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Biomedical subjects

M H Criqui

Publications and source records attributed to M H Criqui.

At least 109 records · Page 6Linked to original sources
PubMed1985

The prevalence of peripheral arterial disease in a defined population.

Because patients with peripheral arterial disease (PAD) may be asymptomatic or may present with atypical symptoms or findings, the true population prevalence of PAD is essentially unknown. We used four highly reliable, sophisticated noninvasive tests (segmental blood pressure, flow velocity by Doppler ultrasound, postocclusive reactive hyperemia, and pulse reappearance half-time) to assess the prevalence of large-vessel PAD and small-vessel PAD in an older (average age 66 years) defined population of 613 men and women. A total of 11.7% of the population had large-vessel PAD on noninvasive testing, and nearly half of those with large-vessel PAD also had small-vessel PAD (5.2%). An additional 16.0% of the population had isolated small-vessel PAD. Large-vessel PAD increased dramatically with age and was slightly more common in men and in subjects with hyperlipidemia. Isolated small-vessel PAD, by contrast, was essentially unrelated to sex, hyperlipidemia, or age, although it was somewhat less common before age 60. Intermittent claudication rates in this population were 2.2% in men and 1.7% in women, and abnormalities in femoral or posterior tibial pulse were present in 20.3% of men and 22.1% of women compared with the noninvasively assessed large-vessel PAD rate of 11.7%. Thus assessment of large-vessel PAD prevalence by intermittent claudication dramatically underestimated the true large-vessel PAD prevalence and assessment by peripheral pulse examination dramatically overestimated the true prevalence.

Adult↗
PubMed1985

The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population.

In a companion article we have reported the prevalence, in an older, defined population, of traditional assessments (intermittent claudication and abnormal pulse examination) of peripheral arterial disease (PAD) as compared with the results of highly accurate noninvasive testing. In this article we report the sensitivity, specificity, and positive and negative predictive values for claudication and abnormal pulses for the diagnosis of large-vessel and small-vessel PAD as determined by noninvasive testing. Claudication and abnormal pulses were completely unrelated to isolated small-vessel PAD. In contrast, both claudication and abnormal pulses were significantly correlated with large-vessel PAD. Claudication and an abnormal femoral pulse showed a high specificity and positive predictive value but a low sensitivity for large-vessel PAD. Conversely, an abnormal dorsalis pedis pulse showed a good sensitivity but low specificity and positive predictive value. The best single discriminator was an abnormal posterior tibial pulse, which had high sensitivity, specificity, and positive predictive value. Various combinations of claudication and pulse abnormalities revealed a good sensitivity for broader criteria but at the expense of specificity, whereas stricter criteria had a good specificity and positive predictive value but a poor sensitivity. No combination was superior to an abnormal posterior tibial pulse alone.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Noninvasively diagnosed peripheral arterial disease as a predictor of mortality: results from a prospective study.

Intermittent claudication has been reported in previous studies to approximately double the risk of subsequent mortality. However, a history of claudication is often present in the absence of significant peripheral arterial disease (PAD) and absent in the presence of PAD. For this reason we evaluated the association between large-vessel and small-vessel PAD, measured by highly reliable and valid noninvasive tests, and mortality in 567 older subjects from a defined population followed-up for an average of 4 years. Large-vessel PAD was strongly and significantly predictive of all-cause mortality in both men and women with a relative risk of 4 to 5, and this finding was independent of other cardiovascular disease risk factors in multivariable analysis. In addition, this finding persisted after exclusion of subjects with extant cardiovascular disease at baseline. The associations of both claudication and abnormal peripheral pulses with mortality were weaker than the large-vessel PAD association. Isolated small-vessel PAD was unrelated to subsequent mortality. These findings suggest older subjects of both sexes at a high risk of impending mortality can be identified through noninvasive testing for large-vessel PAD.

Adult↗
PubMed1984

Is borderline fasting hyperglycemia a risk factor for cardiovascular death?

The majority of previously reported studies of borderline hyperglycemia as a risk factor for cardiovascular disease are based on post-challenge glucose levels, are limited to men, and show either no significant association or a possible threshold effect. In order to determine whether fasting plasma glucose (FPG) in the normal range (less than 140 mg/dl) predicts mortality, we prospectively studied a geographically defined Southern California community of 3625 nondiabetic men and women aged 40-79, 99.5% of whom were followed for 9 years. Levels of FPG were significantly associated with levels of most heart disease risk factors. After adjusting for these risk factors, FPG, analyzed either as a continuous or categorical variable, was independently and significantly associated with all-cause, cardiovascular and ischemic heart disease mortality in men in proportional hazard models. An excess of all-cause mortality with the highest levels of FPG (130-139 mg/dl) was the only statistically significant association seen in women. The absence of a significant linear association in women may reflect true sex differences or a lack of power owing to the relatively small numbers of deaths in women. The independent linear glucose mortality association in men found here differs from previous studies, and may reflect both the larger number of events and the use of FPG, which has less intra-individual variability and less potential for misclassification bias than post-challenge glucose.

Adult↗
PubMed1984

Ischemic heart disease risk factors after age 50.

Previous studies have suggested that the predictive power of the three major risk factors for ischemic heart disease (hypertension, hypercholesterolemia, and cigarette smoking) decreases sharply with age. We re-examined this question in a cohort of 3187 adults aged 50-79 with baseline evaluation in 1972-1974 who were followed at least 9 years during a period of a marked decline in national cardiovascular disease mortality. Four-hundred and eighty-three subjects died, 123 of ischemic heart disease. Predictors of outcome were studied separately in younger (age 50-64) and older (age 65-79) groups. After multivariable adjustment for potential confounders using Cox proportional hazards models, cholesterol retained a significant independent predictor of ischemic heart disease mortality at older ages for both men and women. Cigarette smoking and hypertension were significantly related to all-cause but not to ischemic heart disease mortality in this older population. We suggest that the persistence of cholesterol as an independent predictor of fatal ischemic heart disease in old age may reflect the consequences of a shift in risk factor distribution with deferred selective mortality in a cohort with an overall favorable risk factor status.

Age Factors↗
PubMed1984

Characteristics of persons with marked hypocholesterolemia. A population-based study.

Because of recent heightened epidemiologic interest in persons with very low cholesterol levels, we compared men and women at the lowest and middle deciles of plasma cholesterol in a large population study for multiple sociologic, biologic, and medical attributes. Two sex-specific age groups were studied, 30-54 years and 55-79 years. In general, comparisons between deciles for each of these four age-sex groups revealed only minor differences for demographic variables; systolic or diastolic blood pressure; fasting plasma glucose; weight; height; obesity; cigarette smoking; dietary eggs or milk; medications for hypertension, hyperglycemia, hyperuricemia, or hyperlipidemia; family history of myocardial infarction, diabetes, or stroke; and personal history of myocardial infarction, congestive heart failure, hypertension, or stroke. Thus, the lowest and the middle deciles of plasma cholesterol in this population shared similar sociologic, biologic, and medical profiles. One unexpected finding was somewhat more diabetics in the lowest decile , and greater obesity and triglyceride levels in the lowest decile diabetics compared to either lowest decile non-diabetics or middle decile diabetics, perhaps suggesting a metabolically distinct subset.

Adolescent↗
PubMed1984

Plasma cholesterol and cancer morbidity and mortality in an adult community.

The relationship between plasma cholesterol and seven-year cancer morbidity and mortality was assessed in 4035 residents of Rancho Bernardo , CA, aged 40-89 years. Cancer was the underlying cause of death for 139 persons and occurred in an additional 168 individuals after the 1972-74 cholesterol measurement. The age-adjusted cancer mortality rate per years of experience showed a slightly U-shaped relationship with cholesterol levels in men. For women, little association was seen between cancer mortality and cholesterol levels. Age-adjusted cancer morbidity rates per years of experience, indicated no association for men or women. Mean cholesterol levels did not differ significantly by cancer site. In addition, analysis of cholesterol levels by length of time between cholesterol measurement and cancer occurrence showed no significant trends, suggesting the progression of subclinical cancer did not result in lower cholesterol levels. In summary, in this population no significant association of cholesterol and cancer was seen in men or women.

Adult↗
PubMed1983

Estrogen use and all-cause mortality. Preliminary results from the Lipid Research Clinics Program Follow-Up Study.

The association of exogenous estrogen use and hysterectomy status with all-cause mortality was examined in 2,269 white women, aged 40 to 69 years, who had been followed up for an average of 5.6 years in the Lipid Research Clinics Program Follow-up Study. A total of 72 deaths occurred during this period. The relative risk of death in estrogen users compared with nonusers was 0.54 in gynecologically intact women, 0.34 in hysterectomized women, and 0.12 in bilaterally oophorectomized women. The risk of death in estrogen users, irrespective of hysterectomy status, was 0.37 times that in nonusers (3.4/1,000 v 9.3/1,000). The significant negative association of estrogen use with mortality persisted after multivariate adjustment for confounding factors. Hysterectomy status alone was not a significant predictor of death. Some, but not all, of the lower risk of mortality in estrogen users can be accounted for by increased levels of high-density lipoprotein cholesterol.

Adult↗
PubMed1983

Clustering of heart disease risk factors in diabetic compared to nondiabetic adults.

In a population-based study conducted by the Lipid Research Clinic between 1972 and 1974, the authors investigated the frequency and clustering of five heart disease risk factors--cholesterol, triglycerides, systolic blood pressure, obesity, and cigarette smoking--in 347 diabetic and 2285 euglycemic nondiabetic adults aged 35 to 79 years. Diabetics were more likely than nondiabetics to have high risk factor levels, although excesses for cholesterol and cigarette smoking were not statistically significant. Subjects at or above the 70th or 90th percentiles for one risk factor were more likely to be at or above these percentiles for other risk factors, and this clustering of heart disease risk factors was more common among diabetics than nondiabetics. Excess clustering in diabetics persisted after controlling for obesity and when only cholesterol, blood pressure, and cigarette smoking were analyzed. Clustering was more marked in women than in men. This may explain some of the excess risk of heart disease in female compared to male diabetics, which has been reported by others.

Adult↗
PubMed1983

Change and correlates of change in high and low density lipoprotein cholesterol after six years: a prospective study.

Change and correlates of change in high and low density lipoprotein cholesterol (HDL and LDL) were studied in a prospective population-based study of 614 men and women in Rancho Bernardo, CA, 1972-1980. Correlations between baseline and follow-up examination an average of six years later were 0.72 for HDL and 0.68 for LDL, and 86% of HDL and 89% of LDL values were within +/- 30% of their original values. Predictions of HDL and LDL change were determined by multivariate analysis. Regression to the mean was the strongest single predictor of lipoprotein change and was more important than behavioral change. Among the behavioral variables, HDL change was positively associated with change in alcohol use in both sexes and with change in postmenopausal estrogen use in women and was inversely associated with change in obesity index in men. LDL change correlated positively with change in obesity index in both sexes. Change in reported cigarette use or exercise was unrelated to changes in HDL and LDL in this analysis. The similarity of lipoprotein values at baseline and follow-up suggests reasonable reliability and prognostic validity for a single HDL or LDL measurement. The multivariate analysis results generally confirm current cross-sectionally derived concepts about behavioral correlates of lipoproteins. However, the degree of regression to the mean indicates the wisdom of repeat measurements, particularly for persons with extreme values.

Adult↗
PubMed1983

Spouse concordance for systolic and diastolic blood pressure.

Eighty-two per cent of all adult residents of Rancho Bernardo, California, participated in a study of the prevalence of heart disease risk factors in 1972-1974. Spouse correlations for systolic and diastolic blood pressure were examined in 1702 spouse pairs including 403 spouse pairs married 40 or more years. Both systolic and diastolic blood pressure showed significant spouse correlation after adjustment for spouse similarities in age and relative weight (r = 0.102 for systolic, r = 0.114 for diastolic, p less than or equal to 0.05). An examination of blood pressure correlations by duration of marriage and age of wife showed correlations to be influenced by age of wife rather than duration of marriage. Spouse correlations were lowest when the wife was aged 40-49 years and highest when the wife was 50-59 years of age. The differential concordance by wife's age is compatible with different degrees of shared behaviors for couples at different ages.

Adult↗
PubMed1983

Isolated systolic hypertension and mortality after age 60 years. A prospective population-based study.

A total of 165 out of 2636 adults aged 60 years or older (6.3 per cent) in Rancho Bernardo, California, had isolated systolic hypertension with a systolic blood pressure greater than or equal to 160 mmHg and a diastolic blood pressure less than 90 mmHg when studied in 1972-1974. A 6.4-year follow-up of this cohort showed isolated systolic hypertension to be as important a risk factor for all-cause mortality as other types of hypertension in both men and women (adjusted relative risk = 1.5, p greater than 0.10). After adjustment for age and other covariates, male but not female subjects with isolated systolic hypertension experienced an excess risk of death from stroke (relative risk = 4.0, p less than 0.10), a relative risk exceeding that seen in men with treated hypertension. Isolated systolic hypertension was unassociated with an excess risk of fatal ischemic heart disease in subjects of either sex in this population. The excess risk of death and stroke is consistent with results published elsewhere, and supports the concept that isolated systolic hypertension is not a benign condition of the elderly. The efficacy and safety of therapeutic intervention in older adults with isolated systolic hypertension remain to be determined.

Aged↗
PubMed1983

Predictors of systolic blood pressure response to treadmill exercise: the Lipid Research Clinics Program Prevalence Study.

We used multiple linear regression to study predictors of systolic blood pressure response (SBPR), i.e., the increase in pressure above baseline after 3, 6, and 9 min of treadmill exercise, in 4262 men and women. Predictors considered were usual SBP, the difference (delta SBP) between resting SBP and SBP immediately before exercise, age, education, obesity index, alcohol consumption, cigarette smoking, preexercise heart rate and, in women, gonadal hormone use. In men, age, obesity index, and cigarette smoking were positively associated with SBPR and in women 20 to 49 years old, age, obesity index, and alcohol consumption were positively associated with SBPR. In women 50 years old or older, usual SBP was negatively associated with SBPR. In both men and women a larger delta SBP was associated with a smaller SBPR. These results help explain the considerable variation in SBPR, and the delta SBP results suggest that potential SBPR may, to certain extent, have a specific, finite range. The similarity of predictor variables for SBPR to predictor variables for hypertension is concordant with the previous observation that a high SBPR may foreshadow subsequent hypertension.

Adult↗
PubMed1982

Impact of a heart disease risk factor screening survey on an upper-middle class community.

The impact of a community-based heart disease risk factor screening program was evaluated after three years. The study population was predominantly white, older, and upper-middle class. Rescreening of the 211 study subjects showed improvements in both health-related behaviors and in risk factor distributions to a degree which would be expected to reduce the risk of heart disease. Although some changes were attributable to secular trends and regression to the mean, direct impact of the survey itself was also demonstrated.

Adult↗
PubMed1982

Spouse concordance of plasma cholesterol and triglyceride.

Spouse concordance for plasma cholesterol and triglyceride was studied in 1971 spouse pairs including 545 spouse pairs married 40 or more years. Both lipids showed modest but statistically significant age corrected Kendall Tau-B correlations; 0.046 (P = 0.005) for cholesterol and 0.070 (P = 0.0001) for triglycerides. Concordance was not explained by season of sampling or by selective mortality. Relative weight was positively correlated in spouse pairs and appeared to explain much of the observed correlations in cholesterol and triglycerides. Spouse pairs also showed positive correlations for cigarette smoking and egg and milk consumption, though these behavioral variables explained little of the concordance for cholesterol and triglycerides. Lipid concordance was highest in marriages of the shortest (1-9 yr) and longest (40 + yr) durations, as was relative weight concordance, suggesting an interaction between duration of marriage and environmental and/or selective factors affecting plasma lipids.

Animals↗
PubMed1982

A community study of calorie and nutrient intake in drinkers and nondrinkers of alcohol.

Nutrient intake and alcohol consumption were studied in a 15% random sample of a predominantly white upper-middle class suburban community in Southern California. Based on 24-h dietary recall, 51% of the 691 men and women aged 30 to 90 yr in the study population had consumed an average of 30 g alcohol during the preceding 24 h. In general, alcohol-derived calories were added to the diet, and did not replace calories derived from other nutrients. Consequently, alcohol consumers had a significantly higher total caloric intake than did nondrinkers. Dietary differences were greatest in moderate drinkers, who tended to consume fewer nonalcohol-derived calories, and less of most specific nutrients. Although dietary differences in moderate drinkers were similar in men and women, statistically significant differences in women were limited to carbohydrate consumption. Moderate drinking men consumed significantly less protein, fat, carbohydrate, and cholesterol. These dietary differences suggest one mechanism whereby moderate alcohol consumption might reduce the risk of coronary heart disease. Although alcohol intake resulted in an increase in total calories consumed, alcohol drinkers were not more obese than nondrinkers. Since similar proportions of drinkers and nondrinkers exercised regularly, these data may suggest that alcohol calories are not fully utilized.

Adult↗
PubMed1982

Adjustment for obesity in studies of cardiovascular disease.

To evaluate the validity and implications of using various obesity indices in adjusting or controlling for obesity, correlations were analyzed between six cardiovascular disease risk factors, age, cholesterol, log triglyceride, systolic blood pressure, diastolic blood pressure, and fasting plasma glucose, and weight (W), height (H), and five commonly used obesity indices, W/H, W/H2, 3 square root W/H, -H/3 square root W, and relative weight in a defined population of 4956 men and women. Subjects were residents of Rancho Bernardo, California and were surveyed in 1972-1974. Correlations of weight, height, and the obesity indices were also evaluated with each other. W/H, 3 square root W/H, and -H/3 square root W were highly correlated with weight (correlations = 0.96-0.997), but also correlated with height (correlations = 0.10-0.48). These very high correlations with weight and moderate correlations with height resulted in risk factor correlations with these three indices reflecting weight-risk factor correlations rather than obesity-risk factor correlations. W/H2 and relative weight were not quite so highly correlated with weight (correlations = 0.83-0.89), very highly correlated with each other (correlations = 0.999), and relatively uncorrelated with height (correlations = 0.17-0.01). W/H2 and relative weight risk factor correlations reflected true obesity-risk factor correlations and were significantly greater than risk factor correlations with weight, W/H, 3 square root W/H, and -H/3 square root W. These data strongly support the use of either W/H2 or relative weight for obesity adjustment in cardiovascular disease studies. Use of W/H, 3 square root W/H, or -H/3 square root W may result in underadjustment for obesity.

Adult↗