Hartwig Ziegler

Klinikum Saarbrücken, Saarbrücken, Saarland, Germany

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Publications (65)215.17 Total impact

  • 01/2010: pages 1-315;
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    ABSTRACT: Breast-conserving therapy (BCT) was developed to improve quality of life (QOL) in early stage breast cancer patients. Except for differences in body image, literature comparing the psychosocial sequelae of BCT with mastectomy is ambiguous and shows a lack of substantial benefits. However, knowledge regarding long term effects of treatment on QOL in breast cancer is very limited as most of the pertinent studies have been performed in the early post-operative period. Therefore we compared QOL in women with breast cancer undergoing BCT versus women undergoing mastectomy over a 5-year period following primary surgery. QOL was assessed at 1, 3, and 5 years after diagnosis in a population based cohort of 315 women with early stage breast cancer (UICC stage I-II) from Saarland (Germany) using the EORTC QLQ-C30 questionnaire and the breast cancer specific module BR23. Breast-conserving therapy was performed in 226 women (72%). After control for potential confounding, women with BCT reported better physical and role functioning, were sexually more active and more satisfied with their body image already at 1 year after diagnosis (all P values < 0.05). Differences in overall QOL and social functioning were gradually increasing over time and became statistically significant only at 5 years. Whereas some, very specific benefits of BCT, such as a better body image, are already visible very timely after completion of therapy, benefits in broader measures such as psychosocial well-being and overall quality of life gradually increase over time and become fully apparent only in the long run.
    Journal of Cancer Research and Clinical Oncology 05/2008; 134(12):1311-8. · 2.91 Impact Factor
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    ABSTRACT: Aktuelle Daten darüber, wie sich Krebsinzidenz und -mortalität verändern, sind von öffentlichem Interesse. Um zu präzisen quantitativen Angaben zu gelangen, haben wir die Daten zur Mortalität der letzten 52Jahre in Deutschland und zur Inzidenz der letzten 34Jahre im Saarland einer Trendanalyse unterzogen. Grundlage der Auswertung sind die Mortalitätsdaten aus der amtlichen Todesursachenstatistik (Quelle: Statistisches Bundesamt und WHO) sowie die Inzidenzdaten des Krebsregisters des Saarlandes. Die altersstandardisierte Mortalitätsrate an Krebs insgesamt sowie den meisten einzelnen Krebsarten mit Ausnahme von Lungenkrebs bei Frauen geht statistisch signifikant zurück. Neuerdings weisen auch die Inzidenzraten keine statistisch sicherbare Zunahme mehr auf. Allerdings gibt es weiterhin ansteigende Inzidenzraten für kolorektale Tumoren, Brust- und Prostatakrebs sowie Lymphome. Dem gegenüber fällt die Inzidenz bei bösartigen Neubildungen des Magens bei beiden Geschlechtern, der Gallenblase bei Frauen sowie bei Kehlkopf- und Lungenkrebs bei Männern. Primäre Prävention ist offensichtlich verantwortlich für den Rückgang bei Lungenkrebs unter Männern sowie Früherkennung für den Rückgang bei Gebärmutterhalskrebs unter Frauen. Behandlungserfolge dürften maßgeblich sein für den Rückgang bei Brustkrebs und Hodenkrebs sowie Lymphomen. Umgekehrt weisen das Ausbleiben einer Wende in der Mortalität an Lungenkrebs bei Frauen, ein langsamerer Rückgang der Mortalität an Gebärmutterhalskrebs oder ein späteres Einsetzen des Rückganges der Mortalität an Brustkrebs jeweils im Vergleich zu anderen Ländern auf Schwächen in Prävention, Früherkennung und rascher Umsetzung moderner Behandlungsverfahren hin. Current data on how incidence and mortality of cancer change arouse public interest. In order to obtain precise quantitative information, we performed a trend analysis using data on mortality of the last 52years in Germany and on incidence of the last 34years in the Saarland. The evaluation is based on mortality data taken from the official statistics of causes of deaths (sources: Federal Office of Statistics and WHO) as well as on incidence data taken from the cancer registry of the Saarland. The age-standardized mortality rate for cancer in general as well as for most types of cancer except for lung cancer in women exhibits a statistically significant decline. Recently the incidence rates are also no longer increasing significantly. Nevertheless there still are growing incidence rates for colorectal tumors, breast and prostate cancer as well as lymphomas. In contrast, the incidence of malignant neoplasms of the stomach is declining in both genders, of the gallbladder in women as well as of laryngeal and lung cancer in men. Primary prevention obviously is responsible for the decline of lung cancer in men as well as early diagnosis for the decline of cervical cancer in women. Treatment successes may significantly be involved in the decrease of breast and testicular cancer as well as lymphomas. Conversely, the facts that lung cancer mortality in females has not been reversed, cervical cancer mortality is declining more slowly, or a decrease in breast cancer mortality occurs later compared to other countries reveal weaknesses in prevention, early diagnosis, and quick implementation of modern disease management.
    Der Onkologe 01/2008; 14(3):276-290. · 0.13 Impact Factor
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    ABSTRACT: To examine lifetime patterns of cardiovascular risk factors and their implications in subsequent birth cohorts of older adults in Germany, who experienced very different political and socioeconomic conditions at various phases of their lives. Participants of the ESTHER study, a statewide cohort study conducted in Saarland, Germany, were categorized into four birth cohorts: 1925-1934, 1935-1939, 1940-1944, 1945-1952. At baseline, lifetime history of body weight, physical activity, smoking and drinking habits, and of physician-diagnosed diabetes mellitus were documented. The average BMI, the average number of hours of physical activity, prevalence of smoking and alcohol consumption between ages 20 and 50 years were assessed. The relative risks of a first diagnosis of diabetes mellitus before or at the age of 50 years by birth cohorts were assessed by multiple logistic regressions controlling for education and BMI at the age of 20. For both men and women, later birth cohorts had considerably worse lifestyle profiles. The frequency of diabetes mellitus up to the age of 50 years was much higher in the later than in the earlier cohorts. The increase was more pronounced among men than among women. Women and men reaching old age in the forthcoming years have more unfavourable lifetime risk factor profiles than earlier birth cohorts. These patterns might have substantial implications for the future burden of chronic disease.
    European Journal of Cardiovascular Prevention and Rehabilitation 01/2008; 14(6):809-14. · 3.69 Impact Factor
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    ABSTRACT: The ageing of populations makes outcome monitoring among elderly cancer patients particularly important. Using data from the population-based Cancer Registry of Saarland, we examined age-specific trends in 5-year relative survival from 1979 to 2003 for patients with 15 common cancers in Germany. Model-based period analysis was applied to estimate 5-year relative survival for four age groups (15-54, 55-64, 65-74, 75+) in the periods 1979-1983, 1984-1988, 1989-1993, 1994-1998, and 1999-2003. Overall, 5-year relative survival improved steadily from 42.2% in 1979-1983 to 56.7% in 1999-2003. From the youngest to the oldest age group, 5-year relative survival increased by 14.5, 12.1, 12.5, and 8.4 percent units, respectively, after adjusting for changes in the spectrum of cancer sites, and survival significantly improved for 10, 12, 11, and 5 cancer sites, respectively. The age gradient particularly increased for cancer sites with major progress in chemotherapeutic treatment regimens, such as ovarian cancer, non-Hodgkin's lymphoma and leukemia. Relative survival of cancer patients increased considerably for many forms of cancer in Germany from 1979 to 2003. Increases were much less pronounced among elderly patients, leading to an increasing age gradient in prognosis.
    Annals of Oncology 08/2007; 18(7):1253-9. · 6.58 Impact Factor
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    ABSTRACT: Transatlantic cancer survival comparisons are scarce and involve mostly aggregate European data from the late 1980s. We compare the levels of cancer patient survival achieved in Germany and the United States (US) by the beginning of the 21st century, using data from the Cancer Registry of Saarland/Germany and the SEER Program of the US. Age-adjusted 5- and 10-year relative survival for 23 common forms of cancer derived by period analysis for the 2000-2002 period were calculated, with additional detailed age- and stage-specific analyses for cancers with the highest incidence. Among the 23 cancer sites, 5 (10) year relative survival was significantly higher for 1 (2) and 8 (5) cancers in Germany and the US, respectively. In Germany, survival was significantly higher for patients with stomach cancer, whereas survival was higher in the US for patients with breast, cervical, prostate, colorectal and oral cavity cancer. Among the most common cancers, age-specific survival differences were particularly pronounced for older patients with breast, colorectal and prostate cancer. Survival advantages of breast cancer patients in the US were mainly due to more favorable stage distributions. This comprehensive survival comparison between Germany and the US suggests that although survival was similar for the majority of the compared cancer sites, long-term prognosis of patients continues to be better in the US for many of the most common forms of cancer. Among these, differences between patients with breast and prostate cancer are probably due to more intensive screening activities.
    International Journal of Cancer 08/2007; 121(2):395-400. · 5.01 Impact Factor
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    ABSTRACT: The objective of this analysis was to examine the impact of lifetime physical activity (PA) on major cardiovascular disease. At the baseline examination of the ESTHER study, a cohort study with 9953 participants, ages 50-74 years, with a lifetime history of PA and a physician-diagnosed myocardial infarction or stroke (major cardiovascular events, MCVE) were documented. The average number of hours per week of light and heavy PA (occupational and leisure time) between 20 and 50 years of age were calculated, and their association with the occurrence of MCVE after the age of 50 years was assessed by multiple logistic regression controlling for age, sex, smoking, body mass index, and education. A total of 569 study participants (6.1%) experienced a MCVE. Participants with no heavy PA at all or >or=40 hours per week had an increased risk for MCVE compared with study participants with PA up to 7 hours per week (odds ratios, 95% confidence intervals: 1.65, 1.10-2.46, and 1.69, 1.17-2.45, respectively). Both absence and (typically occupation related) excess of heavy PA during adulthood seem to increase the risk of MCVE. Health effects of heavy PA are likely to be a matter of type and of dose.
    Annals of Epidemiology 06/2007; 17(6):417-24. · 2.15 Impact Factor
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    ABSTRACT: Prevalence studies of atopic diseases such as atopic dermatitis (AD), hay fever and allergic asthma have mostly been performed in children. Studies in the adult population are still rare. We estimated the lifetime prevalence of different atopic diseases in an elderly population in Saarland, Germany. Additionally we investigated the association between atopic diseases and sociodemographic factors including age, gender, duration of school education (as a proxy measure of socioeconomic status), family history, and size of place of residence. This study was conducted between June 2000 and December 2002 in the State of Saarland, Germany. Participants aged 50-75 years (n=9961) were recruited by their general practitioner in the context of a general health screening examination. All filled out a standardized questionnaire and reported whether a physician had ever diagnosed an atopic disease (hay fever, AD or asthma). Overall, 9949 subjects (mean age 62 years, 45% men) were included in this analysis. The lifetime prevalence of reported AD, hay fever and asthma was 4.3%, 8.3% and 5.5%, respectively. Lifetime prevalence of AD and asthma among women, and lifetime prevalence of hay fever among both genders, strongly decreased with age. Duration of school education (<or= 9 years, 10-11 years, > 11 years) was strongly associated with AD (3.7%, 5.7%, 6.8%; P trend < 0.0001) and hay fever (7.2%, 11.2%, 12.8%; P trend < 0.0001), but only tentatively with asthma. The lifetime prevalence of AD is considerably lower in the elderly compared with the prevalence reported among younger adults in recent studies. Adults with a longer duration of school education appeared to have a higher risk for atopic diseases.
    British Journal of Dermatology 04/2007; 156(4):693-7. · 4.10 Impact Factor
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    ABSTRACT: The paper presents the statistical analysis of current and past trends of cancer mortality rates in Germany in terms of annual percent change, overall and for the major sites, and contrasts them with trends in incidence of the Cancer Registry of the Saarland, the only registry in this country with long-term completeness. It addresses also the issue of a cross-over of cancer mortality and mortality from cardiovascular diseases (CVD) in the near future, as suggested by various authors. Analyses are based on the mortality data of the official mortality statistics as published by the Federal Statistical Office and reported annually to the WHO, and the regularly reported incidence data of the Cancer Registry of the Saarland. The data was age-standardised and analysed by piecewise regression using a freely available dedicated software package. The report shows a downward trend of mortality rates for all cancers combined based on declining rates for many individual sites with only few exceptions affecting mainly females (e.g. lung cancer). Recently, the long-term increase of cancer incidence also flattened out with rather heterogeneous underlying site-specific trends increasing for some sites (e.g. cancers of the intestine, breast, prostate, or some lymphoma) and decreasing for others (e.g. cancers of the stomach, gall bladder in females, larynx, and lung in males). A crossover of cancer mortality and mortality from CVD might occur-if at all-after 2,020 in males and 2,030 in females. Depending on cancer site, primary prevention (e.g. lung cancer among males), early detection (cervical cancer), and treatment (e.g. breast and testicular cancer, lymphoma) contributed to the current decline of mortality rates. Absence of a turnaround (e.g. lung cancer among females), slower decline than in other countries (e.g. cervical cancer), or later turnaround (e.g. breast cancer) may be related to failures in promoting prevention (lung cancer among females), early detection programmes (cervical cancer), or delays in the translation of modern treatment into routine health care (breast cancer) and indicate major challenges for current and future health policy.
    Journal of Cancer Research and Clinical Oncology 02/2007; 133(1):23-35. · 3.01 Impact Factor
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    ABSTRACT: Whereas the role of specific symptoms, such as pain and fatigue, for quality of life (QOL) is unquestioned, their relative importance for long-lasting impairments in QOL in cancer patients has rarely been assessed quantitatively. The authors, therefore, aimed to identify symptoms most predictive of limitations to function and overall QOL in women with breast cancer after completion of primary therapy. The European Organisation for Research and Treatment of Cancer questionnaire QLQ-C30 and the breast-cancer-specific module QLQ-BR23 were used to measure QOL in a population-based sample from Saarland (Germany) of 314 women with breast cancer 1 year after diagnosis. Symptoms most predictive for limitations to function and overall QOL were identified with a multiple linear regression analysis. Fatigue emerged as the strongest predictor by far of QOL, explaining around 30% to 50% of variability within function scores and overall QOL. Other symptoms, including pain, nausea and/or vomiting, breast symptoms, systemic therapy side effects, and arm symptoms, explained on average <5% of variability of various QOL scales beyond fatigue and age. Sociodemographic and clinical factors had little impact on QOL. Although QOL is a multidimensional concept, the analysis suggested that fatigue is the symptom that had, by far, the largest impact on limiting function and on overall QOL in breast cancer patients after their completion of primary therapy. Specific interventions to reduce the burden of fatigue may represent a particularly worthwhile effort to improve QOL in women with breast cancer.
    Cancer 12/2006; 107(10):2496-503. · 4.90 Impact Factor
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    ABSTRACT: Despite the burden and prevalence of colorectal cancer (CRC), there is only limited information regarding quality of life of patients who have survived beyond the first year post treatment. We assessed quality of life in a population-based cohort of 309 patients with CRC from Saarland (Germany) one and three years after diagnosis using the QLQ-C30 questionnaire and the tumour specific module QLQ-CR38. When compared with reference data from the general population, most patients with CRC reported high overall quality of life and only small deficits in physical functioning but deficits in emotional and social functioning persist over years in patients with colorectal cancer. Improvements in quality of life from the first to the third year after diagnosis in patients who remained free of disease were very modest and limited to less financial difficulties, a better future perspective and fewer stoma-related problems.
    European Journal of Cancer 09/2006; 42(12):1848-57. · 4.82 Impact Factor
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    ABSTRACT: To assess the relevance of pre-existing body weight for successful smoking cessation among women and men. We carried out a retrospective cohort analysis among 4270 ever smoking participants of a general health screening examination in Germany recruited from July 2000 to June 2002 aged 50 to 74, who provided lifetime histories of both body weight and smoking. In the extended Cox model, the relative cessation rate (RCR) increased significantly with increasing body mass index (BMI) among both genders (test for trend: P < 0.01 for women and P < 0.0001 for men). In women, this effect was mainly due to a lower cessation rate in low-weight (BMI <20) smokers (adjusted RCR = 0.76, 95% confidence interval (CI) 0.62-0.95), whereas in men, the effect was mainly due to a higher cessation rate among overweight and obese smokers (adjusted RCR = 1.26, 95% CI 1.11-1.35, and 1.38, 95% CI 1.17-1.63, respectively) compared to normal-weight smokers. While in men, overweight and obesity are associated with increased smoking cessation, possibly related to increased health concerns, in women, low weight is associated with decreased smoking cessation, possibly related to increased fear of weight gain.
    Preventive Medicine 03/2006; 42(2):109-13. · 2.93 Impact Factor
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    ABSTRACT: We evaluated the impact of demographic factors, smoking patterns, and the occurrence of smoking-related diseases on smoking cessation, with a particular emphasis on the temporal relationship between diagnosis of smoking-related diseases and cessation. A cohort was assembled of participants of a general health screening examination aged 50-74 years. Lifetime smoking habits and medical history were obtained by a self-administered questionnaire. In a retrospective cohort study approach, predictors of cessation among ever-smokers (n = 4,575) were identified using the extended proportional hazards model. Male gender, late onset of smoking, and higher educational level were predictive of cessation. However, the by far strongest predictors of cessation were diagnoses of smoking-related diseases: relative cessation rates in the year of disease occurrence were 11.2 for myocardial infarction (95% confidence interval CI = 8.9-14.0), 7.2 for stroke (95% CI = 5.1-11.6), 2.5 for diabetes mellitus (95% CI = 1.6-4.0) and 4.8 for cancer (95% CI = 3.1-7.4) relative to years before diagnosis of the respective diseases. Our results underline the key role of perceived detrimental effects of smoking for cessation. When smokers personally experience the health consequences of smoking, many permanently quit.
    Journal of Clinical Epidemiology 02/2006; 59(1):82-9. · 5.48 Impact Factor
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    ABSTRACT: To assess whether detriments in quality of life (QOL) among women with breast cancer persist over years. QOL was assessed in a population-based cohort of 314 women with breast cancer from Saarland (Germany) 1 and 3 years after diagnosis and compared internally and with reference data from the general population. Three years after diagnosis, deficits in QOL were still apparent for role, emotional, cognitive, and social functioning and for the symptoms of insomnia, fatigue, dyspnea, and financial difficulties. Differences between breast cancer patients and women from the general population were predominantly found in younger ages. Compared with the QOL scores measured 1 year after diagnosis, only minor functional changes were observed, but recurrence of breast cancer during the follow-up interval had a deleterious effect on QOL. Deficits in role, emotional, cognitive, and social functioning persist over years in women with breast cancer and predominantly affect younger patients.
    Journal of Clinical Oncology 09/2005; 23(22):4945-53. · 17.88 Impact Factor
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    ABSTRACT: Endoscopic screening (sigmoidoscopy, colonoscopy) with removal of precancerous lesions can prevent a large proportion of colorectal cancers (CRCs). However, there is lack of data regarding optimal age, time intervals and numbers of screening examinations. We developed and applied modified techniques of epidemiological analysis to evaluate the impact of various endoscopy-based screening strategies on prevention of clinically manifest CRCs between the ages of 50 and 79 in a population-based case-control study (294 cases, 254 controls) conducted in Saarland, Germany. We found a strong potential for reduction of CRC occurrence even with a single screening endoscopy. The optimal age for a single screening endoscopy appears to be around 55 (estimated potential for prevention of cases between the ages of 55 and 79 in case of 100% compliance: 77% (95% confidence interval (CI) 46-90%)). A single screening endoscopy at age 50 would have a lower impact due to failure to prevent CRC at higher ages. Similarly, screening at ages 60 or older would have a lower impact because it would fail to prevent CRC at lower ages. Repeated offers of screening examinations could provide substantial additional benefit with the levels of compliance to be expected in practice, but they would have to be weighed against the increased risks and costs.
    European Journal of Cancer Prevention 07/2005; 14(3):231-7. · 2.76 Impact Factor
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    ABSTRACT: The prevalence and main determinants of exocrine pancreatic insufficiency were investigated in a large population-based sample of older adults by measuring pancreatic elastase-1 in stool. The study comprised 914 participants aged 50 to 75 years recruited by their general practitioner during a general health examination. All participants and their physicians were asked to fill out a standardized questionnaire which contained information on socio-demographic and lifestyle factors as well as medical history. Native stool was examined for pancreatic elastase-1 with a commercially available ELISA (ScheBo Tech, Giessen, Germany). Overall, 524 women and 390 men aged 50 to 75 years (mean age 61.9 years) were included in the analysis. In total, 105 (11.5%) of the 914 subjects showed signs of exocrine pancreatic insufficiency (EPI) with =200 microg elastase-1/g stool, and 47 (5.1%) subjects showed signs of a severe exocrine pancreatic insufficiency (SEPI, < 100 microg elastase-1/g stool). There was a clear increase in EPI with age. Patients taking angiotensin-converting enzyme (ACE) inhibitors had a lower prevalence than subjects without this medication; these associations persisted after adjustment for covariates. Prevalence of EPI increases with age and seems to be tentatively higher in men than in women. However, smoking seems to be an independent risk factor for EPI and SEPI whereas ACE-inhibitor intake might be a protective factor. The latter finding may even point to new options in the treatment of chronic pancreatitis.
    Scandinavian Journal of Gastroenterology 06/2005; 40(6):697-704. · 2.33 Impact Factor
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    H Brenner, C Stegmaier, H Ziegler
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    ABSTRACT: Over the last decades, long-term survival rates have substantially increased for many forms of cancer. However, these improvements have often been detected with substantial delay by traditional methods of survival analyses. Using data of the population-based Saarland Cancer Registry, 5- and 10-year relative survival rates were derived for patients with 24 common forms of cancer in Saarland/Germany for the years 2000-2002 by period analysis and compared with conventional cohort estimates of 5- and 10-year relative survival rates pertaining to patients diagnosed in 1990-1992. For many forms of cancer, the 2000-2002 period survival estimates were substantially higher than the corresponding estimates for the cohorts of patients diagnosed in 1990-1992. For example, 10-year relative survival rates achieved in 2000-2002 were close to 100% for patients with testis and thyroid cancer, >85% for patients with melanomas of the skin, approximately 80% for patients with endometrial cancer and prostate cancer, close to 70% for patients with breast cancer and kidney cancer, and close to 60% for patients with colon cancer and lymphomas. Survival expectations of patients diagnosed with cancer at the beginning of the third millenium are substantially higher than previously available survival statistics have suggested.
    Annals of Oncology 06/2005; 16(6):981-6. · 6.58 Impact Factor
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    ABSTRACT: Quality of life (QOL) has become an important outcome measure for patients with cancer, but long-term results from population-based studies are rare. The objective of our study was to identify specific limitations of QOL in survivors of colorectal cancer in comparison with men and women from the general population 1 year after diagnosis when acute treatment effects are expected to have declined. QOL was assessed 1 year after diagnosis in a population-based cohort of 439 patients with colorectal cancer from Saarland (Germany) using the EORTC-QLC30 questionnaire. Specific functional and symptom QOL scores were compared with published reference data from the general population. Of 439 patients, 378 of them survived the first year after tumor diagnosis (86.1%). Of these, 309 returned the questionnaire (response rate, 81.7%). Compared with the general population, colorectal cancer patients scored their physical, role, cognitive, and global health functioning only slightly worse. More severe limitations were observed for the emotional and social functioning scales and for the symptom subscales of fatigue, dyspnea, insomnia, constipation, diarrhea, and financial difficulties. The differences regarding functional and symptom scores were predominantly found in younger age groups whereas older cancer patients and controls rated their health and QOL similarly. Deficits in emotional and social functioning and specific limitations like fatigue, dyspnea, insomnia, constipation, diarrhea, and financial difficulties are main factors hampering the QOL among colorectal cancer patients and seem to affect predominantly younger patients.
    Journal of Clinical Oncology 01/2005; 22(23):4829-36. · 17.88 Impact Factor
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    ABSTRACT: Demographic changes in Germany will result in a marked rise in the prevalence of chronic diseases, presenting a central challenge in the coming decades. The ESTHER study on this question has as its objective to bring about innovative ways for the early recognition and prevention of diseases in the elderly. We herein give the concept of the study and the results of the basic enquiry. The ESTHER study includes 9961 persons, aged between 50 and 74 years, who had a health check-up by their general practitioner. Standardized questionnaires for doctors and patients were used in addition to the check-up test to provide extensive basic data on risk factors, previous illnesses, family history and relevant items on life style. Blood, urine and stool samples were kept for later testing This cohort had a high prevalence of known risk factors for various chronic diseases, especially of the cardiovascular system. 42% of the cohort already had a history of hypertension, 40% of hyperlipidaemia, 11% had diabetes mellitus and 9% coronary heart disease. There was an association with obesity (present in many). The check-up test newly diagnosed one of the diseases or the presence of relevant risk factors in 13.4%. The high prevalence of risk factors for chronic diseases in the elderly underlines the urgency of stressing preventive measures. The ESTHER study - because of its long-term follow-up and saved specimens for later testing - provides an excellent basis for identifying new risk factors and risk indicators of chronic diseases.
    DMW - Deutsche Medizinische Wochenschrift 01/2005; 129(49):2643-7. · 0.55 Impact Factor
  • DMW - Deutsche Medizinische Wochenschrift 12/2004; 129(49):2643-2647. · 0.55 Impact Factor

Publication Stats

1k Citations
215.17 Total Impact Points


  • 2010
    • Klinikum Saarbrücken
      Saarbrücken, Saarland, Germany
  • 1990–2008
    • German Cancer Research Center
      • Division of Clinical Epidemiology and Aging Research
      Heidelberg, Baden-Wuerttemberg, Germany
  • 2001–2005
    • Universität Heidelberg
      • Department of Angiology
      Heidelburg, Baden-Württemberg, Germany
  • 1990–2004
    • Universität Ulm
      Ulm, Baden-Württemberg, Germany
  • 1994–1995
    • Ludwig-Maximilians-University of Munich
      München, Bavaria, Germany
  • 1989
    • Universität des Saarlandes
      Saarbrücken, Saarland, Germany