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Biomedical subjects

A G Shaper

Publications and source records attributed to A G Shaper.

At least 163 records · Page 9Linked to original sources
PubMed1989

Short stature, lung function and risk of a heart attack.

In a large prospective study of cardiovascular disease in 7735 middle-aged men--the British Regional Heart Study--the 443 subjects who experienced a major ischaemic heart disease event within 7.5 years of follow-up were on average 1.6 cm shorter than the other men (p less than 0.001). The risk of heart attack was approximately twice as great in the shortest quintile of men compared with the tallest quintile. When a number of recognized risk factors for ischaemic heart disease were taken into account--age, social class, serum total cholesterol, HDL-cholesterol, systolic blood pressure, cigarette smoking--there was a marked reduction in the risk of heart attack associated with height. When a measure of lung function (FEV1 not standardized for height) was adjusted for in addition to these risk factors, the height-related risk of heart attack disappeared. Indeed, FEV1 alone was sufficient to account for most of the association between height and the risk of heart attack.

Adult↗
PubMed1989

Using the WHO (Rose) angina questionnaire in cardiovascular epidemiology.

During 1978-80, 7735 men aged 40-59 took part in a screening examination which included an administered version of the WHO (Rose) questionnaire on chest pain. Those men who had 'possible' angina were as likely to have an ischaemic electrocardiogram at rest as those with 'definite' angina. Furthermore, the heart attack rate over 7.5 years was similar in men with 'definite' and 'possible' angina and did not diminish with length of follow-up. Five years after the initial screening 98% of the surviving men replied to a postal questionnaire which included a self-administered version of the chest pain questionnaire. Age-specific prevalence rates of angina based on the administered questionnaire at screening and on the self-administered postal version five years later, were similar. Men who had angina ('definite' or 'possible') on both occasions had the highest prevalence rate of ischaemic electrocardiograms, men who were positive on only one occasion had intermediate rates and those who were negative on both occasions had the lowest rates. We conclude that in cardiovascular studies of middle-aged men which use the WHO (Rose) questionnaire for the purposes of determining prevalence or assessing risk of a heart attack, angina should include both 'possible' and 'definite' angina.

Adult↗
PubMed1989

Blood pressure measurement in children: the importance of cuff bladder size.

The effect of cuff bladder size on blood pressure measurement has been investigated in 838 children aged 5-7 years, using a Dinamap oscillometric automated blood pressure recorder and a Hawksley random zero sphygmomanometer. With both instruments the smallest (infant) cuffs recorded higher pressures than the child cuffs (mean systolic differences: Dinamap 4.6 mmHg, Hawksley 6.6 mmHg), which in turn recorded higher pressures than the largest (adult) cuffs (mean systolic differences: Dinamap 5.5 mmHg, Hawksley 8.1 mmHg). These differences in measurement between cuffs are sufficiently large as to be of concern in both clinical and epidemiological studies. Since they are little affected by arm circumference, their occurrence cannot be prevented simply by following current guidelines for selection of cuff size. Methods of dealing with these problems are discussed.

Blood Pressure Determination↗
PubMed1989

Diurnal variations in serum biochemical and haematological measurements.

Twenty five biochemical and haematological measurements were determined on nonfasting blood and serum samples collected between 9 am and 7 pm from a representative group of 7685 British middle-aged men. Most measurements showed significant diurnal variations, but only for bilirubin, phosphate, and triglyceride did time of day account for more than 5% of the between subject variance. Serum bilirubin concentrations showed a pronounced downward trend in the afternoon, the mean value after 6 pm being 30% lower than the mean value in the morning. Mean serum triglyceride and phosphate concentrations increased steadily through the day. Mean concentrations of potassium, haemoglobin, and haematocrit and red cell count were higher in the morning, while urea and creatinine concentrations and white cell count had higher means in the afternoon. Glucose showed a pattern consistent with short term response to meals. The effects of these diurnal trends on routine use of biochemical tests needs careful consideration, and a greater understanding of their biological mechanisms is required.

Adult↗
PubMed1988

Alcohol and mortality in British men: explaining the U-shaped curve.

In a prospective study of 7735 middle-aged 7 British men, 504 of whom died in a follow-up period of 7.5 years, there was a U-shaped relationship between alcohol intake and total mortality and an inverse relationship with cardiovascular mortality, even after adjustment for age, cigarette smoking, and social class. These mortality patterns were seen in all smoking categories (with ex-smoking non-drinkers having the highest mortality) and were observed in manual but not in non-manual workers. The alcohol-mortality relationships (total and cardiovascular) were present only in men with cardiovascular or cardiovascular-related doctor-diagnosed illnesses at initial examination. The data suggest that the observed alcohol-mortality relationships are produced by pre-existing disease and by the movement of men with such disease into non-drinking or occasional-drinking categories. The concept of a "protective" effect of drinking on mortality, ignoring the dynamic relationship between ill-health and drinking behaviour, is likely to be ill founded.

Alcohol Drinking↗
PubMed1988

Blood pressure in British children: associations with adult blood pressure and cardiovascular mortality.

Blood pressure was measured in 4186 children aged 5 to 7 years in 9 British towns. 3 towns had high, 3 had intermediate, and 3 had low adult blood pressure levels observed in an earlier study of middle-aged men. Significant differences between the towns were found for the children's mean systolic blood pressure (range 96.7 to 102.4 mm Hg) and diastolic pressure (range 55.9 to 60.3 mm Hg). The pattern of systolic blood pressure differences in children was similar to that observed in the study of middle-aged men (r = 0.65). The town mean systolic pressures in children show an association with standardised mortality ratios for cardiovascular disease in adults. The pattern of geographical differences in blood pressure observed in British adult men may have its origins early in life.

Adolescent↗
PubMed1988

Prediction of men at high risk of heart attack and its relevance to pilots.

In this paper we have extrapolated from data on the general population of middle-aged men and made suggestions for risk prediction and prevention policy in aircrew. As suggested previously, it would be helpful in future if data on the risk of heart attack in pilots could be generated from a central recording system covering both current pilots and those who retire for whatever reason. Indefinite follow-up information on ischaemic events would also be particularly helpful.

Adult↗
PubMed1988

Men who do not drink: a report from the British Regional Heart Study.

Men who do not drink are frequently used as a baseline against which the effects of alcohol consumption are measured. The characteristics of such men have been examined in a large-scale prospective study of cardiovascular disease involving 7735 middle-aged men drawn from general practices in 24 British towns. Non-drinkers include lifelong teetotallers and ex-drinkers, both long-term and recent. Long-term ex-drinkers have many characteristics likely to increase their morbidity and mortality; recent ex-drinkers have similar characteristics but to a less marked degree. Ex-drinkers are older than the other groups and include an increased proportion of unmarried men and men in manual occupations. They have the same high percentage of current cigarette smokers as moderate/heavy drinkers and a prevalence of hypertension and obesity similar to moderate/heavy drinkers and higher than lifelong teetotallers or occasional/light drinkers. Ex-drinkers have the highest percentage of men with multiple doctor-diagnosed disorders. In particular, they have the highest prevalence rates of angina and possible myocardial infarction on standardized questionnaire, of myocardial infarction on electrocardiogram and of recall of a doctor-diagnosis of ischaemic heart disease. They also have high prevalence rates of recall of high blood pressure, peptic ulcer, diabetes, gall bladder disease and bronchitis. They have the highest rates for regular medical treatment and the highest proportion of men who consider their health to be poor. It is abundantly clear that the general category of non-drinkers, which includes a large proportion of ex-drinkers, should not be used as a baseline against which to measure the effects of alcohol consumption. Overall, it would appear that the occasional/light drinking category (less than 15 drinks/week) provides a large and satisfactory baseline group for comparative purposes in the study of cardiovascular and other organic disorders.

Adult↗
PubMed1988

Breathlessness, lung function and the risk of heart attack.

Men with moderate or severe breathlessness had a greater than two-fold risk of suffering a major ischaemic heart disease (IHD) event compared to men with no evidence of breathlessness, based on 7.5-year follow-up in a prospective study of 7735 British men aged 40-59 years. Even after adjustment for other risk factors, including cigarette smoking, the relative risk remained two-fold. Men in the lowest fifth of the forced expiratory volume is 1 s (FEV1) distribution also had a two-fold risk of IHD compared to men in the highest fifth after similar adjustment. In part, the role of breathlessness as a risk factor for major IHD events was explained by its strong association with pre-existing, but usually undiagnosed, IHD. However, breathlessness was associated with an increased risk of heart attack even in men without any evidence of pre-existing IHD at screening. FEV1 was related to risk of a major IHD event in men without evidence of pre-existing IHD at screening and in men with previously undiagnosed IHD detected at screening. Measures of breathlessness and lung function could be more widely used in clinical situations and in screening as additional independent indicators of both unrecognized IHD and of risk for major IHD events.

Adult↗
PubMed1988

Parental death from heart disease and the risk of heart attack.

In the British Regional Heart Study, 7735 men aged 40-59 years were asked at initial screening whether their father or mother was alive or dead and to what cause any death had been attributed. They were followed up for the occurrence of major ischaemic heart disease events. At screening the men reported that 23% of the fathers and 43% of the mothers were alive and that 19% of the fathers and 11% of the mothers had died of heart trouble. In a sample of parental deaths, the death certificate was obtained and it was found that a son's report of a parental death from 'heart trouble' was a reliable indication that death had been certified to ischaemic heart disease. However, about half of the parental deaths certified as ischaemic heart disease were not reported as 'heart trouble' by their sons. A major ischaemic heart disease event was experienced by 336 men over an average follow-up of 6.2 years. Men who said their father had died from 'heart trouble' were at twice the risk of a major ischaemic heart disease event compared with men whose fathers were still alive and 1.5 times the risk of men who reported their father to be dead from another or unknown cause, even after accounting for age, systolic blood pressure, serum total cholesterol, cigarette smoking and serum HDL-cholesterol. For men with mother dead from heart trouble, the corresponding figures were 1.3 and 1.0.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

The role of risk factors in heart attacks occurring in men with pre-existing ischaemic heart disease.

The importance of three risk factors--serum total cholesterol, systolic blood pressure, and cigarette smoking--on the risk of new major ischaemic heart disease events in men who already have evidence of ischaemic heart disease was assessed. Data from the initial examination in a large prospective study of cardiovascular disease in middle aged men (the British Regional Heart Study) were used to separate 7710 men into three groups on the basis of a resting electrocardiogram, a standardised chest pain questionnaire, and recall of a doctor's diagnosis of angina or of a previous heart attack: (group 1) no evidence of ischaemic heart disease (75%), (group 2) evidence of ischaemic heart disease short of a definite myocardial infarction (20%), (group 3) definite myocardial infarction (6%). In the average follow up period of 7.5 years, 443 men suffered a new major event caused by ischaemic heart disease (fatal or non-fatal myocardial infarction or sudden cardiac death). Age standardised event rates were determined for each of the three groups for varying levels of the established risk factors. Cigarette smoking is strongly associated with the event rate in group 1 but in men with existing heart disease, especially group 3, differences in risk between the smoking categories were smaller. The strong relation between systolic blood pressure and event rate persisted in groups 1 and 2 but not in group 3. The positive association between serum concentration of total cholesterol and the event rate was strongest in group 1 and weaker in groups 2 and 3, though it remained highly significant. These observations, taken together with the results of previous prospective studies and intervention trials, suggest that the important association between serum total cholesterol and the risk of heart attack persists in men with pre-existing ischaemic heart disease, including myocardial infarction. Therefore, in these men the reduction of serum total cholesterol concentration may be at least as important as it is in men without evidence of ischaemic heart disease.

Adult↗
PubMed1988

Height and social class in middle-aged British men.

A study of 7735 middle-aged British men drawn from general practices in twenty-four towns shows that there has been a progressive increase in mean height in the men who were born between 1919 and 1939. This is true for both manual and non-manual classes, but the mean heights of the two groups are significantly different and remain widely separated over this period of time. Manual workers lag twenty years behind non-manual workers in their attained height. Data from other studies indicate that this social class difference in adult height is still present in those born up to 1960. The variation in mean height between the twenty-four towns is less marked than the variation in mean height between the social classes. After social class and age have been taken into account, a "town effect" on height is still present. If height is accepted as an indicator of socio-economic circumstances in childhood, then there is a difference in adult height between social class groups in Great Britain which does not appear to be diminishing.

Body Height↗
PubMed1988

Blood cadmium concentrations in the general population of British middle-aged men.

Blood cadmium concentrations were determined for 6919 men aged 40-59 randomly selected from general practice registers in 24 British towns. The mean and median blood cadmium were 1.9 and 1.4 micrograms/1 respectively and the distribution was highly skewed. The mean levels in non-smokers was 1.0 micrograms/l and current smokers showed a marked gradient with the daily amount smoked, with a mean of 3.9 micrograms/l in men smoking 40 or more cigarettes per day. Whereas 95% of men who never smoked had blood cadmium less than 2.0 micrograms/l, 80% of men smoking 20 or more cigarettes a day exceeded this figure. 1% of the men had blood cadmium concentrations greater than or equal to 7 micrograms/l virtually all of whom currently smoked cigarettes. Blood cadmium levels in ex-smokers were much lower than in current smokers even for those who had stopped within the past year. However, the mean levels in ex-smokers remained higher than the 'never smoked' for several years after stopping. There was little evidence that age, social class, or alcohol consumption were associated with blood cadmium levels after allowance for cigarette smoking. There is substantial geographic variation in mean blood cadmium for middle-aged men which could not be completely accounted for by smoking differences. Towns in the south and east of England all had mean levels under 2.0 micrograms/l whereas the majority of towns in other parts of Britain had mean levels greater than 2.0 micrograms/l. Possible reasons for this geographic pattern (e.g. geochemistry, industrial exposure, dietary differences) need further exploration.

Adult↗
PubMed1988

The relationship between blood lead, blood pressure, stroke, and heart attacks in middle-aged British men.

The relationship between blood lead concentration and blood pressure is examined in a survey of 7371 men aged 40 to 59 from 24 British towns. After allowance for relevant confounding variables, including town of residence and alcohol consumption, there exists a very weak but statistically significant positive association between blood lead and both systolic and diastolic blood pressure. These cross-sectional data indicate that an estimated mean increase of 1.45 mm Hg in systolic blood pressure occurs for every doubling of blood lead concentration with a 95% confidence interval of 0.47 to 2.43 mm Hg. After 6 years of follow-up, 316 of these men had major ischemic heart disease, and 66 had a stroke. After allowance for the confounding effects of cigarette smoking and town of residence there is no evidence that blood lead is a risk factor for these cardiovascular events. However, as the blood lead-blood pressure association is so weak, it is unlikely that any consequent association between lead and cardiovascular disease could be demonstrated from prospective epidemiological studies. An overview of data from this and other large epidemiological surveys provides reasonably consistent evidence on lead and blood pressure. While NHANES II data on 2254 U.S. men indicate a slightly stronger association between blood lead and systolic blood pressure, data from two Welsh studies on over 2000 men did not show a statistically significant association. However, the overlapping confidence limits for all these studies suggest that there may be a weak positive statistical association whereby systolic blood pressure is increased by about 1 mm Hg for every doubling of blood lead concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Alcohol and blood pressure in middle-aged British men.

The relationships between alcohol intake and blood pressure have been examined in 7,735 middle-aged men drawn at random from general practices in 24 British towns. Both mean systolic and diastolic BP are increased in moderate (16-42 drinks/week) and heavy (greater than 42 drinks/week) drinkers. The alcohol-blood pressure relationship is independent of age, body mass index and social class despite their associations with both alcohol intake and BP. The prevalence of hypertension (systolic greater than or equal to 160 mmHg or diastolic greater than or equal to 90 mmHg) is increased in both moderate and heavy drinkers. Non-drinkers have higher rates of diastolic hypertension than occasional or light drinkers, probably due to changes in drinking habits made by those diagnosed as hypertensives. Furthermore, recall of doctor diagnosis of hypertension and of anti-hypertensive treatment is highest among non-drinkers. It is estimated that about 10% of hypertension (systolic or diastolic) can be attributed to moderate or heavy drinking. There is a clear need for increased awareness of the alcohol-blood pressure relationship. Current drinking status should be determined in all hypertensive subjects, and assessment of alcohol effect by temporary withdrawal should be the first step in the management of anyone with sustained hypertension who drinks.

Adult↗
PubMed1988

Changes in drinking habits in middle-aged British men.

The drinking behaviour of 7735 middle-aged men drawn from general practices in 24 British towns was determined in 1978-80 and five years later in 1983-85. Those with heavier initial drinking were more likely to have reduced consumption after five years. At every level of consumption manual workers showed a greater tendency to decrease drinking than non-manual workers. Of those who became non-drinkers over the five years, 12% had been moderate or heavy drinkers. Men who were told by a doctor that they had developed ischaemic heart disease during the five years were more likely to reduce their alcohol consumption than men who remained free of ischaemic heart disease. Similarly, men who were put on regular medical treatment of any kind or who acquired two or more diagnoses of illness (including ischaemic heart disease) were more likely to become occasional or non-drinkers. Nondrinkers at both reviews had higher rates of diagnosed illness than drinkers. In particular, the ex-drinkers, who comprised 70% of non-drinkers at follow up, had higher rates of ischaemic heart disease and cardiovascular-related problems, such as high blood pressure and diabetes, than drinkers.It is essential to be aware of the tendency for moderate or heavy drinkers to reduce or stop drinking over time, particularly if illness has been diagnosed. Non-drinkers and exdrinkers should not be used as a baseline in studies relating alcohol to disease.

Alcohol Drinking↗