Changes in plasma lipid and lipoprotein cholesterol and weight prior to the diagnosis of cancer.

Changes in lipoprotein cholesterol, total plasma cholesterol, and weight prior to the diagnosis of cancer were examined in 103 men who developed cancer in a cohort of 3805 type IIa hyperlipidemic men aged 35-59 enrolled in the Lipid Research Clinics Coronary Primary Prevention Trial. Study measurements were made bimonthly. After adjusting for the effects of the trial intervention and other determinants of lipid levels, the cholesterol levels of the cases diagnosed with nonlocalized cancer dropped below the expected level approaching diagnosis when compared to the entire study population. The decrease averaged 9.3 mg/dl and began about 2 years prior to diagnosis. Weight levels dropped an average of 1.2 kg over the same period. Weight and cholesterol were significantly lower than expected within 8 months of diagnosis (P less than 0.05). No decrease was seen for those diagnosed with localized malignancies. Patterns for low-density lipoprotein cholesterol reflected those of total cholesterol. There was no clear relationship between cancer diagnosis and patterns of change for triglycerides and high-density lipoprotein cholesterol. In the future, investigations of any relationship between a host physiological state and cancer occurrence should account for the metabolic effects of preclinical disease demonstrated here. To protect against spurious conclusions, incident cases occurring within 2 years of measurement should be analyzed separately. In studies of cancer mortality, deaths occurring within 3.5 years of the base-line measurement should be analyzed separately.

Anger proneness predicts coronary heart disease risk: prospective analysis from the atherosclerosis risk in communities (ARIC) study.

BACKGROUND: Increased research attention is being paid to the negative impact of anger on coronary heart disease (CHD). METHODS AND RESULTS: This study examined prospectively the association between trait anger and the risk of combined CHD (acute myocardial infarction [MI]/fatal CHD, silent MI, or cardiac revascularization procedures) and of "hard" events (acute MI/fatal CHD). Participants were 12 986 black and white men and women enrolled in the Atherosclerosis Risk In Communities study. In the entire cohort, individuals with high trait anger, compared with their low anger counterparts, were at increased risk of CHD in both event categories. The multivariate-adjusted hazard ratio (HR) (95% CI) was 1.54 (95% CI 1.10 to 2.16) for combined CHD and 1.75 (95% CI 1.17 to 2.64) for "hard" events. Heterogeneity of effect was observed by hypertensive status. Among normotensive individuals, the risk of combined CHD and of "hard" events increased monotonically with increasing levels of trait anger. The multivariate-adjusted HR of CHD for high versus low anger was 2.20 (95% CI 1.36 to 3.55) and for moderate versus low anger was 1.32 (95% CI 0.94 to 1.84). For "hard" events, the multivariate-adjusted HRs were 2.69 (95% CI 1.48 to 4.90) and 1.35 (95% CI 0.87 to 2.10), respectively. No statistically significant association between trait anger and incident CHD risk was observed among hypertensive individuals. CONCLUSIONS: Proneness to anger places normotensive middle-aged men and women at significant risk for CHD morbidity and death independent of the established biological risk factors.

Hypertension and subclinical carotid artery atherosclerosis in blacks and whites. The Atherosclerosis Risk in Communities Study. ARIC Investigators.

OBJECTIVE: To describe the distribution of hypertension and its association with subclinical atherosclerosis in blacks and whites. DESIGN: Population-based survey of 15,587 middle-aged adults from the Atherosclerosis Risk in Communities Study. Ultrasound-measured carotid artery intima media thickness (IMT) was used to estimate atherosclerosis. Hypertension was defined by the revised fifth Joint National Committee categories. Continuous systolic and diastolic blood pressure measurements also were evaluated. RESULTS: Among participants not reporting use of antihypertensive medication, 43% to 52% of black and 68% to 78% of white participants had optimal to high-normal blood pressure across the 4 study centers; 11% to 22% of black and 6% to 9% of white participants had stage I or higher hypertension. Use of antihypertensive medications was reported by 34% to 45% of blacks and 20% of whites; 11% to 17% of blacks had stage I or higher hypertension compared with 4% to 7% of whites when treated. Higher hypertension categories were associated with thicker intima medias in all ethnic and gender groups, in participants who did and did not use medications. In participants who did not use medications, multiple linear regression models adjusted for diastolic blood pressure and other risk factors found that systolic blood pressure was positively associated with IMT except in black men; diastolic blood pressure was not related to IMT in blacks and had a negative relation with IMT in white men and a J-shaped relation with IMT in white women. Results of similar direction and magnitude were found in participants who used medications. CONCLUSIONS: Hypertension was higher in blacks than whites and was associated with subclinical atherosclerosis. The association of atherosclerosis with hypertension is accounted for predominantly by systolic blood pressure. The intriguing negative association of diastolic blood pressure and atherosclerosis implies that pulse pressure may be an important correlate of atherosclerosis.

Coffee consumption and mortality. Total mortality, stroke mortality, and coronary heart disease mortality.

Total mortality showed no association with coffee usage in the four race-sex groups of Evans County, Georgia. Deaths of coronary heart disease (CHD) in white men and women and black men showed no statistically significant difference between high and low coffee consumers. In an area that has been designated as the "Stroke Belt," neither CHD nor cerebrovascular death rates seem related to coffee-drinking habits. However, to refute or confirm the allegations of a detrimental influence of high coffee intake, larger samples are needed. Nevertheless, our finding that mortality from all causes is not increased in the high coffee-consuming group means that a finding of increased CHD mortality with high coffee consumption would have to be compensated by a protective lower rate for other causes of death.

Coronary disease mortality and risk factors in black and white men. Results from the combined Charleston, SC, and Evans County, Georgia, heart studies.

BACKGROUND: Epidemiologic studies begun in the southeastern United States in the 1960s indicated that the prevalence of coronary disease was two to three times greater among white men than black men and also showed an excess incidence of coronary disease among white men, although hypertension was twice as prevalent among blacks. This study was conducted to determine if racial differences exist in coronary heart disease mortality and coronary risk factors. METHODS: Data from the two population-based cohorts of the Charleston, SC, and Evans County, Georgia, Heart Studies were pooled to make comparisons of coronary disease mortality and its risk factors. A total of 726 black men and 1346 white men aged 35 years or older in 1960 in the combined cohort were followed up for 30 years. RESULTS: There were 125 deaths among the black men and 323 deaths among the white men attributable to coronary disease; the age-adjusted rates were 5.0 per 1000 person-years in the black men and 6.5 per 1000 person-years in white men. Black-white coronary mortality risk ratios were 0.8 when age adjusted and 0.7 when also adjusted for other cardiovascular risk factors. Elevated systolic blood pressure and cigarette smoking were significant predictors of coronary mortality in black and white men. Serum total cholesterol level was a statistically significant risk factor only in white men. Higher education level was significantly protective in black and white men. CONCLUSIONS: Black men experienced significantly less coronary disease mortality than white men. Except for cholesterol level, the risk factors for coronary mortality in black and white men were similar.

Body mass index and body girths as predictors of mortality in black and white women.

BACKGROUND: The high prevalence of obesity in black women has been hypothesized to contribute to higher rates of coronary heart disease and total mortality. Investigators have recently refined the study of obesity by differentiating anatomic patterns of the physical location of adipose tissue on the body. We examined fat patterning as a predictor of mortality in black women. METHODS: Body mass index (BMI) and body girths were examined as predictors of all-cause and coronary heart disease mortality during 25 to 28 years of follow-up in black and white women in the Charleston Heart Study. RESULTS: The BMI was associated with all-cause and coronary heart disease mortality in white, but not black, women. After controlling for differences in BMI, the risk of all-cause mortality was greater in white women with larger chest and abdominal girths, while midarm girths were inversely associated with mortality. The hazard at the 85th percentile relative to the 15th percentile of abdomen/midarm ratio was 1.44 in models that included BMI, education, and smoking as covariates. In black women, the girths were not predictive of either all-cause or coronary heart disease mortality. CONCLUSIONS: The failure of BMI and fat patterning to predict mortality in black women challenges previously held assumptions regarding the role of overweight in the higher mortality experienced by black women.

Socioeconomic status in the epidemiology and treatment of hypertension.

The association of socioeconomic status (SES), as indexed by educational achievement, with the prevalence, prognosis, and efficacy of treatment of hypertension in the Hypertension Detection and Follow-up Program (HDFP) was reviewed. The prevalence of hypertension varied inversely with SES during the screening program initiated to identify HDFP eligibles in 14 communities in 1973-1974. There was a strong inverse gradient of 5-year all-cause mortality with SES among the hypertensive participants referred to usual care in the HDFP. The association of mortality with SES among hypertensive subjects was eliminated by the HDFP stepped-care program. A large portion of the efficacy of the HDFP was associated with in-trial blood pressure control. Inasmuch as these results are generalizable to the nation, a large fraction of hypertension-associated morbidity and mortality in the United States was related to lower SES in the 1970s, before widespread implementation of programs resulting in increased awareness, treatment, and control of hypertension.

Race and sex differences in the correlates of blood pressure change.

Potential predictors of systolic and diastolic blood pressure change between 1960 and 1967 in the biracial population of Evans County, Georgia, were investigated. An all possible regressions multiple linear regression analysis was used. For systolic blood pressure change, the level of systolic blood pressure, age, and change in Quetelet index were significant (p less than 0.05) correlates in white men. The level of systolic blood pressure, the level and change of socioeconomic status, change in Quetelet index, and change in cholesterol were significant correlates for white women. The level of Quetelet index was of borderline significance (p less than 0.055) when the other significant variables were included in the model for white women. The change in Quetelet index was the only significant correlate of systolic blood pressure change in blacks. For diastolic blood pressure change, age, change in hematocrit, and change in Quetelet index were significant correlates for white men. Age, level and change of socioeconomic status, level and change of Quetelet index, and change in hematocrit were the significant correlates in white women. In black men, change in Quetelet index and age were significant. In black women, only age was a significant correlate of diastolic blood pressure change. These results indicate that there may be important differences in these correlates between race-sex groups and thus in the mechanism of blood pressure change for different race-sex groups. groups.

Arterial stiffness and the development of hypertension. The ARIC study.

Decreased elasticity in large and medium-sized arteries has been postulated to be associated with cardiovascular diseases. We prospectively examined the relation between arterial elasticity and the development of hypertension over 6 years of follow-up in a cohort of 6992 normotensive men and women aged 45 to 64 years at baseline from the biracial, population-based Atherosclerosis Risk in Communities (ARIC) Study. Arterial elasticity was measured from high-resolution B-mode ultrasound examination of the left common carotid artery as adjusted arterial diameter change (in micrometers, simultaneously adjusted for diastolic blood pressure, pulse pressure, pulse pressure squared, diastolic arterial diameter, and height), Peterson's elastic modulus (in kilopascals), Young's elastic modulus (in kilopascals), and beta stiffness index. Incident hypertension (n=551) was defined as systolic blood pressure >/=160 mm Hg, diastolic blood pressure >/=95 mm Hg, or the use of antihypertensive medication at a follow-up examination conducted every 3 years. The age-, ethnicity-, center-, gender-, education-, smoking-, heart rate-, and obesity-adjusted means (SE) of baseline adjusted arterial diameter change, Peterson's elastic modulus, Young's elastic modulus, and beta stiffness index were 397 (5), 148 (2.0), 787 (12.7), and 11.43 (0.16), respectively, in persons who developed hypertension during follow-up, in contrast to 407 (1), 124 (0.6), 681 (3.7), and 10.34 (0.05), respectively, for persons who did not. The similarly adjusted cumulative incident rates of hypertension from the highest to the lowest quartiles of arterial elasticity were 6.7%, 8.0%, 7.3%, and 9.6%, respectively, when measured by adjusted arterial diameter change (P<0.01). One standard deviation decrease in arterial elasticity was associated with 15% greater risk of hypertension, independent of established risk factors for hypertension and the level of baseline blood pressure. These results suggest that lower arterial elasticity is related to the development of hypertension.

Dietary and other correlates of changes in total and low density lipoprotein cholesterol in hypercholesterolemic men: the lipid research clinics coronary primary prevention trial.

Correlates of changes in total (TOTAL-C) and low density lipoprotein cholesterol (LDL-C) were examined in the 3806 hypercholesterolemic men of the Lipid Research Clinics Coronary Primary Prevention Trial. These correlates included changes in weight, dietary and alcohol intake, plasma glucose and thyroxine, cigarette smoking, packet count, lipid-lowering drugs other than cholestyramine, and antihypertensive drugs. In both placebo plus diet and cholestyramine plus diet treatment groups, decreases in Quetelet index and in saturated fat and cholesterol intake and increases in polyunsaturated fat intake were consistently associated with reductions in TOTAL-C and in LDL-C. In the cholestyramine group, plasma glucose and smoking were predictors of increased TOTAL-C and LDL-C; age and packet count were predictors of decreased TOTAL-C and LDL-C. Diuretic use was associated with increases in TOTAL-C in both groups and with increases in LDL-C in the cholestyramine group.

Interaction of the glutathione S-transferase genes and cigarette smoking on risk of lower extremity arterial disease: the Atherosclerosis Risk in Communities (ARIC) study.

Glutathione S-transferases M1 or T1 (GSTM1/GSTT1) affect the body's ability either to detoxify or to activate chemicals in cigarette smoke. Cigarette smoking increases the risk of lower extremity arterial disease (LEAD). We conducted a cross-sectional study to evaluate a hypothesized interaction of the genetic polymorphisms of GSTM1 and T1 with cigarette smoking in the risk of LEAD in the ARIC study. A stratified-random sample, including 212 LEAD cases (ankle-brachial index <0.9 in men or <0.85 in women) and 1277 non-cases, was selected from the ARIC cohort of 12041 middle-aged participants free of CHD, transient ischemic attack and stroke at baseline (1987-1989). Overall, the differences in the frequencies of GSTM1-0 and GSTT1-0 (the homozygous deletion genotype) were not statistically significant between cases and non-cases (44 vs. 41% and 28 vs. 18%). However, smoking was more prevalent among LEAD cases than non-cases. The results suggest that the non-deletion genotype GSTM1-1 interacts with smoking to increase the risk of LEAD, but this interaction was not statistically significant. The functional genotype GSTT1-1 was significantly associated with increased risk of LEAD given smoking after adjustment for other risk factors. In individuals with GSTT1-1, the odds ratios (ORs) (95% confidence intervals) of LEAD were 3.6 (1.4, 9.0) for current smoking and 5.0 (1.9, 13.0) for 20+ pack-years. However, in those with GSTT1-0, the ORs were 0.8 (0.2, 2.8) for current smoking and 0.6 (0.1, 2.1) for 20+ pack-years. The interaction was significant (P<0.05) on the additive scale for current smoking and on both the additive and multiplicative scales for 20+ pack-years. Among non-smokers, GSTT1-1 was not associated with LEAD. The results suggest that the GSTT1-1 polymorphism may be a susceptibility factor modifying the risk of LEAD associated with cigarette smoking.

Glutathione S-transferase genotype as a susceptibility factor in smoking-related coronary heart disease.

Cancer studies suggest that the null polymorphisms of glutathione S-transferase M1 or T1 (GSTM1/GSTT1) may affect the ability to detoxify or activate chemicals in cigarette smoke. The potential modification of the association between smoking and coronary heart disease (CHD) by GSTM1 and GSTT1 has not been studied in humans. A case-cohort study was conducted to test the hypotheses that specific genotypes of GSTM1 or GSTT1 affect susceptibility to smoking-related CHD. CHD cases (n=400) accrued during 1987-1993 and a cohort-representative sample (n=924) were selected from a biracial cohort of 15792 middle-aged men and women in four US communities. A significantly higher frequency of GSTM1-0 and a lower frequency of GSTT1-0 were found in whites (GSTM1-0=47.1%, GSTT1-0=16.4%) than in African-Americans (AAs) (GSTM1-0=17.5%, GSTT1-0=25.9%). A smoking-GSTM1-0 interaction for the risk of CHD was statistically significant on an additive scale, with ever-smokers with GSTM1-0 at a approximately 1.5-fold higher risk relative to ever-smokers with GSTM1-1 and a approximately 2-fold higher risk relative to never-smokers with GSTM1-0, after adjustment for other CHD risk factors. The interaction between having smoked >/=20 pack-years and GSTT1-1 was statistically significant on both multiplicative and additive scales. The risk of CHD given both GSTT1-1 and >/=20 pack-years of smoking was approximately three times greater than the risk given exposure to >/=20 pack-years of smoking alone, and approximately four times greater than the risk given exposure to GSTT1-1 alone. The modification of the smoking-CHD association by GSTM1 or GSTT1 suggests that chemicals in cigarette smoke that are substrates for glutathione S-transferases may be involved in the etiology of CHD.

Overview of clinical trials of cholesterol lowering in relationship to epidemiologic studies.

The results of clinical trials have produced convincing evidence of the direct relationship between total plasma cholesterol lowering and reduction in coronary heart disease risk. Quantitative overviews suggest efficacy in primary and secondary prevention of coronary heart disease, both in pharmacologic and dietary trials. Within-treatment group analyses (as observational epidemiologic studies) of the clinical trials and overview analyses of the aggregate outcome of the trials (as proper randomized experiments) are consistent with the results of population-based epidemiologic surveys: they disclose a continuous decrease in coronary heart disease risk with decreasing levels of total plasma cholesterol over a wide range of values. Integrated with knowledge of the distribution of plasma cholesterol levels in populations, these results indicate that there is a major potential for control of the contemporary epidemic of coronary heart disease by a combined high-risk individual and general population intervention approach to the reduction of plasma cholesterol levels.

Cholesterol and cardiovascular disease. An overview of Lipid Research Clinics (LRC) epidemiologic studies as background for the LRC Coronary Primary Prevention Trial.

The Lipid Research Clinics (LRC) Program has implemented an integrated series of observational epidemiologic, community-based studies that provide a frame of reference for the results of the LRC Coronary Primary Prevention Trial (CPPT). The observational studies were performed in 16 populations sampled in the United States, Canada, the Soviet Union and Israel. Findings based on data from more than 80,000 study participants indicate that atherogenic profiles of plasma total, low-density lipoprotein and high-density lipoprotein cholesterol levels are highly prevalent in middle-aged adults. The lipoprotein cholesterol fraction components are related to a wide range of demographic, behavioral, anthropometric, medical status, drug utilization and hormonal factors, in addition to the well known major dietary and genetic determinants. The results of the LRC CPPT are directly applicable to high-risk, high total cholesterol, and high low-density lipoprotein cholesterol levels in middle-aged men. Considered jointly with the observational finding that the major burden of ischemic heart disease is associated with moderately elevated lipid levels, the LRC studies suggest that 2 concurrent approaches are necessary to achieve community control: approaches for high-risk person through individualized medical intervention and hygienic, population-oriented approaches toward achieving less atherogenic distributions of lipids and lipoproteins. With this combined approach, the current epidemic of ischemic heart disease can be controlled.

Black-white differences in electrocardiographic left ventricular mass and its association with blood pressure (the ARIC study). Atherosclerosis Risk in Communities.

Black-white differences in the association between antihypertensive therapy, continuous measures of mean arterial and pulse pressures and left ventricular (LV) mass estimated from a multivariable electrocardiographic algorithm were examined in 6,020 men (23% black) and 7,970 women (29% black) participating in the Atherosclerosis Risk in Communities (ARIC) study. Mean arterial and pulse pressures, weight, the percentage of subjects taking antihypertensive medication, and LV mass were higher in black than in white men (98 vs 89 mm Hg, 47 vs 46 mm Hg, 188 vs 187 pounds, 30% vs 17%, and 243 vs 217 g, respectively). Results of similar direction but greater magnitude were observed in black versus white women (mean arterial pressure, 94 vs 85 mm Hg; pulse pressure, 50 vs 47 mm Hg; weight, 180 vs 153 pounds; percent treated, 42% vs 18%; and LV mass, 203 vs 169 g, respectively). In multivariable regression analyses, blacks had higher levels of LV mass, and LV mass increased more sharply with increasing mean arterial pressure in blacks than in whites after adjusting for age, pulse pressure, and weight. At equal mean arterial and pulse pressures, age, and weight, treated blacks had higher LV mass than treated whites. These data indicate that blacks have higher LV mass than whites, and a more pronounced blood pressure-LV mass relation after controlling for other risk factors and treatment status. Given the prognostic importance of LV hypertrophy,

Influence of race, sex and weight on blood pressure behavior in young adults.

This study is concerned with blood pressure behavior in young adults (aged 15 to 29 years) in the biracial community of Evans County, Ga., on two occasions 7 years apart. On the basis of casual blood pressure recordings the prevalence of systolic pressure equal to or greater than 140 mm Hg or diastolic pressure equal to or greater than 90 mm Hg, or both, showed race/sex differences as follows: white males 19.0 percent, white females 12.7 percent. black males 34.0 percent, black females 31.6 percent. Similar differences were noted in the incidence during the 7 year interval. The problem presented by the variability of the casual blood pressure recording is apparent in this interval study. Of particular interest is the association of weight with blood pressure in this youthful group, particularly among white males and females and black females, in relation to both initial and subsequent pressure levels. The data suggest that in this population under 30 years, weight is a risk factor for hypertension, and that maintenance of ideal weight, instituted in youth, may be a preventive measure.

Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TEXCAPS): additional perspectives on tolerability of long-term treatment with lovastatin.

This study presents the long-term safety data from AFCAPS/TexCAPS, the first primary prevention trial to demonstrate that men and women with average levels of low-density lipoprotein cholesterol (LDL-C) and below average levels of high-density lipoprotein cholesterol (HDL-C) can significantly benefit from long-term treatment to lower LDL-C; lovastatin 20 to 40 mg/day reduced the risk of a first acute major coronary event (fatal or nonfatal myocardial infarction, unstable angina, or sudden death) by 37% (p = 0.00008). This double-blind randomized, placebo-controlled trial, in 6,605 generally healthy middle-aged and older men and women, had prespecified end point and cancer analyses. All analyses were intention-to-treat. Safety monitoring included history, physical examination, and laboratory studies (including hepatic transaminases and creatine phosphokinase [CPK]). All participants, even those who discontinued treatment, were contacted annually for vital status, cardiovascular events, and cancer history. After an average of 5.2 years of follow-up, there were 157 deaths (80 receiving lovastatin and 77 receiving placebo; relative risk [RR] 1.04; 95% confidence interval [CI] 0.76 to 1.42; p = 0.82); of which 115 were noncardiovascular (RR 1.21; CI 0.84 to 1.74; p = 0.31), and of these, 82 were due to cancer (RR 1.41; CI 0.91 to 2.19; p = 0.13). There were no significant differences between treatment groups in overall cancer rates, discontinuations for noncardiovascular adverse experiences, or clinically important elevations of hepatic transaminases or CPK. Among those who used cytochrome P450 isoform (CYP3A4) inhibitors, there were no treatment group differences in the frequency of clinically important muscle-related adverse events. Treatment with lovastatin 20 to 40 mg daily for primary prevention of coronary heart disease was well tolerated and reduced the risk of first acute coronary events without increasing the risk of either noncardiovascular mortality or cancer.

Serum cholesterol and coronary heart disease risk in female and older hypertensives. The experience under usual community care in the Hypertension Detection and Follow-up Program.

The coronary heart disease (CHD) risk function associated with baseline serum cholesterol levels among women and older hypertensives was determined for the 5455 participants who were randomized in the Hypertension Detection and Follow-up Program (HDFP), referred to usual care in 14 US communities, and followed for the years 1974 through 1979. The risk of fatal CHD in relation to serum cholesterol for those under age 65 appeared as strong in women as in men in age- and race-adjusted analyses stratified by serum cholesterol levels; however, there was no association of serum cholesterol levels with combined fatal plus nonfatal incident coronary events for these women, adjusting for other major risk factors and covariables. There was no association of serum cholesterol with fatal or combined fatal plus nonfatal CHD events in either adjusted or unadjusted analyses for older hypertensive women. In contrast to the findings for women, serum cholesterol levels were strongly predictive of fatal plus nonfatal CHD in both younger and older hypertensive men, controlling for the effects of other factors such as age, antecedent history of antihypertensive medication, and presence of comorbidity. This study, based on the experience of the usual care group within the HDFP, was observational in nature. Clinical trials of specific regimens of serum cholesterol lowering in hypertensives are required definitively to determine their efficacy and safety for these high-risk patients; however, the experience within the HDFP indicates the desirability of detection and prudent management of hypercholesterolemia in older as well as younger male hypertensives.

Serum cholesterol and 20-year mortality in black and white men and women aged 65 and older in the Evans County Heart Study.

Serum cholesterol and 20-year mortality rates were studied in 396 Evans County black and white men and women who were 65 years and older and free of prevalent coronary heart disease (CHD) at baseline examination in 1960 to 1962. Previous reports on Evans County men and women younger than 65 found cholesterol levels to be significantly associated with all-cause and CHD mortality in white men, with CHD mortality in black men, and with cardiovascular disease mortality in white women. The independent role of total serum cholesterol as a predictor of CHD and all-cause mortality in the 65-and-older age group was evaluated using Cox proportional hazards models. Among white men, serum cholesterol level was positively associated with CHD mortality (relative risk of 1.54, P < 0.05 for an increment of 40 mg/dL [1.03 mmol/L], or one standard deviation in cholesterol). A significant J-shaped relationship of cholesterol with all-cause mortality was found among white men. Among black women, cholesterol was negatively associated with all-cause mortality. Neither all-cause nor CHD mortality was related to serum cholesterol among black men or white women. Although based on small numbers, the results of this study suggest that in Evans County, total serum cholesterol is an independent predictor of mortality in white men aged 65 and over, while these results should not be generalized to other race-gender groups in this cohort.

Employment status and high blood pressure in women: variations by time and by sociodemographic characteristics.

PURPOSE: The association between employment status and high blood pressure in women was examined at two time periods to determine if associations between employment status and high blood pressure varied by time period or by age, race, education, marital status, or parental status. METHODS: Women participants from the National Health Examination Survey (1960) and the Second National Health and Nutrition Survey (1976-1980) between the ages of 25 and 64 and currently employed or keeping house were included. Logistic regression analysis was used to examine the cross-sectional association between employment status and high blood pressure in each survey, taking into account potential effect modifiers and covariates. RESULTS: In 1960 employment was associated with a slight, but not statistically significant, elevation in odds of high blood pressure. In 1976-1980, it was associated with a modest but significant reduction in odds of high blood pressure. Variations in associations occurred by marital status (protective associations were limited to unmarried women) and race (associations were of stronger magnitude among African-American women). CONCLUSIONS: The employment status-high blood pressure relationship shifted across surveys. Changes in the composition of the employed and nonemployed groups account for at least part of the varying relationships.