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Biomedical subjects

M G Marmot

Publications and source records attributed to M G Marmot.

At least 145 records · Page 8Linked to original sources
PubMed1985

Trial of relaxation in reducing coronary risk: four year follow up.

On screening 192 men and women aged 35-64 were identified as having two or more of the following risk factors: blood pressure greater than or equal to 140/90 mm Hg, plasma cholesterol concentration greater than or equal to 6.3 mmol/l (243.6 mg/100 ml), and current smoking habit greater than or equal to 10 cigarettes a day. They were randomly allocated to a group for modification of behaviour or to serve as controls. Both groups were given health education leaflets containing advice to stop smoking, to reduce animal fats in the diet, and on the importance of reducing blood pressure. In addition, the treatment group had group sessions of one hour a week for eight weeks in which they were taught breathing exercises, relaxation, and meditation and about managing stress. It had previously been found that after eight weeks and eight months there was a significantly greater reduction in both systolic and diastolic blood pressures in the group taught to relax compared with the control group. After four years of follow up these differences in blood pressure were maintained. Plasma cholesterol concentration and the number of cigarettes smoked were lower in the treatment group at eight weeks and eight months but not at the four year follow up. At four years more subjects in the control group reported having had angina and treatment for hypertension and its complications. Incidence of ischaemic heart disease, fatal myocardial infarction, or electrocardiographic evidence of ischaemia was significantly greater in the control group. If the results of this study could be obtained in a larger study the financial and health care implications would be enormous.

Adult↗
PubMed1985

Psychosocial factors and blood pressure.

The evidence linking psychosocial factors to sustained blood pressure elevation is highly suggestive and comes from a variety of sources. Hypertensives show increased responsiveness to emotional and mental stimuli. The hemodynamic characteristics of unstimulated hypertensives are similar to those of normotensives under emotional stress. It is likely that the sympathoadrenomedullary system partly mediates these responses, but the evidence in humans is mixed. Stranger evidence comes from studies of mice showing that symbolic stimuli in the form of disordered social relations lead to hypertension and increased heart size. In humans, the evidence linking psychological traits to hypertension is inconsistent. The prevalence of hypertension varies by social class and ethnic group and increases with acculturation from rural, traditional to modernized societies. One possible explanation for this is the attendant psychosocial changes. A variety of stress-management techniques have been shown to lower blood pressure, adding weight to a stress hypothesis.

Arousal↗
PubMed1985

Interpretation of trends in coronary heart disease mortality.

Coronary heart disease (CHD) mortality has decreased markedly in the U.S.A., Finland, Australia and other countries. Although the data are lacking, a decline in incidence is likely. Possible reasons include increased dietary consumption of essential fatty acids and decreased consumption of saturated fat and cholesterol, reduction in smoking, increased control of high blood pressure and increase in exercise. Not all countries fit this schema. Sweden has an increased CHD mortality which is not easily explained. Japan has had a continued decline in CHD mortality despite apparent increases in dietary fat. In the U.K., a decrease in CHD mortality began late, but there are encouraging signs both of changes in life style and of decreased mortality.

Adult↗
PubMed1984

Effect of L-dopa on course of Parkinson's disease.

A review of the progress of 176 patients with Parkinson's disease who were given maximum tolerated doses of L-dopa between November, 1969, and December, 1972, showed that the ratio of observed to expected deaths after 12 years' sustained therapy was 2.59 (2.14 for males and 3.64 for females). This contrasts with the overall 6-year follow-up figure for the same patients of 1.45 (1.29 for males and 1.85 for females). These findings indicate that although L-dopa may improve life expectancy during the first 6 years of therapy the protective effect subsequently declines.

Adult↗
PubMed1984

Inequalities in death--specific explanations of a general pattern?

In the Whitehall study, 17 530 civil servants were classified according to employment grade, and their mortality was recorded over 10 years. There was a steep inverse relation between grade and mortality. Compared with the highest grade (administrators), men in the lowest grade had 3 times the mortality rate from coronary heart disease, from a range of other causes, and from all causes combined. This is larger than the mortality differences, nationally, between classes I and V. Smoking and other coronary risk factors are more common in the lowest grades, but these differences account for only part of the mortality difference. The similarity of the risk gradient from a range of specific diseases could indicate the operation of factors affecting general susceptibility. The inverse relation between height and mortality suggests that factors operating from early life may influence adult death rates.

Adult↗
PubMed1984

Alcohol and coronary heart disease.

The data on two questions are reviewed: does heavy alcohol intake increase the risk of coronary heart disease (CHD)? And, is moderate intake protective? Identified alcoholics and problem drinkers have an increased risk of CHD, and in Britain there is a correlation among 22 towns, between the proportion of heavy drinkers in a town and CHD mortality. Of seven longitudinal studies reviewed, one shows heavy drinkers to have an increased CHD incidence. An inverse association between alcohol consumption and CHD mortality is seen in international comparisons and in time trends in the USA. Of six case-control studies reviewed from England and the USA, all show an inverse association between CHD and alcohol consumption which persists after control for other risk factors. Longitudinal studies, in Japanese-Americans, white American men and women, British civil servants, Puerto Ricans, Yugoslavs and Australians, all show moderate drinkers to have a lower CHD risk than abstainers. Abstainers are likely to differ from moderate drinkers in a number of ways. To date it has not proved possible to show that any of these differences account for the higher CHD risk of abstainers. The apparent protective effect is not large (RR = 0.5) but the consistency of the association and the existence of plausible mechanisms increase the likelihood that the negative association is causal. However, if alcohol intake were to increase in the population the social and medical consequences would be large. An increased intake is therefore not recommended as a community measure for CHD prevention.

Alcohol Drinking↗
PubMed1984

Life style and national and international trends in coronary heart disease mortality.

An international comparison of trends in mortality from coronary heart disease (CHD) since 1968 shows a sizeable decline in the U.S.A., Australia, New Zealand, Finland, Canada, Belgium and Japan. By contrast England, Wales and Scotland had shown no evidence of decline in CHD mortality until 1979. This has resulted in a marked deterioration in the CHD ranking of Scotland and England and Wales relative to other countries. Sweden, Hungary, Poland, Yugoslavia, Bulgaria, Rumania and the U.S.S.R. have all had increases in CHD mortality. There are many possible reasons for these changes. In general, countries that had had a decrease in CHD mortality have experienced changes in the type and/or quantity of fat in the national diet. The changes in CHD mortality in Sweden and Japan are out of line with the pattern in other countries. There is some evidence that changes in smoking and blood pressure control may have contributed to changes in CHD mortality. Changes in physical activity may have also played a part.

Adult↗
PubMed1983

Stress, social and cultural variations in heart disease.

The social and cultural environment may act as a precipitant of disease, as with stressful life events; or it may influence predisposition e.g. by the level of social support. There has not been a concerted research programme to determine to what extent social and cultural variations in coronary heart disease (CHD) may be explained by similar variations in 'stress' or predisposition to it. Japanese culture is characterised by a high degree of social support. There is evidence that this may contribute to the low rate of heart disease in Japan, and among Japanese-Americans who retain their traditional culture. Preliminary findings indicate that the higher rate of heart disease in lower income groups in Britain may be associated with less social support, as well as a greater concentration of other coronary risk factors such as smoking and overweight. The link between Type-A behaviour and CHD has been replicated in women as well as men, and in Europe and the U.S.A. But the distribution in the population of Type-A behaviour does not follow the distribution of CHD.

Adult↗
PubMed1983

Blood pressure in 15- to 16-year-old adolescents of different ethnic groups in two London schools.

A blood pressure screening survey was conducted in 357 students, aged 15-16 years, in 2 London schools. Males had higher systolic blood pressures than females, and white males had significantly higher mean systolic pressures than black males, but diastolic pressures were similar. There is no evidence in this survey that blacks have higher mean blood pressures than whites--rather the reverse. This and the difference in blood pressure between schools suggest environmental factors may be important determinants of blood pressure.

Adolescent↗
PubMed1982

Smoking and Parkinson's disease.

In a case control study of the relationship between smoking habits and Parkinson's disease a negative association was demonstrated with a relative risk of 0 x 52. A history of smoking up to 20 years earlier was associated with a risk of developing Parkinson's disease equal to about half that in non-smokers. The type of disease, age of onset and rate of progression were associated with a similar reduction in risk implying that in respect of smoking history the disease is homogeneous. The positive correlation of degenerative vascular disease with smoking is further evidence that arteriosclerosis is not involved in the causation of Parkinson's disease. The negative association between Parkinson's disease and smoking is confirmed and is independent of other associated factors. The known and serious risks of smoking far outweigh the possible benefit of lowered risk of Parkinson's disease.

Adult↗
PubMed1981

Controlled trial of biofeedback-aided behavioural methods in reducing mild hypertension.

Employees of a large industry were screened for the presence of coronary risk factors. A total of 204 employees, aged 35-64 years, with two or more such factors (serum cholesterol concentration greater than or equal to 6.3 mmol/l (243.6 mg/100 ml), blood pressure greater than or equal to 140/90 mm Hg, and current cigarette consumption greater than or equal to 10 cigarettes a day) were randomly allocated to a biofeedback group receiving training in relaxation and management of stress or a control group. Both groups received simple health education literature. After eight weeks of training, and again eight months later, the biofeedback group showed a significantly greater fall in systolic and diastolic blood pressures than the control group (p less than 0.001). Plasma renin activity and plasma aldosterone concentration were measured in a subsample at entry to the study and again at eight weeks and eight months; both showed a greater reduction in the biofeedback compared with the control group at eight weeks' follow-up. The greater reduction in blood pressure in the subjects in the biofeedback group compared with the control group (11.0 mm Hg systolic and 8.8 mm Hg diastolic), persisting eight months after the training, suggests that relaxation-based behavioural methods might be offered as a first-time treatment to patients with mild hypertension.

Adult↗