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Rising tide of cardiovascular disease in American Indians. The Strong Heart Study.

BACKGROUND: Although cardiovascular disease (CVD) used to be rare among American Indians, Indian Health Service data suggest that CVD mortality rates vary greatly among American Indian communities and appear to be increasing. The Strong Heart Study was initiated to investigate CVD and its risk factors in American Indians in 13 communities in Arizona, Oklahoma, and South/North Dakota. METHODS AND RESULTS: A total of 4549 participants (1846 men and 2703 women 45 to 74 years old) who were seen at the baseline (1989 to 1991) examination were subjected to surveillance (average 4.2 years, 1991 to 1995), and 88% of those remaining alive underwent a second examination (1993 to 1995). The medical records of all participants were exhaustively reviewed to ascertain nonfatal cardiovascular events that occurred since the baseline examination or to definitively determine cause of death. CVD morbidity and mortality rates were higher in men than in women and were similar in the 3 geographic areas. Coronary heart disease (CHD) incidence rates among American Indian men and women were almost 2-fold higher than those in the Atherosclerosis Risk in Communities Study. Significant independent predictors of CVD in women were diabetes, age, obesity (inverse), LDL cholesterol, albuminuria, triglycerides, and hypertension. In men, diabetes, age, LDL cholesterol, albuminuria, and hypertension were independent predictors of CVD. CONCLUSIONS: At present, CHD rates in American Indians exceed rates in other US populations and may more often be fatal. Unlike other ethnic groups, American Indians appear to have an increasing incidence of CHD, possibly related to the high prevalence of diabetes. In the general US population, the rising prevalence of obesity and diabetes may reverse the decline in CVD death rates. Therefore, aggressive programs to control diabetes and its risk factors are needed.

Aged↗

The burden of adult hypertension in the United States 1999 to 2000: a rising tide.

This study aims to estimate the absolute number of persons with hypertension (the hypertension burden) and time trends using data from the National Health and Nutrition Examination Survey of United States resident adults who had hypertension in 1999 to 2000. This information is vitally important for health policy, medical care, and public health strategy and resource allocation. At least 65 million adults had hypertension in 1999 to 2000. The total hypertension prevalence rate was 31.3%. This value represents adults with elevated systolic or diastolic blood pressure, or using antihypertensive medications (rate of 28.4%; standard error [SE], 1.1), and adults who otherwise by medical history were told at least twice by a physician or other health professional that they had high blood pressure (rate of 2.9%; SE, 0.4). The number of adults with hypertension increased by approximately 30% for 1999 to 2000 compared with at least 50 million for 1988 to 1994. The 50 million value was based on a rate of 23.4% for adults with elevated blood pressure or using antihypertensive medications and 5.5% for adults classified as hypertensive by medical history alone (28.9% total; P<0.001). The approximately 30% increase in the total number of adults with hypertension was almost 4-times greater than the 8.3% increase in total prevalence rate. These trends were associated with increased obesity and an aging and growing population. Approximately 35 million women and 30 million men had hypertension. At least 48 million non-Hispanic white adults, approximately 9 million non-Hispanic black adults, 3 million Mexican American, and 5 million other adults had hypertension in 1999 to 2000.

Adult↗

ALKALINE TIDES.

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Journal Article↗

The turn of the tide.

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Adaptation, Psychological↗

Post traumatic stress disorder: turning the tide without opening the floodgates.

The development of the legal concept of nervous shock represents a compromise between the need to compensate those suffering psychiatric damage and the need to protect a defendant from unlimited liability. The criteria which have developed to achieve this balance are arbitrary ones, which take little account of psychological or physiological knowledge about post traumatic stress disorder. It is suggested that recent developments in scientific understanding of this condition could usefully inform the legal process, and that some aspects of the dilemma could be avoided.

Humans↗

The tide to come: elderly health in Latin America and the Caribbean.

This article introduces a conjecture and reviews partial evidence about peculiarities in the aging of populations in Latin America and the Caribbean (LAC) that may impact future elderly health status. Using Survey on Health and Well-Being of Elders data (SABE; n = 10,902), the authors estimated effects of early childhood conditions on adult diabetes and heart disease. Using Waaler-type surfaces, the authors obtained expected mortality risks for SABE and also U.S. elderly (Health and Retirement System, n = 12,527). Expected mortality risks using Waaler-type surfaces among elderly in LAC reflected excesses supporting our conjecture. There was partial evidence of a relation between various indicators of early childhood nutritional status (knee height, waist-to-hip ratio) and diabetes and even stronger evidence of a relation between rheumatic fever and adult heart disease. There is some evidence, albeit weak, to suggest that the conjecture regarding elderly health status' connection to early conditions has some merit.

Aged↗

Postnatal stem cell survival: does the niche, a rare harbor where to resist the ebb tide of differentiation, also provide lineage-specific instructions?

Postnatal stem cells regulate the homeostasis of the majority of our tissues. They continuously generate new progenitors and mature, functional cells to replace old cells, which cannot assume the tissue function anymore and are eliminated. Blood, skin, gut mucosa, muscle, cartilage, nerves, cornea, retina, liver, and many other structures are regulated by stem cells. As a result of their ability to produce large numbers of functionally mature cells, postnatal stem cells represent a promising tool for regenerative therapy. Indeed, unmanipulated stem cells or their progeny amplified in vitro are already used in some clinical applications to restore the function of injured or genetically deficient tissues. However, despite our cumulating understanding concerning postnatal stem cells, many aspects of their functionality remain unclear. For instance, in most tissues, we cannot reliably define the phenotype of the postnatal stem cells sustaining its survival. We do not know to which extent the environment surrounding the stem cell-the niche-which is a key actor insuring stem cell self-maintenance, is also implicated in the maintenance of stem cell lineage specificity. Moreover, we have to clarify whether postnatal stem cells are capable of undertaking "transdifferentiation", that is, the conversion of one cell type into another under physiological conditions. Answering these questions should help us to draw a more accurate picture of postnatal stem cell biology and should lead to the design of safe, effective therapies.

Cell Differentiation↗

Measuring the rising tide. How many dementia cases will there be by 2001?

Numerous surveys have attempted to estimate the prevalence of dementia. Despite difficulties of measurement, evidence suggests figures may be lower than is generally realised. Factors which are likely to affect prevalence rates are discussed. Forthcoming changes in the demography of old age indicate that increases in the prevalence of dementia may have been seriously underestimated.

Age Factors↗