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Delany S, Stokes J. Bicarbonate administration in acidaemia--is it therapeutic? THE NEW ZEALAND MEDICAL JOURNAL 1992; 105:6-7. [PMID: 1312688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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127
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Lissner L, Odell PM, D'Agostino RB, Stokes J, Kreger BE, Belanger AJ, Brownell KD. Variability of body weight and health outcomes in the Framingham population. N Engl J Med 1991; 324:1839-44. [PMID: 2041550 DOI: 10.1056/nejm199106273242602] [Citation(s) in RCA: 396] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Fluctuation in body weight is a common phenomenon, due in part to the high prevalence of dieting. In this study we examined the associations between variability in body weight and health end points in subjects participating in the Framingham Heart Study, which involves follow-up examinations every two years after entry. METHODS The degree of variability of body weight was expressed as the coefficient of variation of each subject's measured body-mass-index values at the first eight biennial examinations during the study and on their recalled weight at 25 years of age. Using the 32-year follow-up data, we analyzed total mortality, mortality from coronary heart disease, and morbidity due to coronary heart disease and cancer in relation to intraindividual variation in body weight, including only end points that occurred after the 10th biennial examination. We used age-adjusted proportional-hazards regression for the data analysis. RESULTS Subjects with highly variable body weights had increased total mortality (P = 0.005 for men, P = 0.01 for women), mortality from coronary heart disease (P = 0.009 for men, P = 0.009 for women), and morbidity due to coronary heart disease (P = 0.0009 for men, P = 0.006 for women). Using a multivariate analysis that also controlled for obesity, trends in weight over time, and five indicators of cardiovascular risk, we found that the positive associations between fluctuations in body weight and end points related to mortality and coronary heart disease could not be attributed to these potential confounding factors. The relative risks of these end points in subjects whose weight varied substantially, as compared with those whose weight was relatively stable, ranged from 1.27 to 1.93. CONCLUSIONS Fluctuations in body weight may have negative health consequences, independent of obesity and the trend of body weight over time.
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Posner BM, Cobb JL, Belanger AJ, Cupples LA, D'Agostino RB, Stokes J. Dietary lipid predictors of coronary heart disease in men. The Framingham Study. ARCHIVES OF INTERNAL MEDICINE 1991; 151:1181-7. [PMID: 2043019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The relationship between dietary lipids and the 16-year incidence of coronary heart disease (CHD) morbidity and mortality was examined in two male cohorts, aged 45 to 55 years (n = 420) and 56 to 65 years (n = 393) from the Framingham Study. Dietary lipids were assessed through a single 24-hour recall at the initiation of follow-up in 1966 to 1969. In the younger cohort, there were significant positive associations between the incidence of CHD and the proportion of dietary energy intake from total fat and monounsaturated fatty acids. The proportion of energy intake from saturated fatty acids had a marginally significant positive association with CHD. The associations remained even after adjustment for cardiovascular disease risk factors, including serum cholesterol level, suggesting that their effects are at least partially independent of other established risk factors. In contrast to the younger cohort, none of the dietary lipids were associated with CHD in the older cohort. Dietary intervention for the prevention of CHD in younger men is supported by these findings.
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129
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Delany S, Stokes J. Percutaneous dilational tracheostomy: one years experience. THE NEW ZEALAND MEDICAL JOURNAL 1991; 104:188-9. [PMID: 2027610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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130
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Kannel WB, Cupples LA, Ramaswami R, Stokes J, Kreger BE, Higgins M. Regional obesity and risk of cardiovascular disease; the Framingham Study. J Clin Epidemiol 1991; 44:183-90. [PMID: 1995775 DOI: 10.1016/0895-4356(91)90265-b] [Citation(s) in RCA: 353] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Risk of cardiovascular events was determined over 24 years of surveillance in relation to general adiposity reflected by relative weight and by regional obesity estimated by skinfolds and waist girth per inch of height. Upper quintile values of relative weight, subscapular skinfolds and waist girth were each associated with increased risks of cardiovascular disease in both sexes. Risk of total cardiovascular events increased with the degree of regional, central or abdominal obesity. Mortality from cardiovascular disease was also increased. Increased relative weight and central obesity were both associated with increased risk factors including cholesterol, blood pressure, glucose and uric acid. Changes in weight were mirrored by changes in risk factors with linear trends over a 15 lb range of weight fluctuations. Subscapular skinfold and the ratio of subscapular-to-triceps skinfold, measures of central obesity, were in either sex also associated with an increased probability of coronary attacks in particular. The subscapular skinfold contributed to CHD risk independent of body mass index (BMI). Multivariate analyses taking all the risk factors into account indicate an independent effect of abdominal obesity on stroke, cardiac failure and cardiovascular and all-cause mortality in men. In women, only the subscapular-to-triceps skinfold ratio independently contributes to CHD, cardiovascular and all cause mortality. Regional obesity appears to be an independent contributor to cardiovascular disease at a given level of general adiposity, its effect only partially mediated through promotion of other known risk factors. These data suggest that cardiovascular disease is as closely linked to abdominal as to general adiposity.
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131
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Stokes J, Bamford JM. Transition from pre-linguistic to linguistic communication in hearing-impaired infants. BRITISH JOURNAL OF AUDIOLOGY 1990; 24:217-22. [PMID: 2224287 DOI: 10.3109/03005369009076559] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This paper examines the development of the ability to signal intentionality in hearing-impaired infants. Four infants were monitored from the time aids were accepted and worn consistently until an expressive vocabulary of ten words was recorded. The focus of the study was the child's developing ability to coordinate attention to both a person and an object. Longitudinal video-taping allowed analysis of the stages and rate at which these infants achieved this pattern of attention. These infants were found to follow a sequence of steps similar to that reported in studies of hearing children. This finding and its possible implications for early identification of hearing impairment are discussed.
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132
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Stokes J. Ethical committees. THE NEW ZEALAND MEDICAL JOURNAL 1990; 103:304. [PMID: 2367003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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133
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Hamlett K, Eaker ED, Stokes J. Psychosocial correlates of alcohol intake among women aged 45 to 64 years: the Framingham Study. J Behav Med 1989; 12:525-42. [PMID: 2634108 DOI: 10.1007/bf00844823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study of 749 women, aged 45 to 64 years, investigates the psychological, behavioral, and social correlates of alcohol intake. These data from the Framingham Study are uniquely based on a community sample of women, which results in a normative study of drinking behavior in women. Two measures of alcohol intake were utilized in these analyses: (1) the frequency of alcohol intake over 1 week and (2) drinking vs abstaining from alcohol. Among this sample of women, increased socioeconomic status, worrying about aging, and being easily upset were positively associated with frequency of alcohol intake. The rigid attitude scale was the strongest discriminating variable for drinkers vs nondrinkers. Older women were more likely to be nondrinkers compared to younger women, however, among older women, being a homemaker was significantly associated with increased alcohol intake. Contrarily, younger women who were homemakers were more likely to be abstainers than women employed outside the home. As would be expected, cigarette smoking was associated with drinking alcohol.
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Pryor DB, Bruce RA, Chaitman BR, Fisher L, Gajewski J, Hammermeister KE, Pauker SG, Stokes J. Task Force I: Determination of prognosis in patients with ischemic heart disease. J Am Coll Cardiol 1989; 14:1016-25. [PMID: 2794262 DOI: 10.1016/0735-1097(89)90484-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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135
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Stokes J, Kannel WB, Wolf PA, D'Agostino RB, Cupples LA. Blood pressure as a risk factor for cardiovascular disease. The Framingham Study--30 years of follow-up. Hypertension 1989; 13:I13-8. [PMID: 2535213 DOI: 10.1161/01.hyp.13.5_suppl.i13] [Citation(s) in RCA: 196] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Data from 30 years of follow-up of the original Framingham Study cohort of 5,070 men and women aged 30-62 years who were first examined during the period 1948-1952 and who were free of cardiovascular disease reveal that blood pressure is a strong and consistent predictor of the development of coronary heart disease, stroke, transient ischemic attack, and congestive heart failure. Other factors related to blood pressure like obesity, left ventricular hypertrophy as demonstrated on electrocardiograms, and heart enlargement as shown by x-ray radiography made several selective additional independent contributions to risk; heart enlargement by x-ray radiography was the best predictor of congestive heart failure.
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136
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Abbott RD, Levy D, Kannel WB, Castelli WP, Wilson PW, Garrison RJ, Stokes J. Cardiovascular risk factors and graded treadmill exercise endurance in healthy adults: The Framingham Offspring Study. Am J Cardiol 1989; 63:342-6. [PMID: 2913738 DOI: 10.1016/0002-9149(89)90343-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To help describe the association between exercise endurance and cardiovascular risk factor profiles, 2,606 young and middle-aged healthy adults in the Framingham Offspring Study were given submaximal treadmill tests. For both men and women, exercise endurance was inversely related to resting heart rate (p less than 0.001), body mass index (p less than 0.001), systolic blood pressure (p less than 0.001) and blood glucose (p less than 0.01), and positively related to high density lipoprotein (HDL) cholesterol (p less than 0.05). In men, cigarette smoking (p less than 0.05), high levels of total cholesterol (p less than 0.01) and very low density lipoprotein (VLDL) cholesterol (p less than 0.001) were also associated with poor exercise endurance. After adjusting for age, resting heart rate and body mass index, significant independent associations persisted for HDL cholesterol (p less than 0.05) in both sexes and for systolic blood pressure, VLDL cholesterol, blood glucose and cigarette smoking in men (p less than 0.05). Risk factors associated with overt cardiovascular disease in older individuals are also associated with poor exercise endurance in those who are younger and asymptomatic.
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137
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Levy D, Anderson KM, Christiansen JC, Campanile G, Stokes J. Antihypertensive drug therapy and arrhythmia risk. Am J Cardiol 1988; 62:147-9. [PMID: 2898205 DOI: 10.1016/0002-9149(88)91383-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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138
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Stokes J. National workshop on nursing standards. THE LAMP 1988; 45:10. [PMID: 3419271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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139
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Kannel WB, Cupples LA, D'Agostino RB, Stokes J. Hypertension, antihypertensive treatment, and sudden coronary death. The Framingham Study. Hypertension 1988; 11:II45-50. [PMID: 3280493 DOI: 10.1161/01.hyp.11.3_pt_2.ii45] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
During 30 years of follow-up, there were 183 sudden deaths in men and 77 in women ages 35 to 94 years who participated in the Framingham Study. Risk of sudden death was increased threefold in hypertensive persons but only if there was no previously diagnosed coronary heart disease. Men receiving antihypertensive treatment had more than twice the risk of sudden death compared with those who were untreated, whether or not they had prior manifestations of coronary heart disease. More than twice as many men who died suddenly were receiving antihypertensive therapy compared with those in the population at risk of the same age. In those with overt coronary heart disease, 34% of those dying suddenly were on antihypertensive treatment compared with 18% of those of the same age in the general population. Multivariate analysis taking into account the level of blood pressure, electrocardiographic abnormalities, and previously diagnosed coronary heart disease and cardiac failure, all of which are predisposing factors for sudden death, indicated a persistent increased risk of sudden death in association with antihypertensive treatment. Tests of interaction indicate that the excess sudden death risk was not confined to those with electrocardiographic abnormalities. In women, it may be associated with diabetes. These data suggest that some feature of antihypertensive treatment as practiced in the general population may contribute to sudden death incidence in an ill-defined subgroup of hypertensive persons.
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140
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Elsenhans B, Schmolke G, Kolb K, Stokes J, Forth W. Metal-metal interactions among dietary toxic and essential trace metals in the rat. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 1987; 14:275-287. [PMID: 3691380 DOI: 10.1016/0147-6513(87)90071-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Exposure to toxic and essential metals is thought to be reflected by corresponding metal concentrations in tissues. However, toxic and essential metals may influence each other in regard to their retention in the body. Therefore a basic diet containing four toxic metals (As 7, Cd 9, Ni 13, and Pb 20 ppm) and adequate amounts of essential metals was fed to rats for 2 weeks. Test groups received the basic diet with increasing concentrations of one of the toxic metals (up to 90 ppm As, 180 ppm Cd, 365 ppm Ni, and 394 ppm Pb). As, Cd, Ni, Pb, Cu, Fe, Mn, and Zn were determined by atomic emission spectroscopy in liver, kidney, intestine, brain, muscle, bone, skin, hair, and blood. A linear relationship between diet and tissue concentration is observed for As and Ni in the kidney, for Cd in the liver, and for Pb in the bone. In other tissues saturation was observed. While Cd-Fe interactions were common to most of the tissues, other interactions were detected only in specific tissues, e.g., As-Cu in the kidney, Cd-Zn in the liver, and As-Mn, Cd-Mn, or Ni-Cu in the intestine. Increases of renal Pb and intestinal Cd by dietary Ni, and a decrease in bone As by dietary Pb were the most pronounced interactions between the toxic metals. The results demonstrate that potential target organs for the evaluation of metal exposure need to be carefully analyzed for interfering metal-metal interactions.
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141
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Stokes J. No patients please, we're students. NURSING TIMES 1987; 83:72. [PMID: 3658753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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142
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Alemi F, Stokes J, Rice J, Karim E, LaCorte W, Saligman L, Nau R. Appraisal of modifiable hospitalization risks. Med Care 1987; 25:582-91. [PMID: 3695663 DOI: 10.1097/00005650-198707000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Nine prevention experts rated hospitalization risks of 64 hypothetical healthy adults between 20 and 65 years old. There was substantial agreement among seven out of the nine experts. Pairwise correlations between any two of the experts ranged between 0.66 and 0.86. Decision analytic tools were used to model the average of the experts' ratings. The panel of experts provided us with the factors used, the relationship between the factors, and the relative importance of each factor. An index based on this information was highly correlated with the judgments of seven experts. Thus, we concluded that the scoring procedure can simulate the experts' judgments. Next, the index was used in an interactive computer program to assess modifiable health risks of individuals. This program is provided along with the paper to facilitate further research on validity and impact of the program.
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143
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Stokes J, Kannel WB, Wolf PA, Cupples LA, D'Agostino RB. The relative importance of selected risk factors for various manifestations of cardiovascular disease among men and women from 35 to 64 years old: 30 years of follow-up in the Framingham Study. Circulation 1987; 75:V65-73. [PMID: 3568338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Substantial differences were noted in the risk profiles for various manifestations of cardiovascular disease (CVD) that occurred before the age of 65 during the first 30 years of follow-up of the 5070 subjects of the original Framingham cohort. Hypertension contributed most consistently to short-term risk of all manifestations of CVD. Differences were noted between the sexes and age groups in both the univariate and multivariate analyses. These patterns have biological, clinical, and statistical significance, particularly as they relate to the need for future studies to distinguish better between those factors that precipitate cardiovascular events and those that relate to the pathogenesis of the underlying atherosclerosis.
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144
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Stokes J. Health promotion movement is coming of age. Am J Prev Med 1987; 3:121-2. [PMID: 3452348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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145
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Garrison RJ, Kannel WB, Stokes J, Castelli WP. Incidence and precursors of hypertension in young adults: the Framingham Offspring Study. Prev Med 1987; 16:235-51. [PMID: 3588564 DOI: 10.1016/0091-7435(87)90087-9] [Citation(s) in RCA: 473] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The occurrence of hypertension and its precursors is examined in the Framingham Offspring Study of 2,027 men and 2,267 women ages 20-49 years followed for 8 years. The age-specific prevalence of hypertension was similar at both the first (1971-1975) and the second (1979-1983) examination for both men and women. Prevalence rates were higher among men than among women, and there was a higher rate of hypertension treatment at the second exam, particularly among women, 75% of whom reported being treated for hypertension. The incidence of hypertension in participants free from hypertension at the first examination increased threefold from the second to the fifth age decades in men and eight-fold in women. Under age 40, men were twice as likely as women to develop hypertension, but after age 40, 8-year incidence rates were similar in men (14.2%) and women (12.9%). Adiposity, relative weight, heart rate, alcohol intake, hematocrit, blood sugar, serum protein, triglyceride, and phosphorous were all related to hypertension occurrence in one or both sexes, controlling for age. In multivariate analysis, adiposity (P less than 0.01), heart rate (P less than 0.01), and triglyceride (P less than 0.05) were all significant independent predictors of hypertension in men. In women, adiposity (P less than 0.001), heart rate (P less than 0.01), hematocrit (P less than 0.05), and alcohol consumption (P less than 0.05) were independent contributors. When controlling for blood pressure measured at the first examination, the best single predictor of hypertension incidence, the multivariate assessment changed very little. Adiposity stands out as a major controllable contributor to hypertension. Changes in body fat over 8 years were related to changes in both systolic and diastolic blood pressure. Markedly obese women in their fourth decade were seven times more likely to develop hypertension than were lean women of the same age. Weight control deserves a high priority in efforts to prevent hypertension in the general population.
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146
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Berkeley JL, Israel I, Stokes J. Health assessment in the Framingham Offspring Study: a research proposal. JOURNAL OF CHRONIC DISEASES 1987; 40 Suppl 1:169S-182S. [PMID: 3597695 DOI: 10.1016/s0021-9681(87)80046-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This paper proposes that a broader health assessment be made in the Framingham Offspring/Spouse Study than is undertaken in the Framingham Study. The Offspring Study is composed of the children (and their spouses) of the members of the original Framingham Study cohort. The Offspring population has a broader age range and an average age that is approximately 30 years younger than the original parent cohort. Therefore, mortality and morbidity measures, which were used as indices of health status for the parent cohort and which focus on the negative "sickness" component of health, are less appropriate for use in this relatively healthy population. Thus, we propose a broader conceptual framework of health that emphasizes the positive "wellness" side of the health continuum. The essential components of the comprehensive health index we describe include global health perceptions, measures of physical, mental, and social functioning across valued social roles, the ability to withstand stress as mediated by the coping process and social resources, and the assessment of genetic, behavioral, and physiological risk factors. One purpose of the proposal is to stimulate discussion in the hope of achieving general agreement regarding a shared conceptual frame of reference that would guide the development and testing of a reliable and valid health status instrument.
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147
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Stokes J. U.S. nutrition policy. Am J Prev Med 1987; 3:1. [PMID: 3452332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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148
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Howland J, Stokes J, Crane SC, Belanger AJ. Adjusting capitation using chronic disease risk factors: a preliminary study. HEALTH CARE FINANCING REVIEW 1987; 9:15-23. [PMID: 10312390 PMCID: PMC4192869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Researchers have sought ways to modify Medicare's capitation formula, the adjusted average per capita cost (AAPCC), by including measures of individual health status. The present study assesses the value of risk factors for disease as predictors of hospitalization for Framingham Heart Study participants (1,210 males and 1,496 females) 60-65 years of age. Regression models including several common physiologic measures and prior hospitalizations yielded adjusted R2s of 9.69 percent for males and 3.61 percent for females. The contributions of the risk factors and prior hospitalization were about equal and independent. These results confirm the potential utility of disease risk factors for adjusting the AAPCC.
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149
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Pinsky JL, Leaverton PE, Stokes J. Predictors of good function: the Framingham Study. JOURNAL OF CHRONIC DISEASES 1987; 40 Suppl 1:159S-167S, 181S-2. [PMID: 2954993 DOI: 10.1016/s0021-9681(87)80045-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This paper asks the question: among 1474 Framingham Study participants aged 35-68 years who were healthy at their fourth examination (1954-1958), what are the physiologic, behavioral, and demographic characteristics that distinguish those who survive and report good function from those who do not after 21 years of biennial observations? Although a larger proportion of women than men survived, their functional status was not as good. Multiple logistic regression analysis revealed that age, alcohol intake, cigarette smoking, ventricular rate, and education were all significantly related to functional status for men, with all but the last of these factors inversely related to good function. For women, the only significant predictor other than age was education, which, as with men, was directly associated with good function. The effect of education is probably mediated by numerous factors such as availability and use of health care services, quality of health care, occupation, and lifestyle.
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150
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Savage DD, Garrison RJ, Kannel WB, Levy D, Anderson SJ, Stokes J, Feinleib M, Castelli WP. The spectrum of left ventricular hypertrophy in a general population sample: the Framingham Study. Circulation 1987; 75:I26-33. [PMID: 2947749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To assess the prevalence, characteristics, and correlates of echocardiographically determined left ventricular hypertrophy (echo LVH) in a free-living population, 510 men and 855 women from the original Framingham cohort (age 59 to 90 years) were studied by M-mode echocardiography. Offspring and offspring spouses (1718 men and 1892 women; age 17 to 75 years) were similarly studied. The severity of echo LVH, as reflected by left ventricular mass indexed to body surface area, ranged from 101 g/m2 (women) and 132 g/m2 (men) to more than 400 g/m2. The prevalence of electrocardiographically assessed LVH increased proportionately with increased echocardiographic left ventricular mass. Women with echocardiographic left ventricular mass indexes exceeding 200 g/m2 were three to four times more likely to have electrocardiographic LVH than men with similar elevations of echocardiographic left ventricular mass index. The prevalence of echo LVH ranged from 6.6% in the younger (offspring study) women to 33% in the older (original cohort) women (8.6% and 23.7%, respectively, for men) and included a spectrum of forms--eccentric-dilated, eccentric-nondilated, concentric, and disproportionate septal thickness--which varied in prevalence in the various age-sex groups. Each of these forms of echo LVH was associated with higher systolic blood pressures at the time of echocardiographic examination and over the previous 30 years when compared with blood pressures of Framingham subjects without echo LVH.
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