Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 289 records · Page 16Linked to original sources

PubMed1985

Effects of passive smoking on ischemic heart disease mortality of nonsmokers. A prospective study.

The mortality attributable to ischemic heart disease as a result of cigarette smoking is greater of a community of older adults in southern California, the authors tested the hypothesis that nonsmoking women exposed to their husband's cigarette smoke would have an elevated risk of fatal ischemic heart disease. Married women aged 50-79 years who had never smoked cigarettes (n = 695) were classified according to the husband's self-reported smoking status at entry into the study: never, former, or current smoker. After 10 years, nonsmoking wives of current or former cigarette smokers had a higher total (p less than or equal to 0.05) and age-adjusted (p less than or equal to 0.10) death rate from ischemic heart disease than women whose husbands never smoked. After adjustment for differences in risk factors for heart disease, the relative risk for death from ischemic heart disease in nonsmoking women married to current or former cigarette smokers was 14.9 (p less than or equal to 0.10). These data are compatible with the hypothesis that passive cigarette smoking carries an excess risk of fatal ischemic heart disease.

Aged↗

PubMed1985

Coffee, plasma cholesterol, and lipoproteins. A population study in an adult community.

The associations between intake of coffee or decaffeinated coffee and plasma cholesterol and lipoprotein measurements were examined in a probability sample from a defined community of adults. The results were based on 24-hour dietary recall interviews and laboratory measurements carried out in 1972-1974 on 381 women and 320 men conducted as part of the La Jolla Lipid Research Clinic study. Intake of 8+ oz (230+ ml) of coffee per day was reported by 65% of women and 70% of men. Plasma cholesterol increased with increasing coffee drinking in women as follows: 0-7 oz (0-229 ml), 214 mg/dl; 8-32 oz (230-960 ml), 222 mg/dl; and 33+ oz (961+ ml), 234 mg/dl. This trend was significant at p less than 0.01. Almost all of the difference could be accounted for by an increase in low density lipoprotein cholesterol. Plasma cholesterol was not affected by coffee intake in men or by decaffeinated coffee intake in either sex. The results were unaffected by adjustment for age, obesity index, number of cigarettes smoked per day, ml of alcohol consumed per day, oral contraceptive use, regular exercise, daily intake of saturated, monounsaturated, and polyunsaturated fat, polyunsaturated/saturated fat ratio, use of cream in coffee, and use of sugar in coffee. This study confirms the previously reported significant increase in plasma cholesterol and low density lipoprotein levels with increasing coffee intake in women, and demonstrates that the increase is due largely to elevation of low density lipoprotein cholesterol. The reasons for a differential response to coffee in women and men, reported previously and in this study, deserve further investigation.

Adult↗

PubMed1985

Parasites and asthma--predictive or protective?

Most prevalence surveys (figures 1 and 2) suggest that asthma is less common in heavily parasitized countries, but case-control studies either show no association or an increase in parasitism in asthmatics. Studies which included egg counts suggest that asthmatics have a lower parasite burden than normals, compatible with the notion that asthma protects against parasitic infection, or vice versa. The completely contradictory findings of serum IgE in three studies do not help to elucidate any association or its mechanism. The available epidemiologic data neither refute nor support the theory that parasitic disease protects against or causes asthma. A more definitive answer might come from a comparison of asthma prevalence in heavily parasitized and parasite-free subjects, or from a prospective study of asthma incidence in two or more comparable communities where one population is naturally or therapeutically free of intestinal parasites. If an effective antihelminthic vaccine is developed, it would also be interesting to watch vaccinees for development of, or changes in, asthma symptoms, and to determine whether these findings correlate with vaccine-induced changes in IgE.

Adult↗

PubMed1985

The prevalence of peripheral arterial disease in a defined population.

Because patients with peripheral arterial disease (PAD) may be asymptomatic or may present with atypical symptoms or findings, the true population prevalence of PAD is essentially unknown. We used four highly reliable, sophisticated noninvasive tests (segmental blood pressure, flow velocity by Doppler ultrasound, postocclusive reactive hyperemia, and pulse reappearance half-time) to assess the prevalence of large-vessel PAD and small-vessel PAD in an older (average age 66 years) defined population of 613 men and women. A total of 11.7% of the population had large-vessel PAD on noninvasive testing, and nearly half of those with large-vessel PAD also had small-vessel PAD (5.2%). An additional 16.0% of the population had isolated small-vessel PAD. Large-vessel PAD increased dramatically with age and was slightly more common in men and in subjects with hyperlipidemia. Isolated small-vessel PAD, by contrast, was essentially unrelated to sex, hyperlipidemia, or age, although it was somewhat less common before age 60. Intermittent claudication rates in this population were 2.2% in men and 1.7% in women, and abnormalities in femoral or posterior tibial pulse were present in 20.3% of men and 22.1% of women compared with the noninvasively assessed large-vessel PAD rate of 11.7%. Thus assessment of large-vessel PAD prevalence by intermittent claudication dramatically underestimated the true large-vessel PAD prevalence and assessment by peripheral pulse examination dramatically overestimated the true prevalence.

Adult↗

PubMed1985

The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population.

In a companion article we have reported the prevalence, in an older, defined population, of traditional assessments (intermittent claudication and abnormal pulse examination) of peripheral arterial disease (PAD) as compared with the results of highly accurate noninvasive testing. In this article we report the sensitivity, specificity, and positive and negative predictive values for claudication and abnormal pulses for the diagnosis of large-vessel and small-vessel PAD as determined by noninvasive testing. Claudication and abnormal pulses were completely unrelated to isolated small-vessel PAD. In contrast, both claudication and abnormal pulses were significantly correlated with large-vessel PAD. Claudication and an abnormal femoral pulse showed a high specificity and positive predictive value but a low sensitivity for large-vessel PAD. Conversely, an abnormal dorsalis pedis pulse showed a good sensitivity but low specificity and positive predictive value. The best single discriminator was an abnormal posterior tibial pulse, which had high sensitivity, specificity, and positive predictive value. Various combinations of claudication and pulse abnormalities revealed a good sensitivity for broader criteria but at the expense of specificity, whereas stricter criteria had a good specificity and positive predictive value but a poor sensitivity. No combination was superior to an abnormal posterior tibial pulse alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

Is hypertension more benign when associated with obesity?

To determine the effect of obesity on prognosis in hypertensive subjects, a population of 1727 men 50 to 79 years of age was dichotomized by baseline body mass index (less than 27 and greater than or equal to 27 kg/m2) and systolic blood pressure (less than 160 and greater than or equal to 160 mm Hg). After 9 years of follow-up, age-adjusted all-cause, cardiovascular, and ischemic heart disease mortality rates were highest in the nonobese hypertensive subjects. The relative risk for mortality associated with a systolic blood pressure of 160 mm Hg or higher was significantly increased only in the nonobese group, with the largest difference in relative risk between obese and nonobese for ischemic heart disease. Results were consistent after separately excluding those with a history of heart disease, diabetes, current use of antihypertensive medication, and cigarette smoking, and those who died within 2 years of the baseline examination. When the independent effect of risk factors, including age, plasma cholesterol level, cigarette smoking, use of antihypertensive medication, and personal history of heart disease or diabetes was assessed with the Cox model, systolic blood pressure was a significant independent predictor of all-cause, cardiovascular, and ischemic heart disease death only in the nonobese subjects. We do not exclude an adverse effect of raised blood pressure in the obese. However, these data suggest that the prognosis is poorer in leaner hypertensive patients than in those who are overweight.

Aged↗

PubMed1985

Noncontraceptive estrogen use and cardiovascular disease.

To summarize, estrogens have powerful effects on certain biologic parameters, the alteration of which could influence cardiovascular disease risk. Estrogens have long been known to influence lipid and lipoprotein levels by decreasing LDL (the atherogenic lipoprotein) and by increasing HDL (the protective lipoprotein). THese lipid alterations could favorably influence the risk of cardiovascular disease. Estrogens also temporarily increase glucose intolerance and lower fasting glucose levels; although the former event could adversely affect cardiovascular disease risk, the clinical significance of increased glucose intolerance with low fasting levels has not been determined. There is no consistent evidence that menopausal estrogens adversely affect coagulation or blood pressure levels, although both of these parameters could be affected in selected individuals. Overall, the estrogenic effects on lipid/lipoprotein levels appear to be the most consistent and the most powerful; given this assumption, estrogens should protect against cardiovascular disease. There is another interpretation of the biologic effect of estrogens on cardiovascular risk. It is possible that estrogens may increase the risk of a thromboembolic event due to an adverse influence on coagulation parameters and, at the same time, decrease the risk of an atherogenic event (via favorably altered lipid/lipoprotein levels). This proposed dual action of estrogens may explain the apparently conflicting results of increased risks of thromboembolism and decreased risks of atherosclerosis or myocardial infarction in men treated with high doses of estrogen (36, 196, 197). In women, there is some suggestion that (low-dose) postmenopausal estrogens may increase the risk of thromboembolism (79, 204), although the majority of studies report no such increase. The difference in risk of thromboembolism between men and women using estrogens may be due to several factors. First, the dose (potency) of the estrogen used by men is usually higher than that used by postmenopausal women, and the risk of estrogen-induced thrombus formation may be dose-dependent. Second, men tend to have more atherosclerotic lesions than women and thus would have more substrate available for thrombus formation. (This hypothesis is supported by the observation that the increased risk of thromboembolism was evident in men using estrogens for the secondary prevention of cardiovascular disease.) Indirect evidence supporting the hypothesis that endogenous estrogen levels are protective against cardiovascular disease is most consistent for women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1984

The constancy of parent-offspring similarity of total cholesterol throughout childhood and early adult life. The Lipid Research Clinics Program Prevalence Study.

In a cross-sectional study of 11,409 white parent-offspring pairs in five North American populations we examined the effect of age of the offspring on parent-offspring total cholesterol correlations. In general there were no differences in correlations by age of the offspring for the four types (by gender) of parent-offspring pairs. This was true within each of the five populations and for the average of all populations combined. For offspring from less than 2-29 years of age, these average age-specific correlations ranged from 0.17 to 0.42. Despite the considerable physiologic and environmental changes which influence cholesterol levels from birth to early adulthood, the strength of parent-offspring similarity shows no consistent pattern of change.

Adolescent↗

PubMed1984

Racial differences in susceptibility to tuberculosis: risk of disease after infection.

It is generally believed that certain racial groups are highly susceptible to tuberculosis disease while others have developed a "natural resistance." Epidemiological studies reporting differences in case rates among different racial groups, provide inconclusive evidence. Many factors influence the development of active tuberculosis including sex, age, body weight, and virulence of the infecting organism. These, as well as other factors, may be more important determinants which, up to now, have been confused with race.

Adolescent↗

PubMed1984

Is borderline fasting hyperglycemia a risk factor for cardiovascular death?

The majority of previously reported studies of borderline hyperglycemia as a risk factor for cardiovascular disease are based on post-challenge glucose levels, are limited to men, and show either no significant association or a possible threshold effect. In order to determine whether fasting plasma glucose (FPG) in the normal range (less than 140 mg/dl) predicts mortality, we prospectively studied a geographically defined Southern California community of 3625 nondiabetic men and women aged 40-79, 99.5% of whom were followed for 9 years. Levels of FPG were significantly associated with levels of most heart disease risk factors. After adjusting for these risk factors, FPG, analyzed either as a continuous or categorical variable, was independently and significantly associated with all-cause, cardiovascular and ischemic heart disease mortality in men in proportional hazard models. An excess of all-cause mortality with the highest levels of FPG (130-139 mg/dl) was the only statistically significant association seen in women. The absence of a significant linear association in women may reflect true sex differences or a lack of power owing to the relatively small numbers of deaths in women. The independent linear glucose mortality association in men found here differs from previous studies, and may reflect both the larger number of events and the use of FPG, which has less intra-individual variability and less potential for misclassification bias than post-challenge glucose.

Adult↗

PubMed1984

Ischemic heart disease risk factors after age 50.

Previous studies have suggested that the predictive power of the three major risk factors for ischemic heart disease (hypertension, hypercholesterolemia, and cigarette smoking) decreases sharply with age. We re-examined this question in a cohort of 3187 adults aged 50-79 with baseline evaluation in 1972-1974 who were followed at least 9 years during a period of a marked decline in national cardiovascular disease mortality. Four-hundred and eighty-three subjects died, 123 of ischemic heart disease. Predictors of outcome were studied separately in younger (age 50-64) and older (age 65-79) groups. After multivariable adjustment for potential confounders using Cox proportional hazards models, cholesterol retained a significant independent predictor of ischemic heart disease mortality at older ages for both men and women. Cigarette smoking and hypertension were significantly related to all-cause but not to ischemic heart disease mortality in this older population. We suggest that the persistence of cholesterol as an independent predictor of fatal ischemic heart disease in old age may reflect the consequences of a shift in risk factor distribution with deferred selective mortality in a cohort with an overall favorable risk factor status.

Age Factors↗

PubMed1984

Plasma cholesterol and cancer morbidity and mortality in an adult community.

The relationship between plasma cholesterol and seven-year cancer morbidity and mortality was assessed in 4035 residents of Rancho Bernardo , CA, aged 40-89 years. Cancer was the underlying cause of death for 139 persons and occurred in an additional 168 individuals after the 1972-74 cholesterol measurement. The age-adjusted cancer mortality rate per years of experience showed a slightly U-shaped relationship with cholesterol levels in men. For women, little association was seen between cancer mortality and cholesterol levels. Age-adjusted cancer morbidity rates per years of experience, indicated no association for men or women. Mean cholesterol levels did not differ significantly by cancer site. In addition, analysis of cholesterol levels by length of time between cholesterol measurement and cancer occurrence showed no significant trends, suggesting the progression of subclinical cancer did not result in lower cholesterol levels. In summary, in this population no significant association of cholesterol and cancer was seen in men or women.

Adult↗

PubMed1984

Dietary potassium and blood pressure in a population.

A population based study of 685 men and women aged 20 to 79 yr in a predominantly Caucasian community in Southern California found dietary potassium intake estimated from 24-h recall dietary history to be significantly and negatively correlated with age-adjusted systolic pressure in both men and women and with age-adjusted diastolic blood pressure in men. These correlations remained after exclusion of persons taking antihypertension medication or those with categorical hypertension (blood pressure greater than 160/95), and also persisted after adjusting for other dietary variables including alcohol and calcium intake. In women, correlations with blood pressure increased after excluding those taking sex hormones, suggesting that hormonal status may be an important determinant of blood pressure in women and may obscure other relationships. These findings support the etiological relationship of dietary potassium with blood pressure in populations.

Adult↗

PubMed1984

Fasting plasma glucose, uric acid, and triglycerides as predictors of the ratio of total cholesterol to HDL-C.

It was reported previously that a score composed of glucose, uric acid, and triglyceride was correlated closely with the total cholesterol:high density lipoprotein cholesterol (TC:HDL) ratio and could be used to predict those subjects for whom the more expensive HDL measurement would be useful. The authors tested this score using multiple regression and discriminant function analysis in a population sample of 209 men aged 40-79 years, Triglyceride was the only component of the score that contributed to the prediction or classification of the TC:HDL ratio. Although the correlations of the score with the TC:HDL ratio were relatively good (r = 0.72 or greater), the discriminant function analysis showed that subjects with high or low scores could have high or low TC:HDL ratios. The authors conclude that the score (essentially the triglyceride level) is inadequate to permit the classification of any individual as having a definite high or low TC:HDL ratio.

Adult↗

PubMed1984

Is an educated wife hazardous to your health?

Three of four previous studies have suggested that men whose wives are more educated than they are at increased risk of coronary heart disease, defined to include angina pectoris, but one study of coronary heart disease exclusive of angina failed to show an association with educational discordance. In this study, the authors used data from a cohort of 1698 spouse pairs aged 45-79 years who were followed prospectively for nine years to determine whether discordance for education was predictive of ischemic heart disease death. In this upper-middle-class population, men with more educated wives tended to be older, had a lower socioeconomic status, and higher blood pressure levels. A significant increase in risk of all-cause and ischemic heart disease death was seen in men whose wives were more educated than they, compared with men whose wives were less educated. This risk was highest for the least educated men with the most educated wives, and was not totally explained by differences in age, socioeconomic status, blood pressure, or other risk factors. These data support a causal role for status incongruity and fatal ischemic heart disease.

Aged↗

PubMed1984

Systolic blood pressure and cancer mortality in an elderly population.

In a nine-year follow-up of a southern California community of 2,852 men and women aged 60-79 years, systolic blood pressure was a significant predictor of subsequent cancer mortality in men. This effect was independent of age, antihypertensive medication, smoking, obesity, and plasma cholesterol. Trends in women were similar but not statistically significant. Compared with those still alive, higher initial systolic blood pressure levels were apparent in those who died of colon cancer, stomach cancer, and all other cancers combined except for lung and prostate cancer. Possible mechanisms for this association and the implications of the data with regard to the benefits of measures to treat high blood pressure or lower population distribution of blood pressure are discussed.

Age Factors↗

PubMed1984

Interaction between cigarette smoking and diabetes mellitus in the prediction of death attributed to cardiovascular disease.

Previous studies have shown that the increased risk of cardiovascular disease in adults with diabetes is independent of heart disease risk factors and have suggested that the effect of these risk factors is similar in diabetics compared with nondiabetics. To determine whether there was interaction between diabetes and the classic heart disease risk factors (cholesterol, blood pressure, and cigarette smoking) in the prediction of cardiovascular death, the etiologic fraction due to interaction was assessed in a nine-year follow-up of 2,620 older Caucasian adults (60-79 years) who resided in Rancho Bernardo, California, 8.7% of whom had diabetes by history of fasting hyperglycemia. In these older adults, the frequency of categoric hypertension, hypercholesterolemia, or current cigarette smoking did not differ significantly among diabetics compared with nondiabetics. Overall, the age-adjusted relative cardiovascular mortality risk among diabetics was similar to that in nondiabetics for all risk factors except cigarette smoking, for which the relative risk for diabetics was 2.2 compared with 1.2 for nondiabetics. High cholesterol and systolic blood pressure levels showed no interaction with diabetes, but cigarette smoking had a large and significant interaction with diabetes, such that an estimated 65% of the cardiovascular disease deaths among diabetics could be attributed to the interaction of diabetes and cigarette smoking. If confirmed, these data have important implications for the prevention of cardiovascular death in older diabetics.

Aged↗

PubMed1984

Family history of heart attack as an independent predictor of death due to cardiovascular disease.

Although a family history of ischemic heart disease is a well-accepted risk factor for cardiovascular disease, only three prospective studies--all in men--have examined the predictive strength of a positive family history after adjusting for other heart disease risk factors. The present analysis is based on a 9 year follow-up of 4014 men and women from 40 to 79 years old who resided in Rancho Bernardo, CA, and who reported no known cardiovascular disease in response to a standardized interview. At baseline 38% of this group reported a family history of a heart attack in a parent, sibling, or child; 15% of those with a positive family history in a first-degree relative indicated that the heart attack had occurred before the relative was 50 years old. Younger men (less than 60 years) with a positive family history at any age had significantly higher mean blood pressures and total plasma cholesterol levels; older men were more likely to have diabetes mellitus. Younger women with a positive family heart attack to subsequent cardiovascular death was determined by the Cox model after adjusting for age, systolic blood pressure, total plasma cholesterol level, obesity, cigarette smoking, personal history of diabetes, and estrogen use (in women). In men, but not in women, a positive family history of heart attack was independently predictive of death from all causes and from cardiovascular and ischemic heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗