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Biomedical subjects

L Kuller

Publications and source records attributed to L Kuller.

At least 73 records · Page 4Linked to original sources
PubMed1988

Mechanism of death and prevalence of myocardial ischemic symptoms in the terminal event after acute myocardial infarction.

A prospective study to determine prognostic factors for risk stratification in 867 patients surviving the coronary care unit phase of acute myocardial infarction (AMI) is reported. During a 48-month follow-up, 144 patients (17%) died. The deaths were examined for the chronology, cause, mechanism, location and presence of myocardial ischemia in the terminal event. A classification previously proposed by Hinkle and Thaler was used to define the mechanism of cardiac death and the presence of ischemia. There were 113 deaths due to coronary atherosclerotic coronary artery disease, including 5 due to complications of coronary artery bypass graft surgery. Of the remaining 108 of these deaths, 74% were classified as due to an arrhythmic mechanism and 26% as myocardial failure. Of the deaths due to an arrhythmia or to myocardial failure, 56 (52%) occurred out of hospital. The ratio of arrhythmic: myocardial failure deaths was not different for the patients who died within 3 months after the index AMI compared with later deaths. Sudden death (less than or equal to 1 hour of new symptoms) was strongly associated with arrhythmic death but 32 (54%) of patients who died greater than 1 hour after the onset of symptoms were also classified as having an arrhythmic cause of death. Previously described risk factors, including an ejection fraction less than 0.40 and greater than or equal to 10 ventricular premature complexes/hour, were independent predictors of mortality but did not differentially predict the mechanism of cardiac death. Evidence of myocardial ischemia before the terminal event was found in about 50 (60%) patients whose deaths were witnessed and who died from an arrhythmia or myocardial failure.

Coronary Disease↗
PubMed1988

Inoculation of baboons and macaques with simian immunodeficiency virus/Mne, a primate lentivirus closely related to human immunodeficiency virus type 2.

A primate lymphotropic lentivirus was isolated on the human T-cell line HuT 78 after cocultivation of a lymph node from a pig-tailed macaque (Macaca nemestrina) that had died with malignant lymphoma. This isolate, originally designated M. nemestrina immunodeficiency virus (MnIV) and now classified as simian immunodeficiency virus (SIV/Mne), was inoculated intravenously into three juvenile rhesus monkeys (Macaca mulatta), three juvenile pig-tailed macaques (M. nemestrina), and two juvenile baboons (Papio cynocephalus). All six macaques became viremic by 3 weeks after inoculation, whereas neither of the baboons developed viremia. One pig-tailed macaque died at 15 weeks with suppurative peritonitis secondary to ulcerative, necrotizing colitis. Immunologic abnormalities included a marked decrease in CD4+ peripheral blood lymphocytes. Although five macaques mounted an antibody response to SIV/Mne, the animal that died at 15 weeks remained antibody negative. Three other macaques (two rhesus and one pig-tailed) died 66 to 87 weeks after inoculation after exhibiting progressive weight loss, anemia, and diarrhea. Histopathologic findings at necropsy included various manifestations of immune deficiency, nephropathy, subacute encephalitis, pancreatitis, adenocarcinoma, and lymphoid atrophy. SIV/Mne could be readily isolated from the spleens and lymph nodes of all necropsied macaques, and from the cerebrospinal fluid, brains, bone marrow, livers, and pancreas of some of the animals. SIV antigens were localized by avidin-biotin immunohistochemistry to pancreatic islet cells and to bone marrow endothelial cells. The data suggest that African baboons may be resistant to infection by SIV/Mne, whereas Asian macaques are susceptible to infection with this pathogenic primate lentivirus.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Predictors of cardiovascular events and mortality in the Systolic Hypertension in the Elderly Program pilot project.

Do the established cardiovascular risk factors for younger persons remain important predictors of cardiovascular disease events and mortality in those who are older? The authors examined this question in the Systolic Hypertension in the Elderly Program pilot project which prospectively followed 551 men and women 60 years of age and older with pretreatment systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg who were enrolled between May 1981 and July 1982. Mean age was 72 years, 37% were men, 82% were white, and 24% had attended college. The vital status of all 551 participants was known at the end of follow-up, an average of 34 months after entry; there were 39 deaths from all causes, 66 first cardiovascular events, 18 strokes, and 20 episodes of myocardial infarction/sudden death. Univariate Cox proportional hazard analysis revealed that age was a predictor (p less than 0.05) of all-cause mortality, first cardiovascular event, and stroke. Less than college education was a predictor of all-cause mortality and first cardiovascular event, smoking was a predictor of first cardiovascular event and myocardial infarction/sudden death, cholesterol was a predictor of first cardiovascular event, and lower body mass index was a predictor of increased all-cause mortality. After adjustment for covariables, age, lower education, lower body mass index, and baseline electrocardiographic abnormalities were significant predictors of all-cause mortality, and age, lower education, history of cardiovascular event, and smoking remained significant predictors of first cardiovascular event. Sex was not a risk factor, and the ability to examine hypertension as a risk factor was impaired by the fact that the entire cohort had systolic hypertension at baseline, and most were treated. These findings, combined with prior evidence, suggest that smoking, low education level, and perhaps serum cholesterol are risk factors for cardiovascular disease in the elderly. Although the excess risk conveyed by these factors is large, its reversibility needs to be demonstrated by intervention studies.

Age Factors↗
PubMed1986

Use of diuretics in treatment of hypertension in the elderly.

Men and women with isolated systolic hypertension who were at least 60 years of age were treated for 1 year with chlorthalidone (25-50 mg daily) or matching placebo as the step I drug. Most patients reached goal blood pressure without requiring a step II drug. The blood pressure response was similar in all age, sex and race subgroups, with an overall difference between the randomised groups of 17 mm Hg for systolic blood pressure (p less than 0.001) and 6mm Hg for diastolic blood pressure (p less than 0.001). The only common adverse effects were asymptomatic changes in the serum concentrations of potassium (0.5 mmol/L lower in the chlorthalidone group, p less than 0.001), uric acid (0.9 mg/dl higher, p less than 0.001), and creatinine (0.08 mg/dl higher, p = 0.02). Compliance was good, and more than 80% of participants were still taking the study medications at the end of the year.

Aged↗
PubMed1985

Coronary heart disease and all-causes mortality in the Multiple Risk Factor Intervention Trial: subgroup findings and comparisons with other trials.

The Multiple Risk Factor Intervention Trial (MRFIT) was a randomized primary prevention trial to test whether a special intervention (SI) program to reduce high blood pressure, elevated blood cholesterol, and/or cigarette smoking could lower coronary heart disease (CHD) mortality in middle-aged men at above average risk. After an average follow-up period of 7 years, risk factor levels were reduced substantially more in SI than in usual-care (UC) men; however, SI-UC differences in CHD mortality (7.1%) and total mortality (-2.1%) were not statistically significant. Subgroup analysis showed 35% fewer SI than UC CHD deaths (P = 0.14) but no all-causes mortality difference in men comparable to the cohort having dietary and smoking intervention in Oslo (the "Oslo-like" cohort). Among the subgroup hypertensive at entry, SI-UC differences in CHD and total mortality appeared to be heterogeneous: CHD mortality was 24% lower in SI than UC men with a normal resting ECG at baseline, but 67% higher if baseline ECG abnormalities were present (nominal P = 0.02, for difference in relative risk estimates). These findings were supported by within-group analyses and are generally consistent with results of other CHD/cardiovascular disease prevention trials. They pose a new hypothesis about possible adverse effects of diuretic therapy in a minority of the hypertensive population.

Adult↗
PubMed1985

Occupational noise exposure, noise-induced hearing loss, and the epidemiology of high blood pressure.

The role of noise exposure in the etiology of high blood pressure is unclear. A cross-sectional study of occupational noise exposure and high blood pressure was conducted in March 1981-August 1982 in a group of blue-collar workers from a noisy (greater than or equal to 89 dBA) and a less noisy plant (less than 81 dBA). There were 197 randomly sampled men from the noisier plant and 169 from the comparison factory. Clinical examinations, audiograms and a psychologic inventory were conducted. Body mass index, alcohol intake, and family history of hypertension were comparable for the two groups. There was no difference in mean systolic or diastolic blood pressure between workers in the two plants. There was, however, a strong relationship between severe noise-induced hearing loss (greater than or equal to 65 dBA loss at 3, 4, or 6 k Hz) and high blood pressure (greater than or equal to 90 mmHg diastolic or taking blood pressure medication) in the 56+ age group in both plants after adjusting for risk factors (p less than 0.02). Multiple regression analysis revealed that in the noisier plant, body mass index, severe noise-induced hearing loss, and noisy hobbies explained a significant amount of the variation in diastolic pressure (p less than 0.05) R2 = 0.19. This suggests that there may be a population at increased risk for hearing loss and high blood pressure.

Adult↗
PubMed1985

Relationship of diuretic therapy and serum magnesium levels among participants in the Multiple Risk Factor Intervention Trial.

Thiazide-like diuretics cause an increased excretion of magnesium in the urine. Low serum and selected tissue magnesium levels have been reported among diuretic users. Low magnesium levels have been associated with cardiac arrhythmias, neuromuscular changes, and increases in lipoprotein levels. The dietary intake of magnesium is borderline compared with the recommended dietary allowances. Water sources may therefore play an important role. Hard water contains more magnesium than soft water. The authors studied serum magnesium levels among special intervention Multiple Risk Factor Intervention Trial participants in two centers: Pittsburgh, Pennsylvania and Davis, California. These participants were men aged 35-57 years at entry to the trial in 1972-1974; the blood samples were obtained primarily in 1980-1981. Diuretic users primarily of chlorthalidone had an average 1 ppm lower serum magnesium level than nondiuretic users. About 15% of diuretic users had persistently lower magnesium levels on two samples approximately four months apart. The serum magnesium level was not correlated with the serum potassium level. This study is the first long-term follow-up of a well-defined group of hypertensives taking thiazide-like diuretics versus suitable controls. The results suggest that within similar populations, low serum magnesium levels are relatively rare even in the absence of supplementation with magnesium. Specific high-risk populations may exist in which a combination of diuretic therapy and low intake may contribute to magnesium deficiency. Further epidemiologic studies should include monitoring both serum and intracellular levels of magnesium among these potential high-risk groups on diuretic therapy. This approach may offer the best method of testing the relationship between water hardness, minerals, and cardiovascular disease.

Adult↗
PubMed1984

The association between long-term diabetic control and early retinopathy.

A study was performed to determine the relationship between level of long-term antecedent diabetic control and early diabetic retinopathy changes. Fifty-eight insulin dependent diabetics aged 14 to 17 1/2 years, with duration of diabetes of at least 8 years, were studied. Glycosylated hemoglobins were assessed a mean of 8.5 times per patient, over a mean period of 3.1 years, representing 28% of the mean duration of diabetes in this patient population. Fluorescein angiography, obtained according to a standardized technique, was assessed in masked fashion for number of microaneurysms, presence of abnormal areas of capillary nonperfusion, and presence of intraretinal dye leakage. Sixty-four percent of the study population showed some evidence of retinopathy. There was a high correlation found between degree of metabolic control as measured by glycosylated hemoglobin level, and presence of early retinopathy changes as defined by angiography.

Adolescent↗
PubMed1984

Optimal resources for primary prevention of atherosclerotic diseases. Atherosclerosis Study Group.

This statement is an update of the 1970 Inter-Society Commission for Heart Disease Resources ( ICHD ) report, "Primary Prevention of the Atherosclerotic Diseases." The charge to the Study Group was to assess relevant new data and, where the evidence is less than definitive, to formulate conclusions and recommendations based on best judgment. Current developments are reviewed, and issues raised in response to the earlier recommendations are considered. Recommendations are intended to serve as a guide for individual behavior, physician practice, and the formulation of public health policy.

Alcohol Drinking↗
PubMed1984

Optimal resources for primary prevention of artherosclerotic diseases. Atherosclerosis Study Group.

This statement is an update of the 1970 Inter -Society Commission for Heart Disease Resources (ICHD) report, Primary Prevention of the Atherosclerotic Diseases. The charge to the Study Group was to assess relevant new data and, where the evidence is less than definitive, to formulate conclusions and recommendations based on best judgment. Current developments are reviewed, and issues raised in response to the earlier recommendations are considered. Recommendations are intended to serve as a guide for individual behavior, physician practice, and the formulation of public health policy.

Adult↗
PubMed1983

Parent--child obesity and cardiovascular risk factors.

Blood pressure, cholesterol, high density lipoprotein cholesterol, and triglycerides were studied in obese children and obese parents selected to participate in a weight treatment program. The relationships between parent and child risk levels, as well as the relationship between child and parent weight and risk factors, were established. Results showed that children's cholesterol and triglycerides were related to parental lipid levels, independent of weight. Children's blood pressure readings were strongly related to their weight, but not to parental blood pressure. High density lipoprotein cholesterol levels were negatively related to weight in both child and parent female populations, and weakly positively related to weight for male children. Implications of these risk factor patterns for intervention are discussed.

Blood Pressure↗
PubMed1983

Identification of Campylobacter jejuni in Macaca fascicularis imported from Indonesia.

Campylobacter jejuni was selectively cultured in 33 (66%) of 50 Macaca fascicularis that had been imported from Indonesia. As there was no published information on the incidence of Campylobacter infection in nonhuman primates from Indonesia, a survey was conducted to determine the presence and incidence of Campylobacter jejuni in 50 macaques before they were exported from Indonesia. The organism was positively identified in 18 (36%) of the specimens examined. Repeat cultures after importation and during the quarantine period produced 37 of 48 (77%) positive results. Stool cultures from 57 other Macaca fascicularis and Macaca nemestrina in more preliminary stages of captivity in Indonesia produced only two positive identifications. These findings suggest that Campylobacter jejuni is not a natural pathogen of macaques in Indonesia, but it infects them after capture.

Animals↗
PubMed1982

Pittsburgh diabetes mellitus study. II. Secondary attack rates in families with insulin-dependent diabetes mellitus.

Family history data were collected in 1203 consecutive admissions of insulin-dependent diabetes mellitus cases to the Children's Hospital of Pittsburgh between Dec. 31, 1964 and Jan. 1, 1981. This report deals with two issues: the closeness in time of dates of onset of diabetes in multiple sibling case families and the similarity of ages of onset within these families. The age-specific incidence rates among siblings were 6-18 times higher than in the general population. Contrary to other reports, this study does not find an increased risk to siblings during the first year or two after the onset of the index diabetic case. The mean duration between cases is 6.1 years. Fitting a log-normal distribution to the periods between cases verified the long median incubation period (4.35 years) with a high degree of variability (dispersion factor = 3.38). However, the log-normal was not a good fit to the data (p less than 0.005). There is a significant correlation for age of onset for pairs of affected siblings within families (0.25). However, it is shown that the similarity in age of onset within families may be a function of the greater similarity to ages of siblings within a family. It is noted that secondary cases are more often younger children in the family, particularly so if the index child is of school age at the time of onset.

Adolescent↗
PubMed1982

Control of cigarette smoking from a medical perspective.

Cigarette smoking cessation is apparently associated with decreased risk of heart attack and cancer and improvement in pulmonary function. We suspect, however, that those who quit smoking are not the "highest risk group." The preliminary results of clinical trials at least for heart disease and smoking cessation are not as impressive as the results of observational studies. Isolated smoking cessation programs with reference to a definable population contribute little to our knowledge of the health effects of smoking cessation, probably attract relatively "low risk smokers," and have a smaller public health impact than anticipated.

Adult↗
PubMed1981

Plasma testosterone, high density lipoprotein cholesterol and other lipoprotein fractions.

High density lipoprotein (HDL) cholesterol levels are strongly related to risk of heart attack. Identification of determinants of high density lipoprotein cholesterol may provide important information concerning the cause of heart disease. The relation between one possible determinant, testosterone, and high density lipoprotein cholesterol and other lipoprotein fractions was evaluated in 247 middle-aged men. The results indicate that testosterone levels (both free and total) were positively correlated with high density lipoprotein cholesterol (r = +0.24, p less than 0.01) and negatively correlated with triglycerides and very low density lipoprotein cholesterol. The association between testosterone and high density lipoprotein cholesterol could not be explained by intake of alcohol, obesity, age, smoking or physical activity. Furthermore, the relation of testosterone to HDL cholesterol was independent of the relation of testosterone to very low density lipoprotein (VLDL) cholesterol or triglycerides.

Age Factors↗
PubMed1981

The relationship between alcohol consumption, liver enzymes and high-density lipoprotein cholesterol.

High-density lipoprotein (HDL) cholesterol concentrations are inversely related to risk of heart attack. Alcohol consumption is a primary factor related to increased HDL concentrations. We investigated HDL cholesterol before and after cessation of high alcohol consumption in alcoholics. Men admitted to an alcohol detoxification hospital had a mean HDL cholesterol level of 85 mg/dl, which is almost twice that found in the general population. After 4 days of treatment, HDL cholesterol levels decreased an average of 12.5 mg/dl. The decrease was directly correlated with the initial HDL cholesterol levels and inversely correlated with the change in triglyceride levels. Alcoholics who abstained for at least 1 month had HDL cholesterol concentrations similar to those of the general population. The increased HDL cholesterol levels in the alcoholics were highly correlated with liver enzyme concentrations, especially SGOT. The results suggest that alcohol increases HDL cholesterol concentrations through hepatic microsomal enzyme induction.

Adult↗