PubMed Health⌕ Search

Biomedical subjects

R F Gillum

Publications and source records attributed to R F Gillum.

At least 19 recordsLinked to original sources
PubMed1995

Erythrocyte sedimentation rate and coronary heart disease: the NHANES I Epidemiologic Follow-up Study.

Erythrocyte sedimentation rate (ESR) is a simple and relatively inexpensive laboratory test. Data were examined to determine whether elevated ESR was a predictor of CHD incidence and death in a large U.S. national sample of persons aged 45-74 at baseline. In the NHANES I Epidemiologic Follow-up Study cohort, white men aged 45-64 years with ESR in the upper quintile at baseline had increased incidence of CHD (RR = 1.73, 95% CL 1.12, 2.68) over a 15 year follow-up after controlling multiple risk factors compared to white men with ESR in the lowest quintile. Furthermore, men aged 45-64 with ESR in the upper quintile had more than twice the risk of CHD death (RR = 2.73, 95% CL 1.21, 6.15) of men with ESR in the lowest quintile after adjusting other risk factors. No significant associations were seen in white women. The mechanism of this association is unclear. Further studies are needed to replicate this finding and elucidate the mechanism for this association in longitudinal studies in which plasma fibrinogen, HDL cholesterol, as well as ESR are measured.

Aged↗
PubMed1995

Epidemiology of aortic aneurysm in the United States.

Recent apparent increases in occurrence of aortic aneurysm were reported for abdominal aortic aneurysm from several countries. In order to assess U.S. trends, an analysis of mortality and hospitalization data from the National Center for Health Statistics for aortic aneurysm in the United States in 1979-1992 was performed. In 1991, 16,696 deaths were attributed to aortic aneurysm, abdominal aneurysm accounting for 52%. Between 1979 and 1990, dissecting aneurysm death rates showed inconsistent changes in males and slight increases in females. Age-adjusted rates were higher in blacks than whites, and in males than females. Death rates for abdominal aneurysms showed slight decreases in white males and slight increases in black males and white females. Rates were higher in whites than blacks, and in males than females. The number of hospital discharges with a first-listed diagnosis of aortic aneurysm increased from 39,000 in 1979 to 67,000 in 1992. The rate of diagnoses increased from 1979 to 1984 with no consistent change thereafter for total and abdominal aneurysms, which comprised over 75% of total diagnoses. The number of all-listed aortic aneurysm resections with graft replacement increased from 10,000 in 1979 to 40,000 in 1988 with no consistent change thereafter. Increased utilization of diagnostic ultrasound of the abdomen and retroperitoneum leading to improved case finding for abdominal aneurysms may have been one cause of increasing hospital discharge rates prior to 1985. Continued monitoring of national data on mortality and morbidity from aortic aneurysms is desirable to assess effects of diagnostic, therapeutic, and preventive interventions.

Adult↗
PubMed1995

The epidemiology of stroke in Native Americans.

BACKGROUND AND PURPOSE: Because of the paucity of published information, this report seeks to better characterize the pattern of stroke occurrence and risk factors among Native Americans in the United States. METHODS: Data from the US Vital Statistics System and two National Health and Nutrition Examination Surveys were analyzed. RESULTS: Stroke was a leading cause of death among US Native Americans in 1990. In persons aged 45 and over, stroke was the cause of 6% of deaths in Native Americans and 7% of deaths in whites. The percentage of stroke deaths due to hemorrhagic stroke was higher in Native Americans than whites. In 1988 through 1990, stroke death rates were similar in Native Americans and whites under age 65 but lower in Native Americans at ages 65 years and over. High prevalence of diabetes, smoking, and obesity may contribute to stroke mortality in Native Americans. CONCLUSIONS: Targeted research, innovative analyses of existing data, and use of ongoing surveys and the Census should be considered in the study of the epidemiology of stroke, other leading causes of death, and risk factors in Native Americans. Continued hypertension detection and treatment efforts are needed for Native Americans as for other groups. Smoking cessation and prevention should receive high priority in Native American populations.

Adolescent↗
PubMed1995

Epidemiology of stroke in Hispanic Americans.

BACKGROUND AND PURPOSE: In 1990 cerebrovascular disease was the fourth leading cause of death in Hispanics in the United States. However, little information has been published about the epidemiology of stroke in US Hispanic populations. METHODS: Data from the National Center for Health Statistics were examined to characterize the pattern of stroke occurrence and risk factors among Hispanics in the United States. RESULTS: In 1989 through 1991, stroke death rates were similar in Hispanics and whites aged 45 to 64 years; at ages 65 and over, Hispanics had rates that were substantially lower than those of whites. Data from national surveys suggest that the ethic differences in stroke mortality may be due in part to lower blood pressure in Hispanics than non-Hispanics. CONCLUSIONS: Cohort studies, well-designed case-control studies, and continued oversampling of Hispanics in national surveys are needed to further define the epidemiological patterns of stroke in US Hispanics and to guide stroke prevention efforts.

Adult↗
PubMed1995

Epidemiology of carotid endarterectomy and cerebral arteriography in the United States.

BACKGROUND AND PURPOSE: Results of North American and European trials of carotid endarterectomy published in 1991 may have affected the frequency of the procedure in the United States. Therefore, data from a national survey of hospital discharges were examined to determine whether rates of carotid endarterectomy and arteriography increased after 1991 and whether race and sex variations in rates have persisted. METHODS: Data from the National Hospital Discharge Survey were examined for the years 1980 through 1993. Estimated numbers of procedures performed in nonfederal US hospitals were used to compute rates per 100,000 population by year, age, race, and sex. RESULTS: In persons aged 65 years and over, the rate of carotid endarterectomy increased rapidly between 1980 and 1983 with a slight further increase through 1985. A marked fall in the rate occurred between 1985 and 1988, followed by a plateau and a sharp upturn in 1992. After 1985, there was a steady decline in the rate of cerebral arteriography procedures in hospital. No reliable data were available on outpatient cerebral arteriography. Throughout the period, whites had estimated rates of carotid endarterectomy procedures over four times higher than blacks. Whites also had higher rates of cerebral arteriography, but the disparity was not as great as for endarterectomy. Rates of carotid endarterectomy were 60% higher in men than women, but rates of cerebral arteriography were only 9% higher in men than women. CONCLUSIONS: Rates of carotid endarterectomy increased sharply after the 1991 publication of trial results. Marked racial disparities in the use of this procedure persist and require further evaluation.

Black or African American↗
PubMed1994

Relation between serum albumin concentration and stroke incidence and death: the NHANES I Epidemiologic Follow-up Study.

Relatively high serum albumin levels have been associated with reduced cardiovascular mortality and coronary heart disease incidence. No prospective studies have examined serum albumin and stroke mortality and incidence. Therefore, data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study were examined to assess serum albumin level as a risk factor for stroke. White men aged 65-74 years with serum albumin concentrations of > 4.4 g/dl had a risk of stroke incidence over a follow-up period of 9-16 years of only about two-thirds that of men with serum albumin concentrations of < 4.2 g/dl. This effect persisted after controlling for multiple stroke risk variables (relative risk = 0.61, 95% confidence interval 0.41-0.89). A similar association with stroke death was found in white men aged 65-74 years. Serum albumin was not associated with stroke risk in white women aged 65-74 years. In blacks aged 45-74 years, serum albumin concentrations of > 4.4 g/dl were associated with a risk of stroke incidence only one-half and a risk of stroke death only one-fourth that seen at levels < 4.2 g/dl after controlling other risk variables. Further studies are needed to confirm these findings and to elucidate mechanisms for the effect of serum albumin on stroke incidence and death.

Adult↗
PubMed1994

White blood cell count and stroke incidence and death. The NHANES I epidemiologic follow-up study.

A 1982 report (J Chronic Dis 1982;35:703-14) that a relatively high white blood cell (WBC) count predicted increased incidence of cerebral thrombosis could not establish whether this association was independent of smoking. Therefore, the authors examined data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, conducted in 1971-1987, to assess WBC count as a risk factor for stroke in a sample of the US population. White men with a WBC count of > 8,100 cells/mm3 had a 39% increase in age-adjusted stroke incidence compared with those with a WBC count of < 6,600 cells/mm3. However, controlling for cigarette smoking reduced the association and rendered it statistically nonsignificant (relative risk = 1.26, 95% confidence interval 0.93-1.70). No significant associations of WBC count with stroke incidence were seen in white women or in blacks. In white men, elevated WBC count may be a mediator of cardiovascular effects of smoking, an indicator of smoking exposure, or both. Further studies are needed to confirm these findings and to elucidate mechanisms for the effect of smoking and WBC count on stroke incidence and death.

Aged↗
PubMed1994

Body iron stores and the risk of coronary heart disease.

BACKGROUND: Recent studies have suggested an association between higher body iron stores and the risk of coronary heart disease. To assess these findings, we examined the association between transferrin saturation and the risk of coronary heart disease, myocardial infarction, overall mortality, and mortality from cardiovascular causes in a large population. METHODS: We studied a total of 4518 men and women from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, using a multivariate Cox proportional-hazards model. Base-line data were collected from 1971 to 1974, with follow-up through 1987. Transferrin saturation (serum iron concentration divided by total iron-binding capacity) was used as a measure of the amount of circulating iron available to tissues. RESULTS: The risk of coronary heart disease was not related to transferrin-saturation levels in white men or women. Estimates of the relative risk of coronary heart disease for the fifth quintile of transferrin saturation as compared with the first quintile were 0.72 (95 percent confidence interval, 0.51 to 1.00) for men and 0.85 (95 percent confidence interval, 0.60 to 1.21) for women. The results were similar for myocardial infarction. A significant inverse association with transferrin saturation was found for overall mortality and for mortality from cardiovascular causes in white men and women. Transferrin saturation was not associated with any of the clinical outcomes in blacks, possibly owing to the small sample. CONCLUSIONS: Higher transferrin-saturation levels were not associated with an increased risk of coronary heart disease or myocardial infarction. On the contrary, the results indicate that there may be an inverse association of iron stores with overall mortality and with mortality from cardiovascular causes.

Adult↗
PubMed1994

Epidemiology of congenital heart disease in the United States.

Data from the National Center for Health Statistics were examined to aid in assessing the burden of congenital heart disease in the United States. In 1979 through 1988 combined, 46,450 deaths were attributed to CHD, 26,319 occurring in the first year of life. Another 14,283 deaths were attributed to other congenital anomalies of the circulatory system. In 1988 through 1990 combined, there were > 300,000 hospital discharges with any diagnosis of CHD, with 2.7 million days of care provided. For infants aged < 1 year, the rate was 13.7 per 1000 live births per year. Another 242,049 discharges had any diagnosis of other congenital circulatory anomalies. In 1983 through 1985, > 700,000 persons reported a history of CHD. In 1989, heart malformations were reported on the birth certificate of 4621 live births in 45 states and the District of Columbia. In 1988 through 1990 there were an estimated 37,445 repairs of atrial and ventricular septa. In addition, 45,635 cardiac catheterizations were performed in patients aged < 5. Average annual percentage declines in infant mortality rates for the period 1979 through 1988 were consistent with an effect of improvements in surgical technique and intensive care. The average annual infant mortality rate for hypoplastic left heart syndrome increased 1.3%, and rates for five causes amenable to treatment such as transposition of great vessels declined. Infant mortality rates in nonmetropolitan areas were higher than in metropolitan areas, suggesting that limited access to care might be associated with mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1994

Trends in acute myocardial infarction and coronary heart disease death in the United States.

Coronary heart disease accounted for 489,171 deaths in 1990. Age-adjusted death rates decreased faster between 1976 and 1990 for white men than for white women or blacks. Out of hospital death rates for coronary heart disease decreased in the 1980s. Hospital fatality rates for acute myocardial infarction continued a long-term decrease through 1990. Trends in risk factors and invasive procedures support the conclusion that risk factor reduction has resulted in reduced incidence of acute myocardial infarction and sudden coronary death and that improvements in medical care have resulted in a continued decrease in acute myocardial infarction fatalities and overall coronary deaths.

Age Distribution↗
PubMed1994

White blood cell count and hypertension incidence. The NHANES I Epidemiologic Follow-up Study.

To test the hypothesis that elevated white blood cell count (WBC) is associated with increased incidence of essential hypertension, data from the NHANES I Epidemiologic Follow-up Study (NHEFS) were analyzed. Incidence of hypertension was determined in a cohort of 5782 white and 674 black persons with complete data who were normotensive at baseline. There was a statistically significant increase of about 50% in risk of hypertension over approximately 10 years' follow-up in white men aged 25-74 years with WBC > 8600 compared to men with WBC < 6200 cells/mm3. The association was independent of other risk variables. In white women, an association of high WBC with increased age-adjusted risk of hypertension was seen only at ages 45-64 and 65-74 years. The association was diminished and no longer significant after controlling for multiple risk variables. Data for black women suggested an increased risk among women with higher WBC compared to those with lower WBC at ages 65-74 after controlling other risk variables (p = 0.0001). No positive association was seen in black men. Thus, data from NHEFS confirm the previously reported association of higher WBC with increased incidence of hypertension in white men, and possibly older white and black women. Given the lack of a compelling biological explanation, further studies of this association are needed, especially in women and blacks.

Adolescent↗
PubMed1994

Prevalence of cardiovascular and pulmonary diseases and risk factors by region and urbanization in the United States.

Cardiovascular and pulmonary mortality rates vary among US regions and places of varying levels of urbanization. Morbidity rarely has been analyzed within regions by urbanization level. Therefore, data from the National Health Interview Survey were examined for geographic patterns for 1983 through 1987. The most consistent finding was high rates of self-reported cardiovascular disease in non-metropolitan areas of the South. Otherwise, geographic variation of rates of self-reported disease prevalence with region and urbanization was not consistent across age and sex groups. Nor did rates consistently parallel patterns reported for mortality, with the exception of high rates in the nonmetropolitan South and relatively low rates in some groups in metropolitan areas outside central cities. Heart disease and ischemic heart disease patterns did not parallel patterns of high blood pressure, smoking, or low education, except for the tendency of all to be high in the nonmetropolitan South. In white men aged 45 to 64, the ischemic heart disease prevalence rate in the nonmetropolitan South was nearly twice that in the West or in the metropolitan Northeast. In blacks, rates of heart disease were lowest in metropolitan areas outside central cities and similar in central cities and nonmetropolitan areas. In the South, a similar pattern was seen in the only region with adequate numbers of nonmetropolitan-dwelling blacks in the sample. In blacks aged 45 to 64, rates of high blood pressure were lowest in metropolitan areas outside central cities and highest in nonmetropolitan areas, with little variation among regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Black or African American↗