Genetic architectures of proximal and distal colorectal cancer are partly distinct

OBJECTIVE

An understanding of the etiologic heterogeneity of colorectal cancer (CRC) is critical for improving precision prevention, including individualized screening recommendations and the discovery of novel drug targets and repurposable drug candidates for chemoprevention. Known differences in molecular characteristics and environmental risk factors among tumors arising in different locations of the colorectum suggest partly distinct mechanisms of carcinogenesis. The extent to which the contribution of inherited genetic risk factors for CRC differs by anatomical subsite of the primary tumor has not been examined.

DESIGN

To identify new anatomical subsite-specific risk loci, we performed genome-wide association study (GWAS) meta-analyses including data of 48 214 CRC cases and 64 159 controls of European ancestry. We characterised effect heterogeneity at CRC risk loci using multinomial modelling.

RESULTS

We identified 13 loci that reached genome-wide significance (p<5×10-8) and that were not reported by previous GWASs for overall CRC risk. Multiple lines of evidence support candidate genes at several of these loci. We detected substantial heterogeneity between anatomical subsites. Just over half (61) of 109 known and new risk variants showed no evidence for heterogeneity. In contrast, 22 variants showed association with distal CRC (including rectal cancer), but no evidence for association or an attenuated association with proximal CRC. For two loci, there was strong evidence for effects confined to proximal colon cancer.

CONCLUSION

Genetic architectures of proximal and distal CRC are partly distinct. Studies of risk factors and mechanisms of carcinogenesis, and precision prevention strategies should take into consideration the anatomical subsite of the tumour.

Discovery of common and rare genetic risk variants for colorectal cancer

To further dissect the genetic architecture of colorectal cancer (CRC), we performed whole-genome sequencing of 1,439 cases and 720 controls, imputed discovered sequence variants and Haplotype Reference Consortium panel variants into genome-wide association study data, and tested for association in 34,869 cases and 29,051 controls. Findings were followed up in an additional 23,262 cases and 38,296 controls. We discovered a strongly protective 0.3% frequency variant signal at CHD1. In a combined meta-analysis of 125,478 individuals, we identified 40 new independent signals at P < 5 × 10-8, bringing the number of known independent signals for CRC to ~100. New signals implicate lower-frequency variants, Krüppel-like factors, Hedgehog signaling, Hippo-YAP signaling, long noncoding RNAs and somatic drivers, and support a role for immune function. Heritability analyses suggest that CRC risk is highly polygenic, and larger, more comprehensive studies enabling rare variant analysis will improve understanding of biology underlying this risk and influence personalized screening strategies and drug development.

Race/Ethnic Differences in Birth Size, Infant Growth, and Body Mass Index at Age Five Years in Children in Hawaii

BACKGROUND

Factors at birth and infancy may increase risk of being overweight in childhood. The aim of this study was to examine the relationship of birth size and infant growth (2-24 months) with BMI at age 5 years in a multiethnic population.

METHODS

This was a retrospective study (using electronic medical records of a health maintenance organization in Hawaii) of singleton children born in 2004-2005, with linked maternal and birth information, infant weights (n = 597) and lengths (n = 473) in the first 2 years, and BMI measures at age 5 years (n = 894). Multiple regression models were used to estimate the association of BMI at age 5 years with birth size and infant growth.

RESULTS

Birth weight was positively associated with BMI at age 5 years, adjusting for gestational age, sex, race/ethnicity, and maternal prepregnancy weight, age, education, and smoking. A greater change in infant weight was associated with a higher BMI at age 5 years, though the effect of birth weight on BMI was neither mediated nor modified by infant growth rate. Birth weight, change in infant weight, and BMI at age 5 years varied by race/ethnicity. Change in infant BMI in the first 2 years was higher in other Pacific Islanders and whites (Δ = 0.966; confidence interval [CI] = 0.249-1.684; p = 0.02) than in Asian, other, and part Native Hawaiian race/ethnic groups.

CONCLUSIONS

Early biological measures of birth weight and infant weight gain varied by race/ethnicity and positively predicted BMI at age 5 years.

Genetic variation in the raptor gene is associated with overweight but not hypertension in American men of Japanese ancestry

BACKGROUND

The mechanistic target of rapamycin (mTOR) pathway is pivotal for cell growth. Regulatory associated protein of mTOR complex I (Raptor) is a unique component of this pro-growth complex. The present study tested whether variation across the raptor gene (RPTOR) is associated with overweight and hypertension.

METHODS

We tested 61 common (allele frequency ≥ 0.1) tagging single nucleotide polymorphisms (SNPs) that captured most of the genetic variation across RPTOR in 374 subjects of normal lifespan and 439 subjects with a lifespan exceeding 95 years for association with overweight/obesity, essential hypertension, and isolated systolic hypertension. Subjects were drawn from the Honolulu Heart Program, a homogeneous population of American men of Japanese ancestry, well characterized for phenotypes relevant to conditions of aging. Hypertension status was ascertained when subjects were 45-68 years old. Statistical evaluation involved contingency table analysis, logistic regression, and the powerful method of recursive partitioning.

RESULTS

After analysis of RPTOR genotypes by each statistical approach, we found no significant association between genetic variation in RPTOR and either essential hypertension or isolated systolic hypertension. Models generated by recursive partitioning analysis showed that RPTOR SNPs significantly enhanced the ability of the model to accurately assign individuals to either the overweight/obese or the non-overweight/obese groups (P = 0.008 by 1-tailed Z test).

CONCLUSION

Common genetic variation in RPTOR is associated with overweight/obesity but does not discernibly contribute to either essential hypertension or isolated systolic hypertension in the population studied.

Genetic analysis of TOR complex gene variation with human longevity: a nested case-control study of American men of Japanese ancestry

The mechanistic target of rapamycin (mTOR) pathway is crucial for life span determination in model organisms. The aim of the present study was to test tagging single-nucleotide polymorphisms that captured most of the genetic variation across key TOR complex 1 (TORC1) and TOR complex 2 (TORC2) genes MTOR, RPTOR, and RICTOR and the important downstream effector gene RPS6KA1 for association with human longevity (defined as attainment of at least 95 years of age) as well as health span phenotypes. Subjects comprised a homogeneous population of American men of Japanese ancestry, well characterized for aging phenotypes and who have been followed for 48 years. The study used a nested case-control design involving 440 subjects aged 95 years and older and 374 controls. It found no association of 6 tagging single-nucleotide polymorphisms for MTOR, 61 for RPTOR, 7 for RICTOR, or 5 for RPS6KA1 with longevity. Of 40 aging-related phenotypes, no significant association with genotype was seen. Thus common genetic variation (minor allele frequency ≥10%) in MTOR, RPTOR, RICTOR, and RPS6KA1 is not associated with extreme old age or aging phenotypes in this population. Further research is needed to assess the potential genetic contribution of other mTOR pathway genes to human longevity, gene expression, upstream and downstream targets, and clinically relevant aging phenotypes.

Abstract 661: Foxo3 Genotype Increases Lifespan By A Major Effect On Cardiovascular Mortality

The strongest, most consistently replicated genetic influences on human lifespan worldwide involve specific alleles of the ApoE and Foxo3 genes. For FOXO3 , the G allele of SNP rs2802292 exhibits the most robust association. The aim of the present study was to determine FOXO3 genotype-related cause-specific mortality over 9 years in 3,584 elderly American men of Japanese ancestry from the Kuakini Hawaii Lifespan Study, an extensively characterized, long-studied, robust cohort drawn from the Honolulu Heart Program, which recruited subjects in 1965–1968. A Cox proportional hazards model computed relative risk of mortality for coronary heart disease (CHD), cancer, stroke, other circulatory diseases, and remaining causes. We created multivariate models that included other major risk factors for all-cause and cause-specific mortality. We determined contribution of FOXO3 genotype and other risk factors to mortality by estimating population attributable risk over 9 years follow-up for cause-specific mortality, and total mortality over 21 years. The survival curve, age standardized at 78 years (mean subject age at baseline), for carriers and non-carriers of the longevity-associated G allele showed that G allele carriers had longer survival ( P =0.016) during follow-up over 9 years (1,272 total deaths), and 21 years ( P =0.004; 3,211 total deaths). Over the 9 years, the 1,683 carriers of the G allele exhibited risk reductions of 16% (RR 0.84, 95% CI 0.74–0.95; P =0.008) for all-cause mortality, 41% (RR 0.59, 95% CI 0.43–0.80; P <0.001) for CHD mortality (202 deaths) and 21% (RR 0.79, 95% CI 0.67–0.94; P =0.009) for 535 deaths from causes besides CHD, cancer or stroke, independent of other major risk factors. Population attributable risk for the TT non-protective genotype was 24% for 9-year CHD mortality, 24% for hypertension, 21% for diabetes, 18% for inflammation and 12% for hypercholesterolemia. In conclusion, the G allele of the FOXO3 SNP rs2802292 has a major effect on mortality, principally through reduction in CHD risk, independent of known major risk factors. The findings support research on FOXO3 as a target for therapeutic intervention in healthy aging.

Abstract 662: Association Analysis of Raptor Gene Variants with Overweight and Hypertension in American Men of Japanese Ancestry

The mechanistic target of rapamycin (mTOR) pathway is pivotal for cell growth and has been implicated in aging, cardiovascular disease, obesity, diabetes and cancer. mTOR signaling is involved in cardiac leptin-mediated cardiac hypertrophy and fibrosis associated with obesity. mTOR is a key component of two multiprotein complexes, mTOR complex 1 and mTOR complex 2. The former is pro-growth and contains a unique protein, raptor. The present study tested for the first time whether genetic variation across the raptor gene ( RPTOR ) is associated with overweight/obesity, essential hypertension (EHT) and isolated systolic hypertension (ISH). We genotyped 61 common (allele frequency ≥ 0.1) tagging single nucleotide polymorphisms (SNPs) that captured most of the genetic variation across RPTOR in 374 subjects of normal lifespan and 439 subjects with a lifespan exceeding 95 years. Subjects were drawn from the Honolulu Heart Program, a homogeneous population of American men of Japanese ancestry, well characterized for phenotypes relevant to conditions of aging. Hypertension status was ascertained when subjects were 45–68 years old. Statistical evaluation was performed by contingency table analysis, logistic regression and recursive partitioning (RP), which is regarded as amongst the most powerful methods for statistical analysis of large complex sets of genetic information. After analysis of RPTOR genotypes by each statistical approach we found no significant association between genetic variation in RPTOR and either EHT or ISH. For EHT, RP revealed that even the most predictive SNPs ( rs4969322 and rs4890052 ) provided little contribution to correctly assigning individuals to EHT or NT ( P =0.22 by Z test). In the case of ISH, RP revealed that only one SNP ( rs2589118 ) made a noticeable contribution, and that this was no better than the contribution from the weakest laboratory/examination variable (overweight/obesity). In contrast, for overweight/obesity, the RP model revealed that RPTOR SNPs significantly enhanced the predictive capacity of the model ( P =0.008 by one-tailed Z test). In conclusion, genetic variation across RPTOR is associated with overweight/obesity, but not EHT or ISH in the populations of normal lifespan and of long-lived subjects studied.

Shorter men live longer: association of height with longevity and FOXO3 genotype in American men of Japanese ancestry

Objectives

To determine the relation between height, FOXO3 genotype and age of death in humans.

Methods

Observational study of 8,003 American men of Japanese ancestry from the Honolulu Heart Program/Honolulu-Asia Aging Study (HHP/HAAS), a genetically and culturally homogeneous cohort followed for over 40 years. A Cox regression model with age as the time scale, stratified by year of birth, was used to estimate the effect of baseline height on mortality during follow-up. An analysis of height and longevity-associated variants of the key regulatory gene in the insulin/IGF-1 signaling (IIS) pathway, FOXO3, was performed in a HHP-HAAS subpopulation. A study of fasting insulin level and height was conducted in another HHP-HAAS subpopulation.

Results

A positive association was found between baseline height and all-cause mortality (RR = 1.007; 95% CI 1.003–1.011; P = 0.002) over the follow-up period. Adjustments for possible confounding variables reduced this association only slightly (RR = 1.006; 95% CI 1.002–1.010; P = 0.007). In addition, height was positively associated with all cancer mortality and mortality from cancer unrelated to smoking. A Cox regression model with time-dependent covariates showed that relative risk for baseline height on mortality increased as the population aged. Comparison of genotypes of a longevity-associated single nucleotide polymorphism in FOXO3 showed that the longevity allele was inversely associated with height. This finding was consistent with prior findings in model organisms of aging. Height was also positively associated with fasting blood insulin level, a risk factor for mortality. Regression analysis of fasting insulin level (mIU/L) on height (cm) adjusting for the age both data were collected yielded a regression coefficient of 0.26 (95% CI 0.10–0.42; P = 0.001).

Conclusion

Height in mid-life is positively associated with mortality, with shorter stature predicting longer lifespan. Height was, moreover, associated with fasting insulin level and the longevity genotype of FOXO3, consistent with a mechanistic role for the IIS pathway.

Association analyses of insulin signaling pathway gene polymorphisms with healthy aging and longevity in Americans of Japanese ancestry

Evidence from model organisms suggests that the insulin/IGF-1 signaling pathway has an important, evolutionarily conserved influence over rate of aging and thus longevity. In humans, the FOXO3 gene is the only widely replicated insulin/IGF-1 signaling pathway gene associated with longevity across multiple populations. Therefore, we conducted a nested case-control study of other insulin/IGF-1 signaling genes and longevity, utilizing a large, homogeneous, long-lived population of American men of Japanese ancestry, well characterized for aging phenotypes. Genotyping was performed of single nucleotide polymorphisms, tagging most of the genetic variation across several genes in the insulin/IGF-1 signaling pathway or related gene networks that may be influenced by FOXO3, namely, ATF4, CBL, CDKN2, EXO1, and JUN. Two initial, marginal associations with longevity did not remain significant after correction for multiple comparisons, nor were they correlated with aging-related phenotypes.

FOXO3 gene variants and human aging: coding variants may not be key players

FOXO3 is generally recognized as a "master" gene in aging since its association with longevity has been replicated in multiple organisms and human populations. A group of single nucleotide polymorphisms in linkage disequilibrium with a coding region has been associated with human longevity, but the actual functional variant is unidentified. Therefore, we sequenced the coding region in our long-lived Japanese American population in order to enhance resources for fine mapping this region. We demonstrate that of 38 published variants, 6 are misalignments with homologous nonallelic sequences from FOXO3B (ZNF286B), a pseudogene on a different chromosome; 2 are attributable to ZNF286B only, and the remaining 30 were unconfirmed, indicating that they are very rare and not likely involved in longevity. Furthermore, we identified a novel, unique, nonsynonymous coding variant in exon 3 (Gly566Ala; rs138174682) that is prevalent in multiple ethnic groups but appeared too rare for major longevity effects in our study populations.

Association of fibrinogen with Parkinson disease in elderly Japanese-American men: a prospective study

BACKGROUND

The purpose of this prospective study was to examine whether fibrinogen level is associated with Parkinson disease (PD) for both prevalent and incident cases.

METHODS

The Honolulu Asia-Aging Study is a longitudinal study of Japanese-American men based on the Honolulu Heart Study birth cohort. The original cohort consisted of 8,006 participants with selective service records who were living on the island of Oahu, Hawaii, in 1965. For this analysis, baseline was defined as the 1991-1993 examination (n = 3,845) when men were aged 71-93 years old. Multivariate logistic regression and Cox proportional hazards models were used, adjusting for potential confounders.

RESULTS

We identified 61 prevalent cases and 61 incident cases of PD during the follow-up. High fibrinogen level (presence in the top quintile) was associated with higher frequency of PD for both prevalent (OR = 2.07, 95% CI = 1.10-3.88, p = 0.024) and incident cases (HR = 3.05, 95% CI = 1.34-6.97, p = 0.008) among men aged 76-93 years, after adjusting for age, smoking, and low-density lipoprotein cholesterol.

CONCLUSIONS

These results suggest high fibrinogen level is associated with increased risk of PD among men over 75 years.

Characteristics of women who sought emergency contraception at a university-based women's health clinic

OBJECTIVE

The purpose of this study was to identify unique characteristics for seeking emergency contraception (EC) among sexually active unmarried women who attended a university-based women's health clinic (WHC).

STUDY DESIGN

Three hundred nine consecutive women who attended the women's health clinic for 3 months of the 2006 spring semester completed an anonymous self-administered questionnaire. Fisher exact and Student t tests were used to assess bivariate associations, and step-wise regression was used to determine independent associations.

RESULTS

Women who requested EC were more likely to have previously used EC (P < .001), to have had unprotected sex in the past 6 months (P < .001), to have experienced an unintended pregnancy in the past year (P = .009), and to perceive the need for EC use in the next 3 months (P < .001) but were less likely to use hormonal contraception or an intrauterine device (P < .001).

CONCLUSION

Our findings support the need for increased education that would include the use of and access to effective primary contraceptive methods in conjunction with EC awareness.

A prospective study of high-density lipoprotein cholesterol, cholesteryl ester transfer protein gene variants, and healthy aging in very old Japanese-american men

BACKGROUND

High-density lipoprotein cholesterol (HDL-C) and cholesteryl ester transfer protein (CETP) gene deficiency mutations that increase HDL-C levels have been associated with exceptional longevity. However, a recent clinical trial of a promising CETP inhibitor that markedly increases HDL-C was terminated due to increased mortality. In light of this controversy, we examined the relationship among HDL-C, CETP mutations, and longevity phenotypes in the long-lived Japanese-American men of the Honolulu Heart Program (HHP).

METHODS

Japanese-American men (n = 3562) were followed for up to 8 years, from average age 78 to average age 84 (maximum age 99), or until death. Total mortality, cause-specific mortality, and healthy survival were evaluated for associations with HDL-C level and CETP genetic variants common in the Japanese population (CD442G and Int 14A).

RESULTS

HDL-C was negatively associated with cardiovascular disease (CVD) mortality (p =.002) but not related to non-CVD (p =.147) or total (p =.547) mortality after adjustment for common risk factors. There was a trend for lower mortality for the men with the Int 14A variant. These men also had higher HDL-C levels (p =.047) and were significantly more likely to be healthy survivors (absence of six major age-related diseases and high physical/cognitive function) beyond the age of 90 years (p =.005).

CONCLUSIONS

Low HDL-C level is a risk factor for CVD mortality in elderly Japanese-American men. High HDL-C and the Int 14A variant of the CETP gene may increase odds for healthy aging.

FOXO3A genotype is strongly associated with human longevity

Human longevity is a complex phenotype with a significant familial component, yet little is known about its genetic antecedents. Increasing evidence from animal models suggests that the insulin/IGF-1 signaling (IIS) pathway is an important, evolutionarily conserved biological pathway that influences aging and longevity. However, to date human data have been scarce. Studies have been hampered by small sample sizes, lack of precise phenotyping, and population stratification, among other challenges. Therefore, to more precisely assess potential genetic contributions to human longevity from genes linked to IIS signaling, we chose a large, homogeneous, long-lived population of men well-characterized for aging phenotypes, and we performed a nested-case control study of 5 candidate longevity genes. Genetic variation within the FOXO3A gene was strongly associated with human longevity. The OR for homozygous minor vs. homozygous major alleles between the cases and controls was 2.75 (P = 0.00009; adjusted P = 0.00135). Long-lived men also presented several additional phenotypes linked to healthy aging, including lower prevalence of cancer and cardiovascular disease, better self-reported health, and high physical and cognitive function, despite significantly older ages than controls. Several of these aging phenotypes were associated with FOXO3A genotype. Long-lived men also exhibited several biological markers indicative of greater insulin sensitivity and this was associated with homozygosity for the FOXO3A GG genotype. Further exploration of the FOXO3A gene, human longevity and other aging phenotypes is warranted in other populations.

Absence of evidence for an association between resistin gene variants and insulin resistance in an Asian population with low and high blood pressure

AIMS

Although the function of resistin in human biology is unclear, some evidence suggests resistin gene variants influence insulin resistance, and insulin resistance-related hypertension. We searched for associations between common resistin gene variants and factors related to insulin resistance in Asian individuals with high or low blood pressure (BP).

METHODS

Non-diabetic Chinese or Japanese sibling pairs were included if one had extreme hypertension and the other was either hypertensive or hypotensive. Four common, non-coding single nucleotide polymorphisms (SNPs) were identified by sequencing the resistin gene in 24 hypertensive probands. Generalized estimating equations (GEEs)-based regressions were then performed to test for SNP associations using the entire study population (n=1556).

RESULTS

Of 72 tests, only one was significant at the 0.05 level; 3.5 significant tests were expected by chance alone. High variability in insulin and triglyceride levels created wide confidence intervals, thus the negative results are not conclusive for these phenotypes. However, the large sample size resulted in narrow confidence intervals for BMI, fasting and 120min post-load glucose, and high and low density lipoprotein cholesterol (LDL-C).

CONCLUSION

Several factors associated with insulin resistance are not likely influenced by the resistin gene in non-diabetic Asian individuals with high and low blood pressure.

Association between lifestyle activity and depressed mood among home-dwelling older people: a community-based study in Japan

In the community-based cross-sectional study, we investigated patterns of lifestyle activities among older people and examined the association between specific types of lifestyle activity and depressed mood status. The participants were 656 men and women aged 65 or older in 2004 who lived in a rural town in Japan, neither institutionalized nor hospitalized and who did not have symptoms of dementia. We found that less interaction with neighbors, society and friends was highly associated with depressed mood for men. Additionally, although they were physically active in gardening/farming, it did not necessarily mean that they were mentally healthy if they did not have close ties with friends, family and children/grandchildren. For women, it seemed important to engage in several types of activities relating to society, leisure and children/grandchildren to be in less depressed mood. Even if they were socially inactive, if they had frequent contact with family and children/grandchildren or going out for pleasure they were less likely to be depressed. Distinguishing gender differences in lifestyle activity patterns and the association of activities with depressed mood will help to guide the development of depression intervention programs.

Midlife risk factors and healthy survival in men

CONTEXT

Healthy survival has no clear phenotypic definition, and little is known about its attributes, particularly in men.

OBJECTIVE

To test whether midlife biological, lifestyle, and sociodemographic risk factors are associated with overall survival and exceptional survival (free of a set of major diseases and impairments).

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study within the Honolulu Heart Program/Honolulu Asia Aging Study. A total of 5820 Japanese American middle-aged men (mean age, 54 [range, 45-68] years) free of morbidity and functional impairments were followed for up to 40 years (1965-2005) to assess overall and exceptional survival. Exceptional survival was defined as survival to a specified age (75, 80, 85, or 90 years) without incidence of 6 major chronic diseases and without physical and cognitive impairment.

MAIN OUTCOME MEASURE

Overall survival and exceptional survival.

RESULTS

Of 5820 original participants, 2451 participants (42%) survived to age 85 years and 655 participants (11%) met the criteria for exceptional survival to age 85 years. High grip strength and avoidance of overweight, hyperglycemia, hypertension, smoking, and excessive alcohol consumption were associated with both overall and exceptional survival. In addition, high education and avoidance of hypertriglyceridemia were associated with exceptional survival, and lack of a marital partner was associated with mortality before age 85 years. Risk factor models based on cumulative risk factors (survival risk score) suggest that the probability of survival to oldest age is as high as 69% with no risk factors and as low as 22% with 6 or more risk factors. The probability of exceptional survival to age 85 years was 55% with no risk factors but decreased to 9% with 6 or more risk factors.

CONCLUSION

These data suggest that avoidance of certain risk factors in midlife is associated with the probability of a long and healthy life among men.

Asian adolescents have a higher trunk:peripheral fat ratio than Whites

Body fat, especially in the upper body, has been associated with increased risk of chronic disease among adults. Factors associated with these traits among ethnically diverse populations are not well studied. We examined factors influencing body fat and weight among Asian and White adolescent girls from the female adolescent maturation longitudinal study (initial exam plus 2-y follow-up examination) in Hawaii. The objective of this study was to identify and compare influences on and differences in body size and fat distribution among Asian and White adolescent girls. Subjects were identified among age-eligible members of a large HMO. Of the 214 girls recruited for Exam 1, 107 girls returned for Exam 2. The girls' age, ethnicity, a 3-d diet record, and physical activity recall were obtained by questionnaire at both times, and Tanner pubic hair stage and anthropometry were clinically measured by trained staff at both exams. The ethnic proportion of the study sample was 57% Asian and 43% White. Each girl's ethnicity was based on the ethnic proportion of each biologic parent. The percentage of body fat was measured by Lunar Prodigy dual energy X-ray absorptiometry (DXA) at the follow-up exam only. Among various measures of skeletal size and adiposity, only leg length (inversely) and DXA trunk:peripheral fat ratio (directly) were associated with proportion of Asian ethnicity, after adjusting for age, Tanner pubic hair stage, physical activity, and energy intake. In a multivariate analysis focusing on the trunk:peripheral fat ratio, this measure of central obesity was positively associated with proportion of Asian ethnicity (P = 0.001) and bi-iliac breadth (P = 0.002), and negatively associated with birth weight (P = 0.021), after adjustment for Tanner pubic hair stage, physical activity, energy intake, biacromial breadth, and height. In conclusion, Asian adolescents have a higher trunk:peripheral fat ratio than Whites. Adolescent bi-iliac breadth (positively) and birthweight (negatively) are associated with more body fat on the trunk vs. periphery during adolescence.

Ethnicity and Nutrition of Adolescent Girls in Hawaii

OBJECTIVE

To describe the ethnicity and nutrition of adolescent girls in Hawaii.

DESIGN

This was a cross-sectional survey.

SUBJECTS

Girls, aged 9 to 14 years, were identified from the membership files of Kaiser Permanente Hawaii, a large Hawaii health maintenance organization.

MAIN OUTCOME MEASURES

Nutrient and food group intakes were compared against recommended intakes, physical activity levels, and anthropometric measurements of height, weight, body mass index (BMI), and subscapular and iliac skinfold thicknesses.

STATISTICAL ANALYSIS PERFORMED

Asian girls, girls of mixed ethnicity, and white girls were compared using analysis of variance.

RESULTS

Although Asian girls weighed the least and were the most sedentary, white girls had the lowest BMIs. Mixed ethnicity girls had the highest weights, BMIs, and subscapular and iliac skinfold thicknesses. No significant differences were found in major macronutrient intake. However, mixed ethnicity and Asian girls had lower fiber, iron, folate, and calcium intake than white girls. All groups met recommendations for iron intake, whereas none met fiber and calcium recommendations. All girls met folate recommendations. No differences were found in intakes for tofu, soy, grains, vegetables, or fruit and nuts food groups. Mixed ethnicity girls had the highest sweetened carbonated beverage intake although overall sugar intake was highest in white girls. Asian and mixed ethnicity girls' meat intakes were higher than white girls'. Intakes of mixed ethnicity girls more closely resembled those of Asians, although they exhibited the highest BMIs.

CONCLUSIONS

These data suggest grain, vegetable, fruit, and dairy intake should be encouraged as part of a balanced diet for adolescent girls in Hawaii.

Volcano Related Atmospheric Toxicants in Hilo and Hawaii Volcanoes National Park: Implications for Human Health

Volcanic fog (vog) from Kilauea volcano on the island of Hawaii includes a variety of chemical species including sulfur compounds and traces of metals such as mercury. The metal species seen tended to be in the nanograms per cubic meter range, whereas oxides of sulfur: SO2 and SO3 and sulfate aerosols, were in the range of micrograms per cubic meter and rarely even as high as a few milligrams per cubic meter of air (nominally ppb to ppm). These sulfur species are being investigated for associations with both acute and chronic changes in human health status. The sulfate aerosols tend to be less than 1 microm in diameter and tend to dominate the mass of this submicron size mode. The sulfur chemistry is dynamic, changing composition from predominantly sulfur dioxide and trioxide gasses near the volcano, to predominantly sulfate aerosols on the west side of the island. Time, concentration and composition characteristics of submicron aerosols and sulfur dioxide are described with respect to the related on-going health studies and public health management concerns. Exposures to sulfur dioxide and particulate matter equal to or less than 1 microm in size were almost always below the national ambient air quality standards (NAAQS). These standards do not however consider the acidic nature and submicron size of the aerosol, nor the possibility of the aerosol and the sulfur dioxide interacting in their toxicity. Time series plots, histograms and descriptive statistics of hourly averages give the reader a sense of some of the exposures observed.

Are Remnant-Like Particles Independent Predictors of Coronary Heart Disease Incidence?

Background— Remnant-like particles have been proposed as a new risk factor for coronary heart disease (CHD). This is the first long-term prospective investigation of the relationship between remnant-like particles and a cardiovascular disease outcome in healthy men.

Methods and Results— A cohort of 1156 Japanese-American men aged 60 to 82 from the Honolulu Heart Program was followed for 17 years. During that period 164 incident cases of CHD were identified. In multivariate Cox regression analyses, baseline remnant-like particle cholesterol (RLP-C) and triglyceride (RLP-TG) levels were significantly related to CHD incidence independently of nonlipid cardiovascular risk factors and of total cholesterol or high-density and low-density lipoprotein cholesterol levels. Total triglyceride levels were an independent predictor of CHD incidence. However, in models including RLP and triglyceride level simultaneously, neither variable was significant when adjusted for the other. This finding can be attributed to the strong correlation between RLP-C and RLP-TG levels and total triglycerides. When individuals with normal triglyceride levels (n=894) were separated from those with elevated triglycerides (n=260), the association between RLPs and CHD relative risk was only significant for the group with elevated triglyceride levels.

Conclusions— RLP levels predicted CHD incidence independently of nonlipid risk factors and of total cholesterol or high-density and low-density lipoprotein cholesterol levels. However, RLP levels did not provide additional information about CHD incidence over and above total triglyceride levels. Therefore, this study does not support the need for testing of remnants in men if measures of fasting triglycerides are available.

Diabetes, insulin resistance, and dementia among HIV-1-infected patients

OBJECTIVES

Metabolic complications have been associated with HIV-1 infection and with long-term use of antiretroviral (ARV) medications. In some studies, such complications have been linked to cardiovascular events, yet limited data exist concerning metabolic complications and dementia. The objective of this study was to examine the relationship between HIV-associated dementia (HAD) and diabetes among patients with HIV-1 infection.

DESIGN

Cross-sectional analysis of entry data for a longitudinal cohort study.

METHODS

A total of 203 participants who were enrolled in the Hawaii Aging with HIV Cohort between October 2001 and November 2003 served as the study population. Research case definitions of HAD were determined in consensus conferences by a panel that included neurologists, neuropsychologists, and a geriatrician. Diabetes was determined by self-report or a fasting glucose level > 125 mg/dL.

RESULTS

Participants' ages ranged between 20-76 years at enrollment with approximately one-half aged >/=50 years. After adjustment for important covariates including age, education, ethnicity, CD4 lymphocyte count, duration of HIV infection, and protease inhibitor-based ARV therapy, we found a statistically significant association of diabetes with HAD (odds ratio 5.43, 1.66-17.70). A significant association remained after adjustment for other vascular risk factors. Among participants without diabetes, fasting glucose levels were higher with increasing impairment category.

CONCLUSIONS

Within the Hawaii Aging with HIV Cohort, a longitudinal study enriched with older HIV-1-infected individuals, diabetes is associated with prevalent dementia. This finding is not fully explained by age or coexisting vascular risk factors. Evaluation of underlying mechanisms is warranted.

Dairy intake is associated with lower body fat and soda intake with greater weight in adolescent girls

Body fat and weight of 9- to 14-y-old girls (n = 323) from Kaiser Permanente were studied in relation to age, ethnicity, and physical activity. Mean age, calcium intake, weight, and iliac skinfold thickness were 11.5 +/- 1.4 y, 736.5 +/- 370.7 mg/d, 44.6 +/- 13.0 kg, and 12.4 +/- 6.1 mm, respectively. Multiple regression with age, ethnicity, height, Tanner breast stage, physical activity, energy, soda, and calcium intake explained 17% of the variation in iliac skinfold thickness. Calcium intake, age, and physical activity were significantly negatively associated with iliac skinfold thickness whereas height, Tanner breast stage, and Pacific Islander ethnicity were significantly positively associated (P < 0.0001, R(2) = 0.165). Substituting total calcium with dairy and nondairy calcium in separate models accounted for 16 and 15% of the variance, respectively (P < 0.0001, both models); 1 mg of total and dairy calcium was significantly associated with 0.0025 mm (P = 0.01) and 0.0026 mm (P = 0.02) lower iliac skinfold thickness. Thus, 1 milk serving was associated with 0.78 mm iliac skinfold thickness. The interaction of Asian ethnicity and dairy intake was significant (P = 0.027). Nondairy calcium was not associated with weight or iliac skinfold thickness. Soda intake was significantly positively associated with weight in both models (P = 0.01, both models). Decreasing soda and increasing dairy consumption among Asians may help maintain body fat and weight during adolescence.

Adolescent dairy consumption and physical activity associated with bone mass

BACKGROUND

This study identifies key modifiable factors influencing Asian and White adolescent bone development. Cross-sectional analysis of baseline data of cohort.

METHODS

Three hundred and twenty-three girls were examined from age-eligible girls at Kaiser Permanente Oahu in Hawaii. Girls' age, ethnicity, Tanner stage, 3-day diet record, level of physical activity, anthropometry, and calcaneal bone status were obtained by questionnaire and measurement, respectively. Lunar Achilles calcaneal was used to measure calcaneal bone mass. Multiple regression was used for analysis of factors influencing bone mass.

RESULTS

The mean age of adolescents was 11.6 +/- 1.5 years. Girls were generally ethnically mixed; the mean Asian ethnic proportion was 48% while White ethnic proportion was 43% and other ethnic proportion was 10%. Multiple regression explained 40.8% and 25.6% of the variation in calcaneal broadband ultrasound attenuation (BUA) and speed of sound (SOS), respectively, in a model where age, weight, biacromial breadth, Tanner pubic hair stage, Asian ethnicity, dairy intake, and physical activity positively influenced bone mass.

CONCLUSIONS

Tanner pubic hair stage, ethnicity, and biacromial breadth had the greatest influence on SOS; while physical activity, body weight, and dairy product intake had the greatest influence on BUA.

Tree-structured supervised learning and the genetics of hypertension

This paper is about an algorithm, FlexTree, for general supervised learning. It extends the binary tree-structured approach (Classification and Regression Trees, CART) although it differs greatly in its selection and combination of predictors. It is particularly applicable to assessing interactions: gene by gene and gene by environment as they bear on complex disease. One model for predisposition to complex disease involves many genes. Of them, most are pure noise; each of the values that is not the prevalent genotype for the minority of genes that contribute to the signal carries a "score." Scores add. Individuals with scores above an unknown threshold are predisposed to the disease. For the additive score problem and simulated data, FlexTree has cross-validated risk better than many cutting-edge technologies to which it was compared when small fractions of candidate genes carry the signal. For the model where only a precise list of aberrant genotypes is predisposing, there is not a systematic pattern of absolute superiority; however, overall, FlexTree seems better than the other technologies. We tried the algorithm on data from 563 Chinese women, 206 hypotensive, 357 hypertensive, with information on ethnicity, menopausal status, insulin-resistant status, and 21 loci. FlexTree and Logic Regression appear better than the others in terms of Bayes risk. However, the differences are not significant in the usual statistical sense.

Ontogeny of Arousal

Ontogeny of arousal data constitute a vital supplement to the sparse literature on spontaneous neuronal activity. These data demonstrate that measurable infant spontaneous arousals (SAs) with an inherent oscillatory entrainment occur six times more in active sleep than in quiet sleep of the same duration and are identifiable as a human neurobiologic function. These SAs are not significantly associated with race or ethnicity, gender, total hours spent sleeping, percent time spent in active or quiet sleep, preterm status, history of a life-threatening event, having had a sibling who died of sudden infant death syndrome (SIDS), or having had a mother who smoked during this pregnancy. As measurable neurophysiologic events, SAs establish parameters for research at molecular and molar levels focusing on several critical areas: (1) the neuronal control of SA related to neurotransmitters, (2) as a significant antecedent factor in clinical cardiorespiratory events occurring in infants at high epidemiologic risk for SIDS; (3) as a regulatory biologic factor underlying temperament and executive cognitive functioning, and (4) morbidity and mortality effects possibly related to therapeutic interventions that alter SA levels.

Formula feeding in infancy is associated with adolescent body fat and earlier menarche

The tempo, level of growth and maturation during adolescence may have important implications to future adult health. The purpose of the study was to examine factors associated with menarche. Three hundred and forty girls, 9 to 14 years old, were selected from all age eligible girls at Kaiser Permanente Oahu (Honolulu). Girls' age, ethnicity, menstrual status and feeding pattern during infancy were obtained by questionnaire. The mean age of girls was 11.5 +/- 1.4 yr and the mean age at menarche among 112 (33%) girls who had reached menarche was 11.6 +/- 1.1 yr. In logistic regression, achievement of menarche was positively explained by age, Asian ethnicity and formula feeding during infancy. In simple linear regression, higher body mass index (BMI) and subcutaneous fat were also positively associated with formula feeding during infancy. The study suggests that girls who were formula fed deposit more body fat than girls who were breast-fed, resulting in early attainment of menarche.

Mediators of lifestyle behavior change in Native Hawaiians: initial findings from the Native Hawaiian Diabetes Intervention Program

OBJECTIVE

To examine the association of stage of change with diet and exercise behaviors in response to a lifestyle intervention for Native Hawaiians (NHs).

RESEARCH DESIGN AND METHODS

A family ('ohana) support lifestyle intervention was compared with a standard intervention in NHs with or at risk for diabetes in two rural communities in Hawaii (n = 147). Stage of change, as a hypothesized mediator of behavior change, and dietary and exercise behaviors were measured at baseline and at 1 year postintervention.

RESULTS

Stage of change was significantly associated with positive dietary and exercise behaviors. NHs receiving the 'ohana support (OS) intervention were more likely to advance from pre-action to action/maintenance for fat intake and physical activity than the group who received the standard intervention. Participants in the OS group who advanced from pre-action to action/maintenance showed more improvement in fat intake and physical activity than those in the standard group.

CONCLUSIONS

These initial findings suggest that stage of change is an important factor in mediating lifestyle behavior changes in persons with or at risk for diabetes and merits further study among minority populations at high risk for diabetes.

Plasma fibrinogen as a predictor of total and cause-specific mortality in elderly Japanese-American men

The relation between plasma fibrinogen and total and cause-specific mortality was investigated in a cohort of 3571 Japanese-American men aged 71 to 93 years during a median follow-up of 4.4 years. There were a total of 728 deaths, of which 37% were accounted for by cardiovascular disease and 27% by cancer. The age-adjusted relative risk (RR) for total mortality in the top quintile of fibrinogen (>3.51 g/L) compared with the bottom quintile (<2.57 g/L) was 4.3 (P<0.0001) in the first year of follow-up. RR was reduced to 1.7 in the second year but remained significantly and slightly increased in subsequent years. After adjustment for age and confounding risk factors, the RRs (and 95% confidence intervals) associated with a 1-SD increment of fibrinogen (0.64 g/L) for all-cause, cardiovascular disease, cancer, and other-cause mortality were 1.3 (1.2 to 1.4), 1.2 (1.1 to 1.4), 1.3 (1.2 to 1.5), and 1.3 (1.2 to 1.5), respectively. Preexisting diseases did not influence the significant association of fibrinogen with mortality. There was a significant interaction of fibrinogen with white blood cell count but not with cigarette smoking. We conclude that plasma fibrinogen is an independent risk factor for mortality from a broad spectrum of diseases in elderly men and that this universal effect of fibrinogen on mortality may be mediated partly through inflammation.

The effects of childhood residence in Japan and testing language on cognitive performance in late life among Japanese American men in Hawaii

OBJECTIVES

To examine the association of years spent in Japan during childhood with cognitive test performance in late life among Japanese American men, and to assess the influence of the language used for testing on this association.

DESIGN

A cross-sectional study.

SETTING/PARTICIPANTS

A total of 3734 Japanese American men, aged 71-93 years, who were first- or second-generation migrants and living on Oahu Island, Hawaii.

MEASUREMENTS

The outcome variable was cognitive test performance assessed using the Cognitive Abilities Screening Instrument (CASI), which was developed for cross-cultural studies of cognitive impairment. The explanatory variable of main interest was the number of years spent in Japan during school-age childhood years (ages 6-17). The associations of CASI scores with childhood years in Japan was evaluated using a stepwise multiple linear regression model in which a total of 40 potential confounders were included as covariates.

RESULTS

In the total sample, there was an inverse association between CASI scores and middle childhood years in Japan. This association remained significant after controlling for age, education, socioeconomic status, traditional Japanese food consumption, pulmonary function, apolipoprotein E4, proficiency in speaking Japanese, and other possible confounders. When data were analyzed separately for subgroups according to the language preferred at testing (English or Japanese), associations between childhood years in Japan and CASI scores were in opposite directions negative for the group tested in English and positive for the group tested in Japanese. The interaction between the testing language and childhood years in Japan was statistically significant.

CONCLUSIONS

There was an inverse association between years spent in Japan during school-age years of childhood and cognitive test performance in late life. This association could not be accounted for by age, education, or other confounding factors. However, this finding was not observed in participants who preferred being tested in Japanese. To assess cognitive test performance in older people, it is of prime importance to use the most optimal language for testing, usually the subject's native language.

Spatial relationships between prevalent and incident spine fractures

Women with prevalent fractures have an increased risk of developing additional, incident fractures. This article examines the relation between the location of prevalent fractures within the spine and the risk of subsequent vertebral fractures. The subjects were 721 Japanese-American women of mean age 69.5 +/- 5.3 (SD) years. For the analyses, the spine was categorized into three regions: an upper region, vertebrae T3-11; a middle region, vertebrae T-12 and L-1; and a lower region, vertebrae L2-5. Initial analyses were limited to women with, at most, one prevalent fracture. Compared to women without fracture, women with a prevalent fracture had odds ratios of 2-5 for developing an incident fracture outside the prevalent region. Subsequent analyses included women with multiple prevalent fractures. Women having two or three prevalent fractures had odds ratios of 7-9 for developing an incident fracture outside the prevalent region. The results suggest that the increased fracture risk of women with prevalent fractures extends beyond nearby vertebrae, and can affect vertebrae both above and below the prevalent fracture.

Variability in systolic blood pressure--a risk factor for coronary heart disease?

Among 1,433 men of Japanese ancestry living in Hawaii with blood pressure measured at four different physical examinations over a 10-year period, 110 events of definite coronary heart disease (CHD) occurred during 11.6 years of subsequent follow-up. Each subject's mean blood pressure, the slope of the regression of his blood pressure on age, and the variance of blood pressure about this regression line were tested for association with subsequent incident definite CHD. Adjusted for mean systolic blood pressure (SBP), the variance of SBP was significantly associated with CHD (p < 0.001); however, the slope was not significantly associated with CHD. Variation in body weight was an independent risk factor for CHD. The effect of variation in SBP was significantly higher among men not taking antihypertensive medication; among men taking antihypertension medication, the standardized relative risk was 1.00. Comparing men in the highest quintile of SBP variation with those in the lowest quintile, the relative risk of CHD was 2.0 among all subjects and 5.3 among the 1,007 men not taking antihypertensive medication (95% confidence interval 1.8-15.4). Some of the beneficial effect of taking antihypertensive medication may have been due to reducing the effect of SBP variance rather than simply lowering the average SBP.

Increased coronary heart disease in Japanese-American men with mutation in the cholesteryl ester transfer protein gene despite increased HDL levels

Plasma high density lipoprotein (HDL) levels are strongly genetically determined and show a general inverse relationship with coronary heart disease (CHD). The cholesteryl ester transfer protein (CETP) mediates the transfer of cholesteryl esters from HDL to other lipoproteins and is a key participant in the reverse transport of cholesterol from the periphery to the liver. A high prevalence of two different CETP gene mutations (D442G, 5.1%; intron 14G:A, 0.5%), was found in 3,469 men of Japanese ancestry in the Honolulu Heart Program and mutations were associated with decreased CETP (-35%) and increased HDL chol levels (+10% for D442G). However, the overall prevalence of definite CHD was 21% in men with mutations and 16% in men without mutations. The relative risk (RR) of CHD was 1.43 in men with mutations (P < .05); after adjustment for CHD risk factors, the RR was 1.55 (P = .02); after additional adjustment for HDL levels, the RR was 1.68 (P = .008). Similar RR values were obtained for the D442G mutation alone. Increased CHD in men with mutations was primarily observed for HDL chol 41-60 mg/dl; for HDL chol > 60 mg/dl men with and without mutations had low CHD prevalence. Thus, genetic CETP deficiency appears to be an independent risk factor for CHD, primarily due to increased CHD prevalence in men with the D442G mutation and HDL cholesterol between 41 and 60 mg/dl. The findings suggest that both HDL concentration and the dynamics of cholesterol transport through HDL (i.e., reverse cholesterol transport) determine the anti-atherogenicity of the HDL fraction.

Identifiability of segregation parameters using estimating equations

To eliminate the need for distributional assumptions and to reduce the computational burden associated with the method of maximum likelihood, several researchers have proposed using estimating equations techniques for segregation analysis. One concern with the application of this technique has been that the first and second order moments may not carry sufficient information for identifying all of the parameters in segregation models. It is shown that in addition to the marginal means and covariances from nuclear family data, up to the third order product moments need to be used in estimating equations for identifying all of the segregation parameters in a major gene model. A polygenic component and potentially a common family environment parameter can also be identified using up to the fourth order moments. Two weighting functions are developed to improve statistical efficiency.

Inhibition by chlorophyllin of 2-amino-3-methylimidazo-[4,5-f]quinoline-induced tumorigenesis in the male F344 rat

This report describes a 1-year carcinogenicity bioassay in which male F344 rats received 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) by gavage 2-3 times per week throughout the first 35 weeks of study, while 0.1% sodium/copper chlorophyllin (CHL) was given concomitantly in the drinking water. The carcinogen dose was calculated to provide an average exposure of 4.2 mg IQ/rat per day, equivalent to that reported in previous carcinogenicity study in which rats were given 0.03% IQ in the diet. Adjusted for length of follow-up, inhibition was highly significant for total tumor burden (P < 0.001), and for specific sites was significant in the small intestine and Zymbal's gland (P < or = 0.1), and in the liver (P < 0.01). In rats given CHL, the first onset of tumors in the Zymbal's gland was delayed from week 20 to 36, but was shortened from week 31 to 26 in the skin (P < 0.05). These results support a chemopreventive role for CHL in several of the major target organs for IQ tumorigenesis in the rat, but raise concerns over possible deleterious effects in the skin.

Trends in stroke incidence and mortality in Hawaiian Japanese men

BACKGROUND AND PURPOSE

Vital statistics show a sharp decline in stroke mortality since the late 1960s. It is not clear whether this has been associated with a decline in stroke incidence.

METHODS

Since 1966 the Honolulu Heart Program has monitored the incidence and mortality of coronary heart disease and stroke in a target population of 11,136 men of Japanese ancestry living on Oahu. Trends were analyzed from January 1, 1969, through December 31, 1988.

RESULTS

Of 7893 men aged 45 to 68 years and free of stroke at entry examination, 530 developed first episodes of stroke in the period 1969 to 1988 (389 cases of thromboembolic stroke, 124 cases of hemorrhagic stroke, and 17 cases of stroke of unknown type). Age-adjusted annual stroke incidence declined from 5.1 per 1000 person-years in 1969 to 1972 to 2.4 in 1985 to 1988. The incidences of thromboembolic stroke, hemorrhagic stroke, and total stroke decreased 3.5%, 4.2%, and 4.4% per year, respectively. The 1-month case-fatality rates for thromboembolic stroke decreased moderately; those for hemorrhagic stroke fell dramatically.

CONCLUSIONS

These findings suggest that the decline in stroke mortality in the past two or three decades results from a decline in both incidence rates and early case-fatality rates in thromboembolic and hemorrhagic stroke and stroke of unknown type. The decreases may be related to changes in risk factors, such as the decline in blood pressure and the decrease in cigarette smoking, as well as improvements in diagnosis and treatment.

Determinants of the prognosis after a first myocardial infarction in a migrant Japanese population. The Honolulu Heart Program

BACKGROUND

Although numerous studies have been published on the prognostic assessment of myocardial infarction, little is known about determinants of the prognosis after a first myocardial infarction, especially regarding the role of standard risk factors for coronary heart disease (CHD) measured before the development of myocardial infarction.

METHODS AND RESULTS

In a prospective study of CHD among men of Japanese ancestry living in Hawaii, 457 patients with a first myocardial infarction (age range, 46 to 84 years) were identified during 20 years of follow-up. The relations of clinical variables and CHD risk factors to mortality in early (< 30 days) and two stages of late (30 days to 5 years and 5 to 10 years) periods after myocardial infarction in these patients were investigated. In multivariate analyses using logistic regression models (for early mortality) and Cox regression models (for late mortality), age at myocardial infarction and severe complications (Killip classes 3 and 4) were independent predictors of both early and late mortality (up to 5 years after myocardial infarction). In addition, ventricular arrhythmias predicted only early mortality, whereas anterior myocardial infarction, radiological evidence of cardiomegaly and/or pulmonary congestion, and intraventricular block predicted only late mortality (up to 5 years after myocardial infarction). Only age was an independent predictor of all-cause mortality more than 5 years after myocardial infarction. After adjusting for age at myocardial infarction and these clinical variables, preinfarction-measured risk factors such as 1-hour postload serum glucose (positively) and 1-second forced expiratory volume (inversely) were significantly associated with late mortality up to 5 years, whereas systolic blood pressure was the only independent predictor of late mortality after 5 years.

CONCLUSIONS

This study has confirmed the importance of age at myocardial infarction and clinical indicators of complications such as Killip class 3 or 4, radiological evidence of pulmonary congestion, and ventricular arrhythmias or intraventricular block as the prognostic determinants of myocardial infarction. In addition, some of the preinfarction-measured standard risk factors for CHD were found to predict long-term prognosis independent of age and clinical factors.

Lipids and lipoproteins as risk factors for coronary heart disease in men with abnormal glucose tolerance: the Honolulu Heart Program

OBJECTIVES

To evaluate lipids and lipoproteins as risk factors for coronary heart disease (CHD) in older men with non-insulin-dependent diabetes (NIDDM) or abnormal glucose tolerance compared with normoglycaemic men.

DESIGN

A prospective, population-based cohort study based on the lipoprotein examination (1970-72) of the Honolulu Heart Program. Follow-up was through to December 1988.

SETTING

Honolulu, Hawaii.

SUBJECTS

Japanese-American men, ages 51-72 at baseline: 2042 with 1 h glucose < 12.5 mmol l-1 (normal group); 376 on oral hypoglycaemic agents or with 1 h glucose > or = 12.5 mmol l-1 after 50 g oral glucose challenge (abnormal glucose tolerance group). None had prevalent coronary heart disease (CHD) or stroke at baseline.

MAIN OUTCOME MEASURES

Incident CHD: definite non-fatal myocardial infarction (MI) or fatal CHD.

RESULTS

There were 221 incident cases in the normal group, and 65 in the abnormal glucose tolerance group. Total and high-density lipoprotein (HDL) cholesterol were significant predictors of incident CHD in men with NIDDM or abnormal glucose tolerance after controlling for age, body-mass index, systolic blood pressure, pack-years of cigarettes and alcohol consumption (P < 0.05). Total, low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) cholesterol were significant predictors in normal men, and HDL cholesterol was of borderline significance.

CONCLUSIONS

Abnormal lipids and lipoproteins are significant, independent predictors of CHD in subjects with NIDDM or abnormal glucose tolerance. Attention to lipid and lipoproteins as CHD risk factors should be part of clinical management of these patients.

Correlation analysis of twin data with repeated measures based on generalized estimating equations

Repeated measures allow additional tests of common assumptions in twin correlation analysis. Analysis of log serum triglyceride level in NHLBI male twins using generalized estimating equations disclosed that the mean and variance shifted across exams, presumably because of changes in laboratory practice.

Evaluation of the sampling plan used in collecting data for a study of LDL subclass pattern

The genetic epidemiologic study of coronary heart disease conducted by a group in the Donner Laboratory used survey and ad hoc sampling plans, resulting in a random and an ad hoc sample of families, respectively. These two samples were used to evaluate the ad hoc sampling plan used in that study. Following the description of data collection, we adjusted for ascertainment, but still found that the aggregation patterns of many lipoproteins in the ad hoc sample were different from those in the random sample.

Relationship between bone mass and rates of bone change at appendicular measurement sites

The rate of bone change among postmenopausal women may vary depending upon the initial bone mass. Examining this possibility is difficult, however, because of a negative statistical bias that occurs when change is regressed against the initial value of the same variable. In this article, four statistical methods were applied to measure the association between bone mass and the rate of bone change. The study population was Japanese-American women, who were monitored for approximately 5 years. Bone changes were determined for the calcaneus and the distal and proximal radius. The results were consistent across the bone sites but differed between statistical methods. Three of the four methods indicated that the women with the greater bone mass had the greater loss rates. The fourth method did not support this association. Possible reasons for the discordant results are discussed. Using the "best" estimate of the relationship, a gradual convergence of bone mass was projected over time toward the population mean. The convergence occurred because women with higher bone mass had a somewhat faster loss rate than women with lower bone mass. Overall, however, the variation in bone mass between individuals was large compared to the rate of convergence.

Will lowering population levels of serum cholesterol affect total mortality? Expectations from the Honolulu Heart Program

Major campaigns now underway to reduce the serum cholesterol levels of entire national populations have not given serious consideration to the high rates of noncardiovascular disease and death associated with low cholesterol levels (less than 190 mg/dl). To explore this problem, the relationships between serum cholesterol levels, measured in 1965-1968 in 7478 Japanese American men in Hawaii, and subsequent total and cause-specific mortality through 1985, were analyzed by multivariate Cox regression to control for potential confounders. Total mortality rates for 1648 deaths showed a U-shaped curve by baseline cholesterol level, with significant inverse trends (p less than 0.03) for deaths due to hemorrhagic stroke, all cancer, benign liver disease, chronic obstructive lung disease and "unknown cause". Only the inverse trends for cancer and benign liver disease showed flattening when 227 deaths in the first 5 years of follow-up were deleted from the analysis. Simulation models using three different strategies of cholesterol reduction in this cohort revealed that none of these approaches had any substantial impact on predicted total mortality over 15 years. However, the population-based approach might theoretically increase mortality for 60% of the cohort with baseline cholesterol levels less than 225 mg/dl.

The association of blood pressure with cancer incidence in a prospective study

A cohort of 8,006 Japanese-American men living in Hawaii was examined from 1965 to 1968 and followed for about 20 years. The study identified 1,155 incident cases of histologically confirmed cancer and 648 deaths due to cancer. There was no association between systolic or diastolic blood pressure and total cancer incidence or deaths due to cancer. The relative risk was 1.03 for cancer incidence and 1.00 for cancer mortality for subjects with a systolic pressure of 160 mmHg or greater. Adjustment was made for age, smoking, alcohol, and measures related to obesity. When cancers of specified sites were studied, blood pressure was positively associated with the incidence of kidney cancer (17 cases). After adjustment for the significant effect of taking antihypertensive medication, the effect of blood pressure became nonsignificant. Among seven other cancer sites, there were no statistically significant associations with blood pressure after adjustment for confounding factors.

Estimating the sensitivity of breast cancer screening--experience with the Honolulu BCDDP data

The 'capture-recapture' models for estimating breast cancer screening sensitivity can be generalized to include factors that affect sensitivity such as cancer size. Including such factors can help reduce the covariance between mammographic and physical exam sensitivity, which will improve the estimates. One model relating sensitivity to cancer length is presented and tested using data from the Honolulu Breast Cancer Detection Demonstration Project (BCDDP). The model predicts sensitivity fairly well for large breast cancers, but underestimates sensitivity for small cancers. Using both mammography and physical examination, the total screening sensitivity is estimated as 0.91 +/- 0.03 for cancers longer than 12 mm (for the second through fifth screenings for Honolulu and Tucson screening data combined). Limited data suggest similar screening sensitivities for Orientals and Caucasians in Hawaii. Shortcomings of the BCDDP data include inaccurate measurements of cancer length. Suggestions to improve data for future work are given.

A prospective study of stomach cancer and its relation to diet, cigarettes, and alcohol consumption

From 1965 to 1968 in Hawaii, 7990 American men of Japanese ancestry were interviewed and examined in a cohort study. The intake of 20 separate foods in a food frequency questionnaire and the intake of carbohydrate and other nutrients, based on a 24-h diet recall history, were recorded. Since then, 150 incident cases of stomach cancer have been identified. Although men with stomach cancer (cases) consumed pickles and ham/bacon/sausages more often and fruits and fried vegetables less often than men without cancer (noncases), none of the differences was statistically significant. Current cigarette smokers had an increased risk (relative risk = 2.7; 95% confidence interval = 1.8 to 4.1) compared with nonsmokers, but there was no dose-response effect with heavier cigarette smoking. The consumption of alcohol, either from beer, spirits, or wine, did not affect the incidence of stomach cancer. The failure to detect an association with dietary foods in this study may be due to the omission of many oriental foods in the questionnaire and the limitations of the 24-h diet recall history.