Biomedical subjects

Steven J Jacobsen

Publications and source records attributed to Steven J Jacobsen.

At least 91 records · Page 5Linked to original sources

PubMed2004

Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure.

OBJECTIVES: Questionnaires are used to estimate disease burden. Agreement between questionnaire responses and a criterion standard is important for optimal disease prevalence estimates. We measured the agreement between self-reported disease and medical record diagnosis of disease. STUDY DESIGN AND SETTING: A total of 2,037 Olmsted County, Minnesota residents > or =45 years of age were randomly selected. Questionnaires asked if subjects had ever had heart failure, diabetes, hypertension, myocardial infarction (MI), or stroke. Medical records were abstracted. RESULTS: Self-report of disease showed >90% specificity for all these diseases, but sensitivity was low for heart failure (69%) and diabetes (66%). Agreement between self-report and medical record was substantial (kappa 0.71-0.80) for diabetes, hypertension, MI, and stroke but not for heart failure (kappa 0.46). Factors associated with high total agreement by multivariate analysis were age <65 years, female sex, education >12 years, and zero Charlson Index score (P < .05). CONCLUSION: Questionnaire data are of greatest value in life-threatening, acute-onset diseases (e.g., MI and stroke) and chronic disorders requiring ongoing management (e.g.,diabetes and hypertension). They are more accurate in young women and better-educated subjects.

Age Factors↗

PubMed2004

Longitudinal changes in lower urinary tract symptoms among a cohort of black American men: the Flint Men's Health Study.

OBJECTIVES: To examine the progression of lower urinary tract symptoms in a longitudinal population-based cohort of black men. Population-based studies of prostatism and longitudinal data regarding changes in lower urinary tract symptom severity have largely focused on white men, with little attention directed toward black men. METHODS: In 1996, a probability sample of 369 black men, aged 40 to 79 years, residing in Genesee County, Michigan, and without a prior history of prostate cancer/surgery participated in a prostate cancer screening protocol that included completing the American Urological Association Symptom Index (AUASI). Four years after baseline, 175 of the 369 men agreed to participate in the follow-up protocol. Of the 175 men, 149 had not reported undergoing treatment for benign prostatic hyperplasia and had complete symptom data. These men were included in this study. Differences between baseline and follow-up AUASI scores were examined. RESULTS: The mean and standard deviation AUASI scores at baseline and follow-up were 7.1 (6.4) and 7.0 (6.8), respectively. Although overall no statistically significant change was found in the mean AUASI during the 4 years of follow-up (-0.11; SD 6.2; P = 0.7), the average change in the symptom score and the variability in the change increased with patient age at baseline from a mean of -0.42 (SD 5.0) among men in their 40s to 2.1 (SD 6.6) among men in their 70s. Of the 91 men (61.1%) who reported mild to no symptoms (AUASI score 7 or less) at baseline, 24 (26.4%) reported moderate to severe symptoms (AUASI score 8 or more) at follow-up. This progression of symptom severity was observed across all ages. CONCLUSIONS: In this population-based study of longitudinal changes in urinary symptoms in black men, we found a substantial percentage of men demonstrated a measurable progression in urinary symptom severity over time. Additional studies are needed to examine critically any racial differences in lower urinary tract symptom progression.

Adult↗

PubMed2004

Identification of women's coronary heart disease and risk factors prior to first myocardial infarction.

PURPOSE: To understand when women's coronary heart disease (CHD) and CHD risk factors are recognized prior to first myocardial infarction (MI). METHODS: Medical record review of the 10 years prior to incident MI among women with a confirmed incident MI between January 1, 1996, and December 31, 2001, to determine the timing of CHD diagnosis as well as assessment and treatment for risk factors. RESULTS: One hundred fifty women had incident MIs during the study period. They made 8732 ambulatory visits and had 457 hospitalizations during the period of review (mean 9.1 years, range 6.2-10 years). Average age at incident MI was 74.7 years (SD 12.6, range 38.9-99.8 years). A CHD diagnosis prior to first MI was present in 52% (n = 78) of the women but was less common in those <70 years (p = 0.001). All but 3 women had one or more modifiable risk factors identified prior to their first MI. Treatment of recognized risk factors varied from 81% (antihypertension medications) to only 28% (drug therapy for abnormal lipid levels). Having a diagnosis of CHD was associated with an increased likelihood of having identified risk factors and receiving drug treatment for identified risk factors. CONCLUSIONS: Women with undiagnosed CHD (48%) and those with unrecognized or untreated risk factors for CHD, especially younger women, represent missed opportunities for prevention of cardiac events.

Adult↗

PubMed2004

Prostatitis as a risk factor for prostate cancer.

BACKGROUND: The association of infection or inflammation of the prostate with prostate cancer has been suggested but not established. This study was undertaken to investigate this association. METHODS: Cases were Olmsted County, Minnesota, residents with histologically proven prostate cancer diagnosed between January 1980 and December 1996. Cases (n = 409) were each matched to 2 control subjects (n = 803) on age at diagnosis of prostate cancer, residency in Olmsted County, and duration of the community medical record. The medical record of each subject was reviewed for a history of acute or chronic bacterial prostatitis or chronic pelvic pain syndrome (inflammatory type). RESULTS: The relative odds of prostate cancer were elevated in men with history of any type of prostatitis (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.1-2.6) or acute prostatitis (2.5; 1.3-4.7). The mean time from most recent episode of acute prostatitis to the diagnosis of prostate cancer was 12.2 years. After exclusion of men with acute prostatitis 2 years before the index date, the relationship was somewhat reduced (1.9; 0.9-3.8). Chronic bacterial prostatitis was more weakly associated with prostate cancer (1.6; 0.8-3.1), whereas chronic pelvic pain syndrome was not associated at all (0.9; 0.4-1.8). CONCLUSIONS: Infection in the form of acute or chronic bacterial prostatitis may be associated with prostate cancer. However, our data do not provide compelling evidence to support this. As a result of the limitations of current methods of assessing chronic prostatitis, biochemical or tissue markers of infection or inflammation of the prostate may help clarify their role in the pathogenesis of prostate cancer.

Acute Disease↗

PubMed2004

Pertussis vaccination and the risk of respiratory syncytial virus-associated hospitalization.

BACKGROUND: Animal data suggest an association between recent vaccination with a pertussis-containing vaccine and increased severity of respiratory syncytial virus (RSV) infection. We sought to determine whether such an association exists in humans by studying a population-based cohort of young children. PATIENTS AND METHODS: We performed a nested case-control study of 280 children younger than 24 months of age hospitalized with RSV infection in Olmsted County, MN from January 1990 to December 1999. Controls (2 per case) consisted of nonhospitalized residents of Olmsted County matched to cases by date of birth and sex. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for the odds of hospitalization for RSV infection among subjects with a recent pertussis-containing vaccination in proximity to the cases' date of hospitalization relative to the odds among subjects with no vaccination. RESULTS: The OR for receipt of a pertussis-containing vaccine within 0 to 6 days of a case's hospitalization for RSV disease was 0.8 (95% CI 0.4-1.8). For the time intervals 7-13, 14-20 and > or =21 days, the OR were 1.3 (95% CI 0.5-3.0), 1.3 (95% CI 0.5-3.2) and 0.7 (95% CI 0.3-1.5), respectively. Adjusting for vaccine delay and for risk status did not alter the findings. The median interval between the most recent pertussis-containing vaccine and the case's date of hospitalization was 40 days for cases and 42.5 days for controls (P = 0.69). Among the RSV cases, pertussis vaccination in the month preceding hospitalization was not a risk factor for oxygen requirement (P = 0.82), intensive care unit admission (P = 0.46) or need for mechanical ventilation (P = 0.28). CONCLUSION: In our study, recent immunization with a pertussis-containing vaccine was not a risk factor for hospitalization for RSV infection. In addition, among children hospitalized with RSV infection, recent pertussis immunization was not associated with a more severe clinical course.

Case-Control Studies↗

PubMed2004

Low agreement between previous physician diagnosed prostatitis and national institutes of health chronic prostatitis symptom index pain measures.

PURPOSE: We evaluate the agreement between self-reported physician diagnosed prostatitis and pain questions from the National Institutes of Health Chronic Prostatitis Symptom Index (CPSI). MATERIALS AND METHODS: A randomly selected cohort of white men 47 to 90 years old from Olmsted County, Minnesota completed a study questionnaire on a history of physician diagnosed prostatitis in the preceding 2 years, including the CPSI questions. The medical records were also reviewed for physician diagnosis of chronic prostatitis during the preceding 10 years. RESULTS: Of 1,543 men 27 (1.7%) reported a physician diagnosis of prostatitis in the preceding 2 years. There were strong associations between self-reported prostatitis and pain at the tip of the penis (OR 6.3, 95% CI 1.4, 28.5), ejaculatory (5.9, CI 1.3, 26.6) and testicular (3.6, 1.2, 10.8) pain. The chance corrected agreement between self-reported prostatitis and pain symptoms was low at 0.01 (pubic pain) to 0.07 (pain at the tip of the penis, ejaculatory pain and testicular pain). Agreement in positive responses was also low at 3.7% (perineal pain) to 8% (pain at the tip of the penis, ejaculatory pain and testicular pain). The predictive value of the modified total CPSI score for prostatitis was 0.67, which was better than chance (0.5). Associations based on medical record ascertainment of prostatitis during followup were weak, and the area under the curve was 0.57, which was no better than chance. CONCLUSIONS: These findings demonstrate low agreement between CPSI-like pain measures and self-reported physician diagnosed prostatitis. The stronger associations between pain symptoms and self-reported diagnosed prostatitis, and the moderate predictive ability of the modified total CPSI score measures for self-reported prostatitis compared to medical record ascertainment demonstrate the sensitivity of the CPSI to prevalent symptoms. Thus, the tool may be best used to evaluate the severity of current symptoms rather than to assess the presence or absence of prostatitis.

Adult↗

PubMed2004

Inverse association between prostate cancer and the use of calcium channel blockers.

Calcium channel blockers block calcium signal-mediated apoptosis. It is hypothesized that the use of these drugs may be associated with the development of cancer. This study investigated the association between daily use of calcium channel blockers and prostate cancer in a community-based cohort of men who participated in a longitudinal study of lower urinary tract symptoms. Study subjects were men ages 40 to 79 years by January 1, 1990, and were randomly selected from Olmsted County in Minnesota. At baseline, participants underwent an interview to determine all medications taken on a daily basis, including calcium channel blockers and to elicit a family history of prostate cancer. During follow-up, all men with a histological diagnosis of prostate cancer were identified through patient self-report and by a review of the complete medical record. Over 12,668 person years of follow-up, 15 (6.8%) of 220 calcium channel blocker users and 120 (10.5%) of 1142 nonusers developed prostate cancer (P = 0.09; odds ratio, 0.62; 95% confidence interval, 0.36-1.10). With adjustment for age and family history of prostate cancer, the risk (odds ratio, 95% confidence interval) of prostate cancer was 0.55 (0.31-0.97) in calcium channel blocker users compared with nonusers. In analyses stratified by family history of prostate cancer, the risk of prostate cancer was 0.45 (0.23-0.88) in men without a family history and 2.64 (0.82-8.47) in men with a family history of prostate cancer (P = 0.006). These findings suggest an association between prostate cancer and daily use of calcium channel blockers that varies by family history of prostate cancer.

Adult↗

PubMed2004

Measurement of ejection fraction after myocardial infarction in the population.

OBJECTIVES: To assess the secular trends in left ventricular ejection fraction (LVEF) assessment after myocardial infarction (MI) and to identify the determinants of testing. DESIGN: A population-based MI incidence cohort. METHODS: The use of tests measuring LVEF (echocardiography, radionuclide, and left ventricular [LV] angiography) was examined among all consecutive residents of Olmsted County, MN, hospitalized for a validated incident MI between 1979 and 1998. Baseline characteristics and outcome were ascertained from community medical records. RESULTS: Among 2,317 patients with incident MI, LVEF assessment increased from 1979 to 1986 (22 to 85%; p value for trend = 0.0001) to stabilize thereafter until 1998. During the most recent decade, LVEF was measured during the hospital stay in 81% of the patients. Characteristics associated with lesser use of tests included older age and measurement of ejection fraction within 1 year prior to the index MI. Larger MI size, prolonged hospital stay, and involvement of a cardiologist as a care provider were positively associated with determination of LVEF. CONCLUSIONS: Measurement of LVEF after MI increased in the last 2 decades, but there continues to be a group of patients in whom it is not done. Given the potential benefits of LVEF measurement, including knowledge for risk stratification and therapeutic choices as underscored in recent practice guidelines, there may be additional opportunities for improving outcomes by ensuring its more consistent use. However, as testing for LVEF differs according to patient characteristics, reliance on selected clinically performed LVEF measurements will result in biased estimates of the prevalence of LV dysfunction after MI.

Adult↗

PubMed2004

Prevalence and secular trends of excess body weight and impact on outcomes after myocardial infarction in the community.

OBJECTIVES: To determine the trends in the prevalence of overweight and obese individuals among patients with myocardial infarction (MI), and to assess the association between weight and outcomes after MI. DESIGN: Population-based cohort study. METHODS: MIs occurring in Olmsted County, MN, between 1979 and 1998 were validated using standardized criteria. Clinical characteristics and outcomes were ascertained from community medical records. The prevalence and trends of excess weight and its association with outcomes were analyzed. RESULTS: Sixty-four percent of the 2,277 subjects with incident MI were overweight or obese. The prevalence of overweight/obese patients increased from 58% in the period from 1979 to 1983, to 72% in the period from 1994 to 1998 (p < 0.001), while the prevalence of class 3 obesity (body mass index >or= 40) increased from 0.6 to 4.4%. Overweight and obese patients were more likely to have diabetes, hypertension, familial coronary disease, and hyperlipidemia than persons with normal weight but less likely to have comorbidities (obstructive lung disease, heart failure, cancer, renal failure, and stroke) [all p values < 0.05]. When compared to patients with normal weight, after adjusting for age and other confounders, overweight and obese patients had a lower mortality (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.73 to 0.96 for overweight; and RR, 0.85; 95% CI, 0.72 to 1.02 for obese) and a similar risk of cardiac events. CONCLUSION: The prevalence of overweight and obese individuals among patients with MI is high and increased over time. Despite a higher prevalence of other cardiovascular risk factors among patients with excess weight, these patients did not experience worse outcomes, underscoring the need to further study the paradoxical relation between weight and post-MI outcomes.

Aged↗

PubMed2004

Lower urinary tract symptoms and sexual dysfunction in community-dwelling men.

OBJECTIVES: To evaluate the cross-sectional association between lower urinary tract symptoms (LUTS) severity and sexual function in a population-based sample of men and the extent to which this association might be explained by age. SUBJECTS AND METHODS: Subjects in The Olmsted County Study of Urinary Symptoms and Health Status Among Men (55% participation rate) included 2115 white men aged 40 to 79 years; subjects were recruited on January 1, 1990, from a random sample identified through the Rochester Epidemiology Project. At baseline in 1990 and biennially thereafter, these men completed a self-administered questionnaire that assessed LUTS severity with questions similar to those of the American Urological Association Symptom Index. At the 6-year follow-up, 11 previously validated questions about male sexual function from the Brief Sexual Function Inventory were added. RESULTS: Overall, each of the sexual function domains (sexual drive, erectile function, ejaculatory function, problem assessment, and overall sexual satisfaction) was inversely associated with the severity of LUTS, with Spearman correlation coefficients ranging from -0.21 to -0.31 (all P<.001). In age-adjusted analyses, the ejaculatory function and problem assessment domains were most strongly associated with overall LUTS severity, whereas the association with sexual drive was substantially diminished. Little difference was noted in the magnitude of association between sexual function and either obstructive or irritative symptoms. CONCLUSIONS: The cross-sectional data suggest that sexual function is inversely associated with LUTS severity and that this association is only partially attributable to the confounding effects of age.

Adult↗

PubMed2004

Evidence-based therapies for myocardial infarction: secular trends and determinants of practice in the community.

OBJECTIVES: To examine secular trends in the use of evidence-based therapies in a geographically defined cohort of patients with myocardial infarction (MI) and to test the hypotheses that baseline use is increasing and that disparities in use are diminishing, PATIENTS AND METHODS: All consecutively hospitalized patients who were dismissed from Olmsted County, Minnesota, hospitals between 1979 and 1998 with a diagnosis of MI were identified using standardized criteria (biomarkers, cardiac pain, and electrocardiography). The entire community medical record, available via the Rochester Epidemiology Project, was reviewed to ascertain baseline characteristics including comorbidity, presence of ST-segment elevation on electrocardiography, and treatment. Logistic regression models were used to examine the association of treatment with age and sex, independent of other baseline characteristics. RESULTS: Between 1979 and 1998, 2317 incident MIs (patient mean +/- SD age, 67+/-14 years; 43% women; 57% aged > or = 65 years) occurred in Olmsted County. The use of all evidence-based therapies increased over time, primarily reflecting the introduction of these medications at the time of Index MI. Between 1989 and 1998, age was not independently associated with use of aspirin or ACE inhibitors. Disparities in use persisted for reperfusion therapy and beta-blockers. Reperfusion therapy or revascularization was used less frequently in older persons, particularly in elderly women (P<.001). Use of beta-blockers decreased 16% among persons aged 65 years or older, independent of measurable differences in baseline characteristics and MI severity (hazard ratio, 0.84; 95% confidence interval, 0.74-0.93). CONCLUSIONS: The use of all evidence-based therapies for MI increased markedly over time; however, residual gaps in use were noted. Reperfusion therapy or revascularization is used less frequently in women and elderly persons, and beta-blockers are used less frequently in elderly persons. These differences are not explained by measurable differences in baseline characteristics. Women and elderly persons represent an increasing proportion of patients with MIs in the community; therefore, these findings define therapeutic opportunities.

Adrenergic beta-Antagonists↗

PubMed2004

Early life risk factors for attention-deficit/hyperactivity disorder: a population-based cohort study.

OBJECTIVES: To Identify risk factors for attention-deficit/hyperactivity disorder (ADHD) and to determine whether these factors differ between boys and girls. SUBJECTS AND METHODS: We conducted a case-control study of all children born between January 1, 1976, and December 31, 1982, in Olmsted County, Minnesota (N=5701), and examined birth certificates for risk factors for ADHD. Using school and medical records, we identified 305 children with ADHD. All children not identified with ADHD served as controls (N=5326). Risk factors that were assessed included demographic characteristics of both children and parents, as well as pregnancy, labor, and delivery characteristics, including the effect of a multiple birth and presence of pregnancy and delivery complications. RESULTS: Pregnancy and labor characteristics, low birth weight, and presence of a twin birth were not associated with ADHD. Male sex (odds ratio [OR], 3.05; 95% confidence interval [CI], 2.34-3.98) was associated with an increased risk for ADHD, whereas high maternal and paternal education levels (high maternal education: OR, 0.57; 95% CI, 0.42-0.78; high paternal education: OR, 0.58; 95% CI, 0.49-0.78) were associated with a decreased risk for ADHD. In addition, low maternal and paternal education levels increased the risk for ADHD in boys more than in girls. CONCLUSION: Male sex and low parental education levels are significant risk factors for ADHD. In addition, boys born to parents with low maternal and paternal education levels appear to be at an increased risk for ADHD compared with girls born to parents with low education levels.

Adult↗

PubMed2003

No association of germline alteration of MSR1 with prostate cancer risk.

The macrophage scavenger receptor 1 gene (MSR1) was recently identified as a candidate susceptibility gene for hereditary prostate cancer and as a risk factor for sporadic prostate cancer. To confirm these findings, we screened MSR1 for germline mutations among individuals with familial prostate cancer and tested gene variants for associations in both sporadic and familial prostate cancer. Our results do not support MSR1 as a risk factor for prostate cancer.

Aged↗

PubMed2003

Luteinizing hormone beta polymorphism and risk of familial and sporadic prostate cancer.

BACKGROUND: Circulating testosterone plays an important role in maintenance and growth of prostate cells. Luteinizing hormone (LH), secreted from the anterior pituitary, signals testicular Leydig cells to secrete testosterone. A genetic variant of the LH-beta protein, LH-betaV, exists in up to 40% of Caucasians and is more bioactive than the wild-type protein. We hypothesized that genetically determined variation in LH function might affect susceptibility to prostate cancer via altered testosterone secretion. METHODS: We determined the frequency of the LH-betaV polymorphism (two linked polymorphisms: Trp(8) --> Arg and Ile(15) --> Thr) in familial prostate cancer patients (n = 446), in sporadic prostate cancer patients (n = 388), and in population-based controls without prostate cancer (n = 510) to assess the role of this polymorphism in susceptibility to prostate cancer. RESULTS: A higher frequency of this variant genotype (LH-betaV: Arg(8)/Thr(15)) was observed in familial prostate cancer patients (18.6%) than in controls (13.7%), and after taking into account the correlation of the familial cases and adjusting for age and body mass index (BMI), there was a weak positive association between the variant LH-beta genotype, and risk of familial prostate cancer (OR = 1.29; 95% CI 0.96-1.75). The sporadic case group was also slightly more likely to have a variant genotype (15.2%) compared to the controls (13.7%), and after adjustment for age and BMI, a similar association with this variant was found (OR = 1.33; 95% CI 0.86-02.07). Surgical cases showed a slightly stronger association for the variant LH-beta genotype compared to non-surgical cases, but among the surgical cases there was little variability in risk across nodal status, stage, and tumor grade. CONCLUSIONS: These data are consistent with the hypothesis that the LH-beta variant is a weak risk factor for prostate cancer.

Adult↗

PubMed2003

Incidence of heart failure after myocardial infarction: is it changing over time?

Improved survival after myocardial infarction (MI) could result in MI survivors' contributing to the US heart failure epidemic. Conversely, since the severity of MI is declining over time, a decline in post-MI heart failure might also be anticipated. This study tested the hypothesis that the incidence of post-MI heart failure was declining over time in a geographically defined MI incidence cohort. Between 1979 and 1994, 1,537 patients with incident MI and no prior history of heart failure were hospitalized in Olmsted County, Minnesota. Framingham Heart Study criteria were used to ascertain the incidence of inpatient and outpatient heart failure over a mean follow-up period of 7.6 years (standard deviation 5.5). Overall, 36% of patients experienced heart failure. After adjustment for factors related to post-MI heart failure (age, hypertension, smoking, and biomarkers), the incidence of heart failure declined by 2% per year (relative risk = 0.98, 95% confidence interval: 0.96, 0.99; p = 0.01). The relative risk of developing heart failure among persons with MIs occurring in 1994 versus 1979 was 0.72 (95% confidence interval: 0.55, 0.93), indicating a 28% reduction in the incidence of heart failure. Administration of reperfusion therapy within 24 hours after MI was associated with lower risk of post-MI heart failure and accounted for most of the temporal decline in heart failure. This suggests that improved survival after MI is unlikely to be a major contributor to the heart failure epidemic.

Adult↗

PubMed2003

Insulin-like growth factor I, insulin-like growth factor binding protein 3, and urologic measures of benign prostatic hyperplasia.

Laboratory studies suggest that insulin-like growth factor I (IGF-I) promotes prostatic growth. The authors evaluated the association between benign prostatic hyperplasia and IGF-I and its binding protein IGFBP-3 in community-dwelling men to determine whether this laboratory finding is manifest at the population level. Participants (n = 471) were Olmsted County, Minnesota, Caucasian males aged 40-79 years in 1990. Urologic measures were assessed from the International Prostate Symptom Score, peak urinary flow rates, prostate volume, and serum prostate-specific antigen (PSA), and serum IGF-I and IGFBP-3 levels were measured. After adjustment for age, the relative odds (odds ratios) of an abnormal urologic measure in men with high versus low serum IGF-I levels were 0.98 (95% confidence interval (CI): 0.66, 1.45) for a symptom score of >7, 1.14 (95% CI: 0.72, 1.80) for a peak urinary flow rate of <12 ml/second, 1.11 (95% CI: 0.72, 1.72) for a prostate volume of >30 ml, and 0.71 (95% CI: 0.46, 1.09) for a PSA level of >1.4 ng/ml. A low IGFBP-3 level was associated with an enlarged prostate (odds ratio = 1.72, 95% CI: 1.05, 2.82), after simultaneous adjustment for IGF-I and age, but not with other urologic measures. These data do not provide evidence for an association between benign prostatic hyperplasia and serum IGF-I.

Adult↗

PubMed2003

Coronary heart disease death and sudden cardiac death: a 20-year population-based study.

Trends in out-of-hospital coronary heart disease (CHD) death, a surrogate for sudden cardiac death (SCD), are important for understanding the decline in CHD mortality. Little is known about out-of-hospital CHD death without prior CHD diagnosis, the definition of unexpected SCD. The authors analyzed secular trends in CHD death and unexpected SCD over a 20-year period (1979-1998) to examine the association between prior CHD and SCD and to test the hypothesis that in-hospital deaths declined more than SCDs. The yearly decline in CHD mortality rates was 5.3% for in-hospital deaths and 1.8% for out-of-hospital deaths (p = 0.001). Among all SCDs, the proportion of unexpected SCD was 49%. Mortality rates for both unexpected SCD and SCD with prior CHD declined over time, but unexpected SCD declined at a slower rate than SCD with prior CHD (p = 0.001). The relative odds of prior CHD were higher among persons with SCD than among controls, but there was a modest decline in the magnitude of the association. Thus, during the past 20 years, the decline was greater for in-hospital CHD deaths than for SCDs. Since approximately half of the SCDs were unexpected and rates of these deaths declined less over time than rates of SCD with prior CHD, primary prevention is becoming increasingly more important in sustaining the decline in CHD mortality.

Adult↗

PubMed2003

Left atrial volume as an index of left atrial size: a population-based study.

OBJECTIVES: We studied left atrial volume (LAV) as an index of atrial size. BACKGROUND: Increased left atrial dimension (LAD) measured by M-mode echocardiography is a risk factor for atrial fibrillation, stroke, and death. METHODS: A random sample of residents of Olmsted County, Minnesota, age > or =45 years (n = 2,042) underwent Doppler echocardiography with assessment of LAD and LAV. A subgroup of the population (n = 767) with no cardiovascular disease and normal systolic and diastolic function was used to develop reference ranges for LAD and LAV. In the total population, the prevalence of left atrial enlargement and the association between cardiovascular disease and left atrial size as determined by both indexes were assessed. RESULTS: In the normal subgroup, both indexes were associated with gender and body size, thus models controlling for body size were used to determine gender-specific reference ranges for LAD and LAV. In the total population, left atrial enlargement was common, with a prevalence of 18% (men) and 12% (women) using LAD/body surface area (BSA) and of 16% (men and women) using LAV/BSA. The agreement between the indexes was only fair (kappa = 0.53). Adjusting for age and gender, LAV/BSA was more strongly associated with the presence of cardiovascular diseases than LAD/BSA. CONCLUSIONS: We described a simple technique of measuring LAV, examined methods for indexing LAV, and described its normal range in a large, healthy reference cohort. Further, we find that in the community, left atrial enlargement is common and reflects the burden of cardiovascular disease.

Age Factors↗