Upsala J Med Sci 88: 6 1 4 2 , 1983

SHORT COMMUNICATION

On Cerebrovascular Deaths in Middle-aged Men during a
7-10-year Follow-up

Hans Wberg, Hans Lithell and Hans Wedstrand
From the Department of Internal Medicine, University Hospital, and the Institute of Medical Geriatrics,

Uppsala Uniuersity, Uppsala, Sweden

Between 1970 and 1973 all men born in 1920-1924 in the city of Uppsala
were invited to a health examination. I n all 2.322 men participated and 446
men did not participate. Those with hypertension, hyperlipidaemia and reduced
glucose tolerance were treated.

The death causes up to September 1980, during an average follow-up of 8.5
years (range 7-10 years) were examined. The number of cerebrovascular death
(CVD) among participants was 9 (0.4 %) and among non-participants 4 (0.9 %).
Thus the annual incidence of CVD was 45.6 and 105.5 per 100 000 men, respec-
tively. The corresponding figure in all Sweden was 50.2 (1). A s the number of

CVD was small the differences i n incidence should be interpreted with caution.
The proportion o f different subdiagnoses within the group of CVD was

surprising (Table below).

Participants Non-participants Total

Subarachnoid haemorrhage 7

Encephalomalacia 1
Intracerebral haemorrhage 1

Total 9 4 13

All except one of the 13 men had had autopsy. The non-autopsied man had

no hypertension and a clinical diagnosis o f subarachnoid haemorrhage (SAH).
The ratio between deaths from SAH and other CVD was 3.5:l among the

participants. The same ratio in the male 50-59 year age group of the whole of
Sweden was 1:3.9. There were 7 deaths in SAH in Uppsala (2.5 were expected)
and 2 deaths in other cerebrovascular causes (7.4 were expected). The number
of deaths due to SAH was significantly (p< 0.05) greater than expected.

Hypertension was known in two men - one with cerebral haemorrhage and one
with encephalomalacia. The first man had a known hypertension since the end of
the 1950s with an unsatisfactory blood pressure reduction most of the time.
One more man, a non-participant, had a cerebral haemorrhage. Thus, cerebral
haemorrhage is a rare cause of death in middle-aged men if they are treated
for hypertension. No participant with SAH had hypertension at the health
examination.

The main observation in the present follow-up was that the ratio between
deaths due to SAH and due to other cerebrovascular lesions was greater in
Uppsala than in Sweden. I n fact, the incidence of SAHs was significantly
greater in Uppsala than in Sweden. The reason for this is not known. I n other
mortality statistics, SAH has not decreased in spite of a reduced overall
incidence of CVD (1, 2 ) .

The occurrence o f SAH should not be influenced to any great extent by an
improved antihypertensive treatment which is considered to be the most likely
explanation of the reduction of other CVD. SAH is generally caused by rupture
of a congenital aneurysm. Therefore, it is possible that any further reduction
o f CVD in middle-aged men is limited by the lack of reduction of the incidence
of SAHS.

REFERENCES

1. Causes of death 1969-1978. Official Statistics of Sweden, National
Central Bureau of Statistics, Stockholm.

2 . Garraway, W.M., Whisnant, J.P., Furlan, A.J., Phillips 11, L . H . , Kurland,
L.T. & 0-Fallon, W.M.: The declining incidence of stroke. New Engl. J .
Med. 300: 449-452, 1 9 7 9 .

Address for reprints:

Dr Hans aberg
Department of Medicine
University Hospital
S-75014 UPPSALA
Sweden