***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVE --To examine the effect on mortality of stopping smoking after myocardial infa rct ion and the psychosocial factors that influence the decision to stop . DESIGN -- Analysis of smokers in a large prospect i ve study . Self completed question naires provided information on psychosocial factors . SETTING --Coronary care units at six English hospitals participating in a multicentre clinical trial . SUBJECTS -- These comprised consenting myocardial infa rct ion survivors who had been identified as smokers and who completed question naires within seven days of infa rct at six hospitals participating in the Anglo-Sc and inavian study of early thrombolysis . The 532 patients identified have been followed for over five and a half years . The main outcome measure was five year all cause mortality . MAIN RESULTS --Smokers who stopped within one month showed significantly reduced mortality compared with those who persisted , adjusting for other prognostic indicators ( odds ratio 0.56 , 95 % confidence interval 0.33 , 0.98 ) . Overall , 74 % stopped smoking . Being married , low life stress levels before infa rct , and higher social class were associated with stopping smoking but the differentials were small . Of the clinical variables , a final diagnosis of definite myocardial infa rct ion was associated with stopping smoking . All associations remained after multiple logistic regression . CONCLUSION --Smoking cessation can halve the smokers ' odds of dying after myocardial infa rct ion and psychosocial factors play a small but important role in the important decision to stop smoking . Health professionals should continue to stress the importance of stopping smoking to all patients as there is little evidence to support specific directing of advice to relatively " stress or " socially isolated " groups STUDY OBJECTIVE : To determine the relationship between obesity and subsequent incidence of ischaemic heart disease ( IHD ) .  DESIGN : Prospect i ve cohort survey . SETTING : Study of three occupational groups , with follow up examinations . SUBJECTS : 3500 people recruited between 1972 and 1978 ( 80 % response rate ) , and followed up between 1978 and 1984 . This report is based on subgroup of 1511 white men aged 40 - 64 at entry . MEASUREMENTS AND MAIN RESULTS : Information was obtained on smoking and family history of IHD . Blood pressure , weight , height , skinfold thickness at four sites , fibrinogen , factor VII activity and cholesterol were measured during follow up . Body mass index ( BMI ) was used as an index of obesity . BMI was found to be more strongly correlated with IHD than any of the skinfold measurements , none of which was significantly associated with IHD when BMI was allowed for . Increase in BMI by 1 SD ( approximately 8 kg ) was associated with a 44 % increase in the risk of IHD . Of the four skinfolds , subscapular was the most closely associated with risk , confirming the relevance of central obesity . The association between obesity and IHD remained when possible mechanisms for its effects were taken into account , and its strength may increase with time : for 1 SD increase in BMI , risk of events within 5 years was increased by 28 % , while risk of events after longer than 5 years was increased by 65 % . CONCLUSIONS : Preventive strategies for IHD should include avoidance of obesity In the British United Provident Association ( BUPA ) study , a prospect i ve observational study of 21,520 men , the serum albumin of 877 men who died during 10 years of follow-up was compared with that of 877 controls  , each matched to a case by age ( within 1 year ) and date of attendance ( within 3 months ) . There was little overall difference ( mean case-control difference = -0.11 milligram , P > 0.2 ) despite the fact that other studies have reported a long-term association between low serum albumin and increased mortality . Cause-specific mortality data showed no association of low albumin with ischaemic heart disease or other circulatory diseases . An inverse association with cancer was confined to the first few years of follow-up and so attributable to pre- clinical cancer lowering both serum albumin itself and serum cholesterol , with which albumin was associated . There was an association of chronic respiratory , neurological , renal , liver and gut diseases with low serum albumin ( case-control difference = -1.19 milligram , P < 0.001 ) consistent with the effect of pre- clinical disease lowering serum albumin . Other causes of death showed no association with albumin . Our data do not support a cause and effect association of low serum albumin and mortality BACKGROUND Previous studies on diet and coronary heart disease ( CHD ) focused primarily on individual nutrients or foods . OBJECTIVE We examined whether overall dietary patterns derived from a food-frequency question naire ( FFQ ) predict  risk of CHD in men . DESIGN This was a prospect i ve cohort study of 44875 men aged 40 - 75 y without diagnosed cardiovascular disease or cancer at baseline in 1986 . RESULTS During 8 y of follow-up , we documented 1089 cases of CHD ( nonfatal myocardial infa rct ion and fatal CHD ) . Using factor analysis , we identified 2 major dietary patterns using dietary data collected through a 131-item FFQ . The first factor , which we labeled the " prudent pattern , " was characterized by higher intake of vegetables , fruit , legumes , whole grains , fish , and poultry , whereas the second factor , the " Western pattern , " was characterized by higher intake of red meat , processed meat , refined grains , sweets and dessert , French fries , and high-fat dairy products . After adjustment for age and CHD risk factors , the relative risks from the lowest to highest quintiles of the prudent pattern score were 1.0 , 0 . 87 , 0.79 , 0.75 , and 0.70 ( 95 % CI : 0.56 , 0.86 ; P : for trend = 0.0009 ) . In contrast , the relative risks across increasing quintiles of the Western pattern score were 1.0 , 1.21 , 1.36 , 1.40 , and 1.64 ( 95 % CI : 1.24 , 2.17 ; P : for trend < 0.0001 ) . These associations persisted in subgroup analyses according to cigarette smoking , body mass index , and parental history of myocardial infa rct ion . CONCLUSIONS These data suggest that major dietary patterns derived from the FFQ predict risk of CHD , independent of other lifestyle variables Editorial by Jackson Current guidelines for prescribing lipid lowering drugs are based on an individual 's risk of coronary heart disease rather than on the reduction in risk that treatment may bring . We report a strategy for making treatment decisions that combines computer assisted calculation of absolute risk with an estimate of benefit to the patient from treatment . During a period of 14 months , 17 r and omly selected general practice s ( 63 practitioners ) in north Staffordshire were asked to send to the department of clinical biochemistry their requests for coronary heart disease risk assessment on patients being considered for lipid lowering drug treatment .  Coronary risk factors in patients being considered for lipid lowering drugs .  Values are means ( SD ) We used the Framingham statistical model to estimate a patient 's absolute risk of coronary heart disease over five years . The reduction in risk that treatment would bring over the next five years was calculated from the product of the absolute five OBJECTIVE : To investigate the associations of individual and area-based socioeconomic indicators with cardiovascular disease risk factors and mortality . DESIGN : Prospect i ve study . SETTING : The towns of Renfrew and Paisley in the west of Scotl and . PARTICIPANTS : 6961 men and 7991 women included in a population -based cardiovascular disease screening study between 1972 and 1976 . MAIN OUTCOME MEASURES : Cardiovascular disease risk factors and cardiorespiratory morbidity at the time of screening : 15 year mortality from all causes and cardiovascular disease . RESULTS : Both the area-based deprivation indicator and individual social class were associated with generally less favourable profiles of cardiovascular disease risk factors at the time of the baseline screening examinations . The exception was plasma cholesterol concentration , which was lower for men and women in manual social class groups . Independent contributions of area-based deprivation and individual social class were generally seen with respect to risk factors and morbidity . All cause and cardiovascular disease mortality rates were both inversely associated with socioeconomic position whether indexed by area-based deprivation or social class . The area-based and individual socioeconomic indicators made independent contributions to mortality risk . CONCLUSIONS : Individually assigned and area-based socioeconomic indicators make independent contributions to several important health outcomes . The degree of inequalities in health that exist will not be demonstrated in studies using only one category of indicator . Similarly , adjustment for confounding by socioeconomic position in aetiological epidemiological studies will be inadequate if only one level of indicator is used . Policies aim ed at reducing socioeconomic differentials in health should pay attention to the characteristics of the areas in which people live as well as the characteristics of the people who live in these areas Abstract Objective : To investigate the association between birth weight of offspring and mortality among fathers and mothers in the west of Scotl and . Design : Prospect i ve observational study . Participants : 794 married couples in Renfrew district of the west of Scotl and . Main outcome measures : Mortality from all causes and from cardiovascular disease over 15 year follow up . Results : Women who had heavier babies were taller , had higher body mass index and better lung function , and were less likely to be smokers than mothers of lighter babies . Fathers of heavier babies were taller and less likely to be smokers than fathers of lighter babies . Mortality was inversely related to offspring 's birth weight for both mothers ( relative rate for a 1 kg lower birth weight 1.82 ( 95 % confidence interval 1.23 to 2.70 ) ) and fathers ( relative rate 1.35 ( 1.03 to 1.79 ) ) . For mortality from cardiovascular disease , inverse associations were seen for mothers ( 2.00 ( 1.18 to 3.33 ) ) and fathers ( 1.52 ( 1.03 to 2.17 ) ) . Adjustment for blood pressure , plasma cholesterol , body mass index , height , social class , area based deprivation category , smoking , lung function , angina , bronchitis , and electrocardiographic evidence of ischaemia had little effect on these risk estimates , although levels of statistical significance were reduced . Conclusions : Birth weight of offspring  was related inversely to mortality , from all causes and cardiovascular disease , in this cohort . The strength of this association was greater than would have been expected by the degree of concordance of birth weights across generations , but an extensive range of potential confounding factors could not account for the association . Mortality is therefore influenced by a factor related to birth weight that is transmissible across generations . Key messages Low birth weight is associated with increased mortality from cardiovascular disease in later life , and birth weight is associated across generations so that both maternal and paternal birth weights are associated with the offspring 's birth weight In this observational study we found that lower birth weight of offspring  was associated with higher parental mortality from all causes and from cardiovascular disease This elevated mortality could not be explained by a range of social , environmental , behavioural , and physiological risk factors The strength of the association was greater than would have been expected by the degree of concordance of birth weights across generations We conclude that mortality is influenced by a factor that is related to birth weight and is transmissible across In prospect i ve studies , disease rates during follow-up are typically analyzed with respect to the values of factors measured during an initial baseline survey . However , because of " regression dilution , " this generally tends to underestimate the real associations of disease rates with the " usual " levels of such risk factors during some particular exposure period . The " regression dilution ratio " describes the ratio of the steepness of the uncorrected association to that of the real association . To assess the relevance of the usual value of a risk factor during particular exposure periods ( e.g. , first , second , and third decades ) to disease risks , regression dilution ratios can be derived by relating baseline measurements of the risk factor to replicate measurements from a reasonably representative sample of study participants after an interval equivalent to about the midpoint of each exposure period ( e.g. , at 5 , 15 , and 25 years , respectively ) . This report illustrates the impact of this time interval on the magnitude of the regression dilution ratios for blood pressure and blood cholesterol . The analyses were based on biennial re measurements over 30 years for participants in the Framingham Study ( Framingham , Massachusetts ) and a 26-year resurvey for a sample of men in the Whitehall Study ( London , Engl and ) . They show that uncorrected associations of disease risk with baseline measurements underestimate the strength of the real associations with usual levels of these risk factors during the first decade of exposure by about one-third , the second decade by about one-half , and the third decade by about two-thirds . Hence , to correct appropriately for regression dilution , replicate measurements of such risk factors may be required at varying intervals after baseline for at least a sample of participants Abstract Objective : To determine the association between adverse psychosocial characteristics at work and risk of coronary heart disease among male and female civil servants . Design : Prospect i ve cohort study ( Whitehall II study ) . At the baseline examination ( 1985 - 8 ) and twice during follow up a self report question naire provided information on psychosocial factors of the work environment and coronary heart disease . Independent assessment s of the work environment were obtained from personnel managers at baseline . Mean length of follow up was 5.3 years 
    Output:
    
‘ Early ’ cohorts were important in defining the major risk factors for CHD , particularly smoking , cholesterol , blood pressure , physical activity and body mass index .
Conclusions The current and proposed prospect i ve UK cohorts have sufficient power potentially to determine the importance of many traditional and newer CHD risk factors on cardiovascular risk in men , women and even ethnic minorities .