort study individuals without history of myocardial infarction were identified and the relative risk of baseline variables was assessed in relation to verified myocardial infarction or coronary death during follow-up.Of the 9681 women and 8888 men who attended risk assessment from 1967-1991, with follow-up period of up to 28 years, 706 women and 1700 men suffered a non-fatal myocardial infarction or coronary death.Serum cholesterol was a significant risk factor for both sexes, with hazard ratios (HR) decreasing with age. Systolic blood pressure was a stronger risk factor for women as was ECG-confirmed left ventricular hypertrophy (women HR 2.89, 95% confidence interval [CI] 1.67-5.01; men HR 1.11 [CI 0.86-1.43]). Fasting blood glucoseor =6.7 mmol/L identified significantly higher risk for women (HR 2.65) than men (HR 2.08) as did self-reported diabetes. Triglyceride risk was significantly higher for women and decreased significantly with age. Smoking increased risk two- to five-fold, increasing with dose, for women, which was significantly higher than the doubling in risk for men.This large study of the major risk factors compared between the sexes demonstrates similar relative risk of myocardial infarction associated with cholesterol for both sexes, however, the relative risk is higher in women for many other risk factors such as smoking, diabetes, elevated triglycerides and left ventricular hypertrophy.

To analyse to what extent the recent decline in coronary heart disease mortality in Iceland is due to changes in incidence, recurrence and case fatality rates.A countrywide registration of myocardial infarction (MI) in people aged 25-74 was performed in Iceland during 1981-1999 according to the MONICA protocol. Possible cases were found by review of all hospital discharge records, autopsy records and death certificates.MI death rate declined by 63% in males and 51% in females, most in the youngest age groups in men (86%) and least in the oldest (49%). In women there was not a significant difference in age groups. Overall the age-adjusted reduction in MI death rate was 55.4% in both sexes combined; of this 23.1% was due to incidence reduction, 22.8% to recurrence reduction and 11.6% to case fatality reduction. In the youngest age groups the decline in incidence contributed most to the decline in MI death rate (62% in men and 71% in women), but thereafter the decline in case fatality in men. In the older age groups decline in recurrence rate has greater weight.The recent decline in MI mortality under the age of 75 years in Iceland is due to reduction in incidence and recurrence rate by about 40% each and to reduction in case fatality by 20%.

The aim of the present study was to evaluate the mortality rate and causes of death of individuals with Dupuytren's disease. In 1981/82, as part of The Reykjavik Study, a general health survey, 1297 males were examined for clinical signs of Dupuytren's disease. Based on the clinical evaluation the participants were classified into three groups: (1) those with no signs of Dupuytren's disease were referred to as the reference cohort; (2) those with palpable nodules in the palmar fascia were classified as having stage 1; and (3) those who had contracted fingers or had been operated on due to contractures were classified as having stage 2 of Dupuytren's disease. In 1997, after a 15- year follow-up period, the mortality rate and causes of death were investigated in relation to the clinical findings from 1981/82. Information about causes of death were obtained from the National Icelandic Death Registry and the Icelandic Cancer Registry. During the follow-up period, 21.5% (225/1048) of the reference cohort were deceased compared to 29.9% (55/184) of those with stage 1 and 47.7% (31/65) of those with stage 2 of Dupuytren's disease. When adjusted for age, smoking habits and other possible confounders, individuals with stage 2 of the disease showed increased total mortality [hazard ratio (HR) = 1.6; 95% CI 1.1-2.4]. Cancer deaths were increased (HR = 1.9; CI 1.0-3.6). In contrast, participants with stage 1 of Dupuytren's disease did not show increased mortality. A moderate but non-significant increase in cancer incidence was observed among individuals with stage 2 of Dupuytren's disease (HR = 1.5; 95% CI 0.9-2.4, P = 0.15). The study showed increased total mortality of individuals with Dupuytren's disease stage 2, where 42% of the excess in mortality could be attributed to cancer deaths.

Dupuytren's disease or palmar fibromatosis is a common disabling hand disorder, mainly confined to Caucasians of northwestern European origin. The prevalence of Dupuytren's disease and possible risk factors related to the disease were evaluated in a random sample of 1297 males and 868 females, aged 46 to 74 years. Blood samples were collected and biochemical parameters were evaluated. The possible relation between the disease and clinical, social, and biochemical parameters were estimated with age-adjusted univariate logistic regression analysis. Altogether 19.2% of the males and 4.4% of the female participants had clinical signs of Dupuytren's disease. The prevalence increased with age, from 7.2% among males in the age group 45-49 years up to 39.5% in those 70-74 years old. The more severe form of the disease, finger contractures, was found in 5.0% of the men and 1.4% had required operation, while this was rarely seen among women. In men elevated fasting blood glucose (P < 0.04), low body weight, and body mass index were significantly correlated with the presence of the disease (P < 0.001). Dupuytren's disease was common among heavy smokers (P = 0.02) and those having manual labor as occupation (P = 0.018). These results show that Dupuytren's disease is common in the Icelandic population and occupation and lifestyle seem to be related to the disease.

Levels of serum lipids and lipoproteins, and the fatty acid composition of plasma phospholipids, were measured in two genetically comparable, but widely separated, populations. The 1975 mortality rates for ischemic heart disease were significantly higher in one of these populations, the Manitoban residents of pure Icelandic descent, than in the other, a rural population from Northeastern Iceland. Two study populations, Icelanders and Icelandic-Canadians, were drawn from these larger populations. The study populations were matched for age and sex and divided into three age groups, 20-39, 40-59, and 60-69 years. In comparison to the Icelandic-Canadians, the Icelanders exhibited significantly higher levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, but lower triglyceride levels. Their plasma phospholipids contained significantly lower levels of saturated fatty acids (SFA), monounsaturated fatty acids, and n-6 polyunsaturated fatty acids (PUFA); but their n-3 PUFA levels were three times as high. It was additionally found that fatty acid composition of plasma phospholipids differed among Icelanders of different ages. SFA levels were significantly lower, and n-6 PUFA levels significantly higher, in the 20-39 year group than in the 60-69 year group, possibly due to different dietary fat consumption patterns between generations. No corresponding age-related difference in the fatty acid composition of plasma phospholipids was found in the Icelandic-Canadian study population. As the Icelandic and Icelandic-Canadian groups are assumed to be genetically similar, the biochemical differences between them are evidently due to environmental, probably dietary, differences. The findings indicate that n-3 PUFA may be cardioprotective in the context of an otherwise atherogenic diet.

Objective : To investigate the relationship between fasting and postprandial glucose levels and the risk of hypertension, both cross-sectionally in different age and body mass index (BMI) groups, and prospectively. Design : Long-term prospective health survey in the Reykjavik area, of a large representative population sample of males and females in various age groups, conducted since 1967. Methods : Values from 8285 males and 9183 females were included in the cross-sectional analysis. The prospective analysis included 2639 males and 2346 females, with two consecutive observations for each individual, with a 3- to 8-year interval. Results : After controlling for year of examination, age, BMI and various other risk factors, we found a strongly significant relationship between the blood glucose level, both fasting and 90min after an oral glucose load, and risk for hypertension. The strength of the correlation between postprandial glucose value and blood pressure was similar in different age and BMI groups, except for in the males, in whom there was a stronger correlation with diastolic blood pressure with higher BMI. The 90-min glucose level was also predictive for development of hypertension 3-8 years later. The predictive power was somewhat stronger for females. Fasting glucose level was predictive for hypertension only for the females. Concurrent weight gain had a very strong independent explanatory power for development of hypertension. Conclusions : This study confirms the role of metabolic factors in hypertension. The correlation between impaired glucose tolerance and hypertension was found to be remarkably consistent throughout adult life, for both sexes and all values of BMI. Fasting glucose was predictive of hypertension in the females, and blood glucose at 90 min after the glucose-tolerance test was predictive of future development of hypertension in both sexes.

Evidence about the influence of hypertension in pregnancy on later health and in particular the risk of cardiovascular disorders is conflicting, although a link has been suggested. In a population-based study with a long follow-up time the potential association between hypertension in pregnancy, preeclampsia and eclampsia with increased death rates from ischemic heart disease (IHD) was investigated.All 7543 case records at the main maternity hospital in Iceland during 1931-1947 were reviewed to identify women with hypertension in pregnancy, subdivided by parity and severity of disease into those with eclampsia, preeclampsia and hypertension alone. Information on those who had died was obtained from death certificates, supplemented by autopsy reports and hospital records. Death rates from IHD were compared to population data from public health and census reports during corresponding periods and between study groups.Of 374 hypertensive women 177 had died. The death rate was slightly higher among women with any hypertension in pregnancy than in the reference population (RR = 1.20; 95% CI 1.01-1.42). About half of the increase was attributed to excess mortality from IHD with a relative risk of dying of 1.47 (95% CI 1.05-2.02). The relative risk of dying from IHD was significantly higher among eclamptic women (RR = 2.61; 95% CI 1.11-6.12) and those with preeclampsia (RR = 1.90; 95% CI 1.02-3.52) than those with hypertension alone. Parous women at the index pregnancy had a twofold higher risk of dying from IHD than primigravid women (RR = 2.05; 95% CI 1.19-3.55; p = 0.01).There is an indication of increased death rates among women with a history of hypertension in pregnancy, where ischemic heart disease may be more common than in the general population.

The epidemiology of peripheral vascular disease has been studied much less extensively than the epidemiology of coronary heart disease (CHD). The prospective Reykjavik Study gave an opportunity to monitor secular trends from 1968 to 1986 of clinical intermittent claudication (IC) amongst Icelandic males, aged 34–80 and to assess the importance of possible risk factors. Both prevalence and incidence of IC decreased sharply after 1970 in all age groups, and this decline occurred a few years earlier than the decline of CHD in Iceland. The only significant risk factors for intermittent claudication, in addition to age, were smoking which increased the risk of IC 8- to 10-fold and serum cholesterol level. Approximately one-half of the striking decline in the incidence of IC can be explained by decreased smoking and cholesterol levels amongst Icelandic men. A follow-up study verified that IC patients stood twice the risk of cardiovascular and total mortality as non-IC patients, indicating that IC is a high risk group which should receive all possible preventive measures.

OBJECTIVE--To monitor trends in mortality and morbidity due to ischaemic heart disease and compare these with observed levels of risk factors from population surveys. DESIGN--Analysis of trends in death rates from ischaemic heart disease in Iceland compared with expected rates computed from population surveys. Risk factor levels together with beta factors obtained from Cox's regression analysis were used to compute expected death rates. Trends in morbidity due to acute myocardial infarction were assessed and secular trends in dietary consumption compared with trends in cholesterol concentrations. SETTING--Reykjavik, Iceland (total population 250,000; over half the population live in Reykjavik). SUBJECTS--12,814 randomly selected residents in the Reykjavik area aged 45-64 (6623 men, 6191 women; 72% and 80% of those invited). MAIN OUTCOME MEASURES--Age adjusted rates of myocardial infarction and deaths from ischaemic heart disease. Expected risk from risk factor levels (smoking, total serum cholesterol concentration, systolic blood pressure) at each unique survey visit. RESULTS--Mortality from ischaemic heart disease has decreased by 17-18% since 1970. During 1981-6 the myocardial infarction attack rate in men under 75 decreased by 23%. A decrease occurred in the level of all three major risk factors after 1968. The fall in the serum cholesterol concentration coincided with a reduction in consumption of dairy fat and margarine. The calculated reduction in risk for the age group 45-64 was about 35%, which was closely similar to the observed decrease in mortality due to ischaemic heart disease in that age group. CONCLUSION--The reduction in mortality from ischaemic heart disease was substantially due to a decreased incidence of myocardial infarction and could be attributed largely to the reduction in risk factors.

During the last thirty years the Research Clinic of the Icelandic Heart Association has been engaged in several extensive cardiovascular population surveys. Smoking habits have been assessed by a questionnaire and the purpose of the present study is to describe the changes in smoking habits during the period 1967-2001, their causes and the reliability of the information gathered.The subjects were participants in four population surveys: The Reykjavik Study 1967-1996, Survey of "Young People" 1973-1974 and 1983-1985, MONICA Risk Factor Surveys 1983, 1988-1989 and 1993-1994 and the "Reykjavik Offspring Study" 1997-2001. The age of participants was 30-88 years and 26,311 examinations of males and 26,222 of females were performed, a number of individuals attending more often than once. A standardized smoking questionnaire was used and the reliability was assessed.Smoking prevalence decreased substantially in both sexes during the study period. In the youngest male group the prevalence decreased from 65% to 42%, but in the oldest from 45% to 19%, while in the youngest female group the decrease was from 50% to 35% but in the oldest age group from 30% to 20%. The decrease in smoking was almost exclusively in the category of "light smokers" (i.e. 1-14 cigarettes a day or pipe/cigar smoker). The main reasons for quitting smoking were concerns about health and symptoms associated with smoking and the cost. The cost had greater weight at the beginning of the period than during the latter part but health concerns seem to be increasingly important. Compared to other countries smoking prevalence in Icelandic males is low but high in females.During the last three decades smoking prevalence in Icelanders 30 years and older has decreased substantially. The main reasons for quitting smoking are health concerns and cost. Continued information about the deleterious effects of smoking as well as increase in the price of tobacco is likely to reduce further the smoking prevalence.

The relationship between educational level and mortality is well known. This has been shown in the Reykjavik Study and was only partly accounted for by unequal distribution of known risk factors. The objective of the present study was to explore the relationship between educational level and physical activity and whether that relationship could partly explain differences in mortality.This is a part of the Reykjavik Study. Presented is data from 18,912 participants, divided into four groups by educational level. Physical activity was assessed by questionnaire. The relationship between physical activity and educational level was assessed by logistic regression and between mortality and educational level by Cox regression analysis. Adjustments were made for age, year of examination, known risk factors (serum lipids, blood pressure, height, weight, smoking, use of anti-hyertensive drugs and 90 min glucose tolerance) and physical activity.There was a positive relationship between physical activity and educational level (p0.001). By adding adjustments for physical activity to a multiple regression analysis containing other known risk factors the relationship between total mortality and educational level was reduced. For highest versus lowest educational group hazard ratio was elevated from 0.77 to 0.80 for men and from 0.91 to 0.93 for women. Same trend existed for cardiovascular mortality and to a less extent for cancer mortality.The association between educational level and mortality can be partly explained by differences in leisure-time physical activity. In spite of adjustments for known risk factors and physical activity there remains a statistically significant relationship between educational level and mortality.

The prevalence of kidney stones varies greatly between ethnic groups and geographic locations, ranging from 8% to 19% in males and from 3% to 5% in females in Western countries. The aim of this study was to examine the epidemiology of kidney stones in Iceland.Data were derived from the Reykjavik Study, a population-based cohort study carried out between 1967 and 1991. All subjects answered a thorough questionnaire concerning their medical history at each visit. The lifetime prevalence of kidney stones was calculated based on the answer to the question "Have you ever been diagnosed with a kidney stone?" at each person's first visit. Incidence was calculated based on answers from subjects who had made two or more visits. Prevalence and incidence were age-standardized to the truncated world population. Family history of kidney stones was also evaluated.A total of 9039 men aged 33-80 years and 9619 women aged 33-81 years participated. Of these, 423 males and 307 females had a history of kidney stones (p=0.001). Prevalence increased significantly with age for both genders. Men aged 30-34 years had a prevalence of 2.9%, compared to 8.8% for those aged 65-69 years, whereas corresponding values for women were 2.5% and 5.0%. The age-standardized prevalence for the 30-79 years age group was 4.3% for men and 3.0% for women. No significant increase in prevalence was observed over time. The incidence was 562 per 100 000 per year among men and increased significantly with age. The incidence among women was 197 per 100 000 per year and did not differ between age groups. A family history of nephrolithiasis was present in 25% of subjects with a history of kidney stones, and in 4% of those without.The incidence and prevalence of kidney stones in Icelandic women are similar to those that have been reported in other Western countries. The prevalence among men is lower that in neighboring countries but the incidence is similar. A strong family history of kidney stones suggests a genetic predisposition.

To assess the risk for coronary heart disease, myocardial infarction, cancer deaths, and all deaths associated with different smoking categories as determined by smoking status at a baseline examination only and at a baseline with reexamination 15-19 years later (persistent smokers).The participants were a random sample of 2930 men and 3084 women aged 34-61 years (when selected in 1967) invited for various standardized examinations under two periods, 1967-1972 and 1979-1991 and followed-up until the end of year 2001. The main outcome measures were clinical coronary heart disease, myocardial infarction, cancer deaths, and all deaths. Risk was calculated for each smoking category as determined by two assessments of smoking habits and also compared with the risk as determined by one baseline examination only.Mean follow-up for men was 26 years (SD 9 years). For women the mean follow-up was 28 years (SD 7 years). There were substantial differences in hazard ratios (HR) and median lifetime in smoking groups as determined by one or two examinations. In men the greatest difference in hazard ratios was for cancer deaths (one examination: 2.80, two: 3.83) in women for total deaths (3.02 vs. 3.7). Loss of median lifetime was greatest in "heavy" cigarette smoking men (one examination: eight years; two examinations: 13 years), in women the corresponding figures were nine and 10 years, in "light" cigarette smokers, the figures for men were four and nine years, and for women four and six years.Middle-aged men smoking one or more packets of cigarettes per day shorten their life expectancy by 13 years and middle-aged women by 10 years. Only one baseline determination of smoking status with subsequent follow-up underestimates the health risk associated with smoking by 15-40% at least in populations where smoking prevalence is declining.

The Reykjavík Study 1967-1985: Risk factors for coronary heart disease mortality have been investigated in a prospective study of 8001 randomly selected Icelandic men and 8468 women. The men were aged 34-64 and the women 34-76 at the time of their first examination. After followup from 2-17 years 1140 (14.2%) of the men and 537 (6.3%) of the women had died. Coronary heart disease accounted for 43% of the mortality among the men, cancer 27% and cerebrovascular disease 7%. This distribution is in contrast to what was found among the women. Coronary heart disease accounted for 19.4% of the mortality, cancer 42.3% while the relative contribution of cerebrovascular mortality was similar. The effects of various factors were assessed simultaneously with multivariate survival analysis using the Cox's proportional hazard model. Age, serum total cholesterol, triglycerides, smoking and systolic blood pressure were all significant independent risk factors for coronary heart disease mortality in both sexes. Fasting blood sugar was of borderline significance, reaching significance among men, but not among women. However, since the women have much lower risk of dying from coronary heart disease than the men the absolute risk associated with each of the risk factors is much lower in the women.

To examine the prognosis of treated, hypertensive individuals in the Reykjavik Study.A population-based longitudinal study of 9328 men and 10 062 women. Subjects were included in the study during the period 1967-1996. Two groups of treated, hypertensive subjects were defined at baseline: with controlled blood pressure and with uncontrolled blood pressure. Main outcome measures were cardiovascular disease (CVD) mortality and all-cause mortality.Of the hypertensive men 24.8% were treated, and of those 38.3% were controlled, and of the hypertensive women 45.3% were treated, and of those 52.7% were controlled. Comparing treated and uncontrolled (systolic blood pressure (SBP)or =160 mmHg and/or diastolic blood pressure (DBP)or =95 mmHg) versus treated and controlled hypertensive subjects, followed for up to 30 years, the uncontrolled men and women were at significantly higher risk of CVD mortality, hazard ratio (HR) = 1.47 (95% confidence interval (CI): 1.06-2.02) and HR 1.70 (CI: 1.23-2.36), respectively, showing the benefit of hypertension control. The risk of all-cause mortality was increased for treated, uncontrolled men and women, compared with those who were treated and controlled, but did not reach significance. When analyzing blood pressure as a continuous variable among treated, hypertensive subjects, SBP was a better predictor than DBP of CVD mortality and all-cause mortality in women. This was not the case in men.Control of blood pressure among hypertensive-treated subjects at baseline was associated with a lower risk of CVD mortality during follow-up. SBP was the single best predictor of CVD mortality and all-cause mortality in treated women. The uncontrolled women were at a higher risk than the uncontrolled men.

The aim was to examine the risk profiles and prognosis of treated and untreated hypertensive subjects and examine to what degree confounding by indication was present in a population-based cohort study with up to 30-year follow-up. The study population consisted of 9328 men and 10 062 women, aged 33-87 years at the time of attendance from 1967 to 1996. The main outcome measures were myocardial infarction (MI), cardiovascular disease (CVD) mortality and all-cause mortality. Comparing the risk profiles between treated and untreated subjects entering the study showed significantly higher values for some risk factors for treated subjects. During the first 10 years, hypertensive men without treatment, compared with those treated, had a significantly lower risk of suffering MI, CVD and all-cause mortality, hazard ratio (HR) 0.72 (95% CI; 0.57, 0.90), 0.75 (95% CI; 0.59, 0.95) and 0.81 (95% CI; 0.61, 0.98), respectively. No significant differences in outcome were seen during the following 20 years. In identically defined groups of women, no significant differences in mortality were seen between groups. Subgroup analysis, at two stages of the study 5 years apart, revealed that some cardiovascular risk factors had a higher prevalence in hypertensive men who were treated at the later stage, compared with those who remained untreated (P=0.004). In conclusion, hypertensive treated men had a worse prognosis during the first 10 years of follow-up than untreated ones, which is most likely due to worse baseline risk profile. Hypertensive men that were treated at a later stage had a worse risk profile than those not treated at a later stage.

The aim of the present study was to evaluate the mortality rate and causes of death of individuals with Dupuytren's disease. In 1981/82, as part of The Reykjavík Study, a general health survey, 1297 males were examined for clinical signs of Dupuytren's disease. Based on the clinical evaluation the participants were classified into three groups: (1) those with no signs of Dupuytren's disease were referred to as the reference cohort; (2) those with palpable nodules in the palmar fascia were classified as having stage 1; and (3) those who had contracted fingers or had been operated on due to contractures were classified as having stage 2 of Dupuytren's disease. In 1997, after a 15- year follow-up period, the mortality rate and causes of death were investigated in relation to the clinical findings from 1981/82. Information about causes of death were obtained from the National Icelandic Death Registry and the Icelandic Cancer Registry. During the follow-up period, 21.5% (225/1048) of the reference cohort were deceased compared to 29.9% (55/184) of those with stage 1 and 47.7% (31/65) of those with stage 2 of Dupuytren's disease. When adjusted for age, smoking habits and other possible confounders, individuals with stage 2 of the disease showed increased total mortality [hazard ratio (HR) = 1.6; 95% CI 1.1-2.4]. Cancer deaths were increased (HR = 1.9; CI 1.0-3.6). In contrast, participants with stage 1 of Dupuytren's disease did not show increased mortality. A moderate but non-significant increase in cancer incidence was observed among individuals with stage 2 of Dupuytren's disease (HR = 1.5; 95% CI 0.9-2.4, P = 0.15). The study showed increased total mortality of individuals with Dupuytren's disease stage 2, where 42% of the excess in mortality could be attributed to cancer deaths.

Hardarson T, Gardarsdottir M, Gudmundsson KTh, Thorgeirsson G, Sigvaldason H, Sigfusson N (National University Hospital, Reykjavik and University of Iceland; and Icelandic Heart Association, Reykjavik, Iceland). The relationship between educational level and mortality. The Reykjavik Study. J Intern Med 2001; 249: 495–502. Objectives. Epidemiological studies have indicated an association between socioeconomic factors and health. It has not been clearly established whether this association is wholly or partly independent of classical risk factors. Our objective was to estimate the relationship between educational level and coronary artery disease (CAD), mortality and all-cause mortality. The Reykjavik Study involving 18 912 participants followed-up 4–30 years provides an ideal opportunity to address this question. Design and subjects. The participants were aged 33–81 years and living in the Reykjavik area. They were divided into four groups according to education. The standard risk factors were assessed on entry and mortality, and cause of death registered during follow-up. Multiple Cox regression analysis was applied to assess the relationship between age at examination, year of examination, educational level and mortality. Results. The all-cause mortality and CAD mortality was significantly related to education, even after adjustment for classical risk factors. For men, 14% (95% CI: 2–24) reduction was found in CAD mortality for those having high school education relative to elementary school. The figures for junior college and university education were 17% (95% CI: 1–31) and 38% (95% CI: 21–32), respectively. These figures were only slightly lower when major CAD risk factors were controlled for and still significant. Similar figures were found for all-cause mortality. For women 34% (95% CI: 18–48) reduction was found in CAD mortality for high school education and 55% (95% CI: 22–74) for junior college, but too few had university education for reliable results. The figures were lower for all-cause mortality, but significant. The figures were reduced when major CAD risk factors were controlled for, but still significant. Conclusion. Education is a strong protective factor both for all-cause and CAD mortality. Only a small part of this effect can be explained through conventional risk factors.

High intakes of trans fatty acids (TFA) have been found to exert an undesirable effect on serum lipid profiles, and thus may increase the risk for cardiovascular disease.Investigation of the association between TFA intake and serum lipids.Cross-sectional study in eight European countries (Finland, France, Greece, Iceland, The Netherlands, Portugal, Spain, Sweden) among 327 men and 299 women (50-65 y). Using a dietary history method, food consumption was assessed and TFA intake was calculated with recent figures on TFA levels of foods, collected in the TRANSFAIR study.Mean (+/-s.d.) TFA intake was 2.40+/-1.53 g/day for men and 1.98+/-1.49 g/day for women (0.87+/-0.48% and 0. 95+/-0.55% of energy, respectively), with the highest consumption in Iceland and the lowest in the Mediterranean countries. No associations were found between total TFA intake and LDL, HDL or LDL/HDL ratio after adjustment for cardiovascular risk factors. Additional adjustment for other fatty acid clusters resulted in a significant inverse trend between total TFA intake and total cholesterol (Ptrend0.03). The most abundantly occurring TFA isomer, C18:1 t, contributed substantially to this inverse association. The TFA isomers C14:1 t9, C16:1 t9 and C22:1 t were not associated or were positively associated with LDL or total cholesterol.From this study we conclude that at the current European intake levels of trans fatty acids they are not associated with an unfavourable serum lipid profile.Unilever Research Laboratorium, the Dutch Dairy Foundation on Nutrition and Health, Cargill BV, the Institute of Food Research Norwich Laboratory, the Nutrition Branch of the Ministry of Agriculture, Fisheries and Food, the International Fishmeal and Oil Manufacturers' Association, Kraft Foods, NV Vandemoortele Coordination Center, Danone Group, McDonalds Deutschland Inc, Danish Veterinary and Food Administration, Valio Ltd, Raisio Group. European Journal of Clinical Nutrition (2000) 54, 126-135

The Reykjavik Study is a large population-based cohort study, starting in 1967. A total of 9,139 men, born in the years 1907 to 1934, have been followed for 4 to 24 years. Heart size was determined by chest roentgenogram in 2 planes and cardiomegaly, defined as a relative heart size exceeding 550 ml/m2, was detected in 517. Multivariate Cox regression analysis was used to estimate the independent contribution of variables measured at each participant's first visit to the risk of both all-cause and coronary artery disease (CAD) mortality. Cardiomegaly was detected in 3.7% of men aged40 years and in 21.2% of those75 years. One half of these men had hypertension, one third had manifestations of CAD, and 37% had neither. Among men with cardiomegaly, the presence of CAD had marked deleterious effect on prognosis. Serum total cholesterol and systolic blood pressure were significant independent risk factors of CAD mortality with risk ratio of 1.008 per mg/dl serum cholesterol (95% confidence interval 1.00 to 1.01; p = 0.004) and 1.015/mm Hg (95% confidence interval 1.000 to 1.300; p = 0.043), respectively. Smoking25 cigarettes/day carried a 2.3-fold risk (95% confidence interval 1.3 to 4.4; p = 0.008) of all-cause mortality. The traditional risk factors for CAD, serum cholesterol, high blood pressure, and smoking maintain their detrimental effect on prognosis among patients with cardiomegaly. These findings have implications for secondary prevention, signifying that in the presence of cardiomegaly, complacency is not justified in controlling major risk factors for CAD.

Objectives. We sought to evaluate the prognostic value and clinical characteristics associated with electrocardiographic (ECG) ST-T changes among men without other manifestations of coronary heart disease. Background. Recent achievements in secondary prevention and treatment of coronary heart disease have highlighted the importance of early diagnosis of both symptomatic and silent forms of the disease. The prognostic and clinical importance of ST-T changes in men with no other manifestations of coronary heart disease is still unclear. Do they reflect silent coronary heart disease or hypertension, or both, and what is their independent contribution to prognosis? Methods. The subjects were 9,139 men born in the years 1907 to 1934 and followed up for 4 to 24 years. On initial visit they were assigned to different categories of coronary heart disease on the basis of Rose chest pain questionnaire, hospital records, 12-lead ECG, history and physical examination. Results. The prevalence of silent ST-T changes among men without overt coronary heart disease was strongly influenced by age, increasing from 2% at age 40 years to 30% at age 80 years. Men with such ST-T changes were older and had higher serum triglyceride levels and worse glucose tolerance than men without such changes or other evidence of coronary heart disease. Their blood pressure was higher, and they more often had an enlarged heart or left ventricular hypertrophy and more often took antihypertensive medication, digitalis or diuretic drugs. Serum cholesterol levels were not different between the two groups. After adjustment for other risk factors, these silent ST-T changes had a risk ratio of 2.0 for death from coronary heart disease and 1.6 for subsequent myocardial infarction or angina pectoris. Conclusions. Silent ST-T changes that are ischemic by the Minnesota code are probably both a marker of silent coronary heart disease and high blood pressure. They define a distinct group of patients with a highly abnormal risk factor profile. Although not specific for coronary heart disease and often transient, they are associated with the development of every clinical manifestation of coronary heart disease and are independent predictors of reduced survival.

Since 1967 the Reykjavik study has monitored coronary artery disease and its risk factors in randomly selected cohorts. From 1979 to 1984, 3246 men and 3545 women aged 45-74 years were studied. Routine biplane chest X rays were assessed by a radiologist who noted the presence or absence of aortic calcification (AC), but had no detailed knowledge of the subjects. Overall, AC was diagnosed in 283 (8%) women, but in only 54 of the men (1.7%). In the women, the prevalence of AC increased from 2.0% at age 45-49 years to 17.1% at the age of 70-74 years, while in men it was 0 and 8.3%, respectively. In women, multivariate analysis of risk factors showed AC to be positively related to systolic and negatively related to diastolic blood pressure, indicating a potential relation to pulse pressure. Furthermore, AC was independently associated with age, drug treatment for hypertension, nonfasting blood sugar, use of antidiabetic drugs, total serum cholesterol levels, and the amount of smoking. Too few men had AC for multivariate assessment of risk factors. In addition, in women AC was also related to a previous myocardial infarction (p < 0.05), mortality from coronary artery disease (p < 0.01), and the presence of intermittent claudication (p < 0.01). In men, however, AC was related only to total mortality (p < 0.05). Thus, these data show AC to be more prevalent in women, independently associated with recognized atherosclerotic risk factors, and a potential marker for coronary and peripheral artery disease.

Background While coronary heart disease (CHD) is a serious and often fatal disease the prognosis is variable and major effort has been invested in risk stratification. The purpose of this study was to examine the relation between long-term prognosis and risk factors in different clinical categories of CHD. Methods A general population sample of 9141 men, aged 34-79 at entry into the study was divided into six groups with respect to manifestations of CHD at entry: I. Symptomatic infarction. II. Silent or unrecognized infarction. III. Angina pectoris with ischaemic changes on ECG. IV. Angina without ischaemic changes. V. Angina by Rose questionnaire but not confirmed by a physician. VI. No manifestations of CHD. Results The risk factor profile varied considerably between the different categories and by life-table analysis marked differences in survival were demonstrated between the groups. The risk factors maintained their detrimental effects on prognosis in the presence of CHD. Thus, age, serum total cholesterol, impaired glucose tolerance and smoking were found by Cox's regression to be statistically significant independent risk factors of CHD mortality among men having manifestations of CHD (groups I-V). Furthermore, the composite risk score, a measure of the overall risk factor exposures had marked effect on the prognosis of the various CHD groups. When the comprehensive risk factor score for both CHD mortality and all-cause mortality was accounted for marked differences persisted in the long-term prognosis. Compared to those without CHD the infarct groups had about a 7.6- and 3.7-fold risk of dying from CHD and all causes respectively. Those with angina had from 2.5- to 3.2-fold risk of CHD mortality and 1.7- to 2.2-fold risk of all-cause mortality depending on the subgroup of angina, again compared to those without manifestations of CHD. Conclusion Different categories of CHD had different risk factor profiles and the long-term prognosis resulted from a complex interplay between those factors and the diagnostic category of CHD. The risk factors maintained their detrimental effects on prognosis in the presence of CHD and after accounting for the comprehensive risk factor score marked differences persisted in the long-term prognosis, being worst for those having suffered a myocardial infarction, either symptomatic or silent.

This study is based on the Reykjavik Study, a long-term prospective cardiovascular survey, which included a representative population of 9135 men and 9627 women, 33-79 years old, who were invited to participate during the years 1967-91. Right bundle branch block (RBBB) was found in 126 men and 67 women. The prevalence increased with age, from 0% among men and women 30-39 years of age to 4.1% and 1.6% in men and women, respectively, who where 75-79 years old. The incidence increased with age. In men younger than 60 years RBBB had a significant relationship with hypertension (P < 0.05), elevated fasting blood glucose (P = 0.05), and increased heart size (P < 0.05). In men with RBBB regardless of age, an association was found with cardiomegaly (P < 0.05), ischaemic heart disease (P < 0.05), arrhythmias (P < 0.001) and bradycardia (P < 0.01). A higher mortality from heart disease (P < 0.01) was found in men with RBBB compared to the control population. This was not significant when risk factors of heart disease were taken into account by multivariate Cox analysis. There was a relationship (P < 0.05) between hypertension and RBBB in women younger than 60 years. RBBB in women younger than 60 years is often associated with hypertension and in men younger than 60 it is often associated with an underlying cardiovascular disease, hypertension, cardiomegaly and elevated blood glucose.

Some studies have suggested that measurements of apolipoproteins may be valuable in the clinical assessment of susceptibility to coronary artery disease, over and above the lipoprotein lipids. Only a few of these studies have been prospective in nature and further knowledge is therefore needed to clarify the issue. The independent prognostic value of apolipoproteins (apo-B, apo-AI and apo[a]) with regard to coronary artery disease was estimated from a prospective survey among 1,332 randomly selected Icelandic men, aged 45 to 72 years, participating in a health survey from 1979 to 1981. The group was followed for 8.6 years, and during that period 104 men had fatal or nonfatal myocardial infarction. The Cox's proportional hazards model was used to estimate the significance of independent variables. The results of multivariate analysis showed that apo(a) was a significant independent risk factor (odds ratio 1.22 for 1 SD), but apo-AI was a stronger negative risk factor (odds ratio 0.70 for 1 SD). Apo-B was a highly significant risk factor in a univariate analysis, but not in a multivariate analysis when serum cholesterol was included. Previous population surveys in Iceland have confirmed the importance of cigarette smoking, cholesterol, triglycerides and blood pressure as risk factors for coronary artery disease. The present results illustrate additional importance of apo-AI and apo(a) concentrations in predicting coronary artery disease among Icelandic men, whereas apo-B did not contribute anything further to the prediction than serum total cholesterol.

Stroke is a major cause of illness, death, and health expenditures. Leisure-time physical activity may reduce the risk for stroke.To examine the association of leisure-time physical activity and pulmonary function with risk for stroke.Prospective cohort study.Reykjavík, Iceland.4484 men 45 to 80 years of age followed for a mean (+/-SD) of 10.6 +/- 3.6 years.Patients underwent physical examination, blood sampling, and spirometry and completed a questionnaire about health and exercise. Computerized hospital records were used to identify strokes, and the Icelandic National Registry was used to identify deaths.New stroke developed in 249 men (5.6%) (hemorrhagic stroke in 44 [18%] and ischemic stroke in 205 [82%]). In a multivariable hazard analysis that controlled for known risk factors for cerebrovascular disease, leisure-time physical activity maintained after 40 years of age was associated with a reduced risk for stroke (relative risk, 0.69 [CI, 0.47 to 1.01] for total stroke and 0.62 [CI, 0.40 to 0.97] for ischemic stroke). Risk for stroke increased with diminished ventilatory function (FVC or FEV1) (relative risk, 1.9 [CI, 1.06 to 3.25] for the lowest compared with the highest quintile).Middle-aged men who participate in leisure-time physical activity and have good pulmonary function seem to have a lower risk for stroke than men who are not active or have diminished pulmonary function.

To evaluate the incidence, prevalence, characteristics, and prognosis associated with clinically unrecognized myocardial infarction as diagnosed by electrocardiographic changes.Prospective, population-based cohort study with 4- to 20-year follow-up.Icelandic Heart Association Preventive Clinic.9141 men residing in the Reykjavik area who were born between 1907 and 1934.Patients were assigned to categories of coronary heart disease at first visit on the basis of hospital records, Rose chest pain questionnaire, standardized 12-lead electrocardiogram, and history and physical examination. Incidence and prevalence of unrecognized myocardial infarction were determined, survival was measured, and causes of death were determined from death certificates and autopsy records.Prevalence was strongly influenced by age. Nearly undetectable in the youngest age group, it increased to more than 5% in the group aged 75 to 79 years. Incidence was almost zero up to age 40, then increased steeply to more than 300 cases per year per 100,000 persons at age 60, and decreased with age after age 65. Ten- and 15-year survival probabilities were 51% and 45%, respectively, and were similar to those for patients with recognized myocardial infarction. One third of men with unrecognized and 58% of men with recognized myocardial infarction had a history of angina pectoris (P0.001). Angina pectoris had a greater effect on coronary heart disease mortality in the former group than in the latter. The risk ratio for unrecognized myocardial infarction was 4.6 without angina (95% CI, 2.4 to 8.6) and 16.9 with angina (CI, 9.4 to 30.3); the risk ratio for recognized myocardial infarction was 6.3 without angina (CI, 3.7 to 10.6) and 8.5 with angina (CI, 5.8 to 12.6).At least one third of all myocardial infarctions were unrecognized. Prognosis and risk factor profiles for patients with recognized and unrecognized myocardial infarction were similar. Although those with unrecognized myocardial infarction were less likely than those with recognized myocardial infarction to have a history of angina pectoris, angina in these cases was usually associated with ischemic electrocardiographic changes and a poor prognosis, suggesting severe coronary heart disease.

The relationship between non-esterified fatty acids (NEFA) in serum and heart muscle was examined in 15 patients who died of myocardial infarction (MI) and seven people who died suddenly in accidents. There was no correlation between NEFA levels of serum and non-infarcted cardiac muscle in patients with fatal MI. No significant difference was encountered in cardiac NEFA content between patients with fatal MI and people who died in accidents. The phospholipid (PL) content was significantly lower in patients with fatal MI than observed in people who died in accidents. The arachidonic acid (20:4 (n-6)) concentration of serum NEFA was significantly lower in patients with fatal MI compared to normal subjects. The cardiac NEFA and PL in patients with fatal MI contained significantly lower percentage levels of arachidonic acid compared to people who died in accidents. The results indicate that the death of the MI patients was not accompanied by elevated cardiac NEFA levels.

In a randomly selected population of 9067 individuals, 32-64 years of age in 1967-1970, 25 (0.28%) had chronic atrial fibrillation (CAF). Eight had lone atrial fibrillation. In 1984 the cases were compared with an age- and sex-matched control group of 50 and found to have more cerebrovascular accidents (6 versus 2; P less than 0.05), congestive heart failure (9 versus 1; P less than 0.001), and valvular rheumatic heart disease (3 versus 0) or history consistent with rheumatic fever (6 versus 0; P less than 0.01). The mortality in the CAF group was 60% higher due to an excess in cardiovascular (relative risk 6.1; P less than 0.05) and cerebrovascular (relative risk 12.2; P less than 0.05) causes. The prevalence or incidence of ischaemic or hypertensive heart disease or the presence of coronary risk factors did not significantly differ in the two groups. By M-mode echocardiography the left atrial size, left ventricular enddiastolic dimension and left ventricular mass were increased in the CAF patients, while the systolic left ventricular shortening was significantly less. Thus, the prevalence of CAF is low in a randomly selected population 32-64 years of age and CAF is not strongly associated with ischaemic heart disease or hypertension. The CAF patients have an increased risk of dying prematurely particularly from cerebrovascular causes, even in the absence of valve disease.

The fatty acid composition and concentrations of serum phospholipids (PL) were examined in 14 normal subjects (NS), 10 patients with coronary heart disease (CHD) and stable angina pectoris, and in 12 patients with acute, fatal myocardial infarction (MI). The NS and patients with CHD and stable angina pectoris were matched with respect to age, height, body weight, blood pressure and serum cholesterol. Serum PL of patients with CHD and of patients with acute, fatal MI contained significantly more arachidonic acid (20:4n6, AA) than serum PL of the NS. Docosahexaenoic acid (22:6n3, DHA) was also increased in serum PL of patients with acute, fatal MI. AA and DHA levels in serum PL reflect changes in lipid metabolism that may relate to the cause and/or consequences of CHD.