Biomedical subjects

E L Barrett-Connor

Publications and source records attributed to E L Barrett-Connor.

30 records · Page 2Linked to original sources

PubMed1993

Prevalence of cardiovascular and renal complications in older adults with normal or impaired glucose tolerance or NIDDM. A population-based study.

OBJECTIVE: To determine the prevalence of CVD and renal disease by glucose tolerance status in a population-based study. RESEARCH DESIGN AND METHODS: The study consisted of 991 men and 1243 women, aged 50-89 yr, living in the upper-middle class community of Rancho Bernardo, CA. All participants received a standard OGTT between 1984 and 1987. RESULTS: A total of 159 men and 158 women had NIDDM, whereas 237 men and 348 women had IGT. Age-adjusted prevalence of complications generally was highest in those who were previously diagnosed with NIDDM. A significant correlation was observed between increases in the prevalence of complications and increases in glucose intolerance for microproteinuria, macroproteinuria, and myocardial infarction (borderline), as well as for stroke and claudication in men and myocardial infarction and stroke in women. In men with IGT or NIDDM, the age-adjusted prevalence of proteinuria and CVD was highest when other complications were present whereas in women such a prevalence was highest when other complications were absent. In men with diabetes, microproteinuria was associated with duration of disease. CONCLUSIONS: Prevalent CVD and renal disease were increased in adults with NIDDM and elevated in adults with IGT compared to those with normal glucose tolerance. The prevalence of complications in NIDDM subjects in this population-based study was substantially lower than that reported for clinic-based diabetic populations.

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PubMed1992

Albumin levels as a predictor of mortality in the healthy elderly.

Serum albumin levels probably predict subsequent mortality in the elderly, but it is not clear whether this is independent of disease. A 3 year prospective study of 2342 healthy non-institutionalized men and women aged 50-89 years old, residing in Rancho Bernardo, California, confirmed the following findings. Serum albumin levels decreased with increasing age in both men and women, and this association was independent of health status. In addition, for every standard deviation decrease in albumin, the relative odds of dying was 1.24 (p = 0.04), after adjusting for age, sex and lifestyle factors such as smoking, exercise and alcohol consumption. Separating the study sample into those who did and did not report disease at baseline did not appreciably alter these findings. Most of the albumin levels of the older adults (70-89) fall within the normal and narrow range of the younger adults (50-69), nevertheless, albumin levels predict outcome independent of known disease. The albumin-early mortality association suggests that serum albumin levels are a predictor for subclinical disease in the healthy elderly.

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PubMed1992

Increased meal frequency associated with decreased cholesterol concentrations; Rancho Bernardo, CA, 1984-1987.

The hypothesis that meal frequency is associated with plasma cholesterol was tested in a population-based sample of 2034 white men and women aged 50-89 y. Total, low-density-lipoprotein (LDL) and high-density-lipoprotein (HDL) cholesterol and triglycerides were measured after a 12-h fast in a Lipid Research Clinic laboratory and meal frequency was obtained by questionnaire. The age-adjusted total cholesterol concentrations for men and women reporting greater than or equal to 4 meals/d averaged 0.23 mmol/L lower than for those who reported 1-2 meals/d (P = 0.01). Similarly, LDL concentrations were lower in those reporting higher meal frequency (0.16 mmol/L, P = 0.06). These associations persisted after adjustment for smoking, alcohol, waist-to-hip ratio, systolic blood pressure, body mass index, and dietary nutrients. These results suggest that cholesterol reductions might be achieved by modest increases in meal frequency without an increase in caloric intake.

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PubMed1991

Why is diabetes mellitus a stronger risk factor for fatal ischemic heart disease in women than in men? The Rancho Bernardo Study.

We report here the 14-year sex-specific effect of non-insulin-dependent diabetes mellitus on the risk of fatal ischemic heart disease in a geographically defined population of men and women aged 40 through 79 years. There were 207 men and 127 women who had diabetes at baseline based on medical history or fasting hyperglycemia. They were compared with 2137 adults who had fasting euglycemia and a negative personal and family history of diabetes. The relative hazard of ischemic heart disease death in diabetics vs nondiabetics was 1.8 in men and 3.3 in women, after adjusting for age, and 1.9 and 3.3, respectively, after adjusting for age, systolic blood pressure, cholesterol, body mass index, and cigarette smoking using the Cox regression model. The sex difference in the independent contribution of diabetes to fatal heart disease was largely explained by the persistently more favorable survival rate of women (than men) without diabetes.

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PubMed1991

Are insulin and hypertension independently related?

Hyperinsulinemia has been proposed as the common pathogenetic mechanism of obesity, non-insulin-dependent diabetes mellitus, and hypertension. We examined the cross-sectional relationship between fasting and postchallenge insulin levels and hypertensive status in a population-based study of 653 men and 784 women, aged 50 to 93 years, in Rancho Bernardo, California. Hypertensive subjects had slightly but not significantly higher fasting plasma insulin levels than did normotensive subjects, but significantly higher postchallenge insulin levels. After stratification for obesity and glucose intolerance, there was no significant difference between the mean age-adjusted fasting or postchallenge insulin levels of those with and those without hypertension in 12 possible subgroups. Analysis of variance of both fasting and postchallenge insulin levels also failed to reveal a significant relationship between insulin and hypertensive status after adjusting for age, sex, body mass index, and diabetes. The current study does not support the hypothesis that insulin is independently associated with hypertension.

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PubMed1991

Visual impairment and retinopathy in people with normal glucose tolerance, impaired glucose tolerance, and newly diagnosed NIDDM.

OBJECTIVE: Prevalence rates of visual impairment and retinopathy were compared in 1992 people with normal glucose tolerance, impaired glucose tolerance (IGT), or newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM). RESEARCH DESIGN AND METHODS: Glucose tolerance status was based on an oral glucose tolerance test after exclusion of those with a history of diabetes and/or diabetes medication use in an upper middle-class community of older white adults in southern California between 1984 and 1987. RESULTS: Although many sex-specific comparisons were made between glucose tolerance groups, only a few emerged as statistically significant. Among those, women with IGT had significantly higher age-adjusted rates of visual impairment (10.8%) than women with normal glucose tolerance (4.4%). Among men, those with IGT had significantly higher age-adjusted rates of visual impairment (7.9%) than men with newly diagnosed NIDDM (4.0%). CONCLUSIONS: Low frequencies of retinopathy were found in all three glucose tolerance groups.

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PubMed1990

Leisure time exercise and lipid and lipoprotein levels in an older population.

Plasma lipid and lipoprotein levels were measured in 1,019 men and 1,273 women, aged 50 to 89, who were classified according to whether they reported participation in regular strenuous exercise. In men and women, strenuous exercisers had significantly (P less than .01) higher age-adjusted high-density lipoprotein (HDL) cholesterol levels than nonstrenuous exercisers, and male strenuous exercisers also had lower plasma triglyceride levels. Adjusting for differences in cigarette smoking, alcohol consumption, or obesity did not alter these results. A subgroup of 498 consecutive men and 615 consecutive women that completed a more detailed exercise questionnaire were classified into categories of light, moderate, heavy, or no exercise. In men, age-adjusted HDL cholesterol levels were higher and triglyceride levels lower with higher exercise-intensity categories (P for trend less than .001). In the heavy exercise category, HDL cholesterol levels were 15% higher and plasma triglyceride levels were 41% lower than in the sedentary group. In women, HDL cholesterol levels were significantly higher and triglyceride levels lower at the more moderate levels of exercise. In both genders results among exercise-intensity groups did not change after adjusting for age, cigarette smoking, and alcohol consumption. In men, adjusting for obesity did not significantly alter the intergroup differences, whereas in women adjusting for body mass index or waist-to-hip ratio reduced differences in HDL cholesterol levels between exercising and sedentary participants to nonsignificance. We conclude that exercise levels attainable by older adults may significantly improve HDL cholesterol levels and could theoretically reduce the risk of ischemic heart disease.

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PubMed1990

Abnormal glucose tolerance and hypertension.

To quantify the association of abnormal glucose tolerance with hypertension and postural hypotension, 2480 men and women aged 50-89 yr from a defined population were evaluated by oral glucose tolerance and measurements of supine, seated, and standing blood pressure. In both sexes, adults with impaired glucose tolerance or non-insulin-dependent diabetes mellitus (NIDDM) had increased mean blood pressure compared with those with normal glucose tolerance. These differences were both statistically (P less than 0.05) and clinically (3-12 mmHg) significant and were independent of age, obesity, and the use of antihypertensive medication. Age-adjusted rates of systolic hypertension and isolated systolic hypertension were also higher in subjects with impaired glucose tolerance or NIDDM compared with those with normal glucose tolerance. Diastolic blood pressures and rates of diastolic hypertension were minimally higher in adults with impaired glucose tolerance and NIDDM. In both sexes, systolic blood pressure correlated significantly with fasting plasma glucose and 2-h postchallenge plasma glucose even after adjustment for age and obesity. Postural hypotension occurred in 7% of all subjects and did not vary significantly according to glucose tolerance.

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PubMed1985

BCG vaccine.

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Animals↗

PubMed1985

Obesity, atherosclerosis, and coronary artery disease.

Although several risk factors for heart disease including high blood pressure, diabetes mellitus, and lipid and lipoprotein abnormalities are associated with overweight, overweight is not consistently associated with coronary heart disease risk. Some prospective studies of white men (life insurance cohorts, airline pilots, cancer study volunteers, and the Framingham population) have shown a positive linear relationship of weight to coronary heart disease. Other epidemiologic studies show a negative association, no association, a U-shaped relationship, or a threshold effect. The inconsistencies do not appear to be explained by differences in the definition or distribution of obesity, duration of follow-up, or risk factor distribution. Neither misclassification bias nor confounding by cigarette smoking or chronic disease appears to explain the inconsistencies. No known protective effect of obesity could explain these divergent findings. Inconsistent results with regard to the nature, strength, and linearity of the association between obesity and atherosclerosis do not support the hypothesis that obesity causes atherosclerosis, despite its biological plausibility.

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PubMedDate not supplied

Recent nutrient intake and fasting plasma glucose in healthy North-American adults.

In order to examine the relationship of recent diet to fasting plasma glucose we compared dietary variables with fasting plasma glucose levels in 1204 non-diabetic men and women aged 20-79 years who were residents in a defined community. Total caloric and macronutrient intake (carbohydrate, protein, fat, and alcohol) were determined quantitatively by a history taken by a dietitian. This was determined for the 24 h preceding a 12 h fast. Fasting plasma glucose levels correlated significantly with age and body mass index in both men and women, but showed no clinically significant association with dietary variables by continuous analysis. These data suggest that carbohydrate loading is not needed for valid fasting plasma glucose measurement, in contrast to some recommendations that had been made for performance of the oral glucose tolerance test.

Adult↗

PubMedDate not supplied

The risks and benefits of long-term estrogen replacement therapy.

Estrogen replacement therapy (ERT) for postmenopausal women greatly reduces the risk of osteoporotic fractures, but carries an increased risk of endometrial cancer. This risk can be reduced by the addition of progestin, which does not interfere with the osteoporotic benefit of estrogen. Although long-term use data are few, there is presently little evidence for an increase or decrease in breast cancer risk associated with estrogen by itself (unopposed estrogen), or estrogen plus progestin. In contrast, a large body of evidence suggests that unopposed estrogen significantly reduces the risk of cardiovascular disease; there is no evidence that this benefit will persist when a progestin is added. The preferred method of estrogen replacement therapy, to prevent osteoporosis in a postmenopausal woman with an intact uterus, should be chosen with these different risks and benefits in mind.

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