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Martin G Larson

Publications and source records attributed to Martin G Larson.

98 records · Page 6Linked to original sources
PubMed2002

Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study.

CONTEXT: The long-term risk for developing hypertension is best described by the lifetime risk statistic. The lifetime risk for hypertension and trends in this risk over time are unknown. OBJECTIVES: To estimate the residual lifetime risk for hypertension in older US adults and to evaluate temporal trends in this risk. DESIGN, SETTING, AND PARTICIPANTS: Community-based prospective cohort study of 1298 participants from the Framingham Heart Study who were aged 55 to 65 years and free of hypertension at baseline (1976-1998). MAIN OUTCOME MEASURES: Residual lifetime risk (lifetime cumulative incidence not adjusted for competing causes of mortality) for hypertension, defined as blood pressure of 140/90 mm Hg or greater or use of antihypertensive medications. RESULTS: The residual lifetime risks for developing hypertension and stage 1 high blood pressure or higher (greater-than-or-equal to 140/90 mm Hg regardless of treatment) were 90% in both 55- and 65-year-old participants. The lifetime probability of receiving antihypertensive medication was 60%. The risk for hypertension remained unchanged for women, but it was approximately 60% higher for men in the contemporary 1976-1998 period compared with an earlier 1952-1975 period. In contrast, the residual lifetime risk for stage 2 high blood pressure or higher (greater-than-or-equal to 160/100 mm Hg regardless of treatment) was considerably lower in both sexes in the recent period (35%-57% in 1952-1975 vs 35%-44% in 1976-1998), likely due to a marked increase in treatment of individuals with substantially elevated blood pressure. CONCLUSION: The residual lifetime risk for hypertension for middle-aged and elderly individuals is 90%, indicating a huge public health burden. Although the decline in lifetime risk for stage 2 high blood pressure or higher represents a major achievement, efforts should be directed at the primary prevention of hypertension.

Antihypertensive Agents↗
PubMed2002

Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study.

BACKGROUND: Although excessive alcohol consumption can promote cardiomyopathy, little is known about the association between alcohol consumption and risk for congestive heart failure in the community. OBJECTIVE: To determine the relation between alcohol consumption and risk for congestive heart failure in the community. DESIGN: Community-based, prospective observational study. SETTING: Framingham, Massachusetts. PARTICIPANTS: Participants in the Framingham Heart Study who were free of congestive heart failure and coronary heart disease. MEASUREMENTS: Self-reported alcohol consumption; sex-specific rates of congestive heart failure per 1000 person-years of follow-up by level of alcohol consumption. RESULTS: In men, 99 cases of congestive heart failure occurred during 26 035 person-years of follow-up. In women, 120 cases of congestive heart failure occurred during 35 563 person-years of follow-up. After adjustment for multiple confounders, risk for congestive heart failure was lower among men at all levels of alcohol consumption compared with men who consumed less than 1 drink/wk. The hazard ratio for congestive heart failure was lowest among men who consumed 8 to 14 drinks/wk (0.41 [95% CI, 0.21 to 0.81]) compared with those who consumed less than 1 drink/wk. In women, the age-adjusted hazard ratio for congestive heart failure was lowest among those who consumed 3 to 7 drinks/wk (0.49 [CI, 0.25 to 0.96]) compared with those who consumed less than 1 drink/wk. However, after adjustment for multiple predictors of congestive heart failure, this association was no longer statistically significant. CONCLUSIONS: In the community, alcohol consumption is not associated with increased risk for congestive heart failure, even among heavy drinkers (> or = 15 drinks/wk in men and > or = 8 drinks/wk in women). To the contrary, when consumed in moderation, alcohol appears to protect against congestive heart failure.

Adult↗
PubMed2002

Serum potassium is not associated with blood pressure tracking in the Framingham Heart Study.

BACKGROUND: Abnormal potassium homeostasis accompanies many secondary forms of hypertension as well as uncommon inherited, monogenic forms of hypertension. We hypothesized that serum potassium may be associated with longitudinal tracking of blood pressure (BP) and development of hypertension. METHODS: A total of 2358 participants (1292 women, 1066 men) in the Framingham Heart Study who were free of hypertension, were not taking drugs affecting potassium homeostasis, and had serum potassium measured in 1979 to 1983 were followed for longitudinal tracking of BP and development of hypertension at examination 4 years later. Progression of BP stage was defined as an increment of one or more BP category, as defined by the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI), between baseline and follow-up examinations. RESULTS: At baseline, there were no differences in systolic or diastolic BP across serum potassium quartiles. Over 4 years of follow up, 37% (457 women, 412 men) of subjects progressed by one or more JNC-VI BP category. In a logistic regression model adjusting for multiple confounders, serum potassium quartile was not associated with risk of BP progression. During follow-up, 14% (162 women, 175 men) of subjects progressed to hypertension. After adjustment for multiple confounders, there was no significant association between serum potassium quartile and risk for progression to hypertension. CONCLUSIONS: In our community-based study sample, serum potassium was not associated with current BP, longitudinal BP tracking, or progression to hypertension.

Adult↗
PubMed2002

Genetic variability of adult body mass index: a longitudinal assessment in framingham families.

OBJECTIVE: To explore the contribution of genetics to the mean, SD, maximum value, maximum less the mean, and change over time in body mass index (BMI) and the residual of body weight after adjustment for height. BMI is frequently used as a general indicator of obesity because of its ease and reliability in ascertainment. Cross-sectional twin and family studies have shown a moderate-to-substantial genetic component for BMI. However, the contribution of genetics to the long-term average, variability, or change over time in BMI is less clear. RESEARCH METHODS AND PROCEDURES: Longitudinal data from the Framingham heart study were used to create pedigrees of age-matched individuals. Heritability estimates were derived using variance-decomposition methods on a total of 1051 individuals from 380 extended pedigrees followed for a period of 20 years. All subjects were followed from approximately age 35 to 55 years. RESULTS: Moderate heritability estimates were found for the mean BMI (h(2) = 0.37), maximum BMI (h(2) = 0.40), and the mean residual of body weight (h(2) = 0.36). Low heritability estimates (h(2) congruent with 0.20) were found for the maximum less the mean in BMI and the SDs of BMI and residual of body weight. No additive genetic contribution was found for the average change over time in BMI or the residual of body weight. DISCUSSION: These findings suggest that there is a significant genetic component for the magnitude of BMI throughout an individual's middle-adult years; however, little evidence was found for a genetic contribution to the variability or rate of change in an individual's BMI.

Adult↗
PubMed2002

Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study.

BACKGROUND: Peripheral arterial disease (PAD) is associated with an increased risk for mortality. We sought to assess the prevalence of PAD and its risk factors in a population-based sample. METHODS: We examined 1554 males and 1759 females with a mean age of 59 years who attended a Framingham Offspring Study examination from 1995 to 1998. PAD was defined by an ankle-brachial blood pressure index of <0.9. Age- and sex-adjusted and multivariable logistic regression analyses were performed to identify factors associated with PAD. RESULTS: The prevalences of PAD, current intermittent claudication, lower extremity bruits and surgical intervention were 3.9%, 1.9%, 2.4% and 1.4% in males and 3.3%, 0.8%, 2.3% and 0.5% in females. Hypercholesterolemia, high-density lipoprotein cholesterol, triglyceride, diabetes, hypertension, current smoking, pack-years of smoking, body mass index, fibrinogen, and prevalent coronary disease were associated with PAD in age- and sex-adjusted analyses. Odds ratios and 95% CIs for significant associations identified from multivariable analyses are as follows: each 10 years of age, 2.6 (2.0, 3.4); hypertension, 2.2 (1.4, 3.5); smoking, 2.0 (1.1, 3.4); 10 pack-years of smoking, 1.3 (1.2, 1.4); 50 mg/dL of fibrinogen, 1.2 (1.1, 1.4); 5 mg/dL of high-density lipoprotein, 0.9 (0.8, 1.0); coronary disease, 2.6 (1.6, 4.1). CONCLUSIONS: Smoking cessation and hypertension control are important goals in the aim to reduce PAD and its associated impact on quality of life, functional decline, and risk for subsequent cardiovascular disease.

Adult↗
PubMed2002

Treatment and control of hypertension in the community: a prospective analysis.

Cross-sectional national data indicate poor levels of treatment and control of hypertension. We identified factors that prospectively predict initiation of antihypertensive therapy and attainment of blood pressure control in the community. We included all Framingham Heart Study subjects examined between 1987 and 1999 who had untreated or uncontrolled hypertension (systolic > or =140 or diastolic > or =90 mm Hg) at a baseline examination and presented for follow-up examination 4 years later. Clinical covariates were examined for their association with initiation or control at follow-up. Among 1103 hypertensive participants who were untreated at baseline, 350 (31.7%) subjects were receiving therapy at follow-up, including 25.7% of subjects with stage 1 and 51.2% of those with stage > or =2 hypertension at baseline. Multivariate predictors of initiation of therapy included higher systolic and diastolic pressure, prevalent and interim cardiovascular disease, and left ventricular hypertrophy. Other cardiovascular risk factors did not predict initiation of treatment. Among 2475 hypertensive participants who were uncontrolled (treated or untreated) at baseline, 988 (39.9%) were controlled at follow-up. Prevalent cardiovascular disease and interim initiation of therapy predicted control; older age and higher baseline systolic levels predicted lack of control. These data provide estimates of longitudinal rates of treatment and control of hypertension in the community. It appears that global risk was not taken into consideration when making decisions for initiation of therapy. Greater emphasis is needed on achieving blood pressure control in all patients but particularly among older subjects and those with systolic hypertension.

Adult↗
PubMed2002

Coronary artery calcification in type 2 diabetes and insulin resistance: the framingham offspring study.

OBJECTIVE: To assess risk for subclinical coronary atherosclerosis using electron beam- computed tomography in subjects with or without insulin resistance and with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT/impaired fasting glucose [IFG]) or type 2 diabetes. RESEARCH DESIGN AND METHODS: We categorized glucose tolerance by type 2 diabetes therapy (diagnosed diabetes) or with an oral glucose tolerance test (OGTT) (IFG, IGT, and OGTT-detected diabetes) and insulin resistance as an elevated fasting insulin level, in subjects attending the fifth examination (1991-1995) of the Framingham Offspring Study. A representative subset of subjects without clinical atherosclerosis was selected for electron beam computed tomography in 1998-1999 from age- and sex-stratified quintiles of the Framingham risk score. The presence of subclinical atherosclerosis was defined as the upper quartile of the Agatston score distribution (score > 170). We assessed risk for subclinical atherosclerosis using multivariable logistic regression. RESULTS: Of 325 subjects aged 31-73 years, 51% were men, 11.2% had IFG/IGT, and 9.9% had diabetes (2.8% with diagnosed diabetes); 14.5% had insulin resistance. Compared with NGT, subjects with IFG/IGT tended to be more likely (adjusted odds ratio 1.5, 95% CI 0.7-3.4) and those with diabetes were significantly more likely (2.7, 1.2-6.1) to have subclinical coronary atherosclerosis. In age- and sex-adjusted models, subjects with insulin resistance were more likely to have subclinical atherosclerosis than those without insulin resistance (2.1, 1.01-4.2), but further risk factor adjustment weakened this association. In adjusted models including insulin resistance, diabetes remained associated with risk for subclinical atherosclerosis (2.8, 1.2-6.7); diagnosed diabetes (6.0, 1.4-25.2) had a larger effect than OGTT-detected diabetes (2.1, 0.8-5.5). CONCLUSIONS: Individuals with diabetes have an elevated burden of subclinical coronary atherosclerosis. Aggressive clinical atherosclerosis prevention is warranted, especially in diagnosed diabetes.

Adult↗