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Biomedical subjects

Arthur L Klatsky

Publications and source records attributed to Arthur L Klatsky.

At least 19 recordsLinked to original sources
PubMed2006

Sequelae of systemic hypertension in alcohol abstainers, light drinkers, and heavy drinkers.

A link exists between alcohol intake and increased blood pressure (BP), with many studies showing increased hypertension prevalence in heavy drinkers. The harmful and beneficial effects of alcohol can confound the study of the long-term risks of alcohol-related hypertension. We therefore studied cardiovascular sequelae separately in heavy drinkers, light drinkers, and abstainers among 127,212 subjects with BP and alcohol intake ascertained at 1978 to 1985 health examinations. Subsequent cardiovascular end points included mortality risk, hospitalization risk, and outpatient diagnosis of hypertension. Analyses were performed for all subjects and stratified by 5 alcohol-drinking categories (from never drinkers to >or=3 drinks/day). With <120/80 mm Hg as the referent, Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals for 3 higher BP categories (120 to 129/80 to 84, 130 to 139/85 to 89, and >or=140/90 mm Hg). The covariates were age, gender, race, body mass index, education, and smoking. The risk of all outcomes was progressively higher for increasing BP categories, with a similarly increased risk for abstainers, light drinkers, and heavy drinkers. The interaction tests for alcohol and BP were not statistically significant for the mortality and hospitalization outcomes. Interpretation was limited by an inability to separate subjects with increased BP from alcohol consumption from those with other etiologies. In conclusion, the data indicate that the risks of hypertension are similar regardless of the amount of alcohol consumption.

Adult↗
PubMed2006

Coffee, cirrhosis, and transaminase enzymes.

BACKGROUND: A minority of persons at risk develop liver cirrhosis, but knowledge of risk modulators is sparse. Several reports suggest that coffee drinking is associated with lower cirrhosis risk. METHODS: We studied 125,580 multiethnic members of a comprehensive prepaid health care plan without known liver disease who supplied baseline data at voluntary health examinations from 1978 to 1985. Subsequently, through 2001, 330 of them were diagnosed with liver cirrhosis. Review of medical records confirmed the diagnosis of cirrhosis and ascertained probable etiology. The association of coffee drinking with cirrhosis was estimated by Cox proportional hazards models with 7 covariates. We also did a cross-sectional analysis of baseline aspartate aminotransferase and alanine aminotransferase levels, studied by logistic regression. RESULTS: In the cohort study, relative risks of alcoholic cirrhosis (199 subjects) for coffee drinking (vs none) were less than 1 cup per day, 0.7 (95% confidence interval [CI], 0.4-1.1); 1 to 3 cups, 0.6 (95% CI, 0.4-0.8; P<.001); and 4 or more cups, 0.2 (95% CI, 0.1-0.4; P<.001). For 131 subjects with nonalcoholic cirrhosis, relative risks were less than 1 cup, 1.2 (95% CI, 0.6-2.2); 1 to 3 cups, 1.3 (95% CI, 0.8-2.1); and 4 or more cups, 0.7 (95% CI, 0.4-1.3). These relative risks for coffee drinking were consistent in subsets. Tea drinking was unrelated to alcoholic or nonalcoholic cirrhosis. In the cross-sectional analyses, coffee drinking was related to lower prevalence of high aspartate aminotransferase and alanine aminotransferase levels; for example, the odds ratio of 4 or more cups per day (vs none) for a high aspartate aminotransferase level was 0.5 (95% CI, 0.4-0.6; P<.001) and for a high alanine aminotransferase level, 0.6 (95% CI, 0.6-0.7; P<.001), with stronger inverse relations in those who drink large quantities of alcohol. CONCLUSION: These data support the hypothesis that there is an ingredient in coffee that protects against cirrhosis, especially alcoholic cirrhosis.

Alanine Transaminase↗
PubMed2006

Higher prevalence of systemic hypertension among moderate alcohol drinkers: an exploration of the role of underreporting.

OBJECTIVE: Heavy alcohol drinking is associated with increased prevalence of systemic hypertension (HTN), but the relationship between moderate drinking and HTN remains unclear. We explored the possible role of underreporting among moderate drinkers. METHOD: In a cross-sectional analysis of 105,378 persons, we defined a subset among persons reporting three or fewer drinks per day that was likely to include a disproportionate number of underreporters. This subset included persons who, on another occasion, indicated intake of three or more drinks per day or who ever had a diagnosis of an alcohol-related condition; these persons are called "positive." Persons who never reported three or more drinks per day and who had no alcohol-related diagnosis were called "negative." Logistic regression models estimated the odds ratios (ORs) for prevalent HTN (140/90 mm Hg or greater) in the positive and negative subgroups, compared with lifelong abstainers as referent. All persons and four race-gender groups were studied, and they were controlled for age, education, smoking, and body mass index. We also studied the relationship of blood liver transaminase enzyme levels in the positive and negative subgroups at specific alcohol intake strata. RESULTS: For persons reporting one to two drinks per day, the OR (95% confidence interval) of HTN was 1.32 (1.21-1.43) for positive persons and 1.16 (1.09-1.25) for negative persons. For those reporting less than one drink per day, the ORs were 0.97 (0.89-1.06) for positives and 0.92 (0.87-0.98) for negatives. For those reporting one to two drinks per day, positive/negative comparisons showed approximately a 75% increased prevalence of high liver transaminase enzymes. For those reporting less than one drink per day, the positive/negative difference was approximately 30%. CONCLUSION: In these data, increased prevalence of HTN among persons reporting one to two drinks per day appears to be partially due to underreporting of alcohol intake.

Adult↗
PubMed2005

Alcohol drinking and risk of hospitalization for heart failure with and without associated coronary artery disease.

Myocardial damage from heavy alcohol intake can cause the heart failure (HF) syndrome, but the relation of lighter alcohol intake to HF has rarely been studied. We examined the risk of HF hospitalization among 126,236 subjects who supplied data about alcohol during health examinations from 1978 to 1985. Among 2,594 subjects who were subsequently hospitalized for HF, record review established an association between coronary artery disease (CAD) and HF (CAD-HF) in 1,559 patients. Among the remaining 1,035 subjects who had HF (non-CAD-HF), we attempted determination of preponderant etiologic and contributory factors. Analyses used Cox models that were controlled for 7 covariates, with usual alcohol intake studied categorically compared with that in subjects who did not drink alcohol. Heavier drinkers (> or =3 drinks/day) but not light to moderate drinkers had increased risk of non-CAD-HF; e.g., relative risk for subjects who reported > or =6 drinks/day was 1.7 (95% confidence interval 1.1 to 2.6). This association of non-CAD-HF with heavy drinking was limited to subsets with cardiomyopathy or of unclear preponderant etiology. Alcohol drinking was inversely related to risk of CAD-HF (e.g., at 1 to 2 drinks/day, relative risk 0.6, 95% confidence interval 0.5 to 0.7), with consistency across subgroups of age, gender, ethnicity, education, smoking status, interval to diagnosis, and presence or absence of baseline heart disease or systemic hypertension. Moderate drinking was inversely related to non-CAD-HF only in subjects who had diabetes mellitus (n = 252). In conclusion, heavy, but not light, alcohol drinking is associated with increased risk of non-CAD-HF and that apparent protection by alcohol drinking against CAD-HF risk provides confirmation of a protective effect of alcohol against CAD.

Adult↗
PubMed2005

Risk of hemorrhagic stroke in Asian American ethnic groups.

The sparseness of prospective data about hemorrhagic stroke (HS) risk among Asian American ethnic groups led to the investigation of 128,934 persons with self-classified ethnicity at health examinations in 1978-1985. Subsequently, 431 persons were hospitalized for HS; 31% for subarachnoid hemorrhage (SAH) and 69% for intracerebral hemorrhage (ICH). Ethnic predictors of HS were studied by Cox proportional hazard models with 7 covariates. With whites as reference, the adjusted relative risk (95% CI) of all Asians for HS was 1.6 (1.1-2.3, p = 0.01), due substantially to increased risks of SAH in Japanese people and ICH in Filipinos. These data mandate emphasis upon preventive measures in these groups.

Adult↗
PubMed2005

Health problems and hospitalizations among Asian-American ethnic groups.

OBJECTIVES: To study health status and hospitalization risk among Asian Americans. DESIGN: Cross-sectional analyses and cohort study. SETTING: Comprehensive prepaid health care program in Northern California. PATIENTS: Adult Asian Americans (N=13,592), self-classified at health examinations as 6050 (44.5%) Chinese, 1707 (12.6%) Japanese, 4232 (31.1%) Filipinos, 714 (5.3%) South Asians, and 889 (6.5%) Other Asians. INTERVENTIONS: None except data analysis. OUTCOME MEASURES: With Chinese and Whites (n=72,019) as referents, comparison of symptom composites by logistic regression and hospitalization risk by Cox proportional hazards models. RESULTS: Compared to Chinese, Filipinos, South Asians, and other Asians more frequently reported coronary, respiratory, gastrointestinal, and emotional problems. Chinese and Japanese generally had the lowest hospitalization risk. Compared to Chinese, hospitalization risk was higher (P<.05) among Filipinos for circulatory (men or women), respiratory (men), and digestive (women) conditions (relative risks [RR] range from 1.5 to 1.7) and among South Asian men for cardiovascular conditions (RR=2.2). While Asian groups generally had similar or lower hospitalization risk than Whites, risks were higher for asthma (Filipino and South Asian men, RRs >3.0), peptic ulcer (Chinese men, Filipino men and women, other Asian women [RRs 1.9-5.6]), and coronary disease (South Asian men (RR=2.3) and Filipino women (RR=1.5). CONCLUSIONS: Variations in risk of hospitalization and frequency of reported health problems point out differences in health problems and health needs among subgroups of Asian Americans. This diversity shows the need to study Asian ethnic groups separately.

Adult↗
PubMed2004

Analysis of late risk of systemic blood pressures <120/80 mm Hg.

We studied categories of blood pressure (BP) <120/80 mm Hg as predictors of hypertension 10 to 22 years later by logistic regression analyses with 6 covariates. There was progressively increased risk for subjects with systolic BP 100 to 109 and 110 to 119 mm Hg (vs <100 mm Hg) or diastolic BP 70 to 74 and 75 to 79 mm Hg (vs <70 mm Hg). These relations were similar in men, women, and several ethnic groups but stronger in subjects <40 years old. These data suggest a definition of optimal BP of <100/70 mm Hg, similar to usual BP levels in children <10 years old.

Adult↗
PubMed2004

Smoking, coffee, and pancreatitis.

OBJECTIVES: We studied relationships of cigarette smoking and coffee drinking to risk of pancreatitis. METHODS: This was a cohort study among 129,000 prepaid health plan members who supplied data about demographics and habits in 1978-85. Among 439 persons subsequently hospitalized for pancreatitis, probable etiologic associations were cholelithiasis (168/439 = 38%), alcohol (125/439 = 29%), idiopathic (110/430 = 25%), and miscellaneous (36/439 = 8%). Cox proportional hazards models with seven covariates (including alcohol intake) yielded relative risk estimates for smoking and coffee use. RESULTS: Increasing smoking was strongly related to increased risk of alcohol-associated pancreatitis, less related to idiopathic pancreatitis, and unrelated to gallstone-associated pancreatitis. Relative risks (95% confidence intervals, CI) of one pack per day (vs never) smokers for pancreatitis groups were: alcohol = 4.9 (2.2-11.2, p < 0.001), idiopathic = 3.1 (1.4-7.2, p < 0.01), and gallstone = 1.3 (0.6-3.1). The relationship of smoking to alcohol-associated pancreatitis was consistent in sex and race subsets. Drinking coffee, but not tea, was weakly inversely related to risk only of alcohol-associated pancreatitis, with relative risk (95% CI) per cup per day = 0.85 (0.77-0.95; p= 0.003). Male sex, black ethnicity, and lower-educational attainment were other predictors of alcohol-associated pancreatitis. CONCLUSIONS: Cigarette smoking is an independent risk factor for alcohol-associated and idiopathic pancreatitis. Coffee drinking is associated with reduced risk of alcohol-associated pancreatitis. The data are compatible with the hypotheses that smoking may be toxic to the pancreas or may potentiate other pancreatic toxins while some ingredient in coffee may have a modulating effect.

Coffee↗
PubMed2003

Wine, liquor, beer, and mortality.

A substantially increased risk for heavy drinkers and a slightly reduced risk for lighter drinkers results in the J-shaped alcohol-mortality curve. Limited data suggest a more favorable mortality experience for drinkers of wine than for drinkers of liquor or beer. To examine these relations, the authors performed a cohort study of participants in a large Northern California prepaid health care program. Demographic and history data were collected from 128,934 adults undergoing health evaluations in 1978-1985, with subsequent death ascertained by an automated linkage system. Cox proportional hazards models with eight covariates were used to determine relative risk estimates according to total alcohol intake and days per week of drinking wine, wine types, beer, or liquor. The J-shaped alcohol-mortality relation was stable for 20 years. Independently, frequency of wine drinking was associated with lower mortality risk (p<0.001) largely because of lower coronary disease risk. Similar risk reductions were associated with red wine, white wine, other types of wine, and combinations of wine types. Much of the lower risk associated with light drinking was related to wine drinking. The authors conclude that drinkers of any type of wine have a lower mortality risk than do beer or liquor drinkers, but it remains unclear whether this reduced risk is due to nonalcoholic wine ingredients, drinking pattern, or associated traits.

Adult↗
PubMed2003

The early repolarization normal variant electrocardiogram: correlates and consequences.

PURPOSE: We compared the characteristics and outcomes of patients with "early repolarization" electrocardiograms (ECGs) with those who had normal ECGs. METHODS: In 1983 to 1985, we collected photocopies of 2234 selected ECGs from 73088 patients undergoing health examinations. Excluding 153 ECGs with missing data or that were judged to be abnormal, the remaining ECGs were reinterpreted in 2000 by cardiologists as showing early repolarization (n = 670), or being borderline (n = 330) or normal (n = 1081). Characteristics and outcomes of persons with early repolarization ECGs were compared with those who had normal ECGs using analysis of variance, logistic regression, or proportional hazards models. Information on exercise was available in 325 patients. RESULTS: Patients with early repolarization were more likely to be male (81% [n = 583] vs. 33% [n = 360]), <40 years old (60% [n = 441] vs. 37% [n = 403]), black (48% [n = 384] vs. 26% [n = 280]), and more athletically active (mean [+/- SD], 10.4 +/- 1.3 hours per week of activity vs. 6.4 +/- 1.2 hours per week of activity) than those with normal ECGs. Patients with early repolarization were not more likely to be hospitalized (hazard ratio [HR] = 1.0; 95% confidence interval [CI]: 0.9 to 1.2) or to die (HR = 0.8; 95% CI: 0.6 to 1.2) during follow-up than those with normal ECGs. Outpatient diagnoses were not more common in those with early repolarization; arrhythmias were actually less common (P <0.01). CONCLUSION: Although especially prevalent in young, athletic, black men, early repolarization is not rare in other patients. The long-term prognosis of early repolarization is benign.

Adult↗
PubMed2003

Traits of persons who drink decaffeinated coffee.

PURPOSE: Little is known about the traits of decaffeinated coffee drinkers, who are sometimes used to ascertain whether the health effects of coffee intake are due to caffeine or some other coffee ingredient. METHODS: We studied these traits in 12,467 persons who reported type of coffee consumed at health examinations; 36% drank caffeinated only, 13% drank decaffeinated only, 27% drank both types and 24% drank no coffee. RESULTS: Odds ratios estimated from logistic regression analyses revealed that compared with regular (caffeinated) coffee drinkers or abstainers, decaffeinated coffee drinkers were less likely to be heavy coffee drinkers, smokers, alcohol drinkers, users of caffeinated soft drinks and medication and to be free of illness. Increased decaffeinated coffee drinking was associated with older age, female sex, African American ethnicity, use of special diets and cardiovascular, gastrointestinal, or neuropsychiatric symptoms. Persons on special diets were more likely to drink decaffeinated coffee whether they had heart disease or were free of any illness. CONCLUSION: These data suggest that decaffeinated coffee use is related to illness in some persons but to a healthy lifestyle in others. These potential and possibly conflicting confounding factors need to be considered when studying the health effects of coffee or caffeine.

Adult↗
PubMed2003

Alcohol and cardiovascular disease--more than one paradox to consider. Alcohol and hypertension: does it matter? Yes.

Observational studies and clinical experiments solidly establish an empiric relationship between heavy drinking (>/= 3 standard drinks/day) and higher blood pressure. A biologic mechanism for this link remains unclear. It has been difficult to study the incidence of usual hypertension sequelae in alcohol-associated hypertension because of complex interactions of alcohol, hypertension and cardiovascular conditions. Even with these limitations, a causal association is the most likely explanation and control of alcohol intake is probably important in prevention and treatment of hypertension.

Alcohol Drinking↗