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Biomedical subjects

A G Shaper

Publications and source records attributed to A G Shaper.

At least 145 records · Page 8Linked to original sources
PubMed1990

Alcohol and mortality: a review of prospective studies.

Non-drinkers and heavy drinkers tend to have higher total and cardiovascular mortality rates than light or moderate drinkers. The finding is not disputed; it is the interpretation of this U-shaped curve that is controversial, and in particular the belief that light and moderate drinking protects against coronary heart disease. The British Regional Heart Study of middle-aged British men has shown that 70% of non-drinkers are ex-drinkers. Those ex-drinkers have high rates of doctor-diagnosed illnesses including heart disease, hypertension, diabetes and bronchitis as well as high prevalence rates of measured hypertension, obesity, current smoking and regular medical treatment. Over a five-year period men who were diagnosed as having heart disease, had multiple diagnoses or were put on regular medication had an increased likelihood of becoming non-drinkers or occasional drinkers. The study suggests a downward drift from heavy and moderate drinking towards non-drinking under the influence of accumulating ill health. The data strongly suggest that the observed alcohol-mortality relationships in prospective studies are produced by symptoms and disease present at the time of screening, and by the prior movement of men with such disorders into non-drinking or occasional drinking categories. The concept of a protective effect on mortality which ignores the dynamic relationship between ill health and drinking behaviour is likely to be ill-founded. A review of the major prospective studies reveals an inadequate exploration of the nature of non-drinkers, who are clearly unsuitable for use as a baseline in studies of the effects of alcohol on health.

Aged↗
PubMed1990

Weight change, perceived health status and mortality in middle-aged British men.

The association between weight change over a 5-year period, the subsequent perception of health and the mortality during a 4-year follow-up period has been examined in a prospective study of 7735 middle-aged British men. There were 357 deaths from all causes. Self-assessment of health status was considered as a potential guide to whether weight loss was intended or involuntary. Irrespective of weight change those who reported poor or fair health had a more than two-fold increase in death rate compared to those who reported good or excellent health. Considerable weight gain (greater than 10%) was associated with high rates of cardiovascular disease regardless of health perception, although this was most marked in those who perceived poor or fair health. Moderate weight gain was of little importance except in those who regarded their health as poor or fair. Weight loss was associated with increased death rates from cancer regardless of health perception, although the rates were highest in those who perceived poor or fair health. This study emphasizes that weight loss is a potentially serious symptom even in men who report good health. Assessment of weight change and of perception of health status are both of value and could be used in standard health enquiries to monitor health status in individuals and the community.

Adult↗
PubMed1990

Casual urine concentrations of sodium, potassium, and creatine in population studies of blood pressure.

The relationships between blood pressure and the concentrations of urinary sodium, potassium and creatinine have been examined using casual urine specimens collected from a random sample of 1,556 men aged 40-59. Partial correlations with systolic blood pressure after adjustment for age, body mass index (BMI), alcohol consumption, and town showed that sodium was not significantly associated with BP, but potassium [r = -0.09 (P less than 0.001)] and creatinine [r = -0.07 (P less than 0.01)] were negatively associated. The sodium/creatinine ratio [r = 0.10 (P less than 0.001)] and sodium/potassium ratio [r = 0.11 (P less than 0.001)] were positively correlated with SBP. Comparable results were found throughout for diastolic pressure. Multiple regression analysis suggested that it was creatinine rather than sodium that was the important component of the sodium/creatinine ratio, and raised the possibility that potassium may play a part in this association because of the strong correlation between potassium and creatinine. Similarly, potassium appeared to be the more important component of the sodium/potassium ratio. The regression coefficients for sodium, potassium, and the sodium/potassium ratio in this study of casual urine samples were found to be similar in direction and magnitude to two large studies using 24 hour urine collections. We suggest that causal specimens may be useful for estimating sodium and potassium intake in population studies.

Adult↗
PubMed1990

Weight change in middle-aged British men: implications for health.

The relationship between weight change over a 5-year period and subsequent mortality during a further 4-year follow-up was examined in a prospective study of 7735 British middle-aged men. Over half of the men remained stable (less than 4 per cent change in body weight), 31 per cent gained weight and 14 per cent lost weight over 5 years. There were 357 deaths from all causes and men with stable weight had the lowest mortality rates. Considerable weight gain (greater than 15 per cent gain in body weight) was associated with an increased risk of cardiovascular (CVD) mortality even after adjustment for initial age, body mass index, blood cholesterol, systolic blood pressure and smoking status. Loss of weight was significantly associated with increased mortality largely due to cancer and other non-cardiovascular causes. The association between weight loss and cancer was more marked in non-obese men and emphasizes that weight loss is a potentially serious symptom. Weight loss to non-obese status was associated with a halving of cardiovascular mortality. The benefit was restricted to hypertensive obese men in whom the mortality reduction was considerable and significant. Considerable weight gain in later adult life, even over a short period of follow-up, is not a benign process, it is harmful to health.

Body Weight↗
PubMed1990

Differences between observers in blood pressure measurement with an automatic oscillometric recorder.

Blood pressure measurements made with a Dinamap oscillometric blood pressure recorder by two observers on a total of 2596 male and female subjects aged between 25 and 59 living in nine British towns were examined for evidence of observer differences. After adjusting for age, body mass index and town, significant differences between the two observers were found for systolic pressure, 3.07 mmHg (P = 0.001) for male subjects and 2.08 mmHg (P = 0.036) for female subjects. Observer differences for mean arterial pressure and diastolic pressure were less than 1 mmHg and were not significant. The magnitude of observer differences also varied between towns and, when tested statistically, was significant in male subjects for systolic (P = 0.011), mean arterial (P = 0.009) and diastolic pressure (P = 0.002); for female subjects it was significant only for diastolic pressure (P = 0.023). We conclude that although the highly automated Dinamap has kept observer variation within acceptably low limits in field study conditions, the problem has not been altogether eliminated.

Adult↗
PubMed1989

Association between serum albumin and mortality from cardiovascular disease, cancer, and other causes.

In a prospective study of 7735 middle-aged British men (British Regional Heart Study) 660 died during an average follow-up period of 9.2 years. There was a marked increase in mortality rate with decreasing serum albumin concentrations that persisted even after adjustment for age, social class, town of residence, cigarette smoking, serum total cholesterol, systolic blood pressure, serum total calcium, and forced expiratory volume in 1 s. When serum albumin concentration was less than 40 g/l, the mortality rate was 23/1000 per year compared with 4/1000 per year for a concentration equal to or above 48 g/l. A similar pattern was observed for cardiovascular, cancer, and other deaths. The associations persisted for cardiovascular disease and cancer even when deaths within the first five years of follow-up were excluded. These results must be interpreted with caution since there was no prior hypothesis concerning serum albumin. However, the strength of the association between serum albumin and mortality seems to be comparable with that for cigarette smoking.

Adult↗
PubMed1989

Body weight and mortality in middle aged British men: impact of smoking.

OBJECTIVE: To assess the relation between body mass index and mortality in middle aged British men. DESIGN: Men who were recruited for the British Regional Heart Study were followed up for a mean of nine years. SETTING: General practices in 24 British towns. SUBJECTS: 7735 Men aged 40-59 years selected from the age-sex registers of one group practice in each of the 24 towns. MAIN OUTCOME MEASURE: Mortality from cardiovascular and non-cardiovascular causes. RESULTS: 660 Of the men died. There was a U-shaped relation between body mass index and total mortality. Very lean men (less than 20 kg/m2) had by far the highest mortality followed by lean men (20-22 kg/m2) and obese men (greater than or equal to 28 kg/m2). The high mortality in lean and very lean men was due largely to non-cardiovascular causes, particularly lung cancer and respiratory disease, which are associated with cigarette smoking. In obese men deaths were more likely to be due to cardiovascular causes. There was a strong inverse association between body weight and cigarette smoking. When the pattern of mortality was examined by age, smoking habits, and pre-existing smoking related disease both very lean men and obese men consistently had an increased mortality. The U-shaped relation was most prominent in men in the oldest age group (55-59). Current smokers had a higher mortality than former smokers at virtually all values of body mass index. An increased mortality in lean men was seen only in current smokers and in men with smoking related disease. Among men who had never smoked, lean men had the lowest total mortality, thereafter mortality increased with increasing body mass index (p less than 0.01). CONCLUSIONS: This study provides strong evidence of the impact of cigarette smoking on body weight and mortality and strongly suggests that the benefits of giving up smoking are far greater than the problems associated with the increase in weight that may occur.

Adult↗
PubMed1989

Early influences on blood pressure: a study of children aged 5-7 years.

OBJECTIVE: To examine factors that influence blood pressure in children. DESIGN: Cross sectional study of children aged 5.0-7.0 years who had blood pressure measurements and for whom parental questionnaires were completed. SETTING: School based survey. SUBJECTS: 3591 Children aged 5.0-7.5 years selected by stratified random sampling of primary schools in nine British towns (response rate 72%); 3591 were examined and their parental questionnaires were completed. Data were complete for birth rank in 3559, maternal age in 3542, maternal history of hypertension in 3524, and paternal history in 2633. RESULTS: Birth weight was inversely related to mean systolic blood pressure but only when standardised for current weight (weight standardised regression coefficient -1.83 mm Hg/kg (95% confidence interval -1.31 to -2.35). Mean diastolic pressure was similarly related to birth weight. Maternal age, birth rank, and a parental history of hypertension were all related to blood pressure. After standardisation for current weight a 10 year increase in maternal age was associated with a 1.0 mm Hg (0.4 to 1.6) rise in systolic pressure; first born children had systolic blood pressure on average 2.53 mm Hg (0.81 to 4.25) higher than those whose birth rank was greater than or equal to 4; and a maternal history of hypertension was associated with a systolic pressure on average 0.96 mm Hg (0.41 to 1.51) higher than in those with no such history. The effects described were largely independent of one another and of age and social class. The relation for birth rank was, however, closely related to that for family size. CONCLUSIONS: Influences acting in early life may be important determinants of blood pressure in the first decade. The relation between birth weight and blood pressure may reflect the rate of weight gain in infancy. The reasons for the relation with birth rank and maternal age are unknown; if confirmed they imply that delayed motherhood and smaller family size may be associated with higher blood pressure in offspring.

Birth Order↗
PubMed1989

Relative weight and major ischaemic heart disease events in hypertensive men.

Some studies have suggested that lean hypertensive men may be at greater risk of major ischaemic heart disease (IHD) events than obese hypertensive men. The issue was examined on data from the British Regional Heart Study for 7735 middle-aged men followed up for an average of 7.5 years; during this time 443 men experienced a major IHD event. Hypertension was defined as systolic blood pressure of 160 mm Hg or above, diastolic blood pressure of 95 mm Hg or above, or receiving treatment for hypertension. For both hypertensive and normotensive men the rate of major IHD events, standardised for age and cigarette smoking, rose with increasing body mass index (BMI). The relative odds associated with a 5 kg/m2 difference in BMI (ie, a 15 kg difference in weight in men of average height [1.73 m]) were 1.30 (p = 0.02) and 1.43 (p = 0.0004) for hypertensive and normotensive men, respectively. A review of eleven prospective studies, including the British Regional Heart Study, presented in standard form for comparative purposes, suggests that lean hypertensive men are not at higher risk of major IHD events than overweight/obese hypertensive men. There seems to be no justification for the suggestion that a policy of weight reduction to lower blood pressure might be inappropriate.

Adult↗
PubMed1989

Breathlessness, angina pectoris and coronary artery disease.

The relation of breathlessness to angina was examined in 7,735 middle-aged British men. Among men who did not report breathlessness, the age-standardized prevalence rate of angina was 4%. In men with mild, moderate or severe breathlessness, the prevalence rates of angina were 16, 29 and 41%, respectively. The association between breathlessness and angina was independent of age or cigarette smoking, with similar relations observed in men who had never smoked. The prevalence of electrocardiograms revealing ischemia increased with the severity of breathlessness, even in men without angina or other evidence of coronary artery disease (CAD) at screening. In men with a low forced expiratory volume in 1 second, the prevalence of angina was also increased, but the association was much weaker than that observed between angina and breathlessness. After a 5-year follow-up, 25% of men severely breathless at screening but without any initial evidence of CAD had developed angina, 5% had had a heart attack (half of these were fatal) and 7% were dead from causes other than CAD. The corresponding rates for men not breathless at screening and without evidence of CAD were: 4% angina, 2.5% heart attack and 2% dead from causes other than CAD. Breathlessness appears to be an early indicator of CAD in the absence of either angina or electrocardiographic evidence of ischemia.

Adult↗
PubMed1989

Concentrations of high density lipoprotein cholesterol, triglycerides, and total cholesterol in ischaemic heart disease.

OBJECTIVE: To assess the roles of serum concentrations of total cholesterol, high density lipoprotein cholesterol, and triglycerides in predicting major ischaemic heart disease. DESIGN: Men recruited for the British regional heart study followed up for a mean of 7.5 years. SETTING: General practices in 24 British towns. PATIENTS: 7735 Middle aged men. END POINT: Predictive value of serum concentrations of lipids. MEASUREMENTS AND MAIN RESULTS: At initial screening serum concentrations of total cholesterol, high density lipoprotein cholesterol, and triglycerides were determined from non-fasting blood samples. Altogether 443 major ischaemic heart disease events (fatal and non-fatal) occurred during the study. Men in the highest fifth of the distribution of total cholesterol concentration (greater than or equal to 7.2 mmol/l) had 3.5 times the risk of ischaemic heart disease than did men in the lowest fifth (less than 5.5 mmol/l) after adjustment for high density lipoprotein cholesterol concentration and other risk factors. Men in the lowest fifth of high density lipoprotein cholesterol concentration (less than 0.93 mmol/l) had 2.0 times the risk of men in the highest fifth (greater than or equal to 1.33 mmol/l) after adjustment for total cholesterol concentration and other risk factors. Men in the highest fifth of triglyceride concentration (greater than or equal to 2.8 mmol/l) had only 1.3 times the risk of those in the lowest fifth (less than 1.08 mmol/l) after adjustment for total cholesterol concentration and other risk factors; additional adjustment for high density lipoprotein cholesterol concentration made the association with ischaemic heart disease disappear. CONCLUSIONS: Serum concentration of total cholesterol is the most important single blood lipid risk factor for ischaemic heart disease in men. High density lipoprotein cholesterol concentration is less important, and triglyceride concentrations do not have predictive importance once other risk factors have been taken into account.

Adult↗
PubMed1989

Migration and geographic variations in ischaemic heart disease in Great Britain.

The British Regional Heart Study seeks to explain the geographic variations in cardiovascular disease in Great Britain. A strong geographic gradient in the risk of a major ischaemic heart disease (IHD) event was found in 7735 middle-aged men who were followed up for 6.5 years. Regardless of where they were born, men examined in Scotland experienced the highest IHD risk, while those examined in the South of England had the lowest. The place of examination (ie, residence) was a more important determinant of the risk of a major IHD event than the place of birth. It seems unlikely that the geographic differences in IHD risk among middle-aged British men can be directly explained by their genetic inheritance or by their prenatal and postnatal diet.

Adult↗