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Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 91 records · Page 5Linked to original sources
PubMed1998

A prospective study of bone loss in menopausal Australian-born women.

Two hundred and twenty-four women (74 pre-, 90 peri-, 60 post-menopausal), aged 46-59 years, from a population-based cohort participated in a longitudinal study of bone mineral density (BMD). BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral neck and the time between bone scans was on average 25 (range 14-41) months. The aim of the study was to assess changes in BMD in relation to changes in normal menopausal status. During the study period women who were between 3 and 12 months past their last menstrual period (n = 22, late perimenopausal) at the time of the second bone scan had a mean (SE) annual change in BMD of -0.9% (0.4%) at the lumbar spine and -0.7% (0.6%) at the femoral neck (both p < 0.05 compared with women who remained premenopausal). In the women who became postmenopausal (n = 42) the mean annual changes in BMD were -2.5% (0.2%) at the lumbar spine and -1.7% (0.2%) at the femoral neck (both p < 0.0005), and in the women who remained post-menopausal (n = 60) they were -0.7% (0.2%) per year and -0.5% (0.3%) per year respectively (both p < 0.05), compared with women who remained premenopausal. In the 1-3 years after the final menstrual period (FMP) there was greater bone loss from the lumbar spine than the femoral neck (p < 0.05). In women who were menstruating at the time of the second bone scan and whose FMP could be dated prospectively (n = 35), higher baseline oestradiol levels were associated with less lumbar spine bone loss (p < 0.005). In the women who remained postmenopausal there was an association between baseline body mass index (BMI) and percentage change per year in femoral neck BMD (p < 0.05), such that women with higher BMI had less bone loss. In conclusion, during the time of transition from peri- to post-menopause, women had accelerated BMD loss at both the hip and spine.

Absorptiometry, Photon↗
PubMed1998

Serum albumin and bone mineral density in healthy older men and women: the Rancho Bernardo Study.

Serum albumin has been found to be positively correlated with bone mass in small studies of ambulatory men or women with diagnosed osteoporosis. In this study the relation between serum albumin and bone mineral density (BMD) was examined in 1593 white, community-dwelling men and women aged 50-95 years. BMD was determined using single-photon absorptiometry (SPA) at the ultradistal radius and the midshaft radius, and using dual-energy X-ray absorptiometry (DXA) at the hip and spine. Albumin was measured from a fasting blood sample using the Technicon SMA 12 autoanalyzer. Mean albumin levels in both men and women decreased significantly with increasing age. All but four values were within the normal range (3.5-5.0 g/dl). BMD decreased with increasing age at all sites. In both sexes there was weak positive correlation between serum albumin and BMD in the unadjusted model (Pearson's r values < 0.3, p values < 0.005). After age adjustment, however, the relationship was no longer significant (Pearson's r values < 0.05, p values > 0.18). Men and women were divided into three sex-specific categories--osteoporotic, osteopenic and normal--based on World Health Organization criteria in relation to young adult means (normal, BMD > -1 SD; osteopenia, BMD between -1 SD and -2.5 SD; osteoporosis, BMD < -2.5 SD). Mean albumin values did not differ significantly across the three BMD categories in men or women. BMD levels stratified for albumin levels and calcium supplement status (a marker for osteoporosis awareness) also did not differ. Albumin levels were also not associated with a history of low-trauma fractures. In summary, there was no age-independent association between serum albumin within the normal range and low BMD or fractures in community-dwelling healthy older adults. We conclude that previously reported associations most likely reflect inadequate adjustment for the age-related decrease in albumin levels and the selection of very frail osteoporotic subjects.

Age Factors↗
PubMed1998

Symptom relief and side effects of postmenopausal hormones: results from the Postmenopausal Estrogen/Progestin Interventions Trial.

OBJECTIVE: To assess pair-wise differences between placebo, estrogen, and each of three estrogen-progestin regimens on selected symptoms. METHODS: This was a 3-year, multicenter, double-blind, placebo-controlled trial in 875 postmenopausal women aged 45-64 years at baseline. Participants were assigned randomly to one of five groups: 1) placebo, 2) daily conjugated equine estrogens, 3) conjugated equine estrogens plus cyclical medroxyprogesterone acetate, 4) conjugated equine estrogens plus daily medroxyprogesterone acetate, and 5) conjugated equine estrogens plus cyclical micronized progesterone. Symptoms were self-reported using a checklist at 1 and 3 years. Factor analysis reduced 52 symptoms to a set of six symptom groups. RESULTS: In intention-to-treat analyses at 1 year, each active treatment demonstrated a marked, statistically significant, protective effect against vasomotor symptoms compared with placebo (odds ratios [ORs] 0.17-0.28); there was no additional benefit of estrogen-progestin over estrogen alone. Only progestin-containing regimens were significantly associated with higher levels of breast discomfort (OR 1.92-2.27). Compared with placebo, women randomized to conjugated equine estrogens reported no increase in perceived weight. Those randomized to medroxyprogesterone acetate reported less perceived weight gain (OR 0.61-0.69) than placebo. Anxiety, cognitive, and affective symptoms did not differ by treatment assignment. Analyses restricted to adherent women were not materially different than those using intention-to-treat, except that women adherent to medroxyprogesterone acetate and micronized progesterone regimens reported fewer musculoskeletal symptoms (OR 0.62-0.68). CONCLUSION: These results confirm the usefulness of post-menopausal hormone therapy for hot flashes, show convincingly that estrogen plus progestin causes breast discomfort, and demonstrate little influence of postmenopausal hormones on anxiety, cognition, or affect.

Double-Blind Method↗
PubMed1998

Prospective association of smoking and alcohol use with cognitive function in an elderly cohort.

Cross-sectional studies of the associations of alcohol and tobacco use with cognitive function do not take into account behavior change after memory loss or differential survival. This prospective study examines the association of cigarette smoking and alcohol consumption at baseline with risk of poor cognitive function 13-18 years later. Between 1973 and 1975, 1469 relatively well-educated, noninstitutionalized men and women from Rancho Bernardo, California, answered standardized questions about smoking and alcohol consumption. Between 1988 and 1991, 511 of these men and women completed five standardized cognitive function tests. At baseline, 20.4% of the men and 23.0% of the women were cigarette smokers. Smoking was associated with increased mortality in men but not in women. In surviving male participants, cognitive function test scores did not significantly differ by baseline smoking status. Among female participants, smoking was associated with categorically defined poorer function on two of five tests. At baseline, 16% of the men and 29% of the women were nondrinkers. Drinking more than two drinks per day was associated with decreased mortality in both sexes. Among women, increasing consumption of alcohol predicted a significant decline in the long-term recall and savings scores of the visual reproduction test. Moderate drinking, approximately two drinks per day, predicted categorically defined poor performance on the Buschke long-term recall task in women. Alcohol consumption was not associated with cognitive function in men. Overall, the observed associations were weak, and no clear pattern was observed. Although there were some gender differences in observed associations and a survivor effect cannot be excluded, data from these healthy, educated, noninstitutionalized people offer no compelling evidence that social drinking or cigarette smoking causes or prevents impaired cognitive function in old age. The large number of comparisons and inconsistent results suggest that the few statistically significant findings may be spurious. Additional long-term prospective studies are needed to determine the generalizability of these findings to individuals in less healthy or less well-educated cohorts.

Adult↗
PubMed1998

Prior oral contraceptive use is associated with higher blood pressure in older women.

Studies of young, premenopausal women suggest that changes in coronary risk factors do not persist after discontinuation of oral contraceptive use. However, little is known about longterm effects of past oral contraceptive use in older, postmenopausal women, who typically have a more atherogenic profile. This study examines the relation of past oral contraceptive use (including duration) to heart disease risk factors in postmenopausal women. Subjects were 517 women aged 50-69 from the Rancho Bernardo Study who attended follow-up clinic visits. Past oral contraceptive use was reported by 24.2% and two thirds had used oral contraceptives < or = 5 years. After adjustment for covariates, the only significant difference was that past users had higher diastolic blood pressures than never users (p < 0.01). Among older women, the diastolic blood pressure of past users was 3.9 mm Hg higher than that of never users (p < 0.01). Women who used oral contraceptives for < or = 5 years had diastolic blood pressures 3.6 mm Hg higher than those of never users (p < 0.01). No differences were found among younger women or those who used oral contraceptives > or = 6 years. Past oral contraceptive users may be at increased risk for heart disease because of a small but significant elevation in diastolic blood pressure that persists many years after discontinuing oral contraceptive use.

Age Factors↗
PubMed1998

Type A behavior pattern, heart disease risk factors, and estrogen replacement therapy in postmenopausal women: the Rancho Bernardo Study.

Cardiovascular disease is the leading cause of death among older American women. Estrogen replacement therapy (ERT) appears to reduce the risk of heart disease. For nearly five decades, the Type A behavior pattern (TABP) has been implicated in the cardiac morbidity and mortality of both men and women, but no studies have examined the use of replacement estrogen or whether its association with heart disease risk factors is different in Type A versus Type B women. We examined the effects of ERT and TABP on heart disease risk factors in a large population-based sample. Subjects were 1070 postmenopausal women, aged 50-89 years, who had been participants in the Rancho Bernardo Study. At a clinic visit made during 1984-1987, TABP was assessed with the Bortner Rating Scale, and heart disease risk factors (total cholesterol, high-density and low-density lipoprotein (HDL and LDL), triglycerides, fasting and postchallenge insulin and glucose, and blood pressure) were measured. Based on a median split (median = 154.0) of scores on the Bortner Rating Scale, 52% of these women were classified as Type A. Type A women were significantly younger than Rating women (mean = 68.4 versus 71.0 years, respectively). After adjustment for age, significantly more Type A than Type B women were on ERT (35% versus 24.7%, p = 0.001). Analyses stratified by TABP indicated that within the Type A group, current users of ERT had higher levels of HDL cholesterol (p) = 0.001) and lower levels of LDL cholesterol (p < 0.01), fasting plasma glucose (p < 0.001), and fasting insulin (p < 0.01). Among Type B women, current users of ERT had higher levels of HDL cholesterol (p = 0.07) and triglycerides (p < 0.01), lower levels of LDL cholesterol (p < 0.01), and lower systolic blood pressure (p < 0.05) but no significant differences in either fasting or postchallenge levels of either plasma glucose or serum insulin (each p < 0.01). Results of this study suggest that ERT may be associated with significant differences in the heart disease risk factor profile in Type A versus Type B women, and these differences may favor Type A women.

Age Distribution↗
PubMed1998

Hormone and nonhormone therapy for the maintenance of postmenopausal health: the need for randomized controlled trials of estrogen and raloxifene.

Multiple health benefits have been postulated for the long-term use of hormone therapy in postmenopausal women, most notably for prevention of osteoporotic fractures and coronary heart disease, as well as several risks, including cancer of the breast and uterus and venous thromboembolism. Cardiovascular disease is the most common cause of death among postmenopausal women. If real, the reduction in risk of coronary heart disease by hormone use suggested by observational studies would likely outweigh the risks. The decision to initiate and maintain hormone therapy is complicated by uncertainties about estrogen's true benefits and risks. Raloxifene, a selective estrogen receptor modulator (SERM), appears to have many of the benefits of estrogen without the cancer risks. It is not known if SERMs can provide significant cardiovascular protection. This article reviews the relation of use of postmenopausal hormones and raloxifene to women's health and addresses the need for large randomized trials to quantify the effect of both postmenopausal estrogen and raloxifene on cardiovascular health.

Cardiovascular Diseases↗
PubMed1998

The association of non-insulin-dependent diabetes mellitus and cognitive function in an older cohort.

OBJECTIVE: In this study, we examined the association of non-insulin-dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) with cognitive function in a population-based sample of older individuals. RESEARCH DESIGN AND METHODS: Subjects were 1509 healthy, community-dwelling men and women aged 55 years and older who were participants in the Rancho Bernardo Study and attended clinic visits in 1984-87 and in 1988-91. An oral glucose tolerance test was administered during the 1984-87 visits. Based on World Health Organization criteria, participants were classified into those with NIDDM, IGT, or normal glucose tolerance. During the 1988-91 clinic visits, 12 tests of cognitive function were administered. RESULTS: Of the participants, 14.3% of the men and 9.9% of the women had NIDDM, and 21.0% of the men and 28.0% of the women had IGT. Multiple regression analysis was used to compare the cognitive function of individuals with NIDDM and IGT with individuals with normal glucose tolerance after adjustment for age, education, obesity, depression, blood pressure, and current estrogen use. In men, there were no statistically significant differences in any of the 12 cognitive function tests by glucose tolerance category. Compared with those with normal glucose tolerance, women with IGT had lower scores on almost every cognitive function test, whereas women with NIDDM had higher scores, but none of these differences were statistically significant after adjustment for multiple comparisons. Furthermore, observed differences by NIDDM or IGT status were small and accounted for < or = 0.6% of the explained variance in cognitive function. CONCLUSIONS: This study shows no strong or consistent association between IGT or mild diabetes with cognitive function in community-dwelling older adults.

Aged↗
PubMed1998

Altered antibody pattern to Epstein-Barr virus but not to other herpesviruses in multiple sclerosis: a population based case-control study from western Norway.

OBJECTIVE: The prevalence of anti-EBV antibodies was studied in a group of 144 patients with multiple sclerosis and 170 age, sex, and area matched controls from the county of Hordaland, western Norway. The prevalence of three other herpesviruses, herpes simplex virus (HSV), varicella zoster virus (VZV), and cytomegalovirus (CMV), were also included. METHODS: Antibodies to various virus antigens were determined by enzyme linked immunosorbent assay (ELISA) and indirect immunfluorescence (IIF) in serum samples from 144 patients with multiple sclerosis and 170 controls. RESULTS: All of the 144 patients with multiple sclerosis had IgG antibodies to EBV compared with 162 of 170 controls (p=0.008). The frequency of IgG antibodies to EBV capsid antigen (VCA), nuclear antigen (EBNA), and early antigen (EA) was significantly higher in patients with multiple sclerosis compared with the controls (p<0.000001, p=0.01, and p<0.0001 respectively). The presence of antibodies was independent of the initial course of the disease and the disease activity at the time of blood sampling. The prevalence of IgG antibodies to HSV, CMV, and VZV did not differ between cases and controls. CONCLUSION: The results suggest a role for EBV in the aetiology of multiple sclerosis.

Adolescent↗
PubMed1998

Hormone replacement therapy, heart disease, and other considerations.

Multiple observational studies suggest a marked reduction in risk of coronary heart disease (CHD) associated with postmenopausal estrogen use. A new meta-analysis presented here extends these results to estrogen plus progestin regimens. Although the findings from observational studies are strong and consistent, and there are several plausible mechanisms by which estrogen might reduce risk for CHD, most of the known biases would tend to exaggerate estrogen's benefit. Further, estrogen therapy clearly increases risk for endometrial hyperplasia and cancer, venous thromboembolic events and gallbladder disease, and long-term use probably also increases the risk of breast cancer. Therefore, until findings from randomized trials confirm and quantitate the benefit of estrogen therapy for prevention of CHD, we believe it should not be recommended to all postmenopausal women.

Bias↗
PubMed1998

Gender differences in insulin-like growth factor and bone mineral density association in old age: the Rancho Bernardo Study.

Insulin-like growth factor-I (IGF-I) clearly plays a role in bone metabolism and maintenance, as evidenced by in vitro and animal studies. In clinical studies, the age-related decrease in IGF-I parallels the age-related decrease in bone mineral density (BMD), but several age-adjusted cross-sectional studies show no consistent association of IGF-I and BMD. We report here a cross-sectional study of serum IGF-I and BMD levels in 483 men and 455 postmenopausal women not using estrogen; subjects were 55 years of age and older, community-dwelling, ambulatory, and unselected for bone density. IGF-I was measured by a highly specific radioimmunoassay. BMD was measured at the lumbar spine and hip using dual-energy X-ray absorptiometry. Men had higher IGF-I and BMD levels than women. In age-adjusted and age-stratified models, IGF-I was associated with BMD only in women (test for interaction, p < 0.0001). Gender differences persisted in gender-specific multiple regression analyses adjusted for age, body mass index, thiazide diuretic use, current smoking, alcohol intake, physical activity, and weight change; IGF-I was significantly associated with BMD at the spine (p = 0.0001) and hip (p = 0.02) in women, but not in men (p's > 0.6). Circulating estradiol levels were not associated with IGF-I levels in either gender, testosterone was inversely associated with IGF-I and only in men. This striking gender difference has not been described previously. Its etiology is unknown. The answer could lead to improved understanding of gender differences in osteoporosis and in response to treatment with IGF-I or growth hormone.

Absorptiometry, Photon↗
PubMed1998

Scoliosis in elderly and age-related bone loss: a population-based study.

Osteoporosis, a common metabolic condition resulting in reduced bone mass, causes significant morbidity in affected individuals by predisposing them to osteoporotic fractures. To determine the relationship of scoliosis and osteoporosis, dual-energy X-ray absorptiometry (DXA) scans of 493 men and 762 women were analyzed according to their scoliotic status. No association was observed in the few scoliotic men without osteoarthritis of the spine compared to nonscoliotic men. Without osteoarthritis, scoliotic women had significantly decreased bone mass of the total hip and the femoral neck (p < 0.05) compared to nonscoliotic women, whereas in spine, bone mass was also decreased compared to nonscoliotic women, but not statistically significant. This suggests that scoliosis associates with bone loss, and affected women may benefit from early institution of therapeutic measures.

Journal Article↗
PubMed1998

Birth weight, adult weight, and girth as predictors of the metabolic syndrome in postmenopausal women: the Rancho Bernardo Study.

OBJECTIVE: Recent studies have demonstrated an association between low birth weight and chronic and metabolic disorders in adulthood such as type 2 diabetes, hypertension, and dyslipidemia. These disorders tend to cluster in a condition known as the metabolic syndrome (syndrome X). Only two studies have reported an association of birth weight to the metabolic syndrome. The present study is distinguished as the only study to focus on postmenopausal women. RESEARCH DESIGN AND METHODS: Subjects were 303 community-dwelling, postmenopausal Caucasian women aged 50-84 years. Metabolic and anthropometric variables were measured at a clinic visit; birth weight was assessed by self-report on a mailed questionnaire. RESULTS: The metabolic syndrome, defined as the simultaneous presence of hypertension, dyslipidemia, and abnormal glucose tolerance, was present in 7.9% of these women. Compared with women in the highest birth weight tertile (8.1-13.0 lb, mean 9.4 lb), those in the lowest birth weight tertile (2.5-6.8 lb, mean 5.5 lb) exhibited an increased prevalence (12.0 vs. 4.3%, P < 0.05) and 2.41 times the risk (95% CI 1.06-5.51) of developing the metabolic syndrome. Women with a heavy birth weight had an increased risk of adult obesity. Nevertheless, women in the lowest birth weight tertile who became adults in the highest tertile of BMI (>25.2 kg/m2) or waist circumference (>80.7 cm) had the highest prevalence of the metabolic syndrome (approximately 30%). CONCLUSIONS: Low birth weight coupled with adult obesity is a strong determinant of the metabolic syndrome in postmenopausal women.

Adult↗
PubMed1998

Isolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men. The Rancho Bernardo Study.

OBJECTIVE: To determine whether diabetes defined by isolated postchallenge hyperglycemia (IPH) (2-h postchallenge plasma glucose > or = 11.1 mmol/l with fasting plasma glucose [FPG] < 7.0 mmol/l) increases the risk of fatal cardiovascular disease (CVD) in older women and men. RESEARCH DESIGN AND METHODS: In a prospective study, we followed 769 men and 1,089 women, aged 50-89 years, who had no history of diabetes or myocardial infarction and demonstrated no fasting hyperglycemia (i.e., FPG < 7.0 mmol/l) when they underwent oral glucose tolerance testing at baseline in 1984-1987. RESULTS: At baseline, 70% of 125 women and 48% of 133 men with previously undiagnosed diabetes had IPH. Over the next 7 years, women with IPH had a significantly increased risk of fatal CVD and heart disease compared with nondiabetic women. This increased risk was not observed in men with IPH. This association was independent of age, hypertension, central obesity, cigarette smoking, HDL cholesterol, and triglycerides (multiply adjusted hazard ratio and 95% CI: 2.6 and 1.4-4.7 for CVD; 2.9 and 1.3-6.4 for heart disease). CONCLUSIONS: Diabetes defined by IPH alone is common in older adults and more than doubles the risk of fatal CVD and heart disease in older women. Because the prevalence of IPH increases with age, the use of fasting glucose alone for diabetes screening or diagnosis may fail to identify most older adults at high risk for CVD and should be reevaluated.

Adult↗