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Biomedical subjects

M G Marmot

Publications and source records attributed to M G Marmot.

At least 127 records · Page 7Linked to original sources
PubMed1990

Blood cadmium in London civil servants.

Blood cadmium was measured in 466 randomly selected London civil servants not exposed to heavy metals at work. Blood cadmium ranged from 3.6 to 75.6 nmol/L (0.4 to 8.5 micrograms/L) with a geometric mean of 6.4 nmol/L (0.7 micrograms/L) in nonsmokers and 13.6 nmol/L (1.5 micrograms/L) in smokers (p less than 0.001). Blood cadmium was higher in women than in men (9.5 versus 7.8 nmol/L) and was inversely correlated with employment grade (p less than 0.001). The associations with age, body weight and alcohol intake were not significant. After adjusting for gender and the number of cigarettes smoked per day, 36% of the variance of blood cadmium was explained, while the contribution of employment grade was not significant. There was an unexpected negative relationship between serum creatinine and blood cadmium in men (r = -0.16; p less than 0.01). This was not true in women (r = +0.03), but the correlation remained present in men after adjustment for age, body mass index and smoking. In contrast, in the two sexes, the correlations between blood pressure and blood cadmium were weak and not statistically significant. In conclusion, in unexposed subjects, gender and smoking are important determinants of blood cadmium. In addition, a low level of environmental exposure to cadmium is not associated with a deterioration of renal function or an increase in blood pressure.

Age Factors↗
PubMed1990

Blood lead concentration, renal function, and blood pressure in London civil servants.

Blood lead concentration was measured in 398 male and 133 female London civil servants not subject to industrial exposure to heavy metals. The relation between blood lead and serum creatinine concentrations and blood pressure were examined. Blood lead concentration ranged from 0.20 to 1.70 mumol/l with a geometric mean concentrations of 0.58 mumol/l in men and 0.46 mumol/l in women (p less than 0.001). In women blood lead concentration increased with age (r = +0.27; p = 0.002). In the two sexes blood lead concentration was positively correlated with the number of cigarettes smoked a day (men r = +0.17 and women r = +0.22; p less than or equal to 0.01), with the reported number of alcoholic beverages consumed a day (men r = +0.34 and women r = 0.23; p less than 0.01), and with serum gamma-glutamyltranspeptidase (men r = +0.23 and women r = +0.14; for men p less than 0.01). Blood lead concentration was not correlated with body weight, body mass index, and employment grade. In men 14% of the variance of blood lead concentration was explained by the significant and independent contributions of smoking and alcohol intake and in women 16% by age, smoking, and alcohol consumption. In men serum creatinine concentration tended to rise by 0.6 mumol/l (95% confidence interval from -0.2 to +1.36 mumol/l) for each 25% increment in blood lead concentration. In men and women the correlations between blood lead concentration and systolic and diastolic blood did not approach statistical significance. In conclusion, in subjects not exposed to heavy metals at work gender, age, smoking, and alcohol intake are determinants of blood lead concentration. At a low level of exposure, lead accumulation may slightly impair renal function, whereas blood pressure does not seem to be importantly influenced. Alternatively, a slight impairment of renal function may give rise to an increase in blood lead concentration.

Alcohol Drinking↗
PubMed1989

Coronary heart disease in south Asians overseas: a review.

Coronary heart disease rates have been reported in several parts of the world to be unusually high in people originating from the Indian subcontinent. High coronary disease rates appear to be common to South Asian groups of different geographical origin, religion, and language. This presents a challenge to the understanding of coronary heart disease: the high rates in South Asians are not explained on the basis of elevated serum cholesterol, smoking or hypertension. Low plasma HDL cholesterol, high plasma triglyceride levels and high prevalence of non-insulin-dependent diabetes have been consistently found in South Asians overseas: this probably reflects an underlying state of insulin resistance. Further studies are needed to determine whether this metabolic disturbance can account for the high rates of coronary heart disease in South Asians, and to identify possibilities for prevention.

Adult↗
PubMed1989

Diet and fecal steroid profile in a South Asian population with a low colon-cancer rate.

South Asian immigrants to England and Wales have low mortality from colon cancer and high mortality from coronary heart disease compared with the general population. In a survey of a predominantly Gujarati population in northwest London, both vegetarians and nonvegetarians had similar total dietary fat intake to the native British population but higher dietary fiber intake. Total fecal bile acid and neutral animal sterol concentrations were lower in South Asians than in a native British comparison group. Sixty-two percent of South Asians excreted detectable quantities of free primary bile acids, which were not present in stools from native British subjects. The ratio of fecal coprostanol to total neutral animal sterols was also lower in South Asians. Low risk of colon cancer in this population may be related to reduced microbial activity in the bowel and low levels of tumor-promoting secondary bile acids.

Asia, Southeastern↗
PubMed1989

Public health measures for blood pressure control in the whole community.

One approach to the prevention of blood pressure-associated cardiovascular disease is to find increased numbers of "hypertensives" and bring them under treatment. A complementary approach is to attempt to change the blood pressure distribution of the whole population. It can be calculated that, if the association between blood pressure level and mortality were reversible, a reduction of diastolic blood pressure of 5 mmHg in the population mean would be associated with a substantial reduction in cardiovascular mortality. The assumption of reversibility of risk of coronary heart disease may be more reasonable in the long than in the short term. The evidence from INTERSALT and other studies suggests that readily achievable changes in sodium and potassium intake, in body mass index and in alcohol intake, could lead to average blood pressure change across a whole population of 5 mmHg. A major task for public health is the implementation of such life-style changes among different social class and ethnic groups.

Blood Pressure↗
PubMed1988

Pulse rate and twenty-four hour urinary sodium content interact to determine blood pressure levels of male London civil servants.

Blood pressures, pulse rates and 24-h urinary electrolyte content were measured in 371 male and 125 female randomly selected civil servants. The male and female subjects were divided into nine subgroups each, by tertiles of sodium (Na) excretion and tertiles of pulse rate. Those in the subgroup with highest values for both variables had the highest mean systolic and diastolic blood pressure (adjusted to age 50 years and a body mass index of 25 kg/m2) among the male and female groups, and those in the subgroup with lowest values for both variables had the lowest systolic pressure among the male and female groups and the lowest diastolic pressure of the female groups. Both systolic and diastolic blood pressure were significantly related to an interaction term between urinary Na excretion and pulse rate among males (P less than 0.02, P less than 0.03 respectively). These data support the hypothesis that psychological stress (assessed by pulse) and dietary sodium (assessed by sodium excretion) may interact to determine levels of blood pressure.

Blood Pressure↗
PubMed1988

Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London.

Immigrants from the Indian subcontinent (South Asians) in England and Wales have higher morbidity and mortality from coronary heart disease than the general population; this seems to apply to both Hindus and Muslims. Studies in north west London and Trinidad found that the increased risk of coronary heart disease in Indians was not explained by dietary fat intakes, smoking, blood pressure, or plasma lipids. In the present study the distribution of coronary risk factors was measured in an East London borough where the mortality and attack rate from coronary heart disease are higher in the Asian population, predominantly Muslims from Bangladesh, than in the rest of the population. In a sample of 253 men and women aged 35-69 from general practice, mean plasma cholesterol concentrations were lower in Bangladeshi than in European men and women. Mean systolic blood pressures were 10 mm Hg lower in Bangladeshis. Plasma fibrinogen concentrations were similar in Bangladeshis and Europeans and factor VII coagulant activity was lower in Bangladeshi than in European men. In contrast with the findings in Hindus in north west London, smoking rates were high in Bangladeshi men and the ratio of polyunsaturated fatty acids to saturated fatty acids in plasma lipids was lower in Bangladeshis than in Europeans. Diabetes was three times more common in Bangladeshis than in Europeans and serum insulin concentrations measured after a glucose load were twice as high in Bangladeshis. High insulin concentrations in Bangladeshis were associated with high plasma triglyceride and low high-density lipoprotein cholesterol concentrations. Insulin resistance, leading to diabetes, hyperinsulinaemia, and secondary lipoprotein disturbances, is a possible mechanism for the high rates of coronary heart disease in South Asians in Britain and overseas.

Adult↗
PubMed1987

Community intervention to control plasma lipids.

A necessary part of the strategy of modification of hypercholesterolaemia to prevent coronary heart disease (CHD) is the detection and treatment, by diet or by drugs, of high risk individuals. There are several drawbacks to this approach: (1) the cost of screening to find individuals at risk and of monitoring by physicians of their therapy; (ii) the problem of labelling asymptomatic people as 'sick' and advising them on special diets; (iii) difficulties in compliance. If the community norm is to eat a diet high in fat, it is difficult for individuals to change, both because it marks them as 'odd' within the culture and because foods low in saturated fat may be difficult to obtain and are expensive. A further limitation is that only those individuals at highest risk may benefit. In a country with a high rate of CHD the problem is that the mean is high. The aim therefore should be to reduce the population mean and shift the whole distribution to the left. This suggests a policy of health education and of policies that remove the barriers against choosing a healthy diet. Even were such policies to be implemented successfully these alone would not abolish social and regional differences in CHD mortality.

Cholesterol↗
PubMed1987

Stress management, blood pressure and quality of life.

This paper addresses three questions. First, we examine the effectiveness of relaxation and stress management in reducing hypertension and its complications by reviewing published studies including our own. Secondly, we report quality of life under such treatment, and thirdly, we discuss possible mechanisms. There is considerable evidence to show the effectiveness of a variety of non-pharmacological measures. In a randomized, controlled trial we showed that relaxation and stress-management training was associated with a reduction in blood pressure (BP) maintained over 4 years of observation. There were signs of a possible reduction in coronary heart disease (CHD) risk while maintaining or even enhancing the quality of life. Significantly more subjects in the relaxation group reported improved relationships at work, general health, enjoyment of life, and personal and family relationships than those in the control group at a 4-year follow-up. A similar but statistically insignificant trend was shown for the general level of physical energy, sexual life, concentration at work, mental well-being and social life. The relaxation group also displayed a belief in greater control over their health. There was no consistent relationship between the degree of reduction in BP and improvement in the above aspects of life, but those who practised relaxation regularly, who integrated relaxation in everyday activities and who used cognitive reappraisal as part of their stress-management strategies, showed greater reduction in BP than those who did not. Other studies have shown that this therapy can contribute significantly to the better control of BP with smaller doses of antihypertensive drugs, thus reducing the chances of side effects.

Biofeedback, Psychology↗
PubMed1986

Mortality decline and widening social inequalities.

Mortality from coronary heart disease (CHD) is higher in manual than in non-manual occupational classes and is higher in Scotland, Wales, and the North of England than in the South. Trends in these inequalities were examined in the light of the decline in CHD mortality in Great Britain. With the use of 1979/83 death rates as standard, mortality ratios (SMRs) for all causes, lung cancer, CHD, and cerebrovascular disease in 1979/83 were compared with SMRs in 1970-72. Despite the general fall in mortality the relative disadvantage of manual compared with non-manual classes has increased for each of these 4 cause groups. The regional differences in CHD mortality persist. Among men, in every region of Great Britain, CHD mortality has declined in non-manual classes. Only in Wales has there been an appreciable decline in CHD mortality in manual classes. Among women, lung cancer and CHD mortality have fallen in non-manual classes but have increased in manual classes. Differences in smoking between social classes are likely to be important. Other differences in behaviour may be important, but the effect of unemployment and increased income differentials should also be explored.

Adult↗
PubMed1986

The relationship between both sodium and potassium intake and blood pressure in London Civil Servants. A report from the Whitehall Department of Environment Study.

The relationship was examined in 459 male London Civil Servants between the casual lying systolic and diastolic (phase V) blood pressures measured in the clinic, and 24-hr urinary sodium and potassium excretion collected an average of 6 weeks later. Systolic and diastolic pressures, after adjusting for age and weight, were both negatively associated with the 24 hr potassium excretion (r = -0.17 [p less than 0.001, 95% confidence limits -0.07, -0.27) and r = -0.11 (p less than 0.05, 95% CL 0.00, -0.21) for systolic and diastolic pressure respectively]. Adjusted systolic but not diastolic pressure was also negatively associated with plasma potassium estimated at the time of blood pressure measurement (r = -0.15, p less than 0.001, 95% CL -0.06, -0.24). In 159 female London Civil Servants both systolic and diastolic pressures were negatively correlated with plasma potassium. However, there was no evidence for a negative relationship between urinary potassium excretion and blood pressure in women. Urinary sodium excretion was not related to blood pressure either in men or women. Blood pressure was also measured by the subjects at home over a one week period during which time the urine collection was made. There was no evidence for an association between blood pressure measured at home 6 weeks after the time of drawing blood, and plasma sodium. On the other hand, in men, the negative relationship between blood pressure and urinary potassium excretion was consistent and independent of the time and place of measuring blood pressure. This is consistent with a true effect of diet, a low potassium intake being associated with an increased blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Diet and risk factors for coronary heart disease in Asians in northwest London.

Asian immigrants to England and Wales have high mortality from coronary heart disease but low mortality from colon cancer. A survey of Asians in the London boroughs of Brent and Harrow was undertaken with the object of investigating this. Compared with the British population, the Asians consumed less saturated (S) fat and cholesterol and more polyunsaturated (P) fat and vegetable fibre. The P/S ratio of the Asians' diet was 0.85 compared with 0.28 in the British population: this was reflected in the very high linoleic acid content of their plasma lipids. The plasma total cholesterol and high-density-lipoprotein cholesterol of Asian men was similar to that of a British comparison group; the concentrations in Asian women were much lower than in British women. Smoking rates were low in both Asian men and Asian women. The high rates of coronary heart disease in Asian immigrants are not explained by the levels of these risk factors.

Adult↗
PubMed1985

Fibrinogen: a possible link between social class and coronary heart disease.

Mortality from coronary heart disease in civil servants in the lowest grade of employment has been found to be about three times that of men in the highest grade of employment. As part of an investigation of this finding several haemostatic variables were measured in a sample of 29 men in lower grades of employment and 45 men in higher grades. There was a significant difference in plasma fibrinogen concentrations between men in lower grades of employment and those in higher grades (mean 3.39 g/l v 2.95 g/l, respectively; p less than 0.01) but not in other haemostatic variables. Multiple regression analyses showed significant independent associations of fibrinogen concentration with smoking (p less than 0.05) and grade of employment (p less than 0.05). The size of the observed difference between the grades of employment was similar to that between those dying of coronary heart disease or surviving during longitudinal study; it may therefore be an important part of the mechanism underlying social class differences in coronary heart disease. The statistical relation between fibrinogen concentrations and other characteristics that may be concerned in the aetiology of coronary heart disease was examined. A summary measure of job stress was significantly related to fibrinogen concentration (p less than 0.01) and made a substantial contribution to explaining the differences between grades of employment. Behaviour type and a score of physical activity were not significantly related to fibrinogen concentration.

Adult↗