Relation between depressive symptoms and common carotid artery atherosclerosis in American persons > or =65 years of age.

Few epidemiologic studies have examined the association between depressive symptoms and atherosclerosis in subjects aged > or =65 years. Most of these studies were cross sectional and could not determine the temporality between depressive symptoms and the development of abnormal common carotid artery (CCA) intima-media thickness (CCA-IMT). To investigate the association between depressive symptoms and CCA atherosclerosis in subjects aged > or =65 years, data from 3,781 participants aged > or =65 years from the Cardiovascular Health Study were analyzed. The presence of depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale, while CCA-IMT as an indicator of CCA atherosclerosis was measured by B-mode carotid ultrasonography. Multivariate generalized estimation equations adjusted for age, gender, race, alcohol intake, blood glucose status, body mass index, and time showed that subjects aged > or =65 years with depressive symptoms had larger CCA-IMTs than those who did not have such symptoms (beta = 18.26 microm, SE 8.06, p = 0.03). Using 1,000 and 1,140 microm as cut-off points to exclude participants who had abnormal CCA-IMTs at baseline, the adjusted relative risks and the corresponding 95% confidence intervals of developing abnormal CCA-IMT over 3 years were 1.30 (95% confidence interval 1.10 to 1.44) and 1.21 (95% confidence interval 1.00 to 1.46), respectively. Similar results were obtained after excluding participants with prevalent cardiovascular disease at baseline. In conclusion, these data indicate that depressive symptoms are associated with the development of atherosclerosis in subjects aged > or =65 years.

Trends in the diabetes quality improvement project measures in Maine from 1994 to 1999.

OBJECTIVE: To examine changes in the management of patients with diabetes from 1994 to 1999 using the claims-based Diabetes Quality Improvement Project (DQIP) accountability measures. RESEARCH DESIGN AND METHODS: Administrative claims from an employer-based health insurance cohort in Maine were used to describe the prevalence of claims-based DQIP accountability measures-HbA(1c) testing, dilated eye examination, lipid profile, and monitoring for diabetic nephropathy-from 1994 (n = 1151) to 1999 (n = 2221) in a 100% sample of adults (18-64 years of age) with diabetes. The Mantel-Haenszel chi(2) test for trend was performed on each measure. Prevalence estimates were also stratified by three insurance products: health maintenance organization (HMO), point of service, and indemnity. RESULTS: There was a positive trend for all outcome measures (P < 0.001). The baseline and final frequencies (percent increase) for lipid testing, HbA(1c), dilated eye examination, and screening for diabetic nephropathy were as follows: 13-50% (257%), 37-69% (92%), 30-46% (53%), and 37-50% (36%), respectively. Individuals with diabetes and indemnity insurance were much less likely to receive these measures than individuals with other types of insurance, whereas people in HMOs were more likely to receive HbA(1c) testing and lipid profiles. CONCLUSIONS: The proportion of patients with diabetes receiving DQIP accountability measures significantly increased from 1994 to 1999. There is large variation in prevalence among these measures and insurance products. It is urgent to identify effective mechanisms for delivering consistent preventive care that are congruent with defined standards of benefit.

Antiphospholipid antibodies and stroke in young women.

BACKGROUND AND PURPOSE: Antiphospholipid antibodies have been associated with ischemic stroke in some but not all studies. METHODS: We performed a population-based case-control study examining antiphospholipid antibodies (anticardiolipin antibodies and lupus anticoagulants) using stored frozen sera and plasma in 160 cases and 340 controls enrolled in the Stroke Prevention in Young Women study. We evaluated for the presence of anticardiolipin antibody (IgG, IgM, and IgA isotypes) by an enzyme-linked immunosorbent assay and for the lupus anticoagulant using several phospholipid-dependent coagulation tests (activated partial thromboplastin time, dilute Russell's viper venom time) with mixing studies. If mixing studies were prolonged, confirmatory tests were performed. RESULTS: A positive anticardiolipin antibody level of any isotype was seen in 43 cases (26.9%) and 62 controls (18.2%) (P=0.03), lupus anticoagulant in 29 cases (20.9%) and 38 controls (12.8%) (P=0.03), and either anticardiolipin antibody or lupus anticoagulant in 61 cases (42.1%) and 86 controls (27.9%) (P=0.003). After adjustment for age, current cigarette smoking, hypertension, diabetes, angina, ethnicity, body mass index, and high-density lipoprotein levels, the relative odds of stroke for women with anticardiolipin antibody immunoreactivity of any isotype or a lupus anticoagulant was 1.87 (95% confidence interval, 1.24 to 2.83; P=0.0027). CONCLUSIONS: The results from this study support the importance of antiphospholipid antibodies as an independent risk factor for stroke in young women.

Secular trends in cardiovascular disease mortality, incidence, and case fatality rates in adults in the United States.

PURPOSE: To assess the effects of changes in cardiovascular disease incidence and case fatality rates on secular trends in mortality in the U.S. population between 1971-1982 and 1982-1992. METHODS: Using data from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, two cohorts (10,869 subjects in the 1971-1982 cohort and 9774 in the 1982-1992 cohort) of participants aged 35 to 74 years were created. Baseline medical history questionnaires were administered in 1971-1975 and 1982-1984, with follow-up interviews, hospital record reviews, and death certificate searches conducted in 1982-1984, 1986, 1987, and 1992. RESULTS: Between 1971-1982 and 1982-1992, age-standardized cardiovascular disease mortality declined from 79.1 (95% confidence interval [CI]: 75.2 to 83.0) to 53.0 (95% CI: 49.5 to 56.5) per 10,000 person-years, while cardiovascular disease incidence rates decreased from 293.5 (95% CI: 284.5 to 302.4) to 225.1 (95% CI: 216.6 to 233.5) per 10,000 person-years. The 28-day case fatality rate for cardiovascular disease declined from 15.7% (95% CI: 14.5% to 16.8%) to 11.7% (95% CI: 10.3% to 13.0%). After adjustment for age, sex, and race, rates were 31% lower for cardiovascular disease mortality, 21% lower for incidence, and 28% lower for 28-day case fatality in the 1982-1992 cohort than in the 1971-1982 cohort (each P <0.001). CONCLUSION: The decrease in cardiovascular disease mortality between 1971-1982 and 1982-1992 was due to declines in both the incidence and case fatality rates in this national sample. These findings suggest that both primary and secondary prevention and treatment contributed to the decline in cardiovascular disease mortality in the United States.

Differential association of birth weight with cardiovascular risk variables in African-Americans and Whites: the Bogalusa heart study.

PURPOSE: To study the relationship between low birth weight and the subsequent development of cardiovascular risk factors and to compare this relationship between African-Americans and whites at 7 to 21 years of age. METHODS: The relationship of birth weight with cardiovascular risk factors, namely, systolic and diastolic blood pressure (BP), BMI, HDL, LDL, triglycerides, and HOMA insulin resistance (HOMA-IR) was examined retrospectively using information on 1155 participants (730 whites and 425 African-Americans) from two cohorts of the Bogalusa Heart Study. RESULTS: Participants with lower birth weight had higher systolic BP, HOMA-IR, triglycerides, and LDL. The association of birth weight with LDL, triglycerides, and HOMA-IR was stronger in African-Americans, while the association with systolic BP was stronger in whites. Subjects with birth weight <2500 g were at increased risk of having values of HOMA-IR and LDL in the upper quartile of the observed range compared with those with birth weight >2500 g. CONCLUSIONS: These results support a relationship between low birth weight and the later development of important cardiovascular risk factors in young African-Americans and white individuals. This relationship tends to be stronger in African-Americans than in whites, except for systolic blood pressure.

Pulmonary function as a predictor of lung cancer mortality in continuing cigarette smokers and in quitters.

BACKGROUND: Forced expiratory volume in 1 second (FEV(1)) may be useful for identifying smokers at higher risk of lung cancer. We examined the association of FEV(1) with lung cancer mortality (LCM) among cigarette smokers in the Multiple Risk Factor Intervention Trial (MRFIT). METHODS: In all, 6613 MRFIT baseline smokers alive at trial end in 1982 had acceptable FEV(1) measures and complete smoking history; men were classified as during-trial long-term quitters (N = 1292), intermittent quitters (1961), and never quitters (3360). Proportional hazards models for LCM were fit with quintiles of average FEV(1), adjusted for age, height, race, smoking history, and other risk factors. RESULTS: For long-term, intermittent, and never quitters respectively, mean baseline cigarettes/ day was 28, 32, and 35; trial-averaged FEV(1) was 3201, 3146, and 3082 ml; and average decline in FEV(1) was -46.0, -54.6, and -62.5 ml/year. With median post-trial mortality follow-up of 18 years, there were 363 lung cancer deaths. Age-adjusted LCM rates varied across FEV(1) quintiles from 50 (lowest quintile) to 11 (highest quintile), 58 to 11, and 76 to 20, per 10 000 person-years, for long-term quitters, intermittent quitters, and never quitters, respectively. Multivariate adjusted hazard ratios for 100 ml higher FEV(1) were 0.92 [P = 0.004], 0.95 [P = 0.003], and 0.95 [P < 0.0001] respectively. CONCLUSIONS: These results demonstrate the strong predictive value of FEV(1) for lung cancer among cigarette smokers independent of smoking history; results did not differ by during-trial quit status. FEV(1) may be a biological marker for smoking dose or it may be that genetic susceptibilities to both decreased FEV(1) and lung cancer are associated.

Bone density-related predictors of blood lead level among peri- and postmenopausal women in the United States: The Third National Health and Nutrition Examination Survey, 1988-1994.

Because of the long half-life of lead stored in bone (years), skeletal lead stores may be a source of endogenous lead exposure during periods of increased bone demineralization, such as menopause. To test the hypothesis that postmenopausal bone resorption increases blood lead levels, the authors examined cross-sectional associations of bone density-related factors with blood lead levels among women aged 40-59 years from the Third National Health and Nutrition Examination Survey (1988-1994). Factors related to bone turnover were significant predictors of blood lead level. Bone mineral density was significantly inversely related to blood lead levels in log-linear multivariate models that adjusted for age, race/ethnicity, smoking, education, household income, alcohol use, and residence (urban/rural). With menopausal status added to the model, naturally and surgically menopausal women had adjusted median blood lead levels that were 25% and 30% higher, respectively, than those of premenopausal women (2.0 microg/dl). Current use of hormone replacement therapy was associated with significantly lower adjusted median blood lead levels (1.8 microg/dl) than past use (2.6 microg/dl) and never use (2.2 microg/dl). Lead stored in bone may significantly increase blood lead levels in perimenopausal women because of postmenopausal bone mineral resorption. Attention to factors that prevent bone loss may lessen or prevent this endogenous lead exposure.

Blood lead, blood pressure, and hypertension in perimenopausal and postmenopausal women.

CONTEXT: Lead exposures have been shown to be associated with increased blood pressure and risk of hypertension in older men. In perimenopausal women, skeletal lead stores are an important source of endogenous lead exposure due to increased bone demineralization. OBJECTIVE: To examine the relationship of blood lead level with blood pressure and hypertension prevalence in a population-based sample of perimenopausal and postmenopausal women in the United States. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional sample of 2165 women aged 40 to 59 years, who participated in a household interview and physical examination, from the Third National Health and Nutrition Examination Survey conducted from 1988 to 1994. MAIN OUTCOME MEASURES: Associations of blood lead with blood pressure and hypertension, with age, race and ethnicity, cigarette smoking status, body mass index, alcohol use, and kidney function as covariates. RESULTS: A change in blood lead levels from the lowest (quartile 1: range, 0.5-1.6 micro g/dL) to the highest (quartile 4: range, 4.0-31.1 microg/dL) was associated with small statistically significant adjusted changes in systolic and diastolic blood pressures. Women in quartile 4 had increased risks of diastolic (>90 mm Hg) hypertension (adjusted odds ratio [OR], 3.4; 95% confidence interval [CI], 1.3-8.7), as well as moderately increased risks for general hypertension (adjusted OR, 1.4; 95% CI, 0.92-2.0) and systolic (>140 mm Hg) hypertension (adjusted OR, 1.5; 95% CI, 0.72-3.2). This association was strongest in postmenopausal women, in whom adjusted ORs for diastolic hypertension increased with increasing quartile of blood lead level compared with quartile 1 (adjusted OR, 4.6; 95% CI, 1.1-19.2 for quartile 2; adjusted OR, 5.9; 95% CI, 1.5-23.1 for quartile 3; adjusted OR, 8.1; 95% CI, 2.6-24.7 for quartile 4). CONCLUSIONS: At levels well below the current US occupational exposure limit guidelines (40 microg/dL), blood lead level is positively associated with both systolic and diastolic blood pressure and risks of both systolic and diastolic hypertension among women aged 40 to 59 years. The relationship between blood lead level and systolic and diastolic hypertension is most pronounced in postmenopausal women. These results provide support for continued efforts to reduce lead levels in the general population, especially women.