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Biomedical subjects

D L Wingard

Publications and source records attributed to D L Wingard.

At least 91 records · Page 5Linked to original sources
PubMed1987

Family history of diabetes and cardiovascular disease risk factors and mortality among euglycemic, borderline hyperglycemic, and diabetic adults.

In a prospective population-based study begun in 1972 in Rancho Bernardo, California, the association of cardiovascular disease risk factors, at baseline, with a family history of diabetes and subsequent death from cardiovascular disease was investigated among 3,081 euglycemic, 1,290 borderline hyperglycemic, and 347 diabetic adults between 20 and 79 years of age. The main difference in risk factor distribution was in diabetic men and women 20-49 years of age, of whom those with a family history of diabetes were older and had higher levels of fasting plasma cholesterol and triglyceride. In addition, in all age-sex-diabetes status groups, those with a family history of diabetes included a greater proportion with a family history of heart attack. In five out of 12 groups, the association was statistically significant. Significant independent predictors of cardiovascular disease mortality in euglycemic and borderline hyperglycemic adults were age, sex, cholesterol, and systolic blood pressure, while fasting plasma glucose was a significant predictor in euglycemic adults only. Family history of heart attack was significantly associated with cardiovascular disease mortality in euglycemic and borderline hyperglycemic adults. Family history of diabetes was not significantly associated with mortality risk in any of the three groups, but the risk followed an increasing trend from euglycemic (0.89) to borderline hyperglycemic (1.17) to diabetic (1.31) adults.

Adult↗
PubMed1987

Sex differentials in health and mortality.

It is common knowledge that females tend to live longer than males. In the United States and most other countries, female death rates are lower than male rates for all age groups and most important causes of death. But while they are alive, females' health seems to be worse than males'. Health surveys repeatedly show that females have higher rates of illness, disability days, and health services use. In this article, sex differentials in mortality are presented first, followed by sex differentials in health. Possible explanations for these sex differentials are discussed, and the apparent contradiction--why there is excess female morbidity but excess male mortality--is considered.

Acute Disease↗
PubMed1985

Effects of passive smoking on ischemic heart disease mortality of nonsmokers. A prospective study.

The mortality attributable to ischemic heart disease as a result of cigarette smoking is greater of a community of older adults in southern California, the authors tested the hypothesis that nonsmoking women exposed to their husband's cigarette smoke would have an elevated risk of fatal ischemic heart disease. Married women aged 50-79 years who had never smoked cigarettes (n = 695) were classified according to the husband's self-reported smoking status at entry into the study: never, former, or current smoker. After 10 years, nonsmoking wives of current or former cigarette smokers had a higher total (p less than or equal to 0.05) and age-adjusted (p less than or equal to 0.10) death rate from ischemic heart disease than women whose husbands never smoked. After adjustment for differences in risk factors for heart disease, the relative risk for death from ischemic heart disease in nonsmoking women married to current or former cigarette smokers was 14.9 (p less than or equal to 0.10). These data are compatible with the hypothesis that passive cigarette smoking carries an excess risk of fatal ischemic heart disease.

Aged↗
PubMed1985

Coffee, plasma cholesterol, and lipoproteins. A population study in an adult community.

The associations between intake of coffee or decaffeinated coffee and plasma cholesterol and lipoprotein measurements were examined in a probability sample from a defined community of adults. The results were based on 24-hour dietary recall interviews and laboratory measurements carried out in 1972-1974 on 381 women and 320 men conducted as part of the La Jolla Lipid Research Clinic study. Intake of 8+ oz (230+ ml) of coffee per day was reported by 65% of women and 70% of men. Plasma cholesterol increased with increasing coffee drinking in women as follows: 0-7 oz (0-229 ml), 214 mg/dl; 8-32 oz (230-960 ml), 222 mg/dl; and 33+ oz (961+ ml), 234 mg/dl. This trend was significant at p less than 0.01. Almost all of the difference could be accounted for by an increase in low density lipoprotein cholesterol. Plasma cholesterol was not affected by coffee intake in men or by decaffeinated coffee intake in either sex. The results were unaffected by adjustment for age, obesity index, number of cigarettes smoked per day, ml of alcohol consumed per day, oral contraceptive use, regular exercise, daily intake of saturated, monounsaturated, and polyunsaturated fat, polyunsaturated/saturated fat ratio, use of cream in coffee, and use of sugar in coffee. This study confirms the previously reported significant increase in plasma cholesterol and low density lipoprotein levels with increasing coffee intake in women, and demonstrates that the increase is due largely to elevation of low density lipoprotein cholesterol. The reasons for a differential response to coffee in women and men, reported previously and in this study, deserve further investigation.

Adult↗
PubMed1984

Is borderline fasting hyperglycemia a risk factor for cardiovascular death?

The majority of previously reported studies of borderline hyperglycemia as a risk factor for cardiovascular disease are based on post-challenge glucose levels, are limited to men, and show either no significant association or a possible threshold effect. In order to determine whether fasting plasma glucose (FPG) in the normal range (less than 140 mg/dl) predicts mortality, we prospectively studied a geographically defined Southern California community of 3625 nondiabetic men and women aged 40-79, 99.5% of whom were followed for 9 years. Levels of FPG were significantly associated with levels of most heart disease risk factors. After adjusting for these risk factors, FPG, analyzed either as a continuous or categorical variable, was independently and significantly associated with all-cause, cardiovascular and ischemic heart disease mortality in men in proportional hazard models. An excess of all-cause mortality with the highest levels of FPG (130-139 mg/dl) was the only statistically significant association seen in women. The absence of a significant linear association in women may reflect true sex differences or a lack of power owing to the relatively small numbers of deaths in women. The independent linear glucose mortality association in men found here differs from previous studies, and may reflect both the larger number of events and the use of FPG, which has less intra-individual variability and less potential for misclassification bias than post-challenge glucose.

Adult↗
PubMed1984

Ischemic heart disease risk factors after age 50.

Previous studies have suggested that the predictive power of the three major risk factors for ischemic heart disease (hypertension, hypercholesterolemia, and cigarette smoking) decreases sharply with age. We re-examined this question in a cohort of 3187 adults aged 50-79 with baseline evaluation in 1972-1974 who were followed at least 9 years during a period of a marked decline in national cardiovascular disease mortality. Four-hundred and eighty-three subjects died, 123 of ischemic heart disease. Predictors of outcome were studied separately in younger (age 50-64) and older (age 65-79) groups. After multivariable adjustment for potential confounders using Cox proportional hazards models, cholesterol retained a significant independent predictor of ischemic heart disease mortality at older ages for both men and women. Cigarette smoking and hypertension were significantly related to all-cause but not to ischemic heart disease mortality in this older population. We suggest that the persistence of cholesterol as an independent predictor of fatal ischemic heart disease in old age may reflect the consequences of a shift in risk factor distribution with deferred selective mortality in a cohort with an overall favorable risk factor status.

Age Factors↗
PubMed1984

Plasma cholesterol and cancer morbidity and mortality in an adult community.

The relationship between plasma cholesterol and seven-year cancer morbidity and mortality was assessed in 4035 residents of Rancho Bernardo , CA, aged 40-89 years. Cancer was the underlying cause of death for 139 persons and occurred in an additional 168 individuals after the 1972-74 cholesterol measurement. The age-adjusted cancer mortality rate per years of experience showed a slightly U-shaped relationship with cholesterol levels in men. For women, little association was seen between cancer mortality and cholesterol levels. Age-adjusted cancer morbidity rates per years of experience, indicated no association for men or women. Mean cholesterol levels did not differ significantly by cancer site. In addition, analysis of cholesterol levels by length of time between cholesterol measurement and cancer occurrence showed no significant trends, suggesting the progression of subclinical cancer did not result in lower cholesterol levels. In summary, in this population no significant association of cholesterol and cancer was seen in men or women.

Adult↗
PubMed1984

Subcultural differences in alcohol use among youth.

A specifically designed anonymous questionnaire concerning the use of alcoholic beverages was given to all young people in residence at the San Diego Job Corps Center. Corpsmembers (n = 335), age 16-22 years (mean 18.7 years) completed the questionnaire. There were 67 Caucasians, 65 Blacks, 111 Hispanics, 69 Indochinese, and 23 others. Eighty-five percent of the corpsmembers reported drinking alcohol 1-5 times weekly during the previous six months, and 14% reported average weekend binges of more than 20 drinks. Sixty percent of the adolescent drinkers reported medical, legal, or vocational problems as a result of their drinking. Some striking differences were noted in the drinking habits of the four major subcultural groups represented: 1) Caucasian males began serious drinking at an earlier age than Black, Hispanic or Indochinese youth; 2) more Hispanic youth than others used multiple drugs in addition to marijuana, which was commonly used by all adolescent drinkers; and 3) recently immigrated Indochinese youth indicated that they had turned to alcohol as a means of forgetting past experiences.

Adolescent↗
PubMed1984

The sex differential in morbidity, mortality, and lifestyle.

In the United States women live longer than men, and they have lower death rates at virtually every age and for most causes of death. Similar relationships prevail in most developed nations. The sex differential in mortality has been increasing since the early 1900s , especially for those 15-24 and 55-64 years of age. Since 1970, however, that trend has slowed for persons 45-74, and in 1980 the sex differential was actually lower than in 1970 among those 55-64. Although the female sex advantage in respect to most causes of death has been increasing, the differential for coronary heart disease has recently stabilized; and the lung cancer mortality rate among women is now increasing faster than that among men. Recent statistics for these two important causes of death may indicate that the previous, more favorable trend in women than in men may be reversing in response to changes in lifestyle. Women's health may be improving at a slower rate because they are exposed to more job stresses and other risk factors, such as cigarettes, than before; alternatively, men's health may be improving at a faster rate because they are exercising more, smoking cigarettes less, and following healthier diets in recent decades. Despite their continuing mortality advantage, women experience more illness than men. This may reflect women's greater utilization of medical services, and physicians' diagnostic patterns, as well as women's greater willingness to acknowledge and report illness. Sex differences in illness persist, however, when physical examinations are used for assessment in population-based samples. Women appear to have higher rates of conditions that rarely cause death, for example, rheumatoid arthritis; whereas men tend to have more fatal conditions, such as coronary heart disease. At least two categories of lifestyle characteristics are associated with male-female differences in health: (a) social roles, such as marriage, parenthood, and employment; and (b) behaviors, such as cigarette smoking and Type A behavior. Preliminary evidence indicates that some of these lifestyle characteristics may act synergistically on health. Several aspects of lifestyle thus underlie sex differences in morbidity and mortality. There is also evidence that biological factors influence male/female mortality differences, particularly in infancy and prenatal life. A substantial sex differential remains, however, even after adjusting for numerous lifestyle and biological variables. This is especially true for heart disease mortality.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1983

Clustering of heart disease risk factors in diabetic compared to nondiabetic adults.

In a population-based study conducted by the Lipid Research Clinic between 1972 and 1974, the authors investigated the frequency and clustering of five heart disease risk factors--cholesterol, triglycerides, systolic blood pressure, obesity, and cigarette smoking--in 347 diabetic and 2285 euglycemic nondiabetic adults aged 35 to 79 years. Diabetics were more likely than nondiabetics to have high risk factor levels, although excesses for cholesterol and cigarette smoking were not statistically significant. Subjects at or above the 70th or 90th percentiles for one risk factor were more likely to be at or above these percentiles for other risk factors, and this clustering of heart disease risk factors was more common among diabetics than nondiabetics. Excess clustering in diabetics persisted after controlling for obesity and when only cholesterol, blood pressure, and cigarette smoking were analyzed. Clustering was more marked in women than in men. This may explain some of the excess risk of heart disease in female compared to male diabetics, which has been reported by others.

Adult↗
PubMed1983

The sex differential in mortality from all causes and ischemic heart disease.

The sex differential in mortality from all causes and ischemic heart disease is examined in an upper-middle class Caucasian community of 3516 adults in southern California, who were followed for a minimum of seven years. The influence of several demographic, behavioral, and biologic risk factors is simultaneously controlled for by means of a multiple logistic analysis. Risk factors include age, marital status, education, cigarette smoking, cholesterol, systolic blood pressure, fasting plasma glucose, and obesity. Both the prevalence and relative mortality risk associated with several risk factors differ by sex. Adjustment decreases the sex differential for mortality from 1.7 to 1.3 for all causes and from 4.8 to 2.4 for ischemic heart disease. When analysis is limited to healthy men and women, the adjusted sex differential in mortality is 1.2 for all causes and 2.0 for ischemic heart disease. Findings of this study are compared with two other population-based studies.

Adult↗
PubMed1983

Sex differential in ischemic heart disease mortality in diabetics: a prospective population-based study.

Two previous population-based US studies that examined the sex differential for heart disease mortality in diabetics showed an independent effect of diabetes on fatal heart disease only in women. This paper reports sex-specific ischemic heart disease mortality rates and relative risks for a geographically defined population in southern California of men and women aged 40-79 years, 99.5 per cent of whom were followed prospectively for seven years. When the 212 men and 131 women who had diabetes defined by personal history and/or fasting hyperglycemia were compared with 2104 nondiabetics defined by fasting euglycemia and a negative personal and family history of diabetes, the age-adjusted relative risk of death in diabetics attributed to ischemic heart disease was 2.5 for diabetic men and 3.4 for diabetic women. The sex difference increased only minimally after adjustment for heart disease risk factors when the Cox regression model was used: the adjusted risk ratio was 2.4 for diabetic men and 3.5 for diabetic women. In both men and women, diabetes, along with age and plasma cholesterol, was a statistically significant independent predictor of ischemic heart disease mortality. Among diabetics, male sex made a significant independent contribution to the prediction of fatal ischemic heart disease.

Adult↗
PubMed1983

Mortality risk associated with sleeping patterns among adults.

The mortality risk associated with different sleeping patterns was assessed by use of the 1965 Human Population Laboratory survey of a random sample of 6928 adults in Alameda County, CA and a subsequent 9-year mortality follow-up. The analysis indicates that mortality rates from ischemic heart disease, cancer, stroke, and all causes combined were lowest for individuals sleeping 7 or 8 h per night. Men sleeping 6 h or less or 9 h or more had 1.7 times the total age-adjusted death rate of men sleeping 7 or 8 h per night. The comparable relative risk for women was 1.6. The association between sleeping patterns and all causes of mortality was found to be independent of self-reported trouble sleeping and self-reported physical health status at the time of the 1965 survey. Simultaneous adjustment for age, sex, race, socioeconomic status, physical health status, smoking history, physical inactivity, alcohol consumption, weight status, use of health services, social networks, and life satisfaction reduced the relative mortality risk associated with sleeping patterns to 1.3 (p less than or equal to 0.04).

Adult↗
PubMed1982

The sex differential in mortality rates: demographic and behavioral factors.

By using the 1965 Human Population Laboratory Survey of a random sample of 6928 adults in Alameda County, California, and a nine-year follow-up, mortality risk is examined by sex, while simultaneously controlling for 16 demographic and behavioral risk factors by a multiple logistic analysis. Risk factors include age, race, socioeconomic status, occupation, physical health status, use of health services, smoking, alcohol consumption, physical activity, weight, sleeping patterns, marital status, social contacts, church and group membership and life satisfaction. The prevalence and relative mortality risk of each factor combine to influence the sex differential. The unadjusted relative mortality risk for men compared to women is 1.5 (p less than or equal to 0.001). Adjustment for some factors (e.g., smoking and alcohol) decreases this difference, while other adjustments (e.g., for physical activity, physical health status and marital status) increase the difference. Adjustment for all 16 factors slightly increases the relative risk to 1.7 (p less than or equal to 0.001). These demographic and behavioral risk factors do not account for the overall sex difference in mortality rates. Examination of the interaction of biologic and behavioral risk factors may more fully explain the sex differential in mortality.

Adult↗
PubMed1982

Adjustment for obesity in studies of cardiovascular disease.

To evaluate the validity and implications of using various obesity indices in adjusting or controlling for obesity, correlations were analyzed between six cardiovascular disease risk factors, age, cholesterol, log triglyceride, systolic blood pressure, diastolic blood pressure, and fasting plasma glucose, and weight (W), height (H), and five commonly used obesity indices, W/H, W/H2, 3 square root W/H, -H/3 square root W, and relative weight in a defined population of 4956 men and women. Subjects were residents of Rancho Bernardo, California and were surveyed in 1972-1974. Correlations of weight, height, and the obesity indices were also evaluated with each other. W/H, 3 square root W/H, and -H/3 square root W were highly correlated with weight (correlations = 0.96-0.997), but also correlated with height (correlations = 0.10-0.48). These very high correlations with weight and moderate correlations with height resulted in risk factor correlations with these three indices reflecting weight-risk factor correlations rather than obesity-risk factor correlations. W/H2 and relative weight were not quite so highly correlated with weight (correlations = 0.83-0.89), very highly correlated with each other (correlations = 0.999), and relatively uncorrelated with height (correlations = 0.17-0.01). W/H2 and relative weight risk factor correlations reflected true obesity-risk factor correlations and were significantly greater than risk factor correlations with weight, W/H, 3 square root W/H, and -H/3 square root W. These data strongly support the use of either W/H2 or relative weight for obesity adjustment in cardiovascular disease studies. Use of W/H, 3 square root W/H, or -H/3 square root W may result in underadjustment for obesity.

Adult↗
PubMed1982

A multivariate analysis of health-related practices: a nine-year mortality follow-up of the Alameda County Study.

Associations between several common health-related practices and a variety of health outcomes have been reported. However, the independent associations between each of these practices and mortality from all causes have not been assessed. In the present report, a multiple logistic analysis of seven potentially health-related practices (individually and in a summary index) and mortality from all causes is conducted, using data from the Human Population Laboratory Study of a random sample of 6928 adults living in Alameda County, California in 1965 and a subsequent nine-year mortality follow-up. Many covariables such as physical health status and socioeconomic status are simultaneously analyzed. The health-related practices examined are: 1) never smoking; 2) regular physical activity; 3) low alcohol consumption; 4) average weight status; 5) sleeping seven to eight hours/night; 6) not skipping breakfast; and 7) not snacking between meals. The analysis reveals that five of the practices are associated with lower mortality from all causes. Neither eating breakfast nor not snacking have significant independent associations with lower mortality. After covariable adjustment, respondents who reported few low-risk practices have a relative risk of 2.3 (p less than 0.001) when compared with those who had many low-risk practices. Mortality risks for possible combinations of health-related practices are discussed.

Adult↗
PubMedDate not supplied

Practice styles. A comparison of obstetricians and nurse-midwives.

Iain Chalmers and the National Perinatal Epidemiology Unit, Oxford, England, developed a comprehensive listing of perinatal care procedures shown to reduce the frequency of adverse outcomes during pregnancy and childbirth. This list was used as a framework for a pilot study conducted in 1992 that reviewed similarities and differences in opinion and practice style between certified nurse-midwives (CNMs) and obstetrician/gynecologists. Twenty CNMs and 57 obstetrician/gynecologists who were active clinical practitioners in San Diego commented on 24 items drawn from Chalmers' work. The CNMs were more likely to favor the availability of social and psychological support variables and to use them in their practice. The groups were more alike than different in their views concerning preventive interventions during the prenatal period. CNMs were more likely to support the availability of alternatives to maternal positions for labor and birth, exhalatory breathing, and delayed pushing and less likely to support the availability of electronic fetal monitoring, epidural anesthesia, episiotomy, and active management of the third stage. A small sample size and limited response rate restricted interpretation and generalizability of these data. Nevertheless the data offer support for other studies with similar findings. They also suggest that health system administrators should inform women and families about differences in practice styles before families select from among the various insurance options that may, in the end, restrict the choice of provider or birth setting.

Chi-Square Distribution↗