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Biomedical subjects

P McKeigue

Publications and source records attributed to P McKeigue.

16 recordsLinked to original sources
PubMed2006

Systemic lupus erythematosus: genes versus environment in high risk populations.

The risks of systemic lupus erythematosus (SLE) are known to vary considerably with ethnic origin. Prevalence of lupus is increased in African-American, Afro-Caribbean, Native American, Asian Indian, Polynesian and Chinese populations compared with people of European descent. The consistency with which high prevalence of lupus occurs in these populations descent living in different environments suggests that genetic factors are likely to underlie the high risk in this group. However the increased risk of lupus in high risk groups such as West Africans compared with Europeans does not appear to be accounted for by differences in allele frequencies at any of the loci where associations with SLE have been found, including those in the HLA region. To date the contribution of environmental factors to a complex disease such as lupus is still not fully understood. This article explores possible environmental risk factors for SLE in high risk ethnic groups. Smoking, occupational exposures to silica and exposure to infection in childhood may explain some non-genetic risk factors for SLE in these groups.

Clinical Trials as Topic↗
PubMed2000

Risk for rheumatic disease in relation to ethnicity and admixture.

Risk of systemic lupus erythematosus (SLE) is high in west Africans compared with Europeans, and risk of rheumatoid arthritis (RA) is high in Native Americans compared with Europeans. These differences are not accounted for by differences in allele or haplotype frequencies in the human leucocyte antigen (HLA) region or any other loci known to influence risk of rheumatic disease. Where there has been admixture between two or more ethnic groups that differ in risk of disease, studies of the relationship of disease risk to proportionate admixture can help to distinguish between genetic and environmental explanations for ethnic differences in disease risk and to map the genes underlying these differences.

Africa↗
PubMed2000

Prevalence of excessive gambling before and after introduction of a national lottery in the United Kingdom: another example of the single distribution theory.

BACKGROUND: According to the single distribution theory advocated by Rose, the prevalence of a deviant condition such as excessive alcohol consumption depends upon the average level of the corresponding characteristic in the population. The objective of this study was to establish whether the single distribution theory applies to gambling behaviour. METHODS: Household gambling expenditure in the United Kingdom was examined using Family Expenditure Survey data collected before and after the introduction of a national lottery in November 1994. RESULTS: In cross-sectional analyses, the mean (or median) household expenditure on gambling for each region predicted the prevalence of excessive gambling in that region: the slope of the relationship in 1995-96 was equivalent to an increase of 1.2 (95% CI 0.7-1.7) points in the percentage of households gambling more than 10% of income for every increase of 1 Pound in mean household gambling expenditure. The introduction of the national lottery was associated with an increase in mean household gambling expenditure from 1.45 Pounds to 3.81 Pounds per week, and an increase in the proportion of households gambling more than 10% of total income four-fold from 0.4% to 1.7%. Among households with income of less than 200 Pounds/week, the proportion gambling more than 10% of their income increased from 0.6% to 3.2%. INTERPRETATION: The single distribution theory applies to gambling behaviour. The increase in average gambling expenditure associated with the introduction of a national lottery in the United Kingdom has led to a pronounced increase in the prevalence of excessive gambling, especially in low-income households. This is likely to increase the prevalence of gambling disorders and to exacerbate social inequalities in health.

Cross-Sectional Studies↗
PubMed2000

Cardiovascular disease in women with polycystic ovary syndrome at long-term follow-up: a retrospective cohort study.

OBJECTIVE: Polycystic ovary syndrome (PCOS) is associated with higher prevalence of cardiovascular risk factors but the relative prevalence of cardiovascular disease in women with PCOS has not previously been reported. We have compared cardiovascular mortality and morbidity in middle-aged women previously diagnosed with PCOS and age-matched control women. DESIGN: A retrospective cohort study of women diagnosed with PCOS in the United Kingdom before 1979. PATIENTS: Seventy cohort members died before 31 March 1999. Morbidity data were collected from 319 women with PCOS and 1060 age-matched control women. Sixty-one women with PCOS and 63 control women attended a clinical examination. MEASUREMENTS: Data were collected from death certificates, general practitioners' records and questionnaires with measurement of cardiovascular risk factors in a subsample of questionnaire respondents. RESULTS: All-cause and cardiovascular mortality in the cohort were similar to women in the general population (standardized mortality ratios (95% CI): 93 (72-117) and 78 (45-124), respectively). Women with PCOS had higher levels of several cardiovascular risk factors: diabetes (P = 0.002) hypertension (P = 0.04), hypercholesterolaemia (P < 0.001), hypertriglyceridaemia (P = 0.02) and increased waist:hip ratio (P = 0.004). After adjustment for BMI, odds ratios (OR) were 2.2 (0.9-5. 2) for diabetes, 1.4 (0.9-2.0) for hypertension and 3.2 (1.7-6.0) for hypercholesterolaemia. A history of coronary heart disease (CHD) was not significantly more common in women with PCOS (crude OR (95%CI) 1.5 (0.7-2.9)) but the crude OR for cerebrovascular disease was 2.8 (1.1-7.1). CONCLUSION: At long-term follow-up, a history of nonfatal cerebrovascular disease and cardiovascular risk factors including diabetes are more prevalent among women with polycystic ovary syndrome. Morbidity and mortality from of coronary heart disease among women with polycystic ovary syndrome is not as high as previously predicted. This finding challenges our understanding of the aetiology of coronary heart disease in women.

Aged↗
PubMed1998

Plasminogen activator inhibitor-1 activity is independently related to both insulin sensitivity and serum triglycerides in 70-year-old men.

Increased levels of plasminogen activator inhibitor-1 (PAI-1) have been discussed as a part of the insulin resistance syndrome. However, it is not clear whether the relationship between PAI-1 and insulin resistance is independent of or mediated by increased triglycerides levels. The aim of this study was to investigate whether PAI-1 activity is associated with insulin sensitivity independently of serum triglycerides (sTG) and of other potential confounders. Seventy-year-old men (n=871), participating in a cohort study undergoing extensive metabolic investigations, had blood samples taken for determination of PAI-1 activity. Insulin sensitivity was determined by the euglycemic hyperinsulinemic clamp. In multivariate correlation and regression analyses, insulin sensitivity was a statistically significant determinant of PAI-1 activity (partial r=-.12; P<.001), independent of sTG, body mass index, waist-hip ratio, and other potential confounders. The levels of sTG were also independently related to PAI-1 activity (partial r=.18; P<.001). The relationships between PAI-1 and insulin sensitivity and sTG were independent of fasting glucose levels. Aggregation of risk factors of the insulin resistance syndrome was associated with increased activity of PAI-1 in men with normal glucose tolerance. We conclude that PAI-1 activity is related to insulin sensitivity and sTG, independently of each other and of other potential confounders, and that increased levels of PAI-1 should be regarded as a component of the insulin resistance syndrome.

Aged↗
PubMed1997

Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92.

OBJECTIVE: To compare mortalities for selected groups of immigrants with the national average. DESIGN: Analysis of mortality for adults aged 20-69 in 1970-2 and 1989-92 using population data from 1971 and 1991 censuses. Mortality of Scottish and Irish immigrants aged 25-74 was also compared with mortality in Scotland and Ireland for 1991. SETTING: England and Wales. MAIN OUTCOME MEASURES: Standardised mortality ratios for deaths from all causes, ischaemic heart disease, cerebrovascular disease, lung cancer, and breast cancer. RESULTS: In 1989-92 mortality from all causes was higher than the national average for Scottish immigrants, by 32% for men and 36% for women; for Irish immigrants it was higher by 39% for men and 20% for women; and for Caribbean born men it was lower by 23%. Ischaemic heart disease and lung cancer accounted for 30-40% of the excess mortality in Scottish and Irish immigrants. For south Asians, excess mortality from circulatory disease was balanced by lower mortality from cancer. Standardised mortality ratios for cerebrovascular disease in 1989-92 were highest for west African immigrants (271 for men and 181 for women). CONCLUSIONS: Widening differences in mortality ratios for migrants compared with the general population were not simply due to socioeconomic inequalities. The low mortality from all causes for Caribbean immigrants could largely be attributed to low mortality from ischaemic heart disease, which is unexplained. The excess mortality from cerebrovascular and hypertensive diseases in migrants from both west Africa and the Caribbean suggests that genetic factors underlie the susceptibility to hypertension in people of black African descent.

Adult↗