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Manolio TA, Burke GL, Savage PJ, Jacobs DR, Sidney S, Wagenknecht LE, Allman RM, Tracy RP. Sex- and Race-Related Differences in Liver-Associated Serum Chemistry Tests in Young Adults in the Cardia Study. Clin Chem 2019. [DOI: 10.1093/clinchem/38.9.1853] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Simultaneous multiple automated analyses of liver function can be performed quickly and cheaply, but their usefulness in mass screening is questionable. Reference intervals are frequently applied without regard to race and sex, despite the fact that reported values may vary considerably in relation to these factors. Serum analyte results for greater than 5000 black and white men and women in the CARDIA Study showed clinically and statistically significant differences by race and sex for values of aspartate aminotransferase, gamma-glutamyltransferase, alkaline phosphatase, total bilirubin, total protein, and albumin; these differences were not explained by differences in age, body mass, reported ethanol intake, smoking, or oral contraceptive use. Results for at least one of these six tests were out of range in 38% of the men and 19% of the women. Sex- and race-specific reference intervals are recommended to decrease the frequency of values reported as abnormal in otherwise healthy young adults.
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Affiliation(s)
- T A Manolio
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
| | - G L Burke
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
| | - P J Savage
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
| | - D R Jacobs
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
| | - S Sidney
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
| | - L E Wagenknecht
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
| | - R M Allman
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
| | - R P Tracy
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, MD 20892
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Elfaquir J, Sidney S, Poupard M, Duverger C, Dieye T, Gervais R, Khuong-Josses MA. Génériques des antirétroviraux (ARV) : perception et tolérance des patients. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marcus JL, Hurley LB, Prasad A, Zaroff J, Klein DB, Horberg MA, Go AS, DeLorenze GN, Quesenberry CP, Sidney S, Lo JC, Silverberg MJ. Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals. HIV Med 2018; 20:19-26. [PMID: 30178911 DOI: 10.1111/hiv.12670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES We evaluated the association of HIV infection and immunodeficiency with acute coronary syndrome (ACS) recurrence, and with all-cause mortality as a secondary outcome, after hospitalization for ACS among HIV-infected and HIV-uninfected individuals. METHODS We conducted a retrospective cohort study within Kaiser Permanente Northern California of HIV-infected and HIV-uninfected adults discharged after ACS hospitalization [types: ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina] during 1996-2010. We compared the outcomes of ACS recurrence and all-cause mortality within 3 years, both overall by HIV status and stratified by recent CD4 count, with HIV-uninfected individuals as the reference group. Hazard ratios (HRs) were obtained from Cox regression models with adjustment for age, sex, race/ethnicity, year, ACS type, smoking, and cardiovascular risk factors. RESULTS Among 226 HIV-infected and 86 321 HIV-uninfected individuals with ACS, HIV-infected individuals had a similar risk of ACS recurrence compared with HIV-uninfected individuals [HR 1.08; 95% confidence interval (CI) 0.76-1.54]. HIV infection was independently associated with all-cause mortality after ACS hospitalization overall (HR 2.52; 95% CI 1.81-3.52). In CD4-stratified models, post-ACS mortality was higher for HIV-infected individuals with CD4 counts of 201-499 cells/μL (HR 2.64; 95% CI 1.66-4.20) and < 200 cells/μL (HR 5.41; 95% CI 3.14-9.34), but not those with CD4 counts ≥ 500 cells/μL (HR 0.67; 95% CI 0.22-2.08), compared with HIV-uninfected individuals (P trend < 0.001). CONCLUSIONS HIV infection and immunodeficiency were not associated with recurrence of ACS after hospitalization. All-cause mortality was higher among HIV-infected compared with HIV-uninfected individuals, but there was no excess mortality risk among HIV-infected individuals with high CD4 counts.
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Affiliation(s)
- J L Marcus
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - L B Hurley
- Kaiser Permanente Division of Research, Oakland, CA
| | - A Prasad
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - J Zaroff
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - D B Klein
- Kaiser Permanente San Leandro Medical Center, San Leandro, CA
| | - M A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, MD, USA
| | - A S Go
- Kaiser Permanente Division of Research, Oakland, CA
| | | | | | - S Sidney
- Kaiser Permanente Division of Research, Oakland, CA
| | - J C Lo
- Kaiser Permanente Division of Research, Oakland, CA
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Kremer PHC, Koeleman BPC, Pawlikowska L, Weinsheimer S, Bendjilali N, Sidney S, Zaroff JG, Rinkel GJE, van den Berg LH, Ruigrok YM, de Kort GAP, Veldink JH, Kim H, Klijn CJM. Evaluation of genetic risk loci for intracranial aneurysms in sporadic arteriovenous malformations of the brain. J Neurol Neurosurg Psychiatry 2015; 86:524-9. [PMID: 25053769 PMCID: PMC4302044 DOI: 10.1136/jnnp-2013-307276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 07/01/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND In genome-wide association studies (GWAS) five putative risk loci are associated with intracranial aneurysm. As brain arteriovenous malformations (AVM) and intracranial aneurysms are both intracranial vascular diseases and AVMs often have associated aneurysms, we investigated whether these loci are also associated with sporadic brain AVM. METHODS We included 506 patients (168 Dutch, 338 American) and 1548 controls, all Caucasians. Controls had been recruited as part of previous GWAS. Dutch patients were genotyped by KASPar assay and US patients by Affymetrix SNP 6.0 array. Associations in each cohort were tested by univariable logistic regression modelling, with subgroup analysis in 205 American cases with aneurysm data. Meta-analysis was performed by a Mantel-Haenszel fixed-effect method. RESULTS In the Dutch cohort none of the single nucleotide polymorphisms (SNPs) were associated with AVMs. In the American cohort, genotyped SNPs near SOX-17 (OR 0.74; 95% CI 0.56-0.98), RBBP8 (OR 0.76; 95% CI 0.62-0.94) and an imputed SNP near CDKN2B-AS1 (OR 0.79; 95% CI 0.64-0.98) were significantly associated with AVM. The association with SNPs near SOX-17 and CDKN2B-AS1 but not RBBP8 were strongest in patients with AVM with associated aneurysms. In the meta-analysis we found no significant associations between allele frequencies and AVM occurrence, but rs9298506, near SOX-17 approached statistical significance (OR 0.77; 95% CI 0.57-1.03, p=0.08). CONCLUSIONS Our meta-analysis of two Caucasian cohorts did not show an association between five aneurysm-associated loci and sporadic brain AVM. Possible involvement of SOX-17 and RBBP8, genes involved in cell cycle progression, deserves further investigation.
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Affiliation(s)
- P H C Kremer
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B P C Koeleman
- Department of Biomedical Genetics and Complex Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Pawlikowska
- Department of Anesthesia, Center for Cerebrovascular Research, University of California-San Francisco, San Francisco, California, USA Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - S Weinsheimer
- Department of Anesthesia, Center for Cerebrovascular Research, University of California-San Francisco, San Francisco, California, USA
| | - N Bendjilali
- Department of Anesthesia, Center for Cerebrovascular Research, University of California-San Francisco, San Francisco, California, USA
| | - S Sidney
- Division of Research, Kaiser Permanente of Northern California, Oakland, California, USA
| | - J G Zaroff
- Division of Research, Kaiser Permanente of Northern California, Oakland, California, USA
| | - G J E Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L H van den Berg
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y M Ruigrok
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G A P de Kort
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J H Veldink
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Kim
- Department of Anesthesia, Center for Cerebrovascular Research, University of California-San Francisco, San Francisco, California, USA Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - C J M Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Zhu N, Jacobs DR, Meyer KA, He K, Launer L, Reis JP, Yaffe K, Sidney S, Whitmer RA, Steffen LM. Cognitive function in a middle aged cohort is related to higher quality dietary pattern 5 and 25 years earlier: the CARDIA study. J Nutr Health Aging 2015; 19:33-8. [PMID: 25560814 PMCID: PMC5466430 DOI: 10.1007/s12603-014-0491-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preserving cognitive function is an important public health issue. We investigated whether dietary pattern associates with cognitive function in middle-age. METHODS We studied 2435 participants in the community-based Coronary Artery Risk Development in Young Adults (CARDIA) study of black and white men and women aged 18-30 in 1985-86 (year 0, Y0). We hypothesized that a higher A Priori Diet Quality Score, measured at Y0 and Y20, is associated with better cognitive function measured at Y25. The diet score incorporated 46 food groups (each in servings/day) as the sum of quintile ranks of food groups rated beneficial, 0 for food groups rated neutral, and reversed quintile ranks for food groups rated adverse; higher score indicated better diet quality. Y25 cognitive testing included verbal memory (Rey Auditory-Verbal Learning Test (RAVLT)), psychomotor speed (Digit Symbol Substitution Test (DSST)) and executive function (Stroop). RESULTS Per 10-unit higher diet score at Y20, the RAVLT was 0.32 words recalled higher, the DSST was 1.76 digits higher, and the Stroop was 1.00 seconds+errors lower (better performance) after adjusting for race, sex, age, clinic, and energy intake. Further adjustment for physical activity, smoking, education, and body mass index attenuated the association slightly. Diet score at Y0 and increase in diet score over 20 years were also positively associated with each cognitive test. CONCLUSIONS A higher quality dietary pattern was associated with better cognitive function 5 years and even 25 years later in apparently healthy middle-aged adults.
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Affiliation(s)
- N Zhu
- David R. Jacobs, 1300 South 2nd Street, Ste 300, Minneapolis, MN 55454, Phone: 612-624-4196, Fax: 612-624-0315,
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Nayak S, Hubbard A, Sidney S, Syme SL. PP66 Self-rated health in the CARDIA Study: a recursive partitioning approach to contextualising health determinants. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vijayaraghavan M, Kushel MB, Vittinghoff E, Kertesz S, Jacobs D, Lewis CE, Sidney S, Bibbins-Domingo K. Housing instability and incident hypertension in the CARDIA cohort. J Urban Health 2013; 90:427-41. [PMID: 22752301 PMCID: PMC3665966 DOI: 10.1007/s11524-012-9729-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Housing instability, a growing public health problem, may be an independent environmental risk factor for hypertension, but limited prospective data exist. We sought to determine the independent association of housing instability in early adulthood (year 5, 1990-1991) and incident hypertension over the subsequent 15 years of follow-up (years 7, 10, 15, and 20) in the Coronary Artery Risk Development in Young Adults (CARDIA) study (N = 5,115). Because causes of inadequate housing and its effects on health are thought to vary by race and sex, we hypothesized that housing instability would exert a differential effect on incident hypertension by race and sex. At year 5, all CARDIA participants were asked about housing and those free of hypertension were analyzed (N = 4,342). We defined housing instability as living in overcrowded housing, moving frequently, or living doubled up. Of the 4,342 participants, 8.5 % were living in unstable housing. Across all participants, housing instability was not associated with incident hypertension (incidence rate ratio (IRR), 1.1; 95 % CI, 0.9-1.5) after adjusting for demographics, socioeconomic status, substance use, social factors, body mass index, and study site. However, the association varied by race and sex (p value for interaction, <0.001). Unstably housed white women had a hypertension incidence rate 4.7 times (IRR, 4.7; 95 % CI, 2.4-9.2) that of stably housed white women in adjusted analysis. There was no association among white men, black women, or black men. These findings suggest that housing instability may be a more important risk factor among white women, and may act independently or as a marker for other psychosocial stressors (e.g., stress from intimate partner violence) leading to development of hypertension. Studies that examine the role of these psychosocial stressors in development of hypertension risk among unstably housed white women are needed.
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Affiliation(s)
- M Vijayaraghavan
- Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA
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Flint AC, Kamel H, Navi BB, Rao VA, Faigeles BS, Conell C, Klingman JG, Hills NK, Nguyen-Huynh M, Cullen SP, Sidney S, Johnston SC. Inpatient statin use predicts improved ischemic stroke discharge disposition. Neurology 2012; 78:1678-83. [DOI: 10.1212/wnl.0b013e3182575142] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Xun P, Hou N, Daviglus M, Liu K, Morris JS, Shikany JM, Sidney S, Jacobs DR, He K. Fish oil, selenium and mercury in relation to incidence of hypertension: a 20-year follow-up study. J Intern Med 2011; 270:175-86. [PMID: 21205024 PMCID: PMC3070957 DOI: 10.1111/j.1365-2796.2010.02338.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Long-chain omega-3 polyunsaturated fatty acids (LCω3PUFAs), selenium (Se) and mercury (Hg) are three important components in fish. The cardioprotective effect of LCω3PUFA intake has been recognized; however, the hypothesis that this benefit may be greatest with high Se and low Hg levels has not been investigated. DESIGN A cohort of 4508 American adults aged 18-30, without hypertension at baseline in 1985, were enrolled. Six follow-ups were conducted at examinations in 1987, 1990, 1992, 1995, 2000 and 2005. Diet was assessed by a validated interviewer-administered quantitative food frequency questionnaire at exams in 1985, 1992 and 2005. Incident hypertension was defined as first occurrence at any follow-up examination of systolic blood pressure (BP) ≥ 140 mmHg, diastolic BP ≥ 90 mmHg or taking antihypertensive medication. Toenail clippings were collected in 1987, and Se and Hg levels were quantified by instrumental neutron-activation analysis. RESULT Participants in the highest LCω3PUFA intake quartile had a significantly lower incidence of hypertension (hazard ratio: 0.65; 95% CI: 0.53-0.79; P(trend) < 0.01) compared to those in the lowest quartile after adjustment for potential confounders. Docosahexaenoic acid showed a greater inverse association than eicosapentaenoic acid. The inverse association of LCω3PUFA intake with hypertension appeared more pronounced at higher Se and lower Hg levels, although interaction tests were statistically nonsignificant. CONCLUSIONS Our findings indicated that LCω3PUFA intake was inversely associated with incidence of hypertension. The prior hypothesis that the potential antihypertensive effect of LCω3PUFA intake varies depending on joint levels of Se and Hg received modest support and cannot be ruled out.
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Affiliation(s)
- P Xun
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, North Carolina, Chapel Hill, NC 27599, USA
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Eisner MD, Blanc PD, Omachi TA, Yelin EH, Sidney S, Katz PP, Ackerson LM, Sanchez G, Tolstykh I, Iribarren C. Socioeconomic status, race and COPD health outcomes. J Epidemiol Community Health 2011; 65:26-34. [PMID: 19854747 PMCID: PMC3017471 DOI: 10.1136/jech.2009.089722] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although chronic obstructive pulmonary disease (COPD) is a common cause of death and disability, little is known about the effects of socioeconomic status (SES) and race-ethnicity on health outcomes. METHODS The aim of this study is to determine the independent impacts of SES and race-ethnicity on COPD severity status, functional limitations and acute exacerbations of COPD among patients with access to healthcare. Data were used from the Function, Living, Outcomes and Work cohort study of 1202 Kaiser Permanente Northern California Medical Care Plan members with COPD. RESULTS Lower educational attainment and household income were consistently related to greater disease severity, poorer lung function and greater physical functional limitations in cross-sectional analysis. Black race was associated with greater COPD severity, but these differences were no longer apparent after controlling for SES variables and other covariates (comorbidities, smoking, body mass index and occupational exposures). Lower education and lower income were independently related to a greater prospective risk of acute COPD exacerbation (HR 1.5; 95% CI 1.01 to 2.1; and HR 2.1; 95% CI 1.4 to 3.4, respectively). CONCLUSION Low SES is a risk factor for a broad array of adverse COPD health outcomes. Clinicians and disease management programs should consider SES as a key patient-level marker of risk for poor outcomes.
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Affiliation(s)
- M D Eisner
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0111, USA.
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Calderon-Margalit R, Schwartz SM, Wellons MF, Lewis CE, Daviglus ML, Schreiner PJ, Williams OD, Sternfeld B, Carr JJ, O'Leary DH, Sidney S, Friedlander Y, Siscovick DS. Prospective association of serum androgens and sex hormone-binding globulin with subclinical cardiovascular disease in young adult women: the "Coronary Artery Risk Development in Young Adults" women's study. J Clin Endocrinol Metab 2010; 95:4424-31. [PMID: 20554712 PMCID: PMC2936074 DOI: 10.1210/jc.2009-2643] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT The role of endogenous androgens and SHBG in the development of cardiovascular disease in young adult women is unclear. OBJECTIVE Our objective was to study the prospective association of serum androgens and SHBG with subclinical coronary and carotid disease among young to middle-aged women. DESIGN AND SETTING This was an ancillary study to the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based multicenter cohort study with 20 yr of follow-up. PARTICIPANTS Participants included 1629 women with measurements of serum testosterone and SHBG from yr 2, 10, or 16 and subclinical disease assessment at yr 20 (ages 37-52 yr). MAIN OUTCOME MEASURES Coronary artery calcified plaques (CAC) and carotid artery intima-media thickness (IMT) were assessed at yr 20. The IMT measure incorporated the common carotid arteries, bifurcations, and internal carotid arteries. RESULTS SHBG (mean of yr 2, 10, and 16) was inversely associated with the presence of CAC (multivariable adjusted odds ratio for women with SHBG levels above the median = 0.59; 95% confidence interval = 0.40-0.87; P = 0.008). SHBG was also inversely associated with the highest quartile of carotid-IMT (odds ratio for women with SHBG levels in the highest quartile = 0.56; 95% confidence interval = 0.37-0.84; P for linear trend across quartiles = 0.005). No associations were observed for total or free testosterone with either CAC or IMT. CONCLUSION SHBG levels were inversely associated with subclinical cardiovascular disease in young to middle-aged women. The extent to which low SHBG is a risk marker or has its own independent effects on atherosclerosis is yet to be determined.
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Affiliation(s)
- R Calderon-Margalit
- Departments of Epidemiology, University of Washington, Seattle, Washington 98101, USA.
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Gardner MA, Hills NK, Sidney S, Johnston SC, Fullerton HJ. The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort. Neurology 2010; 74:372-8. [PMID: 20054007 DOI: 10.1212/wnl.0b013e3181cbcd48] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite increasing awareness of the long-term impact of pediatric stroke, there are few estimates of the costs of care. We examined acute and 5-year direct costs of neonatal and childhood stroke in a population-based cohort in Northern California. METHODS We obtained electronic cost data for 266 children with neurologist-confirmed strokes, and 786 age-matched stroke-free controls, within the population of all children (<20 years) enrolled in a large managed care plan from 1996 through 2003. Cost data included all inpatient and outpatient health service costs including care at out-of-plan facilities. Costs were assessed for 5 years after stroke, expressed in 2003 US dollars, and stratified by age at stroke onset (neonatal, defined as <29 days of life, vs childhood). Stroke costs were adjusted for costs in stroke-free age-matched controls. RESULTS Average adjusted 5-year costs for pediatric stroke are substantial: $51,719 for neonatal stroke and $135,161 for childhood stroke. The average cost of a childhood stroke admission was $81,869. The average birth admission cost for a neonatal stroke was $39,613; adjustment for control birth admission costs reduced this by only $4,792, suggesting the stroke accounted for 88% of costs. Even among neonates whose strokes were not recognized until later in childhood ("presumed perinatal strokes"), admission costs exceeded those of controls. Chronic costs were highest in the first year poststroke, but continued to exceed control costs even in the fifth year by an average of $2,016. CONCLUSIONS The economic burden of neonatal and childhood stroke is both large and sustained.
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Affiliation(s)
- M A Gardner
- Department og Pediatrics, University of California, San Francisco, Department of Neurology, San Francisco, CA 94143-0114, USA
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Armstrong-Wells J, Grimes B, Sidney S, Kronish D, Shiboski SC, Adams RJ, Fullerton HJ. Utilization of TCD screening for primary stroke prevention in children with sickle cell disease. Neurology 2009; 72:1316-21. [PMID: 19365052 DOI: 10.1212/wnl.0b013e3181a110da] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In 1998, the Stroke Prevention Trial in Sickle Cell Anemia showed a >90% reduction in stroke rates after blood transfusion therapy in children with sickle cell disease (SCD) identified as high risk with transcranial Doppler ultrasonography (TCD) screening. METHODS We studied the utilization of TCD screening in a retrospective cohort of all children with SCD within a large managed care plan from January 1993 to December 2005. Rates of first TCD screening were estimated using life table methods; predictors of TCD were evaluated using Cox proportional hazards regression. Stroke incidence rates were estimated in person-time before (pre-TCD) and after (post-TCD) first TCD. RESULTS The average annual rate of TCD screening in 157 children with SCD was 1.8 per 100 person-years pre-1998, 5.0 from January 1, 1998, to December 31, 1999, and 11.4 after 1999. The only independent predictor of TCD screening was proximity to the vascular laboratory. The annualized stroke rate pre-TCD was 0.44 per 100 person-years, compared to 0.19 post-TCD. CONCLUSIONS Since the Stroke Prevention Trial in Sickle Cell Anemia, the rate of transcranial Doppler ultrasonography (TCD) screening in sickle cell disease (SCD) has increased sixfold within a large health care plan. Children living farther from a vascular laboratory are less likely to be screened. Increased availability of TCD screening could improve the utilization of this effective primary stroke prevention strategy.
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Affiliation(s)
- J Armstrong-Wells
- University of California, San Francisco, Department of Neurology, Box 0114, 505 Parnassus Avenue, San Francisco, CA 94143-0114, USA
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Blanc PD, Iribarren C, Trupin L, Earnest G, Katz PP, Balmes J, Sidney S, Eisner MD. Occupational exposures and the risk of COPD: dusty trades revisited. Thorax 2008; 64:6-12. [PMID: 18678700 DOI: 10.1136/thx.2008.099390] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The contribution of occupational exposures to chronic obstructive pulmonary disease (COPD) and, in particular, their potential interaction with cigarette smoking remains underappreciated. METHODS Data from the FLOW study of 1202 subjects with COPD (of which 742 had disease classified as stage II or above by Global Obstructive Lung Disease (GOLD) criteria) and 302 referent subjects matched by age, sex and race recruited from a large managed care organisation were analysed. Occupational exposures were assessed using two methods: self-reported exposure to vapours, gas, dust or fumes on the longest held job (VGDF) and a job exposure matrix (JEM) for probability of exposure based on occupation. Multivariate analysis was used to control for age, sex, race and smoking history. The odds ratio (OR) and adjusted population attributable fraction (PAF) associated with occupational exposure were calculated. RESULTS VGDF exposure was associated with an increased risk of COPD (OR 2.11; 95% CI 1.59 to 2.82) and a PAF of 31% (95% CI 22% to 39%). The risk associated with high probability of workplace exposure by JEM was similar (OR 2.27; 95% CI 1.46 to 3.52), although the PAF was lower (13%; 95% CI 8% to 18%). These estimates were not substantively different when the analysis was limited to COPD GOLD stage II or above. Joint exposure to both smoking and occupational factors markedly increased the risk of COPD (OR 14.1; 95% CI 9.33 to 21.2). CONCLUSIONS Workplace exposures are strongly associated with an increased risk of COPD. On a population level, prevention of both smoking and occupational exposure, and especially both together, is needed to prevent the global burden of disease.
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Affiliation(s)
- P D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94117, USA
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16
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Abstract
OBJECTIVE To evaluate if midlife cardiovascular risk factors are associated with risk of late-life dementia in a large, diverse cohort. METHOD The authors conducted a retrospective cohort study of 8,845 participants of a health maintenance organization who underwent health evaluations from 1964 to 1973 when they were between the ages of 40 and 44. Midlife cardiovascular risk factors included total cholesterol, diabetes, hypertension, and smoking. Diagnoses of dementia were ascertained by medical records from January 1994 to April 2003. RESULTS The authors identified 721 participants (8.2%) with dementia. Smoking, hypertension, high cholesterol, and diabetes at midlife were each associated with a 20 to 40% increase in risk of dementia (fully adjusted Cox proportional hazards model: HR 1.24, 95% CI 1.04 to 1.48 for hypertension, HR 1.26, 95% CI 1.08 to 1.47 for smoking, HR 1.42, 95% CI 1.22 to 1.66 for high cholesterol, and HR 1.46, 95% CI 1.19 to 1.79 for diabetes). A composite cardiovascular risk score was created using all four risk factors and was associated with dementia in a dose-dependent fashion. Compared with participants having no risk factors, the risk for dementia increased from 1.27 for having one risk factor to 2.37 for having all four risk factors (fully adjusted model: HR 2.37, 95% CI 1.10 to 5.10). CONCLUSION The presence of multiple cardiovascular risk factors at midlife substantially increases risk of late-life dementia in a dose dependent manner.
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Affiliation(s)
- R A Whitmer
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612, USA.
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Gunderson EP, Murtaugh MA, Lewis CE, Quesenberry CP, West DS, Sidney S. Excess gains in weight and waist circumference associated with childbearing: The Coronary Artery Risk Development in Young Adults Study (CARDIA). Int J Obes (Lond) 2004; 28:525-35. [PMID: 14770188 PMCID: PMC3133634 DOI: 10.1038/sj.ijo.0802551] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the association of childbearing with weight and waist circumference (WC) changes, we compared women with and without pregnancies or births during follow-up. STUDY DESIGN A multicenter, longitudinal observational study over 10 years. Comparison groups defined by the number of pregnancies and births during follow-up: P0 (0 pregnancies; nongravid), P1 (1+ miscarriages or abortions; 'short' pregnancies), B1 (1 birth), and B2 (2+ births). Mean changes in weight and WC for P1, B1 and B2 groups vs P0 were examined separately by race (black and white), baseline parity (nulliparous and parous) and baseline weight status (normal weight; BMI <25 kg/m(2) and overweight; BMI >/=25 kg/m(2)). SUBJECTS A population-based sample of 2070 women aged 18-30 y at baseline (1053 black subjects and 1017 white subjects) from Birmingham, Alabama, Chicago, Illinois, Minneapolis, Minnesota, and Oakland, California were examined five times between 1985-1986 and 1995-1996. MEASUREMENTS Weight and WC measurements were obtained using standardized protocol at baseline and examinations at years 2, 5, 7 and 10. Sociodemographic, reproductive, and behavioral attributes were assessed at baseline and follow-up examinations. RESULTS Gains in weight and WC associated with pregnancy and childbearing varied by race (P<0.001), baseline parity (P<0.05) and overweight status (P<0.001). Among overweight nulliparas, excess gains in weight (black subjects: 3-5 kg, white subjects: 5-6 kg) and WC (black subjects: 3-4 cm, white subjects: 5-6 cm) were associated with 'short' pregnancies and one or more birth(s) during follow-up compared to no pregnancies (P<0.01 and 0.001). Among normal weight nulliparas, excess gains in weight (about 1 kg) and WC (2-3 cm) were associated with follow-up birth(s) (P<0.05). Among women parous at baseline, no excess weight gains were found, but excess WC gains (2-4 cm) were associated with follow-up births. CONCLUSION Substantial excess weight gain is associated with both short pregnancies and a first birth in women overweight prior to initiation of childbearing. Excess weight gain was not associated with higher order births. Increases in waist girth were cumulative with both first and higher order births among overweight as well as normal weight women. Interventions to prevent obesity should be targeted at women who are overweight prior to initiation of childbearing. The impact of excess WC gains associated with childbearing on women's future health risk should be evaluated further.
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Affiliation(s)
- E P Gunderson
- Kaiser Permanente Foundation Hospitals, Division of Research, 2000 Broadway, Oakland, CA 94612, USA.
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18
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Palonen KP, Lewis CE, Sidney S, Hulley S, Kiefe CI. 145 DOES PARITY INFLUENCE BONE DENSITY? RESULTS FROM THE CARDIA STUDY. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Cobb KL, Kelsey JL, Sidney S, Ettinger B, Lewis CE. Oral contraceptives and bone mineral density in white and black women in CARDIA. Coronary Risk Development in Young Adults. Osteoporos Int 2002; 13:893-900. [PMID: 12415437 DOI: 10.1007/s001980200123] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To examine whether exposure to oral contraceptives (OCs) is associated with bone mineral density (BMD) in young women, we studied, cross-sectionally and longitudinally, 216 white and 260 black women enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Spine, hip and whole body BMDs were measured by dual-energy X-ray absorptiometry (DXA) when the women were aged 25-37 years, and whole body BMD was remeasured in 369 of the women 3 years later. A comprehensive history of OC use, including dose of ethinyl estradiol (estrogen) and duration of use, was determined from an interviewer-administered questionnaire. After adjustment for other relevant variables, we found that cumulative estrogen from OCs (mg) explained 4.0% of the variation in spine BMD ( p = 0.024) among white women, but did not explain any of the variance in BMD in black women. Cumulative OC estrogen was associated with a decreased risk for low bone density (lowest quartile) at the spine, hip and whole body in white women. The odds ratios (95% CIs) comparing women in the highest quartile of cumulative OC estrogen with those in the lowest quartile were, at the spine: 0.08 (0.02, 0.46); at the hip: 0.23 (0.06, 0.87); and at the whole body: 0.37 (0.11, 1.26). OC exposure was not related to low bone density in black women. OCs did not predict longitudinal changes in whole body BMD in either race. These results suggest that exposure to the estrogen from OCs during the premenopausal years may have a small beneficial effect on the skeleton in white women. Benefit is proportional to the cumulative estrogen exposure, suggesting that previous cross-sectional studies that considered OC use as a dichotomous variable may have lacked the power to detect an association.
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Affiliation(s)
- K L Cobb
- Division of Epidemiology, Department of Health Research and Policy, Stanford University, Stanford, California 94305, USA.
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Iribarren C, Sidney S, Lydick E, Sorel ME, Eisner MD. The association between asthma, asthma, therapeutic classes and hepatic enzyme elevation among adult HMO members. Compr Ther 2002; 27:133-9. [PMID: 11430260 DOI: 10.1007/s12019-996-0007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The results of this case-control study conducted at a large HMO support the notion that severe asthma may be associated with transient hepatic enzyme elevation. Conversely, we found no evidence of associations between asthma therapeutic classes and hepatic enzyme elevation.
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Affiliation(s)
- C Iribarren
- Kaiser Permanente Medical Care Program, Northern California Region, Oakland, Calif., USA
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21
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Affiliation(s)
- A L Klatsky
- Division of Cardiology, Department of Medicine, Kaiser Permanente Medical Center, Oakland, California 94611, USA.
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22
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Kiefe CI, Williams OD, Weissman NW, Schreiner PJ, Sidney S, Wallace DD. Changes in US health care access in the 90s: race and income differences from the CARDIA Study. Coronary Artery Risk Development in Young Adults. Ethn Dis 2001; 10:418-31. [PMID: 11110359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE Health care financing is changing rapidly in the United States. We investigated whether and how health care access is changing concurrently with changes in financing, with special attention to a minority population. METHODS We examined a longitudinal biracial (half African-American, half White) urban cohort of 3,565 individuals, aged 25-37 years old, in 1992-93 and again in 1995-96. We measured access by self-reported (1) health insurance status, (2) regular source of medical care, and (3) lack of care due to financial problems. RESULTS In 1992-93, 30.3% of the cohort experienced at least one access barrier, with a decline to 26.8% in 1995-96 (P<.005). However, access improved more for Whites than for African Americans; and access improved for higher, but not for lower, income groups (7% improvement for high income, vs 2% deterioration for lower income, P<.01). In addition, there was an 11% to 19% absolute increase in individuals making co-payments for health care utilization across all race/sex groups, with African Americans having markedly higher proportions of cost-sharing. African-American, low income, and unemployed individuals reported more acute care, but fewer outpatient visits. Income and employment explained racial differences. CONCLUSION While access has improved or stabilized for higher income groups, there is a widening gap according to income, accompanied by an acute care pattern for low income groups that may be both inadequate and cost inefficient.
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Affiliation(s)
- C I Kiefe
- University of Alabama at Birmingham, 35205-4785, USA.
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23
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Abstract
BACKGROUND Glycemic control is associated with microvascular events, but its effect on the risk of heart failure is not well understood. We examined the association between hemoglobin (Hb) A(Ic) and the risk of heart failure hospitalization and/or death in a population-based sample of adult patients with diabetes and assessed whether this association differed by patient sex, heart failure pathogenesis, and hypertension status. METHODS AND RESULTS A cohort design was used with baseline between January 1, 1995, and June 30, 1996, and follow-up through December 31, 1997 (median 2.2 years). Participants were 25 958 men and 22 900 women with (predominantly type 2) diabetes, >/=19 years old, with no known history of heart failure. There were a total of 935 events (516 among men; 419 among women). After adjustment for age, sex, race/ethnicity, education level, cigarette smoking, alcohol consumption, hypertension, obesity, use of beta-blockers and ACE inhibitors, type and duration of diabetes, and incidence of interim myocardial infarction, each 1% increase in Hb A(Ic) was associated with an 8% increased risk of heart failure (95% CI 5% to 12%). An Hb A(Ic) >/=10, relative to Hb A(Ic) <7, was associated with 1.56-fold (95% CI 1.26 to 1.93) greater risk of heart failure. Although the association was stronger in men than in women, no differences existed by heart failure pathogenesis or hypertension status. CONCLUSIONS These results confirm previous evidence that poor glycemic control may be associated with an increased risk of heart failure among adult patients with diabetes.
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Affiliation(s)
- C Iribarren
- Kaiser Permanente Division of Research, Oakland, CA, USA.
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Bild DE, Folsom AR, Lowe LP, Sidney S, Kiefe C, Westfall AO, Zheng ZJ, Rumberger J. Prevalence and Correlates of Coronary Calcification in Black and White Young Adults. Arterioscler Thromb Vasc Biol 2001; 21:852-7. [PMID: 11348886 DOI: 10.1161/01.atv.21.5.852] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
—Whereas cardiovascular risk factor levels are substantially different in black and white Americans, the relative rates of cardiovascular disease in the 2 groups are not always consistent with these differences. To compare the prevalence of coronary calcification, an indicator of coronary atherosclerosis, in young adult blacks and whites, we performed electron-beam computed tomography of the heart in 443 men and women aged 28 to 40 years recruited from a population-based cohort. The presence of calcium, defined as at least 1 focus of at least 2.05 mm
2
in area and >130 Hounsfield units in density within the coronary arteries, was identified in 16.1% of black men, 11.8% of black women, 17.1% of white men, and 4.6% of white women (
P
=0.04 for comparison across groups). Coronary calcium was associated with age and male sex, and after adjustment for age, race, and sex, coronary calcium was positively associated with body mass index, weight, systolic blood pressure, total cholesterol, low density lipoprotein cholesterol, triglycerides, and fasting insulin and negatively associated with education (all
P
<0.05). Independent risk factors included male sex, body mass index, and low density lipoprotein cholesterol. Race was not significantly associated with coronary calcium in men or women, before or after adjustment for risk factors. Coronary calcification is associated with increased levels of cardiovascular risk factors in young adults, and its prevalence is not significantly different in blacks and whites.
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Affiliation(s)
- D E Bild
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-7934, USA.
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Abstract
CONTEXT Management of patients with acute transient ischemic attack (TIA) varies widely, with some institutions admitting all patients and others proceeding with outpatient evaluations. Defining the short-term prognosis and risk factors for stroke after TIA may provide guidance in determining which patients need rapid evaluation. OBJECTIVE To determine the short-term risk of stroke and other adverse events after emergency department (ED) diagnosis of TIA. DESIGN AND SETTING Cohort study conducted from March 1997 through February 1998 in 16 hospitals in a health maintenance organization in northern California. Patients A total of 1707 patients (mean age, 72 years) identified by ED physicians as having presented with TIA. MAIN OUTCOME MEASURES Risk of stroke during the 90 days after index TIA; other events, including death, recurrent TIA, and hospitalization for cardiovascular events. RESULTS During the 90 days after index TIA, 180 patients (10.5%) returned to the ED with a stroke, 91 of which occurred in the first 2 days. Five factors were independently associated with stroke: age greater than 60 years (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.7; P=.01), diabetes mellitus (OR, 2.0; 95% CI, 1.4-2.9; P<.001), symptom duration longer than 10 minutes (OR, 2.3; 95% CI, 1.3-4.2; P=.005), weakness (OR, 1.9; 95% CI, 1.4-2.6; P<.001), and speech impairment (OR, 1.5; 95% CI, 1.1-2.1; P=.01). Stroke or other adverse events occurred in 428 patients (25.1%) in the 90 days after the TIA and included 44 hospitalizations for cardiovascular events (2.6%), 45 deaths (2.6%), and 216 recurrent TIAs (12.7%). CONCLUSIONS Our results indicate that the short-term risk of stroke and other adverse events among patients who present to an ED with a TIA is substantial. Characteristics of the patient and the TIA may be useful for identifying patients who may benefit from expeditious evaluation and treatment.
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Affiliation(s)
- S C Johnston
- Department of Neurology, University of California, San Francisco 94143-0114, USA.
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Abstract
To assess the risk of myocardial infarction in users of post-menopausal hormone replacement therapy who are at high risk of coronary disease because of hypertension, diabetes mellitus, or smoking, we used data from a previously published case-control study of women 45-74 years. After adjustment for age, ethnicity, and education, the odds ratio for myocardial infarction in current users of hormone replacement therapy was 0.9 (95% confidence interval (CI) = 0.5-1.6) in women with no major coronary risk factors, 0.8 (95% CI = 0.5-1.8) in women with one risk factor, and 1.1 (95% CI = 0.5-2.2) in women with two risk factors.
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Affiliation(s)
- D B Petitti
- Kaiser Permanente Medical Care Program, Southern California, Pasenda, CA, USA
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27
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Iribarren C, Sidney S, Jacobs DR, Weisner C. Hospitalization for suicide attempt and completed suicide: epidemiological features in a managed care population. Soc Psychiatry Psychiatr Epidemiol 2000; 35:288-96. [PMID: 11016523 DOI: 10.1007/s001270050241] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Understanding factors that contribute to high suicide risk holds important implications for prevention. We aimed to examine the sociodemographic and medical predictors of attempted suicide (severe enough to require hospitalization) and of completed suicide in a large population-based sample from a health maintenance organization (HMO) in northern California, USA. METHOD We designed a cohort study, including 87,257 women and 70,570 men aged 15 through 89 years old at baseline (in 1977-1985) with follow-up for hospitalizations and mortality through the end of 1993. RESULTS After a median of 10 years, 169 first hospitalizations for attempted suicide (111 among women, 58 among men) and 319 completed suicides (101 among women, 218 among men) were identified. There was a greater incidence of hospitalization for suicide attempt in women than in men and, conversely, a greater incidence of completed suicide in men than in women. The predominant methods of attempted and completed suicides were ingestion of psychotropic agents and use of firearms, respectively. In gender-specific multivariate analysis of hospitalization for suicide attempt, statistically significant associations were seen for age 15-24 years (women), 65-89 years (men), white race (women), 12th grade or less education (both genders), technical/business school education (men), never being married (men), history of emotional problems (both genders), history of family problems (women), history of job problems (men) and presence of one or more comorbidities (men). The independent predictors of completed suicide were: age 15-24 years (both genders), Asian race (women), Caucasian race (both genders), never being married (both genders), being separated/divorced (women), prior inpatient hospitalization for suicide attempt (both genders) and history of emotional problems (both genders). CONCLUSION These findings could help health professionals be more effective in the prevention of suicide morbidity and mortality.
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Affiliation(s)
- C Iribarren
- Kaiser Permanente Division of Research, Oakland, CA 94611, USA.
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Iribarren C, Sidney S, Sternfeld B, Browner WS. Calcification of the aortic arch: risk factors and association with coronary heart disease, stroke, and peripheral vascular disease. JAMA 2000; 283:2810-5. [PMID: 10838649 DOI: 10.1001/jama.283.21.2810] [Citation(s) in RCA: 349] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT Calcium deposits in coronary and extracoronary arterial beds may indicate the extent of atherosclerosis. However, the incremental predictive value of vascular calcification, beyond traditional coronary risk factors, is not clearly established. OBJECTIVE To evaluate risk factors for aortic arch calcification and its long-term association with cardiovascular diseases in a population-based sample. DESIGN AND SETTING Cohort study conducted at a health maintenance organization in northern California. PARTICIPANTS A total of 60,393 women and 55,916 men, aged 30 to 89 years at baseline who attended multiphasic health checkups between 1964 and 1973 and for whom incidence of hospitalizations and/or mortality data were ascertained using discharge diagnosis codes and death records through December 31, 1997 (median follow-up, 28 years). MAIN OUTCOME MEASURE Hospitalization for or death due to coronary heart disease, ischemic stroke, hemorrhagic stroke, or peripheral vascular disease, as associated with aortic arch calcification found on chest radiograph at checkup from 1964-1973. RESULTS Aortic arch calcification was present in 1.9% of men and 2.6% of women. It was independently associated with older age, no college education, current smoking, and hypertension in both sexes, but it was inversely related to body mass index and family history of myocardial infarction. In women, aortic arch calcification was also associated with black race and elevated serum cholesterol level. After adjustment for age, educational attainment, race/ethnicity, cigarette smoking, alcohol consumption, body mass index, serum cholesterol level, hypertension, diabetes, and family history of myocardial infarction, aortic arch calcification was associated with an increased risk of coronary heart disease (in men, relative risk [RR], 1.27; 95% confidence interval [CI], 1.11-1.45; in women, RR, 1. 22; 95% CI, 1.07-1.38). Among women, it was also independently associated with a 1.46-fold increased risk of ischemic stroke (95% CI, 1.28-1.67). CONCLUSION In our population-based cohort, aortic arch calcification was independently related to coronary heart disease risk in both sexes as well as to ischemic stroke risk in women. JAMA. 2000;283:2810-2815
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Affiliation(s)
- C Iribarren
- Division of Research, Kaiser Permanente Medical Care Program, 3505 Broadway, Oakland, CA 94611.
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Iribarren C, Sidney S, Bild DE, Liu K, Markovitz JH, Roseman JM, Matthews K. Association of hostility with coronary artery calcification in young adults: the CARDIA study. Coronary Artery Risk Development in Young Adults. JAMA 2000; 283:2546-51. [PMID: 10815118 DOI: 10.1001/jama.283.19.2546] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Psychosocial factors, including personality and character traits, may play a role in the development and expression of coronary artery disease. OBJECTIVE To evaluate whether hostility, a previously reported predictor of clinical coronary artery disease, is associated with coronary calcification, which is a marker of subclinical atherosclerosis. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS Volunteer subsample from Chicago, Ill, and Oakland, Calif, consisting of 374 white and black men and women, aged 18 to 30 years at baseline, who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Cook-Medley hostility assessment data were collected at baseline from 1985 to 1986 and at year 5 examinations from 1990 to 1992. After the 10-year examinations in the 1995-1996 year, electron-beam computed tomographic scans were performed. MAIN OUTCOME MEASURES Presence of any detectable coronary artery calcification (coronary calcium score >0), and coronary artery calcium scores of 20 or higher. RESULTS In logistic regression analysis adjusting for age, sex, race, and field center comparing those with hostility scores above and below the median of the distribution of the present sample, the odds ratio of having any coronary calcification was 2.57 (95% confidence interval, 1.31-5.22), and the odds ratio of having a calcium score of 20 or higher was 9.56 (95% confidence interval, 2.29-65.9) for calcium scores of 20 or higher. The associations with any coronary artery calcification persisted after adjusting for demographic, lifestyle, and physiological variables. Results using a cynical distrust subscale were somewhat weaker than for those using the global hostility score. Power was inadequate to perform sex- or race-specific analyses. CONCLUSION These results suggest that a high hostility level may predispose young adults to coronary artery calcification. JAMA. 2000;283:2546-2551
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Affiliation(s)
- C Iribarren
- Kaiser Permanente Division of Research, 3505 Broadway, Oakland, CA 94611, USA.
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Braun BL, Hannan P, Wolfson M, Jones-Webb R, Sidney S. Occupational attainment, smoking, alcohol intake, and marijuana use: ethnic-gender differences in the CARDIA study. Addict Behav 2000; 25:399-414. [PMID: 10890293 DOI: 10.1016/s0306-4603(99)00076-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the prospective interrelationship of smoking, alcohol intake, marijuana use, and educational and occupational attainment of Black and White young adults. METHODS Logistic or mixed model linear regression were used to evaluate relationships between self-reported substance use, ethnicity, gender, college graduation, and four measures of occupational attainment. RESULTS College graduation in the next 10 years was negatively associated with smoking and marijuana use, but not daily alcohol consumption in all ethnic and gender groups. In Whites, marijuana use was associated with less prestigious occupations and lower family income, while smoking was unrelated and moderate daily drinking was positively associated. In Blacks, marijuana use was generally unrelated to occupational measures, while smoking and daily alcohol consumption were negatively associated. CONCLUSIONS Relationships between smoking, marijuana use, daily drinking, and occupational attainment were not universally negative in this age group. Substance use, particularly smoking, is associated with reduced occupational attainment in Blacks compared with Whites after considering sociodemographic factors potentially limiting educational progression and occupational attainment.
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Affiliation(s)
- B L Braun
- Institute for Research and Education, Health Research Center, HealthSystem Minnesota, Minneapolis 55416, USA.
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Iribarren C, Jacobs DR, Sidney S, Gross MD, Eisner MD. Cigarette smoking, alcohol consumption, and risk of ARDS: a 15-year cohort study in a managed care setting. Chest 2000; 117:163-8. [PMID: 10631215 DOI: 10.1378/chest.117.1.163] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To examine the association of cigarette smoking and alcohol consumption with hospital presentation of ARDS in a well-defined, multiethnic population. DESIGN Retrospective cohort study. SETTING Health maintenance organization in Northern California. PARTICIPANTS A total of 121,012 health plan subscribers (54.2% women), aged 25 to 89 years. OUTCOME MEASURE Hospital presentation of ARDS (validated by medical chart review) from baseline in 1979 to 1985 through the end of 1993 (median, 9.9 years). RESULTS There were 56 cases of ARDS (33 in men, 23 in women). The case fatality rate was 39% in both genders. ARDS was independently related to increasing age (rate ratio of 10 years, 1.38; 95% confidence interval [CI], 1.12 to 1.71), to current smoking of < 20 cigarettes/d (rate ratio vs never cigarette smokers, 2.85; 95% CI, 1. 23 to 6.60), and to current cigarette smoking of > or = 20 cigarettes/d (rate ratio vs never smokers, 4.59; 95% CI, 2.13 to 9.88). No association was observed between alcohol consumption and ARDS. CONCLUSIONS The results of this study suggest a relationship (with evidence of dose-response effect) between cigarette smoking and ARDS. Assuming a causal relationship, approximately 50% of ARDS cases were attributable to cigarette smoking.
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Affiliation(s)
- C Iribarren
- Kaiser Permanente Division of Research, Oakland, CA 94611, USA.
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Abstract
BACKGROUND The sale of cigars in the United States has been increasing for the past six years. Cigar smoking is a known risk factor for certain cancers and for chronic obstructive pulmonary disease (COPD). However, unlike the relation between cigarette smoking and cardiovascular disease, the association between cigar smoking and cardiovascular disease has not been clearly established. METHODS We performed a cohort study among 17,774 men 30 to 85 years of age at base line (from 1964 through 1973) who were enrolled in the Kaiser Permanente health plan and who reported that they had never smoked cigarettes and did not currently smoke a pipe. Those who smoked cigars (1546 men) and those who did not (16,228) were followed from 1971 through the end of 1995 for a first hospitalization for or death from a major cardiovascular disease or COPD, and through the end of 1996 for a diagnosis of cancer. RESULTS In multivariate analysis, cigar smokers, as compared with nonsmokers, were at higher risk for coronary heart disease (relative risk, 1.27; 95 percent confidence interval, 1.12 to 1.45), COPD (relative risk, 1.45; 95 percent confidence interval, 1.10 to 1.91), and cancers of the upper aerodigestive tract (relative risk, 2.02; 95 percent confidence interval, 1.01 to 4.06) and lung (relative risk, 2.14; 95 percent confidence interval, 1.12 to 4.11), with evidence of dose-response effects. There appeared to be a synergistic relation between cigar smoking and alcohol consumption with respect to the risk of oropharyngeal cancers and cancers of the upper aerodigestive tract. CONCLUSIONS Independently of other risk factors, regular cigar smoking can increase the risk of coronary heart disease, COPD, and cancers of the upper aerodigestive tract and lung.
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Affiliation(s)
- C Iribarren
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, Calif 94611, USA.
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Sidney S, Lewis CE, Hill JO, Quesenberry CP, Stamm ER, Scherzinger A, Tolan K, Ettinger B. Association of total and central adiposity measures with fasting insulin in a biracial population of young adults with normal glucose tolerance: the CARDIA study. Obes Res 1999; 7:265-72. [PMID: 10348497 DOI: 10.1002/j.1550-8528.1999.tb00405.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the association of computed tomography (CT)-measured visceral adipose tissue (AT) and other measures of adiposity with fasting insulin in a biracial (African American and Caucasian) study population of young adults. RESEARCH METHODS AND PROCEDURES The study population consisted of 251 young adults with normal glucose tolerance (NGT), ages 28-40 years, who were volunteers from the Birmingham, Alabama, and Oakland, California centers of the Coronary Artery Risk Development in Young Adults (CARDIA) study. RESULTS In regression models with total adiposity measures (body mass index or dual-energy X-ray absorptiometry-measured percent fat), visceral AT (measured as a cross-sectional area in cm2) was generally a stronger predictor of insulin than overall adiposity in all race/gender groups (partial correlation coefficients ranging from 0.31 to 0.47) except for black men, in whom the associations were nonsignificant. Partial correlation coefficients between waist circumference and insulin, controlling for percent fat, were nearly identical to those between visceral AT and insulin in women and in white men. Analyses performed on 2060 NGT CARDIA subjects who were not in this study of visceral AT showed significant correlations of waist circumference with insulin in all race/gender groups, including black men, and that black men in the visceral AT study group were significantly leaner than other black male CARDIA subjects. DISCUSSION We conclude that visceral AT was associated with fasting insulin in NGT participants in three of the four race/gender groups (black men excepted) and that waist circumference was a good surrogate for visceral AT in examining associations of central adiposity with fasting insulin.
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Affiliation(s)
- S Sidney
- Kaiser Permanente Division of Research, Oakland, CA 94611, USA
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Bikle DD, Ettinger B, Sidney S, Tekawa IS, Tolan K. Differences in calcium metabolism between black and white men and women. Miner Electrolyte Metab 1999; 25:178-84. [PMID: 10436403 DOI: 10.1159/000057442] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To determine whether environmental factors influence racial differences in calcium metabolism, the authors evaluated the influence of three factors (season, length of sunlight exposure, and diet) on calciotropic hormones, renal calcium excretion, and markers of bone turnover in an ambulatory population aged 25-36 years. Included were 109 black men, 114 white men, 95 black women, and 84 white women. Compared with white subjects, black subjects of both genders showed lower levels of serum 25-hydroxyvitamin D (25-OHD) and higher levels of serum 1,25-dihydroxyvitamin D [1,25(OH)(2)D]. The mean winter levels of 25-OHD were 19 to 29% lower than the summer levels in all groups. The urinary calcium excretion was 26% lower in black men than in white men and was 36% lower in black women than in white women. The parathyroid hormone levels were 29% higher in black women than in white women, but no statistically significant racial differences in parathyroid hormone levels were seen in men. Bone turnover markers (serum osteocalcin, bone-specific alkaline phosphatase, urinary pyridinoline cross-link excretion) did not show consistent racial differences. Racial and gender differences in calcium excretion did not significantly correlate with differences in lifestyle or with levels of the calciotropic hormones. Environmental factors such as diet and sunlight exposure do not appear to influence racial differences in the levels of the calciotropic hormones or renal calcium excretion.
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Affiliation(s)
- D D Bikle
- Department of Medicine, Division of Endocrinology, University of California and Veterans Administration Medical Center, San Francisco, Calif. 94121, USA.
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Hill JO, Sidney S, Lewis CE, Tolan K, Scherzinger AL, Stamm ER. Racial differences in amounts of visceral adipose tissue in young adults: the CARDIA (Coronary Artery Risk Development in Young Adults) study. Am J Clin Nutr 1999; 69:381-7. [PMID: 10075320 DOI: 10.1093/ajcn/69.3.381] [Citation(s) in RCA: 193] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In several white populations, visceral adipose tissue (VAT) is a risk factor for development of type 2 diabetes and dyslipidemia. VAT can be accurately assessed by computed topography or magnetic resonance imaging, but is also estimated from anthropometric variables, such as waist-to-hip ratio, waist circumference, or sagittal diameter. To date, anthropometric variables have been used largely in whites and inadequate data are available to evaluate the validity of these variables in other groups. OBJECTIVES The objectives of this study were to 1) determine whether amount of VAT in relation to total body fatness differs in different race and sex groups and 2) determine which anthropometric variables predict amount of VAT in different race and sex groups. DESIGN We determined the amount and location of body fat, including assessment of VAT by computed tomography, in young adult white and black men and women participating in the 10-y follow-up of the CARDIA (Coronary Artery Risk Development in Young Adults) Study. RESULTS Black men had less visceral fat (73.1+/-35.9 cm2) than white men (99.3+/-40 cm2), even when VAT was corrected for total body fatness. Black women were more obese than white women and thus had more visceral fat (75.1+/-37.5 compared with 58.6+/-35.9 cm2, respectively). This difference disappeared when corrected for total body fatness. CONCLUSIONS Both waist circumference and sagittal diameter were good predictors of VAT in all groups. However, the nature of this relation differed such that race- and sex-specific equations will likely be required to estimate VAT from waist circumference or sagittal diameter.
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Affiliation(s)
- J O Hill
- Center for Human Nutrition, University of Colorado Health Sciences Center, Denver 80262, USA.
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Sternfeld B, Sidney S, Jacobs DR, Sadler MC, Haskell WL, Schreiner PJ. Seven-year changes in physical fitness, physical activity, and lipid profile in the CARDIA study. Coronary Artery Risk Development in Young Adults. Ann Epidemiol 1999; 9:25-33. [PMID: 9915606 DOI: 10.1016/s1047-2797(98)00030-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To relate seven year changes in physical fitness and physical activity in the young adult population to changes in the plasma lipid profile and to examine the influence of weight change on those relationships. METHODS The participants in this observational study were the 1777 black and white men and women, ages 18-30 at entry into the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, who completed a symptom-limited graded treadmill exercise test and had an overnight fasting blood draw at both the Baseline (1985-86) and Year 7 (1992-93) exams. CARDIA, a longitudinal study of the relationships of lifestyle and physiological variables to the development of coronary heart disease risk factors, consists of population-based cohorts in Birmingham, Alabama, Minneapolis, Minnesota and Chicago, Illinois and a cohort recruited from the membership of a large, pre-paid health care plan, broadly representative of the population, in Oakland, California. RESULTS All race/gender groups experienced mean decreases in physical fitness and self-reported physical activity and increases in weight. Decreased fitness was associated with decreased high density lipoprotein-cholesterol (HDL-C), and conversely, increased fitness was associated with increased HDL-C. The correlation coefficients of change in fitness with change in HDL-C ranged from 0.17 in white men and black women to 0.24 in white women (P < 0.001 for all race/gender groups). Change in fitness was minimally correlated with change in low density lipoprotein-cholesterol (LDL-C) in all groups (r ranged from -0.09 in black women to -0.20 in white women), triglycerides (TG) in men and white women (r ranged from -0.10 to -0.15), and total cholesterol (TC) in white men and women (r = -0.11 and -0.15, respectively). The magnitude of these correlations was further reduced with adjustment for weight change. Correlations between change in activity and change in lipid and lipoprotein values were generally weak or nonexistent, except for the suggestion of a small, direct relationship with change in HDL-C in black and white women (r = 0.14 and r = 0.11, respectively). All of the weight change adjusted correlations were essentially unaffected by further adjustment for baseline fitness or activity and other covariates. CONCLUSIONS Decreased fitness during young adulthood is associated with unfavorable changes in lipid profile, explained mostly by increased weight. Lack of association between change in activity and change in lipid profile observed in this study may be due, in part, to imprecision of activity measurement.
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Affiliation(s)
- B Sternfeld
- Division of Research, Kaiser Permanente Medical Care Program, Broadway, Oakland, CA 94611-5714, USA
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Schwartz SM, Petitti DB, Siscovick DS, Longstreth WT, Sidney S, Raghunathan TE, Quesenberry CP, Kelaghan J. Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies. Stroke 1998; 29:2277-84. [PMID: 9804634 DOI: 10.1161/01.str.29.11.2277] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The available data on low-dose oral contraceptive pill (OCP) use and stroke risk in US women are limited by small numbers. We sought more precise estimates by conducting a pooled analysis of data from 2 US population-based case-control studies. METHODS We analyzed interview data from 175 ischemic stroke cases, 198 hemorrhagic stroke cases, and 1191 control subjects 18 to 44 years of age. RESULTS For ischemic stroke, the pooled odds ratio (pOR) adjusted for stroke risk factors for current use of low-dose OCPs compared with women who had never used OCP (never users) was 0.66 (95% confidence interval [CI], 0.29 to 1.47) and compared with women not currently using OCPs (nonusers) the pOR was 1.09 (95% CI, 0.54 to 2.21). For hemorrhagic stroke, the pOR for current use of low-dose OCPs compared with never users was 0.95 (95% CI, 0.46 to 1.93) and compared with nonusers the pOR was 1.11 (95% CI, 0.61 to 2.01). The pORs for current low-dose OCP use and either stroke type were not elevated among women who were >/=35 years, cigarette smokers, obese, or not receiving medical therapy for hypertension. pORs for current low-dose OCP use were 2.08 (95% CI, 1. 19 to 3.65) for ischemic stroke and 2.15 (95% CI, 0.85 to 5.45) for hemorrhagic stroke among women reporting a history of migraine but were not elevated among women without such a history. Past OCP use (irrespective of formulation) was inversely related to ischemic stroke but unrelated to hemorrhagic stroke. CONCLUSIONS Women who use low-dose OCPs are, in the aggregate, not at increased risk of stroke. Studies are needed to clarify the risk of stroke among users who may be susceptible on the basis of age, smoking, obesity, hypertension, or migraine history.
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Affiliation(s)
- S M Schwartz
- Cardiovascular Health Research Unit, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, USA.
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Petitti DB, Sidney S, Quesenberry C, Bernstein A. Stroke and cocaine or amphetamine use. Epidemiology 1998; 9:596-600. [PMID: 9799166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The association of cocaine and amphetamine use with hemorrhagic and ischemic stroke is based almost solely on data from case series. The limited number of epidemiologic studies of stroke and use of cocaine and/or amphetamine have been done in settings that serve mostly the poor and/or minorities. This case-control study was conducted in the defined population comprising members of Kaiser Permanente of Northern and Southern California. We attempted to identify all incident strokes in women ages 15-44 years during a 3-year period using hospital admission and discharge records, emergency department logs, and payment requests for out-of-plan hospitalizations. We selected controls, matched on age and facility of usual care, at random from healthy members of the health plan. We obtained information in face-to-face interviews. There were 347 confirmed stroke cases and 1,021 controls. The univariate matched odds ratio for stroke in women who admitted to using cocaine and/or amphetamine was 8.5 (95% confidence interval = 3.6-20.0). After further adjustment for potential confounders, the odds ratio in women who reported using cocaine and/or amphetamine was 7.0 (95% confidence interval = 2.8-17.9). The use of cocaine and/or amphetamine is a strong risk factor for stroke in this socioeconomically heterogeneous, insured urban population.
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Affiliation(s)
- D B Petitti
- Kaiser Permanente Medical Care Program, Southern California, USA
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Iribarren C, Jacobs DR, Sidney S, Claxton AJ, Feingold KR. Cohort study of serum total cholesterol and in-hospital incidence of infectious diseases. Epidemiol Infect 1998; 121:335-47. [PMID: 9825784 PMCID: PMC2809530 DOI: 10.1017/s0950268898001435] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A multiethnic cohort of adult members of the Kaiser Permanente Medical Care Program (55300 men and 65271 women) was followed for 15 years (1979-93) to assess the association between total cholesterol and risk of infections (other than respiratory and HIV) diagnosed in the in-patient setting. Using multivariate Cox regression, total cholesterol was inversely and significantly related to urinary tract, venereal, musculo-skeletal, and all infections among men; and to urinary tract, all genito-urinary, septicaemia or bacteraemia, miscellaneous viral site unspecified, and all infections among women. The reduction of risk of all infections associated with a 1 S.D. increase in total cholesterol was 8% in both men (95% CI, 4-12 %) and women (95% CI, 5-11%). For urinary tract infections among men, as for septicaemia or bacteraemia and nervous system infections among women, the risk relation was restricted to persons aged 55-89 years. Nervous system infections were positively related to total cholesterol among women aged 25-54. In both genders, the significant inverse association with all infections persisted after excluding the first 5 years of follow-up. Collectively, these data are suggestive of an inverse association, although not entirely consistent, between total cholesterol and incidence of infections either requiring hospitalization or acquired in the hospital. Further research is needed to elucidate whether these associations are biologically plausible or represent uncontrolled confounding by unmeasured risk factors.
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Affiliation(s)
- C Iribarren
- Kaiser Permanente Division of Research, Oakland, CA 94611, USA
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Sidney S, Siscovick DS, Petitti DB, Schwartz SM, Quesenberry CP, Psaty BM, Raghunathan TE, Kelaghan J, Koepsell TD. Myocardial infarction and use of low-dose oral contraceptives: a pooled analysis of 2 US studies. Circulation 1998; 98:1058-63. [PMID: 9736591 DOI: 10.1161/01.cir.98.11.1058] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Population-based case-control studies to assess the relationship of low-dose oral contraceptive (OC) use with myocardial infarction (MI) were performed at 2 sites in the United States (California and Washington state). The purpose of the present study was to estimate risk of MI in relation to use of low-dose OCs in a pooled analysis combining results from the 2 sites. METHODS AND RESULTS The study included as cases women aged 18 to 44 years with incident MI who had no prior history of ischemic heart disease or cerebrovascular disease. Women in the case and control groups were interviewed in person regarding OC use and cardiovascular risk factors. The analysis included 271 MI cases and 993 controls. Compared with noncurrent users, the adjusted pooled odds ratio for MI in current OC users was 0.94 (95% CI, 0.44, 2.20) after adjustment for major risk factors and sociodemographic factors. Compared with never users, the adjusted pooled odds ratio for MI was 0.56 (0.21, 1.49) in current OC users and 0.54 (0.31, 0.95) in past OC users. Among past OC users, duration and recency of use were unrelated to MI risk as was current hormone replacement therapy. There was no evidence of interaction between OC use and age, presence of cardiovascular risk factors (hypercholesterolemia, hypertension, diabetes), obesity, or smoking. CONCLUSIONS We conclude that low-dose OCs as used in these populations are safe with respect to risk of MI in women.
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Affiliation(s)
- S Sidney
- From the Division of Research, Kaiser Permanente Medical Care Program, Northern California, Oakland, CA 94611, USA.
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Krieger N, Sidney S, Coakley E. Racial discrimination and skin color in the CARDIA study: implications for public health research. Coronary Artery Risk Development in Young Adults. Am J Public Health 1998; 88:1308-13. [PMID: 9736868 PMCID: PMC1509091 DOI: 10.2105/ajph.88.9.1308] [Citation(s) in RCA: 130] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed whether skin color and ways of handling anger can serve as markers for experiences of racial discrimination and responses to unfair treatment in public health research. METHODS Survey data on 1844 Black women and Black men (24 to 42 years old), collected in the year 5 (1990-1991) and year 7 (1992-1993) examinations of the Coronary Artery Risk Development in Young Adults (CARDIA) study, were examined. RESULTS Skin color was not associated with self-reported experiences of racial discrimination in 5 of 7 specified situations (getting a job, at work, getting housing, getting medical care, in a public setting). Only moderate associations existed between darker skin color and being working class, having low income or low education, and being male (risk ratios under 2). Comparably moderate associations existed between internalizing anger and typically responding to unfair treatment as a fact of life or keeping such treatment to oneself. CONCLUSIONS Self-reported experiences of racial discrimination and responses to unfair treatment should be measured directly in public health research; data on skin color and ways of handling anger are not sufficient.
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Affiliation(s)
- N Krieger
- Department of Health and Social Behavior, Harvard School of Public Health, Boston, Mass 02115, USA.
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Abstract
STUDY OBJECTIVE This study evaluated the relation between self-reported marijuana use and 3-year incidence of injury. METHODS We conducted a retrospective cohort study of adult Kaiser Permanente Medical Care Program members who underwent multiphasic health examinations between 1979 and 1986 (n=4,462). Injury-related outpatient visits, hospitalizations, and fatalities within 3 years of examination were determined. RESULTS Outpatient injury events totaled 2,524; 1,611 participants (36%) had at least 1 injury-related outpatient visit. Injury-related hospitalizations (n=22) and fatalities (n=3) were rare. Among men, there was no consistent relation between marijuana use and injury incidence for either former users (rate ratio, 1.15; 95% confidence interval [CI], .97 to 1.36) or current users (rate ratio, 0.97; 95% CI, .81 to 1.17), compared with those who had never used marijuana. Among women, former and current users showed little difference in their rate of later injury compared with never users; the rate ratios were 1.05 (95% CI, .87 to 1.26) and 1.20 (95% CI, 1.00 to 1.44), respectively. No statistically significant associations were noted between marijuana use and cause-specific injury incidence in men or women. CONCLUSION Among members of a health maintenance organization, self-reported marijuana use in adult men or women was not associated with outpatient injury within 3 years of marijuana use ascertainment.
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Affiliation(s)
- B L Braun
- St. Mary's/Duluth Clinic Health System, Division of Education and Research, MN, USA
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Petitti DB, Siscovick DS, Sidney S, Schwartz SM, Quesenberry CP, Psaty BM, Raghunathan TE, Koepsell TD, Longstreth WT. Norplant implants and cardiovascular disease. Contraception 1998; 57:361-2. [PMID: 9673845 DOI: 10.1016/s0010-7824(98)00036-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A 1995 publication on serious adverse events in users of Norplant implants submitted to the Food and Drug Administration's MedWatch Spontaneous Reporting System reported 14 hospitalizations for stroke in Norplant users. This number was higher than expected. This is a report on the association of current use of Norplant implants with stroke and myocardial infarction (MI) based on a pooled analysis of data from two population-based, case-control studies conducted in the US. All data collection for these two studies occurred after approval of Norplant implants for marketing in the US in December 1990. The methods of the individual studies are detailed in prior publications.
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Affiliation(s)
- D B Petitti
- Kaiser Permanente Southern California, Pasadena 91188, USA.
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Abstract
Epidemiologic studies of current oral contraceptive (OC) use and myocardial infarction (MI) have been contradictory and confusing. This comprehensive review of the epidemiologic literature attempts to draw conclusions about the risk of myocardial infarction in oral contraceptive users, focusing on recent, methodologically rigorous studies of the topic. Recent studies are consistent in showing a higher relative risk of MI in current OC users who smoke compared with current OC users who do not smoke. Studies in aggregate suggest that the relative risk of MI is higher in current OC users with hypertension than in current OC users without hypertension. Recent studies do not show a relationship between higher estrogen dose and higher risk of MI, but the effect of estrogen dose and progestogen type and dose are difficult to separate. The limited data on the risk of MI in current users of low estrogen OC do not allow a firm conclusion about the possibility that progestogen type might affect the risk of MI in current users. Past OC use does not increase or decrease the risk of MI.
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Affiliation(s)
- D B Petitti
- Kaiser Permanente Southern California, Pasadena, California 91101, USA
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Sidney S, Sternfeld B, Haskell WL, Quesenberry CP, Crow RS, Thomas RJ. Seven-year change in graded exercise treadmill test performance in young adults in the CARDIA study. Cardiovascular Risk Factors in Young Adults. Med Sci Sports Exerc 1998; 30:427-33. [PMID: 9526890 DOI: 10.1097/00005768-199803000-00014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Most studies of physical fitness change have been relatively small, not population-based, and lacking in women and nonwhites. The purpose of this analysis was to evaluate the 7-yr change in physical fitness in a biracial (black and white) population of young men and women. METHODS We evaluated change in exercise treadmill test performance in a biracial (black and white) population of 1,962 young adults, ages 18-30 yr at baseline, who completed symptom-limited graded exercise treadmill tests at the baseline (1985-1986) and year 7 (1992-1993) examinations of the CARDIA study. RESULTS Mean test duration decreased 58 s (9.5%) over 7 yr (black men, 13.6% decrease, white men, 7.4%; black women, 11.1%; white women, 7.0%). Mean time to heart rate 130 (WL130), a measure of submaximal performance, decreased 31 s (11.3%) (black men, 16.9%; white men, 10.0%; black women, 12.3%; white women, 6.1%). Baseline body mass index (BMI) and physical activity were not statistically significant predictors of test duration change in any race-gender group, but change in BMI and activity were. Seven-year weight gain >20 lbs (31% of cohort) was associated with a large decrease in fitness (18.5% decrease in mean duration, 21.8% decrease in WL130). CONCLUSION These data suggest that fitness declines during young adulthood in blacks and whites and that fitness changes are related to changes in weight and physical activity.
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Affiliation(s)
- S Sidney
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, USA
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Affiliation(s)
- G D Friedman
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94611, USA
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Claxton AJ, Jacobs DR, Iribarren C, Welles SL, Sidney S, Feingold KR. Association between serum total cholesterol and HIV infection in a high-risk cohort of young men. J Acquir Immune Defic Syndr Hum Retrovirol 1998; 17:51-7. [PMID: 9436759 DOI: 10.1097/00042560-199801010-00008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Low serum total cholesterol (TC) is associated with a variety of nonatherosclerotic diseases, but the association of TC with infectious disease has been little studied. In this study, we examined the relationship between serum TC and HIV infection in members of a large health maintenance organization in Northern California. The cohort consisted of 2446 unmarried young men 15 to 49 years of age at high risk of HIV infection, defined as self-reported history of sexually transmitted disease or liver disease. Baseline measurements were taken between 1979 and 1985, and subjects were passively followed for HIV infection until the end of 1993 (average length of follow-up, 7.7 years). From a multivariate-adjusted Cox regression, the rate ratio (RR) of HIV infection was 1.66 (95% CI = 1.07, 2.56) for men with serum TC levels <160 mg/dl compared with those with TC levels between 160 and 199 mg/dl. Similar excess risk of AIDS and AIDS-related death was observed. These findings suggest that low serum TC levels should be considered a marker of increased risk of HIV infection in men already at heightened risk of HIV infection.
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Affiliation(s)
- A J Claxton
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
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Abstract
BACKGROUND AND PURPOSE Information about the risk of stroke in current postmenopausal hormone users is limited. METHODS In this case-control study, women aged 45 to 74 years hospitalized with a fatal or nonfatal stroke in any of 10 Northern California Kaiser Permanente facilities during the period November 1991 to November 1994 were identified as cases. Controls were selected at random from female Health Plan members. Data regarding use of estrogen plus progestogen or estrogen alone were obtained in interviews. RESULTS The analysis was based on nonproxy responses from 349 cases of ischemic stroke and 349 matched control subjects. After adjustment for confounders, the odds ratio for ischemic stroke in current hormone users was 1.03 (95% confidence interval, 0.65 to 1.65). The odds ratios for ischemic stroke in current hormone users showed no clear trend of increasing or decreasing risk in relation to duration of hormone use. The odds ratio for ischemic stroke in past hormone users was 0.84 (95% confidence interval, 0.54 to 1.32). CONCLUSIONS In this study postmenopausal hormone use was not associated with an increase or decrease in the risk of ischemic stroke, a finding that is consistent with the body of literature on this topic.
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Affiliation(s)
- D B Petitti
- Kaiser Permanente Medical Care Program, Southern California, USA.
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Abstract
The steep rise in hip fracture incidence rates with age is not fully explained by an increase in the frequency of falls or by reduction in bone mineral density, suggesting that circumstances of falls may also affect the risk of hip fracture. Previous studies conducted mainly among women have identified the importance of the orientation of a fall in the etiology of hip fracture. In this case-control study among men of 45 years and older, we evaluated how the circumstances of falls affect the risk of hip fracture. We compared 214 cases with hip fracture due to a fall with 86 controls who had fallen within the past year but did not sustain a hip fracture. As expected, in multivariable age-adjusted analyses men who reported hitting the hip/thigh in a fall had a markedly elevated risk of hip fracture (OR = 97.8; 95% CI = 31.7-302). Hitting the knee in a fall was associated with reduced risk (OR = 0.24; 95% CI = 0.09-0.67). Other factors that were associated with reduced risk of hip fracture among men who fell were more hours of physical activity in the past year (OR = 0.84; 95% CI = 0.73-0.97, for each additional 4 h per week), a greater body mass index (OR = 0.60; 95% CI = 0.40-0.90, for each additional 4 kg/m2), and a history of a fracture when age 45 years or older (OR = 0.26; 95% CI = 0.10-0.69). Reported lower limb dysfunction was associated with increased risk of hip fracture (OR = 6.41; 95% CI = 2.09-19.6) among fallers. The increased risk associated with hitting the hip/thigh in a fall and the reduced risk associated with high body mass index suggest that preventive efforts for older men at high risk might include protective hip pads to reduce the force on the hip in a fall. Exercise and strength training programs may also reduce the risk of hip fracture among men who fall.
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Affiliation(s)
- A V Schwartz
- Division of Epidemiology, Stanford University School of Medicine, California.
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Iribarren C, Jacobs DR, Sidney S, Claxton AJ, Gross MD, Sadler M, Blackburn H. Serum total cholesterol and risk of hospitalization, and death from respiratory disease. Int J Epidemiol 1997; 26:1191-202. [PMID: 9447398 DOI: 10.1093/ije/26.6.1191] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In earlier studies, serum total cholesterol was inversely associated with death due to respiratory diseases. METHODS Relationships of cholesterol with risk of respiratory diseases were examined between 1978 and 1993 in a health maintenance organization in Northern California (48,188 men, 55,276 women, about 60% white, age range 25-89). Incident and fatal endpoints were ascertained using hospital discharge diagnostic codes and underlying cause of death, respectively. RESULTS An inverse association of cholesterol level with pneumonia/influenza hospitalization was found among men and women except that, contrary to hypothesis, a positive association was seen in women under 55 years of age. Inconsistent inverse associations were found in men, but not women, between cholesterol level and hospitalization for chronic obstructive pulmonary disease (COPD). Hospitalization for asthma was unrelated to cholesterol level. An inverse association existed between cholesterol level and hospitalization for miscellaneous respiratory diseases among men, but not women. Exclusion of early hospitalizations tended to attenuate risk for cholesterol level below 4.14 mmol/l, but not the risk gradient across higher cholesterol levels. For deaths, cholesterol level was statistically significantly inversely associated only with COPD. CONCLUSIONS Cholesterol had graded inverse associations with some respiratory diseases, but not others, tending to be stronger in men than in women, and in older than in younger participants. Associations varied for hospitalizations compared to deaths. More epidemiological and basic research is needed to elucidate the potential mechanisms underlying the observed associations.
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Affiliation(s)
- C Iribarren
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94611, USA
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