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Biomedical subjects

T A Pearson

Publications and source records attributed to T A Pearson.

At least 55 records · Page 3Linked to original sources
PubMed2000

Cholesterol lowering with pravastatin improves resistance artery endothelial function: report of six subjects with normal coronary arteriograms.

STUDY OBJECTIVES: Improvement in coronary artery endothelial function has been demonstrated after cholesterol lowering in hypercholesterolemic patients with significant atherosclerosis. However, to our knowledge, no previous study has shown improvement in resistance artery function in subjects with normal coronary arteries after cholesterol lowering. The purpose of our study was to investigate the effect of cholesterol lowering with pravastatin on coronary resistance artery endothelial function in the setting of angiographically normal coronary arteries. METHODS: Invasive testing of coronary endothelial and vasomotor function was performed at baseline and after 6 months of pravastatin treatment in six patients with normal coronary arteriograms. RESULTS: After 6 months of pravastatin treatment, low-density lipoprotein cholesterol level dropped from 157+/-11 to 117+/-8 mg/dL (p = 0.02) and percent increase in coronary blood flow after acetylcholine improved from 97+/-13% to 160+/-16% (p = 0.01). There was a trend (p = 0.17) toward enhanced epicardial dilation in response to acetylcholine after pravastatin treatment when compared with the baseline study. CONCLUSIONS: Our study demonstrates significant improvement in coronary resistance artery endothelial function after 6 months of cholesterol lowering with pravastatin in six subjects presenting with chest pain who were found to have normal coronary arteriograms. A trend toward improved epicardial vasomotion was also observed.

Adult↗
PubMed1999

Cardiovascular disease in developing countries: myths, realities, and opportunities.

The burden of cardiovascular disease (CVD), especially ischemic heart disease and stroke, varies remarkably between regions of the world, with declining rates in Europe, North America, and Australia/New Zealand, burgeoning epidemics in the former socialist economies and India, and relatively lower impact in developing regions such as sub-Saharan Africa. The basis for a prediction of a global CVD epidemic lies in the "epidemiologic transition," in which control of infectious, parasitic, and nutritional diseases allows most of the population to reach the ages in which CVD manifests itself. In fact, CVD is already the leading cause of death not only in developed countries but, as of the mid-1990s, in developing countries as well. A variety of myths have attempted to minimize the rationale for CVD control in developing countries. In reality, CVD affects men, not only the elderly, and the rich, but rather a broad spectrum of the population. Moreover, as a cause of disability it will be a world leader by 2020. Finally, there is evidence that the epidemic can be curtailed. Projections to the year 2020 predict an expansion of the CVD epidemic to the developing world, with CVD exceeding infectious and parasitic diseases in all regions except sub-Saharan Africa. These estimates, in fact, may be conservative, because several factors may allow multiplication of risk. In utero or early childhood deprivation, the use of disposable income for deleterious health behaviors (such as tobacco and a high fat/cholesterol diet), interactions between multiple coexisting risk factors, and the interaction between newly acquired health behaviors and genes may all inflate the risk to levels above those predicted. Efforts to control CVD should invest strategically in research to understand the prevalence of, and risks associated with, CVD risk factors, as well as in studies of new risk factors, measures to prevent or modify risk, and clinical trials to demonstrate the efficacy of these interventions. In lieu of this improved research base, a number of initiatives should go forward to prevent the dissemination of risk factors, to treat risk factors appropriately in high-risk subjects, and to develop case-management strategies shown to be both efficacious and cost effective. A global epidemic of CVD in developing countries may be inevitable unless there is a better understanding of its origins, a prediction of its magnitude, and the organization of preventive and case-management strategies early enough to control it.

Adult↗
PubMed1999

Comparative lipid and lipoprotein responses to solid-food diets and defined liquid-formula diets.

BACKGROUND: Liquid-formula diets (LFDs) are useful in metabolic studies of the cholesterolemic effects of dietary lipids because they can be formulated with accuracy, facilitating precise delivery of fatty acids of interest. However, because of differences in composition and nutrient delivery between LFDs and solid-food diets (SFDs), there is a need to determine differences in their effects. OBJECTIVE: Our objective was to compare lipid and lipoprotein responses to changes in total fat, saturated fatty acids (SFAs), and cholesterol in subjects consuming an SFD or LFD. DESIGN: Twenty-one healthy subjects consumed controlled diets representative of an average American diet [AAD; 37% of energy from fat (15% from SFAs), and <50 mg cholesterol/MJ] or a National Cholesterol Education Program (NCEP) Step II diet [26% fat (5% from SFAs) and <25 mg cholesterol/MJ]. Other nutrients were similar between diets. Diets were consumed for 23 d in a randomized, crossover design. RESULTS: For the AAD and NCEP Step II diet, there were no significant differences in lipids and apolipoproteins when the LFD or SFD versions were consumed. In contrast, consumption of the SFD was associated with significantly lower total cholesterol and triacylglycerols than was consumption of the corresponding AAD or Step II LFD (P < 0.05). Subjective ratings of satiety, hunger, and quality of life between diet forms did not differ significantly. CONCLUSIONS: Both LFDs and SFDs yield quantitatively similar cholesterolemic responses to changes in dietary fat, SFAs, and cholesterol. LFDs may offer advantages because they provide easily administered, complete, balanced nutrition without affecting satiety.

Adult↗
PubMed1999

High-monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations.

BACKGROUND: Low-fat diets increase plasma triacylglycerol and decrease HDL-cholesterol concentrations, thereby potentially adversely affecting cardiovascular disease (CVD) risk. High-monounsaturated fatty acid (MUFA), cholesterol-lowering diets do not raise triacylglycerol or lower HDL cholesterol, but little is known about how peanut products, a rich source of MUFAs, affect CVD risk. OBJECTIVE: The present study compared the CVD risk profile of an Average American diet (AAD) with those of 4 cholesterol-lowering diets: an American Heart Association/National Cholesterol Education Program Step II diet and 3 high-MUFA diets [olive oil (OO), peanut oil (PO), and peanuts and peanut butter (PPB)]. DESIGN: A randomized, double-blind, 5-period crossover study design (n = 22) was used to examine the effects of the diets on serum lipids and lipoproteins: AAD [34% fat; 16% saturated fatty acids (SFAs), 11% MUFAs], Step II (25% fat; 7% SFAs, 12% MUFAs), OO (34% fat; 7% SFAs, 21% MUFAs), PO (34% fat; 7% SFAs, 17% MUFAs), and PPB (36% fat; 8% SFAs, 18% MUFAs). RESULTS: The high-MUFA diets lowered total cholesterol by 10% and LDL cholesterol by 14%. This response was comparable with that observed for the Step II diet. Triacylglycerol concentrations were 13% lower in subjects consuming the high-MUFA diets and were 11% higher with the Step II diet than with the AAD. The high-MUFA diets did not lower HDL cholesterol whereas the Step II diet lowered it by 4% compared with the AAD. The OO, PO, and PPB diets decreased CVD risk by an estimated 25%, 16%, and 21%, respectively, whereas the Step II diet lowered CVD risk by 12%. CONCLUSION: A high-MUFA, cholesterol-lowering diet may be preferable to a low-fat diet because of more favorable effects on the CVD risk profile.

Adult↗
PubMed1999

Shifting the distribution of risk: results of a community intervention in a Swedish programme for the prevention of cardiovascular disease.

STUDY OBJECTIVE: To examine the impact of a systematic risk factor screening and counselling carried out by family physicians and family nurses within the larger framework of a community intervention programme for the prevention of cardiovascular disease (CVD). DESIGN: Quasi-experimental study comparing trends in an intervention area with those in a reference area. SETTING: A Northern Sweden municipality (5500 inhabitants) constituted the intervention area while the Northern Sweden region (510,000 inhabitants) served as the reference area. PARTICIPANTS: All 30, 40, 50, and 60 year old inhabitants were invited each year from 1985 to 1992. Among 2046 eligible 1893 participated (92.5%), which formed eight independent cross sections. One cross section, 1986, was re-surveyed forming a panel. MAIN RESULTS: In the cross sections, mean total cholesterol was reduced from 7.09 to 6.27 mmol/l for men (p < 0.001) and from 7.13 to 5.89 mmol/l for women (p < 0.001) and mean systolic blood pressure from 132.2 to 123.7 mm Hg for men (p < 0.05) and from 129.2 to 122.0 mm Hg for women (p < 0.001) during the eight years. Body mass index (BMI) increased from 25.6 to 26.2 for men (p < 0.05) and from 25.0 to 25.5 for women (NS). A corresponding reduction in cholesterol and blood pressure (for women) occurred in the panel, while BMI was unchanged. The risk for CVD, using the Framingham equation, was estimated to be reduced overall by 19% (p = 0.0021) when comparing early cross sections (1985/86) with the later cross sections (1990/91). CONCLUSIONS: It was concluded that a long term community based CVD prevention programme that combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. The individual attention and evaluation provided by the health provider survey seem to accelerate, but not increase the amount of, risk reduction.

Adult↗
PubMed1998

Rural epidemiology: insights from a rural population laboratory.

To study the epidemiology of rural populations in the context of contemporary issues in public health, a population laboratory (Health Census '89) was established in Otsego County, New York, by the Research Institute of the M.I. Bassett Hospital, affiliated with the Columbia University School of Public Health. Such a laboratory is needed because of an apparent lag in positive health indices in rural populations across the United States, resulting in rates of chronic diseases, such as coronary heart disease, for which rural areas now exceed urban ones. This was confirmed for Otsego County by the survey Health Census '89, the foundation of a rural population laboratory, in which all residents were enumerated and characterized as to their prevalent diseases, health behaviors, use of preventive services, and environmental exposures. Heart disease, cancer, and diabetes mellitus rates were found to exceed average rates for US urban areas, while the data on preventive health behaviors suggest this is a population of "late adopters." The survey, conducted in 1989, had an 86.6% response rate, and enumerated 17,147 households and 44,406 persons. The authors discuss adults aged 17-64 years, 58 percent of the total census (n=25,614). Sharp gradients in disease prevalence, risk factors, and utilization of preventive services were observed across educational strata. Data from Health Census '89 were used as the basis for a successful community intervention program, which targeted identified high risk groups. Rural populations are excellent settings for community interventions, offering laboratories where new strategies of risk reduction and provision of preventive services might be tested.

Adolescent↗
PubMed1998

Lipid lowering in a multidisciplinary clinic compared with primary physician management.

A multidisciplinary lipid reduction clinic achieved greater reduction of serum cholesterol when compared with primary physicians among patients with coronary heart disease. The lipid clinic was more likely than the primary physicians to prescribe lipid-lowering medication, to prescribe multiple medications, and to use drug doses in excess of the "starting dose."

Aged↗