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Biomedical subjects

Peter Schnohr

Publications and source records attributed to Peter Schnohr.

At least 19 recordsLinked to original sources
PubMed2006

Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study.

RATIONALE: We have previously reported that regular physical activity reduces risk of chronic obstructive pulmonary disease (COPD) exacerbation. We hypothesized that higher levels of regular physical activity could reduce the risk of COPD by modifying smoking-related lung function decline. OBJECTIVE: To estimate the longitudinal association between regular physical activity and FEV(1) and FVC decline and COPD risk. METHODS: A population-based sample (n = 6,790) was recruited and assessed with respect to physical activity, smoking, lung function, and other covariates, in Copenhagen in 1981-1983, and followed until 1991-1994. Mean level of physical activity between baseline and follow-up was classified into "low," "moderate," and "high." FEV(1) and FVC decline rates were expressed as milliliters per year. COPD was defined as FEV(1)/FVC < or = 70%. Adjusted associations between physical activity and FEV(1) and FVC decline, and COPD incidence, were obtained using linear and logistic regression, respectively. RESULTS: Active smokers with moderate and high physical activity had a reduced FEV(1) and FVC decline compared with those with low physical activity (relative change of +2.6 and +4.8 ml/yr of FEV(1), P-for-trend = 0.006, and +2.6 and +7.7 ml/yr of FVC, P-for-trend < 0.0001, for the moderate and high physical activity group, respectively), after adjusting for all potential confounders and risk factors of lung function decline. Active smokers with moderate to high physical activity had a reduced risk of developing COPD as compared with the low physical activity group (odds ratio, 0.77; p = 0.027). CONCLUSIONS: This prospective study shows that moderate to high levels of regular physical activity are associated with reduced lung function decline and COPD risk among smokers.

Activities of Daily Living↗
PubMed2006

Plasma pro-B-type natriuretic peptide in the general population: screening for left ventricular hypertrophy and systolic dysfunction.

AIMS: B-type natriuretic peptide (BNP) measurement in screening for left ventricular hypertrophy (LVH) and left ventricular systolic dysfunction (LVSD) has been evaluated in the general population, but corresponding information on proBNP and the N-terminal proBNP fragment is still limited. We therefore examined whether proBNP measurement is useful for LVH and LVSD screening in the general population. METHODS AND RESULTS: In the 4th Copenhagen City Heart Study, 3497 participants underwent echocardiography with assessment of left ventricular ejection fraction (LVEF) and mass. The impact of gender and age was determined and the diagnostic performance of the plasma proBNP concentration was evaluated using receiver operating characteristic (ROC) curves. Of 1502 men and 1995 women, 4.1 and 2.6% had LVSD defined as an LVEF<60% whereas only 0.4% displayed LVEF<40%. The proBNP concentration was 1.7-fold higher in women compared with men (P<0.0001) and related to age in both genders. The mean proBNP plasma concentration was two-fold higher in subjects with LVSD than without LVSD (P<0.0001). Likewise, LVH imposed a 1.9-fold increase in the proBNP concentration (P<0.0001): Both differences persisted after adjusting for ischaemic heart disease, hypertension, diabetes, gender, and age. The diagnostic performance of proBNP in detecting LVEF<40% was high with an area under the ROC curves of 0.92 (95% CI 0.79-1.00) in women and 0.85 (95% CI 0.74-0.96) in men. CONCLUSION: We have established the impact of age and gender on the proBNP concentration in a large, community-based cohort. The diagnostic performance for proBNP measurement in screening for LVH and LVSD in the general population parallels the reported data for BNP.

Echocardiography↗
PubMed2006

[Self-reported stress and risk of breast cancer--a secondary publication].

A possible association between stress and risk of breast cancer has been assessed in different study designs with conflicting results. We prospectively followed 6,689 women from the Copenhagen City Heart Study for 18 years for a first-time diagnosis of primary breast cancer. The women were asked about stress intensity and frequency at baseline in 1981-83. Women reporting high levels of stress were at lower risk of breast cancer (hazard ratio = 0.60; 95% CI: 0.37-0.97) than women reporting low levels of stress. This association was most pronounced among women who received hormone therapy.

Aged↗
PubMed2006

Perceived stress and risk of ischemic heart disease: causation or bias?

BACKGROUND: It is unclear whether the commonly recognized link between stress and cardiovascular disease is causal or the result of reporting bias. The objective of this study was to address the association between perceived stress and first incidence of ischemic heart disease and to evaluate the suggested reporting bias by addressing subdiagnoses of ischemic heart disease separately. METHODS: The 11,839 men and women who participated in the Copenhagen City Heart Study were at baseline (1981-1983) asked about their stress level. The participants were followed in nationwide registries until the year 2000, and fewer than 0.1% were lost to follow-up. During follow-up, 2316 individuals were diagnosed with ischemic heart disease. RESULTS: High levels of stress were associated with slightly higher risk of incident ischemic heart disease in both women (hazard ratio = 1.23; 95% confidence interval = 1.01-1.51) and men (1.25; 1.00-1.56). When subdiagnoses of ischemic heart disease were analyzed separately, high stress was associated with markedly higher incidence of angina pectoris for women (1.83; 1.15-2.91) and for men (2.14; 1.32-3.47). There was no association with myocardial infarction for women (0.80; 0.56-1.15) or for men (1.09; 0.79-1.52). All associations attenuated with prolonged follow-up. CONCLUSIONS: It remains uncertain whether perceived stress affects subdiagnoses of ischemic heart disease differently or whether the strong association with angina pectoris was spuriously created by a tendency for stressed individuals to report more cardiovascular symptoms. Future studies on this issue should address subdiagnoses of ischemic heart disease separately and should carefully consider the impact of reporting bias and prolonged follow-up.

Adult↗
PubMed2006

Long-term physical activity in leisure time and mortality from coronary heart disease, stroke, respiratory diseases, and cancer. The Copenhagen City Heart Study.

BACKGROUND: The purpose of this study was to describe the associations between different levels of long-term physical activity in leisure time and subsequent causes of deaths. DESIGN: The Copenhagen City Heart Study is a prospective cardiovascular population study of 19 329 men and women aged 20-93 in 1976. Physical activity in leisure time was estimated at the examinations in 1976-78 and 1981-83. This analysis consists of 2136 healthy men and 2758 women aged 20-79 years, with unchanged physical activity at the two examinations, and with all covariates included in the multivariate analyses: smoking, total-cholesterol, high-density lipoprotein-cholesterol, systolic blood pressure, diabetes mellitus, alcohol consumption, body mass index, education, income, and forced expiratory volume in 10.78 (% predicted). RESULTS: Adjusted relative risks (95% confidence interval) for coronary heart disease were, for moderate physical activity 0.71 (0.51, 0.99) and for high 0.56 (0.38, 0.82). For cancer, moderate activity 0.77 (0.61, 0.97) and high activity 0.73 (0.56, 0.95) and for all-cause mortality, moderate 0.78 (0.68, 0.89) and high 0.75 (0.64, 0.87) for both sexes combined. Using Kaplan-Meier plots we calculated gained years of expected lifetime from age 50. Men with high physical activity survived 6.8 years longer, and men with moderate physical activity 4.9 years longer than sedentary men. For women the figures were 6.4 and 5.5 years, respectively. CONCLUSION: Long-term moderate or high physical activity was in both sexes associated with significantly lower mortality from coronary heart disease, cancer and all-causes. The same tendency was found for stroke and respiratory diseases, but the associations did not reach statistical significance.

Adult↗
PubMed2005

Zinc Finger Protein 202: a new candidate gene for ischemic heart disease: The Copenhagen City Heart Study.

OBJECTIVE: Zinc Finger Protein 202 (ZNF202) is a transcriptional repressor of genes affecting the vascular endothelium as well as lipid metabolism. A phenotype associated with genetic variation in ZNF202 is presently unknown. We tested the hypothesis that a common variant in ZNF202, A154V, predicts risk of ischemic heart disease (IHD), myocardial infarction (MI), and ischemic cerebrovascular disease (ICVD). METHODS AND RESULTS: We conducted a prospective study of more than 9000 individuals from the general population with 24 years follow-up. In women, age-adjusted hazard ratios in heterozygotes and homozygotes versus non-carriers were 1.2 (95% CI: 1.0-1.5, P = 0.04) and 1.5 (1.1-2.1, P = 0.007) for IHD, 1.5 (1.1-2.1; P = 0.01) and 1.7 (1.1-2.8, P = 0.02) for MI, and 1.3 (1.0-1.8, P = 0.07) and 1.3 (0.8-2.1; P = 0.33) for ICVD. Adjustments for lipids and lipoproteins did not alter these hazard ratios substantially. Genotype did not predict risk in men. Finally, results for IHD were borderline significant (P = 0.06) in an independent case-control study including 933 patients and 8068 controls. CONCLUSION: This is the first study to suggest that ZNF202 could be a new candidate gene for IHD and MI in the general population.

Carrier Proteins↗
PubMed2005

Mutation in ABCA1 predicted risk of ischemic heart disease in the Copenhagen City Heart Study Population.

OBJECTIVES: We tested whether heterozygosity for the K776N mutation (frequency: 0.4%) in ATP-binding cassette transporter A1 (ABCA1) predicted ischemic heart disease (IHD) in the Copenhagen City Heart Study population. BACKGROUND: In a complex trait like IHD, genetic variation is considered to be conferred by common DNA polymorphisms, although rare mutations may have a larger impact. Tangier disease, a rare high-density lipoprotein cholesterol (HDL-C) deficiency syndrome with IHD, is caused by homozygous ABCA1 mutations. METHODS: We analyzed blood samples from a large cohort study of 9,076 Danish individuals followed for 24 years (167,287 person-years), during which 1,033 incident IHD events occurred. The hypothesis was retested in an independent case-control study comparing 562 IHD patients with 3,103 controls. RESULTS: The cumulative incidence of IHD as a function of age was increased in K776N heterozygotes compared with non-carriers (log-rank test: p = 0.005). At the age of 80 years, 48% of heterozygotes and 23% of non-carriers had IHD. Incidence rates in non-carriers and K776N heterozygotes were 61 and 157 per 10,000 person-years. The age-adjusted hazard ratio for IHD in K776N heterozygotes versus non-carriers was 2.4 (95% confidence interval 1.3 to 4.5). Adjusting for HDL-C, or for smoking, diabetes, and hypertension did not change the result, suggesting that genotype predicted risk of IHD beyond that offered by HDL-C, and by other conventional risk factors. Similar trends were obtained in an independent case-control study. CONCLUSIONS: Heterozygosity for an ABCA1 mutation (K776N) conferred two- to three-fold risk of IHD in 37 participants in the Copenhagen City Heart study.

ATP Binding Cassette Transporter 1↗
PubMed2005

Self reported stress and risk of breast cancer: prospective cohort study.

OBJECTIVE: To assess the relation between self reported intensity and frequency of stress and first time incidence of primary breast cancer. DESIGN: Prospective cohort study with 18 years of follow-up. SETTING: Copenhagen City heart study, Denmark. PARTICIPANTS: The 6689 women participating in the Copenhagen City heart study were asked about their perceived level of stress at baseline in 1981-3. These women were followed until 1999 in the Danish nationwide cancer registry, with < 0.1% loss to follow-up. MAIN OUTCOME MEASURE: First time incidence of primary breast cancer. RESULTS: During follow-up 251 women were diagnosed with breast cancer. After adjustment for confounders, women with high levels of stress had a hazard ratio of 0.60 (95% confidence interval 0.37 to 0.97) for breast cancer compared with women with low levels of stress. Furthermore, for each increase in stress level on a six point stress scale an 8% lower risk of primary breast cancer was found (hazard ratio 0.92, 0.85 to 0.99). This association seemed to be stable over time and was particularly pronounced in women receiving hormone therapy. CONCLUSION: High endogenous concentrations of oestrogen are a known risk factor for breast cancer, and impairment of oestrogen synthesis induced by chronic stress may explain a lower incidence of breast cancer in women with high stress. Impairment of normal body function should not, however, be considered a healthy response, and the cumulative health consequences of stress may be disadvantageous.

Adult↗
PubMed2005

Social network diversity and risks of ischemic heart disease and total mortality: findings from the Copenhagen City Heart Study.

Measures of various types of social contacts were used as predictors of ischemic heart disease events and total mortality in an age-stratified random sample of 9,573 adults enrolled in the Copenhagen City Heart Study (Copenhagen, Denmark). Baseline examinations were conducted in 1991-1994, and participants were followed until the end of 1997. Contacts with parents, children, family members, and friends were associated with better health. The presence of a spouse or partner was protective for men. Contacts with neighbors showed a trend toward a reversed pattern, and the effects of contacts with work colleagues and children differed by gender. Most types of contacts that occurred at least monthly were just as protective as those occurring more frequently. An index of intimate social contact diversity with family and friends had graded relations with both outcomes. Comparisons of persons reporting three or more types of contacts with those reporting fewer types yielded age- and gender-adjusted hazard ratios of 0.73 (95% confidence interval (CI): 0.64, 0.82) for mortality and 0.75 (95% CI: 0.61, 0.91) for ischemic heart disease. Comparable fully adjusted hazard ratios were 0.83 (95% CI: 0.73, 0.95) and 0.82 (95% CI: 0.67, 1.00). These data suggest that health benefits are derived from the diversity of social roles, especially those involving intimate relationships.

Adult↗
PubMed2005

Generalized additive models applied to analysis of the relation between amount and type of alcohol and all-cause mortality.

The J-shaped relation between alcohol intake and mortality is well established, whereas the nadir of the curve is not determined. Due to non-linearity of the relation, categorical alcohol variables have been used to model the relation. In Generalized Additive Models (GAM) non-linear relations can be modelled without the disadvantages of categorization and without assumptions regarding the functional form. The aim of this study was to use GAM to evaluate the relation between alcohol intake, amount and type, and mortality. The relation was investigated using data from the Copenhagen City Heart Study (11,920 participants of whom 5552 died during 20 years follow-up). Using GAM, a smooth J-shaped relation between alcohol and mortality was found. However, if non-drinkers were categorized separately there was a positive association between alcohol and mortality even for low alcohol intake. For equal total alcohol intake, men and women drinking wine or spirits had lower mortality than beer drinkers. The nadir of the relation between alcohol and mortality was sensitive to the handling of non-drinkers. When non-drinkers were categorized separately we found no indication of a beneficial influence of low alcohol intake on mortality.

Adolescent↗
PubMed2005

The ischemic electrocardiogram: a harbinger for ischemic heart disease independent of the blood pressure level. The Copenhagen City Heart Study.

Information is limited on the co-existence and prognostic association of the ischemic electrocardiogram (ECG) and blood pressure. Prospectively collected data sets from 28,118 examinations in the Copenhagen City Heart Study were analyzed for cardiac morbidity and mortality for a 5.9-year follow-up. The prognosis of the ECG, independently of blood pressure, was examined. The Cox proportional hazard model was employed to evaluate the prognostic implications of ECG findings and relative risk was adjusted for age and multivariately adjusted for traditional cardiovascular risk factors. End-points were (1) fatal and non-fatal ischemic heart disease (IHD) events and (2) cardiovascular disease (CVD) mortality. During a total follow-up period of 166,471 person years (mean: 5.9 years) 1.481 IHD events were recorded and 1.051 CVD deaths. The relative risk of an ischemic ECG was independent of the blood pressure level. The multivariately adjusted relative risk for fatal and non-fatal IHD for the ischemic ECG was 1.70 (95% CI: 1.39-2.09, p < 0.001) in women, and 1.96 (95% CI: 1.67-2.30, p < 0.001) in men, and for CVD mortality 1.71 (95% CI: 1.34-2.17, p < 0.001) in women and 2.08 (95% CI: 1.74-2.49, p < 0.001) in men. An ECG with left ventricular hypertrophy (LVH) and ST-depression was the finding with the highest risk for future events. LVH by ECG voltage-only was associated with no statistically increased risk, except for men treated for arterial hypertension.

Adult↗
PubMed2005

Physical activity in leisure-time and risk of cancer: 14-year follow-up of 28,000 Danish men and women.

AIM: The preventive effect of physical activity on risk of cancer in general remains controversial. This study aimed at assessment of the associations between leisure- time physical activity and incidence of cancer in the general population of adult men and women. METHODS: 13,216 women and 18,718 men aged 20-93 years selected from the general population participated in a health examination including a questionnaire with information on physical activity, smoking, alcohol intake, postmenopausal hormones, and socioeconomic status. Incident cases of cancers where recorded during a follow-up period of 14 years. The six most frequent cancer cases in both sexes were included in this analysis. RESULTS: A highly significant inverse association was seen between vigorous physical activity in leisure time and cancer of the ovary, adjusted rate ratio being 0.33 (95% CI 0.16-0.67; p = 0.001) for the most physical active women. In men there was a highly significant increase for non-melanoma skin cancer, with adjusted rate ratio of 1.72 (95% CI 1.23-2.40; p = 0.001), for the most active men and vigorous activity was associated with a non-significant lower risk of colon cancer, the adjusted rate ratio being 0.72 (95% CI 0.47-1.11; p = 0.06). CONCLUSION: Generally, there were no, or only weakly, inverse associations between physical activity in leisure time and incidence of cancer, except for cancer of the ovary.

Adult↗
PubMed2004

A population-based study of morbidity and mortality in mannose-binding lectin deficiency.

Reduced levels of wild-type mannose-binding lectin (MBL) may increase susceptibility for infection, other common diseases, and death. We investigated associations between MBL deficiency and risk of infection, other common diseases, and death during 24, 24, and 8 yr of follow-up, respectively. We genotyped 9,245 individuals from the adult Danish population for three MBL deficiency alleles, B, C, and D, as opposed to the normal noncarrier A allele. Hospitalization incidence per 10,000 person. yr was 644 in noncarriers compared with 631 in heterozygotes (log-rank: P = 0.39) and 658 in deficiency homozygotes (P = 0.53). Death incidence per 10,000 person. yr was 235 in noncarriers compared with 244 in heterozygotes (P = 0.44) and 274 in deficiency homozygotes (P = 0.12). After stratification by specific cause of hospitalization or death, only hospitalization from cardiovascular disorders was increased in deficiency homozygotes versus noncarriers (P = 0.02). When retested in two case control studies, this association could not be confirmed. Incidence of hospitalization or death from infections or other serious common disorders did not differ between deficiency homozygotes and noncarriers. In conclusion, in this large study in an ethnically homogeneous Caucasian population, there was no evidence for significant differences in infectious disease or mortality in MBL-deficient individuals versus controls. Our results suggest that MBL deficiency is not a major risk factor for morbidity or death in the adult Caucasian population.

Adult↗
PubMed2004

Factor V Leiden and the risk for venous thromboembolism in the adult Danish population.

BACKGROUND: Odds ratios for venous thromboembolism (deep venous thrombosis and pulmonary embolism) derived from case-control studies range from 3 to 16 for heterozygotes compared with noncarriers and up to 79 for homozygotes compared with noncarriers. OBJECTIVE: To estimate risks for venous thromboembolism in the adult Danish population according to factor V Leiden genotype. DESIGN: Cohort study with 23 years of follow-up. SETTING: Adult Danish population. PARTICIPANTS: 9253 randomly selected individuals. MEASUREMENTS: Hospitalization and death from venous thromboembolism, factor V Leiden genotype, and additional thromboembolic risk factors. RESULTS: Adjusted hazard ratios in heterozygotes and homozygotes compared with noncarriers were 2.7 (95% CI, 1.8 to 3.8) and 18 (CI, 4.1 to 41) for venous thromboembolism overall, 2.4 (CI, 1.3 to 3.8) and 22 (CI, 0 to 60) for deep venous thrombosis, and 3.0 (CI, 1.7 to 4.9) and 11 (CI, 0 to 33) for pulmonary embolism. The lowest absolute 10-year risks for venous thromboembolism in factor V Leiden heterozygotes and homozygotes--0.7% (CI, 0.5% to 1.0%) and 3% (CI, 1% to 8%)--were found in nonsmokers younger than 40 years of age with a body mass index below 25 kg/m2; the corresponding highest risks--10% (CI, 7% to 14%) and 51% (CI, 13% to 100%)--were found in smokers older than 60 years of age with a body mass index above 30 kg/m2. CONCLUSIONS: Hazard ratios for venous thromboembolism in factor V Leiden heterozygotes and homozygotes compared with noncarriers in the adult Danish population were approximately 3 and 18, respectively. The simultaneous presence of smoking, obesity, and old age resulted in absolute 10-year thromboembolic risks of 10% in heterozygotes and 51% in homozygotes.

Adult↗
PubMed2004

Single nucleotide polymorphism in the low-density lipoprotein receptor is associated with a threefold risk of stroke. A case-control and prospective study.

BACKGROUND: More than 600 different, but rare, mutations in the low-density lipoprotein (LDL) receptor have been identified as the cause of familial hypercholesterolaemia. In contrast, only a single common amino acid-changing polymorphism (A370T) has been reported in this gene. The association of this polymorphism with variations in lipid levels is at present unclear. METHODS: We obtained genotypes for 9238 individuals from The Copenhagen City Heart Study, of which 465 had stroke and 1019 had ischaemic heart disease. RESULTS: In this cohort from the Danish general population, 90.2% (n = 8,332), 9.5% (n = 875), and 0.3% (n = 31) were 370A homozygotes, A370T heterozygotes, and 370T homozygotes, respectively. The incidences of stroke in 370A homozygotes, A370T heterozygotes, and 370T homozygotes were 28, 26, and 100 per 10,000 person-years, respectively (370T homozygotes vs. 370A homozygotes: log-rank, P = 0.002). The relative risk and odds ratio for stroke in 370T homozygotes vs. 370A homozygotes were 3.6 (95% confidence interval, 1.5-8.8) and 3.6 (95% confidence interval, 1.3-9.8) in prospective and cross-sectional studies, respectively. Furthermore, average age at onset of stroke in 370T homozygotes tended to be lower than in heterozygotes and 370A homozygotes combined (59 vs. 66 years, P = 0.08). In contrast, neither levels of cholesterol, LDL cholesterol, apolipoprotein B, or triglycerides, nor risk of ischaemic heart disease was associated with genotype. CONCLUSION: This is the first prospective study to suggest an association between a polymorphism in the LDL receptor and stroke. Because this association is independent of lipid levels, our results point toward a hitherto unknown function of this receptor in the brain.

Adult↗