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Biomedical subjects

Shah Ebrahim

Publications and source records attributed to Shah Ebrahim.

At least 91 records · Page 5Linked to original sources
PubMed2004

Gender and age inequity in the provision of coronary revascularisation in England in the 1990s: is it getting better?

Although the mortality and incidence of coronary heart disease (CHD) in England and Wales has declined in recent years, an ageing population has contributed to keeping the prevalence of CHD largely unchanged. Evidence suggests that revascularisation procedures have contributed not only to this decline in mortality, but also to the decline in morbidity from heart disease, and to improvements in quality of life, even in old age. Despite clinical evidence of benefit, revascularisation is less often provided for older people and for women. This paper considers the equity of the provision of revascularisation according to need by gender and age using the Hospital Episodes Statistics (HES) database which includes all NHS hospital admissions in England. Trends from 1991 to 1999 were examined comparing admissions for acute myocardial infarction (as a proxy indicator of need in the absence of direct measures) and the procedures coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). The rates of CABG and PTCA have increased dramatically by 72% and 48%, respectively, between 1991/3 and 1997/9. Making allowance for differences in need, to achieve equitable provision with men, over 12,000 extra CABG and over 5000 PTCA procedures would be required for women, amounting to 19% and 10% increases in the total volume of each procedure, respectively. Similarly, attempting to meet need up to the age of 79 years would require over 13,000 extra CABG and over 13,000 PTCA procedures for men, and an additional 14,300 CABG and almost 10,000 extra PTCA procedures for women, representing 42% and 40% increases in CABG and PTCA, respectively. As women tend to present with CHD at older ages this indicates that they may be the victims of a 'double whammy' of inequity. Moreover, these inequities have remained constant through the study period. Possible explanations for this shortfall of provision are proposed.

Adult↗
PubMed2004

Hyperinsulinaemia and increased risk of breast cancer: findings from the British Women's Heart and Health Study.

OBJECTIVE: To assess the association between fasting insulin levels and breast cancer. DESIGN: Cross sectional study. PARTICIPANTS: 3868 women aged 60-79 years. MAIN OUTCOME MEASURE: Prevalent breast cancer (151 cases). RESULTS: Insulin levels were positively associated with breast cancer. The age adjusted odds ratio (95% confidence interval) for a one unit increase in log(e) insulin levels among women without diabetes was 1.34 (1.02, 1.77). This association was not substantively altered by adjustment for potential confounding factors (age of menopause, hysterectomy/oophorectomy, hormone replacement use, oral contraceptive use, parity, adult social class and smoking) or potential mediating factors (body mass index, waist to hip ratio, leg length, age at menarche and childhood social class). Women with both long legs and higher insulin levels were at particularly increased risk, with breast cancer prevalence being 5.7% among women in the highest thirds of both insulin levels and leg-length compared to 1.8% among those in the lowest thirds of both. Positive associations between insulin levels and breast cancer were found for both pre- and post-menopausal breast cancers. Fasting glucose levels, HOMA score, diabetes and a history of gestational glycosuria or diabetes were also positively associated with breast cancer CONCLUSIONS: Hyperinsulinaemia is positively associated with breast cancer in this cohort of older women. This effect may be mediated via a number of hormonal pathways acting at different stages of the life course.

Aged↗
PubMed2004

Chronic diseases, locomotor activity limitation and social participation in older women: cross sectional survey of British Women's Heart and Health Study.

OBJECTIVES: To examine the association of chronic degenerative diseases with locomotor activity limitation and social participation among older British women. METHODS: Cross-sectional survey of 4,286 women aged 60-79 years from 23 towns in England, Scotland and Wales. RESULTS: The prevalence of locomotor activity limitation was 37.2% and 33.5% of women had difficulty with some aspect of social participation. This prevalence of locomotor activity limitation and difficulties with social participation increased with increasing age and with increasing number of chronic diseases. All chronic diseases assessed were independently (of each other and confounding factors) associated with locomotor activity limitation. Associations were particularly strong for stroke (OR 5.44, 95% CI 3.38-8.75), arthritis (OR 3.95, 95% CI 3.25-4.81) and coronary heart disease (OR 2.26, 95% CI 1.77-2.88). The population attributable fraction for locomotor activity limitation was greatest for arthritis: 37.8% (95% CI 32.0-43.1) and coronary heart disease: 6.7% (95% CI 4.8-8.8). Locomotor activity limitation was strongly associated with social participation. Most chronic diseases of ageing were independently (of locomotor activity limitation, other chronic diseases and confounding factors) associated with reduced social participation. CONCLUSIONS: Locomotor activity limitation and difficulties in social participation are common. Arthritis and coronary heart disease contribute importantly to locomotor activity limitation and difficulties with social participation. Effective strategies to prevent or limit the disabling impact of these conditions are essential to improving the quality of life of older women.

Aged↗
PubMed2004

The challenge of secondary prevention for coronary heart disease in older patients: findings from the British Women's Heart and Health Study and the British Regional Heart Study.

BACKGROUND: Secondary prevention of coronary heart disease (CHD) among older individuals is associated with considerable benefit. METHODS: In this study, we have examined the extent of secondary prevention among British women and men aged 60-79 years who were surveyed and examined between 1998 and 2001. RESULTS: Among 483 women (12.1% of the whole sample) and 831 men (19.5%) with CHD, >90% of both sexes had at least one modifiable risk factor, with over two-fifths having high blood pressure and over three-quarters high cholesterol. For total cholesterol and body mass index, mean values in both male and female subjects were above recommended levels, and a large shift in the population distributions would be required for targets to be met. Less than one-quarter of subjects of either sex were on a statin, and whilst the majority of men were taking an antiplatelet medication, only 40% of women were. CONCLUSIONS: Most older women and men in Britain were failing to meet National Service Framework standards for secondary prevention in the period immediately before its implementation. Large shifts in the population distributions of some risk factors would be required in this group to meet these standards.

Aged↗
PubMed2004

Reasons underpinning patients' preferences for various angina treatments.

OBJECTIVE: To elicit patients' preferences for the treatment of angina. DESIGN: Angina patients were interviewed in order to elicit their personal reasons underlying preferences for various treatment options. Interviews followed a general repertory grid technique, in which seven treatment options were presented to patients in triads. Treatments considered ranged from medication to invasive revascularization therapies, with a 'no treatment' option. SETTING: Two general practices in Norwich, Norfolk. SUBJECTS: Twenty-one patients with diagnosed angina, which was both mild and stable. MAIN OUTCOME MEASURES: Treatment preferences verbalized by patients during interview, and the underlying reasons for these. RESULTS: Attitudes voiced towards the range of treatments for angina were diverse; 27 different reasons underlying patients' preferences were identified. Patients' preferences were largely justified by reasons associated with the conditional effectiveness or otherwise of treatments. When presented with treatment triads, medication (drug) treatments were over 2.5 times more likely to be chosen as a most preferred option than invasive or surgical treatments. Although surgical treatments were generally considered to be 'effective', it was perceived that they were more appropriate for situations when the condition became life-threatening. There were occasions, however, when preferences were driven by other reasons, such as a desire to avoid surgery because it was perceived negatively as 'invasive' and 'frightening'. Drug treatments were viewed as 'quick', 'easy' and reversible. Personal experiences of the effectiveness or otherwise of treatments were frequently cited as reasons for stated preferences. However, patients often commented that they would prefer the doctor to make the decision about their treatment. CONCLUSIONS: Patients choices among treatments was largely driven by perceptions of their effectiveness or otherwise. Although surgery was perceived as 'effective' it was also seen as conditionally so, dependent upon severity of the condition - which is not necessarily the case, as the risks of adverse events and surgical complications increase for emergency cases. As such, access to better information about the effectiveness and timeliness of interventions is needed. Although respondents held anxieties about treatment, particularly invasive or surgical treatments, fewer choices were driven by emotional and lifestyle factors unrelated to 'effectiveness', such as fear or ease of treatment.

Adult↗
PubMed2004

Sex differences in body fat distribution and carotid intima media thickness: cross sectional survey using data from the British regional heart study.

OBJECTIVE: To determine the role of central adiposity in explaining sex differences in carotid intima media thickness (IMT). DESIGN: Cross sectional survey. SETTING: Two British towns. PARTICIPANTS: 800 men and women aged 56-75 years. MAIN OUTCOME MEASURES: Carotid IMT. RESULTS: There was a continuous linear association between waist-hip ratio and IMT in both men and women. The magnitude of the association between waist to hip ratio and IMT was identical in both sexes. In age adjusted analyses IMT was 14% greater in men compared with women (age adjusted male to female ratio of geometric means 1.14; 95% confidence interval 1.07 to 1.21) with adjustment for waist to hip ratio this attenuated to no difference (1.00; 0.92 to 1.09). Adjustment for body mass index and for lifestyle risk factors had very little effect on the sex difference in mean intima media thickness. CONCLUSIONS: Sex differences in body fat distribution may explain sex differences in arterial atherosclerosis.

Aged↗
PubMed2004

Socioeconomic position and hormone replacement therapy use: explaining the discrepancy in evidence from observational and randomized controlled trials.

OBJECTIVES: We assessed the association between life-course socioeconomic status or position (SEP) and hormone replacement therapy (HRT). METHODS: We conducted a cross-sectional analysis of 4286 women aged 60 to 79 years. RESULTS: Women experiencing adverse socioeconomic circumstances across the life course were less likely to have used HRT. The associations of childhood socioeconomic measures with HRT use were independent of adult SEP, behavioral risk factors, and physiological risk factors for heart disease. CONCLUSIONS: SEP from across the life course is associated with HRT use. Because the association between early life SEP and HRT is not fully explained by adult risk factors, residual confounding (which is not captured by adjustment for adult variables only) may explain some of the disparity between observational studies and randomized controlled trials in this area.

Aged↗
PubMed2004

Association between childhood socioeconomic status and coronary heart disease risk among postmenopausal women: findings from the British Women's Heart and Health Study.

OBJECTIVES: We assessed the association between childhood socioeconomic status (SES) and coronary heart disease among postmenopausal women. METHODS: We conducted a cross-sectional analysis of 3444 women aged 60 to 79 years. RESULTS: There was an independent linear association between childhood and adult SES and coronary heart disease. The association between childhood SES and coronary heart disease was attenuated when we adjusted for insulin resistance syndrome, adult smoking, physical activity, biomarkers of childhood nutrition, and passive smoking. CONCLUSIONS: The association between adverse childhood SES and coronary heart disease is in part mediated through insulin resistance, which may be influenced by poor childhood nutrition, and in part through the association between childhood SES and adult behavioral risk factors.

Aged↗
PubMed2003

Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study.

OBJECTIVE: To establish the predictive accuracy of the Framingham risk score for coronary heart disease in a representative British population. DESIGN: Prospective cohort study. SETTING: 24 towns in the United Kingdom. PARTICIPANTS: 6643 British men aged 40-59 years and free from cardiovascular disease at entry into the British regional heart study. MAIN OUTCOME MEASURES: Comparison of observed 10 year coronary heart disease mortality and event rates with predicted rates for each individual, using the relevant Framingham risk equation. RESULTS: Of 6643 men, 2.8% (95% confidence interval 2.4% to 3.2%) died from coronary heart disease compared with 4.1% predicted (relative overestimation 47%, P < 0.0001). A fatal or non-fatal coronary heart disease event occurred in 10.2% (9.5% to 10.9%) of the men compared with 16.0% predicted (relative overestimation 57%, P < 0.0001). These relative degrees of overestimation were similar at all levels of coronary heart disease risk, so that overestimation of absolute risk was greatest for those at highest risk. A simple adjustment provided an improved level of accuracy. In a "high risk score" approach, most cases occur in the low risk group. In this case, 84% of the deaths from coronary heart disease and non-fatal events occurred in the 93% of men classified at low risk (< 30% in 10 years) by the Framingham score. CONCLUSION: Guidelines for the primary prevention of coronary heart disease advocate offering preventive measures to individuals at high risk. Currently recommended risk scoring methods derived from the Framingham study significantly overestimate the absolute coronary risk assigned to individuals in the United Kingdom.

Adult↗
PubMed2003

Association between falls in elderly women and chronic diseases and drug use: cross sectional study.

OBJECTIVE: To assess the associations between having had a fall and chronic diseases and drug use in elderly women. DESIGN: Cross sectional survey, using data from the British women's heart and health study. SETTING: General practices in 23 towns in Great Britain. PARTICIPANTS: 4050 women aged 60-79 years. MAIN OUTCOME MEASURE: Whether women had had falls in the previous 12 months. RESULTS: The prevalence of falling increased with increasing numbers of simultaneously occurring chronic diseases. However, no such relation with falling was found in the fully adjusted data for the number of drugs used. Circulatory disease, chronic obstructive pulmonary disease, depression, and arthritis were all associated with an increased odds of falling. The fully adjusted, population attributable risk of falling associated with having at least one chronic disease was 32.2% (95% confidence interval 19.6% to 42.8%). Only two classes of drugs (hypnotics and anxiolytics, and antidepressants) were independently associated with an increased odds of falling. Each class was associated with an increase of about 50% in the odds of falling, and each had a population attributable risk of < 5%. CONCLUSION: Chronic diseases and multiple pathology are more important predictors of falling than polypharmacy.

Accidental Falls↗
PubMed2003

Is the association between parity and coronary heart disease due to biological effects of pregnancy or adverse lifestyle risk factors associated with child-rearing? Findings from the British Women's Heart and Health Study and the British Regional Heart Study.

BACKGROUND: Parity is associated with coronary heart disease (CHD) risk. In the present study, we assessed the associations between number of children and CHD in both women and men. METHODS AND RESULTS: A total of 4286 women and 4252 men aged 60 to 79 years from 24 British towns were studied. Number of children was positively associated with body mass index and waist-hip ratio in both sexes. In women but not in men, number of children was inversely associated with high-density lipoprotein cholesterol and was positively associated with triglycerides and diabetes. For both sexes, similar "J" shaped associations between number of children and CHD were observed, with the prevalence lowest among those with 2 children and increasing linearly with each additional child beyond 2. For those with at least 2 children, each additional child increased the age-adjusted odds of CHD by 30% (odds ratio, 1.30; 95% confidence interval, 1.17 to 1.44) for women and by 12% for men (odds ratio, 1.12; 95% confidence interval, 1.02 to 1.22). Adjustment for obesity and metabolic risk factors attenuated the associations between greater number of children and CHD in both sexes, although in women some association remained. CONCLUSIONS: Lifestyle risk factors associated with child-rearing lead to obesity and result in increased CHD in both sexes; biological responses of pregnancy may have additional adverse effects in women.

Aged↗