Abstract
The population of Leningrad suffered from severe starvation, cold and psychological stress during the siege in 1941–1944. We investigated long-term effects of the siege on cardiovascular risk factors and mortality in surviving men and women. 3905 men born 1916–1935 and 1729 women born 1910–1940, resident in St Petersburg (formerly Leningrad) between 1975 and 1982, of whom a third experienced the siege as children, adolescents or young adults, were examined for cardiovascular risk factors in 1975–1977 and 1980–1982 respectively and followed till end 2005. Effects of siege exposure on blood pressure, lipids, body size, and mortality were studied in multivariate analysis stratified by gender and period of birth, adjusted for age, smoking, alcohol and social characteristics. Women who were 6–8 years-old and men who were 9–15 years-old at the peak of starvation had higher systolic blood pressure compared to unexposed subjects born during the same period of birth (fully adjusted difference 8.8, 95% CI: 0.1–17.5 mm Hg in women and 2.9, 95% CI: 0.7–5.0 mm Hg in men). Mean height of women who were exposed to siege as children appeared to be greater than that of unexposed women. Higher mortality from ischaemic heart disease and cerebrovascular disease was noted in men exposed at age 6–8 and 9–15, respectively. The experience of severe stress and starvation in childhood and puberty may have long-term effects on systolic blood pressure and circulatory disease in surviving men and women with potential gender differences in the effect of siege experienced at pre-pubertal age.
Similar content being viewed by others
References
Lucas A (1998) Programming by early nutrition: an experimental approach. J Nutr 128:401S–406S
Ravelli GP, Stein ZA, Susser MW (1976) Obesity in young men after famine exposure in utero and early infancy. N Engl J Med 295:349–353
Ravelli ACJ, van der Meulen JHP, Osmond C, Barker DJP, Bleker OP (1999) Obesity at the age of 50 years in men and women exposed to famine prenatally. Am J Clin Nutr 70:811–816
Roseboom TJ, van der Meulen JH, Ravelli AC, et al. (1999) Blood pressure in adults after prenatal exposure to famine. J Hypertens 17:325–330
Painter RC, Roseboom TJ, Bleker OP (2005) Prenatal exposure to the Dutch famine and disease in later life: an overview. Reprod Toxicol 20:345–352
Stanner SA, Bulmer K, Andres C, et al. (1997) Does malnutrition in utero determine diabetes and coronary heart disease in adulthood? Results from the Leningrad siege study, a cross sectional study. BMJ 315:1342–1348
Yudkin JS, Phillips DI, Stanner S (1997) Proteinuria and progressive renal disease: birth weight and microalbuminuria. Nephrol Dial Transplant 2 (12 Suppl):10–13
Stanner SA, Yudkin JS (2001) Fetal programming and the Leningrad Siege study. Twin Res 4:287–292
Elias SG, van Noord PAH, Peeters PHM, den Tonkelaar I, Grobbee DE (2005) Childhood exposure to the 1944–1945 Dutch famine and subsequent female reproductive function. Human Reproduction 20:2483–8
Dirx MJ, van den Brandt PA, Goldbohm RA, Lumey LH (2003) Energy restriction early in life and colon carcinoma risk: results of The Netherlands Cohort Study after 7.3 years of follow-up. Cancer 97:46–55
Elias SG, Peeters PH, Grobbee DE, van Noord PA (2004) Breast cancer risk after caloric restriction during the 1944–1945 Dutch famine. J Natl Cancer Inst 96:539–46
Chmelnizkij OK (1987) Role of pathologists in the besieged city of Leningrad (1941–1943) [in German]. Zentralbl Allg Pathol 133:307–310
Pavlov D. Leningrad 1941: the blockade. Chicago: University of Chicago Press, 1965
Sparén P, Vågerö D, Shestov DB, et al. (2004) Long-term mortality after severe starvation. Echo from the siege of Leningrad. BMJ 328:11–15
Vågerö D, Shestov D, Galanti R, Sparén P (2004) Long term mortality after starvation during the Leningrad siege: Authors reply. BMJ 328:346–7
Singhal A, Lucas A (2004) Early origins of cardiovascular disease: is there a unifying hypothesis?. The Lancet 363:1642–1645
Brozek J, Chapman C, Keys A (1948) Drastic food restriction: effect on cardiovascular dynamics in normotensive and hypertensive conditions. J Am Med Ass 137:1569–1574
Keys A, Brozek J, Henschel A, Mickelsen O, Taylor H (1950) The Biology of Human Starvation. University of Minnesota Press, Minneapolis
Olearchyk AS, Olearchyk RM (1999) Reminiscences of Vasilii I Kolesov. Ann Thorac Surg 67:273–276
Boitsov SA, Karpenko MA, Kuchmin AN, Pestova LV, Belokon GV (2000) Clinical manifestation of hypertension in citizens of siege Leningrad (1941–1944). Retrospective analysis of archive materials [in Russian]. Ter Arkh 72:54–58
Khoroshinina LP (2004) Peculiarities of somatic diseases in people of middle and old age survived Leningrad siege at childhood [in Russian]. Adv Gerontol 14:55–65
Davis CE, Deev AD, Shestov DB, et al. (1994) Correlates of mortality in Russian and US women. The Lipid Research Clinics Research Program. Am J Epidemiol 139:369–379
Thorn MD, Furberg B, Abernathy JR, et al. (1998) Correlates of systolic and diastolic blood pressures and lipids and lipoproteins in men aged 20–69 years from US and USSR Lipid Research Clinics Populations. Atherosclerosis Rev 17:157–184
Abernathy JR, Furberg B, Thorn MD, et al. (1998) Correlates of systolic and diastolic blood pressure in women aged 20–69 years from US and USSR Lipid Research Clinics Populations. Atherosclerosis Rev 17:185–199
Grigoriev AA (ed) (2000) Krasnojarsky krai in Russian History: volume three 1941–1953 [in Russian]. Publishing House, Krasnojarsk
Horta B, Barros FC, Victora CG, Cole TJ (2003) Early and late growth and blood pressure in adolescence. J Epidemiol Community Health 57:226–230
Adair LS, Cole TJ (2003) Rapid child growth raises blood pressure in adolescent boys who were thin at birth. Hypertension 41:451–456
van Noord PA, Kaaks R (1991) The effect of wartime conditions and the 1944–45 “Dutch famine” on recalled menarcheal age in participants of the DOM breast cancer screening project. Ann Hum Biol 18:57–70
Remsberg KE, Demerath EW, Schubert CM, Chumlea WC, Sun SS, Siervogel RM (2005) Early menarche and the development of cardiovascular disease risk factors in adolescent girls: the Fels Longitudinal Study. J Clin Endocrinol Metab 90:2718–2724
Lawlor DA, Ebrahim S, Davey Smith G (2002) Is there a sex difference in the association between birth weight and systolic blood pressure in later life? Findings from a meta-regression analysis. Am J Epidemiol 156:1100–1104
Fall CHD, Osmond C, Barker DJP, et al. (1995) Fetal and infant growth and cardiovascular risk factors in women. BMJ 310:428–432
Forsen T, Eriksson JG, Tuomilehto J, Osmond C, Barker DJ (1999) Growth in utero and during childhood among women who develop coronary heart disease: longitudinal study. BMJ 319:1403–1407
Forsen T, Osmond C, Eriksson JG, Barker DJ (2004) Growth of girls who later develop coronary heart disease. Heart 90:20–24
Okubo M (1981) Increase in mortality of middle-aged males in Japan. NUPRI Res Paper Ser 3:1–21
Horiuchi S (1983) The long-term impact of war on mortality: old-age mortality of the First World War survivors in the Federal Republic of Germany. UN Population Bull 5:80–92
Gonzales-Barranco J, Rios-Torres JM, Castillo-Martinez L, et al. (2003) Effect of malnutrition during the first year of life on adult plasma insulin and glucose tolerance. Metabolism 52:1005–1011
Falkner B, Sherif K, Michel S, Kushner H (2000) Dietary nutrients and blood pressure in urban minority adolescents at risk of hypertension. Arch Pediatr Adolesc Med 154:918–922
Simons-Morton DG, Obarzanek E (1997) Diet and blood pressure in children and adolescents. Pediatr Nephrol 11:244–249
Webber J, Macdonald IA (1994) The cardiovascular, metabolic and hormonal changes accompanying acute starvation in men and women. Br J Nutr 71:437–447
Moodie DS (1987) Anorexia and the heart. Results of studies to assess effects. Postgrad Med 81:46–55
Palla B, Litt IF (1988) Medical complications of eating disorders in adolescents. Pediatrics 81:613–623
Schocken DD, Holloway JD, Powers PS (1989) Weight loss and the heart. Effects of anorexia nervosa and starvation. Arch Intern Med 149:877–881
Acknowledgements
This study was supported by grants from the Foundation for Baltic and East European Studies and the Swedish Council for Social Research. Denny Vågerö is a member of the Macarthur Foundation network on social upheaval and health, which also gave support to the re-organisation of the data base. We would like to thank Maria Branting and Reidar österman for help with preparation of the dataset, David Leon, Hans Lithell and anonymous reviewers for comments on an earlier draft, and Sviatoslav Plavinski and Diana Kuh for alerting us to some crucial references on war time starvation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Koupil, I., Shestov, D.B., Sparén, P. et al. Blood pressure, hypertension and mortality from circulatory disease in men and women who survived the siege of Leningrad. Eur J Epidemiol 22, 223–234 (2007). https://doi.org/10.1007/s10654-007-9113-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-007-9113-6