The Manitoba Follow-up Study (MFUS) is Canada's longest running study of cardiovascular disease and ageing. The MFUS cohort consists of 3983 men recruited from the Royal Canadian Air Force at the end of World War II. At entry to the study, 1 July 1948, their mean age was 31 years, with 90% between ages 20 and 39 years. All study members were free of clinical evidence of ischaemic heart disease. The protocol of MFUS was to obtain routine medical examinations from these men at regular intervals over time. The research goal of the study was to examine the role that any abnormalities detected on routine electrocardiograms from apparently healthy men might play in the prediction of subsequent diagnoses of cardiovascular disease. Over the course of 65 years, about 35% of the cohort has documented evidence of ischaemic heart disease. The research focus was expanded in 1996 to explore the roles of physical, mental and social functioning in support of healthy and successful ageing. On 1 July 2013, 429 original cohort members were alive with a mean age of 92 years. Collaborative research with others outside the in-house team is welcomed.

PURPOSE:Of all Canadian and American men who live to age 75 years, about half can expect to live to age 85. Our objective is to examine how clinical diagnoses made before age 75 relate to a man's survival to age 85 years.DESIGN AND METHODS:Since 1948, a cohort of 3,983 young men (mean age of 31 years at entry) has been followed with routine contact and medical examinations to prospectively document incident disease. Over 62 years of follow-up, 2,414 of the cohort lived to celebrate their 75th birthday. Of these survivors, 1,060 (44%) died before their 85th birthday. Cox proportional hazard models were used to examine the effects of ischemic heart disease, cancer, cerebrovascular disease, diabetes mellitus, peripheral arterial disease, and chronic obstructive pulmonary disease on all-cause mortality between age 75 and 85 years.RESULTS:Modeled as six binary risk factors at age 75 years, all were significantly (p < .01) and independently related to 10-year mortality. Multivariate risk ratios ranged from 1.36 to 1.46 except for chronic obstructive pulmonary disease with a risk ratio of 1.85 (95% CI: 1.38, 2.49). The cumulative 10-year probability of survival from age 75 to 85 among men with none of these diagnoses was 63%, 52% for any one diagnosis, 39% for two diagnoses, and 22% for three or more diagnoses.IMPLICATIONS:Joint independence of these six common clinical diagnoses implies that each is important and their effects on mortality are cumulative.

It does not seem long ago since I served as President of our Society, when, in fact, we were only into our third decade of activity. Several of you who currently read The Canadian Journal of Cardiology were working with me at that time. Others were just dreaming about a career in medicine. And yes, some readers had not even seen the light of day. Whatever your experience, I would like to turn back the pages and share memories from some of the most rewarding years in my career. When I served as president in 1974 to 1976, the notion of simpler, calmer and gentler times applied to our world of cardiology. We had not yet been overwhelmed by the array of technological advances on the horizon. When a new research tool or piece of equipment hit the market, it did not become obsolete once the wrapping was removed. Practices and policies changed from year to year, certainly, but it was not yet an era of relentless upheaval in virtually every aspect of work with patients, hospitals and associates from other fields. Nor were we able to benefit from up-to-the-minute news of our colleagues’ activities across Canada, given that the launch of the Journal was still several years away. All the same, we did make encouraging inroads in cardiac care during the 1970s and maintained Canada’s respected profile throughout the world. During my term, I was fortunate to be part of a talented, hard working and resourceful council. It included nationwide representation from Nova Scotia to British Columbia, and the members pursued a full agenda of timely issues. One of our most significant challenges was to sell our synopsis of standards with respect to coronary care units and cardiac surgical intensive care units to the federal government. Dr Claude Labrosse of the Sherbrooke University Hospital Centre in Sherbrooke, Quebec, chaired the task force. He obtained input from a broad range of cardiologists and cardiac surgeons across Canada and then presented a brief in Ottawa. It may well have been the first official submission to recommend combined or adjacent coronary and cardiac surgical units. Another matter on our action list concerned the granting of affiliate status to groups such as the Canadian Stroke Network and the Canadian Council of Cardiovascular Nurses (both had representatives on our council, but were not fully affiliated in any formal sense). The Canadian Society of Clinical Perfusion also expressed interest in joining the Canadian Cardiovascular Society (CCS). Personally, I was in favour of these societies becoming our affiliates, with full voting rights and active representation at the scientific annual meetings. On the other hand, our by-laws did not permit such a degree of amalgamation and would have had to be amended. Although the council and I had different opinions as to how quickly we should evolve in concert with other colleagues, the issue was eventually resolved after my tenure. We did not exactly get the ball rolling, but at least the ball got placed squarely on the field! One can never underestimate the important role that the province of Quebec has played in the history of the CCS. Our Society’s very existence is rooted in talks that originated in Montreal, and during the 1970s, the Quebec Heart Foundation kindly offered to accommodate the CCS in Montreal, so we could finally boast of having a ‘head office’. Despite the changes that have taken place in our profession, there remains a constant factor that bridges the generations, in terms of both time and people; that is the role that trainees and newly certified cardiologists can play in making the CCS a strong advocate for professionals involved in treating and preventing heart disease. It goes without saying that their energy and talent are crucial in clinics, hospitals and laboratories. However, we also need their collective voice backing our efforts to lobby governments to remain onside in creating a world-class cardiac care system. Our Society can only be as effective and relevant as the sum of its individual members, be they the young or the young-at-heart. When I attend our next annual conference in Quebec City, Quebec, I will pay particular attention to the contributions of our newest members. Although I am retired from the practice of cardiology, I still do some research. I look forward to hearing of innovations in research and practice from the future leaders in our field. I have always regarded the teacher-student relationship to be a privilege and a rewarding experience. Happy anniversary to one and all.

PURPOSE: As the first and only manifestation of ischemic heart disease, sudden unexpected cardiac death (SUCD) is a serious clinical and epidemiological concern. Prospective population Studies permit the identification of risk factors for SUCD. Knowledge of the short and long-term risks for SUCD key to understanding the basis of any intervention. The present paper explores the effect of time since the detection of factors oil the risk for SUCD.SUBJECTS AND METHODS: The Manitoba Follow-Up Study is;a longitudinal, prospective study of 3983 originally healthy young men who have been followed with routine medical examinitions since 1948. During, 56 years Of follow-up, SUCD occurred in 171 men. This analysis examined 21 possible risk factors for SUCD, including clinical findings, social variables and electrocardiographic abnormalities. Time-dependent covariate Cox proportional hazard models were used to estimate age-adjusted relative risks for SUCD. In multivariate model's, the relative risk of SUCD was estimated as a function of time since the documentation of each risk factor.RESULTS: Excess alcohol consumption and T wave changes were dissociated with a high short,term risk for SUCD. Arterial hypertension and ST/T changes had sustained-excess risk over both the short and long term. Newly developed left: bundle branch block was a highly significant short-term risk that diminished with time.CONCLUSION: These findings add new information for the clinical management of risk factors. The identification of time since the detection of these risk factors is an important consideration to reduce SUCD.

BACKGROUND:There is a paucity of long-term follow-up data on individuals with asymptomatic Brugada electrocardiographic (ECG) pattern.OBJECTIVES:To investigate the incidence and prognosis of spontaneous Brugada ECG pattern in a prospective cohort.METHODS:The Manitoba Follow-up Study is Canada's longest-running study of cardiovascular disease. Since 1948, a cohort of 3983 healthy aircrew recruits has been followed with routine medical examination, including ECG. Over a 55-year follow-up period, clinical and ECG assessments were performed every three to five years, with yearly contact to monitor vital status. The mean age of the cohort at entry and the average age of the 1375 survivors in 2003 were 31 and 83 years of age, respectively. Brugada ECG pattern was defined as ST-segment elevation in at least one of leads V1 to V3 with a J wave amplitude of at least 2 mm, negative T waves, generally coved ST-T configuration, in the absence of alternative explanations. Serial ECGs of 273 subjects (6.9% of the cohort) with complete right bundle branch block at any time during follow-up were reviewed. Follow-up records pertaining to clinical course were also reviewed.RESULTS:All ECGs (in total 5665) from this cohort were reviewed. Four men had intermittent Brugada ECG pattern (lifetime incidence one per 1000): three men (all 80 years of age or older) were well on last follow-up and one had died of Alzheimer's disease. None of these men had syncope or ventricular arrhythmias documented during follow-up.CONCLUSIONS:The longevity of asymptomatic individuals in this cohort was not affected by spontaneous Brugada ECG pattern.

Purpose: Although the concept of successful aging is used widely in the field of gerontology, there is no agreed-on standard or common underlying definition for measuring success in aging. Our recent survey of an elderly male population asked respondents to define "successful aging." This paper describes the themes that evolved from those definitions, explores interrelationships between the themes, and examines the association between characteristics of respondents and the themes provided in their definition. Design and Methods: The Manitoba Follow-up Study has followed a cohort of 3,983 World War II Royal Canadian Air Force male aircrew recruits since July 1, 1948. At a mean age of 78 years in 1996, the survivors were surveyed and asked, "What is your definition of successful aging?" and "Would you say you have aged successfully?" A content analysis identified themes emerging from their definitions. Results: The most frequent of the 20 component themes from the definitions of successful aging as provided by 30% of the 1,771 respondents related to "health and disease"; "physical," "mental," and "social activity" were more likely to be found in a definition including "interest," "having goals," "family," or "diet," and they were less likely to be mentioned with themes of "independence" or "health." Many of the themes reflect an individual's attitudes toward life and the aging process. Current life satisfaction, self-rated health, and limitation in activities of daily living were significantly associated with an increased likelihood of reporting specific themes in definitions. implications: As health care professionals adapt to the changing demographic composition of society, it should be of interest to understand what successful aging might mean to the elderly males to whom they are attending.

PURPOSE:The purpose of this paper is to determine the age-specific relationships between risk factors at age 40 through 75 years and ischemic heart disease (IHD), and to determine the effects of aging on these relationships in a cohort of 3983 Canadian males. METHODS:The Manitoba Follow-Up Study is the prospective investigation of cardiovascular disease as it develops in a cohort of 3983 young men. Over a period of 45 years, from 1948 to 1993, 1094 study members (27%) developed clinical evidence of IHD. Blood pressure, body weight, smoking, and presence of diabetes mellitus have been recorded at regular intervals throughout the follow-up period. Using measurements from examinations every 5 years between ages 40 and 75 years, age-specific Cox proportional hazard models were fit to relate these risk factors to IHD. RESULTS:The adjusted relative risk of IHD for systolic blood pressure, diastolic blood pressure and smoking were found to significantly (p < 0.001) decline with advancing age. The adjusted relative risk for body mass index and presence of diabetes mellitus for ischemic heart disease did not vary with age (p > 0.05). After age 65 years, these risk factors were of little value for the prediction of IHD. CONCLUSIONS:The relative risk and statistical significance of blood pressure and smoking, as risk factors for IHD, decline with age.

PURPOSE:The purpose of this study was to test the hypothesis that overprotectiveness of patients after myocardial infarction (MI) by the spouse has a negative effect on recovery. METHODS:Subjects were 52 male patients who were admitted to one of four area hospitals with a first documented myocardial infarction (MI) and their wives. While in hospital, patients were interviewed by a research nurse who rated the patient's emotional distress on a scale from 1 to 10. Patients completed a Family APGAR and a self-efficacy scale for cardiac patients estimating their level of functioning in 3 months. Wives also completed a Family APGAR, an estimate of their husbands' functioning in 3 months using the self-efficacy scale, and Zung Depression and Anxiety scales. At 3 months post-MI, patients completed the following questionnaires: Family APGAR, self-efficacy scale for cardiac patients regarding current functioning, Zung Anxiety and Depression scales, and the Psychosocial Adaptation to Illness Scale. Perceived overprotectiveness and criticism were measured using the Influential Relationships Questionnaire. The Goldman Specific Activity Scale was used to quantify cardiac recovery. Wives completed the same questionnaires as at the first assessment. RESULTS:Perceived overprotectiveness was positively correlated with patients' anxiety and depression, with perceived criticism from their wives, and correlated negatively with quality-of-life. However, it was not related to the patients' confidence in their functional abilities or to cardiac functional classification at 3 months. Wives who were perceived as overprotective had been less optimistic about their husbands' functional recovery immediately after the MI. Patients who perceived themselves to be overprotected at 3 months had also been less optimistic about their functional recovery when assessed a few days post-MI. CONCLUSIONS:Although perceived overprotectiveness is part of a negative emotional experience for the male patients, it does not appear to be related to perceived functional abilities or cardiac functional classification at 3 months post-MI. Whether the perceived overprotectiveness studied here is a function of the patient's overall emotional state or the wife's actual behavior or a combination of both is an area for future research.

High blood pressure is a well-recognized, modifiable, cardiovascular disease risk factor. Tracking of blood pressure was examined in the University of Manitoba Follow-up Study, a cohort of 3,983 men followed over a 40-year period, between 1948 and 1988. Blood pressure measurements recorded over time in these men, prior to the development of ischemic heart disease, were used in this analysis. Two approaches to tracking were used; correlation analysis and the quantification of the likelihood for a man whose blood pressure was in either the top or bottom quintile to remain in the extreme end of the distribution at later measurement. For ages 25-75 years and for intervals between blood pressure measurement ranging from 5 to 35 years, significant evidence for tracking was found. The strongest evidence for tracking was in middle age, 45-55 years. Strength of tracking decreased with increasing time between measurements. This analysis suggests that men at highest risk for hypertension can be identified at a young age. Hence, strategies for prevention of cardiovascular complications can be targeted in early adulthood.

PURPOSE:Atrial fibrillation is a common arrhythmia associated with increased cardiovascular morbidity and mortality. This study was undertaken to identify the natural history of this condition, including risk factors for its development, and outcome.PATIENTS AND METHODS:The incidence of atrial fibrillation among 3,983 male air crew recruits observed continuously for 44 years was calculated based on person-years of observation. Age and 23 variables were examined to identify risk factors for atrial fibrillation. Controlling for age and 9 prognostic variables, the effect of atrial fibrillation on 8 outcomes was examined. Analysis of risk factors for atrial fibrillation and outcome after atrial fibrillation was based on a Cox proportional hazard model using time-dependent covariates.RESULTS:Of the 3,983 study members, 299 (7.5%) developed atrial fibrillation during 154,131 person-years of observation. The incidence rose with age from less than 0.5 per 1,000 person-years before age 50 to 9.7 per 1,000 person-years after age 70. Risk for atrial fibrillation was increased with myocardial infarction (relative risk [RR] 3.62), angina (RR 2.84), and ST-T wave abnormalities in the absence of ischemic heart disease (RR 2.21). The RR for atrial fibrillation was strongest at the onset of ischemic heart disease and diminished over time. The rate of atrial fibrillation was 1.42 times increased in men with a history of hypertension. Congestive heart failure, valvular heart disease, and cardiomyopathy were important but uncommon risk factors. Atrial fibrillation independently increased the risk for stroke (RR 2.07) and congestive heart failure (RR 2.98). Total mortality rate was increased 1.31 times; cardiovascular mortality including and excluding fatal stroke were also increased (RR 1.41 and 1.37, respectively).CONCLUSIONS:The incidence of atrial fibrillation in men increases with advancing age. Clinical cardiac abnormalities, particularly recent ischemic heart disease and hypertension, are strongly associated with increased risk for atrial fibrillation. Atrial fibrillation increases morbidity and mortality, but the magnitude of the increase may be less than previously reported.