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Biomedical subjects

S G Wannamethee

Publications and source records attributed to S G Wannamethee.

At least 19 recordsLinked to original sources
PubMed2002

Taking up regular drinking in middle age: effect on major coronary heart disease events and mortality.

AIM: To examine effects of taking up regular drinking by middle aged non-drinkers and occasional drinkers on major coronary heart disease events and total mortality. METHODS: A prospective study of 7735 men from general practices in 24 British towns screened in 1978-80 at age 40-59 years (Q1). Five years after screening, 7157 men then aged 45-64 completed postal questionnaires (Q5) on changes in alcohol intake. RESULTS: In 6503 men without diagnosed coronary heart disease, there were 874 major coronary heart disease events and 1613 total deaths during 16.8 years of follow up after Q5. With stable occasional drinkers as baseline, men who continued to drink regularly had a significantly lower risk of major coronary heart disease events, coronary heart disease mortality, and overall cardiovascular mortality, but a slightly increased risk of non-cardiovascular mortality. New regular drinkers (89% light), even after adjustment for their many advantageous characteristics, showed a lower risk of major coronary heart disease events than stable occasional drinkers (relative risk (RR) = 0.70; 95% confidence interval (CI) 0.48 to 1.03; p = 0.07). New drinkers showed no reduction in coronary heart disease or cardiovascular mortality and experienced an increase in risk of non-cardiovascular mortality (RR = 1.40; 95% CI 0.99 to 1.97; p = 0.06). In 654 men with diagnosed coronary heart disease, new drinkers experienced no mortality benefit compared with stable occasional drinkers. CONCLUSIONS: Middle aged new regular drinkers experienced lower risk of major coronary heart disease events than stable occasional drinkers or non-drinkers, but had increased risk of non-cardiovascular mortality and total mortality. These findings provide little support for encouraging older men who do not drink or who only drink occasionally to take up regular drinking, whether or not they have coronary heart disease.

Adult↗
PubMed2002

Alcohol consumption and the incidence of type II diabetes.

BACKGROUND: This study examines the relation between alcohol and type II diabetes and the possible mediating effects of HDL-cholesterol and serum insulin. METHODS: Prospective study of 5221 men aged 40-59 years with no history of coronary heart disease, diabetes, or stroke drawn from general practices in 18 British towns. RESULTS: During the mean follow up of 16.8 years there were 198 incident cases of type II diabetes. Occasional drinkers were the reference group. A non-linear relation was seen between alcohol intake and age adjusted risk of diabetes, with risk lowest in light and moderate drinkers and highest in heavy drinkers (quadratic trend p=0.03). Further adjustment for body mass index decreased risk in heavy drinkers. After additional adjustment for physical activity, smoking, and (undiagnosed) pre-existing coronary heart disease, only moderate drinkers showed significantly lower risk than occasional drinkers (RR=0.66 95% CI 0.44 to 0.99). Alcohol intake was inversely associated with serum insulin and positively associated with HDL-cholesterol. Adjustment for these factors reduced the "protective" effect in moderate drinkers (adjusted RR=0.73 95% CI 0.48 to 1.10) but the quadratic trend remained significant (p=0.02). CONCLUSION: There is a non-linear relation between alcohol intake and the risk of type II diabetes. Serum insulin and HDL-cholesterol explained a small amount (20%) of the reduction in risk of type II diabetes associated with moderate drinking. The adverse effect of heavy drinking seemed to be partially mediated through its effect on body weight.

Adult↗
PubMed2001

Physical activity and risk of cancer in middle-aged men.

A prospective study was carried out to examine the relationship between physical activity and incidence of cancers in 7588 men aged 40-59 years with full data on physical activity and without cancer at screening. Physical activity at screening was classified as none/occasional, light, moderate, moderately-vigorous or vigorous. Cancer incidence data were obtained from death certificates, the national Cancer Registration Scheme and self-reporting on follow-up questionnaires of doctor-diagnosed cancer. Cancer (excluding skin cancers) developed in 969 men during mean follow-up of 18.8 years. After adjustment for age, smoking, body mass index, alcohol intake and social class, the risk of total cancers was significantly reduced only in men reporting moderately-vigorous or vigorous activity; no benefit seen at lesser levels. Sporting activity was essential to achieve significant benefit and was associated with a significant dose-response reduction in risk of prostate cancer and upper digestive and stomach cancer. Sporting (vigorous) activity was associated with a significant increase in bladder cancer. No association was seen with colo-rectal cancer. Non-sporting recreational activity showed no association with cancer. Physical activity in middle-aged men is associated with reduced risk of total cancers, prostate cancer, upper digestive and stomach cancer. Moderately-vigorous or vigorous levels involving sporting activities are required to achieve such benefit.

Adult↗
PubMed2001

Variability of angina symptoms and the risk of major ischemic heart disease events.

Variability of angina symptoms over a 5-year period was examined in a prospective study, in which 7,109 British middle-aged men completed two chest pain questionnaires, Q1 (1978-1980) and Q5 (1983-1985), and were classified as having no chest pain, nonexertional chest pain, or angina (Q) (exertional chest pain) on each occasion. Within persons, there was considerable variability in response to the chest pain questions at Q1 and Q5. Angina (Q) persistence showed marked associations with previous myocardial infarction, diagnosed angina, electrocardiogram ischemia, and subsequent major ischemic heart disease events from Q5 onward. Compared with men without angina (Q), the age-adjusted hazard ratios were 1.5 (95% confidence interval (CI): 1.1, 2.2) for angina (Q) at Q1 only, 2.6 (95% CI: 2.1, 3.2) for angina (Q) at Q5 only, and 3.4 (95% CI: 2.8, 4.3) for angina (Q) on both occasions. For men without diagnosed ischemic heart disease, for whom apparent remission of angina (Q) was particularly frequent, a similar pattern of association was found between angina (Q) persistence and subsequent major events. In middle-aged men, exertional chest pain is a strong indicator of major coronary risk but frequently appears transient in the longer term. Persistently reported symptoms are associated with severe disease and a poor prognosis.

Adult↗
PubMed2001

Serum uric acid is not an independent risk factor for coronary heart disease.

Many large epidemiologic studies have confirmed a positive association between raised serum uric acid and risk of coronary heart disease or cardiovascular disease, both in the general population and among hypertensive patients. There is much controversy concerning the role of uric acid as an independent risk factor in the development of coronary heart disease because serum uric acid is related to many of the established etiologic risk factors for cardiovascular disease that could confound the observed association. This review finds little support for an independent causal role for serum uric acid in the development of coronary heart disease.

Coronary Disease↗
PubMed2001

Weight change, body weight and mortality: the impact of smoking and ill health.

OBJECTIVES: This paper examines the influence of cigarette smoking and ill health on the relationship between weight change, body weight and subsequent mortality to determine whether weight loss and leanness in middle to older age is deleterious to health. METHODS: Men aged 40-59 years at screening drawn from one general practice in each of 24 British towns, who completed a questionnaire 5 years after screening (Q5) and provided full information on changes in weight and smoking status (n = 7065) were then followed up for an average of 13.8 years. RESULTS: In all men a shallow U-shaped relationship was seen between body mass index (BMI) at Q5 and all-cause mortality rates. Weight loss and substantial weight gain (> or =10%) were associated with increased mortality rates compared to the stable weight group. The increased risk associated with weight loss was seen in long- term non-smokers (n = 4101) and recent ex-smokers (n = 722) but not in current smokers (n = 2242) after adjustment for a wide range of potential confounders. However, the increased risk was markedly attenuated after exclusion of those with ill health (relative risk [RR] = 1.16, 95% CI : 0.84-1.59 and RR = 0.79, 95% CI : 0.29-2.20 for long-term non-smokers and recent ex-smokers, respectively). Moderate weight gain (4-10%) was associated with lower risk of mortality than observed in those with stable weight but only in recent ex-smokers and in current smokers, not in long-term non-smokers. A positive association was seen between BMI at Q5 and all-cause mortality in non-smokers and this was strengthened by exclusion of men with weight loss. CONCLUSION: The increased risk of mortality associated with weight loss or low body weight in middle-aged and older men appears to be a direct consequence of ill health leading to weight loss and leanness. In healthy non-smoking men weight loss and leanness are not associated with increased mortality and moderate weight gain (4-10%) was neither deleterious nor beneficial.

Adult↗
PubMed2001

Geographic variation in incidence of coronary heart disease in Britain: the contribution of established risk factors.

OBJECTIVE: To determine the extent to which geographic variation in the incidence of major coronary heart disease (CHD) in Great Britain may be explained by established risk factors. DESIGN: Prospective study. SETTING: 24 British towns with widely differing CHD mortality. SUBJECTS: 7735 men followed up from screening in 1978-80 for 15 years. MAIN OUTCOME MEASURES: Percentage of variance between the towns in major CHD incidence that can be explained by individual characteristics of men in the towns. RESULTS: Age standardised incidence rates over a 15 year period varied from 0.52% per annum in Maidstone to 1.07% per annum in Dewsbury and tended to follow the known pattern of higher rates in Scottish and northern English towns and lower rates in southern English towns ("north-south gradient"). Higher town incidence rates were related to prevalence of current cigarette smoking, low physical activity, and low alcohol consumption, and to mean body mass index, mean systolic blood pressure, low mean height, and prevalence of manual social class, but not to mean serum total cholesterol. The 95% range for true age adjusted CHD incidence (over 15 years) was estimated as 0.58-1.03% per annum among British towns. After adjustment for baseline smoking status, physical activity, body mass index, alcohol consumption, systolic blood pressure, serum total cholesterol, occupational social class, and height, this variation was reduced by 50%. A model based on these eight variables accounted for the major part of the north-south gradient. CONCLUSIONS: Much of the variation in CHD incidence among British towns was accounted for by established risk variables. The remaining unexplained variation may be related to measurement error in the established risk variables, to environmental factors such as climate, or to the combined effect of a wide range of minor risk factors.

Adult↗
PubMed2001

Physical activity in the prevention of cardiovascular disease: an epidemiological perspective.

This review of the epidemiological evidence regarding physical activity and cardiovascular disease (CVD) provides substantial evidence from many different populations that leisure time physical activity is associated with reduced risk of coronary heart disease (CHD) and cardiovascular mortality in both men and women and in middle-aged and older individuals. Physical activity appears to be a critical factor in both primary and secondary prevention of CHD. The studies indicate a dose-response relationship between overall physical activity and CVD, which is linear at least up to a certain level of activity. Prospective studies suggest that physical activity is also associated with reduced risk of stroke. The mechanisms underlying the protective effect of physical activity on CVD are still unclear. In recent years. the view that physical activity has to be vigorous to achieve a reduction in risk of CHD has been questioned. Overall, the evidence points to the benefit of continued regular moderate physical activity which does not need to be strenuous or prolonged and includes daily leisure activities such as walking or gardening which are readily attainable by large sections of the population. Taking up regular light or moderate physical activity in middle or older age confers significant benefit for CVD and all-cause mortality.

Cardiovascular Diseases↗
PubMed2001

Smoking as a modifiable risk factor for type 2 diabetes in middle-aged men.

OBJECTIVE: To examine the effects of cigarette smoking, giving up smoking, and primary or secondary pipe or cigar smoking on the risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: A prospective study followed 7,735 men aged 40-59 years from general practices in 24 British towns for an average of 16.8 years. Incident cases of physician-diagnosed diabetes were ascertained by repeated postal questionnaires and systematic reviews of primary care records. RESULTS: A total of 290 incident cases of diabetes were found in 7,124 men with no history of diabetes, coronary heart disease, or stroke. Cigarette smoking was associated with a significant increase in risk of diabetes, even after adjustment for age, BMI, and other potential confounders. The benefit of giving up smoking was only apparent after 5 years of smoking cessation, and risk reverted to that of never-smokers only after 20 years. The risk of diabetes in those who switched from smoking cigarettes to pipe or cigars remained equal to the risk in continuing cigarette smokers. Men who gave up smoking during the first 5 years of follow-up showed significant weight gain and subsequently higher risk of diabetes than continuing smokers. CONCLUSIONS: Cigarette smoking is an independent and modifiable risk factor for type 2 diabetes. Smoking cessation is associated with weight gain and a subsequent increase in risk of diabetes, but in the long term, the benefits of giving up smoking outweigh the adverse effects of early weight gain.

Adult↗
PubMed2000

Physical activity and mortality in older men with diagnosed coronary heart disease.

BACKGROUND: We have studied the relations between physical activity, types of physical activity, and changes in physical activity and all-cause mortality in men with established coronary heart disease (CHD). METHODS AND RESULTS: In 1992, 12 to 14 years after the initial screening (Q1) of 7735 men 40 to 59 years of age from general practices in 24 British towns, 5934 (91% of available survivors, mean age 63 years) provided further information on physical activity (Q92) and were followed up for 5 years; 963 had a physician's diagnosis of CHD (myocardial infarction or angina). After exclusions, there were 772 men with established CHD, 131 of whom died of all causes. The lowest risks for all-cause and cardiovascular mortality were seen in light and moderate activity groups (adjusted relative risk compared with inactive/occasionally active: light, 0.42 (0.25, 0.71); moderate, 0.47 (0.24, 0.92); and moderately vigorous/vigorous, 0.63 (0.39, 1.03). Recreational activity of >/=4 hours per weekend, moderate or heavy gardening, and regular walking (>40 min/d) were all associated with a significant reduction in all-cause mortality. Nonsporting activity was more beneficial than sporting activities. Men sedentary at Q1 who began at least light activity by Q92 showed lower mortality rates on follow-up than those who remained sedentary (relative risk 0.58, 95% CI 0.33 to 1.03; P:=0.06). CONCLUSIONS: Light or moderate activity in men with established CHD is associated with a significantly lower risk of all-cause mortality. Regular walking and moderate or heavy gardening were sufficient to achieve this benefit.

Adult↗
PubMed2000

Physical activity, metabolic factors, and the incidence of coronary heart disease and type 2 diabetes.

OBJECTIVE: To examine the role of nonfasting serum insulin level and components of the insulin resistance syndrome in the relationship between physical activity and the incidence of coronary heart disease and type 2 diabetes. METHODS: Prospective study of 5159 men aged 40 to 59 years with no history of coronary heart disease, type 2 diabetes, or stroke drawn from general practices in 18 British towns. During an average follow-up period of 16.8 years, there were 616 cases of major coronary heart disease events (fatal and nonfatal) and 196 incident cases of type 2 diabetes. RESULTS: After adjustment for potential confounders (lifestyle characteristics and preexisting disease), physical activity was inversely related to coronary heart disease rates, with the lowest rates in the men undertaking moderate physical activity and with no further benefit thereafter. For type 2 diabetes, risk decreased progressively with increasing levels of physical activity. Physical activity was associated with serum insulin level and with factors associated with insulin, ie, heart rate, hyperuricemia, diastolic blood pressure, and high-density lipoprotein cholesterol level, and with gamma-glutamyltransferase level, a possible marker of hepatic insulin resistance. Adjustment for insulin and associated factors made little difference to the relationship between physical activity and risk of coronary heart disease. By contrast, these factors together with gamma-glutamyltransferase level appear to explain a large proportion of the reduction in risk of type 2 diabetes associated with physical activity. CONCLUSIONS: The relationship between physical activity and type 2 diabetes appears to be mediated by serum true insulin level and components of the insulin resistance syndrome. However, these factors do not appear to explain the inverse relationship between physical activity and coronary heart disease.

Adult↗
PubMed2000

Characteristics of older men who lose weight intentionally or unintentionally.

In most prospective studies involving older subjects, weight loss is associated with increased mortality. The authors examined the characteristics and health status of middle-aged men from 24 towns (the British Regional Heart Study), who reported that they had lost weight intentionally or unintentionally as they aged. Questionnaires were completed at screening (1978-1980), 5 years later, and in 1992 and 1996. This paper concerns the 4,713 men who reported their weight in 1992 and 1996 and their perceived weight change over this period. Weight loss was reported by 847 men (18%), of whom 39% stated that it was intentional. Compared with intentional weight loss, unintentional weight loss was associated with lower social class, more smoking, less obesity, and less physical activity and with the highest rates of "poor health,"long-standing disability, cancer, and respiratory diseases. The rates of recalled heart attack, stroke, diabetes, and cardiovascular hospitalization were higher than among men whose weight was stable. Men who lost weight intentionally had been more obese than those who lost weight unintentionally and had high rates of obesity-related conditions. Thus, both intentional and unintentional weight loss may follow the development of disease. These findings probably account for the lack of benefit and the increased mortality associated with weight loss observed in most large-scale prospective studies.

Age Distribution↗
PubMed2000

The natural history of prevalent ischaemic heart disease in middle-aged men.

OBJECTIVE: To describe the long-term outcome of different forms of symptomatic and asymptomatic ischaemic heart disease in middle-aged men. METHODS: 7735 men aged 40-59, randomly selected from 24 general practices in Britain were classified into one of seven ischaemic heart disease groups according to a questionnaire and electrocardiogram (ECG): I=diagnosed myocardial infarction; II=unrecognized myocardial infarction; III= diagnosed angina; IV=angina symptoms; V=possible myocardial infarction symptoms; VI=ECG ischaemia or possible myocardial infarction; VII=no evidence of ischaemic heart disease. The association of disease group with a range of fatal and non-fatal outcomes during 15 years of follow-up was assessed. RESULTS: At baseline 25% of men had evidence of ischaemic heart disease (groups I-VI). Risks of major ischaemic heart disease events, total and cardiovascular mortality, stroke, and major cardiovascular events tended to increase strongly from group VII to I. Diagnosed myocardial infarction was associated with a much poorer prognosis than all other groups (including unrecognized infarction) for all cardiovascular outcomes other than stroke. The relative risk associated with ischaemic heart disease at baseline declined dramatically over time. However, men with myocardial infarction who survived event-free for 10 years continued to experience a high excess risk in the subsequent 5 years, in contrast to event-free survivors of angina and other ischaemic heart disease. Adjusted to an average age of 50, the percentage of men surviving for 15 years free of a new major cardiovascular event was 44 for diagnosed myocardial infarction, 52 for unrecognized myocardial infarction, 66 for diagnosed angina, 68 for angina symptoms, 73 for possible myocardial infarction symptoms, 73 for ECG ischaemia, and 79 for no ischaemic heart disease. Comparison of outcome between prevalent and incident myocardial infarction illustrated the improved prognosis of men surviving the initial years after their event. CONCLUSIONS: Differing manifestations of prevalent ischaemic heart disease are associated with widely differing outcome, and the majority of middle-aged men in the community who have evidence of ischaemic heart disease short of myocardial infarction survive for 15 years without heart attack or stroke. The excess risk associated with myocardial infarction appears more persistent than that associated with angina and other ischaemic heart disease, remaining high even after 10 years of event-free survival.

Adult↗
PubMed2000

Alcohol intake and mortality in middle aged men with diagnosed coronary heart disease.

OBJECTIVE: To examine the effects of alcohol on risk of mortality from coronary heart disease (CHD), cardiovascular disease, and all causes in men with established CHD. METHODS AND RESULTS: In a population based prospective study of 7169 men aged 45-64 years followed for a mean of 12.8 years, 655 men (9.1%) had a physician diagnosis of CHD (myocardial infarction 455, angina only 200). In these 655 men, there were 294 deaths from all causes including 175 CHD deaths. Ex-drinkers had the highest risk of CHD, cardiovascular mortality, and all cause mortality even after adjustment for lifestyle characteristics and pre-existing disease. Using occasional drinkers as the reference group, lifelong teetotallers, occasional drinkers, and light drinkers all showed similar risks of mortality from CHD, cardiovascular disease, and all causes. Moderate/heavy drinkers showed increased risk of mortality from CHD, cardiovascular disease, and all causes compared to occasional drinkers. The adverse effect of moderate/heavy drinking was confined to the 455 men with previous myocardial infarction (adjusted relative risk for all cause mortality 1.50, 95% confidence interval 1.01 to 2.23). In contrast to lighter drinking, giving up smoking within five years of the start of follow up was associated with a considerable reduction in risk of all cause and cardiovascular mortality compared to those who continued to smoke. CONCLUSION: Compared to occasional drinking, regular light alcohol consumption (1-14 units per week) in men with established coronary heart disease is not associated with any significant benefit or deleterious effect for CHD, cardiovascular disease or all cause mortality. Higher levels of intake (>/= 3 drinks per day) are associated with increased mortality in men with previous myocardial infarction. In contrast, smoking cessation in men with established CHD substantially reduces the risk of mortality.

Adult↗
PubMed2000

HDL-Cholesterol, total cholesterol, and the risk of stroke in middle-aged British men.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the relation between serum HDL cholesterol and total cholesterol and risk of stroke. METHODS: We carried out a prospective study in 7735 men, 40 to 59 years of age, drawn from 1 group practice in each of 24 British towns. Men with history of stroke were excluded (n=52). RESULTS: During the mean follow-up period of 16.8 years, there were 343 stroke cases (fatal and nonfatal) in the 7683 men with no history of stroke. Higher levels of HDL cholesterol were associated with a significant decrease in risk of stroke even after adjustment for potential confounders (top fifth versus lowest fifth: adjusted relative risk=0.68, 95% CI 0.46 to 0.99). The inverse relation was seen only for nonfatal strokes (adjusted relative risk=0.59, 95% CI 0.39 to 0.90; top fifth versus lowest fifth). Total cholesterol showed no graded association with fatal strokes, but men with levels > or =8.1 mmol/L (top 5% of the distribution) showed increased risk of nonfatal stroke, although this was not statistically significant after adjustment (adjusted RR=1.46, 95% CI 0.91 to 2.32). The beneficial effects of elevated HDL cholesterol on nonfatal stroke were seen in both smokers and nonsmokers and were more evident in men with hypertension than in normotensives. In hypertensive men, elevated HDL cholesterol (top fifth) was associated with a significant 50% reduction in risk of nonfatal strokes compared with men in the lowest fifth. CONCLUSIONS: Higher levels of HDL cholesterol were associated with a significant decrease in risk of nonfatal stroke. In contrast, elevated total cholesterol showed a weak positive association with nonfatal strokes. The marked inverse association between HDL cholesterol and stroke seen in hypertensives emphasizes the importance of those modifiable risk factors for stroke known to lower the concentrations of HDL cholesterol.

Adult↗
PubMed2000

Locomotor disability in a cohort of British men: the impact of lifestyle and disease.

BACKGROUND: Increasing life expectancy has brought public health concern about the increase in prevalence of disability in old age. Reducing the prevalence of disability in older age requires the identification of preventable or modifiable risk factors earlier in life. We have examined the relationship between lifestyle and other potential risk factors in men aged 40-59 years at screening and locomotor disability 12-14 years later to assess whether any of these factors have direct and independent roles in influencing disability in later life. METHODS: In 1978-1980, a longitudinal study of cardiovascular disease was initiated in 7735 men aged 40-59 years drawn from one general practice in each of 24 British towns. The present study concerns 5717 men, 88% of the surviving men who were available to follow-up (i.e. were registered with a GP and had an address) and who satisfactorily completed the disability section of a follow-up postal questionnaire in 1992 (Q92). The main endpoint from the questionnaire was locomotor disability based on self-reported inability in any one or more of the following: to get outdoors, walk 400 m, climb stairs, maintain balance, bend down, or straighten up. RESULTS: In the 5717 men (mean age 63 years) who provided information on disability status, 25.0% reported locomotor disability and the majority of these men recalled a doctor-diagnosed disease of which cardiovascular disease was most strongly associated with locomotor disability. Lifestyle factors at screening (smoking, physical inactivity, obesity and heavy drinking) and manual social class were strongly and independently associated with increased odds of locomotor disability 12-14 years later. By contrast, baseline blood pressure and serum total cholesterol showed little relationship with locomotor disability. Among men with diagnosed major cardiovascular disease (stroke, myocardial infarction, angina or aortic aneurysm) those with locomotor disability showed significantly higher adverse lifestyle factors at screening than those who were able. Similarly, adverse lifestyle factors were also seen more frequently among disabled men with respiratory disease and among disabled men with other non-cardiovascular conditions than among their able counterparts. CONCLUSIONS: Smoking, obesity, physical inactivity and heavy drinking in middle age are strong predictors of locomotor disability in later life independent of the presence of diagnosed disease. Leading a healthy lifestyle improves survival and reduces the incidence of disease. It also reduces the risk of locomotor disability and increases the odds of being disability-free even in the event of developing major cardiovascular disease.

Adult↗
PubMed1999

Is serum uric acid a risk factor for coronary heart disease?

The role of uric acid as an independent risk factor in the development of coronary heart disease (CHD) has been questioned as serum urate is related to many of the established etiological risk factors for cardiovascular disease which could confound the observed association. This review assesses the role of elevated serum uric acid as an independent role for coronary heart disease.

Biomarkers↗