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Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 415 records · Page 23Linked to original sources
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Demographic, behavioral, biochemical, and dietary correlates of plasma triglycerides. Lipid Research Clinics Program Prevalence Study.

Few studies have simultaneously examined the relationship of triglyceride levels with a wide variety of potential covariates. Thus, the present study was designed to assess in a large, free-living population the association of fasting plasma triglyceride values with selected demographic, behavioral, biochemical, and dietary measures. These analyses were done using data obtained from 5189 white men and women aged 20 to 69 years who participated in the Lipid Research Clinics Program Prevalence Study. Of the eight nondietary factors examined, age, Quetelet Index, fasting plasma glucose, and cigarette smoking were strongly, positively associated (p less than 0.0001) with triglycerides in men and in women not using gonadal hormones. Among women using oral contraceptives or estrogens, only Quetelet Index (p less than 0.01) and cigarette smoking (p = 0.01) were significantly related to triglyceride values. Physical activity was inversely associated (p less than 0.0001) and use of diuretic medications was positively related (p less than 0.01) to triglycerides only in men. Results of analyses of triglycerides and six selected dietary measures varied by age, sex, and hormone-use subgroups. Although none of the dietary variables showed consistent associations with triglycerides across all of the subgroups, triglycerides tended to be inversely associated with total calories per kilogram of body weight and the percentage of calories as dietary fat.

Adult↗
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Population-based study of glycosylated hemoglobin, lipids, and lipoproteins in nondiabetic adults.

Glycosylated hemoglobin levels reflect glucose homeostasis over the preceding months. Many investigators have reported levels of glycosylated hemoglobin in diabetics and have noted a strong correlation of these levels with lipids and lipoproteins, but not with HDL cholesterol. We report here the first population-based study of the predominant fraction of glycosylated hemoglobin, HbA1, and its correlates in nondiabetics. In 558 euglycemic adults (fasting plasma glucose less than 140 mg/dl) aged 40 to 79 years who had no history of diabetes, HbA1 was normally distributed, was unrelated to age, and was correlated with fasting plasma glucose in men and women and with obesity in women. After adjusting for age and obesity, HbA1 was significantly correlated with total plasma cholesterol and LDL cholesterol in both sexes and with total plasma triglyceride and VLDL cholesterol in men. HDL cholesterol was not significantly associated with HbA1 in men or women. These associations are similar, although weaker, than those reported in most studies of diabetics. The finding that the association of glycosylated hemoglobin with lipids and lipoproteins extends throughout the normal range of blood sugar suggests that this association may be relevant to both the excess risk of ischemic heart disease in diabetics and in nondiabetics with higher levels of fasting plasma glucose.

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Asymptomatic hyperglycemia is associated with lipid and lipoprotein changes favoring atherosclerosis.

We studied lipid and lipoprotein concentrations and their relationships to insulin level in 994 men and 1246 women ages 50 to 91 years in the upper middle-class community of Rancho Bernardo in southern California. Altogether, 593 men and 741 women had normal glucose tolerance, 240 men and 348 women, impaired glucose tolerance (IGT), 104 men and 117 women, newly diagnosed noninsulin-dependent diabetes (NIDDM), and 57 men and 40 women, previously diagnosed NIDDM. In women but not men, total cholesterol and low density lipoprotein were significantly higher in those with newly diagnosed NIDDM, compared to subjects with normal glucose tolerance. In both men and women, high density lipoprotein (HDL) cholesterol was significantly lower, and total triglyceride significantly higher, in subjects with IGT and NIDDM compared to those with normal glucose tolerance; these differences persisted after adjusting for age, body mass index, smoking, alcohol intake, and exercise level. Multiple linear-regression analyses showed that fasting insulin (but not 2-hour insulin) was significantly associated with low HDL cholesterol and high total triglycerides independently from other variables (age, body mass index, waist/hip ratio, alcohol intake, smoking, exercise, and 2-hour glucose). Overall, these results show that asymptomatic hyperglycemia (IGT, newly diagnosed NIDDM) is associated with lipid and lipoprotein changes favoring atherosclerosis and that fasting hyperinsulinemia (insulin resistance) is the most important factor associated with these lipid and lipoprotein abnormalities

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Alcohol consumption and blood pressure. The lipid research clinics prevalence study.

The relationship between alcohol consumption and systolic and diastolic blood pressure (BP) was examined in 2482 men and 2301 women 20 years of age or older in nine North American populations. Men at the highest level of alcohol consumption (greater than or equal to 30 ml alcohol per day) had the highest BP, while women either at the highest level of alcohol consumption or consuming no alcohol had the highest BP. Men aged greater than or equal to 35 years of age consuming greater than or equal to 30 ml alcohol per day were 1.5 to 2 times more likely to be hypertensive than non-drinkers. Multivariate analysis showed systolic and diastolic BP in both men and women to be positively and significantly (p less than 0.05) related to alcohol consumption, and this relationship was independent of the potential confounding effects of age, obesity, cigarette smoking, regular exercise, education, and gonadal hormone use in women. The regression coefficients indicated that an average of 30 ml of alcohol per day would produce a 2 to 6 mm Hg increase in systolic BP. Analyses suggested the univariate U-shaped alcohol-BP association in women was confounded by differences in obesity and cigarette smoking in nondrinking women, and by very low alcohol consumption in hypertensive women using medication. Additional analyses indicated that alcohol consumed in the 24 hours prior to the study was much more strongly associated with elevated BP than alcohol consumed in the week prior to the study excluding the previous 24 hours. We conclude that alcohol appears to have a modest but consistent and independent effect on systolic and diastolic BP.

Adult↗
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Predictors of stroke-associated mortality in the elderly.

Although stroke is a major cause of death in older adults, few studies have examined the independent contribution of cardiovascular disease risk factors to stroke mortality in the geriatric age group. We report here a nine-year followup of a Southern California community of 2107 men and women aged 65 to 84 years. In this older cohort, age was the most significant independent risk factor for stroke-associated mortality in both sexes. Systolic blood pressure was weakly but significantly associated with stroke mortality in this older age group. Cigarette smoking was positively related and educational level of head of household negatively related to stroke mortality in both sexes, with the predominant effect in women. No significant independent effect of cholesterol, fasting plasma glucose or obesity was discernible. Both blood pressure and cigarette smoking are potentially remedial risk factors for stroke after age 65.

Age Factors↗
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Postmenopausal estrogen, cancer and other considerations.

The female hormone estrogen is widely prescribed to postmenopausal women. Its major documented benefit is prevention of bone mineral loss, which is a major risk factor for fracture in the elderly. Its clearly documented risk is promotion of cancer of the endometrium. There is a growing body of data that suggests that postmenopausal estrogen therapy reduces the risk of cardiovascular disease. This benefit, if real, may be lost when a cyclic progestin is added to reduce the risk of cancer. Further studies are needed to provide a firmer basis for balancing these risks and benefits.

Breast Neoplasms↗
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Insulin-dependent diabetes mellitus and ischemic heart disease.

A review of case series of patients with insulin-dependent diabetes mellitus (IDDM) shows an excess frequency of cardiovascular death and probably myocardial infarction. The excess risk is not well quantitated, not clearly associated with poor control of hyperglycemia, and probably not explained by conventional heart disease risk factors. High-density lipoprotein cholesterol levels are not consistently lower in patients with diabetes than in those without diabetes. The relationship of described abnormalities of the coagulation system in diabetes to cardiovascular disease is unknown. Physiologic and pathologic abnormalities are seen in some younger patients without macrovascular disease, but their importance in relation to the excess cardiovascular morbidity and mortality is obscure.

Age Factors↗
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Life satisfaction, symptoms, and the menopausal transition.

OBJECTIVE: The aims of this study were to examine the relation between life satisfaction and the menopausal transition, identify factors predictive or associated with life satisfaction, and determine the relation between life satisfaction and other health outcomes. RESEARCH DESIGN AND METHODS: This is a prospective population-based study of 438 middle-aged Australian-born women followed for 6 years after baseline measures. Retention rate at 6 years was 90% (n = 395). Two self-reported measures of life satisfaction (Life Satisfaction Index-Z scale [LSI-Z] and Satisfaction with Life Scale [SWLS]) were used in year 6. Positive and negative affect scales and questions about satisfaction with work and daily living were also used. Sociodemographic variables were measured at baseline, and attitudes toward menopause and aging were documented at years 2 and 5, respectively. Other explanatory variables, including symptoms, health, stress, life events, sexual functioning, and lifestyle were measured in year 6. RESULTS: Women overwhelmingly endorsed positive responses to life satisfaction questions. The LSI-Z and the SWLS were highly correlated with each other (r = 0.70), with the mood scales, and with responses to questions about satisfaction with work and daily living. The LSI-Z and SWLS were not related to menopausal status, hormone levels (follicle-stimulating hormone, estradiol), age, body mass index, hot flushes, hormone replacement therapy, sexual interest, employment status, type of profession, children at home, alcohol, chronic conditions, surgery, premenstrual complaints, life events (major or secondary), and social support. Stepwise multiple regression found that life satisfaction was predicted by earlier attitudes and was positively associated with feelings for partner and exercise and negatively associated with daily hassles, interpersonal stress, dysphoric symptoms, and current smoking. CONCLUSIONS: Life satisfaction was closely related to mood, predicted by earlier attitudes, and affected by relationship to partner, stress, and lifestyle. Life satisfaction was unrelated to menopause status, hormone levels, or hormone replacement therapy.

Female↗
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Exercise patterns in a population of older adults.

Little is known about the extent to which older adults engage in exercise, despite recent enthusiasm for exercise among people of all ages. This report describes the exercise patterns in a well-defined population of older adults living in southern California. From 1984 through 1987, we asked 1,140 members of a previously defined adult community 50-93 years of age to report the frequency and duration of participation in 14 leisure-time activities in the two weeks preceding a physical examination. Exercises were categorized as light, moderate, or heavy according to a previously validated scale. Interviewers ascertained information on chronic disease history, cigarette smoking, physical and emotional functioning, and self-rated health. More than 90% of the group reported some physical activity in the two-week period before their evaluation. While the rates of moderate and heavy exercise decreased with age, rates of participation in and duration of light exercise actually increased. Walking was the most common form of exercise reported and was positively associated with other exercise: walkers were more likely to engage in nearly every form of exercise ascertained by the questionnaire than were nonwalkers. Of those who walked or engaged in moderate or heavy exercise, nearly 60% did so three times a week for at least 20 minutes a time. Exercise frequency was lower in those with a history of chronic disease, obesity, or current cigarette smoking, and exercise was positively associated with physical and emotional functioning and self-rated health. These data illustrate that older adults can and do exercise late into life.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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Cardiovascular disease risk factors in an Indochinese population.

One hundred seventeen Indochinese adults were screened for heart disease risk factors at a San Diego community health facility during December 1986. Two levels of excess risk, moderate-high and high, were categorically defined for blood pressure, total cholesterol, cigarette smoking, and obesity. Overall, 61% were at moderate-high or high risk in at least one category, and 34% were at high risk by these criteria. Systolic blood pressure, diastolic blood pressure, and total cholesterol were positively correlated to age, and ethnicity was a significant covariate for cholesterol, body mass index, and cigarette smoking. The Hmong, compared with other Indochinese, had a significantly lower mean cholesterol level, which remained after adjusting for age and body mass. High rates of cigarette smoking were found among Vietnamese men and young Indochinese men. If confirmed, the high prevalence of heart disease risk factors in Indochinese refugees and immigrants suggests that cardiovascular health education programs are appropriate in Indochinese communities.

Adolescent↗
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Lipoproteins as predictors of ischemic heart disease in non-insulin-dependent diabetic men.

In order to determine whether low levels of high-density lipoprotein cholesterol (HDL-C), which are predictive of ischemic heart disease in the general population, can also predict death from ischemic heart disease among diabetic men, we contrasted lipoprotein and other heart disease risk factors in 62 men with non-insulin-dependent diabetes mellitus, 14 of whom died of ischemic heart disease during a 12-year follow-up period. Compared to all other diabetic men, those who died of ischemic heart disease were older, had higher levels of fasting plasma glucose (FPG) total plasma cholesterol, and triglycerides, lower HDL-C levels, and higher low-density lipoprotein cholesterol (LDL-C) levels and were more likely to have been cigarette smokers; only total cholesterol, LDL-C, and the LDL/HDL ratio were statistically significant. Age, FPG, total plasma cholesterol, and LDL-C were all independently predictive of fatal heart disease by multivariate analysis. Neither HDL-C nor the LDL/HDL ratio predicted ischemic heart disease death better than the total plasma cholesterol or LDL-C. The use of HDL-C, LDL-C, or total plasma cholesterol level in the model did not eliminate the significant association with FPG, which suggests that the noxious effect of hyperglycemia is independent of the changes in blood lipids.

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Diabetes and pancreatic carcinoma.

OBJECTIVE: To analyse the association between pancreatic cancer and non-insulin-dependent diabetes mellitus. DESIGN: Cohort study of fatal pancreatic cancer with 17 years of follow-up. SETTING: Working men in Paris. PARTICIPANTS: 6,988 men aged 44-55 years employed by a government agency. Following a 75 g oral glucose tolerance test, subjects were classed at baseline, according to the WHO criteria as normoglucose tolerant, impaired glucose tolerant or diabetic. Known diabetic patients were grouped with the latter. RESULTS: Among the 312 diabetic subjects (both known and newly diagnosed) the death rate from pancreatic cancer was 64 per 100,000 person years, and 28 and 18 per 100,000 person years among the 684 impaired glucose tolerant and 5,992 normoglycaemic subjects respectively. After the exclusion of deaths during the first five years of follow-up, a possible marker of occult cancer at baseline, the relative risk of fatal pancreatic cancer in diabetic versus normoglycaemic men was 4.9 (95% CI, 1.3 to 18 after adjustment for age and tobacco consumption).

Adult↗
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Factors associated with health behavior change among residents 50 to 96 years of age in Rancho Bernardo, California.

Alterations in personal health habits can prevent disease and reduce morbidity and mortality. We examined the association between self-reported healthy behavioral change and age, sex chronic disease, plasma cholesterol, and body mass index in an older Caucasian population in southern California. Overall, about two thirds of respondents reported decreased dietary salt or fat intake over the last 15 years, whereas one third reported increased frequency of exercise. Women were more likely than men to report increasing exercise, changing diet, or reading self-help materials. Individuals 50-69 years of age reported more positive health behavior changes than those 70 years and older. Those with diabetes and hypertension were more likely to decrease salt intake, but less likely to increase exercise than those without disease. Hypertensive and diabetic men, but not women, were also more likely to change their diet or read self-help materials than their peers without disease. The presence of risk factors for cardiovascular disease, such as obesity, elevated serum cholesterol, diabetes, and hypertension, were generally associated with positive alterations in diet and inversely related to increasing exercise.

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Oophorectomy status and bone density in older, hysterectomized women.

INTRODUCTION: This study examined the long-term effects of hysterectomy, with and without bilateral oophorectomy, and treatment with estrogen replacement on bone mineral density in older hysterectomized women. METHODS: Subjects were 346 women 60-89 years of age, who were participants in the Rancho Bernardo Study and attended a follow-up clinic visit in 1988-1991. Bone density was measured at the ultradistal wrist, midshaft radius, lumbar spine and hip. RESULTS: Of these women, 182 had a hysterectomy with conservation of one or both ovaries and 164 had a hysterectomy with bilateral oophorectomy. Current estrogen users had the highest bone densities; those who never used estrogen replacement had the lowest. Only 9.1% of oophorectomized women, compared to 19.2% of those with ovarian conservation had never used estrogen (P < .01). After adjustment for covariates including estrogen replacement therapy, hysterectomized women with ovarian conservation had marginally higher bone densities at the wrist (P < .09) and spine (P < .06) than oophorectomized women. We found significant differences only among women currently using estrogen (P < .05 for wrist and P < .01 for spine densities, respectively). Bone density did not differ at any site by oophorectomy status among past or never users of estrogen. CONCLUSIONS: Hysterectomized women who use estrogen replacement therapy have better bone density, regardless of a bilateral oophorectomy. In addition, bilateral oophorectomy may not have a long-term negative effect on bone density; hysterectomized women who do not use estrogen appear to have equivalent bone density whether or not they had a bilateral oophorectomy.

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