Cardiovascular disease (CVD) remains one of the leading cause of mortality and disability worldwide. This work-area, led by Annika Rosengren, will focus on trends and determinants over time for cardiovascular disease including both biological and psychosocial susceptibility risk factors such as stress, social networks, socioeconomic status (SES), societal influences and functional capacity throughout adulthood. Further influence of selected genetic factors will also be studied. The overall aim of work area 1 (WPA1) is to address research questions about the long-term and short-term risk of CVD throughout adulthood and the inter-relationships between risk factors. For this purpose several Swedish data registries and population based studies forms the basis for this work. Additionally, WA1 is involved in several international collaborations, adding data from Sweden to large investigations involving low- middle- and high-income countries worldwide.
Cohort, period and aging effects in midlife and after
The men born in 1913, and subsequent cohorts of men born in 1923, 1933, 1943 and 1953 constitute an example of the traditional Gothenburg studies, offering possibilities to examine how living conditions have changed over four decades and the health effects of these changes. From the outset, psychosocial variables have been included, affording a design that combines cross-sectional, as well as longitudinal studies, and studies of comparative trends, for example how psychosocial risk factors for CVD differ across cohorts and as predictors.
International collaboration – PURE study and INTERHEART study
The PURE (Prospective Urban Rural Epidemiologic) study is a prospective cohort study to track changing lifestyles, nutrition, risk factors and chronic disease in urban and rural areas of 15 different countries at various levels of economic development. Started in 2005, this international study of societal determinants of health has (so far) collected data on over 600 Swedish urban men and women, with data collection in rural men and women (Skaraborg) starting in the autumn of 2006. The data collection will be going on until 2008 with a target of 5000 people included from Sweden (140,000 globally). PURE is in some respects a successor to the INTERHEART study, which collected data on nearly 30,000 cases and controls from 52 countries from all major regions of the world and will provide unique insight into determinants of cardiovascular health from a societal perspective.. Studies on the effect of SES have, so far, only been done in high-income countries. After the INTERHEART publication of the psychosocial factors (2004), the next issue to be studied by our group is the effect of psychosocial factors on obesity.
Stress, low SES as risk factors for CVD and diabetes
The Primary Prevention cohort was established in the early 1970s and follow-up has been conducted in collaboration with the Swedish Hospital discharge registry (worldwide, only Scotland, Finland and Denmark have similar registries) through which we have been able to identify a large number of men with selected diagnoses. How stress and low SES affect other conditions than CHD and stroke is not well known. We will be studying the impact of socioeconomic conditions and stress on stroke and diabetes.
The IMPACT is an advanced model study in which multiple data from several sources are used to explain variations in coronary mortality over time. IMPACT uses population data for men and women age 25-84 years, with information taken from official registers, qualitative registers, population studies (risk factors), medical trials and meta-analysis. The data are entered into an Excel-based model to calculate to what extent tentative changes in a disease can be explained by changes in risk factors and medical management. This model has been used to explain why the mortality rate from coronary heart disease decreased more than 50% between 1986 and 2002. We found that the decreased mortality for the most part could be explained by improved risk factors in the population (lower cholesterol, less smoking, lower blood pressure), while improved medical treatment explained a smaller portion. It has also been used to calculate how increased level of medical treatment in Sweden can reduce mortality even further. The IMPACT model has been used in several countries of Europe and in the USA, New Zealand and China (Beijing). The Swedish IMPACT model has been developed by the group together with a research team from Liverpool University, UK and Trinity Centre, Dublin, Ireland. In addition, our research group is involved in an EU project to update and validate the model for a large number of countries are planned. We plan to update the Swedish IMPACT model for the years 2002-2010.