Long term mortality after severe starvation during the siege of Leningrad: prospective cohort study.
OBJECTIVE
To determine whether starvation during periods of increased growth after birth have long term health consequences.


METHODS
Analysis of cardiovascular risk factors and mortality in a longitudinal follow up after the 1941-4 siege of Leningrad. Mortality measured from 1975 up to the end of 1999.


METHODS
St Petersburg, Russia (formerly Leningrad).


METHODS
5000 men born 1916-35 who lived in Leningrad, randomly selected to take part in health examinations in 1975-7. Of the 3905 men who participated, a third had experienced the siege.


METHODS
Relative risk of ischaemic heart disease and mortality from stroke by siege exposure. Odds ratios and means for several cardiovascular risk factors.


RESULTS
Three to six decades after the siege, in men who experienced the siege around the age of puberty blood pressure was raised (mean difference in systolic 3.3 mm Hg, in diastolic 1.3 mm Hg) as was mortality from ischaemic heart disease (relative risk 1.39, 95% confidence interval 1.07 to 1.79) and stroke (1.67, 1.15 to 2.43), including haemorrhagic stroke (1.71, 0.90 to 3.22). The effect on mortality was partly mediated via blood pressure but not by any other measured biological, behavioural, or social factor.


CONCLUSIONS
Starvation, or accompanying chronic stress, particularly at the onset of or during puberty, may increase vulnerability to later cardiovascular disease.
Sparén
Pär
P
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. Par.Sparen@meb.ki.se
Vågerö
Denny
D
Shestov
Dmitri B
DB
Plavinskaja
Svetlana
S
Parfenova
Nina
N
Hoptiar
Valeri
V
Paturot
Dominique
D
Galanti
Maria Rosaria
MR
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D012959:Socioeconomic Factors; D013217:Starvation / Q000401:mortality*; D020521:Stroke / Q000401:mortality