The Copenhagen General Population Study (CGPS; ) is an ongoing Danish

longitudinal Longitudinal is a geometric term of location which may refer to: * Longitude ** Line of longitude, also called a meridian * Longitudinal engine, an internal combustion engine in which the crankshaft is oriented along the long axis of the vehicle, ...

cohort study A cohort study is a particular form of longitudinal study that samples a Cohort (statistics), cohort (a group of people who share a defining characteristic, typically those who experienced a common event in a selected period, such as birth or gra ...

, that investigates the

epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and Risk factor (epidemiology), determinants of health and disease conditions in a defined population, and application of this knowledge to prevent dise ...

of a wide range of

diseases A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...

, in particular

cardiovascular disease Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases (e.g. angina, heart attack), heart failure, hypertensive heart disease, rheumati ...

respiratory disease Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, ...

cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...

infections An infection is the invasion of tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

and other multifactorial diseases, in a representative sample of the Danish population. Headquartered at the Department of Clinical Biochemistry at

Herlev Hospital Herlev Hospital (former ) is a teaching hospital in Herlev, Denmark, close to Copenhagen. The building is tall and has 25 floors. It was famous for being Denmark's tallest building, but was surpassed in 2022 by Light House in Aarhus Aa ...

, it was established in 2003 with professor Børge Nordestgaard as principal investigator, and it is the world's largest

population study Population study is an interdisciplinary field of scientific study that uses various statistical methods and models to analyse, determine, address, and predict population challenges and trends from data collected through various data collection me ...

that follows the long-term health development of a healthy population over time, currently collecting data on over 170,000 enrolled

participants Participation or participant may refer to: Politics *Participation (decision making), mechanisms for people to participate in social decisions *Civic engagement, Civic participation, engagement by the citizens in government *e-participation, citi ...

. Expanding upon the earlier and less extensive sister study, the Copenhagen City Heart Study (CCHS; ), the population survey has been conducted in several phases since 1976, incipiently involving a representative

sample Sample or samples may refer to: * Sample (graphics), an intersection of a color channel and a pixel * Sample (material), a specimen or small quantity of something * Sample (signal), a digital discrete sample of a continuous analog signal * Sample ...

of people in the

Østerbro Østerbro () is one of the 10 official districts of Copenhagen Municipality, Denmark. It is located just north of the city centre, outside the old city gate Østerport which, after it was moved around 1700, used to be located close to present-day ...

neighbourhood of

Copenhagen Copenhagen ( ) is the capital and most populous city of Denmark, with a population of 1.4 million in the Urban area of Copenhagen, urban area. The city is situated on the islands of Zealand and Amager, separated from Malmö, Sweden, by the ...

. In 2003, the CGPS was established to expand the study to cover an increasingly large area in the

Copenhagen metropolitan area The Copenhagen metropolitan area or Metropolitan Copenhagen (, , literally "The Capital Area") is a large commuter belt (the area in which it is practical to commute to work) surrounding Copenhagen, the capital of Denmark. It includes Copenha ...

. A second phase is currently in progress for the study, whereas a sixth is underway under the auspices of CCHS. All participants are recalled for follow-up examinations, and are followed in the Danish Civil Registration System and

medical records The terms medical record, health record and medical chart are used somewhat interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdict ...

. The survey includes a comprehensive

physical examination In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a Disease, medical condition. It generally consists of a series of ...

, preceded by a

questionnaire A questionnaire is a research instrument that consists of a set of questions (or other types of prompts) for the purpose of gathering information from respondents through survey or statistical study. A research questionnaire is typically a mix of ...

on lifestyle factors. The examination covers heart and

lung function The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory system ...

, measurements of height, weight,

blood pressure Blood pressure (BP) is the pressure of Circulatory system, circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term ...

, ankle-brachial pressure index, extensive

blood sample In medicine, sampling is gathering of matter from the body to aid in the process of a medical diagnosis and/or evaluation of an indication for treatment, further medical tests or other procedures. In this sense, the sample is the gathered matter ...

analysis Analysis (: analyses) is the process of breaking a complex topic or substance into smaller parts in order to gain a better understanding of it. The technique has been applied in the study of mathematics and logic since before Aristotle (38 ...

and other clinical examinations. Since 1976, the study and its precursor have produced over 1,330

scientific articles Science is a systematic discipline that builds and organises knowledge in the form of testable hypotheses and predictions about the universe. Modern science is typically divided into twoor threemajor branches: the natural sciences, which stu ...

in the medical press, including significant research in

general A general officer is an Officer (armed forces), officer of high rank in the army, armies, and in some nations' air force, air and space forces, marines or naval infantry. In some usages, the term "general officer" refers to a rank above colone ...

and

genetic epidemiology Genetic epidemiology is the study of the role of genetic factors in determining health and disease in families and in populations, and the interplay of such genetic factors with environmental factors. Genetic epidemiology seeks to derive a statist ...

. Notable findings include the positive impact of regular

physical activity Physical activity is defined as any voluntary movement produced by skeletal muscles that requires energy expenditure.Global Recommendations on Physical Activity for Health, 2009. World Health Organization. Geneva, Switzerland. Accessed 13/07/2018 ...

on lifespan, the health benefits of moderate

red wine Red wine is a type of wine made from dark-colored grape varieties - (red grapes.) The color of the wine can range from intense violet, typical of young wines, through to brick red for mature wines and brown for older red wines. The juice fro ...

consumption, and the role of

triglycerides A triglyceride (from ''wikt:tri-#Prefix, tri-'' and ''glyceride''; also TG, triacylglycerol, TAG, or triacylglyceride) is an ester derived from glycerol and three fatty acids. Triglycerides are the main constituents of body fat in humans and oth ...

and

genetic predisposition Genetic predisposition refers to a genetic characteristic which influences the possible phenotypic development of an individual organism within a species or population under the influence of environmental conditions. The term genetic susceptibil ...

in developing various diseases. As of 2023, 27 doctoral theses and 96

PhD A Doctor of Philosophy (PhD, DPhil; or ) is a terminal degree that usually denotes the highest level of academic achievement in a given discipline and is awarded following a course of graduate study and original research. The name of the deg ...

dissertations have been based on the study's data, with around 20 PhD students and hundreds of other researchers currently working with the data.

History

Precursor

The Copenhagen General Population Study is an offshoot of the Copenhagen City Heart Study (CCHS), known in Danish as ''Østerbroundersøgelsen''. The CCHS was launched in 1976 by Professor Anders Tybjærg Hansen and

cardiologists Cardiology () is the study of the heart. Cardiology is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery di ...

Dr. , Dr. Gorm Jensen and

statistician A statistician is a person who works with Theory, theoretical or applied statistics. The profession exists in both the private sector, private and public sectors. It is common to combine statistical knowledge with expertise in other subjects, a ...

Jørgen Nyboe, and began as a large

cardiovascular In vertebrates, the circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the body. It includes the cardiovascular system, or vascular system, that consists of the heart a ...

-focused study. The study was launched in response to a sharp

post Post, POST, or posting may refer to: Postal services * Mail, the postal system, especially in Commonwealth of Nations countries **An Post, the Irish national postal service **Canada Post, Canadian postal service **Deutsche Post, German postal s ...

World War II World War II or the Second World War (1 September 1939 – 2 September 1945) was a World war, global conflict between two coalitions: the Allies of World War II, Allies and the Axis powers. World War II by country, Nearly all of the wo ...

increase in mortality from

acute myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom is retr ...

(AMI) in Denmark, particularly in the capital region. From the 1950s onwards, cardiovascular disease emerged as a leading

cause of death In law, medicine, and statistics, cause of death is an official determination of the conditions resulting in a human's death, which may be recorded on a death certificate. A cause of death is determined by a medical examiner. In rare cases, an ...

, yet knowledge about its causes and

risk factors In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often ...

remained limited. Inspired by large-scale epidemiological initiatives such as the

Framingham Heart Study The Framingham Heart Study is a long-term, ongoing cardiovascular cohort study of residents of the city of Framingham, Massachusetts. The study began in 1948 with 5,209 adult subjects from Framingham, and is now on its third generation of partic ...

(US), the

Seven Countries Study The Seven Countries Study is an epidemiological longitudinal study directed by Ancel Keys at what is today the University of Minnesota Laboratory of Physiological Hygiene & Exercise Science (LPHES). Begun in 1956 with a yearly grant of US$200,00 ...

(

Keys Key, Keys, The Key or The Keys may refer to: Common uses * Key (cryptography), a piece of information needed to encode or decode a message * Key (instrument), a component of a musical instrument * Key (lock), a device used to operate a lock * ...

), and the

Whitehall Study The Whitehall Studies investigated social determinants of health, specifically the cardiovascular disease prevalence and mortality rates among British civil servants. The initial prospective cohort study, the Whitehall I Study, examined over 17,5 ...

(UK), Danish Professor Tybjærg Hansen initiated the national cohort study. It incipiently received funding from the Danish Heart Foundation and support from

municipal A municipality is usually a single administrative division having corporate status and powers of self-government or jurisdiction as granted by national and regional laws to which it is subordinate. The term ''municipality'' may also mean the gov ...

health authorities. Although designed with a large emphasis on

, specifically

coronary heart disease Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of cardiovascular disease, heart disease involving Ischemia, the reduction of blood flow to the cardiac muscle due to a build-up ...

hypertension Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...

and

stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

, it quickly expanded to include a wide array of health conditions, such as

pulmonary diseases Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bron ...

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to Cardiac cycle, fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF ...

arrhythmia Arrhythmias, also known as cardiac arrhythmias, are irregularities in the cardiac cycle, heartbeat, including when it is too fast or too slow. Essentially, this is anything but normal sinus rhythm. A resting heart rate that is too fast – ab ...

dementia Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...

, and various genetic and

psychosocial The psychosocial approach looks at individuals in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness and their ability to function. This approach is ...

factors. The initial study population of the Copenhagen City Heart Study consisted of a random sample of nearly 20,000 men and women, aged 20 to 93, selected from approximately 90,000 residents aged 20 and older in ten wards around

Rigshospitalet Rigshospitalet (meaning ''the National'', ''State'', ''Kingdom'' or ''Hospital of the Realm'', but not usually translated) is the largest public and teaching hospital in Copenhagen and the most highly specialised hospital in Denmark. The hospital ...

, encompassing all of

and one-third of

Nørrebro Nørrebro (, ) is one of the 10 official districts of Copenhagen Municipality, Denmark. It is northwest of the city centre, beyond the location of the old Northern Gate (''Nørreport''), which, until dismantled in 1856, was near the current N ...

districts A district is a type of administrative division that in some countries is managed by the local government. Across the world, areas known as "districts" vary greatly in size, spanning regions or counties, several municipalities, subdivisions ...

Copenhagen Municipality Copenhagen Municipality (), also known in English language, English as the Municipality of Copenhagen, located in the Capital Region of Denmark, is the largest of the four municipalities that constitute the City of Copenhagen (), the other three ...

Establishment of the study

The Copenhagen General Population Study (CGPS) was established on 26 November 2003 at Herlev Hospital under the leadership of Professor Børge Nordestgaard. Designed as an expansion of this precursor study, it broadened the scope to include a larger and more diverse cohort from the

. Initially, the study recruited over 100,000 participants aged 20 to 100, who contributed through

questionnaires A questionnaire is a research instrument that consists of a set of questions (or other types of prompts) for the purpose of gathering information from respondents through survey or statistical study. A research questionnaire is typically a mix of ...

, biological samples, and

physical examinations Physical may refer to: *Physical examination In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a Disease, medical co ...

. In 2010, ethical approval enabled the integration of cardiac

CT imaging A computed tomography scan (CT scan), formerly called computed axial tomography scan (CAT scan), is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or ...

, providing insights into cardiovascular

biomarkers In biomedical contexts, a biomarker, or biological marker, is a measurable indicator of some biological state or condition. Biomarkers are often measured and evaluated using blood, urine, or soft tissues to examine normal biological processes, p ...

. The cohort has since expanded to include over 170,000 enrolled participants. A key feature of the CGPS and its predecessor studies is the integration with Denmark’s comprehensive national registries. These registries provide detailed and updated information on participants, including hospital discharge diagnoses, cancer records, causes of death, prescription use, and

demographic Demography () is the statistics, statistical study of human populations: their size, composition (e.g., ethnic group, age), and how they change through the interplay of fertility (births), mortality (deaths), and migration. Demographic analy ...

data such as education and income. This infrastructure ensures nearly 100% follow-up, eliminating a common source of bias in

longitudinal studies A longitudinal study (or longitudinal survey, or panel study) is a research design that involves repeated observations of the same variables (e.g., people) over long periods of time (i.e., uses longitudinal data). It is often a type of observation ...

. The registries also enable cost-effective management of large cohorts and allow disease-free participants to serve as controls for case-control studies.

Scientific impact and findings

Scientific findings

Numerous highly cited

have been published on the results of the studies, for example that 65-79 year olds who start exercising about 4 hours a week will increase their lifespan by an average of 4 years. One highly publicized result showed that moderate

consumption was associated with a significantly reduced risk of

myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when Ischemia, blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom ...

and lower all-cause mortality. The finding was cited by

U.S. President The president of the United States (POTUS) is the head of state and head of government of the United States. The president directs the Federal government of the United States#Executive branch, executive branch of the Federal government of t ...

Bill Clinton William Jefferson Clinton (né Blythe III; born August 19, 1946) is an American politician and lawyer who was the 42nd president of the United States from 1993 to 2001. A member of the Democratic Party (United States), Democratic Party, ...

and featured on

CBS CBS Broadcasting Inc., commonly shortened to CBS (an abbreviation of its original name, Columbia Broadcasting System), is an American commercial broadcast television and radio network serving as the flagship property of the CBS Entertainme ...

’s ''

60 Minutes ''60 Minutes'' is an American television news magazine broadcast on the CBS television network. Debuting in 1968, the program was created by Don Hewitt and Bill Leonard, who distinguished it from other news programs by using a unique style o ...

'', sparking global interest. Other findings from the studies include the clinical implication of elevated

triglyceride A triglyceride (from '' tri-'' and '' glyceride''; also TG, triacylglycerol, TAG, or triacylglyceride) is an ester derived from glycerol and three fatty acids. Triglycerides are the main constituents of body fat in humans and other vertebrates ...

levels for the development of

and the importance of

for the development of cardiovascular disease,

lung disease The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syst ...

and

, among others. For example, in cardiovascular health, its findings established that elevated nonfasting

levels correlate with a heightened risk of

ischaemic heart disease Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of heart disease involving the reduction of blood flow to the cardiac muscle due to a build-up of atheromatous plaque in the a ...

, and mortality in both men and women. Additionally, the study revealed nuanced effects of

alcohol consumption Drinks containing alcohol (drug), alcohol are typically divided into three classes—beers, wines, and Distilled beverage, spirits—with alcohol content typically between 3% and 50%. Drinks with less than 0.5% are sometimes considered Non-al ...

, showing that different types of alcoholic beverages may influence blood pressure differently. In the field of genetic research, CGPS researchers has employed

Mendelian randomization In epidemiology, Mendelian randomization (commonly abbreviated to MR) is a method using measured variation in genes to examine the causal effect of an exposure on an outcome. Under key assumptions (see below), the design reduces both reverse causat ...

to uncover the

causal Causality is an influence by which one Event (philosophy), event, process, state, or Object (philosophy), object (''a'' ''cause'') contributes to the production of another event, process, state, or object (an ''effect'') where the cause is at l ...

links between long-term

and

risk factors. In respiratory health, CGPS provided pivotal data on early identification of

chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by chronic respiratory symptoms and airflow limitation. GOLD defines COPD as a heterogeneous lung condition characterized by chronic respiratory s ...

(COPD), emphasizing the roles of age and smoking exposure in disease progression and associated risks. The study's findings in

metabolic Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the ...

health revealed that increased triglyceride metabolism, characterized by elevated levels of plasma

glycerol Glycerol () is a simple triol compound. It is a colorless, odorless, sweet-tasting, viscous liquid. The glycerol backbone is found in lipids known as glycerides. It is also widely used as a sweetener in the food industry and as a humectant in pha ...

and β-hydroxybutyrate, is strongly linked to higher risks of all-cause mortality, including deaths from cardiovascular diseases and cancer. These discoveries underscore the CGPS's broad impact on understanding the interplay of lifestyle, genetics, and metabolic factors in health outcomes.

References

Citations

Sources

{{Cite journal , last1=Laugesen , first1=Kristina , last2=Mengel-From , first2=Jonas , last3=Christensen , first3=Kaare , last4=Olsen , first4=Jørn , last5=Hougaard , first5=David M. , last6=Boding , first6=Lasse , last7=Olsen , first7=Anja , last8=Erikstrup , first8=Christian , last9=Hetland , first9=Merete Lund , last10=Høgdall , first10=Estrid , last11=Kjaergaard , first11=Alisa D. , last12=Sørensen , first12=Erik , last13=Brügmann , first13=Anja , last14=Petersen , first14=Eva Rabing Brix , last15=Brandslund , first15=Ivan , date=2023 , title=A Review of Major Danish Biobanks: Advantages and Possibilities of Health Research in Denmark , journal=Clinical Epidemiology , volume=15 , pages=213–239 , doi=10.2147/CLEP.S392416 , doi-access=free , issn=1179-1349 , pmc=9960719 , pmid=36852012 1976 establishments in Denmark Epidemiological study projects Cohort studies Health research Danish medical research