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M G Marmot

Publications and source records attributed to M G Marmot.

161 records · Page 9Linked to original sources
PubMed1981

Alcohol and mortality: a U-shaped curve.

In a longitudinal study of civil servants, 1422 men were classified according to their average daily alcohol intake. Over 10 years of follow-up, the mortality rate was lower in men reporting moderate alcohol intake than in either non-drinkers or heavier drinkers (greater than 34 g alcohol per day). Cardiovascular mortality was greater in non-drinkers and non-cardiovascular mortality was greater in the heavier drinkers. The heavier drinkers had higher mean blood pressures and contained a greater proportion of smokers. A multivariate analysis showed this U-shaped relationship between reported alcohol consumption and subsequent mortality to be largely independent of differences in smoking, blood pressure, plasma cholesterol, and grade of employment.

Adult↗
PubMed1981

Social class and coronary heart disease.

Over the past 40 years in England and Wales the rise in mortality from coronary heart disease has continued unabated among working-class men, whereas among professional men the rate has changed little for the past 20 years. As a result it is now 26 per cent higher in social class V compared with social class I. The difference in women is larger (+ 152%), and it has been present for at least 40 years. The social class gradient for men was confirmed in a survey of 17530 London civil servants aged between 40 and 64 (the Whitehall Study). When men in the lowest employment grade were compared with those in the top (administrative) grade, the age-adjusted prevalence rate was 53 per cent higher for angina, 77 per cent higher for ischaemic-type electrocardiographic abnormalities, and 75 per cent higher for the prevalence of electrocardiographic abnormality among men with angina. At follow-up, the seven-and-a-half year coronary mortality was 3.6 times higher in the lowest than in the top grade. This social class difference was partly explained by known coronary risk factors: men in the lower grades smoked more and exercised less, they were shorter and more overweight, and they had higher blood pressures and lower levels of glucose tolerance. Most of the difference, however, remains unexplained. It seems that there are major risk factors yet to be identified, and that these may throw light on how it is possible for members of a highly-placed social group to have a relatively low risk of coronary heart disease.

Adult↗
PubMed1980

Effect of breast-feeding on plasma cholesterol and weight in young adults.

The relation between breast-feeding and plasma cholesterol level in adult life was examined in a longitudinal study of a sample of people born in 1946. One hundred and seventy-two subjects whose breast-feeding history had been recorded during infancy were examined when they were 32 years old. Women who had been breast-fed had significantly lower mean plasma cholesterol than women who had been bottle-fed (5.4 mmol/l compared with 5.9 mmol/l). For men the difference was smaller and not significant. An unexpected finding was the higher mean weight and skinfold thickness in men who had been breast-fed. These results support the hypothesis that factors acting very early in life affect the risk of disease in adults.

Adult↗
PubMed1979

Childhood cultural experience and the incidence of coronary heart disease in Hawaii Japanese men.

Possible effects of cultural variables on the risk of coronary heart disease (CHD) were examined in 7705 men of Japanese ancestry living in Hawaii. The six-year incidence of CHD was related to birthplace (Japan or elsewhere), number of years spent in Japan, ability to read and write Japanese, ability to speak Japanese, and to an index of preference for a traditional Japanese diet. Statistically significant inverse relationships were found between CHD incidence and all of these variables which reflect the degree of exposure to Japanese culture during childhood. In multivariate analyses where the major CHD risk factors were taken into account, years spent in Japan and ability to read and write Japanese remained significant. Hence, exposure to Japanese culture during childhood appears to protect against CHD in adulthood. This may explain, in part, the gradient of CHD frequency among Japanese in Japan, Japanese-Americans, and Caucasians that could not be entirely attributed to the established risk factors.

Acculturation↗
PubMed1979

Epidemiological basis for the prevention of coronary heart disease.

Epidemiological studies have laid the basis for a preventive approach to coronary heart disease (CHD). On balance, present evidence indicates that the following should form the basis of a preventive programme: low-fat diet, cessation of smoking, and control of blood pressure. Other factors likely to produce a beneficial effect on CHD occurrence include reduction of obesity and increased physical activity. Although psychosocial factors are most likely to be causally related to CHD, it is not possible at present to provide clear guidelines as to their role in a preventive programme.TRIALS ARE BEING CONDUCTED TO INVESTIGATE THE POSSIBILITY OF PREVENTING CHD BY A VARIETY OF APPROACHES: a doctor-centred approach or health education in certain sectors of a community or in whole communities. These trials have shown that it is possible to achieve behavioural changes and a reduction in the levels of risk factors in a proportion of the participants. It is not yet clear to what extent these changes in levels of risk factors in middle-aged people will lead to a reduction in the incidence of CHD. It can be calculated, however, that the greatest benefit is likely to come from approaches to prevention that involve the whole community, rather than only high-risk groups.

Blood Pressure↗
PubMed1978

Changing social-class distribution of heart disease.

Analysis of mortality trends over 40 years in England and Wales showed that mortality from coronary heart disease had become progressively more common in working-class men and women than in those from the middle and upper classes. The change was most noticeable for men. Whereas in 1931 and 1951 heart disease was more common in men of social classes I and II, by 1961 it was more common in men of classes IV and V. This change in social-class distribution can only partly be explained by changes in diagnostic methods. The worsening mortality of classes IV and V correlated with relatively more smoking, a higher consumption of sugar, and a lower consumption of wholemeal bread in these classes. There was no correlation between change in heart disease and change in the social-class pattern of fat consumption.

Adult↗
PubMed1978

Employment grade and coronary heart disease in British civil servants.

The relationship between grade of employment, coronary risk factors, and coronary heart disease (CHD) mortality has been investigated in a longitudinal study of 17 530 civil servants working in London. After seven and a half years of follow-up there was a clear inverse relationship between grade of employment and CHD mortality. Men in the lowest grade (messengers) had 3.6 times the CHD mortality of men in the highest employment grade (administrators). Men in the lower employment grades were shorter, heavier for their height, had higher blood pressure, higher plasma glucose, smoked more, and reported less leisure-time physical activity than men in the higher grades. Yet when allowance was made for the influence on mortality of all of these factors plus plasma cholesterol, the inverse association between grade of employment and CHD mortality was still strong. It is concluded that the higher CHD mortality experienced by working class men, which is present also in national statistics, can be only partly explained by the established coronary risk factors.

Adult↗
PubMed1976

Acculturation and coronary heart disease in Japanese-Americans.

Among men of Japanese ancestry, there is a gradient in the occurrence of coronary heart disease (CHD). It is lowest in Japan, intermediate in Hawaii, and highest in California. This gradient appears not to be completely explained by differences in dietary intake, serum cholesterol, blood pressure or smoking. To test the hypothesis that social and cultural differences may account for the CHD differences between Japan and the United States, 3809 Japanese-Americans in California were classified according to the degree to which they retained a traditional Japanese culture. The most traditional group of Japanese-Americans had a CHD prevalence as low as that observed in Japan. The group that was most acculturated to Western culture had a three- to five-fold excess in CHD prevalence. This difference in CHD rate between most and least acculturated groups could not be accounted for by differences in the major coronary risk factors.

Acculturation↗
PubMed1975

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: introduction.

It has been observed that among men of Japanese ancestry, there is a gradient in CHD mortality increasing from Japan to Hawaii to California. A study of 11,900 Japanese men in Hiroshima and Nagasaki, Japan, Honolulu, Hawaii, and the San Francisco Bay Area of California has been conducted to investigate this disease difference. This paper describes the selection of the study populations and their age distributions, and outlines the study methods. This paper also introduces and briefly summarizes four papers that give the results for mortality comparisons, biochemical and blood pressure distributions and results for heart disease prevalence among the three cohorts.

Aged↗
PubMed1975

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of coronary and hypertensive heart disease and associated risk factors.

A study of coronary heart disease (CHD) among Japanese migrants compared with Japanese living in Japan provided the opportunity to study factors possibly responsible for the high rates of CHD in America as compared with Japan. Comparable methods were employed in examining 11,900 men of Japanese ancestry aged 45--69 living in Japan, Hawaii and California. The age-adjusted prevalence rates for definite CHD as determined by ECG were: Japan 5.3, Hawaii 5.2 and California 10.8/1000. For definite plus possible CHD the rates were 25.4, 34.7 and 44.6. The prevalence of angina pectoris and pain of possible myocardial infarction, determined by questionnaire, showed a similar gradient. Elevated serum cholesterol showed a Japan-Hawaii-California gradient, but the prevalence of hypertension in Japan was intermediate between the prevalence in Hawaii and the higher prevalence in California. The three geographic locations were compared as to prevalence of CHD at comparable levels of blood pressure and cholesterol. At each blood pressure level and at each cholesterol level, the greater prevalence of CHD in California persisted. These facts, plus the near universality of smoking in Japan, suggest that conventional risk factors only partly explain the observed gradient in CHD.

Age Factors↗
PubMedDate not supplied

Psychosocial work characteristics and social support as predictors of SF-36 health functioning: the Whitehall II study.

OBJECTIVE: To assess whether work characteristics and social support are predictors of physical, psychological, and social functioning. METHOD: Work characteristics (Karasek and Siegrist models) and social support at baseline were used to predict health functioning measured by the SF-36 General Health Survey 5 years later in a prospective cohort study of 10,308 British male and female civil servants. RESULTS: Effort-reward imbalance and negative aspects of close relationships predicted poor physical, psychological, and social functioning after adjustment for the potential confounding effects of age, employment grade, baseline ill health, and negative affectivity. These psychosocial characteristics seem to act in a similar way in the healthy and those with existing illness. Psychological demands at work in women, and low confiding/emotional support in men, also predicted poor functioning. Etiologically. these effects are not mediated through health-related behaviors. CONCLUSIONS: Negative aspects of work (high demands and effort-reward imbalance) and negative aspects of close relationships are independent powerful predictors of poor health functioning. They may have an etiological role, which is independent of baseline illness.

Adult↗
PubMedDate not supplied

Blood pressure reactions to acute psychological stress and future blood pressure status: a 10-year follow-up of men in the Whitehall II study.

OBJECTIVE: The aim of this study was to examine whether blood pressure reactions to mental stress predicted future blood pressure and hypertension. METHODS: Blood pressure was recorded at an initial medical screening examination after which blood pressure reactions to a mental stress task were determined. A follow-up screening assessment of blood pressure and antihypertensive medication status was undertaken 10 years later. Data were available for 796 male public servants, between 35 and 55 years of age upon entry to the study. RESULTS: Systolic blood pressure reactions to mental stress were positively correlated with follow-up screening systolic blood pressure and to a lesser extent, follow-up diastolic pressure. In multivariate tests, by far the strongest predictors of follow-up blood pressures were initial screening blood pressures. In the case of follow-up systolic blood pressure, systolic reactions to stress emerged as an additional predictor of follow-up systolic blood pressure. With regard to follow-up diastolic blood pressure, reactivity did not enter the analogous equations. The same outcomes emerged when the analyses were adjusted for medication status. When hypertension at 10-year follow-up was the focus, both systolic and diastolic reactions to stress were predictive. However, with correction for age and initial screening blood pressure, these associations were no longer statistically significant. CONCLUSIONS: The results of this study provide modest support for the hypothesis that heightened blood pressure reactions to mental stress contribute to the development of high blood pressure. At the same time, they question the clinical utility of stress testing as a prognostic device.

Acute Disease↗