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Shah Ebrahim

Publications and source records attributed to Shah Ebrahim.

At least 73 records · Page 4Linked to original sources
PubMed2004

Associations of parental, birth, and early life characteristics with systolic blood pressure at 5 years of age: findings from the Mater-University study of pregnancy and its outcomes.

BACKGROUND: We examined the associations of a range of parental and early life characteristics with systolic blood pressure at 5 years of age. METHODS AND RESULTS: Information from 3864 children who were followed up prospectively from their mother's first antenatal clinic assessment was used. Maternal age, body mass index, and smoking during pregnancy were all positively associated with offspring systolic blood pressure at 5 years of age. The systolic blood pressure of children whose mothers had smoked throughout pregnancy was on average 0.92 mm Hg (95% CI 0.17 to 1.68) greater than that of children whose mothers had never smoked, after full adjustment. Children who had been breast fed until at least 6 months had lower systolic blood pressure than those who were breast fed for a shorter duration. Paternal body mass index and child's weight, height, and body mass index were all positively associated with blood pressure at age 5. CONCLUSIONS: Because childhood blood pressure tracks into adulthood, interventions aimed at early life risk factors, such as quitting smoking during pregnancy, breast feeding, and prevention of obesity in all family members, may be important for reducing the population distribution of blood pressure and thus cardiovascular disease risk.

Adult↗
PubMed2004

The association of the PON1 Q192R polymorphism with coronary heart disease: findings from the British Women's Heart and Health cohort study and a meta-analysis.

BACKGROUND: There have been inconsistent results from case-control studies assessing the association of the PON1 Q192R polymorphism with coronary heart disease (CHD). Most studies have included predominantly men and the association in women is unclear. Since lipid levels vary between the sexes the antioxidant effect of PON1 and any genes associated with it may also vary by sex. We have examined the association of the PON1 Q192R polymorphism with CHD in a large cohort of British women and combined the results from our cohort study with those from all other published studies. RESULTS: The distribution of genotypes was the same among women with CHD and those without disease. The odds ratio (95% confidence interval) of having CHD comparing those with either the QR or RR genotype to those with QQ genotype (dominant model of association) was 1.03 (0.89, 1.21) and the per allele odds ratio was 0.98 (0.95, 1.01). In a meta-analysis of this and 38 other published studies (10,738 cases and 17,068 controls) the pooled odds ratio for the dominant effect was 1.14 (1.08, 1.20) and for the per allele effect was 1.10 (1.06, 1.13). There was evidence of small study bias in the meta-analyses and the dominant effect among those studies with 500 or more cases was 1.05 (0.96, 1.15). Ethnicity and reporting of whether the genotyping was done blind to the participants clinical status also contributed to heterogeneity between studies, but there was no difference in effect between studies with 50% or more women compared to those with fewer women and no difference between studies of healthy populations compared to those at high risk (with diabetes, renal disease of familial hypercholesterolaemia). CONCLUSION: There is no robust evidence that the PON1 Q192R polymorphism is associated with CHD risk in Caucasian women or men.

Aged↗
PubMed2004

(Mis)use of factor analysis in the study of insulin resistance syndrome.

Over the last decade, factor analysis has been used increasingly to describe patterns of simultaneous occurrence of the central components of the insulin resistance syndrome. In this paper, the authors describe factor analysis, review studies that have used factor analysis to examine the insulin resistance syndrome, and explore how factor analysis might be used to increase our understanding of this syndrome. Most studies that they reviewed gave vague reasons for using factor analysis and did not demonstrate an understanding of the use and limitations of this statistical method. Confirmatory factor analysis based on sound theoretical concepts and a clear understanding of the statistical methods may provide some insights into the pathophysiology of the syndrome. However, to date none of the studies has adopted this approach, and other statistical approaches and study designs are likely to provide greater understanding of the syndrome.

Factor Analysis, Statistical↗
PubMed2004

Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials.

PURPOSE: To review the effectiveness of exercise-based cardiac rehabilitation in patients with coronary heart disease. METHODS: A systematic review and meta-analysis of randomized controlled trials was undertaken. Databases such as MEDLINE, EMBASE, and the Cochrane Library were searched up to March 2003. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise training alone or in combination with psychological or educational interventions. RESULTS: We included 48 trials with a total of 8940 patients. Compared with usual care, cardiac rehabilitation was associated with reduced all-cause mortality (odds ratio [OR] = 0.80; 95% confidence interval [CI]: 0.68 to 0.93) and cardiac mortality (OR = 0.74; 95% CI: 0.61 to 0.96); greater reductions in total cholesterol level (weighted mean difference, -0.37 mmol/L [-14.3 mg/dL]; 95% CI: -0.63 to -0.11 mmol/L [-24.3 to -4.2 mg/dL]), triglyceride level (weighted mean difference, -0.23 mmol/L [-20.4 mg/dL]; 95% CI: -0.39 to -0.07 mmol/L [-34.5 to -6.2 mg/dL]), and systolic blood pressure (weighted mean difference, -3.2 mm Hg; 95% CI: -5.4 to -0.9 mm Hg); and lower rates of self-reported smoking (OR = 0.64; 95% CI: 0.50 to 0.83). There were no significant differences in the rates of nonfatal myocardial infarction and revascularization, and changes in high- and low-density lipoprotein cholesterol levels and diastolic pressure. Health-related quality of life improved to similar levels with cardiac rehabilitation and usual care. The effect of cardiac rehabilitation on total mortality was independent of coronary heart disease diagnosis, type of cardiac rehabilitation, dose of exercise intervention, length of follow-up, trial quality, and trial publication date. CONCLUSION: This review confirms the benefits of exercise-based cardiac rehabilitation within the context of today's cardiovascular service provision.

Aged↗
PubMed2004

Hospital admissions, age, and death: retrospective cohort study.

OBJECTIVES: Ageing of the population brings the possibility of increased burdens for acute hospital services because of the marked increase in many common diseases with age. We aimed to examine the relation between age and use of acute services in hospitals in the period before death in a national sample of deaths in hospital. DESIGN: Retrospective cohort analysis of English hospital episode statistics database. SETTING: All NHS hospitals in England. DATA SET: All post-neonatal deaths occurring in English NHS hospitals during financial year 1999-2000, with episodes of care in the previous three years determined through matching on sex, date of birth, and postcode. MAIN OUTCOME MEASURES: Total bed days, mean and median length of stay. RESULTS: 253 799 in-hospital deaths were identified, representing about 45% of all deaths occurring in 1999-2000. Patients who died in hospital spent a median of 23 days in hospital in the three years before death; the median rose with age up to 45 years, but was fairly stable for ages 45 and above. The number of admissions to NHS hospitals in the three years before death averaged 3.6; this peaked at 10.4 in patients aged 5-9 years and decreased with age to 2.2 in those aged 85 and over. CONCLUSIONS: The average number of bed days spent in hospital in the period before death does not increase with increasing age.

Adolescent↗
PubMed2004

How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials.

BACKGROUND: Lack of adherence to blood pressure-lowering medication is a major reason for poor control of hypertension worldwide. The objective of this study was to determine the effectiveness of interventions to increase adherence to blood pressure-lowering medication. METHODS: We performed a systematic review of randomized controlled trials and searched for all-language publications in the Cochrane Controlled Trials Register, MEDLINE, EMBASE, and CINAHL in April 2002. RESULTS: We included 38 studies testing 58 different interventions and containing data on 15 519 patients. The studies were conducted in 9 countries between 1975 and 2000. The duration of follow-up ranged from 2 to 60 months. Because of heterogeneity between studies in terms of interventions and the methods used to measure adherence, we did not pool the results. Simplifying dosing regimens increased adherence in 7 of 9 studies, with a relative increase in adherence of 8% to 19.6%. Motivational strategies were partly successful in 10 of 24 studies with generally small increases in adherence up to a maximum of 23%. Complex interventions comparing more than 1 technique increased adherence in 8 of 18 studies, ranging from 5% to a maximum of 41%. Patient education alone seemed largely unsuccessful. CONCLUSIONS: Reducing the number of daily doses appears to be effective in increasing adherence to blood pressure-lowering medication and should be tried as a first-line strategy, although there is so far less evidence of an effect on blood pressure reduction. Some motivational strategies and complex interventions appear promising, but we need more evidence on their effect through carefully designed randomized controlled trials.

Ambulatory Care↗
PubMed2004

Clustering of risk factors and social class in childhood and adulthood in British women's heart and health study: cross sectional analysis.

OBJECTIVE: To examine co-occurrence and clustering of risk factors used in the Framingham equation by social class in childhood and adult life. DESIGN: Cross sectional study. SETTING: 23 towns across England, Wales, and Scotland. PARTICIPANTS: 2936 women aged 60-79 years. MAIN OUTCOME MEASURES: Prevalence of risk factors (hypertension, obesity, smoking, left ventricular hypertrophy on electrocardiography, diabetes, and low concentration of high density cholesterol); ratios of observed to expected frequencies of clusters of risk factors. RESULTS: Risk factors were more common in women from manual social classes in either childhood or adult life, and the co-occurrence of three or four of these risk factors was greater among more disadvantaged groups. Within the four socioeconomic groups, these risk factors occurred together more than would be expected from their individual frequency distributions, indicating that they were clustered. The extent of this clustering was similar in all four social class groups. CONCLUSIONS: Clustering of risk factors included in the Framingham risk function occurs in all social class groups, but the lack of social patterning makes it unlikely that clustering is an explanation of socioeconomic inequalities in cardiovascular disease. As the proportion of women with co-occurrence of risk factors is greatest in those from manual social class in childhood, this measure of socioeconomic position might prove useful in risk prediction.

Aged↗
PubMed2004

Body mass index and ischemic and hemorrhagic stroke: a prospective study in Korean men.

BACKGROUND AND PURPOSE: The association between obesity and stroke remains controversial, with earlier studies suggesting that differences might stem from heterogeneous stroke subtype compositions. The association between body mass index (BMI) and stroke subtypes was examined prospectively in a large cohort study. METHODS: A total of 234 863 Korean men aged 40 to 64 years without substantial weight loss over 4 years after baseline examination in 1986 were divided into 8 categories of BMI and were followed up between 1991 and 2000 for fatal and nonfatal stroke events. RESULTS: There was a positive association across the whole range of BMI and ischemic stroke, with a confounder-adjusted hazard of 11% (95% CI, 1.09 to 1.12) for 1 kg/m2 higher BMI. A J-shaped association was observed between BMI and hemorrhagic stroke; groups with a higher BMI than the reference category (22 to 23 kg/m2) had significantly increased risks. Full adjustment for confounders and variables potentially on the causal pathway (ie, blood pressure, blood glucose, and cholesterol) attenuated the association between BMI and stroke subtypes only for those with BMI greater than the reference category. Exclusion of deaths during the first 8 years or stratified analysis according to smoking habit did not change the relation between BMI and stroke subtypes. CONCLUSIONS: BMI is a risk factor for both ischemic and hemorrhagic stroke but shows different relationships with each. When the total burden of stroke is considered, there is an urgent need to find better ways of reducing the trend toward growing obesity in both Western and Asian countries.

Adult↗
PubMed2004

Coronary risk scores.

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Anticholesteremic Agents↗
PubMed2004

Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease.

AIMS: To estimate the potential effectiveness of different "high-risk" and "population" approaches to the primary prevention of cardiovascular disease (CVD) in middle-aged British men, after correction for regression dilution bias. METHODS AND RESULTS: We used a combination of cohort and randomised controlled trial evidence to estimate the effectiveness of high-risk strategies, based on the identification of high-risk factors or high absolute risk, and strategies based on population-wide reductions in cholesterol and blood pressure. High-risk strategies were potentially effective but would need to be used widely to have a substantial effect on CVD in the population. Aggressive pharmacological treatment (using statins, beta-blockers, ACE-inhibitors and aspirin) in individuals with a 10-year Framingham event risk of >or=30% (6% of population) would have reduced major CVD by at most 11%. This figure increased to 34% at a >or=20% treatment threshold (26% of population). In contrast, modest downwards shifts in the population distributions of serum total cholesterol and systolic blood pressure led to marked expected reductions in major CVD. Taking regression dilution bias into account, 10% reductions in long-term mean blood cholesterol and blood pressure could have reduced major CVD by 45%. CONCLUSIONS: If high-risk strategies are to have a major impact on CVD in the population, they need to be more widely used than previously envisaged. Population-wide reduction of major risk factors is needed if CVD is to be substantially reduced.

Cardiovascular Diseases↗
PubMed2004

Social inequalities and disability in older men: prospective findings from the British regional heart study.

The independent association of socio-economic position with self-reported disability was assessed. The effect of home and car ownership as additional indices of socio-economic position within occupational social classes was explored. Data from a prospective study of a cohort of 7735 men aged 40-59 years at recruitment and representative of the occupational social class distribution of middle-aged men in Great Britain were used. Men were selected from one general practice in each of 24 towns in England, Wales and Scotland in 1978-1980. The present study concerns 5773 (88.4% of those able to take part) men aged 52-73 years at follow up in 1992 who completed the disability section of a postal questionnaire. A quarter (1453) of men reported disability. Socio-economic position measured as both occupational class (social class I vs. V: age-adjusted OR 5.0, 95% CI 3.4-7.5) and ownership of home and car (both vs. neither: age-adjusted OR 2.8, 95% CI 2.3-3.4) showed a graded relationship with likelihood of reporting disability in 1992. Within all social class groups, those owning both home and car had a lower risk of disability than those who owned neither, even after adjustment for a wide range of risk factors. Men from manual occupations were more likely than those in non-manual occupations to report disability on developing chronic diseases. The relationship between socio-economic position and severe, but not milder, disability appeared to be independent of disease status. Socio-economic position is a strong predictor of disability in later life independent of a wide range of lifestyle factors and presence of diagnosed disease. The likelihood of reporting disability between and within social class groups is influenced by material wealth.

Activities of Daily Living↗