The possible role of plasma insulin levels as a risk factor of coronary heart disease has been studied in a population of 7246 non diabetic, working men, aged 43-54 years, initially free from heart disease, and followed for 63 months on average. 128 new coronary heart disease events (non fatal myocardial infarction and coronary related deaths) were detected during this period. The annual risk is analysed by a multivariate model including age, serum cholesterol and triglycerides, blood pressure, smoking, obesity, plasma glucose and insulin fasting and 2 hours after a 75 g oral glucose load. It is shown that the fasting plasma insulin level and the fasting insulin-glucose ratio are positively associated with risk independent of the other factors. The same variables, 2 hours after the glucose load are also positively associated with risk but their contributions are not significant in the multivariate analysis. It is concluded that high insulin levels may constitute an independet risk factor for coronary heart disease complications in middle aged non diabetic men.

The Paris Prospective Study is a long-term, large-scale study of the factors predicting coronary heart disease. The first follow-up examination included, for subjects not known as having diabetes mellitus, a 75 g oral glucose tolerance test with measurement of plasma insulin and glucose levels, fasting and 2 h post-load. Between 1968 and 1973, 6903 men aged 43-54 years were thus examined. Causes of death were ascertained within this group after 15 years of mean follow-up. The baseline variables were tested as predictors of death from coronary heart disease by a Cox regression analysis. Significant independent predictors of coronary heart disease death were: systolic blood pressure, number of cigarettes per day, plasma cholesterol level, and 2 h post-load plasma insulin level when entered as a categorical variable (below or above 452 pmol/l. i.e. the lower limit of the fifth quintile of the distribution). This dichotomization was performed to account for the non-linear univariate distribution of deaths with increasing post-load insulin values. Fasting plasma insulin level was not an independent predictor of death by coronary heart disease over this long-term follow-up. Levels of blood glucose were not significant independent predictors of death by coronary heart disease when plasma insulin levels were included in the model. The same applied to abnormalities of glucose tolerance when the 125 men with known non-insulin-treated diabetes at baseline were added to the group. Under the assumption that hyperinsulinaemia is a marker of insulin resistance, the results are consistent with the hypothesis that insulin resistance is associated with a higher risk of coronary heart disease mortality. However, it is doubtful that circulating insulin per se is a direct cause of arterial complications.

The association between smoking habits and diet was examined in a sample of 1126 men, aged 45-64 years, from the general population living in the three French MONICA monitoring areas: Bas-Rhin (BR) (n = 346), Haute-Garonne (HG) (n = 400) and Urban Community of Lille (UCL) (n = 380). Diet was assessed by the 3-day record method. The energy and nutrient intakes were calculated for each of the 3 centres, using the same food composition tables. Alcohol consumption was higher among smokers (P less than 0.001). Taking into account alcohol consumption, age, body mass index, centre, educational level and family size, the analyses showed no difference in non-alcoholic energy intake, proteins, carbohydrates, and total fat. However, smokers had a lower intake of polyunsaturated fatty acids (P less than 0.05) and dietary fibre (P less than 0.01) than non-smokers. With regard to food items, smokers had a higher intake of sucrose (P less than 0.05) and a lower intake of vegetables (P less than 0.001), dairy products (P less than 0.05) and cheese (P less than 0.05). These results suggest that analyses in future epidemiological research regarding the role of diet in the aetiology of tobacco-related diseases should consider this association of potential risk factors.

SUMMARY The Paris Cardiovascular Risk Factor Prevention Trial was designed to determine whether individualised intervention could induce a reduction in the coronary risk factor levels in young men. Three thousand three hundred and thirty-six men aged 25 to 35, working in the 160 sections of a large Parisian administration, were examined. The sections were randomly allocated to a control and an intervention group. Advice concerning diet, cigarette smoking, and physical activity was provided repeatedly to the subjects in the intervention group. Two years after the first intervention, the first 1292 subjects who entered the study, whether from the intervention or the control group, were recalled; 86% of the intervention group and 84% of the control group responded. The changes in weight, blood pressure, and cigarette smoking in the intervention group, corrected for changes in the control group, were respectively -0.4 kg (p = 0 06), -1*4 mm Hg (p <005), and -1*2 cigarettes (p <0.01). There was no difference between the two groups in serum cholesterol change. Most of these results concerning young men are in agreement with recently reported results of community intervention programmes in middle-aged men.The association between the incidence of coronary heart disease (CHD) and the levels of blood pressure, plasma cholesterol, and cigarette consumption is now well-established. As the levels of these risk factors can be modified by some intervention, many prevention trials have been organised to test the hypothesis that intervention can also reduce the recurrence or the incidence of CHD.Multifactorial prevention trials constitute a pragmatic approach and if their efficiency can be proved their methods of intervention could be extended to larger populations. At the present time, many multifactorial primary prevention trials on middle-aged men free of CHD at entry are under way.1 The first question that such trials must answer is: 'Can this kind of intervention reduce the level of coronary risk factors or prevent their increase?'The Paris trial was organised to test the short-and middle-term effects of an intervention programme on modifications of the levels of risk factors in men aged 25 to 35, before the occurrence of extended coronary lesions. Preventive measures in young adults, if observed, are expected to have more effect on the atherosclerotic process than in middle-aged subjects, but it is also probable that young subjects are less 91 well-motivated towards prevention. In young men, risk factors increase rapidly, partly for intricate sociological reasons, and the aim of intervention is mainly to prevent such an increase rather than to reduce risk factors.To increase the efficiency of the trial, it was decided to intervene more frequently in a group of subjects with elevated risk factors (cigarette smoking, plasma cholesterol, blood pressure). In young men, however, elevation of these risk factors is relatively rare, and consequently men who were substantially overweight, even without other abnormalities, were also...

The prevalence of varicose veins was higher among lower social subjects and was positively associated with a body-mass index, cigarette consumption and diastolic blood pressure. A detailed dietary survey in a subsample of the population showed a significantly higher total calory intake in men with varicose veins but no difference in the distribution of the various nutrients. During follow up for subsequent atherosclerotic disease (average 6.6 yrs), men with varicose veins were at a significantly higher risk for intermittent claudication and, at least in the lower social class, for hard coronary heart disease. No association was found with angina pectoris incidence.