Search PubMed⌕ Search

Biomedical subjects

J E Manson

Publications and source records attributed to J E Manson.

At least 271 records · Page 15Linked to original sources
PubMed1990

Aspirin in the primary prevention of angina pectoris in a randomized trial of United States physicians.

PURPOSE: The objective of this study was to examine the effect of low-dose aspirin (325 mg on alternate days) on the primary prevention of angina pectoris in the United States Physicians' Health Study. Despite a postulated role of platelets in atherogenesis and myocardial ischemia, the effect of chronic platelet inhibition on the development of clinical angina pectoris is unknown. SUBJECTS AND METHODS: The Physicians' Health Study is a randomized, double-blind, placebo-controlled trial among 22,071 male physicians aged 40 to 84 years, free from previous myocardial infarction, stroke, and transient cerebral ischemia at entry, and followed for an average of 60.2 months. The 21,738 physicians who were also free from angina pectoris at baseline constituted the study population for the present analyses. RESULTS: During 106,652 person-years of follow-up, 331 patients with confirmed angina pectoris were diagnosed, 194 of whom underwent a coronary revascularization procedure (coronary artery bypass graft surgery or coronary angioplasty). As compared to participants assigned placebo, the relative risk of confirmed angina pectoris in the aspirin group was 1.10 (95% confidence interval [CI], 0.88 to 1.38). For coronary revascularization, the relative risk was 1.19 (95% CI, 0.88 to 1.59). After simultaneous control for other coronary risk factors in a proportional-hazards model, these relative risks remained near unity at 1.07 (95% CI, 0.84 to 1.36) and 1.11 (95% CI, 0.81 to 1.52), respectively. When the risks of angina pectoris were examined according to year of randomization in the trial, there was no pattern of increasing benefit with longer duration of treatment. CONCLUSION: These randomized trial data indicate that chronic platelet inhibition with low-dose aspirin for an average duration of 60.2 months does not reduce the incidence of angina pectoris.

Adult↗
PubMed1990

Serum sickness in children after antibiotic exposure: estimates of occurrence and morbidity in a health maintenance organization population.

The computerized outpatient records of the Harvard Community Health Plan, a 230,000-member health maintenance organization, were used to determine the frequency with which serum sickness is recognized in the practice setting after exposure to antibiotics. The medical records of 3,487 children who had been prescribed cefaclor or amoxicillin were searched in December 1986 for coded diagnoses of serum sickness and related conditions. Diagnoses were validated by blinded review of dictated and written office notes. There were 12 cases of serum sickness in 11,523 child-years. During this time, these children were prescribed 13,487 courses of amoxicillin, 5,597 courses of trimethoprim-sulfamethoxazole (TMP-SMZ), 3,553 courses of cefaclor, and 2,325 courses of penicillin V. Serum sickness was considered to be antibiotic-related if it occurred within 20 days of initiation of antibiotic therapy. Five cases were temporally associated with cefaclor, one with both amoxicillin and TMP-SMZ, four with TMP-SMZ alone, and one with penicillin V alone. One case was not associated with any antibiotic exposure. All antibiotic-related cases occurred in children under age 6 years who were treated for otitis media or streptococcal pharyngitis, and most cases began 7-11 days after initiation of antibiotic. All but one of the antibiotic-related cases occurred in children who had relatively heavy lifetime antibiotic exposure. The risk of serum sickness was significantly elevated after cefaclor compared with amoxicillin, even among the most heavily exposed children (relative risk = 14.8, p = 0.01, 95% confidence interval 2.0-352.0). Most cases prompted several physician visits, but none required hospitalization.

Adolescent↗
PubMed1990

Weight as a risk factor for clinical diabetes in women.

To determine the relation of body mass index (weight/height2) with the risk of clinical non-insulin-dependent diabetes, the authors analyzed data from a cohort of 113,861 US women aged 30-55 years in 1976. During 8 years of follow-up (826,010 person-years), 873 definite cases were identified among women initially free from diagnosed diabetes. Among women of average body mass index, 23-23.9 kg/m2, the relative risk was 3.6 times that of women having a body mass index less than 22 kg/m2. The risk continued to increase above this level of body mass index. The authors observed a much weaker positive association with weight at age 18, and this association was eliminated after adjustment for current body mass index. Thus, weight gain after age 18 was a major determinant of risk. For an increase of 20-35 kg, the relative risk was 11.3, and for an increase of more than 35 kg, the relative risk was 17.3. Adjusting for family history did not appreciably alter the strong relation observed among women at average levels of body mass index. These data indicate that, at even average weight, women are at increased risk of clinical non-insulin-dependent diabetes and that the relation between body mass index and risk of diabetes is continuous.

Adult↗
PubMed1990

Circadian variation of acute myocardial infarction and the effect of low-dose aspirin in a randomized trial of physicians.

Increased platelet aggregation in the morning and upon assuming an upright posture may account at least in part for the observed circadian variation in onset of acute myocardial infarction. The Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of alternate-day aspirin intake (325 mg) among 22,071 US male physicians, afforded the opportunity to assess this circadian pattern and examine whether it is altered by aspirin therapy. During a 5-year period of follow-up, 342 cases of nonfatal myocardial infarction were confirmed, of which the time of onset was available in 211 (62%). The placebo group showed a bimodal circadian variation in onset of myocardial infarction with a primary peak between 4:00 AM and 10:00 AM (p less than 0.001). In the aspirin group, however, this circadian variation was minimal (p = 0.16), due primarily to a marked reduction in the morning peak of infarction. Specifically, aspirin was associated with a 59.3% reduction in the incidence of infarction during the morning waking hours, compared with a 34.1% reduction for the remaining hours of the day. The greater reduction was observed during the 3-hour interval immediately after awakening, a period with a risk of infarction twice that of any other comparable time interval (p less than 0.001). Aspirin intake was associated with a mean reduction in the incidence of infarction of 44.8% over the entire 24-hour cycle. These data support the hypothesis that increased platelet aggregability in the morning and upon arising contributes to the occurrence of myocardial infarction and that aspirin reduces the risk of infarction by inhibiting platelet aggregation during these critical periods.

Adult↗
PubMed1988

A prospective study of moderate alcohol drinking and risk of diabetes in women.

Several investigators have observed an association between alcohol consumption and elevated glucose levels, raising the possibility that alcohol may increase the risk of diabetes. This hypothesis was evaluated prospectively among 85,051 women participating in the Nurses' Health Study who were 34 to 59 years of age in 1980 and had no history of cancer, coronary heart disease, or diabetes. At baseline, participants completed an independently validated dietary questionnaire which included information on the consumption of beer, wine, and liquor. Incident cases of non-insulin-dependent diabetes were reported on follow-up questionnaires sent in 1982 and 1984 (98% response to at least one follow-up); 526 cases were confirmed by a supplementary questionnaire regarding symptoms, laboratory values, and treatment. The risk of diabetes decreased monotonically with increasing alcohol consumption (chi trend = -9.4, p less than 0.0001). Compared with nondrinkers, women consuming 5-14.9 g of alcohol per day (about 4-10 drinks per week) had an age-adjusted relative risk of diabetes of 0.4 (95% confidence interval (CI) 0.3-0.6); for 15 g or more per day, the relative risk was 0.3 (95% CI 0.2-0.4). However, a strong inverse association between alcohol drinking and body weight explained much of the apparent protective effect of alcohol. After simultaneous adjustment for Quetelet index (weight (kg)/height (m)2), family history of diabetes, total caloric intake, and age, the relative risk of diabetes for consumers of 5-14.9 g per day was 0.8 (95% CI 0.6-1.2), and for women who drank 15+ g per day, the relative risk was 0.6 (95% CI 0.3-0.9). These data provide no support for the hypothesis that moderate alcohol intake increases the risk of non-insulin-dependent diabetes.

Adult↗
PubMed1987

Body weight and longevity. A reassessment.

Conflicting results have been reported concerning the association between body weight and longevity. The shape of the curve relating weight to all-cause mortality has been variously described as linear, J-shaped, and even U-shaped. To assess the validity of the evidence for optimal weight recommendations, we examined the 25 major prospective studies on the subject. Each study had at least one of three major biases: failure to control for cigarette smoking, inappropriate control of biologic effects of obesity, such as hypertension and hyperglycemia, and failure to control for weight loss due to subclinical disease. The presence of these biases leads to a systematic underestimate of the impact of obesity on premature mortality. Although these biases preclude a valid assessment of optimal weight from existing data, available evidence suggests that minimum mortality occurs at relative weights at least 10% below the US average.

Body Weight↗
PubMed1985

Intranasal aerosolized insulin. Mixed-meal studies and long-term use in type I diabetes.

We assessed the efficacy of intranasal aerosolized insulin containing laureth-9 as a surfactant in patients with Type I diabetes by fasting studies in 8 patients, mixed-meal studies in 15, and long-term home use in 8. The intranasal insulin (1 U per kilogram of body weight in 1 per cent laureth-9) was rapidly absorbed (in 15 minutes); it lowered the plasma glucose level by 50 per cent in 45 minutes in fasting normal controls and by 50 per cent in 120 minutes in fasting diabetics. The glucose-lowering potency depended on the insulin dose and surfactant concentration. Nasal irritation was proportional to surfactant concentration, with great variability among subjects. After intranasal insulin used before meals (1 U per kilogram in 1 per cent laureth-9), the two-hour postprandial glucose level increased above before-meal levels by 38 mg per deciliter, as compared with 191 mg per deciliter after intranasal placebo in patients with Type I diabetes (P less than 0.05). An outpatient feasibility study examining three months of use of intranasal aerosolized insulin before meals as a supplement to Ultralente insulin revealed that the aerosol was well tolerated, with glycemic control (as indicated by the percentage of glycohemoglobin, home glucose measurements, and hypoglycemic reactions) comparable to that during a subsequent three-month period of conventional subcutaneous insulin treatment. The results suggest that intranasal insulin has potential as an adjunct to subcutaneous insulin in the therapy of Type I diabetes.

Absorption↗
PubMed1985

Watery diarrhea syndrome due to an adrenal pheochromocytoma secreting vasoactive intestinal polypeptide.

A 55-year-old woman presented with several protracted episodes of diarrhea; it was found to be secretory in origin. In the course of evaluating the diarrhea, an ultrasound of the abdomen was performed which disclosed a large right adrenal mass. Endocrinologic studies revealed elevated serum levels of gastrin, vasoactive intestinal polypeptide (VIP), catecholamines, and its metabolites. Surgery was performed successfully without any intraoperative complications, and postoperatively the patient was asymptomatic without further episodes of diarrhea. Histologically the tumor was a pheochromocytoma with neuroendocrine granules of vasoactive intestinal polypeptide and norepinephrine. To our knowledge, there have been six previously reported cases of pheochromocytoma secreting vasoactive intestinal polypeptide. In a patient with secretory diarrhea of unknown etiology, the adrenal glands as well as the pancreas should be examined by ultrasound and/or computerized tomography for the presence of a mass. Should an adrenal mass be discovered, it is necessary to evaluate the tumor for catecholamine production, despite the absence of clinical symptoms of a pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Dietary patterns and the risk of coronary heart disease in women.

BACKGROUND: Although substantial information on individual nutrients or foods and risk of coronary heart disease (CHD) is available, little is known about the role of overall eating pattern. METHODS: Using dietary information from a food frequency questionnaire in 1984 from the Nurses' Health Study, we conducted factor analysis and identified 2 major dietary patterns-"prudent" and "Western"-and calculated factor scores of each pattern for individuals in the cohort. We used logistic regression to examine prospectively the associations between dietary patterns and CHD risk among 69 017 women aged 38 to 63 years in 1984 without history of major chronic diseases. RESULTS: The prudent pattern was characterized by higher intakes of fruits, vegetables, legumes, fish, poultry, and whole grains, while the Western pattern was characterized by higher intakes of red and processed meats, sweets and desserts, french fries, and refined grains. Between 1984 and 1996, we documented 821 CHD cases. After adjusting for coronary risk factors, the prudent diet score was associated with a relative risk (RR) of 0.76 (95% confidence interval (CI), 0.60-0.98; P for trend test,.03) comparing the highest with lowest quintile. Extreme quintile comparison yielded an RR of 1.46 (95% CI, 1.07-1.99; P for trend test,.02) for the Western pattern. Those who were jointly in the highest prudent diet quintile and lowest Western diet quintile had an RR of 0.64 (95% CI, 0.44-0.92) compared with those with the opposite pattern profile. CONCLUSION: A diet high in fruits, vegetables, whole grains, legumes, poultry, and fish and low in refined grains, potatoes, and red and processed meats may lower risk of CHD.

Adult↗
PubMedDate not supplied

Adherence to aspirin in the prevention of myocardial infarction. The Physicians' Health Study.

BACKGROUND: The primary aim of this article was to explore, in subgroup analyses, whether participants with differing frequencies of aspirin consumption in a randomized, double-blind, placebo-controlled, primary prevention trial had different magnitudes of benefit in the prevention of myocardial infarction. Secondary aims were to identify factors associated with adherence and to examine the relationship of adherence with cardiovascular outcomes in the placebo group. METHODS: The Physicians' Health Study randomized 22071 US male physicians who were free of myocardial infarction and cerebrovascular disease at baseline. The average follow-up during the aspirin component of the trial was 60.2 months. Baseline cardiovascular risk factors and adherence to therapy during the trial were assessed by questionnaire; cardiovascular outcomes were reported by questionnaire and confirmed by record review by an Endpoints Committee. RESULTS: Several cardiovascular disease risk factors assessed at baseline were related to poor adherence (taking < 50% of study tablets): cigarette smoking, obesity, lack of exercise, and history of angina. After adjusting for baseline differences in risk factors, participants in the aspirin group with excellent adherence (taking at least 95% of study tablets) had a statistically significant 51% reduction in myocardial infarction compared with those with excellent adherence in the placebo group. Those in the aspirin group with poor adherence had a smaller, non-significant reduction in risk of myocardial infarction (a 17% reduction associated with taking < 50% of study tablets). In the placebo group better adherence was not associated with decreased risk of myocardial infarction, but was strongly associated with decreased risk of death. CONCLUSIONS: These subgroup data raise the possibility that a less than alternate day aspirin regimen may yield lower benefits in the prevention of myocardial infarction. Alternate explanations are that these analyses reflect either the play of chance or effects of uncontrolled confounding since comparisons were no longer randomized. Randomized trials are necessary to address the question of frequency of administration of aspirin to achieve optimal benefits in primary prevention of myocardial infarction.

Adult↗
PubMedDate not supplied

Baseline characteristics of participants in the Physicians' Health Study: a randomized trial of aspirin and beta-carotene in U.S. physicians.

The Physicians' Health Study is a randomized, double-blind, placebo-controlled trial of primary prevention designed to assess the effects of low-dose aspirin on cardiovascular disease and of beta-carotene on risks of cancer. A total of 22,071 U.S. male physicians 40 to 84 years of age were randomized to one of four treatment groups: active aspirin and active beta-carotene, active aspirin and beta-carotene placebo, aspirin placebo and active beta-carotene, or both placebos. Whereas the beta-carotene component of the trial is ongoing, the blinded aspirin component was terminated early primarily because of a statistically extreme benefit of aspirin on first myocardial infarction. We obtained data relating to a large number of variables, including demographics, personal medical history, family history, health habits, and diet before randomization and compared them among the four treatment groups. As expected in a randomized trial of this sample size, the distribution of baseline characteristics was virtually identical among the treatment groups. This comparison indicates certainly no confounding by the baseline variables that were collected and suggests that other unmeasured or unknown potential confounders are also likely to be distributed evenly between the treatment groups. Thus, any observed differences in outcome between these groups likely result from the effects of the treatments themselves.

Adult↗
PubMedDate not supplied

A prospective study of aspirin use and primary prevention of cardiovascular disease in women.

OBJECTIVE: The aim of the study was to examine prospectively the association between regular aspirin use and the risk of a first myocardial infarction and other cardiovascular events in women. DESIGN: Prospective cohort study including 6 years of follow-up. SETTING: Registered nurses residing in 11 US states. PARTICIPANTS: US registered nurses (n = 87,678) aged 34 to 65 years and free of diagnosed coronary heart disease, stroke, and cancer at baseline. Followup was 96.7% of total potential person-years of follow-up. MAIN OUTCOME MEASURES: Incidence of myocardial infarction, stroke, cardiovascular death, and all important vascular events. RESULTS: During 475,265 person-years of follow-up, we documented 240 nonfatal myocardial infarctions, 146 nonfatal strokes, and 130 deaths due to cardiovascular disease (total, 516 important vascular events). Among women who reported taking one through six aspirin per week, the age-adjusted relative risk (RR) of a first myocardial infarction was 0.68 (95% confidence interval [CI], 0.52 to 0.89; P = .005), as compared with those women who took no aspirin. After simultaneous adjustment for risk factors for coronary disease, the RR was 0.75 (95% CI, 0.58 to 0.99; P = .04). For women aged 50 years and older, the age-adjusted RR was 0.61 (95% CI, 0.45 to 0.84; P = .002) and the multivariate RR was 0.68 (95% CI, 0.50 to 0.93; P = .02). We observed no alteration in the risk of stroke (multivariate RR = 0.99; P = .94). The multivariate RR of cardiovascular death was 0.89 (P = .56) and of important vascular events was 0.85 (P = .12). When examined separately, the results were nearly identical for the subgroups who took one through three and four through six aspirin per week. Among women who took seven or more aspirin per week, there were no apparent reductions in risk. CONCLUSIONS: The use of one through six aspirin per week appears to be associated with a reduced risk of a first myocardial infarction among women. A randomized trial in women is necessary, however, to provide conclusive data on the role of aspirin in the primary prevention of cardiovascular disease in women.

Adult↗
PubMedDate not supplied

The incidence of herpes zoster.

BACKGROUND: There are few population-based studies of the natural history and epidemiology of herpes zoster. Although a relatively common cause of morbidity, especially among the elderly, contemporary estimates of herpes zoster incidence are lacking. Herein we describe a population-based investigation of incident and recurrent herpes zoster from 1990 through 1992 in a health maintenance organization. METHODS: The health maintenance organization's automated medical records contain clinical and administrative information about care rendered to patients in ambulatory settings, emergency departments, and hospitals. Cases of herpes zoster were ascertained by screening the medical record for coded diagnoses. The predictive value of a herpes zoster diagnosis code was determined by review of a sample of patient records. Records from all patients with potential recurrences were also reviewed. RESULTS: The overall incidence, based on 1075 cases in 500,408 person-years, was 215 per 100,000 person-years (95% confidence interval, 192 to 240 per 100,000) and did not vary by gender. Although the rate increased sharply with age, approximately 5% of the cases occurred among children younger than 15 years. Infection with human immunodeficiency virus was documented in 5% of the persons with incident herpes zoster and cancer in 6%. Four persons had confirmed recurrences of herpes zoster (744 per 100,000 person-years; 95% confidence interval, 203 to 1907); three of these persons were infected with the human immunodeficiency virus. CONCLUSIONS: The recorded incidence of herpes zoster was 64% higher than that reported 30 years ago; the age-standardized rate was more than twofold higher. Immunosuppressive conditions had little impact on overall incidence, although they were strongly associated with early recurrences.

Adolescent↗
PubMedDate not supplied

A prospective study of alcohol consumption and risk of cataract.

The role of alcohol as a determinant of age-related cataract is largely unexplored, although a possible influence has been suggested by previous retrospective and cross-sectional studies. We used the prospective data base of the Physicians' Health Study to examine the association between alcohol consumption and incidence of cataract as well as cataract extraction among U.S. male physicians. Participants in the Physicians' Health Study, a randomized trial of aspirin and beta-carotene among 22,071 male physicians 40-84 years of age at entry in 1982, were included in these analyses if they did not report cataract at baseline and if they provided information about alcohol consumption and other cataract risk factors. A total of 17,824 physicians satisfied these criteria. An incident cataract was defined as a self-report confirmed by medical record review, first diagnosed after randomization, with an age-related cause, and responsible for a reduction in best corrected visual acuity to 20/30 or worse. During 88,565 person-years of follow-up, 371 participants had a confirmed incident cataract and 110 underwent cataract extraction. Compared to physicians consuming alcohol less than once per month, daily consumers of alcohol had an age-adjusted relative risk (RR) of cataract of 1.31 (95% confidence interval [CI] = 0.95, 1.81). For posterior subcapsular (PSC) cataract, the most disabling subtype in terms of vision loss, the RR was 1.38 (95% CI = 0.84, 2.27); for PSC cataract extraction, the RR was 1.43 (95% CI = 0.71, 2.88).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Primary prevention of non-insulin-dependent diabetes mellitus.

Non-insulin-dependent diabetes mellitus (NIDDM) is one of the most prevalent chronic conditions worldwide. Despite an important role of genetic factors, NIDDM can be viewed as a largely preventable disease. In this article, the current epidemiologic evidence on potentially modifiable determinants of NIDDM is reviewed, including obesity, body fat distribution, physical activity, and dietary factors. Cigarette smoking, parity, and exogenous hormone use are also addressed. Achievable reductions in the risk of NIDDM by favorably altering the modifiable determinants of NIDDM were estimated to be 50%-75% for obesity and 30%-50% for physical activity. Inconsistent results have been observed between specific dietary factors, including saturated fat, sugar, and fiber intake. Data are currently insufficient to provide a reliable estimate of the influence of diet in the prevention of NIDDM. No randomized clinical trial data are available to prove conclusively the benefits of favorable modifications of body weight, body fat distribution, physical activity, and diet on the risk of NIDDM. An extension of research activities to include randomized trials of primary prevention strategies, as well as further observational, clinical, and laboratory research, is needed and strongly recommended.

Body Composition↗