Is estrogen for you?
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Contraindications↗
Biomedical subjects
Shari S Bassuk
Publications and source records attributed to Shari S Bassuk.
Social engagement and depressive symptoms in late life: longitudinal findings.
OBJECTIVE: The purpose is to investigate whether social engagement protects against depressive symptoms in older adults. METHOD: Three waves of data from a representative cohort study of community-dwelling adults aged 65 years and above from the New Haven Established Populations for the Epidemiologic Study of the Elderly are examined using random effects models. RESULTS: Social engagement (an index combining social and productive activity) is associated with lower CES-D scores after adjustment for age, sex, time, education, marital status, health and functional status, and fitness activities. This association is generally constant with time, suggesting a cross-sectional association. In addition, social engagement is associated with change in depressive symptoms, but only among those with CES-D scores below 16 at baseline. DISCUSSION: Social engagement is independently associated with depressive symptoms cross-sectionally. A longitudinal association is seen only among those not depressed at baseline.
Aged↗
Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease.
Epidemiological studies suggest that physically active individuals have a 30-50% lower risk of developing type 2 diabetes than do sedentary persons and that physical activity confers a similar risk reduction for coronary heart disease. Risk reductions are observed with as little as 30 min of moderate-intensity activity per day. Protective mechanisms of physical activity include the regulation of body weight; the reduction of insulin resistance, hypertension, atherogenic dyslipidemia, and inflammation; and the enhancement of insulin sensitivity, glycemic control, and fibrinolytic and endothelial function. Public health initiatives promoting moderate increases in physical activity may offer the best balance between efficacy and feasibility to improve metabolic and cardiovascular health in largely sedentary populations.
Clinical Trials as Topic↗
High-sensitivity C-reactive protein: clinical importance.
High-sensitivity C-reactive protein (hsCRP) is a marker of inflammation that predicts incident myocardial infarction, stroke, peripheral arterial disease, and sudden cardiac death among healthy individuals with no history of cardiovascular disease, and recurrent events and death in patients with acute or stable coronary syndromes. hsCRP confers additional prognostic value at all levels of cholesterol, Framingham coronary risk score, severity of the metabolic syndrome, and blood pressure, and in those with and without subclinical atherosclerosis. hsCRP levels of less than 1, 1 to 3, and greater than 3 mg/L are associated with lower, moderate, and higher cardiovascular risks, respectively. This article summarizes epidemiologic data on the relation between CRP and atherothrombotic disease and provides clinical guidelines for hsCRP screening in cardiovascular risk assessment.
C-Reactive Protein↗
Obesity in the United States: a fresh look at its high toll.
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Cost of Illness↗
C-reactive protein and risk of cardiovascular disease: evidence and clinical application.
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C-Reactive Protein↗
Physical activity and the prevention of cardiovascular disease.
This article summarizes recent evidence on the role of physical activity in the prevention of overt and subclinical vascular disease. Epidemiologic data suggest that as little as 30 minutes per day of moderate-intensity physical activity, including brisk walking, reduces the incidence of clinical cardiovascular events in men and women. Regular exercise may also retard the progression of asymptomatic coronary and peripheral arteriosclerosis. Cardioprotective mechanisms of physical activity include reducing adiposity, blood pressure, diabetes incidence, dyslipidemia, and inflammation, and enhancing insulin sensitivity, glycemic control, fibrinolysis, and endothelial function. In a sedentary society such as the United States, public health initiatives that promote moderate increases in activity represent the optimal balance between efficacy and feasibility to achieve desired improvements in cardiovascular health.
Blood Glucose↗
Characteristics of the Modified Mini-Mental State Exam among elderly persons.
This study assesses psychometric properties of the Modified Mini-Mental State Exam (3MS) and present population norms and demographic risk factors for low 3MS scores. The subjects were 885 persons aged 65 and older who took the 3MS as part of the Stirling County Study, a population-based longitudinal study of adult residents of a county in Atlantic Canada. 3MS scores were not dependent on the specific rater who scored the test; thus, the 3MS is free of rater bias. Interrater reliability was high (intraclass correlation coefficient=0.98), as was internal consistency (coefficient alpha=0.91). Test-retest reliability over 3 years was 0.78. One third of subjects tested as cognitively impaired. Risk factors for low scores include older age, less education, male gender, and examination in French. The correlation between 3MS and Mini Mental State Exam scores was 0.95. The 3MS can be used as an epidemiologic measure of global cognitive performance among elderly persons.
Aged↗
Does vitamin E supplementation prevent cardiovascular events?
In recent years, vitamin E has been investigated as a cardioprotective agent. Experimental studies have identified potential mechanisms by which vitamin E may inhibit the development of atherosclerosis, and observational studies of individuals without coronary disease suggest that vitamin E intake may prevent future cardiovascular events. Secondary prevention trials to date have demonstrated little benefit from vitamin E supplementation. It remains possible, however, that supplementation may be useful among certain high-risk groups, including those with nutritional deficiencies. Limited data from completed primary prevention trials also indicate minimal cardioprotection from vitamin E, but large-scale trials now in progress may yet show benefit. Results from ongoing trials will contribute powerfully to the totality of evidence on which to formulate both appropriate clinical recommendations for individual patients and a rational public health policy for the population as a whole. At this time, there is insufficient evidence for issuing a public health recommendation to use vitamin E supplements to prevent cardiovascular disease (CVD). Rather, increased intake of fruits, vegetables, and other antioxidant-rich foods should be promoted as part of a healthy diet because they provide nutritional benefits beyond any potential antioxidant effect. Moreover, even if found to reduce CVD risk, vitamin supplement use should be considered an adjunct, not an alternative, to established cardioprotective measures, such as smoking abstention, avoidance of obesity, adequate physical activity, and control of high blood pressure and hyperlipidemia.
Adult↗
Physical activity and cardiovascular disease prevention in women: how much is good enough?
Epidemiologic data suggest that 30 min x d(-1) of brisk walking can reduce cardiovascular disease incidence in women and men. In a sedentary society, public health initiatives that promote moderate increases in physical activity may represent the optimal balance between efficacy, feasibility, and safety to achieve the desired cardioprotective effect.
Adult↗
Socioeconomic status and mortality among the elderly: findings from four US communities.
The effect of socioeconomic status (SES) on mortality was examined in the community-dwelling elderly. Data were obtained from four population-based studies that enrolled elderly residents of four US communities (East Boston, Massachusetts; New Haven, Connecticut; east-central Iowa; and the Piedmont region of North Carolina) and followed them for 9 years, starting in 1982 or 1986. Higher SES, whether measured by education, by household income, or by occupational prestige, was generally associated with lower mortality. However, the pattern of findings varied by gender and by community. For men, all three SES indicators were associated with mortality in the majority of cohorts. For women, this was true only for income. SES-mortality associations were attenuated but not eliminated after adjustment for behavior and health status. SES-mortality associations were stronger in New Haven and North Carolina than in East Boston and Iowa. The latter communities are more homogeneous with respect to ethnicity, urbanization, and occupational history than the former. Future research should investigate the relative validity of traditional SES measures for men and women and develop more balanced assessment methods. These findings also suggest that it is important to consider not only individual characteristics but also community attributes that mediate or modify the pathways through which socioeconomic conditions may influence health.
Aged↗
The Women's Antioxidant Cardiovascular Study: design and baseline characteristics of participants.
BACKGROUND: The evidence for a potential benefit of antioxidant vitamins and folic acid in cardiovascular disease (CVD) prevention is derived from laboratory, clinical, and observational epidemiological studies but remains inconclusive. Large-scale randomized trials with clinical end points are necessary to minimize confounding and provide unbiased estimates of the balance of benefits and risks, yet data from such trials are scarce, especially among women. METHODS: The Women's Antioxidant Cardiovascular Study (WACS) is a randomized, double-blind, placebo-controlled trial testing whether antioxidant vitamins and a folic acid/vitamin B(6)/vitamin B(12) combination prevent future cardiovascular events among women with preexisting CVD or >or=3 CVD risk factors. This paper describes the design of the trial and baseline characteristics of participants, evaluates the success of randomization, and addresses the generalizability of future findings. RESULTS: In a factorial design, 8171 U.S. female health professionals aged >or=40 years were randomized to vitamin E, vitamin C, beta-carotene, or placebos. Of these women, 5442 were also subsequently randomized to folic acid/vitamin B(6)/vitamin B(12) or placebo. The randomization was successful, as evidenced by similar distributions of baseline demographic, health, and behavioral characteristics across treatment groups. The clinical profile of participants was similar to that observed in another large trial of women with CVD. CONCLUSIONS: The similar distribution of known potential confounders across treatment groups provides reassurance that unmeasured or unknown potential confounders are also equally distributed. Although a definitive conclusion regarding generalizability requires additional trials in diverse populations, there is little biological basis for supposing that the benefit-risk balance differs in other high-risk women.
Adult↗
Postmenopausal hormone therapy: new questions and the case for new clinical trials.
Observational studies suggest that postmenopausal hormone therapy (HT) prevents coronary heart disease, whereas randomized clinical trials have not confirmed a cardioprotective effect. Although observational studies may have overestimated the coronary benefit conferred by postmenopausal hormone use, there are other plausible explanations for the apparent discrepancy between previous results and the less favorable findings from clinical trials such as the large Women's Health Initiative. There is now a critical mass of data to support the hypothesis that age or time since menopause may importantly influence the benefit-risk ratio associated with HT, especially with respect to cardiovascular outcomes, and that the method of administration, dose, and formulation of exogenous hormones may also be relevant. Although the weight of the evidence indicates that older women and those with subclinical or overt coronary heart disease should not take HT, estrogen remains the most effective treatment currently available for vasomotor symptoms, and its effects on the development of coronary disease in newly postmenopausal women remain unclear. Moreover, effects of HT on quality of life and cognitive function in recently postmenopausal women merit further study. These unresolved clinical issues provide the rationale for the design of the Kronos Early Estrogen Prevention Study, a 5-year randomized trial that will evaluate the effectiveness of low-dose oral estrogen and transdermal estradiol in preventing progression of atherosclerosis in recently postmenopausal women.
Administration, Cutaneous↗