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Biomedical subjects

D E Grobbee

Publications and source records attributed to D E Grobbee.

At least 397 records · Page 22Linked to original sources
PubMed1994

Adverse reactions attributed to sumatriptan. A postmarketing study in general practice.

There are several reports on cardiac adverse reactions attributed to the antimigraine drug sumatriptan in the recent literature. In order to assess the frequency and the character of adverse reactions to sumatriptan, a postmarketing cohort study was performed one year after registration of the drug in The Netherlands. With assistance of 86% of the drug dispensing general practitioners in The Netherlands, 1727 patients who had received sumatriptan were traced in July, 1992. Via their general practitioners, a questionnaire about use of sumatriptan, adverse reactions and other medication was sent to the patients in December 1992. During the study period, seven patients were lost to follow-up. Of the 1720 remaining patients, 1202 (70%) responded to the questionnaire, of whom 1187 had actually used sumatriptan. The most frequently reported suspected adverse reactions were paraesthesiae (139 patients, 95% CI 9.9%-13.5%) and dizziness (96 patients, 95% CI 6.5%-9.7%). Chest pain after use of sumatriptan was reported by 94 patients (7.9%, 95% CI 6.4%-9.4%), and according to the close temporal relationship with the intake of sumatriptan and a positive rechallenge, a causal relationship was probable in most of those patients. The frequency of chest pain attributed to sumatriptan was higher in females (9.0% vs 4.6%; relative risk 1.9, 95% CI 1.1-3.4). Age and hypertension were not associated with chest pain attributed to sumatriptan. Dyspnoea attributed to sumatriptan was reported by 26 patients (2.2%), and was associated with obstructive lung disease (relative risk 5.4 95% CI 1.7-16.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Reproducibility of carotid vessel wall thickness measurements. The Rotterdam Study.

We studied the reproducibility of measurement of ultrasonographically assessed common carotid intima-media thickness and assessed whether measurement error of intima-media thickness occurred randomly or was associated with potential determinants of atherosclerosis. Eighty participants of the Rotterdam Study underwent a second ultrasound scan of both carotid arteries within 3 months of the first scan. The replicate measurements involved the posterior intima-media thickness of the distal common carotid artery. Mean differences (SD) in intima-media thickness of the right common carotid artery between paired measurements of sonographers, readers and visits were -0.004 mm (0.10), 0.066 mm (0.07), and -0.013 mm (0.13), respectively. Similar results were obtained for the left common carotid artery. Measurement error of intima-media thickness, i.e. the absolute difference in measurements between two subsequent visits, increased significantly with increasing common carotid intima-media thickness. This association disappeared after logarithmical transformation of the intima-media thickness data. Age, sex, smoking, body mass index, serum lipids, fibrinogen, and systolic and diastolic blood pressure were not significantly associated with the measurement error of intima-media thickness. Our findings indicate that measurements of common carotid intima-media thickness are highly reproducible. Measurement error of intima-media thickness is small and appears to be proportional with the level of intima-media thickness and is not significantly associated with most risk factors for atherosclerotic vessel wall disease.

Aged↗
PubMed1994

The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The Rotterdam Study.

PURPOSE: The objective of this study is to assess the prevalence of primary open-angle glaucoma (POAG) in a defined population in Rotterdam, The Netherlands. METHODS: The Rotterdam Study is a single-center prospective cohort study of a total population of more than 10,000 people, 55 years of age or older. For the current analysis, the first 3062 consecutive, unselected, noninstitutionalized participants were examined according to standard protocols, including perimetry. The diagnosis of POAG was based on the presence of a glaucomatous visual field defect combined with either a vertical cup: disc ratio of 0.5 or more or a cup:disc ratio asymmetry of 0.2 or more, or an intraocular pressure (IOP) more than 21 mmHg, with open and normal anterior chamber angles. RESULTS: The overall prevalence of POAG in the current study was 1.10% (95% confidence interval [CI]: 1.09, 1.11). Age-specific prevalence figures increased from 0.2% (95% CI: 0.16, 0.24) in the age group of 55 to 59 years to 3.3% (95% CI: 2.57, 4.04) in the age group of 85 to 89 years. Men had a more than three times higher risk of having POAG than women (odds ratio, 3.6). In 52.9% of the patients, POAG had not been diagnosed previously. Of these patients, 38.9% had IOPs of 21 mmHg or lower. In 8.8% of the eyes (2.9% of patients), visual acuity was 20/200 or less due to POAG. CONCLUSION: The overall prevalence of POAG in the current study was 1.1%. The prevalence of POAG was higher in men than in women. Of the untreated patients, 38.9% had IOPs of 21 mmHg or lower.

Age Factors↗
PubMed1994

The association between age and bone mineral density in men and women aged 55 years and over: the Rotterdam Study.

In this cross-sectional study, bone mineral density (BMD) measurements were performed in 1762 ambulatory subjects (678 men and 1084 women) aged 55 years and over from the Rotterdam Study, a population based study of diseases in the elderly. BMD measurements of the proximal femur and lumbar spine were performed using dual energy X-ray absorptiometry. No age-related decline in BMD could be observed in the lumbar spine. Yearly percentage BMD reduction in women and men was -0.6% and -0.3% in the femoral neck, -0.8% and -0.5% in the Ward's triangle, and -0.4% and -0.3% in the trochanter, respectively. Late menopause was associated with high BMD in Ward's triangle and lumbar spine. We conclude that: (1) accurate assessment of age-related bone reduction in the spine is impossible from cross-sectional studies since BMD measurements in the elderly may be influenced by spinal osteoarthritis; and (2) the rate of age-related bone reduction in the femoral neck appears to be approximately two times higher in women than in men.

Absorptiometry, Photon↗
PubMed1994

Reduction of blood pressure with oral magnesium supplementation in women with mild to moderate hypertension.

In a double-blind controlled trial, 91 middle-aged and elderly women with mild to moderate hypertension who were not on antihypertensive medication were randomly assigned to treatment with magnesium aspartate-HCl (20 mmol Mg/d) or placebo for 6 mo. Magnesium aspartate-HCl in the given dose was well-tolerated and was not associated with an increased frequency of diarrhea compared with placebo. At the end of the study, systolic blood pressure had fallen by 2.7 mm Hg (95% CI -1.2, 6.7; P = 0.18) and diastolic blood pressure by 3.4 mm Hg (1.3, 5.6; P = 0.003) more in the magnesium group than in the placebo group. Blood pressure response was not associated with baseline magnesium status, as measured by dietary magnesium intake and urinary magnesium excretion. Urinary magnesium excretion in the magnesium group increased by 50% during the intervention period. No changes were seen in other biochemical indexes, including serum concentrations of total and high-density-lipoprotein cholesterol. The findings suggest that oral supplementation with magnesium aspartate-HCl may lower blood pressure in subjects with mild to moderate hypertension.

Administration, Oral↗
PubMed1994

Anthropometric measures, fitness and habitual physical activity in offspring of hypertensive parents. Dutch Hypertension and Offspring Study.

As part of the Dutch Hypertension and Offspring Study, subjects with contrasting risk for hypertension according to their parental history of hypertension were compared with respect to anthropometric measures and measures of fitness and physical activity. Body height, weight, two skinfolds, and blood pressure at rest were measured. Fitness was evaluated by a maximal exercise test, and habitual physical activity was assessed using a questionnaire. No differences were observed in body mass index after adjustment for slight differences in age and proportion of men between the groups (difference between groups: 0.74 kg/m2, 95% CI: -0.30, 1.78). Offspring of hypertensive parents, however, had significantly more central fat (difference between groups: 2.32 mm, 95% CI: 0.18, 4.46). No differences in fitness or physical activity were present between the two groups. The results of this study indicate a potential role for central fat in the etiology of primary hypertension. Fitness or habitual physical activity are, however, not different between groups of subjects at different risk for future hypertension.

Adolescent↗
PubMed1994

Hypertension and determinants of blood pressure with special reference to socioeconomic status in a rural south Indian community.

OBJECTIVES: The objective of the study was to establish the prevalence of hypertension and to assess determinants of blood pressure with special reference to socioeconomic status in a rural south Indian community. DESIGN: This was a door to door, cross sectional survey. SETTING: A rural south Indian community, KV Kuppam panchayat, North Arcot District, Tamil Nadu. SUBJECTS: The area has a total population of 3500 people. Those aged over 20 years who were available at the time of measurement were asked to participate (mean age 39.5 years). This convenience sample totalled 1027 (456 men, 571 women). Out of 697 families, 487 were visited; 15 people refused to participate. MEASUREMENTS AND MAIN RESULTS: The following potential determinants of blood pressure were assessed: age, body weight, pulse rate, salt intake, meat intake, and socioeconomic class. The prevalence of hypertension was 12.5%. Using multiple linear regression analysis, the most important positive determinants of high blood pressure seemed to be age, body weight, and pulse rate. Salt and meat intake were not significantly associated with hypertension. The prevalence of hypertension in the highest socioeconomic group (22.5%) was more than twice that in the lowest socioeconomic group (8.8%). When adjusted for body weight, the mean (SEM) difference in systolic blood pressure between the highest and lowest socioeconomic classes was 5.83 mmHg (1.63). CONCLUSION: Hypertension is not yet as important a health problem in rural southern India as it is in westernised societies. Those particularly at risk of hypertension, however, are the elderly and overweight people of high socioeconomic class.

Adult↗
PubMed1994

Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study.

High-resolution B-mode ultrasonography of the carotid arteries is used to investigate the signs of early atherosclerotic vessel wall disease. To assess whether carotid artery findings reflect atherosclerosis elsewhere, we studied the association between common carotid intima-media thickness and lower extremity arterial atherosclerosis among the first 1000 participants of the Rotterdam Study. The Rotterdam Study is a single-center population-based prospective follow-up study of 7983 subjects, > or = 55 years old. Baseline measurements include ultrasound imaging of intima-media thickness of the distal common carotid artery and determination of the ankle-to-arm systolic blood pressure index. Lower extremity arterial disease was defined as an ankle-arm index < 0.90 in at least one leg. An increase of 0.1 mm in common carotid artery intima-media thickness was associated with an age- and sex-adjusted reduction of the ankle-arm index of 0.026 (95% confidence interval [CI]: 0.018 to 0.034). The age- and sex-adjusted odds ratio of lower extremity arterial disease for subjects with an intima-media thickness > or = 0.89 mm (upper quintile) to that of subjects with an intima-media thickness < 0.89 mm was 3.4 (95% CI: 2.2 to 5.2). Analysis among subjects free from symptomatic cardiovascular disease yielded a reduction in ankle-arm index per 0.1 mm increase in intima-media thickness of 0.018 (95% CI: 0.008 to 0.28) and an odds ratio for lower extremity arterial disease of 3.0 (95% CI: 1.7 to 5.1). Adjustments for differences in serum lipids, hypertension, and current smoking status only slightly attenuated the results.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Cognitive correlates of ventricular enlargement and cerebral white matter lesions on magnetic resonance imaging. The Rotterdam Study.

BACKGROUND AND PURPOSE: Ventricular enlargement and white matter lesions are frequent findings on cerebral magnetic resonance imaging scans of elderly subjects. In demented subjects they seem related to the severity of the dementia, but in nondemented subjects their clinical significance is less clear. We investigated the relation of size of the lateral ventricles and white matter lesions with cognitive function in a population-based random sample of nondemented elderly persons. METHODS: The study population consisted of 90 subjects, aged 65 to 84 years, who were randomly selected from the cohort of the Rotterdam Study, and who were not demented. The presence of white matter lesions and the ventricle-to-brain ratio were assessed on magnetic resonance scans. Participants were tested with a neuropsychological battery that covered a broad range of cognitive functions. RESULTS: Ventricular enlargement and white matter lesions were both and independently associated with poorer performance on all tests. After adjustment for age and sex, ventricular enlargement was significantly associated with worse scores on tests assessing global cognitive function (Mini-Mental State Examination, P = .02; Groninger Intelligence Test, P = .01), memory (Word List Learning delayed recall, P = .03), and executive control functions (Stroop part II, P = .02; Trial Making Test B, P < .01); for white matter lesions the differences were significant for tests measuring executive control functions and mental speed (Trail Making Test A and B, P = .01 and P < .01, respectively; verbal fluency, P = .01), and memory (Word List Learning delayed recall, P = .04). CONCLUSIONS: This study suggests that white matter lesions are primarily related to impairment of subcorticofrontal functions, whereas enlargement of the lateral ventricles is associated with disturbances of cortical functions as well.

Age Factors↗
PubMed1994

Stroke incidence and mortality in rural and urban Shanghai from 1984 through 1991. Findings from a community-based registry.

BACKGROUND: Mortality from stroke has declined in many countries. This decline may result from a fall in incidence of stroke or a decrease in case fatality from stroke. The present study was conducted to investigate the temporal trends of incidence rate, mortality rate, and case fatality of stroke in an urban and rural Chinese population. METHODS: A community-based registry study was established in 1983 in defined rural and urban areas of Shanghai with a population aged 35 to 74 years of approximately 86,000 subjects, adhering to the methods and definitions of the World Health Organization MONICA protocol. All stroke events occurring in the population aged 35 to 74 years in these areas were registered by a special three-level case-registration system. RESULTS: From 1984 through 1991, 1391 stroke cases were identified. No significant change in the incidence rate of stroke was observed from 1984 through 1991 in men and women living in rural and urban areas. Age-standardized mortality rates (per 100,000 person years) of stroke declined significantly during this period, except for rural women. The annual changes and 95% confidence intervals of age-standardized mortality rates were: for rural men -4.6% (-5.4, -3.9), for rural women -0.6% (-1.6, 0.5), for urban men -2.5% (-3.5, -1.6), and for urban women -4.7% (-5.2, -4.2). A significant decrease in case fatality from stroke from 1984 through 1991 was found among men living in rural areas (from 62.4% to 46.0%) and among women living in urban areas (from 48.4% to 33.3%). Overall case fatality, however, showed a nonsignificant decline over time. CONCLUSIONS: We observed a decline in stroke mortality rate in a rural and urban Chinese population. No significant changes in stroke incidence were found in this study, whereas case fatality appeared to have decreased, in particular among men living in rural areas and women living in urban areas.

Adult↗
PubMed1994

Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study: the Rotterdam Study.

Cerebral white matter lesions are a common finding on MRI in elderly persons. We studied the prevalence of white matter lesions and their relation with classic cardiovascular risk factors, thrombogenic factors, and cognitive function in an age- and gender-stratified random sample from the general population that consisted of 111 subjects 65 to 84 years of age. Overall, 27% of subjects had white matter lesions. The prevalence and severity of lesions increased with age. A history of stroke or myocardial infarction, factor VIIc activity, and fibrinogen level were each significantly and independently associated with the presence of white matter lesions. Significant relations with blood pressure level, hypertension, and plasma cholesterol were present only for subjects aged 65 to 74 years. White matter lesions tended to be associated with lower scores on tests of cognitive function and were significantly associated with subjective mental decline. This study suggests that classic cardiovascular risk factors, as well as thrombogenic factors, are associated with white matter lesions in subjects over 65 years of age in the general population, and that these lesions may be related to cognitive function.

Aged↗
PubMed1994

Do non-potassium-sparing diuretics increase the risk of sudden cardiac death in hypertensive patients? Recent evidence.

Whether non-potassium-sparing diuretics (NPSD) increase the risk of sudden cardiac death in hypertensive patients has been vigorously debated. Diuretic-induced potassium or magnesium depletion leading to cardiac arrhythmias has been suggested as the underlying mechanism. A clear dose-response relationship between NPSD and the reduction in serum K+ exists. Data regarding serum Mg++ and intracellular K+ and Mg++ are too limited to allow conclusions. NPSD seem to increase the risk of ventricular arrhythmias among hypertensive patients with clinical evidence of heart disease, but the number of studies is small. The findings among patients without evidence of heart disease are less conclusive. The interpretation of the studies on electrolyte changes and arrhythmias following diuretic therapy is obscured by the fact that only a minority of studies included a randomly allocated placebo-treated control group. The large hypertension trials provide the strongest evidence that NPSD for hypertension may induce sudden death. Although blood pressure lowering may be expected to reduce the incidence of sudden cardiac death, the incidence in the NPSD group is similar to or even higher than that in the control group in 9 of 10 trials. We conclude that the beneficial effect of NPSD therapy for hypertension is partly offset by an excess risk of sudden death. Thus, alternative drugs, notably potassium-sparing diuretics or beta-blockers, could be preferred as antihypertensive drugs of first choice, although the efficacy of beta-blockers in older patients has recently been challenged.

Adult↗
PubMed1994

Electrolytes and hypertension: results from recent studies.

The effects of dietary electrolytes on blood pressure may start as early as the prenatal period as there is evidence to suggest that a high maternal calcium, magnesium, and potassium intake is reflected in lower infant blood pressure levels. One randomized trial in newborn infants suggested that, in this early phase, high sodium intake is associated with an increased blood pressure change. Such a sodium effect is not present when children grow older, and between 6 and 16 years a high potassium intake appears to limit the increase in blood pressure. Recent observational population studies have shown that the association between dietary sodium intake and blood pressure level in adults is less than initially reported. In randomized trials, the average fall in blood pressure from moderate sodium restriction is small, although benefits may be larger in the elderly. A high potassium intake has consistently been shown to reduce blood pressure levels in treated and untreated hypertensive subjects, although the overall effects are modest. The available data on calcium are difficult to interpret. From observational studies an inverse association between dietary calcium intake and blood pressure levels has repeatedly been reported. Also, several disturbances in calcium metabolism in hypertensive subjects have been demonstrated. Findings in randomized trials are less consistent and indicate a marked heterogeneity in response.

Animals↗
PubMed1993

Relation between birth weight and blood pressure: longitudinal study of infants and children.

OBJECTIVE: To study the relation between birth weight and systolic blood pressure in infancy and early childhood. DESIGN: Longitudinal study of infants from birth to 4 years of age. SETTING: A middle class community in the Netherlands. PARTICIPANTS: 476 Dutch infants born in 1980 to healthy women after uncomplicated pregnancies. MAIN OUTCOME MEASURES: Systolic blood pressure and body weight measured at birth and at 3 months and 4 years of age; the relation between systolic blood pressure and birth weight as estimated by multiple regression models that include current weight and previous blood pressure and control for gestational age, length at birth, and sex. RESULTS: Complete data were available on 392 infants. At 4 years of age the relation between blood pressure and birth weight appeared to be U shaped; low and high birthweight infants had raised blood pressure. Current weight and previous blood pressure were also positively associated with blood pressure at that age. Low birthweight infants (birth weight < 3100 g) had a greater gain in blood pressure and weight in early infancy. High birthweight infants (birth weight > or = 3700 g) had high blood pressure at birth, and weight and blood pressure tended to remain high thereafter. CONCLUSIONS: Even among normal infants there seem to be subgroups defined by birth weight in which blood pressure is regulated differently. Future investigations are needed to examine the physiological basis of these differences. Studies of correlates of adult disease related to birth weight should investigate mechanisms related to increased risk separately in infants of low and high birth weight.

Aging↗
PubMed1993

Cerebral white matter lesions and atherosclerosis in the Rotterdam Study.

Cerebral white matter lesions (WML) seen on magnetic resonance imaging scans are associated with cardiovascular disease and vascular risk factors. To assess the association between WML and atherosclerosis, we studied 111 people, aged 65 to 85 years, randomly sampled, and stratified by age and sex, from participants in the Rotterdam Study. Cerebral T2-weighted magnetic resonance images in the axial plane were obtained for all subjects. Carotid atherosclerosis was ultrasonographically assessed by the presence of stenosis, measurement of intima to media wall thickness (IMT), and the presence of atherosclerotic plaques. A possible or definite myocardial infarction on an electrocardiogram was used as an indicator of coronary atherosclerosis. The ankle to arm systolic blood pressure ratio (ABI) was determined, and peripheral arterial disease was defined as an ABI lower than 0.90 in at least one side. Carotid atherosclerosis was significantly more pronounced in people with WML. The difference in common carotid IMT was 0.13 mm (95% confidence interval [CI] 0.04-0.21), whereas the odds ratio of WML associated with plaques in the carotid bifurcation was 3.9. The degree of internal carotid artery stenosis was not, however, associated with WML. The mean ABI was significantly lower in people with WML than in those without lesions with a difference of -0.11 (95% CI -0.21 to -0.01). The odds ratio of WML associated with peripheral arterial disease and a possible or definite myocardial infarction was 2.4 and 3.1, respectively. We conclude that atherosclerosis, indicated by increased common carotid IMT, carotid plaques, and a lower ABI, is related to WML.

Aged↗