Biomedical subjects
R Shinton
Publications and source records attributed to R Shinton.
Overweight and stroke in the Whitehall study.
STUDY OBJECTIVE: The aim was to examine the risk of increasing overweight for death from stroke. DESIGN: This was a prospective cohort study, in which the main outcome measure was the mortality ratio for stroke with increasing body mass index. SETTING: Civil service departments, Whitehall, London. SUBJECTS: Participants were 17,753 men aged 40 to 64 years. MEASUREMENTS AND MAIN RESULTS: 208 stroke deaths were recorded. Men aged 40 to 54 in the most overweight quintile of body mass index had a mortality ratio of 2.01 (95% confidence interval 0.9 to 4.7) compared to the thinnest quintile. The mortality ratio was 1.19 (95% CI 0.7 to 2.0) in men aged 55 to 64. The increase in risk was more apparent in non-smokers: age adjusted mortality ratio 2.58 (95% CI 1.2 to 5.7). When smoking status and overweight were considered in combination a gradient of the age adjusted mortality ratio was observed, from 1.0 in thinner/non-smokers up to 3.15 in fatter/current smokers. On the assumption that smoking and obesity cause strokes, an estimated 60% of strokes could be prevented if these two easily identifiable risk factors could be avoided. CONCLUSIONS: The risks of overweight for death from stroke were more apparent in younger subjects and non-smokers. A substantial proportion of stroke deaths occurring under the age of 80 years would probably be prevented if cigarette smoking and overweight could be avoided.
Cerebral haemorrhage and berry aneurysm: evidence from a family for a pattern of autosomal dominant inheritance.
Although families with several members suffering a cerebral haemorrhage have been reported previously, a family history of this stroke sub-type has not yet been firmly established as a risk factor for the disease. A family in whom cerebral haemorrhage has been clearly documented in five members, spanning three generations, is reported. In three a berry aneurysm was detected. There was no evidence of hypertension among any of the five cases. A sixth member of the family probably died of a cerebral haemorrhage but no necropsy was performed. By using established incidence rates for cerebral haemorrhage in the population, the probability of five such unrelated events arising in any family of similar size and longevity was calculated to be 4.9 x 10(-10). This family strengthens the case that an underlying genetic susceptibility does exist for a proportion of patients who have a cerebral haemorrhage. This susceptibility appears to be consequent upon berry aneurysm formation. The distribution of cases within this family is consistent with an autosomal dominant pattern of inheritance.
Is serum gamma-glutamyl transferase a good marker of alcohol intake in stroke patients?
Serial serum gamma-glutamyl transferase (GGT) levels were estimated in 23 consecutive patients admitted to hospital with a diagnosis of acute stroke. The proportion of patients with elevated GGT levels in the initial, 36-hour and 72-hour samples was 13%, 30% and 24% respectively, suggesting a transient rise following a stroke. Patients with a history of diabetes mellitus had an initial serum GGT level 21 IU/l (95% confidence interval 6 to 37) higher than non-diabetics. We conclude that GGT levels after a stroke may reflect a history of diabetes and cerebral damage as well as the usual more established causes. Physicians, therefore, should be wary of attributing all unexplained high GGT levels in stroke patients to alcohol.