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Biomedical subjects

U Keil

Publications and source records attributed to U Keil.

At least 127 records · Page 7Linked to original sources
PubMed1992

The association of antihypertensive treatment patterns and adverse lipid effects in population-based studies.

We investigated the relationship between antihypertensive drug treatment of hypertensives and their mean serum lipid concentrations in population based studies in Germany. Data from three surveys (Luebeck Blood Pressure Study (LBS) of 1984, MONICA Augsburg Survey I of 1984/85, MONICA Augsburg Survey II of 1989/90), obtained on random samples of the population aged 25-64 years, were used for cross-sectional analyses. Moreover, prospective analyses were carried out on participants of the MONICA Augsburg cohort study of 1987/88 (3-year-follow-up of the MONICA Survey I). Blood pressure, non-fasting serum total cholesterol and HDL-cholesterol, and body height and weight were measured under strictly standardized conditions. Interview data were available on medical history including medication use, and on smoking and alcohol consumption. In cross-sectional and prospective analyses treated male and female hypertensives in each population had significantly lower crude mean HDL-C concentrations than untreated hypertensives, borderliners, or normotensives. Differences in mean HDL-C between untreated and treated hypertensives were attenuated but still significant after control of confounders and ranged from 1.8 to 6.1 mg/dl (i.e. in relative terms, -3.4 to -12.9%) in men and from 3.6 to 9.4 mg/dl (-5.7 to -14.9%) in women. By contrast, crude and multivariate associations of antihypertensive treatment with non-HDL-C (total minus HDL-C) levels were inconsistent and not significant. The inverse association of drug therapy with HDL-C was confirmed by prospective analyses in the MONICA cohort study supporting a causal relationship. Treatment patterns in a community (prevalence of prescribed drug classes) correlated with the magnitude and significance of HDL-C effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Food intake and nutrient sources in the diet of middle-aged men in southern Germany: results from the WHO MONICA Augsburg Dietary Survey 1984/85.

Diet records of the WHO MONICA Augsburg dietary survey 1984/85 sample of 899 men aged 45-64 were used to derive quantitative data about food intake and the contribution of food groups to energy intake and the intake of those nutrients relevant to the discussion about nutrition and cardiovascular disease: protein, fat, saturated, mono- and polyunsaturated fatty acids, cholesterol, carbohydrate, polysaccharides and total fiber. The present lists of nutrient sources should be helpful for the development of acceptable dietary advises, which make allowance for actual eating patterns as well as for developing improved instruments of dietary assessment.

Diet Surveys↗
PubMed1992

Determinants of plasma fibrinogen: relation to body weight, waist-to-hip ratio, smoking, alcohol, age, and sex. Results from the second MONICA Augsburg survey 1989-1990.

In the second World Health Organization MONItoring Trends and Determinants in CArdiovascular Disease (MONICA) Augsburg survey in 1989-1990 (n = 4,940), the association between nephelometric plasma fibrinogen level and lifestyle-related potential determinants was assessed in 4,434 subjects aged 25-74 years (89.8% of participants). Irrespective of pregnancy and the use of oral contraceptives, crude fibrinogen values were consistently higher in women than in men of all ages (age-standardized difference, 12.2 mg/dl; 95% confidence interval, 7.0-17.4 mg/dl). Fibrinogen concentrations were positively correlated (p less than or equal to 0.0001) with age, body mass index, and waist-to-hip ratio in both sexes and with cigarette smoking in men and were negatively correlated with alcohol consumption in both sexes. In multiple linear regression analyses using categorized determinants as independent variables, a strongly J-shaped relation for body mass index in women and a linear association for waist-to-hip ratio in men were revealed. Smoking had a dose-dependent effect on fibrinogen concentration in men but a lesser effect in women. For alcohol consumption a U-shaped association was found, particularly in men. The curvilinear relations were confirmed in multiple polynomial regression models using continuous determinant variables. The potential epidemiological impact of a determinant was assessed by calculating differences in adjusted fibrinogen concentrations associated with the 10th and 90th percentile values of the determinant distributions actually observed among the study participants. This impact on the population fibrinogen level was most pronounced for age in both sexes, followed by body mass index, cigarette smoking, and alcohol consumption in women and by smoking, waist-to-hip ratio, and alcohol consumption in men.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1992

Association between rheology and components of lipoproteins in human blood. Results from the MONICA project.

BACKGROUND: Recent studies have suggested that several hemostatic factors, leukocyte count, and plasma viscosity are predictive of coronary heart disease. Detailed analyses on lifestyle correlates, in particular plasma lipids and lipoproteins, of determinants of blood rheology have not been reported from epidemiological studies. METHODS AND RESULTS: We studied the relation between determinants of blood rheology and components of lipoproteins in a large sample of a population aged 25-64 years. The rheological parameters investigated were plasma viscosity, hemoglobin, and total serum protein; the lipoprotein variables included total cholesterol, high density lipoprotein (HDL) cholesterol, and the apoproteins A-I, A-II, and B. Covariables considered for possible confounding effects were age, body mass index, smoking behavior, alcohol consumption, and hypertension. Plasma viscosity was found to have a positive linear association with total cholesterol and apoprotein B (partial correlations after adjustment for all covariables including total serum protein for men and women were r = 0.23/0.19 and 0.24/0.25, respectively) and a small negative linear association with HDL cholesterol (r = -0.14/-0.10) and with apoprotein A-I (r = -0.08/-0.06). Polynomial regression showed a strong quadratic relation with HDL cholesterol in men, whereas no other variable revealed an appreciable deviation from linearity. The covariables had only a small, if any, confounding effect. Total serum protein, after control for the covariables, appeared to be associated only with total cholesterol. No association was found with hemoglobin. CONCLUSIONS: We conclude that rheological mechanisms may be involved in the pathogenesis of ischemic syndromes in hyperlipidemias. However, the finding that in particular men with very low HDL cholesterol exhibit increased plasma viscosity cannot be explained in pure rheological terms but may be, at least in part, the result of concomitant hypertriglyceridemia. This was not assessed in this study.

Adult↗
PubMed1991

Knowledge and attitudes towards hypertension and hypercholesterolemia in a population of southern Germany: results from a population survey in the Augsburg area.

The survey was conducted to assess knowledge and attitudes of a population in Southern Germany towards hypertension and hypercholesterolemia. A questionnaire, mailed to a random sample of 2000 citizens of the Augsburg area between 25 and 74 years of age, was responded by 67%. Knowledge about determinants and complications of hypertension or hypercholesterolemia was considerably high. Major deficiencies were found in knowledge about personal values and recommended definitions of the two risk factors. Fifty eight percent claimed to know their personal blood pressure value, but merely 14% reported to know their personal blood cholesterol value. Just 21% were able to give the correct definition of hypertension and 10% defined hypercholesterolemia correctly. People had more trust in the effect of lowering high blood pressure (54%) to prevent heart disease than in the effect of lowering high blood cholesterol (43%). Sixty percent claimed to take some kind of actions to control their blood pressure and blood cholesterol.

Adult↗
PubMed1991

[Population-based heart infarct register in the Augsburg region: possibilities and limitations].

Special procedures were developed to establish the Augsburg Coronary Event Register in accordance with the German data confidentiality laws. Contracts with the 26 hospitals in the study region and the adjacent ares (registration of 95% of all acute myocardial infarctions (AMI)) were specified to ensure their cooperation with the MONICA Project (WHO project Monitoring Trends and Determinants in Cardiovascular Disease). Written consent of the patients, declaring their participation in the project is required. Fatal events with suspected AMI within the study region (4% of male and 7% of female coronary deaths occur outside the region) are selected from the information in the anonymous death certificates provided by the three regional health departments. Each health department allocates an identification (ID) number to each event and sends a questionnaire for cause of death validation (MONICA questionnaire) to the last attending physician and/or the coroner. The register receives this information in anonymous form and links the MONICA questionnaire and the death certificate by means of the ID number. While data confidentiality laws do not impair case finding, they do restrict the validation of the diagnosis and person-based registration. The inclusion of fatal events with insufficient data on cause of death (25% of all registered fatal events) seems prudent to avoid underestimating attack rates and mortality, i.e. the AMI risk for the resident study population.

Cause of Death↗
PubMed1991

[Comparison of 2 methods for the assessment of physical activity].

There is no standardized method for the assessment of physical activity, so it is important to investigate the validity and the comparability of different measures. In the first survey (1984/85) of the MONICA Augsburg project of the World Health Organisation (WHO), physical activity was determined by two different methods, an interview and a seven-day activity diary, and these are compared in this analysis. In the first MONICA Augsburg survey 2023 men and 1999 women participated (overall response 80.0% men and 78.7% women). The seven-day activity diary was completed only by men of the age group 45 to 64 years (overall response 62.2%). On the assumption that the seven-day activity diary is an instrument of proven validity, the interview was validated against this reference method in men aged 45-64 years. Activity scores for occupational and leisure time physical activity were formed by means of the data from the seven-day diary. Participants were classified as active or inactive, by using energy expenditure during work as an estimate for occupational physical activity, and duration of sport as an estimate for leisure time physical activity. The interview offered four possibilities for answering the activity questions. By means of these answers the participants were again classified into active and inactive groups, for both leisure time and occupational physical activity. This grouping was compared to the one obtained by the reference diary method. Validity of the interview-based scores required an efficiency of at least 160% and an error rate not above 20%.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1991

[Differences in nutrition behavior between weekends and work days: results of the nutrition survey in 1984/85 of the MONICA project in Augsburg].

Seven-day food records of the MONICA project Augsburg dietary survey 1984/85 in 899 men aged 45-64 years were used to compare food and nutrient intake of weekdays and weekends. Differences were found in food intake. The mean intake of energy, macronutrients and especially alcohol was higher on weekends, whereas the dietary constituents independent of total energy intake, as percentage supply of energy from macronutrients, did not show huge differences.

Alcohol Drinking↗
PubMed1991

Comorbidities and perioperative complications among patients with surgically treated benign prostatic hyperplasia.

We address the question of whether or not age and comorbidity are related to intra- and postoperative complications after a transurethral resection. The data are derived from a retrospective, population-based study conducted in Hagen, Germany, which included all patients with an initial prostatectomy for benign prostatic hyperplasia (N = 621) during the five-year period 1984-1988. Seventy-seven percent of the patients had at least one of the following preoperative risk factors: heart disease, hypertension, smoking, chronic obstructive lung disease, and diabetes. There was no intraoperative death. The risk of intraoperative circulatory complications was found to be related to age only for patients without a history of heart diseases or hypertension. The incidence of major complications was 3.1 percent and was significantly higher in the oldest age group. Three patients (0.54%) died postoperatively in the hospital. Infections were the most frequent postoperative complications. The relationship of age and overall postoperative complications was not statistically significant either for patients with (p = 0.121) or without any comorbidity (p = 0.651). Based on this study it seems reasonable to conclude that age is not a clinically relevant risk factor for perioperative complications in patients who have a transurethral resection for benign prostatic hyperplasia.

Age Factors↗
PubMed1991

Case finding, data quality aspects and comparability of myocardial infarction registers: results of a south German register study.

The population-based Augsburg Coronary Event Register (330,000 residents, age 25-74 years) has registered a total of 1012 cases of acute myocardial infarction (AMI) in 1985 and 1021 AMI in 1986 and categorized them on the basis of the current WHO diagnostic algorithm for AMI. The register is designed for longitudinal comparisons of annual AMI risk (incidence, attack rate, death rate), and the risk to the AMI patients themselves (28-day case fatality). The methodology and specific issues encountered during registration and data evaluation are described. With an estimated 95% completeness of case finding, the quality control data review which the register conducts annually shows a consistency of specific data structures which indicate stable case finding and validation procedures. However, local conditions which affect case finding and data completeness per case are responsible for the creation of subsets of AMI which are in turn distinguished by differences in diagnostic category structures. With regard to the study objectives, the differences among subsets appear to have the least effect on rate calculations if DEFINITE and POSSIBLE AMI are combined. The implications of methodological variations and subset differences within and across registers on annual rate calculations and result comparisons are discussed.

Adult↗
PubMed1991

Weight change and change of total cholesterol and high-density-lipoprotein cholesterol. Results of the MONICA Augsburg cohort study.

Data from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg cohort were used to study the effect of weight change on changes in serum levels of total and high-density-lipoprotein cholesterol. Weight gain was associated with rising levels of total cholesterol and falling levels of high-density-lipoprotein cholesterol in both sexes, more so in men than in women. Moreover, these relationships weakened with advancing age in women, but not in men. The results support the view that weight loss may more favorably affect lipid levels in men than in women, particularly at older ages.

Adult↗
PubMed1991

Association between plasma viscosity and blood pressure. Results from the MONICA-project Augsburg.

The relationship between determinants of blood viscosity and blood pressure (BP) variables was studied in a large sample of a population aged 25 to 64 years. Plasma viscosity, hemoglobin, and total serum protein were examined. Systolic and diastolic BP and the prevalence of hypertension showed a crude positive association with plasma viscosity levels in both sexes. Age, body mass index, and total serum protein appeared to have a confounding effect on this relationship, whereas hemoglobin, smoking behavior, and alcohol consumption did not. A crude positive association was also found between total serum protein levels and the prevalence of hypertension in men and women; however, since total serum protein was treated as a covariable, no further analyses were carried out. In contrast to findings reported in the literature, hemoglobin levels were not correlated with BP variables in either sex. After adjusting for all confounders, a significant main effect of plasma viscosity still was found. However, the magnitude of the effect was not as large as for body mass index, a well-established risk variable for hypertension. These results indicate that BP is positively associated with plasma viscosity. Whether increased plasma viscosity in hypertension constitutes a primary or a secondary phenomenon remains to be answered. Since plasma viscosity is significantly associated with hypertension but any BP variable, increased levels of plasma proteins (particularly fibrinogen as the main determinant of plasma viscosity) may represent the cause for elevated plasma viscosity. This might contribute to persistently increased resistance to blood flow on the microcirculatory level in arterial hypertension.

Adult↗
PubMed1991

Diagnosis and management of hypertension by physicians in the Federal Republic of Germany.

Diagnosis and management of hypertension by physicians in two large cities in the northwest of Germany were studied in 1988. Three hundred and fifteen out-of-hospital physicians (71%) responded to a mailed questionnaire. Sixty-eight per cent reported measuring blood pressure at almost each patient visit and 36% involved allied health professionals in the measurement process. Only 63% used disappearance of sound for the diastolic reading (phase V). A comparison with US data from 1987 showed that German physicians started drug therapy at higher levels of diastolic blood pressure than their American colleagues. Only 43% of the German physicians initiated antihypertensive medication at diastolic blood pressure values below 100 mmHg; this compares with 92% for US physicians. In Germany, beta-blockers were clearly preferred as step-one therapy for young patients, while diuretics were prescribed for the majority of the older patients. Forty per cent reported reducing or stopping antihypertensive medication when the blood pressure was controlled.

Adult↗
PubMed1991

Alcohol and blood pressure and its interaction with smoking and other behavioural variables: results from the MONICA Augsburg Survey 1984-1985.

Data from the Augsburg Survey 1984-1985 of the WHO-project Monitoring Trends and Determinants in Cardiovascular Disease (MONICA), a cross-sectional study on a two-stage cluster sample (n = 5312) of the 25-64-year-old population of the Augsburg study area, were analyzed with regard to alcohol consumption and blood pressure. Putative confounders such as age, body mass index, smoking, sporting activity and educational attainment were controlled for by multiple regression analyses. The main effect models showed that men aged 25-64 years consuming greater than or equal to 80 g alcohol per day had, on average, 3-11 mmHg higher systolic blood pressure (SBP) values and 2-6 mmHg higher diastolic blood pressure (DBP) values compared with non-drinkers. Women consuming greater than or equal to 40 g alcohol per day showed consistently higher SBP (2-6 mmHg) and DBP (1-5 mmHg) values compared with non-drinkers. In the group aged 55-64 years, no clear relationship was seen for SBP or DBP in men or women. Multiple regression models, allowing for interactions between alcohol consumption and the four behavioural variables: smoking, sporting activity; coffee consumption; and type A/B behaviour, showed a consistent interaction between alcohol consumption and smoking in men and women. Smoking modified the effect of alcohol on SBP and DBP in men by 2-8 mmHg and in women by 1-14 mmHg. These findings confirm those obtained for women in previous studies in Munich and Lübeck. Interactions between alcohol and sporting activity, coffee consumption and type A/B behaviour are less consistent.

Adult↗
PubMed1991

Selected nutrient intakes of middle-aged men in southern Germany: results from the WHO MONICA Augsburg Dietary Survey of 1984/85.

In the WHO MONICA Augsburg survey of 1984/85 dietary intake was assessed in an age-stratified cluster sample of 899 men aged 45-64 years by 7-day records. The mean energy intake was 2,609 kcal (10.9 MJ), 15.9% of which came from protein, 38.1% from fat, and 36.6% from carbohydrate. A remarkably high proportion of 9.4% was derived from alcohol. Saturated fatty acids accounted for 14.6% of total energy, monounsaturated fatty acids for 13.2% and polyunsaturated fatty acids for 5.2%. The results showed that current dietary habits do not conform with the national nutritional guidelines.

Diet↗
PubMed1991

Association of wake time and the onset of myocardial infarction. Triggers and mechanisms of myocardial infarction (TRIMM) pilot study. TRIMM Study Group.

A morning increase in onset of acute myocardial infarction (MI) has been documented, but its association with wake time and possible triggering events is unclear. The community-based, ongoing Triggers and Mechanisms of Myocardial Infarction (TRIMM) study was designed to investigate the factors associated with the transition from chronic coronary artery disease to acute MI. During the pilot phase in 1989, 224 consecutive hospitalized MI patients (176 men and 48 women, aged 60.3 +/- 9.2 years) of the prospectively defined Monitoring of Trends and Determinates of Cardiovascular Disease (MONICA) Augsburg MI register were interviewed 16.8 +/- 6.5 days after the event. The frequency of onset of MI was significantly higher (p less than 0.01) during the morning from 6 to 9 AM compared with other times of day. After adjustment for individual wake times, the peak of onset of MI was markedly sharper; the relative risk of MI during the 3-hour peak interval (the 3 hours after awakening) compared with other times of day increased from 1.8 (95% confidence interval, 1.3-2.4) to 2.4 (95% confidence interval, 1.8-3.1). Sixty-seven percent of the patients reported possible acute triggers of MI and/or unusual life events; among those, 52% reported stress or emotional upset. The TRIMM pilot study demonstrated the feasibility of a community-based study of possible triggering events of MI. The circadian variation of MI appears to result primarily from increased onset after awakening. This narrowing of the time frame of increased risk of MI should facilitate study of pathogenic mechanisms and aid in the design of more effective preventive regimens.

Adrenergic beta-Antagonists↗