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Biomedical subjects

D Levy

Publications and source records attributed to D Levy.

At least 253 records · Page 14Linked to original sources
PubMed1993

The natural history of borderline isolated systolic hypertension.

BACKGROUND: Patients with isolated systolic hypertension are at increased risk for cardiovascular disorders. We attempted to determine whether those with borderline isolated systolic hypertension (defined as a systolic blood pressure of 140 to 159 mm Hg and a diastolic blood pressure below 90 mm Hg) have a greater risk of progression to definite (more severe) hypertension and of major morbid or fatal events than people with normal blood pressure (< 140/90 mm Hg). METHODS: A total of 2767 of the original participants in the Framingham Heart Study were monitored with biennial examinations for up to 34 years for the development of definite hypertension (defined as a systolic blood pressure of > or = 160 mm Hg, a diastolic blood pressure of > or = 90 mm Hg, or the initiation of antihypertensive therapy) and for major cardiovascular events. RESULTS: Borderline isolated systolic hypertension was the most common type of untreated hypertension among adults over the age of 60. After 20 years of follow-up, 80 percent of those with borderline isolated systolic hypertension had progression to definite hypertension, as compared with 45 percent of the normotensive participants (P < 0.001). After adjustment for age, sex, and risk factors for cardiovascular disease, participants with borderline isolated systolic hypertension had an excess long-term risk of cardiovascular disease (hazard ratio, 1.47; 95 percent confidence interval, 1.24 to 1.74) and death from cardiovascular disease (hazard ratio, 1.57; 95 percent confidence interval, 1.24 to 2.00), as compared with normotensive participants. In an analysis of pooled data from biennial examinations to study short-term sequelae, subjects with borderline isolated systolic hypertension had an increased risk of progression to definite hypertension (odds ratio, 3.84; 95 percent confidence interval, 3.35 to 4.41) and of cardiovascular disease (odds ratio, 1.39; 95 percent confidence interval, 1.06 to 1.82). CONCLUSIONS: In both the short term and the long term, subjects with borderline isolated systolic hypertension are at increased risk of progression to definite hypertension and the development of cardiovascular disease.

Adult↗
PubMed1993

Impact of heart rate and PR interval on Doppler indexes of left ventricular diastolic filling in an elderly cohort (the Framingham Heart Study).

The relations of heart rate and PR interval to Doppler-derived diastolic indexes were examined in 260 men (mean age 75 years) and 462 women (mean age 76 years) from the Framingham Heart Study. Subjects receiving any antihypertensive or cardiac medications were excluded from eligibility; those with mitral stenosis or prosthesis, pacemaker, atrial fibrillation, arrhythmia, left bundle branch block, congestive heart failure, previous myocardial infarction, and technically inadequate Doppler study were also excluded. Peak velocity of early (E) and late (A) diastolic left ventricular (LV) filling, ratio of peak velocities E/A, ratio of time velocity integrals E/A, and atrial filling fraction were studied by multivariable analyses adjusting for age, sex, blood pressure, heart rate and PR interval. Heart rate was a major determinant of all 5 Doppler indexes of diastolic filling; heart rate was inversely associated with peak velocity E, E/A, and time velocity integral E/A, and was directly associated with peak velocity A and atrial filling fraction. PR interval was inversely associated with time velocity integral E/A (p < 0.01) and directly associated with atrial filling fraction. The results were largely unaltered after further adjustment for LV wall thickness, LV end-diastolic diameter and left atrial diameter (in addition to age, sex and blood pressure). Heart rate and PR interval are independent contributors to Doppler-assessed LV diastolic filling in the elderly. The atrial contribution to LV filling depends on its timing in the cardiac cycle and on heart rate. Failure to account for heart rate and PR interval may lead to inappropriate assessment of Doppler diastolic filling.

Aged↗
PubMed1993

Bile acid transport into hepatocyte smooth endoplasmic reticulum vesicles is mediated by microsomal epoxide hydrolase, a membrane protein exhibiting two distinct topological orientations.

Bile acids, such as taurocholate, have been shown to be transported into hepatocyte smooth endoplasmic reticulum (SER) vesicles. This process is Na(+)-independent, electrogenic, inhibitable by 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid and taurochenodeoxycholate, with a Km of 352 microM and a Vmax of 29.6 nmol/mg protein/min. The observed transport is mediated by the bifunctional protein, microsomal epoxide hydrolase (mEH) which can also mediate bile acid transport into hepatocytes across the sinusoidal plasma membrane (von Dippe, P., Amoui, M., Alves, C., and Levy, D. (1993) Am. J. Physiol. 264, G528-G534). mEH was isolated from SER membranes by immunoprecipitation with monoclonal antibody (mAb) 25D-1 which recognizes this protein on the surface of intact hepatocytes. The SER-derived protein exhibited an apparent molecular weight, isoelectric point, N-terminal amino acid sequence, and mEH-specific activity that were indistinguishable from the plasma membrane form of the enzyme. Proteoliposome reconstitution of the SER taurocholate transport system indicated that mEH was absolutely required for the expression of transport capacity. The interaction of mAb 25D-1 with mEH on intact right-side-out SER vesicles demonstrated that the epitope found on the surface of hepatocytes was also found on the cytoplasmic surface of these vesicles (80%) and in the lumen (20%) suggesting the presence of two forms of this protein in the SER, the latter from being sorted to the cell surface. The existence of two orientations of this protein in the SER was confirmed by the sensitivity to tryptic digestion, where 75% of the mAb epitope was accessible to the enzyme. The loss of the 25D-1 epitope correlated with loss of taurocholate transport capacity. The role of mEH in the transport process and the orientation of the transporting isoform was further established by demonstrating that mAb 25A-3, which also reacts with mEH on the hepatocyte surface, was able to directly inhibit taurocholate transport in the SER vesicle system. These and previous results thus establish that isoforms of mEH can mediate taurocholate transport at the sinusoidal plasma membrane and in SER vesicles and that this bifunctional protein can exist in two orientations in the SER membrane. The association of bile acids with the SER suggests a possible role of intracellular vesicles in the transhepatocellular movement of bile acids from the sinusoidal to the canalicular compartment.

Animals↗
PubMed1993

Echocardiographic assessment of left ventricular structure and diastolic filling in elderly subjects with borderline isolated systolic hypertension (the Framingham Heart Study).

Abnormalities in left ventricular (LV) structure and function have been shown in patients with diastolic hypertension and recently in subjects with isolated systolic hypertension. The purpose of this study was to determine whether abnormalities of cardiac structure or function are present in elderly subjects with borderline isolated systolic hypertension (defined as systolic blood pressure [BP] between 140 and 159 mm Hg, and diastolic BP < 90 mm Hg). Ninety-one subjects (mean age 77 years) from the original Framingham Heart Study with untreated borderline isolated systolic hypertension, who were free of cardiovascular disease, were compared with 139 normotensive (BP < 140/90 mm Hg) subjects (mean age 76 years). Measurements included M-mode values for LV structure, and 6 Doppler indexes of LV diastolic filling. Subjects with borderline isolated systolic hypertension and the control group differed in mean systolic (147 vs 125 mm Hg) and diastolic (76 vs 70 mm Hg) BP. Borderline systolic hypertension was the most frequent form of untreated hypertension in this elderly group. The sum of LV wall thicknesses (septum+posterior wall) was significantly higher in borderline hypertensive subjects than in normotensive ones (20.5 vs 19.7 mm; p = 0.002). No difference was detected in LV internal dimension or systolic function. After adjustment for age and other clinical variables, comparisons between the groups revealed significant differences in indexes of Doppler diastolic filling. Peak velocity of early filling, and the ratio of early to late peak velocities were lower in the hypertensive group (40 vs 44 cm/s [p = 0.03] and 0.69 vs 0.76 [p = 0.01], respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Sex differences in cardiac adaptation to isolated systolic hypertension.

This study examines the association of isolated systolic hypertension with left ventricular (LV) mass and geometry in men and women. The subjects of this study were surviving members of the Framingham Heart Study and the Framingham Offspring Study who attended the index examination (between 1979 and 1983) and were aged > or = 50 years, free of clinically apparent cardiovascular disease, not taking antihypertensive medication and without diastolic hypertension (diastolic blood pressure < 90 mm Hg), and in whom LV mass could be determined by echocardiography. Examinations routinely included 12-lead resting electrocardiography, measurements of resting blood pressure, anthropometry, blood glucose levels, and M-mode echocardiography. M-mode echocardiograms adequate to assess LV hypertrophy were obtained for 1,282 normotensive subjects (538 men and 744 women) and 79 subjects with isolated systolic hypertension (26 men and 53 women). Adjusting for age, body mass index and diastolic blood pressure, the relative odds of LV hypertrophy associated with isolated systolic hypertension were 2.58 (95% confidence interval 0.97 to 6.86) in men and 5.94 (95% confidence interval 3.06 to 11.53) in women. Women with isolated systolic hypertension had increased LV wall thickness and mass without LV chamber enlargement, but men had LV dilation and increased LV mass without increased wall thickness. In conclusion, although isolated systolic hypertension was associated with increased LV mass in men and women, the geometric pattern of increased LV mass differed by sex; although women demonstrated a pattern of concentric hypertrophy, an eccentric pattern was observed in men.

Adaptation, Physiological↗
PubMed1993

Bone mineral density and knee osteoarthritis in elderly men and women. The Framingham Study.

OBJECTIVE: To examine the possible inverse relationship between osteoporosis and osteoarthritis (OA) by evaluating the association between bone mineral density (BMD) and knee OA in the Framingham Study cohort. METHODS: Of the 1,154 Framingham Study cohort subjects in whom BMD measurements were obtained at biennial examination 20, 932 (81%) had had knee OA assessed during the Framingham Knee OA Study 4 years earlier. BMD of the proximal femur and radius was measured by densitometry. Knee OA was assessed from a weight-bearing anteroposterior radiography and graded on a scale of 0 (no OA) to 4 (severe OA). Osteophytes and joint space narrowing were also evaluated separately. Linear regression was used to test the association of BMD with knee OA, with osteophytes, and with joint space narrowing, after adjustment for age, body mass index, and mean number of cigarettes smoked per day. RESULTS: The subjects included 572 women and 360 men with an age range of 63-91 years (mean 71 years). Of these, 351 had no OA, 269 had grade 1 OA, 170 had grade 2 OA, 93 had grade 3 OA, and 49 had grade 4 OA. Mean femoral BMD at the 3 proximal femur sites was 5-9% higher in men and women with either grade 1, grade 2, or grade 3 knee OA, compared with those with no knee OA (P < 0.0001). Mean femoral BMD in those with grade 4 OA was not higher than in those with no OA. Radius BMD was not associated with knee OA in subjects of either sex. Women with osteophytes had higher BMD compared with women with no osteophytes. Mean BMD did not differ across levels of joint space narrowing. CONCLUSION: We conclude that, among women, femoral BMD is higher in those with osteophytosis of the knee, and BMD is not necessarily associated with joint space narrowing.

Aged↗
PubMed1993

Improved detection of echocardiographic left ventricular hypertrophy using a new electrocardiographic algorithm.

OBJECTIVES: The purpose of this study was to use the Framingham data base to devise and test an improvement in an electrocardiographic (ECG) voltage criterion for detecting left ventricular hypertrophy that is gender specific and adjusts for age and obesity. BACKGROUND: Electrocardiographic detection of left ventricular hypertrophy has been receiving increasing attention. The "Cornell" ECG voltage, defined as the sum of voltages for the R wave of lead aVL and S wave of lead V3, has been shown to correlate strongly with echocardiographically estimated left ventricular mass. Because the magnitude of this voltage varies with both age and obesity, we have proposed a simple formula for its adjustment for these two variables. METHODS: Using linear regression, the adjustment formula was estimated from data on 1,468 men and 1,883 women from the Framingham Heart Study cohort who were free of myocardial infarction and who had both an ECG and an echocardiogram recorded during the same clinic examination. A modified receiver operating characteristic curve method was used to compare sensitivities at the same specificity levels. The adjustment formula was estimated from one randomly chosen half of the study cohort and applied to the other half for evaluation. RESULTS: Significant improvement in sensitivity for the detection of left ventricular hypertrophy was realized at all levels of specificity. At a specificity level of 98%, the adjustment increased the sensitivity of the Cornell voltage from 10% to 17% in men and from 12% to 22% in women. For severe hypertrophy, defined as a left ventricular mass > 3 SD above the gender-specific mean, the sensitivity increased from 23% to 38% for men and from 22% to 55% for women at a specificity level of 95%. CONCLUSIONS: This approach can substantially enhance the utility of the ECG for the detection of left ventricular hypertrophy. If these results are validated in other population groups, this approach may prove valuable in the screening of hypertensive populations and for the monitoring of patients undergoing treatment for hypertension.

Age Factors↗
PubMed1993

Asymptomatic ventricular arrhythmias and mortality risk in subjects with left ventricular hypertrophy.

OBJECTIVES: The purpose of this study was to evaluate the long-term prognostic role of asymptomatic ventricular arrhythmias in original Framingham Heart Study subjects and Framing-ham Offspring Study subjects who had echocardiographic evidence of left ventricular hypertrophy. BACKGROUND: Echocardiographically determined left ventricular hypertrophy is associated with increased risk for ventricular arrhythmias. There are no population-based data available with regard to the long-term prognostic implications of asymptomatic ventricular arrhythmias in subjects with left ventricular hypertrophy. METHODS: In a population-based cohort study, we studied 224 men and 393 women with echocardiographically determined left ventricular hypertrophy who were free of coronary heart disease and had 1-h ambulatory electrocardiograms at the baseline examination. The age-adjusted prevalence of complex or frequent ventricular arrhythmias (> 30 ventricular premature beats/h, multiform premature complexes, couplets, ventricular tachycardia or R on T ventricular premature complexes) was 28% (51 of 224) in men and 17% (71 of 393) in women. The mean follow-up period was 5.7 years for cohort and 4.5 years for offspring subjects. RESULTS: In men with complex or frequent arrhythmias, the 6-year cumulative incidence of all-cause mortality was 38%, whereas in those free of arrhythmia it was 12%; corresponding values in women were 22% and 11%. The cumulative incidence of myocardial infarction or death due to coronary heart disease was 20% for men with and 10% for men without arrhythmia, but in women little difference was noted (5% vs. 4%). After adjustment for age and gender in a Cox proportional hazards model, subjects with complex or frequent arrhythmia were at increased risk for all-cause mortality (hazard ratio 1.80, 95% confidence interval [CI] 1.13 to 2.87, p = 0.013). After adjusting for eight clinical covariates, the increased risk for all-cause mortality remained marginally significant (hazard ratio 1.62, 95% CI 0.98 to 2.68, p = 0.058). No significant increased risk was noted for myocardial infarction or death due to coronary heart disease. CONCLUSIONS: In subjects with left ventricular hypertrophy, the presence of asymptomatic ventricular arrhythmias was associated with higher mortality, which was statistically significant after adjusting for age and gender and marginally significant after taking into account other covariates.

Aged↗
PubMed1993

The epidemiology of heart failure: the Framingham Study.

Congestive heart failure has become an increasingly frequent reason for hospital admission during the last 2 decades and clearly represents a major health problem. Data from the Framingham Heart Study indicate that the incidence of congestive heart failure increases with age and is higher in men than in women. Hypertension and coronary heart disease are the two most common conditions predating its onset. Diabetes mellitus and electrocardiographic left ventricular hypertrophy are also associated with an increased risk of heart failure. During the 1980s, the annual age-adjusted incidence of congestive heart failure among persons aged > or = 45 years was 7.2 cases/1,000 in men and 4.7 cases/1,000 in women, whereas the age-adjusted prevalence of overt heart failure was 24/1,000 in men and 25/1,000 in women. Despite improved treatments for ischemic heart disease and hypertension, the age-adjusted incidence of heart failure has declined by only 11%/calendar decade in men and by 17%/calendar decade in women during a 40-year period of observation. In addition, congestive heart failure remains highly lethal, with a median survival time of 1.7 years in men and 3.2 years in women and a 5-year survival rate of 25% in men and 38% in women.

Adult↗
PubMed1993

Blood pressure during the first minutes of focal cerebral ischemia.

STUDY OBJECTIVE: To determine whether blood pressure declines spontaneously during the first minutes and hours of focal cerebral ischemia. DESIGN: Multiple blood pressure measurements as part of an urgent stroke therapy trial (treatment within 90 minutes of stroke onset). SETTING: Thirteen hospitals in three metropolitan communities. PARTICIPANTS: Sixty-nine patients (mean age, 65 +/- 9 years) with acute ischemic stroke who were participants in a phase I urgent stroke therapy trial of recombinant tissue plasminogen activator. MAIN OUTCOME MEASURE: Blood pressures recorded at the scene of stroke by life-squad personnel, in the emergency department, and in the ICU. RESULTS: The mean time from stroke onset to the time of first blood pressure measurement was 19 +/- 13 minutes. Twenty-four of the 69 patients in the urgent stroke therapy trial had an initial systolic blood pressure of at least 160 mm Hg. Of these, 23 had a significant decline in systolic and diastolic blood pressure during the first 90 minutes after the onset of stroke (mean change in systolic pressure, -29 +/- 22 mm Hg, P < .001; mean change in diastolic pressure, -10 +/- 14 mm Hg, P < .01). No patients received antihypertensive therapy during the time in which the decline in blood pressure was noted. CONCLUSION: Mildly or moderately elevated blood pressure frequently declines spontaneously during the first minutes and hours of focal cerebral ischemia and generally does not require urgent pharmacologic treatment.

Acute Disease↗
PubMed1993

Correlates and determinants of bone mineral content and density in healthy adolescent girls.

The relationships between whole-body and lumbar spine bone mineral content and density, and measures of chronologic age, body composition, physical activity, cardiorespiratory and strength fitness, gynecologic attributes, sexual maturity, and endocrine status were studied in 35 healthy menarcheal girls (14-18 years of age). Body mass (0.464 < r < 0.704), growth hormone (-0.34 < r < -0.42), and one-repetition maximum double-leg press strength (0.343 < r < 0.467) were significantly (p < 0.05) correlated with each of the five bone mineral measures. Multiple regression analysis indicated that body mass accounted for the largest significant proportion of the explained variance (30.2-68.2%) in each of the five bone mineral measures. Age at first menses accounted for a smaller but still significant proportion of the variance in whole-body bone mineral content (4.05%) and lumbar spine bone mineral content (8.06%). Growth hormone entered the regression model as an important predictor of whole-body bone mineral content, accounting for 3.51% of the explained variance in this variable. Age, cardiorespiratory fitness, level of habitual activity, and strength did not contribute significantly to the explained variance in any of the bone mineral measures. Body mass appears to be the single most important determinant of bone mineral among females during this developmental period.

Adolescent↗
PubMed1993

Na(+)-dependent bile acid transport by hepatocytes is mediated by a protein similar to microsomal epoxide hydrolase.

A protein mediating hepatocyte sodium-dependent bile acid transport across the sinusoidal plasma membrane has been purified by immunoprecipitation with monoclonal antibody (MAb) 25D-1, which specifically recognizes this protein on the surface of intact hepatocytes (Ananthanarayanan et al. J. Biol. Chem. 263: 8338-8343, 1988). The function of this protein was further established by proteoliposome reconstitution (von Dippe et al. J. Biol. Chem. 265: 14812-14816, 1990). NH2-terminal amino acid sequence analysis and amino acid composition revealed this protein to be closely related to the enzyme microsomal epoxide hydrolase (mEH). Both proteins exhibited the same elution times on a reverse-phase high-pressure liquid chromatography column, comigrated with an apparent molecular weight of 49,000 as measured by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and possessed identical isoelectric points of 8.2. The MAb was capable of immunoprecipitating chromatographically purified mEH, as well as a protein derived from the sinusoidal plasma membrane that exhibited mEH activity comparable to that of the protein isolated from the endoplasmic reticulum. The subtilisin fragmentation patterns derived from chromatographically purified mEH and the MAb-precipitated plasma membrane protein were also identical. Hydropathy profile analysis of the amino acid sequence of mEH suggested the presence of four transmembrane domains. The results of these studies indicate that a protein that is involved in mediating sodium-dependent bile acid transport is closely related to mEH.

Animals↗
PubMed1993

Survival after the onset of congestive heart failure in Framingham Heart Study subjects.

BACKGROUND: Relatively limited epidemiological data are available regarding the prognosis of congestive heart failure (CHF) and temporal changes in survival after its onset in a population-based setting. METHODS AND RESULTS: Proportional hazards models were used to evaluate the effects of selected clinical variables on survival after the onset of CHF among 652 members of the Framingham Heart Study (51% men; mean age, 70.0 +/- 10.8 years) who developed CHF between 1948 and 1988. Subjects were older at the diagnosis of heart failure in the later decades of this study (mean age at heart failure diagnosis, 57.3 +/- 7.6 years in the 1950s, 65.9 +/- 7.9 years in the 1960s, 71.6 +/- 9.4 years in the 1970s, and 76.4 +/- 10.0 years in the 1980s; p < 0.001). Median survival after the onset of heart failure was 1.7 years in men and 3.2 years in women. Overall, 1-year and 5-year survival rates were 57% and 25% in men and 64% and 38% in women, respectively. Survival was better in women than in men (age-adjusted hazards ratio for mortality, 0.64; 95% CI, 0.54-0.77). Mortality increased with advancing age in both sexes (hazards ratio for men, 1.27 per decade of age; 95% CI, 1.09-1.47; hazards ratio for women, 1.61 per decade of age; 95% CI, 1.37-1.90). Adjusting for age, there was no significant temporal change in the prognosis of CHF during the 40 years of observation (hazards ratio for men for mortality, 1.08 per calendar decade; 95% CI, 0.92-1.27; hazards ratio for women for mortality, 1.02 per calendar decade; 95% CI, 0.83-1.26). CONCLUSIONS: CHF remains highly lethal, with better prognosis in women and in younger individuals. Advances in the treatment of hypertension, myocardial ischemia, and valvular heart disease during the four decades of observation did not translate into appreciable improvements in overall survival after the onset of CHF in this large, unselected population.

Age Factors↗
PubMed1993

Prognosis after the onset of coronary heart disease. An investigation of differences in outcome between the sexes according to initial coronary disease presentation.

BACKGROUND: Differences exist between men and women in prognosis after the onset of coronary heart disease (CHD). METHODS AND RESULTS: All Framingham Heart Study subjects with the onset of clinically apparent coronary disease from 1951 through 1986 were studied to compare prognosis in men and women according to CHD presentation. Coronary disease presentations included angina, coronary insufficiency (unstable angina), recognized myocardial infarction, unrecognized myocardial infarction, and coronary death. Less than 1% of subjects were lost to follow-up for overall mortality. Cox modeling was used to examine the sex differences in outcome for each coronary presentation. New nonfatal coronary disease developed in 750 men (mean age, 63 years) and 583 women (mean age, 67 years). After onset of angina, men were at greater risk than women for myocardial infarction (hazards ratio [HR], 2.20; 95% confidence interval [CI], 1.45 to 3.34) and coronary death (HR, 2.11; 95% CI, 1.32 to 3.36) after adjustment for age and coronary disease risk factors. After a recognized myocardial infarction, there was a trend toward greater risk for overall mortality in women than men after adjustment for age and risk factors (HR, 0.75; 95% CI, 0.53 to 1.08). In contrast, after an unrecognized myocardial infarction, men were at increased risk for death compared with women (HR, 2.01; 95% CI, 1.28 to 3.15). CONCLUSIONS: Women fare at least as poorly as men after recognized myocardial infarction, whereas women have a more favorable outlook than men after the onset of angina or unrecognized myocardial infarction. The favorable outcome in women after angina and unrecognized myocardial infarction is due, in part, to greater misclassification of these coronary events in women than in men.

Adult↗
PubMed1993

Impact of microbiological consultation on clinical decision making: a case-control study of clinical management of recurrent periodontitis.

Data obtained from diagnostic tests may influence the clinician's perception of the patient's state and in some instances may alter subsequent choices of therapeutic interventions. To determine if microbiological consultation influences the clinical management of patients with recurrent periodontitis, an observational, case-control study was conducted to measure the amount and type of periodontal treatment provided by periodontists (n = 13) who had referred patients with recurrent periodontitis for microbiological consultation. The control group consisted of periodontists (n = 10) who had not referred recurrent periodontitis patients for testing. Patients (n = 31; 20 females, 11 males; mean age 49.8 +/- 10.0 years) treated by the case group of periodontists were matched for age and sex to patients (n = 48; 22 females, 26 males; mean age 49.9 +/- 8.5 years) treated by the control group of periodontists. Questionnaires were administered to quantitatively assess the amount and type of treatment before and after receiving the microbiological report. Specific analyses were performed as a function of the time of receipt of the microbiology report. Case-control differences prior to the receipt of the report indicated that the amount of surgery/year was 43% greater for controls (P < 0.04), in spite of control patients exhibiting fewer deep pockets than case patients (P < 0.05). Case-control differences after the receipt of the report indicated that case patients were provided with 45% greater number of appointments/year (P < 0.005), 46% greater scaling/year (P < 0.02), and 79% greater antibiotics/year (P < 0.01) compared with controls. The report influenced 9 (69%) case periodontists to change treatment. Case patients who received a change in treatment (n = 21) exhibited greater number of deep pockets at the time of entry into the study (P < 0.05) as compared with case patients who did not receive a change in treatment. Paired t-tests of differences within groups before and after the report demonstrated that case patients had a significant increase in treatment after the report as shown by 22% greater number of visits/year (P < 0.05) and 54% greater number of antibiotic prescriptions/year (P < 0.01). In contrast, controls demonstrated no significant change in treatment. Further, contrasts of change in treatment before and after the report again indicated that case patients exhibited a significantly higher number of visits/year (P < 0.04) and number of antibiotic prescriptions/year (P < 0.02) compared with control patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Anti-Bacterial Agents↗
PubMed1993

A multifactorial approach to coronary disease risk assessment.

Coronary heart disease (CHD) remains a major cause of morbidity and mortality in Western societies. Hypertension has been identified as a cardinal risk factor for CHD. Guidelines for hypertension classification and treatment are based on the results of clinical trials that have demonstrated reductions in cardiovascular endpoints in treated hypertensive patient. Controversy persists regarding the level of blood pressure at which treatment should be initiated and the desirable blood pressure goals of treatment. Several algorithms for CHD risk prediction have been developed. This report will review one recently developed approach for predicting CHD risk based upon observational data from the Framingham Heart Study. A rationale is presented for considering absolute level of CHD risk to guide hypertension treatment.

Adult↗