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Biomedical subjects

J Stamler

Publications and source records attributed to J Stamler.

At least 217 records · Page 12Linked to original sources
PubMed1985

Nonpharmacological control of hypertension.

Ability to safely withdraw well-controlled mild hypertensives from drugs is being tested in a three-group randomized trial. Group I (intervention) was removed from drugs after the first 2 months of nutrition counseling. Counseling is continuing through the remaining years of the trial to achieve a minimum weight loss of 10 lb if overweight, reduction of sodium intake to less than 1,800 mg, and reduction of alcohol intake to not more than two drinks per day. Group II (the first control group) was also removed from drugs to see if previous long-term blood pressure control had a carryover effect without dietary change. Blood pressure is monitored frequently in both groups, with return to drug treatment in the event of specified blood pressure rise. Group III (the second control group) has remained on drugs for comparison of blood pressure and biochemical variables. In Group I mean 30-month weight loss was 8 lb, with 35% losing 10+ lb; sodium intake was reduced by 38%. Blood pressure control without drugs was maintained for 47% of Group I patients but only 16% of group II patients (P less than 0.05). These findings indicate it may be possible, after establishing good blood pressure control, to maintain control in a sizable proportion without medication, when reduction of weight, sodium, and alcohol intake is achieved.

Alcohol Drinking↗
PubMed1985

Ethnic differences in blood pressure and heart rate of Chicago school children.

In 1975-1978, the Chicago Department of Health conducted a screening program that included measurements of blood pressure, heart rate, height, weight, triceps skinfold thickness, and arm circumference, and calculation of body mass index and muscle circumference for non-public school children. Based on data on 4,086 boys and girls aged 5-10 years from the program, this study examined the ethnic differences in blood pressure and heart rate among children of white, black, Latino, and Oriental ethnicity. Mean levels for both systolic and diastolic blood pressure were higher for Oriental and black children than for white and Latino children. These differences were independent of age, height, weight, and skinfold thickness. The black children had a much lower mean heart rate than the other children. A seasonal variation was observed for systolic blood pressure, i.e., with each sex group, the mean systolic blood pressure adjusted for age, skinfold thickness, and height tended to be higher in spring than in fall and winter. (Note-- no child was screened during the summer because of summer break.) With control for season, ethnic differences in systolic blood pressure disappeared, but not the ethnic differences in diastolic blood pressure and heart rate.

Blood Pressure↗
PubMed1985

The MRFIT behavior pattern study. II. Type A behavior and incidence of coronary heart disease.

Behavior pattern was assessed by interview for 3,110 men at eight centers in the Multiple Risk Factor Intervention Trial (1973-1976). The Type A pattern was not significantly associated with risk of first major coronary events (coronary death and definite nonfatal myocardial infarction) after a mean follow-up of 7.1 years. Crude relative risks for Types A1-A2 versus X-B were 1.08 in usual care, 0.82 in special intervention, and 0.92 overall. Adjustment for age, blood pressure, cigarette smoking, serum cholesterol, consumption of alcohol, and educational attainment yielded relative risks of 0.99 in usual care, 0.81 in special intervention, and 0.87 overall (95% confidence interval = 0.59-1.28). The Jenkins Activity Survey Type A score, obtained for 12,772 men at all 22 centers, was also not significantly associated with risk of first major coronary events. Overall, crude risks in the lowest (Type B) through highest (Type A) quintiles of the score's distribution were 5.0%, 4.4%, 4.0%, 4.3%, and 4.1%, respectively. The proportional hazards regression coefficient, adjusted for the variables listed above, was -0.006 (95% confidence interval = -0.015-0.003). These results raise questions regarding the robustness of the Type A hypothesis in its present form. Further studies are needed to investigate these questions and to evaluate the validity of procedures used to assess behavior patterns.

Adult↗
PubMed1985

The marked decline in coronary heart disease mortality rates in the United States, 1968-1981; summary of findings and possible explanations.

During the years 1940-1967, age-adjusted mortality rates from coronary heart disease (CHD) rose in the USA by 14.1% for all persons aged 35-74. This upward trend was recorded for white men, black men, and black women, but not for white women. From 1968 to 1981 (year of latest record), the trend in the preceding period was reversed, i.e., CHD death rates decreased steadily, at a rate averaging about 3% per year. This downward trend has involved all age-sex-color groups in the adult population and all regions of the country. It has encompassed both main categories of CHD, i.e., acute myocardial infarction (AMI) and chronic ischemic heart disease (CIHD), the former more prominently than the latter, especially among adults aged 35-64. The US decline in CHD mortality rates is greater-absolutely and relatively-than that of any other country. US death rates from stroke have also fallen markedly over these years, so that death rates from the major cardiovascular diseases (CVD) and all causes also fell substantially, with savings of hundreds of thousands of people from premature death since 1968. Responding to vigorous development in the USA over the last 25 years of public policy and strategy for the prevention and control of the coronary epidemic, tens of millions of Americans have made changes in eating habits resulting in lower population mean intake of total fat, saturated fat, cholesterol; increased intake of polyunsaturated fats; decreased mean levels of serum cholesterol and rates of hypercholesterolemia. Prevalence rates of cigarette smoking among adults have also decreased markedly. Tens of millions have taken up leisure time exercise. All these changes have occurred more among the more educated-affluent than among the less educated-affluent. Over the last decade the proportion of persons with hypertension whose hypertension was detected, treated, and controlled has risen from 10 to 15% to embrace a majority of hypertensives. It is a reasonable inference that these mass changes in life-styles and life-style-related major CHD risk factors have contributed importantly to the large sustained declines in CHD, CVD, and all causes death rates in the USA. Concordant with this inference are data sets indicating greater declines in CHD mortality among the more educated-affluent strata than among the general population (matched for age-sex-color), in keeping with the greater changes in life-styles among the more educated-affluent, e.g., as exemplified by findings for physicians.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

Intervention for the prevention and control of hypertension and atherosclerotic diseases: United States and international experience.

Intervention to control hypertension and prevent coronary heart disease was initially undertaken in the United States in the late 1950s. It was conducted along three lines: randomized controlled trials, community demonstration projects, and broad public health and medical care efforts involving both the general population and its high-risk strata. This article reviews findings from the United States trials, particularly those on the primary prevention of coronary heart disease by unifactorial means (such as fat-modified diet, serum cholesterol-lowering drugs, antihypertensive drug treatment) and by multifactorial interventions. Results of unifactorial and multifactorial trials are discussed with reference to the prevention of high blood pressure. Studies in the United States are compared with research abroad, and current research needs are reviewed together with the implications for medical practice and public health. The United States population as a whole has a large high-risk segment. Since the late 1950s, significant population-wide changes have occurred in life-styles (diet, smoking, exercise habits), and this is especially true of the more educated. The proportion of persons with detected, treated, and controlled high blood pressure has risen markedly in all population strata. Consequently, a favorable shift has occurred in the population distribution of the major established risk factors: "rich" diet, hypercholesterolemia, high blood pressure, and cigarette smoking. It can be reasonably inferred that the steady and marked declines in death rates in the United States from coronary heart disease, stroke, all cardiovascular diseases, and all causes since 1968 are related to reductions in these risk factors.

Adult↗
PubMed1984

Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial.

The Multiple Risk Factor Intervention Trial was a randomized clinical trial that studied the efficacy of multiple risk factor reduction in lowering coronary heart disease mortality in high-risk men. Nutrition counseling based on a fat-modified eating pattern resulted in a significant reduction of total cholesterol and low-density lipoprotein cholesterol. However, based on further analysis not involving comparisons of randomized groups, the reduction in total cholesterol appeared to be blunted by the effects of the antihypertensive medication utilized in the stepped-care therapy in this study. The use of diuretics was associated with an increase in triglycerides and a lesser decrease in total plasma cholesterol when compared with non-diuretic users. The use of diuretic therapy was also associated with a slight decrease in high-density lipoprotein cholesterol, when compared with changes in those not receiving diuretic therapy. The combination of diuretics plus propranolol was related to a substantial decrease in high-density lipoprotein cholesterol in both the Special Intervention and Usual Care participants. The changes in lipoproteins for men receiving diuretic therapy are probably influenced substantially by nutritional factors, especially weight change. Concomitant nutritional changes must be considered when analyzing the short- and long-term effects of therapy with diuretics or other antihypertensive drugs on lipoprotein metabolism.

Adult↗
PubMed1984

Prevalence of diabetes/hyperglycemia and associated cardiovascular risk factors in blacks and whites: Chicago Heart Association Detection Project in Industry.

Prevalence rates of diabetes, asymptomatic hyperglycemia, and cardiovascular risk factors were examined in an employed population of 28,895 whites and 2607 blacks, ages 25 to 64 years. Diabetes had been previously diagnosed in this population among approximately 3% of the males of both races and 2% of the females. Plasma glucose 1 hour after a 50 gm oral load was highest among white males (141 mg/dl), similar and at intermediary levels among black males (134 mg/dl) and white females (135 mg/dl), and lowest among black females (126 mg/dl). A divergent pattern of obesity was observed, however, with black females being by far the most overweight. Preliminary mortality data for males suggest that both blacks and whites with diabetes have sizably higher death rates than those without diabetes; a black-white differential is not apparent.

Adult↗
PubMed1984

Responses of black and white males to the special intervention program of the Multiple Risk Factor Intervention Trial.

Of the 12,866 males aged 35 to 57 years who were randomly assigned to the special intervention (SI) and usual care (UC) groups of the Multiple Risk Factor Intervention Trial (MRFIT), 931 (7.2%) were black. With use of a multivariate score from the Framingham study, all were assessed to be in the upper 10% to 15% of coronary risk because of their diastolic blood pressure, serum cholesterol level, and/or cigarette use. Blacks in the MRFIT were of lower educational and income levels and were less often employed in professional-technical-managerial or other white-collar jobs than whites. At baseline, blacks had higher mean blood pressures and a higher prevalence of hypertension than whites, were more often smokers but smoked fewer cigarettes per day, and had a higher prevalence of ECG abnormalities. Dietary lipid composition was similar for black and white males; so also were weight and body mass index, plasma total cholesterol levels, and low-density lipoprotein (LDL) cholesterol levels. High-density lipoprotein cholesterol levels were higher and triglyceride levels lower for blacks than whites. Attendance rates over the years of the trial were similarly high for blacks and whites. Among males in the SI group, smoking cessation rates, changes in dietary lipid composition and in plasma total and LDL cholesterol, and achievement of normotensive diastolic pressure with antihypertensive stepped-care treatment were comparable for black and white males. This MRFIT experience indicates ability to induce extensive changes in life-styles (eating and smoking habits) of both black and white American males of varying educational and socioeconomic backgrounds and also to achieve long-term effective adherence to programs for the treatment and control of hypertension.

Adult↗
PubMed1984

Age specific mortality trends in the U.S.A. from 1960 to 1980: divergent age-sex-color patterns.

Trends in age-specific mortality (10-year age groups, 5-74) for the U.S. population were reviewed for all causes of death from 1960 to 1980. The age-specific mortality rate generally declined. However, the following age-sex-color groups showed divergent mortality trends compared to those of other groups: (1) The death rates for white male teenagers and young adults (ages 15-24 and 25-34) increased during 1960s and stayed at the same level during 1970s. The ratio of male to female deaths for white teenagers and young adults (15-24 and 25-34) increased over both decades, although the mortality rate for white women age 15-24 increased during the 1960s. (2) Non-white men age 15-24 and 25-34 experienced biphasic mortality trends, with a rise peaking in 1971 and then a fall. (3) The mortality ratios, non-white to white men, age 25-34 and 35-44, were far higher then those of other age groups. (4) The mortality ratios, non-white males to females, increased steadily for all age groups, and those of age groups 15-24 and 25-34 turned up sharply. Selected causes of death (1960-1977) were reviewed to uncover reasons for the unfavorable mortality trends among males. The following causes contributed to rising mortality among males: (a) accidents, suicide, and homicide for white and non-white teenagers and young adults, age 15-24, 25-34 and 35-44; (b) suicide and homicide for non-white men age 45-54; (c) cirrhosis of the liver for white men age 35-44 and for non-white 25-34, 35-44 and 45-54; (d) malignant neoplasms for white men age 35-44 and for non-white age 45-54.

Accidents↗
PubMed1984

Sex and race differences in sodium-lithium countertransport and red cell sodium concentration.

A total of 417 individuals from all four major sex-race groups were examined for the rate of sodium flux via the countertransport pathway and the sodium concentration within red cells. The age span was from early adolescence to retirement. Males of both races had sizable higher countertransport rates than did women (p less than 0.01), and a slight increase in sodium concentration (p greater than 0.05). Contrariwise, while whites or both sexes had higher countertransport than their black counterparts, sodium concentration was higher in blacks than whites (p less than 0.01). This pattern is not consistent with a direct relationship between both countertransport or sodium concentration and blood pressure which applies across both racial groups. Sex-race differences must be taken into account in any group comparisons of these variables.

Adolescent↗
PubMed1984

Blood pressure and sodium-lithium countertransport: findings in population-based surveys.

A total of 448 individuals ranging in age from 11 to 72 years were studied in a series of seven population-based surveys. Although the relationship was positive in all surveys, a significant correlation was noted between sodium-lithium countertransport and blood pressure in only three of the seven. Hypertensives as a group had significantly higher levels of countertransport than did those with a normal blood pressure. In stepwise regression analysis, however, entering weight into the equation eliminated a significant predictive effect of countertransport. Red cell sodium concentration and membrane leak did not bear any significant relationship to blood pressure. The association between countertransport and blood pressure appears to be weaker in the general population than previously reported for case-control studies.

Adolescent↗
PubMed1984

Family history of hypertension and rates of sodium transport: absence of an association in population-based studies.

In a series of population-based studies, the relationship between a family history of hypertension and sodium transport was examined. In the total sample of 417 individuals, and in each sex-race-specific sub-sample, no significant differences were noted in red cell sodium-lithium countertransport, sodium concentration, or passive leak. A higher proportion of hypertensives was not found in the group with a positive family history, and blood pressures were only slightly higher in those--compared to those without--a positive family history. If family history of hypertension is associated with levels of countertransport, it would appear that the relationship is weak in the general population.

Adolescent↗
PubMed1984

Optimal resources for primary prevention of atherosclerotic diseases. Atherosclerosis Study Group.

This statement is an update of the 1970 Inter-Society Commission for Heart Disease Resources ( ICHD ) report, "Primary Prevention of the Atherosclerotic Diseases." The charge to the Study Group was to assess relevant new data and, where the evidence is less than definitive, to formulate conclusions and recommendations based on best judgment. Current developments are reviewed, and issues raised in response to the earlier recommendations are considered. Recommendations are intended to serve as a guide for individual behavior, physician practice, and the formulation of public health policy.

Alcohol Drinking↗
PubMed1984

Assessment of sodium intake in epidemiological studies on blood pressure.

Previous studies suggested that seven to fourteen 24-hour urine collections are necessary to minimize the attenuation due to the large day-to-day variation in an individual's Na intake and due to inadequate numbers of 24-hour urinary collections. Difficulties and inconveniences in collecting such a large number of 24-hour urine specimens are likely to result in a relatively large proportion of people who will either refuse to participate in the study or will collect incomplete specimens. The latter problem is especially serious since no satisfactory criteria are currently available to determine the completeness of urine specimen. There is no perfect solution to the problem of feasibility of multiple 24-hour specimens. Suggestions given in this paper can only help to partially solve the problem. The average Na/K and Na/creatinine ratios calculated from multiple, timed overnight urine specimens deserve some attention in future research.

Adolescent↗
PubMed1984

Optimal resources for primary prevention of artherosclerotic diseases. Atherosclerosis Study Group.

This statement is an update of the 1970 Inter -Society Commission for Heart Disease Resources (ICHD) report, Primary Prevention of the Atherosclerotic Diseases. The charge to the Study Group was to assess relevant new data and, where the evidence is less than definitive, to formulate conclusions and recommendations based on best judgment. Current developments are reviewed, and issues raised in response to the earlier recommendations are considered. Recommendations are intended to serve as a guide for individual behavior, physician practice, and the formulation of public health policy.

Adult↗