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Biomedical subjects

J Cutler

Publications and source records attributed to J Cutler.

At least 19 recordsLinked to original sources
PubMed1995

Blood pressure and mortality among men with prior myocardial infarction. Multiple Risk Factor Intervention Trial Research Group.

BACKGROUND: The purpose of the present study was to describe the relation between blood pressure (systolic [SBP] and diastolic [DBP]) and death from coronary heart disease (CHD) and all causes for men with a history of myocardial infarction (MI). METHODS AND RESULTS: The study cohort consisted of men aged 35 to 57 years screened for the Multiple Risk Factor Intervention Trial (MRFIT) in 1973 through 1975 and followed for survival for an average of 16 years through 1990. There were 5362 men who reported prior hospitalization for a heart attack of at least 2 weeks' duration at the initial screening of MRFIT. There was a J-shaped relation between SBP and DBP with both CHD and all-cause mortality during the first 2 years of follow-up in older (age, 45 to 57 years) men only. Risk nadirs for SBP were 152 and 145 mm Hg, respectively, for CHD death and all-cause mortality; corresponding DBP risk nadirs were 94 and 90 mm Hg. After the first 2 years, there was a positive association between SBP and death from CHD and all causes. By 15 years, cumulative CHD mortality percentages for men with screening SBP < 120, 120 to 139, 140 to 159, and > or = 160 mm Hg were 19.7%, 21.3%, 27.5%, and 32.0%, respectively. When deaths only after year 2 were considered, although the linear DBP coefficient was significant, the quadratic term for DBP was no longer significant (P > .05). However, the relation still appeared J-shaped as cumulative mortality for those with DBP < 70, 70 to 79, 80 to 89, 90 to 99, and > or = 100 mm Hg was 24.3%, 20.8%, 21.1%, 25.5%, and 29.7%, respectively. When the joint relation of SBP and DBP was considered, there were no survival differences among the four cohorts (SBP > or = 140 and DBP < 80, SBP > or = 140 and DBP > or = 80, SBP < or = 140 and DBP < 80, and SBP < or = 140 and DBP > or = 80) during the first 2 years. After 2 years, both CHD and all-cause mortality rates were approximately 40% higher for participants with SBP > or = 140 mm Hg versus < 140 mm Hg regardless of DBP level (< 80 or > or = 80 mm Hg). CONCLUSIONS: In this large cohort of men with prior MI, the association of SBP and DBP with CHD and all-cause mortality varied over the 16-year follow-up period. During early follow-up, in older men only, J- or U-shaped relations were evident. However, after 2 years, these same relations had become positive and graded. Given the substantial excess mortality risk in this cohort associated with high blood pressure, particularly SBP, efforts to gradually lower blood pressure should receive high priority among hypertensive men with prior MI.

Adult↗
PubMed1993

Risk factors for death from different types of stroke. Multiple Risk Factor Intervention Trial Research Group.

UNLABELLED: The objective of this study was to investigate risk factors for death from different types of stroke among men screened for the Multiple Risk Factor Intervention Trial (MRFIT). A total of 353,340 men were screened by 20 centers for the MRFIT in 1973 to 1975; vital status has been ascertained over an average of 12 years of follow-up (range: 11 to 13 years). Death certificates were coded using the International Classification of Diseases (ICD), ninth revision. Deaths from stroke were classified as death from subarachnoid hemorrhage (ICD code 430), death from intracranial hemorrhage (ICD codes 431 and 432), death from nonhemorrhagic stroke (ICD codes 433 through 438), and death from any type of stroke (ICD codes 430 through 438). RESULTS: During an average of approximately 12 years of follow-up, 765 deaths from stroke were identified; 139 of these deaths were attributable to subarachnoid hemorrhage; 227, to intracranial hemorrhage; and 399 were classified as nonhemorrhagic stroke. Blood pressure and cigarette smoking were strongly related to each type of stroke. Systolic blood pressure was a stronger predictor than diastolic blood pressure. With the exception of subarachnoid hemorrhage, death rates from each type of stroke increased with age and were higher for black men. The positive association of age and race with subarachnoid hemorrhage was much weaker than for the other types of stroke and was not significant. Income was inversely associated with risk of death from nonhemorrhagic stroke and was not associated with either subarachnoid or intracranial hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Changes in hypertension awareness, treatment, and control rates. 20-year trend data.

In the last 2 decades, public knowledge, awareness, treatment, and control of high blood pressure have changed remarkably. These changes are real, and have been associated with the activities of the National High Blood Pressure Education Program. Without a control group it is always difficult to attribute causality; however, the improving levels are remarkably large and consistent, and they have occurred concurrently with the decline in age-adjusted stroke mortality.

Adult↗
PubMed1992

Variance imputation for overviews of clinical trials with continuous response.

Overviews of clinical trials are an efficient and important means of summarizing information about a particular scientific area. When the outcome is a continuous variable, both treatment effect and variance estimates are required to construct a confidence interval for the overall treatment effect. Often, only partial information about the variance is provided in the publication of the clinical trial. This paper provides heuristic suggestions for variance imputation based on partial variance information. Both pretest-posttest (parallel groups) and crossover designs are considered. A key idea is to use separate sources of incomplete information to help choose a better variance estimate. The imputation suggestions are illustrated with a data set.

Analysis of Variance↗
PubMed1992

Baseline characteristics of participants in phase I of the Trials of Hypertension Prevention.

Phase I of the Trials of Hypertension Prevention was designed to test the effectiveness and safety of three life-style (weight loss, sodium restriction, and stress management) and four nutrition supplement (calcium, magnesium, potassium, and fish oil) interventions in reducing diastolic blood pressure (DBP) in persons with a high-normal blood pressure. A total of 2182 persons with a DBP between 80 and 89 mm Hg met the eligibility criteria for participation in phase I and were randomized to one of the active intervention or control treatment groups. Most were white (82%), male (70%), married (76%), nonsmoking (88%), college graduate (53%), full-time employees (91%). The average blood pressure prior to entry into the trial was 124.9 mm Hg systolic and 83.8 mm Hg diastolic. A variety of baseline observations, including sociodemographic characteristics, personal and family medical history, health habits, diet, and biologic measurements, were documented before randomization and compared among the seven active intervention and control groups. As might be expected in a randomized trial of this sample size, the distribution of measured baseline characteristics was virtually identical in the treated and control groups. Based on this finding and the knowledge that randomization procedures were implemented without deviation from the phase I protocol, it is probable that unknown potential confounders were also equally distributed at entry into the study. Given the achievement of high rates of follow-up, subsequent differences in blood pressure are unlikely to have been due to baseline differences between the active treatment and control groups, and can probably be attributed to effects of the active interventions.

Adult↗
PubMed1991

The Hypertension Prevention Trial: assessment of the quality of blood pressure measurements.

Blood pressure variability is an important consideration in hypertension trials for determining required sample size and consequently making accurate outcome statements. The Hypertension Prevention Trial was a randomized controlled trial carried out in 1983-1986 in four US clinics on men and women with high normal diastolic blood pressure. This trial provided an opportunity to assess conditions affecting blood pressure measurement variability. Trained blood pressure observers measured systolic and diastolic blood pressures twice, 30 seconds apart, using a random-zero sphygmomanometer. The quality of blood pressure measurements was assessed by computing the variability of the two readings per participant-visit for each blood pressure observer at each study clinic. Other sources of variability investigated included observer digit preference, time of day, and ambient temperature. On the basis of data from this population, it is estimated that the standard deviation of blood pressure values can be reduced by 5% by taking two measurements per participant-visit. An additional reduction of variability can be effected by having the duplicate blood pressure measurements made by different blood pressure observers. In special instances where the range of blood pressure values is very restricted, use of the random-zero sphygmomanometer can increase or decrease the among-participant variability in blood pressure values, depending upon where the distribution of blood pressure values is centered.

Adult↗
PubMed1991

Human exposure to polychlorinated biphenyls in Greater New Bedford, Massachusetts: a prevalence study.

A study was conducted in the community of Greater New Bedford, Massachusetts, from 1984 through 1987 to assess the prevalence of elevated levels of polychlorinated biphenyls (PCBs) in the serum of individuals aged 18 to 64 years who had resided in the area for at least 5 years. Eight hundred and forty subjects were interviewed, examined, and tested in a cross-sectional sample of the towns of Acushnet, Dartmouth, and Fairhaven and the city of New Bedford. Serum PCBs were measured to estimate the extent of human exposure. Because of documented environmental contamination by PCBs in the New Bedford area, and the practice of recreational fishing in the harbor for food, a significant number of persons with elevated serum PCB levels were expected to be identified. Instead, the prevalence of elevated serum PCBs in the sample was found to be typical of "unexposed" urban populations in the United States. Only 1.3% of the subjects had serum PCB levels greater than 30 ppb. The same percentage was observed among males (n = 391) and females (n = 449). The geometric means of PCB levels were 4.3 ppb among males (Range = 0.50-60.9) and 4.2 ppb among females (Range = 0.38-154). We conclude that the prevalence of elevated serum PCBs is low in the population of Greater New Bedford.

Adolescent↗
PubMed1991

Thyroid releasing hormone test in schizophrenic patients with post-psychotic depression.

1. TSH response to TRH was assessed in 25 patients meeting operationalized criteria for the post-psychotic depression syndrome and in an age and sex matched control group of 34 primary depressed patients. 2. A blunted TSH response was observed in 36% of the patients with post-psychotic depression. 3. The rate of blunted TSH response was similar for patients with secondary post-psychotic depression to those patients with primary depressions. 4. Demographic and clinical parameters did not distinguish those post-psychotic depressed patients who had a blunted response from those who did not. 5. A blunted TSH response to TRH did not predict which patients were more likely to have a favorable response when adjunctive imipramine was added to their on-going fluphenazine decanoate and benztropine regimen.

Adult↗
PubMed1990

Circadian variation in ventricular electrical instability associated with coronary artery disease.

Although sudden cardiac deaths and ischemic cardiac events clearly occur in a circadian pattern, such a pattern has not been shown for primary arrhythmic events. Because primary arrhythmic events are thought to play an important role in sudden cardiac death, a large series of ventricular stimulation studies was analyzed to determine whether circadian variation in ventricular electrical instability exists. If such a circadian variation could be shown, it could have implications for the conduct and interpretation of electrophysiologic testing and the etiology of circadian variation in sudden cardiac death. Results of 2 drug-free ventricular stimulation studies performed 4 to 28 hours apart in each of 162 patients with coronary artery disease were analyzed. Rate and duration of induced arrhythmia, number of extrastimuli required to induce arrhythmia and changes in these factors between the 2 tests in each patient were analyzed. Comparisons were made by half-day, by hour and in a temporally continuous manner to eliminate errors associated with any single method. No significant circadian variation was found in any electrophysiologic measure of ventricular electrical instability despite adequate statistical power. These findings show that the time of day during which ventricular stimulation tests are performed does not affect test results, and therefore does not need to be controlled during electrophysiologic studies. If these findings are parallel to those in ambulatory patients with coronary artery disease, then circadian changes in ventricular electrical instability may not play as important a role in the circadian pattern of sudden cardiac death as had been previously thought.

Cardiac Pacing, Artificial↗
PubMed1990

Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias.

The associations of diastolic blood pressure (DBP) with stroke and with coronary heart disease (CHD) were investigated in nine major prospective observational studies: total 420,000 individuals, 843 strokes, and 4856 CHD events, 6-25 (mean 10) years of follow-up. The combined results demonstrate positive, continuous, and apparently independent associations, with no significant heterogeneity of effect among different studies. Within the range of DBP studied (about 70-110 mm Hg), there was no evidence of any "threshold" below which lower levels of DBP were not associated with lower risks of stroke and of CHD. Previous analyses have described the uncorrected associations of DBP measured just at "baseline" with subsequent disease rates. But, because of the diluting effects of random fluctuations in DBP, these substantially underestimate the true associations of the usual DBP (ie, an individual's long-term average DBP) with disease. After correction for this "regression dilution" bias, prolonged differences in usual DBP of 5, 7.5, and 10 mm Hg were respectively associated with at least 34%, 46%, and 56% less stroke and at least 21%, 29%, and 37% less CHD. These associations are about 60% greater than in previous uncorrected analyses. (This regression dilution bias is quite general, so analogous corrections to the relations of cholesterol to CHD or of various other risk factors to CHD or to other diseases would likewise increase their estimated strengths.) The DBP results suggest that for the large majority of individuals, whether conventionally "hypertensive" or "normotensive", a lower blood pressure should eventually confer a lower risk of vascular disease.

Adult↗
PubMed1989

Electrocardiographic left ventricular hypertrophy and effects of antihypertensive drug therapy in hypertensive participants in the Multiple Risk Factor Intervention Trial.

Data are reported on electrocardiographic left ventricular hypertrophy (ECG LVH) among 8,012 men classified as hypertensive at baseline in the Multiple Risk Factor Intervention Trial. Compared with those allocated to the usual care (UC) control group, men allocated to the special intervention (SI) group experienced a mean reduction of 4 mm Hg in diastolic blood pressure and 7 mm Hg in systolic blood pressure, over 6 years of follow-up. There were 378 new cases of ECG LVH during follow-up; the incidence in the SI group was about 23% less than that in the UC group (4.2 vs 5.4% 2P less than 0.01). Among the 189 men with ECG LVH at baseline, those in the SI group experienced about 24% more annual follow-up visits at which they were free of ECG LVH (4.6 vs 3.7 visits; 2P less than 0.01). This reduced incidence and increased reversal of ECG LVH in the SI group compared with that in the UC group was consistent with significant overall reductions (2P less than 0.001) among SI men in mean wave amplitude in those leads in which voltage is correlated with left ventricular mass (T wave in V1, R wave in aVL and S wave in V3). In SI and UC groups combined, the presence of ECG LVH either at baseline or at follow-up was associated with several-fold increases in death from cardiovascular diseases in general, and death from coronary artery disease in particular.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Psychophysiological factors in ventricular arrhythmias and sudden cardiac death.

Plasma catecholamine levels were measured preceding programmed electrophysiological studies of patients who had survived a ventricular tachyarrhythmia episode. Psychological assessments of desire for control, locus of control and behavior pattern were obtained. Psychophysiological variables were analysed with respect to the severity of arrhythmias induced by the electrophysiological procedure. Analysis of data from 17 subjects showed desire for control was significantly higher in those with induced sustained arrhythmias than in those in which nonsustained arrhythmias were induced. No relationship was found between behavior pattern and arrhythmia severity or plasma catecholamine levels. There was a significant interaction between desire for control and behavior pattern with respect to epinephrine level. The findings indicate that psychological factors such as desire for control may be associated with potentially lethal arrhythmias and implicated in sudden cardiac death.

Adult↗
PubMed1987

Obesity and hypertension: epidemiological and clinical issues.

The relationship between obesity and hypertension has been investigated in a large number of cross-sectional population studies and a smaller number of prospective, observational studies. The results indicate that in most populations, blood pressure increases linearly with increasing body weight or body mass index. The relationship is present across all subgroups, although the magnitude of the association appears greater in whites than blacks and greater in younger than older persons. It is estimated that as much as one-third of all hypertension may be attributable to obesity in populations where hypertension and obesity are widely prevalent. Evidence from prospective studies and clinical trials suggests that hypertension in obese patients increases the risk of cardiovascular disease and that drug treatment of hypertension reduces the risk. However, it is uncertain whether the risks associated with hypertension and the benefits of treatment are as great in obese hypertensives as they are in lean hypertensives. The effects of weight reduction on blood pressure have been investigated in a small number of randomized, controlled trials involving a total of about 600 participants. Overall, the results of the trials indicate that weight reduction lowers blood pressure over intervals of up to one year. The magnitude of the blood pressure response appears to be directly proportional to the amount of weight loss achieved. However, the latter is inversely related to the length of follow-up. Adequate maintenance of weight loss remains a major problem for the much-needed, long-term trials of the effects of weight reduction on blood pressure and the cardiovascular complications of hypertension.

Adult↗
PubMed1986

Intestinal parasites in a migrant farmworker population.

Three hundred thirty-nine migrant worker women and children were screened by single stool examination for intestinal parasites. Infection occurred in 34.2%. Giardia lamblia and Trichuris trichiura were the most common pathogens; Entamoeba coli and Endolimax nana were the most common commensals. Infants under 1 year of age were free of infection. Children between 2 and 5 years old and women between 25 and 35 years old had the highest prevalence. Significantly more Haitians were infected than Mexican-Americans or American blacks. Of ten symptoms, only abdominal pain and gas correlated significantly with infection. This migrant population has a greater prevalence of intestinal parasites than the general American public. Screening by stool examination may be beneficial to diminish the reservoir of infection.

Adolescent↗