Showing papers by "Diederick E. Grobbee published in 1994"
TL;DR: The Rotterdam Study as discussed by the authors assessed the prevalence of primary open-angle glaucoma (POAG) in a defined population in the Netherlands, and the overall prevalence of POAG was 1.10% (95% confidence interval [CI]: 1.09,1.11).
520 citations
TL;DR: The data supporting the use of ultrasonographically measured intima-media thickness of the major arteries, and in particular of the carotid artery, for visualizing and monitoring atherosclerosis are discussed.
Abstract: In recent years, the possibility of measuring vessel wall abnormalities using ultrasound images has gained increasing interest. In particular, ultrasonographic B-mode measurement of the thickness of the wall of major arteries has shown to be feasible. Bmode imaging of the carotid artery is currently used in several population-based epidemiological studies [14]. In addition, this technique is advocated and used in trials to assess the efficacy of certain interventions to regress atherosclerosis [5, 61. Not only is the method noninvasive, imaging of the vessel wall rather than the lumen permits the evaluation of early disease or advanced disease of the arterial wall that does not yet obstruct the lumen [7]. The use of this approach to assess the presence and progression of atherosclerosis noninvasively in large groups of subjects, with and without symptomatic cardiovascular disease, has opened up ways in which to shed light on the factors that promote atherosclerotic vessel disease and lead to ischaemic complications [8]. However, the potential of ultrasound measurements of wall thickness relies on certain assumptions, some of which have been tested in studies and others that remain speculative. One assumption is that the technique is sufficiently precise and reproducible. A second assumption is that the images provide valid assessments of the disorder of interest, e.g. atherosclerosis. Finally, increases in wall thickness should be related to subsequent cardiovascular morbidity and mortality to make the measurement useful in longitudinal studies as an intermediate or ‘surrogate ’ end-point for disease. This paper discusses the data supporting the use of ultrasonographically measured intima-media thickness of the major arteries, and in particular of the carotid artery, for visualizing and monitoring atherosclerosis. To illustrate these issues, experience is drawn from the Rotterdam Study [4]. In particular, the question is addressed of whether it is important that common carotid intima-media thickness directly measures local atherosclerosis or may merely (but usefully) function as a quantitative indicator of generalized atherosclerosis.
452 citations
TL;DR: This study suggests that white matter lesions are primarily related to impairment of subcorticofrontal functions, whereas enlargement of the lateral ventricles is associated with disturbances of cortical functions as well.
Abstract: Ventricular enlargement and white matter lesions are frequent findings on cerebral magnetic resonance imaging scans of elderly subjects. In demented subjects they seem related to the severity of the dementia, but in nondemented subjects their clinical significance is less clear. We investigated the relation of size of the lateral ventricles and white matter lesions with cognitive function in a population-based random sample of nondemented elderly persons.The study population consisted of 90 subjects, aged 65 to 84 years, who were randomly selected from the cohort of the Rotterdam Study, and who were not demented. The presence of white matter lesions and the ventricle-to-brain ratio were assessed on magnetic resonance scans. Participants were tested with a neuropsychological battery that covered a broad range of cognitive functions.Ventricular enlargement and white matter lesions were both and independently associated with poorer performance on all tests. After adjustment for age and sex, ventricular enlar...
341 citations
TL;DR: The association between common carotid intima-media thickness and lower extremity arterial atherosclerosis among the first 1000 participants of the Rotterdam Study was studied and adjustments for differences in serum lipids, hypertension, and current smoking status only slightly attenuated the results.
Abstract: High-resolution B-mode ultrasonography of the carotid arteries is used to investigate the signs of early atherosclerotic vessel wall disease. To assess whether carotid artery findings reflect atherosclerosis elsewhere, we studied the association between common carotid intima-media thickness and lower extremity arterial atherosclerosis among the first 1000 participants of the Rotterdam Study. The Rotterdam Study is a single-center population-based prospective follow-up study of 7983 subjects, > or = 55 years old. Baseline measurements include ultrasound imaging of intima-media thickness of the distal common carotid artery and determination of the ankle-to-arm systolic blood pressure index. Lower extremity arterial disease was defined as an ankle-arm index or = 0.89 mm (upper quintile) to that of subjects with an intima-media thickness < 0.89 mm was 3.4 (95% CI: 2.2 to 5.2). Analysis among subjects free from symptomatic cardiovascular disease yielded a reduction in ankle-arm index per 0.1 mm increase in intima-media thickness of 0.018 (95% CI: 0.008 to 0.28) and an odds ratio for lower extremity arterial disease of 3.0 (95% CI: 1.7 to 5.1). Adjustments for differences in serum lipids, hypertension, and current smoking status only slightly attenuated the results.(ABSTRACT TRUNCATED AT 250 WORDS)
244 citations
TL;DR: Findings indicate that measurements of common carotid intima-media thickness are highly reproducible and are not significantly associated with most risk factors for atherosclerotic vessel wall disease.
141 citations
01 Jan 1994
TL;DR: In this paper, the authors studied the association between common carotid intima-media thickness and lower extremity arterial atherosclerosis among the first 1000 participants of the Rotterdam Study.
Abstract: High-resolution B-mode ultrasonography of the carotid arteries is used to investigate the signs of early atherosclerotic vessel wall disease. To assess whether carotid artery findings reflect atherosclerosis elsewhere, we studied the association between common carotid intima-media thick- ness and lower extremity arterial atherosclerosis among the first 1000 participants of the Rotterdam Study. The Rotterdam Study is a single-center population-based prospective fol- low-up study of 7983 subjects, £55 years old. Baseline mea- surements include ultrasound imaging of intima-media thick- ness of the distal common carotid artery and determination of the ankle-to-arm systolic blood pressure index. Lower extrem- ity arterial disease was defined as an ankle-arm index <0.90 in at least one leg. An increase of 0.1 mm in common carotid artery intima-media thickness was associated with an age- and sex-adjusted reduction of the ankle-arm index of 0.026 (95% confidence interval (CI): 0.018 to 0.034). The age- and sex-
115 citations
TL;DR: It is concluded that the beneficial effect of NPSD therapy for hypertension is partly offset by an excess risk of sudden death, and alternative drugs, notably potassium-sparing diuretics or β-blockers, could be preferred as antihypertensive drugs of first choice.
Abstract: Whether non-potassium-sparing diuretics (NPSD) increase the risk of sudden cardiac death in hypertensive patients has been vigorously debated. Diuretic-induced potassium or magnesium depletion leading to cardiac arrhythmias has been suggested as the underlying mechanism. A clear dose-response relationship between NPSD and the reduction in serum K+ exists. Data regarding serum Mg++ and intracellular K+ and Mg++ are too limited to allow conclusions. NPSD seem to increase the risk of ventricular arrhythmias among hypertensive patients with clinical evidence of heart disease, but the number of studies is small. The findings among patients without evidence of heart disease are less conclusive. The interpretation of the studies on electrolyte changes and arrhythmias following diuretic therapy is obscured by the fact that only a minority of studies included a randomly allocated placebo-treated control group. The large hypertension trials provide the strongest evidence that NPSD for hypertension may induce sudden death. Although blood pressure lowering may be expected to reduce the incidence of sudden cardiac death, the incidence in the NPSD group is similar to or even higher than that in the control group in 9 of 10 trials. We conclude that the beneficial effect of NPSD therapy for hypertension is partly offset by an excess risk of sudden death. Thus, alternative drugs, notably potassium-sparing diuretics or beta-blockers, could be preferred as antihypertensive drugs of first choice, although the efficacy of beta-blockers in older patients has recently been challenged.
48 citations
TL;DR: The available literature on etiology, diagnosis, prevalence, incidence, risk indicators, and prognosis of AAA is reviewed to detect gaps in the knowledge and to make suggestions as to the direction of future research in the light of the question as to whether screening of the general population for aneurysms of the abdominal aorta should be advocated.
46 citations
TL;DR: The results suggest that a single GAD65 antibody test may have a higher sensitivity for predictingIDDM than a test for islet cell cytoplasmic antibodies, but that a combined positive test for both antibodies increases the specificity for predicting IDDM over a period of 11.5 years.
Abstract: The value of a test for islet cell cytoplasmic antibodies together with a test for GAD65 antibodies to predict the subsequent development of diabetes over a period of 11.5 years was assessed in an open childhood population comprising 2,805 individuals. A single serum sample was obtained from each individual between 1975 and 1977 and screened for islet cell cytoplasmic antibodies for which eight individuals were positive (0.29%). During the average follow-up period of 11.5 years, four of eight islet cell antibody positive and three islet cell antibody negative individuals developed clinical diabetes. Sera from all individuals, who were islet cell antibody positive and/ or developed diabetes (total of 11) and from 100 randomly selected control subjects were analysed for GAD65 antibodies. Six of eight islet cell antibody positive individuals were GAD65 antibody positive including all four who subsequently developed IDDM. Furthermore, one of the three islet cell antibody negative individuals who developed IDDM was GAD65 antibody positive both in 1976 and in 1989. Thus, a positive test for GAD65 antibodies alone correctly predicted diabetes in five of seven children, who developed the disease. Only one of the children, who developed diabetes was positive for insulin autoantibodies and this individual was also positive for islet cell cytoplasmic antibodies and GAD65 antibodies. One of the 100 control subjects was positive for GAD65 antibodies (1%). The results suggest that a single GAD65 antibody test may have a higher sensitivity for predicting IDDM than a test for islet cell cytoplasmic antibodies, but that a combined positive test for both antibodies increases the specificity for predicting IDDM over a period of 11.5 years.
45 citations
TL;DR: In view of the high frequency of chest pain after use of sumatriptan and reports in the literature of cardiac disturbances, including myocardial infarction, cautious use of the drug is advised.
Abstract: There are several reports on cardiac adverse reactions attributed to the antimigraine drug sumatriptan in the recent literature. In order to assess the frequency and the character of adverse reactions to sumatriptan, a postmarketing cohort study was performed one year after registration of the drug in The Netherlands.
41 citations
TL;DR: The board of the Netherlands Epidemiological Society was surprised to read Tony Sheldon's restrictive interpretation of a proposed Dutch law concerning patients' rights, which has not yet passed the First Chamber in the Netherlands.
Abstract: EDITOR, - The board of the Netherlands Epidemiological Society, which has 850 members, was surprised to read Tony Sheldon's restrictive interpretation of a proposed Dutch law concerning patients' rights, which has not yet passed the First Chamber in the Netherlands.1 Sheldon reports that the proposed law formed the basis of a document on patients' rights endorsed by 36 European nations after consultation by the World …