A longitudinal population study of 1462 women aged 38-60 was carried out in Gothenburg, Sweden, in 1968-9. In univariate analysis the ratio of waist to hip circumference showed a significant positive association with the 12 year incidence of myocardial infarction, angina pectoris, stroke, and death. The association with incidence of myocardial infarction remained in multivariate analysis and was independent of age, body mass index, smoking habit, serum cholesterol concentration, serum triglyceride concentration, and systolic blood pressure. The relation between the ratio of waist to hip circumference and the end points of myocardial infarction, angina pectoris, stroke, and death was stronger than for any other anthropometric variable studied.

https://www.bmj.com/content/bmj/289/6454/1257.full.pdf

Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden.

Contraceptive failure in the United States

This report provides a review of the cadmium exposure situation in Sweden and updates the information on health risk assessment according to recent studies on the health effects of cadmium. The report focuses on the health effects of low cadmium doses and the identification of high-risk groups. The diet is the main source of cadmium exposure in the Swedish nonsmoking general population. The average daily dietary intake is about 15 micrograms/day, but there are great individual variations due to differences in energy intake and dietary habits. It has been shown that a high fiber diet and a diet rich in shellfish increase the dietary cadmium intake substantially. Cadmium concentrations in agricultural soil and wheat have increased continuously during the last century. At present, soil cadmium concentrations increase by about 0.2% per year. Cadmium accumulates in the kidneys. Human kidney concentrations of cadmium have increased several fold during the last century. Cadmium in pig kidney has been shown to have increased by about 2% per year from 1984-1992. There is no tendency towards decreasing cadmium exposure among the general nonsmoking population. The absorption of cadmium in the lungs is 10-50%, while the absorption in the gastrointestinal tract is only a few percent. Smokers have about 4-5 times higher blood cadmium concentrations (about 1.5 micrograms/l), and twice as high kidney cortex cadmium concentrations (about 20-30 micrograms/g wet weight) as nonsmokers. Similarly, the blood cadmium concentrations are substantially elevated in persons with low body iron stores, indicating increased gastrointestinal absorption. About 10-40% of Swedish women of child-bearing age are reported to have empty iron stores (S-ferritin < 12 micrograms/l). In general, women have higher concentrations of cadmium in blood, urine, and kidney than men. The population groups at highest risk are probably smokers, women with low body iron stores, and people habitually eating a diet rich in cadmium. According to current knowledge, renal tubular damage is probably the critical health effect of cadmium exposure, both in the general population and in occupationally exposed workers. Tubular damage may develop at much lower levels than previously estimated, as shown in this report. Data from several recent reports from different countries indicate that an average urinary cadmium excretion of 2.5 micrograms/g creatinine is related to an excess prevalence of renal tubular damage of 4%. An average urinary excretion of 2.5 micrograms/g creatinine corresponds to an average concentration of cadmium in renal cortex of 50 micrograms/g, which would be the result of long-term (decades) intake of 50 micrograms per day. When the critical concentrations for adverse effects due to cadmium accumulation are being evaluated, it is crucial to consider both the individual variation in kidney cadmium concentrations and the variations in sensitivity within the general population. Even if the population average kidney concentration is relatively low for the general population, a certain proportion will have values exceeding the concentration where renal tubular damage can occur. It can be estimated that, at the present average daily intake of cadmium in Sweden, about 1% of women with low body iron stores and smokers may experience adverse renal effects related to cadmium. If the average daily intake of cadmium would increase to 30 micrograms/day, about 1% of the entire population would have cadmium-induced tubular damage. In risk groups, for example, women with low iron stores, the percentage would be higher, up to 5%. Both human and animal studies indicate that skeletal damage (osteoporosis) may be a critical effect of cadmium exposure. We conclude, however, that the present evidence is not sufficient to permit such a conclusion for humans. We would like to stress, however, that osteoporosis is a very important public health problem worldwide, but especially in the Scandinav

Health effects of cadmium exposure - a review of the literature and a risk estimate

We review herein the evidence that estrogen is protective against the development of cardiovascular disease in women To our knowledge, no studies in women have looked at endogenous estrogen levels as predictors of cardiovascular disease Studies of surrogate measures of endogenous estrogen such as parity, age at menarche, and age at menopause have provided inconsistent results Current use of oral contraceptives increases risk in older women who smoke cigarettes, but most studies of past use show no increased risk Most, but not all, studies of hormone replacement therapy in postmenopausal women show around a 50% reduction in risk of a coronary event in women using unopposed oral estrogen These important observations need to be confirmed in a double-blind, randomized clinical trial, since the protection is biologically plausible and the magnitude of the benefit would be quite large if selection factors can be excluded ( JAMA  1991;265:1861-1867)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=385577&pdfFileName=jama_265_14_033.pdf

Estrogen and coronary heart disease in women.

On the regulation and control of fibrinolysis. Edward Kowalski Memorial Lecture.

The previous literature on menstrual blood loss studies was reviewed. A new study was conducted to ascertain the variation of menstrual blood loss at various ages and to establish the upper normal limit of menstrual blood loss. The study involved 476 women of all ages in Goteborg Sweden. Amenorrheic women were excluded from the study. Measurement of hemoglobin concentration plasma iron concentration and hematocrit levels indicated wide variation among women. No statistically significant differences in menstrual blood loss were observed among age groups except that women 50 and older had the highest and women 15 and under the lowest mean loss levels. It was concluded that a loss of 60-80 ml is normal; losses above 80 ml should be considered pathological.

Menstrual blood loss--a population study. Variation at different ages and attempts to define normality.

Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: A randomized comparative trial

Levonorgestrel-releasing intrauterine device in the treatment of menorrhagia.

A population study of women in Gothenburg, Sweden, is presented. The women were representative of the total female population in Gothenburg in the age strata 38, 46, 50, 54 and 60 years. Altogether 1 462 women participated in the examination, the participation rate being 90.1%. Social data of participants and non-participants are given. The performance of the examination is described and research projects are outlined. It is concluded that the selection of a strictly representative sample, together with careful uniformity of performance and high participation rate, will make it possible to draw valid conclusions about the total population of middle-aged women in Gothenburg.

The study of women in Gothenburg 1968-1969--a population study. General design, purpose and sampling results.

A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia.

Göran Rybo

Papers

Menstrual blood loss--a population study. Variation at different ages and attempts to define normality.

Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: A randomized comparative trial

Levonorgestrel-releasing intrauterine device in the treatment of menorrhagia.

The study of women in Gothenburg 1968-1969--a population study. General design, purpose and sampling results.

A comparison of flurbiprofen, tranexamic acid, and a levonorgestrel-releasing intrauterine contraceptive device in the treatment of idiopathic menorrhagia.