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Biomedical subjects

D E Grobbee

Publications and source records attributed to D E Grobbee.

At least 379 records · Page 21Linked to original sources
PubMed1995

Measuring quality of life in patients with myocardial infarction or stroke: a feasibility study of four questionnaires in The Netherlands.

OBJECTIVE: To test in patients with a history of myocardial infarction or stroke the feasibility of four quality of life measurements--the Nottingham health profile (NHP), the heart patients psychological questionnaire (HPPQ), the sickness impact profile (SIP), and the hospital anxiety and depression scale (HAD). DESIGN: Subjects were tested and retested after an interval of 14 days: questionnaires were self assessed. SUBJECTS: Participants were randomly selected from the Rotterdam stroke data bank (stroke patients; n = 16, mean (SD) age 66.0 (11.0) years and from the population based Rotterdam study (myocardial infarction; n = 20, mean (SD) age 72.7 (7.9) years, controls; n = 17, mean (SD) age 72.8 (7.3) years. MEASUREMENTS AND MAIN RESULTS: Mean (SD) administration times for the NHP, HPPQ, SIP, and HAD were 7.9 (3.5), 10.5 (4.3), 21.0 (9.8), and 5.5 (2.8) minutes respectively. On average, the test-retest reliability was good, with Spearman correlations ranging from 0.31 to 0.95. In spite of the limited size of the study, all instruments were able to show differences between the study groups. For instance, median SIP total scores for myocardial infarction and stroke patients were 12.4 (interquartile range 7.0-19.1) and 11.4 (5.9-15.4) respectively, compared with 7.7 (3.7-11.3) in the control group (p values of 0.04 and 0.14 respectively). CONCLUSIONS: This study suggests that use of the four instruments tested may be feasible and reliable for assessing aspects of quality of life in patients with a history of a myocardial infarction or stroke.

Aged↗
PubMed1995

Prevalence of Parkinson's disease in the elderly: the Rotterdam Study.

We assessed the prevalence of Parkinson's disease (PD) in a general elderly population in the Netherlands. The study formed part of the Rotterdam Study, a population-based door-to-door study, and included 6,969 persons 55 years of age or older living in a suburb of Rotterdam, the Netherlands. All participants were examined, and those who either had at least one possible cardinal sign of parkinsonism at the neurologic screening, reported that they had PD, or were taking antiparkinsonian drugs were invited for further evaluation. The prevalence of PD in this population was 1.4% (1.2% for men, 1.5% for women). Prevalence increased with age, and prevalence figures were 0.3% for those aged 55 to 64 years, 1.0% for those 65 to 74, 3.1% for those 75 to 84, and 4.3% for those 85 to 94. The corresponding age-specific figures for men were 0.4%, 1.2%, 2.7%, and 3.0%, and for women, 0.2%, 0.8%, 3.4%, and 4.8%. Among 95- to 99-year-old women the prevalence was 5.0%. Twelve percent of the subjects with PD were detected through the screening and had not been diagnosed previously.

Age Distribution↗
PubMed1995

Retinopathy, glucose, and insulin in an elderly population. The Rotterdam Study.

We studied the association between retinopathy and glucose metabolism in a population-based study of elderly men and women. Glucose metabolism was assessed by serum fructosamine and a nonfasting oral glucose tolerance test, and retinopathy was evaluated by fundus photography. Retinopathy was present in 296 of 6,191 subjects examined (4.8%; 120 men and 176 women). Serum glucose and fructosamine levels were higher in subjects with retinopathy compared with those without (8.4 vs. 6.8 mmol/l and 329.8 vs. 308.5 mumol/l, respectively, P < 0.001). Two-hour postload insulin levels and insulin resistance, assessed by the ratio of postload insulin over postload glucose level, did not differ between the two groups. These associations were similar in men and women and in subjects with and without diabetes and did not change after adjustment for body mass index or systolic blood pressure. Within the group of subjects who had retinopathy, serum glucose was significantly associated with the number of hemorrhages. These findings suggest that the presence and severity of retinopathy are associated with higher serum glucose levels, both in subjects with and without diabetes.

Aged↗
PubMed1995

Does drug treatment improve survival? Reconciling the trials in mild-to-moderate hypertension.

OBJECTIVE: To evaluate whether drug treatment for mild-to-moderate hypertension in middle-aged patients improves survival and to study how the conflicting results of individual trials may be explained. STUDY SELECTION: A meta-analysis was performed, including seven randomized trials in mild-to-moderate hypertensive (diastolic blood pressure 90-114 mmHg) middle-aged patients. DATA EXTRACTION: A comparison was made between all-cause mortality and fatal coronary heart disease and stroke in the intervention and control group of the individual trials, using a method of meta-analysis based on weighted linear regression. RESULTS: In trials with a high all-cause mortality rate (> 6 per 1000 patient-years) in the control group, antihypertensive drug treatment increased life expectancy. When all-cause mortality in the control group was low, treatment showed no effect or even an opposite effect. Findings on mortality from coronary heart disease were similar, whereas drug treatment decreased stroke mortality irrespective of the incidence of stroke in the control group. CONCLUSIONS: Drug treatment for mild-to-moderate hypertension in middle-aged patients may reduce all-cause mortality and the risk of fatal coronary events when treatment is initiated in those beyond a certain baseline mortality risk. Drug treatment in hypertensive patients at a lower mortality risk has no influence on or may even increase mortality.

Adult↗
PubMed1995

Calcium metabolism and familial risk of hypertension.

There is circumstantial evidence that disturbances of calcium metabolism are implicated in primary hypertension. From a large number of observational epidemiological studies, data have shown that a low dietary calcium intake increases the risk for high blood pressure. There is no general sensitivity for the effects of inadequate calcium intake, but subgroups of hypertensive patients have been described characterized by reduced serum ionized calcium levels, increased urinary excretion of calcium, raised intracellular calcium levels, reduced cellular membrane calcium binding, and other indicators of a relative calcium need. Some of these changes, however, may be secondary to blood pressure elevation. The family history approach enables to study the pathophysiology of early primary hypertension, at a stage at which blood pressure differences between future hypertensive subjects and normotensive subjects are still limited. In the Dutch Hypertension and Offspring Study, young normotensive subjects were studied selected on the basis of presence or absence of familial predisposition for hypertension. The findings show that disturbances in calcium metabolism are present in the early phase of primary hypertension and may precede the development of high blood pressure. Moreover, they suggest that changes in calcium metabolism may be a characteristic of familial hypertension and could reflect a genetic basis for calcium sensitive hypertension. The presence of a relatively reduced serum calcium and increased plasma PTH [1-84] level in the offspring of hypertensive parents indicates that calcium balance in prehypertensive subjects is maintained at a higher level of circulating PTH. The implications of these findings in relation to other available data are discussed.

Adolescent↗
PubMed1995

Long-term moderate sodium restriction does not adversely affect the serum HDL/total cholesterol ratio.

We examined the effect of long-term moderate sodium restriction on the HDL/total cholesterol ratio within a randomised trial of the effect of mineral salt on blood pressure (BP). Eighty nine untreated hypertensive men and women aged 55-75 years were included in the analysis. During 24 weeks, 46 subjects used a low sodium, high potassium, high magnesium salt and 43 controls used common salt. Serum cholesterol levels were measured at baseline and at the end of the trial. After 24 weeks, 24 h urinary sodium was decreased by 41 mmol (95% Cl 23-60 mmol, P < 0.0001) in the mineral salt group compared with the controls. Serum total cholesterol was decreased in both groups, but 0.45 mmol/l (95% Cl 0.12-0.78, P = 0.01) more in the controls than in the mineral salt group after adjustment for age, sex and changes in body weight, serum total protein and potassium excretion. Serum HDL-cholesterol was decreased by 0.07 mmol/l in the controls and increased by 0.06 mmol/l in the mineral salt group, yielding a difference of 0.14 mmol/l (95% Cl 0.05-0.22 mmol/l, P = 0.003). The change in HDL/total cholesterol ratio was more favourable in the mineral salt group than in the controls (0.014 and 0.004 units, respectively, P = 0.014). We conclude that long-term moderate sodium restriction does not adversely affect the serum HDL/total cholesterol ratio and is a safe dietary measure for lowering BP.

Aged↗
PubMed1995

Non-potassium-sparing diuretics and risk of sudden cardiac death.

OBJECTIVE: To review current evidence for a possible association between the use of non-potassium-sparing diuretics and the risk of sudden cardiac death in hypertension. METHODS: Examination of published randomized trials and recent case-control studies. RESULTS: Numerous studies have shown that the administration of non-potassium-sparing diuretics causes a dose-dependent decrease in serum potassium levels in hypertensive patients. Although largely circumstantial, some evidence implies that diuretic-induced electrolyte depletion leading to arrhythmias may be the mechanism involved in the association between diuretics and sudden death. Published randomized trials on the efficacy of non-potassium-sparing diuretic therapy have consistently failed to show a reduction in the incidence of sudden cardiac death, while findings from hypertension trials including potassium-sparing diuretic combinations demonstrated an impressive decrease in coronary events. Two similar, recent case-control studies, together comprising 371 cases of sudden cardiac death in patients taking drug treatment for hypertension, indicated that hypertensive patients who were prescribed non-potassium-sparing diuretics had approximately double the risk of sudden cardiac death compared with users of potassium-sparing diuretic therapy. Although treatment allocation in these studies is, by definition, non-random, adequate measures were taken to reduce sources of bias. CONCLUSIONS: Current evidence supports the hypothesis that diuretic-induced potassium loss causes sudden cardiac death in some hypertensive patients. It seems prudent to use thiazide diuretics at a low dose only. Adding a potassium-sparing diuretic drug may further reduce the mortality risk.

Benzothiadiazines↗
PubMed1994

Postprandial triglyceride response in young adult men and familial risk for coronary atherosclerosis.

OBJECTIVE: To determine whether an increased familial risk for coronary artery disease in young adult men is related to changes in postprandial lipoprotein metabolism. DESIGN: Cross-sectional study. SETTING: Coronary angiography departments of four central general hospitals in the Netherlands. PATIENTS: 80 sons (mean age, 24.8 years) of men with severe coronary artery disease and 55 sons (mean age, 23.2 years) of controls. MEASUREMENTS: Postprandial levels of serum triglycerides, retinyl palmitate, and total cholesterol were measured during a 12-hour period after a standardized oral lipid load. RESULTS: Both groups showed a marked increase in levels of serum triglyceride and retinyl palmitate after lipid loading, reaching a maximum 4 to 6 hours postprandially. No changes in postprandial total cholesterol levels were observed in either group. Sons of men with coronary artery disease had prolonged postprandial hypertriglyceridemia when compared with sons of controls. Significant differences in postprandial triglyceride levels were found at 8 hours (difference, 0.35 mmol/L; 95% CI, 0.07 to 0.62 mmol/L), at 10 hours (difference, 0.21 mmol/L; CI, 0.06 to 0.36 mmol/L), and at 12 hours after lipid loading (difference, 0.13 mmol/L; CI, 0.01 to 0.26 mmol/L). Levels of postprandial retinyl palmitate were also slightly, but not statistically, different (mainly after 6 hours). CONCLUSIONS: Healthy young adult sons, whose fathers have established coronary artery disease, have prolonged postprandial hypertriglyceridemia. Changes in postprandial lipoprotein metabolism appear to be associated with familial risk for coronary atherosclerosis.

Adult↗
PubMed1994

Reduction in blood pressure with a low sodium, high potassium, high magnesium salt in older subjects with mild to moderate hypertension.

OBJECTIVE: To examine the effect of a reduced sodium and increased potassium and magnesium intake on blood pressure. DESIGN: Randomised double blind placebo controlled trial. SETTING: General population of a suburb of Rotterdam. SUBJECTS: 100 men and women between 55 and 75 years of age with untreated mild to moderate hypertension. INTERVENTIONS: During 24 weeks the intervention group received a mineral salt (sodium: potassium: magnesium 8:6:1) and foods prepared with the mineral salt. Controls received common salt and foods. MAIN OUTCOME MEASURE: Change in blood pressure. RESULTS: Complete follow up was achieved for 97 of the 100 randomised subjects. Systolic blood pressure (mean of measurements at weeks 8, 16, and 24) fell by 7.6 mm Hg (95% confidence interval 4.0 to 11.2) and diastolic blood pressure by 3.3 mm Hg (0.8 to 5.8) in the mineral salt group compared with the controls, with a 28% decrease in urinary sodium excretion and a 22% increase in urinary potassium excretion. Twenty five weeks after the study the difference in blood pressure between the groups was no longer detectable. CONCLUSION: Replacing common sodium salt by a low sodium, high potassium, high magnesium mineral salt could offer a valuable non-pharmacological approach to lowering blood pressure in older people with mild to moderate hypertension.

Aged↗
PubMed1994

Cardiovascular disease and distribution of cognitive function in elderly people: the Rotterdam Study.

OBJECTIVE: To investigate the distribution of cognitive function in elderly people and to assess the impact of clinical manifestations of atherosclerotic disease on this distribution. DESIGN: Single centre population based cross sectional door to door study. SETTING: Ommoord, a suburb of Rotterdam, the Netherlands. SUBJECTS: 4971 subjects aged 55 to 94 years. MAIN OUTCOME MEASURE: Cognitive function as measured by the mini mental state examination. RESULTS: The overall participation rate in the study was 80%. Cognitive test data were available for 90% of the participants. Increasing age and lower educational level were associated with poorer cognitive function. Previous vascular events, presence of plaques in the carotid arteries, and presence of peripheral arterial atherosclerotic disease were associated with worse cognitive performance independent of the effects of age and education. On average the differences were moderate; however, they reflected the net result of a shift of the total population distribution of cognitive function towards lower values. Thereby, they resulted in a considerable increase in the proportion of subjects with scores indicative of dementia. CONCLUSIONS: These findings are compatible with the view that atherosclerotic disease accounts for considerable cognitive impairment in the general population.

Age Distribution↗
PubMed1994

[Increase in the number of admissions due to heart failure in Dutch hospitals in the period 1980-1992].

OBJECTIVE: Determination of the trend in the occurrence of hospital admissions because of heart failure in the Netherlands. DESIGN: Descriptive investigation. SETTING: Dutch general and university hospitals. METHOD: Data on hospital admissions because of heart failure from 1980 to 1992, obtained from the National Medical Register, were analysed. Three ICD-9 CM diagnoses were combined (congestive heart failure 428.x, diseases of the heart due to hypertension 402.x and myocardial degeneration 429.I). RESULTS: From 1980 through 1992 the annual number of hospital admissions for heart failure increased by 69%, for both men and women, from 14,441 to 24,368. Age-adjusted admission rates increased by 43% for men, and by 30% for women. The admission rates were strongly age-related, with higher rates in the older age groups. Among men 89% of the patients in 1992 were older than 60 years, and 63% older than 70 years. Among women these figures were 94% and 79%, respectively. During the study period the age-specific admission rates rose in all relevant age groups. The rise was higher in the older age groups. In 1992 the average duration of stay in hospital was 14 days for men and 17 for women. CONCLUSION: Probable causes of the rise in the number of hospital admissions for heart failure were the increasing median age of the population, higher survival rates after acute myocardial infarction and longer survival of persons with heart disease. Demographic changes and medical progress will probably lead to a further rise in morbidity and mortality and of costs of heart failure.

Academic Medical Centers↗
PubMed1994

J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis.

The J-shaped relation between diastolic blood pressure and mortality from coronary heart disease continues to provoke controversy. We examined the association between diastolic blood pressure and progression of aortic atherosclerosis in a population-based cohort of 855 women, aged 45-64 years at baseline. The women were examined radiographically for calcified deposits in the abdominal aorta, which have been shown to reflect intimal atherosclerosis. After 9 years of follow-up, slight progression of atherosclerosis was noted in 19% of women and substantial progression in 16%. The age-adjusted relative risk of substantial atherosclerotic progression in women with a decrease in diastolic pressure of 10 mm Hg or more was 2.5 (95% CI 1.3-5.6), compared with the reference group of women who had a smaller decrease or no change. The excess risk in this group was confined to women whose increase in pulse pressure was above the median (3.9 [1.5-9.9] vs 1.1 [0.3-4.2] in women with an increase in pulse pressure below the median). The relative risks for women with rises in diastolic pressure of 1-9 mm Hg and 10 mm Hg or more were 2.2 (1.1-4.3) and 3.5 (1.6-8.0), respectively. These findings suggest that a decline in diastolic blood pressure indicates vessel wall stiffening associated with atherosclerotic progression. They support the hypothesis that in low-risk subjects progression of atherosclerosis may be accompanied by a decrease in diastolic blood pressure rather than the opposing idea that low diastolic blood pressure precipitates the occurrence of atherosclerotic events.

Age Factors↗
PubMed1994

Age-associated changes in ultrasound measurements of the calcaneus in men and women: the Rotterdam Study.

Broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the os calcis were measured in a sample of 1405 persons (628 men), aged 55-93 years, from the cohort of the Rotterdam Study, a population-based study of diseases in the elderly. We studied the effect of age, body mass index, age at menopause, current use of thiazides, loop diuretics, and estrogens, smoking, and disability on SOS and BUA. Comparisons were made between ultrasound measurements and bone mineral density (BMD) measurements of the lumbar spine and proximal femur using DXA. We found a significant decline with age in SOS and BUA in men (-0.4 and -0.1 %/year, respectively) and women (-1.3 and -0.4%/year, respectively), which persisted after adjustment for body mass index. Age at menopause was not associated with SOS or BUA. Pack-years of smoking was negatively related to SOS in both sexes and to BUA in men. Severe disability was associated with lower SOS and BUA in men, but not in women. Despite the small number of exposed persons, current corticosteroid use was associated with lower BUA in men. The other risk factors examined did not affect the ultrasound measurements. We observed modest correlations between SOS or BUA, on the one hand, and BMD of the lumbar spine, on the other hand (r = 0.32-0.42). Similar correlations were found between ultrasound measurements and BMD measurements of the proximal femur. We conclude that in persons 55 years or over (1) there is a significant age-related decline of BUA and SOS, which is about three times higher in women compared with men, and (2) ultrasound measurements are not able to predict low BMD in hip or spine.

Absorptiometry, Photon↗
PubMed1994

Reliability of intraocular pressure measurement with the Goldmann applanation tonometer in epidemiological studies.

The reproducibility of intraocular pressure (IOP) measurement with the Goldmann applanation tonometer was investigated as part of a population-based epidemiological study. Sixty-two subjects were examined in a first measurement session. The IOP was measured three times consecutively in both eyes according to a fixed protocol. The mean standard deviation (SD) of these measurements was 0.8 mmHg. The mean intraobserver variation for the first measurement was 1.64 (SD 2.07) mmHg. For the median of the three measurements the intra-observer variation was 1.50 (SD 1.96) mmHg. The mean inter-observer values were 1.79 (SD 2.41) mmHg for the first measurement and 1.60 (SD 2.15) mmHg for the median measurement. The correlation coefficient between the median values of the three measurements of both observers was 0.81. No systematic differences were found between the two observers. Using the median value of three consecutive measurements reduced the inter-observer variation by 11% and the intra-observer variation by 9% compared with a single measurement.

Aged↗