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Biomedical subjects

H A Tyroler

Publications and source records attributed to H A Tyroler.

At least 19 recordsLinked to original sources
PubMed1992

Skin color and mortality.

The relation of skin color and mortality from all causes, coronary heart disease, and all cardiovascular diseases was explored in 787 black men and women of the Charleston Heart Study Cohort. Associations were studied by examining rates of mortality during the period 1960-1990 by tertiles of skin color, as measured by reflectometer. Across the tertiles of reflectance there were no significant differences in mortality rates, except for sex differences. Proportional hazard regression analyses were used to investigate the relation between skin color, as a continuous variable, and time to death. Covariates for regression analyses were age, sex, skin color, the interaction of skin color and sex, education, blood pressure, serum total cholesterol, cigarette smoking, body mass index, and history of diabetes. Across the random sample of black men and women there was no significant relation between skin color and time to death, except for lighter skin color and all-cause mortality (p = 0.03). Our study results provided no evidence of a long-term effect of darker skin color, as measured by skin reflectance of light, on mortality from all types of cardiovascular disease, coronary disease, or all causes.

Age Factors↗
PubMed1992

Body mass index and body girths as predictors of mortality in black and white men.

Anthropometric measurements collected from black and white men in the 1960 (n = 946) and 1963 (n = 456) examinations of the Charleston Heart Study cohort (Charleston County, South Carolina) were examined as predictors of all cause and coronary heart disease mortality. Anthropometric measurements included body mass index, chest girth (at the third intercostal space), abdominal girth (at the umbilicus) and midarm circumference. Vital status of 98 percent of the cohort was determined through 1988. Body mass index was not associated with mortality in the white men; however, it was predictive of all cause and coronary heart disease mortality in the black men. Analyses conducted separately in the lower and upper range of body mass index in black men showed the adjusted relative hazard at the 50th versus the 10th percentile of body mass index was 0.54 for all cause mortality, but was not significant for coronary heart disease mortality; whereas the adjusted relative hazard for the 90th relative to the 50th percentile was 1.7 for coronary heart disease deaths, but not significant for deaths from all causes. The circumference measurements were not predictive of all cause or coronary heart disease mortality in the white men. In the black men, the adjusted relative hazard ratios for all cause mortality for the 85th relative to the 15th percentiles were 0.22 for midarm circumference and 2.0 for abdominal circumference.

Age Factors↗
PubMed1992

Demographic and behavioural correlates of high density lipoprotein cholesterol. An international comparison between northern Italy and the United States.

Recently published results of longitudinal follow-up studies conducted in the US have identified high density lipoprotein (HDL)-cholesterol as an independent and strong predictive factor for coronary heart disease (CHD). Some inconsistencies in this association have been found when geographical comparisons were done, which could be explained by hypothesizing differences in population HDL-cholesterol determinants. We carried out a comparative analysis of demographic and behavioural correlates of HDL-cholesterol between Northern Italy and the US, two countries with well-known differences in CHD risk and HDL-cholesterol levels. The study was conducted on representative samples of these two countries (MONICA Project-Area Brianza for Northern Italy and NHANES II for the US) and used comparable methodologies for data collection and statistical analysis. Results indicate that gender, age, body mass, cigarette smoking and alcohol consumption are independently associated with HDL-cholesterol in both populations; physical activity is positively, but not significantly, associated with HDL-cholesterol mean levels, and education achievement is independently associated only in the American sample. The comparison of the magnitude of the multivariate regression coefficients between the two studies suggests similar functional relationships for most of the correlates considered. The small, albeit significant, discrepancies found for body mass and smoking status could be related either to some methodological inconsistencies between the two surveys, or to possible effects of other covariates, not available to be tested in this study, like dietary habits. Moreover, HDL-cholesterol mean level differences between populations could be also due to differences in the prevalence of the examined correlates.

Adult↗
PubMed1992

Antihypertensive treatment and US trends in stroke mortality, 1962 to 1980.

OBJECTIVES: This study examines the association between increases in antihypertensive pharmacotherapy and declines in stroke mortality among 96 US groups stratified by race, sex, age, metropolitan status, and region from 1962 to 1980. METHODS: Data on the prevalence of controlled hypertension and socioeconomic profiles were obtained from three successive national health surveys. Stroke mortality rates were calculated using data from the National Center for Health Statistics and the Bureau of the Census. The association between controlled hypertension trends and stroke mortality declines was assessed with weighted regression. RESULTS: Prior to 1972, there was no association between trends in controlled hypertension and stroke mortality declines (beta = 0.04, P = .69). After 1972, groups with larger increases in controlled hypertension experienced slower rates of decline in stroke mortality (beta = 0.16, P = .003). Faster rates of decline were modestly but consistently related to improvements in socioeconomic indicators only for the post-1972 period. CONCLUSIONS: These results do not support the hypothesis that increased antihypertensive pharmacotherapy has been the primary determinant of recent declines in stroke mortality. Additional studies should address the association between declining stroke mortality and trends in socioeconomic resources, dietary patterns, and cigarette smoking.

Black or African American↗
PubMed1992

Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women.

BACKGROUND: Regional, metropolitan, and socioeconomic factors related to the onset of decline of coronary heart disease (CHD) mortality among White women are reported. Such studies are important for planning population-level interventions. METHODS: Mortality data for 1962 to 1978 were used, to estimate the year of onset of decline. Ecological analyses of socioeconomic data from the US census were used to emphasize structural and organizational aspects of changes in disease, rather than as a substitute for an individual-level design. RESULTS: Onset of decline of CHD mortality among White women was estimated to have occurred by 1962 in 53% of 507 state economic areas (SEAs), ranging from 79% in the Northeast to 39% in the South. Metropolitan areas experienced earlier onset of decline than did nonmetropolitan areas. Average income, education, and occupational levels were highest in early onset areas and declined across onset categories. CONCLUSIONS: The results provide additional evidence for previously observed geographic and social patterns of CHD decline. Emphasis on structural economic factors determining the shape of the CHD epidemic curve does not detract from the medical importance of risk factors, but underscores the importance of community development to public health improvements. The results are consistent with the idea that the course of the CHD epidemic in the United States has been strongly influenced by socioeconomic development.

Adult↗
PubMed1992

Does equal socioeconomic status in black and white men mean equal risk of mortality?

Although concerns have been expressed that mortality from coronary disease and all other causes is greater among Blacks than Whites, we hypothesized that, when socioeconomic status is adequately considered, mortality inequalities between Blacks and Whites are insignificant. The study population was a random sampling of Black and White men who were 35 years of age or older when recruited into the Charleston Heart Study in 1960. Education level and occupational status at baseline were used to compare mortality over the ensuing 28 years between Black and White men, who were classified as low or high socioeconomic status. In no instance were Black-White differences in all-cause or coronary disease mortality rates significantly different when socioeconomic status was controlled. We conclude that socioeconomic status is an important predictor of mortality and that, when socioeconomic status is considered, differences in Black-White mortality rates may be small.

Adult↗
PubMed1992

Greater incidence of electrocardiographic left ventricular hypertrophy in black men than in white men in Evans County, Georgia.

Population-based studies of black populations in the United States and Puerto Rico have reported higher prevalences of electrocardiographic left ventricular hypertrophy compared to white or lighter-skinned populations residing in the same areas. This study examines the incidence and correlates of electrocardiographic left ventricular hypertrophy in a population-based, biracial cohort of 435 white and 163 black men from the Evans County, Georgia, Heart Study, who were examined at entry in 1960 and reexamined in 1967. Only men over 35 years of age who were free of cardiovascular disease and had normal electrocardiograms at entry were eligible. Black men had a nearly fourfold greater incidence of electrocardiographic left ventricular hypertrophy compared to white men (13.5% vs 3.7%, respectively; incidence ratio 3.7; 95% CI 3.2-4.4). After statistically adjusting for age, systolic blood pressure, weight, and the change in weight and blood pressure, black men had a threefold greater incidence of electrocardiographic left ventricular hypertrophy compared to white men (logistic odds ratio 3.0; 95% CI 1.6-6.1). In summary, black men showed a significantly greater risk of developing electrocardiographic left ventricular hypertrophy at 7-year follow-up in Evans County compared to their white counterparts. This elevated risk could not be explained by the independent or joint effects of risks factors for electrocardiographic left ventricular hypertrophy.

Adult↗
PubMed1992

Social inequality of stroke mortality among US black populations, 1968 to 1987.

Though the rate of stroke mortality in the United States has been declining for all race-sex-specific groups, rates for blacks are among the highest in the world. Studies of the geographic and social variation of stroke mortality between populations have focused solely on either trends or social determinants, but not on both. In addition, conclusions have concentrated on the comparison of whites to nonwhites. The purpose of this study was to investigate the variation in stroke mortality trends, from 1968 to 1987, between US black populations categorized by the socioeconomic structure of the state economic area. The educational achievement profile of the population (percentage of the state economic area that had not completed high school) was used as an indicator of socioeconomic development. This aggregate study assessed whether (1) an inverse relationship existed between stroke mortality and educational achievement category, and (2) levels and trends of stroke mortality by educational achievement category varied from 1968 to 1987, for each age-gender-specific group (35 to 64, 65 to 74, and 75 to 84 years). Results showed an inverse relationship between educational achievement level of communities and stroke mortality, as well as a rank-ordering in level of educational achievement for all age-gender-specific groups. The absolute difference in rates among educational achievement levels clearly converged over time, with greater convergence in the period 1968 to 1978 than 1979 to 1987. The percent declines were similar across education categories. Results suggest that geographic inequalities in stroke mortality, in relation to socioeconomic structure, have converged over time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Body mass index and body girths as predictors of mortality in black and white women.

BACKGROUND: The high prevalence of obesity in black women has been hypothesized to contribute to higher rates of coronary heart disease and total mortality. Investigators have recently refined the study of obesity by differentiating anatomic patterns of the physical location of adipose tissue on the body. We examined fat patterning as a predictor of mortality in black women. METHODS: Body mass index (BMI) and body girths were examined as predictors of all-cause and coronary heart disease mortality during 25 to 28 years of follow-up in black and white women in the Charleston Heart Study. RESULTS: The BMI was associated with all-cause and coronary heart disease mortality in white, but not black, women. After controlling for differences in BMI, the risk of all-cause mortality was greater in white women with larger chest and abdominal girths, while midarm girths were inversely associated with mortality. The hazard at the 85th percentile relative to the 15th percentile of abdomen/midarm ratio was 1.44 in models that included BMI, education, and smoking as covariates. In black women, the girths were not predictive of either all-cause or coronary heart disease mortality. CONCLUSIONS: The failure of BMI and fat patterning to predict mortality in black women challenges previously held assumptions regarding the role of overweight in the higher mortality experienced by black women.

Adult↗
PubMed1991

Analysis and interpretation of treatment effects in subgroups of patients in randomized clinical trials.

A key principle for interpretation of subgroup results is that quantitative interactions (differences in degree) are much more likely than qualitative interactions (differences in kind). Quantitative interactions are likely to be truly present whether or not they are apparent, whereas apparent qualitative interactions should generally be disbelieved as they have usually not been replicated consistently. Therefore, the overall trial result is usually a better guide to the direction of effect in subgroups than the apparent effect observed within a subgroup. Failure to specify prior hypotheses, to account for multiple comparisons, or to correct P values increases the chance of finding spurious subgroup effects. Conversely, inadequate sample size, classification of patients into the wrong subgroup, and low power of tests of interaction make finding true subgroup effects difficult. We recommend examining the architecture of the entire set of subgroups within a trial, analyzing similar subgroups across independent trials, and interpreting the evidence in the context of known biologic mechanisms and patient prognosis.

Cardiovascular Diseases↗
PubMed1991

Changes in plasma lipid and lipoprotein cholesterol and weight prior to the diagnosis of cancer.

Changes in lipoprotein cholesterol, total plasma cholesterol, and weight prior to the diagnosis of cancer were examined in 103 men who developed cancer in a cohort of 3805 type IIa hyperlipidemic men aged 35-59 enrolled in the Lipid Research Clinics Coronary Primary Prevention Trial. Study measurements were made bimonthly. After adjusting for the effects of the trial intervention and other determinants of lipid levels, the cholesterol levels of the cases diagnosed with nonlocalized cancer dropped below the expected level approaching diagnosis when compared to the entire study population. The decrease averaged 9.3 mg/dl and began about 2 years prior to diagnosis. Weight levels dropped an average of 1.2 kg over the same period. Weight and cholesterol were significantly lower than expected within 8 months of diagnosis (P less than 0.05). No decrease was seen for those diagnosed with localized malignancies. Patterns for low-density lipoprotein cholesterol reflected those of total cholesterol. There was no clear relationship between cancer diagnosis and patterns of change for triglycerides and high-density lipoprotein cholesterol. In the future, investigations of any relationship between a host physiological state and cancer occurrence should account for the metabolic effects of preclinical disease demonstrated here. To protect against spurious conclusions, incident cases occurring within 2 years of measurement should be analyzed separately. In studies of cancer mortality, deaths occurring within 3.5 years of the base-line measurement should be analyzed separately.

Adult↗
PubMed1991

Selenium, retinol, retinol-binding protein, and uric acid. Associations with cancer mortality in a population-based prospective case-control study.

Using a prospective case-control study design, baseline levels of plasma selenium, retinol, and retinol-binding protein, and baseline blood uric acid levels were compared in 136 case patients who subsequently died from cancer and 238 matched control subjects. Subjects were followed for an average of 8 1/2 years. In matched analyses, selenium levels were lower in case patients with gastrointestinal or prostate cancer; retinol levels, lower in those with gastrointestinal or breast cancer; retinol-binding protein levels, lower in case patients with gastrointestinal cancer; and uric acid levels, lower in a group with "other" cancers. However, only the uric acid association with "other" cancers and the retinol-binding protein association with gastrointestinal cancer were statistically significant (P < or = .02) in conditional logistic regression analyses controlling for multiple potential covariates. Relationships for each of the substances varied by cancer site, and although some relationships were suggestive, our results point to the need for larger studies with adequate numbers for site-specific analyses.

Adult↗
PubMed1991

Black-white differences in blood pressure among participants in NHANES II: the contribution of blood lead.

Separate studies using data from the second National Health and Nutrition Examination Survey, 1976-1980 (NHANES II) have shown that blacks in the United States have higher blood lead levels than whites and that blood lead is positively related to blood pressure. Based on these reports, we examined data from NHANES II to determine the extent to which race differences in blood pressure were explained by elevated blood lead levels in blacks. Regression analyses, with race as an indicator variable, were used to estimate the contribution of blood lead to black-white differences in blood pressure. The overall effect of blood lead on race differences in blood pressure was small, reflecting, in part, the magnitude of race differences in blood lead and in the association of blood lead and blood pressure. Nevertheless, a pronounced and consistent effect of lead on race differences in blood pressure was found among the poor, particularly women.

Adolescent↗
PubMed1991

Socioeconomic status and morbidity and mortality in hypertensive blacks.

Despite an overall limited range of social and economic opportunities in the recent past, blacks of lower socioeconomic status have experienced marked excesses in hypertension-related burdens compared with their more advantaged peers: the incidence, prevalence, and severity of hypertension and its end-organ sequelae increased with decreasing educational achievement and the 5-year mortality was two times higher for black hypertensives of lower than higher educational achievement under conditions of usual care in U.S. communities in the 1970s. The Stepped Care program of antihypertensive pharmacologic therapy of the HDFP reduced all-cause mortality by 19% for black hypertensive men and 28% for black women. The HDFP also eliminated the association of mortality with educational achievement; the favorable impact of the program was greatest in the group at highest risk, blacks of lowest socioeconomic status.

Adult↗
PubMed1990

Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease.

To determine the associations of total, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol with mortality from coronary heart disease and cardiovascular disease, we studied 2541 white men who were 40 to 69 years old at base line and followed them for an average of 10.1 years. Seventeen percent had some manifestation of cardiovascular disease at base line, whereas the others did not. Among the men who had cardiovascular disease at base line, we found, after multivariate adjustment, that those with "high" blood cholesterol levels (above 6.19 mmol per liter) had a risk of death from cardiovascular disease, including coronary heart disease, that was 3.45 times higher (95 percent confidence interval, 1.63 to 7.33) than that for men with "desirable" blood cholesterol levels (below 5.16 mmol per liter). The corresponding hazard ratios were 5.92 (95 percent confidence interval, 2.59 to 13.51) for LDL cholesterol levels above 4.13 mmol per liter as compared with those below 3.35 mmol per liter, and 6.02 (95 percent confidence interval, 2.73 to 13.28) for HDL cholesterol levels below 0.90 mmol per liter as compared with those above 1.16 mmol per liter. All three lipid levels were also significant predictors of death from coronary heart disease alone (P less than 0.005). Total cholesterol and LDL cholesterol levels were also significant predictors of death from cardiovascular and coronary heart disease in men without preexisting cardiovascular disease, although at a lower level of absolute risk of death. Thus, the 10-year risk of death from cardiovascular disease for a man with preexisting cardiovascular disease increased from 3.8 percent to almost 19.6 percent with increasing levels of total cholesterol from "desirable" to "high," whereas the corresponding risk for a man who was free of cardiovascular disease at base line increased from 1.7 percent to 4.9 percent. Our findings suggest that total, LDL, and HDL cholesterol levels predict subsequent mortality in men 40 to 69 years of age, especially those with preexisting cardiovascular disease.

Adult↗
PubMed1990

Trends in the geographic inequality of cardiovascular disease mortality in the United States, 1962-1982.

Substantial geographic variation of cardiovascular disease (CVD) mortality within the U.S. has been recognized for decades. Analyses reported here address the question of whether relative geographic inequality has increased or decreased during the period of rapidly declining CVD mortality 1962-1982. Trends in geographic inequality, as measured by the weighted coefficient of variation of State Economic Area rates, are analyzed for whites and blacks by sex for 10-year age groups 35-44 to 85 and over. The average annual percent change in the coefficient of variation for each demographic group is presented for all cause mortality, all CVD, stroke and ischemic heart disease. In general, geographic inequalities declined in total mortality for all except the youngest age group. This is consistent with reports of a strong convergence of age-adjusted cancer mortality in U.S. counties. By contrast, increasing geographic inequality dominates in the CVD categories, especially for whites in heart disease and stroke. At younger ages, increases in the coefficient of variation for all race-sex groups exceeded 1% per year in stroke and 2% per year in heart disease. These results suggest that factors influencing the percent decline of CVD mortality are not reaching communities of the U.S. equally. Since increases in relative inequality are strongest in the younger age groups, the pattern of inequality may be accentuated as these cohorts move into ages of higher mortality.

Adult↗