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Biomedical subjects

Elizabeth Barrett-Connor

Publications and source records attributed to Elizabeth Barrett-Connor.

At least 19 recordsLinked to original sources
PubMed2007

Measures of renal function, BMD, bone loss, and osteoporotic fracture in older adults: the Rancho Bernardo study.

UNLABELLED: The association between bone and renal function in healthy seniors is not well studied. In this cross-sectional and longitudinal study in 1713 older men and women, creatinine clearance was significantly associated with hip BMD. If confirmed, this may warrant adding mild to moderate renal dysfunction as an indication for osteoporosis screening. INTRODUCTION: This study determined the cross-sectional and longitudinal association between measures of renal function and BMD, bone loss, and osteoporotic fracture in older adults. It determined which measure of renal function--creatinine clearance by the Cockcroft-Gault (CG) equation, estimated glomerular filtration rate by the Modification of Diet in Renal Disease (MDRD) equation, or serum creatinine--is most strongly associated with BMD and osteoporotic fracture. MATERIALS AND METHODS: This was a cross-sectional and prospective study in older community-dwelling men and women. Between 1992 and 1995, 1713 participants (average age, 71.3 +/- 11.1 years) completed standardized questionnaires, physical examinations, laboratory testing, and bone densitometry; 1023 participants returned for a follow-up visit in 1997-1999, an average of 4.1 +/- 0.9 years later. RESULTS: Calculated renal function declined with age (p < 0.001). Renal function was categorized by Kidney Disease Outcomes Quality Initiative (K/DOQI) chronic kidney disease (CKD) stage. By the CG equation, at baseline, 5.5% of participants had stage 1 CKD (glomerular filtration rate > or = 90 ml/min/1.73 m(2)), 43.0% had stage 2 CKD (60-89 ml/min/1.73 m(2)), 48.8% had stage 3 CKD (30-59 ml/min/1.73 m(2)), and 2.7% had stages 4 and 5 CKD (<30 ml/min/1.73 m(2)). Using the MDRD equation, these percents were 7.0%, 61.7%, 30.9%, and 0.5%, respectively. In cross-sectional analyses, there was a significant linear association between creatinine clearance by CG or glomerular filtration rate by MDRD and hip BMD. In prospective analyses, there was an average annual bone loss of 0.6% and a significant association between baseline CG and 4-year hip bone loss. There was no association between baseline MDRD or serum creatinine and bone loss. At baseline, 180 of 1713 participants (11%) reported at least one clinical fracture of the hip, femur, forearm, or wrist; 79 (8%) reported new clinical fractures during follow-up. Baseline renal function by any measure was not significantly associated with prevalent or incident clinical fractures. CONCLUSIONS: Although renal function measured by both CG and MDRD was associated with BMD in cross-sectional analyses, only creatinine clearance by CG predicted 4-year bone loss. If confirmed, this should be the preferred method for assessing the association between renal function and BMD. Cross-sectional associations between renal function and BMD were strongest at higher CKD stage. None of the baseline renal function estimates was associated with prevalent or incident fractures, perhaps reflecting the multifactorial etiology of fractures beyond BMD. If further studies in the elderly confirm renal function as an important predictor of bone loss and fracture, this may warrant adding mild to moderate renal dysfunction as an indication for osteoporosis screening.

Absorptiometry, Photon↗
PubMed2007

Predictors of non-spine fracture in elderly men: the MrOS study.

UNLABELLED: We examined determinants of nonvertebral fracture in elderly men from six U.S. communities followed an average of 4.1 years. Six clinical risk factors predicted fracture risk independent of hip BMD: tricyclic antidepressant use, previous fracture, inability to complete a narrow walk trial, falls in previous year, age > or =80 years, and depressed mood. INTRODUCTION: There are few prospective studies of fracture determinants in men. We examined the associations between a comprehensive set of clinical risk factors and risk of nonspine fracture in older men and whether determinants of fracture risk were independent of total hip BMD. MATERIALS AND METHODS: A total of 5995 men > or =65 years of age were recruited from six communities in the Unites States and followed prospectively for an average of 4.1 years. Baseline assessments of demographic, lifestyle, medical history, functional status, anthropometry, and cognitive, visual, and neuromuscular function were assessed by questionnaire or examination. Triannual mailed questionnaires ascertained incident fracture; reported fractures were adjudicated by physicians using medical records and X-ray reports. Proportional hazards models were used to develop multivariable models, selecting variables and controlling for BMD. RESULTS: Of 5876 men, 4.7% (N = 275) reported an incident nonspine fracture during follow-up (11.46/1000 person-years). Tricyclic antidepressant use (hazard ratio [HR], 2.36; 95% CI, 1.25-4.46), history of fracture at or after age 50 (HR, 2.07; 95% CI, 1.62-2.65), inability to complete a narrow walk trial (HR, 1.70; 95% CI, 1.23-2.34), falls in previous year (HR, 1.59; 95% CI, 1.23-2.05), age > or =80 years (HR, 1.33; 95% CI, 1.01-1.76), depressed mood (HR, 1.72; 95% CI, 1.00-2.95), and decreased total hip BMD (HR, 1.53; 95% CI, 1.34-1.74) were independently related to increased risk. Compared with having none (48.0% of men), having three or more of the clinical risk factors (4.9% of men) increased fracture risk 5-fold, independent of BMD. Having three or more risk factors and being in the lowest tertile of BMD was associated with a 15-fold greater risk than having no risk factors and being in the highest BMD tertile. CONCLUSIONS: Several clinical risk factors were independently associated with nonspine fractures in elderly men. The combination of multiple risk factors and low BMD was a very powerful indicator of fracture risk.

Aged↗
PubMed2006

Coronary artery calcium versus intima-media thickness as a measure of cardiovascular disease among asymptomatic adults (from the Rancho Bernardo Study).

Detection and quantification of subclinical coronary heart disease by noninvasive imaging techniques offers the potential for earlier diagnosis with targeted prevention and therapy. This study, designed to determine the extent to which carotid artery intima-media thickness (IMT) predicts coronary artery calcium (CAC) in asymptomatic older adults, included 141 men and 137 women > or =55 years of age with no previous coronary heart disease who had B-mode ultrasound of the common and/or internal carotid arteries in 1997 to 1999 to measure IMT and electron beam computed tomographic scanning in 2001 to 2002 to measure CAC score. Overall, 29% of participants had a severe plaque burden (CAC score >400); 50% of these had a CAC score >800. IMT of the common and internal carotid arteries was significantly associated with the CAC score measured an average of 3 years later. The ability to correctly identify subjects with a severe CAC score (sensitivity) was 50% to 60% for an IMT of the internal or common carotid artery > 80th percentile (internal carotid IMT > or =1.9 mm and common carotid IMT > or =1.04 mm). Specificity, the ability to correctly identify those who did not have a severe CAC score (> or =400), was approximately 75%. In conclusion, IMT of the carotid arteries predicted the severity of CAC burden an average of 3 years later in community-dwelling asymptomatic older adults.

Aged↗
PubMed2006

Association of adiponectin with coronary heart disease and mortality: the Rancho Bernardo study.

Hypoadiponectinemia has been implicated in the development of obesity-related conditions, including dyslipidemia and coronary heart disease (CHD). In this study, the authors examined the association of adiponectin with CHD prevalence, incidence, and mortality among 1,513 community-dwelling men and women aged 50-91 years who were followed from 1984-1987 through 2004. In cross-sectional analyses, adiponectin concentrations were positively related to female sex, age, and high density lipoprotein cholesterol level and inversely related to waist girth, triglyceride level, and fasting plasma glucose level (all p's < 0.001). Adiponectin levels in the highest sex-specific quintile, as compared with the lowest, were associated with 44% decreased odds of prevalent CHD (p for trend = 0.03); adjustment for high density lipoprotein cholesterol and/or triglycerides eliminated this association. In 20-year prospective analyses, higher adiponectin concentrations predicted reduced risk of nonfatal myocardial infarction in men only; adiponectin was not associated with fatal incident CHD events or 20-year CHD mortality (n = 215 deaths) in either sex. Adiponectin levels in the highest sex-specific quintile, as compared with lower levels, were associated with almost 40% increased risks of cardiovascular disease death (n = 441) and death from all causes (n = 925), independent of age, sex, waist girth, lipid levels, and glucose level (both p's < 0.001). These results suggest that use of adiponectin for cardiovascular disease risk stratification is premature.

Adiponectin↗
PubMed2006

Association of interleukin-6 and C-reactive protein with subclinical carotid atherosclerosis (the Rancho Bernardo Study).

Studies of interleukin-6 (IL-6) and C-reactive protein (CRP) as predictors of atherosclerosis have had mixed results. The purpose of this study was to assess the associations of IL-6 and CRP with the severity of subclinical carotid atherosclerosis measured 12 years later. Participants were 392 adults (56.9% women, mean age 63.2 years) from the Rancho Bernardo Study who had biomarkers measured from 1984 to 1987 and carotid intima-media thickness (IMT) measured from 1996 to 1998. Age-adjusted mean carotid IMT was significantly greater in men than women. After adjusting for traditional cardiovascular risk factors, carotid IMT increased significantly with increasing IL-6 quartiles (p <0.001). In similar analyses, the association between CRP quartiles and carotid IMT was weaker but remained statistically significant (p <0.05). In multiple regression analysis, IL-6 was significantly associated with carotid IMT regardless of CRP. Conversely, CRP was significantly associated with carotid IMT when IL-6 was not included in the model, but this association became nonsignificant when IL-6 was included. In conclusion, baseline IL-6 and CRP were significantly associated with carotid atherosclerosis independent of traditional cardiovascular disease risk factors. The association of IL-6 was independent of CRP, but not vice versa, suggesting an effect of IL-6 on an earlier state of atherosclerosis.

Atherosclerosis↗
PubMed2006

Endogenous testosterone levels, physical performance, and fall risk in older men.

BACKGROUND: Gonadal steroid levels decline with age in men. Whether low testosterone levels affect the development of common age-related disorders, including physical functioning and falling, is unclear. METHODS: This longitudinal, observational follow-up study sought to determine whether low testosterone levels are associated with physical performance and fall risk in older men. A total of 2587 community-based men aged 65 to 99 years were selected using a stratified random sampling scheme from a study cohort of 5995 volunteers. Bioavailable testosterone and estradiol levels and physical performance measures were determined from baseline. Incident falls were ascertained every 4 months during 4 years of follow-up. Generalized estimating equations were used to estimate risk ratios for the relation of sex steroids to falls. RESULTS: Fifty-six percent of the men reported at least 1 fall; many fell frequently. Lower bioavailable testosterone levels were associated with increased fall risk. Men with testosterone levels in the lowest quartile had a 40% higher fall risk than those in the highest quartile. The effect of low testosterone levels was most apparent in younger men (65-69 years) (relative risk, 1.8; 95% confidence interval, 1.2-2.7); testosterone level was not associated with falls in the oldest men (>/=80 years). Lower testosterone concentrations were associated with reduced physical performance. However, the association between low testosterone levels and fall risk persisted despite adjustment for performance. CONCLUSIONS: Falls were common among older men. Fall risk was higher in men with lower bioavailable testosterone levels. The effect of testosterone level was independent of poorer physical performance, suggesting that the effect of testosterone on fall risk may be mediated by other androgen actions.

Accidental Falls↗
PubMed2006

Association between the ankle-brachial index and carotid intimal medial thickness in the Rancho Bernardo Study.

Previous cross-sectional studies have demonstrated significant associations between the ankle-brachial index (ABI) and carotid intimal medial thickness (IMT). In a longitudinal study, 637 participants who had ABI measurements from 1992 to 1994 were tested for carotid IMT an average of 4.8 years later. Mean age was 72.5 years; 60% were women. More than half (51%) were hypertensive, whereas 28% had dyslipidemia, 56% were past or current smokers, and 6% had diabetes. The mean +/- SD ABI and IMT were 1.06 +/- 0.13 and 1.28 +/- 0.44 mm, respectively. Mean age- and gender-adjusted IMTs for the ABI groups of <or=0.90, 0.91 to 0.99, and 1.00 to 1.09 were significantly greater than those from 1.10 to 1.26 (1.53, 1.49, 1.28, and 1.18 mm, respectively, p <0.05 for all). In logistic regression analyses, each of these ABI groups was significantly associated with increased odds for an IMT in the highest decile compared with an ABI of 1.10 to 1.26 (odds ratios 3.2, 4.3, and 2.3, respectively, p <0.05 for all). In conclusion, an ABI of 1.10 to 1.26 was associated with the lowest levels of cardiovascular disease risk factors and carotid atherosclerosis, suggesting that a new cut point for ABI risk stratification should be considered.

Aged↗
PubMed2006

Association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men.

CONTEXT: The clinical value of measuring testosterone and estradiol in older men with osteoporosis and of measuring bone mineral density (BMD) in older men with testosterone or estradiol deficiency is uncertain. OBJECTIVE: The objective of the study was to examine the association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men. DESIGN: This study was a cross-sectional and longitudinal analysis. SETTING: The study was conducted at six U.S. centers of the Osteoporotic Fractures in Men study. PARTICIPANTS: The study population consisted of 2447 community-dwelling men aged 65 yr or older. MAIN OUTCOME MEASURES: Total testosterone deficiency was defined as less than 200 ng/dl. Total estradiol deficiency was defined as less than 10 pg/ml. Osteoporosis was defined as femoral neck or total hip BMD T-score of -2.5 or less. Rapid bone loss was defined as 3%/yr or more. RESULTS: Prevalence of osteoporosis in men with deficient and normal total testosterone was 12.3 and 6.0% (P = 0.003) and 15.4 and 2.8% (P < 0.0001) in those with deficient and normal total estradiol. Among osteoporotic men and those with normal BMD, prevalence of total testosterone deficiency was 6.9 and 3.2% (P = 0.01), and prevalence of total estradiol deficiency was 9.2 and 2.4% (P = 0.0001). Incidence of rapid hip bone loss in men with deficient and normal total testosterone was 22.5 and 8.6% (p = 0.007) and in those with deficient and normal total estradiol was 14.3 and 6.3% (p = 0.08). CONCLUSIONS: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency. BMD testing of older men with sex steroid deficiency may be clinically warranted.

Aged↗
PubMed2006

Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women.

BACKGROUND: The effect of raloxifene, a selective estrogen-receptor modulator, on coronary heart disease (CHD) and breast cancer is not established. METHODS: We randomly assigned 10,101 postmenopausal women (mean age, 67.5 years) with CHD or multiple risk factors for CHD to 60 mg of raloxifene daily or placebo and followed them for a median of 5.6 years. The two primary outcomes were coronary events (i.e., death from coronary causes, myocardial infarction, or hospitalization for an acute coronary syndrome) and invasive breast cancer. RESULTS: As compared with placebo, raloxifene had no significant effect on the risk of primary coronary events (533 vs. 553 events; hazard ratio, 0.95; 95 percent confidence interval, 0.84 to 1.07), and it reduced the risk of invasive breast cancer (40 vs. 70 events; hazard ratio, 0.56; 95 percent confidence interval, 0.38 to 0.83; absolute risk reduction, 1.2 invasive breast cancers per 1000 women treated for one year); the benefit was primarily due to a reduced risk of estrogen-receptor-positive invasive breast cancers. There was no significant difference in the rates of death from any cause or total stroke according to group assignment, but raloxifene was associated with an increased risk of fatal stroke (59 vs. 39 events; hazard ratio, 1.49; 95 percent confidence interval, 1.00 to 2.24; absolute risk increase, 0.7 per 1000 woman-years) and venous thromboembolism (103 vs. 71 events; hazard ratio, 1.44; 95 percent confidence interval, 1.06 to 1.95; absolute risk increase, 1.2 per 1000 woman-years). Raloxifene reduced the risk of clinical vertebral fractures (64 vs. 97 events; hazard ratio, 0.65; 95 percent confidence interval, 0.47 to 0.89; absolute risk reduction, 1.3 per 1000). CONCLUSIONS: Raloxifene did not significantly affect the risk of CHD. The benefits of raloxifene in reducing the risks of invasive breast cancer and vertebral fracture should be weighed against the increased risks of venous thromboembolism and fatal stroke. (ClinicalTrials.gov number, NCT00190593 [ClinicalTrials.gov].).

Aged↗
PubMed2006

The Dehydroepiandrosterone And WellNess (DAWN) study: research design and methods.

Levels of dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEAS), the major secretory products of the adrenal gland, decline dramatically with age, concurrent with the onset of degenerative changes and chronic diseases associated with aging. Epidemiological evidences in humans and animal studies suggest that DHEA(S) may have cardioprotective, antiobesity, antidiabetic, and immuno-enhancing properties. These observations led to the proposal that restoration of DHEA to young adult levels may have beneficial effects on age-related conditions. Most clinical trials of DHEA replacement have been limited due to small samples and short duration, restriction to one sex, failure to adjust for baseline endogenous hormone level and age, or lack of placebo comparison groups. We designed a double blind, placebo-controlled randomized trial to determine the acceptability, benefits, and adverse effects of 50 mg daily oral DHEA replacement for one year in 110 men and 115 women, aged 55 to 85, who were healthy and not currently using hormone therapy. A wide range of biological outcomes were studied including bone mineral density and metabolism, body composition and muscle strength, immune function, and cardiovascular risk factors. Steroid hormone levels, bone markers, cytokines, and the IGF-I, IGF binding protein system were measured at baseline and at 3 follow-up clinic visits. Changes in mood and well-being, cognitive function, and sexuality were assessed. Information on potentially confounding covariates such as smoking, alcohol consumption, exercise, diet and dietary supplements were obtained, and potential adverse effects of DHEA administration were monitored. This study enables an examination of the benefits of DHEA administration on the health of older men and women, and the influence of gender, age, and baseline endogenous DHEA level on each outcome variable. Potential mechanisms of DHEA action, including the biotransformation of DHEA to active steroids and steroid metabolites, enhancement of IGF-I bioavailability, and inhibition of IL-6 production can also be evaluated.

Adjuvants, Immunologic↗
PubMed2006

Effect of raloxifene on cardiovascular adverse events in postmenopausal women with osteoporosis.

The impact of selective estrogen receptor modulators on cardiovascular disease outcomes in postmenopausal women remains unclear. This analysis assessed the effect of raloxifene on the incidence of cardiovascular adverse events in postmenopausal women followed for < or =8 years as participants in a 4-year osteoporosis treatment trial and a subsequent 4-year follow-up trial. The Continuing Outcomes Relevant to Evista (CORE) trial, designed to determine the effect of raloxifene on the incidence of invasive breast cancer, was a 4-year follow-up study to the 4-year Multiple Outcomes of Raloxifene Evaluation (MORE) osteoporosis treatment trial. Of the 7,705 participants originally enrolled in MORE, 4,011 were enrolled in CORE and thus participated in both trials (MORE-CORE participants). The incidence of serious cardiovascular (i.e., coronary and cerebrovascular) adverse events during 8 years, confirmed by external adjudication in the 2 trials, was compared between treatment groups using Cox proportional hazards models. The 8-year incidence of serious cardiovascular adverse events did not differ significantly between the raloxifene (5.5%) and placebo (4.7%) groups (hazard ratio [HR] 1.16, 95% confidence interval [CI] 0.86 to 1.56). Similar results were obtained when coronary (HR 1.22, 95% CI 0.82 to 1.83) or cerebrovascular (HR 1.19, 95% CI 0.78 to 1.84) events were analyzed separately, and when cardiovascular events were analyzed in the 459 MORE-CORE participants who were at increased risk of cardiovascular events by previously established criteria (HR 1.03, 95% CI 0.58 to 1.82). In conclusion, we found no evidence of a beneficial or harmful effect of raloxifene on the incidence of cardiovascular events overall, or coronary or cerebrovascular events, in postmenopausal osteoporotic women at relatively low risk of cardiovascular events.

Aged↗
PubMed2006

Progestins affect mechanism of estrogen-induced C-reactive protein stimulation.

PURPOSE: To determine whether the mechanisms of C-reactive protein production differ depending on the presence or absence of a progestin in the regimen. SUBJECTS AND METHODS: We examined data from the Postmenopausal Estrogen Progestin Intervention (PEPI) study, a 5-group (3 different combined estrogen-progestin regimens, conjugated equine estrogen-only, and placebo) randomized clinical trial. This substudy included 221 postmenopausal women assigned to active treatment groups who took at least 80% of pills and had stored plasma specimens available to assess 12-month changes in estrone, sex hormone binding globulin, interleukin (IL)-6, and C-reactive protein levels. RESULTS: All treatments resulted in increases in estrone, sex hormone binding globulin, and C-reactive protein at 12 months compared with baseline values. In all progestin-containing groups, 12-month change in IL-6 was positively correlated with 12-month change in C-reactive protein (r between 0.34 and 0.65, each P <.010). By contrast, in the conjugated equine estrogen-only group, 12-month change in IL-6 was negatively correlated with 12-month change in C-reactive protein (r value -0.31, P = .055). In adjusted models predicting 12-month C-reactive protein change, an interaction between change in IL-6 and treatment group was highly significant (P=.0008-P <.0001) for each of the progestin-containing groups compared with the conjugated equine estrogen-only group. In the conjugated equine estrogen-only group, the change in C-reactive protein per unit increase in IL-6 was -0.88, whereas in the progestin-containing groups it ranged from 1.46 to 2.85 (P <.0001 for each comparison with conjugated equine estrogen-only). CONCLUSION: Progestins in combination with conjugated equine estrogen potentiate the IL-6 (inflammatory)-mediated stimulation of C-reactive protein. These findings support the hypothesis that progestins plus estrogen, not estrogen alone, generate C-reactive protein through an inflammatory mechanism.

C-Reactive Protein↗
PubMed2006

The influence of age on the effects of lifestyle modification and metformin in prevention of diabetes.

BACKGROUND: The incidence of type 2 diabetes increases with age. It is unknown whether interventions to prevent diabetes are as effective in elderly persons as in younger adults. METHODS: The Diabetes Prevention Program (DPP) demonstrated that an intensive lifestyle intervention (ILS) or metformin could prevent or delay diabetes. A predefined secondary outcome of DPP was to determine if treatment effects varied by age. RESULTS: At baseline, participants aged 60-85 years were leaner and had the best insulin sensitivity and lowest insulin secretion compared to younger age groups. Diabetes incidence rates did not differ by age in the placebo group, but ILS was more effective with increasing age (6.3, 4.9, and 3.3 cases per 100 person-years, in the 25-44, 45-59, and 60-85 year age groups, respectively; p(trend) =.007). Participants aged 60-85 years had the most weight loss and metabolic equivalent (MET)-hours of physical activity. The metformin group showed a trend toward higher diabetes incidence among older participants (6.7, 7.7, and 9.3 cases per 100 person-years in the 25-44, 45-59, and 60-85 year age groups, respectively; p(trend) =.07); and diabetes risk increased with age (hazard ratio [age 60-85 vs 25-44] 1.63, p =.02), after adjusting for the greater weight loss in the 60-85 year age group. CONCLUSIONS: Lifestyle modification was exceptionally effective in preventing diabetes in older individuals; this finding was largely explained by greater weight loss and physical activity. The limited effectiveness of metformin in older persons may reflect age-related differences in insulin action and secretion. A lifestyle modification program can be recommended for older individuals at high risk for type 2 diabetes.

Adult↗
PubMed2006

Sex-specific association of the androgen to oestrogen ratio with adipocytokine levels in older adults: the Rancho Bernardo Study.

OBJECTIVE: Androgens and oestrogens have opposing effects on some adipocyte functions. Thus, the androgen to oestrogen balance may be as important as the individual hormones in determining the biological interaction between endogenous sex hormones and adipocyte-derived factors such as adiponectin and leptin. We tested this hypothesis by evaluating the sex-specific, cross-sectional association of sex hormones and androgen to oestrogen ratios with serum adiponectin and leptin in older men and postmenopausal women. DESIGN: Cross-sectional. PARTICIPANTS: A total of 1510 community dwelling men and postmenopausal women aged 50-92 years. MEASUREMENTS: Serum leptin, adiponectin and sex hormone levels. RESULTS: Adiponectin and leptin levels were higher in women than men (P < 0.001). In both sexes, adiponectin concentrations were lower, and leptin levels higher, with increasing BMI and waist girth (all P < 0.001). Although the ratio of total testosterone to total oestradiol was significantly associated with both adipocytokines in both sexes, the strongest and most consistent hormone-adipocytokine associations were observed when the androgen to oestrogen ratio was expressed as total testosterone to bioavailable oestradiol. In linear regressions, the testosterone to bioavailable oestradiol ratio was positively related to adiponectin and inversely related to leptin, with nearly identical standardized beta-coefficients for men and women (all P < 0.001). The strength of the hormone ratio-adipocytokine associations was reduced, but not eliminated, after adjustment for age, adiposity and cardiovascular disease risk factors, including insulin resistance. CONCLUSIONS: The striking similarity of the hormone ratio-adipocytokine associations for men and women, despite wide differences in sex hormone and adipocytokine levels, suggests these results reflect underlying physiological mechanisms common to both sexes.

Adiponectin↗
PubMed2006

Electron beam computed tomography screening and heart disease risk factor modification.

The authors examined the effect of electron beam computed tomography screening on perceived risk, behavior change, and medical intervention among community-dwelling adults with no history of heart disease. Participants were 184 men and 180 women aged 55 years and older who had electron beam computed tomography scans in 2000-2001 and responded to a questionnaire 6 months later. They were classified as low-, medium-, or high-risk based on coronary artery calcification score, an indicator of coronary artery plaque burden. Overall, only 5% of participants were alarmed or quite worried about developing heart disease. Compared with those with lower risk, high-risk participants were more likely to discuss scan results with a physician, undergo further cardiac testing, have a cholesterol test (all p < 0.001), and begin cholesterol-lowering medication (p < 0.001), aspirin (p = 0.009), and multivitamins (p = 0.018). The authors conclude that electron beam computed tomography screening motivates initiation of measures to prevent clinical heart disease without causing undue alarm among older men and women.

Aged↗
PubMed2006

Alcohol intake and its relationship with bone mineral density, falls, and fracture risk in older men.

OBJECTIVES: To examine the association between alcohol intake and problem drinking history and bone mineral density (BMD), falls and fracture risk. DESIGN: Cross-sectional and prospective cohort study. SETTING: Six U.S. clinical centers. PARTICIPANTS: Five thousand nine hundred seventy-four men aged 65 and older. MEASUREMENTS: Alcohol intake and problem drinking histories were ascertained at baseline. Follow-up time was 1 year for falls and a mean of 3.65 years for fractures. RESULTS: Two thousand one hundred twenty-one participants (35.5%) reported limited alcohol intake (<12 drinks/y); 3,156 (52.8%) reported light intake (<14 drinks/wk), and 697 (11.7%) reported moderate to heavy intake (> or =14 drinks/wk) in the year before baseline. One thousand one men (16.8%) had ever had problem drinking. In multivariate models, as alcohol intake increased, so did hip and spine BMD (P for trend < .001). Greater alcohol intake was not associated with greater risk for nonspine or hip fractures. Men with light intake, but not moderate to heavy intake, had a lower risk of two or more incident falls (light intake: relative risk (RR) = 0.77, 95% confidence interval (CI) = 0.65-0.92; moderate to heavy intake: RR = 0.83, 95% CI = 0.63-1.10) than abstainers. Men with problem drinking had higher femoral neck (+1.3%) and spine BMD (+1.4%), and a higher risk of two or more falls (RR = 1.59; 95% CI = 1.30-1.94) than those without a history of problem drinking and similar total hip BMD and risk of fracture. CONCLUSION: In older men, recent alcohol intake is associated with higher BMD. Alcohol intake and fracture risk is unclear. Light alcohol intake may decrease the risk of falling, but a history of problem drinking increased fall risk.

Accidental Falls↗
PubMed2006

Leptin predicts BMD and bone resorption in older women but not older men: the Rancho Bernardo study.

UNLABELLED: We studied the relation of leptin to bone, bone loss, and bone turnover in community-dwelling men and women. Leptin predicted higher BMD and lower bone turnover only in women. Leptin was not associated with 4-year bone loss in either sex. INTRODUCTION: Leptin, the protein product of the obesity (OB) gene produced in fat tissue, was originally thought to be involved only in the regulation of food intake and energy balance. Recent evidence suggests that leptin may play a role in the pathophysiology of several chronic diseases. Studies of the association between leptin and bone have been numerous yet inconclusive. Only one previous longitudinal study has been reported, which showed no association of leptin with BMD after adjusting for body size. MATERIALS AND METHODS: We report the association of serum leptin with BMD at the hip, spine, and midshaft radius in community-dwelling men (n = 498) and nonestrogen-using postmenopausal women (n = 411) 45-92 years of age. Serum leptin was measured in blood obtained between 1984 and 1987. Between 1988 and 1991, BMD was measured at the midshaft radius by single photon absorptiometry and at the femoral neck, total hip, and lumbar spine by DXA; at the same visit, height, weight, and body fat (by bioelectrical impedance analysis) were measured, and bone resorption was assessed in a subset of men (n = 286) and women (n = 241) using urine N-telopeptide (NTX). Four years later, axial BMD was remeasured in 536 participants. Sex-specific associations of leptin with BMD, NTX, and bone loss were tested using regression analysis. RESULTS: In unadjusted analyses, leptin was associated with BMD at the femoral neck, total hip, lumbar spine, and midshaft radius in both sexes (p < 0.01). In multiple regression analyses, adjusted for age, BMI, and other bone-related factors, only women showed a graded stepwise positive association between serum leptin and BMD at all sites and a negative stepwise association with NTX (all p for trend < 0.01). Baseline leptin levels did not predict 4-year bone loss in either sex. CONCLUSIONS: A favorable dose-dependent leptin-BMD association unexplained by obesity was observed only in women. The reason for the sex difference is unknown.

Absorptiometry, Photon↗