Biomedical subjects

Gary C Curhan

Publications and source records attributed to Gary C Curhan.

At least 19 recordsLinked to original sources

PubMed2007

Differences in 24-hour urine composition between black and white women.

Black women are less likely to develop kidney stones and have greater bone mass than white women. However, little is known about racial differences in urine composition. Urine pH, volume, and 24-h urinary excretion of calcium, citrate, oxalate, uric acid, sodium, potassium, magnesium, phosphate, sulfate, and creatinine of 146 black women were compared with 330 white women in the Nurses' Health Study. All participants were postmenopausal non-stone formers. ANOVA was used to compare mean urinary values. Linear regression models were adjusted for age, body mass index, dietary intake, and urinary factors. On average, black women excreted 65 mg less urinary calcium (P < 0.001), 4 mg more oxalate (P < 0.001), 9 mEq less potassium (P < 0.001), 11 mg less magnesium (P = 0.003), 120 mg less phosphate (P < 0.001), and 3 mmol less sulfate (P < 0.001) per day than did white women. The urine pH of black women was 0.11 units higher (P = 0.03) and urine volume was 0.24 L less (P = 0.001). The urinary relative supersaturations of calcium oxalate (P = 0.03) and brushite (P = 0.002) were lower in black women. No other significant differences were observed. Differences in urinary calcium and pH persisted after multivariate adjustment and after exclusion of participants who were taking thiazide diuretics or those with diabetes. In conclusion, black women excrete less urinary calcium and have a higher urinary pH than do white women. These differences are not explained by differences in age, body mass index, or diet and may account for the lower incidence of both nephrolithiasis and osteoporosis in black women.

Aged↗

PubMed2006

Plasma uric acid level and risk for incident hypertension among men.

Several studies have found that uric acid (UA) level is associated with an increased risk for hypertension, but the association could be confounded by metabolic factors that were not included in these previous studies. UA level and risk for incident hypertension was examined prospectively among men who participated in the Health Professionals' Follow-up Study. From among men without hypertension at the time blood was collected, 750 participants who developed hypertension during the subsequent 8 yr and 750 age-matched controls were selected. In addition to adjustment for standard hypertension risk factors and renal function, adjustments controlled for fasting insulin, triglyceride, and cholesterol levels. The mean age of participants was 61 yr, and mean plasma UA level was 6.0 mg/dl (SD 1.25 mg/dl). The multivariable relative risk (RR) for a 1-SD increase in UA was 1.02 (95% confidence interval [CI]0.87 to 1.18); the RR comparing the highest with lowest quartile of UA was 1.08 (95% CI 0.71 to 1.63). The multivariable RR associated with a 1-SD increase in UA was 1.38 (95% CI 1.05 to 1.81) for men aged <60 yr and 0.90 (95% CI 0.74 to 1.10) for men >or=60 yr (P = 0.04 for interaction). However, further adjustment for fasting insulin, triglyceride, and cholesterol levels attenuated the results (RR for men <60 yr 1.24; 95% CI 0.93 to 1.66). In conclusion, no independent association between UA level and risk for incident hypertension was found among older men.

Age Factors↗

PubMed2006

Screening, monitoring, and treatment of albuminuria: Public health perspectives.

Microalbuminuria is an early sign of progressive cardiovascular and renal disease in individuals with and without diabetes. Despite compelling data, at present only a minority of patients with diabetes and rarely individuals without diabetes are screened for albuminuria in a systematic way. All of the criteria to implement systematic albuminuria screening are fulfilled in diabetes, and most are nearly fulfilled for microalbuminuria screening in individuals without diabetes. Because of the growing evidence that treatment of microalbuminuria in individuals without diabetes may offer a cost-effective benefit to prevent cardiovascular disease, nephrologists and other health care providers should pay more attention to the early detection and subsequent treatment of individuals with microalbuminuria.

Albuminuria↗

PubMed2006

Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure.

Administrative and claims databases may be useful for the study of acute renal failure (ARF) and ARF that requires dialysis (ARF-D), but the validity of the corresponding diagnosis and procedure codes is unknown. The performance characteristics of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for ARF were assessed against serum creatinine-based definitions of ARF in 97,705 adult discharges from three Boston hospitals in 2004. For ARF-D, ICD-9-CM codes were compared with review of medical records in 150 patients with ARF-D and 150 control patients. As compared with a diagnostic standard of a 100% change in serum creatinine, ICD-9-CM codes for ARF had a sensitivity of 35.4%, specificity of 97.7%, positive predictive value of 47.9%, and negative predictive value of 96.1%. As compared with review of medical records, ICD-9-CM codes for ARF-D had positive predictive value of 94.0% and negative predictive value of 90.0%. It is concluded that administrative databases may be a powerful tool for the study of ARF, although the low sensitivity of ARF codes is an important caveat. The excellent performance characteristics of ICD-9-CM codes for ARF-D suggest that administrative data sets may be particularly well suited for research endeavors that involve patients with ARF-D.

Acute Kidney Injury↗

PubMed2006

Nonsteroidal antiinflammatory drugs, acetaminophen, and the risk of cardiovascular events.

BACKGROUND: Although randomized trials of cyclooxygenase-2 (COX-2) inhibitors have shown increased cardiovascular risk, studies of nonselective, nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen have been inconsistent. METHODS AND RESULTS: We examined the influence of NSAIDs and acetaminophen on the risk of major cardiovascular events (nonfatal myocardial infarction, fatal coronary heart disease, nonfatal and fatal stroke) in a prospective cohort of 70,971 women, aged 44 to 69 years at baseline, free of known cardiovascular disease or cancer, who provided medication data biennially since 1990. During 12 years of follow-up, we confirmed 2041 major cardiovascular events. Women who reported occasional (1 to 21 d/mo) use of NSAIDs or acetaminophen did not experience a significant increase in the risk of cardiovascular events. However, after adjustment for cardiovascular risk factors, women who frequently (> or =22 d/mo) used NSAIDs had a relative risk (RR) for a cardiovascular event of 1.44 (95% CI, 1.27 to 1.65) compared with nonusers, whereas those who frequently consumed acetaminophen had a RR of 1.35 (95% CI, 1.14 to 1.59). The elevated risk associated with frequent NSAID use was particularly evident among current smokers (RR=1.82; 95% CI, 1.38 to 2.42) and was absent among never smokers (Pinteraction=0.02). Moreover, we observed significant dose-response relations: Compared with nonusers, the RRs for a cardiovascular event among women who used > or =15 tablets per week were 1.86 (95% CI, 1.27 to 2.73) for NSAIDs and 1.68 (95% CI, 1.10 to 2.58) for acetaminophen. CONCLUSIONS: Use of NSAIDs or acetaminophen at high frequency or dose is associated with a significantly increased risk for major cardiovascular events, although more moderate use did not confer substantial risk.

Acetaminophen↗

PubMed2006

Declining mortality in patients with acute renal failure, 1988 to 2002.

Despite improvements in intensive care and dialysis, some experts have concluded that outcomes associated with acute renal failure (ARF) have not improved significantly over time. ARF was studied in hospitalized patients between 1988 and 2002 using the Nationwide Inpatient Sample, a nationally representative sample of discharges from acute-care, nonfederal hospitals. During a 15-yr period, 5,563,381 discharges with ARF and 598,768 with ARF that required dialysis (ARF-D) were identified. Between 1988 and 2002, the incidence of ARF rose from 61 to 288 per 100,000 population; the incidence of ARF-D increased from 4 to 27 per 100,000 population. Between 1988 and 2002, in-hospital mortality declined steadily in patients with ARF (40.4 to 20.3%; P < 0.001) and in those with ARF-D (41.3 to 28.1%; P < 0.001). Compared with 1988 to 1992, the multivariable-adjusted odds ratio (OR) of death was lower in 1993 to 1997 (ARF: OR 0.62, 95% confidence interval [CI] 0.61 to 0.64; ARF-D: OR 0.63, 95% CI 0.59 to 0.66) and 1998 to 2002 (ARF: OR 0.40, 95% CI 0.39 to 0.41; ARF-D: OR 0.47, 95% CI 0.45 to 0.50). The percentage of patients who had ARF with a Deyo-Charlson comorbidity index of 3 or more increased from 16.4% in 1988 to 26.6% in 2002 (P < 0.001). This study provides evidence from an administrative database that the incidence of ARF and ARF-D is rising. Despite an increase in the degree of comorbidity, in-hospital mortality has declined.

Acute Kidney Injury↗

PubMed2006

Angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor antagonist therapy is associated with prolonged patient and graft survival after renal transplantation.

Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II type 1 receptor blockers (ARB) reduce cardiovascular death in the general population, but data for renal transplant recipients remain elusive. Similarly, ACEI/ARB have been shown to reduce proteinuria, but data on graft survival are lacking. Therefore a retrospective open cohort study was conducted of 2031 patients who received their first renal allograft at the Medical University of Vienna between 1990 and 2003 and survived at least 3 mo. Patient and graft survival was compared between patients with versus without ACEI and/or ARB therapy. Data were analyzed with and without propensity score models for ACEI/ARB therapy. Medication and comorbidities were analyzed as time-dependent variables in the Cox regression analyses. Ten-year survival rates were 74% in the ACEI/ARB group but only 53% in the noACEI/ARB group (P<0.001). The hazard ratio (HR) of ACEI/ARB use for mortality was 0.57 (95% confidence interval [CI] 0.40 to 0.81) compared with nonuse. Ten-year actual graft survival rate was 59% in ACEI/ARB patients but only 41% in nonusers (P=0.002). The HR of actual graft failure for ACEI/ARB recipients was 0.55 (95% CI 0.43 to 0.70) compared with nonusers; the HR of functional graft survival was 0.56 (95% CI 0.40 to 0.78). Ten-year unadjusted functional graft survival rates were 76% among ACEI/ARB patients and 71% in noACEI/ARB recipients (P=0.57). In summary, the use of ACEI/ARB therapy was associated with longer patient and graft survival after renal transplantation. More frequent use of these medications may reduce the high incidence of death and renal allograft failure in these patients.

Adult↗

PubMed2006

Risk factors for urinary incontinence among middle-aged women.

OBJECTIVE: The purpose of this study was to identify risk factors for urinary incontinence in middle-aged women. STUDY DESIGN: We conducted a cross-sectional analysis of 83,355 Nurses' Health Study II participants. Since 1989, women have provided health information on mailed questionnaires; in 2001, at the ages 37 to 54 years, information on urinary incontinence was requested. We examined adjusted odds ratios of incontinence using logistic regression. RESULTS: Forty-three percent of the women reported incontinence. After adjustment, black (odds ratio, 0.49; 95% CI, 0.40-0.60) and Asian-American women (odds ratio, 0.57; 95% CI, 0.46-0.72) were at reduced odds of severe incontinence compared with white women. Increased age, body mass index, parity, current smoking, type 2 diabetes mellitus, and hysterectomy all were associated positively with incontinence. Women who were aged 50 to 54 years had 1.81 times the odds of severe incontinence compared with women who were <40 years old (95% CI, 1.66-1.97); women with a body mass index of > or =30 kg/m2 had 3.10 times the odds of severe incontinence compared with a body mass index of 22 to 24 kg/m2 (95% CI, 2.91-3.30). CONCLUSION: Urinary incontinence is highly prevalent among these middle-aged women. Potential risk factors include age, race/ethnicity, body mass index, parity, smoking, diabetes mellitus, and hysterectomy.

Adult↗

PubMed2006

Association of prevalent hypertension with 24-hour urinary excretion of calcium, citrate, and other factors.

BACKGROUND: The relation between hypertension and the urinary excretion of calcium, citrate, and other factors is unclear. It has been proposed that increased urinary calcium excretion is a central feature of essential hypertension. Metabolic acidosis also may be associated with hypertension and decreases urinary citrate levels. METHODS: To compare the urine composition of individuals with and without hypertension, we studied 24-hour urinary excretion of calcium, citrate, oxalate, uric acid, sodium, magnesium, potassium, phosphorus, and creatinine and pH in a subset of participants with and without nephrolithiasis in the Nurses' Health Study I (older women; N = 1,284), Nurses' Health Study II (younger women; N = 952), and the Health Professionals Follow-up Study (men; N = 788). Logistic regression models adjusted for age, weight, dietary intake, and urinary factors. RESULTS: In participants with and without nephrolithiasis, citrate was the only urinary factor consistently related to hypertension. Compared with those in the lowest quartile of urinary citrate excretion, multivariate odds ratios of prevalent hypertension in the highest quartile were 0.37 (95% confidence interval [CI], 0.24 to 0.55; P trend < 0.001) for older women, 0.54 (95% CI, 0.32 to 0.92; P trend = 0.03) for younger women, and 0.27 (95% CI, 0.16 to 0.45; P trend < 0.001) for men. Urinary calcium levels were not related consistently to hypertension. Excluding participants with single 24-hour urine collections and those administered thiazide diuretics or angiotensin-converting enzyme inhibitors did not change the results. CONCLUSION: Lower urinary citrate excretion is associated independently with prevalent hypertension. Factors that regulate urinary citrate excretion may play a role in hypertension.

Adult↗

PubMed2006

Body size and 24-hour urine composition.

BACKGROUND: Greater body mass index (BMI) is a risk factor for kidney stones. However, the relation between BMI and the urinary excretion of many lithogenic factors remains unclear. METHODS: We studied urine pH, urine volume, and 24-hour urinary excretion of calcium, oxalate, citrate, uric acid, sodium, magnesium, potassium, phosphate, and creatinine in stone-forming and non-stone-forming participants in the Health Professionals Follow-Up Study (599 stone-forming and 404 non-stone-forming men), Nurses' Health Study (888 stone-forming and 398 non-stone-forming older women), and Nurses' Health Study II (689 stone-forming and 295 non-stone-forming younger women). Each cohort was divided into quintiles of BMI. Tests of linear trend were conducted by 1-way analysis of variance. Linear regression models were adjusted for age, history of stone disease, dietary intake, and urinary factors. RESULTS: Participants with greater BMIs excreted more urinary oxalate (P for trend <or= 0.04), uric acid (P < 0.001), sodium (P < 0.001), and phosphate (P < 0.001) than participants with lower BMIs. There was an inverse relation between BMI and urine pH (P <or= 0.02). Positive associations between BMI and urinary calcium excretion in men and stone-forming younger women (P <or= 0.02) did not persist after adjustment for urinary sodium and phosphate excretion. Because of differences in urinary volume and excretion of inhibitors such as citrate, we observed no relation between BMI and urinary supersaturation of calcium oxalate. Urinary supersaturation of uric acid increased with BMI (P <or= 0.01). CONCLUSION: Positive associations between BMI and urinary calcium excretion likely are due to differences in animal protein and sodium intake. The greater incidence of kidney stones in the obese may be due to an increase in uric acid nephrolithiasis.

Adult↗

PubMed2006

Total fluid intake and use of individual beverages and risk of renal cell cancer in two large cohorts.

Moderate alcohol consumption has been inversely associated with risk of renal cell cancer in recent prospective studies, and increased total fluid intake has been hypothesized to be a possible mechanism. We prospectively examined the associations between total fluid and beverage intakes and risk of renal cell cancer. Among 88,759 women followed for 20 years in the Nurses' Health Study, and 47,828 men followed for 14 years in the Health Professionals Follow-up Study, we documented 248 incident cases of renal cell cancer. We assessed consumption of beverages every 2 to 4 years using a validated semiquantitative food frequency questionnaire, and total fluid intake was derived from the frequency of consumption of 18 to 22 beverage items. Cox proportional hazards regression was used to estimate study-specific multivariate relative risks (RR), which were pooled using a random-effects model. We found no association between total fluid intake and risk of renal cell cancer; the pooled multivariate RR for the highest quartile versus the lowest was 0.99 (95% confidence interval, 0.63-1.55; P, test for trend = 0.78). Alcohol intake was marginally inversely associated with renal cell cancer risk; compared with nondrinkers, the pooled multivariate RR for > or = 15 g/d was 0.66 (95% confidence interval, 0.43-1.00; P, test for trend = 0.07). We did not find clear associations between intakes of coffee, tea, milk, juice, soda, punch, and water and risk of renal cell cancer. Our data suggest an inverse association between alcohol intake and risk of renal cell cancer, but do not support the hypothesis that greater total fluid intake reduces the risk of renal cell cancer.

Adult↗

PubMed2006

Intakes of fruits, vegetables, vitamins A, C, and E, and carotenoids and risk of renal cell cancer.

BACKGROUND: Fruits and vegetables rich in antioxidants have been proposed to reduce the risk of renal cell cancer. However, few prospective studies have examined the intakes of fruits, vegetables, and antioxidant vitamins in relation to the risk of renal cell cancer. METHODS: We prospectively examined the associations between the intakes of fruits, vegetables, vitamins A, C, and E, and carotenoids and risk of renal cell cancer in women and men. We followed 88,759 women in the Nurses' Health Study from 1980 to 2000, and 47,828 men in the Health Professionals Follow-up Study from 1986 to 2000. We assessed dietary intake every 2 to 4 years using a validated semiquantitative food frequency questionnaire. The Cox proportional hazards model was used to estimate study-specific multivariate relative risks (RR), which were pooled using a random effects model. RESULTS: A total of 248 (132 women and 116 men) incident renal cell cancer cases were ascertained during 2,316,525 person-years of follow-up. The consumption of fruits and vegetables was associated with a decreased risk of renal cell cancer in men (multivariate RR, 0.45; 95% CI, 0.25-0.81, for >or=6 servings of fruit and vegetable intake/d versus <3 servings/d; P test for trend = 0.02), but not in women (multivariate RR, 1.17; 95% CI, 0.66-2.07, for the same contrast; P test for trend = 0.25; P test for between-studies heterogeneity = 0.02). Intakes of vitamins A and C from food and carotenoids were inversely associated with the risk of renal cell cancer in men only, but we cannot exclude the possibility that this was due to other factors in fruit and vegetables. No clear association was observed for vitamin E in women or men. CONCLUSIONS: Fruit and vegetable consumption may reduce the risk of renal cell cancer in men.

Adult↗

PubMed2006

Antihypertensive medications and the risk of incident type 2 diabetes.

OBJECTIVE: The purpose of this study was to examine the association between the use of different classes of antihypertensive medications and the risk of incident type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a prospective study of three cohorts: the Nurses' Health Study (NHS) I and II and the Health Professionals Follow-up Study (HPFS). Antihypertensive medication use was ascertained by biennial questionnaires. After excluding participants who reported a history of diabetes at baseline, 41,193 older women (NHS I), 14,151 younger women (NHS II), and 19,472 men (HPFS), all with hypertension, were followed for 8, 10, and 16 years, respectively. RESULTS: We documented 3,589 incident cases of diabetes. After adjustment for age, BMI, physical activity, the use of other antihypertensive medications, and other risk factors, the multivariate relative risk (RR) of incident diabetes in participants taking a thiazide diuretic compared with those not taking a thiazide was 1.20 (95% CI 1.08-1.33) in older women, 1.45 (1.17-1.79) in younger women, and 1.36 (1.17-1.58) in men. The multivariate RR in participants taking a beta-blocker compared with those not taking a beta-blocker was 1.32 (1.20-1.46) in older women and 1.20 (1.05-1.38) in men. ACE inhibitors and calcium channel blockers were not associated with risk. CONCLUSIONS: Thiazide diuretic and beta-blocker use were independently associated with a higher risk of incident diabetes. Increased surveillance for diabetes in patients treated with these medications may be warranted.

Adult↗

PubMed2005

Habitual caffeine intake and the risk of hypertension in women.

CONTEXT: Caffeine acutely increases blood pressure, but the association between habitual consumption of caffeinated beverages and incident hypertension is uncertain. OBJECTIVE: To examine the association between caffeine intake and incident hypertension in women. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study conducted in the Nurses' Health Studies (NHSs) I and II of 155,594 US women free from physician-diagnosed hypertension followed up over 12 years (1990-1991 to 2002-2003 questionnaires). Caffeine intake and possible confounders were ascertained from regularly administered questionnaires. We also tested the associations with types of caffeinated beverages. MAIN OUTCOME MEASURE: Incident physician-diagnosed hypertension. RESULTS: During follow-up, 19,541 incident cases of physician-diagnosed hypertension were reported in NHS I and 13,536 in NHS II. In both cohorts, no linear association between caffeine consumption and risk of incident hypertension was observed after multivariate adjustment (NHS I, P for trend = .29; NHS II, P for trend = .53). Using categorical analysis, an inverse U-shaped association between caffeine consumption and incident hypertension was found. Compared with participants in the lowest quintile of caffeine consumption, those in the third quintile had a 13% and 12% increased risk of hypertension, respectively (95% confidence interval in NHS I, 8%-18%; in NHS II, 6%-18%). When studying individual classes of caffeinated beverages, habitual coffee consumption was not associated with increased risk of hypertension. By contrast, consumption of cola beverages was associated with an increased risk of hypertension, independent of whether it was sugared or diet cola (P for trend <.001). CONCLUSION: No linear association between caffeine consumption and incident hypertension was found. Even though habitual coffee consumption was not associated with an increased risk of hypertension, consumption of sugared or diet cola was associated with it. Further research to elucidate the role of cola beverages in hypertension is warranted.

Caffeine↗

PubMed2005

Vitamin D intake and risk of incident hypertension: results from three large prospective cohort studies.

Emerging evidence suggests an inverse relation between vitamin D and blood pressure. We examined the independent association between intake of vitamin D and the risk of incident hypertension among participants of 3 large and independent prospective cohorts: Nurses Health Study I (NHS I; n=77,436), NHS II (n=93,803), and Health Professionals' Follow-up Study (HPFS; n=38,074). Relative risks and 95% confidence intervals for incident hypertension were computed according to quintiles of vitamin D intake using Cox proportional hazards regression and adjusted for relevant covariates. Each cohort was followed for > or =8 years. Vitamin D intake was not associated with the risk of developing hypertension. The multivariable relative risk estimates for the highest compared with lowest quintile of intake were 0.98 (0.93 to 1.04) in NHS I, 1.13 (0.99 to 1.29) in NHS II, and 1.03 (0.93 to 1.15) in HPFS. When we compared participants who consumed > or =1600 to <400 IU per day and those who consumed > or =1000 to <200 IU per day, no association was found. We conclude that higher intake of vitamin D is not associated with a lower risk of incident hypertension.

Adult↗

PubMed2005

Long-term use of aspirin and nonsteroidal anti-inflammatory drugs and risk of colorectal cancer.

CONTEXT: Randomized trials of short-term aspirin use for prevention of recurrent colorectal adenoma have provided compelling evidence of a causal relationship between aspirin and colorectal neoplasia. However, data on long-term risk of colorectal cancer according to dose, timing, or duration of therapy with aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) remain limited. OBJECTIVE: To examine the influence of aspirin and NSAIDs in prevention of colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 82 911 women enrolled in the Nurses' Health Study providing data on medication use biennially since 1980 and followed up through June 1, 2000. MAIN OUTCOME MEASURE: Incident colorectal cancer. RESULTS: Over a 20-year period, we documented 962 cases of colorectal cancer. Among women who regularly used aspirin (> or =2 standard [325-mg] tablets per week), the multivariate relative risk (RR) for colorectal cancer was 0.77 (95% confidence interval [CI], 0.67-0.88) compared with nonregular users. However, significant risk reduction was not observed until more than 10 years of use (P< or =.001 for trend). The benefit appeared related to dose: compared with women who reported no use, the multivariate RRs for cancer were 1.10 (95% CI, 0.92-1.31) for women who used 0.5 to 1.5 standard aspirin tablets per week, 0.89 (95% CI, 0.73-1.10) for 2 to 5 aspirin per week, 0.78 (95% CI, 0.62-0.97) for 6 to 14 aspirin per week, and 0.68 (95% CI, 0.49-0.95) for more than 14 aspirin per week (P<.001 for trend). Notably, women who used more than 14 aspirin per week for longer than 10 years in the past had a multivariate RR for cancer of 0.47 (95% CI, 0.31-0.71). A similar dose-response relationship was found for nonaspirin NSAIDs (P = .007 for trend). The incidence of reported major gastrointestinal bleeding events per 1000 person-years also appeared to be dose-related: 0.77 among women who denied any aspirin use; 1.07 for 0.5 to 1.5 standard aspirin tablets per week; 1.07 for 2 to 5 aspirin per week; 1.40 for 6 to 14 aspirin per week; and 1.57 for more than 14 aspirin per week. CONCLUSIONS: Regular, long-term aspirin use reduces risk of colorectal cancer. Nonaspirin NSAIDs appear to have a similar effect. However, a significant benefit of aspirin is not apparent until more than a decade of use, with maximal risk reduction at doses greater than 14 tablets per week. These results suggest that optimal chemoprevention for colorectal cancer requires long-term use of aspirin doses substantially higher than those recommended for prevention of cardiovascular disease, but the dose-related risk of gastrointestinal bleeding must also be considered.

Adult↗

PubMed2005

Non-narcotic analgesic dose and risk of incident hypertension in US women.

Acetaminophen, ibuprofen, and aspirin are the most commonly used drugs in the United States. Although the frequency of their use has been associated with hypertension, prospective data examining the dose of these drugs and risk of hypertension are lacking. Furthermore, whether certain indications for analgesic use, particularly headache, mediate the association is unclear. We conducted 2 prospective cohort studies among older women 51 to 77 years of age (n=1903) from the Nurses' Health Study I and younger women 34 to 53 years of age (n=3220) from the Nurses' Health Study II who completed detailed supplemental questionnaires pertaining to their analgesic use and who did not have hypertension at baseline. We analyzed incident hypertension according to categories of average daily dose of acetaminophen, nonsteroidal anti-inflammatory drugs, and aspirin. Information on indications for analgesic use as well as relevant confounders was also gathered prospectively. Compared with women who did not use acetaminophen, the multivariable adjusted relative risk for those who took >500 mg per day was 1.93 (1.30 to 2.88) among older women and 1.99 (1.39 to 2.85) among younger women. For nonsteroidal anti-inflammatory drugs, similar comparisons yielded multivariable relative risks of 1.78 (1.21 to 2.61) among older women and 1.60 (1.10 to 2.32) among younger women. These associations remained significant among women who did not report headache. Aspirin dose was not significantly associated with hypertension. Higher daily doses of acetaminophen and nonsteroidal anti-inflammatory drugs independently increase the risk of hypertension in women. Because acetaminophen and nonsteroidal anti-inflammatory drugs are commonly used, they may contribute to the high prevalence of hypertension in the United States.

Adult↗

PubMed2005

Effect of pravastatin on rate of kidney function loss in people with or at risk for coronary disease.

BACKGROUND: Limited data suggest that HMG-CoA reductase inhibitors (statins) reduce rates of kidney function loss. We performed this analysis to determine whether pravastatin reduced the rate of kidney function loss over approximately 5 years in people with or at high risk for coronary disease. METHODS AND RESULTS: This was a post hoc subgroup analysis of data from 3 randomized double-blind controlled trials comparing pravastatin 40 mg/d and placebo in subjects with a previous acute coronary syndrome or who were at high cardiovascular risk. The primary outcome was the rate of change in estimated glomerular filtration rate (GFR; in mL/min per 1.73 m2/y). The Modified Diet and Renal Disease Study (MDRD) and Cockcroft-Gault equations were used to estimate GFR. We studied 18,569 participants, 3402 (18.3%) of whom had moderate chronic kidney disease as defined by an estimated GFR of 30 to 59.9 mL/min per 1.73 m2 body surface area. In subjects with moderate chronic kidney disease at baseline, pravastatin reduced the adjusted rate of kidney function loss by approximately 34%, although the absolute reduction in the rate of loss was small (0.22 mL/min per 1.73 m2/y by MDRD-GFR; 95% CI, 0.07 to 0.37). Pravastatin did not reduce the frequency of > or =25% decreases in kidney function in this group when MDRD-GFR was used to estimate GFR (relative risk [RR], 0.84; 95% CI, 0.66 to 1.06). When all 18,569 subjects were considered, pravastatin reduced the adjusted rate of kidney function loss by 8% (0.08 mL/min per 1.73 m2/y by MDRD-GFR; 95% CI, 0.01 to 0.15) and the risk of acute renal failure (RR, 0.60; 95% CI, 0.41 to 0.86) but did not significantly reduce the frequency of a > or =25% decline in kidney function by MDRD-GFR (RR, 0.94; 95% CI, 0.88 to 1.01). CONCLUSIONS: Pravastatin modestly reduced the rate of kidney function loss in people with or at risk for cardiovascular disease. However, the primary indication for the use of statins in people with or at risk for coronary events remains the reduction in mortality that results from their use.

Aged↗