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Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 271 records · Page 15Linked to original sources
PubMed1987

Dietary potassium and stroke-associated mortality. A 12-year prospective population study.

Hypertension is the most important known risk factor for stroke. Clinical, experimental, and epidemiologic evidence suggests that a high dietary intake of potassium is associated with lower blood pressure. In hypertensive rats, a high intake of potassium is reported to protect against stroke, even though blood pressure is not affected. We examined the relation between the 24-hour dietary potassium intake at base line and subsequent stroke-associated mortality in a population-based cohort of 859 men and women (aged 50 to 79 years) in Southern California. After 12 years, 24 stroke-associated deaths had occurred. The relative risks of stroke-associated mortality in the lowest tertile of potassium intake, as compared with that in the top two tertiles combined, were 2.6 (P = 0.16) in men and 4.8 (P = 0.01) in women. In multivariate analyses, a 10-mmol increase in daily potassium intake was associated with a 40 percent reduction in the risk of stroke-associated mortality (P less than 0.001). This effect was independent of other dietary variables, including the intake of calories, fat, protein, fiber, calcium, magnesium, and alcohol. The effect was also apparently independent of known cardiovascular risk factors, including age, sex, blood pressure, blood cholesterol level, obesity, fasting blood glucose level, and cigarette smoking. These findings support the hypothesis that a high intake of potassium from food sources may protect against stroke-associated death.

Age Factors↗
PubMed1987

Borderline fasting hypertriglyceridemia: absence of excess risk of all-cause and cardiovascular disease mortality in healthy men without hypercholesterolemia.

The majority of prospective studies have shown no independent effect of triglyceride on the prediction of cardiovascular disease after the effects of cholesterol and other heart disease risk factors have been accounted for statistically. Because the association of borderline elevation of triglyceride levels (250-499 mg/dl) with cardiovascular risk might be obscured by its strong correlation with hypercholesterolemia, we examined the relationship in healthy men without hypercholesterolemia. In a population sample of 1,589 healthy fasting men ages 30-79 without known cardiovascular disease or categorical hypercholesterolemia, the prevalence of borderline hypertriglyceridemia was 4.2%, and was unrelated to age. There was no significant excess of borderline hypertriglyceridemia in men with systolic hypertension, or in men who reported use of antihypertensive drugs, current cigarette smoking, or a family history of heart attack before or after age 50. Only obesity, a personal history of diabetes, and fasting hyperglycemia were significantly more common in men with borderline hypertriglyceridemia. Moreover, hypertriglyceridemia was a relatively weak marker for those with diabetes or obesity, being present in only 9% of the former and 6% of the latter. A 12-year follow-up of these men showed no significant association of hypertriglyceridemia with all-cause or cardiovascular death either by univariate analysis or after adjusting for risk factors. These data support the conclusion that borderline hypertriglyceridemia is a poor marker for cardiovascular risk in healthy older men without hypercholesterolemia.

Adult↗
PubMed1987

Cigarette smoking and increased endogenous estrogen levels in men.

In a population-based study of 590 Rancho Bernardo, California men aged 30-79 years without a history of cardiovascular disease, and who were first surveyed in 1972-1974, current cigarette smokers had significantly higher mean endogenous androstenedione, estrone, and estradiol levels compared to nonsmokers. In the cigarette smokers, a dose-response relationship was apparent for these hormones with mean levels increasing with increasing reported cigarette consumption. These differences persisted after adjusting for age and body mass index, and were not accounted for by either caffeine or alcohol intake, or exercise habit. In a further 89 men with a history of cardiovascular disease, hormone levels were not significantly related to smoking habit. The higher endogenous estrogen levels in cigarette smokers may confound the interpretation of studies reporting higher estrogen levels in male myocardial infarction survivors compared to controls.

Adult↗
PubMed1987

Family history of diabetes and cardiovascular disease risk factors and mortality among euglycemic, borderline hyperglycemic, and diabetic adults.

In a prospective population-based study begun in 1972 in Rancho Bernardo, California, the association of cardiovascular disease risk factors, at baseline, with a family history of diabetes and subsequent death from cardiovascular disease was investigated among 3,081 euglycemic, 1,290 borderline hyperglycemic, and 347 diabetic adults between 20 and 79 years of age. The main difference in risk factor distribution was in diabetic men and women 20-49 years of age, of whom those with a family history of diabetes were older and had higher levels of fasting plasma cholesterol and triglyceride. In addition, in all age-sex-diabetes status groups, those with a family history of diabetes included a greater proportion with a family history of heart attack. In five out of 12 groups, the association was statistically significant. Significant independent predictors of cardiovascular disease mortality in euglycemic and borderline hyperglycemic adults were age, sex, cholesterol, and systolic blood pressure, while fasting plasma glucose was a significant predictor in euglycemic adults only. Family history of heart attack was significantly associated with cardiovascular disease mortality in euglycemic and borderline hyperglycemic adults. Family history of diabetes was not significantly associated with mortality risk in any of the three groups, but the risk followed an increasing trend from euglycemic (0.89) to borderline hyperglycemic (1.17) to diabetic (1.31) adults.

Adult↗
PubMed1987

Dietary fiber and reduced ischemic heart disease mortality rates in men and women: a 12-year prospective study.

The authors examined the relation between 24-hour dietary fiber intake at baseline survey in 1972-1974 and subsequent 12-year ischemic heart disease mortality in a southern Californian population-based cohort of 859 men and women aged 50-79 years. Relative risks of ischemic heart disease mortality in those with dietary fiber intake of 16 gm/24 hours or more compared with those with intake less than 16 gm/24 hours were 0.33 in men and 0.37 in women. A 6 gm increment in daily fiber intake was associated with a 25% reduction in ischemic heart disease mortality (p less than 0.01). This effect was independent of other dietary variables, including calories, fat, cholesterol, protein, carbohydrate, alcohol, calcium, and potassium. Some, but not all, of this effect appears to be mediated through the known cardiovascular risk factors: after multivariate adjustment for age, sex, blood pressure, plasma cholesterol, obesity, fasting plasma glucose, and cigarette smoking habit, the magnitude of the protective effect of fiber was reduced but still significant in both sexes combined. These findings support the hypothesis that high dietary fiber intake is protective for ischemic heart disease mortality.

California↗
PubMed1987

Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study.

A cohort of 2270 white women, aged 40-69 years at baseline, were followed for an average of 8.5 years in the Lipid Research Clinics Program Follow-up Study. There were 44 deaths due to cardiovascular disease among the 1677 nonusers of estrogens and six cardiovascular disease deaths among the 593 estrogen users. The age-adjusted relative risk (RR) of cardiovascular disease deaths in users compared with nonusers was 0.34 (95% confidence limits 0.12 to 0.81). After multivariable adjustment for potential confounding factors (age, blood pressure, and smoking), the estimated RR for estrogen use was 0.37 (95% confidence limits 0.16 to 0.88). Analyses were done to explore whether these results could be due to selection bias for estrogen use. However, the prevalence of cardiovascular disease at baseline was slightly higher in estrogen users (12%) than in nonusers (10%); furthermore, the exclusion of all women with prevalent cardiovascular disease at baseline did not alter the apparent protective effect of estrogen use on cardiovascular disease mortality (RR = 0.42, 95% confidence limits 0.13 to 1.10). Additional analyses examining the complex association between estrogen use, lipoprotein levels, and cardiovascular disease mortality suggest that the protective effect of estrogen is substantially mediated through increased high-density lipoprotein levels.

Adult↗
PubMed1986

A prospective study of dehydroepiandrosterone sulfate, mortality, and cardiovascular disease.

It has been postulated that dehydroepiandrosterone (DHEA) and its sulfate ester, dehydroepiandrosterone sulfate (DHEAS), the major secretory products of the human adrenal gland, may be discriminators of life expectancy and aging. We examined the relation of base-line circulating DHEAS levels to subsequent 12-year mortality from any cause, from cardiovascular disease, and from ischemic heart disease in a population-based cohort of 242 men aged 50 to 79 years at the start of the study. Mean DHEAS levels decreased with age and were also significantly lower in men with a history of heart disease than in those without such a history. In men with no history of heart disease at base line, the age-adjusted relative risk associated with a DHEAS level below 140 micrograms per deciliter was 1.5 (P not significant) for death from any causes, 3.3 (P less than 0.05) for death from cardiovascular disease, and 3.2 (P less than 0.05) for death from ischemic heart disease. In multivariate analyses, an increase in DHEAS level of 100 micrograms per deciliter was associated with a 36 percent reduction in mortality from any causes (P less than 0.05) and a 48 percent reduction in mortality from cardiovascular disease (P less than 0.05), after adjustment for age, systolic blood pressure, serum cholesterol level, obesity, fasting plasma glucose level, cigarette smoking status, and personal history of heart disease. Our conclusions are limited by the single determination of DHEAS levels, but the data suggest that the DHEAS concentration is independently and inversely related to death from any cause and death from cardiovascular disease in men over age 50.

Aged↗
PubMed1986

A population-based study of nonfatal childhood injuries.

A random-digit-dialing telephone survey was used to assess the frequency and associated characteristics of childhood poisoning, burns, and head injuries in 1,213 San Diego County households having at least one child 14 years of age or younger at the time of the telephone interview in 1980. The survey population was representative of the general San Diego County population with regard to socioeconomic status and geographic distribution. The frequency of injuries judged to be serious enough to require medical care and the median ages for each injury were head injury, 4.2% and 5.5 years; burns 4.0% and 2 years; and poisonings, 3.4% and 2 years. Forty-four percent of all poisonings were related to drugs, of which aspirin was the single most common medication. Hot liquids or hot surfaces were responsible for 52% of burns. The majority of head injuries (65%) were caused by falls, usually outside the home. Education was positively associated with poisonings, and income was negatively associated with burns. Children of caretakers working outside the home did not have higher injury rates than those whose caretakers were not so employed. Differences in caretaker attitudes were few, and may reflect the experience of having an injury, rather than factors preceding it. The advantages and limitations of this method of assessing childhood injury in populations are discussed.

Adolescent↗
PubMed1986

Family history of stroke as an independent predictor of ischemic heart disease in men and stroke in women.

The major known cardiovascular risk factors, age, cholesterol, blood pressure, cigarette smoking, and diabetes and family history of heart attack, explain only a proportion of cardiovascular disease. In a study of 1,491 men and 1,924 women aged 50-79 years in an upper middle-class Caucasian population in Rancho Bernardo, southern California, who were free of known cardiovascular disease at baseline in 1972-1974 and who were followed for an average of nine years, family history of stroke in any first-degree relative was an independent predictor of ischemic heart disease mortality in men 50-64 years of age (relative risk = 3.3, p less than 0.05) and of stroke mortality in women 50-79 years of age (relative risk = 2.3, p less than 0.05) after controlling for all the above risk factors. In contrast, family history of stroke was not predictive of stroke mortality in men or of ischemic heart disease mortality in women. These results suggest that family history of stroke may be used as a marker for high-risk subjects and to identify and investigate other major genetic or environmental determinants for cardiovascular disease, particularly sex differences.

Age Factors↗
PubMed1986

Resting and exercise electrocardiographic abnormalities associated with sex hormone use in women. The Lipid Research Clinics Program Prevalence Study.

Prevalence rates for resting and exercise electrocardiographic abnormalities were determined according to the use or nonuse of oral contraceptives and exogenous estrogens in 1,919 women participants from 10 defined North American study populations of the Lipid Research Clinics Program. Among women 30-49 years of age, no significant differences in the prevalence of resting electrocardiographic abnormalities between oral contraceptive users and nonusers were seen after adjustment for age, blood pressure, cigarette smoking, alcohol, and obesity. Abnormal graded exercise electrocardiograms, however, were more prevalent among the oral contraceptive users (odds ratio = 2.7, p less than 0.05). Among women 50 years and older, a significant deficit of abnormal Q waves on resting electrocardiogram and nonsignificant excess of abnormal S-T segment responses to exercise were noted in estrogen users compared with nonusers. Possible sources of bias and the pathophysiologic implications of these findings are discussed.

Adult↗
PubMed1986

Correlates of change in postmenopausal estrogen use in a population-based study.

During the late 1970s, there was a dramatic reduction in postmenopausal estrogen use in the United States, which may have reflected concern over a well-publicized postmenopausal estrogen-endometrial cancer link. The authors studied 310 postmenopausal women in a defined population over the period 1974-1981 to evaluate whether hysterectomy and certain other characteristics predicted change in postmenopausal estrogen use status during this period and, as a secondary issue, whether women who subsequently began postmenopausal estrogen use had different characteristics prior to use, an important question in the evaluation of the relation of postmenopausal estrogen use to morbidity and mortality from cancer, cardiovascular disease, or other diseases in observational studies. The only strong predictor of whether postmenopausal estrogen use would be discontinued was the presence of an intact uterus. Women who discontinued postmenopausal estrogen use were also somewhat older and heavier than those who continued, but were otherwise quite similar on a wide range of variables, including risk factors for and the presence of various chronic diseases. Similarly, the absence of a uterus was the only strong predictor of the initiation of postmenopausal estrogen use. Thus, concern about a possible postmenopausal estrogen-endometrial cancer link appeared to have been the major determinant of change in postmenopausal estrogen use in this time period. In the secondary analysis, variables other than hysterectomy did not discriminate between women who initiated postmenopausal estrogen use versus those who did not report use of postmenopausal estrogens, suggesting that a broad range of other characteristics was not a priori different in these two groups.

Aged↗
PubMed1986

Family history of heart attack: a modifiable risk factor?

A family history of heart attack is reported to be an independent predictor of cardiovascular death in men. In a 9 year follow-up of 4014 adults from 40 to 79 years old in the Rancho Bernardo Study, men under 60 years of age with a family history of heart attack were at fivefold increased risk. In this study, we sought to determine whether modifiable risk factors, i.e., blood pressure, plasma cholesterol, obesity, and cigarette smoking, have a differential effect on cardiovascular risk in those with and without a family history of heart attack. For both sexes, cigarette smoking was a stronger predictor of cardiovascular disease in those with a family history of heart attack (relative risk of smokers vs nonsmokers was 2.5 for men and 4.0 for women) than in those with no such family history (relative risk of smokers vs nonsmokers was 1.1 for men and 1.7 for women). Conversely, an increased risk of cardiovascular mortality in men with a family history of heart attack was present predominantly in smokers (relative risk related to positive family history was 1.2 in nonsmokers, and 3.3 in smokers). An estimated 68% of the excess deaths in men with a family history of heart attack were attributable solely to the interaction of family history with smoking habit and were therefore potentially avoidable. The risk of cardiovascular disease associated with an apparently inherited predisposition appears to be profoundly affected by modifiable behavior.

Adult↗
PubMed1986

A screening survey of dyslipoproteinemias associated with prescription drug use. The Lipid Research Clinics Program Prevalence Study.

In 10 North American study populations, we surveyed alterations in blood cholesterol, triglyceride, and high-density lipoprotein cholesterol levels associated with the use of 20 categories of prescription medications. In addition, odds ratios for use of these medication categories were determined for five of the more common dyslipoproteinemias found in these populations. Increased lipid levels were found in association with use of several categories of cardiovascular drugs as well as allopurinol and warfarin. Decreased lipid levels were found in association with anti-infective agents and thyroid hormone. Few significant lipid level alterations were found with the use of antihistamines, barbiturates, analgesics, and the phenothiazines. The associations described here must be interpreted cautiously because of limitations in the study design, particularly the confounding effects of the conditions under drug treatment. However, several drug-lipid effects are suggested that may alter lipid levels and that require experimental confirmation. These findings have implications for both clinical management of individuals with dyslipoproteinemias and in the determinants and modification of population lipid levels.

Adult↗
PubMed1986

Postmenopausal estrogens--current prescribing patterns of San Diego gynecologists.

San Diego gynecologists were surveyed to determine 1985 prescribing patterns and indications for postmenopausal estrogens. More than 75% of the 103 respondents indicated that they prescribed estrogen for at least 75% of their recently postmenopausal patients, usually for a prolonged period. The dose and duration of estrogen were those recommended to prevent osteoporosis, which was given by all but one physician as a major indication for estrogen use. Only five gynecologists prescribed estrogen without a progestin, which was added primarily to reduce the risk of estrogen-associated endometrial cancer. These data suggest that San Diego gynecologists are well informed about the risks and benefits of estrogen-replacement therapy and are less concerned about the paucity of data concerning long-term progestin use in older women.

California↗
PubMed1986

Progeny's lipid and lipoprotein levels by parental mortality. The Lipid Research Clinics Program Prevalence Study.

Using data from Lipid Research Clinics study participants at visit 2 (3972 and 2346 adult men and women), we examined the hypothesis that parental mortality from cardiovascular disease (CVD) or cancer before age 60 predicts their adult progeny's lipid and lipoprotein levels. Weighted regression analysis was used to control for the potential effect of progeny's other CVD risk factors (age, systolic blood pressure, Quetelet index, cigarette smoking, and alcohol consumption), and to assess for the effect of progeny's parental cause-specific mortality status on progeny's lipids and lipoproteins. Nearly all of the statistically significant parent-progeny predictions were for sons. Paternal death from CVD before age 60 years was associated with significantly higher plasma total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels in sons and (at marginal significance) in daughters, when compared with those in reference progeny with paternal survival over age 60 or over age 75. Maternal death from CVD before 60 was associated with lower levels of high-density lipoprotein cholesterol (HDL-C) in sons. Paternal and maternal death from cancer before age 60 years were associated with higher triglyceride levels in adult sons than in sons whose parents had lived beyond ages 60 and 75. Paternal all-cause mortality before age 60 was associated with higher cholesterol and triglycerides in sons; maternal all-cause mortality before age 60 was associated with depression of HDL-C in sons. Familial aggregation of lipids and lipoproteins may account, in part, for familial aggregation of CVD. Knowledge of family history facilitates identification of progeny at higher risk for CVD by virtue of elevated cholesterol or LDL-C, or reduced HDL-C.

Adult↗
PubMed1985

Dietary vitamin D and calcium and risk of colorectal cancer: a 19-year prospective study in men.

Mortality rates from colon cancer in the USA are highest in populations exposed to the least amounts of natural sunlight; differences in endogenous vitamin D production and calcium absorption could be responsible. To investigate this possibility, the association of dietary vitamin D and calcium with 19-year risk of colorectal cancer was examined in 1954 men who had completed detailed, 28-day dietary histories in the period 1957-59. Risk of colorectal cancer was inversely correlated with dietary vitamin D and calcium. In the quartiles of a combined index of dietary vitamin D and calcium, from lowest to highest, observed risks of colorectal cancer were 38.9, 24.5, 22.5, and 14.3/1000 population. This association remained significant after adjustment for age, daily cigarette consumption, body mass index, ethanol consumption, and percentage of calories obtained from fat.

Adult↗
PubMed1985

The low yield of routine radiographic screening of tuberculin-positive hospital employees.

On the basis of limited benefit in relation to cost, mass radiographic screening for tuberculosis was challenged and abandoned in the 1970s. In the 1980s the value of such periodic screening of hospital employees with known positive tuberculin reactions was queried on the same grounds but without comparable data. We report here the results of 11 years of radiographic screening of tuberculin-positive employees of a university hospital. Although 3900 chest films were obtained at considerable cost, only one proved and six suspect cases of tuberculosis were detected, all of which were symptomatic. Even in the absence of symptoms all could have been identified by other screening criteria, five on the basis of recent tuberculin conversion and two as tuberculin-positive new employees. These data support the recent statement that periodic chest roentgenograms of hospital employees with known positive reactions to tuberculin skin testing are not justified.

Adult↗