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Biomedical subjects

B M Stults

Publications and source records attributed to B M Stults.

30 records · Page 2Linked to original sources
PubMed1988

Family history as an independent risk factor for incident coronary artery disease in a high-risk cohort in Utah.

To test independence of family history of coronary artery disease (CAD) as a risk factor for the development of new clinical CAD, data collected at 2 clinic visits on 1,196 men and women, ages greater than 20 years, were analyzed using Cox proportional hazard method. During a mean follow-up of 2.5 years, 16 new CAD cases were observed. After adjustment for age, sex, total cholesterol, high density lipoprotein cholesterol, hypertension, diabetes, cigarette smoking and body mass index, family history remained a highly significant predictor of future CAD (p = 0.0017). Only age was a more significant covariate (p = 0.0001) than family history. Sex (p = 0.00074) and serum total cholesterol (p = 0.015) also contributed significantly to CAD incidence while high density lipoprotein cholesterol, hypertension, diabetes, body mass index and several interaction terms did not improve the prediction in this population. These results provide evidence for the existence of other heritable risk factors which appear to contribute strongly to the occurrence of early CAD in many high-risk families.

Adult↗
PubMed1988

Familial dyslipidemic hypertension. Evidence from 58 Utah families for a syndrome present in approximately 12% of patients with essential hypertension.

Population-based sibships with essential hypertension diagnosed before the age of 60 years are being screened in Utah to find two or more hypertensive siblings with the same biochemical abnormality as a clue to an inherited cause for their specific type of hypertension. Among 131 hypertensive subjects in 58 sibships, concordant abnormalities in fasting serum lipid concentrations were observed in two or more siblings in 48% of the sibships. After adjusting for effects of antihypertensive medications, abnormal values reported in only 10% of the Lipid Research Clinics data were observed in 30% of patients for serum triglycerides, 19% for serum low-density lipoprotein cholesterol, and 39% for high-density lipoprotein cholesterol. More than one lipid level was abnormal in almost all concordant sibships, suggesting an association between hypertension and a syndrome of mixed lipid abnormalities, probably familial combined hyperlipidemia (renamed "familial combined dyslipidemia" because of common low high-density lipoprotein cholesterol levels). We conclude that familial dyslipidemic hypertension may be a specific syndrome with lipid abnormalities more severe than blood pressure elevations.

Adult↗
PubMed1988

A digoxin-like factor associates with erythrocyte sodium concentration, sodium transport, and ouabain binding.

To investigate what effects a circulating digoxin-like factor (DLF) might have on sodium metabolism, we examined data collected on 1,327 individuals screened in the Cardiovascular Genetics Clinic at the University of Utah. This sample included 639 unmedicated adults, 582 youths under age 18, and 106 medicated hypertensive individuals, all on an unrestricted diet when attending clinic. No individuals look digitalis. A digoxin assay detected measurable levels of plasma DLF in 13.4% of the youths, 17.2% of the normotensive adults, and 25.5% of the hypertensive adults. In all three groups of individuals, those with a measurable DLF had a significantly lower erythrocyte ouabain sensitive sodium efflux rate constant (adjusted for age, sex and body mass) than those with no measurable DLF (p less than 0.01). Normotensive and hypertensive adults with measurable DLF also had an increased erythrocyte intracellular sodium level. Either the number of ouabain binding sites and/or the apparent affinity for ouabain were reduced for those with DLF levels in all three groups. There was a small nonsignificant increase in blood pressure for the normotensive adults and youths with a measurable DLF. We conclude that plasma DLF is associated with reduced ouabain sensitive sodium transport and increased intracellular sodium concentration, possibly due to changes in the number of or the competition for the Na+ - K+ ATPase sites.

Adult↗
PubMed1988

Definition of genetic factors in hypertension: a search for major genes, polygenes, and homogeneous subtypes.

Essential hypertension is a heterogeneous group of disorders with different causes. This report reviews approaches taken and results found in current studies of the genetic and environmental determinants of essential hypertension. Recent observations from the University of Utah Cardiovascular Genetics Research Clinic and published data from other studies are cited. Several biochemical tests show strong associations with hypertension and substantial major gene and/or polygenic determination including: urinary kallikrein excretion, intracellular sodium concentration, sodium-lithium countertransport, plasma haptoglobin phenotypes, MN blood groups, and familial dyslipidemia.

Genes↗
PubMed1987

Blood pressure reactivity in adult male twins.

The purpose of the present investigation was to examine possible genetic contributions to cardiovascular reactivity by contrasting patterns of association in 82 monozygotic (MZ) and 88 dizygotic (DZ) adult male twin pairs (age range = 21 to 61 years, M = 35 years). Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were recorded during baseline and during a mental arithmetic task (i.e., serial subtraction). The task produced significant elevations in all three cardiovascular measures (i.e., 10 mmHg SBP, 8 mmHg DBP, and 6 bpm HR, respectively). Levels of SBP and DBP reactivity were significantly correlated in MZ pairs but not in DZ pairs. Statistical tests suggest a heritability estimate of about 50% that was marginally significantly for SBP and DBP changes during the task. There was no indication of a genetic influence on HR reactivity. Resting level and static task period measures of SBP, DBP, and HR demonstrated statistically significant heritability estimates of 60% to 80%.

Adult↗
PubMed1986

Preventive cancer care for the elderly.

There is a great need for effective cancer prevention programs for the elderly. Unfortunately, the elderly have been omitted from most studies of cancer prevention; little is currently known concerning the benefits, risks, and feasibility of most primary and secondary cancer prevention measures in this segment of the population. Available data justify annual casefinding activities in the office of the primary care physician for breast cancer in elderly women and colorectal cancer in elderly persons of both sexes. PAP smear screening is also indicated for elderly women who have had few or no PAP smear in the past. There is some evidence that the health beliefs and practices of elderly persons and their physicians may impede the utilization of available cancer prevention measures. Further research is needed to define the efficacy of cancer prevention measures for the elderly and to improve the delivery of these measures to the elderly population.

Aged↗
PubMed1984

Preventive health care for the elderly.

Demographic, economic and humanitarian considerations dictate that effective preventive health care be provided to the elderly. A disease-specific approach to geriatric preventive health care will not suffice; measures to enhance or maintain physical, mental and social function must also be emphasized. Unfortunately, the effectiveness of many preventive care procedures has not been adequately investigated in the elderly. Research is urgently needed to determine the efficacy of and appropriate target population for various geriatric preventive health care measures.

Accident Prevention↗
PubMed1983

Effect of erythromycin stearate on serum theophylline concentration in patients with chronic obstructive lung disease.

The effect of erythromycin stearate (ES) on serum theophylline concentration (STC) was studied in 15 male adult subjects taking maintenance oral theophylline for clinically stable chronic obstructive lung disease. Steady-state trough STCs were measured before and after two- and seven-day courses of ES, 500 mg every six hours. For the group as a whole, there was no significant increase in trough STC after either course of ES therapy, but five of 15 subjects exhibited increases in trough STC ranging from 4 to 8 micrograms/ml (mean increase of 5.4 micrograms/ml) within 48 to 96 hours of beginning ES therapy. Clinical theophylline toxicity developed in one of these subjects. Based on this study and others in the literature, erythromycin preparations may induce a clinically significant and potentially toxic increase in STC in a variable proportion of patients taking maintenance theophylline therapy.

Administration, Oral↗
PubMed1983

Influenza vaccination and theophylline pharmacokinetics in patients with chronic obstructive lung disease.

Total Theophylline clearance rate was measured before and 24 hours after standard influenza vaccination in seven men with stable chronic obstructive lung disease. In four, total theophylline clearance rate was also measured 48 hours after vaccine administration. There was no significant change in the clearance rate after either time interval. These results do not support recent recommendations to monitor serum theophylline concentrations or reduce theophylline dosage during the 48-hour period following influenza vaccination. Nevertheless, pending further studies, patients maintained on a regimen of theophylline preparations should be followed clinically for theophylline toxicity for the first several days after receiving influenza vaccine.

Aged↗
PubMed1982

Digoxin use in the elderly.

The current extensive use of digoxin in elderly patients with left ventricular failure and sinus rhythm may not be clinically justifiable; in a significant proportion of these patients the frequency of digitalis toxicity may outweight the therapeutic benefits of the drug. When digoxin is used in elderly patients, the specific geriatric pharmacology of the drug must be considered. Clinical benefit should be documented before proceeding to long-term maintenance therapy. In selected elderly patients, withdrawal of digoxin with careful follow-up may be a worthwhile procedure. Studies are needed comparing the relative benefits and toxicities of digoxin versus diuretics in the management of heart failure in the elderly.

Adult↗
PubMedDate not supplied

Apolipoprotein, low density lipoprotein subfraction, and insulin associations with familial combined hyperlipidemia. Study of Utah patients with familial dyslipidemic hypertension.

Familial dyslipidemic hypertension (FDH) is a syndrome recently described from sibships selected for early familial hypertension and found to have one or more of three fasting lipid abnormalities [high triglycerides, low high density lipoprotein (HDL) cholesterol, high low density lipoprotein (LDL) cholesterol]. In further analyses of these same 131 hypertensive subjects, apolipoprotein A-I and B, fasting plasma insulin (adjusted for body mass index), and detailed anthropometrics were different in two subgroups of FDH. Of 63 FDH patients, 19 met the criteria for familial combined hyperlipidemia (FCHL); 44 did not, but still had high triglyceride and/or low HDL cholesterol levels. When compared to 20 normolipidemic hypertensive patients, the 19 hypertensive patients with FCHL had 196% higher very low density lipoprotein cholesterol (p = 0.0001), 33% higher apolipoprotein B (p = 0.0002), smaller LDL particles (p = 0.007), and 73% higher fasting insulin (p = 0.003), but no significant differences in body mass index or skinfold thicknesses. The other 44 FDH patients without FCHL had 33% lower HDL (p = 0.0001), with only 8% lower apolipoprotein A-I levels (p = 0.20); significantly higher subscapular skinfolds (p = 0.02), weights (p = 0.002), body mass index (p = 0.006), knee widths (p = 0.0007), and wrist circumferences (p = 0.0009); smaller, denser LDL subfractions (p = 0.001); and increased apolipoprotein B levels (p = 0.01) compared to the normolipidemic hypertensive group. Increased fasting insulin levels were similar to the normolipidemic group and significantly lower than the FCHL group after adjustment for body mass index, suggesting a relationship between obesity and fasting insulin levels only in the non-FCHL group. We conclude that FDH consists of at least two subgroups: 1) FCHL with high apolipoprotein B, small LDL particles, and increased fasting plasma insulin levels, and 2) a less well-defined residual having upper central obesity with low HDL cholesterol and high triglyceride levels. Elevated insulin levels found in both groups, but possibly originating through different physiological mechanisms, may provide the pathophysiological connections between dyslipidemia, obesity, and hypertension.

Apolipoprotein A-I↗