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Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 199 records · Page 11Linked to original sources
PubMed1992

Lower endogenous androgen levels and dyslipidemia in men with non-insulin-dependent diabetes mellitus.

OBJECTIVE: To compare plasma androgen levels in diabetic and nondiabetic men and to determine their relation to diabetic dyslipidemia. DESIGN: A population-based, case-control study. SETTING: Community. PARTICIPANTS: Men 53 to 88 years of age from the Rancho Bernardo, California, cohort who were screened for diabetes using an oral glucose tolerance test. MEASUREMENTS: Plasma androgen levels were compared in 44 men with untreated non-insulin-dependent diabetes mellitus and 88 age-matched men who had a normal glucose tolerance test. The relation of lipid and lipoprotein levels to androgen level and diabetic status was assessed before and after adjusting for covariates. RESULTS: Men with diabetes had significantly lower plasma levels of free (4.96 nmol/L compared with 5.58 nmol/L) and total testosterone (14.7 nmol/L compared with 17.4 nmol/L), dihydrotestosterone (428 pg/mL compared with 533 pg/mL), and dehydroepiandrosterone sulfate (DHEA-S) (1.92 mumol/L compared with 2.42 mumol/L) than nondiabetic men. They also had significantly lower high-density lipoprotein (HDL) cholesterol and significantly higher triglyceride levels. Differences were not explained by obesity, alcohol use, or cigarette habit. Overall, the total testosterone level, but not the free testosterone level, was positively correlated with the HDL cholesterol level (P = 0.009) and negatively correlated with the triglyceride level (P = 0.0001). Similar associations were seen in analyses restricted to the men without diabetes. CONCLUSIONS: Lower levels of endogenous androgens are seen in older diabetic men, and low androgen levels are associated with diabetic dyslipidemia.

Aged↗
PubMed1992

Pregnancy and lactation as determinants of bone mineral density in postmenopausal women.

The relation of pregnancy and breast feeding to bone mineral density of the wrist, radius, hip, and spine was examined in a white, upper middle-class, homogeneous sample of 741 postmenopausal women ranging in age from 60 to 89 years. Number of pregnancies ranged from 0 to 14, with a mean of 2.0 pregnancies and 1.5 live births. Almost two thirds of the women who had had a live birth reported breast feeding. Unadjusted comparisons indicated that bone mineral density of the wrist, radius, and hip increased with increasing numbers of pregnancies, and women who had breast-fed had higher bone mineral densities at these sites. However, after adjustment for age or age and body mass index, these associations were no longer significant. Multiple regression analyses adjusted for age, age at menopause, obesity, cigarette smoking, and estrogen and thiazide use also indicated that number of pregnancies and breast feeding were not significantly associated with bone mineral density at any of the four sites measured. Results of the present study suggest that reproductive history and breast feeding are not long-term determinants of bone mineral density.

Age Factors↗
PubMed1992

Sex hormones and postmenopausal breast cancer: a prospective study in an adult community.

Few studies have examined the role of endogenous sex hormones in breast cancer, and to the authors' knowledge, only two have done so prospectively. The authors report here the results of a prospective study based on an available bank of previously analyzed plasma collected in 1972-1974 from 442 women aged 50-79 years in Rancho Bernardo, California. These women were followed for 12-15 years, during which time 42 cases of breast cancer were identified: 15 incident cases diagnosed 1 year or more after baseline, 18 prevalent cases diagnosed earlier than 1 year after baseline, and 9 cases with unknown dates of onset. No apparent trends in plasma levels of sex hormones or sex hormone-binding globulin and incidence or prevalence of breast cancer were observed. Mean crude and age-adjusted plasma hormone levels at baseline (in pg/ml) for incident cases, total cases, and noncases, respectively, were: androstenedione: 647, 638 +/- 328 (standard deviation); 626, 620 +/- 245; and 664, 664 +/- 291; testosterone: 254, 258 +/- 120; 238, 241 +/- 153; and 262, 261 +/- 143; estrone: 37, 38 +/- 18; 35, 35 +/- 15; and 37, 37 +/- 17, and estradiol: 13, 13 +/- 7; 15, 15 +/- 8; and 15, 15 +/- 9. For sex hormone-binding globulin, mean crude and age-adjusted levels at baseline (nM) were 35 and 36 +/- 33 for incident cases; 31 and 31 +/- 25 for total cases; and 29 and 29 +/- 21 for noncases. Cox proportional hazards multiple regression showed no associations with breast cancer after simultaneous adjustment for age, body mass index, and cigarette smoking.

Aged↗
PubMed1992

The influence of aging on plasma sex hormones in men: the Telecom Study.

From April 1985 to July 1987, 1,408 healthy white men aged 20-60 years in Paris, France, recruited on an occupational basis, underwent a physical examination and measurements of plasma sex hormones in a cross-sectional study. Both total testosterone and estradiol showed a significant stepwise decrease with age (p less than 0.001) starting in the early adult years, while estrone did not vary. These relations of testosterone and estradiol with age remained significant after adjustment for body mass index, subscapular skinfold, and tobacco and alcohol consumptions, and they were not modified by exclusion of the men who reported chronic disease. Both the mechanism for the early decrease in testosterone and its clinical significance merit further investigation.

Adult↗
PubMed1992

Intensive surveillance for infections in a three-year study of nursing home patients.

The authors report the results of a 3-year (August 1984-May 1987) prospective study of intensive surveillance for nursing home-associated infections in 666 patients in a 300-bed nursing home in San Diego, California. Ninety-three percent (666 of 714) of the eligible subjects enrolled; 75% were women. The mean age of the subjects was 81.6 years. Lengths of stay ranged from 1 day to 1,025 days, with a mean of 166 days; the cumulative length of stay for all subjects was 110,746 days (303 years). Operational definitions that were heavily dependent on evaluation of clinical signs and symptoms were used by nurse practitioners in weekly or biweekly assessments of all patients to identify infections. The overall incidence of nursing home-associated infection was 7.1 infections/1,000 patient-days. Many of the infections would not have been recognized by persons less skilled than nurse practitioners. Among the 788 nursing home-associated infections identified, 362 (47%) were in the respiratory tract (286 lower respiratory and 76 upper respiratory); 200 (25%) were associated with skin and subcutaneous and mucous membranes; 140 (18%) were symptomatic urinary tract infections; 13 (2%) were bacteremia; and 73 (9%) were other infections.

Adult↗
PubMed1992

Cigarette smoking, obesity, and benign prostatic hypertrophy: a prospective population-based study.

The authors examined the relation of smoking and obesity to surgically treated benign prostatic hypertrophy in a prospective study of white men aged 40-79 years who were first examined in 1972-1974 and were followed for an average of 12 years. After exclusion of those whose surgery preceded assessment of smoking and obesity and those who had prostate cancer, there were 165 cases of benign prostatic hypertrophy among 929 men. Age-adjusted relative risk of benign prostatic hypertrophy in current or previous smokers compared with nonsmokers was 1.1 (95% confidence interval 0.8-1.6). Age-adjusted relative risk of benign prostatic hypertrophy in the most obese tertile (body mass index (kg/m2) greater than 26.75) compared with the remainder showed a relative risk of 0.9 (95% confidence interval 0.6-1.4). Multivariate analysis also failed to show a relation between cigarette smoking or obesity and the development of surgically treated benign prostatic hypertrophy.

Age Factors↗
PubMed1992

Interrelation between plasma testosterone and plasma insulin in healthy adult men: the Telecom Study.

Plasma insulin is a risk factor for diabetes mellitus and cardiovascular disease in men. We investigated the association between plasma testosterone and plasma insulin in an occupational sample of 1292 healthy adult men. Total plasma testosterone decreased with each decade of age and insulin increased with each decade of age. In these cross-sectional data, this significant graded inverse association between testosterone and insulin was independent of age. The association was reduced but not explained by the addition of obesity and subscapular skinfold to the model. Adjustment for alcohol consumption, cigarette smoking and plasma glucose did not materially alter the association. These results are the reverse of the positive association of androgens with insulin in women and suggest alternative possible explanations for the effect of hyperinsulinaemia on cardiovascular disease risk. Prospective studies will be necessary to determine the direction and causal nature of this association.

Adult↗
PubMed1992

Cigarette smoking, mortality, institutional and community-based care utilization in an adult community.

We evaluated mortality and health services utilization in a prospective study of 630 older residents of a Southern California community. All participants were 65 years or older when initially evaluated in 1973-1975. In addition to being followed for vital status each year, participants were reinterviewed in 1984-1986 and asked about nursing home, hospital, and community-based care for the interim period. Current cigarette use in 1973-1975 was a significant predictor of mortality for both men and women. In addition, former smoking status (before 1973-1975) significantly predicted both mortality and hospital inpatient utilization in men and women combined. However, smoking was not significantly associated with nursing home utilization or use of three categories of community-based care services. More research is necessary to identify the relationship between cigarette smoking and outpatient service use. The findings for mortality and inpatient hospital service utilization reaffirm the hazards of cigarette smoking.

Adult↗
PubMed1992

Estrogen replacement therapy and the risk of venous thrombosis.

PURPOSE: Estrogen replacement therapy is believed by many physicians to cause thrombophlebitis and to be contraindicated in women at risk for this disease. However, clinical data supporting this assumption are scant, and further investigation is required. PATIENTS AND METHODS: We tested the estrogen-thrombophlebitis association in a case-control study. Charts of all consecutive women aged 45 years or older with a primary or secondary discharge diagnosis of thrombophlebitis, venous thrombosis, or pulmonary embolism were reviewed; 121 cases and 236 controls matched for age, year of admission, admitting service, and socioeconomic status were obtained. Hormone use and nonuse were validated in a subset of randomly selected women. RESULTS: Cases and controls, whose average age was 65 years, did not differ significantly on matching variables or on current use of exogenous estrogen (5.1% of cases versus 6.3% of controls). Other analyses that variously excluded women with a past history of thrombosis, women less than 50 years of age, women with thrombosis occurring after admission, and women whose estrogen use was indeterminate also did not support an increased risk of thrombotic disease. Adjustment for the presence of independent thrombotic risk factors did not alter the odds ratio for estrogen use. CONCLUSION: This case-control study of older women, unselected for other thrombotic risk factors, does not support the commonly held assumption that replacement estrogen increases the risk of venous thrombosis.

Aged↗
PubMed1992

The relationship between multiparity and lipoprotein levels in older women.

The relation between multiparity and lipid and lipoprotein levels was examined in a sample of 1275 Rancho Bernardo women aged 50-89. Number of pregnancies ranged from 0 to 13 with a mean of 2.1. Pregnancy was unrelated to high density lipoprotein cholesterol level in women with 4 or fewer pregnancies, but women with 5 or more pregnancies had significantly lower levels both before and after adjustment for age, obesity, diabetes, alcohol and cigarette consumption, exercise and estrogen use. After multiple regression analysis, women with 5 or more pregnancies had high density lipoprotein levels that were 4.9 mg/dl lower than women with 4 or fewer pregnancies. No differences in total cholesterol, low density lipoprotein cholesterol or triglyceride levels were observed by number of pregnancies. If confirmed by others, these results suggest that one factor mediating the previously reported relationship between multiparity and cardiovascular disease may be a decreased level of high density lipoprotein cholesterol.

Aged↗
PubMed1992

Lower endogenous androgens predict central adiposity in men.

Central adiposity, sometimes described as male pattern fat distribution, is adversely related to cardiovascular risk and mortality independent of other measures of obesity. In a cohort of 511 men aged 30 to 79 years in 1972 to 1974, levels of androstenedione, testosterone, and sex hormone-binding globulin measured at baseline were inversely related to subsequent central adiposity, estimated 12 years later using the waist-hip circumference ratio. The observed differences in waist-hip ratio between top and bottom tertiles of these hormones and sex hormone-binding globulin were similar to mean waist-hip ratio differences between men with stroke or ischemic heart disease and those without in another prospective study. These findings, consistent with studies suggesting that testosterone seems to mobilize the abdominal depot on males, suggest that "male pattern" fat distribution may be a misleading description for central adiposity, at least, in men. Degree of maleness as indicated by total androgen levels is, in fact, negatively associated with central adiposity. However, the role of sex hormone-binding globulin in regulating androgenic activity warrants further investigation.

Adult↗
PubMed1992

Hormone replacement and cancer.

The increasing extended use of noncontraceptive oestrogen by postmenopausal women, intended to prevent other conditions, may at the same time increase their risk of reproductive cancer. The risk of endometrial cancer triples after only a few years of unopposed oestrogen, persists for many years after oestrogen has been discontinued, and appears to be preventable by the addition of a progestin. The effect of replacement hormones on the risk of breast or ovarian cancer is unknown. Most studies suggest a small but significant increased risk of breast cancer after long-term use. Awareness of the known and uncertain cancer risks should be included in decisions to use replacement hormones.

Breast Neoplasms↗
PubMed1992

Exogenous estrogen and endogenous sex hormones.

Estrogen replacement therapy is widely used to treat menopausal symptoms and prevent osteoporosis. The mechanism of these and other estrogen effects is currently under investigation. We studied the plasma steroid hormone and sex hormone binding globulin levels in frozen plasma obtained from 977 women aged 50 to 79 years from 1972 to 1974. Almost all of the 301 women who reported current use of noncontraceptive estrogen were taking conjugated estrogen by mouth; none reported use of a progestin. Women taking estrogen were significantly younger, thinner, and more likely to smoke cigarettes than women not taking estrogen. Sex hormone binding globulin and all endogenous hormones except testosterone were negatively correlated with age; estradiol was positively and cortisol and sex hormone binding globulin were negatively associated with obesity. After adjusting for age and obesity, dehydroepiandrosterone sulfate, androstenedione, and free testosterone were significantly lower in women currently taking estrogen than in women not using estrogen. These differences were independent of cigarette smoking. As expected, estrogens (including free estradiol), sex hormone binding globulin, and cortisol levels were higher in treated than untreated women. The possibility that some of the benefits and risks of replacement estrogen are secondary to altered adrenal steroid metabolism and androgen levels needs further evaluation.

Aged↗
PubMed1992

Risks and benefits of replacement estrogen.

Many studies show that the risk of a coronary event is reduced by about 50% in postmenopausal women using unopposed oral estrogen compared to women not taking oral estrogens. This protection is biologically plausible, and the magnitude of the benefit would be large if selection factors could be excluded. Studies also show an approximate 50% reduction in hip fracture after three or more years of hormone replacement. An increased risk of endometrial cancer approximately equals the number of years of unopposed estrogen use and continues after estrogen has been discontinued. Use of estrogen for more than five years may increase the risk of breast cancer by 50%, but more data are needed to exclude the effects of selection and diagnostic detection bias. Until clinical trial data are available on estrogen-progestin use, no universal recommendation for hormone replacement or type and duration of treatment can be made.

Cardiovascular Diseases↗
PubMed1992

Employment status and heart disease risk factors in middle-aged women: the Rancho Bernardo Study.

BACKGROUND: In recent years, an increasing number of women have been entering the labor force. It is known that in men, employment is related to heart disease risk, but there are few studies examining this association among women. METHODS: The relation between employment status and heart disease risk factors including lipid and lipoprotein levels, systolic and diastolic blood pressure, fasting and postchallenge plasma glucose and insulin levels, was examined in 242 women aged 40 to 59 years, who were participants in the Rancho Bernardo Heart and Chronic Disease Survey. At the time of a follow-up clinic visit between 1984 and 1987, 46.7% were employed, primarily in managerial positions. RESULTS: Employed women smoked fewer cigarettes, drank less alcohol, and exercised more than unemployed women, but these differences were not statistically significant. After adjustment for covariates, employed women had significantly lower total cholesterol and fasting plasma glucose levels than unemployed women. Differences on other biological variables, although not statistically significant, also favored the employed women. CONCLUSIONS: Results of this study suggest that middle-aged women employed in managerial positions are healthier than unemployed women.

Adult↗
PubMed1992

Diabetes mellitus, hypertriglyceridemia, and heart disease risk in women.

Coronary heart disease is the most common cause of death in men and women in developed countries. Three primary risk factors--high serum cholesterol concentration, hypertension, and cigarette smoking--are known to increase the risk in both men and women more or less equally, although the latter two risk factors are a somewhat greater risk to men. This paper reviews two additional risk factors whose impact may be greater in women: diabetes and hypertriglyceridemia. Understanding how diabetes and hypertriglyceridemia act differently in women may explain some of the sex differences in the risk of heart disease.

Adult↗
PubMed1992

Estrogen use and depressive symptoms in postmenopausal women.

The potential antidepressant effects of estrogen replacement therapy were examined cross-sectionally in a population of 1190 women 50 years and older living in Rancho Bernardo, California. Of the total, 294 (24.7%) were currently using estrogen. Among women aged 50-59 years, those currently using noncontraceptive estrogen had a significantly higher rate of Beck Depression Inventory scores of 13 or higher than all untreated women of the same age and higher mean depressive symptom scores than women who had never used estrogen. However, after age 60, mean depressive symptom scores and rates of categorical depression increased significantly in the untreated women but not in the treated women. A similar pattern was found when depressive symptom measures of treated and untreated women were stratified by the number of years since last menstrual period. Greater depressive symptoms in currently treated versus untreated women aged 50-59 years may reflect treatment selection bias, as a higher proportion of symptomatic depressed climacteric women seek treatment. The decreased risk of depressive symptoms after age 60 may reflect a long-term benefit of estrogen replacement or the selective discontinuation of estrogen by depressed women. In this cohort, reports of hot flushes, moods, and insomnia as the reason for estrogen use fell in parallel with a decline in depressive symptoms with increasing age, suggesting that hormone replacement therapy provided relief of physical symptoms, ie, possible causes of psychological distress. Clinical trials are needed to confirm these observations and postulated explanations.

Age Factors↗