British blood cholesterol values and the American consensus.
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Adult↗
Biomedical subjects
A G Shaper
Publications and source records attributed to A G Shaper.
Population studies: an integrated course in epidemiology and sociology for medical students.
At the Royal Free Hospital School of Medicine, London, an integrated course in epidemiology and sociology for preclinical students was introduced in 1979. The course--Population Studies--is taken by the 100 second-year medical students in the summer term before they enter their clinical years. It occupies one full day and one half day each week for 8 weeks--approximately 80 hours of tuition. Population Studies is unusual in two respects. Firstly, it introduces a substantial amount of epidemiology into the preclinical curriculum. And, secondly, this is the only London medical school to integrate the teaching of sociology and epidemiology into the one course.
Education, Medical, Undergraduate↗
Risk factors for ischaemic heart disease: the prospective phase of the British Regional Heart Study.
Risk factors for major ischaemic heart disease (acute myocardial infarction or sudden death) have been investigated in a prospective study of 7735 men aged 40-59 years drawn from general practices in 24 British towns. After a mean follow-up of 4.2 years, there have been 202 cases of major ischaemic heart disease. Univariate estimates of the risk of ischaemic heart disease show that serum total cholesterol, HDL-cholesterol and triglyceride concentrations, systolic and diastolic blood pressures, cigarette smoking, and body mass index are all associated with increased risk of ischaemic heart disease. Evidence of ischaemic heart disease at initial examination is also strongly associated with increased risk of subsequent ischaemic heart disease. All these factors were then considered simultaneously using multiple logistic models. Definite myocardial infarction on electrocardiogram and recall of a doctor diagnosis of ischaemic heart disease remained predictive of subsequent major ischaemic heart disease, after allowance for all other risk factors. Serum total cholesterol, blood pressure, and cigarette smoking each remained as highly significant independent risk factors whereas overweight, above average levels of HDL-cholesterol and serum triglyceride were not predictive of risk after allowance for the above factors. Men with and without pre-existing ischaemic heart disease were examined separately in the same way (using multiple logistic models). The strength of association between the principal risk factors and subsequent major ischaemic heart disease was reduced in the men with pre-existing ischaemic heart disease, only age and serum total cholesterol remaining highly significant. Overall the levels of the major risk factors commonly encountered in British men have a marked effect on the risk of ischaemic heart disease. Modification of these risk factors in the general population constitutes an important national priority.
Adult↗
Biochemical and haematological response to alcohol intake.
In a clinical survey of 7735 middle-aged men, alcohol consumption has been related to 25 biochemical and haematological measurements obtained from a single blood sample. Most measurements showed some association with alcohol consumption, gamma-glutamyl transferase (GGT) being the most strongly associated. Lead, mean corpuscular haemoglobin (MCH), mean corpuscular volume, high-density lipoprotein-cholesterol (HDL-C), urate and aspartate transaminase also showed substantial associations with alcohol intake. Using a discriminant analysis technique, a simple score based on five variables (GGT, HDL-C, urate, MCH and lead) provided the best discrimination between heavy drinkers (e.g. more than three pints of beer daily) and occasional drinkers, but still failed to identify more than half of the heavy drinkers. This combined score may prove a useful measure of an individual's biochemical/haematological response to alcohol consumption for use in epidemiological and clinical studies of alcohol related disorders. The use of such indices should complement but not replace measures of alcohol intake derived from questionnaires.
Adult↗
Blood lead concentration, blood pressure, and renal function.
Blood lead concentrations were related to blood pressure and indicators of renal function in a clinical survey of 7735 middle aged men from 24 British towns. There was no overall evidence that blood lead concentrations were associated with systolic or diastolic blood pressure (r = +0.03 and +0.01, respectively). In the 74 men with a blood lead concentration of 1.8 mumol/l (37.3 micrograms/100 ml) or more there was some suggestion of increased hypertension, but this did not reach significance. Blood lead concentration did not have any relation with serum creatinine concentration. Moderate increases in blood lead concentration were associated with small increases in mean serum urate concentration and small decreases in mean serum urea concentration; these associations were both reduced when alcohol consumption was taken into account. There is no indication that exposure to lead at concentrations commonly encountered in British men is responsible for impaired renal function or increased blood pressure.
Adult↗
Changes in water hardness and cardiovascular death rates.
Ten years ago Crawford, Gardner and Morris reported that changes in cardiovascular death rates between 1951 and 1961 had been associated with changes in the hardness of water supplies. That study has been critically reviewed but after amendments to method and data its overall conclusion is upheld. New results based on changes that have taken place in water hardness and in cardiovascular death rates between 1961 and 1971 in the county boroughs of England and Wales indicate a significant trend for men, in the direction of decreasing cardiovascular mortality with increasing hardness, but no trend for women. The trend in male mortality appears to be specific to cardiovascular disease. The results are similar to those of the earlier study and support the hypothesis of a weak causal relationship between the hardness of drinking water and mortality from cardiovascular disease.
Aged↗
Geographic variations in cardiovascular mortality in Great Britain.
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Adult↗
Prevalence of ischaemic heart disease in middle aged British men.
The prevalence of ischaemic heart disease was determined by an administered questionnaire and electrocardiography in 7735 men aged 40-59 years drawn at random from general practices in 24 British towns. Overall, one quarter of these men had some evidence of ischaemic heart disease on questionnaire or electrocardiogram or both. On questionnaire, 14% of men had possible myocardial infarction or angina, with considerable overlap of the two syndromes. The prevalence of possible myocardial infarction combined with angina and of definite angina only showed a fourfold increase over the age range studied. Electrocardiographic evidence of ischaemic heart disease (definite or possible) was present in 15% of men, there being myocardial infarction in 4.2% and myocardial ischaemia in 10.3%. Electrocardiographic evidence of myocardial infarction increased fourfold over the age range studied. There was considerable overlap of questionnaire and electrocardiographic evidence of ischaemic heart disease. Nevertheless, more than half of those with possible myocardial infarction combined with angina had no resting electrocardiographic evidence of ischaemic heart disease, and half of those with definite myocardial infarction on electrocardiogram had no history of chest pain at any time. This national population based study strongly suggests that the prevalence of ischaemic heart disease in middle aged British men is greater than has been indicated by previous studies based on occupational groups.
Adult↗
Recall of diagnosis by men with ischaemic heart disease.
In a study of the prevalence of ischaemic heart disease in middle aged men in 24 British towns, the subjects were asked whether a doctor had ever told them that they had any form of cardiovascular disease. Their recall of various diagnoses was related to evidence of ischaemic heart disease obtained by an administered questionnaire on chest pain and electrocardiography. Twenty one per cent of men recalled a diagnosis of cardiovascular disease, in one quarter of whom it was ischaemic heart disease. There was a sixfold increase in the prevalence of recall of a diagnosis of ischaemic heart disease over the age range studied. Only one third of the men with possible myocardial infarction on questionnaire recalled such a diagnosis having been made by a doctor. Only half of those with a definite myocardial infarction on an electrocardiogram could recall a diagnosis of ischaemic heart disease. Even in severe (grade 2) angina 40% could not recall being told that they had heart disease. Overall, only one in five of those regarded as having ischaemic heart disease was able to recall such a diagnosis having been made by a doctor, and these were likely to be those most severely affected. Ischaemic heart disease is common in middle aged British men, but most of those affected are apparently not aware of their condition. This low level of awareness among patients and doctors may contribute to a lack of public concern regarding the need for action to reduce the incidence of ischaemic heart disease in Great Britain.
Adult↗
Follow-up of subjects in prospective studies based in general practice.
In prospective studies of ischaemic heart disease, data on the incidence of morbidity as well as mortality are critical to the understanding of the natural history of disease. In the Regional Heart Study, 7,735 middle-aged men recruited from general practices in 24 towns in England, Wales and Scotland have been examined, and are being followed for morbidity and mortality for at least five years. This paper explains the methods used and the difficulties encountered in maintaining the flow of information on these subjects and, in particular, discusses the problems of removal and tracing. A network of enquiries, using Family Practitioner Committees, the NHS Central Register and the additional 500 doctors (to date) to whom subjects have transferred, has enabled contact to be maintained. In the first seven towns reviewed at five years from the initial examination, replies have been received from 98 per cent of the original sample still alive and living in Great Britain.
Adult↗
Type A behaviour in British men: reliability and intercorrelation of two measures.
Two questionnaire measures of the Type A behaviour pattern, the Jenkins Activity Survey and the Bortner Questionnaire were completed by a sample of 151 middle-aged male civil servants on three occasions, up to 34 weeks apart. The reliability of both measures was satisfactory. The reliability coefficient of the JAS Type A measure did not fall below 0.79 while the Bortner achieved a reliability of 0.71 over the longest time interval studied. The intercorrelation of the two tests on two occasions was approximately 0.7. In addition it was shown that both tests were largely independent of a number of standard cardiovascular risk factors. It was concluded that in the population studied both tests had satisfactory psychometric properties and that they were measuring a very similar behavioural characteristic.
Adult↗
Blood lipids in middle-aged British men.
The concentrations of serum total cholesterol, high density lipoprotein-cholesterol, and triglycerides have been measured in 7735 men aged 40 to 59 years who were drawn from general practices in 24 towns in England, Wales, and Scotland. The distribution of these blood lipids, their interrelations and their association with age, social class, body mass index, cigarette smoking, alcohol intake, and physical activity at work have been examined. Body mass index emerges as the factor most strongly associated with these three blood lipids. Serum total cholesterol increased with increasing body mass index until about 28 kg/m2 but thereafter showed no further rise. The relation between body mass index and high density lipoprotein-cholesterol was negative and linear; that between body mass index and triglycerides was positive and linear. The inverse relation between high density lipoprotein-cholesterol and triglycerides was independent of the fact that both were related to body mass index. Alcohol intake was associated with increased high density lipoprotein-cholesterol concentrations and cigarette smoking with lowered high density lipoprotein concentrations; the association with alcohol appeared to be dominant. No significant trends with age were observed for the three blood lipids. In this population, body mass index is closely associated with the concentration of blood lipids but its effects are probably indirect and mediated by a complex of dietary and other factors.
Adult↗
Effects of tap water lead, water hardness, alcohol, and cigarettes on blood lead concentrations.
A survey of middle-aged men in 24 British towns has found pronounced geographical variation in blood lead concentrations. Towns with the highest mean blood lead concentrations have soft water supplies and have the highest water lead concentrations. Individual blood lead can be considerably increased by raised household tap water lead concentrations. Mean blood lead is estimated to be 43% higher for men when the concentration of lead in first-draw domestic tap water is 100 micrograms/l compared with a zero concentration. Individual blood lead is also affected by alcohol consumption and cigarette smoking, such that on average these two life-style habits together contribute an estimated 17% to the blood concentration of lead in middle-aged men. Lead in water should be given greater priority in any national campaign to reduce lead exposure.
Adult↗
The prevalence of dysuria in women in London.
A postal questionnaire was used in a survey of dysuria in women aged 20-54 years in four London general practices. Twenty per cent of all women reported dysuria in the previous year (recent dysuria) and half of these women suffered at least one further episode in the same year. The prevalence of recent dysuria showed a decline with increasing age, a small increase with increasing number of pregnancies, no social class effect and no difference with marital status. Frequent recent episodes were more likely in women whose first reported episode of dysuria occurred before the age of 20 years. The risk of dysuria occurring in any pregnancy was about 12 per cent, and a small group - about 6 per cent of those who had had more than one pregnancy - reported dysuria in every pregnancy. Comparison of the practice records of non-responders and responders suggested that the true prevalence of recent dysuria was over-estimated by about one third. The routine use of a few specific questions in clinical and epidemiological practice may help to identify those women at increased risk from urinary tract infection, particularly in pregnancy.
Adult↗
Health of unemployed middle-aged men in Great Britain.
The frequencies of several factors, including major physical disease, in employed and unemployed men enrolled in the British Regional Heart Study (BRHS) have been compared. The BRHS is a prospective study of cardiovascular disease in middle-aged men selected at random from general practices in twenty-four towns. The unemployed group was subdivided into those who said they were unemployed because of ill-health and those who regarded their unemployment as not due to illness. The ill unemployed reported a much higher rate of doctor-diagnosed illnesses than the not-ill unemployed or the employed. The frequencies of bronchitis, obstructive lung disease, and ischaemic heart disease were higher in the unemployed than the employed, with the highest rates in the ill unemployed. The frequency of hypertension was the same in employed and unemployed men. Cigarette smoking and heavy drinking were apparently more common among the unemployed, but after adjustment for social class and town of residence only smoking was slightly higher among the unemployed. Use of tranquillisers was three to four times more common in the ill unemployed than in the not-ill unemployed or the employed. In this study, the unemployed had far more chronic physical illnesses than the employed, whether or not the employed men regarded themselves as ill. Studies of the health consequences of unemployment must allow for the pre-existing state of health, and evidence on the state of health cannot rely solely on self-reporting of illness.
Adult↗
Effects of alcohol and smoking on blood lead in middle-aged British men.
A survey of middle-aged men in 24 British towns showed a strong association between blood lead concentrations, alcohol consumption, and cigarette smoking. The association with alcohol persisted after age, social class, body mass index, cigarette smoking, water lead concentrations, and the town of residence had been taken into account. There was an independent but less pronounced association between cigarette smoking and blood lead concentrations after adjustment for the other factors. The possible mechanisms include a decreased excretion of lead due to alcohol-induced hepatic dysfunction and an increased lead intake from cigarette smoking. These findings have implications for widespread measurement of blood lead concentrations in adults in the community and for all studies attempting to relate blood lead concentrations to environmental exposure.
Adult↗
Tranquillizer use in middle-aged British men.
We have examined the use of tranquillizers by 7,735 middle-aged men currently enrolled in the British Regional Heart Study, a prospective study of cardiovascular disease in 24 towns throughout Great Britain. Tranquillizer use was reported by 620 men (8 per cent). There was a slightly greater prevalence of tranquillizer use in the older men and the non-manual workers. Men with physical disease diagnosed by their doctor or by objective measurements during the study were more likely to be using tranquillizers than men with no physical disease. This was most evident for ischaemic heart disease, however diagnosed, and for hypertension diagnosed by their doctors. There was an inverse relationship between drinking and tranquillizer usage: heavy drinkers had lower rates of usage. There was no association between tranquillizer use and smoking habits.This study indicates that tranquillizer use in these middle-aged men is little influenced by age, social class or smoking, but that there is a strong, positive association between tranquillizer use and the presence of doctor-diagnosed physical disease. While our data provide support for the suggestion that alcohol and tranquillizers may be used interchangeably by some individuals, this finding could also be an outcome of doctors' and patients' awareness of the undesirable effects of combining alcohol and tranquillizers.
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