Læknablaðið - 15.09.1992, Síða 13

LÆKNABLAÐIÐ
275
Factor Intervention Trial (MRFIT) (13). Sem
dæmi um samverkun áhættuþátta má nefna að
það að vera karl er áhættuþáttur í sjálfu sér
og magnar áhrif kólesterólsins. Þegar fleiri
áhættuþættir koma saman verða áhrifin enn
greinilegri.
SUMMARY
The Reykjavik 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 íirst examination. After follow-
up 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 risk factors were assessed
simultaneously with multivariate survival analysis
using the Cox’s proportional hazards model. Age,
semm 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. Body mass
index and former history of smoking were not
significant independent risk factors.
The relative contribution of major risk factors
for coronary heart disease mortality is similar
among Icelandic men and 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.
HEIMILDIR
1. Castelli WP. Doyle JT, Gordon T. HDL cholesterol
and other lipids in coronary heart disease. Circulation
1977; 55: 767-72.
2. Miller NE, Förde OH, Thelle DS, Mjös OD. The
Tromsö Heart Study. High density lipoprotein and
coronary heart disease: a prospective case-control
study. Lancet 1977; i: 965-8.
3. Pocock SJ, Shaper AG, Philips AN, Walker M,
Whitehead TP. High density lipoprotein cholesterol
is not a major risk factor for ischemic heart disease in
British men. Br Med J 1986; 292: 515-9.
4. Sigurðsson JA, Bengtsson C. Eru blóðfitur
áhættuþáttur hjá konum? Samantekt úr þversniðs-
og langtímaferilrannsóknum á konum í Gautaborg.
Læknablaðið 1990; 76: 303-6.
5. Kannel WB. Update on the role of cigarette smoking
in coronary artery disease. Am Heart J 1981; 101:
319-28.
6. Roberts WC. Atherosclerotic risk factors - Are there
ten or is there only one? Am J Cardiol 1989; 64:
552-4.
7. Bjömsson OJ, Davíðsson D, Ólafsson Ó, Sigfússon
N, Thorsteinsson Th. Health survey in the Reykjavík
area. - Men. Stages I-III, 1967-1968, 1970-1971 and
1974-1976. Participants, invitation, responses etc.
Reykjavík: Rannsóknarstöð Hjartavemdar, 1979.
8. Bjömsson G, Bjömsson OJ, Davíðsson D,
Kristjánsson BTh, Sigfússon N. Health survey in
the Reykjavík area. - Women. Stages I-IH, 1968-
1969, 1971-1972 and 1976-1978. Participants,
invitation response etc. Reykjavík, Rannsóknarstöð
Hjartavemdar, 1982.
9. Rose G. Smoking Questionnaires for Health Surveys
Conducted by London School of Hygene and Tropical
Medicine and Guy’s Hospital. London, 1966.
10. Bjömsson OJ. Davíðsson D. Ólafsson Ó, Sigfússon
N, Thorsteinsson Th. Survey of Serum Lipid
Levels in Icelandic Men Aged 34-61 Years. An
epidemiological and statistical evaluation. Acta Med
Scand 1977; Suppl: 616.
11. Cox DR. Regression models and life tables. J Stat
Soc 1972; 34 (Series B); 187-220.
12. Castelli WP. The epidemiology of coronary heart
diease. The Framingham study. Am J Med 1984; 76:
4-12.
13. Stamler J, Wentworth D, Neaton JD (for the MRFIT
Research Group). Is relationship between semm
cholesterol and risk af premature death from coronary
heart disease continuous and graded? Findings in
356.222 primary screenees of the Multiple Risk
Factor Intervention Trial (MRFIT). JAMA 1986; 256:
2823-8.
14. Shaper AG, Pocock SJ, Walker M, Cohen NM, Wale
CJ, Thomson AG. British Regional Heart Study:
Cardiovascular risk factors in middle-aged men in
24 towns. Br Med J 1981; 283: 179-86.
15. Carlson LA, Böttiger LE. Risk factors for ischemic
heart disease in men and women. Results of the 19-
year follow-up of the Stockholm prospective study.
Acta Med Scand 1985; 218: 207-11.
16. Keys A, ed. Coronary heart disease in seven
countries. Circulation 1970; 41-42/Suppl. I: 1-211.
17. Woolf N. Pathology of atherosclerosis. Br Med Bull
1990; 46: 960-85.
18. The Lipid Research Clinics Coronary Primary
Prevention Trial Results I. Reduction in incidence
of coronary heart disease. Lipid Research Clinics
Program. JAMA 1984; 251: 351-64.
19. Blankenhom DH, Nessim SA, Johnson RL, Sanmarco
ME, Azen SP, Cashin-Hemphill L. Beneficial effects
of combined colestipol-niacin therapy on coronary
atherosclerosis and coronary venous bypass grafts.
JAMA 1987; 257: 3233-40.
20. Bush TL, Fried LP, Barrett-Connor E. Cholesterol,
lipoproteins and coronary heart disease in women.
Clin Chem 1988; 34: B60-B70.
21. Corrao JM, Becker RC, Ockene IS, Hamilton GA.
Coronary heart disease risk factors in women.
Cardiology 1990; 77/Suppl. 2: 8-24.
22. Welin L, Larson B, Svardsudd K, Eriksson H,
Wilhelmsen L, Tibblin G. Triglycerider, en
kontroversiell riskfaktor för hjartinfarkt. Nya
syn fra studien »1913 árs man«. Stockholm: