[Is hypothyroidism underdiagnosed?].
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Humans↗
Biomedical subjects
O P Foss
Publications and source records attributed to O P Foss.
Treatment of hypertensive and hypercholesterolaemic patients in general practice. The effect of captopril, atenolol and pravastatin combined with life style intervention.
OBJECTIVE: To elucidate the effect on blood pressure and blood lipids of an angiotensin converting enzyme inhibitor (captopril), and a beta-receptor blocking agent (atenolol), given alone or in combination with a cholesterol reducing drug, the beta-hydroxy-methylglutaryl-coenzyme A reductase inhibitor pravastatin, in patients who were also encouraged to improve their lifestyle. DESIGN: A longitudinal study consisting of three phases. I: Lifestyle intervention alone. II: Continued lifestyle intervention combined with captopril or atenolol. III: Continued lifestyle intervention combined with the same drugs as in phase II and in addition pravastatin or placebo. SETTING: Fifty-four general practice surgeries in Norway. PARTICIPANTS: Hypertensive patients, 210 females and 160 males, treated or untreated with antihypertensive drugs with a sitting diastolic blood pressure between 95 and 115 mmHg and a serum total cholesterol between 6.5 mmol/l (7.0 for those age 60-67 years) and 9.0 mmol/l. RESULTS: The antihypertensive effect of captopril and atenolol was not influenced by concurrent administration of pravastatin. The effect of pravastatin was not limited by concurrent medication with captopril or atenolol. Improvement in lifestyle seemed to reduce the need for supplementary treatment with diuretics. CONCLUSION: Pravastatin can be used in combination with captopril or atenolol in the treatment of hypertensive and hypercholesterolaemic patients.
Adrenergic beta-Antagonists↗
[Can we rely on self-reported smoking habits?].
The reliability of self-reporting on smoking habits has been evaluated by comparing the reported smoking habits with the concentration of serum thiocyanate, which is higher in smokers than in non-smokers and increases with increasing cigarette consumption. When a smoker stops smoking, the level of serum thiocyanate decreases and falls to the level observed in non-smokers after about one month. When the questions asked about smoking were neutral, the reported smoking habits were generally reliable. However, in cases where the questions asked and the interview situation could be regarded as unpleasant, the reported smoking habits were not always correct. Some smokers underreported the number of cigarettes they smoked on a daily basis and some of them denied smoking altogether.
Adult↗
[When should we start to drink?].
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Alcohol Drinking↗
Is smoking intervention in general practice more successful among pregnant than non-pregnant women?
The objective of this study was to evaluate the effect of a simple smoking intervention programme, carried out by a large number of general practitioners (GPs) among pregnant and non-pregnant women. Four groups of women were defined by the dichotomies pregnant versus non-pregnant and intervention versus control. The intervention was semistructured, using a flip-over and a booklet, and it was implemented in an ordinary sequence of consultations. The study involved 187 GPs in western Norway. The subjects were 350 daily smoking pregnant women and 274 daily smoking non-pregnant women, 18-34 years of age. The point prevalence abstinence rate at 18 months was 15 and 20% for pregnant and non-pregnant women, respectively, in the intervention groups, and 7% in the control groups (Ppregnant = 0.06, Pnon-pregnant = 0.006). Twenty-five per cent of the pregnant women and 34% of the non-pregnant women reported that they had reduced their cigarette consumption, but had not stopped smoking entirely. If we include all drop-outs as smokers, the continuous abstinence rate during 15 months was 6%/0% among pregnant women (intervention/control) and 5%/1% among non-pregnant women. Stopping smoking was associated with having a non-smoking partner (P = 0.001), and being encouraged to do so by their partner (P = 0.004). The prevalence of both pregnant and non-pregnant women who stopped smoking was higher in the intervention than in the control groups. Pregnant women stopped smoking as frequently as non-pregnant individuals.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Do pregnant women who report a reduction in cigarette consumption consume less tobacco?
OBJECTIVE: To investigate the relationship between changes in self-reported cigarette consumption and changes in serum thiocyanate among pregnant and non-pregnant women who participated in a smoking cessation trial. DESIGN: Intervention study. SETTING: General practitioners in western Norway. SUBJECTS: 146 pregnant and 102 non-pregnant women who were daily smokers at inclusion. Self-reported cigarette consumption and serum thiocyanate were recorded at inclusion and after 12 months. RESULTS: Women who smoked in the first trimester of pregnancy reported 21% less cigarette consumption than non-pregnant women. This was in accordance with the serum thiocyanate values. Twelve months later the mean values of serum thiocyanate had increased irrespective of whether the postpartum women reported that they had reduced, increased, or not changed their cigarette consumption. However, among those who reported that they had stopped smoking, analyses of serum thiocyanate confirmed their statements, with very few exceptions. Among nonpregnant women, the serum thiocyanate changed in accordance with the reported changes in cigarette consumption in all groups. CONCLUSION: Women smoking daily in the first trimester of pregnancy had a lower exposure to tobacco than daily smoking non-pregnant women. Twelve months later (six months after delivery) analyses of serum thiocyanate indicated that postpartum women underestimated their tobacco consumption.
Adolescent↗
[Smoking habits among Norwegian soldiers in Lebanon 1986].
The smoking habits in 287 Norwegian soldiers, mean age 24 years, who served for six months in the United Nations' peace-keeping forces in Lebanon was studied by self-administered questionnaire and determination of serum-thiocyanate. According to the questionnaires and verified by serum thiocyanate 42% were non-smokers at departure, 88% of them were still non-smokers at return. 7% of the smokers quit smoking while in Lebanon. The other smokers increased the consumption of cigarettes. The study indicates that campaigns against smoking should preferably be directed toward the youngsters since success among them will have long lasting effect.
Adult↗
Long-term effect of lovastatin alone and in combination with cholestyramine on lipoprotein (a) level in familial hypercholesterolemic subjects.
We have determined the effect of lovastatin alone or in combination with cholestyramine on lipoprotein (a) [Lp(a)] levels in 59 heterozygotes for familial hypercholesterolemia (FH) treated for 33.8 (+/- 6.1) months. The median pretrial Lp(a) value was 10.2 mg/100 ml, which is twice the median value in healthy people examined at the Institute of Medical Genetics, University of Oslo. The median Lp(a) level was insignificantly reduced by 10.3% during the first 20 weeks when the subjects were on a standardized medication of increasing doses of lovastatin and cholestyramine. The first 20 weeks were followed by usual care treatment period, and a further decrease in Lp(a) level to 16.2% (P = 0.0012) was observed at the end of the study. Comparison between the 20 subjects on lovastatin monotherapy and the 31 subjects on the combined therapy of lovastatin and cholestyramine, revealed that the subjects on monotherapy had a median reduction of 20.1%, and the subjects on the combined therapy had a reduction of 15.4%. Thus, it appears that the reduction in Lp(a) level could be ascribed to lovastatin alone.
Adolescent↗
Tea consumption. relationship to cholesterol, blood pressure, and coronary and total mortality.
BACKGROUND AND METHODS: The relation of tea to cholesterol, systolic blood pressure, and mortality from coronary heart disease and all causes was studied in 9,856 men and 10,233 women without history of cardiovascular disease or diabetes. All men and women 35-49 years of age from the county of Oppland (Norway) were invited to participate; the attendance rate was 90%. RESULTS: Mean serum cholesterol decreased with increasing tea consumption, the linear trend coefficient corresponded to a difference of 0.24 mmol/liter (9.3 mg/dl) in men and 0.15 mmol/liter (5.8 mg/dl) in women between drinkers of less than one cup and those of five or more cups/day, when other risk factors were taken into account. Systolic blood pressure was inversely related to tea with a difference between the same two tea groups of 2.1 mm in men and 3.5 mm in women. Altogether 396 men and 237 women died from all causes, and of these 141 and 18, respectively, died from coronary heart disease during the 12-year follow-up period. The mortality rate was higher (not statistically significant) among persons drinking no tea or less than one cup compared with persons drinking one or more cups/day. This applies to men and women and to coronary heart disease and all-cause mortality. For men, the relative risk (one or more versus less than one cup) for coronary death from Cox regression was 0.64 (95% CI:0.38, 1.07).
Adult↗
High-density lipoprotein cholesterol and coronary, cardiovascular and all cause mortality among middle-aged Norwegian men and women.
From 1977 to 1982 screening for cardiovascular disease was performed in three Norwegian counties. All those aged between 40 and 54 years were invited, of whom 23,690 men and 23,425 women (90%) attended. Smoking habits and previous cardiovascular disease were recorded; total cholesterol, high-density lipoprotein cholesterol (HDL cholesterol), triglycerides and blood pressure were measured. During subsequent follow-up (mean 6.8 years) 422 men and 54 women died from coronary heart disease, 514 and 114 from all cardiovascular diseases and 983 and 404 from all causes, men and women respectively. For men, mortality decreased with increasing HDL cholesterol, to a minimum of around 1.5 mmol.l-1 (58 mg.dl-1), whereafter mortality increased. This applies to coronary, cardiovascular and all causes of death, as well as to men with and without a history of disease. The association between mortality and HDL cholesterol in healthy men disappeared when total cholesterol was below 6.5 mmol.l-1 (251 mg.dl-1). The inverse association between mortality and HDL cholesterol in women was somewhat stronger than in men, both for coronary and cardiovascular diseases. The relative risks of coronary death, associated with an increase in HDL cholesterol of 0.5 mmol.l-1 (19 mg.dl-1), from the Cox proportional hazards regression, with other major cardiovascular risk factors as covariates, were 0.8 (95% confidence interval: 0.6, 1.0) and 0.8 (0.7, 1.0) for men with and without history of disease, respectively. Corresponding figures for women were 0.5 (0.3, 0.9) and 0.7 (0.4, 1.3).
Accidents↗
Overall survival of breast cancer patients in relation to preclinically determined total serum cholesterol, body mass index, height and cigarette smoking: a population-based study.
Mean overall 5-year survival related to preclinically determined total serum cholesterol, body mass index (BMI), height and cigarette smoking has been analysed among 242 incident cases of breast cancer aged 36-63 years that developed in a population of 24,329 Norwegian women during a mean follow-up of 12 years (range 11-14). The study factors were ascertained at least 1 year prior to diagnosis (mean = 8 years), and the cases have been followed up with respect to death for a mean time of approximately 5 years after diagnosis. Patients whose preclinical total serum cholesterol values were within the highest quartile (greater than or equal to 7.52 mmol/l, mean = 8.58 mmol/l) of the underlying population had a hazard ratio of dying of 2.0 (95% confidence limits, 1.1 and 3.7) compared to cases with cholesterol values in the lowest quartile (mean = 5.28 mmol/l), after adjustment for age at diagnosis, clinical stage, and body mass index. In relation to BMI (Quetelet's index: weight/height2) patients who were obese prior to diagnosis were at higher risk of dying than those who were lean. Compared to patients in the lowest quartile of BMI (mean Quetelet = 21), the hazard ratio was 2.1 (95% confidence limits, 1.2 and 3.8) for patients in the highest quartile (mean Quetelet = 30), after adjustment for age at diagnosis, clinical stage, and total serum cholesterol. For height and for cigarette smoking, no relation with survival was observed. A potential problem of this study might be insufficient information about other well known prognostic factors, but the results suggest that preclinical total serum cholesterol and BMI are positively associated with the risk of dying among women who develop breast cancer.
Adult↗
Total serum cholesterol and triglycerides and risk of breast cancer: a prospective study of 24,329 Norwegian women.
The association between total serum cholesterol and triglycerides and the incidence rate of breast cancer has been examined in 242 incident cases of breast cancer that developed among 24,329 Norwegian women during 11-14 years of follow-up. At the time of lipid measurement they were between 35 and 51 years of age. There was an inverse relation between serum cholesterol and risk of breast cancer which was confined to women diagnosed before the age of 51. The incidence rate ratio was 0.53 (95% confidence limits, 0.32 and 0.88) for women in the highest quartile of serum cholesterol (mean = 8.52 mM = 329 mg/100 ml) compared to women in the lowest quartile (mean = 5.28 mM = 204 mg/100 ml), and the relation displayed a negative trend over quartiles of cholesterol (chi 2 for trend = 3.94, P = 0.05). No association with cholesterol was found among cases diagnosed during the initial 2 years of follow-up, whereas a strong inverse relation was observed among cases that were diagnosed during the following 4 years (chi 2 trend = 12.6, P less than 0.001). For serum triglycerides there was an overall negative, but not statistically significant, association with breast cancer incidence, which was weakened after further adjustment for body mass index and serum cholesterol. The lack of information on reproductive factors associated with breast cancer risk is a limitation of this study, since potential confounding with the results cannot be excluded. We conclude that there is an inverse relation between serum cholesterol and breast cancer risk among women diagnosed before the age of 51 years. The findings indicate that the negative association cannot easily be attributed to a preclinical effect of the cancer.
Adult↗
Coffee consumption and death from coronary heart disease in middle aged Norwegian men and women.
OBJECTIVE: To study the association between number of cups of coffee consumed per day and coronary death when taking other major coronary risk factors into account. DESIGN: Men and women attending screening and followed up for a mean of 6.4 years. SETTING: Cardiovascular survey performed by ambulatory teams from the National Health Screening Service in Norway. PARTICIPANTS: All middle aged people in three counties: 19,398 men and 19,166 women aged 35-54 years who reported neither cardiovascular disease or diabetes nor symptoms of angina pectoris or intermittent claudication. MAIN OUTCOME MEASURE: Predictive value of number of cups of coffee consumed per day. RESULTS: At initial screening total serum cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, height, and weight were measured and self reported information about smoking history, physical activity, and coffee drinking habits was recorded. Altogether 168 men and 16 women died of coronary heart disease during follow up. Mean cholesterol concentrations for men and women were almost identical and increased from the lowest to highest coffee consumption group (13.1% and 10.9% respectively). With the proportional hazards model and adjustment for age, total serum and high density lipoprotein cholesterol concentrations, systolic blood pressure, and number of cigarettes per day the coefficient for coffee corresponded to a relative risk between nine or more cups of coffee and less than one cup of 2.2 (95% confidence interval 1.1 to 4.5) for men and 5.1 (0.4 to 60.3) for women. For men the relative risk varied among the three counties. CONCLUSIONS: Coffee may affect mortality from coronary heart disease over and above its effect in raising cholesterol concentrations.
Age Factors↗
The effect of captopril and metoprolol as monotherapy or combined with bendroflumethiazide on blood lipids.
In a 24-week randomized multicentre single-blind study, including mild to moderate hypertensives free from other diseases, the effect on blood lipids of captopril (n = 51) was studied and compared with that of metoprolol (n = 53). In order to keep the diastolic pressure less than 95 mm Hg, bendroflumethiazide was added to the medication for 11 patients in the captopril group and 11 patients in the metoprolol group. Neither captopril nor metoprolol altered total cholesterol significantly. Captopril as monotherapy increased HDL-cholesterol by 6.2% (P less than 0.01) and decreased triglycerides by 10.6% (P less than 0.05). Metoprolol as monotherapy decreased HDL-cholesterol by 5.6% (P less than 0.01) and increased triglycerides by 10.3% (P less than 0.05). When bendroflumethiazide was added the favourable effect of captopril on the blood lipids disappeared while the undesirable effect of metoprolol became more pronounced.
Adult↗
Fat content and xenobiotic concentrations in human milk: validation of an enzymatic assay of milk fat.
This study reports the validation of an automatic assay for milk triglycerides, as well as the association between milk xenobiotic concentrations and milk triglycerides. The correlation between this assay and a gravimetric reference method for total fat was good (r = 0.997). Triglycerides and xenobiotics were measured in breast milk sampled from one mother. She received two water-soluble drugs, tetracycline and doxycycline in two courses. The levels of organochlorines (DDE, PCB) were also measured and related to those of fat in milk samples from this mother. These and previous results indicate that milk triglyceride variations influence the concentrations of lipophilic xenobiotics in milk.
Dichlorodiphenyl Dichloroethylene↗
Reliability of the Reflotron in the determination of cholesterol.
Measurements of total cholesterol in the field by means of the Reflotron dry-chemistry system (capillary blood) were compared to total cholesterol obtained by a standardized conventional wet-chemistry method in a clinico-chemical laboratory (serum). A total of 1200 people participated in the study. Two identical Reflotron machines were used. In the first period of the study an excellent agreement was found between Reflotron measurements of a reference serum provided by the manufacturer (mean, 4.99 mmol/l; CV, 1.8%) and the stated value (4.97 mmol/l). In the rest of the study higher values and greater variation were found with the Reflotron (mean, 5.32 mmol/l; CV 5.2%). Clearly the Reflotron measurements in the latter period of study were not reliable. In the period with stable instruments most of the values obtained at the two Reflotron machines differed from each other by less than 10%, with a mean difference of 0.08 mmol/l. Reflotron (both machines) and wet-chemistry measurements agreed well for the first 500 participants in the study (mean difference, Reflotron-wet-chemistry, -0.008 mmol/l; 95% confidence interval, -0.035 to 0.019 mmol/l; correlation, 0.967). In this period most Reflotron values differed from wet-chemistry values by less than 9% below to 9% above. With the next 200 participants the Reflotron gave on average slightly higher values than wet-chemistry measurements. The coefficients of variation for measurement variation were higher for Reflotron that for wet-chemistry even in the period with stable instruments. In all parts of the study period a lower HDL-cholesterol level was associated with larger differences between total cholesterol determined by Reflotron and wet-chemistry.
Adult↗
The effect of coffee on blood lipids and blood pressure. Results from a Norwegian cross-sectional study, men and women, 40-42 years.
The association between boiled and filter coffee consumption and levels of cholesterol, triglycerides and blood pressure was studied, including 14168 men and 14859 women. A total of 94% drank coffee, 55% of the men and 48% of the women drank more than 4 cups per day. The type of coffee consumed varied between the counties, from 11 to 49% boiled and 49 to 87% filter coffee. Serum cholesterol increased linearly with increasing coffee consumption, and most strongly for boiled coffee. Controlling for other variables gave, for boiled coffee, an 8% increase for men and 10% for women. For filter coffee drinkers the coffee dose-cholesterol association remained significant only for women. Triglycerides showed a negative association with coffee, significant after adjustment for other variables. This effect was stronger for filter than for boiled coffee in both sexes. For men and women drinking 1 cup of coffee or more, a significant negative association between both systolic and diastolic blood pressure and number of cups of filter coffee was found. The influence of high consumption of different coffee-types on death rate from coronary heart disease is discussed.
Adult↗
Serum triglycerides as an independent risk factor for death from coronary heart disease in middle-aged Norwegian men.
The relation between nonfasting serum triglycerides and death from coronary heart disease was studied in 37,546 men aged 35-49 years who were examined during 1972-1977 in four counties in Norway. During an average follow-up period of nine years, 369 deaths from coronary heart disease occurred. In univariate analysis, log(triglycerides) were a weak, but statistically significant predictor of coronary death in the age groups 40-44 and 45-49 years. Within-area analysis showed that a high triglyceride area represented no extreme. When other coronary risk factors were adjusted for, log(triglycerides) remained a significant independent predictor at ages 45-49 years and at higher levels of serum cholesterol. The predictive strength of serum cholesterol was largely the same whether log(triglycerides) were taken into account or not, whereas the predictive strength of log(triglycerides) depended on whether serum cholesterol was accounted for. The strength of coronary death prediction of the logarithm of serum triglycerides was hardly greater than might be explained by the fact that triglycerides are an indicator of the usual cholesterol level of the subject.
Adult↗