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Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 181 records · Page 10Linked to original sources
PubMed1994

Extended hormone replacement: who should get it, and for how long?

Hormone replacement therapy (HRT) after menopause may prevent cardiovascular disease and osteoporosis, chronic diseases that become increasingly important with age. For cardiovascular disease, this protection may be greatest in women with more risk factors, including age. Data suggest that HRT may mitigate bone loss in women 15 years or more past menopause, but reports are inconclusive regarding how HRT initiated after substantial bone is lost affects fracture incidence. The most troubling question is the possible association between HRT and breast cancer. Both clinician and patient must be aware of the potential for hormone-related symptoms following the initiation of HRT. Most symptoms fade in the first few months, but older women may be less willing to accept these problems unless they are provided a clear rationale for therapy.

Adult↗
PubMed1993

Incidence of insulin-dependent diabetes mellitus in young adults: experience of 1,587,630 US Navy enlisted personnel.

First hospitalizations (n = 1,293) for diabetes mellitus between 1974 and 1988 were used as a surrogate for insulin-dependent diabetes mellitus incidence among 17-34-year-old US Navy enlisted personnel followed for 6,077,856 person-years. In the 15-year period, the overall incidence of insulin-dependent diabetes mellitus was 21.3 per 100,000 person-years. Incidence did not differ significantly by sex, but was higher for blacks than whites (28.4 vs. 20.2 per 100,000 person-years, respectively; p < 0.05). Incidence increased with age threefold for white men and fivefold for black men (p < 0.05) between the ages of 17-19 and 30-34 years.

Adolescent↗
PubMed1993

Estrogen and estrogen-progestogen replacement: therapy and cardiovascular diseases.

The use of postmenopausal estrogens primarily to prevent heart disease should be reserved for women at high risk by virtue of an unfavorable low-density lipoprotein: high-density lipoprotein (LDL:HDL) ratio or the presence of manifest disease. Unopposed oral estrogen should improve lipoproteins within a few weeks, and this change, if sustained, should reduce the risk of cardiovascular disease. There is no reason to give progestins to a woman without a uterus. The management of a woman with an intact uterus is less well defined, given the unknowns about progestin's long-term effects on lipids or the heart.

Aged↗
PubMed1993

Relation between body size and bone mineral density in elderly men and women.

This cross-sectional study of the Rancho Bernardo, California, cohort examines the relation between bone mineral density and eight measures of body size (total weight, body mass index, waist-hip ratio, lean mass, fat mass, percentage fat mass, and current and maximum adult height) measured between 1988 and 1991 in 1,492 ambulatory white adults aged 55-84 years. Lean mass, fat mass, and percentage fat mass were measured by bioelectric impedance. Bone mineral density was measured at the hip and lumbar spine with dual-energy x-ray absorptiometry and at the midshaft and ultradistal radius with single photon absorptiometry. In multiple linear regression models adjusted for age, smoking, exercise, alcohol, thiazide use, and estrogen use (in women), total weight was the most consistent marker of bone mineral density overall. In this cohort, all measures of body size were associated with bone mineral density in both sexes and were better markers of bone mineral density in the weight-bearing sites than in the non-weight-bearing sites, implying a mechanical effect of weight on bone mineral density.

Absorptiometry, Photon↗
PubMed1993

A prospective study of alcohol consumption and bone mineral density.

OBJECTIVES: To study the effects of alcohol consumption on bone mineral density in a defined population. DESIGN: Prospective study of bone mineral density, measured during 1988-91, in a cohort who had given baseline data on alcohol intake in the previous week and in the previous 24 hours and other factors affecting bone mineral density during 1973-5. SETTING: Rancho Bernardo, California. SUBJECTS: 182 men and 267 women aged 45 and over at baseline, half having been randomly selected and half having been chosen for hyperlipidaemia, who gave baseline information on alcohol intake in one week. Of these subjects, 142 men and 220 women gave information on alcohol intake in 24 hours. MAIN OUTCOME MEASURES: Bone mineral density of the radial shaft, ultradistal wrist, femoral neck, and lumbar spine. RESULTS: Men and women were considered separately, and the tertiles of alcohol consumption were used to delineate low, medium, and high values of alcohol intake. With increasing alcohol intake in one week, bone mineral density (adjusted for age, body mass index, smoking, taking exercise, and oestrogen replacement therapy in women) increased significantly in the femoral neck of men (p < 0.01) and the spine of women (p < 0.01). With increasing alcohol intake in 24 hours, adjusted bone mineral density increased significantly in the radial shaft (p < 0.05) and spine (p < 0.001) of women. Similar, but not significant, patterns were seen at the other bone sites. CONCLUSIONS: Social drinking is associated with higher bone mineral density in men and women.

Alcohol Drinking↗
PubMed1993

Estrogen replacement therapy and cognitive function in older women.

OBJECTIVE: To determine whether replacement estrogen delays or prevents loss of cognitive function in elderly women. DESIGN: A 15-year prospective and cross-sectional study. SETTING: Rancho Bernardo, a geographically defined community in Southern California. PARTICIPANTS: Eight hundred women (80% of local surviving women from the original Rancho Bernardo cohort) aged 65 to 95 years. Estrogen use was evaluated at baseline between 1972 and 1974 and at follow-up between 1988 and 1991. MAIN OUTCOME MEASURES: Twelve tests of cognitive function from eight standard instruments administered at follow-up between 1988 and 1991. RESULTS: Almost half of this older, educated cohort had used estrogen at some time after menopause, and one third were current users. The age-related decrement in cognitive function was similar for women who were current, past, or never users of estrogen. Age- and education-adjusted comparisons also failed to show any consistent association between performance on tests of cognitive function and baseline, past, current, or never estrogen use; estrogen dose; or duration of use. Among 132 statistical comparisons, only five statistically significant differences were observed, less than the number expected by chance alone. Furthermore, these significant differences occurred with different tests of cognitive function, and in only one instance was the better test score associated with current estrogen use. No biases were identified that could explain these negative results. CONCLUSIONS: No compelling or internally consistent evidence for an effect of estrogen on cognitive function was found in these older women. These data do not support the hypothesis that estrogen use after the menopause preserves cognitive function in old age.

Aged↗
PubMed1993

A prospective study of dehydroepiandrosterone sulfate (DHEAS) and bone mineral density in older men and women.

The purpose of this study was to prospectively examine the relation of dehydroepiandrosterone sulfate (DHEAS) to bone mineral density in a community-based sample of 260 men and 162 women who were residents of Rancho Bernardo, California. DHEAS levels had been measured in plasma obtained in 1972-1974 when the men were 50-74 years of age and the women were 55-74. In 1988-1991, bone mineral density was measured at the lumbar spine and hip using dual x-ray absorptiometry, and at the mid-radius and ultradistal radius using single photon absorptiometry. Among men, there was a significant decrease in DHEAS levels and bone mineral density at the hip, ultradistal radius, and midshaft radius with increasing age. However, for both men and women, there was no significant association of DHEAS levels with bone mineral density at any site, both before and after adjustment for age, obesity, cigarette smoking, and use of antihypertensive medications. These data do not support the hypothesis of DHEAS having a causal role in senile osteoporosis.

Absorptiometry, Photon↗
PubMed1993

The association of lifetime weight and weight control patterns with bone mineral density in an adult community.

We examined the association of lifetime weight and weight change to bone mineral density (BMD) at four skeletal sites, the radial shaft, the ultradistal wrist, the total hip and lumbar spine, in a community-based population of 1043 older white men and women. In those currently overweight (body mass indices (BMI) > 26), the age-adjusted mean BMD at all sites was significantly higher than in those with BMI less than 26. Lifetime maximum BMI was also positively and significantly associated with a higher age-adjusted BMD at all sites except the ultradistal wrist in men. Weight gain or fluctuation of 10 lbs or more between the ages of 40 and 60 was associated with significantly higher age-adjusted mean BMD at all sites compared to weight loss or no weight change in both men and women. Weight at age 18 was unassociated with BMD but weight gain after age 18 was associated with significantly higher age-adjusted mean BMD at all sites. Conversely, dieting, weight loss or a lifetime maximum BMI of less than 24 were all associated with markedly lower BMD at all sites in both sexes. Weight patterns were closely correlated with current BMI; most of these trends persisted but were no longer statistically significant after controlling for current weight.

Adolescent↗
PubMed1993

Dietary fat, calories, and the risk of breast cancer in postmenopausal women: a prospective population-based study.

We tested the hypothesis that a high-fat diet increases the risk of breast cancer in a population-based study of 590 women aged 40-79 years who were without known breast cancer when they provided a quantitative 24-hour diet recall. Fifteen postmenopausal women were diagnosed with incident breast cancer during the next 15 years (approximately 7600 person-years of follow-up). These women had significantly higher age-adjusted intake of all fats (monounsaturated, polyunsaturated, and saturated), and oleic, linoleic, and linolenic acids, with a stepwise increase in risk across tertiles of intake. Fat intake was associated with total calories, protein, and carbohydrates, and women with incident breast cancer consumed more calories, protein, and carbohydrates than did other subjects. When each nutrient variable (calories, fats, protein, and carbohydrates) was adjusted for age, body mass index, age at menopause, parity, and alcohol consumption, the strongest risks for incident breast cancer were associated with total calories (relative risk per standard deviation = 2.72, 95% confidence interval = 1.51-4.89, p = 0.002) and total fats (relative risk per standard deviation = 2.01, 95% confidence interval = 1.19-3.41, p = 0.01). Fat composition of the diet, expressed either as percent of energy or as fat intake adjusted for calories by regression analysis, was not significantly associated with risk of breast cancer. These results support the hypothesis that total calorie consumption, as well as dietary fat consumption, is a risk factor for breast cancer in postmenopausal women, and parallel observations in animal models.

Adult↗
PubMed1993

Effects of age, gender and education on selected neuropsychological tests in an elderly community cohort.

OBJECTIVE: To establish population-based data, with special emphasis on the effects of age, gender, and education, for eight, widely used neuropsychological tests in a community-dwelling cohort of normal and cognitively impaired older adults. DESIGN: A population-based observational study. SETTING: Examinations were performed in a research clinic by specially trained staff during a 1988-1992 evaluation for osteoporosis. PARTICIPANTS: 1,692 community-dwelling subjects, aged 55 to 94 years, who were members of the Rancho Bernardo Heart and Chronic Disease Study initiated in 1972. The mean age for men was 73.9 years (SD 9.3) and for women, 73.5 (SD 9.1). OUTCOME MEASURES: Eight neuropsychological tests were used to measure cognitive functions. Analysis of variance and post hoc contrasts were performed to determine the effects of age, gender, education, and their interactions on performance on these tests. RESULTS: Performance on all tests decreased progressively, without leveling off, from the youngest, age 55, to the oldest, age 94. Women performed better on verbal tasks and men on tests of visuospatial, visuoconceptual, and mental control functions. Performances of men on several tests declined more rapidly with advancing age than those of women. Both men and women with some college education performed better on most tests than men and women with high school educations, and the rate of decline with age was sometimes slower in the college-educated group. Only the savings score from the Visual Reproduction Test, which is a measure of rate of forgetting, and the scores of short-term recall derived from the Selective Reminding Test (Buschke-Fuld) were unaffected by educational attainment. CONCLUSIONS: In a community-dwelling cohort, including normal and cognitively impaired elderly men and women, advancing age is accompanied by decline in cognitive functions as measured by neuropsychological tests. This decline is slower in women and in college-educated subjects. Two cognitive indices were unaffected by education, and these may be especially useful in cross-cultural studies.

Age Factors↗
PubMed1993

Interrelation between plasma sex hormone-binding globulin and plasma insulin in healthy adult women: the telecom study.

In order to study the relationship between plasma sex-hormone-binding globulin (SHBG) and insulin levels in healthy women, we investigated the association between plasma SHBG and insulin in an occupational sample of 786 nonhormone-using women. Levels of plasma SHBG showed a stepwise decrease with increasing fasting plasma insulin in premenopausal as well as in postmenopausal women. In these cross-sectional data, this significant negative relationship between SHBG and insulin was shown to be independent of age, body mass index, subscapular skinfold, fasting and 2-h plasma glucose in both groups. The etiology and the consequences of this inverse association between SHBG and insulin are unclear. Prospective and clinical studies in women will be necessary to determine the direction and causal nature of the association between SHBG and insulin, as well as its mechanism and its physiological and/or pathophysiological consequences.

Adult↗
PubMed1993

Bone mineral density in postmenopausal women as determined by prior oral contraceptive use.

The long-term consequences of prior oral contraceptive use for bone mineral density were examined in 239 postmenopausal women, 35.1% of whom reported prior oral contraceptive use. Women who had used oral contraceptives for 6 or more years had significantly higher bone densities of the lumbar spine and femoral neck, but not of the ultradistal wrist or radius, than women who never used oral contraceptives.

Aged↗
PubMed1993

Early menopause, number of reproductive years, and bone mineral density in postmenopausal women.

OBJECTIVES: Previous studies have reported positive associations of age at menopause with bone density and inverse associations of age at menarche with bone density. This study examined the relationships of early age at menopause and number of reproductive years (defined as age at menopause minus age at menarche) with bone density in postmenopausal women. METHODS: The subjects were 555 women aged 60 to 89 years who had had either natural menopause (n = 391) or hysterectomy with bilateral oophorectomy (n = 164). Bone density was measured at the ultradistal wrist, midshaft radius, lumbar spine, and hip. RESULTS: Women who had had early menopause and those with the fewest reproductive years had significantly lower bone density at all sites. After adjustment for covariates, both age at menopause and number of reproductive years had significant positive associations with bone density at every site, and total number of reproductive years explained more of the variance in bone mineral density than did either age at menarche or age at menopause. CONCLUSIONS: Elderly women reporting early menopause or fewer reproductive years have more osteoporosis. The number of reproductive years may be more helpful than age at menopause in identifying women at increased risk of osteoporosis.

Age Factors↗
PubMed1993

Cigarette smoking and bone mineral density in older men and women.

OBJECTIVES: The association between cigarette smoking and bone mineral density was examined prospectively in a population-based study of older Caucasian men and women. METHODS: Smoking patterns were determined at a 1972-1974 baseline evaluation and, again, 16 years later when 544 men and 822 women had bone mineral density measurements taken. RESULTS: Men and women who were cigarette smokers at baseline demonstrated significantly reduced bone mineral density of the hip compared with nonsmokers. Baseline smoking was not associated with significantly lower bone density at non-hip sites. Women demonstrated a significant dose-response relationship between baseline smoking status at all hip sites measured. Both sexes exhibited significant dose-response relationships between hip bone mineral density and change in smoking status between baseline and follow-up, demonstrating that smoking cessation in later life was beneficial in halting bone density loss associated with smoking. CONCLUSIONS: Smoking was positively and significantly associated with decreased hip bone mineral density in old age. Bone loss associated with smoking would be expected to predict an increased risk of hip fracture in those who do not succumb earlier to another complication of tobacco use.

Aged↗
PubMed1993

Estrogens, lipids, and heart disease.

The routine prescription of hormone replacement therapy for elderly women to prevent heart disease is not indicated. Until better data are available, the use of estrogens primarily to prevent heart disease probably should be reserved for women at high risk by virtue of their LDL/HDL ratio or the presence of manifest coronary heart disease. There is no reason to give progestins to the woman without a uterus; unopposed oral estrogen should improve lipoproteins within a few weeks, and this change, if sustained, should reduce risk. The management of a woman with an intact uterus is more problematic given the unknowns about progestin's long-term effects on lipids or the heart and the unwillingness of many elderly women to resume regular (or irregular) bleeding. There are, however, many proven benefits of hormone replacement therapy, including the prevention of osteoporosis and urogenital atrophy. Decisions about when it is too late to start estrogen, or when it is time to stop it, will need to be made on a case-by-case basis.

Age Factors↗
PubMed1993

Epidemiology and the menopause: a global overview.

There are 470 million women aged 50 years and older living in the world today, in other words, older than the average age of natural menopause throughout recorded history. Only 50 years ago, even in developed countries, the average women did not live to be 50 years of age. The result of this increased survival is that more and more women are living for longer and longer periods of time after their menopause. What are the implications of prolonged life after the menopause? Most of the current interest in the menopause is prompted by its possible relation to chronic diseases, most notably reproductive cancers, osteoporosis, and heart disease. All of these conditions are more common in women after the menopause, and two of them are directly influenced by the use of replacement estrogen. Thus, estrogen replacement reduces the risk of osteoporotic fractures by about 50%, and unopposed estrogen doubles or triples the risk of endometrial cancer. The risk of these conditions without treatment differs in different countries and populations, and consequently the benefit of hormone replacement will differ. The largest potential benefit of estrogen replacement therapy is the prevention of heart disease. In countries with a relatively high risk of heart disease, observational studies suggest that estrogen reduces this risk by 50%. In other areas, where heart disease in women is much less common, the use of estrogen to prevent heart disease in otherwise healthy women is inappropriate given the uncertain relation of long-term estrogen therapy to the risk of breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus.

OBJECTIVE: To describe the association of non-insulin-dependent diabetes mellitus (NIDDM) with bone mineral density (BMD). DESIGN: A survey of men and women from an established epidemiologic cohort who were separately screened for diabetes by oral glucose tolerance test between 1984 and 1987 and for osteopenia by BMD measured in 1988-1989. SETTING: A community-based population of older adults, Rancho Bernardo, Calif. PARTICIPANTS: The first 627 consecutively seen white men and women aged 55 to 88 years. MAIN OUTCOME MEASURES: Bone density measured by single photon absorptiometry at the ultradistal wrist and midradius and by dual x-ray absorptiometry at the femoral neck and lumbar spine. MAIN RESULTS: Among the 236 men and 391 women, whose average age was 72 years, 41 men and 39 women had NIDDM, 56 men and 110 women had impaired glucose tolerance, and 139 men and 242 women had normal glucose tolerance. Men with diabetes had BMD levels similar to those men with normal glucose tolerance, whereas women with diabetes had significantly higher BMD levels at all sites than women with normal glucose tolerance. The increased bone density in diabetic women was unexplained by age, obesity, cigarette smoking, alcohol intake, regular physical activity, and the use of diuretics and estrogen. The multiply adjusted mean BMD in women with NIDDM compared with normoglycemic women was 0.600 g/cm2 vs 0.548 g/cm2 at the midradius; 0.265 g/cm2 vs 0.230 g/cm2 at the ultradistal wrist; 0.654 g/cm2 vs 0.610 g/cm2 at the femoral neck; and 0.962 g/cm2 vs 0.859 g/cm2 at the spine. The sex differences were unexplained by survivor bias, prior obesity, or duration of diabetes. Differences were seen in women (but not men) whose diabetes was first detected at the screening evaluation, ie, before drug or dietary treatment. Similarly, in women (but not men) without diabetes increasing BMD levels at all four sites were associated with increasing postchallenge glucose levels independent of age and body mass index. CONCLUSIONS: Older women with NIDDM or hyperglycemia had better BMD than women with normal glucose tolerance, independent of differences in obesity and many other risk factors. No differences in bone density by diabetic status were observed in men. We hypothesize that the sex differences may be explained by the greater androgenicity reported in women with hyperglycemic and hyperinsulinemic conditions.

Age Factors↗