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Biomedical subjects

Jeremiah Stamler

Publications and source records attributed to Jeremiah Stamler.

At least 37 records · Page 2Linked to original sources
PubMed2004

Comparison of low risk and higher risk profiles in middle age to frequency and quantity of coronary artery calcium years later.

Little is known about the relation of having favorable levels of all major cardiovascular risk factors (low risk [LR]) earlier in life to coronary artery calcium (CAC) later in life. From 2002 to 2003, CAC was compared in participants aged >60 years who were LR (n = 42) with those not LR (n = 39) at baseline (from 1967 to 1973). Despite adverse changes in risk factors, the prevalence of measurable CAC and mean CAC scores were less for LR participants than for non-LR participants (60% vs 77%, p = 0.09, and 217 vs 443, p = 0.05, respectively).

Adult↗
PubMed2004

Estimating laboratory precision of urinary albumin excretion and other urinary measures in the International Study on Macronutrients and Blood Pressure.

Microalbuminuria is a risk factor for renal failure, stroke, and cardiovascular disease. However, estimating laboratory precision for albumin excretion is problematic because of its highly skewed distribution and the presence of values below assay detection limits. The authors used 781 quality control pairs from 24-hour urine samples collected between 1996 and 1999 in the International Study on Macronutrients and Blood Pressure (INTERMAP) to compare percentage of technical error (%TE), the usual estimate of laboratory precision, with the mean and median values of within-pair coefficients of variation (CVs) for urinary albumin concentration and other urinary variables. In INTERMAP, %TE was larger than mean CV for all variables. Exclusion of potentially mislabeled samples reduced this difference; for example, for sodium, estimates of %TE and mean and median CV were 2.37%, 0.75%, and 0.28%, respectively, for all 781 pairs and 0.84%, 0.48%, and 0.27%, respectively, with possibly mislabeled pairs excluded. For urinary albumin concentration, exclusion of one mislabeled pair changed estimates for %TE and mean CV from 29.6% and 20.8% to 20.6% and 20.6%, while median CV was unchanged at 9.4%. After exclusion of urinary albumin concentration pairs with values below the detection limit, estimates were 15.4%, 11.4%, and 6.4%, respectively. Results indicate that mean and median CV are not equivalent to %TE and that values below the detection limit can markedly affect estimates and should be excluded.

Adult↗
PubMed2004

Impact of diabetes and previous myocardial infarction on long-term survival: 25-year mortality follow-up of primary screenees of the Multiple Risk Factor Intervention Trial.

BACKGROUND: The magnitude of coronary mortality risk associated with diabetes or prior myocardial infarction (MI) is debatable. Modulating effects of age, risk factors, and duration of follow-up may explain discrepancies in previous research. Associations with noncardiovascular mortality are little explored. OBJECTIVES: To compare mortality patterns in men with a history of diabetes or MI and to assess modulating effects on mortality of age, cardiovascular risk factors, and follow-up duration. METHODS: We compared the 25-year mortality of 4809 men with diabetes only and 4625 men with MI only (all men aged 35-57 years). RESULTS: The adjusted hazard ratio (HR) for all-cause mortality for those with MI only vs those with diabetes only was 0.97 (95% confidence interval, 0.92-1.03; P =.32). The pattern of deaths was different: higher coronary mortality (HR = 1.37; P<.001) and lower mortality from noncardiovascular causes (HR = 0.66; P<.001) in those with MI only compared with those with diabetes only. This finding prevailed across all ages and levels of cardiovascular risk factors. Hazard ratios for coronary mortality significantly declined over follow-up (2.7, 1.7, 1.2, 1.1, and 1.0 for < or =5, 6-10, 11-15, 16-20, and >20 years of follow-up, respectively), whereas HRs for noncardiovascular mortality remained relatively constant. CONCLUSIONS: Overall, diabetes and MI were similarly strong predictors of total mortality. Higher mortality from noncardiovascular causes was observed in those with diabetes only, whereas prior MI was more strongly predictive of coronary mortality than diabetes at any age and level of cardiovascular risk factors. The difference in coronary mortality between the 2 groups was most evident in the first 10 years of follow-up.

Adult↗
PubMed2004

Blood pressure differences between northern and southern Chinese: role of dietary factors: the International Study on Macronutrients and Blood Pressure.

Blood pressure and prevalence of high blood pressure are greater for northern than southern Chinese. Reasons for these differences are unclear. Relationships of north-south blood pressure differences with multiple dietary factors were investigated in 839 Chinese participants, International Study on Macronutrients and Blood Pressure (INTERMAP), 561 northern, 278 southern, aged 40 to 59 years. Daily nutrient intakes were determined from four 24-hour dietary recalls and 2 timed 24-hour urine collections. Average systolic/diastolic pressure levels were 7.4/6.9 mm Hg higher for northern than southern participants. Southern participants had lower body mass index, sodium intake, sodium/potassium ratio, and higher intake of calcium, magnesium, phosphorus, and vitamins A and C. Considered singly, with control for age and gender, several dietary variables (eg, body mass index, urinary sodium/potassium ratio, urinary sodium, dietary phosphorus, and magnesium) reduced north-south blood pressure differences by > or =10%. Controlled for age and gender, nondietary variables had little effect on north-south blood pressure differences. With inclusion in regression models of multiple dietary variables (sodium, potassium, magnesium or phosphorus, body mass index), north-south blood pressure differences became much smaller (systolic -1.1, diastolic 1.6 mm Hg) and statistically nonsignificant. In conclusion, multiple dietary factors accounted importantly for north-south blood pressure differences. Efforts are needed to improve nutrition in China, especially in the north, as well as in other populations including those in the United States, for prevention and control of adverse blood pressure levels and major adult cardiovascular disease.

Adult↗
PubMed2004

Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study.

Information is sparse on the role of foods in long-term blood pressure (BP) change. The investigators examined relations of food intake to BP change in a prospective cohort study of 1,710 employed men in Chicago, Illinois, initially aged 41-57 years. In 1958 and 1959, BP was measured and nutrient intake assessed by comprehensive interview. In 1959, intake of 26 specific food groups was also assessed. BP was remeasured annually through 1966. The generalized estimating equation method was used to analyze relations of food group intakes to average annual BP change, adjusting for age, weight at each year, alcohol consumption, calories, and other foods. Average systolic blood pressure (SBP)/diastolic blood pressure (DBP) increase was 1.9/0.3 mmHg per year. The SBP of men who consumed 14-42 cups of vegetables a month (0.5-1.5 cups/day) versus <14 cups a month (<0.5 cups/day) was estimated to rise 2.8 mmHg less in 7 years (p < 0.01). The SBP of men who consumed 14-42 cups of fruit a month versus <14 cups a month was estimated to increase 2.2 mmHg less in 7 years (p < 0.05). Beef-veal-lamb and poultry intakes were related directly to a greater SBP/DBP increase (p < 0.05). These results support the concept that diets higher in fruits and vegetables and lower in meats (except fish) may reduce the risk of developing high BP.

Adult↗
PubMed2004

Ethyl glucoside in human urine following dietary exposure: detection by 1H NMR spectroscopy as a result of metabonomic screening of humans.

Metabonomic screening of human urine samples using 1H NMR spectroscopy has revealed the presence of signals resulting from the excretion of ethyl glucoside. Experiments in volunteers have demonstrated that this ethyl glucoside results from dietary exposure to the compound, which is present in beverages such as rice wine and sake, rather than representing a new route for the metabolism of ethanol by humans. The limited studies undertaken in volunteers indicate that ethyl glucoside has a longer biological half life than ethanol itself. The potential problems associated with using this glucoside metabolite as a marker of ethanol consumption are considered.

Chromatography, High Pressure Liquid↗
PubMed2004

Long-term consequences of body mass index for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study.

PURPOSE: This report: 1) examines the importance of long-term follow-up (25 years) in BMI-cardiovascular mortality associations in eight age-gender subcohorts from the Chicago Heart Association Detection Project in Industry; and 2) addresses the impact of previously identified methodologic problems in studies on weight-mortality associations, which include no adjustment for cigarette smoking, adjustment for physiological effects of obesity, and no exclusion of early deaths. METHODS: Associations were adjusted for age and ethnicity only, then for cigarettes/day, and for systolic blood pressure, serum cholesterol, and diabetes, for three periods of follow-up, 0 to 15, 6 to 15, and 16 to 25 years. RESULTS: In 25-year follow-up with exclusion of deaths for 0 to 15 years, there was a positive association in all subcohorts, with seven significant, both with and without adjustment for smoking or obesity-related risk factors. In contrast, with adjustment for obesity-related risk factors and no exclusion of early deaths in shorter-term (15-year) follow-up, there were two non-significant positive, three non-significant inverse, one significant positive, and one significant quadratic association. CONCLUSION: Failure to address potential methodologic problems can substantially alter associations in BMI-mortality studies and may contribute to observed differences among studies. The long-term outlook with overweight or obesity is adverse and deserves concerted efforts in prevention and treatment.

Adolescent↗
PubMed2004

Standardised coding of diet records: experiences from INTERMAP UK.

Coding diet records is a basic element of most dietary surveys, yet it often receives little attention even though errors in coding can lead to flawed study results. In the INTERnational study of MAcro- and micronutrients and blood Pressure (INTERMAP study), efforts were made to minimise errors in coding the 18, 720 diet records. Staff were centrally trained and certified before being able to process study data and ongoing quality control checks were performed. This involved the senior (site) nutritionist re-coding randomly selected diet records. To facilitate standardisation of coding in the UK, a code book was designed; it included information about coding brand items, density and portion size information, and default codes to be assigned when limited information was available for food items. It was found that trainees, despite previous experience in coding elsewhere, made coding errors that resulted in errors in estimates of daily energy and nutrient intakes. As training proceeded, the number of errors decreased. Compilation of the code book was labour-intensive, as information from food manufacturers and retailers had to be collected. Strategies are required to avoid repetition of this effort by other research groups. While the methods used in INTERMAP to reduce coding errors were time consuming, the experiences suggest that such errors are important and that they can be reduced.

Diet↗
PubMed2003

Body mass index in middle age and health-related quality of life in older age: the Chicago heart association detection project in industry study.

BACKGROUND: Overweight and obesity are associated with higher morbidity and shorter life expectancy, but the effect of body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) ascertained during middle age on subsequent quality of life among older survivors is unknown. This study evaluates whether BMI in middle age is related to health-related quality of life in older age. METHODS: This prospective cohort of adults from the Chicago Heart Association Detection Project in Industry included 6766 middle-aged men and women, aged 36 to 64 years, without diabetes mellitus or myocardial infarction at baseline (November 7, 1967-January 8, 1973), who completed a 26-year follow-up questionnaire in 1996 when they were 65 years and older. Relationships of baseline BMI (categories: normal weight, overweight, and obese) to mean 26-year follow-up Health Status Questionnaire 12 scores (measuring physical, mental, and social well-being) were assessed. RESULTS: For men and women, BMI had significant inverse-graded associations with all Health Status Questionnaire 12 scores (P<.01 for trend for all). Scores (adjusted for baseline cardiovascular disease risk factors and 1996 age) were highest (best) in normal-weight individuals (BMI, 18.5-<25.0) and decreased significantly (P range,.006-<.001 for trend) with higher BMI, with worst outcomes for obese persons (BMI, >or=30.0). A higher multivariate-adjusted percentage of normal-weight persons reported excellent or very good health compared with overweight and obese persons: for women, 46.8% vs 37.9% and 24.3%; and for men, 53.8% vs 49.1% and 36.5% (P<.001 for trend). CONCLUSIONS: A higher BMI in middle age is associated with a poorer quality of life in older age. Preventive measures may lessen the burden of disease and impaired quality of life associated with excess weight.

Aged↗
PubMed2003

Favorable cardiovascular risk profile in middle age and health-related quality of life in older age.

BACKGROUND: Life expectancy is greater for people with favorable midlife cardiovascular risk profiles (ie, low risk). However, some speculate that increased longevity may lead to large numbers of ill, disabled, older persons with lower quality of life. Few data exist on this important issue. This study evaluates the relationship of midlife low-risk status to quality of life and illness in older age. METHODS: Cohort of middle-aged adults from the Chicago Heart Association Detection Project in Industry (2692 women and 3650 men; baseline ages, 36-64 years [average age, 73.2 years in 1996]) without baseline (1967-1973) major electrocardiographic abnormalities or history of diabetes or myocardial infarction. Quality of life (12-item Health Status Questionnaire [HSQ-12] on physical, mental, and social well-being) and self-reported diseases were assessed after 26 years of follow-up. Baseline risk strata included low risk (favorable blood pressure and serum cholesterol levels, no smoking, and no minor electrocardiographic abnormalities); 0 risk factors (ie, no high risk factors but >or=1 risk factors not at favorable levels); or any 1, any 2, or 3 or more of the following 4 risk factors: high blood pressure, high serum cholesterol level, smoking, and minor electrocardiographic abnormalities. The HSQ-12 scores and disease outcomes for low risk were compared with other strata. RESULTS: Adjusted scores for physical, mental, social functioning, and disease-free outcomes were highest for low-risk individuals and decreased significantly with number of risk factors (eg, 58% of low-risk women had excellent/very good health compared with 28% of women with >or=3 risk factors). CONCLUSIONS: Favorable cardiovascular risk profile in middle age is associated with better quality of life and lower risk of diseases in older age. Moreover, the fewer the risk factors, the higher the quality of life.

Adult↗
PubMed2003

Major risk factors as antecedents of fatal and nonfatal coronary heart disease events.

CONTEXT: A frequently cited concept is that individual major risk factors for coronary heart disease (CHD) are absent in many patients (perhaps >50%) with CHD. However, prior studies have not systematically evaluated the extent to which CHD patients have previous exposure to at least 1 risk factor, including diabetes, cigarette smoking, or clinically elevated levels of cholesterol or blood pressure. OBJECTIVE: To determine the frequency of exposure to major CHD risk factors. DESIGN, SETTING, AND PARTICIPANTS: Three prospective cohort studies were included: the Chicago Heart Association Detection Project in Industry, with a population sample of 35 642 employed men and women aged 18 to 59 years; screenees for the Multiple Risk Factor Intervention Trial, including 347 978 men aged 35 to 57 years; and a population-based sample of 3295 men and women aged 34 to 59 years from the Framingham Heart Study (FHS). Follow-up lasted 21 to 30 years across the studies. MAIN OUTCOME MEASURES: Fatal CHD in all cohorts and nonfatal myocardial infarction (MI) in the FHS, compared by exposure to major CHD risk factors, defined as total cholesterol of at least 240 mg/dL (> or =6.22 mmol/L), systolic blood pressure of at least 140 mm Hg, diastolic blood pressure of at least 90 mm Hg, cigarette smoking, and diabetes. Participants were stratified by sex and age (18-39 vs 40-59 years). RESULTS: For fatal CHD (n = 20 995), exposure to at least 1 clinically elevated major risk factor ranged from 87% to 100%. Among those aged 40 to 59 years at baseline with fatal CHD (n = 19 263), exposure to at least 1 major risk factor ranged from 87% to 94%. For nonfatal MI, prior exposure was documented in 92% (95% CI, 87%-96%) (n = 167) of men aged 40 to 59 years at baseline and in 87% (95% CI, 80%-94%) (n = 94) of women in this age group. CONCLUSIONS: Antecedent major CHD risk factor exposures were very common among those who developed CHD, emphasizing the importance of considering all major risk factors in determining CHD risk estimation and in attempting to prevent clinical CHD. These results challenge claims that CHD events commonly occur in persons without exposure to at least 1 major CHD risk factor.

Adult↗
PubMed2003

Middle age cardiovascular risk factors and abdominal aortic aneurysm in older age.

Few prospective studies have examined associations between major cardiovascular risk factors and occurrence of abdominal aortic aneurysm; findings from cross-sectional studies are inconsistent. This long-term population-based study assessed relationships of major risk factors in middle-age to clinical nonfatal plus fatal abdominal aortic aneurysm in older-age in the Chicago Heart Association Detection Project in Industry cohort--10 574 men and 8700 women baseline ages 40 to 64 years screened for risk factors in 1967-1973 at workplaces. With average follow-up of 30 years and clinical cases identified from Medicare records and death certificates, risk factor relationships to abdominal aortic aneurysm occurrence were assessed by Cox regression. There were among men 309 cases and among women, 109--most from Medicare records. Most findings were qualitatively similar for men and women. In multivariate analyses (5 models), hazard ratios for abdominal aortic aneurysm were significantly greater for men than women (> or =1.97), with older age (> or =1.63/5 years), higher serum cholesterol (> or =1.30/40.0 mg/dL), cigarettes/d (> or =2.43/20 cigarettes), past smoking (> or =1.41), height (> or =1.17/7 cm), evidence of adverse blood pressure (hazard ratio 1.10/20 mm Hg higher systolic pressure, 1.12 to 1.14/12 mm Hg higher diastolic pressure, 1.87 with history of treated hypertension). It is concluded that major cardiovascular risk factors--serum cholesterol, smoking, and blood pressure--in middle age relate significantly to risk of abdominal aortic aneurysm in persons surviving into older age.

Adult↗
PubMed2003

Relation of triglyceride levels, fasting and nonfasting, to fatal and nonfatal coronary heart disease.

BACKGROUND: It remains unclear whether hypertriglyceridemia is an independent risk factor for coronary heart disease (CHD), and whether fasting and nonfasting triglyceride (TG) levels are equally predictive. METHODS: A total of 2809 (of 12 866) men randomized during 1973 through 1975 into the Multiple Risk Factor Intervention Trial with fasting and nonfasting TG levels measured at baseline were followed up for CHD incidence and death. Proportional hazards regression models were used to assess associations of fasting and nonfasting TG levels with CHD. RESULTS: Average fasting and nonfasting TG levels were 187 and 284 mg/dL (2.11 and 3.21 mmol/L), respectively. Prevalence of hypertriglyceridemia (200 mg/dL [2.26 mmol/L] or more) was 31% for fasting and 61% for nonfasting. There were 175 nonfatal or fatal CHD events during 8 years and 328 CHD deaths during 25 years. Compared with TG levels less than 200 mg/dL, risk factor-adjusted hazard ratios for CHD mortality for hypertriglyceridemia were 1.24 (P =.09) for fasting and 1.26 (P =.07) for nonfasting. For nonfatal or fatal CHD, fasting and nonfasting TG levels were similarly predictive with hazard ratios of 1.64 (P =.004) for fasting and 1.46 (P =.03) for nonfasting. These associations for fasting TG levels were assessed to be underestimated by 56% because of regression dilution bias, with attenuation likely greater for nonfasting TG levels. CONCLUSIONS: Greater ease of obtaining nonfasting than fasting measurements, greater prevalence of hypertriglyceridemia with nonfasting than fasting values, and similarly increased risk with each indicate that nonfasting TG levels may be more useful than fasting ones for risk stratification.

Adult↗
PubMed2003

Impact of minor electrocardiographic ST-segment and/or T-wave abnormalities on cardiovascular mortality during long-term follow-up.

Minor ST-T abnormalities are common on the resting electrocardiogram of otherwise healthy persons, but the long-term importance of these findings has not been extensively evaluated, especially in women. In a prospective study, 7,985 women and 9,630 men (aged 40 to 64 years at baseline) without other electrocardiographic abnormalities and free of previous coronary heart disease (CHD) were studied using Cox regression for 22-years of follow-up. Primary outcomes were death from CHD and total cardiovascular disease (CVD); total mortality was a secondary outcome. Minnesota Code was employed to assess the presence or absence of electrocardiographic abnormalities. Analyses compared persons with minor Minnesota Code ST-segment (codes 4-3 or 4-4) or T-wave findings (codes 5-3 or 5-4) to those with normal electrocardiographic findings. In combined analyses of men and women adjusted for age, isolated minor T-wave abnormality, minor ST-segment depression, or a combination of minor ST-segment and T-wave abnormalities were each associated with increased mortality risks. For CHD mortality, hazard ratios (HRs) ranged from 1.60 to 2.10; for CVD mortality, HRs ranged from 1.50 to 1.95; and for total mortality, HRs ranged from 1.31 to 1.50 (p <0.05 for all HRs). In separate analyses by gender adjusted for age, increased risks were observed for combined ST-T-wave abnormalities in both genders for CHD and CVD mortality (HR 1.72 to 1.75 for men, p <0.05; HR 2.07 to 2.51 for women, p <0.001). These data indicate that nonspecific (minor) ST-segment depression and/or T-wave abnormalities have a long-term prognostic impact for CHD and CVD death in middle-aged women and men and can be considered markers of heightened CHD and CVD risk.

Adult↗
PubMed2002

Relation of cigarette smoking to 25-year mortality in middle-aged men with low baseline serum cholesterol: the Chicago Heart Association Detection Project in Industry.

It has been suggested that smoking does not influence risk of cardiovascular diseases in populations with low serum cholesterol levels. To determine whether cigarette smoking is an independent risk factor among men with low levels of serum cholesterol, data on 25-year coronary, cardiovascular, and all-cause mortality for 8,816 middle-aged men screened between 1967 and 1973 by the Chicago Heart Association Detection Project in Industry were examined. With Cox multivariate proportional hazards regression, relative risks of coronary heart disease and cardiovascular disease mortality associated with smoking for the two subcohorts with favorable levels of serum total cholesterol, that is, less than 180 and 180-199 mg/dl, were of the same magnitude as those for men with elevated serum cholesterol, that is, 200-239 and 240 mg/dl. In the two lower strata of cholesterol, the absolute risk and absolute excess risk of mortality for current smokers at baseline were substantially higher compared with men who never smoked, with all-cause death rates of 423.0 and 428.0 per 1,000 and absolute excess rates of 209.8 and 225.7 per 1,000. These translate to estimated shorter life expectancies of 5.3 and 5.7 years, respectively. Adverse effects of smoking on risk of coronary, cardiovascular, and all-cause mortality prevail for men with lower as well as higher serum cholesterol levels.

Adult↗
PubMed2002

Eight-year blood pressure change in middle-aged men: relationship to multiple nutrients.

Relationships of nutrients, alcohol intake, and change in weight to change in blood pressure over 8 years in 1714 employed middle-aged men from the Chicago Western Electric Study were explored. At first and second annual examinations, 2 in-depth interviews were performed to assess usual intake of foods and beverages during the preceding 28 days. Annual follow-up data through examination year 9 were used to determine change in weight and blood pressure. Averages of nutrients from 2 interviews were related to annual blood pressure change from baseline by use of the Generalized Estimating Equation, with control for confounders. In analyses of dietary variables considered individually, total and animal protein; total, saturated, monounsaturated, and polyunsaturated fatty acids; cholesterol; Keys dietary lipid score; calcium; alcohol; and average annual change in weight were positively and significantly related to average annual change in systolic pressure; vegetable protein, total carbohydrate, beta-carotene, and an antioxidant vitamin score based on vitamin C and beta-carotene were inversely and significantly related to average annual change in systolic pressure. In analyses of combinations of dietary factors, cholesterol, Keys score, and alcohol were positively related to change in systolic pressure (eg, Z-scores 2.21, 2.05, and 2.50); vegetable protein and antioxidant index were inversely related to change in systolic and diastolic pressure. Change in weight was directly related to change in systolic and diastolic pressure. These findings support the concept that multiple macro- and micronutrients, alcohol intake, and calorie imbalance relate prospectively to blood pressure change.

Adult↗