Macular degeneration and early menopause: a case-control study.
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Aged↗
Biomedical subjects
D E Grobbee
Publications and source records attributed to D E Grobbee.
Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study.
OBJECTIVE: To estimate the prevalence of dementia and its subtypes in the general population and examine the relation of the disease to education. DESIGN: Population based cross sectional study. SETTING: Ommoord, a suburb of Rotterdam. SUBJECTS: 7528 participants of the Rotterdam study aged 55-106 years. RESULTS: 474 cases of dementia were detected, giving an overall prevalence of 6.3%. Prevalence ranged from 0.4% (5/1181 subjects) at age 55-59 years to 43.2% (19/44) at 95 years and over. Alzheimer's disease was the main subdiagnosis (339 cases; 72%); it was also the main cause of the pronounced increase in dementia with age. The relative proportion of vascular dementia (76 cases; 16%), Parkinson's disease dementia (30; 6%), and other dementias (24; 5%) decreased with age. A substantially higher prevalence of dementia was found in subjects with a low level of education. The association with education was not due to confounding by cardiovascular disease. CONCLUSIONS: The prevalence of dementia increases exponentially with age. About one third of the population aged 85 and over has dementia. Three quarters of all dementia is due to Alzheimer's disease. In this study an inverse dose-response relation was found between education and dementia--in particular, Alzheimer's disease.
Aged↗
Bone density in non-insulin-dependent diabetes mellitus. The Rotterdam Study.
OBJECTIVE: To investigate the relation between non-insulin-dependent diabetes mellitus and bone mineral density at the lumbar spine and hip. DESIGN: Population-based study with a cross-sectional survey. SETTING: A district of Rotterdam, the Netherlands. PARTICIPANTS: 5931 residents (2481 men, 3450 women) of the district aged 55 years or more. MEASUREMENTS: Participants were classified as having non-insulin-dependent diabetes mellitus if they were receiving antidiabetic medication or if they had a serum glucose level of 11.1 mmol/L or more after a nonfasting oral glucose tolerance test. Bone mineral density, measured at the lumbar spine and proximal femur using dual-energy x-ray absorptiometry and the frequency of nonvertebral fractures during the preceding 5 years were compared between persons with and without non-insulin-dependent diabetes mellitus. RESULTS: 243 men and 335 women had non-insulin-dependent diabetes mellitus. Both men and women with this condition had substantially higher mean bone mineral density values at all four sites measured than those with normal glucose tolerance. The increase could not be explained by age; obesity; use of estrogens, thiazides, or loop diuretics; impairment in abilities of daily living; smoking; or osteoarthritis. Women with non-insulin-dependent diabetes mellitus reported having had fewer fractures in the 5 preceding years than women without this condition (adjusted odds ratio, 0.63; 95% CI, 0.44 to 0.90). The frequency of fractures in men was similar for those with and without non-insulin-dependent diabetes mellitus (adjusted odds ratio, 0.96; CI, 0.60 to 1.52). CONCLUSIONS: Men and women with non-insulin-dependent diabetes mellitus have increased bone mineral density. Non-insulin-dependent diabetes mellitus in women is associated with a lower frequency of nonvertebral fractures.
Aged↗
Triglyceride levels in sons of patients with coronary artery disease.
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Coronary Disease↗
European postmarketing surveillance of ramipril in hypertension. 1. Feasibility and study cohort.
A prospective observational cohort study of the angiotensin inhibitor, ramipril, was undertaken in four countries within the European Community-Netherlands, United Kingdom, Germany and Belgium. A total of 10,377 consecutive patients with essential hypertension were recruited to the study with the aim of follow-up for one year. Overall 37% of doctors who agreed to participate in the study actually enrolled at least one patient. One third of the doctors who enrolled patients in the study entered two thirds of patients studied. Some 15% of participating males and 27% of females were aged over 70 years. Newly diagnosed hypertensives comprised 22% of the study cohort, the proportion being highest in UK and Netherlands, whereas 53% were established hypertensives of two or more years' duration, the proportion being highest in Germany and Belgium. There were substantial differences among the participating countries in the concurrent treatment these patients were receiving for hypertension, with two or more co-therapies being most frequent in Germany and Belgium. There were also substantial differences in co-therapies for concurrent diseases among the participating countries, reflecting both standard therapeutic practices in local areas and differences in marketing of drugs in the different countries. This report describes the initial findings of this multinational study and emphasises the need to consider several major potentially confounding variables in the analysis of the outcome events both in this study and in other collaborative observational international monitoring schemes for adverse drug reactions.
Aged↗
Vitamin K intake and osteocalcin levels in women with and without aortic atherosclerosis: a population-based study.
Protein-bound gamma-carboxyglutamate (Gla) has been demonstrated in calcified atherosclerotic plaques. Vitamin K is required for the formation of Gla-residues. As the biological activity of Gla-proteins appears to be strictly dependent on the presence of the Gla-residues, vitamin K status may be an important factor in the development and progression of atherosclerotic calcifications. We studied the association of vitamin K status, as assessed by nutritional vitamin K intake and the measurements of two circulating immunoreactive osteocalcin (irOC) fractions, with aortic atherosclerosis in a population-based study of 113 postmenopausal women. Women with calcified lesions (n = 34) had a 42.9 micrograms lower mean age-adjusted dietary vitamin K intake/day (95% C.I. -6.6 to 92.5) than those without calcifications (n = 79). Atherosclerotic women had higher irOC levels with a low affinity for hydroxyapatite (irOCfree): age-adjusted difference of 0.32 ng/ml (95% C.I. 0.03 to 0.61). In addition, the high affinity irOC levels expressed as a percentage (hydroxyapatite binding capacity, HBC) were 5.12% (95% C.I. 1.32 to 8.92) lower in women with calcifications. Our study indicates that women with aortic atherosclerosis have an impaired vitamin K status as reflected by a lower nutritional vitamin K intake, an increased irOCfree level and a reduced HBC level. An impaired vitamin K status in subjects with atherosclerosis is compatible with the view that vitamin K or Gla-containing proteins are involved in the development of calcification of the vessel wall.
1-Carboxyglutamic Acid↗
Calcium metabolism, calcium supplementation and hypertensive disorders of pregnancy.
In recent years growing attention has been directed towards the possible role of calcium in the development of pregnancy-induced hypertension and preeclampsia. Several studies describe calcium metabolism in normal and hypertensive pregnancy, but so far, they have shown discrepant and inconsistent results. Intracellular free calcium, which plays an important role in vascular smooth muscle contraction, has been claimed as a pathogenic factor in hypertensive disorders of pregnancy. Although there is discordance in the data, a possible role of intracellular calcium in the development of hypertensive disorders of pregnancy cannot be excluded. Observational studies in pregnant women suggest an inverse association between calcium intake and the incidence of hypertensive disorders of pregnancy. Despite large methodological differences, the results from the calcium supplementation trials support this finding. Although it is rather difficult to isolate the effect of calcium intake from the intake of other mineral elements, results from calcium supplementation trials are supportive for calcium being the most important. Proposed mechanisms by which calcium supplementation may lower blood pressure involve changes in parathyroid hormone (PTH) level, the renin-angiotensin system and calcium as a modifier of vascular agent regulation, but none of these have yet been elucidated. At present, circumstantial evidence suggest a positive role for calcium in the prevention of hypertensive disorders of pregnancy, but definite evidence is lacking and further research is warranted.
Calcium↗
Prenatal diagnosis of congenital heart disease; prospects and problems.
Routine fetal echocardiography has been submitted as an antenatal screening test for congenital heart disease despite a wide range of efficacy reported. Hence, evaluation of the variable results of prenatal ultrasound screening programs was pursued. As the studies appeared to have a heterogeneous design, the originally reported figures have been corrected for one plausible prevalence of cardiovascular anomalies. Clinical setting (general hospitals vs. teaching hospitals), case ascertainment (retrospective vs. prospective; follow-up on (suspected) cases only vs. routine follow-up) and length of follow-up (< 1 year vs. a longer period) all have similar effects on the reported yield of cases and sensitivity of the proposed screening test. Notably, a relatively low yield of cases causes a seemingly high sensitivity, whereas a higher yield of cases causes a seemingly low sensitivity. Additional factors of study design, e.g. case definition, diagnostic procedures and appliances used, were usually not described in detail, yet may also have affected the results. Evaluating diagnostic tests apparently demands a rigorous study design to overcome biased results. Furthermore, no sufficient evidence could be found meriting current routine prenatal screening for congenital heart disease.
Female↗
Clinical epidemiology. Introduction to the discipline.
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Clinical Medicine↗
Volume adjustment for intermediate prostate-specific antigen values in a screening population.
In a screening population of 812 men, between the ages of 55 and 77 years, and prostate-specific antigen (PSA) below 10.0 ng/ml (Hybritech), digital rectal examination (DRE) and transrectal ultrasonography of the prostate (TRUS) were performed. Seventeen prostate carcinomas were detected. Four methods of prostate volumetry were used to determine volume-adjusted PSA levels. These were PSA density for the total gland volume (PSAD), for the inner zone volume (PSAT) and population-specific excess PSA values. There was a significant difference between the benign and the malignant population for age, PSA, PSAD, PSAT and excess PSA values. The maximal discriminatory potential, analysed by the area under receiver ROC curve, was 0.90, reached for prolate spheroid determined excess PSA. For PSA alone this was 0.86. Volume-adjusted PSA values have no additional benefit beyond unadjusted values in screening for prostate carcinoma in this study.
Aged↗
The prevalence of age-related maculopathy in the Rotterdam Study.
PURPOSE: To determine the prevalence of age-related maculopathy in an elderly population in The Netherlands. METHODS: Fundus photographs of 6251 participants of the Rotterdam Study, a single-center prospective follow-up study in persons 55 to 98 years of age, were reviewed for the presence of drusen, pigmentary abnormalities, and atrophic or neovascular age-related macular degeneration. RESULTS: The prevalence of at least one drusen of 63 microns or larger increased from 40.8% in persons 55 to 64 years of age to 52.6% in those 85 years of age or older. Similarly, the prevalence of the following abnormalities increased significantly in these age categories: drusen of 125 microns or larger from 4.8% to 17.5%, retinal pigment epithelial hypopigmentations from 3.5% to 9.0%, and increased retinal pigment from 3.7% to 15.3%. Atrophic or neovascular age-related macular degeneration was present in 1.7% of the total population. Atrophic age-related macular degeneration increased from 0.1% in persons 55 to 64 years of age to 3.7% in those 85 years of age or older. Neovascular age-related macular degeneration increased from 0.1% to 7.4% in these age groups. No sex differences were observed for these lesions. CONCLUSIONS: The prevalence of atrophic or neovascular age-related macular degeneration is 1.7%. In those 55 years of age or older, the prevalence increases strongly with age and it is similar in men and women. Neovascular age-related macular degeneration was twice as common as atrophic age-related macular degeneration. These findings suggest that age-related maculopathy may be less common in this European population than in similar populations in the United States.
Aged↗
Primary open-angle glaucoma, intraocular pressure, and systemic blood pressure in the general elderly population. The Rotterdam Study.
PURPOSE: The purpose of this study is to investigate the association of primary open-angle glaucoma (POAG), intraocular pressure (IOP), and systemic blood pressure. METHODS: Subjects participating in the Rotterdam Study (n = 4187, 55 years of age and older) were examined according to standard protocols, including a medical history interview, IOP measurement, perimetry, funduscopy, and blood pressure measurement. Primary open-angle glaucoma was defined by the presence of a glaucomatous visual field defect. Additionally, the distinction was made between high-tension glaucoma, defined as POAG with an IOP of more than 21 mmHg, and normal-tension glaucoma, defined as POAG with an IOP of 21 mmHg or less. The relation between blood pressure and hypertension with IOP, POAG, high-tension glaucoma, and normal-tension glaucoma was studied by means of regression analysis. RESULTS: A systolic blood pressure or diastolic blood pressure that was 10 mmHg higher was associated with an IOP that was, on average, 0.23 mmHg (95% confidence interval [CI], 0.19-0.27) or 0.24 mmHg (95% CI, 0.16-0.32) higher, respectively. The presence of hypertension was associated with a higher mean IOP of 0.66 mmHg (95% CI, 0.39-0.93). A higher systolic blood pressure of 10 mmHg was associated with an odds ratio of 1.22 (95% CI, 1.03-1.46) for high-tension glaucoma and 0.90 (95% CI, 0.72-1.12) for normal-tension glaucoma. Hypertension was associated with an odds ratio of 2.33 (95% CI, 0.99-5.47) for high-tension glaucoma and 0.77 (95% CI, 0.22-2.72) for normal-tension glaucoma. CONCLUSION: Systemic blood pressure and hypertension are associated with IOP and high-tension glaucoma. No association was found between blood pressure or hypertension and normal-tension glaucoma.
Aged↗
Early uterine artery Doppler velocimetry and the outcome of pregnancy in women aged 35 years and older.
The objective of this paper was to determine whether first- and second-trimester uterine artery Doppler velocimetry are associated with pregnancy complications in women of advanced maternal age. A prospective cohort study of 352 women aged 35 years and older was studied. The pulsatility index (PI) values at 12-13 weeks of gestation were significantly associated with development of hypertensive disorders, a small-for-gestational-age infant and gestational diabetes, with a relative risk exceeding 4, 2 and 8, respectively for women with PI values in the highest quartile (> 1.67) of the PI distribution when compared with the lowest quartile of the PI distribution (< 1.24). At 23-27 weeks' gestation, uterine artery PI values were found to be associated with preterm delivery with a gestational age-adjusted risk of 10.6 for women with PI values in the highest quartile of PI (> 1.24) when compared with PI values in the lowest quartile of the PI distribution (< 1.09). No associations existed between uterine artery PI, antepartum hemorrhage and Cesarean section rate. The risk estimates for any of the outcome parameters were not affected by maternal age. Results indicate that hemodynamic changes detectable in the uterine artery as early as the first trimester of pregnancy are associated with an increased risk of hypertensive disorders, a small-for-gestational-age infant and gestational diabetes. A similar association exists in the late second trimester of pregnancy, with an increased risk of preterm delivery.
Adult↗
Aspects of the aetiology of congenital heart disease.
A concise overview of current knowledge on the aetiology of congenital heart disease is provided. At present, only 10 to 20% of the cases occurring in neonates can be attributed to known risk factors. Recurrence within relatives, chromosomal anomalies, genetic disorders, maternal disease and teratogen exposure are addressed briefly; contemporary research models and methods, e.g. embryology and genetics and molecular biology, are referred to. A major innovation has been the introduction of the concept of common pathogenetic pathways. Thus, different teratogenic factors or risk-factors may affect normal development at an identical stage and cause similar malformations. Also, the importance of timing of an event is stressed. If the time frame of exposure does not coincide with embryogenesis any teratogenic effect may be missed. Large-scale epidemiological studies on fetuses and neonates with congenital heart disease are introduced as a third mode of research on the aetiology, although this approach is not used efficiently at present; cases of intra-uterine death can be considered a valuable source of information that needs further attention. Combined, the above three lines of research may prove productive, but the design of a comprehensive research project would need to be handled carefully. Possibilities for prevention of the occurrence of cardiovascular malformations are reported. Through lack of knowledge of causality, at present, only secondary prevention may be possible and hence deserves attention. However, there appears to be no provision for thorough pre-natal screening tests for congenital heart disease in an unselected population.
Heart Defects, Congenital↗
Cardiovascular response to mental stress in offspring of hypertensive parents: the Dutch Hypertension and Offspring Study.
OBJECTIVE: To compare blood pressure-regulating mechanisms during mental stress in two groups of offspring with contrasting risk for hypertension. DESIGN: Cardiovascular reactivity to two different types of mental stressors was studied in adolescents and young adults with two hypertensive or two normotensive parents. The two tasks used were intended to evoke either a predominantly adrenergic cardiac response (a memory search task) or a predominantly vascular response (a reaction-time task with visual search and tone avoidance). METHODS: Blood pressure and heart rate were recorded at rest and during stress. To study adaptations of the cardiovascular system to mental stress, cardiac output, total peripheral resistance and indices of vagal and sympathetic influences on the heart were measured. RESULTS: The reactivity of systolic blood pressure (SBP) to the memory search task was significantly higher in offspring of hypertensive parents, which resulted in a longer recovery after the task. In contrast, during the reaction-time task, offspring of hypertensive parents had a significantly enhanced reactivity of peripheral resistance, but no differences in heart rate or blood pressure response were observed. No differences between the two groups were found in sympathetic or vagal activity during either task measured by the ratio of pre-ejection time and left ventricular ejection time, and respiratory sinus arrhythmia, respectively. CONCLUSION: Apart from a higher reactivity of SBP during the memory search task, no other indications supporting the presence of hyperadrenergic activation of the heart in early primary hypertension were found. On the contrary, the results of the present study support the hypothesis that blood pressure responses in prehypertensive subjects are characterized by enhanced vasoconstriction rather than by increased cardiac output.
Adolescent↗
Meta-analysis and the Hippocratic principle of primum non nocere--authors' reply.
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Antihypertensive Agents↗
Association of locomotor complaints and disability in the Rotterdam study.
OBJECTIVE: To determine the association between joint complaints and locomotor disability. METHODS: During a home interview survey 1901 men and 3135 women aged 55 years and over (the Rotterdam Study) were asked about joint pain and morning stiffness in the past month, and locomotor disability was assessed by six questions from the Health Assessment Questionnaire (HAQ). RESULTS: The prevalence of locomotor disability was 24.5% for men and 40.5% for women. The prevalence of joint pain in men was 0.7% for pain in the hips, knees, and feet simultaneously, 3.7% for pain at two joint sites, 16.0% for pain at one joint site, and 20.4% for pain in the hips and/or knees and/or feet (any joint site); the corresponding estimates for women were 1.9%, 9.0%, 23.7%, and 34.5%, respectively. The prevalence of generalised morning stiffness was 4.9% for men and 10.4% for women. The age adjusted odds ratios for locomotor disability in men ranged from 2.4 of pain at one joint site to 8.8 of pain at all three joint sites; for women these odds ratios varied between 2.5 and 5.7, respectively. The age adjusted odds ratios of generalised morning stiffness were 8.0 for men and 7.3 for women. CONCLUSION: There is a strong and independent association between locomotor disability and age, joint pain, and generalised morning stiffness in people aged 55 years and over. The odds for locomotor disability increase onefold for every year increase in age, while the presence of generalised morning stiffness is of greater influence than the presence of joint pain.
Activities of Daily Living↗
Physical activity, calcium intake, and bone mineral content in children in The Netherlands.
STUDY OBJECTIVE: To examine the relation between physical activity, calcium intake, and bone mineral content in children. DESIGN: Population based, cross sectional study. SETTING: Primary schools in Zoetermeer, The Netherlands. PARTICIPANTS: Altogether 1359 Dutch boys and girls, aged 7 to 11 years (response rate 88%). MEASUREMENTS: Bone mineral content was measured by quantitative roentgen microdensitometry of the midphalanx of the second digit at the diaphyseal and metaphyseal site. Maximal exercise testing, according to the Bruce treadmill protocol, was used to assess physical fitness. Habitual physical activity was assessed by use of a questionnaire on physical activities. Daily calcium intake from dairy products was estimated by use of a semiquantitative food frequency questionnaire. MAIN RESULTS: Bone mineral content in boys was not linearly associated with physical fitness after adjustments for differences in height, body weight, chronological age, and skeletal age. In girls a linear association was found at the metaphyseal site only. When extreme groups were compared, bone mineral content was found to be higher in "high fitness children" (upper decile) than "low fitness children" (lowest decile), with statistical significance reached in boys only. When analyses were performed in subgroups of skeletal age, a clear linear relation between physical fitness and bone mineral content was seen in the mature subgroup in both boys and girls. No linear association was found between habitual physical activity and bone mineral content, while the results in extreme groups (that is, upper versus lowest decile) and in subgroups of skeletal age were comparable to those on physical fitness in boys only. No association was found between daily calcium intake and bone mineral content in this age group. CONCLUSIONS: This cross sectional study in children aged 7 to 11 years suggests that an increased bone mineral content is found only in those with a high level of physical activity. This association is most pronounced in the more mature children. No evidence was found for an association between daily calcium intake and bone mineral content in childhood.
Age Determination by Skeleton↗