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Biomedical subjects

J D Curb

Publications and source records attributed to J D Curb.

At least 19 recordsLinked to original sources
PubMed1992

Light to moderate alcohol consumption and mortality in the elderly.

OBJECTIVE: To determine whether there is a relationship of low to moderate alcohol consumption with cardiovascular mortality in the elderly. DESIGN: Prospective cohort studies with 5-year mortality follow-up. SETTING: Three populations of community-dwelling elders. PARTICIPANTS: Population-based cohorts of men and women, aged 65 or older, in three populations. Subjects with prior myocardial infarction, stroke, or cancer, as well as those lacking alcohol consumption data, were excluded from statistical analyses leaving 2,694 subjects in East Boston, Massachusetts, 2,293 subjects in Iowa, and 1,904 subjects in New Haven, Connecticut. MAIN OUTCOME MEASUREMENTS: Alcohol consumption, total mortality, cardiovascular mortality, and cancer mortality. RESULTS: Low to moderate alcohol consumption was associated with statistically significant lowered total as well as cardiovascular mortality in East Boston and New Haven. The relative risks of total mortality for low to moderate consumers of alcohol compared to those consuming no alcohol in the previous year were 0.7 (95% CI 0.6-0.8) in East Boston and 0.6 (95% CI 0.5-0.8) in New Haven. For cardiovascular mortality, the RRs were 0.6 in East Boston and 0.5 in New Haven (95% CI's exclude null). These results persisted after control for potential confounding variables. In Iowa, there were no significant differences in total or cardiovascular mortality according to alcohol consumption patterns. For cancer mortality, there were no significant associations with alcohol consumption in any of the three populations. CONCLUSIONS: These data suggest that the relationship of low to moderate alcohol consumption with reduced total and cardiovascular mortality, which are well documented in middle age, also occur in older populations.

Activities of Daily Living↗
PubMed1991

Blood pressure and mortality risk in the elderly.

Blood pressure was assessed between 1981 and 1983 in all persons over age 65 years in three communities (East Boston, Massachusetts; New Haven, Connecticut; and Iowa and Washington countries, Iowa), and cause-specific mortality was monitored annually over the subsequent 5 years as part of the National Institute on Aging-sponsored Established Populations for Epidemiologic Studies of the Elderly. Each community had 80% or more participation: in East Boston, 3,809 persons with 903 deaths, in New Haven, 2,812 persons with 804 deaths, and in Iowa, 3,673 persons with 763 deaths. At 2 years, odds of death from all causes were higher in the low (less than 130 mmHg) than the middle (130-159 mmHg) systolic blood pressure group for persons aged 65-79 years in all three populations. By 5 years, cardiovascular death increased with increasing systolic pressure in all three communities and reached significance in Iowa. Cancer death was highest in the low systolic pressure stratum in all three centers. All-cause, cardiovascular death, and cancer mortality was highest in the low (less than 75 mmHg) diastolic blood pressure group in East Boston, even at 5 years. Blood pressures obtained 9 years earlier in 2,079 (68%) of the East Boston participants showed a significantly higher risk of cardiovascular death with increasing systolic pressure and no relation between diastolic pressure and mortality risk. In the elderly, excess mortality at lower levels of blood pressure during early follow-up may in part be due to the effects of illness and disability present at baseline. This may obscure the usual rise in mortality with increasing systolic pressure. There is no consistent relation between diastolic pressure and mortality.

Aged↗
PubMed1991

Smoking and mortality among older men and women in three communities.

BACKGROUND: Although cigarette smoking is the leading avoidable cause of premature death in middle age, some have claimed that no association is present among older persons. METHODS: We prospectively examined the relation of cigarette-smoking habits with mortality from all causes, cardiovascular causes, and cancer among 7178 persons 65 years of age or older without a history of myocardial infarction, stroke, or cancer who lived in one of three communities: East Boston, Massachusetts; Iowa and Washington counties, Iowa; and New Haven, Connecticut. At the time of the initial interview, prevalence rates of smoking in the three communities ranged from 5.2 to 17.8 percent among women and from 14.2 to 25.8 percent among men. During five years of follow-up there were 1442 deaths, 729 due to cardiovascular disease and 316 due to cancer. RESULTS: In both sexes, rates of total mortality among current smokers were twice what they were among participants who had never smoked. Relative risks, as adjusted for age and community, were 2.1 among the men (95 percent confidence interval, 1.7 to 2.7) and 1.8 among the women (95 percent confidence interval, 1.4 to 2.4). Current smokers had higher rates of cardiovascular mortality than those who had never smoked (as adjusted for age and community, the relative risk was 2.0 [95 percent confidence interval, 1.4 to 2.9] among the men and 1.6 [95 percent confidence interval, 1.1 to 2.3] among the women), as well as increased rates of cancer mortality (relative risk, 2.4 [95 percent confidence interval, 1.4 to 4.1] among the men and 2.4 [95 percent confidence interval, 1.4 to 3.9] among the women). In both sexes, former smokers had rates of cardiovascular mortality similar to those of the participants who had never smoked, regardless of age at cessation, whereas the rates for all cancers, as well as smoking-related cancers, remained elevated among men who had once smoked. CONCLUSIONS: Our prospective findings indicate that the mortality hazards of smoking extend well into later life, and suggest that cessation will continue to improve life expectancy in older people.

Age Factors↗
PubMed1991

Body fat and obesity in Japanese Americans.

In 1965 a prospective study of greater than 12,000 Japanese men 45-69 y old and living in Japan, Hawaii, and California was initiated. Among the factors measured were height, weight, skinfold thicknesses, and 24-h dietary recall. The mean body mass index (BMI) was substantially lower for Japanese men in Japan than for Japanese men in California or Hawaii for each 5-y age group. Mean BMIs in Hawaii and California were similar. Values for subscapular skinfold thickness were also lower in Japan than in Hawaii or California in all age groups. Although total caloric intake was not greatly different between Japan and Hawaii, the percent caloric intake as fat was two times greater in Hawaii. Thus, these largely first- and second-generation immigrants exhibit increases in body weight that could be expected to significantly affect cardiovascular risk factor levels and endpoints.

Adipose Tissue↗
PubMed1991

Body fat, coronary heart disease, and stroke in Japanese men.

The Honolulu Heart Program (HHP) is a prospective study of heart disease and stroke in Japanese-American men in Hawaii. Body weight, height, and subscapular and triceps skinfold thicknesses were measured by using standard methods at the baseline exam held in 1965-1968. The relationship of measures of body fatness to the 20-y follow-up for coronary heart disease (CHD) and stroke of these men was explored. Body mass index (BMI), subscapular skinfold thicknesses, and centrality index (subscapular skinfold thickness/triceps skinfold thickness) were predictors of CHD in this population, even after other risk factors were added to a multivariate model, indicating an independent contribution of body fat to CHD risk. Neither BMI nor centrality index was related to stroke. However, subscapular skinfold thickness was an independent predictor of stroke. The implications of these findings are that lifestyle changes that lead to an increase in obesity of Japanese men in Hawaii may increase risk for cardiovascular disease.

Adult↗
PubMed1991

Is the serum cholesterol-coronary heart disease relationship modified by activity level in older persons?

Although coronary heart disease remains a leading cause of death and disability in old age, the relationship of serum cholesterol level to risk of coronary heart disease in old age is controversial. Data for 2,388 white persons aged 65-74 who participated in the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (NHEFS) were examined to determine the relationship of serum cholesterol level to coronary heart disease incidence and whether activity level would modify this relationship. While there was no overall relationship between serum cholesterol level and coronary heart disease risk in either men or women, the relationship between serum cholesterol level and coronary heart disease differed within activity groups. For persons who were more active, serum cholesterol level was associated with a graded increase in risk of coronary heart disease, from 1.3 (95% CI 0.7, 2.3) in those with serum cholesterol level of 4.7-5.1 to 1.7 in those with serum cholesterol level of 6.2 mmol/L or more (95% CI 1.0, 2.7), when compared with those with serum cholesterol level below 4.7. For the least active persons, all levels of cholesterol were associated with a significant inverse relative risk, including cholesterol of 6.2 mmol/L or more (Relative risk = 0.4 (95% CI 0.2, 0.7]. These data suggest that factors such as activity level may modify the serum cholesterol-coronary heart disease association in old age. The serum cholesterol-coronary heart disease association in more active older persons resembles that seen in younger populations, whereas the association in less active persons is that of serum cholesterol level and risk of cancer or death. The modification of the serum cholesterol-coronary heart disease association by activity level may have implications for appropriate clinical management as well as appropriate design of research studies of this association.

Aged↗
PubMed1991

Cardiovascular risk factor levels in ethnic Hawaiians.

We report a cardiovascular risk factor survey of "native" Hawaiians 20-59 years old (70 percent, or 257), living on the Hawaiian Homestead lands on the island of Molokai, Hawaii. More than 60 percent of both sexes were overweight. Among males, 42 percent were smokers. The percent of the population with systolic blood pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg or taking hypertensive medications was 14 percent of those ages 20-39 and 36 percent of those ages 40-59. The percent with serum cholesterol greater than or equal to 6.2 mmol/L ranged from 8 percent of those 20-29 years old to 46 percent in those 50-59 years old. Two percent of those ages 20-29 had a history of diabetes, or 2 + or greater glycosuria by dipstick, as did 23 percent of those ages 50-59. The majority of the known diabetics exhibited glycosuria and elevated glycohemoglobin levels, indicating poor control. Hypertension, although usually known to the participant, was frequently uncontrolled. From these data, it appears that among this group of Hawaiians major risk factors for cardiovascular disease were frequent, while at the same time the levels of awareness and/or control for most of these factors were low.

Adult↗
PubMed1991

Effect of thiazide-based therapy on serum alkaline phosphatase. Hypertension Detection and Follow-up Group.

This study reports a correlation of alkaline phosphatase (AP) with diastolic blood pressure (DBP), and a reduction of alkaline phosphatase after chlorthalidone therapy that reached a nadir at three years of therapy, then gradually returned toward, but not reaching, baseline values. The data is from the baseline examination and follow-up of 3928 initially untreated stepped-care patients in the Hypertension Detection and Follow-up Program. In multiple regression analysis, both age and DBP were significantly correlated with increased AP in males and females. After initiation of therapy with chlorthalidone, AP levels fell progressively until the third year, when they were reduced by 11 +/- 15 IU in the males and 14 +/- 15 IU in the females. The data are compatible with the interpretation that thiazide-induced reduction in urinary calcium excretion has led to a more positive calcium balance and reduction of bone turnover, and suggests that a beneficial effect of thiazide-based antihypertensive therapy could be decreased osteoporosis.

Adult↗
PubMed1990

Smoking, pulmonary function, and mortality.

The association of pulmonary function (as percent of predicted forced expiratory volume in 1 second [FEV1]) with total and cause-specific mortality over 15 to 18 years was investigated in a large cohort (5924) of prospectively followed Japanese-American men. Among those who never smoked, pulmonary function was found not to be significantly predictive of total mortality in a multivariate model in which adjustment for variables that might confound the results was made. Among past and current smokers, highly significant associations were found (P < 0.0001). The positive relationship of pulmonary function to mortality in smokers was so strong that it overshadowed these differences in nonsmokers in a model including all smoking groups combined, even after adjusting for smoking. A smoking-pulmonary function interaction term added to this model was statistically significant (P < 0.003). This illustrates the need for attention to the potential for complex interactions between biologic variables when carrying out multivariate statistical analysis. Findings for cardiovascular and noncardiovascular mortality were similar. This analysis indicates that while pulmonary function is associated with subsequent mortality, the relationship is significantly associated with smoking history.

Asian↗
PubMed1990

Health status and life style in elderly Japanese men with a long life expectancy.

The Japanese population in Hawaii has one of the longest life expectancies of any large population subgroup in the U.S. and the world. Cross-sectional data on 1,379 elderly, noninstitutionalized, male Japanese American survivors of a population-based cohort study indicated the most common health problems were hypertension (43%), arthritis (33%), diabetes (13%), and gout (9%). For cancer and hypertension there is a trend toward higher prevalence in older age groups. For coronary heart disease, stroke, and angina the oldest age group (75-81 years) has a higher prevalence than that seen in younger age groups. Other relatively common diseases such as diabetes, gout, peptic ulcer, and arthritis do not have higher prevalence in older age groups. Drugs reported to be used frequently by study participants were for hypertension, gout, CHD, and diabetes. The prevalence rates of major limitations of mobility and of living alone appear to be relatively low in this population. Less than one percent of the current population rate their health status as poor. The prevalence of normal serum cholesterol and smoking are similar to those seen in U.S. White males, while the rates of hypertension appear lower. Prevalence rates for stroke and heart attack also appear to be somewhat lower in these long-lived individuals than those seen in U.S. Whites.

Activities of Daily Living↗
PubMed1990

Designing and executing randomized clinical trials involving elderly persons.

Although randomized clinical trials are the most scientifically rigorous design for evaluating a clinical intervention, the methodology involved is intricate, particularly when elderly subjects are involved. Special attention must be paid to framing precise primary and secondary study hypotheses, adjusting for the potential confounding effects of comorbidity and disability, and analyzing multiple outcomes. When the sample or study cohort is chosen, there will be an inevitable trade-off between internal and external validity. Because elderly study cohorts are more prognostically heterogeneous, consideration should be given to enrolling an "at-risk" cohort and possibly to stratified randomization.

Aged↗
PubMed1990

Chest pain and coronary heart disease mortality among older men and women in three communities.

Angina pectoris is a manifestation of coronary heart disease, yet little is known from clinical or epidemiologic studies about its prognosis in older populations. We investigated the relation of uncomplicated angina symptoms to risk of coronary heart disease mortality within 3 years in a prospective study of 8,359 people aged 65 and older residing in three communities. From baseline (1981-1983) to the third year of follow-up (1984-1986), there were 245 deaths from coronary heart disease. Three classifications of chest pain were defined using the Rose Questionnaire: nonexertional chest pain, chest pain on exertion (including angina), and angina. Exertional chest pain was a strong, independent predictor of coronary heart disease death for older men and women. There were no differences in the prognostic implications of this symptom between the sexes; the relative risks being 2.4 (95% confidence interval, 1.4-4.4) in men and 2.7 (1.7-4.2) in women. The risk of coronary heart disease mortality for those reporting chest pain on exertion was at least as high as that for participants whose symptoms met the Rose Questionnaire criteria for angina. The association between exertional chest pain and coronary heart disease mortality was independent of other coronary risk factors. The relation was specific for deaths from coronary heart disease, as there was no association between exertional chest pain and noncoronary causes of death. Chest pain on exertion conveys important prognostic information about risk of coronary death in older populations, regardless of gender.

Aged↗
PubMed1989

Physical performance measures in aging research.

Evaluation of physical functioning plays a valuable role in clinical geriatrics as well as in aging research. Physical functioning has generally been assessed through self- or proxy-report. An important addition to this form of assessment is the use of performance measures of physical function, in which individuals are asked to actually perform specific tasks and are evaluated using standardized criteria. Although there has been limited methodological work on physical performance instruments, this approach offers a number of potential advantages. Several performance assessments have been developed that correlate highly with other measures of health status and predict need for long-term care and mortality. It is suggested that more widespread use be made of physical performance assessments and that they be evaluated as measures of functioning in cross-national studies, as indicators of change in functioning over time, as endpoints in intervention studies, as tools for identifying persons functioning at high levels, and as sources of relevant information for the clinician.

Activities of Daily Living↗
PubMed1989

Pulmonary function as a predictor of coronary heart disease.

The role of pulmonary function as an independent predictor of coronary heart disease was examined in 1965-1983 in a cohort of Japanese-American men. As part of the Honolulu Heart Program, the authors measured pulmonary function in 5,924 men aged 45-68 years who were free of coronary heart disease at baseline examination and followed them for 15-18 years for the development of nonfatal myocardial infarction and fatal coronary heart disease. Per cent predicted forced expiratory volume in one second (%PFEV1) was significantly inversely related to coronary heart disease incidence in the total cohort after adjusting for age (p less than 0.0001) and then for all known coronary heart disease risk factors (p = 0.0004). However, when examined by smoking status, %PFEV1 was a predictor of coronary heart disease only among past and current smokers, and not for men who had never smoked cigarettes (p = 0.36). The association between pulmonary function and coronary heart disease can be explained by cigarette smoking, which leads to both lung impairment and coronary heart disease incidence.

Aged↗
PubMed1989

The Systolic Hypertension in the Elderly Program (SHEP): an intervention trial on isolated systolic hypertension. SHEP Cooperative Research Group.

The Systolic Hypertension in the Elderly Program (SHEP) is a randomized double-blind placebo-controlled trial to determine if antihypertensive treatment of isolated systolic hypertension (ISH) [systolic blood pressure (SBP) greater than or equal to 160 mmHg, diastolic blood pressure (DBP) less than 90 mmHg] reduces the 5 year incidence of fatal and nonfatal stroke. Between March 1, 1985 and January 15, 1988, 4736 persons (target 4800) with ISH, age 60 years and over, were enrolled. Potential participants met blood pressure (BP) and age criteria. Those on antihypertensive medication prior to enrollment without documented diastolic hypertension had their medication tapered and discontinued, and then met BP criteria (33% of cohort). Stepped-care therapy with chlorthalidone and atenolol (alternative, reserpine) or matching placebos was initiated as first and second steps. At baseline the trial population was 43.1% male, 56.9% female; 13.9% black, 86.1% non-black. Also, the mean age was 71.6 years; the mean SBP was 170.3 mmHg and the mean DBP was 76.6 mmHg; 59.8% had codeable resting electrocardiographic abnormalities. The trial is now in follow-up phase with scheduled termination in 1991.

Aged↗