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Biomedical subjects

D E Grobbee

Publications and source records attributed to D E Grobbee.

At least 343 records · Page 19Linked to original sources
PubMed1996

Increase in hospital admission rates for heart failure in The Netherlands, 1980-1993.

OBJECTIVE: To study the trend in hospital admission rates for heart failure in the Netherlands from 1980 to 1993. DESIGN: All hospital admissions in the Netherlands with a principal discharge diagnosis of heart failure were analysed. In addition, individual records of heart failure patients from a subset of 7 hospitals were analysed to estimate the frequency and timing of readmissions. RESULTS: The total number of discharges for men increased from 7377 in 1980 to 13 022 in 1993, and for women from 7064 to 12 944. From 1980 through 1993 age adjusted discharge rates rose 48% for men and 40% for women. Age adjusted in-hospital mortality for heart failure decreased from 19% in 1980 to 15% in 1993. For all age groups in-hospital mortality for men was higher than for women. The mean length of hospital admissions in 1993 was 14.0 days for men and 16.4 days for women. A review of individual patient records from a 6.3% sample of all hospital admissions in the Netherlands indicated that within a 2 year period 18% of the heart failure patients were admitted more than once and 5% more than twice. CONCLUSIONS: For both men and women a pronounced increase in age adjusted discharge rates for heart failure was observed in the Netherlands from 1980 to 1993. Readmissions were a prominent feature among heart failure patients. Higher survival rates after acute myocardial infarction and the longer survival of patients with heart disease, including heart failure may have contributed to the observed increase. The importance of advances in diagnostic tools and of possible changes in admission policy remain uncertain.

Age Distribution↗
PubMed1996

Incidence and risk factors of ischaemic and haemorrhagic stroke in Europe. EUROSTROKE: A collaborative study among research centres in Europe: rationale and design.

EUROSTROKE is a collaborative study among ten European research centres to investigate (1) the variation in incidence of fatal and non-fatal ischaemic and haemorrhagic stroke among populations in different European countries; (2) whether the observed differences in stroke incidence across countries can be explained by differences in prevalence of established cardiovascular risk factors; (3) the relative importance of selected dietary factors (potassium intake, smoking, alcohol consumption), haemostatic disturbances (fibrinogen) and co-morbidity (rheumatic heart disease, atrial fibrillation) compared to established risk factors as determinants of the occurrence of ischaemic and haemorrhagic stroke. The EUROSTROKE database is drawn from ten European population-based prospective follow-up studies (cohorts) and is designed as a case-control study nested within these ten ongoing studies.

Aged↗
PubMed1996

Antithrombin and atherosclerosis in the Rotterdam Study.

Antithrombin is a potent inhibitor of thrombotic tendency. Whether atherosclerotic disease is associated with high or low antithrombin is unclear. Studies of the relation between antithrombin and presence of arterial disease have shown contrasting results. In the Rotterdam Study, a single-center, population-based cohort study of 7983 subjects aged 55 years and older, the association between atherosclerosis and antithrombin was evaluated. The ratio of ankle to arm blood pressure is a graded marker for atherosclerosis and provides the opportunity to investigate nonlinear associations. In the first 1427 participants of the Rotterdam Study who did not use anticoagulants, both antithrombin and the ratio of ankle to arm blood pressure were measured. In men the association between the two was quadratic: antithrombin activity was increased in men with moderate peripheral arterial atherosclerosis compared with those without, and in men with more severe atherosclerosis it was decreased. In women the association was linear: a decreased ratio of ankle to arm pressure was associated with increased antithrombin activity. These associations were independent of smoking, body mass index, serum lipids, fibrinogen, and factor VIIc. We propose that antithrombin activity rises in response to increased risk of cardiovascular disease and also in response to the presence of atherosclerosis, whereas antithrombin may decrease with increasing severity of the atherosclerotic process in men. This may explain the contrasting results found in previous studies. Changes in antithrombin over time might be useful in predicting the risk of cardiovascular disease and progression.

Aged↗
PubMed1996

Prevalence of stroke in the general population. The Rotterdam Study.

BACKGROUND AND PURPOSE: We assessed the prevalence of self-reported and medically confirmed stroke and the degree to which the event had led to hospitalization. METHODS: From all participants of the Rotterdam Study, a population-based cohort study of 7983 subjects aged 55 years and older living in a suburb of Ommoord in Rotterdam, information on stroke history was obtained by the question, "Did you ever suffer from a stroke, diagnosed by a physician?" Supplementary medical information was obtained from general practitioner or hospital discharge records. RESULTS: Prevalence of self-reported stroke was 2.5% in men aged 55 to 64 years, 5.0% in men aged 65 to 74 years, 8.9% in men aged 75 to 84 years, and 11.6% in men aged 85 years or older. Corresponding figures for women were 1.6%, 3.3%, 6.7%, and 10.5%, respectively. Of the self-reported strokes, 67% could be confirmed by medical information. In 53% (95% confidence interval, 47% to 60%) of subjects with a confirmed stroke, the event had led to hospital admission. The proportion of hospitalized patients decreased with age. CONCLUSIONS: The present study provides valid age- and sex-specific estimates of prevalence of stroke. A substantial proportion of patients with stroke is not hospitalized.

Aged↗
PubMed1996

Gender differences in the associations between cortisol and insulin in healthy subjects.

To investigate the role of cortisol in the etiology of insulin resistance in men and women, we examined 218 healthy non-hospitalized elderly, selected from the Rotterdam Study. Free cortisol was assessed by the ratio of fasting serum cortisol over corticosteroid-binding globulin (CBG), and insulin resistance was estimated by the fasting insulin level. CBG was higher in women and decreased with age. In both men and women, the early morning free cortisol level showed no association with age or waist/hip ratio. In men, an inverse association between cortisol and body mass index was observed. In women, higher cortisol levels were associated with increased insulin levels; an increase of 9.7 mU/l insulin per unit cortisol/CBG (S.E. 3.9, P = 0.01). The association did not change after adjustment for age, body mass index or waist/hip ratio. The results of this study in elderly subjects suggest that in women cortisol may be implicated in the age-associated insulin resistance.

Age Factors↗
PubMed1996

Plasma fibrinogen in NIDDM: the Rotterdam study.

OBJECTIVE: To compare plasma fibrinogen levels across groups of subjects with and without NIDDM with respect to diabetes therapy and to evaluate the influence of metabolic control and other selected factors. RESEARCH DESIGN AND METHODS: In a cross-sectional study, plasma fibrinogen was measured in 2,971 elderly subjects aged 55 years and older (mean age 70.8 years). This was part of the baseline examination of the Rotterdam Study, a population-based study of chronic diseases in the elderly. RESULTS: Plasma fibrinogen levels did not differ among subjects with and without NIDDM (2.84 vs. 2.81 milligrams, P = 0.5). After adjustment for age, sex, smoking, BMI, and waist-to-hip ratio, the plasma fibrinogen levels were higher in subjects receiving insulin therapy. In those without diabetes (n = 2,640), with diabetes but not taking antidiabetes medication (n = 196), taking oral medication (n = 99), and taking insulin (n = 36), the age- and sex-adjusted fibrinogen levels were 2.82 (SE 0.01), 2.79 (0.05), 2.79 (0.07), and 3.23 (0.11) milligrams, respectively (P < 0.005). Adjustment for leukocyte count or serum creatinine level did not affect the observed association, while adjustment for fructosamine decreased the differences. CONCLUSIONS: Plasma fibrinogen levels are elevated in insulin-treated NIDDM patients, which may reflect worse metabolic control in this subgroup.

Age Factors↗
PubMed1996

Decline of coronary heart disease mortality in The Netherlands from 1978 to 1985: contribution of medical care and changes over time in presence of major cardiovascular risk factors.

OBJECTIVE: To study the relative contributions of medical care and changes in cardiovascular risk factors to the decline in coronary heart disease (CHD) mortality in The Netherlands from 1978 to 1985. METHODS: The number of potential CHD deaths prevented in this period was estimated by subtracting the number of observed CHD deaths from the number of deaths that would have occurred without any change in age-specific CHD mortality. In addition, the number of myocardial infarctions over this period was determined. Using estimates of risk associated with smoking, based on national and international data, of effects of changes in total cholesterol level, of benefits of antihypertensive drug treatment and effects of different intervention strategies in subjects with a previous myocardial infarction, we calculated the relative contribution of the separate factors to the decline in CHD mortality. RESULTS: The estimated contribution of treatment in coronary care units, postinfarction treatment and coronary bypass grafting to the fall in CHD mortality was 46%. Approximately 44% of the decline in CHD mortality could be attributed to primary prevention efforts (cessation of smoking, change in cholesterol level and treatment of hypertension). CONCLUSION: On the basis of available estimates of the potential effects of primary and secondary prevention it seems likely that a sizeable proportion of the age-specific reduction in mortality in The Netherlands during the period 1978-85 could have resulted from these measures. However, our findings should be considered to be estimates illustrating the relative benefits of different strategies rather than absolute figures.

Adrenergic beta-Antagonists↗
PubMed1996

Association of the insulin-receptor variant Met-985 with hyperglycemia and non-insulin-dependent diabetes mellitus in the Netherlands: a population-based study.

One of the characteristics of non-insulin-dependent diabetes mellitus (NIDDM) is the presence of insulin resistance. Most NIDDM patients have a normal sequence of the insulin receptor, indicating that, if insulin-receptor mutations contribute to the development of NIDDM, they will be present only in a minor fraction of the NIDDM population. The goal of the present study was to examine whether insulin-receptor mutations contribute to the development of NIDDM. We examined 161 individuals with NIDDM and 538 healthy controls from the population-based Rotterdam study for the presence of mutations in the insulin-receptor gene by SSCP. A heterozygous mutation changing valine-985 into methionine was detected in 5.6% of diabetic subjects and in 1.3% of individuals with normal oral glucose tolerance test. Adjusted for age, gender, and body-mass index, this revealed a relative risk for diabetes of 4.49 (95% confidence interval 1.59-12.25) for Met-985 carriers. When the total study group was analyzed, the prevalence of the mutation increased with increasing serum glucose levels (test for trend P < .005). We conclude that the Met-985 insulin-receptor variant associates with hyperglycemia and represents a risk factor for NIDDM.

Blood Glucose↗
PubMed1996

Cardiovascular response to physical stress in offspring of hypertensive parents: Dutch Hypertension and Offspring Study.

Blood pressure (BP) regulatory mechanisms were studied in youngsters with contrasting risks for hypertension, based on parental history, during physical stress. As a static exercise, an isometric handgrip task (22% of maximal force during 5 min) was used and a dynamic exercise task was performed on a bicycle ergometer. At rest and during stress, BP and heart rate were recorded. In order to study the adaptation of the cardiovascular system to physical stress, cardiac output and total peripheral resistance were measured in addition to indices of vagal and sympathetic influences on the heart. Heart rate and cardiac output declined significantly more in offspring of hypertensive parents during static exercise (difference in heart rate: -2.5 +/- 1.2 bpm, P = 0.04; difference in cardiac output: -9.0 +/- 4.6%, P = 0.05). This is most likely the result of a larger increase in the total peripheral resistance in youngsters at risk (difference: 13.2 +/- 6.8%, P = 0.06). No differences between the two groups were found in reactivity of BP or in the indices of sympathetic activation or vagal inhibition of the heart. The offspring of hypertensive parents showed an attenuated increase in stroke volume during the dynamic exercise task (difference at the first cycling level: -11.5 +/- 5.4%, P = 0.04), while no difference in neural activity or heart rate was found. Youngsters with a parental history of hypertension show an enhanced reactivity of total peripheral resistance during static exercise. This does not lead to a higher BP response in this group, most probably because of a larger decrease of the cardiac output. During dynamic exercise the physiological increase in stroke volume is blunted in offspring of hypertensive parents.

Adolescent↗
PubMed1995

Aneurysms of the abdominal aorta in older adults. The Rotterdam Study.

To assess the age- and sex-specific prevalence and risk factors for aneurysms of the abdominal aorta, the authors performed a population-based study in 5,419 subjects (42% men, 58% women) aged 55 years and over. The proximal and distal diameter of the abdominal aorta were measured by ultrasound. An aneurysm was defined as a distal aortic diameter of 35 mm or more or a dilatation of the distal part of the the abdominal aorta of 50% or more. The mean distal and proximal aortic diameter increased 0.7 mm and 0.3 mm, respectively, with every 10 years of age. In 2.1% (95% confidence interval (CI) 1.7-2.5) of the study population, an aneurysm was present, or in 4.1% (95% CI 3.2-4.9) of the men and 0.7% (95% CI 0.4-1.0) of the women. Subjects with an abdominal aneurysm were more likely to be smokers and they had higher serum cholesterol levels and higher prevalence of cardiovascular disease compared with subjects without an aneurysm. The authors conclude that the ultrasound diameter of the abdominal aorta clearly increases with age in both men and women and that the prevalence of aneurysms of the abdominal aorta in older adults in relatively high, especially in men.

Age Distribution↗
PubMed1995

[Locomotor disability in the elderly; the ERGO Study (Erasmus Rotterdam Health and the Elderly). ERGO Study Group].

OBJECTIVE: Determination of the prevalence of locomotor disability and its association with signs and symptoms of the hips and knees in a Dutch general population aged 55 years and over. DESIGN: Cross-sectional population-based study. SETTING: Rotterdam-Ommoord, the Netherlands. METHOD: During home interviews of 1,901 men and 3,132 women aged 55 years and over living in the Ommoord district of Rotterdam, locomotor disability was assessed using the Health Assessment Questionnaire (HAQ). Morning stiffness and pain in the hips and knees during the past month were assessed. At the research centre weightbearing radiographs of the hips and knees were taken. Radiological osteoarthritis was defined as Kellgren score 2 or more. A complete physical examination of the hips and knees was performed. RESULTS: The prevalence of locomotor disability was 21.9% for independently living men and 36.0% for independently living women. In homes for the elderly these figures were 84.0% en 96.5%, respectively. There were significantly elevated age-adjusted odds ratios for locomotor disability for women, people in homes for the elderly, independently living men with only primary education, independently living participants with a below-median net annual income and widowed men in homes for the elderly. Taking the associations between the independent variables into account only morning stiffness, pain in the hips and knees and restricted flexion of the hips and knees were independently associated with locomotor disability in men. In women radiological osteoarthritis of the hips and knees, restricted endorotation of the hip, instability and valgus deformity of the knees were also associated with disability. CONCLUSION: The prevalence of locomotor disability in people aged 55 years and over in the general population was high and associated with female sex, low education, low income and living in a home for the elderly. Of the signs and symptoms of the hips and knees only pain in the hips and knees, morning stiffness and restricted flexion of the hip were independently associated with locomotor disability. Radiological osteoarthritis of the hip and knee did not contribute much to the explanation of locomotor disability.

Activities of Daily Living↗
PubMed1995

Diuretics, beta-blockers, and the risk for sudden cardiac death in hypertensive patients.

OBJECTIVE: To determine whether the use of non-potassium-sparing diuretics and beta-blockers is associated with an excess risk for sudden cardiac death in hypertensive patients. DESIGN: Case-control study. SETTING: Rotterdam, the Netherlands. PATIENTS: 257 case-patients who had died suddenly while receiving drug therapy for hypertension and 257 living controls also receiving drug therapy for hypertension. MEASUREMENTS: Detailed information on medication use and clinical characteristics of all case-patients and controls was collected from the files of general practitioners. Additional information on medication use was obtained from computerized pharmacy records. RESULTS: Patients receiving non-potassium-sparing diuretics had an increased risk for sudden cardiac death (relative risk, 1.8 [95% CI, 1.0 to 3.1]) compared with a reference group treated primarily with potassium-sparing diuretics. The corresponding relative risk for beta-blocker use was 1.7 (CI, 1.1 to 2.6). The use of non-potassium-sparing diuretics without beta-blockers was associated with a higher risk for sudden death (relative risk, 2.2 [CI, 1.1 to 4.6]) than was concomitant use of non-potassium-sparing diuretics and beta-blockers (relative risk, 1.4 [CI, 0.6 to 3.0]). The risk for sudden cardiac death among recipients of non-potassium-sparing diuretics was more pronounced in those who had been receiving the diuretic for less than 1 year and in those aged 75 years or younger. CONCLUSIONS: The use of non-potassium-sparing diuretics and beta-blockers is associated with an increased risk for sudden cardiac death. This association may offset part of the mortality benefit of these drugs in the treatment of hypertension.

Adrenergic beta-Antagonists↗
PubMed1995

[Prevalence of chronic diseases in the elderly; the ERGO study (Erasmus Rotterdam Health and the Elderly)].

In the Rotterdam Study, prevalence and determinants of chronic diseases in the elderly (age > or = 55 years), were investigated in inhabitants of Ommoord, a suburb of Rotterdam. The study focused on cardiac diseases (myocardial infarction, angina pectoris, cardiovascular risk factors), glaucoma, macular degeneration, osteoporosis, osteoarthrosis and invalidity, dementia (Alzheimer's disease, vascular dementia, Parkinson's disease), epilepsy, cerebrovascular accident. The number of participants was 7983 (3105 men, 4878 women), a response of 78%. The participants were interviewed and were twice examined in an out-patient clinic. The results will be described in subsequent issues of this journal.

Aged↗
PubMed1995

[Coronary heart disease in the elderly; the ERGO study (Erasmus Rotterdam Health and the Elderly)].

OBJECTIVE: To determine the prevalence of cardiovascular disease among elderly people and to investigate the use of cardiovascular medication in this group. DESIGN: Cross-sectional study. SETTING: A quarter in Rotterdam, the Netherlands. METHODS: As a part of the 'Rotterdam elderly study', the cardiovascular anamnesis of 7.983 responding persons > or = 55 years (3105 men and 4878 women) was obtained by means of a questionnaire. RESULTS: Twelve and 4% of men and women, respectively, had at some time had a myocardial infarction, and 5 and 4% a stroke. Almost 7% of both sexes had anamnestic symptoms of angina pectoris. Coronary bypass surgery and percutaneous transluminal coronary angioplasty were done in 4% and 1% of men and 1% and 0.5% of women, respectively. Of all participants 43% used at least one drug for cardiovascular purposes. Half of these used two or more, and a quarter used three or more drugs. Among women, diuretics were the most commonly used drug for cardiovascular purposes (21%), whereas among men beta-blocking agents were most common (15%). CONCLUSION: Cardiovascular diseases are common among elderly men and women. Many of them take at least one drug for cardiovascular purposes.

Aged↗
PubMed1995

[Risk factors for cardiovascular diseases in the elderly; the ERGO study (Erasmus Rotterdam Health and the Elderly)].

OBJECTIVE: To determine the prevalence of risk factors for cardiovascular disease among elderly people. DESIGN: Prospective cohort study. SETTING: A district of Rotterdam, the Netherlands. METHODS: As a part of the Rotterdam Study information about smoking habits, blood pressure, Quetelet index and serum cholesterol of 7,983 responding persons (78%) (3,105 men and 4,878 women) of 55 years and older was obtained by an interview and physical examination during two visits to a research center. RESULTS: Among men and women there were 29.7% and 16.7% smokers and 60.1% and 25.9% ex-smokers, respectively. Among men the proportion of smokers decreased from 31.0% in the age category 55-59 years to 15.9% in de category > or = 85 years, among women from 28.0% to 2.7%. Systolic blood pressure increased with age in both sexes, while diastolic blood pressure hardly changed. Hypertension (systolic blood pressure 160 mmHg and/or diastolic blood pressure > or = 95 mmHg at a single measurement and/or use of antihypertensive drugs) occurred in 23.3% of men and 28.0% of women. In men, total serum cholesterol decreased gradually with age, whereas in women there was a slight increase up to the category 70-74 years. No evident change in HDL cholesterol with increasing age was observed in men, but in women a decrease was observed until the same level was reached as in men. Thirty-five per cent of men and 49.5% of women had an elevated level of serum cholesterol (> or = 6.5 mmol/l). The prevalence of obesity (Quetelet index > 25 kg/m2) was about 50% in both men and women but was less in the categories from 75 years onwards. Approximately 80% of men and women had at least one risk factor, while in almost half of them two or more risk factors were found. CONCLUSION: Risk factors for cardiovascular disease are common among elderly people.

Aged↗
PubMed1995

Age-related macular degeneration is associated with atherosclerosis. The Rotterdam Study.

Age-related macular degeneration is the most frequent cause of blindness in the elderly. A vascular basis of the disease has been suggested, but not confirmed. The association between atherosclerosis and this type of macular degeneration was investigated in 104 subjects with and 1,324 subjects without macular degeneration as part of the population-based Rotterdam Study. The study was performed between March 1990 and July 1993 in a suburb of Rotterdam, the Netherlands. Macular degeneration was assessed on fundus photographs. Carotid atherosclerosis was ultrasonographically evaluated by measurement of the common carotid intima-media thickness and by assessment of the presence of atherosclerotic plaques. Atherosclerosis in arteries of the lower extremities was studied by determination of the ankle-arm systolic blood pressure ratio. In subjects younger than age 85 years, plaques in the carotid bifurcation were associated with a 4.7 times increased prevalence odds of macular degeneration (95% confidence interval (CI) 1.8-12.2); those with plaques in the common carotid artery showed an increased prevalence odds of 2.5 (95% CI 1.4-4.5). The intima-media thickness of the common carotid arteries was not significantly different. Lower extremity arterial disease (ankle-arm index less than 0.90 on at least one side) was associated with a 2.5 times increased prevalence odds (95% CI 1.4-4.5). These findings suggest that atherosclerosis may be involved in the etiology of age-related macular degeneration.

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