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Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 253 records · Page 14Linked to original sources
PubMed1989

Heart disease risk factors, diabetes, and prostatic cancer in an adult community.

The authors studied the association between heart disease and prostatic cancer in Rancho Bernardo, California, from August 1972 to June 1987. During a 14-year follow-up of 1,776 men aged 50-84 years, 100 cases of prostatic cancer were identified, of which 54 were incident. Systolic blood pressure, cigarette smoking, and plasma cholesterol levels in cases did not differ from those in noncases. After adjustment for age and on multivariate analysis, incident cases of prostatic cancer had a nonsignificantly higher frequency of reported heart disease at baseline. History of diabetes was inversely associated with total prostatic cancer (age-adjusted estimated relative risk = 0.2, 90% confidence interval: 0.0-0.8; multivariate-adjusted relative risk = 0.3, 90% confidence interval: 0.1-1.0). The association between heart disease and prostatic cancer is compatible with diagnostic detection bias. The inverse association between diabetes and prostatic cancer is compatible with a cancer-promoting role for endogenous testosterone, the level of which is lower in diabetics, or a risk-reducing effect of antidiabetic diet or drug therapy.

Age Factors↗
PubMed1989

Peripheral arterial disease in large vessels is epidemiologically distinct from small vessel disease. An analysis of risk factors.

The authors used noninvasive techniques, including flow velocity by Doppler ultrasound, to accurately assess and distinguish between large and small vessel peripheral arterial disease in a population study in southern California, 1978-1981. In 565 men and women aged 38-82 years, there were 69 cases of large vessel peripheral arterial disease, 19 of which were severe, and 90 cases of isolated small vessel peripheral arterial disease. In cross-sectional multivariate analysis in men, large vessel peripheral arterial disease was significantly associated with age, pack-years of cigarettes smoked, systolic blood pressure, fasting plasma glucose, and marginally with obesity. Similar analysis in women revealed significant associations only for age and systolic blood pressure, although the associations for pack-years of cigarettes, obesity, and low density lipoprotein cholesterol were suggestive. By contrast, isolated small vessel peripheral arterial disease was not significantly associated with any of the major cardiovascular disease risk factors, including two measures of carbohydrate metabolism, fasting plasma glucose and glycosylated hemoglobin. These findings, coupled with our earlier report that large vessel peripheral arterial disease but not isolated small vessel peripheral arterial disease was independently predictive of subsequent mortality, suggest that large vessel peripheral arterial disease and isolated small vessel peripheral arterial disease are epidemiologically, as well as pathophysiologically, distinct entities.

Adult↗
PubMed1989

Physicians' and medical students' knowledge of nutrition.

A study was conducted to assess the knowledge of nutrition of 184 family practitioners and general internists and 24 first- and second-year medical students before they had received medical school instruction in clinical nutrition. Overall, the physicians answered 69.2% of the questions correctly, a significantly better score than that of the medical students (62.5%, p = .0065). The physicians scored better on topics that have been the most heavily researched (such as diet and coronary heart disease) and worse on less heavily investigated topics (such as diet and cancer, iron absorption). There was no significant difference in overall knowledge in terms of gender or practice. However, a significant negative correlation was found between the number of years since graduation from medical school and respondents' knowledge about nutrition.

California↗
PubMed1989

The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community.

We examined the association of degree and duration overweight, dietary habits and exercise with non-insulin dependent diabetes mellitus risk in a defined population of 886 men and 1114 women who were aged 50 years and older when examined in 1984-1987. After an oral glucose tolerance test, 142 men and 142 women were classified as diabetic using WHO criteria. Compared to those with appropriate childhood weight, reported underweight as a child significantly increased the rate of diabetes as an adult (RR = 1.3, P less than 0.05). Underweight as a teenager was also associated with an increased rate (RR = 1.3, P less than 0.05). Underweight as a teenager was also associated with an increased rate (RR = 1.4, P less than 0.01). In adults with current body mass indices (weight/height2) greater than 26, the diabetes rate was significantly higher for those underweight as children (RR = 1.7, P less than 0.01). A multivariate logistic regression analysis of adult diet and weight behaviors, adjusting for age and current smoking, found that a weight gain or fluctuation between the ages of 40 and 60 of 10 lbs or more significantly increased the diabetes rate (RR = 1.4, P less than 0.05; RR = 1.7, P less than 0.01). Weight gain between age 18 and the 1984-1987 visit also significantly increased the rate (RR = 1.4 per 17.3 percent, P less than 0.001). Exercise as the only means to control weight was associated with a significantly reduced diabetes rate (RR = 0.05, P less than 0.05).

Aged↗
PubMed1988

Dietary calcium and risk of hip fracture: 14-year prospective population study.

To assess the effect of dietary calcium intake on risk of hip fracture, a geographically defined caucasian population in southern California was studied prospectively. Between 1973 and 1975, a quantified 24 hour diet recall was obtained by a dietician from 957 men and women aged 50 to 79 years at baseline. Follow-up to 1987 with mortality records and interviews showed 15 men and 18 women with hip fractures. The age-adjusted risk of hip fracture was inversely associated with dietary calcium whether considered as mg per day or as nutrient density (mg per 1000 kcal). No other nutrient was consistently associated with hip fracture in any Cox proportional hazards model that included calcium. The association between calcium and fracture persisted after adjustment for cigarette smoking, alcohol intake, exercise, and obesity. The significant independent inverse association of dietary calcium with subsequent risk of hip fracture (relative risk = 0.6 per 198 mg/1000 kcal) strongly supports the hypothesis that increased dietary calcium intake protects against hip fracture.

Aged↗
PubMed1988

Cigarette smoking and levels of adrenal androgens in postmenopausal women.

An antiestrogenic effect of cigarette smoking has been suggested, principally on the basis of data on premenopausal women. We examined the relation between cigarette smoking and endogenous sex-hormone levels in a population of 233 white, postmenopausal women 60 to 79 years of age. Current cigarette smokers had significantly higher mean plasma levels of the adrenal androgens dehydroepiandrosterone sulfate and androstenedione than nonsmokers. Mean levels for smokers and nonsmokers were 3.1 mumol per liter (116 micrograms per deciliter) and 2.3 mumol per liter (86 micrograms per deciliter), respectively (P less than 0.001), for dehydroepiandrosterone sulfate, and 27.8 nmol per liter (797 pg per milliliter) and 22.5 nmol per liter (643 pg per milliliter), respectively (P = 0.002), for androstenedione. A dose-response relation was apparent for these hormones; mean plasma levels increased concomitantly with cigarette consumption. The differences in hormone levels remained after adjustment for age and body-mass index. Mean levels of estrone, estradiol, testosterone, and sex-hormone-binding globulin did not differ between smokers and nonsmokers. These results suggest that the possible decreased risk of breast and endometrial cancer associated with cigarette smoking may not be mediated through lower levels of endogenous estrogen, at least in postmenopausal women, and they raise questions about the role of androgens in disease mechanisms in older populations.

Adrenal Glands↗
PubMed1988

A pilot study of community cholesterol screening.

We tested the feasibility and effectiveness of population cholesterol screening in a California shopping center. Total plasma cholesterol (TC) was measured in 429 adults from capillary blood samples, using automatic analyzers (Reflotron). A self-administered questionnaire was used to ascertain demographic variables, lifestyle, and knowledge about cholesterol and heart disease. According to NIH Consensus Conference criteria, 20% of all screenees showed moderate or high risk TC levels, but over half of these had a history of hypercholesterolemia prior to testing. Follow-up of all screenees with TC levels at 220 mg/dl and greater revealed that 32% had been compliant with our advice to contact their physician. Physicians expressed no concern in 71% of those with TC elevation of 220-239 mg% and in 30% of those with TC levels 240+ mg%. Of all participants, 40% reported dietary changes in response to the screening; 78% of this group, however, made changes without a physician's advice. In our experience community cholesterol screening is popular and feasible. Efficacy, however, must be improved by better education of physician and the public.

Adult↗
PubMed1988

Diabetes mellitus: an independent risk factor for stroke?

Raised blood pressure is the strongest single risk factor for stroke in the general population. Diabetics are at increased risk of both hypertension and stroke. It is not clear if diabetes mellitus confers an excess risk of stroke that is independent of blood pressure. The authors examined the relation of diabetic status (personal history of diabetes and/or fasting plasma glucose greater than 7.8 mmol per liter) to stroke risk in a population-based cohort of 3,778 adults aged 50-79 years in Rancho Bernardo, California who were followed from 1972 for an average of 12 years. There were 232 stroke cases, 139 of which were ascertained from death certificates. Diabetics had higher mean systolic blood pressures, significantly so in females, and diabetics of both sexes were significantly more obese. Diabetics had greater univariate age-adjusted stroke mortality and morbidity rates than nondiabetics. The increased stroke rates were still apparent in diabetics after stratifying for systolic blood pressure. In multivariate analyses, the relative risks (RRs) for stroke mortality and morbidity associated with diabetes were not significantly changed in men (RR = 1.8) and women (RR = 2.2), after adjusting for the effect of risk factors including age, systolic blood pressure, cholesterol level, obesity, and smoking habits, and excluding persons with personal history of heart attack, heart failure, or stroke. These findings support the hypothesis that diabetes may confer excess risk of stroke independent of blood pressure.

Aged↗
PubMed1988

Postmenopausal estrogen use and mortality. Results from a prospective study in a defined, homogeneous community.

The authors studied the association between postmenopausal estrogen use and mortality from cardiovascular disease, coronary heart disease, cancer, and all causes in a cohort of 1,868 women aged 50-79 years residing in a planned community. After 12 years, the age-adjusted all-cause mortality rate was lower in the 734 postmenopausal estrogen users (14.9/100 women) compared with the 1,134 nonusers (21.5/100 women) (relative risk (RR) = 0.69, 95% confidence interval (Cl) 0.55-0.87). After adjustment for age, systolic blood pressure, social class, fasting plasma cholesterol, fasting plasma glucose, Quetelet index (weight (lbs)/height (in)2 x 100), and cigarette smoking by the Cox model, the relative risk increased to 0.79 (95% Cl 0.62-1.01). Because a postmenopausal estrogen-smoking interaction term was significant (p = 0.025), separate Cox models were run for never, past, and current smokers. In never and current smokers, estrogen was protective for all-cause mortality, with relative risks of 0.67 (95% Cl 0.45-0.99) and 0.62 (95% Cl 0.39-0.98), respectively. However, past smokers were not protected by postmenopausal estrogen use (RR = 1.32, 95% Cl 0.84-2.08). Cause-specific models revealed differences in the association of postmenopausal estrogen use with cardiovascular disease mortality and coronary heart disease mortality that were dependent on smoking status. Postmenopausal estrogen use was strongly protective in current smokers but was associated with increased risk in past smokers. As expected, cancer mortality was increased in smokers. The confidence intervals for the relative risk estimate of postmenopausal estrogen use for cancer mortality in each smoking category included one. Finally, a separate analysis of subsequent three-year mortality in women surviving the first nine years of follow-up revealed reduced death rates only for women using estrogen at both baseline and nine years of follow-up, suggesting both a conservative bias in our data introduced by the large reduction in postmenopausal estrogen use during the study period and the possibility of a stronger protective effect for recent postmenopausal estrogen use.

Aged↗
PubMed1988

The association between blood pressure, age, and dietary sodium and potassium: a population study.

We examined the relationship between blood pressure and dietary sodium and potassium intake estimated from 24 hr diet recall in a population of 584 men and 718 women 30 to 79 years old in Southern California. In men, but not women, age-adjusted systolic and diastolic blood pressure correlated significantly with dietary sodium intake. In both men and women, age-adjusted diastolic blood pressure significantly inversely correlated with dietary potassium intake. Age-adjusted systolic and diastolic blood pressure correlated significantly with the dietary sodium/potassium ratio in each sex; correlations were better for the ratio than for either sodium or potassium alone. The relationship was apparent over the whole range of blood pressure and dietary intake. A marked age gradient was apparent in men, the regression slope for blood pressure vs sodium/potassium ratio increasing with increasing age, suggesting increasing sensitivity to dietary sodium/potassium ratio with age. Adjusting for intake of other dietary variables, including calories, protein, carbohydrate, saturated fat, alcohol, calcium, and fiber, did not alter the relationships; adjusting for body mass index reduced the strength of the association in women but not in men. These results support the hypothesis that dietary sodium and potassium are related to blood pressure within a population.

Adult↗
PubMed1988

Endogenous sex hormones and cardiovascular disease in men. A prospective population-based study.

Plasma obtained and frozen in 1972-1974 from 1,009 white men (40-79 years old) who have been followed for 12 years was examined for endogenous sex hormone levels according to prevalent or subsequent cardiovascular disease. In these older men, no sex hormone measured (testosterone, androstenedione, estrone, or estradiol) was significantly associated with known cardiovascular disease at baseline or with subsequent cardiovascular mortality or ischemic heart disease morbidity or mortality. Sex hormone-binding globulin levels were also similar by disease status. Analyses of hormone:sex hormone-binding globulin ratios or of estrogen:androgen ratios showed a similar lack of association with cardiovascular disease. Testosterone levels were significantly inversely associated with levels of blood pressure, fasting plasma glucose, and triglyceride and body mass index. In contrast, the only significant estrogen risk factor associations were positive correlations of estrone with total plasma cholesterol, triglyceride, and glucose. These data do not support a causal role for elevated endogenous estrogen levels and heart disease.

Aged↗
PubMed1988

Cholesterol, lipoproteins, and coronary heart disease in women.

In the United States, coronary heart disease is the major cause of death and disability in women and in men. Despite this, little is known about the risk factors, including cholesterol and lipoprotein concentrations, for coronary disease in women. In this paper we review the determinants of cholesterol and lipoprotein concentrations in women, assess whether values for total cholesterol and lipoproteins (HDL and LDL) are associated with the occurrence of coronary heart disease in women, and evaluate the evidence that suggests that modifying the concentrations of lipids in women is associated with changing the risk of coronary disease. Besides genetic determinants, dietary cholesterol, dietary fat, total caloric intake, alcohol consumption, cigarette smoking, and physical activity are known to influence concentrations of lipids in women. Some of the strongest determinants of cholesterol and lipoprotein concentrations in women are sex hormones, including estrogen and progestin. Exogenous use of both of these hormones markedly influences HDL and LDL cholesterol; additional evidence suggests that endogenous sex hormones also influence lipid and lipoprotein concentrations. The few studies that have examined the association of total cholesterol with coronary heart disease occurrence and mortality in women have consistently shown that (a) women have much lower rates of coronary heart disease than men at the same values for cholesterol, and (b) clearly elevated risk for coronary heart disease in women is evident only at relatively high values of total cholesterol (i.e., greater than 260 mg/dL). There also appears to be an age effect, with total cholesterol concentrations being more predictive in older than in younger women.

Adult↗
PubMed1988

Blood pressure and endogenous testosterone in men: an inverse relationship.

Exogenous sex hormone use, including oral contraceptives, post-menopausal hormonal therapy and anabolic steroids, has been associated with blood pressure changes in both sexes, but little is known about the relationship between blood pressure and endogenous sex hormones. We examined this relationship in men in the Rancho Bernardo population study. Out of 1132 men aged 30-79 years, those with hypertension, categorically defined as systolic blood pressure (SBP) greater than 160 mmHg and/or diastolic blood pressure (DBP) greater than 95 mmHg had significantly lower testosterone levels than non-hypertensives. Systolic and diastolic blood pressure inversely correlated with testosterone levels (r = 0.17, P less than 0.001 for systolic; r = -0.15, P less than 0.001 for diastolic) in the whole cohort. This association was present over the whole range of blood pressures and sex hormone levels with a stepwise decrease in mean SBP and DBP per increasing quartile of testosterone. Obesity accounted for some, but not all, of this relationship, which was reduced, but still apparent after adjusting for age and body mass index. No other hormone (androstenedione, estrone, estradiol) nor sex hormone-binding globulin showed a consistent relationship with blood pressure. The clinical and physiological significance of this relationship merits further investigation.

Adult↗