Erythrocyte sedimentation rate (ESR) was examined in blacks and whites aged 18 to 74 years in the first National Health and Nutrition Examination Survey (NHANES I). In each age and sex group, median ESR was 2 mm/hr to 13 mm/hr higher in blacks than in whites even after exclusion of persons with extreme hemoglobin values or history of conditions affecting ESR. Apparently healthy blacks were more likely than whites to have elevated ESR greater than 20 mm/hr in women and 9 mm/hr in men. These data suggest a racial difference in ESR that is independent of age, hemoglobin concentration, and certain chronic diseases.

Adolescent↗

PubMed1993

The association between serum albumin and HDL and total cholesterol.

Relatively low serum albumin is a predictor of increased mortality and coronary heart disease incidence. To shed light on the likelihood of confounding this association by high-density lipoprotein (HDL) cholesterol or other risk factors, data from the National Center for Health Statistics were examined. Serum albumin concentration was significantly correlated with HDL cholesterol concentration only in white men aged 25 to 34 and 35 to 44 years. Serum albumin was positively correlated with serum total cholesterol. Several other cardiovascular risk factors were correlated with serum albumin in whites and blacks. Further studies are needed.

Adolescent↗

PubMed1992

Serum albumin, coronary heart disease, and death.

To confirm a reported association between elevated serum albumin concentrations and reduced risk of death in middle-aged white men and to determine whether such associations exist for CHD incidence in white men and CHD and death in white women and black men and women, data were examined from the NHANES I Epidemiologic Follow-up Study. Over a follow-up period of 9 to 16 years, serum albumin concentrations of 4.5 gm/dl or more were associated with reduced risk of CHD incidence in white men aged 45 to 64 years (RR = 0.51; 95% CL = 0.36, 0.73) and in white women aged 45 to 74 years (RR = 0.70; 95% CL = 0.55, 0.88), independent of baseline risk factors. Independent reductions in risk of death from all causes, cardiovascular diseases, and noncardiovascular diseases were also seen in white men and women. Relative risk of death from all causes at ages 45 to 74 years in the white population was 0.73 (95% CL = 0.62, 0.85) for men and 0.71 (95% CL = 0.59, 0.85) for women. Similar reductions in risk of death from all causes and cardiovascular diseases were seen in black men and women, despite the small numbers. Further studies are needed to confirm these findings for women and black persons and to elucidate mechanisms for the effect of serum albumin.

Aged↗

PubMed1992

Leukocyte count and cardiovascular risk factors.

In view of the growing evidence for leukocyte count as an important cardiovascular risk factor, data from the first National Health and Nutrition Examination Survey (NHANES I) were examined to determine the association of leukocyte count with a number of other cardiovascular risk factors. Complete data were available for 5586 persons. Multiple linear regression analyses revealed hemoglobin concentration and height in white male nonsmokers and hemoglobin, cigarettes/day, and pulse rate in white male smokers were associated with leukocyte count. In white female nonsmokers, age, pulse rate, systolic blood pressure, height, and uric acid concentration were associated with leukocyte count. In white female smokers, hemoglobin, cigarettes/day, pulse rate, and height were associated with leukocyte count. However, associated variables explained only 8% of the variation in leukocyte count. Other measured risk factors were not associated with leukocyte count. Future analyses of leukocyte count and cardiovascular disease should control for hemoglobin concentration and pulse rate in addition to smoking, blood pressure, and cholesterol.

Adult↗

PubMed1992

Body temperature and its relationship to demographic and cardiovascular risk factors in a national sample of children and adolescents.

The association of body temperature with demographic, maturational, constitutional, and cardiovascular risk variables was investigated in a large, representative sample of US children and adolescents in the Health Examination Survey. While body temperatures in children ages 6 to 11 years were not related to demographic variables, temperatures in children ages 12 to 17 were lower at older ages, higher in females than males, and higher in whites than blacks. In multiple regression analyses, demographic variables, maturational variables, and variables related to heat production or loss explained less than 10% of the variation in body temperature. Body temperature was a significant independent correlate of resting heart rate and systolic blood pressure at ages 6 to 11 and 12 to 17. Body temperature showed weak tracking over a follow-up interval averaging 44 months.

Adolescent↗

PubMed1991

Retinal arteriolar findings and coronary heart disease.

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Adult↗

PubMed1991

Pulse rate, coronary heart disease, and death: the NHANES I Epidemiologic Follow-up Study.

To determine whether associations of elevated resting pulse rate with CHD incidence or death in white men are independent of other risk factors and whether such associations exist for women and blacks, data were examined from the NHANES I Epidemiologic Follow-up Study. Over a follow-up period of 6 to 13 years, elevated RR for CHD incidence were found for older white men with baseline pulse greater than 84 beats/min compared with less than 74 beats/min after controlling multiple risk factors (RR = 1.37, 95% CL 1.02, 1.84). Risks of death from all causes, cardiovascular diseases, and noncardiovascular diseases were also elevated for white men with elevated pulse rate independent of other risk factors. CHD incidence was increased in white women with elevated pulse rate. Risks of death from all causes, cardiovascular diseases, and noncardiovascular diseases, were also elevated for white men with elevated pulse rate independent of other risk factors. CHD incidence was increased in white women with elevated pulse rate. Risk of death from all causes and cardiovascular diseases was elevated in black men and women with elevated pulse rate. Risk of death from noncardiovascular disease was elevated in black men with elevated pulse rate. The association with cardiovascular death was particularly striking in black women, even after adjusting for baseline risk factors (RR 3.03, 95% CL 1.46, 6.28). Further studies are needed to assess associations of pulse rate with CHD in blacks and to elucidate mechanisms in all groups.

Aged↗

PubMed1991

Peripheral leukocyte count and pulmonary function in a national sample of women and men.

The inverse relationship between peripheral leukocyte count and forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), previously reported in employed men, was investigated in women and men in a representative national sample. Leukocyte count was negatively correlated with FEV1 and FVC in most age, sex, and smoking subgroups in whites. In linear regression analyses controlling for age, height, and smoking variables, leukocyte count was significantly associated with FEV1 and FVC in white men (P < .05) and white women (P < .002). In "never smokers," significant independent associations were seen for leukocyte count and FVC in white men (P = .01) and FEV1 in white women (P = .02). These findings confirm an independent association of leukocyte count with pulmonary function in white men and extend the findings to white women.

Adult↗

PubMed1991

Is the serum cholesterol-coronary heart disease relationship modified by activity level in older persons?

Although coronary heart disease remains a leading cause of death and disability in old age, the relationship of serum cholesterol level to risk of coronary heart disease in old age is controversial. Data for 2,388 white persons aged 65-74 who participated in the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (NHEFS) were examined to determine the relationship of serum cholesterol level to coronary heart disease incidence and whether activity level would modify this relationship. While there was no overall relationship between serum cholesterol level and coronary heart disease risk in either men or women, the relationship between serum cholesterol level and coronary heart disease differed within activity groups. For persons who were more active, serum cholesterol level was associated with a graded increase in risk of coronary heart disease, from 1.3 (95% CI 0.7, 2.3) in those with serum cholesterol level of 4.7-5.1 to 1.7 in those with serum cholesterol level of 6.2 mmol/L or more (95% CI 1.0, 2.7), when compared with those with serum cholesterol level below 4.7. For the least active persons, all levels of cholesterol were associated with a significant inverse relative risk, including cholesterol of 6.2 mmol/L or more (Relative risk = 0.4 (95% CI 0.2, 0.7]. These data suggest that factors such as activity level may modify the serum cholesterol-coronary heart disease association in old age. The serum cholesterol-coronary heart disease association in more active older persons resembles that seen in younger populations, whereas the association in less active persons is that of serum cholesterol level and risk of cancer or death. The modification of the serum cholesterol-coronary heart disease association by activity level may have implications for appropriate clinical management as well as appropriate design of research studies of this association.

Aged↗

PubMed1991

Chronic obstructive pulmonary disease in blacks and whites: pulmonary function norms and risk factors.

Chronic obstructive pulmonary disease (COPD) and asthma are significant causes of illness and death in blacks. Racial differences in normal values of pulmonary function tests must be considered in both patient care and research. Assessment of risk factors is an important part of COPD management and prevention. An extensive review of data from the National Center for Health Statistics and from other population-based studies confirmed lower lung volumes in blacks compared to whites. However, the ratio of forced expiratory volume in 1 second to forced vital capacity was not lower in blacks; racial differences in flow rates were inconsistently reported. Thoracic dimensions were smaller in blacks than in whites in healthy populations. The cause and the physiologic and pathophysiologic significance of these racial differences are unknown. Population-based studies in blacks have firmly established only age and cigarette smoking as risk factors for COPD other than asthma. In 1987, 43% of black men aged 45 and older smoked cigarettes compared to only 30% of white men. Further research is needed on racial differences in pulmonary function and the effects of multiple risk factors to enhance understanding of COPD etiology and prevention. More vigorous smoking prevention and cessation efforts should be targeted for blacks by physicians and public health organizations.

Adolescent↗

PubMed1991

Blood groups, serum cholesterol, serum uric acid, blood pressure, and obesity in adolescents.

To assess the association of blood groups with coronary risk factors, data were examined from the third cycle of the National Health Examination Survey. In a nationwide sample of more than 6000 black and white adolescents aged 12 to 17 years, ABO blood group, haptoglobin phenotype, selected other genetic markers of blood and secretions, and coronary risk factor levels were measured. Blood group A1 was associated with significantly higher serum total cholesterol levels in white females independent of multiple potential confounders, in white males independent of age and weight, and in southern black females independent of age and weight. ABO blood group was not significantly associated with blood pressure, resting heart rate, or subscapular skinfold thickness. An association with serum uric acid in white males was not independent of weight. In white males only, haptoglobin phenotype 2-2 was associated with significantly higher serum cholesterol levels than 1-1 or 2-1 adjusting for age and weight. No consistent associations were found between Rh types, ABH secretor ability, or group-specific component types and risk factors. This analysis of national data confirms previously reported associations of blood group A with higher serum total cholesterol levels in white adults and adolescents.

ABO Blood-Group System↗

PubMed1991

Resting pulse rate of children aged 1-5 years.

In the first National Health and Nutrition Examination Survey (NHANES 1), the epidemiology of resting pulse rate was examined in preschool children. Among 2800 children aged 1 to 5 years, pulse rate was higher in younger than in older children, and in girls than in boys. Only at ages 4 and 5 was pulse rate lower in blacks than in whites. Of numerous other variables, only height and Southern geographic region showed independent associations with pulse rate. In a subgroup of 1056 children whose mothers were also examined, the child's pulse rate was significantly correlated with the mother's rate at ages 2, 3, and 5. Previously reported negative correlations with mother's blood pressure were not seen. Boys with hypertensive mothers had lower age-adjusted pulse rates, but girls had higher pulse rates than children of normotensive mothers. Further research is needed to determine the mechanisms of these epidemiologic patterns and their relationship to the risk of hypertension and heart disease in later life.

Age Factors↗

PubMed1991

Cardiovascular disease in the United States: an epidemiologic overview.

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Adult↗

PubMed1990

Peripheral arterial occlusive disease of the extremities in the United States: hospitalization and mortality.

PAODE is an important cause of morbidity and health care expenditures among the elderly. Data from the NHDS and National Vital Statistics System were used to assess its impact in the U.S. In 1985 to 1987, an estimated 229 thousand men and 184 thousand women per year were discharged with any diagnosis of chronic PAODE. Discharge rates were much higher in men and increased sharply with age. Lower extremity arteriography was performed during 88 thousand hospitalizations and aorta-iliac-femoral bypass procedures were done during 31 thousand hospitalizations per year. Numbers of procedures increased markedly since 1979. An estimated 60 thousand men and 50 thousand women per year were discharged with any diagnosis of acute PAODE. Embolectomy or thrombectomy of lower limb arteries was listed for 28 thousand discharges per year. Few deaths were attributed to PAODE. Although these data are limited by likely incomplete reporting and by the nonspecificity of diagnostic codes, they provide an indication of the magnitude of the problem. An aging population and advances in surgical techniques suggest continued monitoring using multiple data sources. Vigorous primary prevention programs are needed to lessen the impact of all atherosclerotic diseases.

Acute Disease↗