title: Long term mortality after severe starvation during the siege of Leningrad: prospective cohort study.
abstract: 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.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. Par.Sparen@meb.ki.se
authors.forename: Pär
authors.initials: P
authors.lastname: Sparén
authors.forename: Denny
authors.initials: D
authors.lastname: Vågerö
authors.forename: Dmitri B
authors.initials: DB
authors.lastname: Shestov
authors.forename: Svetlana
authors.initials: S
authors.lastname: Plavinskaja
authors.forename: Nina
authors.initials: N
authors.lastname: Parfenova
authors.forename: Valeri
authors.initials: V
authors.lastname: Hoptiar
authors.forename: Dominique
authors.initials: D
authors.lastname: Paturot
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Galanti
mesh_terms: 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