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Biomedical subjects

E Shahar

Publications and source records attributed to E Shahar.

At least 73 records · Page 4Linked to original sources
PubMed1997

Stroke rates during the 1980s. The Minnesota Stroke Survey.

BACKGROUND AND PURPOSE: The decline in stroke mortality it the United States may have resulted from declining incidence improved survival of stroke patients, or both. We previously reported that stroke patients who were 30 to 74 years old and were treated in Minneapolis/St Paul hospitals in 1990 survived longer than did their counterparts in 1980. In the present study, we examined trends in the rate of hospitalized stroke in Minneapolis/ St Paul between 1980 and 1990. METHODS: For 1980, 1985, and 1990, we obtained lists of discharge codes (International Classification of Diseases, 9th revision) from Minneapolis/St Paul hospitals, identified hospitalizations for acute cerebrovascular disease, and randomly selected 50% of the cases for medical record abstraction. We counted stroke events in five different ways, which were based on discharge codes as well as diagnostic criteria, and computed age adjusted stroke rates for each year. Stroke mortality in the population was computed for 1960 through 1994. RESULTS: Among men, all five measures of hospitalized stroke attack rate indicated a decline between 1980 and 1985, which ranged from 5% to > 20%. Among women, there was a sharp contrast between trends that relied on discharge codes and trends that relied on diagnostic criteria: the former indicated a decline (4% to 19%), whereas the latter indicated some increase. For the second half of the 1980s, most measures of stroke attack rate in men, all measures of stroke attack rate in women, and measures of stroke incidence in both sexes did not indicate a decline in stroke occurrence in the population. Mortality from stroke among 30- to 74-year-old residents of Minneapolis/St Paul, which declined rapidly during the 1970s and early 1980s, declined slowly, if at all, during the second half of the 1980s and early 1990s. CONCLUSIONS: The incidence of stroke may have declined among 30- to 74-year-old residents of Minneapolis/St Paul in the early 1980s. However, we found little indication of such a trend between 1985 and 1990, a period of slow decline or no decline in stroke mortality in that population.

Adult↗
PubMed1997

Glycosylated hemoglobin level and carotid intimal-medial thickening in nondiabetic individuals. The Atherosclerosis Risk in Communities Study.

OBJECTIVE: People with diabetes are at increased risk for cardiovascular events. However, questions remain about what role, if any, homeostatic glucose control plays in the development of cardiovascular disease among nondiabetic individuals. We investigated the relationship between HbA1c level and carotid intimal-medial thickening in normoglycemic individuals. RESEARCH DESIGN AND METHODS: We conducted a case-control study among 208 normoglycemic individuals (fasting glucose < or = 6.4 mmol/l and no history of diabetes) who had carotid initial-medial thickening (case subjects) and 208 normoglycemic control subjects individually matched for age, sex, race, field center, and date of exam. Subjects were free-living men and women, aged 45-64 years at baseline, who participated in the Atherosclerosis Risk in Communities (ARIC) Study. RESULTS: HbA1c levels, expressed as percent of total hemoglobin, ranged from 4 to 7% and correlated only modestly with single measurements of fasting glucose (r = 0.16) and fasting insulin (r = 0.14). The mean level of HbA1c was 5.18% among case subjects and 5.07% among control subjects (P = 0.004, paired t test). As compared with the first quartile of HbA1c the matched relative odds of being a case were 1.15, 1.33, and 2.30 for the second, third, and fourth quartiles, respectively (P = 0.005 for linear trend). After multivariate adjustment for age, fasting glucose, fasting insulin, BMI, smoking status, hypertension, LDL cholesterol, HDL cholesterol, fibrinogen, and education level, the respective relative odds estimates were 0.98, 1.07, and 1.88 (P = 0.16 for linear trend). When modeled linearly as a continuous variable and after adjustment for the above-mentioned covariates, a 1% point increment in HbA1c level was associated with 1.77 greater odds of being a case (95% CI, 0.9-3.5). CONCLUSIONS: These data provide some support to the hypothesis that in the absence of diabetes, homeostatic glycemic control is a risk factor for atherosclerosis.

Arteriosclerosis↗
PubMed1997

Family history of coronary heart disease and hemostatic variables in middle-aged adults. Atherosclerosis Risk in Communities Investigators and Family Heart Study Research Group.

Individuals with a family history of coronary heart disease (CHD) may be predisposed to atherothrombosis. To investigate this hypothesis, a family CHD risk score was computed for approximately 13,000 men and women aged 45 to 64; hemostatic variables (fibrinogen, factor VIIc, factor VIIIc, von Willebrand factor, antithrombin III. protein C) were also measured in plasma. After adjustment for age and ethnicity, there was a statistically significant, positive association between the family risk score and four of the six hemostatic variables (fibrinogen, factor VIIc, factor VIIIc, von Willebrand factor) in women and all six hemostatic variables in men. In general, these associations were weak and substantially attenuated after adjustment for constitutional, lifestyle, and biochemical covariates. These results indicate that mean levels of selected hemostatic variables, like traditional CHD risk factors, are higher in individuals with a family history of heart disease.

Blood Coagulation↗
PubMed1997

Allergy and SLE: common and variable.

Autoimmune conditions and allergic diseases are both characterized by immune dysregulation. The purpose of this study was to evaluate the incidence of various allergic disorders in patients with systemic lupus erythematosus (SLE). Sixty patients with SLE completed a questionnaire detailing their allergic disorders, which we compared with those of 60 age- and sex-matched healthy people. Forty-four of the SLE patients (56%) had at least one type of allergic disorder. Perturbation of immunoregulation in SLE patients may increase the susceptibility to develop IgE-mediated allergic disorders.

Adolescent↗
PubMed1996

Association of transient ischemic attack/stroke symptoms assessed by standardized questionnaire and algorithm with cerebrovascular risk factors and carotid artery wall thickness. The ARIC Study, 1987-1989.

The baseline examination (1987-1989) for the Atherosclerosis Risk in Communities (ARIC) Study was conducted in 15,792 free-living residents aged 45-64 years in four geographically dispersed US communities. A questionnaire on symptoms of transient ischemic attack (TIA) and stroke was evaluated by computer algorithm for 12,205 of these participants. Data were also collected on lipoprotein levels, hemostasis, hematology, anthropometry, blood pressure, medical history, lifestyle, socioeconomic status, and medication use. Noninvasive high resolution B-mode ultrasonographic imaging was used to determine carotid arterial intimal-medial wall thickness (IMT). The cross-sectional relation between the prevalence of TIA/stroke symptoms and putative risk factors was assessed by logistic regression, controlling for age and community. Odds ratios for TIA/stroke symptoms were significantly elevated (p < or = 0.01) for diabetes mellitus, current smoking, hypertension, lower levels of education, income, and work activity, and higher levels of lipoprotein(a), IMT, hemostasis factor VIII, and von Willebrand factor. However, the relations with education and carotid IMT were not present for black Americans. In whites, the relations of TIA/stroke symptoms to IMT were nonlinear. Only at extreme levels of IMT were symptoms substantially more frequent: For example, men with an IMT greater than 1.17 mm or women with an IMT greater than 0.85 mm had approximately twice the odds of having positive TIA/stroke symptoms as those with lower IMTs. The authors plan in future analyses to address the issue prospectively, as well as to examine the relation with magnetic resonance imaging-defined outcomes and clinically defined incident stroke.

Algorithms↗
PubMed1996

[Juvenile myoclonic epilepsy--an underdiagnosed epileptic syndrome].

Clinical and electroencephalographic data and response to drug therapy of 3 boys and 3 girls aged 14-19 years, mean 16, with juvenile myoclonic epilepsy (JME) are described. All presented with violent myoclonic jerks upon awakening, prompted by sleep deprivation and precipitated by deliberate awakening. Following onset of myoclonic jerks, generalized tonic-clonic seizures (GCTS) and absences occurred after 6-18 months (mean 11). The EEG revealed normal background activity in all, along with generalized epileptiform activity in the form of 3-4 Hz polyspike/slow wave or spike/slow wave, commonly induced by hyperventilation. Valproic acid (VPA), 12 mg/kg/day (range 10-15), resulted in complete and rapid cessation of myoclonic jerks, of absences and recurrent GTCS. Discontinuation of VPA resulted in recurrence of myoclonic jerks and then GTCS, but were completely controlled by reinstitution of VPA. All have remained asymptomatic on VPA, with cognition preserved, during a follow-up of up to 6 years. JME is a unique, benign, epileptic syndrome easily and rapidly controlled by rather small doses of valproic acid given on a long-term basis. Myoclonic jerks may serve as a reliable indicator of JME and therefore should be screened for in any case of unprovoked generalized seizures. The smallness of the doses of the drug used suggests that the dose prescribed should be "syndrome" related rather than weight related, as is usually prescribed in children.

Adolescent↗
PubMed1996

Trends in coronary thrombolytic therapy for acute myocardial infarction (the Minnesota Heart Survey Registry, 1990 to 1993).

Between 1990 and 1993, patient selection and relative effectiveness of thrombolytic agents were issues for clinical trials of thrombolytic therapy, particularly the Third International Study of Infarct Survival (ISIS-3) and the Second Gruppo Italiano per Lo Studio della Streptochinasi nell'Infarto Miocardico trials. The purpose of this report is to document the use of coronary thrombolytic therapy in community hospital practice during this period. Patients admitted to the coronary care unit of 6 hospitals with suspect acute myocardial infarction (AMI) between 1990 and 1993 were prospectively enrolled in the Minnesota Heart Survey Registry. Of the 1,225 patients with AMI enrolled, 310 men (37%) and 103 women (26%) received thrombolytic therapy (p < 0.001). The age-adjusted male-to-female odds ratio (95% confidence interval) for receiving thrombolysis among patients with < or = 12 hours since symptom onset was 1.33 (0.94, 1.87). The proportion of those treated receiving tissue plasminogen activator declined from 196 (64%) to 102 (34%) between 1990 and 1991 and 1992 and 1993. Use of streptokinase increased from 48 (16%) to 156 (52%) during the same time period. There were no statistically significant gender or lytic agent type differences in complications from thrombolytic therapy. Changes in type of agent used coincided with the release of results from the ISIS-3 trial.

Age Distribution↗
PubMed1996

Relation of hormone-replacement therapy to measures of plasma fibrinolytic activity. Atherosclerosis Risk in Communities (ARIC) Study Investigators.

BACKGROUND: The mechanisms by which replacement hormones may reduce the risk of coronary heart disease are not fully understood. Of specific interest is a potential effect of replacement hormones on plasma fibrinolytic activity, a putative determinant of thrombotic events. METHODS AND RESULTS: We investigated the relation of current use of replacement hormones to three measures of plasma fibrinolytic activity: tissue-type plasminogen activator (TPA) antigen, plasminogen activator inhibitor-1 (PAI-1) antigen, and D-dimer. The sample was composed of 288 women, free of clinical cardiovascular disease, who were selected for a case-control study of atherosclerosis: 142 women with ultrasonographic evidence of carotid intimal-medial thickening (cases) and 146 control subjects. Twenty percent (59 women) reported current use of replacement hormones. TPA antigen and PAI-1 antigen were highly correlated with each other (r = .67), whereas D-dimer correlated only weakly with TPA or PAI-1. Compared with nonusers, current users of replacement hormones had lower mean levels of TPA and PAI-1 antigens, suggesting enhanced fibrinolytic potential. In the entire sample, the multivariate-adjusted geometric mean values of TPA antigen were 6.3 and 7.3 ng/mL among current users and nonusers, respectively (P = .01); the corresponding values for PAI-1 antigen were 6.1 and 7.5 ng/mL (P = .13). These results were generally consistent for both atherosclerosis cases and their control subjects. D-dimer levels were lower in current hormone users than in nonusers, but the difference was not statistically significant (P > .15) in any of the analyses. CONCLUSIONS: The use of replacement hormones appears to be associated with enhancement of endogenous fibrinolytic potential. Enhanced plasma fibrinolytic activity among hormone users may explain, in part, the inverse association between hormone replacement therapy and coronary heart disease.

Alcohol Drinking↗
PubMed1996

Recent trends in acute coronary heart disease--mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Investigators.

BACKGROUND: Mortality from coronary heart disease (CHD) has declined in the United States since the late 1960s. To understand the reasons for the decline during the period form 1985 to 1990, we examined trends in mortality and morbidity due to CHD, medical care, and risk factors for CHD in a large metropolitan population. METHODS: We identified all deaths from CHD in residents of the Minneapolis-St. Paul, Minnesota, metropolitan area who were 30 to 74 years old and classified the deaths according to whether they occurred in or out of the hospital. For 1985 and 1990, we obtained lists of patients in this age range who were discharged with a diagnosis of acute CHD from all area hospitals, and we selected the medical records of 50 percent of these patients for abstraction. Definite myocardial infarctions were identified with standardized diagnostic algorithm. The 1985 and 1990 cohorts of patients hospitalized for myocardial infarction were followed for at least three years to identify those who died from any cause. Trends in risk factors for CHD were investigated through surveys of 25-to-74-year-olds that were conducted in 1985 through 1987 and 1990 through 1992. RESULTS: Between 1985 and 1990, mortality from CHD fell by 25 percent for both men and women, and the decline in in-hospital mortality (41 percent) exceeded the decline in out-of-hospital mortality (17 percent) among men. The rates of hospitalization for acute myocardial infarction declined slightly, by 5 to 10 percent, between 1985 and 1990. Survival among patients hospitalized for acute myocardial infarction increased substantially during that period. After adjustment for age and previous myocardial infarction, the relative risk of dying within three years of hospitalization for a myocardial infarction (for the 1990 cohort as compared with the 1985 cohort) was 0.76 for men (95 percent confidence interval, 0.65 to 0.89) and 0.84 for women (95 percent confidence interval, 0.71 to 1.00). Substantial increases in the use of thrombolytic therapy, heparin, aspirin, and coronary angioplasty paralleled the survival trends. In general, the risk-factor profile of the area population with respect to CHD also improved considerably during that time. CONCLUSIONS: The recent decline in mortality due to CHD in the Minneapolis-St. Paul metropolitan area can be explained by both the declining incidence of myocardial infarction in the population and the improved survival of patients with myocardial infarction.

Acute Disease↗
PubMed1996

Epileptic blindness in children: a localizing sign of various epileptic disorders.

UNLABELLED: The ictal manifestations, EEG, CT, and MRI correlates, as well as the management and outcome of 11 children with epileptic blindness are presented. Seven males and four females, aged 3 months to 12 years, experienced single or recurrent episodes of acute visual obscuration. Ictal blindness was the solitary epileptic phenomenon in only two children. The rest had other focal or generalized motor epileptic manifestations. Six children had either focal motor phenomena and/or unilateral EEG disturbances, with a normal head CT. The drug of choice in this group was carbamazepine and all became asymptomatic. Two patients had structural abnormalities of the brain, of which one had a low-grade occipital astrocytoma which was resected. His blindness abated shortly following initiation of carbamazepine, even prior to surgery. Status epilepticus amauroticus and focal motor seizures, secondary to focal cortical dysplasia, was detected in another 3-month-old infant. These required cortical resection and she regained full vision. Three patients had generalized epileptiform discharges on EEG, of which two were photic-induced. Blindness was accompanied with motor seizures and myoclonic jerks. Full seizure control could be achieved in only one child. CONCLUSION: our data suggest a relatively benign nature and a favorable outcome in most children with ictal blindness. Resection of a secondary temporo-parietal focus, as occurred in an infant with status epilepticus amauroticus which originated in the occipital region, may result in complete cessation of seizures and visual recovery.

Blindness↗
PubMed1996

Differences between respondents and nonrespondents in a multicenter community-based study vary by gender ethnicity. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.

This study provides data on differences between respondents and nonrespondents by gender and ethnicity in a multicenter community-based study that is rarely collected and that may be useful for estimating bias in prevalence estimates in other studies. Demographic, general health, and cardiovascular risk factors were examined in black and white respondents and nonrespondents to the Atherosclerosis Risk in Communities (ARIC) Study, a prospective study investigating cardiovascular risk factors in approximately 16,000 adults that was initiated in 1986 in four U.S. communities. In one of the communities (Jackson, MS) black participants were recruited exclusively; in another (Forsyth County, NC) 12% of the eligible sample were black, whereas the samples in Washington County, MD and the northwestern suburbs of Minneapolis, MN were almost all white. Demographic and health characteristics were collected during a home interview. Subjects who subsequently agreed to complete a clinical examination were defined as respondents, while eligible participants who only took part in the home interview were considered to be nonrespondents. Approximately 75% of age-eligible individuals (45-64 years) in each community completed the home interview. In three of the communities 86-88% of those who took part in the home interview also completed the clinic examination, whereas only 65% did so in Jackson. Among white participants, response rates were similar in men and women and between communities. Among black participants, the response rates were considerably lower, particularly in men. White male respondents reported a higher socioeconomic status, better general health and a lower prevalence of cardiovascular disease and associated risk factors than white male nonrespondents. The difference between white respondents and nonrespondents were greater for men than women despite similar response rates. Among black participants, respondent/nonrespondent difference were usually of smaller magnitude or absent, particularly in women. General health status and recent hospitalization rates were almost identical in black respondents and nonrespondents. Low response rates can bias estimates of prevalence in community-based studies although differences between respondents and nonrespondents tend to exaggerate real differences between respondents and the eligible population sampled. For example, among white males 25% of respondents and 44% of nonrespondents were current smokers, yet the estimated community prevalence of smoking was 31%. In conclusion, difference observed between respondents and nonrespondents were in the expected direction, but were greater for men than women and for whites than blacks.

Bias↗
PubMed1996

Changes in plasma lipids and lipoproteins associated with starting or stopping postmenopausal hormone replacement therapy. Atherosclerosis Risk in Communities Study.

The Atherosclerosis Risk in Communities Study investigators examined nearly 4000 postmenopausal women from 1987 through 1989 and 3 years later to determine changes in plasma lipids occurring with the starting or stopping of hormone replacement therapy. Women who started estrogen plus progestin therapy (n = 74) had decreases of 9.8 mg/dl in low-density lipoprotein (LDL) cholesterol and 5.8 mg/dl in apolipoprotein B and increases of 1.2 mg/dl in high-density lipoprotein (HDL) cholesterol (HDL change not significant), 13.5 mg/dl in apolipoprotein A-I, and 14.0 mg/dl in triglycerides. Women who started estrogen alone (n = 149) had similar changes, except for a much larger increase in HDL cholesterol (5.8 mg/dl), principally in HDL-2. Women who stopped hormone therapy (n = 138) had lipid changes opposite to those who started therapy, but smaller in magnitude. These results confirm those of the Postmenopausal Estrogen/Progestin Interventions Trial in a community-based longitudinal cohort: women initiating estrogen plus progestin therapy have decreases in LDL cholesterol, but the increase in HDL cholesterol is less than that for starting estrogen alone. In addition, the current study extends findings to apolipoproteins and HDL subfractions.

Apolipoproteins B↗
PubMed1996

Patterns of aspirin use in middle-aged adults: the Atherosclerosis Risk in Communities (ARIC) Study.

To determine correlates of and recent trends in aspirin use in middle-age men and women, we analyzed data from population-based samples selected in four U.S. communities. Aspirin use (during a 2-week period preceding the study examination) was more prevalent in whites than in blacks (30% vs 11%; p < 0.001) and in men than in women among whites (31% vs 28%; p < 0.002) but not blacks (10% in both sexes). In all four race and sex groups, there was a graded positive relation between estimated coronary heart disease (CHD) risk and age-adjusted prevalence of aspirin use. For example, 33% of CHD-free white men who reported diagnoses of hypercholesterolemia and hypertension and had ever smoked reported aspirin use as compared with 25% of their risk factor-free counterparts (p < 0.001). Among men with symptomatic CHD or at high risk for CHD, aspirin use increased by four percentage points between 1987 and 1989 in conjunction with the publication of results from the aspirin primary prevention trials. However, nearly 50% of participants reporting a history of myocardial infarction apparently did not take aspirin regularly.

Black or African American↗
PubMed1996

The effect of nonresponse on prevalence estimates for a referent population: insights from a population-based cohort study. Atherosclerosis Risk in Communities (ARIC) Study Investigators.

Characterization of nonrespondents, with the aim of detecting nonresponse bias, is a crucial component of prospective studies. This study was undertaken to investigate the demographic and health characteristics of nonrespondents to a population-based cohort study of cardiovascular disease, to determine whether early-stage nonrespondents differ from late-stage nonrespondents, and to estimate the bias in prevalence estimates for the source population. Sixty-seven percent of eligible subjects completed all phases of the cohort recruitment. Compared to respondents, nonrespondents were less likely to be married, less likely to be employed, and less likely to be well educated. Nonrespondents tended to describe their general health in less favorable terms and were more likely to be smokers. Their reported disease profile, however, was not dissimilar to that of respondents. For several demographic and health characteristics, including marital status, education, and smoking, early-stage nonrespondents differed from respondents more than did late-stage nonrespondents. For example, 42% of early nonrespondents were smokers compared to 37% of late nonrespondents and 22% of respondents. Overall, the bias in prevalence estimates related to nonresponse was small (< 5%) for most of the measured characteristics. Although nonresponse to health surveys is associated with typical attributes, early nonrespondents differ from respondents more than do late-stage nonrespondents. With few exceptions, however, a 33% nonresponse rate did not appear to introduce substantial bias into prevalence estimates for the source community.

Age Distribution↗
PubMed1996

Assessing medical history in coronary heart disease surveillance: agreement between contemporaneous and retrospective methods.

Coronary heart disease surveillance studies require monitoring of hospitalized events. Retrospective record reviews and patient interviews during hospitalization are common surveillance methods. This study reports the agreement between these two methods in assessing medical history among 4,230 patients enrolled in the Minnesota Heart Survey Registry. Agreements between methods in determining a patient's history of stroke, myocardial infarction, and hypertension were substantial (kappa coefficients > 0.69). Agreements on acute chest pain (kappa coefficient = 0.39) and ever-smoking status (kappa coefficient = 0.43) were only moderate. In determining medical history, retrospective medical record surveillance appears to be comparable to more direct, yet more expensive, contemporaneous methods.

Adult↗
PubMed1996

No relation between excess fatigue and asymptomatic carotid atherosclerosis.

Prospective studies have reported a positive association of excess fatigue and hopelessness with coronary heart disease mortality; a relation to atherosclerosis has not been investigated. We examined the cross-sectional association of the Maastricht excess fatigue questionnaire with carotid intimal-medial wall thickness among 12,448 coronary heart disease-free individuals age 47-68 years. In age-, race-, and field center-adjusted analyses, we found a strong, positive association between excess fatigue and carotid intimal-medial wall thickness in both sexes. Adjustment for other coronary heart disease risk factors substantially attenuated the relation. Pack-years of smoking was the strongest confounder. Furthermore, there was little association among never-smokers. It appears that the association of excess fatigue with atherosclerotic disease is largely accounted for by established risk factors.

Aged↗
PubMed1996

The role of 99Tcm-HMPAO brain SPET in paediatric traumatic brain injury.

Twenty-eight paediatric patients suffering from chronic sequelae of traumatic brain injury (TBI) were examined by EEG, radionuclide imaging with 99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO), computed tomography (CT) and, when available, magnetic resonance imaging (MRI), the results of which were evaluated retrospectively. Our findings indicate that neuro-SPET (single photon emission tomography) with 99Tcm-HMPAO is more sensitive than morphological or electrophysiological tests in detecting functional lesions. In our group, 15 of 32 CT scans were normal, compared with 3 of 35 SPET studies. SPET identified approximately 2.5 times more lesions than CT (86 vs 34). SPET was found to be particularly sensitive in detecting organic abnormalities in the basal ganglia and cerebellar regions, with a 3.6:1 detection rate in the basal ganglia and a 5:1 detection rate in the cerebellum compared with CT. In conclusion, neuro-SPET appears to be very useful when evaluating paediatric post-TBI patients in whom other modalities are not successful.

Adolescent↗