Biomedical subjects

Eric B Rimm

Publications and source records attributed to Eric B Rimm.

At least 73 records · Page 4Linked to original sources

PubMed2004

Employment status, social ties, and caregivers' mental health.

The purpose of this study of mid-life and older women was to assess the relation between informal care provision and depressive symptoms, taking into account concurrent demands on women's time (including multiple caregiving roles and employment outside the home) as well as participants' access to potentially supportive social ties. This cross-sectional study included women ages 46-71, free from major disease, who provided complete health and social information in the 1992 Nurses' Health Study follow-up survey (n = 61,383). In logistic regression models predicting depressive symptoms, we examined the interaction between employment outside the home and informal care provision for a disabled or ill spouse or parent. We also investigated level of social ties, measured with the Berkman-Syme Social Network Index, as a potential modifier of the association between informal care provision and depressive symptoms. In all analyses, higher weekly time commitment to informal care for a spouse or parent was associated with increased risk of depressive symptoms. This relationship persisted whether women were not employed outside the home, were employed full-time, or were employed part-time. Higher weekly time commitment to informal care provision was associated with increased risk of depressive symptoms whether women were socially integrated or socially isolated. However, both informal care provision and social ties were potent independent correlates of depressive symptoms. Therefore, women who reported high spousal care time commitment and few social ties experienced a dramatic elevation in depressive symptoms, compared to women with no spousal care responsibilities and many social ties (OR for depressive symptoms=11.8; 95% CI 4.8, 28.9). We observed the same pattern among socially isolated women who cared for their parent(s) many hours per week, but the association was not as strong (OR for depressive symptoms=6.5; 95% CI 3.4, 12.7). In this cross-sectional study, employment status did not seem to confer additional mental health risk or benefit to informal caregivers, while access to extensive social ties was associated with more favorable caregiver health outcomes.

Adult↗

PubMed2004

Alcohol intake and 8-year weight gain in women: a prospective study.

OBJECTIVE: To examine prospectively the relationship between alcohol and 8-year weight gain in women. RESEARCH METHODS AND PROCEDURES: A prospective study of 49,324 women 27 to 44 years old who did not have a history of cardiovascular disease, cancer, or diabetes, who were not pregnant during the study period, and who reported weights in 1991 and 1999. RESULTS: In cross-sectional analyses, there was a significant inverse relationship between alcohol and BMI even after adjustment for dietary factors and a wide range of confounders. In multivariate prospective analyses, a nonlinear relationship was seen between alcohol and weight gain (>or=5 kg) in all women. Compared with nondrinkers, the adjusted relative odds [95% confidence interval (CI)] of weight gain according to grams per day were 0.94 (0.89, 0.99) for those consuming 0.1 to 4.9 g/d, 0.92 (0.85,0.99) for 5 to 14.9 g/d, 0.86 (0.76, 0.78) for 15 to 29.9 g/d, and 1.07 (0.89,1.28) for those consuming 30+ g/d (p < 0.0001 for quadratic trend). Women who continued to drink heavily and those who became heavy drinkers showed similar increased odds of weight gain. The increased odds of weight gain associated with heavy drinking (30+ g/d) were most marked in the younger women (<35 years) (odds ratio 1.64; 5% CI 1.03 to 2.61). In African-American women, light drinking was associated with increased odds of weight gain compared with nondrinkers (odds ratio = 2.43; 95% CI 1.22 to 4.82). DISCUSSION: Our data suggest that light to moderate drinking (up to 30 g/d) is not associated with weight gain in women except possibly in African-American women. Heavier drinking may promote weight gain in women.

Adult↗

PubMed2004

Magnesium intake and risk of coronary heart disease among men.

OBJECTIVE: Our aim in this study was to assess the relationship between magnesium intake and risk of coronary heart disease (CHD) among men. METHODS: A total of 39,633 men in the Health Professionals Follow-up Study who returned a dietary questionnaire in 1986 were followed up for 12 years. Intakes of magnesium, zinc and potassium and other nutrients were assessed in 1986, 1990 and 1994. Total CHD incidence (nonfatal myocardial infarction (MI) and fatal CHD) was ascertained by biennial questionnaire and mortality surveillance confirmed by medical record review. Standard CHD risk factors were recorded biennially. RESULTS: During 12 years of follow-up (414,285 person-years), we documented 1,449 cases of total CHD (1,021 non-fatal MI cases, and 428 fatal CHD). The age-adjusted relative risk (RR) of developing CHD in the highest quintile (median intake = 457 mg/day) compared with the lowest quintile (median intake = 269 mg/day) was 0.73 (95% CI 0.62-0.87, p for trend <0.0001). After controlling for standard CHD risk factors and dietary factors, the RR for developing CHD among men in the highest total magnesium intake quintile compared with those in the lowest was 0.82 (95% CI 0.65-1.05, p for trend = 0.08). For supplemental magnesium intake, the RR comparing the highest quintile to non-supplement users was 0.77 (95% CI 0.56-1.06, p for trend = 0.14). CONCLUSIONS: These results suggest that intake of magnesium may have a modest inverse association with risk of CHD among men.

Adult↗

PubMed2004

Dietary intake of trans fatty acids and systemic inflammation in women.

BACKGROUND: trans Fatty acid (TFA) intake predicts risks of coronary artery disease and diabetes. Systemic inflammation may be involved in the pathogenesis of such conditions; however, relations between TFA intake and systemic inflammation are not well established. OBJECTIVE: We investigated the relations between TFA intake and inflammatory markers. DESIGN: In 823 generally healthy women in the Nurses' Health Study I and II, concentrations of soluble tumor necrosis factor alpha receptors 1 and 2 (sTNF-R1, sTNF-R2), interleukin 6 (IL-6), and C-reactive protein (CRP) were measured. Usual dietary intakes assessed from 2 semiquantitative food-frequency questionnaires were averaged for each subject. RESULTS: In age-adjusted analyses, TFA intake was positively associated with sTNF-R1 and sTNF-R2 (P for trend < 0.001 for each): sTNF-R1 and sTNF-R2 concentrations were 10% (+108 pg/mL; 95% CI: 50, 167 pg/mL) and 12% (+258 pg/mL; 138, 377 pg/mL) higher, respectively, in the highest intake quintile than in the lowest. These associations were not appreciably altered by adjustment for body mass index, smoking, physical activity, aspirin and nonsteroidal antiinflammatory drug use, alcohol consumption, and intakes of saturated fat, protein, n-6 and n-3 fatty acids, fiber, and total energy. Adjustment for serum lipid concentrations partly attenuated these associations, which suggests that they may be partly mediated by effects of TFAs on serum lipids. TFA intake was not associated with IL-6 or CRP concentrations overall but was positively associated with IL-6 and CRP in women with higher body mass index (P for interaction = 0.03 for each). CONCLUSIONS: TFA intake is positively associated with markers of systemic inflammation in women. Further investigation of the influences of TFAs on inflammation and of implications for coronary disease, diabetes, and other conditions is warranted.

Adult↗

PubMed2004

Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women.

BACKGROUND: Increasing evidence suggests an important role of carbohydrate quality in the development of type 2 diabetes. OBJECTIVE: Our objective was to prospectively examine the association between glycemic index, glycemic load, and dietary fiber and the risk of type 2 diabetes in a large cohort of young women. DESIGN: In 1991, 91249 women completed a semiquantitative food-frequency questionnaire that assessed dietary intake. The women were followed for 8 y for the development of incident type 2 diabetes, and dietary information was updated in 1995. RESULTS: We identified 741 incident cases of confirmed type 2 diabetes during 8 y (716 300 person-years) of follow-up. After adjustment for age, body mass index, family history of diabetes, and other potential confounders, glycemic index was significantly associated with an increased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 1.15, 1.07, 1.27, and 1.59; 95% CI: 1.21, 2.10; P for trend = 0.001). Conversely, cereal fiber intake was associated with a decreased risk of diabetes (multivariate relative risks for quintiles 1-5, respectively: 1, 0.85, 0.87, 0.82, and 0.64; 95% CI: 0.48, 0.86; P for trend = 0.004). Glycemic load was not significantly associated with risk in the overall cohort (multivariate relative risks for quintiles 1-5, respectively: 1, 1.31, 1.20, 1.14, and 1.33; 95% CI: 0.92, 1.91; P for trend = 0.21). CONCLUSIONS: A diet high in rapidly absorbed carbohydrates and low in cereal fiber is associated with an increased risk of type 2 diabetes.

Adult↗

PubMed2004

Fructose, glycemic load, and quantity and quality of carbohydrate in relation to plasma C-peptide concentrations in US women.

BACKGROUND: Circulating C-peptide concentrations are associated with insulin resistance and the development of type 2 diabetes. However, associations between fructose and the quantity and quality of total carbohydrate intake in relation to C-peptide concentrations have not been adequately examined. OBJECTIVE: We assessed the association of dietary fructose, glycemic load, and carbohydrate intake with fasting C-peptide concentrations. DESIGN: Plasma C-peptide concentrations were measured in a cross-sectional setting in 1999 healthy women from the Nurses' Health Study I and II. Dietary fructose, glycemic load, and carbohydrate intake were assessed with the use of semiquantitative food-frequency questionnaires. RESULTS: After multivariate adjustment, subjects in the highest quintile of energy-adjusted fructose intake had 13.9% higher C-peptide concentrations (P for trend = 0.01) than did subjects in the lowest quintile. Similarly, in the multivariate model, subjects in the highest quintile of glycemic load had 14.1% (P for trend = 0.09) and 16.1% (P for trend = 0.04) higher C-peptide concentrations than did subjects in the lowest quintile after further adjustment for total fat or carbohydrate intake, respectively. In contrast, subjects with high intakes of cereal fiber had 15.6% lower (P for trend = 0.03) C-peptide concentrations after control for other covariates. CONCLUSIONS: Our results suggest that high intakes of fructose and high glycemic foods are associated with higher C-peptide concentrations, whereas consumption of carbohydrates high in fiber, such as whole-grain foods, is associated with lower C-peptide concentrations. Furthermore, our study suggests that these nutrients play divergent roles in the development of insulin resistance and type 2 diabetes.

Adult↗

PubMed2004

Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal women.

BACKGROUND: The influence of diet on atherosclerotic progression is not well established, particularly in postmenopausal women, in whom risk factors for progression may differ from those for men. OBJECTIVE: The objective was to investigate associations between dietary macronutrients and progression of coronary atherosclerosis among postmenopausal women. DESIGN: Quantitative coronary angiography was performed at baseline and after a mean follow-up of 3.1 y in 2243 coronary segments in 235 postmenopausal women with established coronary heart disease. Usual dietary intake was assessed at baseline. RESULTS: The mean (+/-SD) total fat intake was 25 +/- 6% of energy. In multivariate analyses, a higher saturated fat intake was associated with a smaller decline in mean minimal coronary diameter (P = 0.001) and less progression of coronary stenosis (P = 0.002) during follow-up. Compared with a 0.22-mm decline in the lowest quartile of intake, there was a 0.10-mm decline in the second quartile (P = 0.002), a 0.07-mm decline in the third quartile (P = 0.002), and no decline in the fourth quartile (P < 0.001); P for trend = 0.001. This inverse association was more pronounced among women with lower monounsaturated fat (P for interaction = 0.04) and higher carbohydrate (P for interaction = 0.004) intakes and possibly lower total fat intake (P for interaction = 0.09). Carbohydrate intake was positively associated with atherosclerotic progression (P = 0.001), particularly when the glycemic index was high. Polyunsaturated fat intake was positively associated with progression when replacing other fats (P = 0.04) but not when replacing carbohydrate or protein. Monounsaturated and total fat intakes were not associated with progression. CONCLUSIONS: In postmenopausal women with relatively low total fat intake, a greater saturated fat intake is associated with less progression of coronary atherosclerosis, whereas carbohydrate intake is associated with a greater progression.

Aged↗

PubMed2004

Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men.

BACKGROUND: Previous studies have suggested that a daily intake of 3 servings of whole-grain foods is associated with a reduced risk of coronary heart disease (CHD). However, methods for the assessment of whole-grain intake differ. Furthermore, any additional effects of added bran and germ, which are components of whole grains, have not been reported. OBJECTIVE: The objective was to evaluate the association of whole-grain, bran, and germ intakes (with the use of new quantitative measures) with the incidence of CHD. DESIGN: This was a prospective cohort study of 42,850 male health professionals aged 40-75 y at baseline in 1986 who were free from cardiovascular disease, cancer, and diabetes. Daily whole-grain, bran, and germ intakes were derived in grams per day from a detailed semiquantitative dietary questionnaire. RESULTS: During 14 y of follow-up, we documented 1818 incident cases of CHD. After cardiovascular disease risk factors and the intakes of bran and germ added to foods were controlled for, the hazard ratio of CHD between extreme quintiles of whole-grain intake was 0.82 (95% CI: 0.70, 0.96; P for trend=0.01). The hazard ratio of CHD in men with the highest intake of added bran was 0.70 (95% CI: 0.60, 0.82) compared with men with no intake of added bran (P for trend < or = 0.001). Added germ was not associated with CHD risk. CONCLUSION: This study supports the reported beneficial association of whole-grain intake with CHD and suggests that the bran component of whole grains could be a key factor in this relation.

Adult↗

PubMed2004

Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts.

BACKGROUND: Epidemiologic studies have suggested a lower risk of coronary heart disease (CHD) at higher intakes of fruit, vegetables, and whole grain. Whether this association is due to antioxidant vitamins or some other factors remains unclear. OBJECTIVE: We studied the relation between the intake of antioxidant vitamins and CHD risk. DESIGN: A cohort study pooling 9 prospective studies that included information on intakes of vitamin E, carotenoids, and vitamin C and that met specific criteria was carried out. During a 10-y follow-up, 4647 major incident CHD events occurred in 293 172 subjects who were free of CHD at baseline. RESULTS: Dietary intake of antioxidant vitamins was only weakly related to a reduced CHD risk after adjustment for potential nondietary and dietary confounding factors. Compared with subjects in the lowest dietary intake quintiles for vitamins E and C, those in the highest intake quintiles had relative risks of CHD incidence of 0.84 (95% CI: 0.71, 1.00; P=0.17) and 1.23 (1.04, 1.45; P=0.07), respectively, and the relative risks for subjects in the highest intake quintiles for the various carotenoids varied from 0.90 to 0.99. Subjects with higher supplemental vitamin C intake had a lower CHD incidence. Compared with subjects who did not take supplemental vitamin C, those who took >700 mg supplemental vitamin C/d had a relative risk of CHD incidence of 0.75 (0.60, 0.93; P for trend <0.001). Supplemental vitamin E intake was not significantly related to reduced CHD risk. CONCLUSIONS: The results suggest a reduced incidence of major CHD events at high supplemental vitamin C intakes. The risk reductions at high vitamin E or carotenoid intakes appear small.

Adult↗

PubMed2004

trans fatty acids and systemic inflammation in heart failure.

BACKGROUND: trans fatty acid (TFA) intake increases systemic inflammation in healthy persons. However, the effect in patients with established heart disease is unknown. OBJECTIVE: Our aim was to determine whether TFAs are associated with systemic inflammation in patients with established heart disease. DESIGN: Red blood cell membrane TFAs, a biomarker of dietary intake, and inflammatory marker concentrations were ascertained in 86 ambulatory patients with established heart failure. Associations between TFA levels and inflammatory markers were evaluated by linear regression. RESULTS: Mean (+/-SD) TFA levels were 1.8 +/- 0.4% of membrane fatty acids (range: 0.7-2.9%). For each inflammatory marker, associations are presented as the absolute difference and percentage difference from the mean for each 1% higher membrane TFA level. After adjustment for age, sex, body mass index, diabetes, smoking, ejection fraction, New York Heart Association class, ischemic etiology, statin use, and serum glucose, TFA levels were positively associated with interleukin (IL) 1beta (difference from mean: 0.38 pg/mL; percentage difference from mean: 66%; P=0.04), IL-1 receptor antagonist (4033 pg/mL; 297%; P=0.006), IL-6 (9.5 pg/mL; 123%; P=0.006), IL-10 (241 pg/mL; 183%; P=0.02), tumor necrosis factor (TNF) alpha (256 pg/mL; 249%; P=0.02), TNF receptor 1 (537 pg/mL; 41%; P=0.03), TNF receptor 2 (39 242 pg/mL; 247%; P=0.001), monocyte chemoattractant protein 1 (117 pg/mL; 119%; P=0.004), and brain natriuretic peptide (40 pg/mL; 57%; P=0.04). Further adjustments for other patient characteristics did not significantly alter the results. CONCLUSION: TFAs are strongly associated with systemic inflammation in patients with heart disease, which suggests that attention to TFA intake may be important for secondary prevention efforts.

Biomarkers↗

PubMed2004

Height, predictors of C-peptide and cancer risk in men.

BACKGROUND: Excessive energy intake tends to increase circulating levels of insulin and free insulin-like growth factor-1 (IGF-I), which may increase risk of some cancers that are common in Western countries. However, the relative importance of these hormonal factors during pre-adulthood and adulthood is unknown. METHODS: We prospectively examined height, as a marker of pre-adult IGF-I bioactivity, and modifiable adult determinants of insulin secretion, in relation to risk of cancer, particularly Western-related cancers (colon, pancreas, kidney, and aggressive prostate cancers) in 47,690 male health professionals. Information about dietary and lifestyle factors for these men was collected at baseline (1986) and was updated periodically. A C-peptide score, representing insulin secretion, was created by using body mass, physical activity, and diet in a stepwise linear regression to predict C-peptide level, in a sample of 263 cohort members. RESULTS: From 1986 to 1998, we documented 3270 incident cancers (excluding the less aggressive prostate cancers). Greater body mass index, lower physical activity, and a Western dietary pattern were independent predictors of higher plasma C-peptide levels in the sample. A C-peptide score, based on these variables, was positively related to risk of Western-related cancers, but not to other cancer types in the entire cohort. Height was also only related to Western-related cancers. For Western-related cancers, 29% (95% CI: 16%, 48%) were attributed to C-peptide scores above the first decile, 30% (95% CI: 11%, 58%) to heights >or=66 inches, and 49% (95% CI: 30%, 69%) to both factors combined. For total cancers, 29% (95% CI: 16%, 46%) were attributable to both factors. CONCLUSIONS: Maximal growth in the pre-adult period and hyperinsulinaemia during adulthood may largely underlie the excess risk of some cancers that are common in Western populations. A substantial proportion of these cancers may be modifiable in adulthood, through alterations in body weight, sedentary behaviour, and dietary patterns that stimulate hyperinsulinaemia.

Adult↗

PubMed2004

Kidney dysfunction, inflammation, and coronary events: a prospective study.

Kidney dysfunction and high C-reactive protein (CRP) levels are independently associated with coronary events. However, it is unclear whether the risk of coronary events associated with decreased kidney function is at least partially mediated by inflammation and whether the association between inflammatory biomarkers and coronary events is influenced by level of kidney function. With the use of a prospective, nested, case-control study design, the association among kidney function, inflammatory biomarker levels, and coronary events was studied. A total of 244 women who were participants in the Nurses' Health Study and had no history of cardiovascular disease received a diagnosis of an incident coronary event (defined as nonfatal myocardial infarction or death as a result of coronary disease) during the follow-up period from 1990 to 1998 and were matched to 486 control subjects. Serum creatinine and inflammatory biomarker levels were measured in blood samples collected in 1989. Creatinine clearance (CrCl) was estimated using creatinine, age, weight, and height. In multivariate analyses, the odds ratio (OR) for a coronary event in women with an estimated CrCl <60 ml/min was 2.33 (95% confidence interval [CI], 1.01 to 5.38) compared with those with a CrCl > or =90 ml/min. When soluble tumor necrosis factor receptor (sTNFR) I and II levels were added into this model individually, the observed OR for women with CrCl <60 ml/min was attenuated. In analyses stratified by estimated CrCl, higher high-sensitivity CRP (hs-CRP), IL-6, and sTNFR I and II levels each were significantly associated with an increased odds of coronary events in women with an estimated CrCl < or =74 ml/min but not in women with an estimated CrCl > or =75 ml/min. The OR per 5-mg/L unit increase in hs-CRP was 1.68 (95% CI, 1.13 to 2.52) for women with an estimated CrCl < or =74 ml/min, compared with 1.23 (95% CI, 0.86 to 1.76) and 0.99 (95% CI, 0.76 to 1.29) for women with an estimated CrCl 75 to 89 and > or =90 ml/min, respectively (P = 0.004 for interaction). In conclusion, kidney dysfunction is associated with an increased odds of coronary events, and inflammation, as assessed by higher sTNFR I and II levels, may mediate some of this risk. Higher inflammatory biomarkers levels, specifically, hs-CRP, IL-6, and sTNFR I and II, were significantly associated with coronary events only in women with reduced kidney function. These findings warrant further investigation in other populations.

Adult↗

PubMed2004

The association between tooth loss and coronary heart disease in men and women.

OBJECTIVES: This paper evaluates the relation of tooth loss to incidence of coronary heart disease in two large cohort studies. METHODS: Participants included 41,407 men and 58,974 women free of any cardiovascular diseases at baseline. We recorded 1,654 incident coronary heart disease events (562 fatal events) among men during 12 years of follow-up and 544 events (158 fatal events) among women during 6 years of follow-up. RESULTS: After controlling for important cardiovascular risk factors, compared to men with 25-32 teeth at baseline, men with 0-10 teeth had a significantly higher risk of coronary heart disease (relative risk [RR]= 1.36; 95 percent confidence interval [CI]=1.11, 1.67). The relative risk increased to 1.79 (95% CI=1.34, 2.40) when limited to fatal events. Women with 0-10 teeth were also at increased risk of coronary heart disease compared to women with 25-32 teeth (RR=1.64; 95% CI=1.31, 2.05). The association was similar for fatal events (RR= 1.65; 95% CI=1.11, 2.46). The association between number of teeth and incidence of coronary heart disease was similar between men with and without a history of periodontal disease, and there was no significant association between tooth loss during follow-up and coronary heart disease. CONCLUSIONS: This study showed a significant association between number of teeth at baseline and risk of coronary heart disease and the mechanisms to explain this association should be further clarified.

Adult↗

PubMed2004

Magnesium intake and risk of type 2 diabetes in men and women.

OBJECTIVE: To examine the association between magnesium intake and risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: We followed 85,060 women and 42,872 men who had no history of diabetes, cardiovascular disease, or cancer at baseline. Magnesium intake was evaluated using a validated food frequency questionnaire every 2-4 years. After 18 years of follow-up in women and 12 years in men, we documented 4,085 and 1,333 incident cases of type 2 diabetes, respectively. RESULTS: After adjusting for age, BMI, physical activity, family history of diabetes, smoking, alcohol consumption, and history of hypertension and hypercholesterolemia at baseline, the relative risk (RR) of type 2 diabetes was 0.66 (95% CI 0.60-0.73; P for trend <0.001) in women and 0.67 (0.56-0.80; P for trend <0.001) in men, comparing the highest with the lowest quintile of total magnesium intake. The RRs remained significant after additional adjustment for dietary variables, including glycemic load, polyunsaturated fat, trans fat, cereal fiber, and processed meat in the multivariate models. The inverse association persisted in subgroup analyses according to BMI, physical activity, and family history of diabetes. CONCLUSIONS: Our findings suggest a significant inverse association between magnesium intake and diabetes risk. This study supports the dietary recommendation to increase consumption of major food sources of magnesium, such as whole grains, nuts, and green leafy vegetables.

Adult↗

PubMed2004

C-reactive protein and incident cardiovascular events among men with diabetes.

OBJECTIVE: Several large prospective studies have shown that baseline levels of C-reactive protein (CRP) are an independent predictor of cardiovascular events among apparently healthy individuals. However, prospective data on whether CRP predicts cardiovascular events in diabetic patients are limited so far. RESEARCH DESIGN AND METHODS: To investigate the association between plasma CRP levels and incidence of cardiovascular events among men with type 2 diabetes, we followed prospectively a cohort of 746 American men aged 46-81 years who were free of cardiovascular diseases at the time of blood collection in 1993-1994. RESULTS: During an average of 5 years of follow-up (3,986 person-years), we identified 103 incident cardiovascular events (18 myocardial infarction, 70 coronary artery bypass grafting or angioplasty, and 15 stroke), confirmed by medical records. After adjustment for age, BMI, smoking, alcohol consumption, physical activity, family history of coronary heart disease, history of high blood pressure, history of high serum cholesterol, aspirin use, and fasting status as well as for fibrinogen, creatinine, HbA(1c), and non-HDL cholesterol levels, CRP remained significantly associated with an increased risk of cardiovascular events. The relative risks for quartiles were 1.00, 1.51, 2.52, and 2.62 (95% CI: 1.29-5.32; P for trend: 0.011). We observed no effect modifications by plasma levels of LDL cholesterol, HDL cholesterol, non-HDL cholesterol, apolipoprotein B, HbA(1c), and fibrinogen or by BMI. CONCLUSIONS: High plasma levels of CRP were associated with an increased risk of incident cardiovascular events among diabetic men, independent of currently established lifestyle risk factors, blood lipids, and glycemic control.

Aged↗

PubMed2004

Relationship between adiponectin and glycemic control, blood lipids, and inflammatory markers in men with type 2 diabetes.

OBJECTIVE: Adiponectin, synthesized in the adipose tissue, appears to play an important role in hyperglycemia and dyslipidemia, as well as in inflammatory mechanisms, which lead to a markedly increased atherosclerotic risk in diabetic subjects. However, previous studies did not evaluate the complex relationships between adiponectin and the array of metabolic abnormalities commonly observed in diabetes. RESEARCH DESIGN AND METHODS: To examine the associations between plasma levels of adiponectin and HbA(1c), blood lipids, and inflammatory markers, we obtained blood samples from 741 participants in the Health Professionals Follow-up Study with a diagnosis of type 2 diabetes. RESULTS: Plasma adiponectin levels were positively correlated with HDL cholesterol and negatively correlated with triglycerides, apolipoprotein B-100 (apoB(100)), C-reactive protein (CRP), and fibrinogen. These associations were not appreciably altered after controlling for lifestyle exposures, medical conditions, and obesity-associated variables. A 10-microg/ml higher level of plasma adiponectin was associated with lower HbA(1c) (-0.21% points, P = 0.001), triglycerides (-0.39 mmol/l, P < 0.001), apoB(100) (-0.04 g/l, P < 0.001), CRP (-0.51 mg/l, P = 0.003), and fibrinogen (-0.53 micromol/l, P < 0.001) and higher HDL cholesterol (0.13 mmol/l, P < 0.001). Associations between adiponectin and inflammatory markers were furthermore independent of HbA(1c) and HDL cholesterol, suggesting that the anti-inflammatory properties of adiponectin are not mediated by potential effects on glycemic control and blood lipids. Our results were consistent among obese and nonobese men. CONCLUSIONS: Our study supports the hypothesis that increased adiponectin levels might be associated with better glycemic control, better lipid profile, and reduced inflammation in diabetic subjects. Measures that increase adiponectin levels might be valuable targets for decreasing the atherosclerotic risk present in diabetes.

Adiponectin↗

PubMed2004

Non-HDL cholesterol and apolipoprotein B predict cardiovascular disease events among men with type 2 diabetes.

OBJECTIVE: To evaluate the role of non-HDL cholesterol and apolipoprotein (apo)B, markers of all potentially atherogenic lipoproteins, as predictors of cardiovascular disease (CVD) in comparison with LDL cholesterol in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We prospectively followed 746 diabetic men in the Health Professionals' Follow-up Study who were aged 46-81 years and free of CVD or cancer at the time of blood draw in 1993-1994. During 6 years of follow-up, we ascertained 103 incident CVD cases. RESULTS: We used Cox proportional hazard modeling to estimate the relative risk (RR) of CVD. After adjustment for age, BMI, and other lifestyle risk factors, the multivariate RR of CVD (the highest versus the lowest quartile) was 2.34 (95% CI 1.26-4.32) for non-HDL cholesterol, 2.31 (1.23-4.35) for apoB, and 1.74 (0.99-3.06) for LDL cholesterol. Comparisons of nested models indicate that non-HDL cholesterol, but not apoB, adds significantly to the prediction of CVD risk beyond LDL cholesterol. The area under the receiver operating characteristic curve was 0.685, 0.691, 0.695, and 0.722 for the CVD risk-prediction model with LDL cholesterol, apoB, non-HDL cholesterol, and total cholesterol-to-HDL cholesterol ratio (or the non-HDL-to-HDL cholesterol ratio), respectively. CONCLUSIONS: Non-HDL cholesterol and apoB are more potent predictors of CVD incidence among diabetic men than LDL cholesterol. Statistically, the ratio of total to HDL cholesterol is the best predictor of CVD in this cohort of diabetic men.

Aged↗

PubMed2004

Lower toenail chromium in men with diabetes and cardiovascular disease compared with healthy men.

OBJECTIVE: Chromium may improve insulin sensitivity, which can modify the risk of diabetes and cardiovascular disease (CVD). Therefore, we evaluated the association between toenail chromium and CVD in diabetic men. RESEARCH DESIGN AND METHODS: We performed cross-sectional and nested case-control analyses among men aged 40-75 years within the Health Professionals Follow-up Study. The cross-sectional analysis compared men with diabetes only (n = 688), diabetes with prevalent CVD (n = 198), and healthy control subjects (n = 361). The nested case-control study included 202 men with baseline diabetes who developed incident CVD and 361 matched control subjects. RESULTS: Mean toenail chromium (microg/g) was 0.71 in healthy control subjects, 0.61 in diabetes-only subjects, and 0.52 in diabetic subjects with prevalent CVD (P for trend = 0.003). In the cross-sectional analysis, the multivariate odds ratio (OR) between extreme quartiles was 0.74 (95% CI 0.49-1.11; P for trend = 0.18), comparing diabetes only with healthy control subjects. A similar comparison between diabetic subjects with prevalent CVD and healthy control subjects yielded an OR of 0.45 (0.24-0.84; P for trend = 0.003). In the nested case-control study, comparing diabetic men with incident CVD with healthy control subjects, the multivariate OR was 0.65 (0.36-1.17; P for trend = 0.16) between extreme quartiles. When we combined prevalent and incident CVD cases among diabetic men and compared them with healthy control subjects, the OR was 0.62 (0.39-1.01; P for trend = 0.02) between extreme quartiles. CONCLUSIONS: Our results suggest that diabetic men with CVD have lower toenail chromium than healthy control subjects. However, this study could not distinguish between the effects of chromium on diabetes and those on CVD. Long-term clinical trials are needed to determine whether chromium supplementation is beneficial for preventing CVD among diabetic patients.

Adult↗