Biomedical subjects

J David Curb

Publications and source records attributed to J David Curb.

46 records · Page 3Linked to original sources

PubMed2003

Risk factor clustering in the insulin resistance syndrome and its relationship to cardiovascular disease in postmenopausal white, black, hispanic, and Asian/Pacific Islander women.

The aim of this study was to examine how major components of the insulin resistance (IR) syndrome relate to each other and to cardiovascular disease (CVD) in postmenopausal women in 4 ethnic groups. Baseline data from the Women's Health Initiative (WHI) on 3,083 50- to 79-year-old women (1,635 white, 802 black, 390 Hispanic, and 256 Asian/Pacific Islander) were examined. Participants underwent a personal interview and a physical examination, blood samples were drawn, and a detailed cardiovascular history was ascertained. Factor analysis was used to assess the clustering and interdependence of groups of CVD-related IR syndrome variables. Four factors were identified. An obesity factor included IR in all groups and had a significant association with CVD in white (P =.0001) and Hispanic (P =.0024) women. A dyslipidemia factor (high-density lipoprotein [HDL], triglycerides, and HDL2: total HDL ratio) also included insulin and IR and was significantly correlated with CVD in black (P=.0006) and Hispanic (P =.0217) women and had a borderline association in white women (P =.068). Total and low-density lipoprotein (LDL) cholesterol did not relate to CVD in any group. Blood pressure was related weakly to CVD in white women (P =.0434) and strongly in black women (P =.0095). Components of the IR syndrome appear to be associated with CVD in postmenopausal women, although the magnitude of these relationships differed by ethnicity.

Black or African American↗

PubMed2003

Out-of-pocket costs and diabetes preventive services: the Translating Research Into Action for Diabetes (TRIAD) study.

OBJECTIVE: Despite the increased shifting of health care costs to consumers, little is known about the impact of financial barriers on health care utilization. This study investigated the effect of out-of-pocket expenditures on the utilization of recommended diabetes preventive services. RESEARCH DESIGN AND METHODS: This was a survey-based observational study (2000-2001) in 10 managed care health plans and 68 provider groups across the U.S. serving approximately 180,000 patients with diabetes. From 11,922 diabetic survey respondents, we studied the occurrence of self-reported annual dilated eye exams and diabetes health education and among insulin users, daily self-monitoring of blood glucose (SMBG). Conditional probabilities were estimated for outcomes at each level of self-reported out-of-pocket expenditure by using hierarchical logistic regression models with random intercepts. RESULTS: Conditional probabilities of utilization (95% CI) varied by expenditure for dilated eye exam [no cost 78% (75-82), copay 79% (75-82), and full price 70% (64-75); P < 0.0001]; diabetes health education [no cost 29% (23-36), copay 29% (23-36), and full price 19% (14-25); P < 0.0001]; and daily SMBG [no cost 75% (68-81), copay 68% (60-75), and full price 59% (49-68); P < 0.0001]. Extensive adjustment for patient factors had no discernible effect on the estimates or their significance, and cost-utilization relationships were similar across income levels and other patient characteristics. CONCLUSIONS: Benefit packages structured to derive greater fiscal contribution from the health plan membership result in suboptimal use of diabetes preventive services and may thus lead to poorer clinical outcomes, greater future costs, and lower health plan quality ratings.

Adolescent↗

PubMed2003

[Electron-beam computed tomography for identification of high-risk persons in primary prevention of coronary heart disease in the United States and its implication for Japan].

Coronary heart disease (CHD) is the leading cause of death in the United States (US). Approximately half of deaths from (CHD) occur out of hospital, most being sudden. The majority of sudden cardiac deaths occur in asymptomatic subjects. Recent lipid-lowering trials in asymptomatic subjects have demonstrated the potential for risk reduction for CHD events by primary prevention. It is, however, generally acknowledged that risk will be underestimated in asymptomatic subjects who fall into the category of intermediate risk by the traditional risk factors. Non-invasive measurements of subclinical atherosclerosis, which is the end result of risk-factor exposure, have the possibility of improving the risk stratification of asymptomatic subjects in intermediate-risk. Electron-beam computed tomography (EBCT) is a non-invasive and highly sensitive means to detect calcification within coronary arterial wall. Coronary artery calcification (CAC) is a recognized marker of atherosclerosis. Atherosclerotic burden of coronary arteries correlates strongly with the amount of CAC measured by EBCT. Studies examining the predictive value of CAC among asymptomatic subjects consistently reported that CAC is a risk for CHD. Two studies reported that unadjusted odds ratios of CAC for CHD were over 20. Incremental value of EBCT over the traditional risk assessment models, however, has not been established. Although CHD mortality in Japan remains uniquely low in industrialized countries, among men aged 30-49, risk factor profiles for CHD are similar between men in the US and Japan, except higher prevalence of cigarette smoking in Japan and higher prevalence of obesity in the US. It is reported that the declining trend in CHD mortality in Japan has recently slowed down in metropolitan areas, especially in men aged 30-49, and that the incidence has increased in middle-aged workers in a metropolitan area. A mortality validation study reported that the differences in CHD mortality between the US and Japan were not as large as suggested by vital statistics. It is, therefore, important to evaluate subclinical atherosclerosis measured by EBCT in men in recent birth cohorts in Japan and compare it to that in men in the US in order to predict future trend in CHD in Japan.

Adult↗

PubMed2002

Early inflammation and dementia: a 25-year follow-up of the Honolulu-Asia Aging Study.

Inflammatory responses are associated with cardiovascular disease and may be associated with dementing disease. We evaluated the long-term prospective association between dementia and high-sensitivity C-reactive protein, a nonspecific marker of inflammation. Data are from the cohort of Japanese American men who were seen in the second examination of the Honolulu Heart Program (1968-1970) and subsequently were reexamined 25 years later for dementia in the Honolulu-Asia Aging Study (1991-1996). In a random subsample of 1,050 Honolulu-Asia Aging Study cases and noncases, high-sensitivity C-reactive protein concentrations were measured from serum taken at the second examination; dementia was assessed in a clinical examination that included neuroimaging and neuropsychological testing and was evaluated using international criteria. Compared with men in the lowest quartile (<0.34mg/L) of high-sensitivity C-reactive protein, men in the upper three quartiles had a 3-fold significantly increased risk for all dementias combined, Alzheimer's disease, and vascular dementia. For vascular dementia, the risk increased with increasing quartile. These relations were independent of cardiovascular risk factors and disease. These data support the view that inflammatory markers may reflect not only peripheral disease, but also cerebral disease mechanisms related to dementia, and that these processes are measurable long before clinical symptoms appear.

Alzheimer Disease↗

PubMed2002

C-reactive protein and myocardial infarction.

C-reactive protein (CRP) has been shown to predict cardiovascular disease. Whether predictions differ across risk factor strata and for short and long-term follow-up has not been clearly examined. The purpose of this report is to assess the relation between CRP and the development of myocardial infarction (MI) over a 20-year period in men in the Honolulu Heart Program. Subjects were aged 48 to 70 years and free of prevalent disease at the time when CRP levels were measured and follow-up began. Using a case-control design, 369 cases of MI were compared with 1,348 control subjects. After risk factor adjustment, the odds of an MI rose with increasing levels of CRP as early as 5 years into follow-up (P = 0.009). Associations appeared to persist beyond this time, but after 15 years, effects became modest. Adverse effects of an elevated CRP level were observed in middle-aged men (< or =55 years), in men without hypertension or diabetes, and in those who were nonsmokers (P < 0.05). Although positive effects were also observed in those who were hypertensive and smoking at the time of CRP measurement, findings suggest that in clinically healthy men, atherosclerosis could have origins more closely linked with inflammation than with other processes.

Adult↗

PubMed2002

Age-related changes in risk factor effects on the incidence of coronary heart disease.

PURPOSE: The purpose of this report is to examine the potential for risk factor effects on the incidence of CHD to change over a broad range of ages from middle adulthood to late-life. METHODS: Findings are based on repeated risk factor measurements at four examinations over a 26-year period in men enrolled in the Honolulu Heart Program. After each examination, six years of follow-up were available to assess risk factor effects as the cohort aged from 45 to 93 years. RESULTS: Based on 18,456 person intervals of follow-up, 677 men developed CHD (3.7%). After risk factor adjustment, a positive relation between hypertension and CHD declined significantly with age (p = 0.013), primarily due to a large increase in the risk of CHD in elderly men (75 to 93) without hypertension. Effects of total cholesterol on CHD also seemed to decline with advancing age, although changes were not statistically significant. In contrast, men with diabetes had a consistent 2-fold excess risk of CHD across all age groups, while a positive association with body mass index in younger men (45 to 54) became negative in those who were the oldest (75 to 93). Due to infrequent smoking in the elderly, associations between smoking and CHD weakened with age. In the oldest men (75 to 93), alcohol intake was unrelated to CHD, while effects of sedentary life-styles on promoting CHD appeared stronger than in those who were younger. CONCLUSION: Findings suggest that changes in risk factor effects on the incidence of CHD with advancing age may require updated strategies for CHD prevention as aging occurs.

Age Factors↗

PubMed2002

Risk of hospitalized stroke in men enrolled in the Honolulu Heart Program and the Framingham Study: A comparison of incidence and risk factor effects.

BACKGROUND AND PURPOSE: Risk of death due to stroke in Japan is more than double the risk in the United States. It remains unknown why some ethnic groups are more prone to stroke than others. Our purpose was to compare the 20-year incidence of hospitalized stroke between Japanese-American men in the Honolulu Heart Program and white men in the Framingham Study. METHODS: This was a 20-year follow-up study beginning around 1965, a population-based study on the island of Oahu, Hawaii, and in Framingham, Mass. Participants were 7589 men in Honolulu and 1216 men in Framingham without prevalent coronary heart disease and stroke. Subjects were 45 to 68 years old when follow-up began. Main outcome measures were incident thromboembolic and hemorrhagic stroke. RESULTS: Framingham men had a 40% excess of thromboembolic stroke compared with Honolulu men after adjustment for age and other risk factors (62/1000 versus 45/1000, respectively, P<0.001), whereas incidence of hemorrhagic stroke was nearly identical (14.8/1000). In both cohorts, each stroke type was consistently elevated in the presence of hypertension and cigarette smoking. Diabetes and body mass index increased the risk of thromboembolic stroke in both samples, and diabetes increased the risk of hemorrhagic events in Framingham. Alcohol intake and low total cholesterol were associated with hemorrhagic events in Honolulu but not in Framingham. Despite occasional differences in risk factor effects, none were significantly different between cohorts. CONCLUSIONS: The incidence of thromboembolic stroke requiring hospitalization is markedly less in Honolulu than in Framingham. The difference in stroke incidence rates observed cannot be explained by the traditional risk factors. Further studies are needed to identify factors that protect Japanese-American men in Honolulu from stroke.

Aged↗

PubMed2002

The American Diabetes Association and World Health Organization classifications for diabetes: their impact on diabetes prevalence and total and cardiovascular disease mortality in elderly Japanese-American men.

OBJECTIVE: To compare the prevalence of diabetes according to the American Diabetes Association (ADA) and World Health Organization (WHO) classifications in a sample of elderly Japanese-American men; to examine the association with total and cardiovascular mortality by diabetes status using both classifications; and to determine whether the fasting or 2-h glucose measurement is a stronger predictor of adverse outcomes. RESEARCH DESIGN AND METHODS: Examinations given from 1991 to 1993 in the Honolulu Heart Program were used as baseline for these analyses. Subjects were 71-93 years of age at that time and were followed for total and cardiovascular disease mortality for up to 7 years. RESULTS: A total of approximately 66% of individuals who had diabetes by WHO criteria were missed when the ADA definition was used. The relative risks of total and cardiovascular mortality for those with versus those without diabetes were similar for both definitions; however, when fasting and postload glucose measures were analyzed as continuous variables, the 2-h measurement was a superior predictor and was independent of fasting glucose. In contrast, fasting glucose was not an independent predictor of these outcomes in the presence of the 2-h measurement. CONCLUSIONS: The prevalence of glucose metabolism abnormalities was very high among elderly Japanese-American men. The WHO classification was superior to the ADA classification in identification of subjects at high risk for adverse outcomes. Therefore, we conclude that the 2-h glucose measurement is valuable and should be retained in epidemiologic studies.

Aged↗

PubMed2002

Relationship of blood pressure with degree of Hawaiian ancestry.

Native Hawaiians have been reported to experience high mortality from heart disease. Hypertension is a leading risk factor for cardiovascular morbidity and mortality. The authors report a cross-sectional study of the relationship of blood pressure and degree of Hawaiian ancestry (DHA) among 572 participants, aged 30 and older. Blood pressure was measured using the mean of the second and third of 3 measurements; hypertension was defined as either SBP> or =140, or DBP> or =90, or having a previous history of hypertension. Degree of Hawaiian ancestry (DHA) (<25%, 25%-49%, 50%-74%, 75%-99% and 100%) was assessed by a brief genealogical interview. Multiple logistic and linear regression techniques were used to adjust for potential confounding from age, body weight, central adiposity, metabolic factors, dietary factors, level of physical activity, social support, and depression symptoms. The prevalence of hypertension by DHA groups was 23.4%, 42.2%, 46.0%, 51.8%, and 34.6%, after adjusting for age, gender, and body mass index. Likewise, mean systolic and diastolic blood pressures were significantly associated with DHA. The association between diastolic blood pressure (DBP) and DHA persisted after adjustment for all demographic, biochemical, and behavioral risk factors. These results suggest that percentage of Hawaiian ancestry may act as a marker for important cultural or genetic risk factors for hypertension.

Adult↗

PubMedDate not supplied

Improving dietary self-monitoring and adherence with hand-held computers: a pilot study.

PURPOSE: Innovations in information technology offer new opportunities for creative application of personalized, tailored feedback strategies for improving dietary adherence. We developed and tested a real-time diet-monitoring and feedback system using hand-held computers. The goals were to increase diet self-monitoring, reduce the burden of monitoring food intake, and increase adherence to dietary goals within a clinical trial. METHODS: Participants were 33 women in the Diet Modification arm of the Women's Health Initiative (WHI). After using focus groups to determine system features, women used the Personal Digital Assistant (PDA)-based system for 1 month and received immediate and weekly tailored feedback. The process and outcomes were evaluated using real-time food records collected through the PDAs; surveys; and self-reported food frequency questionnaires. RESULTS: Participants significantly increased self-monitoring, improved their attitudes toward self-monitoring, and met their dietary goals more often. Reported total fat intake and percent energy from fat decreased significantly. There was a modest decrease in mean caloric intake. DISCUSSION: The pilot study findings support the largely untapped potential of hand-held computers for improving diet monitoring and diet adherence, particularly within a clinical trial.

Aged↗