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Biomedical subjects

G Wannamethee

Publications and source records attributed to G Wannamethee.

At least 37 records · Page 2Linked to original sources
PubMed1994

The association between heart rate and blood pressure, blood lipids and other cardiovascular risk factors.

BACKGROUND: Several studies have shown that an elevated heart rate is associated with an increased risk of ischaemic heart disease. The aim of this study was to examine the relationship between heart rate, blood pressure, blood lipids and other cardiovascular risk factors in middle-aged men. METHODS: A total of 7735 men, aged 40-59 years at screening, were selected at random from one of the general practices in each of the 24 towns participating in the cross-sectional (screening) phase of the British Regional Heart Study. Blood pressure and levels of blood lipids (serum total cholesterol, high-density-lipoprotein (HDL) cholesterol and triglycerides) and blood glucose were measured. RESULTS: All men with pre-existing evidence of ischaemic heart disease and those on regular antihypertensive treatment were excluded from the analysis. In the remaining 5597 men, heart rate showed a strong positive correlation with cigarette smoking and body-mass index and decreased significantly at higher levels of physical activity and FEV1 (forced expiratory volume in 1 s). These associations remained significant after adjustment for each other. Age, alcohol intake and social class were not independently associated with heart rate. There was a significant positive association between heart rate and systolic and diastolic blood pressures, levels of blood cholesterol, triglycerides and blood glucose and a significant inverse association between heart rate and HDL-cholesterol levels, even after adjusting for the above confounding factors. After further adjustment for each of the other physiological variables, heart rate remained independently associated with diastolic and systolic blood pressures and levels of triglycerides and blood glucose. The relationship between heart rate and levels of total cholesterol and HDL cholesterol appeared to be secondary to its association with triglyceride levels. The association between body-mass index and heart rate diminished after further adjustments for systolic blood pressure, suggesting that the primary effect of body weight is on blood pressure rather than on heart rate. CONCLUSION: Our findings indicate that elevated heart rate is associated with hypertension and with an atherogenic lipoprotein profile and support the suggestion that disturbance of the autonomic nervous system may underlie these associations.

Adult↗
PubMed1994

Serum sodium concentration and risk of stroke in middle-aged males.

BACKGROUND AND METHODS: Clinical disturbances of the circulating sodium concentration are both a cause and a consequence of cerebrovascular disease. We examined the relationship between serum sodium level and risk of stroke and major ischaemic heart disease in a prospective study of 7690 middle-aged males drawn from general practices in 24 British towns followed over a 9.5-year period. RESULTS: The mean serum sodium level was 141.5 mmol/l and 375 males on antihypertensive treatment were excluded from the analyses. A significant inverse trend was seen between serum sodium and risk of stroke up to 144 mmol/l; above this the risk of stroke was increased. Those with levels of 143-144 mmol/l showed over a 70% reduction in risk of stroke compared with those with levels of < or = 140 mmol/l. The inverse relationship between sodium and stroke up to 144 mmol/l was seen in males with and without pre-existing ischaemic heart disease or stroke, in normotensives and untreated hypertensives, and in non-smokers and current smokers. A weak but significant inverse association was seen between serum sodium and diastolic but not systolic blood pressure. The association between serum sodium level and stroke remained significant after adjustment for diastolic blood pressure and other factors associated with stroke: age, smoking, social class, body mass index, physical activity, heavy drinking, presence of diabetes, blood glucose and pre-existing ischaemic heart disease. No association was seen between serum sodium level and risk of ischaemic heart disease after adjustment for other risk factors. All-cause and non-cardiovascular mortality were significantly increased at serum sodium levels of < or = 138 mmol/l, probably due to an association between lung cancer and hyponatraemia. CONCLUSION: These findings suggest that sodium concentration may be related to risk of stroke even at levels of sodium usually regarded as normal.

Adult↗
PubMed1994

Haematocrit: relationships with blood lipids, blood pressure and other cardiovascular risk factors.

The relationship between haematocrit and cardiovascular risk factors, particularly blood pressure and blood lipids, has been examined in detail in a large prospective study of 7735 middle-aged men drawn from general practices in 24 British towns. The analyses are restricted to the 5494 men free of any evidence of ischaemic heart disease at screening. Smoking, body mass index, physical activity, alcohol intake and lung function (FEV1) were factors strongly associated with haematocrit levels independent of each other. Age showed a significant but small independent association with haematocrit. Non-manual workers had slightly higher haematocrit levels than manual workers; this difference increased considerably and became significant after adjustment for the other risk factors. Diabetics showed significantly lower levels of haematocrit than non-diabetics. In the univariate analysis, haematocrit was significantly associated with total serum protein (r = 0.18), cholesterol (r = 0.16), triglyceride (r = 0.15), diastolic blood pressure (r = 0.17) and heart rate (r = 0.14); all at p < 0.0001. A weaker but significant association was seen with systolic blood pressure (r = 0.09, p < 0.001). These relationships remained significant even after adjustment for age, smoking, body mass index, physical activity, alcohol intake, lung function, presence of diabetes, social class and for each of the other biological variables; the relationship with systolic blood pressure was considerably weakened. No association was seen with blood glucose and HDL-cholesterol. This study has shown significant associations between several lifestyle characteristics and the haematocrit and supports the findings of a significant relationship between the haematocrit and blood lipids and blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Physical activity, hypertension and risk of heart attack in men without evidence of ischaemic heart disease.

The role of hypertension in the increased rate of heart attack reported in vigorously active subjects was examined in a large prospective study of 7735 middle-aged men drawn from general practices in 24 British towns (The British Regional Heart Study). Analyses were restricted to 5694 men with no evidence of pre-existing ischaemic heart disease or stroke at screening, in whom there were 311 major ischaemic heart disease events after 9.5 years follow-up. Risk of major ischaemic heart disease events decreased significantly with increasing physical activity to levels of moderate/moderately vigorous activity, with a 50% reduction in risk compared with inactive men after adjustment for age, body mass index, smoking, heavy drinking, social class and blood cholesterol. However, at the highest level of physical activity (vigorous group) risk of major ischaemic heart disease events was increased above that seen in the moderate/moderately vigorous group (rr = 1.68, P = 0.05). When separated into normotensives (n = 3888) and hypertensives (n = 1806; SBP > or = 160 mmHg or DBP > or = 90 mmHg or on regular antihypertensive treatment), the increased risk of major ischaemic heart disease events in the vigorous group was only evident in hypertensive men. They showed more than a twofold increase in risk compared with the moderate and moderately vigorous group (rr = 2.7, P < 0.05). In normotensive men, risk was significantly lowered in those engaged in moderate activity with no further decline in rate of heart attack at increasing levels of physical activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Heart rate, physical activity, and mortality from cancer and other noncardiovascular diseases.

The relations between resting heart rate on electrocardiogram, usual physical activity, and risks of all noncardiovascular mortality, cancer mortality, and other noncardiovascular mortality were examined in 7,735 middle-aged British men drawn from general practices in 24 British towns. Subjects were examined and administered questionnaires in 1978-1980. During a follow-up period of 9.5 years (to December 1989), there were 334 deaths from noncardiovascular causes, including 225 cancer deaths. A strong positive association was seen between heart rate and all noncardiovascular mortality, cancer mortality, and other noncardiovascular mortality, even after adjustment for age, blood cholesterol, body mass index, heavy alcohol drinking, physical activity, preexisting ischemic heart disease, smoking, social class, and systolic blood pressure (p < 0.01). The relative risks in men with heart rates of > or = 90 beats/minute, in comparison with those with heart rates of < 60 beats/minute, were 2.33 (95% confidence interval (CI) 1.42-3.74) for total noncardiovascular mortality, 1.68 (95% CI 0.92-3.10) for cancer mortality, and 3.56 (95% CI 1.65-7.65) for mortality due to other noncardiovascular causes. The positive associations with cancer and all noncardiovascular mortality persisted even after further adjustment for lung function (forced expiratory volume in 1 second) and exclusion of men with underlying ill health and of deaths occurring within the first 5 years of follow-up. A significant inverse association with seen between physical activity and risk of cancer death, even after adjustment for the above factors and heart rate, with a significant reduction only in those engaged in high levels of usual physical activity (relative risk = 0.62, 95% CI 0.39-0.98). The data suggest that in middle-aged men, resting heart rate and physical activity are independent prognostic factors for cancer mortality.

Confounding Factors, Epidemiologic↗
PubMed1993

Heart rate, ischaemic heart disease, and sudden cardiac death in middle-aged British men.

OBJECTIVE: To examine the relation between resting heart rate and new major ischaemic heart disease events in middle aged men with and without pre-existing ischaemic heart disease. DESIGN: Prospective study of a cohort of men with eight years follow up for cardiovascular morbidity and mortality for all men. SETTING: General practices in 24 British towns (the British Regional Heart study). SUBJECTS: 7735 men aged 40-59 years drawn at random from the age-sex registers of one general practice in each town. MAIN OUTCOME MEASURES: Major ischaemic heart disease events such as sudden cardiac death, other deaths attributed to ischaemic heart disease, and non-fatal myocardial infarction. RESULTS: During the follow up period of eight years, 488 men had a major ischaemic heart disease event (217 fatal and 271 non-fatal). Of these, 117 were classified as sudden cardiac death (death within one hour of the start of symptoms). The relation between heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease deaths, and sudden cardiac death was examined separately in men with and without pre-existing ischaemic heart disease. In men with no evidence of ischaemic heart disease, there was a strong positive association between resting heart rate and age adjusted rates of all major ischaemic heart disease events (fatal and non-fatal), ischaemic heart disease deaths, and sudden cardiac death. This association remained significant even after adjustment for age, systolic blood pressure, blood cholesterol, smoking, social class, heavy drinking, and physical activity, with particularly high risk in those with heart rate > or = 90 beats/min. The increased risk seen in those with increased heart rate was largely due to a significantly increased risk of sudden cardiac death, which was five times higher than in those with heart rate < 60 beats/min. The effect of heart rate on sudden cardiac death was present irrespective of blood pressure or smoking state. In men with pre-existing ischaemic heart disease a positive association was seen between raised heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease death, and sudden cardiac death, but the effect was less noticeable than in men without pre-existing ischaemic heart disease. CONCLUSION: In this study of middle aged British men increased heart rate > or = 90 beats/min) is a risk factor for fatal ischaemic heart disease events but particularly for sudden cardiac death. The effect is not dependent on the presence of other established coronary risk factors and is most clearly seen in men free of pre-existing ischaemic heart disease at initial examination.

Adult↗
PubMed1993

Lifestyle factors associated with geographic blood pressure variations among men and women in the UK.

The importance of various factors in explaining geographical BP variations in the UK has been examined among 2,596 men and women living in nine British towns. Associations between BP and potential explanatory variables have been examined first for individual subjects (within-population), and second for towns (between-populations). The factors showing associations with BP that were consistent within-population and between-towns were BMI, urine sodium/potassium ratio (Na/K), alcohol and anxiety at examination for men, and BMI, Na/K and anxiety at examination for women. After adjustment for these factors and age, the male BP differences between the nine towns were reduced from 10.1 mmHg systolic in men (P = 0.001) to 7.1 mmHg (P = 0.04), and from 5.9 mmHg diastolic (P = < 0.0001) to 5.5 mmHg (P < 0.0001). For women, adjustment only marginally reduced the between-town systolic differences from 5.6 mmHg (P = 0.05) to 5.5 mmHg (P = 0.3) and increased the diastolic differences from 3.7 mmHg diastolic (P = 0.03) to 5.0 mmHg (P < 0.0001). It is concluded that BMI, alcohol consumption and the Na/K ratio play an important part in the pattern of male SBP variations in the UK. The factors associated with female geographical differences in BP were less clear, but BMI and Na/K ratio appear to be important. This study has been unable to identify factors associated with geographical differences in DBP, with the possible exception of BMI in men. However, as systolic pressure is recognised to be more strongly associated with cardiovascular outcome than diastolic pressure, it can be recommended that primary prevention strategies aimed at reducing the population mean level of BP should involve efforts to reduce overweight, alcohol consumption and the Na/K ratio.

Adult↗
PubMed1992

Physical activity and stroke in British middle aged men.

OBJECTIVES: To assess the relation between physical activity and stroke and to determine the overall benefit of physical activity for all major cardiovascular events. DESIGN: Prospective study of a cohort of men followed up for 9.5 years. SETTING: General practices in 24 towns in England, Wales, and Scotland (British regional heart study). SUBJECTS: 7735 men aged 40-59 at screening, selected at random from one general practice in each of 24 towns. MAIN OUTCOME MEASURES: Fatal and non-fatal strokes and heart attacks. RESULTS: 128 major strokes (fatal and non-fatal) occurred. Physical activity was inversely associated with risk of stroke independent of coronary risk factors, heavy drinking, and pre-existing ischaemic heart disease or stroke (relative risk 1.0 for inactivity, 0.6 moderate activity, and 0.3 vigorous activity; test for trend p = 0.008). The association remained after excluding men reporting regular sporting (vigorous) activity. However, vigorous physical activity was associated with a marginally significant increased risk of heart attack compared with moderate or moderately vigorous activity in men with no pre-existing ischaemic heart disease or stroke (relative risk 1.6%; 95% confidence interval 0.96 to 2.8). In men with symptomatic ischaemic heart disease or stroke those doing moderately vigorous or vigorous activity had a risk of heart attack slightly higher than that in inactive men (relative risk = 1.6; 0.8 to 3.3). CONCLUSIONS: Moderate physical activity significantly reduces the risk of stroke and heart attacks in men both with and without pre-existing ischaemic heart disease. More vigorous activity did not confer any further protection. Moderate activity, such as frequent walking and recreational activity or weekly sporting activity, should be encouraged without restriction.

Adult↗
PubMed1992

Alcohol and sudden cardiac death.

OBJECTIVE: To assess the relation between alcohol intake and sudden cardiac death--ie, death within one hour of the onset of symptoms. DESIGN: Prospective study of a cohort of men followed up for eight years. SETTING: General practices in 24 towns in England, Wales, and Scotland. SUBJECTS: 7735 men aged 40-59 at screening who were selected at random from one general practice in each of 24 towns. MAIN OUTCOME MEASURE: All deaths from ischaemic heart disease with particular reference to those that were sudden (death within one hour of the onset of symptoms). RESULTS: During the follow up period of eight years there were 217 deaths from ischaemic heart disease of which 117 (54%) were classified as sudden. Although heavy drinkers (more than six drinks daily) did not show a high incidence rate of fatal heart attack, they showed the highest incidence rate of sudden cardiac death. This was seen in both manual and non-manual workers and was most clearly seen in older (50-59) men. Death from ischaemic heart disease was more likely to be sudden in heavy drinkers than in other drinking groups; this phenomenon was seen irrespective of the presence or degree of pre-existing ischaemic heart disease. The positive association between heavy drinking and the incidence of sudden death was most apparent in men without pre-existing ischaemic heart disease, with heavy drinkers showing an increase of > 60% compared with occasional or light drinkers. After adjustment for age, social class, and smoking, heavy drinkers free of pre-existing ischaemic heart disease had a marginally significantly higher incidence rates of sudden death than other drinkers combined (relative risk 2.00, 95% confidence interval 0.98 to 4.8). Additional adjustment for systolic blood pressure reduced the risk to 1.7. CONCLUSIONS: This study suggests that heavy drinking is associated with an increased risk of sudden death. Studies that do not take pre-existing ischaemic heart disease into account are likely to underestimate the adverse effects of heavy drinking on the incidence of sudden death because the effects are not as evident in men with pre-existing ischaemic heart disease.

Adult↗
PubMed1992

Blood lipids: the relationship with alcohol intake, smoking, and body weight.

STUDY OBJECTIVE: The aim was to assess the interrelationship between alcohol intake, cigarette smoking, body weight, and blood lipid concentrations. DESIGN: This was the cross sectional (screening) phase of a prospective study. The main outcome measure was the blood lipids (serum total cholesterol, HDL cholesterol, and triglycerides). SETTING: General practices in 24 towns (The British Regional Heart Study). SUBJECTS: Subjects were 7735 men aged 40-59 years, selected at random from the age-sex registers of one group practice in each of the 24 towns. RESULTS: Univariate analysis showed little association between alcohol intake and total cholesterol, a strong positive relation with HDL cholesterol, and a significant increase in triglycerides in heavy drinkers. A strong positive association between alcohol intake and body weight was present in non-smokers but not in moderate/heavy smokers. With the exception of HDL cholesterol, the relationships between alcohol intake and serum lipids were significantly different in smokers and non-smokers, apparently due to the opposing effect of smoking on blood lipids and body weight. Total cholesterol and triglycerides were significantly and positively associated with alcohol intake in non-smokers, the cholesterol association being largely mediated by the influence of alcohol on body weight. In smokers, no such association was seen: current smokers who were heavy drinkers or non-drinkers had the lowest mean cholesterol levels. CONCLUSIONS: The association between alcohol intake and body weight and alcohol intake and blood lipids are strongly conditioned by cigarette smoking. Simple standardisation for smoking in multivariate analyses may obscure the independent relationship with alcohol. These findings are of importance in studies seeking to relate alcohol intake, body weight, or cigarette smoking to blood lipid concentrations, or blood lipid concentration to morbidity or mortality.

Adult↗
PubMed1991

Self-assessment of health status and mortality in middle-aged British men.

In a prospective study of 7725 middle-aged British men, 357 of whom died in an average follow-up period of four years, self-assessment of health status was strongly associated with mortality. Men who reported poor health had an eight-fold increase in total mortality compared with those reporting excellent health. Those perceiving fair or poor health were older, more likely to be manual workers and cigarette smokers, more likely to be thin and to be heavy drinkers or to have given up drinking in the past five years. They were also more likely to recall multiple diagnoses and to be on regular medication. Half of those with poor perceived health had chest pain on exertion (angina), one-third had experienced severe chest pain (possible myocardial infarction) half were breathless on exertion and 80% had been off work for more than a month in recent years. At all age levels between 45 and 64 years, and in both manual and non-manual workers, mortality was twice as high in men reporting fair or poor health than in men reporting excellent or good health. In both men with and without recall of at least one major diagnosis, fair or poor perceived health was associated with a two fold increase in age-adjusted mortality rate. In both groups this increased mortality was to a large extent accounted for by the increase in the prevalence of adverse characteristics such as regular medication, chest pain, breathlessness and current smoking. Self-assessment of health status appears to be a good measure of current physical health and risk of death. It could be useful in both clinical and epidemiological situations.

Adult↗
PubMed1991

The contribution of environmental temperature and humidity to geographic variations in blood pressure.

The pattern of geographic blood pressure variations in Britain has raised the possibility that temperature or other climatic factors may be of importance. Data from two population studies have been examined: the British Regional Heart Study (BRHS), which involved 7735 mean aged 40-59 years, and the Nine Towns Study (NTS), concerning blood pressure among 2596 men and women aged 25-59 years. In the BRHS, significant negative associations were found between daily maximum outdoor temperature and systolic blood pressure (-0.38 mmHg/degrees C; P less than 0.001) and diastolic blood pressure (-0.18 mmHg/degrees C; P less than 0.001). There were similar, although non-significant, associations in the NTS. No significant associations were found between blood pressure and room temperature in either study after taking account of town blood pressure differences, nor between blood pressure and outdoor humidity in the NTS. In the NTS, skin temperature was negatively associated with blood pressure after the adjustment for body mass index, significantly so for male diastolic (-0.62 mmHg/degrees C; P less than 0.05). The BRHS estimates suggest that, in Britain, geographic differences in outdoor temperature may contribute no more than 2 mmHg systolic and 1 mmHg diastolic to regional blood pressure variations. This represents a relatively small proportion of the town differences in blood pressure observed in both the BRHS and NTS. Furthermore, international comparisons suggest that environmental temperature is not an important determinant of population blood pressure levels.

Adult↗
PubMed1991

A critical threshold of exercise capacity in the ventilatory response to exercise in heart failure.

During exercise patients with chronic left heart failure ventilate more than normal individuals at the same workload; the ratio of minute ventilation to minute production of carbon dioxide (VE/VCO2) is increased. The relation between increased VE/VCO2, severity of heart failure, and exercise capacity has not been defined. VE/VCO2 was measured in 47 patients with chronic left heart failure (New York Heart Association grades II and III) and in 1009 healthy controls. Exercise capacity was assessed by peak oxygen consumption (VO2max) during progressive exercise. In the controls VO2max ranged from 25 to 93 ml/kg/min; VE/VCO2 was 17-36 and did not correlate with VO2max. In chronic left heart failure the VO2max ranged from 9 to 29 ml/kg/min; VE/VCO2 was 22-42 and correlated strongly with VO2max. End tidal carbon dioxide and respiratory rate at peak exercise were similar in the controls and patients with chronic left heart failure. The increase in VE/VCO2 on exercise in chronic left heart failure indicates increased physiological dead space, presumably caused by a ventilation-perfusion mismatch. In the controls and patients with chronic left heart failure the relation of VE/VCO2 to VO2max was curvilinear with a threshold of VO2max below which VE/VCO2 started to rise above the normal range. This point of inflection may be explained by the existence of a critical level of cardiac function necessary to perfuse adequately all lung zones on exercise.

Adult↗
PubMed1991

Physical activity and ischaemic heart disease in middle-aged British men.

OBJECTIVE: To assess the relation between reported physical activity and the risk of heart attacks in middle aged British men. DESIGN: Prospective study of middle-aged men followed for a period of eight years (The British Regional Heart Study). SETTING: One general practice in each of 24 British towns. PARTICIPANTS: 7735 men aged 40-59 years at initial examination. END POINT: Heart attacks (non-fatal and fatal). MEASUREMENTS AND MAIN RESULTS: During the follow up period of eight years 488 men suffered at least one major heart attack. A physical activity score used was developed and validated against heart rate and lung function (FEV1) in men without evidence of ischaemic heart disease. Risk of heart attack decreased significantly with increasing physical activity; the groups reporting moderate and moderately vigorous activity experienced less than half the rate seen in inactive men. The benefits of physical activity were seen most consistently in men without preexisting ischaemic heart disease and up to levels of moderately vigorous activity. Vigorously active men had higher rates of heart attack than men with moderate or moderately vigorous activity. The relation between physical activity and the risk of heart attack seemed to be independent of other cardiovascular risk factors. Men with symptomatic ischaemic heart disease showed a reduction in the rate of heart attack at light or moderate levels of physical activity, beyond which the risk of heart attack increased. Men with asymptomatic ischaemic heart disease showed an increasing risk of heart attack with increasing levels of physical activity, but with a progressive decrease in case fatality. Overall, men who engaged in vigorous (sporting) activity of any frequency had significantly lower rates of heart attack than men who reported no sporting activity. However, when all men reporting regular sporting activity at least once a month were excluded from analysis, there remained a strong inverse relation between physical activity and the risk of heart attack in men without pre-existing ischaemic heart disease. CONCLUSION: This study suggests that the overall level of physical activity is an important independent protective factor in ischaemic heart disease and that vigorous (sporting) exercise, although beneficial in its own right, is not essential in order to obtain such an effect.

Adult↗
PubMed1991

Alcohol intake and variations in blood pressure by day of examination.

The patterns of drinking and variations in blood pressure and gamma-glutamyl transferase (GGT) by day of examination have been examined in a large prospective study of cardiovascular disease in 7,735 middle-aged men drawn from general practices in 24 British towns. Overall, mean systolic and diastolic BP levels, as well as the prevalence of measured hypertension, were significantly higher on Mondays and lower on Fridays than on other weekdays. Among occasional, moderate weekend (3-6) and heavy weekend (greater than 6 drinks/day) drinkers, although mean BPs were higher in the heavier drinkers, there was little variation in BP from Monday to Thursday in these groups. In all three groups there was a significant fall in mean BP and in the prevalence of hypertension on Friday, more apparent for systolic than for diastolic pressure and more marked in older men. Among daily drinkers, BP tended to be high on Mondays but was not particularly low on Fridays. Heavy weekend drinkers had higher daily BPs than moderate daily drinkers except on a Friday, even though the estimated total weekly intake was similar. The variations in BP by day of examination were not mirrored by changes in GGT concentrations. The different effect of daily and weekend patterns of drinking on BP may explain some of the discrepancies observed between different alcohol-blood pressure studies. Findings from this study have important implications for the detection of hypertension in populations as well as for clinical practice.

Adult↗
PubMed1990

Weight change, perceived health status and mortality in middle-aged British men.

The association between weight change over a 5-year period, the subsequent perception of health and the mortality during a 4-year follow-up period has been examined in a prospective study of 7735 middle-aged British men. There were 357 deaths from all causes. Self-assessment of health status was considered as a potential guide to whether weight loss was intended or involuntary. Irrespective of weight change those who reported poor or fair health had a more than two-fold increase in death rate compared to those who reported good or excellent health. Considerable weight gain (greater than 10%) was associated with high rates of cardiovascular disease regardless of health perception, although this was most marked in those who perceived poor or fair health. Moderate weight gain was of little importance except in those who regarded their health as poor or fair. Weight loss was associated with increased death rates from cancer regardless of health perception, although the rates were highest in those who perceived poor or fair health. This study emphasizes that weight loss is a potentially serious symptom even in men who report good health. Assessment of weight change and of perception of health status are both of value and could be used in standard health enquiries to monitor health status in individuals and the community.

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