Epidemiology of the killer chronic diseases.
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Biomedical subjects
Publications and source records attributed to J Stamler.
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The association between alcohol consumption and cardiovascular risk factors, the association between alcohol consumption and the incidence of high blood pressure, and the association between alcohol consumption and mortality, both all-cause and cause-specific, were examined in the white males from the Chicago Peoples Gas Company study and the Chicago Western Electric Company study. In both studies, there was a significant cross-sectional association between heavy alcohol use--defined as problem drinking in the Gas Company and as consumption of six or more drinks per day in the Western Electric Company--and the level of blood pressure and high blood pressure. In addition, in 1340 normotensive men ages 27-64 years from the Gas Company and in 871 normotensive men ages 40-55 years from the Western Electric Company, a significant prospective relationship was shown, for the first time, between heavy drinking and risk of developing high blood pressure. In the Gas Company, among 1233 men ages 40-59 years, 38 problem drinkers had significantly higher 15-year mortality from all causes, the cardiovascular diseases and coronary heart disease than the rest of the men. In the Western Electric study, 78 men who consumed six or more drinks per day had significantly higher 17-year mortality from all causes, the cardiovascular diseases and coronary heart disease, cancer and all other causes than the rest of all men.
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In the Chicago Coronary Prevention Evaluation Program (CPEP), 115 men had definite mild hypertension at entry; another 101 men had high-normal diastolic blood pressure (BP). The nutritional-hygienic nonpharmacologic CPEP regimen achieved years-long moderate weight loss, slowing of pulse rate, and reduction in serum cholesterol levels. Sustained falls in BP were recorded-about 10/13 mm Hg for hypertensive men, resulting in long-term normalization of BP, and about 7/4 mm Hg for men with high-normal BP at entry. Change in weight and change in BP were significantly correlated. Long-term improvements in eating and exercise habits yielding moderate sustained weight loss are apparently useful in preventing high BP in hypertension-prone persons and in controlling established "mild" hypertension.
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The associations between heart rate and death from the cardiovascular diseases (CVD), coronary heart disease (CHD) and sudden death from CHD, along with death from all causes and non-cardiovascular causes, are examined for three groups of middle-aged white males: 1233 men aged 40-59 years followed for 15 years from the Chicago Peoples Gas Company study; 1899 men aged 40-55 years followed for 17 years from the Chicago Western Electric Company study; and 5784 men aged 45-64 years followed an average of five years from the Chicago Heart Association Detection Project in Industry. In univariate analyses, mortality from both cardiovascular and non-cardiovascular causes generally increases with increasing heart rate. In bivariate analyses, using the Cox regression model to control for age, heart rate is significantly related to mortality from all causes in each study, with the associations again due to both cardiovascular and non-cardiovascular causes. In multivariate Cox regression, controlling for age, blood pressure, serum cholesterol, cigarettes smoked per day and relative weight, heart rate is a significant risk factor for sudden CHD death and non-CVD death in two of the three studies, with the association with sudden death being U-shaped in one of the studies. Although heart rate may be an independent risk factor for sudden CHD death, the associations with other CVD death and non-sudden CHD death, in general, appear to be secondary to associations between heart rate and other cardiovascular risk factors.
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This study explored the association between sodium excretion and blood pressure (BP). A new method was used to minimize the measurement error introduced by the large intrinsic variability of 24-hour sodium excretion. The ratio of intra- to interindividual variation was used to estimate the number of measurements needed to characterize the individual. When seven consecutive 24-hour samples were collected from 73 children, ages 11-14 years, a significant correlation between mean individual sodium excretion and BP was demonstrated. The independent relationship persisted when controlling for height, weight, pulse, age, sex and race (p = 0.045), but was eliminated by simultaneously considering mean creatinine excretion. Although the cross-sectional association described is quantitatively weak, a linear relationship between BP and sodium over the range consumed in this society could be important for prevention.
In this study, the following were planned and tested: Methods of changing adult eating habits to conform with dietary principles for lowering serum lipids; a method to assess adherence to dietary modifications; and use of nutrition aides as instructors. Six slide-tape units--tested by individual, group, and self-teaching methods, and a combination of these--were effective as judged by such indicators as lowered serum cholesterol, reduced intake of saturated fat and dietary cholesterol, and increased intake of polyunsaturated fat. The Diet Achievement Score is an effective tool for assessing adherence. Nutrition aides proved useful in this study, when effectively supervised by professional nutritionists.
It has been suggested that high fat, high cholesterol, and low fibre intakes play a role in the causation of colon cancer, but since they are highly intercorrelated, it is difficult to determine which (if any) variable is truly related to colon cancer. Food disappearance data for 1954--65 and mortality data for 1967--73 from 20 industrialised countries were used to assess which variables are independently related to colon cancer. Simple correlation analysis indicated that intake of total fat, saturated fat, monounsaturated fat, cholesterol, and fibres are each highly correlated with mortality-rate for colon cancer. The partial correlation of dietary cholesterol with colon cancer remains highly significant when fat or fibre is controlled. However, the partial correlations of fat or of fibre iwth colon cancer are no longer significant when cholesterol is controlled. Cross-classification showed a highly signficant main effect for cholesterol, but nor for fat or fibre. The findings support the possibility of a causal relationship between cholesterol intake and colon cancer.
In a nationwide screening program, blood pressure measurements, family (parental) histories of hypertension, and self-evaluations of weight class were obtained for more than a half million people. Positive family history was associated with hypertension prevalence double that found in persons with negative history and was independent of weight. When overweight was also present, however, hypertension prevalence was three to four times as high. Hypertension was more likely to have been previously diagnosed in screenees if family history was positive. However, such screenees did not have a higher proportion receiving effective treatment than those with negative family history. When an index case of hypertension is found, other family members should be examined. For persons with positive family history, nutritional-hygienic recommendations to avoid overweight may be important in reducing the risk of becoming hypertensive.
Because of the importance of randomized controlled trials in medical research and development, the most competent and qualified individuals from a variety of medical specialties are needed as investigators for these trials. Such people must be highly dedicated to the improvement of human health and they must also be cooperative and able to work in the highly disciplined atmosphere that such a trial demands. In order that the trial investigators be persons of high caliber, certain incentives must be guaranteed, such as recognition of one's contributions to the trial itself, publications, and opportunities to present study results at various meetings. University and medical school policies on promotion and tenure need to be reassessed bearing in mind the complexity of achieving optimal recognition of the individuals investigator's contributions to a clinical trial.
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Explore the source record for details and available documents.
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Despite the finding in cross-cultural comparisons that habitual sodium intake correlates with levels of blood pressure, similar studies from within population groups have yielded inconsistent results. The data presented in this report indicate that in industrialized societies the high degree of intra-individual variability of sodium intake, compared to much smaller inter-individual differences, may obscure potential biological correlations. A quantitative statistical method is presented to assess and minimize the effect of the large intra-individual variation in daily urinary sodium excretion.