Showing papers by "Diederick E. Grobbee published in 2000"

Measures of bioavailable serum testosterone and estradiol and their relationships with muscle strength, bone density, and body composition in elderly men.

Abstract: In the present cross-sectional study of 403 independently living elderly men, we tested the hypothesis that the decreases in bone mass, body composition, and muscle strength with age are related to the fall in circulating endogenous testosterone (T) and estrogen concentrations. We compared various measures of the level of bioactive androgen and estrogen to which tissues are exposed. After exclusion of subjects with severe mobility problems and signs of dementia, 403 healthy men (age, 73-94 yr) were randomly selected from a population-based sample. Total T (TT), free T (FT), estrone (E1), estradiol (E2), and sex hormone-binding globulin (SHBG) were determined by RIA. Levels of non-SHBG-bound T (non-SHBG-T), FT (calc-FT), the TT/SHBG ratio, non-SHBG-bound E2, and free E2 were calculated. Physical characteristics of aging included muscle strength measured using dynamometry, total body bone mineral density (BMD), hip BMD, and body composition, including lean mass and fat mass, measured by dual-energy x-ray absorptiometry. In this population of healthy elderly men, calc-FT, non-SHBG-T, E1, and E2 (total, free, and non-SHBG bound) decreased significantly with age. T (total and non-SHBG-T) was positively related with muscle strength and total body BMD (for non-SHBG-T, respectively, beta = 1.93 +/- 0.52, P < 0.001 and beta = 0.011 +/- 0.002, P < 0.001). An inverse association existed between T and fat mass (beta = -0.53 +/- 0.15, P < 0.001). Non-SHBG-T and calc-FT were more strongly related to muscle strength, BMD, and fat mass than TT and were also significantly related to hip BMD. E1 and E2 were both positively, independently associated with BMD (for E2, beta = 0.21 +/- 0.08, P < 0.01). Non-SHBG-bound E2 was slightly strongly related to BMD than total E2. The positive relation between T and BMD was independent of E2. E1 and E2 were not related with muscle strength or body composition. In summary, bioavailable T, E1, total E2, and bioavailable E2 all decrease with age in healthy old men. In this cross-sectional study in healthy elderly men, non-SHBG-bound T seems to be the best parameter for serum levels of bioactive T, which seems to play a direct role in the various physiological changes that occur during aging. A positive relation with muscle strength and BMD and a negative relation with fat mass was found. In addition, both serum E1 and E2 seem to play a role in the age-related bone loss in elderly men, although the cross-sectional nature of the study precludes a definitive conclusion. Non-SHBG-bound E2 seems to be the best parameter of serum bioactive E2 in describing its positive relation with BMD.

Determinants of peripheral arterial disease in the elderly: The Rotterdam Study

Abstract: Objective To examine which atherosclerotic risk factors are determinants for peripheral arterial disease (PAD), we performed a population-based study in 6450 subjects (40% men, 60% women) aged 55 years and older. Methods The presence of PAD was assessed by measuring the ankle-arm systolic blood pressure index (AAI); PAD was considered present if the AAI was lower than 0.90 in either leg. In addition, a threshold AAI of 0.70 in either leg defined severe PAD. Results Determinants strongly and independently associated with PAD were age of at least 75 years (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0-1.6), fibrinogen level (OR, 1.5; 95% CI, 1.3-1.7), cigarette smoking (OR, 2.8; 95% CI, 2.3-3.4), diabetes mellitus (OR, 2.0; 95% CI, 1.6-2.5), and systolic blood pressure (OR, 1.2; 95% CI, 1.1-1.2). An inverse relation of high-density lipoprotein cholesterol level with PAD (OR, 0.7; 95% CI, 0.5-0.8) was found. Similar results were demonstrated for severe PAD. Separate analyses for men and women did not demonstrate differences in risk factors for PAD. Conclusions Assessment of a wide range of atherosclerotic risk factors enabled us to quantify the relative importance of each factor as determinant for PAD. In total, 69% of the occurrence of PAD is attributable to cardiovascular risk factors measured in our study; smoking accounted for most (etiologic fraction, 18.1%). The results suggest that preventive management of PAD should be directed at systolic blood pressure, fibrinogen level, smoking, high-density lipoprotein cholesterol level, and diabetes mellitus.

Employment grade differences in cause specific mortality. A 25 year follow up of civil servants from the first Whitehall study

Abstract: STUDY OBJECTIVE To test the hypothesis that the association between socioeconomic status and mortality rates cuts across the major causes of death for middle aged and elderly men. DESIGN 25 year follow up of mortality in relation to employment grade. SETTING The first Whitehall study. PARTICIPANTS 18 001 male civil servants aged 40–69 years who attended the initial screening between 1967 and 1970 and were followed up for at least 25 years. MAIN OUTCOME MEASURE Specific causes of death. RESULTS After more than 25 years of follow up of civil servants, aged 40–69 years at entry to the study, employment grade differences still exist in total mortality and for nearly all specific causes of death. Main risk factors (cholesterol, smoking, systolic blood pressure, glucose intolerance and diabetes) could only explain one third of this gradient. Comparing the older retired group with the younger pre-retirement group, the differentials in mortality remained but were less pronounced. The largest decline was seen for chronic bronchitis, gastrointestinal diseases and genitourinary diseases. CONCLUSIONS Differentials in mortality persist at older ages for almost all causes of death.

Arterial Stiffness as Underlying Mechanism of Disagreement Between an Oscillometric Blood Pressure Monitor and a Sphygmomanometer

Abstract: Oscillometric blood pressure devices tend to overestimate systolic blood pressure and underestimate diastolic blood pressure compared with sphygmomanometers. Recent studies indicate that discrepancies in performance between these devices may differ between healthy and diabetic subjects. Arterial stiffness in diabetics could be the underlying factor explaining these differences. We studied differences between a Dinamap oscillometric blood pressure monitor and a random-zero sphygmomanometer in relation to arterial stiffness in 1808 healthy elderly subjects. The study was conducted within the Rotterdam Study, a population-based cohort study of subjects aged 55 years and older. Systolic and diastolic blood pressure differences between a Dinamap and a random-zero sphygmomanometer were related to arterial stiffness, as measured by carotid-femoral pulse wave velocity. Increased arterial stiffness was associated with higher systolic and diastolic blood pressure readings by the Dinamap compared with the random-zero sphygmomanometer, independent of age, gender, and average mean blood pressure level of both devices. The beta-coefficient (95% CI) was 0.25 (0.00 to 0.50) mm Hg/(m/s) for the systolic blood pressure difference and 0.35 (0.20 to 0.50) mm Hg/(m/s) for the diastolic blood pressure difference. The results indicate that a Dinamap oscillometric blood pressure device, in comparison to a random-zero sphygmomanometer, overestimates systolic and diastolic blood pressure readings in subjects with stiff arteries.

Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study

Abstract: Objective To investigate whether an important football match increases stress to such an extent that it triggers acute myocardial infarction and stroke. Design Longitudinal study of mortality around 22 June 1996 (the day the Dutch football team was eliminated from the European football championship). Mortality on 22 June was compared with the five days before and after the match and in the same period in 1995 and 1997. Setting Netherlands. Subjects Dutch population aged 45 years or over in June 1996. Main outcome measures All cause mortality and mortality due to coronary heart disease and stroke. Results Mortality from coronary heart disease and stroke was increased in men on the day of the match (relative risk 1.51, 95% confidence interval 1.08 to 2.09). No clear rise in mortality was observed for women (1.11, 0.80 to 1.56). Among men, about 14 excess cardiovascular deaths occurred on the day of the match. Conclusion Important sporting events may provoke a sufficient level of stress to trigger symptomatic cardiovascular disease. The difference between men and women requires further investigation.

Prevalence, Treatment, and Control of Hypertension by Sociodemographic Factors Among the Dutch Elderly

Abstract: —The study objective was to assess the prevalence, level of treatment, and control of hypertension in a general elderly population according to age and sociodemographic factors. We conducte...

Prognosis of stroke in the south of Greece: 1 year mortality, functional outcome and its determinants: the Arcadia Stroke Registry

Abstract: OBJECTIVES For Greece, data on incidence of stroke, type of stroke, and prognosis of stroke is limited. Recently, results on incidence of stroke were published. Here 1 year mortality, functional outcome after a first ever stroke, and determinants of the prognosis are described. METHODS A population based registry was established in the Arcadia area, located in eastern central Peloponessos in southern Greece. Between 1 November 1993 and 31 October 1995, 555 patients with a first ever stroke were identified using information from death certificates, hospital records, public health centres and general practitioners. Extensive information on cardiovascular risk factors and stroke characteristics was obtained. After 1 year a modified Rankin score was determined in all surviving patients. RESULTS After 1 year of follow up, 204 (36.8%) patients died. The probability of survival 1 year after stroke was higher for cerebral infarction than for intracerebral haemorrhage; 67.8% (95% confidence interval (95% CI) 64–72) and 46.4% (35–57), respectively. Of the survivors, 68.9% had either no symptoms or symptoms that would not interfere with their capacity to look after themselves (Rankin score 0 to 2). Increasing age and low Glasgow coma scale score were the most powerful predictors of death within 1 year (p CONCLUSIONS One year mortality from stroke in Greece is similar to that of other industrialised countries. The most important factors that affect the prognosis of a patient with a first ever stroke are increasing age, stroke severity, and atrial fibrillation.

A population-based study of the associations of stroke occurrence with weather parameters in Siberia, Russia (1982-92).

Abstract: Previous studies have established a seasonal variation in stroke occurrence, but none have assessed the influence of inclement weather conditions on stroke incidence in a general population of Russia. We performed a stroke population-based study in the Oktiabrsky District of Novosibirsk, Siberia, Russia. Included in the analysis were 1929 patients with their first occurrence of ischemic stroke (IS), 215 patients with their first occurrence of intracerebral hemorrhage (ICH) and 64 patients with their first occurrence of subarachnoid hemorrhage (SAH): all patients were aged between 25 and 74 years. The cumulative daily occurrence of total strokes and stroke subtypes was evaluated in relation to aggregated daily mean values of ambient temperature, relative humidity and air pressure by means of Poisson regression analysis to estimate the rate ratio (RR) with corresponding confidence interval (CI) and to identify the weather parameters of most importance. In a multivariate analysis, with adjustment for the effects of season, solar and geomagnetic activity, and age of the patients, low ambient temperature (RR 1.32; 95% CI 1.05-1.66) and mean value of air pressure (RR 0.986; 95% CI 0.972-0.999) were important predictors of IS occurrence, while mild ambient temperature (RR 1.52; 95% CI 1. 04-2.22) was an important predictor of ICH occurrence. No relationship between SAH occurrence and any one of the weather parameters studied was revealed. There was no interaction between any meteorological variables that was statistically significant. Inclement weather conditions are associated with the occurrence of IS and ICH in Siberia, Russia. Among the meteorological parameters studied, low ambient temperature and mean air pressure are the most important predictors of IS occurrence, whereas the occurrence of ICH is associated with mild ambient temperature. There is no association between any one of the weather parameters studied and the occurrence of SAH.

Higher prevalence of depressive symptoms in middle-aged men with low serum cholesterol levels.

Abstract: Objective: Investigators from several studies have reported a positive relationship between low cholesterol levels and death due to violent causes (eg, suicide and accidents), possibly mediated by depressive symptoms, aggression or hostility, or impulsivity We set out to establish whether middle-aged men with chronically low cholesterol levels (#45 mmol/liter) have a higher risk of having depressive symptoms, according to scores on the Beck Depression Inventory, compared with a reference group of men with cholesterol levels between 6 and 7 mmol/liter A similar comparison was also made for measures of anger, hostility, and impulsivity Methods: Cholesterol measurements were obtained as part of a population-based cholesterol screening study in 1990 ‐1991 These levels were remeasured in 1993‐1994 Only those whose cholesterol level remained in the same range were included in the study Depressive symptoms were assessed by using the Beck Depression Inventory; anger, by questionnaires based on the Spielberger Anger Expression Scale and State-Trait Anger Scale; hostility, by the Buss-Durkee Hostility Inventory; and impulsivity, by the Eysenck and Eysenck Impulsivity Questionnaire Results: Men with chronically low cholesterol levels showed a consistently higher risk of having depressive symptoms (Beck Depression Inventory score $15 or $17) than the reference group, even after adjusting for age, energy intake, alcohol use, and presence of chronic diseases No differences in anger, hostility, and impulsivity were observed between the two groups Conclusions: Men with a lower cholesterol level (#45 mmol/liter) have a higher prevalence of depressive symptoms than those with a cholesterol level between 6 and 7 mmol/liter These data may be important in the ongoing debate on the putative association between low cholesterol levels and violent death Key words: depressive symptoms, serum cholesterol, men, hostility, impulsivity, anger

Plasminogen Activator Inhibitor 4G Polymorphism Is Associated With Decreased Risk of Cerebrovascular Mortality in Older Women

Abstract: Background—A common 4G allele of a 4G/5G polymorphism in the promoter region of the plasminogen activator inhibitor-1 (PAI-1) gene is associated with increased transcription of the PAI-1 protein, which may lead to decreased fibrinolysis. It has therefore been proposed as a candidate risk factor for myocardial infarction or stroke. Methods and Results—We studied the relationship between PAI-1 4G/5G genotype and the risk of cardiovascular mortality in a prospective cohort study among 12 239 women initially aged between 52 and 67 years, with a maximum follow-up time of 18 years (153 732 follow-up years). PAI-1 4G/5G genotype was measured in DNA obtained from urine samples, which were collected at baseline, of 498 women who died of a cardiovascular disease and a random sample of 512 women from the same cohort who did not die of cardiovascular disease. The PAI-1 4G/5G genotype was not associated with risk of myocardial infarction or other cardiovascular mortality. However, PAI-1 4G4G homozygotes had a markedly...

Homozygosity for 807 T Polymorphism in α2 Subunit of Platelet α2β1 Is Associated With Increased Risk of Cardiovascular Mortality in High-Risk Women

Abstract: Background —Platelet adhesion to collagen is the initial step in both hemostasis and thrombosis; this adhesion is mediated by α 2 β 1 on the surface of platelet membranes. An 807 C to T single nucleotide exchange polymorphism close to the gene coding for the α 2 subunit of α 2 β 1 is associated with the density of α 2 β 1 on the platelet membrane. Methods and Results —We studied the relation of the α 2 β 1 807 C/T genotype to cardiovascular mortality in a prospective cohort study of 12 239 women who were invited for the breast cancer screening program of Utrecht, the Netherlands. The initial age was between 52 and 67 years. Women were followed on vital status between 1976 and 1995 (168 513 women-years). Data were analyzed by using a nested case-control design. The α 2 β 1 807 C/T genotype was not associated with cardiovascular mortality in the total population: the rate ratio for cardiovascular mortality in 807 TT homozygotes compared with 807 CC wild types was 1.2 (95% CI 0.8 to 1.7). However, the α 2 β 1 807 T polymorphism was associated with an increased risk of cardiovascular mortality in women who smoked or in women who had indications of compromised endothelium, such as diabetes and microalbuminuria. In those who were exposed to ≥2 of these factors, the risk ratio (95% CI) between α 2 β 1 807 TT homozygotes and 807 CC wild types was 14.1 (5.0 to 39.9). Conclusions —α 2 β 1 807 TT homozygosity, coding for increased α 2 β 1 density on the platelet membrane, is associated with an increased risk of cardiovascular mortality in those women with indications of compromised endothelium.

Hypertension and breast cancer risk in a 19-year foIlow-up study (the DOM cohort)

Abstract: Background To investigate whether hypertension and the use of anti-hypertensive drugs are associated with breast cancer risk. Methods This was a prospective study of 11 011 women living in Utrecht, the Netherlands, aged 50-65 years at enrolment in a breast cancer screening project (DOM cohort). Women attended screening rounds between 1974 and 1985 at which blood pressure was measured and information on drug use and breast cancer risk factors was ascertained. Since 1974 (median follow-up time 19 years), information on breast cancer occurrence and death has been registered, Hypertension was defined as a systolic blood pressure > 160 mmHg or a diastolic blood pressure > 95 mmHg or current use of drugs for the indication hypertension, Cox's regression analysis was used to investigate the association between hypertension (treated or untreated) and subsequent breast cancer risk, Analyses were adjusted for age, body mass index, height, parity, familial breast cancer, smoking and oral contraceptive use, Results A total of 523 women were diagnosed with breast cancer, Hypertensive women experienced a statistically significant increased breast cancer risk of 23% (age-adjusted hazard ratio (HRa) = 1.23; 95% confidence interval (CI) 1.01-1.49), After adjustment for all confounders, the increase was 14% (HR =1.14; 95% CI 0.93-1.40). The decline in risk was mainly attributable to the effect of BMI, The risk was similar in treated (HR = 1.22; 95% CI 0.91-1.63) and untreated hypertensive women (HR = 1.13; 95% CI 0.91-1.40), Conclusion These results do not support an association between hypertension and breast cancer, and if there is a link, it is likely to be positive and relatively small in size (+14%), This relation, if present, is not attributable to antihypertensive drugs, since the relation is also present in non-drug users, J Hypertens 2000, 18:249-254 (C) Lippincott Williams & Wilkins.

Socioeconomic status and mortality in Dutch elderly people

Abstract: Background: The aim of the study was to describe the relationship between socioeconomic status and mortality in Dutch elderly people. Methods: A prospective follow-up study was performed among 4,878 women and 3,105 men aged 55 years and over living in Ommoord, a district of Rotterdam, The Netherlands. At baseline, data on education, occupation and income were collected. Data on mortality were obtained from the municipal population registry and general practitioners. Relative risks of mortality by indicators of socioeconomic status were estimated after an average follow-up period of 4.1 years. Separate age-adjusted analyses were performed for men and women. Results: The findings in this study indicate that for men (mean age at baseline of 69 ± 9 years), differences in mortality exist for all three indicators of socioeconomic status. Mortality risks were higher for lower educated men, unskilled manual workers and those with a lower equivalent household income. For women (mean age 72 ± 10 years), the relative risks of mortality were also higher for lower educated groups, but lower equivalent household income and occupational status appeared not to be related to mortality. Conclusions: In elderly Dutch people, there are clear differences in mortality across groups of different socioeconomic status. The mechanisms for explaining the apparent inequalities in health among older subjects require further research.

Quality-of-life of pacemaker patients: a reappraisal of current instruments.

Abstract: Current clinical practice permits the use of single chamber ventricular or dual chamber pacemakers. However, it is not known which type of pacemaker results in superior clinical and patient outcomes. This is of growing importance because of the higher costs and increased risk of technical failures of dual chamber pacemakers. Patient outcomes can be assessed with quality of life questionnaires, but it is unclear which questionnaires are valid for use in pacemaker patients. This article reappraises studies on quality of life instruments for pacemaker patients. We searched MEDLINE (1985-1998) for studies assessing quality-of-life in general and in pacemaker patients. The SF-36 appeared to be the best among generic questionnaires because of its psychometric characteristics and experience of use. Concerning disease specific instruments, the Karolinska quality of life questionnaire has desirable content validity but lacks more rigorous psychometric validation, which constitutes a serious limitation. Previous studies suggested that implantation of atrioventricular pacemakers improves quality-of-life compared to ventricular pacemakers, but since no well-designed and validated questionnaire exists, these results should be interpreted with caution. The best outcome measure to evaluate quality-of-life in pacemaker patients would be a combination of a generic health profile with established reliability and validity supplemented with a cardiovascular assessment adjusted to suit pacemaker patients. By doing so, individual scores can be compared within a disease cohort and to same-aged, nondiseased persons, as well as other diseased populations. The development and validation of such an instrument is currently needed.

Long-term survival after valve replacement with björk-shiley CC valves∗

Abstract: Information on the life expectancy of Bjork-Shiley convexo-concave (BScc) valve recipients is necessary when considering prophylactic replacement. However, little is known about the late results after valve replacement with BScc valves. We describe long-term survival and its determinants of the Dutch BScc cohort and compare mortality figures with those of the general population and those used in guidelines for prophylactic replacement. Follow-up was obtained on all Dutch BScc valve recipients (n = 2,264) (end of study 1996). Survival over a 15-year period and its determinants were described using the Kaplan-Meier product-limit method and Cox regression, respectively. Standardized mortality ratios (SMRs) were used to compare mortality rates of BScc valve recipients who survived at least 30 days after surgery with the Dutch population rates. Survival at 15 years for aortic, mitral, and double valve recipients was 55.0% (95% confidence interval [CI] 51.9 to 58.1), 40.8% (95% CI 37.1 to 44.4), and 38.6% (95% CI 33.2 to 43.9), respectively. The determinants of survival were patient, history, and procedure related. The SMR for all BScc valve recipients was 4.2 (95% CI 3.4 to 5.2) in the first year of follow-up, after which it decreased to 2.0 (95% CI 1.8 to 2.3) and remained constant until the 14th year. SMRs depended on time since implantation, age at the time of implantation, and position of the valve replaced. Most of life expectancy estimates in prophylactic replacement guidelines of BScc valves underrate the true survival estimates. Age, valve position, and time- specific risks of death after valvular surgery should be accounted for. Different excess mortality rates should be applied for patients from different age groups: the older the patient the lower the excess.

Calcium intake and blood pressure: an update.

Abstract: 1350·6277 e 2000 Lippincott Williams &Wilkins Introduction The role of dietary intake of calcium in the prevention and treatment of hypertension is still being debated. After the publication of several extensive reviews on the relation of intake and supplementation of calcium to blood pressure in 1995 and 1996 [1-6] new epidemiologic studies have been performed, results of which have further clarified the role of calcium regulation of blood pressure. In this article we review the current epidemiologic evidence, with a focus on potential determinants of calcium-sensitive response of blood pressure.