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Long-term outcome of the Malmö preventive project: mortality and cardiovascular morbidity
G Berglund1, P Nilsson, K F Eriksson
1Department of Medicine, University of Lund, University Hospital, Malmö, Sweden. glund@medforsk.mas.lu.se
Insights
Preventive screening for cardiovascular disease, alcohol abuse, and cancer did not reduce overall mortality. However, younger participants in the intervention group showed reduced mortality from alcohol-related causes in men and cancer in women.
Area of Science:
- Preventive medicine
- Public health
- Epidemiology
Background:
- Population-based screening programs aim to reduce mortality and morbidity by identifying and treating risk factors.
- Early detection of cardiovascular risk factors, high alcohol intake, and potential breast cancer is crucial for intervention.
Purpose of the Study:
- To analyze the effects of a population-based intervention program, including screening and treatment, on mortality and cardiovascular morbidity.
- To evaluate the impact of early detection and management of cardiovascular risk factors, alcohol abuse, and breast cancer suspicion.
Main Methods:
- A population-based sample was divided into intervention (invited to screening) and control (not invited) groups.
- Screening included physical examination, blood pressure, lifestyle questionnaires, laboratory tests, and mammography for women.
- Participants with identified risk factors were referred for specialized treatment.
Main Results:
- Overall mortality did not differ significantly between intervention and control groups.
- A significant reduction in 'other' deaths (suicide, alcohol-related) was observed in men under 40 in the intervention group.
- Women under 40 in the intervention group showed significantly lower cancer mortality.
Conclusions:
- The Malmö Preventive Project's screening and treatment did not reduce overall mortality in the entire intervention group.
- For participants under 40 at entry, the intervention led to lower total mortality, attributed to reduced alcohol-related deaths in men and cancer deaths in women.
- Non-participants within invited cohorts exhibited higher mortality rates, highlighting the importance of screening participation.
Objectives:
To analyse the effects on mortality and cardiovascular morbidity in a population-based sample, invited to an intervention programme incorporating a baseline screening examination and treatment programmes for subjects with cardiovascular risk factors, high alcohol intake and, in women, suspicion of breast cancer on mammography.
Setting:
Section of Preventive Medicine, Department of Medicine, University Hospital, Malmö, Sweden.
Subjects:
Birth cohorts (aged 32-51 years) invited to screening examination (men = 9. 923; women = 4.422) were compared to birth cohorts not invited (men = 6.655; women = 4.290). Mean participation rate in the invited cohorts was 71% (range 64-78%). SCREENING EXAMINATION: Between 1974 and 1992 a baseline screening including a physical examination, blood pressure, a questionnaire regarding, e.g. family history, lifestyle, and socio-economic factors, laboratory tests of serum cholesterol, triglycerides, gamma-glutamyl-transferase, blood glucose before and after an oral glucose load, as well as a mammography examination in women, was performed.
Interventions:
Subjects with hypertension; hyperlipidaemia; diabetes or glucose intolerance; high alcohol intake; or, in women, suspicion of breast cancer were referred to special outpatient clinics.
Main Outcome Measures:
Total and cause-specific mortality, nonfatal myocardial infarction, and stroke, from the screening examination until the end of 1995, was followed in both the intervention and control groups, using national and/or local registries.
Results:
Total mortality did not differ significantly between the intervention group and control group. Cause-specific deaths were also similar except for 'other' deaths amongst men being significantly lower in the intervention group, mainly due to a lower mortality from 'other' causes (suicide, alcohol related deaths) in men under 40 years of age at baseline. Women under 40 years of age had a significantly lower mortality from cancer in the intervention group than in the control group. Nonfatal myocardial infarction and stroke did not differ between intervention and control group in either sex. Within the invited birth cohorts, nonparticipants had a higher total and cause-specific mortality.
Conclusions:
Risk factor screening for major diseases such as cardiovascular disease, alcohol abuse, diabetes mellitus and breast cancer, and subsequent treatment of the detected risk factors/diseases - The Malmö Preventive Project - did not reduce total mortality in the intervention group as a whole. In subjects under 40 years of age at entry, total mortality was lower in the intervention group than in the control group. In men, this seemed to be due to a reduction of alcohol-related deaths, whilst in women death from cancer was reduced.