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Biomedical subjects

A G Shaper

Publications and source records attributed to A G Shaper.

At least 109 records · Page 6Linked to original sources
PubMed1993

Heart rate, physical activity, and mortality from cancer and other noncardiovascular diseases.

The relations between resting heart rate on electrocardiogram, usual physical activity, and risks of all noncardiovascular mortality, cancer mortality, and other noncardiovascular mortality were examined in 7,735 middle-aged British men drawn from general practices in 24 British towns. Subjects were examined and administered questionnaires in 1978-1980. During a follow-up period of 9.5 years (to December 1989), there were 334 deaths from noncardiovascular causes, including 225 cancer deaths. A strong positive association was seen between heart rate and all noncardiovascular mortality, cancer mortality, and other noncardiovascular mortality, even after adjustment for age, blood cholesterol, body mass index, heavy alcohol drinking, physical activity, preexisting ischemic heart disease, smoking, social class, and systolic blood pressure (p < 0.01). The relative risks in men with heart rates of > or = 90 beats/minute, in comparison with those with heart rates of < 60 beats/minute, were 2.33 (95% confidence interval (CI) 1.42-3.74) for total noncardiovascular mortality, 1.68 (95% CI 0.92-3.10) for cancer mortality, and 3.56 (95% CI 1.65-7.65) for mortality due to other noncardiovascular causes. The positive associations with cancer and all noncardiovascular mortality persisted even after further adjustment for lung function (forced expiratory volume in 1 second) and exclusion of men with underlying ill health and of deaths occurring within the first 5 years of follow-up. A significant inverse association with seen between physical activity and risk of cancer death, even after adjustment for the above factors and heart rate, with a significant reduction only in those engaged in high levels of usual physical activity (relative risk = 0.62, 95% CI 0.39-0.98). The data suggest that in middle-aged men, resting heart rate and physical activity are independent prognostic factors for cancer mortality.

Confounding Factors, Epidemiologic↗
PubMed1993

Heart rate, ischaemic heart disease, and sudden cardiac death in middle-aged British men.

OBJECTIVE: To examine the relation between resting heart rate and new major ischaemic heart disease events in middle aged men with and without pre-existing ischaemic heart disease. DESIGN: Prospective study of a cohort of men with eight years follow up for cardiovascular morbidity and mortality for all men. SETTING: General practices in 24 British towns (the British Regional Heart study). SUBJECTS: 7735 men aged 40-59 years drawn at random from the age-sex registers of one general practice in each town. MAIN OUTCOME MEASURES: Major ischaemic heart disease events such as sudden cardiac death, other deaths attributed to ischaemic heart disease, and non-fatal myocardial infarction. RESULTS: During the follow up period of eight years, 488 men had a major ischaemic heart disease event (217 fatal and 271 non-fatal). Of these, 117 were classified as sudden cardiac death (death within one hour of the start of symptoms). The relation between heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease deaths, and sudden cardiac death was examined separately in men with and without pre-existing ischaemic heart disease. In men with no evidence of ischaemic heart disease, there was a strong positive association between resting heart rate and age adjusted rates of all major ischaemic heart disease events (fatal and non-fatal), ischaemic heart disease deaths, and sudden cardiac death. This association remained significant even after adjustment for age, systolic blood pressure, blood cholesterol, smoking, social class, heavy drinking, and physical activity, with particularly high risk in those with heart rate > or = 90 beats/min. The increased risk seen in those with increased heart rate was largely due to a significantly increased risk of sudden cardiac death, which was five times higher than in those with heart rate < 60 beats/min. The effect of heart rate on sudden cardiac death was present irrespective of blood pressure or smoking state. In men with pre-existing ischaemic heart disease a positive association was seen between raised heart rate and risk of all major ischaemic heart disease events, ischaemic heart disease death, and sudden cardiac death, but the effect was less noticeable than in men without pre-existing ischaemic heart disease. CONCLUSION: In this study of middle aged British men increased heart rate > or = 90 beats/min) is a risk factor for fatal ischaemic heart disease events but particularly for sudden cardiac death. The effect is not dependent on the presence of other established coronary risk factors and is most clearly seen in men free of pre-existing ischaemic heart disease at initial examination.

Adult↗
PubMed1993

Sporting activity and hyperglycemia in middle-aged men.

OBJECTIVE: To assess the relationship between self-reported frequency of participation in sporting activity and the prevalence of hyperglycemia (nonfasting glucose level > or = 7.8 mM) in middle-aged men. RESEARCH DESIGN AND METHODS: We used a cross-sectional study of 7617 British middle-aged men, drawn from 24 general practices in England, Wales, and Scotland, who were participants in the British Regional Heart Study. The response rate was 78%. Patients with diabetes (physician-diagnosed) were excluded from our analysis. Frequency of participation in sporting activity was determined by the respondents and reported as none (61%), occasionally (12%), or frequently (27%). RESULTS: The age-adjusted prevalence odds ratio for hyperglycemia was 0.86 (95% confidence interval, 0.6-1.2) in those reporting occasional, and 0.62 (95% confidence interval, 0.4-0.85) in those reporting frequent sporting activity, compared with those reporting none. This effect of frequent sporting activity on the prevalence of hyperglycemia was independent of body mass index, occupational status, smoking status, systolic blood pressure, use of antihypertensive therapy, and time of sampling. CONCLUSIONS: Frequent sporting activity in middle-aged men is associated with a reduced prevalence of hyperglycemia and may reduce the risk of NIDDM.

Adult↗
PubMed1993

Lifestyle factors associated with geographic blood pressure variations among men and women in the UK.

The importance of various factors in explaining geographical BP variations in the UK has been examined among 2,596 men and women living in nine British towns. Associations between BP and potential explanatory variables have been examined first for individual subjects (within-population), and second for towns (between-populations). The factors showing associations with BP that were consistent within-population and between-towns were BMI, urine sodium/potassium ratio (Na/K), alcohol and anxiety at examination for men, and BMI, Na/K and anxiety at examination for women. After adjustment for these factors and age, the male BP differences between the nine towns were reduced from 10.1 mmHg systolic in men (P = 0.001) to 7.1 mmHg (P = 0.04), and from 5.9 mmHg diastolic (P = < 0.0001) to 5.5 mmHg (P < 0.0001). For women, adjustment only marginally reduced the between-town systolic differences from 5.6 mmHg (P = 0.05) to 5.5 mmHg (P = 0.3) and increased the diastolic differences from 3.7 mmHg diastolic (P = 0.03) to 5.0 mmHg (P < 0.0001). It is concluded that BMI, alcohol consumption and the Na/K ratio play an important part in the pattern of male SBP variations in the UK. The factors associated with female geographical differences in BP were less clear, but BMI and Na/K ratio appear to be important. This study has been unable to identify factors associated with geographical differences in DBP, with the possible exception of BMI in men. However, as systolic pressure is recognised to be more strongly associated with cardiovascular outcome than diastolic pressure, it can be recommended that primary prevention strategies aimed at reducing the population mean level of BP should involve efforts to reduce overweight, alcohol consumption and the Na/K ratio.

Adult↗
PubMed1992

Leukocyte count and risk of major coronary heart disease events.

The association between leukocyte count and subsequent risk of major coronary heart disease events was examined using data from three prospective cohort studies--two from the United States and one from Great Britain. A total of 28,181 middle-aged men were followed for 6-12 years. A total of 1,768 men had a nonfatal myocardial infarction or died of coronary heart disease. In all three cohorts, there was a positive, statistically significant relation between baseline leukocyte count and risk of subsequent major coronary heart disease events after adjustment for age, serum total cholesterol, diastolic blood pressure, and number of cigarettes smoked per day (relative odds = 1.32 (p less than 0.0001), 1.15 (p = 0.0001), and 1.14 (p = 0.003), corresponding to a 2,000/mm3 difference in leukocyte count). The associations persisted when all nonsmokers (former smokers plus never smokers) and never smokers alone were considered and when those with evidence of preexisting coronary heart disease at baseline were excluded. Leukocyte count appears to be an indicator of a person's future risk of major coronary heart disease events.

Adult↗
PubMed1992

Stroke.

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Blood Pressure↗
PubMed1992

Physical activity and stroke in British middle aged men.

OBJECTIVES: To assess the relation between physical activity and stroke and to determine the overall benefit of physical activity for all major cardiovascular events. DESIGN: Prospective study of a cohort of men followed up for 9.5 years. SETTING: General practices in 24 towns in England, Wales, and Scotland (British regional heart study). SUBJECTS: 7735 men aged 40-59 at screening, selected at random from one general practice in each of 24 towns. MAIN OUTCOME MEASURES: Fatal and non-fatal strokes and heart attacks. RESULTS: 128 major strokes (fatal and non-fatal) occurred. Physical activity was inversely associated with risk of stroke independent of coronary risk factors, heavy drinking, and pre-existing ischaemic heart disease or stroke (relative risk 1.0 for inactivity, 0.6 moderate activity, and 0.3 vigorous activity; test for trend p = 0.008). The association remained after excluding men reporting regular sporting (vigorous) activity. However, vigorous physical activity was associated with a marginally significant increased risk of heart attack compared with moderate or moderately vigorous activity in men with no pre-existing ischaemic heart disease or stroke (relative risk 1.6%; 95% confidence interval 0.96 to 2.8). In men with symptomatic ischaemic heart disease or stroke those doing moderately vigorous or vigorous activity had a risk of heart attack slightly higher than that in inactive men (relative risk = 1.6; 0.8 to 3.3). CONCLUSIONS: Moderate physical activity significantly reduces the risk of stroke and heart attacks in men both with and without pre-existing ischaemic heart disease. More vigorous activity did not confer any further protection. Moderate activity, such as frequent walking and recreational activity or weekly sporting activity, should be encouraged without restriction.

Adult↗
PubMed1992

Non-employment and changes in smoking, drinking, and body weight.

OBJECTIVE: To assess the effect of unemployment and early retirement on cigarette smoking, alcohol consumption, and body weight in middle aged British men. DESIGN: Prospective cohort study (British regional heart study). SETTING: One general practice in 24 towns in Britain. SUBJECTS: 6057 men aged 40-59 who had been continuously employed for five years before the initial screening. Five years after screening 4412 men had been continuously employed and 1645 had experienced some unemployment or retired. MAIN OUTCOME MEASURES: Numbers of cigarettes smoked and units of alcohol consumed per week and body mass index (kg/m2). RESULTS: An initial screening significantly higher percentages of men who subsequently experienced non-employment smoked or had high alcohol consumption than of men who remained continuously employed: 43.0% versus 37.0% continuously employed for cigarette smoking (95% confidence interval for difference 3.2% to 9.0%) and 12.1% versus 9.0% for heavy drinking (1.3% to 5.1%). There was no evidence that men increased their smoking or drinking on becoming non-employed. Men non-employed through illness were significantly more likely to reduce their smoking and drinking than men who remained continuously employed. Men who experienced non-employment were significantly more likely to gain over 10% in weight than men who remained continuously employed: 7.5% versus 5.0% continuously employed (0.9% to 4.0%). CONCLUSIONS: Loss of employment was not associated with increased smoking or drinking but was associated with an increased likelihood of gaining weight. The long term effects of the higher levels of smoking and alcohol consumption before nonemployment should be taken into account when comparing mortality and morbidity in groups of unemployed and employed people.

Adult↗
PubMed1992

The leukocyte count and risk of lung cancer.

The association between leukocyte count and subsequent risk of lung cancer was evaluated in three large cohorts from the United States and Britain. A total of 309 lung cancer events occurred among 28,181 men whose cases were followed-up for 7 to 12 years. In all three cohorts, there was a marked increase in risk of lung cancer with increasing leukocyte count, after adjustment for age and the number of cigarettes smoked per day. The adjusted relative odds in the three cohorts, for a 2000/microliters difference in leukocyte count, were 1.58 (P = 0.0001), 1.29 (P = 0.003) and 1.20 (P = 0.02). These relative odds persisted when current smokers were considered alone, when serum markers of cigarette smoking exposure were adjusted for, and when men with lung cancer events during the first 5 years of follow-up were excluded. The leukocyte count appears to be linked to the pathogenesis of smoking-related lung cancer.

Adult↗
PubMed1992

Alcohol and sudden cardiac death.

OBJECTIVE: To assess the relation between alcohol intake and sudden cardiac death--ie, death within one hour of the onset of symptoms. DESIGN: Prospective study of a cohort of men followed up for eight years. SETTING: General practices in 24 towns in England, Wales, and Scotland. SUBJECTS: 7735 men aged 40-59 at screening who were selected at random from one general practice in each of 24 towns. MAIN OUTCOME MEASURE: All deaths from ischaemic heart disease with particular reference to those that were sudden (death within one hour of the onset of symptoms). RESULTS: During the follow up period of eight years there were 217 deaths from ischaemic heart disease of which 117 (54%) were classified as sudden. Although heavy drinkers (more than six drinks daily) did not show a high incidence rate of fatal heart attack, they showed the highest incidence rate of sudden cardiac death. This was seen in both manual and non-manual workers and was most clearly seen in older (50-59) men. Death from ischaemic heart disease was more likely to be sudden in heavy drinkers than in other drinking groups; this phenomenon was seen irrespective of the presence or degree of pre-existing ischaemic heart disease. The positive association between heavy drinking and the incidence of sudden death was most apparent in men without pre-existing ischaemic heart disease, with heavy drinkers showing an increase of > 60% compared with occasional or light drinkers. After adjustment for age, social class, and smoking, heavy drinkers free of pre-existing ischaemic heart disease had a marginally significantly higher incidence rates of sudden death than other drinkers combined (relative risk 2.00, 95% confidence interval 0.98 to 4.8). Additional adjustment for systolic blood pressure reduced the risk to 1.7. CONCLUSIONS: This study suggests that heavy drinking is associated with an increased risk of sudden death. Studies that do not take pre-existing ischaemic heart disease into account are likely to underestimate the adverse effects of heavy drinking on the incidence of sudden death because the effects are not as evident in men with pre-existing ischaemic heart disease.

Adult↗
PubMed1992

The Dinamap 1846SX automated blood pressure recorder: comparison with the Hawksley random zero sphygmomanometer under field conditions.

STUDY OBJECTIVE: The aim was to compare the performance of the Dinamap 1846SX automated oscillometric blood pressure recorder with that of the Hawksley random zero sphygmomanometer during use under field study conditions. DESIGN: Two independent within subject measurement comparisons were made, one in adults and one in children, each conducted in three stages over several months while the Dinamap instruments were being used in epidemiological field surveys. SETTING: The studies were done in outpatients clinics (adults) and primary schools (children). PARTICIPANTS: 141 adults (20-85 years) and 152 children (5-7 years) took part. MEASUREMENTS AND MAIN RESULTS: In adults a pair of measurements was made with each instrument, the order alternating for consecutive subjects. In children one measurements was made with each instrument, in random order. Measurements with the Dinamap 1846SX were higher than those with the random zero sphygmomanometer both in adults (mean difference 8.1 mm Hg; 95% CI 6.5 to 9.7 mm Hg) and in children (mean difference 8.3 mm Hg; 95% CI 6.9 to 9.7 mm Hg). Diastolic measurements were on average very similar both in adults and in children. The results were consistent at all three stages of both studies. The differences in systolic measurement were independent of blood pressure level. However, the extent of agreement in diastolic pressure depended on the diastolic blood pressure level; in both studies Dinamap diastolic measurements were higher at low diastolic pressures while random zero diastolic measurements were higher at high diastolic pressures. CONCLUSIONS: Systolic measurements made with the Dinamap 1846SX instrument are not directly comparable with those of the Hawksley random zero sphygmomanometer and are unlikely to be comparable with those of earlier Dinamap models. These differences have important implications for clinical practice and for comparisons of blood pressure measurement between epidemiological studies. However, the consistency of measurement by the Dinamap 1846SX over time suggests that the instrument may have a place in standardised blood pressure measurement in the research setting.

Adult↗
PubMed1992

Blood lipids: the relationship with alcohol intake, smoking, and body weight.

STUDY OBJECTIVE: The aim was to assess the interrelationship between alcohol intake, cigarette smoking, body weight, and blood lipid concentrations. DESIGN: This was the cross sectional (screening) phase of a prospective study. The main outcome measure was the blood lipids (serum total cholesterol, HDL cholesterol, and triglycerides). SETTING: General practices in 24 towns (The British Regional Heart Study). SUBJECTS: Subjects were 7735 men aged 40-59 years, selected at random from the age-sex registers of one group practice in each of the 24 towns. RESULTS: Univariate analysis showed little association between alcohol intake and total cholesterol, a strong positive relation with HDL cholesterol, and a significant increase in triglycerides in heavy drinkers. A strong positive association between alcohol intake and body weight was present in non-smokers but not in moderate/heavy smokers. With the exception of HDL cholesterol, the relationships between alcohol intake and serum lipids were significantly different in smokers and non-smokers, apparently due to the opposing effect of smoking on blood lipids and body weight. Total cholesterol and triglycerides were significantly and positively associated with alcohol intake in non-smokers, the cholesterol association being largely mediated by the influence of alcohol on body weight. In smokers, no such association was seen: current smokers who were heavy drinkers or non-drinkers had the lowest mean cholesterol levels. CONCLUSIONS: The association between alcohol intake and body weight and alcohol intake and blood lipids are strongly conditioned by cigarette smoking. Simple standardisation for smoking in multivariate analyses may obscure the independent relationship with alcohol. These findings are of importance in studies seeking to relate alcohol intake, body weight, or cigarette smoking to blood lipid concentrations, or blood lipid concentration to morbidity or mortality.

Adult↗
PubMed1992

Non-consulters and high consulters in general practice: cardio-respiratory health and risk factors.

The 1990 General Practitioner contract requires that health promotion and illness prevention services should be provided to all patients aged 16-74 years. Consultation rates over a period of three years were examined in 7010 middle-aged men in Great Britain to compare the cardio-respiratory health and risk factor status of non-consulters (men who did not consult in three years) with those of average consulters (men who consulted 3-5 times in three years) and high consulters (men who consulted 24 or more times in three years) to assess their relative need for health promotion and illness prevention services. The non-consulters (n = 1025) were remarkably similar to the average consulters (n = 1585) in health and lifestyle characteristics. The high consulters (n = 306) had a greater burden of ill-health and a less healthy lifestyle. Chest pain on exertion, chronic bronchitis, breathlessness or wheeze were present in 23 per cent of non-consulters, 27 per cent of average consulters and over 50 per cent of high consulters. Similarly, 48 per cent of the non-consulters smoked, drank heavily or were obese compared with 47 per cent of the average consulters and 61 per cent of the high consulters. The prevalence of recall of high blood pressure which had been diagnosed by a doctor rose from 6 per cent in non-consulters and 10 per cent in average consulters to 29 per cent in high consulters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Casual urine concentrations of sodium and potassium and geographic blood pressure variations in Great Britain.

The associations between blood pressure and urine sodium, potassium and creatinine have been studied among 1,240 men and 1,119 women living in nine British towns in order to assess the contribution of sodium and potassium intake to geographic BP variations within Great Britain. Significant positive associations were found between systolic BP and the urine sodium/potassium ratio for men (P less than 0.05) and for women (P less than 0.001), and for the sodium/creatinine ratio in men (P less than 0.01), after adjustment for age and body mass index. The findings for diastolic BP were similar, but non-significant for men. Associations between BP and sodium concentration were inconsistent and non-significant. The associations between BP and potassium concentration were consistently negative, and significant for diastolic in women (P less than 0.01). The correlations between the mean town systolic BPs and the sodium/potassium ratio were 0.65 (P = 0.058) for men, and 0.60 (P = 0.086) for women. Correlations for diastolic BP were such smaller. The association between BP and the sodium/potassium ratio in this study is consistent both within and between populations, although more so for women than for men. The results are also consistent with the results of other population studies using casual and 24 urine specimens. Although unable to quantify the effects of sodium and potassium with precision, the study suggests that the sodium/potassium ratio is of importance in geographic BP variations in Great Britain, at least for systolic blood pressure.

Adult↗