Biomedical subjects

Lynn E Eberly

Publications and source records attributed to Lynn E Eberly.

At least 19 recordsLinked to original sources

PubMed2006

ZIP-code-based versus tract-based income measures as long-term risk-adjusted mortality predictors.

There is a well-established, strong association between socioeconomic position and mortality. Public health mortality analyses thus routinely consider the confounding effect of socioeconomic position when possible. Particularly in the absence of personally reported data, researchers often use area-based measures to estimate the effects of socioeconomic position. Data are limited regarding the relative merits of measures based on US Census tract versus ZIP code (postal code). ZIP-code measures have more within-unit variation but are also more easily obtained. The current study reports on 293,138 middle-aged men screened in 14 states in 1973-1975 for the Multiple Risk Factor Intervention Trial and having 25-year mortality follow-up. In risk-adjusted proportional hazards models containing either ZIP-code-based or tract-based median household income, all-cause mortality hazard ratios were 1.16 (95% confidence interval: 1.14, 1.17) per Dollars 10,000 less ZIP-code-based income and 1.15 (95% confidence interval: 1.13, 1.16) per Dollars 10,000 less tract-based income; adding either income variable to a risk-adjusted model improved model fit substantially. Both were significant independent predictors in a combined model; tract-based income was a slightly stronger mortality predictor (hazard ratios = 1.05 and 1.11 for ZIP-code-based and tract-based income, respectively). These patterns held across various causes of death, for both Blacks and non-Blacks, and with or without adjustment for ZIP-code-based income diversity or tract-based proportion below poverty.

Analysis of Variance↗

PubMed2006

Agreement of pesticide biomarkers between morning void and 24-h urine samples from farmers and their children.

In pesticide biomonitoring studies, researchers typically collect either single voids or daily (24-h) urine samples. Collection of 24-h urine samples is considered the "gold-standard", but this method places a high burden on study volunteers, requires greater resources, and may result in misclassification of exposure or underestimation of dose due to noncompliance with urine collection protocols. To evaluate the potential measurement error introduced by single void samples, we present an analysis of exposure and dose for two commonly used pesticides based on single morning void (MV) and 24-h urine collections in farmers and farm children. The agreement between the MV concentration and its corresponding 24-h concentration was analyzed using simple graphical and statistical techniques and risk assessment methodology. A consistent bias towards overprediction of pesticide concentration was found among the MVs, likely in large part due to the pharmacokinetic time course of the analytes in urine. These results suggest that the use of single voids can either over- or under-estimate daily exposure if recent pesticide applications have occurred. This held true for both farmers as well as farm children, who were not directly exposed to the applications. As a result, single void samples influenced the number of children exposed to chlorpyrifos whose daily dose estimates were above levels of toxicologic significance. In populations where fluctuations in pesticide exposure are expected (e.g., farm families), the pharmacokinetics of the pesticide and the timing of exposure events and urine collection must be understood when relying on single voids as a surrogate for longer time-frames of exposure.

2,4-Dichlorophenoxyacetic Acid↗

PubMed2006

Ginkgo biloba use in nursing home elderly with epilepsy or seizure disorder.

PURPOSE: Ginkgo biloba, among the most widely used herbs, possesses the capacity both to induce and to inhibit seizures. The purpose of this study was to describe the prevalence of ginkgo and other common herb prescribing in a sample of nursing home (NH) elderly diagnosed with epilepsy/seizure (Epi/Sz) disorder and to determine demographic, clinical, and functional factors associated with ginkgo use. METHODS: This was a 1-year prevalence study of 68,403 NH residents living in 557 nursing facilities throughout the United States. RESULTS: Overall, herb use in the NHs was very low (0.41%). Ginkgo was prescribed 162 times, more than any other herb. St. John's wort was prescribed 40 times; garlic, 29 times; and all others, <20 times, for a total of 307 herb orders. Among all residents with an herb order, ginkgo was prescribed for 61.9% of residents with an Epi/Sz diagnosis and 58.0% (p = 0.820) of residents without an Epi/Sz diagnosis. Dementia, educational level, and the interaction of age group with cognitive impairment were all significantly associated with herb use among Epi/Sz residents. Cognitive impairment and the interaction of Epi/Sz disorder with dementia were associated specifically with ginkgo use. CONCLUSIONS: Ginkgo is the most frequently prescribed herb in this population in which >50% of all herb orders were written for ginkgo. The concern with ginkgo use among elderly with Epi/Sz is the lack of standardization that characterizes ginkgo products. In the absence of standardization, the likelihood is increased that ginkgo products may be adulterated with the Ginkgo biloba plant parts most commonly associated with seizure provocation.

Age Distribution↗

PubMed2006

The association of physical activity with lung cancer incidence in a cohort of older women: the Iowa Women's Health Study.

BACKGROUND: We examined the potential association between physical activity and lung cancer in women. METHODS: In 1986, 36,929 women from Iowa, who were free of prior cancer, completed a questionnaire regarding physical activity, smoking, body mass index, and other life-style factors. Women were followed through 2002 for cancer incidence. RESULTS: After adjusting for potential confounders, women with high physical activity levels were less likely [hazard ratio, 0.77; 95% confidence intervals (CI), 0.64-0.94] to develop lung cancer than women with low activity levels. This hazard ratio was 0.72 (95% CI, 0.55-0.94) in current smokers and 0.63 (95% CI, 0.43-0.92) in former smokers, but was not significant in never smokers. CONCLUSION: These results suggest that physical activity might reduce the risk of lung cancer in women who are current or former smokers.

Aged↗

PubMed2006

Metabolic syndrome: risk factor distribution and 18-year mortality in the multiple risk factor intervention trial.

OBJECTIVE: To examine the long-term association of metabolic syndrome with mortality among those at high risk for cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS: A total of 10,950 Multiple Risk Factor Intervention Trial (MRFIT) survivors were followed for mortality an additional median 18.4 years (1980-1999). Proportional hazards models examined multivariate-adjusted risks associated with Adult Treatment Panel III-defined metabolic syndrome conditions, with BMI substituted for waist circumference. RESULTS: At MRFIT annual visit 6, 4,588 (41.9%) men, mean age (+/-SD) 53.0 +/- 5.9 years, had metabolic syndrome and 6,362 did not. Comparing men with metabolic syndrome to men without, adjusted hazard ratios (HRs) were 1.21 (95% CI 1.13-1.29), 1.49 (1.35-1.64), and 1.51 (1.34-1.70) for 18-year total, CVD, and coronary heart disease mortality, respectively. Among men with metabolic syndrome, elevated glucose (1.54 [1.34-1.78]) and low HDL cholesterol (1.45 [1.17-1.54]) were most predictive of CVD mortality, followed by elevated BMI (1.34 [1.17-1.54]), elevated blood pressure (1.25 [0.98-1.58]), and elevated triglycerides (1.06 [0.86-1.30]). In contrast, for men without metabolic syndrome, the HR for low HDL cholesterol was 1.02 (0.86-1.22). Among metabolic syndrome men with no nonfatal CVD event, smokers with elevated LDL cholesterol showed higher CVD mortality (1.79 [1.22-2.63]) compared with nonsmokers without elevated LDL cholesterol; this additional risk was even greater for metabolic syndrome men with a nonfatal CVD event (2.11 [1.32-3.38]). CONCLUSIONS: Metabolic syndrome is associated with an increased risk of mortality. Among those with metabolic syndrome, risk is further increased by having more metabolic syndrome conditions, by cigarette smoking, and by elevated LDL cholesterol. Primary prevention of each metabolic syndrome condition should be emphasized, and presence of each condition should be treated in accordance with current guidelines.

Body Mass Index↗

PubMed2005

Latino risk-adjusted mortality in the men screened for the Multiple Risk Factor Intervention Trial.

Latinos are now the largest minority in the United States, but their distinctive health needs and mortality patterns remain poorly understood. Proportional hazards regressions were used to compare Latino versus White risk- and income-adjusted mortality over 25 years' follow-up from 5,846 Latino and 300,647 White men screened for the Multiple Risk Factor Intervention Trial. Men were aged 35-57 years and residing in 14 states when screened in 1973-1975. Data on coronary heart disease risk factors, self-reported race/ethnicity, and home addresses were obtained at baseline; income was estimated by linking addresses to census data. Mortality follow-up through 1999 was obtained using the National Death Index. The fully adjusted Latino/White hazard ratio for all-cause mortality was 0.82 (95% confidence interval (CI): 0.77, 0.87), based on 1,085 Latino and 73,807 White deaths; this pattern prevailed over time and across states (thus, likely across Latino subgroups). Hazard ratios were significantly greater than one for stroke (hazard ratio = 1.30, 95% CI: 1.01, 1.68), liver cancer (hazard ratio = 2.02, 95% CI: 1.21, 3.37), and infection (hazard ratio = 1.69, 95% CI: 1.24, 2.32). A substudy found only minor racial/ethnic differences in the quality of Social Security numbers, birth dates, soundex-adjusted names, and National Death Index searches. Results were not likely an artifact of return migration or incomplete mortality data.

Adult↗

PubMed2005

Race/ethnicity, income, major risk factors, and cardiovascular disease mortality.

OBJECTIVES: We explored differences between Black and White men for cardiovascular disease (CVD) mortality across major risk factor levels. METHODS: Major CVD risk factors were measured among 300,647 White and 20,223 Black men aged 35 to 57 years who were screened for the Multiple Risk Factor Intervention Trial (MRFIT). Hazard ratios for CVD deaths for Black and White men over 25 years of follow-up were calculated for subgroups stratified according to risk factor levels. RESULTS: CVD was responsible for 2518 deaths among Black men and 30,772 deaths among White men. The age-adjusted Black-to-White CVD hazard ratio was 1.35 (95% confidence interval [CI]=1.29, 1.40); the risk- and income-adjusted ratio was 1.05 (95% CI=1.01, 1.10). CVD mortality rates were dramatically lower in cases of favorable risk profiles. However, fully adjusted Black-to-White CVD hazard ratios within groups at low, intermediate, high, and very high levels of overall risk were 1.76, 1.20, 1.10, and 0.94, respectively. Similar gradients were evident for individual risk factors. CONCLUSIONS: Higher CVD mortality rates among Black men were largely mediated by risk factors and income. These data underscore the need for sustained primordial risk factor prevention among Black men.

Adult↗

PubMed2005

GEE estimation of a misspecified time-varying covariate: an example with the effect of alcoholism treatment on medical utilization.

The generalized estimation equation (GEE) method is widely used in longitudinal data analysis, particularly when the outcome variable is non-Gaussian distributed. Under mild regulatory conditions, the parameter estimates are consistent and their asymptotic variances are efficient. In an observational study focusing on alcoholism patients, we applied the GEE method to longitudinal count data from medical utilization records from a large national managed care organization. The health services research question was whether there was a change in medical utilization for patients after engaging in alcoholism treatment as compared to before treatment. Thus, the main effect of interest was a time-varying covariate indicating whether the patient had undergone treatment yet or not. GEE under five different working correlations was employed and mixed results regarding the significance of the treatment effect were found. Because of the large sample size, i.e. 8485 patients with an average of 46 repeated measurements per patient, differences across the estimates produced by the different working correlation structures was suspicious. It is shown that these differences are maybe caused by the fact that the time-varying covariate in the marginal mean model is misspecified. A simulation study is performed to demonstrate that misspecification of the time-varying covariate in the marginal mean structure can cause differences in GEE results across various choices of working correlation structure.

Adult↗

PubMed2005

Prevalence of appropriate and problematic antiepileptic combination therapy in older people in the nursing home.

OBJECTIVES: To determine the prevalence of mono- and poly-antiepileptic drug (AED) therapy in a cohort of nursing home (NH) residents and to describe specific AED combinations used, as well as demographic, clinical, and functional factors associated with poly-AED therapy and the most common AED combination. DESIGN: Retrospective, point prevalence study. SETTING: All NHs owned/managed by Beverly Enterprises. PARTICIPANTS: All residents aged 65 and older residing in one of the study NHs on July 1, 1999, and receiving an AED (N=3,881). MEASUREMENTS: Data were gathered using two secondary source data sets: physicians' orders (AED use) and the Minimum Data Set (health status indicators). RESULTS: Of residents taking AEDs, 370 (9.5%) were taking two or more; 268 of those (72%) were taking problematic AED combinations (those with the potential of undesirable pharmacokinetic or pharmacodynamic interactions). Phenytoin (PHT) with phenobarbital (PB) was the most common combination (27.0%). Logistic regression indicated that poly-AED subjects were more likely to have a diagnosis of epilepsy/seizure (epi/sz) and less likely to have a diagnosis of cerebrovascular accident (CVA). Residents taking the PHT/PB combination were more likely to have an epi/sz diagnosis and longer NH stay. The association between CVA and PHT/PB polytherapy differed by presence or absence of aphasia. CONCLUSION: The overall prevalence of poly-AED therapy is less than 10% in NH residents, but 72% of those residents were receiving problematic polytherapy combinations, thereby exposing them to potential risk of adverse reactions and toxicity.

Age Distribution↗

PubMed2004

Depressive symptoms and mortality in men: results from the Multiple Risk Factor Intervention Trial.

BACKGROUND AND PURPOSE: Depression may be a risk factor for cardiovascular disease (CVD) mortality. We evaluated long-term mortality risk associated with depressive symptoms measured at middle age among men at high risk for coronary heart disease (CHD). METHODS: 12,866 men without definite evidence of CHD at study entry but who had above average risk of CHD based on blood pressure, blood cholesterol levels, and/or cigarette smoking were recruited into the Multiple Risk Factor Intervention Trial (MRFIT). Survivors at the end of the trial were followed-up for mortality for an additional 18 years. Men who had completed the Center for Epidemiologic Studies Depression (CES-D) scale near the end of the trial (n=11,216) were used in a prospective analysis of post-trial all-cause and cause-specific mortality during 18-year follow-up after CES-D assessment. RESULTS: Greater depressive symptoms measured at the end of the trial were associated with significantly higher risk of all-cause mortality and for cause-specific death, a higher risk of CVD, and, more specifically, stroke mortality (all P values <0.02) but not CHD mortality (P=0.48) in linear trend analyses. The significant associations were strongest for those reporting the greatest depression: hazard ratio (HR)=1.15 (95% CI, 1.03 to 1.28; P<0.01) for all-cause mortality for those in the highest depressive symptom quintile, HR=1.21 for CVD mortality (95% CI, 1.03 to 1.41; P<0.05), and HR=2.03 for stroke mortality (95% CI, 1.20 to 3.44; P<0.01) compared with those in the lowest quintile. These associations were adjusted for age, intervention group, race, educational attainment, smoking at baseline and visit 6, trial averaged systolic blood pressure, alcohol consumption, and fasting cholesterol, as well as the occurrence of nonfatal cardiovascular events during the trial. CONCLUSIONS: Greater depressive symptoms are associated with an increase in the risk of all-cause and, more specifically, CVD mortality in men. Stroke but not CHD was the form of CVD with which depressive symptoms were associated.

Adult↗

PubMed2004

Consequences of event rate heterogeneity across non-randomized study sub-groups.

Analyses to compare non-randomized groups are more and more common in both post hoc analyses of randomized clinical trials data and in analyses of long-term observational data. In such cases, it is quite likely that there are unknown or uncollected sources of heterogeneity in event rates. Research has shown that an underlying source of heterogeneity in event rates which is not included in proportional hazards regression models leads to biased estimates for included covariate effect estimates and lower power to test them whether the source of heterogeneity is assumed to be fixed or random. We demonstrate here using several post hoc analyses of clinical trials data that a potentially common problem may be that the non-randomized groups which are to be compared have differential variability in their event rates. We then show through simulation that such underlying heterogeneity which varies across the groups, when ignored in the modelling, can lead to an attenuated regression effect estimate for comparing the two groups to each other, lower rejection rates for the effect, and Wald-based confidence intervals with potentially much lower coverage than nominal. When the groups are not significantly different, but heterogeneity differs between them, an analysis ignoring the heterogeneity can even result in a significant negative comparison.

Clinical Trials as Topic↗

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

Sex differences in learning in chimpanzees.

The wild chimpanzees in Gombe National Park, Tanzania, fish for termites with flexible tools that they make out of vegetation, inserting them into the termite mound and then extracting and eating the termites that cling to the tool. Tools may be used in different ways by different chimpanzee communities according to the local chimpanzee culture. Here we describe the results of a four-year longitudinal field study in which we investigated how this cultural behaviour is learned by the community's offspring. We find that there are distinct sex-based differences, akin to those found in human children, in the way in which young chimpanzees develop their termite-fishing skills.

Age Factors↗

PubMed2004

Personal, indoor, and outdoor VOC exposures in a probability sample of children.

As part of the Minnesota Children's Pesticide Exposure Study we measured volatile organic compound (VOC) concentrations in a probability sample of households with children. The 6-day average concentrations for 10 common VOCs were obtained in urban and nonurban residences twice during this multiphase study: screening-phase indoor measurements were collected in 284 households, and in the intensive-phase matched outdoor (O), indoor (I), and personal (P) measurements were collected in a subset (N=72) of the screened households. Screening-phase households with smokers had significantly higher concentrations of benzene and styrene compared to nonsmoking households; households with an attached garage had significantly higher levels of benzene, chloroform, styrene, and m/p- and o-xylene compared to households without an attached garage; and nonurban residences, which had a greater prevalence of smokers and attached garages, had significantly higher 1,1,1-trichloroethane, styrene, and toluene and significantly lower tetrachloroethylene concentrations compared to urban households. The screening-phase weighted distributions estimate the mean and variability in indoor VOC concentrations for more than 45,000 households with children in the census tracts sampled. Overall, median indoor concentrations of most VOCs measured in this study were similar to or lower than indoor levels measured previously in the United States. Intensive-phase outdoor VOC concentrations were generally lower than other major metropolitan areas, but urban concentrations were significantly higher than nonurban concentrations for all compounds except 1,1,1-trichloroethylene. A consistent pattern of P>I>O was observed for nine of 10 VOCs, with 1,1,1-trichloroethylene (I>P>O) being the only exception to this pattern. For most children, the indoor at-home microevironment was strongly associated with personal exposure after controlling for important covariates, but the ratio of median to upper bound exposures was smaller than that observed in studies of adults. There are relatively little data on VOC exposures in children, so these results are useful for estimating the central tendency and distribution of VOC exposures in locations where children spend a majority of their time.

Air Pollutants↗

PubMed2004

Associations of smoking prevalence with individual and area level social cohesion.

STUDY OBJECTIVE: To discover if area level social cohesion, neighbourhood safety, and home safety are associated with current cigarette smoking among adults after adjustment for concentrations of poverty and low education. DESIGN: Cross sectional survey of a random sample of adults, stratified by 19 geographical areas. SETTING: SHAPE, Survey of the Health of Adults, the Population, and the Environment-conducted in 1998 by the Hennepin County Community Health Department and the Minneapolis Department of Health and Family Support in Minnesota. PARTICIPANTS: 5256 men and 4806 women, 18 years and older, randomly selected from 19 geographical areas in an urban county. MAIN RESULTS: Overall, 21.2% of survey respondents reported current cigarette smoking. Both higher area level social cohesion (OR = 0.85, 95% CI = 0.74 to 0.98) and higher individual social cohesion (OR = 0.96, 95% CI = 0.92 to 0.99) were associated with lower likelihoods of smoking. Similar models were obtained for neighbourhood safety and home safety. CONCLUSIONS: These findings contribute to the growing literature on the important role of social cohesion and other area level characteristics on smoking behaviour among adults.

Adolescent↗

PubMed2004

Multiple-stage screening and mortality in the Multiple Risk Factor Intervention Trial.

BACKGROUND: During the design phase of a clinical trial, sample size estimates should take into account medical screening criteria, the 'healthy volunteer' effect, consequences of run-in phases, and secular trends in the event rate of interest. All of these have been shown to relate to subsequent event rates, and hence trial power to detect intervention effects. The Multiple Risk Factor Intervention Trial (MRFIT) used three successive screenings of 361 662 men to enroll 12 866; observed coronary heart disease (CHD) mortality after a mean of 6.9 years was substantially lower than projected during design. We explore factors which may have contributed to these mortality differences and whether they persisted throughout follow-up. METHODS: Proportional hazards models were used to compare 25-year mortality according to trial eligibility, self-exclusions, medical exclusions, and participation. RESULTS: After adjustment for baseline risk factors and age, there was higher mortality among men excluded for presence of disease [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.43-1.61, for total; HR 1.92, CI 1.75-2.11, for CHD] compared to those not excluded which persisted throughout follow-up. Volunteers had lower total (HR 0.82, CI 0.76-0.87) and CHD (HR 0.79, CI 0.70-0.88) mortality than those discontinuing participation. Men excluded with characteristics deemed likely to interfere with adherence had higher total (HR 1.19, CI 1.07-1.33) and non-cardiovascular disease (CVD) (HR 1.32, CI 1.14-1.53) mortality but no higher CVD (HR 1.04, CI 0.88-1.23) or CHD (HR 0.98, CI 0.80-1.20) mortality compared to those not excluded. Differences in mortality were stronger during the first five years, but declined only slightly over 25 years. CONCLUSIONS: 25-year mortality was significantly higher for non-volunteers and exclusions. Differences between observed and predicted six-year total mortality for trial participants were largely attributable to volunteers and exclusions, but there were additional differences for CHD mortality, which were likely due to downward secular trends. These results emphasize the importance of anticipating these factors during clinical trial design, even for trials of short duration.

Adult↗

PubMed2003

Variations in product choices of frequently purchased herbs: caveat emptor.

BACKGROUND: Patients who report use of herbs to their physicians may not be able to accurately describe the ingredients or recommended dosage because the products for the same herb may differ. The purpose of this study was to describe variations in label information of products for each of the 10 most commonly purchased herbs. METHODS: Products for each of 10 herbs were surveyed in a convenience sample of 20 retail stores in a large metropolitan area. Herbs were those with the greatest sales dollars in 1998: echinacea, St John's wort, Ginkgo biloba, garlic, saw palmetto, ginseng, goldenseal, aloe, Siberian ginseng, and valerian. RESULTS: Each herb had a large range in label ingredients and recommended daily dose (RDD) across available products. Strengths were not directly comparable because of ingredient variability. Among 880 products, 43% were consistent with a benchmark in ingredients and RDD, 20% in ingredients only, and 37% were either not consistent or label information was insufficient. Price per RDD was a significant predictor of consistency with the benchmark, but store type was not. CONCLUSIONS: Persons self-medicating with an herb may be ingesting ingredients substantially different from that recommended by a benchmark, both in quantity and content. Higher price per label RDD was the best predictor of consistency with a benchmark. This study demonstrates that health providers and consumers need to closely examine label ingredients of presumably the same or similar herbal products.

Cross-Sectional Studies↗

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↗