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Biomedical subjects

D M Reed

Publications and source records attributed to D M Reed.

At least 19 recordsLinked to original sources
PubMed1992

Will lowering population levels of serum cholesterol affect total mortality? Expectations from the Honolulu Heart Program.

Major campaigns now underway to reduce the serum cholesterol levels of entire national populations have not given serious consideration to the high rates of noncardiovascular disease and death associated with low cholesterol levels (less than 190 mg/dl). To explore this problem, the relationships between serum cholesterol levels, measured in 1965-1968 in 7478 Japanese American men in Hawaii, and subsequent total and cause-specific mortality through 1985, were analyzed by multivariate Cox regression to control for potential confounders. Total mortality rates for 1648 deaths showed a U-shaped curve by baseline cholesterol level, with significant inverse trends (p less than 0.03) for deaths due to hemorrhagic stroke, all cancer, benign liver disease, chronic obstructive lung disease and "unknown cause". Only the inverse trends for cancer and benign liver disease showed flattening when 227 deaths in the first 5 years of follow-up were deleted from the analysis. Simulation models using three different strategies of cholesterol reduction in this cohort revealed that none of these approaches had any substantial impact on predicted total mortality over 15 years. However, the population-based approach might theoretically increase mortality for 60% of the cohort with baseline cholesterol levels less than 225 mg/dl.

Aged↗
PubMed1992

Lipoproteins and blood pressure as biological pathways for effect of moderate alcohol consumption on coronary heart disease.

BACKGROUND: Several epidemiological studies have shown light-to-moderate alcohol consumption to have a net protective effect on the incidence of coronary heart disease (CHD). METHODS AND RESULTS: Major components of this effect, both positive and negative, may be explored using models that include both alcohol and variables expected to mediate the observed alcohol effect. Such modeling in a cohort of men of Japanese descent followed in the Honolulu Heart Program indicates that about half of the observed protection against CHD afforded by moderate alcohol consumption is mediated by an increase in high density lipoprotein cholesterol. An additional 18% of this protection is attributable to a decrease in low density lipoprotein cholesterol, but it is counterbalanced by a 17% increase in risk due to increased systolic blood pressure. The explanation for the residual 50% benefit attributable to alcohol is unknown but may include interference with thrombosis. The results in this population replicate those in the Lipid Research Clinics cohort studied earlier with the same analytic technique. CONCLUSIONS: The consistency of these findings across populations, along with the demonstration of reasonable biological pathways for this effect of alcohol, provides strong support for the hypothesis that light-to-moderate alcohol intake is protective against heart disease in men.

Alcohol Drinking↗
PubMed1992

Dehydroepiandrosterone sulfate, incidence of myocardial infarction, and extent of atherosclerosis in men.

BACKGROUND: Antiatherogenic effects of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) have been suspected for more than 30 years, yet the available evidence to support or refute such effects in humans is inconclusive. The hypothesis has not been adequately tested in large-scale epidemiological studies. METHODS AND RESULTS: The present study used a cohort of men initially free of clinically detectable coronary heart disease, stroke, and cancer to compare DHEAS levels measured in sera obtained in 1968-1971 between 238 cases who had definite coronary heart disease during the subsequent 18 years and 476 age-matched controls who survived the follow-up period and remained free of clinically detectable coronary heart disease. In a separate study, the relation of DHEAS levels to extent of atherosclerosis was examined among 82 cohort men who died during the follow-up period and had protocol autopsies. Age-adjusted DHEAS levels were lower among fatal cases of coronary heart disease than among controls (94.7 versus 106.9 micrograms/dl, respectively; p < 0.05). After adjustment for eight coronary risk factors, the odds ratio for fatal coronary heart disease comparing a 100-micrograms/dl difference in DHEAS level was 0.46 (95% confidence intervals, 0.19-1.07). In contrast, age-adjusted DHEAS levels did not significantly differ between nonfatal cases of myocardial infarction and controls (107.2 versus 106.9 micrograms/dl, respectively). Furthermore, DHEAS levels were not related to extent of atherosclerosis at autopsy. CONCLUSIONS: These findings do not support a role of DHEAS in the development of nonfatal myocardial infarction or the progression of atherosclerosis. The association of DHEAS with fatal coronary heart disease and possibly with death from all causes merits further investigation. These findings suggest continued skepticism that DHEAS has an important role in coronary disease etiology or prevention.

Age Factors↗
PubMed1990

Smoking, pulmonary function, and mortality.

The association of pulmonary function (as percent of predicted forced expiratory volume in 1 second [FEV1]) with total and cause-specific mortality over 15 to 18 years was investigated in a large cohort (5924) of prospectively followed Japanese-American men. Among those who never smoked, pulmonary function was found not to be significantly predictive of total mortality in a multivariate model in which adjustment for variables that might confound the results was made. Among past and current smokers, highly significant associations were found (P < 0.0001). The positive relationship of pulmonary function to mortality in smokers was so strong that it overshadowed these differences in nonsmokers in a model including all smoking groups combined, even after adjusting for smoking. A smoking-pulmonary function interaction term added to this model was statistically significant (P < 0.003). This illustrates the need for attention to the potential for complex interactions between biologic variables when carrying out multivariate statistical analysis. Findings for cardiovascular and noncardiovascular mortality were similar. This analysis indicates that while pulmonary function is associated with subsequent mortality, the relationship is significantly associated with smoking history.

Asian↗
PubMed1990

Health status and life style in elderly Japanese men with a long life expectancy.

The Japanese population in Hawaii has one of the longest life expectancies of any large population subgroup in the U.S. and the world. Cross-sectional data on 1,379 elderly, noninstitutionalized, male Japanese American survivors of a population-based cohort study indicated the most common health problems were hypertension (43%), arthritis (33%), diabetes (13%), and gout (9%). For cancer and hypertension there is a trend toward higher prevalence in older age groups. For coronary heart disease, stroke, and angina the oldest age group (75-81 years) has a higher prevalence than that seen in younger age groups. Other relatively common diseases such as diabetes, gout, peptic ulcer, and arthritis do not have higher prevalence in older age groups. Drugs reported to be used frequently by study participants were for hypertension, gout, CHD, and diabetes. The prevalence rates of major limitations of mobility and of living alone appear to be relatively low in this population. Less than one percent of the current population rate their health status as poor. The prevalence of normal serum cholesterol and smoking are similar to those seen in U.S. White males, while the rates of hypertension appear lower. Prevalence rates for stroke and heart attack also appear to be somewhat lower in these long-lived individuals than those seen in U.S. Whites.

Activities of Daily Living↗
PubMed1990

Potential bias due to prevalent diseases in prospective studies.

In prospective studies, subjects found to have the disease under investigation at the initial screening examination are commonly excluded from analyses. However, the possibility of bias due to prevalent conditions other than the disease of interest is usually not considered. In the present study, an algebraic development enables analysis of the effects of inclusion and exclusion of subjects with certain prevalent conditions upon risk estimates. Hypothetical data are presented for which an association between a risk factor and an incident disease could become null or even reversed after removing subjects with certain prevalent diseases. Bias appears even when the only association present is between risk factor and total disease incidence. Data from the Honolulu Heart Study also have been used to illustrate this finding, examining the association between coronary heart disease (CHD) incidence and smoking. Decisions regarding the inclusion or exclusion of subjects with prevalent diseases requires prior knowledge of alteration of usual risk factors levels by individuals with these diseases. Simply removing all subjects with prevalent diseases might on the contrary create bias. Therefore, people with prevalent diseases should be screened for potential alteration of their risk factor levels as a result of the diseases. The situation becomes still more complex when several risk factors and prevalent diseases need to be considered at the same time as it happens in multivariate analyses. Because this situation represents a bias, and not confounding or effect modification, controlling for the effect of prevalent diseases is not appropriate.

Aged↗
PubMed1990

The paradox of high risk of stroke in populations with low risk of coronary heart disease.

The "paradoxical" occurrence of high rates of stroke and low rates of coronary heart disease observed in Asian and other populations has been examined using accumulated clinical and autopsy data obtained during the long-term follow-up from 1965 to 1985 of cohorts of Japanese men living in Hawaii and Japan. The search for explanatory variables revealed three with the characteristics of having both opposing patterns of associations with clinical stroke compared with coronary heart disease and of being more prevalent in Japan than in Hawaii. These variables were low serum cholesterol levels, high intake of alcohol, and some aspect of an Oriental diet characterized by low intake of fat and protein from animal sources. Analysis of associations of these variables with measures of atherosclerosis in coronary and cerebral arteries revealed no paradoxical differences, with the possible exception of some dietary variables. Associations with autopsy-measured myocardial infarctions, cerebral infarction, and hemorrhage, however, showed opposing patterns similar to those found for clinical disease. The main inference from this work is that the paradoxically high risk of stroke observed in populations with low risk of coronary heart disease is not due to atherosclerosis in the major cerebral arteries. Rather, it is more likely due to lesions in the small intracerebral arteries and appears to be related to low levels of serum cholesterol, high alcohol intake, and some aspect of a traditional Oriental diet.

Alcohol Drinking↗
PubMed1989

Risk factors in middle age that predict early and late onset of coronary heart disease.

Twelve biological and lifestyle characteristics measured in a group of 5919 middle aged men free of clinical coronary heart disease (CHD), stroke and cancer were analyzed for differences in predicting early and late onset of new cases of definite CHD (non-fatal myocardial infarction and fatal CHD) over a 12-year follow-up period. Among these men, 151 cases of definite CHD occurred early (under age 60) and 135 cases occurred later in life (age 60 and over). Serum triglyceride was the only risk factor that was an independent predictor of early onset disease and not of late onset disease. While cigarette smoking was a predictor for both onset groups, the effect of smoking was greater in people who developed CHD earlier in life. Systolic blood pressure, alcohol intake, serum cholesterol and serum glucose were independent predictors for both onset groups, with no difference in effect between groups. The findings indicate that it is possible for some factors to affect CHD risk differently in terms of premature vs delayed onset of disease. The findings for serum triglyceride may account for some of the inconsistencies in reports regarding it as an independent risk factor for CHD. In general, however, most of the characteristics studied here had a similar effect on both early and late onset and thus remain important in the prevention of both premature and late onset of CHD.

Age Factors↗
PubMed1989

Pulmonary function as a predictor of coronary heart disease.

The role of pulmonary function as an independent predictor of coronary heart disease was examined in 1965-1983 in a cohort of Japanese-American men. As part of the Honolulu Heart Program, the authors measured pulmonary function in 5,924 men aged 45-68 years who were free of coronary heart disease at baseline examination and followed them for 15-18 years for the development of nonfatal myocardial infarction and fatal coronary heart disease. Per cent predicted forced expiratory volume in one second (%PFEV1) was significantly inversely related to coronary heart disease incidence in the total cohort after adjusting for age (p less than 0.0001) and then for all known coronary heart disease risk factors (p = 0.0004). However, when examined by smoking status, %PFEV1 was a predictor of coronary heart disease only among past and current smokers, and not for men who had never smoked cigarettes (p = 0.36). The association between pulmonary function and coronary heart disease can be explained by cigarette smoking, which leads to both lung impairment and coronary heart disease incidence.

Aged↗
PubMed1989

Occupational strain and the incidence of coronary heart disease.

The hypothesis that men in high "strain" occupations have an increased risk of developing coronary heart disease was tested during an 18-year follow-up study from 1965-1983 of a cohort of 8,006 men of Japanese ancestry in Hawaii. There were no significant associations between the incidence of coronary heart disease and the individual job components of high psychologic demands and low job control or for the high strain interaction of these two characteristics. There were, in fact, trends of associations opposite to that predicted by the job strain model which were of borderline significance in multivariate analyses. Stratified analyses by level of acculturation showed similar inverse associations of job strain and coronary heart disease for the more Westernized men and no association for the more traditional men. There were also no significant associations among the various job characteristics and the major risk factors for coronary heart disease in this cohort. The disagreement of these results with those from other studies may be due to methodologic differences of using men whose usual and current occupations were the same in this study compared with using only current occupation in the other studies, the use of different methods of measuring job strain, or the possibility that men in this cohort perceive or react to occupational strain differently.

Adult↗
PubMed1989

Predictors of sudden cardiac death among Hawaiian-Japanese men.

A cohort of 7,591 middle-aged Hawaiian-Japanese men free at initial examination of evidence of coronary heart disease or stroke were followed starting in 1965. Between 1965 and 1983, 1,342 of these men died; 229 deaths occurred less than 24 hours after the onset of the terminal episode, of which 98 deaths occurred in less than one hour. In the category of deaths occurring less than one hour after onset, the risk characteristics of those whose deaths were attributed to coronary heart disease and those whose deaths were attributed to an unknown cause were similar. It is appropriate to combine them as "sudden cardiac death." In the category of deaths occurring one to 24 hours after onset, the risk characteristics of those whose deaths were attributed to coronary heart disease and those whose deaths were attributed to an unknown cause differed. It is not appropriate to assume coronary heart disease as the underlying cause of death in this unknown cause group. The predictors of sudden cardiac death were blood pressure, serum cholesterol, serum glucose, cigarette smoking, history of parental heart attack, and electrocardiographic evidence of left ventricular hypertrophy or strain. Inversely related to risk were alcohol intake and the number of years spent in Japan. No factor distinguished those at risk for sudden cardiac death from those at risk for other manifestations of coronary heart disease.

Blood Glucose↗
PubMed1989

Dietary alcohol, calcium, and potassium. Independent and combined effects on blood pressure.

To determine whether or not the previously reported association between alcohol intake and high blood pressure is influenced by differential intake of calcium and potassium in drinkers compared with nondrinkers and to assess the magnitude of the independent contributions of alcohol, calcium, and potassium to blood pressure, these associations were evaluated in 7,011 men of Japanese descent. Categorical analyses and multiple linear regression techniques were used to test the hypotheses that alcohol, calcium, and potassium were independent predictors of blood pressure. Alcohol consumption above a threshold of approximately 20 ml/day was found to be positively, strongly, and independently correlated with systolic and diastolic pressures, and this effect was completely independent of the effects of calcium and potassium. Calcium and potassium intake were highly correlated (r = 0.59) and were inversely related to blood pressure, and their combined effect was greater than the effect of either alone. However, in the subgroup of moderate and heavier drinkers, only potassium was inversely related to blood pressure. This finding is compatible with previous reports of malabsorption and increased excretion of calcium at higher levels of alcohol intake, and it indicates that a small portion of the alcohol-induced blood pressure elevation may be mediated through calcium depletion. In the range of dietary intake in this cohort, the effect of alcohol on blood pressure was stronger than was either the separate or combined effects of calcium and potassium.

Alcohol Drinking↗
PubMed1989

Serum cholesterol and hemorrhagic stroke in the Honolulu Heart Program.

During an average 18 years of follow-up for 7,850 Japanese-American men in Hawaii who were free of stroke at entry, 116 developed hemorrhagic stroke (subarachnoid hemorrhage or intracerebral hemorrhage). There was a significant (p = 0.001) inverse association between serum cholesterol and the risk of intracerebral hemorrhage but not of subarachnoid hemorrhage. This inverse association was nonlinear, with a higher incidence rate only for men with serum cholesterol in the lowest quintile (less than 189 mg/dl). The relative risk (lowest quintile/other four quintiles) was 2.55 (95% confidence interval 1.58-4.12) after controlling for age, blood pressure, serum uric acid, cigarette smoking, and alcohol consumption. There was no evidence for an interaction between blood pressure and serum cholesterol, although the inverse association was stronger for normotensive than for hypertensive men. Public health implications would differ in different countries depending on the relative frequency of intracerebral hemorrhage and on the distribution of serum cholesterol levels in the population.

Aged↗
PubMed1988

The predictive value of resting electrocardiograms for 12-year incidence of coronary heart disease in the Honolulu Heart Program.

The predictive value of electrocardiographic (ECG) abnormalities at baseline for subsequent risk of fatal and total coronary heart disease (CHD) was analyzed in a 12-year follow-up of 7682 men in the Honolulu Heart Program aged 45-68 who were free of CHD at baseline. Univariate analysis showed that men with major or minor ECG abnormalities, ST depression, high R wave, T-wave inversion, left ventricular hypertrophy or strain and premature ventricular contractions had considerably higher (2-10 fold) CHD incidence rates than those with normal ECG. When blood pressure, cigarette smoking, body mass index, alcohol use, physical activity, serum glucose, serum cholesterol, serum uric acid, age and years lived in Japan were taken into consideration through multivariate analysis, the ECG abnormalities retained significant associations with fatal and total CHD. This study demonstrated that resting ECG abnormalities were independent predictors of both total and fatal CHD.

Aged↗
PubMed1988

A comparison of the 12-year mortality and predictive factors of coronary heart disease among Japanese men in Japan and Hawaii.

The mortality and predictive factors of coronary heart disease among men of Japanese ancestry in Japan and Hawaii were compared on the basis of 12 years follow-up data using comparable methods of case ascertainment and risk factor measurements. Among 1,687 men (Japan) and 7,536 men (Hawaii) who were free of coronary heart disease and aged 45-69 at baseline examination in 1965-1968, 20 (Japan) and 123 (Hawaii) cases of fatal coronary heart disease were identified. The age-adjusted mortality rate was 40% higher in Hawaii than in Japan. The difference was not statistically significant, but consistent with earlier studies. More than half of this difference in mortality rate was attributed to different levels of known risk factors in the two cohorts. In multivariate analysis using the combined population, age, blood pressure, serum cholesterol, serum glucose, cigarette smoking, and alcohol intake (inversely) remained as significant predictors of coronary heart disease mortality. Although the associations of risk factors with coronary heart disease tended to be stronger in Hawaii than in Japan, there was no statistically significant difference in regression coefficient for any of the risk factors studied. These findings cannot be claimed to be definitive because of the small number of cases, especially in Japan.

Actuarial Analysis↗
PubMed1988

A prospective study of mortality and morbidity among carpenters in the Honolulu Heart Program Cohort.

The relationship of occupation as a carpenter to the development of definite coronary heart disease, stroke, cancer and total mortality was examined in men of Japanese ancestry participating in the Honolulu Heart Program. After 18 years of follow-up those men who indicated that their present and usual occupation was carpentry had a significantly lower age-adjusted rate of definite coronary heart disease and a significantly lower mortality rate compared to participants who were never occupied as carpenters. There were no significant differences for age-adjusted rates for stroke and cancer nor any differences for those whose usual occupation was carpentry but present occupation was not carpentry. These results were unchanged when controlling for several cardiovascular risk factors and potentially confounding variables. Unlike earlier observations, these findings are not affected by the "healthy worker bias" and support the relationship that carpentry is associated with lower rates of cardiovascular disease.

Cerebrovascular Disorders↗
PubMed1988

Predictive value of resting electrocardiograms for 12-year incidence of stroke in the Honolulu Heart Program.

The importance of electrocardiographic (ECG) abnormalities at baseline examination for subsequent risk of stroke was analyzed in a 12-year follow-up of 7,560 men in the Honolulu Heart Program, aged 45-68 years, who were free of coronary heart disease and stroke at baseline. Age-adjusted univariate analysis showed that men with major ST depression, left ventricular strain, left ventricular hypertrophy, major T wave inversion, and overall major ECG abnormalities had considerably higher (2.5-5.4 times) incidence rates of both thromboembolic and hemorrhagic stroke than those with normal baseline ECG. When blood pressure, age, cigarette smoking, alcohol consumption, fat intake, serum glucose concentration, serum uric acid concentration, years of education, and years lived in Japan were taken into consideration through multivariate analysis, the ECG abnormalities retained a significant relation with stroke. Our study demonstrates that resting ECG abnormalities are independent predictors of both thromboembolic and hemorrhagic stroke.

Aged↗