Biomedical subjects

F B Hu

Publications and source records attributed to F B Hu.

At least 55 records · Page 3Linked to original sources

PubMed2000

Whole grain consumption and risk of ischemic stroke in women: A prospective study.

CONTEXT: Although increased intake of grain products has been recommended to prevent cardiovascular disease (CVD), prospective data examining the relation of whole grain intake to risk of ischemic stroke are sparse, especially among women. OBJECTIVE: To examine the hypothesis that higher whole grain intake reduces the risk of ischemic stroke in women. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort of 75,521 US women aged 38 to 63 years without previous diagnosis of diabetes mellitus, coronary heart disease, stroke, or other CVDs in 1984, who completed detailed food frequency questionnaires (FFQs) in 1984, 1986, 1990, and 1994, and were followed up for 12 years as part of the Nurses' Health Study. MAIN OUTCOME MEASURE: Incidence of ischemic stroke, confirmed by medical records, by quintile of whole grain intake according to FFQ responses. RESULTS: During 861,900 person-years of follow-up, 352 confirmed incident cases of ischemic stroke occurred. We observed an inverse association between whole grain intake and ischemic stroke risk. The age-adjusted relative risks (RRs) from the lowest to highest quintiles of whole grain intake were 1.00 (referent), 0.68 (95% confidence interval [CI], 0.49-0.94), 0.69 (95% CI, 0.51-0.95), 0.49 (95% CI, 0.35-0.69), and 0.57 (95% CI, 0.42-0.78; P =.003 for trend). Adjustment for smoking modestly attenuated this association (RR comparing extreme quintiles, 0.64; 95% CI, 0.47-0.89). This inverse association remained essentially unchanged with further adjustment for known CVD risk factors, including saturated fat and transfatty acid intake (multivariate-adjusted RR comparing extreme quintiles, 0.69; 95% CI, 0.50-0.98). The inverse relation between whole grain intake and risk of ischemic stroke was also consistently observed among subgroups of women who never smoked, did not drink alcohol, did not exercise regularly, or who did not use postmenopausal hormones. No significant association was observed between total grain intake and risk of ischemic stroke. CONCLUSIONS: In this cohort, higher intake of whole grain foods was associated with a lower risk of ischemic stroke among women, independent of known CVD risk factors. These prospective data support the notion that higher intake of whole grains may reduce the risk of ischemic stroke.

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PubMed2000

Trends in the incidence of coronary heart disease and changes in diet and lifestyle in women.

BACKGROUND: Previous studies have found concurrent declines in blood pressure, serum cholesterol levels, and the incidence of and mortality from coronary disease. However, the effects of changes in diet and lifestyle on trends in coronary disease are largely unknown. METHODS: We followed 85,941 women who were 34 to 59 years old and had no previously diagnosed cardiovascular disease or cancer from 1980 to 1994 in the Nurses' Health Study. Diet and lifestyle variables were assessed at base line and updated during follow-up. RESULTS: After adjustment for the effect of age, the incidence of coronary disease declined by 31 percent from the two-year period 1980-1982 to the two-year period 1992-1994. From 1980 to 1992, the proportion of participants currently smoking declined by 41 percent, the proportion of postmenopausal women using hormone therapy increased by 175 percent, and the prevalence of overweight, defined as a body-mass index (the weight in kilograms divided by the square of the height in meters) of 25 or more, increased by 38 percent. During the study period, diet improved substantially. Statistically, changes in these variables--when considered simultaneously--explained a 21 percent decline in the incidence of coronary disease, representing 68 percent of the overall decline from 1980-1982 to 1992-1994. Taken individually, the reduction in smoking explained a 13 percent decline in the incidence of coronary disease; improvement in diet explained a 16 percent decline; and increase in postmenopausal hormone use explained a 9 percent decline. On the other hand, the increase in body-mass index explained an 8 percent increase in the incidence of coronary disease. CONCLUSIONS: Reduction in smoking, improvement in diet, and an increase in postmenopausal hormone use accounted for much of the decline in the incidence of coronary disease in this group of women. An increasing prevalence of obesity, however, appears to have slowed the decline in the incidence of coronary disease.

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PubMed2000

Moderate alcohol consumption and risk of coronary heart disease among women with type 2 diabetes mellitus.

BACKGROUND: Moderate alcohol consumption is associated with reduced risk for coronary heart disease (CHD) in generally healthy populations. We assessed prospectively the association between moderate alcohol intake and CHD risk in women with type 2 diabetes mellitus, a group at high risk for cardiovascular disease. METHODS AND RESULTS: We studied women in the Nurses' Health Study who reported a diagnosis of diabetes mellitus at >/=30 years of age. During 39 092 person-years of follow-up from 1980 to 1994, there were 295 CHD events documented among this population, including 194 cases of nonfatal myocardial infarction and 101 cases of fatal CHD. Odds ratios derived from logistic regression were used to estimate relative risks (RRs) for CHD as a function of usual alcohol intake, with adjustment for potential confounders. Compared with diabetic women reporting no alcohol intake, the age-adjusted RR for nonfatal or fatal CHD among diabetic women reporting usual intake of 0.1 to 4.9 g (<0.5 drinks) of alcohol daily was 0.74 (95% CI 0.56 to 0.98), and among those reporting usual intake >/=5 g/d, it was 0.48 (95% CI 0.32 to 0.72) (P for trend <0.0001). Inverse associations between alcohol intake and CHD risk remained significant in multivariate analysis adjusting for several other coronary risk factors (0.1 to 4. 9 g/d: RR 0.72 [95% CI 0.54 to 0.96]; >/=5 g/d: RR 0.45 [0.29 to 0.68]). CONCLUSIONS: Although potential risks of alcohol consumption must be considered, these data suggest that moderate alcohol consumption is associated with reduced CHD risk in women with diabetes and should not be routinely discouraged.

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PubMed2000

Primary prevention of coronary heart disease in women through diet and lifestyle.

BACKGROUND: Many lifestyle-related risk factors for coronary heart disease have been identified, but little is known about their effect on the risk of disease when they are considered together. METHODS: We followed 84,129 women participating in the Nurses' Health Study who were free of diagnosed cardiovascular disease, cancer, and diabetes at base line in 1980. Information on diet and lifestyle was updated periodically. During 14 years of follow-up, we documented 1128 major coronary events (296 deaths from coronary heart disease and 832 nonfatal infarctions). We defined subjects at low risk as those who were not currently smoking, had a body-mass index (the weight in kilograms divided by the square of the height in meters) under 25, consumed an average of at least half a drink of an alcoholic beverage per day, engaged in moderate-to-vigorous physical activity (which could include brisk walking) for at least half an hour per day, on average, and scored in the highest 40 percent of the cohort for consumption of a diet high in cereal fiber, marine n-3 fatty acids, and folate, with a high ratio of polyunsaturated to saturated fat, and low in trans fat and glycemic load, which reflects the extent to which diet raises blood glucose levels. RESULTS: Many of the factors were correlated, but each independently and significantly predicted risk, even after further adjustment for age, family history, presence or absence of diagnosed hypertension or diagnosed high cholesterol level, and menopausal status. Women in the low-risk category (who made up 3 percent of the population) had a relative risk of coronary events of 0.17 (95 percent confidence interval, 0.07 to 0.41) as compared with all the other women. Eighty-two percent of coronary events in the study cohort (95 percent confidence interval, 58 to 93 percent) could be attributed to lack of adherence to this low-risk pattern. CONCLUSION: Among women, adherence to lifestyle guidelines involving diet, exercise, and abstinence from smoking is associated with a very low risk of coronary heart disease.

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PubMed2000

Physical activity and risk of stroke in women.

CONTEXT: Persuasive evidence has demonstrated that increased physical activity is associated with substantial reduction in risk of coronary heart disease. However, the role of physical activity in the prevention of stroke is less well established. OBJECTIVE: To examine the association between physical activity and risk of total stroke and stroke subtypes in women. DESIGN AND SETTING: The Nurses' Health Study, a prospective cohort study of subjects residing in 11 US states. SUBJECTS: A total of 72,488 female nurses aged 40 to 65 years who did not have diagnosed cardiovascular disease or cancer at baseline in 1986 and who completed detailed physical activity questionnaires in 1986, 1988, and 1992. MAIN OUTCOME MEASURE: Incident stroke occurring between baseline and June 1, 1994, compared among quintiles of physical activity level as measured by metabolic equivalent tasks (METs) in hours per week. RESULTS: During 8 years (560,087 person-years) of follow-up, we documented 407 incident cases of stroke (258 ischemic strokes, 67 subarachnoid hemorrhages, 42 intracerebral hemorrhages, and 40 strokes of unknown type). In multivariate analyses controlling for age, body mass index, history of hypertension, and other covariates, increasing physical activity was strongly inversely associated with risk of total stroke. Relative risks (RRs) in the lowest to highest MET quintiles were 1. 00, 0.98, 0.82, 0.74, and 0.66 (P for trend=.005). The inverse gradient was seen primarily for ischemic stroke (RRs across increasing MET quintiles, 1.00, 0.87, 0.83, 0.76, and 0.52; P for trend=.003). Physical activity was not significantly associated with subarachnoid hemorrhage or intracerebral hemorrhage. After multivariate adjustment, walking was associated with reduced risk of total stroke (RRs across increasing walking MET quintiles, 1.00, 0. 76, 0.78, 0.70, and 0.66; P for trend=.01) and ischemic stroke (RRs across increasing walking MET quintiles, 1.00, 0.77, 0.75, 0.69, and 0.60; P for trend=.02). Brisk or striding walking pace was associated with lower risk of total and ischemic stroke compared with average or casual pace. CONCLUSION: These data indicate that physical activity, including moderate-intensity exercise such as walking, is associated with substantial reduction in risk of total and ischemic stroke in a dose-response manner. JAMA. 2000.

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PubMed2000

Body mass index and cardiovascular risk factors in a rural Chinese population.

The metabolic consequences of obesity are well-documented in Western populations. However, limited data are available on the association between body mass index (BMI) and cardiovascular risk factors in developing countries. The authors therefore examined the association between BMI and cardiovascular risk factors in a very lean population in China. A total of 2,542 subjects aged 20-70 years from a rural area of Anqing, China, participated in a cross-sectional survey, and 1,610 provided blood samples in 1993. Mean BMI (kg/m2) was 20.7 for men and 20.9 for women. After adjustment for age, sex, education level, occupation, current alcohol use, and cigarette smoking, BMI was significantly associated with systolic and diastolic blood pressures (p < 0.0001). The adjusted odds ratio for hypertension (systolic pressure > or =140 mmHg or diastolic pressure > or = 90 mmHg) across quintiles of BMI (quintile medians: 18.0, 19.4, 20.6, 21.8, and 24.0) were 1.0, 1.34, 2.46, 2.61, and 4.90 (95% confidence interval: 3.20, 7.50). A higher BMI was directly associated with higher levels of serum total cholesterol, triglycerides, and fasting glucose and lower levels of high density lipoprotein cholesterol. These data from a very lean Chinese population confirm independent relations between body mass and cardiovascular risk factors observed in predominantly overweight Western populations and extend the range of associations to lower BMI levels than do previous studies.

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PubMed2000

Snoring and risk of cardiovascular disease in women.

OBJECTIVES: To examine prospectively the association between snoring and incidence of cardiovascular disease (CVD) in women. BACKGROUND: Whether snoring increases risk of CVD remains unclear; most previous studies have been small, not prospective and limited to men. METHODS: Seventy-one thousand seven hundred seventy-nine female nurses 40 through 65 years of age and without previously diagnosed CVD or cancer at baseline in 1986 were followed up for eight years. Frequency of snoring was assessed using mailed questionnaires at baseline. RESULTS: During eight years of follow-up, we documented 1,042 incident cases of major CVD events (644 coronary heart disease [CHD] and 398 stroke). Compared with nonsnorers, the age-adjusted relative risks (RRs) of CVD were 1.46 (95% confidence interval 1.23 to 1.74) for occasional snorers and 2.02 (1.62 to 2.53) for regular snorers. The age-adjusted RRs of CHD were 1.43 (1.15 to 1.77) for occasional snorers and 2.18 (1.65 to 2.87) for regular snorers. The age-adjusted RRs of stroke were 1.60 (1.21 to 2.12) and 1.88 (1.29 to 2.74), respectively. After further adjustment for smoking, body mass index (BMI) and other covariates, the positive association between snoring and CVD was attenuated but remained statistically significant (RRs of CVD were 1.20 [1.01 to 1.43] for occasional snorers and 1.33 [1.06-1.67] for regular snorers. CONCLUSIONS: These data suggested that snoring is associated with a modest but significantly increased risk of CVD in women, independent of age, smoking, BMI and other cardiovascular risk factors. While further study is needed to elucidate the biological mechanism underlying this association, snoring may help clinicians identify individuals at higher risk for CVD.

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PubMed2000

A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women.

BACKGROUND: Little is known about the effects of the amount and type of carbohydrates on risk of coronary heart disease (CHD). OBJECTIVE: The objective of this study was to prospectively evaluate the relations of the amount and type of carbohydrates with risk of CHD. DESIGN: A cohort of 75521 women aged 38-63 y with no previous diagnosis of diabetes mellitus, myocardial infarction, angina, stroke, or other cardiovascular diseases in 1984 was followed for 10 y. Each participant's dietary glycemic load was calculated as a function of glycemic index, carbohydrate content, and frequency of intake of individual foods reported on a validated food-frequency questionnaire at baseline. All dietary variables were updated in 1986 and 1990. RESULTS: During 10 y of follow-up (729472 person-years), 761 cases of CHD (208 fatal and 553 nonfatal) were documented. Dietary glycemic load was directly associated with risk of CHD after adjustment for age, smoking status, total energy intake, and other coronary disease risk factors. The relative risks from the lowest to highest quintiles of glycemic load were 1.00, 1.01, 1. 25, 1.51, and 1.98 (95% CI: 1.41, 2.77 for the highest quintile; P for trend < 0.0001). Carbohydrate classified by glycemic index, as opposed to its traditional classification as either simple or complex, was a better predictor of CHD risk. The association between dietary glycemic load and CHD risk was most evident among women with body weights above average ¿ie, body mass index (in kg/m(2)) >/= 23. CONCLUSION: These epidemiologic data suggest that a high dietary glycemic load from refined carbohydrates increases the risk of CHD, independent of known coronary disease risk factors.

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PubMed2000

Prospective study of major dietary patterns and risk of coronary heart disease in men.

BACKGROUND: Previous studies on diet and coronary heart disease (CHD) focused primarily on individual nutrients or foods. OBJECTIVE: We examined whether overall dietary patterns derived from a food-frequency questionnaire (FFQ) predict risk of CHD in men. DESIGN: This was a prospective cohort study of 44875 men aged 40-75 y without diagnosed cardiovascular disease or cancer at baseline in 1986. RESULTS: During 8 y of follow-up, we documented 1089 cases of CHD (nonfatal myocardial infarction and fatal CHD). Using factor analysis, we identified 2 major dietary patterns using dietary data collected through a 131-item FFQ. The first factor, which we labeled the "prudent pattern," was characterized by higher intake of vegetables, fruit, legumes, whole grains, fish, and poultry, whereas the second factor, the "Western pattern," was characterized by higher intake of red meat, processed meat, refined grains, sweets and dessert, French fries, and high-fat dairy products. After adjustment for age and CHD risk factors, the relative risks from the lowest to highest quintiles of the prudent pattern score were 1.0, 0. 87, 0.79, 0.75, and 0.70 (95% CI: 0.56, 0.86; P: for trend = 0.0009). In contrast, the relative risks across increasing quintiles of the Western pattern score were 1.0, 1.21, 1.36, 1.40, and 1.64 (95% CI: 1.24, 2.17; P: for trend < 0.0001). These associations persisted in subgroup analyses according to cigarette smoking, body mass index, and parental history of myocardial infarction. CONCLUSIONS: These data suggest that major dietary patterns derived from the FFQ predict risk of CHD, independent of other lifestyle variables.

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PubMed2000

Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women.

BACKGROUND: Little is known about the overall health effects of adherence to the Dietary Guidelines for Americans. The healthy eating index (HEI), developed at the US Department of Agriculture, measures how well Americans' diets conform to these guidelines. OBJECTIVE: We tested whether the HEI (scores range from 0 to 100; 100 is best) calculated from food-frequency questionnaires (HEI-f) would predict risk of major chronic disease in women. DESIGN: A total of 67272 US female nurses who were free of major disease completed detailed questionnaires on diet and chronic disease risk factors in 1984 and repeatedly over 12 y. Major chronic disease was defined as fatal or nonfatal cardiovascular disease (myocardial infarction or stroke, n = 1365), fatal or nonfatal cancer (n = 5216), or other nontraumatic deaths (n = 496), whichever came first. We also examined cardiovascular disease and cancer as separate outcomes. RESULTS: After adjustment for smoking and other risk factors, the HEI-f score was not associated with risk of overall major chronic disease in women [relative risk (RR) = 0.97; 95% CI: 0.89, 1.06 comparing the highest with the lowest quintile of HEI-f score]. Being in the highest HEI-f quintile was associated with a 14% reduction in cardiovascular disease risk (RR = 0.86; 95% CI: 0.72, 1. 03) and was not associated with lower cancer risk (RR = 1.02; 95% CI: 0.93, 1.12). CONCLUSION: These data suggest that adherence to the 1995 Dietary Guidelines for Americans, as measured by the HEI-f, will have limited benefit in preventing major chronic disease in women.

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PubMed2000

Random-effects regression analysis of correlated grouped-time survival data.

Random-effects regression modelling is proposed for analysis of correlated grouped-time survival data. Two analysis approaches are considered. The first treats survival time as an ordinal outcome, which is either right-censored or not. The second approach treats survival time as a set of dichotomous indicators of whether the event occurred for time periods up to the period of the event or censor. For either approach both proportional hazards and proportional odds versions of the random-effects model are developed, while partial proportional hazards and odds generalizations are described for the latter approach. For estimation, a full-information maximum marginal likelihood solution is implemented using numerical quadrature to integrate over the distribution of multiple random effects. The quadrature solution allows some flexibility in the choice of distributions for the random effects; both normal and rectangular distributions are considered in this article. An analysis of a dataset where students are clustered within schools is used to illustrate features of random-effects analysis of clustered grouped-time survival data.

Biometry↗

PubMed2000

A prospective study of whole-grain intake and risk of type 2 diabetes mellitus in US women.

OBJECTIVES: This study examined the association between intake of whole vs refined grain and the risk of type 2 diabetes mellitus. METHODS: We used a food frequency questionnaire for repeated dietary assessments to prospectively evaluate the relation between whole-grain intake and the risk of diabetes mellitus in a cohort of 75,521 women aged 38 to 63 years without a previous diagnosis of diabetes or cardiovascular disease in 1984. RESULTS: During the 10-year follow-up, we confirmed 1879 incident cases of diabetes mellitus. When the highest and the lowest quintiles of intake were compared, the age and energy-adjusted relative risks were 0.62 (95% confidence interval [CI] = 0.53, 0.71, P trend < .0001) for whole grain, 1.31 (95% CI = 1.12, 1.53, P trend = .0003) for refined grain, and 1.57 (95% CI = 1.36, 1.82, P trend < .0001) for the ratio of refined- to whole-grain intake. These findings remained significant in multivariate analyses. The findings were most evident for women with a body mass index greater than 25 and were not entirely explained by dietary fiber, magnesium, and vitamin E. CONCLUSIONS: These findings suggest that substituting whole- for refined-grain products may decrease the risk of diabetes mellitus.

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PubMed1999

Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study.

CONTEXT: Although many studies suggest that physical activity may reduce risk of type 2 diabetes, the role of moderate-intensity activity such as walking is not well understood. OBJECTIVES: To examine the relationship of total physical activity and incidence of type 2 diabetes in women and to compare the benefits of walking vs vigorous activity as predictors of subsequent risk of type 2 diabetes. DESIGN AND SETTING: The Nurses' Health Study, a prospective cohort study that included detailed data for physical activity from women surveyed in 11 US states in 1986, with updates in 1988 and 1992. PARTICIPANTS: A total of 70,102 female nurses aged 40 to 65 years who did not have diabetes, cardiovascular disease, or cancer at baseline (1986). MAIN OUTCOME MEASURE: Risk of type 2 diabetes by quintile of metabolic equivalent task (MET) score, based on time spent per week on each of 8 common physical activities, including walking. RESULTS: During 8 years of follow-up (534, 928 person-years), we documented 1419 incident cases of type 2 diabetes. After adjusting for age, smoking, alcohol use, history of hypertension, history of high cholesterol level, and other covariates, the relative risks (RRs) of developing type 2 diabetes across quintiles of physical activity (least to most) were 1.0, 0.77, 0.75, 0.62, and 0.54 (P for trend <.001); after adjusting for body mass index (BMI), RRs were 1.0, 0.84, 0.87, 0.77, and 0.74 (P for trend = .002). Among women who did not perform vigorous activity, multivariate RRs of type 2 diabetes across quintiles of MET score for walking were 1.0, 0.91,0.73, 0.69, and 0.58 (P for trend <.001). After adjusting for BMI, the trend remained statistically significant (RRs were 1.0, 0.95, 0.80, 0.81, 0.74; P for trend = .01). Faster usual walking pace was independently associated with decreased risk. Equivalent energy expenditures from walking and vigorous activity resulted in comparable magnitudes of risk reduction. CONCLUSIONS: Our data suggest that greater physical activity level is associated with substantial reduction in risk of type 2 diabetes, including physical activity of moderate intensity and duration.

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PubMed1999

Prospective study of snoring and risk of hypertension in women.

Whether snoring increases the risk of hypertension remains unclear. The authors examined the association between snoring and risk of hypertension in a cohort of 73,231 US female nurses aged 40-65 years and without diagnosed cardiovascular disease or cancer in 1986. Blood pressure levels and physician-diagnosed hypertension were self-reported through validated questionnaires. During 8 years of follow-up, 7,622 incident cases of physician-diagnosed hypertension were reported. Older age, smoking, body mass index, waist circumference, waist-hip ratio, weight gain, less physical activity, and sleeping on the back were directly associated with regular snoring. After adjustment for age, body mass index, waist circumference, and other covariates, snoring was associated with a significantly higher prevalence of hypertension at baseline (odds ratio = 1.22, 95% confidence interval (CI): 1.16, 1.27 for occasional snoring and odds ratio = 1.43, 95% CI: 1.33, 1.5 for regular snoring). In prospective analyses using incident cases of hypertension as the outcome, the multivariate relative risks of hypertension were 1.29 (95% CI: 1.22, 1.37) for occasional snoring and 1.55 (95% CI: 1.42, 1.70) for regular snoring. In addition, snoring was associated with significantly higher systolic and diastolic blood pressure levels. These data suggest that snoring may increase risk of hypertension in women, independent of age, body mass index, waist circumference, and other lifestyle factors.

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PubMed1999

A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women.

BACKGROUND: The role of walking, as compared with vigorous exercise, in the prevention of coronary heart disease remains controversial, and data for women on this topic are sparse. METHODS: We prospectively examined the associations between the score for total physical activity, walking, and vigorous exercise and the incidence of coronary events among 72,488 female nurses who were 40 to 65 years old in 1986. Participants were free of diagnosed cardiovascular disease or cancer at the time of entry and completed serial detailed questionnaires about physical activity. During eight years of follow-up, we documented 645 incident coronary events (nonfatal myocardial infarction or death from coronary disease). RESULTS: There was a strong, graded inverse association between physical activity and the risk of coronary events. As compared with women in the lowest quintile group for energy expenditure (expressed as the metabolic-equivalent [MET] score), women in increasing quintile groups had age-adjusted relative risks of 0.77, 0.65, 0.54, and 0.46 for coronary events (P for trend <0.001). In multivariate analyses, the inverse gradient remained strong (relative risks, 0.88, 0.81, 0.74, and 0.66 for women in increasing quintile groups as compared with those in the lowest quintile group; P for trend=0.002). Walking was inversely associated with the risk of coronary events; women in the highest quintile group for walking, who walked the equivalent of three or more hours per week at a brisk pace, had a multivariate relative risk of 0.65 (95 percent confidence interval, 0.47 to 0.91) as compared with women who walked infrequently. Regular vigorous exercise (> or =6 MET) was associated with similar risk reductions (30 to 40 percent). Sedentary women who became active in middle adulthood or later had a lower risk of coronary events than their counterparts who remained sedentary. CONCLUSIONS: These prospective data indicate that brisk walking and vigorous exercise are associated with substantial and similar reductions in the incidence of coronary events among women.

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PubMed1999

Long-term intake of dietary fiber and decreased risk of coronary heart disease among women.

CONTEXT: Epidemiological studies of men suggest that dietary fiber intake protects against coronary heart disease (CHD), but data on this association in women are sparse. OBJECTIVE: To examine the association between long-term intake of total dietary fiber as well as fiber from different sources and risk of CHD in women. DESIGN AND SETTING: The Nurses' Health Study, a large, prospective cohort study of US women followed up for 10 years from 1984. Dietary data were collected in 1984, 1986, and 1990, using a validated semiquantitative food frequency questionnaire. PARTICIPANTS: A total of 68782 women aged 37 to 64 years without previously diagnosed angina, myocardial infarction (MI), stroke, cancer, hypercholesterolemia, or diabetes at baseline. MAIN OUTCOME MEASURE: Incidence of acute MI or death due to CHD by amount of fiber intake. RESULTS: Response rate averaged 80% to 90% during the 10-year follow-up. We documented 591 major CHD events (429 nonfatal MIs and 162 CHD deaths). The age-adjusted relative risk (RR) for major CHD events was 0.53 (95% confidence interval [CI], 0.40-0.69) for women in the highest quintile of total dietary fiber intake (median, 22.9 g/d) compared with women in the lowest quintile (median, 11.5 g/d). After controlling for age, cardiovascular risk factors, dietary factors, and multivitamin supplement use, the RR was 0.77 (95% CI, 0.57-1.04). For a 10-g/d increase in total fiber intake (the difference between the lowest and highest quintiles), the multivariate RR of total CHD events was 0.81 (95% CI, 0.66-0.99). Among different sources of dietary fiber (eg, cereal, vegetables, fruit), only cereal fiber was strongly associated with a reduced risk of CHD (multivariate RR, 0.63; 95% CI, 0.49-0.81 for each 5-g/d increase in cereal fiber). CONCLUSIONS: Our findings in women support the hypothesis that higher fiber intake, particularly from cereal sources, reduces the risk of CHD.

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PubMed1999

Age at natural menopause and risk of cardiovascular disease.

BACKGROUND: Early natural menopause has been postulated to increase the risk of cardiovascular disease. OBJECTIVE: To examine the relation of age at natural menopause with risk of coronary heart disease (CHD) and stroke in the Nurses' Health Study. METHODS: Analysis was restricted to 35 616 naturally postmenopausal women who never used estrogen replacement therapy and with no diagnosed cardiovascular disease at baseline, followed up from 1976 to 1994. Information on menopausal status, age at menopause, and other risk factors was obtained in 1976 and updated every 2 years by mailed questionnaires. RESULTS: During 354326 person-years of follow-up, we documented 757 incident cases of CHD and 350 incident cases of stroke. After adjusting for age, smoking status, and other cardiovascular risk factors, the relative risks (RRs) across categories of age at natural menopause (<40, 40-44, 45-49, 50-54, and > or = 55 years) were 1.53, 1.42, 1.10, 1.00 (reference), and 0.95, respectively; the RR for each 1-year decrease in age at natural menopause was 1.03 (95% confidence interval, 1.01-1.05). Elevated risk with younger age at menopause was observed among current smokers (RR, 1.04 [95% CI, 1.01-1.07] for each 1-year decrease in age at natural menopause) but not among never smokers (RR, 1.00; 95% CI, 0.96-1.04). Age at natural menopause was not significantly associated with ischemic stroke (RR, 1.01; 95% CI, 0.97-1.04) or hemorrhagic stroke (RR, 1.03; 95% CI, 0.97-1.10). CONCLUSIONS: We observed an overall significant association between younger age at menopause and higher risk of CHD among women who experienced natural menopause and never used hormone therapy. This increased risk was observed among current smokers but not among never smokers. The apparent elevated risk of CHD with decreased age at natural menopause among smokers might reflect residual confounding by smoking.

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PubMed1999

A prospective study of egg consumption and risk of cardiovascular disease in men and women.

CONTEXT: Reduction in egg consumption has been widely recommended to lower blood cholesterol levels and prevent coronary heart disease (CHD). Epidemiologic studies on egg consumption and risk of CHD are sparse. OBJECTIVE: To examine the association between egg consumption and risk of CHD and stroke in men and women. DESIGN AND SETTING: Two prospective cohort studies, the Health Professionals Follow-up Study (1986-1994) and the Nurses' Health Study (1980-1994). PARTICIPANTS: A total of 37851 men aged 40 to 75 years at study outset and 80082 women aged 34 to 59 years at study outset, free of cardiovascular disease, diabetes, hypercholesterolemia, or cancer. MAIN OUTCOME MEASURES: Incident nonfatal myocardial infarction, fatal CHD, and stroke corresponding to daily egg consumption as determined by a food-frequency questionnaire. RESULTS: We documented 866 incident cases of CHD and 258 incident cases of stroke in men during 8 years of follow-up and 939 incident cases of CHD and 563 incident cases of stroke in women during 14 years of follow-up. After adjustment for age, smoking, and other potential CHD risk factors, we found no evidence of an overall significant association between egg consumption and risk of CHD or stroke in either men or women. The relative risks (RRs) of CHD across categories of intake were less than 1 per week (1.0), 1 per week (1.06), 2 to 4 per week (1.12), 5 to 6 per week (0.90), and > or =1 per day (1.08) (P for trend = .75) for men; and less than 1 per week (1.0), 1 per week (0.82), 2 to 4 per week (0.99), 5 to 6 per week (0.95), and > or =1 per day (0.82) (P for trend = .95) for women. In subgroup analyses, higher egg consumption appeared to be associated with increased risk of CHD only among diabetic subjects (RR of CHD comparing more than 1 egg per day with less than 1 egg per week among diabetic men, 2.02 [95% confidence interval, 1.05-3.87; P for trend = .04], and among diabetic women, 1.49 [0.88-2.52; P for trend = .008]). CONCLUSIONS: These findings suggest that consumption of up to 1 egg per day is unlikely to have substantial overall impact on the risk of CHD or stroke among healthy men and women. The apparent increased risk of CHD associated with higher egg consumption among diabetic participants warrants further research.

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