This paper describes the design and methodology of the participating cohorts in the EUROSTROKE project. Information is given about the cohort sampling, its size, the follow up procedures and event classification. Information is also given about the measurement of the cardiovascular and cerebrovascular risk factors in each of the cohorts separately. The cohorts described are the Caerphilly study in Cardiff, United Kingdom; the Kuopio Ischaemic Heart disease study in Kuopio, Finland; the Portugal study in Coimbra, Portugal; the EPIC cohort in Athens, Greece; the Ilsa study from Firenze, Italy; the Rotterdam Study in Rotterdam, the Netherlands, and the Novosibirsk cohort in Novosibirsk, Russia.
Associations have been reported between Chlamydia pneumoniae seropositivity and both acute and chronic obstructive airway diseases. Plasma specimens collected between 1979 and 1983 from 1,773 men 45 to 59 yr of age in Caerphilly, South Wales, were tested for IgG and IgA antibodies to C. pneumoniae (TW183) by microimmunofluorescence. Subsequent mortality and medication for obstructive airway disease were ascertained at 5-yr follow-up examinations. Spirometry was performed at the first and second examinations and analyzed both cross-sectionally and longitudinally; 642 men (36%) had IgG antibodies at a titer of 1:16 or above, of whom 362 also had detectable IgA antibodies. No statistically significant associations were found between either IgG titer or IgA titer and any of the outcome measures: inhaler therapy at entry; commencement of inhalers during follow-up; death from respiratory causes; baseline FEV1, FVC, and FEV1/FVC ratio; and decline in FEV1 (p > 0.1 throughout). Men with high IgG titers ( ⩾ 1:64) had a slower rate of decline of FEV1 than did seronegative subjects (adjusted mean difference in 5-yr change in FEV1: + 22 ml, 95% confidence interval: − 31 ml to + 76 ml). Men with high IgA titers ( ⩾ 1:16) had a slightly faster rate of decline ( − 12 ml, − 96 ml to + 71 ml). This first prospective assessment suggests that chronic C. pneumoniae infection is not a major risk factor for progressive airflow obstruction. Strachan DP, Carrington D, Mendall M, Butland BK, Yarnell JWG, Elwood P. Chlamydia pneumoniae serology, lung function decline and treatment for respiratory disease.
SIR,-Letters in The Lancet late last year drew attention to very high plasma phenylalanine levels observed in some newborn babies receiving total parenteral nutrition (TPN).1-3A diagnosis was recorded for 19 of the 29 infants studied, the most common disorder being necrotising enterocolitis.In about one-third of the babies the phenylalanine levels exceeded 600 pool/1, the recommended upper limit in the management of children with phenylketonuria.4These observations indicate that TPN given to sick, preterm, and newborn babies might be associated with potentially dangerous hyperphenylalaninaemia.The high doses may have contributed: the rates of infusion exceeded that recommended for the aminoacid solution given ('Vamin 9' glucose, KabiVitrum; recommended rate 2'1 g/kg daily) in all three trials, at least in some babies and/or during some period of the therapy.
A randomized controlled trial is reported in which a single dose of aspirin (300 mg) was given to patients with myocardial infarction on first contact with a general practitioner. A total of 1,705 patients with confirmed infarction were studied, and survival ascertained. There was no evidence of benefit from the aspirin.
An attempt was made to assess the importance of selective discharge by death or retirement of workers with respiratory symptoms in a flax mill in Northern Ireland. One hundred and two men who had worked in a flax mill during 1952-62 and who were aged 35 years or more at the time of leaving were followed up. Fourteen of the men had died and 75 were interviewed. The proportion who had dyspnoea on exertion at the time of interview was significantly higher (at P<0·05) in those who had had byssinosis than in those who had not had byssinosis while in the mill, although the proportions with dyspnoea in preparers and nonpreparers did not differ significantly. The proportion who stated that they had left the mill because of exertional dyspnoea of increasing severity was also significantly higher among those who had had byssinosis than among those who had not. Most of the men who had had byssinosis stated that their symptoms had improved after they left the mill, though some thought that work in the mill had permanently affected their chests, and two said that their symptoms had become gradually more severe since discharge. Of the 14 who had died, certificates of the cause of death were traced for 12, in none of which had respiratory disease been entered as a cause of death. In one man who had been a flax preparer, chronic bronchitis had been considered a `significant condition, contributing to the death'. The study indicates that any estimate of the prevalence of byssinosis based solely on the examination of workers in the mills underestimates the true magnitude of the problem.
Several candidate genes have been identified in relation to lipid metabolism, and among these, lipoprotein lipase (LPL) and apolipoprotein E (APOE) gene polymorphisms are major sources of genetically determined variation in lipid concentrations. This study investigated the association of two single nucleotide polymorphisms (SNPs) at LPL, seven tagging SNPs at the APOE gene, and a common APOE haplotype (two SNPs) with blood lipids, and examined the interaction of these SNPs with dietary factors.The population studied for this investigation included 660 individuals from the Prevention of Cancer by Intervention with Selenium (PRECISE) study who supplied baseline data. The findings of the PRECISE study were further replicated using 1238 individuals from the Caerphilly Prospective cohort (CaPS). Dietary intake was assessed using a validated food-frequency questionnaire (FFQ) in PRECISE and a validated semi-quantitative FFQ in the CaPS. Interaction analyses were performed by including the interaction term in the linear regression model adjusted for age, body mass index, sex and country.There was no association between dietary factors and blood lipids after Bonferroni correction and adjustment for confounding factors in either cohort. In the PRECISE study, after correction for multiple testing, there was a statistically significant association of the APOE haplotype (rs7412 and rs429358; E2, E3, and E4) and APOE tagSNP rs445925 with total cholesterol (P = 4 × 10- 4 and P = 0.003, respectively). Carriers of the E2 allele had lower total cholesterol concentration (5.54 ± 0.97 mmol/L) than those with the E3 (5.98 ± 1.05 mmol/L) (P = 0.001) and E4 (6.09 ± 1.06 mmol/L) (P = 2 × 10- 4) alleles. The association of APOE haplotype (E2, E3, and E4) and APOE SNP rs445925 with total cholesterol (P = 2 × 10- 6 and P = 3 × 10- 4, respectively) was further replicated in the CaPS. Additionally, significant association was found between APOE haplotype and APOE SNP rs445925 with low density lipoprotein cholesterol in CaPS (P = 4 × 10- 4 and P = 0.001, respectively). After Bonferroni correction, none of the cohorts showed a statistically significant SNP-diet interaction on lipid outcomes.In summary, our findings from the two cohorts confirm that genetic variations at the APOE locus influence plasma total cholesterol concentrations, however, the gene-diet interactions on lipids require further investigation in larger cohorts.
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Objective: To examine associations between milk consumption and incident heart disease and stroke.
Design: A representative population sample of men was asked to weigh and record their food intake for seven days. The total consumption of milk was obtained from these records. Details of all deaths and vascular events were …
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