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Biomedical subjects

U Goldbourt

Publications and source records attributed to U Goldbourt.

At least 145 records · Page 8Linked to original sources
PubMed1986

High density lipoprotein cholesterol: prognosis after myocardial infarction. The Israeli Ischemic Heart Disease Study.

In people without overt clinical coronary heart disease (CHD), reduced levels of high density lipoprotein cholesterol (HDLC) are a known predictor of a first myocardial infarction (MI), and of death from CHD. Less is known about the role of HDLC in the prognosis of patients with coronary heart disease. In 130 men with electrocardiographic evidence of myocardial infarction examined in the Israeli Ischemic Heart Disease Study in 1963, the relationship of HDLC to prognosis was examined. Approximately 60% (77 men) died between 1963 and 1978. Analysis of mortality by HDLC quartiles revealed the highest rate, 74%, in the bottom HDLC quartile (less than 30 mg/dl). Quartile analysis was also performed for HDLC as a per cent of total cholesterol (PHDL), known as a better predictor of CHD incidence. Mortality was as high as 81% in the bottom quartile (PHDL less than 13%), with a relative mortality risk of 1.71 for subjects in the bottom quartile compared to those in the top quartile (PHDL greater than or equal to 19%). Initial mean PHDL in patients surviving 15 years was significantly higher than in those dying during that time (17.8% versus 16.2%, p less than 0.05). Multivariate analysis, using the Cox proportional hazards model, indicated an association close to conventional statistical significance between HDLC and long-term mortality (p = 0.069). The results are comparable with those reported by the Coronary Drug Project Study. Further investigations of larger cohorts of CHD survivors are needed before firm conclusions about the role of HDLC and the potential for the use of HDLC affecting drugs or lifestyle changes can be drawn.

Adult↗
PubMed1986

Elevated systolic blood pressure as a predictor of long-term cancer mortality: analysis by site and histologic subtype in 10,000 middle-aged and elderly men.

The association of a casual reading of blood pressure (BP) in 1963 to subsequent 15-year cancer mortality was examined in a cohort of 10,059 middle-aged and elderly men. Systolic BP (SBP), but not diastolic BP, predicted significantly long-term cancer mortality occurring in 369 subjects. The covariate-adjusted relative risk (RR) estimated by Cox's proportional hazard model was 1.10 [95% confidence interval (CI), 1.00-1.21]. In patients aged less than 60 at the beginning of the study, increased cancer mortality was mainly observed in association with SBP of more than 150 mm Hg. In subjects aged 60 or above, the estimated RR was 1.21 (95% CI, 1.03-1.42). Exclusion of 40 men in whom diagnosis made prior to 1963 or death occurred through 1965 did not alter the results. An excess mortality in men who reported pharmacologic treatment for hypertension while under follow-up was fully accountable by their age, BP, and smoking habits. Analysis by site suggested that the association was mainly due to increased mortality from cancer of the digestive and genitourinary organs (estimated RR's, respectively, 1.20 and 1.26; 95% CI's, respectively, 1.03-1.39 and 0.99-1.59). Analysis by histologic subtype suggests an association with adenocarcinoma (RR = 1.19, 95% CI, 1.04-1.37) but not squamous cell or transitional cell carcinomas, myeloma, lymphomas, and leukemias.

Adult↗
PubMed1985

Total and high density lipoprotein cholesterol in the serum and risk of mortality: evidence of a threshold effect.

The association of serum total and high density lipoprotein cholesterol values with 15 year mortality was examined in a cohort of 10 059 Israeli male civil servants and municipal employees aged 40 and above. In 618 of 1664 deaths in the cohort (37%) coronary heart disease was documented as the cause of death. Risk of mortality was analysed by quintiles. Neither total mortality nor coronary heart disease mortality rose with serum cholesterol concentrations up to 5.6 mmol/1 (216 mg/100 ml), representing 60% of the sample. Rates rose appreciably only in the highest quintile (cholesterol concentration greater than 6.2 mmol/1; greater than 241 mg/100 ml). High density lipoprotein cholesterol was similarly, although inversely, associated with total mortality when expressed as a percentage of total cholesterol. The inverse association of high density lipoprotein cholesterol with coronary heart disease mortality was, in contrast, continuous. These data support the hypothesis that over most of the range of cholesterol values coronary mortality risk and total mortality risk are nearly independent of total cholesterol and most probably independent of low density lipoprotein cholesterol values. In multivariate analysis a low concentration of high density lipoprotein cholesterol appeared to be more predictive of mortality than a high concentration of total cholesterol. The latter was very weakly related to mortality from all causes after multivariate adjustment. It is concluded that the findings of this and other major epidemiological studies support the notion of a "threshold effect." Success in reducing mortality through the pharmacological reduction of serum cholesterol in hypercholesterolaemic patients does not warrant a similar approach in people with average or slightly above average values. These findings appear to provide support for a "high risk strategy" in reducing the risk of coronary heart disease.

Adult↗
PubMed1985

Trends in coronary heart disease mortality and related factors in Israel.

Age-adjusted mortality from coronary heart disease (CHD) showed a striking decline in Jews living in Israel between 1974 and 1979. The decline was evident for both males (age-adjusted rate, age 25+, declining from 441 to 347/100,000) and females (declining from 303 to 205/100,000, respectively), and probably for each of the different immigrant groups. A similar decline in Arabs and Druse has not been identified and awaits further analysis. The decline has been associated with the presentation of coronary care units, coronary bypass surgery, improved emergency service and cardiopulmonary resuscitation procedures. The modernization of diagnostic procedures, discharge and rehabilitation, and possibly pharmacologic therapy may also have contributed, but available data do not provide unequivocal proof for the role of secondary prevention. In the realm of primary prevention, evidence for improved screening, treatment and control of hypertension is suggestive but not conclusive. Little, if any, change in serum cholesterol levels and cigarette smoking habits has been observed. A continuous increase of the percent of calories derived from fat has been apparent, while energy derived from carbohydrates, notably starch, has been declining. Thus, changes in CHD mortality were not accompanied by putatively anti-atherogenic trends in eating habits. The reasons behind the striking decline of CHD mortality in Israel are not clear, but so far there is very little in the available data to suggest a meaningful effect of life-style modifications on mortality trends.

Adult↗
PubMed1984

Different effects of metoprolol and chlorthalidone on serum lipoprotein levels in mild hypertension. Possible implications for coronary heart disease risk status.

The effects of chlorthalidone and metoprolol on fasting plasma lipids and lipoprotein levels were compared in two similar nonrandomized groups of patients with mild hypertension. Chlorthalidone therapy was associated with an increase in serum cholesterol of 8.1% (17 mg/dl), mainly reflecting an increase in low-density lipoprotein (LDL)-cholesterol. High-density lipoproteins (HDL)-cholesterol decreased, but the difference between pre- and posttreatment levels did not reach statistical significance. Serum triglyceride (TG) concentration increased by 16% (20 mg/dl). Metoprolol therapy was not associated with changes in total, very low-density lipoprotein (VLDL)-, LDL- and HDL-cholesterol levels. Serum TG concentration increased by 22% (28 mg/dl), mainly due to an increase in VLDL-TG. Application of the Israel Ischemic Heart Disease Study data to these findings could predict only a very slight decrease in the 5-year estimated probability of myocardial infarction in the chlorthalidone-treated group. Metoprolol therapy has, theoretically, a more favorable influence on coronary heart disease risk status. These data suggest that the different forms of therapy for mild hypertension have a different effect on the theoretical coronary heart disease risk status, a fact that should be taken into consideration in the choice of medication.

Body Weight↗
PubMed1983

Prevalence and 15-year incidence of retinopathy and associated characteristics in middle-aged and elderly diabetic men.

We examined 178 men for the presence of diabetic retinopathy during 1978-80. They had been part of a group of 205 men from the Jerusalem area, diagnosed as being diabetic or having an abnormal glucose tolerance test in the Israel Ischaemic Heart Disease Project, a 5-year epidemiological investigation of Israeli male government employees. Seventy-four (42%) had diabetic retinopathy as determined by direct and indirect ophthalmoscopy, 3-mirror contact lens examination, and fundus photography. Those with and without retinopathy were compared for clinical, biochemical, behavioural, and biographical variables measured subsequently in 1963, 1965, and 1968. We found no significant differences between the 2 groups with respect to antecedent Quetelet index, blood pressure, peripheral vascular disease, blood lipids, haematocrits, smoking habits, area of birth, and education. Statistically significant differences between men with and without retinopathy were found for severity of carbohydrate metabolic intolerance at identification, duration of the metabolic abnormality, age, casual glucose values, and serum uric acid levels. Low serum uric acid appears to precede the incidence of diabetic retinopathy and to decline further as the disease progresses.

Adult↗
PubMed1983

Coronary heart disease: genetic aspects.

Morbidity and mortality differences between populations, between ethnic groups and between individuals are not satisfactorily explained by the variation of risk factors. Differences in genetic susceptibility might be responsible for a part of the unexplained variation of coronary heart disease (CHD) rates. Genetic factors are also significant in determining the level of risk factors in individuals. Ample evidence links genetic factors to the levels of serum cholesterol, blood pressure and diabetes. Marked sex differences in CHD mortality also indicate the role of heredity in the development of the disease. The male:female ratio varies widely between different countries, as well as between different ethnic groups. These variations are difficult to explain by variation in environmental and behavioral differences between males and females alone. The degree of atherosclerosis in males and females varies, depending on the anatomic location of the atherosclerosis. Inherited disorders of metabolism and the variability of anatomic patterns provide additional indications of the role of genetics. The data accumulated in the Israeli Ischemic Heart Disease Study over 15 years reveal an ethnic variation of risk factors coupled with remarkably larger variation in disease rates. Patterns of incidence assessed in the national mortality data of the Israeli study and in histologic findings in the coronary arteries of infants from different ethnic groups are compatible with a hypothesis that ethnic and sex differences in early structural changes of the coronary arteries partly determine the susceptibility of the latter to the development of atherosclerosis. In conclusion, findings from our studies and the review of the evidence from genetic epidemiologic investigations indicate a significant role of genetics in determining the degree, time course and severity of the atherosclerotic process and of the occurrence of symptomatic CHD. This important role of the genetic component is relevant to preventive strategies offered as tools for reducing the burden of CHD. Research into genetic determinants of both susceptibility to atherosclerosis or clinical manifestation of CHD and individual response to preventive measures should be encouraged.

Adolescent↗
PubMed1983

Hypertension in middle-aged men. Associated factors and mortality experience.

Seven hundred and seventeen hypertensive middle-aged men (HTs) were compared with 4,438 normotensive men (NTs). The association between the prevalence of hypertension and a number of demographic, physical, biochemical and electrocardiographic characteristics was examined by multiple logistic analysis. HTs were characterized by significant elevations of pulse rate, relative weight, serum uric acid, and high-density lipoprotein-cholesterol. HTs had a higher percent of major electrocardiographic findings, such as ischemic T wave changes, ST depression and, most significantly, left-ventricular hypertrophy. They were 4.7 yr older than the NTs and were more often of Central European than of Middle Eastern descent. Mortality in HTs over a 4.5-yr period was dose-response related to casual systolic and diastolic blood pressure readings at baseline. The age-adjusted HT/NT mortality ratio was approximately 2.5:1. Cardiovascular and cerebrovascular disease accounted for 69% of the total mortality among HTs as compared with 48% among NTs. The estimated mortality fraction attributable to hypertension was 23%. This figure provides an estimate for the goal of hypertension control in the community.

Adult↗
PubMed1979

High density lipoprotein cholesterol and incidence of coronary heart disease--the Israeli Ischemic Heart Disease Study.

Using univariate and multivariate analyses, the association between high density lipoprotein (HDL) cholesterol and coronary heart disease (CHD) incidence was investigated. Over 150 cases of myocardial infarction (MI) occurred among 6500 Israeli adult males in a five-year prospective study. At age 50 years and over, there is a significant inverse association between MI incidence and HDL cholesterol. This relationship persists when controlling for risk factors such as age, other cholesterol components, smoking, blood pressure, weight, and diabetes mellitus. Unlike hypercholesterolemia and smoking, the relative risk with HDL cholesterol increases with age above 50. Similar patterns of association occur between HDL cholesterol and angina pectoris incidence, sudden unexpected death and deaths from MI. It is suggested that HDL cholesterol is an independent risk factor for CHD, especially in males over 50, and the implication of this study is that increased HDL cholesterol might play a protective role in the pathogenesis of CHD.

Adult↗