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Biomedical subjects

A Hofman

Publications and source records attributed to A Hofman.

At least 361 records · Page 20Linked to original sources
PubMed1993

Relation between birth weight and blood pressure: longitudinal study of infants and children.

OBJECTIVE: To study the relation between birth weight and systolic blood pressure in infancy and early childhood. DESIGN: Longitudinal study of infants from birth to 4 years of age. SETTING: A middle class community in the Netherlands. PARTICIPANTS: 476 Dutch infants born in 1980 to healthy women after uncomplicated pregnancies. MAIN OUTCOME MEASURES: Systolic blood pressure and body weight measured at birth and at 3 months and 4 years of age; the relation between systolic blood pressure and birth weight as estimated by multiple regression models that include current weight and previous blood pressure and control for gestational age, length at birth, and sex. RESULTS: Complete data were available on 392 infants. At 4 years of age the relation between blood pressure and birth weight appeared to be U shaped; low and high birthweight infants had raised blood pressure. Current weight and previous blood pressure were also positively associated with blood pressure at that age. Low birthweight infants (birth weight < 3100 g) had a greater gain in blood pressure and weight in early infancy. High birthweight infants (birth weight > or = 3700 g) had high blood pressure at birth, and weight and blood pressure tended to remain high thereafter. CONCLUSIONS: Even among normal infants there seem to be subgroups defined by birth weight in which blood pressure is regulated differently. Future investigations are needed to examine the physiological basis of these differences. Studies of correlates of adult disease related to birth weight should investigate mechanisms related to increased risk separately in infants of low and high birth weight.

Aging↗
PubMed1993

[Long-term prognosis following a myocardial infarct: clinically prognostic variables and cardiovascular risk factors].

The long-term prognosis after myocardial infarction; clinical predictive variables and cardiovascular risk factors. In predicting long-term survival of 304 consecutive patients discharged after myocardial infarction between 1978 and 1981, and under 65 years of age, the significance of both hospital data and cardiovascular risk factors was examined. After discharge from hospital, the ten-year all-cause total mortality was 35.5%. Sudden death accounted for 42% of the recorded causes of death. The patients were not yet treated with thrombolysis at that time. After multivariate analysis, age, previous myocardial infarction, abnormal chest X-ray (increased cardiothoracic ratio or pulmonary congestion) and an increased cholesterol level were found to be independent and significant predictors of the ten-year mortality. Hypertension and gender were not associated with mortality. Patients with a previous myocardial infarction had, after adjustment for differences in age and other variables, a relative risk of dying within ten years of 1.70 (95% confidence interval 1.05-2.75) compared with those with a first infarction. A gradual increase of the ten-year mortality with elevated serum cholesterol level could be demonstrated (relative risk 1.14 per mmol/l, 95% CI 1.01-1.28). In conclusion, several routinely obtained parameters after myocardial infarction were related to subsequent long-term survival. Of the prognostic factors that may lead to useful therapeutic intervention after myocardial infarction, hypercholesterolaemia was most clearly associated with a reduced survival in the present study.

Cardiovascular Diseases↗
PubMed1993

Cerebral white matter lesions and atherosclerosis in the Rotterdam Study.

Cerebral white matter lesions (WML) seen on magnetic resonance imaging scans are associated with cardiovascular disease and vascular risk factors. To assess the association between WML and atherosclerosis, we studied 111 people, aged 65 to 85 years, randomly sampled, and stratified by age and sex, from participants in the Rotterdam Study. Cerebral T2-weighted magnetic resonance images in the axial plane were obtained for all subjects. Carotid atherosclerosis was ultrasonographically assessed by the presence of stenosis, measurement of intima to media wall thickness (IMT), and the presence of atherosclerotic plaques. A possible or definite myocardial infarction on an electrocardiogram was used as an indicator of coronary atherosclerosis. The ankle to arm systolic blood pressure ratio (ABI) was determined, and peripheral arterial disease was defined as an ABI lower than 0.90 in at least one side. Carotid atherosclerosis was significantly more pronounced in people with WML. The difference in common carotid IMT was 0.13 mm (95% confidence interval [CI] 0.04-0.21), whereas the odds ratio of WML associated with plaques in the carotid bifurcation was 3.9. The degree of internal carotid artery stenosis was not, however, associated with WML. The mean ABI was significantly lower in people with WML than in those without lesions with a difference of -0.11 (95% CI -0.21 to -0.01). The odds ratio of WML associated with peripheral arterial disease and a possible or definite myocardial infarction was 2.4 and 3.1, respectively. We conclude that atherosclerosis, indicated by increased common carotid IMT, carotid plaques, and a lower ABI, is related to WML.

Aged↗
PubMed1993

Cardiovascular risk and all-cause mortality; a 12 year follow-up study in The Netherlands.

To assess the contribution of cardiovascular risk indicators to all-cause mortality, we used data from a follow-up study conducted in the Netherlands since 1975. Of 6,057 participants aged 20 years or over at the start of the study, 9.5% died during the 9 to 12 year follow-up period. Risk indicators independently related to all-cause mortality were age and diabetes mellitus in both sexes; pulse rate, smoking habits, antihypertensive drug use and a history of myocardial infarction most clearly in men; and body mass index and systolic blood pressure in women. A larger body mass index was associated with a gradual decrease in mortality probability. The risk of death for women in the highest quartile of body mass index (> 26.4 kg/m2) relative to those in the lowest quartile (< 21.9 kg/m2) was 0.56 (95% confidence limits 0.36 and 0.87). Serum cholesterol level showed no association with overall mortality. Risk functions were calculated to predict an individual's probability of dying within 11.5 years as a function of the level of cardiovascular risk indicators. Our findings suggest that the major cardiovascular risk indicators, apart from affecting cardiovascular morbidity and mortality, also influence all-cause mortality. Consequently, favourable changes in these characteristics might lead to an increase in life expectancy. The maximum individual benefit to be expected from these changes may be estimated using the risk functions derived from our data.

Adult↗
PubMed1993

High blood pressure and the incidence of non-insulin dependent diabetes mellitus: findings in a 11.5 year follow-up study in The Netherlands.

To examine the contribution of cardiovascular risk factors to the development of non-insulin dependent diabetes mellitus, a prospective follow-up study was performed of a cohort, initially examined in a population survey on cardiovascular risk factors. The survey was conducted from 1975 to 1978 in the Netherlands among 5700 men and women aged 20 to 65. In 1988 a questionnaire on the prevalence of chronic diseases, including diabetes mellitus, was sent to all living participants of the initial survey. The general practitioners of the persons who indicated to have diabetes mellitus were asked to confirm the diagnosis. Diabetes mellitus was defined as current use of oral hypoglycemic drugs or insulin. After exclusion of the prevalent cases at the initial survey, 65 incident confirmed cases remained. All others responding to the questionnaire served as controls. The incidence of diabetes mellitus was associated with body mass index, use of diuretics, systolic and diastolic blood pressure. After adjustment for age and body mass index systolic and diastolic blood pressure were still associated with the incidence of non-insulin dependent diabetes mellitus in men; relative risks 1.28 (95% confidence interval 1.06-1.54) and 1.40 (95% CI 1.06-1.85) per 10 mmHg respectively. For women, only the relative risk associated with the use of diuretics remained statistically significant (2.26, 95% CI 1.04-4.90). This probably reflects the risk of (treated) hypertension: adjusted for blood pressure, the relative risk lost statistical significance. These findings suggest that elevated blood pressure is a risk for the development of non-insulin dependent diabetes mellitus (NIDDM). This supports the view that NIDDM and hypertension may have a similar origin.

Adult↗
PubMed1993

Genetic transmission of Alzheimer's disease among families in a Dutch population based study.

We evaluated age at onset and transmission patterns of Alzheimer's disease (AD) in families of 198 patients who had onset of symptoms before the age of 65 years and were diagnosed before the age of 70 years. Patients were ascertained in a population based study in The Netherlands. The results suggest that the risk of AD by the age of 90 in first degree relatives is 39% (95% confidence interval 27 to 51). By the age of 90, this risk is 2.8 (95% confidence interval 1.5-5.2) times greater than the corresponding risk of 14% among relatives of age and sex matched control subjects. Segregation analysis indicated that patterns of familial clustering are best explained by transmission of a major autosomal dominant gene with reduced penetrance and a multifactorial component. However, the single major locus model could be rejected in favour of the mixed model only when a cohort effect for heritability was allowed for. The frequency of the AD susceptibility allele was estimated to be 0.48% in the single major locus model and 0.31% in the mixed model. Although our study confirms that a dominant major gene is implicated in early onset AD, the results suggest that other genetic or perhaps non-genetic factors may account for the disease in a considerable number of patients.

Age of Onset↗
PubMed1993

Isolated systolic hypertension and vessel wall thickness of the carotid artery. The Rotterdam Elderly Study.

We studied the association between isolated systolic hypertension (ISH) and generalized atherosclerosis as indicated by intima-media wall thickness (IMT) of the distal common carotid artery. The Rotterdam Elderly Study is a single-center study of a cohort of 11,854 elderly persons > or = 55 years old. Baseline measurements included ultrasonic evaluation of plaques and vessel wall thickness of both carotid arteries and extensive measurements of cardiovascular risk factors. Mean IMT and lumen diameter of subjects with ISH (systolic pressure > or = 160 mm Hg and diastolic pressure < 90 mm Hg) among the first 1,000 participants (n = 33) and 66 age- and sex-matched control subjects were compared. None of the subjects were using antihypertensive drug treatment, and all were free of cardiovascular disease. Mean IMT of the right common carotid artery was significantly higher in those with ISH than in normotensive subjects, with a mean difference of 0.07 mm (95% confidence interval [CI], 0.01, 0.14). Results for the left carotid artery were similar (mean difference, 0.06 mm; 95% CI, -0.01, 0.13). The end-diastolic mean lumen diameter was significantly larger in subjects with ISH than in control subjects for both right and left sides, with a mean difference of 0.70 mm (95% CI, 0.38, 1.01) and 0.48 mm (95% CI, 0.17, 0.80), respectively. Adjustment for differences in body mass index, serum lipids, smoking, and fibrinogen did not materially change the findings. Furthermore, atherosclerotic plaques were more frequently observed among those with ISH compared with control subjects, with a mean difference of 12% (95% CI, -1, 25).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Hemodynamic characteristics of the early phase of primary hypertension. The Dutch Hypertension and Offspring Study.

BACKGROUND: The hemodynamic characteristics of the early phase of primary hypertension are subject to debate. In particular, it remains unclear whether an increased vascular peripheral resistance or a raised cardiac output is involved as the primary hemodynamic alteration in hypertension. METHODS AND RESULTS: We studied hemodynamic characteristics and oxygen consumption in relation to 24-hour ambulatory blood pressure measurements in three groups of normotensive children with a different familial predisposition for hypertension. Selection of participants was based on parental blood pressure levels. Mean 24-hour blood pressure was higher in the offspring of two hypertensive parents compared with the offspring of two normotensive parents; there was a difference of 4.7 mm Hg (95% confidence interval [CI], 1.8-7.6) for systolic blood pressure and a difference of 4.8 mm Hg (CI, 2.3-7.3) for diastolic blood pressure. The 24-hour blood pressure pattern was consistently at a higher level for both systolic and diastolic blood pressures in the offspring of two hypertensive parents compared with the offspring of two normotensive parents. The smallest differences in blood pressure were seen at night, and the largest differences in blood pressure between the groups of offspring were seen during periods of physical activity. Echocardiographic examination combined with registration of oxygen consumption did not show a difference in cardiac index and arteriovenous oxygen difference between the study groups. However, differences in cardiac dimensions were apparent, with an increased left ventricular mass index (8.7 g/m2; CI, 2.4-15.0) in the offspring of two hypertensive parents. CONCLUSIONS: These findings do not support the existence of a hyperkinetic circulatory phase but may indicate the presence of an increased left ventricular mass in early primary hypertension.

Adolescent↗
PubMed1993

Cigarette smoking and the development and progression of aortic atherosclerosis. A 9-year population-based follow-up study in women.

BACKGROUND: Cigarette smoking has been recognized as an important risk factor for cardiovascular disease in men and women. Whether the increased risk results from an atherogenic effect of smoking is still debated. We examined the relation between cigarette smoking and atherosclerotic changes in the abdominal aorta. METHODS AND RESULTS: The association between cigarette smoking and atherosclerotic changes in the abdominal aorta was examined in a population-based cohort of 758 women, initially aged 45 to 64 years. All women were examined radiographically for calcified deposits in the abdominal aorta, which have been shown to represent intimal atherosclerosis. After 9 years of follow-up, atherosclerotic changes, indicating development or progression of plaques, could be demonstrated in 37% of women. A direct association was found between atherosclerotic change and number of cigarettes smoked per day. Compared with women who had never smoked, the relative risks of those who smoked 1 to 9, 10 to 19, and 20 or more cigarettes per day were 1.4 (95% confidence interval, 1.0 to 2.0), 2.0 (1.6 to 2.5), and 2.3 (1.8 to 3.0), respectively, after adjustment for age and other cardiovascular risk factors. Associations of atherosclerotic change with inhaling habit and duration of smoking were borderline significant after number of cigarettes smoked per day was taken into account. Among former smokers, the risk decreased with increasing duration of stopping but a significant excess risk was still observed after 5 to 10 years since quitting (relative risk, 1.6; 95% confidence interval, 1.1 to 2.2). CONCLUSIONS: These follow-up data support the evidence for an effect of cigarette smoking on atherosclerosis. The findings suggest that the rate of atherosclerotic change may be reduced by cessation of smoking, but a residual effect appears to be present for at least 10 years.

Aorta, Abdominal↗
PubMed1993

Alterations in calcium metabolism in young people at risk for primary hypertension. The Dutch Hypertension and Offspring Study.

Several disturbances in calcium metabolism have been reported in primary hypertensive subjects. It is, however, not clear whether these alterations predate the development of hypertension or occur as a consequence of high blood pressure. We studied indexes of calcium metabolism in three groups of normotensive children with different familial predispositions for hypertension, based on parental blood pressure levels, with two, one, or no hypertensive parents. Plasma intact parathyroid hormone [1-84] was higher in the offspring of hypertensive parents compared with offspring of normotensive parents (difference, 0.58 pmol/L; standard error of the difference [SED], 0.24; p = 0.02). Mean serum calcium levels were slightly reduced in the offspring of two hypertensive parents (-0.019 mmol/L, SED = 0.013, p = 0.17). Plasma magnesium and phosphate levels were lower in the offspring of hypertensive parents (-0.032 mmol/L [SED = 0.016, p = 0.05] and -0.045 mmol/L [SED = 0.024, p = 0.05], respectively). Mean 1.25-dihydroxyvitamin D3 levels were similar among the groups. No differences in dietary intake of calcium, phosphate, or fiber were found. Urinary calcium excretion per 24 hours and the ratio of 24-hour urinary calcium excretion to daily calcium intake were somewhat higher in the offspring of hypertensive parents. Renal fractional excretion of calcium was similar in the offspring of two hypertensive parents, and renal fractional excretion of phosphate was lower in the offspring of two hypertensive parents compared with offspring of two normotensive parents (-1.50%, SED = 0.74, p = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop.

Criteria for the diagnosis of vascular dementia (VaD) that are reliable, valid, and readily applicable in a variety of settings are urgently needed for both clinical and research purposes. To address this need, the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), resulting in research criteria for the diagnosis of VaD. Compared with other current criteria, these guidelines emphasize (1) the heterogeneity of vascular dementia syndromes and pathologic subtypes including ischemic and hemorrhagic strokes, cerebral hypoxic-ischemic events, and senile leukoencephalopathic lesions; (2) the variability in clinical course, which may be static, remitting, or progressive; (3) specific clinical findings early in the course (eg, gait disorder, incontinence, or mood and personality changes) that support a vascular rather than a degenerative cause; (4) the need to establish a temporal relationship between stroke and dementia onset for a secure diagnosis; (5) the importance of brain imaging to support clinical findings; (6) the value of neuropsychological testing to document impairments in multiple cognitive domains; and (7) a protocol for neuropathologic evaluations and correlative studies of clinical, radiologic, and neuropsychological features. These criteria are intended as a guide for case definition in neuroepidemiologic studies, stratified by levels of certainty (definite, probable, and possible). They await testing and validation and will be revised as more information becomes available.

Brain↗
PubMed1992

Head trauma and the risk of Alzheimer's disease.

A population-based case-control study of the association between head trauma and Alzheimer's disease was conducted in the Netherlands from 1980 to 1987. The study comprised 198 patients with clinically diagnosed early onset Alzheimer's disease and 198 age- and sex-matched population controls. Adjusted for sex, age, family history of dementia, and education, the odds ratio of a history of head trauma with loss of consciousness was 1.6 (95% confidence interval (CI) 0.8-3.4). The odds ratio for men was 2.5 (95% CI 0.9-7.0), and that for women was 0.9 (95% CI 0.3-2.8). The increase in odds ratio was limited to head trauma that occurred within the period of 10 years prior to the onset of dementia (odds ratio = 10.0; 95% CI 1.0-96.8). There was no evidence of effect modification by family history of dementia as measured on a multiplicative scale. However, the power to show interaction may have been low in this study. The authors' findings are compatible with the view that head trauma may be implicated in Alzheimer's disease, with a short lag time between the head trauma and the first symptoms of disease. The association needs to be confirmed in a prospective follow-up study to fully exclude the possibility of recall bias.

Aged↗
PubMed1992

The interrater reliability of a Dutch version of the Structured Clinical Interview for DSM-III-R Personality Disorders.

This study presents data on the interrater reliability of a Dutch version of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Seventy outpatients were interviewed before the start of their treatment by one rater, while a second rater observed. Both raters were instructed to make independent ratings and the second rater was not allowed to participate in the discussion. On criterion level, interrater reliabilities appear to be very good, with a few exceptions (most reliabilities are higher than 0.75). However, all 5 observation criteria had poor interrater reliabilities. Agreement on personality disorder, on the whole, was excellent (overall kappa = 0.80). The possible reasons why relatively lower reliabilities are found with some criteria are discussed. Finally, problems encountered during the interviews are addressed and possible adjustments of the SCID-II are suggested.

Adolescent↗
PubMed1992

Studies on the incidence of dementia: the European perspective.

Dementing diseases, the most common of which are Alzheimer's disease and vascular dementia, are highly prevalent in Europe. To progress further in the search for the etiology of these diseases, incidence studies are needed. Comparison of the data of such studies will be important; the question of whether they produce comparable and interpretable data is therefore critical. We discuss the methodologic differences between earlier and more recent studies conducted in Europe that may account for some of the variation in the incidence rates of the dementia they report. Issues to be explored in the current European studies on the incidence of dementing diseases are also described.

Age Factors↗
PubMed1992

A community-based study of dementia: the Rotterdam Elderly Study.

The Rotterdam Elderly Study is designed as a community-based prospective follow-up study. The study population consists of almost 12,000 individuals aged 55 years and over who are living in an urban area in Rotterdam, the Netherlands. The objective of the study is to investigate the prevalence, incidence and determinants of neurogeriatric disorders, cardiovascular diseases, locomotor diseases and ophthalmologic diseases. In this paper we give a general outline of the Rotterdam Elderly Study, and a detailed description of the case finding and diagnostic procedures for the study of dementia. The risk factors for dementia that are assessed in the study are summarized.

Aged↗
PubMed1992

Risk factors for Alzheimer's disease: the EURODEM collaborative re-analysis of case-control studies.

Case-control studies of risk factors for Alzheimer's disease have been hampered by low statistical power. Here, we present a collaborative analysis of 11 case-control studies of Alzheimer's disease. The original data of these studies were pooled and re-analyzed. The risk factors considered in this analysis were family history of dementia and related disorders, maternal age at index birth, head trauma, medical and psychiatric history and environmental exposures. This paper gives a brief overview of the findings of the re-analysis.

Age Factors↗