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Biomedical subjects

R F Gillum

Publications and source records attributed to R F Gillum.

At least 37 records · Page 2Linked to original sources
PubMed2000

Diabetes mellitus, coronary heart disease incidence, and death from all causes in African American and European American women: The NHANES I epidemiologic follow-up study.

Few data are available on risk for coronary heart disease in African American women with diabetes mellitus, a well-established coronary risk factor in European American women. This study tests the hypothesis that medical history of diabetes predicts coronary heart disease incidence in African American women in a national cohort. Participants in the NHANES I Epidemiologic Follow-up Study in this analysis were 1035 African American and 5732 European American women aged 25-74 years without a history of coronary heart disease. Average follow-up for survivors was 19 years (maximum 22 years). Risk of incident coronary heart disease by baseline diabetes status was estimated. Proportional hazards analyses for African American women aged 25-74 revealed significant associations of coronary heart disease risk with diabetes after adjusting for age (RR = 2.40; 95% CI, 1.58-3.64, P < 0.01). After adjusting for age, smoking, and low education, there was an elevated risk in diabetics age 25-74 (RR = 2. 34; 95% CI, 1.54-3.56, P < 0.01); this association did not differ significantly from that for European American women. Excess coronary incidence in African American compared to European American women aged 25-64 was statistically explained by controlling for diabetes history, age, education, and smoking but only partly explained by age and diabetes history. In African American women aged 25-74, diabetes was also associated with increased coronary heart disease, cardiovascular, and all-cause mortality. The population attributable risk of coronary heart disease incidence associated with a medical history of diabetes was 8.7% in African American women and 6.1% in European American women. Medical history of diabetes was a significant predictor of coronary heart disease incidence and mortality in African American women and explained some of the excess coronary incidence in younger African American compared to European American women.

Adult↗
PubMed2000

Geographic variation in stroke risk in the United States. Region, urbanization, and hypertension in the Third National Health and Nutrition Examination Survey.

BACKGROUND: In the United States, stroke mortality is higher in the south than in other regions. Hypertension is the main risk factor for stroke among older adults; however, few studies have examined group-specific regional and urbanization differences in hypertension prevalence. METHODS: Data from the Third National Health and Nutritional Examination Survey (NHANES III), 1988 to 1994, were analyzed to calculate the prevalence of hypertension (systolic >140 mm Hg and/or diastolic >90 mm Hg and/or taking antihypertensive medication) by region and urbanization for age (40 to 59 and 60 to 79 years), sex, and ethnic subgroups. Logistic regression models were fitted to estimate the association of hypertension with region and urbanization. RESULTS: With age and urbanization kept constant, southern residence was associated with hypertension among middle-aged non-Hispanic white men (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.12 to 1.90; P<0.006), non-Hispanic black men (OR, 1.36; 95% CI, 1.05 to 1.66; P=0.019), and non-Hispanic black women (OR, 1.23; 95% CI, 1.01 to 1.45; P=0.034). Among older non-Hispanic white men, a significant interaction was noted between region and urbanization (P=0.01), with a higher prevalence in the south only for nonmetropolitan residents (OR, 1.32; 95% CI, 1.06 to 1.56; P<0.013). A similar but not statistically significant trend was also confirmed among non-Hispanic black men in logistic regression analysis (OR, 1.38; 95% CI, 0.97 to 1.68; P=0.061). No statistically significant association was observed for urbanization or region in the other subgroups. CONCLUSIONS: Southern residence was associated with increased hypertension prevalence among middle-aged non-Hispanic white men, non-Hispanic black men and women, and older non-Hispanic white men.

Adult↗
PubMed2000

Assessment of serum albumin concentration as a risk factor for stroke and coronary disease in African Americans and whites.

Relatively high serum albumin levels compared to low levels have been associated with reduced cardiovascular mortality and coronary heart disease and stroke incidence. The nature of these associations remains undefined. Therefore, widely accepted criteria of Bradford Hill were used to assess the likelihood that the association is a causal one. These criteria were applied to the findings of published studies of serum albumin and risk of cardiovascular disease. Favoring a causal association are lack of temporal ambiguity in cohort studies, consistency of findings among studies and biologically plausible mechanisms. Not favoring a causal association are lack of specificity of the association, and inconsistency among age-, sex-groups. Further studies are needed to elucidate mechanisms for the effect of serum albumin on incidence of cardiovascular disease and death.

Biomarkers↗
PubMed1999

Risk factors for stroke in blacks: a critical review.

Stroke is the third leading cause of death in US Blacks and is an important cause of mortality and morbidity worldwide. Mortality rates are higher in Blacks than in Whites in the United States at ages below 70 years. In Blacks, advanced age, elevated blood pressure, diabetes mellitus, and smoking are the only risk factors for stroke whose status has been firmly established by published data. More data are needed to assess other likely risk factors of importance for risk stratification and intervention and to determine the fraction of racial differences in stroke that may be explained by risk factor differences. Higher prevalences of hypertension, diabetes, obesity (in women), elevated lipoprotein(a) level, smoking (in men), and low socioeconomic status may contribute to the higher stroke incidence and mortality in US Blacks as compared with Whites. However, further environmental influences must be studied and candidate genes identified before assuming that racial differences can be attributed to inborn susceptibility linked to inheritance of specific genes.

Black People↗
PubMed1999

Distribution of waist-to-hip ratio, other indices of body fat distribution and obesity and associations with HDL cholesterol in children and young adults aged 4-19 years: The Third National Health and Nutrition Examination Survey.

BACKGROUND: Little data has been published on the association of indices of body fat distribution and HDL cholesterol (HDL), a risk factor for cardiovascular morbidity, in representative samples of total populations of children and adolescents including blacks and Hispanics. OBJECTIVE: To describe the distribution of waist-to-hip ratio (WHR) in US children and adolescents and to assess the association with HDL. DESIGN: Cross-sectional survey of a large national sample, the Third National Health and Nutrition Examination Survey. PARTICIPANTS: People aged 4-19 y. MEASUREMENTS: Body circumferences, skinfold thickness, body mass index (BMI), and serum total and HDL cholesterol concentrations. RESULTS: Mean WHR varied consistently with age, gender, and ethnic group. Levels were highest in Mexican Americans. WHR showed significant negative associations with HDL cholesterol concentration and positive associations with the ratio of total serum cholesterol to HDL in pre- and postpubertal girls independent of age and BMI. However, associations were often not as strong as those with BMI. Other indices of body fat distribution were not superior to WHR. CONCLUSION: Further research is needed on the association of WHR, other indices of body fat distribution and HDL measured in childhood with subsequent risk of atherosclerosis.

Adolescent↗
PubMed1999

Stroke mortality in blacks. Disturbing trends.

BACKGROUND: Despite long-term declines in US stroke mortality rates, declines have slowed in the past decade and targets for blacks for the years 2000 and 2010 seem attainable only by extraordinary measures, if at all. This review focuses attention on key aspects of this problem. Data from the US National Center for Health Statistics and reports of population-based studies of stroke mortality published since 1987 retrieved by computerized literature searches were reviewed. SUMMARY OF REVIEW: The third leading cause of death in black women and the sixth in black men in the United States in 1996, stroke accounted for 10 509 deaths in women and 7972 in men among blacks: 7.92% and 5.33%, respectively, of the total deaths. Age-adjusted death rates per 100 000 were black women, 39.2; white women, 22.9; black men, 50.9; and white men, 26.3. Available data indicate that compared with US whites, US blacks have greater mortality rates for every stroke subtype, with the likely exception of cerebral infarction due to extracranial carotid artery occlusion. These differences will persist into the 21st century. The number of stroke deaths in blacks increased by >8% between 1992 and 1996. CONCLUSIONS: Increased research on stroke in blacks is needed to develop more effective strategies for primary and secondary prevention of stroke to reduce the high burden of premature mortality and morbidity. Renewed efforts to prevent and control stroke risk factors (in particular elevated blood pressure, diabetes, and smoking) are needed among US blacks.

Black People↗
PubMed1999

Geographic variation in cardiovascular disease mortality in US blacks and whites.

Cardiovascular disease mortality rates have dropped significantly over the past several decades, but a shift has occurred over time in the geographic patterns of both coronary heart disease (CHD) and stroke mortality. This article describes these patterns and discusses how they vary by sex, race, age, and over time. Death certificate information for Health Service Areas (HSAs) in 1988-1992 was used to analyze the geographic patterns of CHD and stroke death rates by race, sex, and age. Changes in these patterns from 1979-1993 also were examined. In 1988-1992, considerable geographic variation in both CHD and stroke mortality was demonstrated for each sex and race group. Coronary heart disease rates were particularly high in the lower Mississippi valley and Oklahoma for all four groups, in the Ohio River valley and New York for whites, and to a lesser extent for blacks. Areas of high rates among whites in the Carolinas resemble stroke mortality patterns. There were greater differences by racial group than by gender, by the definition of heart disease. Over time, rates have declined for both CHD and stroke, but regional differences in the rates of change give the appearance of a southwesternly movement of high heart disease rate clusters and a breakup of the "Stroke Belt." Further research is needed to elucidate the cause of regional variation in CHD and stroke mortality. Similar geographic patterns of high rates of CHD and stroke in the southeastern United States may reflect common risk factors. This knowledge can be used to help develop appropriate interventions to target these high-rate areas in the Mississippi and Ohio River valleys.

Adult↗
PubMed1998

Baseline serum total cholesterol and coronary heart disease incidence in African-American women (the NHANES I epidemiologic follow-up study). National Health and Nutrition Examination Survey.

Proportional-hazards analyses for African-American women aged 25 to 74 revealed a variable association of coronary heart disease risk with baseline serum total cholesterol (after adjusting for age fifth vs first quintile: RR = 1.62, 95% confidence interval [CI] 0.89 to 2.98, p = 0.12; after adjusting for age, systolic blood pressure, body mass index, smoking, history of diabetes, low education, and low family income: RR = 1.88, 95% CI 1.02 to 3.45, p = 0.04). Perhaps due to the relatively small number of events, the association of serum total cholesterol with coronary heart disease incidence in African-American women was not consistently significant.

Adult↗
PubMed1998

Association of serum albumin concentration, serum ionized calcium concentration, and blood pressure in the Third National Health and Nutrition Examination Survey.

A few small studies of white persons have found a positive association between serum albumin and blood pressure. However, this association might be due to ionized calcium. No data on albumin or ionized calcium have appeared for African Americans or Hispanics, and few for women. To explore the association of serum albumin (g/L) and ionized calcium (mmol/L) with both systolic and diastolic blood pressure, data from the Third National Health and Nutrition Examination Survey, 1988-94, were analyzed. Results from multiple regressions, controlling for age, overweight, alcohol intake, hematocrit, pulse, antihypertensive medication, and smoking indicate that serum albumin is positively correlated (P < 0.01) to systolic and diastolic blood pressure among non-Hispanic white men 25-59 and 60-89 years old. Ionized calcium was associated negatively with diastolic blood pressure among younger Mexican-American men. In this national sample, serum albumin was consistently associated with systolic and diastolic blood pressure only among non-Hispanic white men.

Adult↗
PubMed1998

Body fat distribution and hypertension incidence in women and men. The NHANES I Epidemiologic Follow-up Study.

OBJECTIVE: To test the hypothesis that an elevated ratio of subscapular to triceps skinfold thickness (SFR), one measure of truncal obesity, is associated with increased incidence of essential hypertension. DESIGN: Data from the NHANES I Epidemiologic Follow-up Study (NHEFS) were analyzed. SUBJECTS: A cohort of 4303 women and 2579 men with complete data who were normotensive at baseline in 1971-1975. MEASUREMENTS: Incidence of hypertension, blood pressure 160/95 mm Hg or greater or on blood pressure medication at follow-up in 1982-1984. RESULTS: There was a statistically significant increase in risk of hypertension over approximately 10 y follow-up in white women aged 25-74 y with SFR in the fifth compared to the first quintile independent of age and body mass index (BMI) (relative risk = 1.52, 95% confidence interval 1.13-2.06, P = 0.006). The association was somewhat diminished after controlling for baseline blood pressure, change in BMI and other risk variables. An even stronger association was seen for subscapular skinfold and hypertension incidence. In white men aged 25-74 y, a significant association of high SFR with age-, BMI-adjusted risk of hypertension was seen (RR = 1.41, 95% CI 1.01-1.96, P = 0.04). Data for black women or black men failed to reveal significant variation in hypertension risk among quintiles of SFR or subscapular skinfold except in black women with low baseline BMI. CONCLUSIONS: Data from NHEFS confirm the association of higher truncal obesity with increased incidence of hypertension in white women. Further studies are needed, especially in larger samples of black women.

Adult↗
PubMed1998

Coronary heart disease risk factors and attributable risks in African-American women and men: NHANES I epidemiologic follow-up study.

OBJECTIVES: This study assessed associations of risk factors with coronary heart disease incidence in African Americans. METHODS: The participants in the NHANES I Epidemiologic Follow-Up Study included in this analysis were 1641 Black and 9660 White persons who were aged 25 to 74 years when examined and who did not have a history of coronary heart disease. Average follow-up for survivors was 19 years. RESULTS: Significant, independent risk factors for coronary heart disease were age, systolic blood pressure, and smoking in Black women and age, systolic blood pressure, serum cholesterol, low education, and low family income in Black men. In this cohort, 19% of incident coronary heart disease in Black women and 34% in Black men might be prevented if systolic blood pressure were below 140 mm Hg. In Black men, attributable risk for low education (46%) was even higher than that for elevated blood pressure. CONCLUSIONS: Elevated systolic blood pressure and smoking were predictive of coronary heart disease incidence in African Americans. Estimates of population attributable risk were highest for elevated systolic blood pressure in women and education less than high school in men. Further studies of serum lipids, education, and coronary heart disease in Black women are needed.

Adult↗
PubMed1997

Coronary heart disease incidence and survival in African-American women and men. The NHANES I Epidemiologic Follow-up Study.

BACKGROUND: Relatively few data are available on risk for or survival with coronary heart disease in African-American persons. OBJECTIVE: To determine whether incidence of coronary heart disease, rate of survival with the disease, and rate of coronary surgery differ between ethnic groups. DESIGN: Prospective cohort study. SETTING: United States. PARTICIPANTS: Persons who responded to the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study. Included in this analysis were 11406 white persons and African-American persons aged 25 to 74 years who had no history of coronary heart disease. Average follow-up for survivors was 19 years (maximum, 22 years). MEASUREMENTS: Incident coronary heart disease. RESULTS: Compared with that in white persons, the age-adjusted risk for coronary heart disease was higher in African-American women aged 25 to 54 years (relative risk, 1.76 [95% CI, 1.36 to 2.29]) but was lower in African-American men within each age subgroup. The age-adjusted risk was lower in African-American men for all ages combined (25 to 74 years) (relative risk, 0.78 [CI, 0.65 to 0.93] for coronary heart disease and 0.62 [CI, 0.42 to 0.92] for acute myocardial infarction). The higher rate in African-American women aged 25 to 54 years could be explained statistically by the higher risk factor levels in these women. Ethnic groups did not significantly differ in survival after the first hospitalization for coronary heart disease. However, the incidence of coronary procedures after hospitalization for coronary heart disease was markedly lower in African-American persons than in white persons (age- and sex-adjusted relative risk, 0.40 [CI, 0.16 to 0.99]). CONCLUSIONS: Total incidence of coronary heart disease is higher in African-American women aged 25 to 54 years than in white women of the same ages and is lower in African-American men aged 25 to 74 years than in white men of the same ages.

Adult↗
PubMed1997

Coronary revascularization and cardiac catheterization in the United States: trends in racial differences.

OBJECTIVES: We sought to determine whether racial differences in rates of coronary artery bypass graft surgery (CABG), percutaneous transluminal coronary angioplasty (PTCA) and cardiac catheterization decreased after 1980. BACKGROUND: Many reports of racial differences in utilization of CABG have been published since 1982. However, changes in the relative utilization of revascularization over time have received little attention. METHODS: Data from the National Hospital Discharge Survey were examined for the years 1980 through 1993. Estimated numbers of procedures performed in nonfederal U.S. hospitals were used to compute age-adjusted rates per 100,000 population by year and race for patients 35 to 84 years old. RESULTS: In patients 35 to 84 years old, the rate of CABG increased in blacks and whites between 1980 and 1993. Between 1986 and 1993, there was little change in the black/white ratio of age-adjusted rates (0.23 in 1980 through 1985 combined, 0.38 in 1986 and 0.43 in 1993). An apparent increase from 0.23 in 1980 through 1985 combined may have been due to sampling variation. Despite rapid increases in rates of PTCA in both races, no increase in the black/white ratio was noted (0.57 in 1993). However, the rate of inpatient cardiac catheterization increased more rapidly in blacks than in whites. This resulted in an increase in the black/white ratio of age-adjusted rates from 0.42 in 1980 to 0.91 in 1993. CONCLUSIONS: Rates of CABG, cardiac catheterization and especially PTCA increased between 1980 and 1993, a period during which racial disparities in the procedures became widely known. Despite apparent increases in the black/white ratio for inpatient cardiac catheterization, large racial disparities in the utilization of CABG and PTCA persist and require further evaluation and possible intervention.

Adult↗
PubMed1997

Secular trends in stroke mortality in African Americans: the role of urbanization, diabetes and obesity.

The decline in stroke mortality rates in African Americans has slowed to that seen in the 1960s; rates remain higher than in European Americans. Rates are higher in the southeastern US and in nonmetropolitan areas. Adverse trends and patterns in diabetes, obesity, and heart disease prevalence are possible explanations. Unless new, effective prevention programs are introduced in African American communities, stroke mortality rates will decline slowly if at all. The best chance to increase the rate of decline in stroke mortality rates in African Americans may be to redouble efforts to achieve the goals for the year 2000. Community and patient education on improving diet, increasing exercise, further improving detection and control of hypertension, using aspirin in stroke prevention and active control of stroke risk factors in diabetics must be stressed.

Adult↗