Objective

To examine whether retinal vascular calibre independently predicts risk of coronary heart disease (CHD) ‐related death.

Methods

In a population‐based cohort study of 3654 Australians aged ⩾ 49 years, retinal arteriolar and venular calibres were measured from baseline retinal photographs and the arteriole to venule ratio (AVR) was calculated. CHD‐related death was confirmed from the Australian National Death Index.

Results

Over nine years, 78 women (4.1%) and 114 men (7.8%) had incident CHD‐related deaths. In people aged 49–75 years, wider venules were associated with CHD death, with relative risk (RR) 1.8 (95% confidence interval (CI) 1.1 to 2.7) and RR 2.0 (95% CI 1.1 to 3.6) per standard deviation (SD) increase in venular calibre for men and women, respectively, after adjustment for traditional risk factors. Additionally, in women aged 49–75 years, smaller AVR and narrower arterioles were associated with CHD death (RR 1.5, 95% CI 1.1 to 2.2, and RR 1.9, 95% CI 1.0 to 3.5 per SD decrease in AVR and arteriolar calibre, respectively, after adjustment). These associations were not observed in people aged > 75 years.

Conclusions

These findings suggest that microvascular disease processes may have a role in CHD development in middle‐aged people, particularly in women. Retinal photography may be useful in cardiovascular risk prediction.

OBJECTIVE--To investigate whether prevalence of asthma in children increased in 10 years. DESIGN--Serial cross sectional studies of two populations of children by means of standard protocol. SETTING--Two towns in New South Wales: Belmont (coastal and humid) and Wagga Wagga (inland and dry). SUBJECTS--Children aged 8-10 years: 718 in Belmont and 769 in Wagga Wagga in 1982; 873 in Belmont and 795 in Wagga Wagga in 1992. MAIN OUTCOME MEASURES--History of respiratory illness recorded by parents in self administered questionnaire; airway hyperresponsiveness by histamine inhalation test; atopy by skin prick tests; counts of house dust mites in domestic dust. RESULTS--Prevalence of wheeze in previous 12 months increased in Belmont, from 10.4% (75/718) in 1982 to 27.6% (240/873) in 1992 (P < 0.001), and in Wagga Wagga, from 15.5% (119/769) to 23.1% (183/795) (P < 0.001). The prevalence of airway hyperresponsiveness increased twofold in Belmont to 19.8% (173/873) (P < 0.001) and 1.4-fold in Wagga Wagga to 18.1% (P < 0.05). The prevalence of airway hyperresponsiveness increased mainly in atopic children only, but the prevalence of atopy was unchanged (about 28.5% in Belmont and about 32.5% in Wagga Wagga). Numbers of house dust mites increased 5.5-fold in Belmont and 4.5-fold in Wagga Wagga. CONCLUSIONS--We suggest that exposure to higher allergen levels has increased airway abnormalities in atopic children or that mechanisms that protected airways of earlier generations of children have been altered by new environmental factors.

This paper describes a study of respiratory illness during the first year of life in a cohort of infants who were born between 1975 and 1978 to mothers who were registered with two inner London group general practices. The types of respiratory illness and their relation to the season of the year and season of birth of the child are examined. The relations among the frequency and type of respiratory illness and several social and family factors that have previously been shown to be associated with high levels of respiratory morbidity are also described.

The relationship between breast or bottle feeding and the incidence of bronchitis and pneumonia in the first year of life was examined in a birth cohort of nearly 2000 children born in Harrow, England, in 1963--65. Fewer episodes of acute bronchitis and pneumonia were reported in children who were breast-fed than in children who were bottle-fed. Firstborn children were more likely to be breast-fed than subsequent children. Mothers who smoked were less likely to breast-feed their babies. Although birth order and parental smoking have been shown to be associated with bronchitis and pneumonia in the same cohort, the association between feeding pattern and respiratory illness history persisted when these and other important factors were taken into account.

We wanted to assess the relative influence of various personal and family factors upon the development of ventilatory function in young children. The relationship of several such factors to peak expiratory flow rates measured at the age of five years was studied in 454 children. These children were members of a birth cohort born between 1963 and 1965 in Harrow, north-west London, who were examined regularly from birth through the first five years of life. Beside its expected association with height, peak expiratory flow rate at the age of five years was also related to a lesser extent with peak expiratory flow rate in parents. Children with a history of lower respiratory illness had mean peak flow rates which were lower than those of children who escaped these illnesses. The earlier the onset of the illness and the more frequent its recurrence, the more marked its effect on ventilatory function. The group of children with a history of asthma and bronchitis had the lowest mean peak expiratory flow rate, but a history of bronchitis or pneumonia alone (that is, without asthma) was also associated with reduced ventilatory function. Respiratory illness beginning in the first year of life was the most potentially modifiable determinant of peak expiratory flow rate in children in this study.

Family factors associated with the incidence of asthma and wheezing during childhood have been studied in a cohort of over 2000 children who, together with their families, were followed-up for five years. Episodes of wheezing not regarded by the parents as asthma had a different pattern of association with family factors to that found for asthma. The outcome of the two conditions in terms of ventilatory function at the age of five years was also different, in that children with a history of asthma had a lower peak expiratory flow rate than did children with a history of non-asthmatic wheezing.

In a study of a cohort of over 2000 children born between 1963 and 1965, the incidence of bronchitis and pneumonia during their first year of life was found to be associated with several family factors. The most important determinant of respiratory illness in these infants was an attack of bronchitis or pneumonia in a sibling. The age of these siblings, and their number, also contributed to this incidence. Parental respiratory symptoms, including persistent cough and phlegm, and asthma or wheezing, as well as parental smoking habits, had lesser but nevertheless important effects. Parental smoking, however, stands out from all other factors as the one most amenable to change in seeking to prevent bronchitis and pneumonia in infants.