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Biomedical subjects

E Barrett-Connor

Publications and source records attributed to E Barrett-Connor.

At least 145 records · Page 8Linked to original sources
PubMed1996

Effect of replacement estrogen on insulin-like growth factor-I in postmenopausal women: the Rancho Bernardo Study.

Insulin-like growth factor-I (IGF-I) is associated with protein, carbohydrate, and bone metabolism. Results of previous studies examining the effect of exogenous estrogen on levels of IGF-I have been inconsistent. We examined the cross-sectional association between serum IGF-I levels and hormone replacement therapy (HRT) use in 672 postmenopausal women aged 50 yr and older. The mean age-adjusted IGF-I level was highest in the 415 women who reported never or past HRT use (126.8 micrograms/L), lowest in the 128 women who reported using estrogen alone (99.3 micrograms/L), and intermediate in the 115 women who reported using combination estrogen and progesterone (112.4 micrograms/L). A significant linear decline in mean age-adjusted IGF-I levels by duration of HRT use among all current users was seen. The decrease in serum IGF-I with current use of HRT is not consistent with the fact that both HRT and increased levels of IGF-I have been associated with improved glucose and bone metabolism and lipid profile. Further research is needed to evaluate the effect of the addition of a progestin to oral HRT on IGF-I-induced changes in GH levels.

Aged↗
PubMed1996

A prospective study of sex hormone-binding globulin and fatal cardiovascular disease in Rancho Bernardo men and women.

Sex hormone-binding globulin (SHBG) has been shown to be associated with several cardiovascular disease (CVD) risk factors. We examined the prospective association between SHBG and the risk of CVD and ischemic heart disease (IHD) death in 760 men and 624 women, aged 50-82 yr, who were free of heart disease at baseline. Health status and cause of death were determined annually for 99.9% of the cohort for 19 yr. SHBG correlated negatively with body mass index in both sexes and increased with age in men. After adjusting for age and body mass index, SHBG correlated negatively with fasting plasma glucose in men and women and with total cholesterol and triglycerides in men. There were 235 CVD and 134 IHD deaths in men and 153 CVD and 80 IHD deaths in women over the 19-yr follow-up. The quintile of baseline SHBG was unrelated to CVD or IHD mortality rate. No association was found in sex-specific, multiply-adjusted Cox proportional hazard models. All risk ratios were close to 1, and 95% confidence intervals were narrow and included 1. Although associated with several strong heart disease risk factors, the SHBG level does not predict CVD or IHD mortality in men or women.

Aged↗
PubMed1996

Does hyperinsulinemia preserve bone?

OBJECTIVE: Obesity and NIDDM are each associated with increased bone mineral density (BMD). We therefore hypothesize that hyperinsulinemia is an osteogenic factor. RESEARCH DESIGN AND METHODS: Subjects consisted of 411 men and 559 women aged 50-89 years who were participants in the Rancho Bernardo Heart and Chronic Disease Study and were not diabetic by history or oral glucose tolerance test. Fasting and 2-h postchallenge insulin were measured by radioimmunoassay. Bone mineral density was measured at the midshaft radius with single photon absorptiometry and at the lumbar spine and hip with dual energy X-ray absorptiometry. RESULTS: Multiple regression analyses indicated that among men, a significant insulin-BMD association at the hip was no longer apparent after adjusting for covariates. Among women, fasting insulin was significantly and positively associated with bone density of the radius and spine (P < 0.05), independent of age, BMI, waist-hip ratio, postmenopausal estrogen use, age at menopause, thiazide use, family history of diabetes, current cigarette smoking, and exercise. Each 10 microU/ml increase in fasting insulin was associated with an increase of 0.33 and 0.57 g/cm2 of the radius and spine, respectively. CONCLUSIONS: Hyperinsulinemia may be responsible for part of the observed association of both diabetes and obesity with BMD in women.

Age Factors↗
PubMed1996

NIDDM, impaired glucose tolerance, and pulmonary function in older adults. The Rancho Bernardo Study.

OBJECTIVE: To determine whether NIDDM or plasma glucose level in subjects without diabetes is associated with reduced pulmonary function in 525 men and 714 women, 51-95 years of age. RESEARCH DESIGN AND METHODS: The analysis was based on data from a community-based study, the Rancho Bernardo Study. Between 1984 and 1987, 82% of community-dwelling residents had an oral glucose tolerance test. Between 1988 and 1991, 80% had lung function assessed by spirometry (forced expiratory volume in 1 s [FEV1] and forced vital capacity [FVC]). RESULTS: In analyses adjusted for age, height, and cigarette smoking, pulmonary function was not associated with known or newly diagnosed NIDDM in men or women. However, FEV1 and FVC were each independently reduced in men with diabetes of 10 or more years' duration. Fasting plasma glucose (FPG) levels were correlated with FEV1 and FVC in men without diabetes. No associations were found in women. CONCLUSIONS: The overall absence of an association of NIDDM with pulmonary function in these older adults may reflect survival bias and the small number of subjects with severe diabetes or diabetes of prolonged duration. The apparent relation of FPG levels to FEV1 and FVC suggests that any effect of glycemia precedes diabetes and contradicts any putative causal role for duration and severity of glycemia, however. More epidemiological studies are needed to provide further information about the relationship between NIDDM and lung function.

Adult↗
PubMed1996

Factors associated with glucose and insulin levels in healthy postmenopausal women.

OBJECTIVE: Little is known about the covariates of hyperglycemia and hyperinsulinemia. We examined candidate factors in postmenopausal women. RESEARCH DESIGN AND METHODS: We determined the cross-sectional associations of sociodemographic, body-size, lifestyle, reproductive, and menopausal factors with pretrial fasting and postchallenge glucose and insulin levels in 869 postmenopausal women aged 45-65 years. Women were participants in the Postmenopausal Estrogen/Progestin Interventions study who were not taking estrogen or insulin. RESULTS: Plasma glucose levels increased significantly with age; serum insulin levels did not. BMI and waist-to-hip ratio (WHR) each showed graded positive and independent associations with glucose and insulin levels. Alcohol intake, cigarette smoking, physical activity, parity, education, and income were also associated with insulin or glucose in age-adjusted models. In multivariable models, BMI and WHR explained 18% of the variability in fasting glucose, 16% in postchallenge glucose, 28% in fasting insulin, and 17% in postchallenge insulin. Age and all other factors combined accounted for < 6% of the variance in glucose or insulin. In multiply adjusted models, African-American and Hispanic women had higher fasting and 2-h insulin levels than non-Hispanic white women. CONCLUSIONS: Most of the variance in glycemia and insulin is unexplained. Measures of obesity and fat distribution account for nearly all the explained variance.

Aged↗
PubMed1996

GHb is a better predictor of cardiovascular disease than fasting or postchallenge plasma glucose in women without diabetes. The Rancho Bernardo Study.

OBJECTIVE: To examine the relation between GHb, fasting plasma glucose (FPG), postchallenge plasma glucose (PCPG), and mortality from cardiovascular disease (CVD) and ischemic heart disease (IHD) in older adults. RESEARCH DESIGN AND METHODS: A community-based study of 1,239 nondiabetic older adults followed for an average of 8 years, from baseline (1984-1987) to 1993. RESULTS: GHb, but not FPG or PCPG, was significantly related to CVD and IHD mortality in women but not men. The age-adjusted relative hazard for those in the highest quintile of GHb (> or = 6.7%) compared with women with lower levels was 2.37 for fatal CVD (95% CI = 1.30-4.31, P = 0.005) and 2.43 for IHD (95% CI = 1.12-5.25, P = 0.024). This association persisted after adjustment for all covariates (age, systolic blood pressure, BMI, LDL, HDL, triglycerides, cigarette smoking, antihypertensive medication use, and estrogen use). GHb was significantly associated with LDL and HDL levels in women, but the association between GHb and CVD or IHD persisted after adjustment for these lipoproteins. CONCLUSIONS: We concluded that GHb is a better predictor of CVD and IHD mortality than FPG or PCPG in women without diabetes; no single measure of glycemia was predictive in men. The reason for the sex difference is unexplained.

Adult↗
PubMed1996

Screening for dementia of the alzheimer type in the community: the utility of the Clock Drawing Test.

This study reports the sensitivity and specificity of the Clock Drawing Test (CDT) for detecting dementia of the Alzheimer type in a community-dwelling sample of elderly subjects. Forty-two patients with clinically diagnosed Alzheimer's disease and 237 cognitively intact subjects were administered the CDT as part of an epidemiological study of aging and dementia. Three individual measures of clock drawing performance (quantitative score, qualitative score, and combined quantitative and qualitative score) were determined for each participant. When qualitative elements such as errors and strategies were incorporated into the CDT score, the sensitivity was 84% and the specificity was 72%. The findings suggest that a CDT score which evaluates qualitative and quantitative features provides reasonably good discrimination between normal elderly individuals and DAT patients. However, the CDT appears to have limited utility as a single screening instrument in the community. Instruments such as the Dementia Rating Scale (Mattis, 1976) provide better discrimination of DAT, indicating that functions such as memory and verbal fluency need to be assessed during screening.

Journal Article↗
PubMed1996

The effect of noninsulin dependent diabetes mellitus on the prevalence of clinical osteoarthritis. A population based study.

OBJECTIVE: To explore the relation between noninsulin dependent diabetes mellitus (NIDDM) and osteoarthritis (OA) in a population. METHODS: The study population included 632 men and 882 women aged 52-95 years from the Rancho Bernardo community. In 1984-87, participants answered questions about history of diabetes and had a standard oral glucose tolerance (OGTT). In 1988-92, subjects completed a questionnaire about history of arthritis, type of arthritis diagnosed, and presence of joint pain. Nurses examined subjects for presence of Heberden's nodes. Subjects with no history of arthritis were compared to those with a history of OA and other types of arthritis with regard to age, body size, and plasma glucose levels. In addition, subjects were classified by diabetes status to determine differences in the prevalence of arthritis and related characteristics. RESULTS: Neither impaired glucose tolerance nor NIDDM was associated with history of OA, regardless of how inclusive the definition of OA, before or after adjustment for age and maximum lifetime obesity. In age and obesity adjusted analyses, men with a history of OA had lower fasting plasma glucose levels than men with no arthritis (100.2 vs. 103.6 mg/dl, p < 0.05), and men with NIDDM had less hand and hip pain than normoglycemic men (p < 0.05). Heberden's nodes were unrelated to glucose tolerance status. CONCLUSION: This population based study found no positive association between clinical OA and NIDDM defined by OGTT. These results are compatible with community based data examining radiographic OA and history of diabetes.

Adult↗
PubMed1995

The epidemiology of DHEAS and cardiovascular disease.

In 1986 we reported that high levels of plasma dehydroepiandrosterone sulfate (DHEAS) reduced the risk of fatal cardiovascular disease (CVD) in 242 men and increased the risk in 289 women from the Rancho Bernardo cohort who were followed up for 12 years. We report here an update on the epidemiology of DHEAS and CVD based on a 19-year follow-up of 1,029 men and 942 women aged 30-88 years from the same cohort. In cross-sectional analyses, DHEAS levels decreased with age in both sexes and were lower in women than men. Men who were overweight were more likely to have low DHEAS levels; women who had hypercholesterolemia or hypertension or were nonusers of estrogen therapy had higher DHEAS levels. Alcohol intake and cigarette smoking were associated with higher DHEAS levels in both sexes. All differences were no longer statistically significant after adjusting for alcohol intake. All participants were followed for vital status. After 19 years there were 254 CVD deaths in men and 199 CVD deaths in women. DHEAS was not associated with CVD or ischemic heart disease (IHD) deaths in age-adjusted analyses where the comparison group was individuals without CVD or IHD death. In contrast, when the comparison group was survivors, multiply adjusted models showed a statistically significant, modestly reduced risk of fatal CVD (RR = 0.85) in men and a nonsignificant increased risk of fatal CVD (RR = 1.11) in women.

Adult↗
PubMed1995

Prospective study of endogenous sex hormones and fatal cardiovascular disease in postmenopausal women.

OBJECTIVES: To examine the association between androstenedione, total and bioavailable testosterone, oestrone, and total and bioavailable oestradiol concentrations and the risk of death from cardiovascular and ischaemic heart disease. DESIGN: 19 year old population based prospective study with 99.9% follow up. SETTING: Rancho Bernardo, California. SUBJECTS: 651 postmenopausal women, none taking oestrogen. MAIN OUTCOME MEASURES: Concentrations of plasma sex hormones measured by radioimmunoassay in an endocrinology research laboratory. Cardiovascular and ischaemic heart disease deaths assessed by death certificate; 85% of 30% sample validated by record review. RESULTS: Age adjusted concentrations of sex hormones did not differ significantly in women with and without a history of heart disease at baseline and did not predict cardiovascular death or death from ischaemic heart disease. Most 95% confidence intervals for the age adjusted relative risk of cardiovascular death or death from ischaemic heart disease were narrow, and all included one. Endogenous oestrogen concentrations were not associated with significantly more favourable risk factors for heart disease, and testosterone was not associated with less favourable risk factors. CONCLUSION: These prospective data do not support a causal or preventive role for endogenous oestrogens or androgens and cardiovascular mortality in older women.

Aged↗
PubMed1995

Lifetime leisure exercise and osteoporosis. The Rancho Bernardo study.

Between 1988 and 1991, the relation between leisure time physical activity, bone mineral density (BMD), and osteoporotic fracture was evaluated in a cohort of community-dwelling California adults (1,014 women and 689 men) with a mean age of 73 years. By means of a modified Paffenbarger questionnaire, participants were asked to report exercise from the past year and to recall their level of exercise during three other periods: the teenage years, age 30 years, and age 50 years. The survey asked the number of times strenuous (e.g., jogging), moderate (e.g., fast walking), or mild (e.g., golfing) exercise was undertaken in an average week. A summary score was constructed to represent lifetime exercise. Analysis of the exercise-fracture and exercise-BMD associations were performed using logistic and linear regression analyses, respectively. Linear regression models were controlled for age, body mass index, sex, diagnosis of arthritis, dietary calcium intake, and use of cigarettes, alcohol, thiazides, and estrogen (women only). No association between current or former exercise and BMD at the radius, wrist, or spine was found. A positive association between current exercise and BMD was found at the total hip (p = 0.001) and at each hip component--greater trochanter (p = 0.02), intertrochanter (p = 0.001), and femoral neck (p = 0.02). Mean hip bone densities of strenuous (p = 0.004) and moderate (p = 0.004) current exercisers were higher than those of mild or less than mild exercisers. Lifetime exercise was also positively associated with BMD of the total hip (p = 0.008) and hip components, and demonstrated a borderline-significant association (p = 0.06) with spine BMD. At the hip, each pairwise comparison between the highest and lowest tertiles of lifetime exercise showed a significant difference (p < or = 0.007). Exercise was unassociated with minimal trauma fracture occurring at any site between 1972 and 1991. These data suggest a protective effect of current and lifelong exercise on hip BMD, but not on osteoporotic fracture, in older men and women.

Aged↗
PubMed1995

Dehydroepiandrosterone sulfate does not predict cardiovascular death in postmenopausal women. The Rancho Bernardo Study.

BACKGROUND: High levels of dehydroepiandrosterone sulfate (DHEAS) appear to be associated with a reduced risk of fatal cardiovascular disease (CVD) in men. We examined the association between baseline DHEAS levels and the 19-year CVD and ischemic heart disease (IHD) mortality rates in 942 postmenopausal women free of known heart disease at baseline. METHODS AND RESULTS: The 199 CVD deaths and 102 IHD deaths were not related to baseline DHEAS levels. DHEAS was not related to body mass index, fasting plasma glucose, or family history of coronary heart disease, but significantly higher DHEAS levels were found in women who had elevated total or HDL cholesterol or blood pressure, were current smokers, or were nonusers of estrogen replacement therapy. After we adjusted for age, cholesterol, blood pressure, smoking, estrogen replacement therapy, obesity, fasting plasma glucose, and family history of heart disease, the relative risk of fatal CVD and IHD was 1.11 (95% confidence interval, 0.81 to 1.23) and 0.92 (95% confidence interval, 0.85 to 1.17), respectively, for a 50-microgram/dL decrease in DHEAS. CONCLUSIONS: Although higher DHEAS levels were associated with several major CVD risk factors, they were unrelated to the risk of fatal CVD in women.

Age Factors↗
PubMed1995

Low bioavailable testosterone levels predict future height loss in postmenopausal women.

The objective of this study was to examine the relation of endogenous sex hormones to subsequent height loss in postmenopausal women, in whom height loss is usually a surrogate for osteoporotic vertebral fractures. This was a prospective, community-based study. The site chosen was Rancho Bernardo, an upper middle class community in Southern California. A total of 170 postmenopausal women participated, aged 55-80 years. None of them were taking exogenous estrogen between 1972 and 1974. Plasma was obtained for sex hormone and sex hormone-binding globulin (SHBG) assays. Estradiol/SHBG and testosterone/SHBG ratios were used to estimate biologically available hormone levels; bioavailable (non-SHBG-bound) testosterone was measured directly in 60 women. Height loss was based on height measurements taken 16 years apart. Height loss was strongly correlated with age (p = 0.001). These women lost an average 0.22 cm/year in height. Neither estrone nor estradiol levels were significantly and independently related to height loss. Both estimated bioavailable testosterone (testosterone/SHBG ratio) and measured bioavailable testosterone levels predicted future height loss (p = 0.02 and 0.08, respectively) independent of age, obesity, cigarette smoking, alcohol intake, and use of thiazides and estrogen. We conclude that bioavailable testosterone is an independent predictor of height loss in elderly postmenopausal women. The reduced height loss is compatible with a direct effect of testosterone on bone mineral density or bone remodeling.

Aged↗
PubMed1995

Low plasma cholesterol predicts an increased risk of lung cancer in elderly women.

BACKGROUND: There have been significant efforts in the United States to lower high cholesterol levels. Studies of men, however, have found a higher total cancer mortality rate at lower levels of plasma cholesterol. Many of these studies have found that lung cancer is more closely associated than other cancers with low cholesterol. Of the studies that include women, none has demonstrated a statistically significant inverse association between low cholesterol and lung cancer. METHODS: We examined the relation between very low plasma cholesterol levels ( < 160 mg/dl) and lung cancer death in an 18-year prospective study of 2,011 men and 2,327 women. RESULTS: After adjusting for age, body mass index, smoking, and education, the relative hazard of lung cancer mortality for those with low cholesterol ( < 160 mg/dl) compared with all other cholesterol levels ( > or = 160 mg/dl) was 1.75 among men (P = 0.28) and 3.29 among women (P = 0.02). Excluding those who died within 5 years of baseline did not change the results. CONCLUSIONS: Both men and women with baseline plasma cholesterol levels < 160 mg/dl were more likely to die of lung cancer. This difference was statistically significant in women. The association could not be explained by occult malignancy, smoking, or socioeconomic status.

Adult↗
PubMed1995

An 18-year prospective study of dietary calcium and bone mineral density in the hip.

The object of this study was to determine whether a single 24-hour diet recall of calcium intake obtained an average of 18 years previously would predict bone mineral density (BMD) in the hip in older men and women. A prospective population-based cohort study was done in Rancho Bernardo, California. Between 1973 and 1975, a 24-hour diet recall was obtained in 140 men and 220 women aged 45 and older by a trained interviewer using food models and containers. Responses were coded by the Nutrition Coordinating Center, University of Minnesota. Between 1988 and 1991, BMD in the femoral neck, trochanter, and intertrochanter was measured using dual-energy x-ray absorptiometry. Results showed that age-adjusted mean BMD levels increased significantly with increasing tertile of calcium intake at all hip sites in women, with the most striking difference at the femoral neck. These associations persisted after adjustment for body mass index, smoking, exercise, alcohol intake, use of estrogen replacement therapy, and number of years postmenopausal. No significant trends were seen for men at any hip site. It is concluded that low dietary calcium predicts low BMD in older women independent of other major determinants of BMD.

Body Mass Index↗
PubMed1995

A community-based study of menopause symptoms and estrogen replacement in older women.

This study examines the symptoms after a natural menopause recalled by women aged 50-89 years. We determined the frequency and clustering of symptoms, the effect of age on symptoms, and the relation of symptoms to the use of estrogen therapy in a cross-sectional, community-based study of 589 Caucasian, middle- to upper-middle-class women from Rancho Bernardo, California. At the time of menopause, 55% of the women reported that they felt life was getting better and 57% were more cheerful. The most frequently recalled symptoms were hot flushes (74%), propensity to weight gain (45%), night sweats (35%), tiredness (32%), and insomnia (28%). Irritability was reported by one-fourth, depression by one-fifth. Nearly 11% reported anxiety about looking older. The recalled prevalence of hot flushes, irritability, weepiness and tiredness did not vary by current age, but younger women were significantly more likely than older women to have experienced night sweats, visible flushes, depression, anxiety about looking older and insomnia. Principal components factor analysis yielded four main independent factors: psychological symptoms (21% of the variance), vasomotor symptoms (14%), positive feelings (11%), and negative self-image (8%). The four symptom groupings suggest different causal mechanisms. Forty-two percent reported past, and 27% reported current use of estrogen therapy. Both past and current hormone users were significantly more likely to report menopause symptoms than non-users. Estrogen use was not associated with positive feelings or self-image at the time of menopause. Although three-quarters experienced symptoms, the majority of women reported positive feelings about menopause.

Aged↗
PubMed1995

Detection of dementia of the Alzheimer type in a population-based sample: neuropsychological test performance.

The ability to detect dementia of the Alzheimer type (DAT) in a community-dwelling sample of elderly individuals on the basis of neuropsychological test performance was examined. Three hundred sixty community-dwelling individuals were identified by neurological examination as having probable or possible Alzheimer's disease, being at risk for Alzheimer's disease, or having no cognitive impairment. A logistic model comprised of tests of verbal and nonverbal memory, mental flexibility, and confrontation naming correctly classified 82% of DAT subjects and 98% of normal elderly subjects. The logistic model classified 77% of subjects who were diagnosed as at risk for Alzheimer's disease as being cognitively normal. A cross-validation with a clinically based sample of subjects correctly classified 89% of DAT patients and 100% of normal control subjects. The results suggest that psychometric discrimination of dementia may be less accurate in community-dwelling populations than in clinically based samples.

Adult↗