OJPM  Vol.5 No.3 , March 2015
Lifestyle, Biological Risk Markers, Morbidity and Mortality in a Cohort of Men 33 - 42 Years Old at Baseline, after 24-Year Follow-Up of a Primary Health Care Intervention
Objective: To study changes in life and biological risk markers in a 24-year follow-up study, and occurrences of cardiovascular diseases (CVD), cancer and total mortality from official registers. Design: A 24-year follow-up survey and register study of a cohort of men 33 - 42 years old, examined with a health profile at baseline. With the health profile based on life , biological risk markers, self-rated mental stress and mental health, the men were separated in different risk groups. Setting: Primary health care center of Habo in Sweden. Subjects: All 757 men, 33 - 42 years old, and living in the community of Habo in Sweden in 1985. Main Outcome Measures: Life , biological risk markers, morbidity from CVD and cancer, and total mortality. Results: Smoking and physical activity decreased during follow-up time while alcohol consumption increased. Biological risk markers, except diastolic blood pressure, deteriorated significantly with age. Based on three- life groups, 16 % of the men had a more favorable life and 19% had a less favorable life- at follow-up compared with baseline. The men, who had been classified as high-risk, based on the health profile at baseline, had a significantly higher incidence of CVD and cancer in the register study compared to men in a low-risk group. The baseline non-participant group had a significantly higher incidence of CVD and a higher mortality compared to the low-risk group. Conclusion: A health profile with a combination of life factors and biological risk markers can already at the age of 33 - 42 years predict incidence of CVD and cancer on group level among men after 24 years.

Cite this paper
Persson, L. , Lingfors, H. , Nilsson, M. and Mölstad, S. (2015) Lifestyle, Biological Risk Markers, Morbidity and Mortality in a Cohort of Men 33 - 42 Years Old at Baseline, after 24-Year Follow-Up of a Primary Health Care Intervention. Open Journal of Preventive Medicine, 5, 92-102. doi: 10.4236/ojpm.2015.53011.
[1]   Sveriges Officiella Statistik. Statistik - Hälso- och Sjukvard. Dödsorsaker 2008. [Official Statistics of Sweden. Statistics - Health and Medical Care. Causes of Death 2008]. English Summery Stockholm: Socialstyrelsen; 2010.

[2]   La Vecchia, C., Levi, F., Lucchini, F., et al. (1998) Trends in Mortality from Major Diseases in Europe, 1980-1993. European Journal of Epidemiology, 14, 1-8.

[3]   The European Health Report (2012)OBJCharting the Way to Well-Being: WHO. Regional Office for Europe.

[4]   Yusuf, S., Hawken, S., Ounpuu, S., et al. (2004) Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction in 52 Countries (the INTERHEART Study): Case-Control Study. Lancet, 364, 937-952.

[5]   O’Donnell, M.J., Xavier, D., Liu, L., et al. (2010) Risk Factors for Ischaemic and Intracerebral Haemorrhagic Stroke in 22 Countries (the INTERSTROKE Study): A Case-Control Study. Lancet, 376, 112-123.

[6]   Coyle, Y.M. (2009) Lifestyle, Genes, and Cancer. Methods in Molecular Biology, 472, 25-56.

[7]   Khan, N., Afaq, F. and Mukhtar, H. (2010) Lifestyle as Risk Factor for Cancer: Evidence from Human Studies. Cancer Letters, 293, 133-143.

[8]   Carlsson, A.C., Wandell, P.E., Gigante, B., et al. (2013) Seven Modifiable Lifestyle Factors Predict Reduced Risk for Ischemic Cardiovascular Disease and All-Cause Mortality Regardless of Body Mass Index: A Cohort Study. International Journal of Cardiology, 168, 946-952.

[9]   Conroy, R.M., Pyorala, K., Fitzgerald, A.P., et al. (2003) Estimation of Ten-Year Risk of Fatal Cardiovascular Disease in Europe: the SCORE Project. European Heart Journal, 24, 987-1003.

[10]   Wilhelmsen, L., Wedel, H., Conroy, R., et al. (2004) The Swedish SCORE Chart for Cardiovascular Risk. Better Possibilities for Prevention of Cardiovascular Diseases. Lakartidningen, 101, 1798-801.

[11]   Persson, L.G., Lindström, K., Lingfors, H. and Bengtsson, C. (1994) A Study of Men Aged 33-42 in Habo, Sweden with Special Reference to Cardiovascular Risk Factors. Design, Health Profile and Characteristics of Participants and Non-Participants. Scandinavian Journal of Social Medicine, 22, 264-272.

[12]   Persson, L.G., Lindström, K., Lingfors, H., Bengtsson, C. and Lissner, L. (1998) Cardiovascular Risk during Early Adult Life. Risk Markers among Participants in “Live for Life” Health Promotion Programme in Sweden. Journal of Epidemiology & Community Health, 52, 425-432.

[13]   Lingfors, H., Lindström, K., Persson, L.G., Bengtsson, C., Lissner, L., Ellegard, L. and Andersson, H.A. (1994) Evaluation of a Pedagogic Dietary Questionnaire Aimed for Health Surveys. Scandinavian Journal of Nutrition, 38, 106- 111.

[14]   Doll, R., Peto, R., Boreham, J. and Sutherland, I. (2004) Mortality in Relation to Smoking: 50 Years’ Observations on Male British Doctors. BMJ, 328, 1519.

[15]   Clarke, R., Emberson, J., Fletcher, A., Breeze, E., Marmot, M. and Shipley, M.J. (2009) Life Expectancy in Relation to Cardiovascular Risk Factors: 38 Year Follow-Up of 19,000 Men in the Whitehall Study. BMJ, 339, b3513.

[16]   Holme, I., Tonstad, S., Sogaard, A.J., Lund Larsen, P.G. and Haheim, L.L. (2007) Leisure Time Physical Activity in Middle Age Predicts the Metabolic Syndrome in Old Age: Results of a 28-Year Follow-Up of Men in the Oslo Study. BMC Public Health, 7, 154.

[17]   Juonala, M., Viikari, J.S., Hutri-Kahonen, N., Pietikainen, M., Jokinen, E., Taittonen, L., et al. (2004) The 21-Year Follow-Up of the Cardiovascular Risk in Young Finns Study: Risk Factor Levels, Secular Trends and East-West Difference. Journal of Internal Medicine, 255, 457-468.

[18]   Miura, K., Daviglus, M.L., Dyer, A.R., Liu, K., Garside, D.B., Stamler, J. and Greenland, P. (2001) Relationship of Blood Pressure to 25-Year Mortality Due to Coronary Heart Disease, Cardiovascular Diseases, and All Causes in Young Adult Men: The Chicago Heart Association Detection Project in Industry. Archives of Internal Medicine, 161, 1501-1508.

[19]   Stamler, J., Daviglus, M.L., Garside, D.B., Dyer, A.R., Greenland, P. and Neaton, J.D. (2000) Relationship of Baseline Serum Cholesterol Levels in 3 Large Cohorts of Younger Men to Long-Term Coronary, Cardiovascular, and All-Cause Mortality and to Longevity. JAMA, 284, 311-318.

[20]   Saltin, B. and Grimby, G. (1968) Physiological Analysis of Middle-Aged and Old Former Athletes. Comparison with Still Active Athletes of the Same Ages. Circulation, 38, 1104-1115.

[21]   Persson, L.G., Lindström, K. and Bengtsson, C. (1994) Oral Glucose Tolerance and Its Relationship to Overweight and Other Cardiovascular Risk Factors in Men Aged 33-42. A Study in the Community of Habo, Sweden. Scandinavian Journal of Primary Health Care, 12, 261-268.

[22]   Persson, L.G., Lindström, K., Lingfors, H. and Bengtsson, C. (1996) Results from an Intervention Programme Dealing with Cardiovascular Risk Factors. Experiences from a Study of Men Aged 33-42 in Habo, Sweden. Scandinavian Journal of Primary Health Care, 14, 184-192.

[23]   Svensson, E. (1998) Ordinal Invariant Measures for Individual and Group Changes in Ordered Categorical Data. Statistics in Medicine, 17, 2923-2936.

[24]   Bopp, M., Braun, J., Gutzwiller, F. and Faeh, D., for the Swiss National Cohort Study Group (2012) Health Risk or Resource? Gradual and Independent Association between Self-Rated Health and Mortality Persists over 30 Years. PLoS ONE, 7, e30795.

[25]   Latham, K. and Peek, C.W. (2013) Self-Rated Health and Morbidity Onset among Late Midlife US Adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 68, 107-116.

[26]   Clarke, R., Breeze, E., Youngman, L., Sherliker, P., Bell, P., Shah, S., et al. (2000) Re-Survey of the Whitehall Study of London Civil Servants: Changes in Risk Factors for Cardiovascular Disease during 29 Years of Follow-Up. Journal of Cardiovascular Risk, 7, 251-257.

[27]   Welin, L., Adlerberth, A., Caidahl, K., Eriksson, H., Hansson, P.-O., Johansson, S., et al. (2008) Prevalence of Cardiovascular Risk Factors and the Metabolic Syndrome in Middle-Aged Men and Women in Gothenburg, Sweden. BMC Public Health, 8, 403.

[28]   Rosengren, A., Wilhelmsen, L., Berglund, G. and Elmfeldt, D. (1987) Non-Participation in a General Population Study of Men, with Special Reference to Social and Alcoholic Problems. Acta Medica Scandinavica, 221, 243-251.

[29]   Wilhelmsen, L., Ljungberg, S., Wedel, H. and Werkö, L. (1976) A Comparison between Participants and Non-Participants in a Primary Preventive Trial. Journal of Chronic Diseases, 29, 331-339.

[30]   Larsen, S.B., Dalton, S.O., Schuz, J., Christensen, J., Overvad, K., Tjonneland, A., et al. (2012) Mortality among Participants and Non-Participants in a Prospective Cohort Study. European Journal of Epidemiology, 27, 837-845.

[31]   Selvarajah, S., Kaur, G., Haniff, J., Cheong, K.C., Hiong, T.G., van der Graaf, Y. and Bots, M.L. (2014) Comparison of the Framingham Risk Score, SCORE and WHO/ISH Cardiovascular Risk Prediction Models in an Asian Population. International Journal of Cardiology, 176, 211-218.

[32]   Petersson, U., &OUMLstgren, C.J., Brudin, L. and Nilsson, P.M. (2009) A Consultation-Based Method Is Equal to SCORE and an Extensive Laboratory-Based Method in Predicting Risk of Future Cardiovascular Disease. European Journal of Cardiovascular Prevention & Rehabilitation, 16, 536-540.

[33]   Hobbs, W.R. and Fowler, J.H. (2014) Prediction of Mortality Using On-Line, Self-Reported Health Data: Empirical Test of the Real Age Score. PLoS ONE, 9, e86385.

[34]   Lissner, L., Skoog, I., Andersson, K., Beckman, N., Sundh, V., Waern, M., et al. (2003) Participation Bias in Longitudinal Studies: Experience from the Population Study of Women in Gothenburg, Sweden. Scandinavian Journal of Primary Health Care, 21, 242-247.