Biomedical subjects

T A Pearson

Publications and source records attributed to T A Pearson.

At least 145 records · Page 8Linked to original sources

PubMed1990

Dyslipidemias with desirable plasma total cholesterol levels and angiographically demonstrated coronary artery disease.

The National Cholesterol Education Program treatment guidelines define a plasma total cholesterol of less than 200 mg/dl as "desirable" and recommend no further evaluation of plasma lipid or lipoprotein levels in patients with coronary artery disease (CAD). To determine the prevalence of dyslipidemias in the presence of coexistent CAD and total cholesterol less than or equal to 200 mg/dl, a retrospective case-control study of 1,000 patients who underwent diagnostic coronary angiography was performed. Of 351 patients with total cholesterol less than or equal to 200 mg/dl, 76% of the men (244) and 44% of the women (107) had angiographically demonstrated CAD. In men with CAD and total cholesterol less than or equal to 200 mg/dl, there was a significantly greater prevalence of low levels of high density lipoprotein (HDL) cholesterol (less than or equal to 35 mg/dl), age greater than 50 years, systemic hypertension and diabetes mellitus compared to non-CAD control subjects. In women with CAD and total cholesterol less than or equal to 200 mg/dl, HDL cholesterol less than or equal to 45 mg/dl and diabetes mellitus were also significantly prevalent. Multiple logistic regression analyses revealed that HDL cholesterol, hypertension and age in men and very low density lipoprotein cholesterol in women were significantly associated with CAD after adjustment for other risk factors. These results suggest that a complete lipid and lipoprotein analysis be obtained in all patients with CAD, irrespective of the plasma (or serum) total cholesterol level.

Adult↗

PubMed1990

Youthful precursors of alcohol abuse in physicians.

PURPOSE: This study was designed to determine youthful precursors of alcohol abuse in physicians. SUBJECTS AND METHODS: We analyzed data from an ongoing prospective study of 1,014 male medical students enrolled in the graduating classes of 1948-1964 at the Johns Hopkins School of Medicine. The cohort, now physicians aged 52 to 68 years, has been contacted regularly since medical school to identify major disease. In 1986, the CAGE alcoholism screening questionnaire was administered. Alcohol abuse was defined as self-admitted alcoholism, excessive consumption of four or more beverages per day on average, or a score of 2 or higher on the CAGE questionnaire. RESULTS: By these criteria, 131 of 1,014 (12.9%) patients abused alcohol. Medical school precursors associated (p less than 0.05) with subsequent alcohol abuse were as follows: non-Jewish ancestry (relative odds [RO] = 3.1), lack of religious affiliation (RO = 4.1), cigarette use of one pack or more per day (RO = 2.6), regular use of alcohol (RO = 3.6), anxiety (RO = 1.8) or anger (RO = 1.8) as a reaction to stress, frequent use of alcohol in nonsocial settings (RO = 1.6), past history of alcohol-related difficulty (RO = 3.1), and maternal alcoholism or mental illness (RO = 1.9). Precursors found not to be associated with alcohol abuse included sleep habits, use of sedatives or amphetamines, interest in athletics or hobbies, and parental relationship. CONCLUSION: Our results suggest that there are several identifiable medical school precursors of alcohol abuse in physicians.

Adult↗

PubMed1990

Plasma dehydroepiandrosterone and dehydroepiandrosterone sulfate in patients undergoing diagnostic coronary angiography.

Serum levels of DHEA sulfate are inversely associated with cardiovascular death in men, and urinary dehydroepiandrosterone (DHEA) levels are inversely associated with clinical manifestations of coronary artery disease. These observations may be related to the antiproliferative effects of DHEA, resulting in inhibition of atherosclerotic intimal hyperplasia. To examine the relation between these steroids and a direct measure of coronary atherosclerosis, plasma DHEA and DHEA sulfate levels were determined in 206 middle-aged patients (103 men, 103 women) undergoing elective coronary angiography. Plasma DHEA sulfate levels were lower in men with at least one stenosis greater than or equal to 50% compared with those without any stenosis greater than or equal to 50% (4.9 +/- 2.7 versus 6.1 +/- 3.5 nmol/ml, p = 0.05). Levels of DHEA sulfate were also inversely related to the number of diseased coronary vessels (r = -0.20, p = 0.05) and a continuous measure of the extent of coronary atherosclerosis (r = -0.25, p = 0.01) in men. The association between DHEA sulfate levels and extent of coronary artery disease was independent of age and other conventional risk factors for coronary disease. In women, there was no association between plasma DHEA or DHEA sulfate levels and coronary disease. These data demonstrate a consistent, independent, inverse, dose-response relation between plasma DHEA sulfate levels and angiographically defined coronary atherosclerosis in men. Plasma DHEA sulfate may be another important and potentially modifiable risk factor for the development and progression of coronary atherosclerosis.

Adult↗

PubMed1990

The epidemiology of idiopathic dilated cardiomyopathy in a biracial community.

An epidemiologic study of idiopathic dilated cardiomyopathy was carried out in order to identify possible risk factors for this often fatal cause of heart failure in young adults. Possible associations with black race and other genetic and environmental factors were examined by comparing newly diagnosed cases ascertained from four Baltimore hospitals (n = 95) with neighborhood controls (n = 95), matched on sex and 5-year age intervals. Matched and unmatched relative odds and conditional logistic regression coefficients were obtained to describe the associations. Statistically significant, independent associations were observed between idiopathic dilated cardiomyopathy and black race, low annual income, and history of asthma (p less than 0.05). The black predominance (relative odds = 2.7, 95% confidence interval 2.0-3.4) was not explained by income, alcohol consumption, cigarette usage, body mass index, hypertension, or asthma. A possible interactive effect was observed between black race and history of asthma and other atopic diseases. Thus, blacks, especially those with a history of hypersensitivity, may represent a high-risk subgroup in need of preventive care or early intervention.

Adolescent↗

PubMed1990

Screening for hypercholesterolemia.

The detection of individuals with hypercholesterolemia has received world-wide support as a means of determining who would benefit from dietary and pharmacologic interventions. However, the clinician or public health practitioner should be aware of several issues that must be resolved before cholesterol screening can attain maximal impact. This review examines whether hypercholesterolemia is a condition worthy of screening programs and discusses the promises and pitfalls of individual and mass screening approaches.

Cholesterol↗

PubMed1990

The effective treatment of postpericardiotomy syndrome after cardiac operations. A randomized placebo-controlled trial.

Although the postpericardiotomy syndrome is a common complication of cardiac operations, the most effective drug regimen for the treatment of this condition has not been established. The present study was designed to evaluate the effectiveness of nonsteroidal antiinflammatory drugs (NSAIDs) in the treatment of postpericardiotomy syndrome, in a double-blind, placebo-controlled randomized trial with a 10-day course of ibuprofen or indomethacin. Of 1019 adult patients undergoing cardiac operations during a 14-month period, a diagnosis of postpericardiotomy syndrome was made in 187, and 149 were enrolled in the study. Diagnosis was based on the presence of at least two of the following: fever, anterior chest pain, and friction rub. Drug efficacy was defined as the resolution of at least two of these criteria within 48 hours of drug initiation. Ibuprofen and indomethacin were 90.2% and 88.7% effective, respectively, and both were significantly more effective than placebo (62.5%, p = 0.003). The occurrence of side effects, including nausea, vomiting, renal failure, and fluid retention, was low in all groups (13.1% for ibuprofen, 16.1% for indomethacin, and 16.7% for placebo [p = not significant). Length of hospital stay, incidence of ischemic events, and accumulation of significant pericardial effusions were similar in all groups. The results of this study demonstrate that both ibuprofen and indomethacin provide safe and effective symptomatic treatment for postpericardiotomy syndrome.

Cardiac Surgical Procedures↗

PubMed1990

Risk factors for cardiovascular disease in U.S. medical students: the Preventive Cardiology Academic Award Collaborative Data Project.

Risk factors for cardiovascular disease are commonly obtained in freshman medical students for the purpose of increasing interest and awareness in preventive cardiology. What would be a normal range of values for this select group? This paper describes the major cardiovascular risk factors for 3,811 male and female freshman medical students from eight U.S. medical schools that were obtained in a standardized fashion as part of the Preventive Cardiology Academic Award (PCAA) programs at these institutions. The distributions of height, weight, Quetelet index, systolic and diastolic blood pressures, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and calculated low-density lipoprotein cholesterol are presented for male and female medical students stratified by race into white, black, Asian, and Hispanic groups. The sex and race distributions of cardiovascular risk factors such as previously diagnosed hypertension, diabetes mellitus, smoking, lack of regular exercise (three times a week or more), oral contraceptive use in women, and family history of coronary heart disease are presented. The cardiovascular risk of freshman medical students is compared to other epidemiologic studies of young adults. The use and limitations of these race- and sex-specific data on cardiovascular risk, including physiologic measurements, are discussed in the context of educational programs for medical students and house staff in preventive cardiology.

Adult↗

PubMed1990

The prediction of midlife coronary heart disease and hypertension in young adults: the Johns Hopkins multiple risk equations.

Educating medical students about the identification of risk factors for coronary disease and hypertension should be enhanced by exercises in which medical students identify their own risk factors and visualize the impact of current risk status on future risk of disease. A cohort of 1,130 former Johns Hopkins medical students were examined in medical school and followed annually from 1948 to 1964 to identify youthful factors associated with the development of coronary heart disease and hypertension in midlife. In the ensuing years through 1984, 51 cases of coronary heart disease and 114 cases of hypertension developed. Multiple risk equations using Cox proportional hazards regression were developed to predict these endpoints. Incidence of coronary heart disease was predicted best by an equation containing age, serum cholesterol at baseline, cigarette smoking at baseline, and paternal history of coronary disease. Hypertension was predicted best by an equation containing age, systolic blood pressure at baseline, paternal history of hypertension, and Quetelet index. These equations were applied to a class of present-day medical students to demonstrate the considerable variability in 30-year risk of coronary disease or hypertension. Thus, coronary heart disease and hypertension in midlife can be predicted by factors identified in youth. The Johns Hopkins multiple risk equations may be valuable as tools in preventive cardiology education to illustrate risk assessment and the importance of risk factor interventions.

Adult↗

PubMed1990

Strategies for increasing house staff management of cholesterol with inpatients.

This study tested the effectiveness of two conceptually different chart audit-based approaches to modifying physicians' clinical practices to conform with quality-assurance standards. The objective was to increase intern utilization of cholesterol management opportunities in the inpatient setting. Using a clinical trial study design, 29 internal medicine interns were randomly assigned to four intervention groups identified by the intervention they received: control, reminder checklists (checklists), patient-specific feedback (feedback), or both interventions (combined). Over a nine-month period, intern management of high blood cholesterol levels in internal medicine inpatients (n = 459) was monitored by postdischarge chart audit. During both a baseline and subsequent intervention period, interns documented significantly more cholesterol management for inpatients with coronary artery disease (CAD) than without CAD. During baseline, 27.3%, 24.3%, 21.7%, 12.4%, 5.4%, and 2.7% of all inpatient charts had intern documentation concerning a low-fat hospital diet, cholesterol history, screening blood cholesterol level assessment, follow-up lipid profile, nutritionist consult, and preventive cardiology consult, respectively. The feedback intervention significantly increased overall intern-documented cholesterol management among inpatients with CAD. The checklists significantly decreased overall intern-documented cholesterol management. Feedback appears to be an effective approach to increasing intern cholesterol management in inpatients.

Adult↗

PubMed1989

Idiopathic dilated cardiomyopathy and atopic disease: epidemiologic evidence for an association with asthma.

Because of recent evidence from in vitro studies suggesting that immediate hypersensitivity or other autoimmune mechanisms may play a role in the initiation or progression of idiopathic dilated cardiomyopathy (DCM), an epidemiologic study was carried out to examine possible associations with atopic diseases and other immunologic disorders. Newly diagnosed cases were ascertained from four Baltimore hospitals and were interviewed along with neighborhood controls identified using a random digit dialing technique. The cases and controls (N = 190) were matched on sex and 5-year age intervals and were compared in the analysis using matched and unmatched estimates of the relative odds and conditional logistic regression methods. A statistically significant, independent association was observed between idiopathic DCM and a history of asthma (p less than 0.05). The association was most pronounced among individuals who were less than 55 years of age (relative odds = 20.3, p less than 0.05), with 31.1% (14 of 45) of the patients who were under the age of 55 having a reported history of asthma. These findings support the theory that hypersensitivity mechanisms may be important in the development of idiopathic DCM. A treatment effect associated with asthma is an alternative possibility.

Adolescent↗

PubMed1989

Regional versus general anesthesia in high-risk surgical patients: the need for a clinical trial.

Regional anesthesia is often preferred over general anesthesia for patients with cardiovascular disease because of presumed decreased risk of perioperative myocardial ischemia. However, few studies have addressed this issue directly. To determine whether the type of anesthesia is independently associated with myocardial ischemia, records of 134 patients undergoing peripheral vascular grafting under general or regional anesthesia were examined. There were no significant differences preoperatively between groups in ASA class, age, sex, or prevalence of angina, diabetes, or hypertension. Twelve patients developed myocardial ischemia or infarction within 7 days of operation; 11 of these 12 patients had received regional anesthesia (p less than 0.015). The association between anesthetic approach and perioperative myocardial ischemia or infarction remained after adjustment for preoperative factors associated with ischemia or with type of anesthesia. General anesthesia does not appear to be associated with increased risk of myocardial ischemia, and stringent recommendations to avoid it in this population may be unfounded. A clinical trial is needed to define more clearly the risks and benefits of different types of anesthesia in high-risk patients.

Anesthesia, Conduction↗

PubMed1989

Cardiovascular reactivity to the cold pressor test as a predictor of hypertension.

Cardiovascular reactivity to stress is hypothesized to be a marker for subsequent neurogenic cardiovascular disease, but few prospective studies of this hypothesis are available. We studied 910 white male medical students who had their blood pressure and pulse rate measured before and during a cold pressor test in the years 1948-1964. Hypertensive status (requiring drug treatment) was ascertained by annual questionnaires in the 20- to 36-year follow-up period. An association was observed between maximum change in systolic blood pressure and later hypertension, with a cumulative incidence of hypertension by age 44 of 6.7%, 3.0%, and 2.4% for a change in systolic blood pressure in the upper, middle two, and lowest quartiles, respectively (Kaplan-Meier, p less than 0.02). After adjustment for study entry age, Quetelet Index, cigarette smoking, pretest systolic blood pressure, and paternal or maternal history of hypertension in a Cox model, the association persisted. The excess risk associated with systolic blood pressure reactivity was not apparent until the population aged some 20 years and was most apparent among those in whom hypertension developed before age 45 (relative risk = 2.5, 95% confidence intervals = 1.47, 4.71 for a 20 mm Hg change). Diastolic blood pressure and heart rate changes were not associated with later hypertension. These data suggest that persons prone to later hypertension manifest an altered physiology at a young age.

Adult↗

PubMed1989

Influences on CHD incidence and case fatality: medical management of risk factors.

The possible role of medical management of risk factors as an explanation of international trends in coronary heart disease (CHD) mortality has been reviewed. In general, hypertension, hypercholesterolaemia and smoking are the only risk factors that can be detected and treated, with a significant effect on CHD risk. Few organized international data are available to relate to international CHD trends. It appears that the rates of hypertension detection and control are improving, but for many countries, they are still quite low. Less is known about the relative contribution of lifestyle versus medical management as a cause for blood pressure change. Despite these caveats, it appears that blood pressure control may have played a role in CHD mortality trends; further impact of newer antihypertensive agents is likely. The increased medical management of hyperlipidaemia is a relatively recent phenomenon and is unlikely to explain past CHD trends. However, the increased use of these agents and the introduction of more effective agents makes a future effect on CHD likely. The impact of the medical system on smoking cessation is unclear; medical care providers clearly have a major potential role in smoking cessation, but it is difficult to measure. Thus, it appears that medical management of risk factors has had a minor impact on international CHD trends, though the data are sketchy at best. Future research should better delineate the detection and management of risk factors as an increasingly potent source of risk factor change and subsequent reduced CHD mortality.

Coronary Disease↗

PubMed1988

The epidemiology of the postpericardiotomy syndrome: a common complication of cardiac surgery.

PPS is a major cause of morbidity after cardiac surgery and may cause bypass graft closure and fatal cardiac tamponade. Little is known about its incidence and cause. To better define this syndrome characterized by postoperative fever, pericardial friction rub, and pericardial pain, we used two out of three of the preceding criteria to diagnose PPS. In a prospective epidemiologic study we followed 944 consecutive patients undergoing open-heart surgery between November 1984 and November 1985. The overall incidence was 17.8%. The incidence was increased in younger patients, in those with a history of prednisone use in the past, in patients with a past history of pericarditis, those with aortic valve replacement, and in patients who received enflurane or halothane anesthesia. PPS is a common syndrome. Knowledge of risk factors associated with PPS may allow its prevention and identification of patients who warrant early and aggressive treatment.

Age Factors↗

PubMed1988

Effect of low-dose alcohol use versus abstention on apolipoproteins A-I and B.

An inverse association between low to moderate alcohol consumption and coronary heart disease has been demonstrated in epidemiologic studies of diverse design. An attempt was made to determine if this association might be due to an effect of alcohol on apolipoproteins A-I and B and to determine if low-dose alcohol intake might have a potentially protective effect by this mechanism in persons at increased risk for coronary heart disease. To address this, an eight-week prospective randomized clinical trial of abstention versus low-dose alcohol consumption, defined as one beverage per day, was conducted in white men, aged 21 to 60 years, most of whom were patients of a preventive cardiology program. Apolipoprotein A-I levels had a mean increase of 9 mg/dl in the 28 participants who drank alcohol compared with a mean decline of 5 mg/dl in the 28 participants who abstained (p less than 0.005). This association was independent of other cardiovascular risk factors. Low-density lipoprotein (LDL)-B levels had a mean increase of 7 mg/dl in both arms of the trial (NS). However, the ratio of apolipoprotein A-I to LDL-B increased by 4 percent in the drinkers and decreased 10 percent in the abstainers (p less than 0.03). No significant changes in mean levels of total high-density lipoprotein (HDL)-, HDL2-, or HDL3-cholesterol were observed with this low dose of alcohol. This effect on apolipoprotein A-I suggests a possible mechanism by which low-dose alcohol may lower the risk of coronary heart disease.

Adult↗

PubMed1988

Attitudes toward prevention of cardiovascular diseases among first-year students at eight American medical schools, 1983-1985.

First-year medical students at eight U.S. medical schools were surveyed by written questionnaire in 1983-1985 to determine their attitudes toward cardiovascular diseases prevention at medical school entry. An overall response rate of 92% was achieved (2,654 questionnaires), and 97% of responders provided complete and analyzable survey data. Response rates at five of eight medical schools were 98-100%, and one school each had rates of 67, 84, or 90%. Differences in mean attitude responses from school to school were small, as were differences between men and women or between blacks and whites. This survey found that entering medical students have generally positive attitudes toward the effectiveness of preventive cardiology practice as well as toward the importance of research efforts in cardiovascular disease prevention. Students frequently indicated, however, that it is "extremely difficult" to change patients' unhealthful habits and that "physician encouragement" may not be sufficient to help patients achieve more healthful behaviors. These findings could be helpful in directing educational efforts for medical students. The data suggest that major emphasis should be placed on conveying facts regarding the physicians' efficacy in clinical preventive cardiology and on teaching the skills of preventive cardiology practice. Less emphasis appears to be necessary on encouraging positive attitudes about the importance of prevention since current students' attitudes appear to be already positive in this dimension.

Attitude of Health Personnel↗

PubMed1988

Risk factors in siblings of people with premature coronary heart disease.

Prior studies of the contribution of coronary disease risk factors to familial aggregation of premature coronary disease may have underestimated risk factors by relying on self-reported risk factor prevalence levels or, when risk factors have been measured, by using cut points in excess of the 90th percentile. To determine the actual prevalence of hyperlipidemia, hypertension and diabetes, and the awareness of these coronary risk factors in unaffected family members, 150 apparently coronary disease-free siblings of 86 people who had documented coronary disease before 60 years of age were studied. All subjects participated in a 1 day screening preceded by a self-administered risk factor questionnaire and a personal interview. Participation of both the index patients and siblings exceeded 86%. With the use of nationally established recommendations for blood pressure and lipids, which are based on coronary disease risk curves, screening revealed that 48% of brothers and 41% of sisters were hypertensive, 45% of brothers and 22% of sisters had a lipid abnormality, 38% of siblings were current cigarette smokers and 4.7% were diabetic. Two or more risk factors were present in 42% of brothers and 26% of sisters. More than 75% of siblings had one or more risk factors that would require intervention. When compared with a race-, gender- and age-matched reference population from the Lipid Research Clinics Prevalence Study, distributions for blood pressure and for total and low density lipoprotein cholesterol were higher for the siblings in every gender and age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Relationship between corticosteroid exposure and plasma lipid levels in heart transplant recipients.

PURPOSE: Accelerated coronary atherosclerosis is a major cause of heart graft failure two years and more after heart transplantation, yet its etiology remains undetermined. We conducted this study to determine the prevalence of coronary risk-associated lipid abnormalities, and the relationship between lipid levels and exposure to corticosteroids and cyclosporine, in heart transplant recipients. PATIENTS AND METHODS: The records of 92 consecutive heart transplant recipients from three different transplantation centers were reviewed. Patients from the three centers varied in age, in corticosteroid regimens, and in the proportion undergoing transplantation for ischemic cardiomyopathy. Although 11 patients were not receiving corticosteroids at the time of the study, all patients had received them immediately after transplantation. In addition to information pertaining to demographics, pretransplant medical history, rejection episodes, drug doses, renal function, and blood glucose levels, data on dietary intake and body weight were collected and plasma lipid levels were measured at the time of record review. RESULTS: A significant number, 48 (52 percent), of heart transplant recipients were above the sex- and age-adjusted 75th percentile, and 35 (38 percent) were above the 90th percentile for total cholesterol in comparison with a general reference population. Similar elevations were found in low-density lipoprotein cholesterol, triglyceride, and high-density lipoprotein cholesterol levels. Bivariate analysis demonstrated cumulative prednisone exposure (r = 0.40, p = 0.0001) and cumulative cyclosporine exposure (r = 0.22, p = 0.04) but not diet or etiology of pretransplant heart disease to be significantly associated with age- or sex-adjusted total cholesterol percentiles. Low-density lipoprotein cholesterol percentiles were also correlated with cumulative prednisone (r = 0.37, p = 0.001) and cumulative cyclosporine exposure (r = 0.24, p = 0.02). Stepwise multiple linear regression analysis, however, demonstrated cumulative prednisone exposure to be the strongest predictor of both total and low-density lipoprotein cholesterol levels and percentiles (p = 0.0001), independent of cumulative cyclosporine exposure and other clinical variables. CONCLUSION: These data suggest that long-term corticosteroid exposure may result in an increased prevalence of unfavorable lipid profiles in heart transplant recipients.

Adolescent↗