Sibling aggregation of blood pressure: nature or nurture?
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Blood Pressure↗
Biomedical subjects
B E Klein
Publications and source records attributed to B E Klein.
Aggregation of blood pressure in infants and their siblings.
Sibling aggregation of blood pressure has been shown in children 2 to 14 years of age. To determine the earliest age at which this finding is detectable, blood pressures were evaluated in 98 siblings from 43 black families with newborns. Variances of blood pressure scores were significantly greater among families than within families for systolic (p less than .025) but not diastolic pressures. Sib-sib intraclass correlation coefficients were .26 (95% two-sided confidence limits .05 to .47) for systolic and .16 (-.06 to .38) for diastolic pressures. When 1-month-old infant pressures were added, significant aggregation was present for systolic (p less than .01) and diastolic (p less than .025) pressures. The intraclass correlation coefficients were .21 (.02 to .38) and .17 (.03 to .34), respectively. When newborn scores were substituted, aggregation was not demonstrable. These data demonstrate a familial influence on blood pressure in infancy by 1 month of age.
Adolescent↗
Cholesterol among children of men with myocardial infarction.
Plasma cholesterol levels were obtained on 90 children of 39 men with premature myocardial infarction and 86 children of 39 healthy men. The mean cholesterol among children of affected men (195.1 mg/100 ml) was higher than among children of healthy men (176.6 mg/100 ml) (P equal to .009). Higher mean levels were demonstrable at each of nine age groups from 1 to 21 years(P equal to .004). Levels greater than 230 mg/100 ml were found in 16.7% of children of affected fathers and 4.7% of children of healthy fathers, a ratio of 3.6 to 1 (P equal to .01). These findings are compatible with the hypothesis that elevated childhood cholesterol level offers a mechanism whereby family history predicts coronary disease. A dip in cholesterol during adolescence, a finding that varies with population studied, was demonstratable among children of both affected healthy men.
Adolescent↗
Risk factors for coronary artery disease in children of affected families.
Risk factors for coronary artery disease were present to a greater degree in children of men who had experienced premature myocardial infarction when compared to children of unaffected male parents. Levels of cholesterol and body weight, as well as family history of premature CAD, differed significantly between the groups of children. The chance of identifying a child with hyperlipidemia was three times greater if the father had premature CAD. Data regarding familial aggregation of risk factors for CAD are reviewed and their significance discussed.
Adolescent↗
Serum uric acid. Its relationship to coronary heart disease risk factors and cardiovascular disease, Evans County, Georgia.
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Adolescent↗
Overweight indices as correlates of coronary heart diseases and blood pressure.
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Adult↗
Long-term incidence of lower-extremity amputations in a diabetic population.
OBJECTIVE: To describe the 10-year cumulative incidence of and risk factors for lower-extremity amputations in diabetics. DESIGN: Cohort study. SETTING: Primary care. PARTICIPANTS: Population-based sample (N = 879) of younger-onset diabetic persons (in whom diabetes was diagnosed before 30 years of age and who were taking insulin) and a stratified random sample (N = 956) of older-onset diabetic persons (diagnosis at or after 30 years of age) participating in baseline, 4-year, and 10-year examinations. MAIN OUTCOME MEASURE: Amputations of the lower extremities as reported by the participants. RESULTS: The 10-year cumulative incidence of lower-extremity amputation was 5.4% in younger-onset and 7.3% in older-onset persons. Multivariate analyses were performed by logistic regression. In younger-onset persons, age (odds ratio [OR] for 10 years, 2.0; 95% confidence interval [CI], 1.5-2.8), history of ulcers (OR,4.8; 95% CI, 2.3-9.9), diastolic blood pressure (OR, 2.1 for 10 mm Hg; 95% CI, 1.5-3.0), glycosylated hemoglobin level (OR, 1.4 for 1%; 95% CI, 1.2-1.6), sex (OR, 5.2 for men; 95% CI, 2.2-12.3), and retinopathy (OR, 1.2 for 2 steps; 95% CI, 1.1-1.4) were significantly associated with incidence of lower-extremity amputation. In older-onset persons, history of ulcers (OR, 3.3; 95% CI, 1.6-6.8), glycosylated hemoglobin level (OR, 1.3 for 1%; 95% CI, 1.1-1.5), duration of diabetes (OR, 1.6 for 10 years; 95% CI, 1.1-2.5), sex (OR, 2.6 for men; 95% CI, 1.3-4.9), diastolic blood pressure (OR, 0.7 for 10 mm Hg; 95% CI, 0.5-1.0), and proteinuria (OR, 2.4; 95% CI, 1.0-5.7) were significantly associated with incidence of lower-extremity amputation. CONCLUSION: These data show there are several risk factors for lower-extremity amputation with potential for modification and preventive strategies.
Adolescent↗
Leisure time, sunlight exposure and cataracts.
Leisure time sunlight exposure is a small or insignificant portion of total sunlight exposure experienced by most people at high risk for cataract. Few studies have been undertaken to evaluate a possible causal relationship, and these have largely been in Western countries. Analyses of data from the National Health and Nutrition Examination Survey (1971-1972) failed to confirm a relationship between leisure time exposure and cataract, but suggested that total exposure to sunlight was significantly related to cataract. A case-control study of cataract in Iowa suggested that controls were more likely to have shielded their eyes from sunlight than cases. A study in Italy suggested a positive relationship between leisure time sunlight exposure and lens opacities. In the large population-based Beaver Dam Eye Study population, we evaluated estimates of sunlight exposure and cataracts. We did not find that more leisure time sunlight exposure was associated with lens opacities. However, in men, estimates of lifetime exposure to ultraviolet-B were associated with cortical cataract. In summary, there is evidence to suggest that sunlight exposure may be related to cataract in diverse populations. Leisure time sunlight exposure is probably responsible for a small portion of that exposure.
Adult↗
The Wisconsin Epidemiologic Study of Diabetic Retinopathy: VIII. The incidence of retinal photocoagulation.
The incidence of focal and panretinal photocoagulation and its relationship to demographic and other characteristics were examined in a population-based study of people with diabetes in southern Wisconsin. For participants whose age at diagnosis was less than 30 years, who were taking insulin, and who had not been previously treated with photocoagulation, the 4 year incidence of panretinal photocoagulation (10.8%) was significantly higher (p less than .0001) than the rate of focal and/or grid photocoagulation of the macula (4.3%). For those whose age at diagnosis was 30 years or older and who had not been previously treated with photocoagulation, the incidence rates of panretinal photocoagulation (4.4%) and focal and/or grid photocoagulation of the macula (3.1%) were not significantly different (p = .11). At follow-up examination, 33.8% of the eyes of younger onset persons and 57.7% of the eyes of older onset persons with Diabetic Retinopathy Study high risk characteristics for severe visual loss had never received panretinal photocoagulation. These relatively high frequencies of untreated eyes in need of panretinal photocoagulation remain a concern.
Adult↗
Retinal microvascular abnormalities and their relationship with hypertension, cardiovascular disease, and mortality.
Retinal microvascular abnormalities, such as generalized and focal arteriolar narrowing, arteriovenous nicking and retinopathy, reflect cumulative vascular damage from hypertension, aging, and other processes. Epidemiological studies indicate that these abnormalities can be observed in 2-15% of the nondiabetic general population and are strongly and consistently associated with elevated blood pressure. Generalized arteriolar narrowing and arteriovenous nicking also appear to be irreversible long-term markers of hypertension, related not only to current but past blood pressure levels as well. There are data supporting an association between retinal microvascular abnormalities and stroke, but there is no convincing evidence of an independent or direct association with atherosclerosis, ischemic heart disease, or cardiovascular mortality. New computer-related imaging methods are currently being developed to detect the presence and severity of retinal arteriolar narrowing and other microvascular characteristics. When reliably quantified, retinal microvascular abnormalities may be useful as risk indicators for cerebrovascular diseases.
Cardiovascular Diseases↗
An international classification and grading system for age-related maculopathy and age-related macular degeneration. The International ARM Epidemiological Study Group.
A common detection and classification system is needed for epidemiologic studies of age-related maculopathy (ARM). Such a grading scheme for ARM is described in this paper. ARM is defined as a degenerative disorder in persons > or = 50 years of age characterized on grading of color fundus transparencies by the presence of the following abnormalities in the macular area: soft drusen > or = 63 microns, hyperpigmentation and/or hypopigmentation of the retinal pigment epithelium (RPE), RPE and associated neurosensory detachment, (peri)retinal hemorrhages, geographic atrophy of the RPE, or (peri)retinal fibrous scarring in the absence of other retinal (vascular) disorders. Visual acuity is not used to define the presence of ARM. Early ARM is defined as the presence of drusen and RPE pigmentary abnormalities described above; late ARM is similar to age-related macular degeneration (AMD) and includes dry AMD (geographic atrophy of the RPE in the absence of neovascular AMD) or neovascular AMD (RPE detachment, hemorrhages, and/or scars as described above). Methods to take and grade fundus transparencies are described.
Aged↗
Does the severity of diabetic retinopathy predict pregnancy outcome?
The authors sought to determine whether the severity of diabetic retinopathy is a predictor of subsequent pregnancy outcome. One hundred and seventy-nine pregnant diabetic women were evaluated in their first trimester of pregnancy. Stereoscopic color photographs of the ocular fundus were taken and graded by the Fundus Photography Reading Center. Thirty-nine women had no retinopathy, while 28 had proliferative retinopathy in the worse eye. The women's history and hospital delivery room charts were reviewed with regard to pregnancy outcome. Thirty-three pregnancies terminated with an adverse outcome. A logistic regression analysis was used to evaluate significant predictors of pregnancy outcome. Of maternal age, duration of diabetes, glycosylated hemoglobin, proteinuria, cigarette smoking status, and severity of diabetic retinopathy, only the last variable significantly predicted an adverse outcome. These data suggest that the severity of retinopathy should be considered when counseling a pregnant diabetic woman.
Adolescent↗
Is peak expiratory flow rate a predictor of complications in diabetes? The Wisconsin Epidemiologic Study of Diabetic Retinopathy.
The Objective of this study was to determine whether peak expiratory flow rate is a predictor of complications of diabetes. Peak expiratory flow rate was measured at the 10-year follow-up (third examination) of a cohort of persons with younger-onset diabetes. The relationships of progression of diabetic retinopathy by two steps, progression to proliferative retinopathy and of incidences of macular edema, sore or ulcers on feet or ankles, lower extremity amputation, proteinuria, and cardiovascular disease 4 years after this examination with respect to peak expiratory flow rate were evaluated. Study procedures including measurements of blood pressure, height and weight, grading of fundus photographs, peak expiratory flow rate, urinalysis, and medical history were performed according to standard protocols. Peak expiratory flow rate was not associated in univariate analyses with progression of retinopathy, incidences of proliferative retinopathy, macular edema or lower extremity amputation, sores or ulcers on feet or ankles, gross proteinuria, or self-reported cardiovascular disease. However, when using multivariable models to include the effects of other risk factors, peak expiratory flow rate was significantly associated with the combined incidences of sores or ulcers on feet and ankles, or lower extremity amputations (OR=0.61, 95% CI 0.42-0.88). These data suggest that peak expiratory flow rate is a predictor of subsequent complications in the lower extremities in those with long duration of younger-onset diabetes. Evaluating this association in an incipient cohort would illuminate whether the relationship we found is likely to be causal.
Adult↗
Survival following alpha particle pituitary irradiation for diabetic retinopathy.
The purpose of this study was to evaluate the mortality experience of persons with longstanding diabetes who had received pituitary irradiation for diabetic retinopathy compared to a matched group of persons with diabetes who had not had pituitary ablation. The irradiated cohort consisted of 167 patients treated at the Donner Pavilion (Lawrence Berkeley Laboratory, University of California, Berkeley), and the comparison cohort was the population evaluated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). Survival analyses were performed comparing the two cohorts using three different sets of matching criteria, each more restrictive than the previous analyses. The three different strategies were (1) matched only on severity of diabetic retinopathy; (2) matched on severity of retinopathy and age; and (3) matched on severity of retinopathy, age, gender, and hypertension status. Tests of comparison were the log-rank test, the Wilcoxon test, and the likelihood ratio test. For the model matching only on severity of retinopathy, mean survival was 8.3 years for the WESDR group and 9.4 years for the ablated group (p > 0.05 for all three statistical tests). For the model matched on retinopathy and age, mean survival was 8.9 years for the WESDR group and 9.2 years for the ablated group (p=0.05 log-rank test, 0.32 Wilcoxon test, and 0.06 likelihood ratio test). For the model matching on retinopathy, age, gender, and hypertension status, mean survival was 8.9 years for the WESDR group and 11.6 years for the ablated group (p=0.72 log-rank test, 0.08 Wilcoxon test, and 0.82 likelihood ratio test). These data are compatible with the notion that pituitary ablation, and therefore induced pituitary growth hormone deficiency, may not decrease survival in those with severe diabetic retinopathy.
Adult↗
Diphtheria and hearing loss.
OBJECTIVE: To determine if infectious diseases usually experienced in childhood have an effect on hearing ability later in life. METHODS: The Epidemiology of Hearing Loss Study (N = 3,753) is a population-based study of age-related hearing loss in adults aged 48 to 92 years in Beaver Dam, Wisconsin. As part of this study, infectious disease history was obtained and hearing was tested using pure-tone audiometry. Hearing loss was defined as a pure-tone average of thresholds at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz greater than 25 decibels hearing level in either ear. RESULTS: After adjusting for confounders, only a history of diphtheria (n = 37) was associated with hearing loss (odds ratio [OR] 2.79; 95% confidence interval [CI] 1.05, 7.36). There was no relationship between hearing loss and history of chickenpox, measles, mumps, pertussis, polio, rheumatic fever, rubella, or scarlet fever. Only two participants with a history of diphtheria and hearing loss reported having a hearing loss before age 20. CONCLUSIONS: Diphtheria in childhood may have consequences for hearing that do not become apparent until later in life. A possible biological mechanism for a diphtheria effect on hearing ability exists: The toxin produced by the Corynebacterium diphtheriae bacteria can cause damage to cranial nerves and therefore may affect the auditory neural pathway. These data may have important implications for areas facing a resurgence of diphtheria cases.
Adult↗
The Beaver Dam Health Outcomes Study: initial catalog of health-state quality factors.
The Beaver Dam Health Outcomes Study (BDHOS) is an ongoing longitudinal cohort study of health status and health-related quality of life for a random sample of adults (age range at interview was 45 to 89 years; mean = 64.1, SD = 10.8) in a community population. In a face-to-face interview lasting approximately an hour, each participant responds to several batteries of questions. Included are a history of chronic medical conditions, current medications, and past surgeries; the SF-36 (a general health-status questionnaire); the Quality of Well-being index; self-rated health status on a five-point scale from "excellent" to "poor"; and evaluation of current health using the method of time tradeoffs. The authors present results from 1,356 interviews on these four principal measures, reporting mean scores by sex, by age, and for persons reporting being affected by various medical conditions. They believe data from the BDHOS will provide researchers and policy makers a reference collection of vital statistics for health-related quality of life. Additionally, the data provide a way to compare results from studies that utilize different indices from among the four principal measures of the BDHOS.
Adult↗
Predicting Quality of Well-being scores from the SF-36: results from the Beaver Dam Health Outcomes Study.
BACKGROUND: The SF-36 and the Quality of Well-being index (QWB) both quantify health status, yet have very different methodologic etiologies. The authors sought to develop an empirical equation allowing prediction of the QWB from the SF-36. DATA: They used empirical observations of SF-36 profiles and QWB scores collected in interviews of 1,430 persons during the Beaver Dam Health Outcomes Study, a community-based population study of health status, and 57 persons from a renal dialysis clinic. METHOD: The eight scales of the SF-36, their squares, and all pairwise cross-products, were used as candidate variables in stepwise and best-subsets regressions to predict QWB scores using 1,356 interviews reported in a previous paper. The resulting equation was cross-validated on the remaining 74 cases and using the renal dialysis patients. RESULTS: A six-variable regression equation drawing on five of the SF-36 components predicted 56.9% of the observed QWB variance. The equation achieved an R2 of 49.5% on cross-validation using Beaver Dam participants and an R2 of 58.7% with the renal dialysis patients. An approximation for computing confidence intervals for predicted QWB mean scores is given. CONCLUSION: SF-36 data may be used to predict mean QWB scores for groups of patients, and thus may be useful to modelers who are secondary users of health status profile data. The equation may also be used to provide an overall health utility summary score to represent SF-36 profile data so long as the profiles are not severely limited by floor or ceiling effects of the SF-36 scales. The results of this study provide a quantitative link between two important measures of health status.
Activities of Daily Living↗
A pilot study of glaucoma visual field screening in diabetes.
Because people with diabetes may be at increased risk of glaucoma, we performed a pilot study using automated visual field testing for screening them. One hundred and seventy-six diabetic persons who had participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy were tested with the Armaly-Drance screening pattern on the Humphrey Visual Field Analyzer. Individuals with moderate diabetic retinopathy or worse tended to have lower sensitivity of the central visual field and missed more points than those with no or only mild retinopathy. People with a history of glaucoma had slightly less sensitivity and missed more points than controls. These preliminary findings suggest that although people with diabetes and glaucoma may more frequently have visual field defects than people with diabetes but no glaucoma, a larger study is needed. This pilot study shows that such a study would be feasible and should be designed to indicate the sensitivity, specificity, and cost-benefit ratio of a screening program so as to assess the utility of the screening visual field test for finding glaucoma amongst people with diabetes.
Adult↗