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Daniel Levy

Publications and source records attributed to Daniel Levy.

157 records · Page 9Linked to original sources
PubMed2002

Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study.

BACKGROUND: Although excessive alcohol consumption can promote cardiomyopathy, little is known about the association between alcohol consumption and risk for congestive heart failure in the community. OBJECTIVE: To determine the relation between alcohol consumption and risk for congestive heart failure in the community. DESIGN: Community-based, prospective observational study. SETTING: Framingham, Massachusetts. PARTICIPANTS: Participants in the Framingham Heart Study who were free of congestive heart failure and coronary heart disease. MEASUREMENTS: Self-reported alcohol consumption; sex-specific rates of congestive heart failure per 1000 person-years of follow-up by level of alcohol consumption. RESULTS: In men, 99 cases of congestive heart failure occurred during 26 035 person-years of follow-up. In women, 120 cases of congestive heart failure occurred during 35 563 person-years of follow-up. After adjustment for multiple confounders, risk for congestive heart failure was lower among men at all levels of alcohol consumption compared with men who consumed less than 1 drink/wk. The hazard ratio for congestive heart failure was lowest among men who consumed 8 to 14 drinks/wk (0.41 [95% CI, 0.21 to 0.81]) compared with those who consumed less than 1 drink/wk. In women, the age-adjusted hazard ratio for congestive heart failure was lowest among those who consumed 3 to 7 drinks/wk (0.49 [CI, 0.25 to 0.96]) compared with those who consumed less than 1 drink/wk. However, after adjustment for multiple predictors of congestive heart failure, this association was no longer statistically significant. CONCLUSIONS: In the community, alcohol consumption is not associated with increased risk for congestive heart failure, even among heavy drinkers (> or = 15 drinks/wk in men and > or = 8 drinks/wk in women). To the contrary, when consumed in moderation, alcohol appears to protect against congestive heart failure.

Adult↗
PubMed2002

Antecedent blood pressure and risk of cardiovascular disease: the Framingham Heart Study .

BACKGROUND: Casual blood pressure (BP) is a powerful predictor of risk of cardiovascular disease (CVD), but a single BP determination may not accurately reflect the residual impact of antecedent BP levels on vascular risk. It is unclear whether time-averaged past BP measures incrementally improve CVD risk assessment. METHODS AND RESULTS: We used sex- and age-specific multivariable Cox regression to evaluate the association of current BP (at baseline), recent antecedent BP (average of readings for all available examinations 1 to 10 years before baseline), and remote antecedent BP (average for all available examinations 11 to 20 years before baseline) with the 10-year risk of CVD in 2313 Framingham Study subjects (910 men, 1403 women) free of CVD at baseline. During follow-up, 899 incident initial CVD events were observed (479 in women). In multivariable models incorporating established CVD risk factors, recent and remote antecedent BP predicted CVD risk incrementally over current BP. This effect was consistent in multiple subgroups: men and women, older and younger age groups, and lower and higher BP groups. The relations of antecedent BP to CVD risk were consistent for systolic BP, diastolic BP, and pulse pressure. CONCLUSIONS: Antecedent BP is an important determinant of future risk of CVD events above and beyond current BP. When available, use of long-term average BP may improve the prognostic utility of conventional CVD risk prediction that is based on current BP. Our findings suggest that effective prevention of CVD requires adequate control of BP throughout life.

Aged↗
PubMed2002

Design of the Omapatrilat in Persons with Enhanced Risk of Atherosclerotic events (OPERA) trial.

The Omapatrilat in Persons with Enhanced Risk of Atherosclerotic events (OPERA) trial is a large clinical trial of omapatrilat, a vasopeptidase inhibitor, in patients with stage 1 isolated systolic hypertension (ISH). OPERA is the first study to examine whether effective antihypertensive treatment can provide survival and clinical end point benefits in older persons with this common condition. This 5-year multinational, randomized, double-blind, parallel-group, placebo-controlled, forced-titration study will be conducted in approximately 12,600 subjects randomized by approximately 1100 study centers worldwide over a recruitment period of approximately 2 years. The primary objective of OPERA is to determine whether treatment with once-daily omapatrilat (target dose 40 mg) will reduce cardiovascular (CV) morbidity and mortality in older (> or = 65 years) men and women with enhanced risk for atherosclerotic events due to stage 1 ISH plus other risk factors for which currently there is no evidence-based requirement for treatment. Blood pressure inclusion criteria are systolic blood pressure (SBP) 140 to 159 mm Hg (SBP 125 to 139 mm Hg in diabetic individuals) and diastolic blood pressure (DBP) <90 mm Hg. The primary end point is defined as the composite of fatal/nonfatal stroke, fatal/nonfatal myocardial infarction, fatal/nonfatal heart failure, and other CV mortality. Secondary end points include the individual components of the primary end point, CV mortality, and major cardiovascular end points, as well as effects on cognitive function and initiation of treatment for diabetes. Additional analyses will be conducted in men and women, in diabetic patients, in different risk classes and according to prior evidence of vascular disease.

Arteriosclerosis↗
PubMed2002

Serum potassium is not associated with blood pressure tracking in the Framingham Heart Study.

BACKGROUND: Abnormal potassium homeostasis accompanies many secondary forms of hypertension as well as uncommon inherited, monogenic forms of hypertension. We hypothesized that serum potassium may be associated with longitudinal tracking of blood pressure (BP) and development of hypertension. METHODS: A total of 2358 participants (1292 women, 1066 men) in the Framingham Heart Study who were free of hypertension, were not taking drugs affecting potassium homeostasis, and had serum potassium measured in 1979 to 1983 were followed for longitudinal tracking of BP and development of hypertension at examination 4 years later. Progression of BP stage was defined as an increment of one or more BP category, as defined by the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI), between baseline and follow-up examinations. RESULTS: At baseline, there were no differences in systolic or diastolic BP across serum potassium quartiles. Over 4 years of follow up, 37% (457 women, 412 men) of subjects progressed by one or more JNC-VI BP category. In a logistic regression model adjusting for multiple confounders, serum potassium quartile was not associated with risk of BP progression. During follow-up, 14% (162 women, 175 men) of subjects progressed to hypertension. After adjustment for multiple confounders, there was no significant association between serum potassium quartile and risk for progression to hypertension. CONCLUSIONS: In our community-based study sample, serum potassium was not associated with current BP, longitudinal BP tracking, or progression to hypertension.

Adult↗
PubMed2002

Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study.

BACKGROUND: Peripheral arterial disease (PAD) is associated with an increased risk for mortality. We sought to assess the prevalence of PAD and its risk factors in a population-based sample. METHODS: We examined 1554 males and 1759 females with a mean age of 59 years who attended a Framingham Offspring Study examination from 1995 to 1998. PAD was defined by an ankle-brachial blood pressure index of <0.9. Age- and sex-adjusted and multivariable logistic regression analyses were performed to identify factors associated with PAD. RESULTS: The prevalences of PAD, current intermittent claudication, lower extremity bruits and surgical intervention were 3.9%, 1.9%, 2.4% and 1.4% in males and 3.3%, 0.8%, 2.3% and 0.5% in females. Hypercholesterolemia, high-density lipoprotein cholesterol, triglyceride, diabetes, hypertension, current smoking, pack-years of smoking, body mass index, fibrinogen, and prevalent coronary disease were associated with PAD in age- and sex-adjusted analyses. Odds ratios and 95% CIs for significant associations identified from multivariable analyses are as follows: each 10 years of age, 2.6 (2.0, 3.4); hypertension, 2.2 (1.4, 3.5); smoking, 2.0 (1.1, 3.4); 10 pack-years of smoking, 1.3 (1.2, 1.4); 50 mg/dL of fibrinogen, 1.2 (1.1, 1.4); 5 mg/dL of high-density lipoprotein, 0.9 (0.8, 1.0); coronary disease, 2.6 (1.6, 4.1). CONCLUSIONS: Smoking cessation and hypertension control are important goals in the aim to reduce PAD and its associated impact on quality of life, functional decline, and risk for subsequent cardiovascular disease.

Adult↗
PubMed2002

Abdominal aortic calcific deposits are associated with increased risk for congestive heart failure: the Framingham Heart Study.

OBJECTIVES: We sought to determine the association of aortic atherosclerosis, detected by calcific deposits in the abdominal aorta seen on lateral lumbar radiographs, with risk for congestive heart failure (CHF). BACKGROUND: Although the association between atherosclerotic coronary heart disease (CHD) and CHF has been extensively studied, there are limited prospective data regarding the association of extracoronary atherosclerosis with CHF. METHODS: Lateral lumbar radiographs were obtained in 2467 Framingham Heart Study participants (1030 males and 1437 females) free of CHF in 1968. An abdominal aortic calcium (AAC) score was calculated for each subject based on the extent of calcium in the abdominal aorta. Proportional hazards models were used to test for associations between AAC score and CHF risk. RESULTS: There were 141 cases of CHF in men and 169 cases in women. In men, the multivariable-adjusted risk for CHF was increased for the second (hazards ratio [HR] 1.5, 95% CI 0.9-2.5) and third (HR 2.2, 95% CI 1.3-3.7) tertiles compared with the lowest tertile. Similarly, in women, the multivariable-adjusted risk for CHF was increased for the second (HR 1.8, 95% CI 1.1-2.9) and third (HR 3.2, 95% CI 2.0-5.1) tertiles compared with the lowest tertile. After further adjustment for CHD occurring prior to the onset of CHF, risk remained significantly increased for both men and women. CONCLUSIONS: Atherosclerosis of the abdominal aorta is an important risk factor for CHF, independent of CHD and other risk factors. Noninvasive detection and quantification of atherosclerosis may be useful in identifying high-risk individuals likely to benefit from strategies aimed at preventing CHF. The possibility of a link between AAC and vascular compliance deserves further study.

Adult↗
PubMed2002

Lymphoid activation: a confounding factor in AIDS vaccine development?

In a previous vaccination trial, inoculation of env gene DNA failed to elicit a detectable antibody response, yet accelerated virus dissemination in most immunized cats following challenge with feline immunodeficiency virus. This result raised the possibility that cell-mediated immune responses had given rise to immune-mediated enhancement of infection. Since high-level replication of immunodeficiency viruses in lymphocytes requires cellular activation, antigen-specific responses or non-specific polyclonal activation may have increased the frequency of optimal target cells. In the present DNA vaccination trial, although designed so as to minimize non-specific polyclonal activation, immune-mediated enhancement was nonetheless observed in certain immunized cats. Moreover, rapid virus dissemination in vivo was associated with the presence of T-helper responses prior to challenge, and was linked to increased susceptibility of lymphocytes to ex vivo infection. Immune activation may thus be a confounding factor in vaccination against lentivirus infection, diminishing vaccine efficacy and giving rise to immune-mediated enhancement.

Animals↗
PubMed2002

Treatment and control of hypertension in the community: a prospective analysis.

Cross-sectional national data indicate poor levels of treatment and control of hypertension. We identified factors that prospectively predict initiation of antihypertensive therapy and attainment of blood pressure control in the community. We included all Framingham Heart Study subjects examined between 1987 and 1999 who had untreated or uncontrolled hypertension (systolic > or =140 or diastolic > or =90 mm Hg) at a baseline examination and presented for follow-up examination 4 years later. Clinical covariates were examined for their association with initiation or control at follow-up. Among 1103 hypertensive participants who were untreated at baseline, 350 (31.7%) subjects were receiving therapy at follow-up, including 25.7% of subjects with stage 1 and 51.2% of those with stage > or =2 hypertension at baseline. Multivariate predictors of initiation of therapy included higher systolic and diastolic pressure, prevalent and interim cardiovascular disease, and left ventricular hypertrophy. Other cardiovascular risk factors did not predict initiation of treatment. Among 2475 hypertensive participants who were uncontrolled (treated or untreated) at baseline, 988 (39.9%) were controlled at follow-up. Prevalent cardiovascular disease and interim initiation of therapy predicted control; older age and higher baseline systolic levels predicted lack of control. These data provide estimates of longitudinal rates of treatment and control of hypertension in the community. It appears that global risk was not taken into consideration when making decisions for initiation of therapy. Greater emphasis is needed on achieving blood pressure control in all patients but particularly among older subjects and those with systolic hypertension.

Adult↗
PubMed2002

A diabetes outcome progression trial (ADOPT): an international multicenter study of the comparative efficacy of rosiglitazone, glyburide, and metformin in recently diagnosed type 2 diabetes.

OBJECTIVE: Therapies with metformin, sulfonylureas, or insulin improve glycemic control in the short term but do not prevent progressive islet beta-cell failure or long-term deterioration in glycemia. Our goal was to evaluate, in patients recently diagnosed with type 2 diabetes (<3 years), the long-term efficacy of monotherapy with rosiglitazone on glycemic control and on the progression of pathophysiological abnormalities associated with type 2 diabetes as compared with metformin or glyburide monotherapy. RESEARCH DESIGN AND METHODS: A Diabetes Outcome Progression Trial (ADOPT) is a randomized, double-blind, parallel-group study consisting of a screening visit, a 4-week placebo run-in, a 4-year treatment period, and an observational follow-up of approximately 3,600 drug-naïve patients with type 2 diabetes diagnosed within the previous 3 years. After run-in, patients will be randomized to rosiglitazone, glyburide, or metformin titrated to the maximum effective daily doses (8 mg rosiglitazone, 15 mg glyburide, or 2 g metformin). The primary outcome is time to monotherapy failure, defined as the time following titration to the maximal effective or tolerated dose when fasting plasma glucose exceeds 180 mg/dl (10 mmol/l). Secondary outcomes include measures of islet beta-cell function, insulin sensitivity, dyslipidemia, changes in urinary albumin excretion, plasminogen activator inhibitor-1 antigen, fibrinogen, and C-reactive protein. Safety and tolerability will also be evaluated. Patient-reported outcomes and resource utilization data will be collected and analyzed. CONCLUSIONS: ADOPT will provide data on the effect of mechanistically differing treatment options on metabolic control, beta-cell function, and markers of macrovascular disease risk in type 2 diabetes.

Albuminuria↗
PubMed2002

Coronary artery calcification in type 2 diabetes and insulin resistance: the framingham offspring study.

OBJECTIVE: To assess risk for subclinical coronary atherosclerosis using electron beam- computed tomography in subjects with or without insulin resistance and with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT/impaired fasting glucose [IFG]) or type 2 diabetes. RESEARCH DESIGN AND METHODS: We categorized glucose tolerance by type 2 diabetes therapy (diagnosed diabetes) or with an oral glucose tolerance test (OGTT) (IFG, IGT, and OGTT-detected diabetes) and insulin resistance as an elevated fasting insulin level, in subjects attending the fifth examination (1991-1995) of the Framingham Offspring Study. A representative subset of subjects without clinical atherosclerosis was selected for electron beam computed tomography in 1998-1999 from age- and sex-stratified quintiles of the Framingham risk score. The presence of subclinical atherosclerosis was defined as the upper quartile of the Agatston score distribution (score > 170). We assessed risk for subclinical atherosclerosis using multivariable logistic regression. RESULTS: Of 325 subjects aged 31-73 years, 51% were men, 11.2% had IFG/IGT, and 9.9% had diabetes (2.8% with diagnosed diabetes); 14.5% had insulin resistance. Compared with NGT, subjects with IFG/IGT tended to be more likely (adjusted odds ratio 1.5, 95% CI 0.7-3.4) and those with diabetes were significantly more likely (2.7, 1.2-6.1) to have subclinical coronary atherosclerosis. In age- and sex-adjusted models, subjects with insulin resistance were more likely to have subclinical atherosclerosis than those without insulin resistance (2.1, 1.01-4.2), but further risk factor adjustment weakened this association. In adjusted models including insulin resistance, diabetes remained associated with risk for subclinical atherosclerosis (2.8, 1.2-6.7); diagnosed diabetes (6.0, 1.4-25.2) had a larger effect than OGTT-detected diabetes (2.1, 0.8-5.5). CONCLUSIONS: Individuals with diabetes have an elevated burden of subclinical coronary atherosclerosis. Aggressive clinical atherosclerosis prevention is warranted, especially in diagnosed diabetes.

Adult↗
PubMedDate not supplied

Repositioning an inverted maxillary central incisor using a combination of replantation and orthodontic movement: a clinical case report.

In some patients, the permanent central incisors fail to erupt and become impacted within the alveolus. In individuals with unfavorable impactions, surgical replantation may be considered to be a reasonable solution before orthodontic repositioning. In this clinical case report, a 9-year-old male patient presented with the permanent maxillary left central incisor in an inverted position high in the vestibule. He was treated with replantation and orthodontic repositioning with fixed appliances. Radiographic review 2 years post-treatment showed an intact lamina dura consistent with a healthy tooth. It is concluded that orthodontic repositioning in combination with surgical replantation can be an optimal treatment choice for impacted teeth, assuming the anatomic location of the tooth is favorable.

Child↗