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Biomedical subjects

J W Rich-Edwards

Publications and source records attributed to J W Rich-Edwards.

13 recordsLinked to original sources
PubMed1999

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

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

Adult↗
PubMed1999

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

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

Adult↗
PubMed1999

Birthweight and the risk for type 2 diabetes mellitus in adult women.

BACKGROUND: Previous reports have suggested an association between birthweight and type 2 diabetes mellitus. OBJECTIVE: To investigate the association between birthweight and type 2 diabetes in a large cohort of adult women, taking into account potential explanatory factors in childhood and adult life. DESIGN: Cohort study. Birthweight was ascertained at the end of follow-up. SETTING: The Nurses' Health Study, a cohort of 121,701 U.S. women born from 1921 to 1946 who have been followed since 1976. PARTICIPANTS: 69,526 women in the Nurses' Health Study who were free of diabetes at baseline and reported their own birthweight on the 1992 questionnaire. MEASUREMENT: 2123 cases of confirmed type 2 diabetes diagnosed from 1976 to 1992. RESULTS: Low birthweight was associated with increased risk for type 2 diabetes. Age-adjusted relative risks suggested a reverse J-shape association between birthweight and risk for type 2 diabetes. However, after adjustment for adult body mass index and maternal history of diabetes, an inverse association across the entire range of birthweight became apparent; compared with the reference group, relative risks by ascending birthweight category were 1.83 (95% CI, 1.55 to 2.16) for birthweight less than 5.0 lb, 1.76 (CI, 1.49 to 2.07) for birthweight 5.0 to 5.5 lb, 1.23 (CI, 1.11 to 1.37) for birthweight 5.6 to 7.0 lb, 0.95 (CI, 0.82 to 1.10) for birthweight 8.6 to 10.0 lb, and 0.83 (CI, 0.63 to 1.07) for birthweight of more than 10 lb (P for trend < 0.001). Adjustment for ethnicity, childhood socioeconomic status, and adult lifestyle factors did not substantially alter this association. The association between birthweight and risk for type 2 diabetes was strongest among women whose mothers had no history of diabetes. CONCLUSIONS: Birthweight is inversely associated with risk for type 2 diabetes during adulthood. Examination of prenatal nutrition and other potential in utero determinants of both birthweight and risk for type 2 diabetes may yield new means to prevent type 2 diabetes.

Adult↗
PubMed1999

Reproducibility and validity of maternal recall of pregnancy-related events.

We assessed the reproducibility and validity of a questionnaire that asks mothers to recall pregnancy-related events from thirty or more years ago. Among 146 women who completed the questionnaire twice, responses were highly reproducible for pre-pregnancy height and weight (r = 0.95), pregnancy complications (r = 0.74), substance use (r = 0.80), preterm delivery (r = 0.82), birthweight (r = 0.94), and breastfeeding (r = 0.89). Among 154 women whose questionnaire responses were compared to data collected during their pregnancies, recall was highly accurate for height (r = 0.90), pre-pregnancy weight (r = 0.86), birthweight (r = 0.91), and smoking (sensitivity = 0.86, specificity = 0.94). These findings suggest that long-term maternal recall is both reproducible and accurate for many factors related to pregnancy and delivery.

Aged↗
PubMed1997

Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976.

OBJECTIVE: To examine the association between birth weight and non-fatal adult cardiovascular disease while controlling for potential confounders such as socioeconomic group and adult lifestyle. DESIGN: Retrospective self report of birth weight in an ongoing longitudinal cohort of nurses followed up by postal questionnaire every two years. SETTING: Nurses' health study, a cohort of 121700 women followed up since 1976. MAIN OUTCOME MEASURES: Non-fatal cardiovascular disease, including myocardial infarction, coronary revascularisation, and stroke. RESULTS: Among the 70297 women free of cardiovascular disease at baseline who reported birth weight in the 1992 questionnaire there were 1309 first cases of non-fatal cardiovascular disease. Increasing birth weight was associated with decreasing risk of non-fatal cardiovascular disease. There were 1216 first cases of non-fatal cardiovascular disease among women who were singletons and had been born full term; their relative risks adjusted for several cardiovascular risk factors were 1.49 (95% confidence interval 1.05 to 2.10) for birth weight < 2268 g (< 5 lb 0 oz); 1.25 (0.98 to 1.61) for birth weight 2268-2495 g (5 lb 0 oz to 5 lb 8 oz); 1.12 (0.98 to 1.27) for birth weight > 2495-3175 g (> 5 lb 8 oz to 7 lb 0 oz); 1.00 (referent) for birth weight > 3175-3856 g (> 7 lb 0 oz to 8 lb 8 oz); 0.96 (0.80 to 1.15) for birth weight > 3856-4536 g (> 8 lb 8 oz to 10 lb 0 oz); and 0.68 (0.46 to 1.00) for birth weight > 4536 g (> 10 lb 0 oz) (P value for trend = 0.0004). The inverse trend was apparent for both coronary heart disease and stroke. CONCLUSIONS: These data provide strong evidence of an association between birth weight and adult coronary heart disease and stroke.

Adult↗
PubMed1997

A prospective study of body mass index, weight change, and risk of stroke in women.

OBJECTIVE: To examine the associations of body mass index (BMI) and weight change with risk of stroke in women. SETTING AND DESIGN: Prospective cohort study among US female registered nurses participating in the Nurses' Health Study. PARTICIPANTS: A total of 116759 women aged 30 to 55 years in 1976 who were free from diagnosed coronary heart disease, stroke, and cancer. MAIN OUTCOME MEASURE: Incidence of ischemic stroke, hemorrhagic stroke (subarachnoid or intraparenchymal hemorrhage), and total stroke. RESULTS: During 16 years of follow-up, 866 total strokes (including 403 ischemic strokes and 269 hemorrhagic strokes) were documented. In multivariate analyses adjusted for age, smoking, postmenopausal hormone use, and menopausal status, women with increased BMI (> or =27 kg/m2) had significantly increased risk of ischemic stroke, with relative risks (RRs) of 1.75 (95% confidence interval [CI], 1.17-2.59) for BMI of 27 to 28.9 kg/m2; 1.90 (95% CI, 1.28-2.82) for BMI of 29 to 31.9 kg/m2; and 2.37 (95% CI, 1.60-3.50) for BMI of 32 kg/m2 or more (P for trend<.001), as compared with those with a BMI of less than 21 kg/m2. For hemorrhagic stroke there was a nonsignificant inverse relation between obesity and hemorrhagic stroke, with the highest risk among women in the leanest BMI category (P for trend=.20). For total stroke the RRs were somewhat attenuated compared with those for ischemic stroke but remained elevated for women with higher BMI (P for trend<.001). In multivariate analyses that also adjusted for BMI at age 18 years, weight gain from age 18 years until 1976 was associated with an RR for ischemic stroke of 1.69 (95% CI, 1.26-2.29) for a gain of 11 to 19.9 kg and 2.52 (95% CI, 1.80-3.52) for a gain of 20 kg or more (P for trend<.001), as compared with women who maintained stable weight (loss or gain <5 kg). Although weight change was not related to risk of hemorrhagic stroke (P for trend=.20), a direct relationship was observed between weight gain and total stroke risk (P for trend<.001). CONCLUSIONS: These prospective data indicate that both obesity and weight gain in women are important risk factors for ischemic and total stroke but not hemorrhagic stroke. The relationship between obesity and total stroke depends on the distribution of stroke subtypes in the population.

Adult↗
PubMed1996

Postmenopausal hormones and coronary heart disease.

Women who self-select to take postmenopausal hormones have lower risks of coronary heart disease, their leading cause of mortality. Women and their primary health care providers must weigh this and other clear (osteoporosis), and possible (stroke, colon cancer, and Alzheimer's disease) benefits against clear (endometrial cancer) and possible (breast cancer) risks. Because all existing data derive only from observational studies, reliable information on the balance of risks and benefits must await the results of the Women's Health Initiative, a large-scale, randomized clinical trial.

Aged↗
PubMed1995

Height and the risk of cardiovascular disease in women.

Height has been inversely associated with coronary heart disease in several prospective studies in men, but data in women are sparse. The relation between height and cardiovascular disease was examined in 14 years of follow-up data from the Nurses' Health Study, a prospective cohort of 121,700 US female nurses aged 30-55 years in 1976. The relative risks associating height with coronary heart disease (nonfatal myocardial infarction (n = 1,000), fatal myocardial infarction (n = 304), confirmed angina (n = 1,343), or coronary revascularization (n = 901)) were estimated after adjustment for a large number of cardiovascular risk factors, including age and body mass index. Compared with the shortest women (< or = 61 inches (< or = 1.55 m)), the relative risk of coronary heart disease was 0.82 (95% confidence interval (CI) 0.73-0.92) for women 62-63 inches (1.57-1.60 m) tall, 0.74 (95% CI 0.65-0.85) for women 64 inches (1.63 m) tall, 0.79 (95% CI 0.70-0.89) for women 65-66 inches (1.65-1.68 m) tall, and 0.73 (95% CI 0.65-0.83) for women 67 or more inches (> or = 1.70 m) tall (p for trend < 0.0001). The inverse association was more pronounced for angina/coronary revascularization (p for trend < 0.0001; relative risk for 67 or more inches = 0.67 (95% CI 0.58-0.78)) than for myocardial infarction (p for trend = 0.03; relative risk for 67 or more inches = 0.78 (95% CI 0.64-0.95)). No trend was evident for height in relation to risk of stroke. These data support the hypothesis that height is inversely related to risk of coronary heart disease in women.

Adult↗
PubMed1994

Test of the National Death Index and Equifax Nationwide Death Search.

The authors compared the ability of the National Death Index and the Equifax Nationwide Death Search to ascertain deaths of participants in the Nurses' Health Study. Each service was sent information on 197 participants aged 60-68 years in 1989 whose deaths were reported by kin or postal authorities and 1,997 participants of the same age who were known to be alive. Neither service was aware of the authors' information regarding participants' vital status. The sensitivity of the National Death Index was 98 percent and that of Equifax was 79 percent. Sensitivity was similar for women aged 65-68 years; however, for women aged 61-64 years, the sensitivity of the National Death Index was 97.7 percent compared with 60.2 percent for Equifax. The specificity of both services was approximately 100 percent. The contrast between the sources of these databases and the matching algorithms they employ has implications for researchers and for those planning health data systems.

Aged↗
PubMed1994

Adolescent body mass index and infertility caused by ovulatory disorder.

OBJECTIVE: Our aim was to examine the association between body mass index at age 18 and subsequent primary ovulatory infertility. STUDY DESIGN: A nested case-control study was conducted within a cohort of 116,678 female registered nurses residing in 14 U.S. states. Cases comprised 2527 married nulliparous nurses unable to become pregnant for at least 1 year because of ovulatory disorder; controls comprised 46,718 married parous nurses with no history of infertility. The risk of ovulatory infertility for women at different levels of body mass index at age 18 was compared with that for women whose body mass index at age 18 was 20 to 21.9 (median for the cohort). Logistic regression was used to adjust for age at infertility or first birth, year of birth, age at menarche, physical activity during ages 18 to 22, smoking at ages 15 to 19, ethnicity, alcohol use at ages 18 to 22, use of oral contraceptives before age 22, and diagnosis of diabetes mellitus. RESULTS: Multivariate relative risks for infertility were: 1.2 (body mass index < 16), 1.1 (body mass index 16 to 17.9), 1.0 (body mass index 18 to 19.9), 1.0 (referent body mass index 20 to 21.9), 1.1 (body mass index 22 to 23.9), 1.3 (body mass index 24 to 25.9), 1.7 (body mass index 26 to 27.9), 2.4 (body mass index 28 to 29.9), 2.7 (body mass index 30 to 31.9), and 2.7 (body mass index > or = 32). The relative risks for all categories of body mass index above 23.9 were statistically significantly elevated. Greater body mass index at age 18 was a predictor of ovulatory infertility in women with and without a diagnosis of polycystic ovary syndrome. CONCLUSION: These findings suggest that elevated body mass index at age 18, even at levels lower than those considered to be obese, is a risk factor for subsequent ovulatory infertility.

Adolescent↗
PubMed1993

Height and incidence of cardiovascular disease in male physicians.

BACKGROUND: An inverse association between height and risk of coronary heart disease (CHD) has been reported in several case-control and cohort studies, but the reasons for the association remain uncertain. We evaluated this association among 22,071 male physicians, a population homogeneous for high educational attainment and socioeconomic status in adulthood. METHODS AND RESULTS: The study population was comprised of participants in the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of low-dose aspirin and beta-carotene in the primary prevention of cardiovascular disease and cancer among US male physicians, aged 40 to 84 years, in 1982. Participants were classified into five height categories at study entry, from shortest to tallest, and were followed an average of 60.2 months to determine the incidence of myocardial infarction (MI), stroke, and death from cardiovascular disease. Men in the tallest (> or = 73 in. or 185.4 cm) compared with the shortest (< or = 67 in. or 170.2 cm) height category had a 35% lower risk of MI (relative risk, 0.65; 95% confidence interval, 0.44 to 0.99; P = .04), after adjusting for known cardiovascular risk factors. Further, a marginally significant inverse trend (P trend = .05) across the height categories was observed. Although the relationship was not strictly linear, for every inch of added height, there was an approximate 2% to 3% decline in risk of MI. In contrast, men in the tallest compared with the shortest height category had only small and nonsignificant decreases in risk of stroke and cardiovascular death. While no significant trend in risks of these end points across the height categories was observed, the numbers of events for these end points were far less than for MI, and thus the confidence intervals were wide. CONCLUSIONS: These data indicate that height is inversely associated with subsequent risk of MI. At this time, a few mechanisms are plausible, but none are convincing. Other epidemiological and basic research efforts are needed to explore a variety of physiological correlates of height that may be responsible for mediating the height-MI association. In the meantime, while height is not modifiable, it is easy to measure and may be useful to evaluate CHD disease risk profiles and target lifestyle interventions.

Adjuvants, Immunologic↗