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Biomedical subjects

E D Eaker

Publications and source records attributed to E D Eaker.

At least 19 recordsLinked to original sources
PubMed1994

Community intervention and trends in dietary fat consumption among black and white adults.

OBJECTIVE: This study assessed whether a state public health department could effectively implement an affordable nutrition intervention program at the community level. DESIGN: Cross-sectional data were collected via telephone surveys of 9,839 adults, aged 18 years or older, in 1987, 1989, and 1991 in two South Carolina communities. Nutrition education programs began in 1988 in one community. The other community served as a comparison site. We assessed and compared changes in community levels of dietary fat and weekly meat consumption, salt use, and nutrition promotion awareness with analysis of covariance regression techniques that included race, sex, and age as covariates. RESULTS: We observed favorable changes in most eating behaviors and levels of awareness in both communities. The intervention community experienced greater absolute changes that the comparison community in use of animal fats (-8.9% vs -4.0%; P = .02) and liquid or soft vegetable fats (+8.4% vs +3.6%; P = .04), and in awareness of restaurant nutrition information (+33.0% vs +19.4%; P = .0001). Although the primary type of dietary fat used differed between black and white respondents, we observed significant change among both groups. CONCLUSIONS: These results suggest that community-wide nutrition education programs may have augmented regional or national changes in dietary behavior among white and black adults in the intervention community.

Adult↗
PubMed1993

Trends in nonfatal coronary heart disease in the United States, 1980 through 1989.

BACKGROUND: Although coronary heart disease mortality has been decreasing, little is known about trends in morbidity from coronary heart disease. We evaluated trends in nonfatal coronary heart disease in the United States during 1980 through 1989. METHODS: We analyzed data from the National Health Interview Survey, an ongoing survey of representative samples of the civilian, noninstitutionalized population of the United States. Survey respondents were determined to have coronary heart disease if they reported ever having a myocardial infarction or heart attack, angina pectoris, or coronary heart disease. Incidence was defined as initial onset of a coronary heart disease condition during the year preceding the interview date. RESULTS: About 6 million people were estimated to be living with coronary heart disease. The age-standardized prevalence was relatively constant at about 25 per 1000. Among white men, however, prevalence increased significantly over the 10-year period. Among 75- to 84-year-old men, prevalence increased from 100 per 1000 in 1980 to 179 per 1000 in 1989. Among men and women 45 to 54 years old, prevalence decreased. Overall, the incidence rate of nonfatal coronary heart disease was relatively flat (at about 3 per 1000 per year after 1983). Among white women, the incidence rate increased from 1.4 to 2.8 per 1000, and by the end of the decade it nearly equaled the incidence rate among white men. CONCLUSIONS: Overall, the burden of nonfatal coronary heart disease remained fairly constant during the 1980s. The trends, however, were not uniform in all population groups. The apparent increasing incidence among women deserves continued monitoring. An encouraging trend is the decreasing prevalence in the younger age groups.

Aged↗
PubMed1993

Racial differences in the use of invasive coronary procedures after acute myocardial infarction in Medicare beneficiaries.

We examined differences in the use of invasive diagnostic and therapeutic coronary procedures between white and black Medicare beneficiaries following acute myocardial infarction. We used Medicare hospitalization data for patients aged 65 years or older who were hospitalized with an acute myocardial infarction in 1988, and we followed them through the calendar year to determine whether they received invasive coronary procedures. We used multivariate logistic regression to control simultaneously for multiple potential confounding factors including age, geographic region, poverty, comorbid conditions, access to hospitals equipped to provide invasive procedures, and short-term survival. We calculated odds ratios for racial differences in use of invasive diagnostic procedures (coronary arteriography, cardiac catheterization) and, separately, of myocardial revascularization procedures (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty). We found that the odds of receiving an invasive diagnostic procedure after acute myocardial infarction were 2.0 times greater for white men than for black men (95% CI: 1.8-2.1); for white women, the odds were 1.5 times greater than for black women (95% CI: 1.4-1.6). Following an invasive diagnostic procedure, the odds of myocardial revascularization were 1.8 times greater among white than among black men (95% CI: 1.6-2.0), and 1.7 times greater among white than among black women (95% CI: 1.6-2.0). We conclude that invasive diagnostic and therapeutic coronary procedures are used more often among white than among black Medicare beneficiaries following acute myocardial infarction. Further investigation of this discrepancy will require detailed clinical and attitudinal information from medical records, patients, and physicians.

Black or African American↗
PubMed1992

Myocardial infarction and coronary death among women: psychosocial predictors from a 20-year follow-up of women in the Framingham Study.

This study investigates the relation of psychosocial variables to the 20-year incidence of myocardial infarction or coronary death among women in the Framingham Study. In 1965-1967, a psychosocial interview was given along with the collection of other coronary risk factor data. This study includes 749 women aged 45-64 years who were free of coronary disease at this baseline examination. Demographic variables, psychosocial scales (such as tension and reactions of anger), and individual interview items (such as attitudes toward children, money, and religion) were measured. When age, systolic blood pressure, the ratio of serum total cholesterol to high-density lipoprotein cholesterol, diabetes, cigarette smoking, and body mass index were controlled for in multivariate proportional hazards models, the predictors of the 20-year incidence of myocardial infarction or coronary death were as follows: among employed women, perceived financial status only; among homemakers, symptoms of tension and anxiety, being lonely during the day, difficulty falling asleep, infrequent vacations, housework affecting health, and believing one is prone to heart disease (p less than 0.05 for all variables); and among both groups of women combined, low educational level, tension, and lack of vacations. These results are discussed in relation to previous findings from the Framingham Study.

Analysis of Variance↗
PubMed1991

Risk factors for regret after tubal sterilization: 5 years of follow-up in a prospective study.

The Collaborative Review of Sterilization is a prospective, multicenter study that interviewed 7,590 women before they underwent tubal sterilization and then conducted yearly follow-up interviews that included questions on sterilization regret. These women contributed 26,641 observations (for up to 5 years after the procedure, 1978 to 1988) to an analysis of the presterilization characteristics most consistently associated with poststerilization regret. Young age at the time of sterilization was the strongest predictor of regret, regardless of parity or marital status; among women 20 to 24 years of age at sterilization, an average of 4.3% reported regret over the follow-up period. The rate of regret was significantly lower for women 30 to 34 years of age (2.4%).

Adult↗
PubMed1989

Frequency of uncomplicated angina pectoris in type A compared with type B persons (the Framingham Study).

The impact of type A behavior on coronary artery disease was examined in 570 men and 719 women based on 20 years of follow-up in the Framingham Study. A comparison of type A and B persons showed similar levels of systolic blood pressure, total and high density lipoprotein cholesterol and body mass index. Behavioral status also was unrelated to diabetes, cigarette smoking and alcohol intake. Despite similar cardiovascular risk profiles, type A behavior was associated with more than a 2-fold excess risk of angina pectoris, uncomplicated by other symptoms of coronary artery disease (p less than 0.05 for men and p less than 0.01 for women). Type A behavior, however, was not related to an increased risk of myocardial infarction and fatal coronary events. Among the victims of uncomplicated angina, the risk of subsequent coronary morbidity and mortality in both type A and type B men and women increased by more than 4-fold (p less than 0.001). Although the risk was reduced among type A persons, it was not statistically significant. It is concluded that uncomplicated angina pectoris occurs with greater frequency in type A persons than in those who are type B, without explanation by concomitant risk factors. In addition, the prognosis for myocardial infarction and coronary artery disease mortality in angina patients classified as type A is as serious as the prognosis for those who are type B.

Angina Pectoris↗
PubMed1989

Psychosocial correlates of alcohol intake among women aged 45 to 64 years: the Framingham Study.

This study of 749 women, aged 45 to 64 years, investigates the psychological, behavioral, and social correlates of alcohol intake. These data from the Framingham Study are uniquely based on a community sample of women, which results in a normative study of drinking behavior in women. Two measures of alcohol intake were utilized in these analyses: (1) the frequency of alcohol intake over 1 week and (2) drinking vs abstaining from alcohol. Among this sample of women, increased socioeconomic status, worrying about aging, and being easily upset were positively associated with frequency of alcohol intake. The rigid attitude scale was the strongest discriminating variable for drinkers vs nondrinkers. Older women were more likely to be nondrinkers compared to younger women, however, among older women, being a homemaker was significantly associated with increased alcohol intake. Contrarily, younger women who were homemakers were more likely to be abstainers than women employed outside the home. As would be expected, cigarette smoking was associated with drinking alcohol.

Adaptation, Psychological↗
PubMed1989

Comparison of the long-term, postsurgical survival of women and men in the Coronary Artery Surgery Study (CASS).

This study compares the survival of men and women an average of 6 years after coronary artery bypass graft surgery (CABG) by means of the Coronary Artery Surgery Study (CASS) registry. Subjects included in these analyses were the 6100 men and 1097 women who survived surgery. Medical history and physical and laboratory information were collected from each patient at baseline. Men and women were compared for differences in baseline characteristics, long-term survival (by means of the Cox proportional hazards models), and predictors of long-term survival. In this study women, at baseline, were older and more likely to have hypertension and diabetes compared to men; whereas men were more likely to have had prior coronary heart disease. In this study of CASS participants there was no difference between men and women with regard to survival after CABG. There was also no difference between men and women in predictors of 6-year mortality. Two baseline variables were strongly related to subsequent mortality in both men and women: a high left ventricular wall motion score and taking both digitalis and diuretics (for women: relative risk = 2.31, confidence interval = 1.38 to 3.87; for men: relative risk = 1.90, confidence interval = 1.45 to 2.50).

Adult↗
PubMed1989

Epidemiology and risk factors for coronary heart disease in women.

The information presented indicates that the risk factors associated with the development of coronary heart disease in women are, for the most part, the same as those identified for men. It is encouraging to note that although the prevalence of hypertension in women has not changed over the past 20 years, the proportion of treated hypertensive women has increased dramatically and the proportion with controlled blood pressure has doubled since 1960. It is also encouraging to note that the number of adult women who smoke cigarettes has decreased since 1960, but the number of young girls who smoke has increased at an alarming rate. Researchers have noted that the number of cigarettes smoked per day by women has increased from the 1950s to the present. The Framingham data reveal that serum cholesterol level increases substantially with age and that women should take steps to eat a healthy, low-saturated fat, low cholesterol diet to maintain a low blood cholesterol level. The Framingham Study data also show that although the same risk factors operate in men and women, the standard risk factors do not explain the marked differences in morbidity and mortality from heart disease between the two sexes. We must continue to study the epidemiology and biology of coronary heart disease in women both to better understand the disease process in women and to understand the large gender differential for CHD in most Westernized countries.

Adult↗
PubMed1989

Psychosocial factors in the epidemiology of coronary heart disease in women.

Although the study of coronary heart disease has provided a fruitful area of research for the psychosocial risk factors for disease, the amount of information among women is limited. Many of the psychological concepts tested in women have been developed from studies of men. The assumption that these psychological constructs (such as type A behavior) are pertinent to the psychology of women must be questioned. When women are included in studies of any disease, the questions asked of them must be applicable to their environment, behaviors, and psychological milieu. Because of the limited amount of data on women, it is difficult to draw conclusions regarding the relationships of psychosocial variables and the development of CHD. Several studies have indicated, however, that the change from a positive to an inverse relationship of SES to CHD in men has not been observed in women. Across various time periods and in different populations low SES is related to the occurrence of CHD in women. The reason for this is not known, and this is clearly an area for future investigations. Several measures of low social support have been found to be related to increase risk of CHD mortality and morbidity in women. A problem with this research is that each study demonstrated a different measure of social support to be the detrimental factor. This may be due to true differences between populations or may be a result of bias introduced from studying different age groups and different populations. It seems to be fairly clear that type A behavior, as measured in Framingham, is not related to definite CHD in women. The fact, however, that type A is related to anginal pain should not be minimized. These men and women are suffering from chest pain and are at increased risk to develop subsequent acute coronary events. For the most part, other personality variables, such as emotional lability, anxiety, depression, and neuroticism, have not been shown to be related to coronary disease in women. This may also be due to a true lack of effect or may be the result of not being able to separate the various manifestations of CHD and perhaps to limited sample sizes of women, which leads to a lack of power to detect at true effect. In the field of coronary heart disease epidemiology, as more studies include women and ask questions that are meaningful to them, a clearer understanding of the possible psychosocial etiology of disease will be possible.(ABSTRACT TRUNCATED AT 400 WORDS)

Coronary Disease↗
PubMed1988

Coronary heart disease in women.

The results presented above indicate that the risk factors associated with the development of coronary heart disease in women are not that different than those identified for men. It is encouraging to note that while the prevalence of hypertension in women has not changed over the past twenty years, the proportion of treated hypertensive women has increased dramatically and the proportion with controlled blood pressure has doubled since 1960. It is also encouraging to note that the number of adult women who smoke cigarettes has decreased since 1960, but the number of young girls who smoke has increased at an alarming rate. It has been noted by researchers that among women who smoke, the number of cigarettes smoked per day has increased from the 1950s to the present. From the Framingham data it can be seen that womens' serum cholesterol level increases substantially with age and women should take steps to eat a healthy low-saturated fat, low cholesterol diet in order to maintain a low blood cholesterol level. It has been shown from the Framingham Study data that although the same risk factors operate in men and women, the standard risk factors do not explain the marked differences in morbidity and mortality from heart disease between the two sexes. We must continue to study the epidemiology and biology of coronary heart disease in women both to better understand the disease process in women and to understand the large sex differential for CHD in most westernized countries.

Adult↗
PubMed1987

Life-style correlates of risk factor change in young adults: an eight-year study of coronary heart disease risk factors in the Framingham offspring.

This paper describes the life-style and behavioral correlates of change in coronary heart disease risk factors measured eight years apart in the young adult offspring of the Framingham Heart Study cohort. Changes in total cholesterol, lipoprotein cholesterols (high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol), and blood pressure were observed longitudinally in 397 men and 497 women who were aged 20-29 years at entry into the study. Stepwise multiple linear regression procedures were used to identify characteristics and their changes that were significantly associated with risk factor changes in each sex. The attribute most strongly and consistently related to lipoprotein and blood pressure changes in both sexes was change in body mass index (p less than or equal to 0.01 or p less than or equal to 0.001). In addition to weight gain, increases in alcohol consumption in men (p less than or equal to 0.001) and beginning oral contraceptive use in women (p less than or equal to 0.01) were associated with increases in blood pressure over the study period. Weight loss, stopping or decreasing cigarette consumption (p less than or equal to 0.01), increasing alcohol intake (p less than or equal to 0.01), and, in women, discontinuing oral contraceptive use (p less than or equal to 0.01) also were independently related to improvements in lipoprotein profiles during follow-up. After adjustment for all life-style correlates of risk factor change, simple self-assessments of physical activity or activity change were negatively associated with changes in VLDL cholesterol (p less than or equal to 0.01) and the total cholesterol/HDL cholesterol ratio (p less than or equal to 0.05) in men and positively associated with changes in HDL cholesterol (p less than or equal to 0.05) in women. Sociodemographic and behavioral characteristics that made a further independent contribution to increases in the total cholesterol/HDL cholesterol ratio in men were blue-collar occupation and trait Type A behavior pattern (p less than or equal to 0.05). Unexplained, but provocative, results of this study included the associations of interim vasectomy with increases in total cholesterol in men (p less than or equal to 0.05) and of number of livebirths with decreases in total cholesterol and HDL cholesterol in women (p less than or equal to 0.01). These findings are among the first to offer prospective evidence which suggests that habits and behaviors during young adulthood have a substantial effect on lipid and lipoprotein profiles in men and women.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

Psychosocial and other features of coronary heart disease: insights from the Framingham Study.

Contributors to CHD include atherogenic personal attributes, living habits which promote these, signs of preclinical disease, and host susceptibility to these influences. Atherogenic traits include the blood lipids, blood pressure, and glucose tolerance. High LDL cholesterol is positively and high HDL cholesterol inversely related to CHD incidence. Hypertension, whether systolic or diastolic, labile or fixed, casual or basal, at any age in either sex contributes powerfully to coronary heart disease. The impact of diabetes on CHD is greater for women than for men and varies according to the level of the foregoing risk factors. The faulty life-style is typified by a diet excessive in calories, fat, and salt, a sedentary habit, unrestrained weight gain, and cigarettes. Alcohol used in moderation may be beneficial. Oral contraceptives worsen atherogenic traits and, when used for long periods beyond age 35 in conjunction with cigarettes, predispose to thromboembolism. Type A persons with an overdeveloped sense of time urgency, drive, and competitiveness develop an excess of angina pectoris. Men married to more highly educated women are at increased risk, as are men married to women in white-collar jobs. Preclinical signs of a compromised coronary circulation include silent MI, ECG-LVH, blocked intraventricular conduction, and repolarization abnormalities. Exercise ECG may elicit still earlier evidence. Measures of innate susceptibility include a family history of premature cardiovascular disease, diabetes, hypertension, and gout. Optimal prediction of CHD requires a quantitative combination of risk factors in multiple logistic risk formulations that identify high-risk persons with multiple marginal abnormalities. Preventive management should also be multifactorial.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1983

Spouse behavior and coronary heart disease in men: prospective results from the Framingham heart study. I. Concordance of risk factors and the relationship of psychosocial status to coronary incidence.

The relationship of social status and behavior type to the incidence of coronary heart disease was examined among husbands and wives in the Framingham Heart Study. Between 1965 and 1967, 269 spouse pairs, in which the husbands were 45-64 years of age, were administered an extensive psychosocial questionnaire. These pairs were followed over a 10-year period for the development of heart disease. Men married to women with 13 or more years of education were 2.6 times more likely to develop coronary disease than men married to women with a grammar school education (95% CI = 1.0-6.9). Incidence rates among husbands married to women employed outside the home were similar to rates among men married to housewives (15.1 vs. 16.1%, respectively). However, men married to women employed in white-collar jobs were over three times more likely to develop heart disease than those married to clerical workers, blue-collar workers, or to housewives (RR = 4.0, 5.4, and 2.9, respectively; p less than or equal to 0.004). The increased risk in husbands married to women educated beyond the high school level was observed only among men married to women employed outside the home. These effects were apparent regardless of the husband's social status or standard coronary risk factors. Further exploration of these associations revealed that higher-educated working wives whose husbands developed coronary heart disease were significantly more likely to have had a nonsupportive boss and fewer job promotions than wives of noncases.

Blood Pressure↗