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F Grodstein

Publications and source records attributed to F Grodstein.

At least 37 records · Page 2Linked to original sources
PubMed1997

A prospective study of risk factors for pulmonary embolism in women.

OBJECTIVE: To investigate risk factors for pulmonary embolism in women. DESIGN: Prospective study based on biennial, mailed questionnaires. SETTING: Nurses' Health Study with 16 years of follow-up from 1976 to 1992. PATIENTS: A group of 112822 women aged 30 to 55 years in 1976, free from diagnosed cardiovascular disease or cancer at baseline. Overall, there were 1619770 person-years of follow-up. MEASUREMENTS: Based on self-report and medical records, we documented 280 cases of pulmonary embolism, of which 125 were primary (no identified antecedent cancer, trauma, surgery, or immobilization). Information on height, weight, cigarette smoking, hypertension, diabetes, and hypercholesterolemia was collected by questionnaire. RESULTS: In multivariate analysis, obesity, cigarette smoking, and hypertension were independent predictors of pulmonary embolism. Specifically, obese women (body mass index > or = 29.0 kg/m2) had an increased risk of primary pulmonary embolism (multivariate relative risk=2.9; 95% confidence interval [CI], 1.5-5.4). Heavy cigarette smokers also had an increased risk of primary pulmonary embolism. The relative risk (RR) of primary pulmonary embolism was 1.9 (95% CI, 0.9-3.7) for women currently smoking 25 to 34 cigarettes per day and 3.3 (95% CI, 1.7-6.5) for those smoking 35 cigarettes or more daily as compared with never smokers. Hypertension, even after adjustment for body mass index, was also associated with an increased risk of primary pulmonary embolism (RR=1.9; 95% CI, 1.2-2.8). High serum cholesterol levels (RR=1.1; 95% CI, 0.62-1.8) and diabetes (RR=0.7; 95% CI, 0.3-1.9) did not appear to be related to primary pulmonary embolism. CONCLUSION: These prospective data indicate that obesity, cigarette smoking, and hypertension are associated with increased risk of pulmonary embolism in women. Control of these risk factors will decrease risks of pulmonary embolism as well as coronary heart disease.

Adult↗
PubMed1997

Attenuation over 24 hours of the efficacy of thrombolysis of pulmonary embolism among patients with cancer.

The efficacy and safety of thrombolysis in patients with cancer with pulmonary embolism is uncertain. Therefore we studied the effects of thrombolysis in 57 patients with cancer and 254 patients without cancer who were treated in five clinical trials with tissue plasminogen activator or urokinase for pulmonary embolism. Immediately after thrombolysis, the proportion of patients with and without cancer who improved on follow-up angiography (77% vs 73%; p = 0.65) was similar. The angiogrophic reduction in clot burden (1.83 +/- 0.27 vs 1.38 +/- 0.13; p = 0.13) was somewhat greater in patients with cancer than in patients without cancer. Twenty-four hours after initiation of thrombolytic therapy, the proportion of patients who improved on follow-up perfusion scan continued to be similar (72% vs 78%; p = 0.40). However, the extent of reperfusion at 24 hours was less in patients with cancer than in patients without cancer (6% vs 13% reperfusion of lung tissue; p = 0.007). These data suggest that patients with cancer should receive effective anticoagulation in the upper portion of the therapeutic range immediately after thrombolysis. It is possible that such a strategy might preserve initial improvement from thrombolysis and prevent attenuation of benefit during the ensuing 24 hours.

Adult↗
PubMed1997

Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis.

We reviewed our database of 312 patients with pulmonary embolism who received thrombolysis in five clinical trials. At baseline, none had a history of stroke, internal bleeding within 6 months, surgery within 10 days, or occult blood in stool. Sixty-six major bleeding episodes occurred within 72 hours of administering thrombolysis in 61 (20%) patients: bleeding at the catheterization site (34 cases), gross hematuria (9), intracranial hemorrhage (5), and 18 other bleeding episodes that led to at least a 10% hematocrit decrease. Patients with a major bleeding complication were on average older than patients with no hemorrhagic complication (mean age 62.9 +/- 1.9 years vs 56.2 +/- 1.1 years; p = 0.005). In an adjusted analysis, there was a fourfold increased risk of bleeding among patients older than 70 years compared with patients younger than 50 years (relative risk [RR] 3.9; 95% confidence interval [CI] 1.7 to 8.9). By using age as a continuous variable, we found a 4% (RR 1.04; 95% CI 1.02 to 1.06) increase in risk of bleeding for each incremental year of age. In addition, patients with higher body mass index had an increased risk of bleeding. Patients who had undergone catheterization had a five times greater risk of bleeding (RR 5.2; 95% CI 1.5 to 17.8). In summary, increasing age, larger body mass index, and catheterization predisposed to bleeding complications after pulmonary embolism thrombolysis.

Age Factors↗
PubMed1997

Parity and other reproductive factors and risk of adenomatous polyps of the distal colorectum (United States).

Evidence for an effect of reproductive factors on colorectal carcinogenesis is inconsistent and little is known about their role in development of precursor adenomatous polyps. We evaluated the relation between reproductive factors and distal colorectal adenomas (n = 982) during 14 years of follow up of 26,983 participants in the Nurses' Health Study (United States). The women were free of diagnosed cancer or polyps in 1980, underwent endoscopy 1980-94, and had reported on their parity, oral contraceptive (OC) use, and ages at menarche, first term-pregnancy, and menopause. We calculated relative risks (RR) and 95 percent confidence intervals (CI) using multiple logistic regression. Women with higher parity had an increased risk of adenomas of the distal colorectum (P trend = 0.004; 6+ cf 0 parity: RR = 1.3, CI = 0.9-1.8) or distal colon (P trend = 0.002, RR = 1.7, CI = 1.2-2.6). This association was significantly stronger among women with a family history of colorectal cancer (P interaction = 0.03); comparing 6+ term-pregnancies with nulliparity, among those with a family history, the RR for distal colon adenoma was 3.2 (CI = 1.4-7.2), while among those without a family history, the RR was 1.3 (CI = 0.8-2.2). We observed no association for distal colorectal adenoma and age at menarche, age at first term-pregnancy, ever use of OCs, or menopausal status. Further work is needed to clarify the relation of parity with colon adenoma risk.

Adenoma↗
PubMed1997

A prospective study of reproductive factors, oral contraceptive use, and risk of colorectal cancer.

To explore the roles of reproductive factors and oral contraceptive use in the etiology of colorectal cancer, we examined incident cases of colorectal cancer (n = 501) that occurred during 1,012,280 person-years of follow-up between 1980 and 1992 in the Nurses' Health Study. The women completed mailed, self-administered questionnaires every 2 years to update information on the risk factors and major medical events. In multivariate analysis, the relative risk (RR) of colorectal cancer among women who experienced menarche at age 14 or older was 0.83 (95% confidence interval (CI) = 0.64-1.08) compared with women who had menarche at age 13; women whose menarche occurred under age 12 were at higher risk (RR = 1.22; 95% CI = 0.96-1.55, P for trend = 0.01). Compared with women whose first pregnancy was before age 24, the risk for colorectal cancer was significantly increased among women whose first pregnancy was at age 30 or older (RR = 1.57; 95% CI = 1.15-2.14; P for trend = 0.02). No important associations were seen for parity or age at menopause. Women who used oral contraceptives for 96 months or longer had a 40% lower risk of developing colorectal cancer (RR = 0.60; 95% CI = 0.40-0.89; P for trend = 0.02) compared with women who never used oral contraceptives. These prospective data suggest that a later age of menarche and use of oral contraceptives may reduce risk of colorectal cancer, whereas women with a later age at first pregnancy may have a higher risk.

Adult↗
PubMed1996

Prospective study of exogenous hormones and risk of pulmonary embolism in women.

BACKGROUND: Current use of oral contraceptives (OCs) is a well-recognised risk factor for venous thrombosis and consequent pulmonary embolism (PE). Little is known about residual effects of past OC use. Furthermore, few epidemiological studies have assessed the relation between postmenopausal use of hormones and thrombotic disease. METHODS: In this prospective study information was obtained through questionnaires sent every 2 years (1976-92) to 1125,93 women aged 30-55 in 1976. We excluded women with previously diagnosed cardiovascular disease or cancer in 1976 and at the beginning of each subsequent 2-year follow-up period. FINDINGS: From self-reports and medical records, we documented 123 cases of primary PE (no identified antecedent cancer, trauma, surgery, or immobilisation). Current users of postmenopausal hormones had an increased risk of primary PE (relative risk adjusted for multiple risk factors 2.1 [95% CI 1.2-3.8]). However, past use showed no relation to PE (1.3 [0.7-2.4]). In current users of OCs the risk of primary PE was about twice that in non-users (2.2 [0.8-5.9]), but this finding was based on only five cases who were current OC users. Users of OCs in the past had no increase in risk of PE (0.8 [0.5-1.2]). These relations were consistent irrespective of cigarette-smoking status. INTERPRETATION: Primary PE was uncommon in this cohort. The risk was increased by current though not past use of postmenopausal hormones or OCs.

Adult↗
PubMed1996

Postmenopausal estrogen and progestin use and the risk of cardiovascular disease.

BACKGROUND: Estrogen therapy in postmenopausal women has been associated with a decreased risk of heart disease. There is little information, however, about the effect of combined estrogen and progestin therapy on the risk of cardiovascular disease. METHODS: We examined the relation between cardiovascular disease and postmenopausal hormone therapy during up to 16 years of follow-up in 59,337 women from the Nurses' Health Study, who were 30 to 55 years of age at base line. Information on hormone use was ascertained with biennial questionnaires. From 1976 to 1992, we documented 770 cases of myocardial infarction or death from coronary disease in this group and 572 strokes. Proportional-hazards models were used to calculate relative risks and 95 percent confidence intervals, adjusted for confounding variables. RESULTS: We observed a marked decrease in the risk of major coronary heart disease among women who took estrogen with progestin (multivariate adjusted relative risk, 0.39; 95 percent confidence interval, 0.19 to 0.78) or estrogen alone (relative risk, 0.60; 95 percent confidence interval, 0.43 to 0.83), as compared with women who did not use hormones [corrected]. However, there was no significant association between stroke and use of combined hormones (multivariate adjusted relative risk, 1.09; 95 percent confidence interval, 0.66 to 1.80) or estrogen alone (relative risk, 1.27; 95 percent confidence interval, 0.95 to 1.69). CONCLUSIONS: The addition of progestin does not appear to attenuate the cardioprotective effects of postmenopausal estrogen therapy.

Adult↗
PubMed1996

Three-year follow-up of participants in a commercial weight loss program. Can you keep it off?

BACKGROUND: One third of Americans are obese, according to the 1988-1991 National Health and Nutrition Endpoint Survey III survey. Obesity increases the risk of death and a variety of chronic diseases. Numerous commercial weight loss programs demonstrate short-term success. OBJECTIVE: To assess maintenance of weight loss achieved during dieting. METHODS: We surveyed 192 participants in the Sandoz Nutrition (Sandoz Pharmaceuticals, Minneapolis, Minn) diet program approximately 3 years after participation. Initial date were supplied by the diet clinics and follow-up data, including weight at various points after the program, participation in other weight loss programs, and lifestyle variables, such as exercise, smoking, and television watching, were collected by a mailed questionnaire. RESULTS: On average, the group lost 22 kg during the diet program. After the follow-up period, the mean weight (mean, 102.6 kg) was only modestly less than the group's original weight at the start of the diet (mean, 105.9 kg). Twelve percent of the subjects maintained 75% of their weight loss after leaving the diet program, 57% maintained at least 5% of the loss, and 40% gained back more than they had lost during the diet. The frequency of exercise after the diet program was the strongest predictor of weight loss maintenance, while television viewing predicted a gain in weight. CONCLUSION: Given the apparent lack of substantial, long-term success at weight reduction, perhaps greater emphasis should be placed on prevention of obesity.

Commerce↗
PubMed1996

Post-menopausal hormone use and tooth loss: a prospective study.

Nearly 32 percent of U.S. women aged 65 to 69 years have no teeth. Because some tooth loss may reflect systemic osteoporosis, and because estrogen therapy seems to protect against osteoporosis, the authors examined the risk of tooth loss in relation to hormone use in a prospective study of 42,171 post-menopausal women. The risk of tooth loss was lower in women who currently used hormones. Although few studies have examined this issue, this research suggests that estrogen may reduce tooth loss.

Adult↗
PubMed1995

A prospective study of incident squamous cell carcinoma of the skin in the nurses' health study.

BACKGROUND: Few epidemiologic studies are available that quantify the magnitude of the risk of squamous cell carcinoma (SCC) of the skin associated with sun exposure and related factors such as skin type. In addition, several studies have found an association between cigarette smoking and SCC. PURPOSE: We prospectively examined the risk of developing SCC in relation to phenotype and the effects of sun exposure, as well as to cigarette smoking and other factors, during 8 years of follow-up in a cohort of 107,900 predominantly white women aged 30-55 years at base line in 1976. METHODS: Questionnaires regarding medical history and health-related variables were sent to Nurses' Health Study participants every 2 years, beginning in 1976. Information on constitutional factors (natural hair color, childhood and adolescent tendency to sunburn and tan, and lifetime number of severe sunburns), lifestyle factors (regular time spent outdoors in the summer and sunscreen use), the state lived in at birth and at ages 15 and 30 years, and cigarette smoking habits were ascertained by questionnaire. A total of 197 women with first-incident, histologically confirmed, invasive SCCs that were diagnosed from 1982 to 1990 were included in this analysis. Multivariate analysis using proportional hazards models was used to calculate the relative risks (RRs) and corresponding 95% confidence intervals (CIs), with adjustment for confounders. RESULTS: The risk of SCC was increased in women living in California (RR = 1.8; 95% CI = 1.3-2.6) and Florida (RR = 2.1; 95% CI = 1.1-3.9) at base line, compared with those living in the northeastern states. This risk was higher for women living in those states at birth and at 15 years of age (RR = 2.5; 95% CI = 1.4-4.4 for California and RR = 3.0; 95% CI = 0.7-1.2 for Florida). Red (RR = 2.0; 95% CI = 1.1-3.7) and light brown (RR = 1.7; 95% CI = 1.2-2.4) hair colors were associated with an increased risk of SCC, compared with dark brown hair. After adjusting for the number of sunburns, women who tended to burn after 2 or more hours of sun exposure as children had a slightly higher risk of SCC than those who never burned (RR = 1.5; 95% CI = 0.9-2.5 for burn and RR = 1.1; 95% CI = 0.6-2.0 for painful burn), although the actual number of severe burns appeared to be a more important factor (RR = 2.4; 95% CI = 1.5-4.0 for six or more burns). Finally, current cigarette smokers showed a 50% increase in the risk of SCC compared with never smokers (RR = 1.5; 95% CI = 1.1-2.1). CONCLUSION: Exposure to the sun leading to sunburn, particularly at early ages, should be avoided to decrease the risk of incident SCC.

Adult↗
PubMed1995

A prospective evaluation of an angiotensin-converting-enzyme gene polymorphism and the risk of ischemic heart disease.

BACKGROUND: In a previous study, men with a history of myocardial infarction were found to have an increased prevalence of homozygosity for the deletional allele (D) of the angiotensin-converting-enzyme (ACE) gene. The D allele is associated with higher levels of ACE, which may predispose a person to ischemic heart disease. We investigated the association between the ACE genotype and the incidence of myocardial infarction, as well as other manifestations of ischemic heart disease, in a large, prospective cohort of U.S. male physicians. METHODS: In the Physicians' Health Study, ischemic heart disease as defined by angina, coronary revascularization, or myocardial infarction developed in 1250 men by 1992. They were matched with 2340 controls according to age and smoking history. Zygosity for the deletion-insertion (D-I) polymorphism of the ACE gene was determined by an assay based on the polymerase chain reaction. Data were analyzed for both matched pairs and unmatched samples, with adjustment for the effects of known or suspected risk factors by conditional and nonconditional logistic regression, respectively. RESULTS: The ACE genotype was not associated with the occurrence of either ischemic heart disease or myocardial infarction. The adjusted relative risk associated with the D allele was 1.07 (95 percent confidence interval, 0.96 to 1.19; P = 0.24) for ischemic heart disease and 1.05 (95 percent confidence interval, 0.89 to 1.25; P = 0.56) for myocardial infarction, if an additive mode of inheritance is assumed. Additional analyses assuming dominant and recessive effects of the D allele also failed to show any association, as did the examination of low-risk subgroups. CONCLUSIONS: In a large, prospectively followed population of U.S. male physicians, the presence of the D allele of the ACE gene conferred no appreciable increase in the risk of ischemic heart disease or myocardial infarction.

Alleles↗
PubMed1995

A prospective study of plasma hormone levels, nonhormonal factors, and development of benign prostatic hyperplasia.

We assessed the relation of plasma hormone levels and nonhormonal factors with subsequent occurrence of surgical treatment for benign prostatic hyperplasia (BPH) among participants in the Physicians' Health Study. Frozen plasma samples, collected at the study onset, were available for 320 men who developed surgically treated BPH up to 9 years later and for 320 age-matched controls. Plasma testosterone (T), dihydrotestosterone (DHT), androstenedione, estradiol (E2), and estrone (E1) were measured for each case-control pair. In unadjusted analyses, none of the hormones or hormone ratios were associated with BPH; for example, for T and E2 the odds ratios (OR) comparing the highest quintile (Q5) with the lowest (Q1) were 0.74 (95% CI = 0.42, 1.30) and 1.07 (95% CI = 0.51, 2.22), respectively. However, in multivariate analyses controlling diastolic blood pressure, exercise, alcohol, E1, and DHT:T ratio, we observed a strong trend for increasing risk across quintiles for E2 (Q5 vs. Q1 OR = 3.56, P trend = 0.009), and a weak inverse trend for E1 (Q5 vs Q1 OR = 0.51, P trend = 0.07). The excess risk associated with E2 was confined to men with relatively low androgen levels. Three nonhormonal factors previously suspected as risk factors were independently associated with surgical BPH in these data. The OR for a 1-mm Hg difference in diastolic blood pressure was 1.04 (95% CI = 1.01, 1.07). Alcohol use and infrequent exercise were inversely associated with risk of BPH surgery; however, risk estimates were not consistent across categories of exercise and alcohol frequency. Our results indicate that normal variation in circulating androgen levels does not influence development of BPH, but that variation in estrogen levels might be important.

Adult↗
PubMed1994

A prospective study of permanent hair dye use and hematopoietic cancer.

BACKGROUND: Use of permanent hair dye has been suggested as a risk factor for several types of cancer, although epidemiologic data have not generally supported this hypothesis. Retrospective studies have reported a possible association between hair dyes and hematopoietic cancers. PURPOSE: Our purpose was to investigate if permanent hair dye was associated with risks of incident lymphoma, leukemia, and multiple myeloma in the Nurses' Health Study, a prospective cohort study of 99,067 women aged 30-55 years in 1976. METHODS: Questionnaires regarding medical history and other health-related variables were sent to Nurses' Health Study participants every 2 years from 1976 to 1990. The follow-up for mortality in this cohort exceeds 98%. We identified 244 newly diagnosed cases of hematopoietic cancers, confirmed by pathology reports. Permanent hair dye use was ascertained over four cycles of questionnaires from 1976-1982; status of hair dye use established in 1982 was then used for the remainder of the follow-up time (through 1990). Age-specific incidence rates were calculated and used to compute relative risks (RRs) with 95% confidence intervals (CIs). RESULTS: We found no evidence of a positive association between ever use of permanent hair dye and all hematopoietic cancers (age-adjusted RR = 0.9; 95% CI = 0.7-1.2) or specific types (Hodgkin's lymphoma [RR = 0.9; 95% CI = 0.4-2.1], non-Hodgkin's lymphoma [RR = 1.1; 95% CI = 0.8-1.6], multiple myeloma [RR = 0.4; 95% CI = 0.2-0.9], chronic lymphocytic leukemia [RR = 0.6; 95% CI = 0.3-1.5], and other leukemias [RR = 0.8; 95% CI = 0.3-1.9]). Further examination of age at first use, duration, frequency, and time since first use and risk of all hematopoietic cancers or non-Hodgkin's lymphoma (the largest diagnostic group), indicated no material associations. CONCLUSION: In this prospective cohort study, permanent hair dye use is not adversely related to risks of hematopoietic cancers.

Adult↗
PubMed1994

Prospective study of plasma fatty acids and risk of prostate cancer.

BACKGROUND: Although some evidence suggests that dietary fat intake is related to prostate cancer, epidemiologic studies have been inconsistent. PURPOSE: Our purpose was to assess the association between plasma lipid levels, particularly linoleic and alpha-linolenic acids, and the development of prostate cancer. METHODS: In 1982, at the start of the Physicians' Health Study, 14916 U.S. male physicians provided plasma samples, which were frozen at -82 degrees C. Data accumulated from a series of questionnaires were used to assess the intake of various foods. We used a nested case-control design to compare the fatty acid compositions in plasma from 120 men who later developed prostate cancer with 120 matched controls who did not. Individual fatty acids were measured in plasma as a percentage of total fatty acids, using capillary gas chromatography. Conditional logistic regression models were used to obtain odds ratio estimates while adjusting simultaneously for the effects of one or more potential confounders. RESULTS: The relative risks (RRs) of prostate cancer for men in successively higher quartiles of plasma alpha-linolenic acid level were 3.0 (95% confidence interval [CI] = 1.2-7.3), 3.4 (95% CI = 1.6-7.5), and 2.1 (95% CI = 0.9-4.9), compared with those with levels below the detection threshold (P trend = .03). For linoleic acid, RRs in successively higher quartiles were 0.7 (95% CI = 0.4-1.5), 0.8 (95% CI = 0.4-1.6), and 0.6 (95% CI = 0.3-1.3), with the lowest quartile as referent (P trend = .24). The effect estimates were not notably altered by adjustment for exercise, body mass, meat and dairy consumption, or other fatty acid levels in the plasma. The RR for eating red meat at least five times per week compared with less than once a week was 2.5 (95% CI = 0.9-6.7) and was little changed by adjustment for alpha-linolenic acid, although alpha-linolenic acid levels were correlated with intake of red meat and butter. The association of alpha-linolenic acid levels with prostate cancer was greater among men with low linoleic acid and reduced meat intake. CONCLUSIONS: These results suggest that low plasma levels of alpha-linolenic acid might be associated with reduced risk of prostate cancer, independently of high meat intake. High linoleic acid and low marine fatty oils were not associated with increased risk, as previously hypothesized. IMPLICATIONS: The effects of dietary alpha-linolenic acid, particularly from vegetable sources, warrant further study. The effects of dietary linoleic acid and marine fatty acids seen in animal bioassays might not apply to human prostate cancer.

Aged↗
PubMed1994

Epidemiology of pelvic inflammatory disease.

The epidemiologic study of pelvic inflammatory disease (PID) is hindered by symptoms that differ substantially from case to case, and by a substantial number of "silent" cases with few or no symptoms. Demographic data indicate that PID is primarily a disease of the young. Race also appears to be a determinant, but whether for biologic or sociologic reasons is not known. Women who are not married face a greater risk for PID than married women. The majority of PID cases are associated with sexually transmitted diseases. Consistent with this finding is the pattern of risk factors related to sexual behavior: young age at first intercourse, high frequency of intercourse, and a large number of sexual partners all increase the risk of PID. On the other hand, barrier methods of contraception appear to reduce the risk of PID, as does oral contraception. Perhaps the best publicized risk factors for PID is another contraceptive, the intrauterine device (IUD). The increased risk of PID in IUD users appears to be confined to new users and women at high risk of sexually transmitted disease infection. Douching and cigarette smoking may also be associated with the development of PID, but the evidence is weak.

Adolescent↗
PubMed1994

Body mass index and ovulatory infertility.

Several studies have examined the association between body mass index and infertility. We compared body mass index in 597 women diagnosed with ovulatory infertility at seven infertility clinics in the United States and Canada with 1,695 primiparous controls who recently gave birth. The obese women (body mass index > or = 27) had a relative risk of ovulatory infertility of 3.1 [95% confidence interval (CI) = 2.2-4.4], compared with women of lower body weight (body mass index 20-24.9). We found a small effect in women with a body mass index of 25-26.9 or less than 17 [relative risk (RR) = 1.2, 95% CI = 0.8-1.9; and RR = 1.6, 95% CI = 0.7-3.9, respectively). We conclude that the risk of ovulatory infertility is highest in obese women but is also slightly increased in moderately overweight and underweight women.

Adult↗