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Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 109 records · Page 6Linked to original sources
PubMed1998

Design of NORA, the National Osteoporosis Risk Assessment Program: a longitudinal US registry of postmenopausal women.

NORA is an observational registry of postmenopausal US women with periodic collection of event and treatment data that will create a database including several hundred thousand subjects. It will utilize peripheral and central measurements of bone density and relate these to other risk factors, treatment patterns, and the natural history of osteoporosis. Initiated in the fall of 1997, the registry will be open to women throughout the United States who agree to complete baseline and on-going surveys. The database created by NORA will provide a resource that is unmatched in size and scope in the medical field and will allow for future research in a number of areas including patient outcomes, types of follow-up employed in clinical practice, diagnostic cost modelling, and osteoporosis therapy use (type, patient compliance, persistence and satisfaction). In addition, upon approval by the Steering Committee, women enrolled in the registry may be randomly selected to receive additional educational materials or questionnaires on a variety of topics of interest to specific researchers.

Bone Density↗
PubMed1997

Can we measure prior postmenopausal estrogen/progestin use? The Postmenopausal Estrogen/Progestin Interventions Trial. The PEPI Investigators.

The objective of this study was to assess: 1) the accuracy of a single self-report question about postmenopausal estrogen use; and 2) the performance and repeated measures agreement of a standardized hormone use interview. Women (n = 863) in the Postmenopausal Estrogen/Progestin Interventions Trial (PEPI) completed a self-report baseline questionnaire (BQ) at enrollment and a History of Hormone Use interview (HHU) at the 3-month follow-up visit (HHU3mos). A subsample of 101 women completed a second HHU interview 3 years later (HHU3yrs). As determined by the HHU3mos, 479 (56%) of women had ever used postmenopausal estrogen and 261 (30%) had ever used postmenopausal progestin. The mean number of years since last estrogen or progestin use was 2.2 and 1.3 years, respectively. Overall, there was 95% agreement between self-reported estrogen use on the BQ and the HHU3mos (kappa = 0.91). Using the HHU3mos as the criterion standard, the BQ misclassified 2.3% of women as false positives and 6.3% as false negatives. The average duration of estrogen use in the false-negative classifications was 1.9 years (range: 1-9 years). On the HHU3mos, 39.7% of participants could not recall at least one of the specific details of estrogen use (preparation, dose, route, or starting or stopping year); similar patterns of recall were found for progestin use. Factors associated with discordant reporting of ever-use of ERT (BQ vs. HHU3mos) or incomplete reporting of estrogen/progestin use on the HHU3mos were: route of administration, recency of hormone use, duration of hormone use, and race. Age, years since menopause, education, income, and hysterectomy status were not related to discordant and/or incomplete reporting. Agreement between the HHU3mos and HHU3yrs for ever-use of estrogen was 85.2% (kappa = 0.71). In sum, a single self-report question was adequate to ascertain ever-use of postmenopausal estrogen. When a structured interview form was used, details of postmenopausal estrogen and progestin use were not well remembered. Some features of hormone use and participant characteristics were associated with completeness of recalled hormone use, which suggests the potential for differential misclassification.

Age Factors↗
PubMed1997

Total, LDL, and HDL cholesterol decrease with age in older men and women. The Rancho Bernardo Study 1984-1994.

BACKGROUND: The purpose of the present study was to study the effects of age, weight change, and covariates on lipid and lipoprotein levels cross-sectionally and prospectively in an elderly population. METHODS AND RESULTS: A community-based sample of 1041 men and 1303 women aged 50 to 93 years was studied cross-sectionally in 1984 to 1987, with follow-up of 372 men and 545 women 8 years later. In the cross-sectional study, levels of total cholesterol (TC) and LDL cholesterol (LDL-C) decreased and levels of HDL cholesterol (HDLC) increased with age in men (all P < .001) but not in women. In the prospective study, TC, LDL-C, and HDL-C levels all decreased in both men and women, in all age groups (50 to 64 years, 65 to 74 years, and > or = 75 years) and in all weight change groups (> 2.5-kg loss, change within 2.5 kg, and > 2.5-kg gain) and in all waist girth change groups, for an overall decrement of approximately 1% per year. In multiple linear regression models, change in weight was the most important independent and consistent predictor of changes in TC, LDL-C, and HDL-C. Similar results were obtained in analyses excluding subjects taking lipid-lowering drugs or estrogen and in analyses adjusted for changes in cigarette smoking, alcohol intake, physical activity, medication use, and incident myocardial infarction, cancer, or diabetes. CONCLUSIONS: Cross-sectional decrements in TC and LDL-C with age in men are not explained by survivor bias because they are also observed prospectively. Although weight change was the most important explanatory variable, TC, LDL-C, and HDL-C levels also decreased in those who lost or gained weight. Age was not an independent predictor of change. Other prospective studies are recommended to better define the causes and consequences of cholesterol and lipoprotein changes in old age.

Aged↗
PubMed1997

Epidemiology of insulin-like growth factor-I in elderly men and women. The Rancho Bernardo Study.

Insulin-like growth factor-I (IGF-I) is abundant in the circulation and has been shown to have a wide array of biologic effects. The authors carried out a cross-sectional community-based study of 420 men and 419 nonestrogen-using postmenopausal women aged 50-97 years to ascertain the within-person and laboratory reliability of IGF-I measurements, and the association of IGF-I with common epidemiologic confounders. There was no evidence of seasonal or diurnal variation. IGF-I decreased linearly with age in both sexes, with significantly higher levels in men than women (134.1 microg/liter vs. 126.9 microg/liter; p = 0.03) [corrected]. In age-adjusted analyses, IGF-I was not associated with height, total or central body fat, lean body mass, current smoking, physical activity, or commonly used medications. By contrast, in both men and women who reported any alcohol use, IGF-I levels were significantly higher compared with those in men and women who reported no alcohol use, and alcohol as a continuous variable showed a significant positive linear trend in men (p = 0.0007). The authors conclude that IGF-I varied significantly only with age, sex, and alcohol use. The minimal number of confounding variables, good reliability, and little intraindividual variation suggest that IGF-I should be suitable for epidemiologic research.

Age Factors↗
PubMed1997

The Postmenopausal Estrogen/Progestin Interventions Study: primary outcomes in adherent women.

OBJECTIVE: To assess the efficacy of unopposed estrogen, and three estrogen/progestin regimens on selected heart disease risk factors among adherent women and to contrast those results with efficacy among all women in the PEPI study. DESIGN: A 3-year, multicenter, randomized, double-blinded, placebo-controlled clinical trial. PARTICIPANTS: A total of 847 healthy postmenopausal women aged 45 to 64 years of age with no known contraindication to hormone therapy, who attended their 36 month clinical visit. INTERVENTION: Participants were randomized in equal numbers to one of the following treatments: (1) placebo; (2) conjugated equine estrogen (CEE) 0.625 mg daily; (3) CEE 0.625 daily plus medroxyprogesterone acetate (MPA) 10 mg, days 1-12; (4) CEE 0.625 daily plus MPA 2.5 mg daily; or (5) CEE 0.625 daily plus micronized progesterone (MP) 200 mg, days 1-12. ANALYSIS: Analyses are based on adherent women, where adherence is defined as taking at least 80% of pills at each 6-month visit. RESULTS: Adherence rates were high in all groups except women with a uterus assigned to unopposed CEE. The difference in HDL-C levels resulting from the CEE vs. CEE+MP was approximately three times larger than in the intent-to-treat analyses, reaching statistical significance (P < 0.05). In each active treatment, LDL-C decreased 10-15%. Triglycerides increased 15-20% in each opposed CEE arm and over 25% in the CEE only arm; this difference was not statistically significant. Fibrinogen increased by 7% among placebo adherers, but decreased or remained fairly stable among the active arm adherers. Systolic blood pressure increased 3-5% in all treatment arms. Women adherent to the CEE+MPA arms had twice the increase of 2 h glucose levels as women adherent to CEE only, or CEE+MP (8-9% vs. 3-4%). Two-hour insulin levels decreased 3-12% for all arms. The patterns of change for fibrinogen, SBP, 2 h glucose and insulin were similar to those from the intent-to-treat analyses. CONCLUSIONS: In analyses limited to adherent women, all active treatments, compared to placebo, continued to have similar and favorable effects on LDL-cholesterol and fibrinogen and no significant effects on blood pressure or insulin levels. Given the overall high adherence rates in PEPI, the results are similar to the intent-to-treat analyses, as expected. Only the trend of HDL-C to have a larger increase in the CEE only arm (in the intent-to-treat analyses) gained statistical significance in analyses restricted to adherers.

Blood Glucose↗
PubMed1997

Parenthood and lipid and lipoprotein levels in older men.

PURPOSE: Parenthood for men and women has been associated with longevity, good physical health, and a deterrent effect on negative health behaviors which may affect subsequent mortality. However, decreased high density lipoprotein cholesterol (HDL-C) levels have been reported in women with greater numbers of pregnancies. Similar studies have not been reported in men. The present study examines the association of number of biological and nonbiological children with lipid and lipoprotein levels in men. METHODS: Subjects included 1039 community-dwelling men aged 50-89 years. A standardized interview was used to obtain information on numbers of biological, adopted and stepchildren. Fasting total HDL, LDL cholesterol, and triglycerides were measured. RESULTS: Men with five or more biological children were more obese than men without biological children. Alcohol consumption, cigarette smoking, and exercise did not vary in relation to the number of biological children. Only triglyceride levels were higher in men with four, five, or more children, and lower in men with one child as compared to men with no children, but this difference was no longer statistically significant after adjustment for obesity. CONCLUSIONS: These results show no favorable effect of parenthood for men with regard to lifestyle, lipid, or lipoprotein levels. Increased triglyceride levels in men with more children appeared to be mediated by greater obesity in men with five or more biological children. These data also suggest that relations between parity and HDL-C levels found for women, could be associated with either the long term biologic consequences of pregnancy or the stress of childrearing.

Aged↗
PubMed1997

Cupid's bow contour of the vertebral body: evaluation of pathogenesis with bone densitometry and imaging-histopathologic correlation.

PURPOSE: To investigate the Cupid's bow contour by means of bone densitometry and imaging-histopathologic correlation. MATERIALS AND METHODS: Radiographs and histologic slices were obtained in 64 cadaveric thoracolumbar spines to assess the morphology, distribution, and histopathologic features of the Cupid's bow contour. Dual-energy x-ray absorptiometry and radiography were performed in the lumbar spine in 406 healthy subjects. Bone density and body height and weight were then related to the presence of the Cupid's bow contour. The Cupid's bow contour was compared with the fish vertebra of osteoporosis and Schmorl node. RESULTS: No clinically important relationship was found between lumbar bone density, body height and weight, and prevalence of the Cupid's bow contour. Histologic examination showed thickened bone in the Cupid's bow end plate with annular fibers inserting into this region. In cadavers, the Cupid's bow contour occurred at multiple lumbar and thoracic levels, with the highest frequency in the lower lumbar spine. Lateral radiographs enabled better detection of the contour change. CONCLUSION: The Cupid's bow deformity is a developmental phenomenon that is unrelated to osteopenia or mechanical stress on the spine.

Absorptiometry, Photon↗
PubMed1997

Endogenous sex steroids and bone mineral density in older women and men: the Rancho Bernardo Study.

This study examines the associations between endogenous sex steroids and bone mineral density (BMD), using data from a geographically defined cohort in Rancho Bernardo, California. Participants were community-dwelling women and men aged 50-89 years who took part in a study of endogenous sex steroid measurement between 1984-1987 and who had BMD measured in 1988-1991. Those taking corticosteroids or estrogen at the time of sex steroid determination were excluded. The main study outcomes were BMD of the ultradistal radius, midshaft radius, lumbar spine, and total hip by sex steroid level, adjusted for age, body mass index, cigarette smoking, alcohol consumption, leisure exercise, use of thiazides, thyroid hormones, and former estrogen use (women only). At the time of the hormone measurements, the mean age of the 457 women was 72.1 years and that of the 534 men was 68.6 years. A statistically significant positive relation was seen between bioavailable estradiol and BMD at all sites in women and men. Total estradiol was significantly associated with BMD at all sites in women and at all but the ultradistal radius in men. Estrone had a global effect on BMD in women and was not measured in men. Higher bioavailable (but not total) testosterone levels were associated with higher BMD of the ultradistal radius, spine, and hip in men and the ultradistal radius in women. Dehydroepiandrosterone was positively associated with BMD of the midradius, spine, and hip in women and was not associated with BMD at any site in men. Of the sex steroids tested, bioavailable estrogen was most strongly associated with BMD in both women and men. We conclude that endogenous sex steroid levels are significantly related to bone density in older women and men. Individual variation in age-related bone loss may be partially accounted for by alterations in sex steroid levels with aging. Further study to elucidate safe environmental and medical methods to maintain optimal sex steroid levels in old age is needed.

Absorptiometry, Photon↗
PubMed1997

The effect of postmenopausal estrogen therapy on the risk of non-insulin-dependent diabetes mellitus.

OBJECTIVES: This study examined the effect of postmenopausal estrogen replacement therapy on the incidence of non-insulin-dependent diabetes in women. METHODS: Postmenopausal women aged 50 through 70 years (n=848) without diagnosed diabetes at baseline were followed for 10 to 15 years for incident diabestes. RESULTS: Over the average 11.5 year follow-ip, there were 105 new cases of diabetes. The age-adjusted relative-risk for development of diabetes was nonsignificantly lower for women with continuous estrogen replacement therapy use than for never users. After adjustment for major covariates, a nonsignificant linear trend with increasing duration of estrogen replacement therapy was reversed. CONCLUSIONS: This study suggests that previous results showing a reduced risk of diabetes in women using estrogen may have been due to selection bias regarding who is prescribed estrogen, confounding factors, or differential diagnostic efforts.

California↗
PubMed1997

Hysterectomy, oophorectomy, and heart disease risk factors in older women.

OBJECTIVES: This study examined the relation of hysterectomy and oophorectomy to heart disease risk factors. METHODS: Data were collected and analyzed for 1150 women aged 50 through 89. RESULTS: Of these women, 21.8% reported hysterectomy with bilateral oophorectomy; 22.1%, hysterectomy with ovarian conservation. Compared with women without hysterectomy, oophorectomized women, especially those 20 or more years postmenopause, had increased lipids, lipoproteins, glucose, and insulin; blood pressures were increased among current estrogen users. Women with hysterectomies with ovarian conservation had similar or more favorable risk factors than nonhysterectomized women. CONCLUSIONS: Bilateral oophorectomy, but not hysterectomy, may have long-term negative consequences for heart disease risk factors not totally ameliorated by estrogen use.

Aged↗
PubMed1997

Sex hormone-binding globulin and glucose tolerance in postmenopausal women. The Rancho Bernardo Study.

OBJECTIVE: Sex hormone-binding globulin (SHBG) has been shown to be associated with several diabetes risk factors, including total body fat, central obesity, and hyperinsulinemic insulin resistance. We examined the cross-sectional association between SHBG and impaired glucose tolerance (IGT) and NIDDM. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study including 657 postmenopausal women, aged > or = 50 years, who were not using hormone replacement therapy. Blood for SHBG and fasting plasma glucose was obtained concurrently in the morning; all women had a 75-g oral glucose tolerance test and measurement of BMI and waist-to-hip ratio (WHR). RESULTS: SHBG was significantly associated with age, BMI, and WHR but not with smoking, physical activity, or alcohol intake. In these women, SHBG was significantly and independently inversely associated with IGT and with NIDDM. CONCLUSIONS: These data strongly support an association between SHBG, or androgenicity, and diabetes in postmenopausal women. Because of the cross-sectional nature of this study, however, the directionality of the association is uncertain.

Age Factors↗